Weitzenhoffer, Andre M. (1957). Posthypnotic behavior and the recall of the hypnotic suggestion. Journal of Clinical and Experimental Hypnosis, 5 (2), 41-58.

1. Posthypnotic phenomena may be spontaneous or suggested in origin. Although no single mechanism appears to exist which will account for all of the spontaneous manifestations, their explanations are relatively straightforward. On the other hand, suggested posthypnotic phenomena are not so readily dealt with.
2. … It seems likely that a relation exists between posthypnotic suggestions and waking instructions of the everyday variety; however, lack of basic information regarding the retention and activation of the latter has made this line of approach unproductive to date. Nor is it possible to talk of posthypnotic phenomena as learned if one regards the posthypnotic signal as stimulus and the suggested act as response. The definition of learning excludes this case because of the presence of hypnosis at the time the response is acquired. In addition, the acquisition and evocation of the posthypnotic effect does not follow any standard paradigm for learning.
3. If, however, one views the posthypnotic suggestion as a whole as being the stimulus, and the act of subjectively, if not objectively, giving reality to the content of the suggestion as the response, then suggested posthypnotic phenomena can be fitted within the framework of modern learning theory. They appear to arise through some form of classical conditioning, abstract conditioning being the most likely form at present. Seen in these terms, posthypnotic suggestions function through the same mechanisms as any other hypnotic suggestion, being merely a special instance of a deferred suggestion. It must be emphasized that posthypnotic phenomena are learned in the sense only that they are brought into being through the use of previously acquired response tendencies. The learning process has usually reached completion by the time the hypnotic subject is capable of giving good posthypnotic responses.
4. The posthypnotic signal holds a unique position in posthypnotic phenomena which allows it to acquire unique and distinctive features with respect to the elicitation of the suggested behavior, among which is the capacity to cause redintegration.
5. The sponsaneous [sic] trance said to accompany the initiation of any posthypnotic act appears to be a natural outcome of the learning process involved in the acquisition of posthypnotic behavior. There is a reinstatement of the original trance state because the posthypnotic trance is the result of associations taking place between the stimulus-suggestion and the symptoms of the initial hypnosis, these symptoms acting as responses.
6. Acquisition and retention of the contents of the suggested posthypnotic act may need to be differentiated from the acquisition and retention by the posthypnotic signal of the capacity to initiate the posthypnotic act. In the light of this observation, experimental data showing that posthypnotic suggestions are forgotten just like any other instructions may hold true only for the memory of the content. The capacity to initiate posthypnotic action, although subject to the same laws of forgetting may be far more enduring because of certain features of the learning process which underlie it” (pp. 55-56).

Dittborn, Julio M. (1956). Toward a semeiology of hypnosis. Journal of Clinical and Experimental Hypnosis, 4 (1), 30-36.

“19 subjects were chosen among two hundred that in the year the experiment took place (1954) were to be 20 years old. 11 of these subjects qualified themselves as good swayers, whereas the 8 others were considered somehow refractory to the postural swaying test.
“All 19 went under a standard hypnotic induction: the operator employed the same words in all cases, and requested from all the execution of the same acts.
“Several involuntary signs of standard induction are described, which reveal that the subject has attained a convenient degree of muscular relaxation after appropriate suggestions.
“Fatigue is apparently an important source of spontaneous amnesia in good swayers.
“In the analyzed cases no involuntary sign has been detected, that could reveal us whether the inducted subject will or not present spontaneous post-hypnotic amnesia” (p. 36).
Includes standardized tests of depth.

LeCron, Leslie M. (1954). A hypnotic technique for uncovering unconscious material. Journal of Clinical and Experimental Hypnosis, 2, 76-79. (Abstracted in Psychological Abstracts, 54: 7497)

“Summary. A technique is given whereby unconscious material and information may be learned under hypnosis through automatic movements of the fingers, or of Chevreul’s pendulum. The movements are controlled by the unconscious mind of the patient. Questions are asked which can be answered either ‘yes’ or ‘no.’ With most people the movements of the pendulum can even be elicited in the waking state. Essentially, the method is a variation of automatic writing with movements substituted for writing. A brief case history is given wherein knowledge was gained in this way as to the causes for severe menstrual pains” (p. 79).

Marcuse, F. L. (1953). Anti-social behavior and hypnosis. Journal of Clinical and Experimental Hypnosis, 1, 18-20.

“The problem of whether an individual under hypnosis can be caused to commit an act contrary to his or her moral code must be paraphrased to ask whether an individual under hypnosis can be caused to commit an act which is socially and objectively reprehensible. When the question is so phrased and suitable technique is used, it is the writer’s opinion that the answer is yes” (p. 20).


Patterson, David R.; Questad, Kent A.; Boltwood, Michael D. (1987). Hypnotherapy as a treatment for pain in patients with burns: Research and clinical considerations. Journal of Burn Care and Rehabilitation, 8 (3), 263-268.

Hypnotherapy has increasingly been included in the management of burn patients, particularly in the area of acute pain. To better understand such issues as (1) overall efficacy of hypnotherapy to alleviate acute burn pain, (2) instances in which hypnotherapy is contraindicated, (3) interaction of hypnotherapy with medication, (4) standard induction techniques to use with various age groups, (5) role of nursing and other staff in facilitating hypnotic effects, and (6) future methodological directions, they examined the clinical and methodological merits of recent studies of hypnoanalgesia. A literature search found 17 studies in which hypnotherapy was applied to the management of burns. The literature generally supports the efficacy of this approach to reduce burn pain; however, little else can be concluded from these studies. Several recent studies have applied hypnotherapy to aspects of burn care other than pain using excellent experimental designs. It is suggested that future studies of acute pain management follow suit.

1971 Aiken, Linda H.; Henrichs, Theodore F. (1971). Systematic relaxation as a nursing intervention technique with open heart surgery patients. Nursing Research, 20, 212-217.

Psychiatric problems frequently occur after open heart surgery, usually from day 2 to day 7 postoperatively. Symptoms include impairment of consciousness, disorientation, sensory disturbances like visual and auditory hallucination, and sometimes delusions and paranoid behavior. Authors defined a postoperative adverse reaction as “when the patient experienced impairment of consciousness with motor restlessness, disordered thinking, sensory disturbances, visual and/or auditory illusions or hallucinations, and paranoid ideation. All of these symptoms do not usually occur together and an additional definition was given for a minor reaction which occurred if only one of the above symptoms was present for 12 hours or less” (p. 214).
The population from which samples were drawn consisted of adult male patients admitted to a university medical center for open heart surgery. The experimental group (N = 15) consisted of all patients admitted from September 1969 through June 1970 (omitting two who were not willing to participate). Controls were 15 adult males admitted for open heart surgery in the prior year.
A relaxation and systematic desensitization technique was used for the experimental group, each patient being given a tape recorder with a 15-minute tape of the exercise “to use whenever he wanted to relax” (p. 214) but at the least four times a day.


Montgomery, Guy H.; David, Daniel; Winkel, Gary; Silverstein, Jeffrey H.; Bovbjerg, Dana H. (2002). The effectiveness of adjunctive hypnosis with surgical patients: A meta-analysis. Anesthesia and Analgesia, 94, 1639-1645.

Hypnosis is a nonpharmacologic means for managing adverse surgical side effects. Typically, reviews of the hypnosis literature have been narrative in nature, focused on specific outcome domains (e.g., patients”””” self-reported pain), and rarely address the impact of different modes of the hypnosis administration. Therefore, it is important to take a quantitative approach to assessing the beneficial impact of adjunctive hypnosis for surgical patients, as well as to examine whether the beneficial impact of hypnosis goes beyond patients”””” pain and method of the administration. We conducted meta-analyses of published controlled studies (n = 20) that used hypnosis with surgical patients to determine: 1) overall, whether hypnosis has a significant beneficial impact, 2) whether there are outcomes for which hypnosis is relatively more effective, and 3) whether the method of hypnotic induction (live versus audiotape) affects hypnosis efficacy. Our results revealed a significant effect size (D = 1.20), indicating that surgical patients in hypnosis treatment groups had better outcomes than 89% of patients in control groups. No significant differences were found between clinical outcome categories or between methods of the induction of hypnosis. These results support the position that hypnosis is an effective adjunctive procedure for a wide variety of surgical patients. IMPLICATIONS: A meta-analytical review of studies using hypnosis with surgical patients was performed to determine the effectiveness of the procedure. The results indicated that patients in hypnosis treatment groups had better clinical outcomes than 89% of patients in control groups. These data strongly support the use of hypnosis with surgical patients. [National Library of Medicine Abstract]

Eimer, Bruce. N. (2000). Clinical applications of hypnosis for brief and efficient pain management psychotherapy. American Journal of Clinical Hypnosis, 43 (1), 17-40. (July)

This paper describes four specific clinical applications of hypnosis that can make psychotherapy for pain management briefer, more goal-oriented, and more efficient: (1) the assessment of hypnotizability; (2) the induction of hypnotic analgesia and development of individualized pain coping strategies;
(3) direct suggestion, cognitive reframing, hypnotic metaphors, and pain relief imagery; and (4) brief psychodynamic reprocessing during the trance state of emtoional factors in the patient”s experience of chonic pain. Important theoretical and clinical issues regarding the relationship between hypnotizability to the induction of hypnotic analgesia are presented, and attempts to individualize pain treatment strategies on the basis of assessed differences in hypnotizability and patients” preferred coping strategies are described. Some ways are also presented of integrating direct hypnotic suggestion, COGNITIVE-EVALUATIVE reframing, hypnotic metaphors, and imagery for alleviating the SENSORY and AFFECTIVE-MOTIVATIONAL components of pain, with an exploratory, insight-oriented, and brief psychodynamic reprocessing approach during trance for resolving unconscious sources of resistance to treatment, and reducing the emotional overlay associated with chronic pain. Some basic assumptions underlying the use of this approach are discussed, and a brief step-by-step protocol is outlined.

-cing 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.

Green, Joseph P.; Lynn, Steven Jay (2000, August). Hypnosis and suggestion-based approaches to smoking cessation: An examination of the evidence. [Paper] Presented at the annual meeting of the American Psychological Association, Washington, D. C..

This article reviews 59 studies of hypnosis and smoking cessation from the point of view of whether the research provides support for hypnosis as an empirically supported treatment (Chambless and Hollon, 1998). Whereas hypnotic procedures generally yield higher rates of abstinence relative to wait list and no treatment conditions, hypnotic interventions are generally comparable to a variety of nonhypnotic treatments. The evidence for whether hypnosis yields outcomes superior to placebos is mixed. In short, hypnosis can not be considered to be a specific and efficacious treatment for smoking cessation. Furthermore, in many cases, it is impossible to rule out cognitive/behavioral and educational interventions as the source of positive treatment gains associated with hypnotic treatments. Hypnosis can not, as yet, be regarded as a well-established treatment for smoking cessation. Nevertheless, it seems justified to classify hypnosis as a “possibly efficacious” treatment for smoking cessation. – Abstract taken from Psychological Hypnosis: A Bulletin of [Amer Psychol Assn] Division 30. Fall, 2000.

Horton-Hausknecht J.; Mitzdorf U.; Melchart D. (2000). The effect of hypnosis therapy on the symptoms and disease activity in rheumatoid arthritis . Psychology and Health, 14 (6), 1089-1104..

from: http://www.imp-muenchen.de/The_effect_of_hypnos.698.1.html
In this study we aimed to assess the effectiveness of clinical hypnosis on the symptoms and disease activity of rheumatoid arthritis (RA). 66 RA patients participated in a controlled group design. 26 patients learnt the hypnosis intervention, 20 patients were in a relaxation control group, and 20 patients were in a waiting-list control group. During hypnosis , patients developed individual visual imagery aimed at reducing the autoimmune activity underlying the RA and at reducing the symptoms of joint pain, swelling, and stiffness. Subjective assessments of symptom severity and body and joint function, using standardized questionnaires and visual analogue scales, were obtained. Objective measures of disease activity via multiple blood samples during the therapy period and at the two follow-ups were also taken. These measurements were of erythrocyte sedimentation rate, C-reactive protein, hemoglobin, and leukocyte total numbers. Results indicate that the hypnosis therapy produced more significant improvements in both the subjective and objective measurements, above relaxation and medication. Improvements were also found to be of clinical significance and became even more significant when patients practiced the hypnosis regularly during the follow-up periods.

Lang, E. V.; Benotsch, E. G.; Fick, L. J.; Lutgendorf, S.; Berbaum, M. L.; Berbaum, K. S.; Logan, H.; Spiegel, D. (2000, Apr 29). Adjunctive non-pharmacological analgesia for invasive medical procedures: A randomised trial. Lancet, 355 (9214), 1486-90.

BACKGROUND: Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study.
METHODS: 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures.
FINDINGS: Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min). INTERPRETATION: Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability. Abstract from National Library of Medicine, PubMed 1999 Mauer, Magaly H.; Burnett, Kent F.; Ouellette, Elizabeth Anne; Ironson, Gail H.; Dandes, Herbert M. (1999). Medical hypnosis and orthopedic hand surgery: Pain perception, postoperative recovery, and therapeutic comfort. International Journal of Clinical and Experimental Hypnosis, 47 (2), 144-161. Orthopedic hand-surgery patients experience severe pain postoperatively, yet they must engage in painful exercises and wound care shortly after surgery; poor patient involvement may result in loss of function and disfigurement. This study tested a hypnosis intervention designed to reduce pain perception, enhance postsurgical recovery, and facilitate rehabilitation. Using a quasi-experimental research design, 60 hand-surgery patients received either usual treatment or usual treatment plus hypnosis. After controlling for gender, race, and pretreatment scores, the hypnosis group showed significant decreases in measures of perceived pain intensity (PPI), perceived pain affect (PPA), and state anxiety. In addition, physician's ratings of progress were significantly higher for experimental subjects than for controls, and the experimental group had significantly fewer medical complications. These results suggest that a brief hypnosis intervention may reduce orthopedic hand-surgery patients' postsurgical PPI, PPA, and anxiety; decrease comorbidity; and enhance postsurgical recovery and rehabilitation. However, true experimental research designs with other types of controls must be employed to determine more fully the contribution of hypnosis to improved outcome. 1998 Felt, Barbara T.; Hall, Howard; Olness, Karen; Schmidt, Wendy; Kohen, Daniel; Berman, Brad D.; Broffman, Gregg; Coury, Daniel; French, Gina; Dattner, Alan; Young, Martin H. (1998). Wart regression in children: Comparison of relaxation-imagery to topical treatment and equal time interventions. American Journal of Clinical Hypnosis, 41 (2), 130-137. Relaxation mental imagery (RMI), standard topical treatment (Top Tx), and equal time-control interventions were compared on measures of wart regression in sixty one, 6-12-year-old children. Subjects chose one common ("index") wart and attended 4 visits over 8 weeks. At each visit, total and "index" extremity wart number were counted and a photo was taken of the "index wart" for later measurement. On average, total wart number decreased by 10% and "index wart" area decreased by 20% with no significant group differences during the first eight weeks. Phone follow [sic] was conducted 6 to 18 months from study entry. At phone follow up, there was a trend for more RMI and Top Tx subjects to report complete wart resolution (p = 0.07) with a majority of RMI children reporting use of RMI or no specific treatment pursuit. We conclude there was no significant short-term benefit for RMI in this randomized controlled trial of wart regression in children. However, longer term benefits for RMI and Top Tx groups are suggested. 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 -tient 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 Schoenberger, Nancy E.; Kirsch, Irving; Gearan, Paul; Montgomery, Guy; Pastyrnak, Steven L. (1997). Hypnotic enhancement of a cognitive behavioral treatment for public speaking anxiety. Behavior Therapy, 28, 127-140. The effectiveness of a multidimensional cognitive behavioral treatment for public speaking anxiety was compared with that of the same treatment supplemented by hypnosis. The hypnotic treatment included all components of the cognitive behavioral treatment. It differed from the nonhypnotic treatment only in that relaxation training was presented as a hypnotic induction, automatic thoughts were referred to as self-suggestions, and explicit hypnotic suggestions for improvement were added. Participants in both treatment conditions improved more than those in a wait-list control group. Moreover, labeling the treatment "hypnotic" appeared to enhance treatment effectiveness. The hypnotic treatment generated expectancies for greater change among participants than did the nonhypnotic treatment, and these expectancies were correlated with treatment outcome. Implications for the use of hypnosis in treatment are discussed. 1996 Kirsch, Irving (1996). Hypnotic enhancement of cognitive-behavioral weight loss treatments--Another meta-reanalysis. Journal of Consulting and Clinical Psychology, 64 (3), 517-519. In a 3rd meta-analysis of the effect of adding hypnosis to cognitive- behavioral treatments for weight reduction, additional data were obtained from authors of 2 studies, and computational inaccuracies in both previous meta-analyses were corrected. Averaged across posttreatment and follow-up assessment periods, the mean weight loss was 6.00 lbs. (2.72 kg) without hypnosis and 11.83 lbs. (5.37 kg) with hypnosis. The mean effect size of this difference was 0.66 SD. At the last assessment period, the mean weight loss was 6.03 lbs. (2.74 kg) without hypnosis and 14.88 lbs. (6.75 kg) with hypnosis. The effect size for this difference was 0.98 SD. Correlational analyses indicated that the benefits of hypnosis increased substantially over time (r=.74). Sapp, Marty (1996). Three treatments for reducing the worry and emotionality components of test anxiety with undergraduate and graduate college students:Cognitive-behavioral hypnosis, relaxation therapy, and support counseling. Journal of College Student Development, 37 (1), 79-87. The effects of cognitive-behavioral hypnosis, relaxation therapy, and supportive counseling in reducing the worry and emotionality components of test anxiety among undergraduate and graduate students were examined. Relaxation therapy was more effective with graduate students undergraduate responded more to supportive counseling. Similarly, cognitive-behavioral hypnosis and relaxation therapy were both more effective in reducing the worry and emotionality components of test anxiety and in improving grade point averages than was supportive counseling Nash, Michael R. (1995, November). What we don't know. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Antonio, TX. In the past few years the quality of psychotherapy research has improved, supporting the position that therapy works. Hypnosis outcome research to date is conceptually and methodologically substandard. APA's Division 12 published a list of 25 treatments considered well established in efficacy or probably effective. Hypnosis was not on the list, and wasn't mentioned as not on the list! The criteria for "well established or probably effective therapies" are: At least two good group design studies, conducted by different investigators, demonstrating efficacy in one or more of the following ways: Superior to pill or psychological placebo or to another treatment. Equivalent to an already established treatment in studies with adequate statistical power (about 30 per group; cf Kazdin & Bass, 1989) or a large series of single case design studies demonstrating efficacy. Such single case studies must have used good experimental designs and compared the intervention to another treatment as in above. Further criteria: --Studies must be conducted with treatment manuals. --Characteristics of the client samples must be clearly specified. David Orlinsky has a useful model, in which hypnosis would be classified as a therapeutic operation, a process variable that could be examined in relationship to outcome. But this approach will not meet the above criteria. We must move ahead to establish the usefulness of hypnosis for a finite number of clinical problems. However doing so would go against the long-standing policy of considering hypnosis not a therapy in itself, but simply adjunctive to another therapy. APA's list includes broad therapies, and we should not try to validate "hypnosis treatment for depression" or "hypnosis treatment for marital problems." But many of the therapies on the APA list of therapies with demonstrated efficacy are very prescribed, e.g. behavior therapy for headache and for irritable bowel syndrome. Some may say that we cannot demonstrate efficacy for hypnosis because during hypnotherapy we use other things like advice, emotional support, etc. That's also true for behavior therapy approaches. Why apologize that we use non-hypnosis procedures in addition to hypnosis? We need to show interventions work, not necessarily _why_ they work. There doesn't have to be a "model of treatment" as there is a behavioral model of treatment, a psychoanalytic model of treatment, etc. We can nevertheless demonstrate efficacy. We should conceptualize some of our work in terms of hypnotic treatment modules, a brief hypnotic treatment for some specific disorder (and call them that-- hypnotic treatment modules). 1994 Rapkin, David; Holroyd, Jean (1994, February). Letter to the Editor (Cost-benefits of presurgery hypnosis) [Letter]. Society for Clinical and Experimental Hypnosis Newsletter, 35 (1), 8. "In her presidential address to the annual meeting of SCEH this autumn, Dr. Karen Olness made a plea for more investigation of cost-benefits in clinical research. To further that end, we would like to share some data that were not published when our article, "Guided Imagery, Hypnosis and Recovery from Head and Neck Cancer Surgery: An Exploratory Study," was published in IJCEH (1991). The data were withdrawn from the article because a reviewer had difficulty believing the cost figures, but it is just such important cost benefits that really ought to be publicized. difficulty believing the cost figures, but it is just such important cost benefits that really ought to be publicized. "In our research, 15 head and neck cancer surgery patients volunteered for hypnosis prior to surgery; they were compared with 21 patients who received usual care (no hypnosis) on medical outcome measures. Postoperative hospital stay was 8.7 days for the hypnosis group and 13.9 days for the usual care group (p< .05). The average savings for the intervention group was $6,725. While this difference fell short of statistical significance on the Wilcoxon test (Z=-1.5402, p < .10), it is rather striking on its face. The range actually was $7849 to $27,782 for Intervention Group patients and $9,390 to $53,627 for Usual Care group patients. "In 1990 a semi-private room at UCLA Center for the Health Sciences cost $405 to $529 per day, depending on quality; standard ICU care (one nurse for two patients) was $1236 per day, and more intensive care (one nurse for one patient) was $2471/day. Head and neck surgery patients may remain in the ICU, driving up costs, solely because they have not learned to suction their own tracheostomies, usually a motivational factor that might be affected by hypnosis. UCLA is a tertiary care hospital in a high-cost area (and is therefore reimbursed at higher rates than many other hospitals), and costs may be driven up by the many additional procedures required for long-stay patients. Therefore the cost savings could not be expected to be as great where expected length of stay is brief, ICU use is limited, and community costs are lower" (p. 8). Ter Kuile, Moniek M.; Spinhoven, Philip; Linssen, A. Corry G.; Zitman, Frans G.; et al. (1994). Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups. Pain, 58 (3), 331-340. The aims of this study were to (a) investigate the efficacy of autogenic training (AT) and cognitive self-hypnosis training (CSH) for the treatment of chronic headaches in comparison with a waiting-list control (WLC) condition, (b) investigate the influence of subject recruitment on treatment outcome and (c) explore whether the level of hypnotizability is related to therapy outcome. Three different subjects groups (group 1, patients (n = 58) who were referred by a neurological outpatient clinic; group 2, members (n = 48) of the community who responded to an advertisement in a newspaper; and group 3, students (n = 40) who responded to an advertisement in a university newspaper) were allocated at random to a therapy or WLC condition. During treatment, there was a significant reduction in the Headache Index scores of the subjects in contrast with the controls. At post-treatment and follow-up almost no significant differences were observed between the 2 treatment conditions or the 3 referral sources regarding the Headache Index, psychological distress (SCL-90) scores and medication use. Follow-up measurements indicated that therapeutic improvement was maintained. In both treatment conditions, the high-hypnotizable subjects achieved a greater reduction in headache pain at post-treatment and follow-up than did the low-hypnotizable subjects. It is concluded that a relatively simple and highly structured relaxation technique for the treatment of chronic headache subjects may be preferable to more complex cognitive hypnotherapeutic procedures, irrespective of the source of recruitment. The level of hypnotic susceptibility seems to be a subject characteristic which is associated with a more favourable outcome in subjects treated with AT or CSH. 1993 Banerjee, Sanjay; Srivastav, Anita; Palan, Bhupendra M. (1993). Hypnosis and self-hypnosis in the management of nocturnal enuresis: A comparative study with imipramine therapy. American Journal of Clinical Hypnosis, 36, 113-119. Various therapeutic modalities have been used for treating enuresis due to the lack of a single identifiable cause. We carried out a comparative study of imipramine and direct hypnotic suggestions with imagery used for the management of functional nocturnal enuresis. Enuretic children, ranging in age from 5 to 16 years, underwent 3 months of therapy with imipramine (N = 25) or hypnosis (N = 25). After termination of the active treatment, the hypnosis group continued practicing self-hypnosis daily during the follow-up period of another 6 months. Of the patients treated with imipramine, 76% had a positive response (all dry beds); for patients treated with hypnotic strategies, 72% responded positively. At the 9-month follow-up, 68% of patients in the hypnosis group maintained a positive response, whereas only 24% of the imipramine group did. Hypnosis and self-hypnosis strategies were found to be less effective in younger children (5-7 years old) compared to imipramine treatment. The treatment response was not related to the hypnotic responsivity of the patient in either group Barber, Joseph (1993). The clinical role of responsivity tests: A master class commentary. International Journal of Clinical and Experimental Hypnosis, 41 (3), 165-168. "What is the proper role of hypnotic responsivity tests in the clinical context? If a patient demonstrates a low score, should the clinician proceed to use hypnosis? To waht extent should the patient's level of hypnotic responsivity guide the clinical use of hypnosis? If the initial hypnotic response is minimal, should the clinician rpoceed with the use of hypnosis?" (p. 165) These are the questions that guide this discussion. What is the proper role of hypnotic responsivity tests in the clinical context? If a patient demonstrates a low score, should the clinician proceed to use hypnosis? To what extent should the patient's level of hypnotic responsivity guide the clinical use of hypnosis? If the initial hypnotic response is minimal, should the clinician proceed with the use of hypnosis? This often-asked question does not have a single, simple answer. This very complex issue is addressed more fully elsewhere (Barber, 1992). Let me approach this more limited discussion by suggesting three important points. 1. The single administration of a test of hypnotic responsiveness does not provide a valid and reliable indication of a patient's responsiveness. 2. A responsivity score is only an estimate of probable responsiveness. 3. Clinical efficacy depends on a variety of hypnotic and nonhypnotic factors, and not soley on responsiveness. Everett, John J.; Patterson, David R.; Burns, G. Leonard; Montgomery, Brenda; Heimbach, David (1993). Adjunctive interventions for burn pain control: Comparison of hypnosis and Ativan. Journal of Burn Care and Rehabilitation, 14, 676-683. Thirty-two patients hospitalized for the care of major burns were randomly assigned to groups that received hypnosis, lorazepam, hypnosis with lorazepam, or placebo controls as adjuncts to opioids for the control of pain during dressing changes. Analysis of scores on the Visual Analogue Scale indicated that although pain during dressing changes decreased over consecutive days, assignment to the various treatment groups did not have a differential effect. This finding was in contrast to those of earlier studies and is likely attributable to the low baseline pain scores of subjects who participated. A larger number of subjects with low baseline pain ratings will likely be necessary to replicate earlier findings. The results are argued to support the analgesic advantages of early, aggressive opioid use via PCA or through careful staff monitoring and titration of pain drugs. Olness, Karen N. (1993, October). Hypnosis, research, and public affairs. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL. Bill Moyers' TV show on public television, Healing and the Mind, was seen by 15 million when first shown, and the book became a Book of the Month selection. Consumer Reports published _Mind-Body Medicine_. A TV program, _Heart of Healing_, sponsored by Noetic Sciences, will be shown; their teaching guides refer to the Society for Clinical and Experimental Hypnosis (SCEH). The federal government's NIH Office of Alternative Medicine (OAM) now has grants providing up to $30,000; in first year they received 800 letters of intent, ultimately 500 applications. In Nursing Research they also have sponsored research with OAM. OAM and the Cancer Institute are evaluating studies on using visual imagery with cancer patients. July of this year there was a 3-day working conference, with 80 scientists--1/2 of them from NIH--; David Spiegel and Karen Olness were there. Forty draft RIA's will be coming out. She will give us a draft of the RIA's. Fetzer Institute of Michigan has been involved, with Robert Lehman--new director--who vows to make it the leading institute for research on the mind. They funded the NIH Conference, but don't give direct research support to investigators. Marketing information on science and clinical medicine is not an interest for me, but Fetzer's marketing effort has resulted in research support that previously we would not have had. We do not have enough research on the value (cost vs benefits) of hypnotherapy. Jacknow & Associates looked at nausea in children; hypnotized patients had less nausea than the control group. Syrjala's study (_Pain_, 1992) and this one did not have a cost benefit component. A medical student and I learned that even HMOs don't know the average costs for various treatments for migraine headaches. There are only 3 controlled studies on child migraine that compare drugs to placebos! 5-7% of children in U.S. have migraines; 18% of men and 22% of women also have migraines. We need more studies of how hypnotic ability can be modified, to increase beneficial outcomes. We are forming a pediatric multi-site group to study Tourette's Syndrome and warts. A Wart Sensor is being developed to measure what is going away and in what order; by Case Western Reserve. There should be increased funds available in the next 5-7 years. The magazine Scientific American, Sept 24 1993, predicts more support for the behavioral sciences It's time to explain the mechanisms of what happens in hypnosis. Patterson, David R. (1993, October). Managing burn pain through hypnosis. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL. Since 1955 there were 13 published reports on managing burn pain through hypnosis, with generally positive results; but almost all were anecdotal, with a lack of standardized measures. Time, location, and duration of the hypnotic interventions were not specified, cost-effectiveness was hard to detect, and medications used were not reported. Publications don't even report the type of hypnotic intervention used. Hypnosis is indicated for procedural pain more than for during resting periods. Going through dressing changes is typically more painful than the burn itself. Opioid medications don't control all the pain. In our research we use J. Barber's Rapid Induction Analgesia, which entails suggestions for: 1. Slow breathing 2. Going down 20 steps 3. Confusion and amnesia 4. Anchoring post-hypnotic suggestions 5. Touching cue for reinstating the hypnosis 6. Relaxing scenario (Patterson added this to the Barber script) 7. Returning up the steps This intervention is good because it's replicable, and it's easy to train students to use it. The hypnosis is done the morning before the dressing change. Instructions for nurses are: 1. Read the card 2. Have patient lie down comfortably, etc. 3. Provide post hypnotic cue (usually a touch on the shoulder) In the first study we used patients refractory to opioids, and also used a historical control group. This was published in the American Journal of Clinical Hypnosis. Our subsequent study was published in the Journal of Consulting and Clinical Psychology (1992). We stabilized administration of opioids; then patients had hypnosis or anxiolytics or were in the control condition. There was significant reduction in pain for hypnosis. Patterson et al (current study). Compared Benzodiazapines to hypnosis using four groups: Hypnosis plus Lorazepam Hypnosis and placebo Lorazepam Hypnosis attention control and Lorazepam Placebo hypnosis and placebo pills Analgesia stabilized on 2 days. There was not an effect, no significant drop in pain scores for either hypnosis or Lorazepam. Perhaps we didn't get a significant drop in pain ratings because in this study we were taking all patients who applied and their initial pain ratings were not as high as in the other study. We have found no relationship or pain reduction with hypnotizability either. Why did we not get the positive results found previously for hypnosis? There are several possibilities. There is always a trend toward a drop in pain ratings over time. People generally bottom out with a rating of 3 or 4, and it looks like a floor effect. Also, the efficacy of hypnosis may be partly contingent on baseline pain level, and motivation to cooperate with the intervention. Could there be the same relation to baseline for benzodiazepines? We have noted that improved application of opioids early on means pain is lower. Marks & Sacher, Annals of Internal Medicine, 1973, indicate physicians under-prescribe opiates. Also Melzack in the Scientific American states this. We feel that we should not push hypnotherapy so much that we feed in to opioidphobia. Hypnosis is a useful adjunct to opiates. We believe that you should stabilize the patient with opioids, and if they are not responding well, then use hypnosis. In future research we want to find out which patients do best with hypnosis. In future research we want to find out which patients do best with hypnosis.