The hippocampus appears to be involved as a gating mechanism in selective attention (Crowne, Konow, Drake & Pribram, 1972; Isaacson, 1982, Isaacson & Pribram, 1986; R. Miller, 1991; Pribram, 1991; Arnolds et al., 1980) This gating function may be promoted “through a cortico-hippocampal relay [that] transmits information by theta wave modulation and Hebbian synaptic modification so that there is selective disattention” (p. 667). The author suggests that hypnotic pain control may involve directing attention away from pain sensory signals.
Highly hypnotizable people generate more EEG theta than low hypnotizables whether they are hypnotized or not, and Crawford (1990) observed marked hemispheric shifts in theta when highs (but not lows) were attempting to control pain with hypnosis.
This paper reports on preliminary results of SERP studies of people given hypnotic analgesia suggestions to reduce electric shock stimulus evoked pain. The results were analyzed individual by individual, because group data obscured pronounced shifts in SERP patterns (e.g. habituation rates differed among Subjects). For highs, the SERP tended to be reduced, and the lower amplitudes were observed as early as the N100-P200 components. This did not occur for low hypnotizables.
Different kinds of mechanisms may be operative for high hypnotizables, however. “In over half of the high hypnotizable subjects the far frontal region (Fp1, Fp2) showed strong arousal during attention to pain, but during hypnotic analgesia there was a flattening out of the SERPs to the point they are hard to measure. By contrast, the more posterior SERPs (including F3 and F4), while reduced in amplitude, were still evident. The other half of highs showed little SERP activity in the far frontal region in either attend or disattend conditions, but substantial reductions of SERPs at all locations during hypnotic analgesia” (p. 670). Additionally, some of the highs evidenced a contingent negative variation (CNV) or a late 400-500 msec negativity in the far frontal region, which author is inclined to interpret as “a preparation for a response or for an inhibition of a response” (p. 670).
Case studies of two patients with intracranial electrodes and scalp electrodes recording SERPs are presented in support of the experimental data. The two female patients were diagnosed with obsessive compulsive disorder; one was highly hypnotizable and one was not. They received 30 moderately painful stimuli to the left middle finger under sequential conditions: waking attention, hypnosis with analgesia suggestions, and hypnosis with attention instructions. The highly hypnotizable patient reported significantly less pain during suggested analgesia, and that reduction in pain was associated temporally with reduction of SERP at P160 in the gyrus cingulus (and at no other recording sites). The ‘unhypnotizable’ patient showed no SERP changes. As an aside, the author notes that “Subsequent to the hypnotic analgesia, when the pain was attended to again during waking this patient showed a significant enhancement of the same positivity wave at Fz, as if there was a rebound effect (something we have also observed in some of our SERP subjects at the BRAINS Center)” (p. 674).
aside, the author notes that “Subsequent to the hypnotic analgesia, when the pain was attended to again during waking this patient showed a significant enhancement of the same positivity wave at Fz, as if there was a rebound effect (something we have also observed in some of our SERP subjects at the BRAINS Center)” (p. 674).
Erickson, James C. (1994, October). The metaphors of pain and therapy. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.
Metaphors of Pain may be: 1. Anatomically or physiologically descriptive. 2. Extremely common, especially in chronic pain syndromes. 3. Unrecognized by many therapists. 4. Often pithy, succinct phrases (like puns). “Pain in the neck, pain in the butt” may reflect symbolic meaning of the pain, which if attended to may benefit the patient.
Head and neck pain metaphors include such things as “a headache, a pain in the neck, grit your teeth, and grin and bear it” (related to bruxism and TMJ syndrome). Also pertains to post-rhinoplasty pain in the nose.
Back pains: upper thoracic pain “a load on my shoulders” like Atlas carrying the world. Or “a cross to bear” which implies uncomplaining, but bearing a heavy burden. Low back pain – a “weak spine,” or “spineless.” With laminectomy, a “yellow streak up the back.”
Dermatitis: Pruritis or dermatitis when “something gets under the skin.”
Chest pains when “sick at heart.”
Nagging, nasty situation is a “thorn in my side.”
“A stab in the back” when wronged by society or a person. “Pain in the ass” may be a spouse or a situation. [Other material provided by the speaker is not reported here.]
Kiernan, Brian; Dane, Joseph R. (1994, October). Hypnoanalgesia reduces new physiologic index of pain, the R-III Index, but the role of hypnotic susceptibility remains unclear. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.
Stimulated by work of Basil Finer, and following upon the Neodissociation theory of Hilgard; pain is registered by the body but dissociation that produces analgesia is a function of higher brain centers.
Could hypnotic analgesia be mediated lower, at the level of the spinal cord? Gate at dorsal horn could be open or shut; subject to descending modulation. Is hypnosis involved in descending modulation of activity in the dorsal horn?
Hypothesis: reduced pain intensity would be associated with reduced activity at dorsal horn. From Price & Barber, we wanted to look at affect and intensity aspects of pain. Polysynaptic reflex, R-III, latency consistent with conduction velocity (when hand touches a hot stove); even with severed spinal cord injury we still demonstrate the reflex. The magnitude of reflex is linearly related to the pain sensation. The stronger the electrical pulse, the greater the magnitude of the reflex. Magnitude of reflex is linearly related to subjective pain. It is an index of nociceptive activity.
Procedure: Evoke reflex with electrical stimulus at ankle; measure signal at muscle with EMG. We anticipated that at dorsal horn, descending modulation would dampen signal.
15 healthy volunteers. Sural nerve was stimulated. R III reflex measured via EMG response. Used the visual analogue scale (VAS) to assess pain.
1993
Bruehl, Stephen; Carlson, Charles R.; McCubbin, James A. (1993). Two brief interventions for acute pain. Pain, 54, 29-36.
This study evaluated two brief (3-5 min) interventions for controlling responses to acute pain. Eighty male subjects were randomly assigned to 1 of 2 intervention groups (Positive Emotion Induction (PEI) or Brief Relaxation (BR)) or to 1 of 2 control groups (No-instruction or Social Demand). The PEI focused on re-creating a pleasant memory, while the BR procedure involved decreasing respiration rate and positioning the body in a relaxed posture. All subjects underwent a 60-sec finger pressure pain trial. Analyses indicated that the PEI subjects reported lower ratings of pain, fear, and anxiety, and experienced greater finger temperature recovery than controls. The BR procedure resulted in greater blood pressure recovery, but did not alter ratings of pain or emotion relative to controls. Further research is needed to explore the clinical use of the PEI for acute pain management.
Covino, Nicholas A.; Frankel, F. M. (1993). Hypnosis and relaxation in the medically ill. Psychotherapy and Psychosomatics, 60, 75-90.
Interest in the application of hypnotic techniques for patients with medical disorders seems to rise and fall over the years. Enthusiasm for this work comes both from patients and from clinicians. Often, however, these techniques are offered without regard to the psychological theories that should inform their operation and the limits that clinical and experimental research suggest. This article offers a brief description of the elements of hypnosis and a review of the history of the use of hypnotic techniques with a variety of medical problems, including asthma, habits, pain, cardiology, surgical preparation, irritable bowel syndrome, persistent nausea and vomiting, trichotillomania, and infection and immunity. Special attention is placed on the psychological and physiological principles that help to establish the valid use of hypnotherapy.
Crawford, Helen J.; Gur, Ruben C.; Skolnick, Brett; Gur, Raquel E.; Benson, Deborah M. (1993). Effects of hypnosis on regional cerebral blood flow during ischemic pain with and without suggested hypnotic analgesia. International Journal of Psychophysiology, 15, 181-195.
Using 133Xe regional cerebral blood flow (CBF) imaging, two male groups having high and low hypnotic susceptibility were compared in waking and after hypnotic induction, while at rest and while experiencing ischemic pain to both arms under two conditions: attend to pain and suggested analgesia. Differences between low and highly-hypnotizable persons were observed during all hypnosis conditions: only highly-hypnotizable persons showed a significant increase in overall CBF, suggesting that hypnosis requires cognitive effort. As anticipated, ischemic pain produced CBF increases in the somatosensory region. Of major theoretical interest is a highly-significant bilateral CBF activation of the orbito-frontal cortex in the highly-hypnotizable group only during hypnotic analgesia. During hypnotic analgesia, highly-hypnotizable persons showed CBF increase over the somatosensory cortex, while low-hypnotizable persons showed decreases. Research is supportive of a neuropsychophysiological model of hypnosis (Crawford, 1991; Crawford and Gruzelier, 1992) and suggests that hypnotic analgesia involves the supervisory, attentional control system of the far-frontal cortex in a topographically specific inhibitory feedback circuit that cooperates in the regulation of thalamocortical activities.
Don, Norman S. (1993, October). Trance surgery in Brazil. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.
Showed a videotape of a Brazilian trance surgeon, who cuts without analgesia or asepsis. Patients later report no pain, infections, etc. The healer/surgeon is believed by everyone to be in a trance state, and the body is believed to be taken over by a spiritual doctor. The people involved deny that the patient is in trance.
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.
1992
Adams, P. C.; Stenn, P. G. (1992). Liver biopsy under hypnosis. Journal of Clinical Gastroenterology, 15, 122-124.
Two patients underwent outpatient percutaneous liver biopsy under hypnosis without complications. One patient had severe anxiety about the procedure because of a previous adverse experience with liver biopsy, and the other had a history of severe allergy to local anesthesia. Both patients had undergone a session of hypnosis at least once prior to the biopsy. One received no local anesthesia, and the other received 1% lidocaine as a local anesthetic. Both patients were completely cooperative during the procedure with the required respiratory maneuvers. Both patients stated that they were aware of the procedure under hypnosis but described no pain and would be most willing to have the procedure done under hypnosis in the future.
Alden, Phyllis (1992, October). The use of hypnosis in the management of pain on a spinal injuries unit. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.
To have a spinal injury is one of the most devastating injuries that can happen, reducing you suddenly from a normal life to situation of loss of control, helplessness, etc.- -with nothing to say about what is being done in surgery or other aspects of treatment.
In UK patients come for acute care and rehabilitation all in one place. Over 2 1/2 yrs we had 46 referrals. 7 refused hypnosis (“witch doctoring”). 30 benefitted
1991
Blankfield, Robert P. (1991). Suggestion, relaxation, and hypnosis as adjuncts in the care of surgery patients: A review of the literature. American Journal of Clinical Hypnosis, 33, 172-186.
He notes that the authors provide little information re complications, and length of stay (LOS) is one of the most sensitive response measures used in these studies. The mean difference in LOS for 5 studies that have randomized assignment is 1.3 days. The N’s are 80-100 for 3 of the studies, 39 and 60 for others. For two well controlled studies that did not achieve significance, the N’s were 40 and 45. Many studies mixed the diagnosis and types of surgeries, making it difficult to interpret the results.
Clarke, J. H.; Reynolds, P. J. (1991). Suggestive hypnotherapy for nocturnal bruxism: A pilot study. American Journal of Clinical Hypnosis, 33, 248-253.
Although one can find many case reports of hypnotherapy for bruxism, there is a paucity of scientific research on the subject. This study describes the use of suggestive hypnotherapy and looks at its effectiveness in treating bruxism. Eight subjects who reported bruxism with symptoms such as muscle pain and complaints of bruxing noise from sleep partners were accepted into the study. An objective baseline of the bruxing was established using a portable electromyogram (EMG) detector attached over the masseter muscle during sleep. Hypnotherapy was then employed. Both self-reports and posttreatment EMG recordings were used to evaluate the hypnotherapy. Long-term effects were evaluated by self-reports only. The bruxers showed a significant decrease in EMG activity; they also experienced less facial pain and their partners reported less bruxing noise immediately following treatment and after 4 to 36 months.
1990
Arendt-Nielsen, Lars; Zachariae, Robert; Bjerring, Peter (1990). Quantitative evaluation of hypnotically suggested hyperaesthesia and analgesia by painful laser stimulation. Pain, 42, 243-251.
Sensory and pain thresholds to laser stimulation were determined, and the laser-pain evoked brain potentials were measured for 8 highly hypnotizable (Harvard Scores 10-11) student volunteers in 3 conditions: (1) waking, (2) suggestion of hyperaesthesia during hypnosis, (3) suggestion of analgesia during hypnosis.
The investigators used a laser beam 3 mm in diameter, with a 200 msec stimulus duration; the same area (but different points within the area) was used for consecutive stimulations. Ss were otherwise maintained in low stimulus conditions so they would not have visual or auditory cues about laser beam onset; they wore goggles, had eyes shut, and had earphones on. Sensory threshold was defined as warmth; pain threshold was defined as a distinct sharp pin prick.
The laser intensity used for stimulation corresponded to strong pain. Interstimulus intervals averaged 15 sec (but were randomly varied between 10-20 sec). Sensory and pain thresholds as well as two evoked potential measurements were taken during waking , hypnotized hyperaesthesia, and hypnotized analgesia conditions in a single 1 1/2 hour session.
The evoked potential component of interest was the negative complex N1 with latency of 300 msec; amplitude (P1=N1-P2) and latency of this complex (N1) were measured. EEG epochs contaminated by eye movement were omitted from analysis.
The standardized induction and deepening of hypnosis required 15-20 minutes; then the suggestion was given that Ss could alter their perception of stimuli such as pain. Hyperaesthesia suggestions were to imagine the right hand was in very hot water, then taken out but still very red, hot, sensitive so that even the vaguest stimulus would be detectable and unpleasant. They were told that they would receive a series of painful but tolerable stimuli, and to raise the left index finger if they could just perceive a laser pulse (sensory threshold), and again if they felt pricking pain (pain threshold).
Suggestions for analgesia were to imagine that their right hand was placed on their chest, and that their ‘former right hand’ was no longer their own but was made of some heavy and completely insensitive material like wood or stone. Sensory and pain threshold measures were then taken. During the evoked potential measurement period they received continuous suggestions of analgesia. They also were told to relax and imagine they were in a pleasant place, ignoring everything except the pleasant, relaxed feelings and imagining pleasant sights, sounds, feelings and the imagined place. They were told that though they would receive stimuli, they probably would be able to ignore the stimuli completely.
Results were as follows.
1. In the hypnotic hyperaesthesia condition, sensory and pain thresholds decreased significantly by 47% and 48%, respectively. Three Ss reacted to laser intensities far below what normally can be perceived in the waking state. [The authors ran a separate small control experiment to make sure that the Subjects were not using any other cues, but mention the possibility of light-sensitive skin reacting to the blue laser light, creating evoked potentials.]
2. In the hypnotic analgesia condition, sensory and pain thresholds increased by 316% and 190%, respectively. 7 of 8 Ss did not even respond to pain threshold when the laser intensity was increased to the noxious level of 3W, which is the level at which tissue damage can occur.
3. Pain-related evoked potentials. Amplitude of the first pain-related potential was increased significantly by 14% in the hyperaesthesia condition and reduced significantly by 31% in the analgesia condition. Changes in the evoked potentials were considered minor however compared to those observed for thresholds, which are subjective response measures. Even in Subjects who reported complete analgesia, the experimenters observed the laser pain evoked responses. There were no differences in latencies of the first pain-related potentials for the three conditions (indicating that peripheral and central afferent conduction velocities were the same).
Discussion. “There has been some dispute concerning the experimental design and the reliability of the data obtained in studies dealing with hypnotic suggested analgesia [Spanos & Chaves, 1970]. In our design 2 ‘opposite’ conditions were induced, and the 2 inductions gave ‘opposite’ results.
“The experience of pain can be significantly altered by suggestions of analgesia, which is in accordance with a number of other studies (for review see [Barber & Adrian, 1982; Hilgard & Hilgard, 1975]). The finding that suggestions of hyperaesthesia can decrease the sensory and pain thresholds and increase the amplitude of the pain evoked potential is a new observation. Since synchronized auditory and visual stimuli from the laser were blocked, and the stimulus was given at random intervals, the changes might be induced by the hypnotic suggestions” (p. 247).
The authors discuss their results in terms of (1) four pain modulation systems (neural/opiate, hormonal/opiate, neural/non-opiate, and hormonal/non-opiate) and (2) focusing and defocusing attention. Because in their pilot study it was necessary to give suggestions continually in order to affect the laser evoked potentials, they conclude that endogenous substances or hormonal/non-opiates would play a minor role, if any, in hypnotic analgesia. (Price and Barber [25] had also found it important to give suggestions continuously.)
hormonal/opiate, neural/non-opiate, and hormonal/non-opiate) and (2) focusing and defocusing attention. Because in their pilot study it was necessary to give suggestions continually in order to affect the laser evoked potentials, they conclude that endogenous substances or hormonal/non-opiates would play a minor role, if any, in hypnotic analgesia. (Price and Barber [25] had also found it important to give suggestions continuously.)
On the other hand, “event-related potentials [7, 26] and pain-related potentials have, previously, been shown to be sensitive to focused and de-focused attention. Recently, Miltner et al. [23] showed the influence of attention on the late pain-related component of potentials, evoked by painful intracutaneous electrical stimulation. The degree to which the subject paid attention to the painful stimulus had a powerful effect on the pain-related complex. When subjects ignored the pain, it was still possible to record the pain-related complex although all the subjects consistently reported less or no pain. In wakeful subjects where cutaneous pain was abolished by lignocaine infiltration, the pain-related evoked potentials were abolished [4]. In our study, we could also record evoked potentials although the subject subjectively did not feel pain. The reason might be that the S acted as if there was full analgesia to the stimuli, in order to satisfy the hypnotist. During suggested hyperaesthesia the thresholds declined below what normally could be perceived in the wakeful state. The volunteers could, therefore, not act hypersensitive, so something did happen.
“The discrepancy in subjective and objective responses might, however, be useful when investigating levels of the neuroaxis at which hypnosis might work” (pp. 248-249).
The authors note that this laser induced pain and the tooth pulp stimulation pain of Mayer & Barber both use the A-delta fibers. Barber & Mayer found it impossible to elicit pain within the output range of the stimulator (up to 150 microA) and reached maximal intensity for all volunteers during suggested analgesia. Using cutaneous laser stimulation the authors found that the skin damage level (3W) could be reached in 7 of 8 volunteers without any reaction of pain.
During the hyperaesthesia condition the sensory threshold was sometimes lower than can be detected in the waking state. Although some researchers have suggested that red light from a helium-neon laser might activate cutaneous photosensitive receptors and thereby elicit brain potentials, the authors were unable to elicit potentials in waking Subjects using their blue and green argon laser light with below sensory threshold intensity.
The authors also note that previous attempts to use physiological correlates of pain such as heart rate, blood pressure, respiration, and galvanic skin response have yielded confusing results. The physiological indicators are present even when Subjects report analgesia, leading some investigators to conclude that the subjective reports are due to illusion [Sutcliffe, 1961], compliance [Wagstaff, 1986], or a placebo induced by the hypnosis context [Wagstaff, 1986]. “These confusing results lead to the conclusion that both the traditional methods used for induction of pain and the monitored physiological responses have been unsatisfactory. The present study has sought to eliminate some of the methodological difficulties by (1) using brief well-defined argon laser stimuli which in awake volunteers induce very stable perceptions between trials [Arendt-Nielsen & Bjerring, 1988], and (2) recording psychophysical thresholds and objective parameters quantitatively related to the intensity of the pain perceived (1, 3)” (p. 249).
Barabasz, Arreed F.; Barabasz, Marianne (1989). Effects of restricted environmental stimulation: Enhancement of hypnotizability for experimental and chronic pain control. International Journal of Clinical and Experimental Hypnosis, 37, 217-231.
Enhancement of hypnotizability and pain tolerance has been demonstrated using restricted environmental stimulation therapy (REST) with university students as Ss (A. F. Barabasz, 1982). The purpose of the present study was to determine whether or not similar results could be obtained with chronic pain patients. Ss consisted of outpatients in treatment for conditions in which pain is prominent who also demonstrated low hypnotizability after repeated hypnosis plateau sessions. 2 groups of Ss were exposed to REST. Situational demand characteristics (Orne, 1962) favored an increase in hypnotizability for REST Group 1 (high demand). REST Group 2 (low demand) was exposed to situational demand characteristics designed to disguise the experimental hypothesis. 2 groups of control Ss were exposed to the same alternative demand characteristic manipulations as the experimental groups, but environmental stimulation was maintained. The Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) of Weitzenhoffer and E. R. Hilgard (1962), including a posthypnotic suggestion for an anesthetic reaction, and an ischemic pain test were administered prior to treatment and again immediately following treatment. After 6 hours of REST, significant increases in SHSS:C scores were found for high-demand and low-demand experimental Ss, as well as for high-demand control Ss. No such increase was found for low-demand controls. Significant decreases in pain scores were found for both high- and low-demand experimental groups. No significant pain score decreases were found for either control group, suggesting a relatively weak effect of demand characteristics. An independent postexperimental inquiry suggested all Ss believed they received active treatments. The inquiry, conducted 10-15 days after the experiment, also revealed a majority of experimental Ss were using hypnosis on a daily basis to reduce pain with a substantial decrease in pain medication. Only 2 control Ss (highest in hypnotizability) reported similar success. Anecdotal reports of pain reduction experiences using hypnosis after REST intervention were supportive of E. R. Hilgard’s (1977) neodissociation theory.
Outpatients getting treatments for conditions involving significant pain, who also were low in hypnotizability (and had reached a plateau level through repeated inductions), had REST (restricted environmental stimulation). Experimental Group 1 = high demand, Experimental Group 2 = low demand (disguised experimental hypothesis). Control groups had pseudo-REST conditions. All Subject spent 6 hrs in the REST chamber (controls read, listened to radio, played computer games, were not stimulus deprived).
The two control groups had the same demand characteristic manipulations as the Experimental groups, but Control Group 1 was cued to the hypnotic focus of the study and given instructions favoring an increase in hypnotizability, while Control Group 2 (low- demand/disguised hypothesis) emphasized the “important psychophysiological measures.”
In both high-demand control and experimental groups, E wore a lab coat, maintained an aura of seriousness, and had a medical tray. In low-demand conditions Es dressed in regular clothes.
The Stanford-C was administered, also including a posthypnotic suggestion for an anesthetic reaction,. An ischemic pain test was administered prior to treatment and again immediately following treatment. After 6 hours of REST, significant increases in SHSS:C scores were found for high-demand and low-demand experimental Subjects, as well as for high-demand control Subjects. No such increase was found for low-demand controls.
Significant decreases in pain scores were found for both high- and low-demand experimental groups. No significant pain score decreases were found for either control group, suggesting a relatively weak effect of demand characteristics.
Significant decreases in pain scores were found for both high- and low-demand experimental groups. No significant pain score decreases were found for either control group, suggesting a relatively weak effect of demand characteristics.
Postexperimental inquiry was conducted by an independent interviewer 10-15 days after the experiment. All 20 Subjects believed they received active treatments. This belief seemed to be strong due to the “extensive efforts in the hypnosis plateauing sessions” (p. 225). Also, a majority of experimental Subject were using hypnosis on a daily basis to reduce pain, with a substantial decrease in pain medication. These were Ss who had the highest post-REST SHSS:C scores (9-12 range). Only 2 control Subjects (highest in hypnotizability) reported similar success. Anecdotal reports of pain reduction experiences using hypnosis after REST intervention were supportive of E. R. Hilgard’s (1977) neodissociation theory.
“[In an earlier study] instructional demand cues for compliance (A. F. Barabasz, 1982) raised Ss’ subjective reports of hypnotic depth in a control condition but failed to significantly raise SHCS scores” (p. 225). The present study “indicate(s) that chamber REST by itself increases hypnotizability and ischemic pain tolerance, and that experimental demand characteristics do not further potentiate this effect” (p. 225).
The authors note that because they used the posthypnotic suggestion of anesthesia for all Subjects, “it is not possible to determine whether the lowered pain reports of REST Ss were due to the posthypnotic suggestion because of enhanced hypnotizability or whether the lowered pain sensitivity was a nonsuggested collateral consequence of REST” (p. 226).
The data support the conclusion that REST enhances hypnotizability and concomitantly decreases ischemic pain reports after a posthypnotic suggestion. This effect, of course, may or may not be mediated by a response to hypnotic suggestion. “It is important to recognize the quality of the anecdotal pain control reports as remarkably consistent with E. R. Hilgard’s (1977) neodissociation theory of hypnosis. Successful pain controllers did not anesthetize their clinical pains, as asked to do for the ischemic pain, but rather dissociated their pain to other parts of their bodies or outside their bodies” (p. 227).
Bierman, Steven F. (1989). Hypnosis in the emergency department. American Journal of Emergency Medicine, 7, 238-242.
Five cases are presented wherein hypnosis was used by the emergency physician either as the primary mode of treatment or as an adjuvant to standard medical care. Common hypnotic phenomena (e.g. anesthesia, analgesia), as well as novel effects, are reported. The technique used for trance induction and utilization is briefly outlined, and criteria are set forth for the bedside recognition of hypnotic trance.
Edelson, Jeffrey; Fitzpatrick, Jody L. (1989). A comparison of cognitive-behavioral and hypnotic treatments of chronic pain. Journal of Clinical Psychology, 45, 316-323.
27 male chronic pain patients were assigned to 1 of 3 treatment groups: hypnosis, cognitive-behavioral, and attention control. Hypnosis and cognitive-behavioral treatments were identical, with the exception of the hypnotic induction. Scores on the McGill Pain Questionnaire (MPQ) and a measure of the overt motor behavior element of chronic pain were collected at pretreatment, posttreatment, and follow-up intervals. Analyses showed significant increases in activity and decreases in pain intensity for the cognitive-behavioral treatment.
Changes for the hypnosis treatment were noted only on the MPQ. Changes for both groups were sustained on the 1-mo follow-up. Findings generally support the superiority of the cognitive-behavioral treatment on behavior measures and its equivalence to hypnosis on subjective measures.
1988
Barabasz, Arreed F. (1988, November). Cold pressor pain and spontaneous hypnosis in flotation restricted environmental stimulation. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Asheville, NC.
6 hours of REST (reclined on bed in sound attenuated chamber) led to 100% increase in hypnotizability. They didn’t get changes with flotation that are obtained with awake bed rest. Chamber method is very good in cigarette smoking (11 replications) but not flotation rest – despite the demand characteristics of a flotation tank. Subjects must remain awake (sleepfree) if meaningful hypnotizability is achieved.
Davies, Peter (1988). Some considerations of the physiological effects of hypnosis. In Heap, Michael (Ed.), Hypnosis: Current clinical, experimental and forensic practices (pp. 61-67). London: Croom Helm Ltd.
This chapter reviews literature on physiological correlates of hypnosis, but these notes are limited to only one fact reported in the review. The author writes, ‘A recently completed, and as yet unpublished study by C. Gillett and H. D. Griffiths at Bradford University investigated the relation between hypnosis and classical conditioning of psychophysiological responses. In a complex design involving both normal conditioning and normal test trials and a repetition of both acquisition and test trials under hypnosis, they found not only suppression of the conditioned response but also suppression of skin conductance responses to the half-second bursts of a 115-dB tone used as the unconditioned stimulus. Not to produce a significant autonomic response to such an intrinsically aversive stimulus is a remarkable feat which is probably outside the repertoire of simulators. However, even such results are not conclusive as the design did not included simulator control groups nor even neutrally instructed non-hypnotized group’ (pp. 64-65 ).
Van der Does, A. J.; Van Dyck, R.; Spijker, R. E. (1988). Hypnosis and pain in patients with severe burns: A pilot study. Burns Including Thermal Injuries, 14, 399-404.
Presents a pilot study on the effectiveness of hypnosis in the control of pain during dressing changes of burn patients. Eight patients were treated, and all evaluated the interventions as beneficial. The treatment of four patients was more closely analyzed by obtaining pain and anxiety ratings daily. Results show a 50%-64% decrease in reported pain level for three patients and a 52% increase of pain for one patient. The mean decrease for these four patients was 30% (for overall as well as worst pain during dressing changes). A 30% reduction of anxiety level and a modest reduction of medication use were achieved concurrently. It is concluded that hypnosis is of potential value during dressing changes of burn patients. Comparison of global evaluations and daily pain ratings shows that systematic research in some cases leads to conclusions opposite from clinical observations. Follow-up recommendations for future studies are given.
Elton, D.; Boggi-Cavallo, P.; Stanley, G. V. (1988). Group hypnosis and instructions of personal control in the reduction of ischaemic pain. Australian Journal of Clinical and Experimental Hypnosis, 16, 31-37.
Three groups of students were tested on ischemic pain threshold and pain tolerance. The control group of 95 subjects received a single pain test. The hypnosis group of 42 subjects received a single session of hypnotic induction prior to the pain test. The hypnosis and personal control group of 32 subjects received hypnotic induction and suggestions of personal control prior to the pain test. The hypnotic procedure included the use of a pendulum, coupled with suggestions of arm elevation and lip analgesia. It was found that hypnotic induction resulted in lower [sic] pain threshold and pain tolerance. Suggestions of personal control and hypnosis further lowered [sic] the pain measures.
The ABSTRACT appears to have mis-statements, for the word should be “higher” or “raised.” In the article the results are stated as, “The hypnosis conditions with suggestion of personal control produced the higher pain threshold (mm/Hg) and longer tolerance (seconds) than the hypnosis only group and both hypnotic inductions produced higher threshold and longer tolerance than the control condition” (p. 35)
“The results suggest that a single brief group session of hypnosis can produce a significant change in response to ischaemic pain. The added instruction of increased personal control produced a greater effect and reinforces the importance of the self concept in the reaction to pain” (p. 36).
Evans, C.; Richardson, P. H. (1988). Improved recovery and reduced postoperative stay after therapeutic suggestions during general anesthesia. Lancet, 2 (8609), 491-493.
The clinical value of suggestions during general anesthesia was assessed in a double-blind randomized placebo-controlled study. 39 unselected patients were allocated to suggestion (N = 19) or control (N = 20) groups who were played either recorded suggestions or a blank tape, respectively, during hysterectomy. The patients in the suggestion group spent significantly less time in the hospital after surgery, suffered from a significantly shorter period of pyrexia, and were generally rated by nurses as having made a better-than-expected recovery. Patients in the suggestion group, unlike the control group, guessed accurately that they had been played an instruction tape.
1987
Bandura, A.; O’Leary, A.; Taylor, C. B.; Gauthier, J.; Gossard, D. (1987). Perceived self-efficacy and pain control: Opioid and non-opioid mechanisms. Journal of Personality and Social Psychology, 53, 563-571.
Subjects who were trained to use psychological coping strategies (e.g. imagery, distraction, dissociation, sensation transformation) had both better pain tolerance on a cold pressor test and higher self efficacy ratings. Those subjects who were given naloxone (which blocks pain reduction effects of beta endorphins) showed more pain tolerance than subjects not given the cognitive training experiences. They attributed much of the pain tolerance increase associated with cognitive interventions to opiate release, suggesting that cognitive interventions may have physiological mediating effects on pain perception.
physiological mediating effects on pain perception.
Evans, Frederick J.; McGlashan, Thomas H. (1987). Specific and non-specific factors in hypnotic analgesia: A reply to Wagstaff. British Journal of Experimental and Clinical Hypnosis, 4, 141-147. (Comment in response to Wagstaff, G. (1987). Is hypnotherapy a placebo? Hypnosis, 4, 135-140.)
This article is a reply to Wagstaff’s (1984) critique of the McGlashan, Evans & Orne (1969) article which was entitled “The nature of hypnotic analgesia and the placebo response to experimental pain,” published in Psychosomatic Medicine, 31, 227-246. The paper to which the authors are replying is Wagstaff, G. F. (1984). Is hypnotherapy a placebo? Paper given at the First Annual Conference of the British Society of Experimental and Clinical Hypnosis, University College, London. An abridged version appeared in the British Journal of Experimental and Clinical Hypnosis, 1987, 4, 135-140.
The closing comments of this Evans & McGlashan 1987 paper read as follows: “The strategy in this study [i.e. McGlashan, Evans & Orne, 1969] was quite different from the usual experimental design. Our goal was to _maximize_ all of those non-specific factors that we could build into the experimental procedure. Only by attempting to maximize non-specific effects is it possible to see whether hypnosis in appropriately responsive subjects can exceed that degree of pain control which occurs due to the maximal operation of these non-specific effects. These non-specific components of the hypnotic situation may account for a great deal of clinical change. … The critical finding was that hypnosis did add a level of pain control that occurred after maximizing clinically related non-specific factors contributing to change in pain tolerance, and that this increased tolerance occurred only in subjects markedly responsive to hypnosis, in contrast to the significant non-specific effects which were uncorrelated with measured hypnotizability” (pp. 143-144).
The principal findings of the McGlashan, Evans & Orne (1969) study were: “(a) The improved ability to tolerate pain following the ingestion of placebo was roughly the same for high hypnotizable and low hypnotizable subjects. (b) The response to the non-specific aspects of taking a ‘drug’ among low hypnotizable subjects was identical to, and highly correlated (.76) with, their response to the legitimized expectation that change would occur under hypnosis for low hypnotizable subjects. The placebo component of a believe-in ‘drug’ ingestion was the same as the placebo component of a believed-in hypnotic experience for these low hypnotizable subjects. (c) The performance of the highly hypnotizable subjects was significantly greater under hypnotic analgesia conditions than it was under placebo conditions.
“This last finding is important conceptually, though of less clinical relevance. It should be noted that not all high hypnotizable subjects showed this result. Even among highly hypnotizable subjects, not all of them had the experience that profound analgesia had occurred! Thus, based on their subjective experience of the relatively small degree of analgesia, 6 of the 12 highly hypnotizable subjects behaved exactly as the low hypnotizable subjects had — their placebo and hypnotic responses were small, significant, but equal. Only 6 out of 12 carefully screened hypnotizable subjects who subjectively experienced marked analgesia showed dramatic objective changes in pain endurance. Dr. Wagstaff might consider the physiological implications of the observation that we became somewhat frightened about the possibility of tissue damage with two of these six subjects. We had to stop their performance at a point where physiologists had assured us that tissue damage could be expected. They had also assured us, wrongly for these subjects, that we did not have to worry about such a critical point because nobody could endure such a degree of occlusion with this procedure. In fact, for these two subjects, anoxia and muscle cramping were not even apparent!” ( p. 144).
assured us that tissue damage could be expected. They had also assured us, wrongly for these subjects, that we did not have to worry about such a critical point because nobody could endure such a degree of occlusion with this procedure. In fact, for these two subjects, anoxia and muscle cramping were not even apparent!” ( p. 144).
Farthing, G. William; Venturino, Michael; Brown, Scott W.; Lazar, Joel D. (1986, April). Internal vs. external distraction in the control of pain as a function of hypnotic susceptibility. [Paper] Presented at the annual meeting of the Eastern Psychological Association, New York.
This study tested the prediction, derived from their 1984 study: for highly hypnotizable subjects, pain reduction methods involving either attention to external distracting stimuli or attention to internally generated distracting images will be effective in reducing pain. However, for low hypnotizables only external stimulus distraction will be effective, and internal images will not be effective distractors for reducing pain.
Used independent groups of college students, with 1/3 highs, 1/3 mediums, and 1/3 lows. Used five conditions: (n=12 per subgroup 3H x 5T) 1. Suggestion – Subjects told “to image as vividly as you can that your hand is numb and insensitive, as if it were made of rubber.” (No hypnotic induction was used.) 2. Guided imagery – Subjects told to listen to a story that would be read to them, and to try to imagine the scenes as vividly as possible. (Story included scenes where the s was the main character.) 3. Word memory – Subjects told to listen to a list of words that would be read to them and try to remember them for later recall test (30 abstract nouns, at rate of 1 every 2 seconds. 4. Pursuit rotor – which subjects did during the ice water immersion. 5. Placebo control – included suggestion, “For this test you will find that you can succeed in not being disturbed by the cold water if you carefully follow the following instructions. While your hand is in the water you should not try to control your thoughts. Just let your mind wander freely to whatever feelings or thoughts or ideas happen to come to you.”
1985
Domangue, Barbara B.; Margolis, Clorinda; Lieberman, D.; Kaji, H. (1985). Biochemical correlates of hypnoanalgesia in arthritic pain patients. Journal of Clinical Psychiatry, 46, 235-238.
Self-reported levels of pain, anxiety, and depression, and plasma levels of beta-endorphin, epinephrine, nor-epinephrine, dopamine, and serotonin were measured in 19 arthritic pain patients before and after hypnosis designed to produce pain reduction. Correlations were found between levels of pain, anxiety, and depression. Anxiety and depression were negatively related to plasma norepinephrine levels. Dopamine levels were positively correlated with both depression and epinephrine levels and negatively correlated with levels of serotonin. Serotonin levels were positively correlated with levels of beta-endorphin and negatively correlated to epinephrine. Following hypnotherapy, there were clinically and statistically significant decreases in pain, anxiety, and depression and increases in beta-endorphin-like immunoreactive material
Finer, B. (1985, August). Altered substance P concentrations in CSF during hypnotic analgesia. [Paper] Presented at the 10th International Congress of Hypnosis and Psychosomatic Medicine, Toronto, Canada.
These notes are not a complete record of the presentation.
Substance P is present at many sites of endorphins or enkephalons. Sometimes a strange sleepiness follows triggerpoint stimulation. Acupuncture also may lead to similar changes (e.g. feeling groggy; having difficulty standing – lasts 1-4 hours). If you inject 4 mgms (10 times the ordinary dose) of Naloxone into Ss it leads to groggy sleepiness, for Naloxone-reversed hypnotic analgesia.
1984
D’Eon, Joyce Lillian (1984). Response to pressure pain as moderated by hypnotic susceptibility, type of suggestion strategy, and choice (Dissertation, Concordia University, Canada). Dissertation Abstracts International, 45 (n4-B), 1313-1314.
“The present study examined the relationship between hypnotic susceptibility and ability to control pain, by comparing high and low susceptible subjects’ response to pressure pain when these subjects employed either an imagery or a distraction pain attenuating strategy. The effect of providing subjects with a choice of which strategy to employ was investigated. In addition, the subjects’ imagery ability and the types of cognitive strategies they engaged in were assessed. Subjects who scored either 9 or above or 4 and below on the Harvard Group Scale of Hypnotic Susceptibility: Form A, were asked to participate in a pain study. All 84 subjects first received a baseline trial on a modified version of the Forgione-Barber Strain Gauge Pain Stimulator, within susceptibility levels. Subjects who were able to keep their finger in the apparatus for 60 seconds were randomly assigned to a Choice, a No Choice, or a Control condition. The 36 high and low susceptible subjects in the Choice condition were given the option of using either an imagery suggestion strategy or a low distraction strategy on the second trial. The 32 high and low susceptible subjects in the No Choice condition were told about both strategies but were assigned randomly to either the imagery or the distraction strategy group. The 16 subjects in the Control group did not receive a strategy. Both pain intensity and pain tolerance were measured. Results indicated that an equivalent number of high and low susceptible subjects, given a choice of strategy, chose the imagery and distraction strategies. There were no differences in either pain intensity or pain tolerance between high and low susceptible subjects in the Choice conditions. The Choice condition subjects exhibited significant pain reductions from the first to the second trial. No Choice and Control subjects did not reduce pain significantly. In addition, high and low susceptible subjects who chose the imagery strategy did not have higher imagery scores than those subjects who chose the distraction strategy. Subjects in the No Choice condition used fewer coping strategies than subjects in the Choice condition, on the second trial. The implication of these results and directions for future research are discussed” (p. ).
Elkins, Gary R. (1984). Hypnosis in the treatment of myofibrositis and anxiety: A case report. American Journal of Clinical Hypnosis, 27, 26-30.
A 38-year-old woman with chronic myofibrositis pain was treated by the se of hypnosis and psychotherapy. Hypnotherapeutic techniques, including symptom alteration, relaxation, and insight, are described. This regimen resulted in reduction in pain and emotional distress. which was maintained at three months and one year after treatment.
Farthing, G. William; Venturino, Michael; Brown, Scott W. (1984). Suggestion and distraction in the control of pain: Test of two hypotheses. Journal of Abnormal Psychology, 93, 266-276
96 18-30 yr old undergraduates, preselected for high or for low hypnotic susceptibility on the Harvard Group Scale of Hypnotic Susceptibility – Form A, reported their level of perceived pain during a 50-sec baseline immersion of their hand in ice water. In a second immersion, independent groups of high and low hypnotizables (n – 12) were tested (without hypnosis) under 4 conditions: analgesia suggestion alone, verbal- distraction task alone, a combination of suggestion plus distraction, and control. Among high hypnotizables, as compared to the control group, all 3 experimental treatments were effective in reducing pain. The combination of suggestion plus distraction was no more effective than was either of the single treatments alone in reducing pain. Among low hypnotizables, only the distraction treatment was effective. Results support an attentional- diversion explanation of the effect of waking analgesia suggestions rather than a special resources hypothesis. It appears that both high and low hypnotizables can divert attention toward external stimuli, but only high hypnotizables can successfully divert attention inward to control pain.
Information about this study presented at the annual meeting of the Society for Clinical and Experimental Hypnosis indicates that for the waking suggestion group, the analgesia suggestion was given without any prior hypnotic induction; it involved telling the subjects to imagine that their hand and forearm were numb and insensitive, like a piece of rubber.
[The fact that distraction did not reduce pain ratios more among high hypnotizables than among lows (whereas suggestion did) is similar to Blum & Nash’s (1982) finding that positive heightened alert attention to a stimulus did not interfere with an illusion, but inhibiting awareness did.]
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.