idea of traveling back in time, glossolalia or speaking in tongues, ecstatic states in certain religious sects, physiological regression (Babinski), medical hypnosis, mysticism, reincarnation theories in religion and philosophy, miraculous healing, and supernatural phenomena.
Kline describes a parallel case described by Professor Flourney (Helene Smith) in which previous life on other planets and use of Martian language was claimed.


McNally, Richard J. (1990). Psychological approaches to panic disorder: A review. Psychological Bulletin, 108 (3), 403-419.

Panic disorder has been the subject of considerable research and controversy. Though biological conceptualizations have been predominant, psychological theorists have recently advanced conditioning, personality, and cognitive hypotheses to explain the etiology of panic disorder. The purpose of this article is to provide an empirical and conceptual analysis of these psychological hypotheses. This review covers variants of the “fear-of-fear” construal of panic disorder (i.e., Pavlovian interoceptive conditioning, catastrophic misinterpretation of bodily sensations, anxiety sensitivity), research on predictability (i.e., expectancies) and controllability, and research on information-processing biases believed to underlie the phenomenology of panic. Suggestions for future research are made.

Gardner, Beatrix T.; Gardner, Allen R. (1989). Beyond Pavlovian classical conditioning. Behavioral and Brain Sciences, 12, 143-144.

This is a commentary on the article by Turkkan (1989) entitled “Classical conditioning: The new hegemony” in Behavioral and Brain Sciences, 12, 121-179. (Pavlov’s theory of hypnosis was based on a conditioning model, which is why this material may be relevant.)
“Traditionally, the mechanism of stimulus association proposed by Pavlov early in this century is invoked to account for conditioning that is independent of the positive and negative consequences of responding. … Pavlov attributed this result to stimulus substitution (i.e., the subject responds to the Sa as if it were the S*) and this has been the dominant view throughout this century” (p. 143).
‘In Pavlov’s classical procedure, only increases and decreases in the original consummatory or defensive response are counted as conditioned responses. … Pavlov’s classical procedure is only a special case of a much broader case of a phenomena” (p. 143).
“Key-pecking by pigeons and lever-pressing by rats are responses that were long held up as prototypes of arbitrary behaviors that could only be shaped by response- contingent reinforcement. In the autoshaping procedure, however, these same responses have been easily conditioned to an arbitrarily selected stimulus (Sa) when the delivery of food was entirely independent of the response of the subjects. Not only that, but robust rates of responding have been maintained when food was withheld if the pigeons pecked the key or the rats pressed the lever, that is, when the contingency was negative (Williams & Williams 1969)” (p. 143).

“Turkkan follows a grand tradition when she discusses the similarities between associative conditioning and fundamental aspects of human verbal behavior. Yet an essential characteristic of verbal behavior is the difference between the response to an object and the response to a word for the object. The response to the spoken or written word ‘apple’ must be distinctly different from the response to an actual apple. Whatever we learn when we acquire vocabulary, it cannot be the simple stimulus-stimulus connection advocated in Pavlov’s classical theory.

Even the popular Rescorla (1967) design for separating stimulus-stimulus contiguity from stimulus-stimulus contingency only succeeds in comparing two sources of stimulus-stimulus association. Meanwhile, the recently discovered autoshaping experiment does offer us a laboratory model in which associative conditioning can result in a response to the Sa that is different from the consummatory response to the S*” (p. 144).
“The theory of stimulus-stimulus association that Pavlov built upon the results of his special procedure is inadequate to deal with the wide range of phenomena of associative conditioning that have been discovered since his time.
“We wholeheartedly agree with Turkkan regarding the enormous theoretical and practical significance of the new discoveries but we are convinced that the terms ‘Pavlovian conditioning’ and ‘classical conditioning’ serve us best in their historical usage. … The new discoveries seem to us to show that a wide range of significant phenomena fall outside the boundary conditions of traditional Pavlovian and Skinnerian theories” (p. 144).

Griffiths, M. D.; Gillett, C. A.; Davies, P. (1989). Hypnotic suppression of conditioned electrodermal responses. Perceptual and Motor Skills, 69, 186.

With 5 subjects who had previously been aversively conditioned to a stimulus, during hypnosis previously acquired electrodermal responses were found to be significantly lower than in 12 control Ss. Thus previously conditioned electrodermal responses were suppressed. This contradicts findings of Edmonston (1968) who found that neutral hypnosis does not influence conditioned electrodermal responses and the validity of Pavlov’s (1927) conditioning (inhibition) theory of hypnosis.

Chertok, Leon (1982). The unconscious and hypnosis. International Journal of Clinical and Experimental Hypnosis, 30 (2), 95-107.

This paper reviews Soviet approaches to the unconscious and to hypnotic phenomena, before examining psychoanalytic theories of hypnosis which are generally based on transference. The author believes the existing theories are inadequate, arguing that there is a psychophysiological dimension to hypnosis; but what unconscious processes does this conceal? Psychoanalysis opened one road to the unconscious, but affect, nonverbal communication, and psychophysiological process are still uncharted territories towards which hypnosis may yet prove to be another royal road.

The author concludes, “hypnosis and the unconscious … are closely linked. Historically, experiments on posthypnotic suggestion were in fact the starting point for the discovery of the unconscious. Posthypnotic suggestion is in effect one of the most irrefutable proofs that psychical contents can influence behavior, albeit eluding the subject’s consciousness.
“In this paper, the present author provides a description of Soviet researchers’ conceptions of the unconscious, and of the point of view from which they approach hypnotic phenomena. Psychoanalytic theories of hypnosis are then presented, which are essentially based on transference. It is shown why this notion seems to the present author powerless to account for the specific nature of the hypnotic relationship. There is, in effect, a psychophysiological dimension to hypnosis. It lies at the crossroads between the instrumental and the relational dimension. But nothing is known about what unconscious processes hide at the psychophysiological level. Psychoanalysis has brought to light the laws governing the functioning of unconscious representations. But the realm of the affect, the nonverbal communication, and bodily processes still remain beyond our knowledge. This is a hidden side of the unconscious, in relation to which hypnosis may serve as another ‘royal road'” (pp. 104-105).

is known about what unconscious processes hide at the psychophysiological level. Psychoanalysis has brought to light the laws governing the functioning of unconscious representations. But the realm of the affect, the nonverbal communication, and bodily processes still remain beyond our knowledge. This is a hidden side of the unconscious, in relation to which hypnosis may serve as another ‘royal road'” (pp. 104-105).

Kratochvil, Stanislav (1970). Sleep hypnosis and waking hypnosis. International Journal of Clinical and Experimental Hypnosis, 18, 25-40.

Subjected 6 highly susceptible female students to a short-term training procedure to induce 2 different types of hypnosis: (a) a sleep hypnosis, and (b) an active waking hypnosis. Ss behavior in both types, during the carrying out of 11 standard suggestions, was rated by 2 independent Os. The behavior in both artificially induced types of hypnosis differed significantly at the 1% level in the expected direction. The failure to obtain more dramatic results is attributed to the shortness of training, to the implicit demands concerning activity, or to Ss” personality traits, which may lower the intrapersonal variability. The relevance of the results for the Pavlovian theory of hypnosis is discussed: They do not support the hypothesis that behavioral characteristics which resemble sleep are intrinsic phenomena of the hypnotic state. (Spanish & German summaries) (34 ref.) (PsycINFO Database Record (c) 2003 APA, all rights reserved)

Sternbach, Richard A. (1968). Pain: A psychophysiological analysis. New York: Academic Press

Anxiety potentiates pain, no matter what the source of the anxiety (“meaning of the wound, intensity of the stimulus, a personality characteristic or introduced into the situation” (p. 25). “Local muscles show a marked increase in their electrical potentials following localized pain produced by pressure (Simons, Day, Goodell, and Wolff, 1943), and this striated muscle can potentiate and prolong the responses to the original stimulus (Hardy, Wolff, and Goodell, 1952)” (p. 51). Shor (1962) investigated the physiological response to pain during hypnotic analgesia and used procedures to minimize anxiety in both waking and hypnotized conditions. The ‘pure pain’ physiological response involved a slight increase in heart rate, depth of respiration, and palmar sweating, “little more than an orienting reflex” (p. 54).
Because people vary in the degree to which their pattern of response to pain is stereotyped, it is difficult to detect a pattern specific to pain. However, frequently there is inhibition of motility of the gastrointestinal tract and blocking of or more rapid contractions; increased oxygen consumption with hyperventilation; increase in muscle tension and hypermotility; and variable cardiovascular responses–sometimes elevated blood pressure, sometimes increased pulse, stroke volume, or peripheral vasoconstriction. The physiological changes appear to be preparing the person to take action.
Personality characteristics have been investigated with respect to pain reactivity and tolerance. Mueller (1962) predicted response to spinothalamic tractectomy for 14 patients with intractable pain due to spinal cord injuries with 85% accuracy using the Rorschach. Field dependence on the rod and frame test is associated with parasympathetic reactivity to pain, and less reaction to pain. “Those who can tolerate pain (intense stimulation) best can tolerate sensory deprivation (minimal stimulation) least, and vise versa” (p. 62). Also, the nondominant hand is more sensitive than the dominant hand.
Sternbach distinguishes pain tolerance from willingness to complain about pain. For example, cultural factors (ethnicity) affect not only pain toleration but also physiological response. Voluntary participation in a pain experience can in fact reduce the discomfort of the pain stimulus. “Pain tolerance may be in part a function of their ability to reduce anxiety concerned with the duration of time (a) a noxious stimulus will last, or (b) before a noxious stimulus will be experienced” (p. 67).

(minimal stimulation) least, and vise versa” (p. 62). Also, the nondominant hand is more sensitive than the dominant hand.
Sternbach distinguishes pain tolerance from willingness to complain about pain. For example, cultural factors (ethnicity) affect not only pain toleration but also physiological response. Voluntary participation in a pain experience can in fact reduce the discomfort of the pain stimulus. “Pain tolerance may be in part a function of their ability to reduce anxiety concerned with the duration of time (a) a noxious stimulus will last, or (b) before a noxious stimulus will be experienced” (p. 67).
Phantom pain is an example of centrally occurring pain. It occurs in only a few patients who have a phantom limb, from 2-10% depending on how they are assessed. Scars and neuromas at the stump may reduce thresholds to peripheral stimulation or may themselves act as pain stimuli. Surgery on the neuromas and scar tissues seldom reduces the phantom limb pain. Most investigators assume it is a ‘central’ phenomenon of some sort, ‘superadded sensations’ which may be of psychogenic origin (Henderson & Smyth, 1948) or a ‘central state of hyperexcitability’ (Cronholm, 1951). Affect seems to be involved. The affects, and the individual’s style of coping with them, seem to be the equivalents of the ‘central’ phenomena which result in pain. Two affects in particular seem to be associated with pain: anger, intropunitively expressed; and grief, the phantom pain representing both the loss and the wish to deny it. Both of these are likely to be associated with depression.
A psychological (rather than neurological) explanation for phantom limb pain is supported by the success demonstrated by three interventions: psychotherapy, electroshock therapy, and sensorimotor task concentration. The latter approach, reported by Morganstern (1984) requires patients to concentrate on sensorimotor tasks while ignoring distracting stimuli, for 2 hours/day. Morganstern attributed their improvement to a combination of concentration and distraction so that central sensory processes gradually are reorganized and the patients become habituated to stimulation of the stump. Sternbach notes that these factors also characterize hypnosis and hypnotic analgesia. He proposes that the Morganstern results should inform our neurological explanation of phantom pain.
Sternbach goes on to discuss hypnosis, particularly as it offers information that could inform us about pain. He notes that hypnotic inductions and the hypnotic state are characterized by “immobility and sensory canalization, a reliance on the hypnotist for information and direction, and an altered state of awareness in which the environs are perceived as suggested by the hypnotist” (pp. 136-137). The Kubie and Margolin (1944) description of a concentrated focus of excitation in the brain with surrounding areas of inhibition is like the description of hypnosis presented by Ivan Pavlov. During this process, the hypnotized subject becomes dependent on the hypnotist for contact with the outside world, but this emotional/motivational response is not central to the induction. “What is essential is the restriction of sensory and motor activity which, in a variety of natural or experimental settings, with or without another person present, will invariably produce hypnoidal states and hypnagogic reverie” (p. 134).
The profound alterations in perception that are observed in hypnosis are relevant to the understanding of pain because pain “involves perception of certain tissue changes.” Sternbach notes that the experimental problem of ascertaining whether a subject is faking hypnotic phenomena is similar to the experimental difficulties inherent in evaluating the (internal) experiencing of pain. He suggests that the Orne (1959) test for toleration of logical inconsistencies is an independent means of evaluating for genuine hypnotic response. Other possible indices are less spontaneous behavior (Gill & Brenman, 1959) or alterations in subjective awareness (Ludwig & Levine, 1965). On the Ludwig & Levine questionnaire, subjects reported changes in thinking, time sense, feelings of loss of control, body image changes, changes in sensations, etc.
It has been observed that physiological response depends on presence or absence of a shock, but behavioral and verbal response depends on suggested or not suggested analgesia (Sutcliffe, 1961).

Levine, 1965). On the Ludwig & Levine questionnaire, subjects reported changes in thinking, time sense, feelings of loss of control, body image changes, changes in sensations, etc.
It has been observed that physiological response depends on presence or absence of a shock, but behavioral and verbal response depends on suggested or not suggested analgesia (Sutcliffe, 1961).
In Sternbach’s summary of the section on hypnosis in this book, he states, “Hypnotic analgesia adds to the above [hypnotic induction] the hypnotist’s suggestion of pain relief, or the inability to perceive pain. Experimental and clinical data suggest that in most but not all instances, pain responses are then greatly attenuated. The data further suggest the reasonable inference that such hypnotic analgesia is effective either because attention is focused elsewhere, or because anxiety (concern about the stimulus effects) is very low. …
“It seems to us reasonable to make a further inference from these data, concerning the relative roles of attention focusing and anxiety-reduction. It is our impression, from the studies cited above, that the focusing of attention is not in itself essential to the elimination of pain. It _is_ necessary for the induction of hypnosis, and it is a useful (but not the only) means for a subject or patient to gain control over anxiety concerning pain stimuli. But the data strongly suggest that in hypnotic analgesia, as well as in other conditions, it is the absence of anxiety about the stimulation which is the single necessary and sufficient condition for perceiving the stimulus as a nonpainful sensation. This is suggested by the fact that subjects with hypnotic analgesia are able to attend to (focus attention on) the stimulus, and even describe it accurately as a sensation, and yet not produce pain responses. This is true also of subjects in control conditions without hypnosis. On the other hand, anxious subjects ( or patients), as we have seen elsewhere (Chapter V), typically produce marked pain responses to appropriate stimulation. Thus it seems reasonable to hypothesize that ‘focusing attention’ serves primarily to reduce a person’s anxiety about his current situation, thus making possible either (1) the regression and altered state of consciousness of a hypnotic trance, or (2) the perception of a noxious stimulus as a nonpainful sensation” (pp. 140-141).

Platonov, K. I. (1959). The word as a physiological and therapeutic factor: The theory and practice of psychotherapy according to I. P. Pavlov. ( 2nd). Moscow: Foreign Languages Publishing House.

On pp. 75-76 the author discusses conditioning in hypnosis. Most of the theoretical material is in the first part of the book; the rest consists of case studies. He presents the position that the activity of the cortex and subcortex are different during states of waking and suggested sleep.
Note: Much of the Russian research done during “suggested sleep” involves subjects who are hypnotized for a long period of time–sometimes hours. Routinely, in treatment, they would give corrective suggestions and then tell the person to “sleep” and would leave them in the “sleep” for an hour or longer.

“Thus, it appears from the foregoing that the basic peculiarities of the activity of the cerebral cortex manifesting themselves in the state of suggested sleep are as follows: 1. In addition to the division of the cerebral hemispheres into sections of sleep and wakefulness typical of the hypnotic sleep of an animal, there is also a functional dissociation of the two signal systems and
within the second signal system. 2

The activity of the second signal system under these conditions is not only confined to the narrow framework of the rapport zone, but is also frequently of a passive nature being directly dependent on the verbal influences of the hypnotist. Outside these influences there is no (or hardly any) activity. 3. A considerable increase in the coupling function with respect to the stimuli of the second signal system is noted at the same time in the rapport zone. This especially favours the formation of new cortical dynamic structures under the verbal influences of the hypnotist, these structures representing the physiological basis for effectuating the suggested actions and states.
“The foregoing peculiarities manifest themselves in the fact that the entire external second signal activity of the subject is reduced only to direct answers to the questions of the hypnotist with no independent reactions to any influences, including verbal, coming from other people (so-called isolated rapport). This is understandable, since the activity of the second signal system lying outside the rapport zone is inhibited” (pp. 73-74).
“As to the problem of the peculiarities of the conditioned reflex activity during suggested sleep, it will be noted that this problem has not been very extensively studied as yet. Nevertheless, the data of various authors are of indubitable interest, since they have revealed a number of specific peculiarities in the state of the higher nervous activity under these conditions.
“According to these data the conditioned reflex activity in suggested sleep undergoes certain changes. Thus, S. Levin observed in his early studies (1931) that in children under conditions of suggested sleep the motor and secretory conditioned reflexes elaborated earlier in the waking state grew very much weaker and that there was a dissociation both between the motor and secretory conditioned reflexes and between the unconditioned reflexes of salivation and mastication; he also observed the transitional (phasic) states–paradoxical, ultraparadoxical and inhibitory phases, all the way to the onset of complete sleep” (pp. 74-75).
Platonov indicates that conditioned reflexes may disappear during suggested sleep (Povorinsky & Traugott, 1936). Arousal from suggested sleep results in gradual restoration of the reflexes, with speech reactions inhibited first and restored last. Pen & Jigarov (1936) also showed that there is a weakening of conditioned reflexes, with increased latency, in suggested sleep. These authors showed that it is impossible to form new conditioned reflexes in deep states of suggested sleep, and the conditioning is difficult in lighter states.
“Y. Povorinsky’s data (1937) indicate that the conditioned reflexes elaborated in the waking state have a longer latent period during suggested sleep and in some subjects they are completely absent. Under these circumstances, the reactions to the verbal influences of the hypnotist are retained even during the deepest suggested sleep. The more complex and ontogenetically later conditioned bonds of the speech-motor analyzer are inhibited first as the subject lapses into a state of suggested sleep and are disinhibited the last as the subject awakens from this state” (p. 75).
“B. Pavlov and Y. Povorinsky observe (1953) that the conditioned bonds reinforced by the words of the hypnotist are formed during suggested sleep faster than in the waking state. In this case, during the somnambulistic phase of suggested sleep verbal reinforcements, as a rule, provoke a stronger and longer reaction with a shorter latent period than a direct first signal stimulus” (p. 76). The conditioning that occurs during suggested sleep does not manifest during waking periods unless suggestions are given during the sleep to react after wakening. The author takes this to be evidence that conditioned reflex activity can be modified by verbal suggestions.

During the somnambulistic stage of suggested sleep, subjects are less adept at performing addition. This indicates that inhibition has spread to the second signal system. However, inhibition of different sensory systems seems to vary from person to person. Krasnogorsky (1951) reported one subject did not react to light, but hearing seemed to be more sensitive than in the waking state.
“All of the above testifies to the considerable changes in the character of cortical activity regularly occurring during suggested sleep and determining, on the whole, the specific nature of higher nervous activity, the systematic study of which should be the object of further research” (p. 77).


Anbar, Ron (2002, Dec 3). Hypnosis in pediatrics: applications at a pediatric pulmonary center.. BMC Pediatrics, 2 (1), 11-18.

This report describes the utility of hypnosis for patients who presented to a Pediatric Pulmonary Center over a 30 month period.
METHODS: Hypnotherapy was offered to 303 patients from May 1, 1998 – October 31, 2000. Patients offered hypnotherapy included those thought to have pulmonary symptoms due to psychological issues, discomfort due to medications, or fear of procedures. Improvement in symptoms following hypnosis was observed by the pulmonologist for most patients with habit cough and conversion reaction. Improvement of other conditions for which hypnosis was used was gauged based on patients”” subjective evaluations.
RESULTS: Hypnotherapy was associated with improvement in 80% of patients with persistent asthma, chest pain/pressure, habit cough, hyperventilation, shortness of breath, sighing, and vocal cord dysfunction. When improvement was reported, in some cases symptoms resolved immediately after hypnotherapy was first employed. For the others improvement was achieved after hypnosis was used for a few weeks. No patients”” symptoms worsened and no new symptoms emerged following hypnotherapy.
CONCLUSIONS: Patients described in this report were unlikely to have achieved rapid improvement in their symptoms without the use of hypnotherapy. Therefore, hypnotherapy can be an important complementary therapy for patients in a pediatric practice.


Anbar, R. D. (2001). Self-hypnosis for management of chronic dyspnea in pediatric patients. Pediatrics, 107 (2), E21.

Instruction in self-hypnosis was offered to 17 children and adolescents with chronic dyspnea, which had not resolved despite medical therapy, and who were documented to have normal lung function at rest. … Chronic dyspnea was defined as recurrent difficulty breathing or shortness of breath at rest or with exertion, which had existed for at least 1 month in patients who had not suffered within a month from an acute pulmonary illness. … Additionally, imagery relating to dyspnea was developed by coaching patients to change their imagined lung appearance from a dyspneic to a healthy state. … The mean duration of their dyspnea before learning self-hypnosis was 2 years (range: 1 month to 5 years). … A patient with a history of psychogenic cough declined to learn self-hypnosis. … Thirteen of the 16 patients reported their dyspnea and any associated symptoms had resolved within 1 month of their final hypnosis instruction session. … There was no recurrence of dyspnea, associated symptoms, or onset of new symptoms in patients in whom the dyspnea resolved.”

Liossi, Christina; Hatira, Popi (1999). Clinical hypnosis versus cognitive behavioural training for pain management with pediatric patients undergoing bone marrow aspirations. International Journal of Clinical and Experimental Hypnosis, 47 (2), 104-116.

Journal of Clinical and Experimental Hypnosis, 47 (2), 104-116.

A randomized controlled trial was conducted to compare the efficacy of clinical hypnosis versus cognitive behavioral (CB) coping skills training in alleviating the pain and distress of 30 pediatric cancer patients (age 5 to 15 years) undergoing bone marrow aspirations. Patients were randomized to one of three groups: hypnosis, a package of CB coping skills, and no intervention. Patients who received either hypnosis or CB reported less pain and pain-related anxiety than did control patients and less pain and anxiety than at their own baseline. Hypnosis and CB were similarly effective in the relief of pain. Results also indicated that children reported more anxiety and exhibited more behavioral distress in the CB group than in the hypnosis group. It is concluded that hypnosis and CB coping skills are effective in preparing pediatric oncology patients for bone marrow aspiration.

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.

Hall, Howard; Papas, Angela; Tosi, Michael; Olness, Karen N. (1996). Directional changes in neutrophil adherence following passive resting versus active imagery. International Journal of Neuroscience, 85, 185-194.

This study was designed to determine whether increases or decreases in neutrophil adherence could be achieved following a self-regulation (relaxation/imagery) intervention. Fifteen subjects were randomly assigned to one of three conditions. Two experimental groups employed imagery focused on either increasing or decreasing neutrophil adherence. Subjects had two weeks of self-regulation practice (4 total training sessions) prior to blood drawings. A third group of control subjects had the same number of resting sessions without imagery training. All subjects had blood samples collected before and after either 30 minutes of self-regulation or resting practice for two sessions. Pulse and peripheral finger temperature measures were taken before and after the blood samples. Both experimental groups demonstrated decreases in neutrophil adherence, and the control group showed a tendency toward increases in this measure. The psychophysiologic data for the control group was suggestive of a relaxation response. The experimental group that attempted to increase neutrophil adherence demonstrated psychophysiologic responses that were contrary to relaxation. We concluded that an active cognitive exercise or process is associated with decreases in neutrophil adherence irrespective of the intent of the exercise. In contrast, relaxation without an active imagery exercise was associated with increases in neutrophil adherence. The results of this study are discussed in terms of behavioral engineering of directional immune changes.

-herence irrespective of the intent of the exercise. In contrast, relaxation without an active imagery exercise was associated with increases in neutrophil adherence. The results of this study are discussed in terms of behavioral engineering of directional immune changes

Sugarman, L. I. (1996). Hypnosis in a primary care practice: Developing skills for the ‘new morbidities’.

Training in hypnotherapy provides the primary care practitioner with skills needed to address increasingly common, significant sources of childhood morbidity: stressful life events, psychophysiological symptoms, chronic disease, and behavioral problems. Although there are many reports on the utility of hypnosis in these areas, there are few on its use within primary care. This paper describes the integration of hypnotherapeutic methods into the continuum of pediatric encounters in a solo general pediatric practice. Specific techniques for approaching and examining young patients and their problems are illustrated. Preliminary data are presented from a prospective chart review of those children and adolescents within the practice who use hypnosis. Guidelines for the application of hypnosis in pediatric primary care are summarized. Emphasis is placed on the necessity and opportunity for research on the efficacy of these methods in the primary care setting.

Culbert, Timothy P.; Reany, Judson B.; Kohen, Daniel P. (1994). Cyberphysiologic strategies for children: The clinical hypnosis/biofeedback interface. International Journal of Clinical and Experimental Hypnosis, 42 (2), 97-117.

This article presents an in-depth discussion of the integrated use of self-hypnosis and biofeedback in the treatment of pediatric biobehavioral disorders. The rationale for integrating these techniques and their similarities and differences are discussed. The concepts of children’s imaginative abilities, mastery, and self-regulation are examined as they pertain to these therapeutic strategies. Three case studies are presented that illustrate the integrated use of self-hypnosis and biofeedback in the treatment of children with psychophysiologic disorders. The authors speculate on the specific aspects of these self-regulation or “cyberphysiologic” techniques that appear particularly relevant to positive therapeutic outcomes.

Zeltzer, Lonnie K. (1992). Hypnosis with children in pain. [Paper] Clinical Hypnosis Seminar, UCLA Department of Psychiatry & Biobehavioral Sciences (J. Holroyd, Instructor).

We use an active approach with children, e.g. “Wouldn’t it be fun to …? Do you have a bike? What’s it like? What do the handlebars feel like?” We use lots of sensory images, and go back and forth between fantasy and the environment. Children often keep their eyes open because they have to check out the strange environment of the hospital.
Preparation for the medical or surgical procedure: 1. Cognitive (a rehearsal of what will happen, what to expect). 2. Sensory (rehearsing what it will feel like).
For someone who has had bad experiences one might say something like, “Wouldn’t it be interesting if it could be _different_ this time? I wonder how it might be different?”

If the child is anxious, the less controls they have, so we do things to help them reorganize. The one thing they _can_ do is breathe. We might whisper something like, “It would be nice to take a nice deep breath” The child may continue screaming, but has to take a breath sooner or later, to which you might say, “Oh, that felt _so_ good.” And it continues along that line. So now the child has some control.
Hypnoanalgesia in anesthesia. In hypnosis, child has readiness to call upon past anesthetic experiences. (We had one boy who was a skier and could anesthetize his hand by imagining that he put it into snow, but snow may produce vasoconstriction, so a thick warm leather glove was used with that child so the veins didn’t close down and prevent needle insertion.) We may use imagery of Disneyland here in Southern California, to get attention off the noxious stimulus.
How many sessions are needed? It depends on whether they have become frightened and phobic due to bad experiences; then they need desensitization. Otherwise, if they had no previous bad experience, 1/2 hour is sufficient. For children with chronic pain, the work takes longer. For younger children, you help the parents and child to be a team.
Screaming does not necessarily mean the child is in severe pain, because a child may scream to focus attention.
The goal is to assist the patient to cope with anxiety and pain, not to make it go away completely.
How young can a child be, to use hypnosis? Josie Hilgard dates fantasy to 3-4 years. Younger children, you may use props (e.g. a red block becomes a fire engine, even with their eyes open). Lee Orick Cutner uses stories for 2-5 year olds (with the parent telling the story), like a transitional object. Capturing the child’s curiosity is critical, as a competing stimulus for the needle which is a potent stimulus.
“Wouldn’t it be fun to take a hose and fill this room and make it into a swimming pool? Capture something dramatic in fantasy at the moment of greatest pain (e.g. “and here comes the big whale!”
Hilgard’s dissociation theory is relevant: part of the patient is in Disneyland. There are 3 components of pain: 1. sensory 2. emotional (suffering) 3. motivational (drive to get rid of it)
With children, they don’t need to relax, e.g. active imagery is useful.
For dying children who are withdrawn and have chronic pain, story telling is used to work through their worries, and fears that child might not have vocabulary for. As an example, one can use fantasy about taking a trip, whales (fear of being alone), or building a house (sense of accomplishment).
Elliott Blass found that stroking rats decreased their pain (and this was not mediated by opioid pathways); sucrose on tongue is mediated by opioid pathways (Naloxone) and also diminishes pain. (Cocaine babies settle down when you stroke them.) In the animal research if you use both together, the stroking wipes out the effect of sucrose.
Susan Jay in research on children published in the Journal of Consulting and Clinical Psychology article, presented a cafeteria of self-control techniques to the children. When there was pre-treatment with Valium, the patients did worse during the procedure, vs no pre-treatment with Valium. It may be because the Valium medicated patients didn’t have clarity of attention during learning. Therefore, short-term gain may lead to long-term losses.
Can increase lockout period of patient- controlled analgesia (PCA). PCA can be used with patients as young as 4-5. You can make an agreement with the patient not to use PCA for a certain period, during which you teach the psychological control technique such as hypnosis.
There is no reason to use intramuscular injections with children; no need to cause pain to decrease pain.

There is no reason to use intramuscular injections with children; no need to cause pain to decrease pain.

Zeltzer, Lonnie K.; Dolgin, M. J.; LeBaron, Samuel; LeBaron, C. (1991). A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer. Pediatrics, 88, 34-42.

Subjects were randomly assigned to hypnosis, nonhypnotic distraction/relaxation, or attention placebo control. children in the hypnosis group reported the greatest reduction in both anticipatory and postchemotherapy symptoms. Distraction/relaxation kept symptoms from getting worse, but they did not get better, and the control children’s symptoms became much worse.

Kuttner, Leora (1988). Favorite stories: A hypnotic pain-reduction technique for children in acute pain. American Journal of Clinical Hypnosis, 30, 289-295.

For young children (aged 3 to 6-11) with leukemia, a hypnotic trance consisting of a child’s favorite story was found to be statistically more effective than behavioral distraction and standard medical practice in alleviating distress, pain, and anxiety during painful bone marrow aspirations. Measured by a behavioral checklist and judgment ratings by physician, parent, nurse, and observers, the favorite-story hypnotic technique had immediate therapeutic impact on these young patients, and the reduction in distress, pain, and anxiety was sustained on subsequent medical procedures. Self-report measures, however, were nonsignificant.

Jay, Susan M.; Elliott, Charles H.; Katz, Ernest; Siegel, Stuart E. (1987). Cognitive-behavioral and pharmacologic interventions for children’s’ distress during painful medical procedures. Journal of Consulting and Clinical Psychology, 55, 860-865.

This study evaluated the efficacy of a cognitive-behavioral intervention package and a low-risk pharmacologic intervention (oral Valium), as compared with a minimal treatment-attention control condition, in reducing children’s distress during bone marrow aspirations. The subjects were 56 leukemia patients who ranged in age from 3 years to 13 years. The three intervention conditions were delivered in a randomized sequence within a repeated-measures counterbalanced design. Dependent outcome measures included observed behavioral distress scores, self-reported pain scores, pulse rate, and blood pressure scores. Repeated-measures analyses of variance indicated that children in the cognitive-behavior therapy condition had significantly lower behavioral distress, lower pain ratings, and lower pulse rates than when they were in the attention- control condition. When children were in the Valium condition, they exhibited no significant differences from the attention control condition except that they had lower diastolic blood pressure scores.

Lonnie Zelzer, M.D., in a UCLA Hypnosis Seminar lecture in 1992, stated that in pre-treatment with Valium the patients did worse during the procedure, vs no pretreatment with Valium, because the medicated patients didn’t have clarity of attention during the cognitive behavioral learning

Kohen, D. P. (1986). Applications of relaxation/mental imagery (self-hypnosis) in pediatric emergencies. International Journal of Clinical and Experimental Hypnosis, 34 (4), 283-294.

Problems for which children come to Emergency Rooms are anxiety-producing for children and parents, whether or not these problems are perceived as “true” emergencies by health care professionals. Fear and pain are important factors in the response to such situations. Self-hypnosis (relaxation/mental imagery) is a useful adjunct for rapid reduction of anxiety and discomfort in pediatric emergency situations; it can serve to diminish fear, improve self-control, and alter the perception of discomfort. Hypnosis can also enhance development of a sense of mastery in the injured or ill child. 6 case examples are described which illustrate the variety of specific clinical applications and hypnotherapeutic approaches.

Kohen, D.; Olness, K.; Colwell, S.; Heimel, A. (1984). The use of relaxation-mental imagery (self-hypnosis) in the management of 505 pediatric behavioral encounters. Journal of Developmental and Behavioral Pediatrics, 5, 21-25.

This report assessed outcomes of hypnotherapeutic interventions for 505 children and adolescents seen by four pediatricians over a period of one year and followed from four months to two years. Presenting problems included enuresis, acute pain, chronic pain, asthma, habit disorders, obesity, encopresis, and anxiety. Using strict criteria for determination of problem resolution (e.g., all beds dry) and recognizing that some conditions were intrinsically chronic, the authors found that 51% of these children and adolescents achieved complete resolution of the presenting problem; an additional 32% achieved significant improvement, 9% showed initial or some improvement; and 7% demonstrated no apparent change or improvement. Children as young as three years of age effectively applied self-hypnosis techniques. In general, facility in self-hypnosis increased with age. There was an inverse correlation (p less than 0.001) between clinical success and number of visits, suggesting that prediction of responsivity is possible after four visits or less.

Discusses the treatment of 505 pediatric patients with a variety of problems(enuresis, pain, obesity, anxiety reactions, habit problems, encopresis, headache, fear of pelvic examinations).

Gardner, G. Gail; Lubner, Alison (1982-83). Hypnotherapy for children with cancer: Some current issues. American Journal of Clinical Hypnosis, 25 (2-3), 135-142

The authors review some of the problems that now face clinicians and researchers working in the field of hypnotherapy for pediatric cancer patients. These include (1) understanding and dealing with resistance and refusal, (2) developing preventive hypnotherapeutic strategies for children who will survive cancer, and (3) carrying out research that

children who will survive cancer, and (3) carrying out research that clarifies the value of hypnotherapy with childhood cancer patients and elucidates when and how specific approaches can best be utilized.

Hall, Marian D. (1982-83). Using relaxation imagery with children with malignancies: A developmental perspective. American Journal of Clinical Hypnosis, 25 (2-3), 143-149.

Developmental theory has been the foundation for this program of relaxation-imagery therapy with its goal of increasing the efficacy of immune mechanisms, thus increasing the survival rate of children with malignancies and/or improving the comfort and quality of their lives. Three basis constructs–the impact of social stress, the positive development of attachment and the negative effects of separation and loss, and the stages of concept formation relating to the functioning of the human body, the processes of disease and death–are basic approaches to the use of imagery-relaxation as an integral part of a comprehensive care plan.

LeBaron, Samuel; Zeltzer, Lonnie (1982, October). The effectiveness of behavioral intervention for reducing chemotherapy related nausea and vomiting in children with cancer. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Indianapolis, IN.

Eight children (nine to seventeen years, Mean age 12.1) with cancer received behavioral intervention for chemotherapy related nausea and vomiting. Within three to five days after the administration of each course of chemotherapy, patients rated (1-10 scale; 1 = none, 10 = all the time or maximal amount) their nausea and vomiting and the extent to which chemotherapy bothered them and disrupted their daily routine. After a pre-intervention assessment of 2.5 courses of chemotherapy, patients received intervention (Mean = 2.6 courses). Significant reductions following intervention (Wilcoxon matched- pairs signed ranks test) were found in nausea (Z = 2.37, p<.02), vomiting (Z = 2.52, p<.01), bother (Z = 2.24, p<.02), and disruption of activities (Z = 2.38, p<.02). This preliminary study indicates that chemotherapy side effects can be reduced through behavioral intervention.