Child with 82 warts was treated using hypnosis; suggestions for removal from face only resulted in 8 of 16 facial warts disappearing after one treatment and two weeks. (Child had previous experience with hypnosis for pain and anxiety associated with lumbar punctures and bone marrow aspirates.)
Spanos, Nicholas P.; Stenstrom, Robert J.; Johnston, Joseph C. (1988). Hypnosis, placebo, and suggestion in the treatment of warts. Psychosomatic Medicine, 50, 245-260.
Two experiments assessed the effects of psychological variables on wart regression. In Experiment 1, subjects given hypnotic suggestion exhibited more wart regression than those given either a placebo treatment or no treatment. In Experiment 2, hypnotic and nonhypnotic subjects given the same suggestions were equally likely to exhibit wart regression and more likely to show this effect than no treatment controls. In both experiments, treated subjects who lost warts reported more vivid suggested imagery than treated subjects who did not lose warts. However, hypnotizability and attribute measures of imagery propensity were unrelated to wart loss. Subjects given the suggestion that they would lose warts on only one side of the body did not show evidence of a side-specific treatment effect.
Tsushima, W. T. (1988). Current psychological treatments for stress-related skin disorders. Cutis, 42, 402-404.
Surveys current methods used by psychologists in the management of stress-related skin disorders, including hypnosis, relaxation training, biofeedback, operant conditioning, and cognitive behavioral therapy. These techniques offer promise in the treatment of certain dermatologic conditions, but the limited amount of well-controlled and replicated studies of their use suggests that caution be taken in their application.
1987
Dobkin de Rios, Marlene; Friedmann, Joyce K. (1987). Hypnotherapy with Hispanic burn patients. International Journal of Clinical and Experimental Hypnosis, 35 (2), 87-94.
This paper examines a culturally sensitive hypnotherapeutic intervention for Hispanic burn patients who suffer symptoms of the post-traumatic stress disorder and discusses the outcome of 27 patients seen by the authors (a medical anthropologist and a clinical psychologist), over a 3.5-year period. Given the difficulties of recent monolingual, Mexican migrants in responding to psychological interventions that are not culturally sensitive, the hypnotherapeutic interventions and procedurs developed by the authors provide a plan for systematic desensitization and cultural concordance to make rehabilitation of Hispanic burn patients more effective.
Locke, Steven E.; Ransil, Bernard J.; Covino, Nicholas A.; Toczydlowski, Janice; Lohse, Christopher M.; Dvorak, Harold F.; Arndt, Kenneth A.; Frankel, Fred H. (1987). Failure of hypnotic suggestion to alter immune response to delayed-type hypersensitivity antigens. Annals of the New York Academy of Sciences, 496, 745-749.
The ability to alter delayed-type hypersensitivity via hypnotic suggestion was tested in 12 highly hypnotizable, untrained subjects and 30 non-hypnotized controls. Subjects were skin tested bilaterally with a standardized panel of delayed hypersensitivity antigens and instructed either to enhance or suppress the skin test response (STR) unilaterally. Compared to controls, STR’s showed no effect of hypnotic suggestion with regard to either the area of induration or the degree of inflammation assessed histologically.
Minichiello, William E. (1987). Treatment of hyperhidrosis of amputation site with hypnosis and suggestions involving classical conditioning. International Journal of Psychosomatics, 7-8.
Hyperhidrosis of an amputation site utilizing hypnosis and/or behavioral strategies has not been reported in the literature. This case report is on the successful use of hypnosis utilizing principles of classical conditioning in the treatment of a patient with hyperhidrosis of an amputated limb with two previous unsuccessful sympathectomies. The patient possessing moderate hypnotic ability as measured by the Stanford Hypnotic Clinical Scale (SHCS), reported a pre-treatment score of 10 on a 0-10 severity and intensity of sweating scale, and a post-treatment score of 0. All gains were maintained at the two-year follow-up.
NOTES
The patient was hypnotized while an electric fan was blowing on his stump and prosthesis. Direct suggestions were given according to procedures of thermal biofeedback. The suggestions were: 1. You will notice in days ahead that your stump feels increasingly cooler and drier. 2. You will feel throughout the day as if a cool breeze from a fan is blowing on your stump. 3. Whenever you pay attention to your leg during the day, particularly after the first few hours of the morning, you will associate that leg with a cool dry breeze from a fan blowing on it. 4. You will increasingly develop the power to cool and dry your stump.
The results were that 2 1/2 weeks later patient reported reduced frequency and intensity of sweating and significant healing of the stump ulcers; rating = 2. One month later, patient reported continued progress with almost normal skin color and stump condition; the patient discontinued disability, and returned to work. Patient returned one month later reporting, “It’s cured and my physician can’t believe it.” Rating = 0.
Author concludes that hypnosis should be tried prior to more invasive traditional procedures. In this case two previous sympathectomies failed to correct the condition and a third sympathectomy was being contemplated.
Shertzer, C. L.; Lookingbill, D. P. (1987). Effects of relaxation therapy and hypnotizability in chronic urticaria. Archives of Dermatology, 123, 913-916.
15 patients with chronic urticaria of 7.8 years’ average duration. Compared with baseline and control session values, the hypnosis session provided relief of pruritus as measured by 3 self-report parameters. There was no change in the number of hives. All Ss were given a standard test for hypnotizability. Assuming that the results were not biased by their preceding relaxation sessions, we determined that 6 Ss were hypnotizable and nine were non hypnotizable. Ss in both groups improved symptomatically, but hypnotizable Ss had fewer hives and became more symptomatic during the control (testing and history taking) session. Hypnotizable Ss also more frequently related stress as a causative factor. At a follow-up examination five to 14 months after the completion of the experimental sessions, six patients were free of hives and an additional seven reported improvement.
1984
Raynaud, Jeanne; Michaux, Didier; Bleirad, Guilhem; Capderou, Andre; Bordachar, Janine; Durand, Jacques (1984). Changes in rectal and mean skin temperature in response to suggested heat during hypnosis in man. Physiology and Behavior, 33, 221-226.
Rectal temperature, mean skin temperature and heart rate were recorded in 7 subjects during hypnosis, induced either alone or while sensations of heat were suggested. During hypnosis alone, a fall in the heart rate of about 10 beat-min-1 was the only autonomic response observed; body temperatures were unaltered. In contrast, during hypnosis with suggestion of heat, the following changes occurred: (1) Mean rectal temperature decreased 0-.20 degrees C. (p<.05) within 50 min. Its mean time course differed significantly from that for hypnosis alone (p<0.001). (2) Comparison of individual rectal temperature time sequences showed that in fact this temperature only declined in 4 subjects out of 7, and tended to form a plateau located 0.35 degrees C below the value of the preceding waking state. Despite reinforcement of heat suggestion, the plateau continued until the end of the hypnotic trance. (3) Mean skin temperature tended to rise. (4) When hypnosis with suggestion ceased, both rectal and skin temperatures very slowly returned to their levels during the preceding waking state. 1983 Borgeat, Francois; Goulet, Jean (1983). Psychophysiological changes following auditory subliminal suggestions for activation and deactivation. Perceptual and Motor Skills, 56, 759-766. This study was to measure eventual psychophysiological changes resulting from auditory subliminal activation or deactivation suggestions. 18 subjects were alternately exposed to a control situation and to 25-dB activating and deactivating suggestions masked by a 40-dB white noise. Physiological measures (EMG, heart rate, skin-conductance levels and responses, and skin temperature) were recorded while subjects listened passively to the suggestions, during a stressing task that followed and after that task. Multi-variate analysis of variance showed a significant effect of the activation subliminal suggestions during and following the stressing task. This result is discussed as indicating effects of consciously unrecognized perceptions on psycho- physiological responses. Braun, Bennett G. (1983). Psychophysiological phenomena in multiple personalities and hypnosis. American Journal of Clinical Hypnosis, 26 (2), 124-137. NOTES "Conclusion. As can be seen from the above example, the final common pathway, physiologic expression, which is seen in multiple peronality is not bizarre when compared with physiologic changes achieved in non-multiples using hypnosis or, in certain cases, non-multiples without the use of hypnosis. A form of hypnosis/autohypnosis* may be a common denominator. The neurophysiologic changes shown by Putnam et. al. (1982), but not observed by Coons (1982), may well have a similar explanation. The question of the neurophysiologic effect of hypnotic suggestion has not as yet been studied with appropriate controls or safeguards. "That multiples do show significant changes in their psychophysiologic response patterns cannot be denied. To consider that the psychophysiologic chages of multiple personality aer so rare or different as to make multiples 'freaks' is not only a disservice to them, but to medical science, since it blocks thinking. The study of multiple personality will further our understanding, theorizing, and treatment of mental and physical illness" (p. 134). "*These terms are being used here in the generic sense" (p. 134). Spiegel, David (1983). Hypnosis with medical/surgical patients. General Hospital Psychiatry, 5, 265-277. The role of hypnosis as a tool in the treatment of problems commonly encountered among medical and surgical patients is examined. Hypnosis is defined as a change in state of mind far more akin to intense concentration than sleep. Diagnostic implications of differences in hypnotic responsivity are explored, and scales suitable for use in the clinic are examined. Uses of hypnosis in treating anxiety, pain, childbirth, psychosomatic symptoms, seizure disorders, neuromuscular dysfunction, and habits are described and evaluated. The phenomenon of hypnosis is presented as a means of exploring the mind-body relationship in a controlled fashion, providing information of diagnostic importance while at the same time allowing hypnotizable patients to intensify their concentration and interpersonal receptivity in the service of a therapeutic goal. 1982 Credidio, Steven G. (1982). Comparative effectiveness of patterned biofeedback vs meditation training on EMG and skin temperature changes. Behaviour Research and Therapy, 20, 233-241. Examined whether a low arousal, relaxation pattern of frontalis EMG decreases and peripheral skin temperature increases could be attained more effectively through biofeedback or meditation training. 30 21-59 yr old females were randomly assigned to 1 of 3 groups: patterned biofeedback, clinically standardized meditation, or control. Prior to training, Ss were administered the Eysenck Personality Inventory. Each S was seen weekly for 7 sessions. Subjective experiences and time spent practicing at home were also recorded. Results indicate that the meditation group showed significantly lower EMG levels at the end of treatment than did the control group. The biofeedback group had difficulty in patterning the 2 feedback signals simultaneously. Extraverts in the control group had the highest EMG levels. The most positive subjective reports came from Ss in the meditation group. It is suggested that meditation offers a viable alternative as a relaxation procedure, requiring little time to learn and devoid of any performance criteria levels. Spanos, Nicholas P.; McNeil, Conrad; Stam, Henderikus J. (1982). Hypnotically 'reliving' a prior burn: Effects on blister formation and localized skin temperature. Journal of Abnormal Psychology, 91 (4), 303-305. 60 Ss who had previously been burned were "hypnotically age regressed" and given both suggestions to "relive" the burn experience and suggestions that a blister was forming. Although 17 Ss reported vividly imagining the burn events, none showed localized skin-coloration changes or evidence of blister formation. Moreover, skin temperature measured before, during, and after age regression indicated no overall suggestion effects. Nevertheless, 1 S did show differential skin-temperature response to the suggestion. This S had showed only moderate hypnotic susceptibility on the Harvard Group Scale of Hypnotic Susceptibility. (10 ref) NOTES 1: NOTES The male subject who appeared to show changes in response to the suggestion increased temperature differences between the burn site and the contralateral site from .3 degrees C before the imagining period to a maximum of 2.7 degrees C during the imagining period and decreased to 0 degrees C after the imagining period. However, temperature differences between the adjacent sites remained very small (never more than .1 degree C) throughout the session. This subject answered "no" to all seven items on the skin-sensitivity questionnaire. He testified postexperimentally to being only "slightly hypnotized" (score 1), "not at all age regressed" (score 0), and to have experienced imagery that was only 50% as vivid as the real experience. (His HGSHS:A score was 8.) 1980 Crosson, B. (1980). Control of skin temperature through biofeedback and suggestion with hypnotized college women. International Journal of Clinical and Experimental Hypnosis, 28 (1), 75-87. 4 groups of 9 college women attempted to raise finger temperature relative to forehead temperature during hypnosis. After a hypnotic induction, each group of Ss received 1 of the following treatments for temperature control: (a) biofeedback, (b) suggestion and imagery, (c) biofeedback plus suggestion and imagery, and (d) a relaxation, false-feedback control. Groups were initially balanced for hypnotic susceptibility. Between-subject differences in baseline temperatures were statistically controlled. After 4 training sessions, only Ss in the groups receiving biofeedback and biofeedback plus suggestion and imagry demonstrated evidence of learned temperature contol, and only Ss in the biofeedback group demonstrated a significantly greater ability to control skin temperature than Ss in the control group. Changes in temperature during hypnotic induction did not appear to affect changes during the subsequent treatment. There was no significant correlation between hypnotic susceptibility and temperature control for Ss in any group, contrary to popular assumption. Future research should attempt to ascertain if combined use of biofeedback and hypnosis offers any advantages to the use of biofeedback alone. 1979 Burrows, Graham D.; Collison, D. R.; Dennerstein, L. (Eds.) (1979). Hypnosis 1979. New York: Elsevier/North-Holland Biomedical Press. Di Piano, Frank A.; Salzberg, H. C. (1979). Clinical applications of hypnosis to three psychosomatic disorders. Psychological Bulletin, 86, 1223-1235. Studies of hypnosis in the treatment of skin disorders, headaches, and asthma were reviewed in terms of outcomes and methodological soundness. Some studies focused on changing physiological functions, others on increasing insight in their patients, and still others on altering patients' perceptions of their symptoms. Methodological weaknesses included lack of control groups, nonrandom assignment of patients to treatment conditions, and confounding of treatment effects or lack of control for placebo effects. Additional weaknesses centered around the use of single outcome measures and the failure to assess the specific roles of mediating variables. Most of the studies reviewed showed positive treatment effects. However, there is equivocal evidence that hypnosis can directly influence autonomic functioning. Hypnosis may be valuable in facilitating one's capacity to gain insight into how one's symptoms developed and are maintained. In addition, hypnotic procedures have resulted in some success when used to indirectly alleviate symptoms by altering how individuals perceive their disorders and how these disorders affect their lives. 1976 Dugan, Michelle; Sheridan, Charles (1976). Effects of instructed imagery on temperature of hands. Perceptual and Motor Skills, 42, 14. NOTES Sixteen college student volunteers were involved in the research. Subjects were randomly assigned to two groups, either to warm or to cool their hands. All 10 subjects attempting to cool their hands were able to cool at least one hand, and six people cooled both hands. For those trying to warm their hands, five warmed at least one hand and one was able to warm both hands. Four people were able to cool their hands without hypnosis, conditioning, or feedback. 1975 Clawson, T. A.; Swade, R. H. (1975). The hypnotic control of blood flow and pain: The cure of warts and the potential for the use of hypnosis in the treatment of cancer. American Journal of Clinical Hypnosis, 17 (3), 160-169. Case histories show that hypnosis can control massive bleeding and pain, and it can remove warts, probably by stopping blood flow to them. We propose that blood flow to cancerous tumors can likewise be controlled, which could destroy them outright, or which control could be a useful adjunct to chemo- or radio-therapy. 1974 Hilgard, Ernest R. (1974, October). Visceral control through hypnosis. [Paper] Presented at the International Congress of Physiological Sciences, New Delhi. NOTESThe author reviews evidence of hypnosis and/or suggestion effects on skin: removal of warts, raising blisters, controlling chemically induced inflammation, modifying temperature. He concludes that although there may be dramatic results, the contributions of suggestion and hypnosis 'remain ambiguous.' 1968 Reid, Allen F.; Curtsinger, George (1968). Physiological changes associated with hypnosis: The effect of hypnosis on temperature. International Journal of Clinical and Experimental Hypnosis, 16, 111-119. STUDIED THE PHYSIOLOGICAL EFFECT ON TEMPERATURE OF HYPNOSIS. UNDER NEUTRAL HYPNOSIS, 20 SS EXPERIENCED AN INCREASE OF ORAL TEMPERATURE AVERAGING .6DEGREES F, WHICH SUBSIDED AFTER TERMINATION OF THE TRANCE. WHEN SKIN TEMPERATURE ON THE FOREHEAD, CHEST, AND HAND WERE MEASURED ON 4 SS, THERE WAS AN EVEN MORE PRONOUNCED INCREASE; MEASUREMENTS ON THE VOLAR SURFACE OF THE FOOT WERE EQUIVOCAL. CONTROL ORAL TEMPERATURE MEASUREMENTS USING RELAXATION WITHOUT HYPNOSIS SHOWED NO SIGNIFICANT INCREASE. IT IS CONCLUDED THAT NEUTRAL HYPNOSIS IS GENERALLY ACCOMPANIED BY AN INCREASE IN ORAL AND SKIN TEMPERATURE. (GERMAN + SPANISH SUMMARIES) (PsycINFO Database Record (c) 2002 APA, all rights reserved) 1965 Barber, Theodore Xenophon (1965). Physiological effects of 'hypnotic suggestions': A critical review of recent research (1960-64). Psychological Bulletin, 201-222. Recent studies are reviewed which were concerned with the effectiveness of suggestions given under "hypnosis" and "waking" experimental treatments in alleviating allergies, ichthyosis, myopia, and other conditions and in eliciting deafness, blindness, hallucinations, analgesia, cardiac acceleration and deceleration, emotional responses, urine secretion to sham water ingestion, narcotic-like drug effects, and other phenomena. The review indicates that a wide variety of physiological functions can be influenced by suggestions administered under either hypnosis or waking experimental treatments, and direct and indirect suggestions to show the particular physiological manifestations are crucial variables in producing the effects. Bernstein, Norman R. (1965). Observations on the use of hypnosis with burned children on a pediatric ward. International Journal of Clinical and Experimental Hypnosis, 13 (1), 1-10. Several cases are described and observations made about the interplay of forces between staff, patient, and therapist, as well as the expectations of the patients to assess how these factors influenced the use of hypnosis. Hypnosis appears to be a particularly useful means for reaching isolated and depressed children with burns and for improving the morale of the staff team working with these children. The results may be along specific lines in terms of pain tolerance and improved eating, or in general improvement of cooperativeness and mood on the part of the child. (PsycINFO Database Record (c) 2002 APA, all rights reserved) 1964 Black, Stephen (1964). Mind and body. London: Kimber. NOTES Defines psychosomatic disease as one that responds to psychotherapy. Believes only 5% are highly hypnotizable, that hypnosis is learnable in 1/2 hour, that hypnosis is not a useful treatment for psychosomatic disorders because you can't use interpretation [of unconscious]. The 'unconscious' is "... a complex of informational systems derived from such primaeval mechanisms" (p. 133). "Primaeval mind is involved in these mechanisms of genetics and immunology" (p. 133). "There is thus a 'somatic mind' which is unconscious and presumably without any means of verbalization of experience--and a 'cerebral mind' which is conscious" (p. 133). The dividing line is not clear. Rapport is discussed on pp. 160, 169 as one of the spontaneous characteristics of hypnosis, in the absence of suggestion. The same for posthypnotic suggestion (rapport and amnesia). Spontaneous _physiological_ changes in hypnosis relate to mind-body relationships (p. 169) Conditioned reflex is discussed on p. 161 "...the subjective evidence indicates that a perceptual change involving any sensory modality can be produced by DSUH" [direct suggestion under hypnosis] p. 178. Suggestion can selectively affect different parts of the body p. 197. Research: "Hypnosis is not only the most important and practical way of _proving_ the existence of the unconscious--which is still in doubt in some circles--but is in fact the only way in which unconscious mechanisms can be manipulated under repeatable experimental conditions for purposes of investigation" (p. 152). Mind-body is "amenability to control" Catatonia, which characterizes both animal and human hypnosis, seen in hypnosis, is induced by constriction (i.e. disorientation). The Cartesian concept of mind and body tends to confuse the issue p. 157. Rapport is discussed (p. 157). Suggestion (p. 159) "It was this concept of 'suggestion'--which so obviously parallels 'amenability to control' in animals--that eventually established hypnosis in the French schools of psychiatry as a state of increased suggestibility. ... still the standard definition of hypnosis in most medical psychiatric textbooks and in lay dictionaries" (p. 159). Black (1969) did some biochemical sleuthing to learn how information transmitted by words becomes information encoded somatically, as when psychosomatic allergies flare and recede or disappear. What accounts for suggestion "curing" an allergic skin reaction in one part of the body while another part not included in the suggestion remains reactive? What accounts for the instantaneous skin allergy cure which sometimes occurs with suggestion (in 24 hours)? Skin sensitivity tests in highly hypnotizable Ss who were also very allergic were inhibited by direct suggestion under hypnosis under highly controlled experimental conditions--and in one subject the effect (inhibition) was relatively permanent--ruling out (he suggests) a neurological mechanism. He did further experiments to examine whether the result was due to an instant neurological mechanism and a long-term endocrinal mechanism. p. 212 He ruled out peripheral blood flow as the cause of diminished skin sensitivity (there was no change in blood flow with suggestions of heat or cold). Therefore decrease in blood flow couldn't explain in neurovascular terms the 'instant' inhibition of skin sensitivity (allergy) tests. Was it due to systemic--especially adrenal-- changes? He demonstrated increases in plasma cortisol under hypnosis with suggestions of fear. On p. 230 he summarizes the facts he established by skin sensitivity tests, plasma- cortisol studies, and histology - endocrinological. Furneaux, W. D. (1964). The heat-illusion test and the structure of suggestibility. International Journal of Clinical and Experimental Hypnosis, 12 (3), 169-180. 2 similar forms of the heat-illusion test are shown to correlate to a smaller degree than would be expected if they measure the same attribute. The 2 versions also differ in the way in which they correlate with other suggestibility tests. It is shown that linear regression techniques are not appropriate for analyzing the data concerned. The interaction of various nonlinear relationships with a difference in "difficulty," as between the 2 forms of the illusion, seems to provide an adequate explanation for the results. It is suggested that these nonlinear relationships may indicate the existence of an attribute which prevents some Ss from responding to any suggestibility test, irrespective of what the specific mechanisms of response may be. (PsycINFO Database Record (c) 2002 APA, all rights reserved) 1963 Black, Stephen; Edholm, O. G.; Fox, R. H.; Kidd, D. J. (1963). The effect of suggestion under hypnosis on the peripheral circulation in man. Clinical Science, 26, 223-230. NOTES "Summary. 1. The effects on the circulation in the forearm and hand of both direct and indirect suggestion under hypnosis of thermal stimuli have been studied. 2. The induction of hypnosis did not significantly alter the forearm blood flow, but a small reduction in hand blood flow was usually observed. Pulse rate in general slowed slightly as did respiration rate. 3. The effect of body heating on forearm and hand blood flow was not modified by hypnosis. 4. Direct suggestion under hypnosis of body heating or body cooling, with and without body heating, produced only small changes. 5. The changes associated with suggestion were not related to the thermal suggestion. Whatever the suggestion, the usual response was a reduction in hand blood flow and an increase in forearm blood flow. 6. The rise of body temperature with heating was not modified by direct suggestion, under hypnosis, of body cooling. 7. No change in body temperature could be elicited by suggestion. 8. In a few experiments marked changes in forearm blood flow occurred. These appeared to resemble the changes in the circulation produced by emotional stimuli. 9. The smaller changes more frequently observed were also similar to those produced by mild emotional stimuli" (p. 229). [N.B. The Subjects were normal, healthy adults, N = 9, between 21-45 years old; highly hypnotizable, amnesic for trance.] Paul, Gordon L. (1963). The production of blisters by hypnotic suggestion: Another look. Psychosomatic Medicine, 25 (3), 233-244. NOTES: Presents a critical evaluation of reported attempts to produce nonherpetic skin blisters through hypnotic suggestion. Even though the majority of these reports are grossly lacking in controls, experimental design, etc., and are subject to alternative explanations, the author concludes that skin anomalies have been produced by suggestion in some instances. Additional studies of psychogenic vascular changes add credence to the possibility of central control of these phenomena. It is also concluded that these reactions do not appear to be limited only to hypnotized Ss. SLEEP 2002 Hammond, D. C. (2002). Treatment of chronic fatigue with neurofeedback and self-hypnosis.. NeuroRehabilitation, 16, 1-6.. A 21 year old patient reported a relatively rapid onset of serious chronic fatigue syndrome (CFS), with her worst symptoms being cognitive impairments. Congruent with research on rapid onset CFS, she had no psychiatric history and specialized testing did not suggest that somatization was likely. Neuroimaging and EEG research has documented brain dysfunction in cases of CFS. Therefore, a quantitative EEG was done, comparing her to a normative data base. This revealed excessive left frontal theta brainwave activity in an area previously implicated in SPECT research. Therefore, a novel treatment approach was utilized consisting of a combination of EEG neurofeedback and self-hypnosis training, both of which seemed very beneficial. She experienced considerable improvement in fatigue, vigor, and confusion as measured pre-post with the Profile of Mood States and through collaborative interviews with both parents. Most of the changes were maintained at 5, 7, and 9 month follow-up testing. 1996 NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia (1996). Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. Journal of the American Medical Association, 276 (4 (Jul 24-31)), 313-318. NOTES Includes hypnosis as one of the recommended interventions for pain. 1994 Brown, Gail W.; Riddell, Rodney; Summers, David; Coffman, Brent (1994, August). Use of hypnosis by practitioners in the school setting. [Paper] Presented at the annual meeting of the American Psychological Association, Los Angeles. NOTES Hypnosis is a therapeutic procedure that is appropriate for some school-age clients. Through the use of hypnosis that utilizes metaphors and imagery, children can be empowered to find unique solutions to their problems. Children enjoy the feeling of power and mastery that they have when able to perform hypnotic phenomena. They like to play magic and can be told that a finger or other body part will become numb. Because a major goal of hypnotherapy is to teach a child to be an active participant in his or her own behalf, the focus is on creating solutions and mastering the situation rather than enduring the problems. Four case studies demonstrate the utility of hypnosis in the treatment of phantom pain and nausea, sleep terror disorder, school phobia, and spider phobia. In each case, treatment goals were realized. Because the solutions were self- generated, the behavioral changes maintained over time and situation. Case #1: Hypnosis was used to help alleviate phantom limb pain and nausea during chemotherapy following amputation of the right leg at the knee due to cancer in a thirteen- year-old male. The client had indicated that he loved nature and enjoyed the mountains. The metaphor described a young tree that has just begun to grow small silvery leaves. The spring floods tear the limbs and branches from the stump. The deep roots and stump of the tree are all that remain. The tree is not the same as before the flood. Its roots are stronger, its base more sturdy compared to the branches and limbs. The young tree has withstood the catastrophe of the torrent of waters and is even stronger than before. To counter the nausea and vomiting associated with chemotherapy a switch mechanism metaphor was used. The client was adroit with computers and had no difficulty picturing a switch located in his brain which could "turn off" the nausea from chemotherapy. A room contained all the unpleasant feelings that were being experienced. In this room is a light of a particular color that represents all the unpleasant sensations. Press the key on the computer that controls the switch to turn off the colored light in that room. Suggestions for healing were also given. Your body has known for years how to heal. Visualize the battle between good and bad cells and the victory of the good cells. Case #2: Hypnosis was used to alleviate sleep terror disorder in a ten-year-old female. The onset of the subject's parasomnic symptomatology appeared to coincide with her starting kindergarten and her family's relocation shortly before. The initial treatment consisted of progressive relaxation, deep breathing, and the visual image of her "secret safe place." An induction utilizing a variety of images was presented. Hiking barefoot on a cool moss covered mountain trial, sitting in a an alpine meadow on a warm summer afternoon, and flying proved most effective in facilitating trance. The participant was told to "Visualize all your anxiety and tension as hard grey rocks. Pick up these rocks and place them in your pockets. Go to the front porch of your "secret safe place and on the porch is a "magic hefty bag." Place your hard grey rocks that contain all your anxiety and tension in the magic bag. Once in the bag, the rocks will no longer weight you down, you will be free of any feelings of stress or tension. Your bed is magic; it is covered with a special glue which will keep you in a reclining position until you are fully rested and ready to awaken." Case #3: Hypnosis was used in the treatment of school phobia in a nine-year-old male. The student experienced intense anxiety whenever separation from the primary caretaker occurred. The teacher stated that this boy experienced frequent absences and crying spells that were only relieved by phone calls to his mother or the presence of his mother next to him in class. In preparation for the intervention, the student was asked to draw a picture of how he felt inside during a panic attack. He drew a fire. He also said that only his mother could put that fire out. This information was utilized in creating a metaphor that described a house in a small town. "The mother had left, and a young boy was left alone. While at home, the boy looked out the window and saw several boys trying to burn a neighbor's yard! Acting quickly, he called the fire department, grabbed the fire extinguisher and unraveled the garden hose. He was able to extinguish the fire. The neighbors and friends were very happy and praised the boy's performance. When his mother heard the good news, she quickly returned home and held a celebration in his honor." Following the metaphor, hypnotherapy continued with suggestions about fire extinguishers that the subject could use to put out emotional fires. Case #4: Hypnosis was used in the treatment of spider phobia. Diagnosis of phobia was made in this eleven-year-old female when the fear or avoidance behavior was distressing. The child's strained facial expressions occurred even at the thought of seeing what she described as "a creepy, crawly creature with 8 legs." Preparatory to her first induction the participant was read the story of Charlotte's Web (White, 1980) to facilitate the imagery for future hypnotic work. In the following session systematic desensitization was accomplished using characters from the story of Charlotte's Web. During the third session the subject was age regressed to the first time she remembered seeing a spider. She recalled playing in the woods outside her family home on an island and seeing a large web stretched between two trees with a very large spider in the center of its web. She was then asked to remain at that place to look closely at that spider as it was most likely Charlotte or one of Charlotte's family. Upon closer investigation she saw not only Charlotte but "teeny-tiny babies." The event was reconstructed as a happy experience. The imagery provided by Charlotte's Web permitted the subject to fantasize her previous frightful experience and reframe spiders as cute little "teeny-tiny" babies with admirable human qualities. 1993 Becker, Philip M. (1993). Chronic insomnia: Outcome of hypnotherapeutic intervention in six cases. American Journal of Clinical Hypnosis, 36, 98-105. Chronic dyssomnia is highly prevalent and has multiple etiologies. Hypnotherapy has been reported as beneficial for insomnia, but the description of the subject populations has been limited. A group of patients was evaluated at a sleep disorders center for a dyssomnia that occurred on at least 3 nights per week for 6 months or more. Six patients accepted hypnotherapy for their persistent psychophysiological insomnia and other sleep disorder diagnoses. Three patients responded to two sessions of structured hypnotherapy. The three responders remained improved at 16-month follow- up. Factors that seemed to contribute to long-term response in this small group of patients included a report of sleeping at least half of the time while in bed, increased hypnotic susceptibility, no history of major depression, and a lack of secondary gain. 1992 Kohen, Daniel P.; Mahowald, Mark W.; Rosen, Gerald M. (1992). Sleep terror disorder in children: The role of self hypnosis in management. American Journal of Clinical Hypnosis, 34, 233-244. This paper describes four children, ages 8 to 12 years, with frequent, prolonged, or dangerous disorders of arousal. None had any significant psychological or behavioral problems. Each had a polysomnogram that showed sudden arousals out of slow-wave sleep associated with complex behavior. All responded to a short course of imipramine, 20 to 60 mg at bedtime, followed by and in conjunction with training in relaxation and mental imagery (self-hypnosis). Once the correct diagnosis was made, the treatment strategy was to (1) demystify the symptom complex through education, (2) establish prompt control of the symptoms with the use of imipramine, (3) train the children in self-regulation with self-hypnosis, and (4) discontinue the medication while maintaining control of the arousals. Over a 2-3 year follow-up all children remain asymptomatic. This is the first report of successful use of self-hypnosis for the treatment of polysomnogram- proven disorders of arousal in the pediatric population. Also reported are seven additional children who were treated equally successfully with hypnosis without the use of medication. Lippincott, Brian (1992). Owls and larks in hypnosis: Individual differences in hypnotic susceptibility relating to biological rhythms. American Journal of Clinical Hypnosis, 34, 185-192. In 1986 Coleman developed the Owl and Lark Questionnaire to differentiate morning people from evening people, with owl individuals being more alert during the evening phase and lark individuals being more alert during the morning phase. Rossi has hypothesized that the bimodal peaks of hypnotizability found by Aldrich and Bernstein in 1987 were caused by alterations in owl and lark circadian rhythms. In the current study I used the Harvard Group Scale of Hypnotic Susceptibility, Form A to test compliance with hypnotic suggestions among 42 graduate students at three times of the day: in the morning, in the evening, and, as a control, in the middle of the night. Owls were more hypnotizable than larks in the morning, and larks were also significantly more hypnotizable in the evening than owls. There was no difference between the two groups in the middle of the night. A possible implication of this study is that one fundamental mechanism of therapeutic hypnosis is the entrainment of psychobiological rhythms. NOTES The author tested Subjects at 8-10 a.m., 4-6 p.m., and midnight to 2 a.m. because they were the times when owls and larks could be most easily differentiated (morning and late afternoon) or were most equal (night). The goal was "to determine if individuals differentiated by the Owl and Lark Questionnaire have different peaks of hypnotizability associated with the rest phases of their biological rhythms." (P. 187). "To control for practice effects (Cooper, Banford, Schubot, & Tart, 1967), one third of the subjects started rotating at each of the three test times and proceeded in clockwise order (morning-evening-night; evening-night-morning; night-morning-evening). "There were at least 24 hours between tests to assure that boredom from the testing was not a factor" (p. 188). DISCUSSION. "Rossi has extended Erickson's naturalistic approach and has hypothesized the entrainment of the ultradian biological rhythms as a possible factor in therapeutic hypnosis. ... Rossi states: 'The ultradian theory of hypnotherapeutic healing proposes that (1) the source of psychosomatic reactions is in stress-induced distortions of the normal periodicity of ultradian cycles and, (2) the naturalistic approach to hypnotherapy facilitates healing by permitting a normalization of these ultradian processes.' (Rossi, 1982, p. 23)" (pp. 189-190). "If owls and larks were not separated, the results of this study would show no differences in hypnosis. Perhaps this is why Hollander et al. (1988) found no change in hypnotizability using a direct-suggestion measure after a 2-day training in Ericksonian techniques" (p. 190). 1991 Brown, Peter (1991). Ultradian rhythms of cerebral function and hypnosis. Contemporary Hypnosis, 8, 17-24. As a consequence of his observations of the clinical work of Milton Erickson, Ernest Rossi has proposed an 'ultradian rhythm theory of hypnosis'. Rossi demonstrated that the spontaneous changes in cognition, affect and behaviour which occur as part of the ultradian cycle (which Erickson referred to as 'the common everyday trance') are similar to the changes which occur during hypnosis. A review of studies of the phasic changes in hemispheric function suggests that ultradian changes do parallel the changes found in hypnosis. NOTES Falling asleep and waking up are regulated by two separate mechanisms rather than being opposite poles of one mechanism (Winfree, 1980). Kleitman (1961) suggested a 90-min cycle, the basic rest-activity cycle (BRAC). In addition to physiological alterations, there are alterations in cognition, mood and behavior (Rossi & Cheek, 1988); vigilance (Okawa, Matousek & Petersen 1984); peripheral blood flow (Ramano & Gizdulich, 1980); respiratory amplitude (Horne & Whitehead, 1976); visual evoked potentials (Zimmerman, Gortelmeyer & Wiemann, 1983); pupillary diameter, stability and reactivity to light, and saccadic eye movements (Lavie & Kripke, 1981). These diurnal variations may relate to hypnotic behavior. There is a recurring increase in daydream and fantasy, as well as visual imagery (Kripke & Sonnenschein, 1978). "There is evidence for a parallel recurring cognitive and emotional cycle with increased emotional responsiveness and a more subjective cognitive processing of information (Evans, 1972; Holloway, 1978; Overton, 1978; Thayer, 1987). Subjects appear to repeat the cycle approximately 16 times per day, with a range of 70-120 minutes. Kripke and Sonnenschein (1978) noted that the subjects were personally unaware of any repeating cycle in their mental lives" (p. 19). The brainstem arousal mechanisms seem to be implicated in periodic changes in the EEG. Ultradian rhythms are "more easily detected under conditions of increased sleep need, reduced external performance demand and lowered motivation to focus externally (Broughton, 1985)" (p. 20). Sterman (1985) observed that the rhythm was most marked in resting state and disappears during complex visuomotor tasks. Relationship of EEG patterns to attentional patterns indicate there may be two different forms of attention, one for focused awareness (often thought to be associated with trance state) and the other a generalized vigilance (which would be reduced in hypnosis). Ultradian changes in consciousness reflected in the EEG may suggest increased internal absorption associated with visual imagery, a feature of the trance state. "There has recently been a partial direct confirmation of Rossi's hypothesis. Aldrich and Bernstein (1987 [International Journal of Clinical and Experimental Hypnosis]) reported a bimodal distribution of Harvard Group Scale Hypnotic Susceptibility (HGSHS) scores when they are done at different times throughout the day. They note the parallel of the changes in HGSHS scores and the circadian variations in body temperature which suggest changes in hypnotic responsiveness coinciding with the fluctuations of physiological rhythms. "Other support comes from some highly original work involving breathing rhythms. There are cyclic alterations in relative air flow between the left and right nostrils with an average period of 2-3 hours (Hasegawa & Kern, 1977). This nasal ultradian rhythm is correlated with an increase in contralateral cerebral hemispheric activity (Werntz, Bickford, Bloom & Shannahoff-Khalsa, 1981, 1983; Klein, Pilon, Prosser & Shannahoff-Khalsa, 1986). The alterations in hemispheric function do appear to be related to changes both in the style of cognition, particularly in an increase in vivid visual imagery, and in performance on specific tasks (Klein et al., 1986). Thus these studies support the notion of an ultradian rhythm of cerebral function which is associated with characteristic physical manifestations mediated by the autonomic nervous system. Whether or not these changes are directly related to the findings reported by Aldrich and Bernstein has yet to be established" (p. 21). The authors conclude that "the most consistent evidence for ultradian rhythms is demonstrated by the mechanisms of the hypothalamic-limbic system and by brain-stem mechanisms that regulate arousal and attention processes (Parmeggiani, 1987); neuroendocrine regulatory mechanisms (Follenius, Simon, Brandenberger & Lenzi, 1987) and autonomic nervous system function (Bossom, Natelson, Levin & Stokes, 1983; Gordon & Lavie, 1986). These studies also suggest an ongoing dynamic interaction between cortical and subcortical structures throughout the ultradian cycle (Parmeggiani, 1987), and suggest that these interactions may be of great significance in hypnosis" (p. 21). 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. DeKoninck, J.; Brunette, R. (1991). Presleep suggestion related to a phobic object: Successful manipulation of reported dream affect. Journal of General Psychology, 118, 185-200. When compared with subjects who received presleep suggestions for negative affect, subjects who received positive affect suggestions had significantly higher levels of positive emotions in their dreams, rated their own dreams as more pleasant, and had significantly lower levels of anxiety, sadness, and aggression. This supports the hypothesis that presleep suggestion can be an effective technique in influencing the affective dimension of the dream. Evans, Frederick J. (1991). Hypnotizability: Individual differences in dissociation and the flexible control of psychological processes. In Lynn, Steven J.; Rhue, Judith W. (Ed.), Theories of hypnosis: Current models and perspectives (pp. 144-170). New York: Guilford Press. NOTES "In summary, some of our recent data suggest that there are a number of interacting reliable correlates of hypnotizability ... . None relate to suggestibility in the traditional sense. ... Hypnotizability is related to the ability to process cognitive information during sleep, to the physiological ease of falling asleep, and to a dimension of subjective sleep characteristics we have labeled the 'control of sleep' (involving ... the ability to fall asleep easily and readily at will, and the tendency to take naps). Additional data have suggested that the concept of absorption can be meaningfully divided into subfactors that reflect the volitional control over the absorption process that correlates with hypnotizability in both normal and patient populations. ... (C)ontrolled absorption correlates significantly with hypnotizability in both normal and patient populations--a result that might be predicted from the concept of multiple pathways as correlates of hypnotizability (J. R. Hilgard, 1970). ... Finally, both the control-of-sleep dimension and hypnotizability relate to the reductions of symptoms and psychopathology even when psychiatric patients are not treated with hynotic techniques" (pp. 164-165). Somer, Eli (1991). Hypnotherapy in the treatment of the chronic nocturnal use of a dental splint prescribed for bruxism. International Journal of Clinical and Experimental Hypnosis, 39, 145-154. A behavioral medicine case is described in which the patient was treated with a combined approach involving both hypnoanalytic and hypnobehavioral techniques. A 55-year-old man with bruxism was referred after 10 years of craniomandibular treatment because of his dependency on a dental splint prescribed for nocturnal use. A projective hypnoanalytic exploration helped to uncover and consequently resolve an earlier conflict that had been reactivated in the patient's work situaation and which had become a constant source of mental and muscular tension. The hypnoanalytic exploration was followed by a cognitive-behavioral hypnotic intervention that was tape-recorded and prescribed for bedtime practice. Pre- and posttherapy psychological, physiological, and self-report measurements corroborated the patient's sense of well being that came with his newly found ability to sleep without the dental splint. The importance of considering multiple etiological factors in the treatment of such psychosomatic disorders as bruxism is discussed.