1995
Holroyd, Jean (1995). Handbook of clinical hypnosis, by Judith W. Rhue, Steven Jay Lynn, & Irving Kirsch (Eds.) [Review]. International Journal of Clinical and Experimental Hypnosis, 43 (4), 401-403.
NOTES
“This is a book for the thinking clinician” (p. 401). “The editors are to be congratulated for making this volume much more coherent than most edited books” (p. 402). “My impression is that the book is best suited for an intermediate or advanced course on hypnotherapy, or for people who are already using hypnosis in treatment. Although there is some material on the basics of hypnotic inductions and a few introductory sample scripts for inductions, a beginners” course should probably use a different book, or this book could be accompanied by an inductions manual. … I recommend it very highly” (p. 403).
Wickramasekera, Ian (1995). Somatization: Concepts, data and predictions from the high risk model of threat perception. Journal of Nervous and Mental Disease, 183, 15-23.
83 consecutive patients with chronic somatic complaints seen prior to therapy were tested on the 8 risk factors of the High Risk Model of Threat Perception. The model identifies 3 predisposing factors (hypnotic ability, catastrophizing, and negative affectivity) that amplify the probability that 2 triggering variables (major life change and minor hassles) will generate psychological or somatic symptoms unless the impact of the triggers and predisposers are buffered. 32% were high and 28% were low on hypnotic ability, which is more highs and lows than would be expected in a normal population. In the high and low hypnotic ability somatizers, the distribution of somatic and psychological symptoms is significantly different from the moderate group. Counterintuitively, hypnotic ability and major life change were orthogonal to all of the other risk factors.
1994
Marmar, Charles (1994, October). Peritraumatic dissociation and PTSD. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.
NOTES
Following trauma there is a tendency to more dissociation and vulnerability. We completed 3 recent studies. In 1991 Spiegel and Cardena presented review that found: 1. Early childhood abuse is associated with profound dissociation. 2. Repeated abuse is more important and profound than single abuse for producing dissociation. 3. Dissociation in childhood and perhaps in adulthood has been viewed as an adaptive attempt to cope, to take distance in time, place, and person; does that confirm long term adaptation, or is it a risk factor? 4. Dissociation is not limited to childhood trauma; it occurs in adults exposed to overwhelming trauma. 5. In adults with PTSD, there is an increase in hypnotizability, which is interesting because most Axis I disorders are associated with reduced hypnotizability.
Peritraumatic dissociation is defined as an immediate dissociative response to trauma. We developed a scale that robustly captures the phenomena. The scale has both self report and rater versions.
Authors used this measure in many studies: combat trauma, accident trauma, victims of terrorism. The scale predicts who will be a PTSD patient 5 months later, even after controlling for initial response in first week (how many symptoms they had) and for the degree of trauma.
Study 1 (Am. J. Psychiatry, June 1994)
Studied 251 male Vietnam Theater Veterans, mean age 41 at time of study. Had high combat exposure and high risk for PTSD. Rater version of Peritraumatic Dissociative Experiences Questionnaire was used. There was a lot of variability in response, but one underlying dimension resulted from the factor analysis (and this factor accounts for 40- 50% of the variance).
Author hypothesized that those who have a greater response to trauma will have more problems later, and would predict stress symptoms but not necessarily psychopathology. The score correlates highly with: Mississippi Scale for PTSD .51; Horowitz’s scales; Impact of Events Scale (Intrusion .53, Avoidance .60); MMPI derived PTSD .42; Dissociative Experiences Scale (recall of time of event) .41; and War Zone Stress Exposure .48.
MMPI-2 clinical scales had almost no correlation with this scale (using partial r’s, and controlling for MMPI-2 PTSD scores).
Prediction of PTSD case classification from this scale, after taking into consideration other predictors: War Zone Stress War Zone Stress, DES War Zone Stress, DES, PDEQ-RV Kappa is .63
You know much more about who will be a case taking into consideration the DES and DEQ than just knowing the amount of stress. Peritraumatic stress is strongly associated with PTSD but not with psychopathology.
Study 2
Replicated Study 1 using 77 female veterans. Females Ss were more highly educated, older, more likely to be in a health profession role (trauma was working with death and dying, exposure to sex abuse and harassment, given even less support than the males). Yet women have had a better course of recovery, though rates were the same (30% developed PTSD after return from war).
Correlation with Impact of Event Scale (Intrusion .41 and Avoidance .40), but correlations with MMPI-2 are low (and with other PTSD scales are lower than with the males). Hierarchical multiple regression models show R squared doesn’t increase with DES but does with PDEQ to Intrusion (less so to Avoidance).
This study replicates the same pattern, with peritraumatic dissociation strongly related to PTSD symptoms years later, and not to general psychopathology, even after accounting for the nature of the stress and for the degree of dissociation.
Study 3
After the 1989 Loma Prieta earthquake in Northern California we studied emergency services personnel involved in the collapse of a freeway in Oakland. 1000 rescue workers were involved. The workers (police, fire personnel, paramedics, CALTRANS road workers) involved one I-880 cohort and a replication cohort, with two control groups (smaller scale incidents like attending a child drowned in swimming pool, removing someone from a wrecked auto). In all 3 samples, 90% were male.
What characteristics of the person or their exposure account for which workers go on to cope and which will later have PTSD symptoms? Predictors: IES-I IES-A IES-H M-PTSD SCL-GSI.
Variables most associated with problems 1.5 to 3 years afterward were years of experience, exposure, adjustment (measured by the Hogan Personality Inventory measure of adjustment), social support, DES, and PDEQ. Regression analyses used the best predictors first: forced exposure, adjustment, years experience, locus of control, social support. For Intrusion scores there were modest but significant increments by the DES and PDEQ; for avoidance scores, there were very significant contributions (.072 and .078).
There is a robust relationship between the DES and PDEQ and how much hyperarousal there is afterward (.104 and .110 %). DES measures a trait, PDEQ measures a state; yet the latter continues to contribute even after accounting for variance by the DES.
The PDEQ also has been found to predict among rape victims who will have PTSD. This was replicated in different cultures and different language groups.
FUTURE DIRECTIONS. Authors plan to examine people with moderate to high exposure after the L.A. earthquake. They gathered personality and coping style data on the rescue workers to answer the question: what characterizes those who are more vulnerable to dissociative tendencies during trauma?
There are treatment implications: given that those who develop the most profound response are the ones who will have more PTSD later, what are the implications?
Uncovering the trauma that caused the PTSD is often associated with re- dissociation There is a question of how this should be managed.
The authors will attempt to see if they can predict in advance if a person would dissociate if exposed. Do those who dissociate have more childhood abusive environments? Hypothesis: there may be an interaction of childhood trauma and combat trauma that produces PTSD.
Spiegel, David (1994, October). Acute stress disorder and dissociation in DSM-IV. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.
NOTES
Starting with the theme on hysteria introduced by Frankel (1994), and Cardena (1994) on trance disorder [Spiegel notes that] in the West our problem is of individuality, so fragmentation of personality is our disorder. There is cultural content in the delusions of schizophrenia, and cultural content in dissociative disorders. We have further evidence of trauma being involved in dissociation. Trauma is the experience of being made into an object, and the core problem is helplessness (not anxiety or fear), and discontinuity in experience. Dissociation permits people to retain control of their minds when they have lost control of their bodies. The discontinuity of dissociation reflects the discontinuity of experience.
[This presentation included the material presented at an earlier meeting and is not reported in full here.]
The difficulty is the problem of lack of identity rather than too many identities.
Wickramasekera, Ian (1994). Psychophysiological and clinical implications of the coincidence of high hypnotic ability and high neuroticism during threat perception in somatization disorders. American Journal of Clinical Hypnosis, 37, 22-33.
The electrodermal response to cognitive threat of unhypnotized female patients with somatic symptoms and high on both hypnotic ability and neuroticism (H-H) was found to be significantly higher (p<.01) than that of a matched group of female patients moderate on hypnotic ability and low on neuroticism (M-L). On verbal report the H-H and the M-L groups did not differ, but they were significantly different on a measure of self-deception (L scale) or repression. The above findings are consistent with predictions from the High Risk Model of Threat Perception (HRMTP), which states that people in the H-H group are both chronically and acutely more reactive to threat than the people in the M-L group. This finding may have important theoretical, clinical, and financial implications for the diagnosis, therapy, and prevention of somatization disorders seen in primary medical care. Wickramasekera, Ian; Pope, Alan T.; Kolm, Paul (1994, August). Chronic pain, hypnotic ability and skin conductance level. [Paper] Presented at the annual meeting of the American Psychological Association, Los Angeles. The High Risk Model predicts that high hypnotic ability is a risk factor for the development of stress related psychophysiological disorders. It was hypothesized that greater threat perception as measured by skin conductance level (SCL) would be associated with higher levels of hypnotic ability. In a consecutive series of 118 adult patients with chronic pain symptoms, larger increases in SCL during cognitive stress were significantly related to higher levels of hypnotic ability. In addition, high hypnotic ability individuals retained higher SCL than low hypnotic ability individuals after stress. The clinical implications of high hypnotic ability for threat perception and recovery from thereat perception are discussed in terms of cognitive mechanisms in the etiology and therapy of chronic stress related disorders. (ABSTRACT from Bulletin of Division 30, Psychological Hypnosis, Fall 1994, Vol. 3, No. 3.) 1993 Spiegel, David; Koopman, Cheryl; Classen, Catherine; Freinkel, Andrew (1993, October). Dissociation, trauma, and DSM-IV Acute Stress Disorder. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL. NOTES This represents a progress report on the research in our laboratory, which is different from traditional approaches that link childhood trauma to current problems. We say if there is a link between dissociation and trauma, one should find the symptoms in people who have trauma. Earthquake Research: They examined data from Loma Prieta earthquake; Stanford had $164 million damage. Oct 1989. [Presents data that he has presented before.] There was a drop in dissociative symptoms over 4 months. McFarlane found that numbing was the best predictor of later PTSD symptoms, and we find that too. Most trauma researchers have focused on anxiety because that is what they are interested in; they have ignored dissociative experiences, because such symptoms are designed not to be noticed. Andrew Frankel and Cheryl Koopman studied 15 journalists who saw Robert Alton Harris' execution--volunteers who reported on the execution, to whom the event did not personally threaten. 40% reported depersonalization experiences, 2/3 felt detached or estranged from others, 27% had problems remembering everyday activities, etc. Dissociative symptoms were especially high in TV journalists, lowest in radio journalists, and in the middle range in newspaper reporters. Oakland Fire Research: Koopman & Classen looked at immediate psychopathology and later problems. They studied people of low, medium, and high exposure as defined by distance from the fire, which related strongly to both dissociative and anxiety symptoms. There were strong relationships between the Mississippi PTSD scale scores and anxiety and dissociative symptoms (.50 and .59 respectively). People who reported recent life stress in the intervening period had higher PTSD and dissociative symptoms. The combination of initial dissociation and subsequent stress was additive in their relationships to PTSD. People who had higher dissociation scores tended to do higher risk things (e.g., cross police barriers). This may explain how clinicians see patients who appear to get themselves re-victimized. Law Office Shooting Research: We followed up on the 1993 shooting of 14 people (8 fatally) in a law office in San Francisco. Survivors filled out dissociation questionnaires in the office (N = 36). They had high scores on the Impact of Event Intrusion Scale. The more they thought they or colleagues were in danger, the higher their scores on anxiety and dissociation measures and on Impact of Event scale. Dissociation Definition: These studies led to a project, with Etzel Cardena, in trying to revise DSM-IIIR, which doesn't capture the symptoms [of post traumatic dissociation]. In DSM-IV there will be the diagnosis of 308.3 Acute Stress Disorder, characterized as: A. Same as DSMIIIR, except it doesn't require that the trauma be "unusual" B. Requires 3 of 5 dissociative symptoms. C, D, and E are classic dissociative symptoms F, G, and H are delimiting factors (e.g., causes significant impairment, length of time, not due to other factor). Also, the multiple personality disorder (MPD) diagnosis has been changed to Dissociative Identity Disorder. The problem for these patients is not in having more than one personality, but not having one _functioning_ personality. Walker, Leslie G.; Johnson, Vanessa C.; Eremin, Oleg (1993). Modulation of the immune response to stress by hypnosis and relaxation training in healthy volunteers: A critical review. Contemporary Hypnosis, 10, 19-27. NOTES They review literature on modulation of the immune response to stress with relaxation and/or hypnosis, and raise the following questions and conclusions: 1. It is not clear which dependent variables should be studied. 2. There is a need to clarify which independent variables are responsible for particular effects. 3. There is the question of moderator variables. 4. There is room for many more case studies, including single case research (given the uncertainties discussed and the costs of controlled studies). 5. There is evidence that pathways exist whereby the brain could alter or modulate aspects of immune reactivity. [They describe assigning 20 healthy volunteers randomly to experimental or control group. The experimental group received 3 weeks progressive relaxation and cue-controlled relaxation training, with hypnosis before exposure to an experimental stressor--video recording and playback of a doctor-patient role play. They evaluated not only the biochemical and immunological effects of relaxation training but also the effect in modulating the biological responses to stress.] 6. They concentrated on studies with healthy volunteers because there are already known immunological changes in patients who have tumors. However people with a healthy immune system may have a natural limit in how much they can improve their immune response with interventions like hypnosis. Wickramasekera, Ian (1993, August). Some psychophysiological and clinical implications of the coincidence of hypnotic ability and neuroticism during threat perception. [Paper] Presented at the annual meeting of the American Psychological Association, Toronto, Canada. NOTES Although not addressing hypnosis specifically, this is a comprehensive review of literature on memory for negative emotional events relevant to issues of hypnosis and memory. The final conclusion is that emotional events are indeed remembered differently than neutral or ordinary events and are well retained with respect to the event itself and concerning central, critical detail (not peripheral detail). Such memories seem less susceptible to forgetting. There is evidence for dissociation between memory for emotional information and memory for specific event information. There is also evidence of amnesia or memory impairment effects after high-arousal events, with memory increasing as more time passes after the event. The functional amnesia effects are probably due to an interaction between altered encoding operations and the specific retrieval circumstances aiding consciously and unconsciously controlled reconstructive processes. There is little evidence to support Loftus' contentions that emotional stress is bad for memory. Claridge, Karen (1992). Reconstructing memories of abuse: A theory-based approach. Psychotherapy, 29, 243-252. The recovery of traumatic memories is an important part of therapy with survivors of abuse. This article describes a conceptual framework for memory reconstruction based on Horowitz' (1986) theory of stress response syndromes. The client's history of intrusive symptoms provides a way to anticipate the nature of the trauma, even when no memory of it exists. Ongoing intrusive symptoms are used to retrieve memory fragments, and their emotional impact is used to build the client's emotional tolerance. Emphasis is placed on preparing for memories by identifying what the client will need when the memories return, building coping skills, and beginning to restructure cognitions at the "what if" stage of remembering. Case material is used to illustrate. Isenberg, S. A.; Lehrer, P. M.; Hochran, S. (1992). The effects of suggestions and emotional arousal on pulmonary functions in asthma: A review and a hypothesis regarding verbal mediation. Psychosomatic Medicine, 54, 192-216. This paper reviews the empirical literature on the relation between asthma, suggestion, and emotion, and proposes the hypothesis that these effects are mediated parasympathetically. The literature indicates that, among asthmatics, suggestion can produce both bronchoconstriction and bronchodilation, and that stress can produce bronchoconstriction. The proportion of asthmatic subjects showing bronchoconstriction to both suggestion and stress averages 35%-40% across studies, but, because of methodological considerations, might be conservatively estimated as closer to 20%. The effect is smaller for suggestion of bronchodilation, and is very short-lived among nonasthmatics. No clear connection has been found between these responses and such subject variables as age, gender, asthma severity, atopy, or method of pulmonary assessment, although some nonsignificant tendencies appear. Most studies in this literature used small n''s and did not systematically examine various somatic, environmental, and demographic factors that could influence results. A hypothesis is presented regarding vagal mediation of psychological effects on the airways, as well as possible alternative mechanisms, and recommendations for future research to evaluate these hypotheses. Mittleman, K. D.; Doubt, T. J.; Gravitz, Melvin A. (1992). Influence of self-induced hypnosis on thermal responses during immersion in 25 degrees C water. Aviation, Space & Environmental Medicine, 63, 689-695. The efficacy of self-induced posthypnotic suggestion to improve thermogenic responses to head-out immersion in 25 degrees C water was evaluated in 12 males. An online computerized system permitted the change in body heat storage to be used as the independent variable and immersion time as the dependent variable. Two one- hour hypnotic training sessions were used. There were no differences in rates of heat production, heat loss, mean skin temperature, or rectal temperature between control and hypnotic immersions. Individual hypnotic susceptibility scores did not correlation with changes in thermal status. Ratings of perceived exertion during exercise were similar for both immersions, but perceived sensation of cold was lower during the second rest period of the hypnotic immersion. Three subjects used images of warm environments during their hypnotic immersion and lost heat at a faster rate than during control immersions. These results indicate that brief hypnotic training did not enhance the thermogenic response to cool water immersion. Morse, Donald R.; Martin, John; Moshonov, Joshua (1992). Stress induced sudden cardiac death: Can it be prevented?. Stress Medicine, 8, 35-46. Previously, psychosomatically induced death relative to stress, hypnosis, mind control, and voodoo was discussed. In this article, emphasis is on one aspect of that - stress induced sudden cardiac death (SCD). A brief review is presented of the sympathetic aspects of the acute stress response and stress induced SCD. Findings from previous studies are presented to highlight sympathetic aspects of the acute stress response. This is followed by a presentation of various strategies to prevent of decrease the possibilities for stress induced SCD. These include long-term measures (e.g. diet control, smoking control, hypertension control, stress management strategies) and immediate measures (e.g. calm, controlled approach, elicitation of the relaxation response, selected use of drugs, and heart rate variability monitoring). Relative to prevention strategies, findings are presented both from previous studies and new investigations. Perry, Nancy W. (1992, Summer). How children remember and why they forget. The Advisor (Published by American Professional Society on the Abuse of Children), 5 (3), 1-2; 13-16. NOTES 'My memory is the thing I forget with.' (a child's definition, cited in Grossberg, 1985, p. 60)" (p. 1). "Unlike the simpler forms of memory retrieval, free recall is strongly age-related... the recall skills of preschool children develop gradually" (p. 2). "...in some cases, younger children can provide _more_ accurate information than adults (Lindberg, 1991). For example, if an event is particularly salient (as sometimes happens in cases of trauma), recall may be exceptionally good (Brainerd & Ornstein, 1991; Lindberg, 1991)" (p. 13). "Children have limited ability to use memory strategies. For this reason, children often know more than they can freely recall" (p. 13). "The use of _rehearsal_ as a memory strategy is almost automatic for adults. ... Ten-year-olds also commonly use rehearsal to aid memory. Young children, however, have not mastered rehearsal (Harris & Liebert, 1991). "Another memory strategy is imagery, which involves (1) mentally picturing a person, place, or object, or (2) visually associating two or more things that are to be remembered. Children develop imagery much later than other memory strategies. Indeed, some people never learn this memory strategy (Flavell, 1977)" (p. 13). "... stress alone may not impair memory processes. Indeed, stress can lead to arousal, heightened attention, and improved encoding (Deffenbacher, 1983). However, stress that results from intimidation may lead to either impairment in encoding or problems in recalling or reporting memories" (p. 14). "Because the effect of suggestion on material that has been well encoded tends not to be significantly different across age groups (Cohen & Harnick, 1980), it may be that younger children's inferior performance on suggestive tasks results from inferior encoding" (p. 15). Spira, James L.; Spiegel, David (1992). Hypnosis and related techniques in pain management. Hospice Journal, 8, 89-119. Hypnosis has been used successfully in treating cancer patients at all stages of disease and for degrees of pain. The experience of pain is influenced not only by physiological factors stemming from disease progression and oncological treatment, but also from psychosocial factors including social support and mood. Each of these influences must be considered in the successful treatment of pain. The successful use of hypnosis also depends upon the hypnotizability of patients, their particular cognitive style, their specific motivation, and level of cognitive functioning. While most patients can benefit from the use of hypnosis, less hypnotizable patients or patients with low cognitive functioning need to receive special consideration. The exercises described in this chapter can be successfully used in groups, individual sessions, and for hospice patients confined to bed. Both self-hypnosis and therapist guided hypnosis exercises are offered. Wickramasekera, Ian (1992, August). Hypnotic ability as a risk factor for psychopathology and pathophysiology. [Paper] Presented at the annual meeting of the American Psychological Association, Washington, DC. Eighty-three patients with psychophysiological disorders seen prior to therapy were tested on the seven risk factors of the High Risk Model. Thirty-two percent of these patients were high on hypnotic ability, and hypnotic ability was unrelated to all of the other six risk factors. Mean social support and coping skills were significantly below the norm. Mean catastrophizing, negative affect (neuroticism), major life change and minor hassles were significantly above the norm. There are positive and significant correlations between hassles, negative affect and catastrophizing. There are also positive and significant correlations between coping skills and number and level of satisfaction with social support. There are negative and significant correlations between coping skills, catastrophizing, negative affect and hassles. There are also negative and significant correlations between satisfaction with social support, catastrophizing, and hassles. (ABSTRACT from the Bulletin of Division 30, Psychological Hypnosis, Fall, 1992, Vol. 1, No. 3.) 1991 Morse, Donald R.; Martin, John; Moshonov, Joshua (1991). Psychosomatically induced death: Relative to stress, hypnosis, mind control, and voodoo: Review and possible mechanisms. Stress Medicine, 7, 213-232. A common denominator in psychosomatically induced death is stress. Death can occur slowly, as from the preponderance of chronic stressor, or it can come on suddenly, as from an acute stressor. Sudden death is more likely in an individual with preexistent serious medical conditions, which were outlined. Seven types of individuals more prone to sudden death were outlined. Most cases of sudden death are related to the presence of a severely stressful situation in which there appears to be no means of control or escape. With mind control, hypnosis, and voodoo curses, circumstances can be manipulated to achieve severe stress and uncontrollability. Palan, Bhupendra M.; Lakhani, Jitendra D. (1991). Converting a 'threat' into a 'challenge': A case of stress-related hemoptysis managed with hypnosis. American Journal of Clinical Hypnosis, 33 (4), 241-247. A 24-year-old patient was treated using hypnosis for chronic repeated episodes of hemoptysis. The symptom episodes were related to academic examinations (perceived as a threat by the patient). Clinical examinations and laboratory investigations failed to indicate an organic cause for hemoptysis. He did not respond to empirical treatment trials. These negative findings suggested the psychosomatic nature of the illness. We used hypnotherapeutic ego-strengthening and guided-imagery approaches. This reduced his acute anxiety but failed to check hymoptysis. Use of explorative hypnotic dreaming revealed an emotional trauma as the possible cause of origin of the symptoms. We restructured the trauma experience during hypnotic regression. We advised him to skip the upcoming examination and conducted a total of six therapeutic sessions. The patient continued using self-hypnosis throughout the follow-up period of 3 years during which he remained symptom free and achieved remarkable academic progress. He now perceives an examination as a challenge. Sapp, Marty (1991, August). The effects of hypnosis in reducing anxiety and stress in adults with neurogenic impairment. [Paper] Presented at the annual meeting of the American Psychological Association, San Francisco. A repeated measures design was utilized to investigate the effects of hypnosis in reducing anxiety and stress in 16 adults with neurogenic impairment. Seven sessions were used to measure the efficacy of hypnosis. Session one was used to obtain a baseline level of anxiety and stress and to initiate hypnosis. Sessions three and six were used to obtain repeated measures of these emotions. Sessions two, four, and five were the treatment sessions. Session seven was used to conduct a four week follow-up on the effects of hypnosis. Levels of anxiety were measured by the State-Trait Anxiety Inventory, while stress was measured by the State-Trait Anger Expression Inventory. The results indicated a statistically significant decrease in anxiety and stress. Hypnosis also significantly increased levels of self-esteem. Finally, follow-up data demonstrated that the treatment gains were maintained. NOTES 1: NOTES Hypnotizability was not related to treatment outcome. The average Barber Susceptibility Scale score was 3, which indicates that the subjects were fairly low in hypnotizability level. Spiegel, David (1991, August). New directions in traumatic stress research. [Paper] Presented at the annual meeting of the American Psychological Association, San Francisco. NOTES Trauma is the experience of being made into an object of someone else's rage. It is a sudden discontinuity in experience: our physical and mental state can be changed radically. The experience of loss of control is what is most horrifying, more than fear of death. Guilt, (blaming oneself) helps deny the loss of control. People who experience trauma distance from the information but the cortex maintains the traumatic memories. Author reviewed literature on effective interventions with trauma victims. 1. Harbor & Pennebaker: Contrast how earthquake victims can talk about it but rape victims often are isolated. The importance of having someone listen raises the question of usefulness of only writing about the trauma. 2. Greenberg: Studied 103 trauma cases; employed a clever methodology, using 2 control groups (but it is difficult for the imaginary control group to be free of associating to their own traumas). I believe the health findings, but it troubles me that there were intrusions (thoughts); the control group utilization [of health services?] went up. 3. Kilpatrick: It is important not to blame the victim for being traumatized. But there may be some people who for sociological or other reasons do not get out of dangerous situations. 4.Terri Orbach: There is a process of "going public" about the trauma, like in Alcoholics Anonymous disclosures. Trauma victims create an account and they go to someone else to tell about it. Summary of what seems important about treatment: There are three means of working with trauma, with thinking, writing, and talking. If you just think but don't talk, assault rate goes up (Pennebaker); and if you don't talk with someone else you feel worse physically. In simply writing about the trauma, there may be an increase of mental intrusions, or avoidance. What seems to be beneficial is not just making sense to oneself about the experience cognitively, but the traumatized person must get feedback from another individual that they are not transformed as a person. Stanton, Harry E. (1991). The reduction in secretarial stress. Contemporary Hypnosis, 8, 45-50. 30 secretaries from a large business firm were matched on their stress thermometer scores and one member of each pair was allocated at random to either an experimental group or a control group which discussed stress management procedures. The experimental group had two treatment sessions in which they learnt a technique of induction, deepening and ego-enhancement which included (1) physical relaxation; (2) mental calmness; (3) disposal of unwanted mental and physical 'rubbish'; (4) removal of a negative barrier; and (5) enjoyment of a special place. The stress thermometer was administered on two further occasions, one immediately after completion of the second training session and one as a follow-up 2 months later. In addition, on these two occasions, subjects completed anecdotal reports, recording their impressions of the experiment. After completion of this first stage of the study, control group secretaries experienced the same two treatment sessions as had the experimental group. Results indicated that stress level was significantly lower both immediately after treatment and at the two-month follow-up. Witz, Marylou; Kahn, Stephen (1991). Hypnosis and the treatment of Huntington's Disease. American Journal of Clinical Hypnosis, 34, 79-90 Describes two cases treated with a wide variety of hypnotic interventions. One was treated for 9 years and the other for 10 sessions. Hypnotic techniques and daily self-hypnosis appeared to ameliorate both physical and psychological difficulties, thereby enhancing the quality of life that remained for the patients. They noted that the increased sense of control that both patients experienced seemed to undercut the cycle of physical symptoms exacerbating psychological symptoms and these in turn increasing physical symptoms. The sense of control over physical symptoms clearly reduced anxiety and depression over the inevitable course of the disease, thereby facilitating tension reduction and overall adjustment to the disease. This reduced stress level may have in turn affected the disease itself. What is unmistakable is that the quality of life was greatly enhanced. 1990 Ader, Robert; Felton, David; Cohen, Nicholas (1990). Interactions between the brain and the immune system. In Cho, Arthur K.; George, Robert; Blaschke, Terrence (Ed.), null (30, pp. 561-602). Palo Alto, CA: Annual Reviews Inc.. NOTES (From the SUMMARY) "Without attempting to cover all the literature, we have used stress effects and conditioning phenomena as illustrations to point out that behavior can influence immune function. We have also described data indicating that the immune system can receive and respond to neural and endocrine signals. Conversely, behavioral, neural, and endocrine responses seem to be influenced by an activated immune system. Thus, a traditional view of immune function that is confined to cellular interactions occurring within lymphoid tissues is insufficient to account for changes in immunity observed in subhuman animals and man under real world conditions. "These data question seriously the notion of an autonomous immune system. ... The immune system is, indeed, capable of considerable self-regulation, and immune responses can be made to take place in vitro. The functions of that component of adaptive processes known as the immune system that are of ultimate concern, however, are those that take place in vivo. There are now compelling reasons to believe that in vivo immunoregulatory processes influence and are influenced by the neuroendocrine environment in which such processes actually take place ... . The immune system appears to be modulated, not only by feedback mechanisms mediated through neural and endocrine processes, but by feedforward mechanisms as well. The immunologic effects of learning, an essential feedforward mechanism, suggest that, like direct neural and endocrine processes, behavior can, under appropriate circumstances, serve an immunoregulatory function in vivo. Conceptually, the capacity to suppress or enhance immune responses by conditioning has raised innumerable questions about the normal operation and modifiability of the immune system via neural and endocrine processes. "We do not yet know the nature of all the channels of communication between the brain and the immune system or the functional significance of the neural and endocrine interrelationships that have been established.... "This integrated circuitry has extensive ascending and descending connections among the regions cited. These regions also share many similarities. They are sites intimately involved in visceral, autonomic, and neuroendocrine regulation. The cortical and limbic forebrain regions mediate both affective and cognitive processes and may be involved in the response to stressors, in affective states and disorders such as depression, in aversive conditioning, and in the emotional context of sensory inputs from the outside as well as the inside world. From an immunologic perspective, these regions are the sites in which lesions result in altered responses of cells of the immune system; they are the regions that respond to immunization or cytokines by altered neuronal activity or altered monoamine metabolism; and they are the regions that possess the highest concentration of glucocorticoid receptors and link some endocrine systems with neuronal outflow to the autonomic and neuroendocrine systems. Thus, this circuitry is the major system of the CNS suspected to play a key role in responding to immune signals and regulating CNS outflow to the immune system" (pp. 587-589). Andrews, Vivian H.; Hall, Howard R. (1990). The effects of relaxation/imagery training on recurrent aphthous stomatitis: A preliminary study. Psychosomatic Medicine, 52, 526-535. Recurrent aphthous stomatitis (RAS) is one of the most common diseases of the oral mucosa. Although etiology remains unknown, immunological and emotional disturbances have been implicated in the pathogenesis of RAS. No consistently effective therapeutic regimen has been found. The present study investigates the voluntary modulation of RAS employing hypnosis-like relaxation/imagery training procedures. A multiple baseline design was used to evaluate change in frequency of ulcer recurrence. The role of psychological distress, ratings of perceived pain, and hypnotizability in the treatment of RAS were also examined. Results suggest that the relaxation/imagery treatment program was associated with a significant decrease in the frequency of ulcer recurrence for all subjects. Psychological distress was examined for relationship to ulcer recurrence and symptomatic changes with treatment, but no pattern was found. Finally, little support was found for the role of high hypnotic ability in the treatment of RAS. Avants, S. Kelly; Margolin, Arthur; Salovey, Peter (1990-91). Stress management techniques: Anxiety reduction, appeal, and individual differences. Imagination, Cognition and Personality, 10, 3-23. NOTES Four stress management techniques were evaluated for their general appeal, their immediate benefits, and the subjective experiences they evoke. One hundred undergraduates were randomly assigned to one of five treatment groups: (1) progressive muscle relaxation (PMR); (2) distraction imagery; (3) focused imagery; (4) listening to music; (5) sitting quietly (control). Distraction imagery and listening to music were the only techniques found to reduce anxiety to a greater extent than simply sitting quietly. The techniques differed in the way they made subjects feel, but not in their general appeal. Individuals with a 'blunting' coping style were more likely to find all five techniques appealing. Tests used included the Miller Behavioral Style Scale, Cognitive-Somatic Anxiety Questionnaire of Schwartz, Davidson & Golman, Life Orientation Test of Scheier & Carver, Somatic Perception Questionnaire of Landy and Stern, Body Consciousness Questionnaire of L. C. Miller, Murphy, & Buss, Betts' Questionnaire Upon Mental Imagery, Shortened Form, State-Trait Anxiety Inventory, and Technique Evaluation Questionnaire of the authors. Progressive muscle relaxation was according to Bernstein & Borkovec. Distraction imagery involved successively imagining a walk along a beach, a stroll across a flower filled meadow, sitting by a stream, a walk into the woods, sitting in a cabin in the woods listening to the rain against the windowpane, all including images in a variety of sense modalities. Focused imagery involved creating an image of a stressor, then through symbolic imagery experiences Ss were guided through a typical day's events that might lead up to the stressor, reinterpreting cues associated with the stressor as signals that they are in control, visualizing encountering the stressor feeling strong and determined, and any physical sensations reinterpreted as 'energy' that would help them to cope, visualizing enjoying their success (from Crits-Cristoph & Singer. Music was a 20-min tape (10 min of music used in the distraction imagery tape--Natural Light by Steve Halpern & David Smith) and 10 min of music used in background of the focused imagery tape (Structures of Silence by Michael Lanz). A 5th group, Control, was instructed to sit quietly with eyes closed. This data can be used in support of imagery-suggestion types of hypnosis (as in surgery study) reducing anxiety. It shows particularly strong effects for people high in cognitive anxiety or low in optimism, pre-treatment. Discussion: "... we feel confident that our distraction techniques were more effective for the immediate relief of anxiety than was PMR. This conclusion is consistent with the Suls and Fletcher meta-analysis (29) that suggested that 'avoidance' is an effective short-term coping strategy. That distraction (positive) imagery may be a more useful clinical technique than focused (active involvement) imagery was concluded in a study comparing these two techniques in the treatment of phobias (24)" (p. 19. [Ref #24 is Crits-Cristoph & Singer (1983) in Imagination, Cognition, and Personality.] "Pessimism and cognitive anxiety emerged as the only individual difference variables to influence anxiety reduction. Pessimism as measured by the LOT is cognitive in nature, with most of the items relating to expectations of negative outcomes; similarly, cognitive anxiety is characterized by worry and an inability to control negative thoughts and images. That individuals who perceive their world somewhat negatively should have entered the study more anxious than individuals who do not is hardly surprising. What is surprising is that despite an inverse relation between cognitive anxiety and the ability to relax, these individuals were able to benefit from whatever technique they performed to a greater extent than were individuals with a more positive outlook. In fact, after performing the technique, pessimists had reduced their anxiety to the level of optimists" (p. 19). "The stress management techniques used in the current study did not differ in their appeal" (p. 20). "Our finding that PMR produced more somatic effects than did focused imagery and less cognitive effects than did distraction imagery, listening to music, or sitting quietly is consistent with the model of anxiety proposed by Davidson and Schwartz (17). Our findings are also generally consistent with a conclusion reached by Woolfolk and Lehrer (4): that although various techniques are generally stress reducing, they seem to have highly specific effects. However, we found no support for the hypothesis that individuals who express anxiety cognitively (or somatically) prefer and benefit most from techniques that produce cognitive (or somatic) effects. In fact, the extremely high correlation found between the cognitive and somatic anxiety subscales of the Schwartz et al. measure (5) casts some doubt on the usefulness of a cognitive-somatic distinction, as does the corr between the experience of physical symptoms under stress (the Somatic Perception Questionnaire) with the cognitive, as well as the somatic, anxiety subscale. "The finding that blunters experiences more 'somatic effects' regardless of the technique they were assigned may have been the result of a single response--'how much did mind-wandering interfere with performing the technique'--which was the only Factor 2 item that was highly inversely) related to blunting. Since blunters are more likely to perceive mind wandering as the essence of stress management rather than as 'interference,' we do not view this main effect as particularly illuminating" (p. 20). "However, our finding that blunters experienced all techniques as appealing is consistent with the results of Martelli et al. (1) who found that individuals with low information-preference benefitted from what the authors labeled an 'emotion-focused' intervention, but which, in fact, included many of the quite diverse stress management techniques that we compared in the current study. That 'avoiders' failed to benefit from any intervention in the Scott and Clum study (11) may be due to the nature of the stressor [postsurgical pain]. Our undergraduates may have been more like the Martelli dental patients in terms of their level of distress than were the Scott and Clum subjects who were patients undergoing major surgery (hysterectomy or cholecystectomy). Future research needs to examine possible three-way, technique by patient by stressor-type, interactions (cf. 19)" pp 20-21. Evans, Frederick J.; Stanley, R. O. (1990). Psychological interventions for coping with surgery: A review of hypnotic techniques. Australian Journal of Clinical and Experimental Hypnosis, 18, 97-105. Illness, hospitalization, and surgery pose many severe stresses for many patients, to the extent that their ability to understand and cope with what is happening may be significantly reduced. Many of these stresses result from the nature and significance of patients' surgical procedures and post-operative treatment. This paper reviews the range of psychological interventions aimed at helping patients cope with pre- and post-operative treatment regimens. The range and content of hypnotic interventions are examined in detail. It is concluded that more rigorous research studies are required to determine the relative effectiveness of different types of interventions and to evaluate the effects of patients' psychological characteristics on the effectiveness of these interventions. Pekala, Ronald J.; Forbes, Elizabeth J. (1990, Spring). Subjective effects of several stress management strategies: With reference to attention. Behavioural Medicine, 39-43. This study assessed variations in reported attentional experience associated with several stress management techniques (hypnosis, progressive relaxation, deep abdominal breathing) and baseline (eyes closed) as a function of hypnotic susceptibility. Three hundred nursing students experienced the stress management conditions and afterward completed a self-report inventory, the Dimensions of Attention Questionnaire (DAQ), in reference to each condition. The DAQ quantifies 12 aspects of attentional experience in a reliable and valid manner. The results demonstrated that progressive relaxation, hypnosis, and deep abdominal breathing are characterized by differences in reported attentional experience that are further moderated by an individual's hypnotic susceptibility. The clinical implications of these results are discussed. NOTES "Significant main effects were found for conditions for perspicacity, absorption, and control, with progressive relaxation associated with increased perspicacity and absorption, but with decreased control vis-a-vis hypnosis. "Significant main effects for groups were found for perspicacity, locus, direction of attention, absorption, control, and vigilance. ... [Post-hoc comparisons] revealed that high susceptibles (vis-a-vis low susceptibles) reported increased perspicacity, absorption, a more inward-focused attention, more feelings of being out of their bodies, and decreased control and vigilance. High-mediums were also different from lows (in the same direction) for all of the above comparisons except for direction of attention. Low-mediums, along with lows, were different from highs for absorption and control. "Significant interactions between conditions and groups were found for absorption, control, and vigilance. Whereas low susceptibles reported significantly increased absorption but significantly decreased control and vigilance during progressive relaxation than during hypnosis, high susceptibles reported no significant differences between relaxation and hypnosis for absorption, control, or vigilance" (p. 41). The authors describe the differences found for deep abdominal breathing on p. 41. "The interaction effects suggest that the experience of hypnosis and progressive relaxation are moderated by a person's hypnotic susceptibility--low susceptibles experience significantly greater absorption, but decreased control and vigilance during progressive relaxation than during hypnosis, although there are no such differences for high susceptibles. This suggests that progressive relaxation may be a 'better' procedure than hypnosis to use with low susceptibles, at least if one wants to increase absorption and decrease vigilance and control" (p. 42). The authors also note that "deep abdominal breathing is associated with increased 'calmness of mind,' in reference to a baseline condition, as demonstrated by increased attentional detachment and equanimity, and decreased vigilance and density (the 'amount' of thoughts going through one's mind)" (p. 42). Somer, E. (1990). Brief simultaneous couple hypnotherapy with a rape victim and her spouse: A brief communication. International Journal of Clinical and Experimental Hypnosis, 38 (1), 1-5. This paper presents a case involving a rape victim and her emotionally affected spouse. Although the assault occurred before the couple met, the husband was too upset to concentrate when the victim wanted to share her rape-related feelings, nor could he provide the much needed empathy and support. This, apparently, was due to his difficulties in handling his own rage. Simultaneous couple hypnotherapy was used to allow the victim to share her experience under conditions safe for both her and her spouse. As he imagined in trance the rape account described by his age-regressed wife, he learned to identify his emotions and experience them in a controlled manner. During subsequent sessions, the husband was encouraged to include himself in his wife's abreaction and reshape the traumatic scene for both of them. The husband's rescuing behavior and the expressions of violent anger towards the perpetrator had several positive consequences. Not only did they change the abandonment component of the victim's traumatic memory, but they also helped the husband deal in better ways with his own feelings of anger. It also provided the couple with a helpful coping mechanism they later effectively applied under different circumstances. 1989 Palan, B.M.; Chandwani, S. (1989). Coping with examination stress through hypnosis: An experimental study. American Journal of Clinical Hypnosis, 31, 173-180. Fifty-six volunteer medical students participated in three groups balanced for number of subjects, performance at last examination, and hypnotizability. The hypnosis and waking groups attended eight group sessions once a week with general ego- strengthening and specific suggestions for study habits, with a ninth session of age progression and mental rehearsal. Subjects in these two groups practiced self-suggestions (in self-hypnosis or waking respectively) daily for the study period of 9 weeks. The control group experienced sessions of passive relaxation induced by light reading for the same period of time. The hypnosis group improved significantly in coping with examination stress, but there was no significant change in performance on examinations by any of the groups. Sanders, B.; McRoberts, G.; Tollefson, C. (1989). Childhood stress and dissociation in a college population. Dissociation, 2, 17-23. Two studies are reported demonstrating that individual differences in dissociation in college students are positively related to differences in self-reported stressful or traumatic experiences in youth. In Study 1, differences in the degree of stress or unpredictable physical violence experienced in childhood or early adolescence were shown to be related to scores on the Dissociative Experiences Scale (DES). Study 2 replicated these relationships and extended them to another dissociation measure, the Bliss scale. Study 2 also demonstrated that both dissociation measures correlate positively with reported physical and psychological abuse. These findings for a nonclinical population are discussed in relation to the etiology of dissociation in clinical groups.