Full title: Cholinergic anti-inflammatory pathway of some non-pharmacological therapies of complementary medicine: possible implications for treatment of rheumatic and autoimmune diseases.

Rheumatologic and autoimmune diseases are among foremost diseases for which patients seek complementary and integrative medicine options. Therefore, physicians should be informed on the advances in research of these therapies, in order to be able to discuss possible indications and contraindications for these treatment modalities with their patients. This review summarizes several therapeutic modalities of complementary medicine that may be involved in the cholinergic anti-inflammatory pathway. The analysis of systematic reviews of acupuncture for rheumatic conditions has concluded that the evidence is sufficiently sound to warrant positive recommendations of this therapy for osteoarthritis, low back pain and lateral elbow pain. There is relatively strong evidence to support the use of hypnosis in pain treatment, such as in cases of fibromyalgia. A recent controlled study that evaLuated tai-chi in fibromyalgia has reported reductions in pain, improvements in mood, quality of Life, self efficacy and exercise capacity. There is also cumulative evidence that acupuncture, hypnosis and tai-chi may decrease the high frequency of heart rate variability, suggesting enhancement of vagus nerve activity. Hence, it has been hypothesized that these modalities might impact the cholinergic anti-inflammatory pathway to modulate inflammation. Further clinical and basic research to confirm this hypothesis should be performed in order to validate integration of these therapies in comprehensive treatment for some inflammatory and autoimmune diseases.

Harefuah. 2011 Aug;150(8):660-3, 687. Gamus D. Complementary Medicine Service, Sheba Medical Center, Tel-Hashomer. dorit.gamus@sheba.health.gov.il

Obtaining complete information lies at the heart of accurate diagnosis in all healthcare fields. Extracting information is a time-honored purpose of the history and physical examination. Practitioners may not be aware that these functions also provide opportunities to impart positive verbal and nonverbal suggestions. Paying attention to language promotes patient self-mastery and helps forge a therapeutic alliance for successful outcomes. Principles taught in hypnosis workshops can also help the practitioner avoid negative, undermining suggestions that could diminish diagnostic and therapeutic effectiveness.

Am J Clin Hypn. 2011 Jul;54(1):5-15. Berberich FR. Pediatric Suggestions, Berkeley, CA 94707, USA. dr.berberich@pediatricsuggestions.net

The popularity of complementary medicine in the western world continues to grow. Complementary medicine has a wide scope of topics including acupuncture, hypnosis, meditation, chiropractic manipulation, tai chi, yoga, botanical and herbal supplements and many other undefined modalities such as copper bracelets, magnets, holy water etc. For most modalities the mechanism of action is unknown and the evidence of benefit is poor. Some modalities such as acupuncture, hypnosis and tai chi may improve pain and other subjective complains. It seems that most of the beneficial effects of complementary medicine are placebo effects. Complementary treatment may be associated with side effects and should not be an alternative to the conventional medicine. Complementary medicine can be used as an adjunct to the conventional medicine and should be used in full agreement with and under the supervision of the attending physician. Patients should be informed about the existing evidence and what to expect from complementary medicine. Further meticulous research should be conducted to expand our knowledge in complementary medicine.

Harefuah. 2011 Aug;150(8):657-8, 687. Grossman E.

The role of parents in the use of hypnosis with their children raises many questions worthy of consideration. A survey of the literature reveals that this important topic has not been given the attention or depth it deserves. The author looks at (a) how, when, and whether to incorporate parents in the treatment of their children; (b) how to address attachment and trance between parent and child; (c) engaging parents in their own hypnotic abilities beginning as early as the birthing experience; and (d) improving parenting skills such as teaching parents to pay attention to their use of language with their children in order to shift patterns of communication from unproductive to useful. In addition, the author explores the ways to invite, teach, support and interact with the family system of parent and child in our hypnotic work.

Am J Clin Hypn. 2011 Jul;54(1):70-81. Linden JH. juliehlinden@comcast.net

Full Title: Complementary and alternative medicine (CAM) among hospitalised patients: Reported use of CAM and reasons for use, CAM preferred during hospitalisation, and the socio-demographic determinants of CAM users.

PURPOSE: This paper reports a study to examine hospitalised patients' frequency and patterns of CAM use, their reasons for CAM use, their preferences of CAMs during hospitalisation, and the association between patients' socio-demographic variables and use of each individual CAM/CAM domain. METHODS: A convenience sample of 353 patients hospitalised in 19 surgical wards at four metropolitan hospitals completed a questionnaire on CAM use and socio-demographic variables. RESULTS: The response rate was 73.5%, and over 90% of the sample acknowledged using CAMs. Non-herbal supplements (60.3%) and massage therapy (45%) were the most frequently used CAMs, with biologically based therapies (68.8%) as well as mind-body interventions (65.4%) being the most often used CAM domains. About 1 in 10 patients (9.6%) used CAMs from all five domains. With the exception of herbal-botanical therapies, self-prayer for health reasons/spiritual healing and music therapy, all CAMs were mainly used on an 'only when needed' basis. The most common reason nominated for using CAMs was that '[it] fits into my way of life/philosophy' (26%). The majority of patients declared interest in and support for the hospital providing CAMs. Patients were most inclined to choose therapies categorised as manipulative and body-based methods (65.4%) for use in hospital. Massage therapy (53.5%) and non-herbal supplements (43.1%) were the top two CAMs favoured for use in hospital. CAM use was also dependent of socio-demographic data (age, gender, marital status, place of residence, education level, religion, and income in hospitalised patients). CONCLUSION: The use of CAMs is pervasive amongst surgical in-patients, making it feasible to initially assess these patients for CAM use and provide them with clinically approved CAMs where possible. Notwithstanding that CAM use is fairly predictable by socio-demographic variables, further studies should be directed to know the variables useful for predicting the use of each CAM approach.

Complement Ther Clin Pract. 2011 Nov;17(4):199-205. Shorofi SA. School of Nursing & Midwifery, Flinders University, GPO Box 2100, Adelaide 5001, Australia.

by Tim Brunson, PhD

In 1953, in what is probably the most famous cartoon quotation, Pogo stated that "We have met the enemy and he is us." No other utterance so closely conveys my misgivings and concerns about the struggle between the clinical approach to hypnotherapy and the rather idealistic one, which is too much en vogue in contemporary practices. My initial training and the numerous certifications previously received from four well-established international hypnotherapy associations clearly stated that I possessed clinical credentials. Yet upon further reflection and after being challenged in 2006 by a group of medical doctors to reconcile my accomplishments with relevant scientific literature, I started questioning how my colleagues – and even those in the medical and psychology professions – were using the word clinical in regards to hypnotherapy. This pondering continued during my successful efforts to complete a PhD dissertation on neurology and hypnosis. During that process I was expected to clarify, validate, and cite my various statements and claims. Many of my concerns emanate from those efforts.

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Hypnotherapy has many uses in pediatrics, and its value, not only as a adjunct but also as a primary therapy for certain conditions, justifies its inclusion in pediatric training programs. Suggestion and expectation have long been related to therapeutic outcomes in medicine, but not all physicians know how to apply them constructively and systematically in communication with patients. In pediatrics there is a tendency to overlook opportunities in which hypnosis might be the treatment of choice. Because children engage in imagination and fantasy easily without the cognitive inhibitions of adults, they are able to use hypnosis more readily than adults. More research into the imaginative skills of children may facilitate understanding of learning mechanisms and make it possible for professionals to prevent the loss of the natural imaginative capacities in children and, therefore, enhance the ability of mature members of society to use these skills. In addition to reduction of specific symptoms through hypnotherapy, children benefit by the sense of mastery which they acquire, a sense which is surely needed to overcome the feelings of hopelessness, loss of control, and depression induced by many diagnostic and therapeutic procedures in medicine.

Pediatrics. 1978 Aug;62(2):228-33. Olness K, Gardner GG.

Full title: Treatment of HPV with Hypnosis-Psychodynamic Considerations of Psychoneuroimmunology: A Brief Communication.

Abstract There is increasing evidence that the hypnotic cure of warts (infection by the human papilloma virus or HPV) results from activation of an immune response, but whether this is cellular or systemic is unknown. The hypnosis can be by direct suggestion or analytical hypnotherapy when indicated. The evidence is reviewed, and 4 clinical cases suggesting cellular immune response are presented.

Psychoneuroimmunology: A Brief Communication. Int J Clin Exp Hypn. 2011 Oct-Dec;59(4):392-8. Ewin DM. a Tulane University Medical School , New Orleans , Louisiana , USA.

Resting state fMRI (functional magnetic resonance imaging) acquisitions are characterized by low-frequency spontaneous activity in a default mode network (encompassing medial brain areas and linked to self-related processes) and an anticorrelated "extrinsic" system (encompassing lateral frontoparietal areas and modulated via external sensory stimulation). In order to better determine the functional contribution of these networks to conscious awareness, we here sought to transiently modulate their relationship by means of hypnosis. We used independent component analysis (ICA) on resting state fMRI acquisitions during normal wakefulness, under hypnotic state, and during a control condition of autobiographical mental imagery. As compared to mental imagery, hypnosis-induced modulation of resting state fMRI networks resulted in a reduced "extrinsic" lateral frontoparietal cortical connectivity, possibly reflecting a decreased sensory awareness. The default mode network showed an increased connectivity in bilateral angular and middle frontal gyri, whereas its posterior midline and parahippocampal structures decreased their connectivity during hypnosis, supposedly related to an altered "self" awareness and posthypnotic amnesia. In our view, fMRI resting state studies of physiological (e.g., sleep or hypnosis), pharmacological (e.g., sedation or anesthesia), and pathological modulation (e.g., coma or related states) of "intrinsic" default mode and anticorrelated "extrinsic" sensory networks, and their interaction with other cerebral networks, will further improve our understanding of the neural correlates of subjective awareness.

Prog Brain Res. 2011;193:309-22. Demertzi A, Soddu A, Faymonville ME, Bahri MA, Gosseries O, Vanhaudenhuyse A, Phillips C, Maquet P, Noirhomme Q, Luxen A, Laureys S. Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium.

Full Title: Complementary and alternative treatment for neck pain: chiropractic, acupuncture, TENS, massage, yoga, Tai Chi, and Feldenkrais.

Of the multitude of treatment options for the management of neck pain, no obvious single treatment modality has been shown to be most efficacious. As such, the clinician should consider alternative treatment modalities if a modality is engaging, available, financially feasible, potentially efficacious, and is low risk for the patient. As evidence-based medicine for neck pain develops, the clinician is faced with the challenge of which treatments to encourage patients to pursue. Treatment modalities explored in this article, including chiropractic, acupuncture, TENS, massage, yoga, Tai Chi, and Feldenkrais, represent reasonable complementary and alternative medicine methods for patients with neck pain.

Phys Med Rehabil Clin N Am. 2011 Aug;22(3):521-37, ix. Plastaras CT, Schran S, Kim N, Sorosky S, Darr D, Chen MS, Lansky R. Department of Physical Medicine and Rehabilitation, Penn Spine Center, University of Pennsylvania, Philadelphia, PA 19104, USA. Christopher.plastaras@uphs.upenn.edu

Full Title: Top-down and bottom-up mechanisms in mind-body medicine: development of an integrative framework for psychophysiological research.

It has become increasingly evident that bidirectional ("top-down and bottom-up") interactions between the brain and peripheral tissues, including the cardiovascular and immune systems, contribute to both mental and physical health. Therapies directed toward addressing functional links between mind/brain and body may be particularly effective in treating the range of symptoms associated with many chronic diseases. In this paper, we describe the basic components of an integrative psychophysiological framework for research aimed at elucidating the underlying substrates of mind-body therapies. This framework recognizes the multiple levels of the neuraxis at which mind-body interactions occur. We emphasize the role of specific fronto-temporal cortical regions in the representation and control of adverse symptoms, which interact reciprocally with subcortical structures involved in bodily homeostasis and responses to stress. Bidirectional autonomic and neuroendocrine pathways transmit information between the central nervous system and the periphery and facilitate the expression of affective, autonomic, hormonal, and immune responses. We propose that heart rate variability (HRV) and markers of inflammation are important currently available indices of central-peripheral integration and homeostasis within this homeostatic network. Finally, we review current neuroimaging and psychophysiological research from diverse areas of mind-body medicine that supports the framework as a basis for future research on the specific biobehavioral mechanisms of mind-body therapies.

Explore (NY). 2010 Jan;6(1):29-41. Taylor AG, Goehler LE, Galper DI, Innes KE, Bourguignon C. Center for the Study of Complementary and Alternative Therapies, School of Nursing, University of Virginia, Charlottesville, VA, USA. agt@virginia.edu

Physicians have long used the power of suggestion informally in their practice as a means of motivating patients and boosting compliance. Recent research shows that formal use of hypnosis can be a valuable primary or adjunctive therapy, especially in children. Children are more in touch with innate imagery processes than adults and consequently can learn and use self-hypnosis easily, particularly to control autonomic responses. Hypnotherapy has proven useful in habit and behavior disorders, psychophysiologic disorders, pain control, anxiety control, cellular growth, and chronic conditions. The cases reported here illustrate the effectiveness of this process in children. Before hypnotherapy can be used clinically, the physician should become certified by an association approved by the American Medical Association and know when hypnotherapy is indicated and how long it should be continued.

Postgrad Med. 1986 Mar;79(4):95-100, 105. Olness KN.

Full Title: What Factors Are Influencing Preferences Toward Conventional Versus Complementary and Alternative Medical Clinic Advertisements?

Abstract Objectives: The present study aimed to determine whether health service advertisements are perceived differently depending on advertising conventional or complementary and alternative medicine clinics. Methods: A total of 42 adults (male=21, female=21) recruited through advertisements in Seoul, South Korea participated in this study. A standardized health service advertisement was designed with three controlled visual components such as (1) medical treatment information, (2) medical practitioner, and (3) medical facilities and it was shown to subjects while their eye movements were tracked and they were asked to rate their preferences for the different advertisements and their separate components. A multiple regression analysis was performed to see the correlation of the preferences for each of the three visual components with the overall preference rating of each health service advertisement. Results: Preferences for the advertisement depended mostly on the preference for the medical treatment information, whereas advertisements for complementary and alternative medical clinics depended also on the preference for the medical practitioner. Conclusions: These results imply that the same health service advertisement will be perceived differently depending on whether it advertises Western or Oriental medical clinics.

J Altern Complement Med. 2011 Oct 6. Shin HW, Chang DS, Lee H, Kang OS, Lee H, Park HJ, Chae Y. Acupuncture & Meridian Science Research Center, College of Oriental Medicine, Kyung Hee University , Seoul, Republic of Korea .

Hypnotic and nonhypnotic suggestibility were investigated in 2 experiments. In Experiment 1, nonhypnotic suggestibility was suppressed when measured after hypnotic suggestibility, whereas hypnotic suggestibility was not affected by the order of assessment. Experiment 2 confirmed a small but significant effect of hypnosis on suggestibility when nonhypnotic suggestibility was measured first. Nonhypnotic suggestibility was correlated with absorption, fantasy proneness, motivation, and response expectancy, but only expectancy predicted suggestibility when the other variables were controlled. Behavioral response to hypnosis was predicted by nonhypnotic suggestibility, motivation, and expectancy in a model accounting for 53% of the variance. Experiential response to hypnotic suggestion was predicted only by nonhypnotic suggestibility. Unexpectedly, hypnosis was found to decrease suggestibility for a substantial minority of participants.

Braffman W, Kirsch I. Department of Psychology, University of Connecticut, Storrs 06269-1020, USA.

The word "suggestion" has been used in educational, scientific and medical literature in slightly different senses. In psychological medicine the use of suggestion has developed out of the earlier use of hypnotic influence.Charcot defined hypnosis as an artificial hysteria, Bernheim as an artificially increased suggestibility. The two definitions need to be combined to give an adequate account of hypnosis. Moreover, due allowance should be made for the factors of dissociation and of rapport in hypnotic phenomena.The relationships between dissociation, suggestibility, and hypnotizability.Theories of suggestion propounded by Pierre Janet, Freud, McDougall, Pawlow and others. Ernest Jones's theory of the nature of auto-suggestion. Janet explains suggestion in terms of ideo-motor action in which the suggested idea, because of the inactivity of competing ideas, produces its maximum effect. Freud explains rapport in terms of the sex instinct "inhibited in its aim" (transference) and brings in his distinction of "ego" and "ego-ideal" (or "super-ego") to supplement the theory. Jones explains auto-suggestion in terms of narcissism. McDougall explains hypnotic suggestion in terms of the instinct of self-abasement. But different instincts may supply the driving power to produce suggestion-effects in different circumstances. Such instincts as those of self-preservation (fear) and gregariousness may play their part. Auto-suggestion as a therapeutic factor is badly named. It supplements, but does not supplant the will, and makes complete volition possible.

J Pers Soc Psychol. 1999 Sep;77(3):578-87. Brown W. Proc R Soc Med. 1928 Feb;21(4):573-82.

An important area of study has examined cognitive aspects of morningness-eveningness orientation. Optimal times of efficiency in participants classified as Morning and Evening types are of great importance for understanding their cognitive abilities. The present review covers the last two decades (1990-2009), during which the important review by Tankova, Adan, and Buela-Casal appeared, and focuses particularly on attention, memory, and executive functions.

Percept Mot Skills. 2011 Apr;112(2):649-65. Cavallera GM, Boari G, Giudici S, Ortolano A. Dipartimento di Scienze del Movimento Umano, Facoltà di Scienze dell'Educazione Motoria, Università G. D'Annunzio, Chieti-Pescara, Italy. g.cavallera@email.it

As part of a wider argument that history is essential to psychological understanding because of the reflexive nature of psychological knowledge, this article examines the case of mesmerism in early Victorian Britain as an example of how psychological knowledge is both constructive and constructed. It is argued that the shift from "mesmerism" to "hypnotism" was a change in understanding that created a new kind of psychological experience. It is also argued that demonstrations of mesmerism, far from being self-evident facts, could be framed as evidence either for or against the central claims of mesmerism. It is concluded that the case of mesmerism in early Victorian Britain provides a further example of the need for historical understanding within Psychology.

Hist Psychol. 2010 Nov;13(4):393-408. Lamont P. Department of Psychology, University of Edinburgh, United Kingdom. peter.lamont@Ed.ac.uk

by Tim Brunson, PhD

Few concepts garner as much misunderstanding, confusion, and fear as the word hypnosis. Novelists and screenwriters perpetuate these myths as they continually portray hypnotic acts as those done by sinister men who suddenly override the common sense and moral trepidations of unwitting victims. Even respectable professional book publishers regularly contract clinical authors who spice up their work by off-handedly referring to hypnosis or otherwise reinforcing the popular – and scientifically unfounded – clichés that are so popular among psychologists and medical professionals. All the while, they serve more to mislead their colleagues than to enlighten them. Additionally, well-established trade and professional organizations regularly certify their members despite the fact that little – if any – of their educational curriculum reflects the relevant impact of recent scientific revelations.

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Full Title: Between psychology and pedagogy: "moral orthopedics" and case studies of children in fin-de-siècle French medicine.

In the latter decades of the 19th century, European physicians debated a controversial practice that mixed placebos with suggestion therapy to treat children diagnosed with neurotic disorders and behavioral problems. Designed to optimize suggestibility in juvenile patients, this "moral orthopedics" offered parents and therapists the message that children could be saved from becoming victims of their own personalities, of familial neuroses, or even of public health problems. Case studies, published in medical journals and books, circulated accounts of innovative strategies to treat childhood hysteria and to change habits that were considered destructive. Moral orthopedics actualized the insight that suggestibility could be therapeutically productive for juvenile subjects. However, because its adherents sought to manipulate patients' behavior and health by influencing unconscious thought, moral orthopedics provoked questions of expertise and disciplinary propriety among domains of medicine, law, and philosophy. This article reconstructs the controversy surrounding moral orthopedics by examining case studies. I argue that adherents of moral orthopedics did overcome philosophical objections raised against the method, and that they did so through what physician Edgar B6rillon referred to as "education of the will."

Hist Psychol. 2011 Feb;14(1):26-52. Rose AC. Department of History, Grand Valley State University, Allendale, MI 49401, USA. crestienne@gmail.com

by Ted Benton M.Ed., CI

The use of the hypnotic hero is a very creative and successful hypnotic technique. Approximately one third of my therapy practice involves children from four until the late teen years. The majority of children have heroes; these heroic people can be real or imagined. I began using this new technique after a weekend of training with the American Psychological Association ( Hypnotherapy and Personality Disorders ). I strongly recommend HYPNOSIS AND HYPNOTHERAPY WITH CHILDREN by Karen Olness, MD and G. Gail Gardner, PHD for any hypnotherapist who is interested in working with children. Request the third edition from 1996.

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PURPOSE: The aims of this study were to evaluate the frequency of complementary and alternative medicine (CAM) use among radiation oncology patients, the coping strategies that influenced this use, and the rates of disclosure of CAM use to their healthcare providers. METHODS: One hundred fifty-three patients undergoing radiation therapy for various neoplasms at rural cancer centers in Minnesota completed the Mayo Complementary and Alternative Medicine Use Survey and the Coping Inventory for Stressful Situations questionnaires. Data regarding CAM use was also compared with provider consultation notes in the medical record at the onset of radiation therapy to determine rates of patient disclosure of CAM use to their healthcare providers. RESULTS: A total of 153 participants completed the study with 61.4% females and 38.6% males and a mean age of 64.9 years. The two most frequent diagnoses of participants were breast cancer (43.8%) and prostate cancer (22.9%). CAM use was reported in 95% of the participants and was categorized into three domains: treatments and techniques, vitamins, and herbs and supplements. The three most frequently reported treatments and techniques were spiritual healing/prayer (62.1%), exercise (19.6%), and music (17.6%). The top three most frequently used biologically based CAM therapies were multivitamins (48.1%), calcium (37.3%), and vitamin with minerals (21.5%). The most frequently used herbs and other dietary supplements were fish oil (19.0%), flaxseed (15.0%), glucosamine (15.0%), and green tea (15.0%). The most common reason cited for CAM treatments and techniques use was previous use (26.1%), for use of vitamins and minerals was recommendation by a physician (33.0%), and for use of herbs and other supplements was previous use (19.0%). One hundred twelve participants reported taking vitamins, minerals, or supplements, and 47% of those 112 did not disclose this use to their providers. CONCLUSIONS: Consistent with previous research, our study found that the majority of cancer patients used CAM treatments. Spiritual healing/prayer was the most commonly reported, followed by multivitamins. Patients reported using CAM primarily due to previous use and physician recommendation. Unfortunately, disclosure of CAM use to healthcare providers was relatively low.

Support Care Cancer. 2011 Apr;19(4):521-9. Epub 2010 Mar 25. Rausch SM, Winegardner F, Kruk KM, Phatak V, Wahner-Roedler DL, Bauer B, Vincent A. Integrative Medicine, H. Lee Moffitt Cancer Center, Tampa, FL, USA. Sarah.rausch@moffitt.org

Holism is the philosophy of understanding people by addressing factors that affect people in all situations. The goal of holistic nursing is to help patients integrate appropriate self-care into their lives. By providing holistic care, the perioperative nurse can help surgical patients experience fewer problems (eg, surgical trauma, pain, anesthetic complications), reach discharge more quickly, attain satisfaction with health care, and more easily resume normal activities. Holistic nursing may include the use of music, guided imagery, therapeutic massage, play therapy, touch therapy, and communication skills. Successful surgery for the patient means not only recovering but regaining physical, mental, and spiritual health as a whole.

AORN J. 2011 Apr;93(4):482-7; quiz 488-90. Selimen D, Andsoy II. Surgical Nursing Department, Marmara University, Istanbul, Turkey.

As part of a wider argument that history is essential to psychological understanding because of the reflexive nature of psychological knowledge, this article examines the case of mesmerism in early Victorian Britain as an example of how psychological knowledge is both constructive and constructed. It is argued that the shift from "mesmerism" to "hypnotism" was a change in understanding that created a new kind of psychological experience. It is also argued that demonstrations of mesmerism, far from being self-evident facts, could be framed as evidence either for or against the central claims of mesmerism. It is concluded that the case of mesmerism in early Victorian Britain provides a further example of the need for historical understanding within Psychology.

Hist Psychol. 2010 Nov;13(4):393-408. Lamont P. Department of Psychology, University of Edinburgh, United Kingdom. peter.lamont@Ed.ac.uk

by Tim Brunson, PhD

There is a big difference between the popular use of many terms and their more precise – and correct – usage. While conversations may abound using the former, legal authority and credibility depend upon the latter. And, it is through the precise use of our terminology that we set ourselves apart from others.

Are you a professional practitioner or just a lay person? Are all of your degrees from "fully accredited" universities? Over the years I've heard many of the leaders of numerous international associations talk about their organizations being comprised of professionals despite their having only a vague idea as to what they were saying. And, there are plenty of websites on which practitioners are extremely adamant claiming that the legitimacy of their organizations or their degrees and certifications are more valid than others. Unfortunately, too many people – with numerous initials trailing their names – are excessively quick when it comes to throwing around terms as if they are certain that they know about what they are talking.

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by Joyce-Anne Locking

Nature has a way of renewing our faith in survival. If every tree, plant and flower follows its own season, our own special work surely has a season of its own too. When we learn to trust in our natural abilities, we begin to treat ourselves more gently. We become kinder to ourselves and others. This compassion is one of the first fruits of aligning our creativity with its source, says creativity thinker, Julia Cameron. When we adjust our thinking and place our dependency on the source itself, the source meets our needs through people, places and things, she says. One of the central tasks of creative recovery is learning to accept this generosity. In other words, our faith in our abilities will win out so long as we trust and believe in what we do. It all sounds so simple. Like an equation, if we follow the steps, we achieve the proper outcome. We are all equally connected to a spiritual source, continues well-known arts writer, Julia Cameron. We do not always know which among us will teach us best. We are all meant to cherish and serve one another. Expect the universe to support your dream. It will. It all comes down to what we believe.

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The terms 'placebo' and 'placebo effects' cause confusion among patients, practitioners and scientists. This confusion results in both the adoption of practices that have no evidence of specificity yet considerable risk (such as surgery for low back pain) or the elimination of clinical practices proven to facilitate healing because they are not 'better than placebo' (such as acupuncture for low back pain). In this article, I discuss these issues and introduce the concept of optimal healing environment as a framework for disentangling what is useful from placebo research for adopting into clinical practice in a manner that is ethical and evidence-based.

Philos Trans R Soc Lond B Biol Sci. 2011 Jun 27;366(1572):1896-904. Jonas WB. Samueli Institute, 1737 King Street, Suite 600, Alexandria, VA 22314, USA.

Prurigo Nodularis (PN) is a chronic pruritic skin condition for which current conventional therapies are of limited benefit and with potentially toxic effects. Acupuncture--the insertion of thin needles at specific points on the skin--has been shown to alleviate itching through a number of itch-associated mediator effects. Hypnosis has been shown to modify and reduce the intensity of itching as well. A 44 year-old woman presented with a 30-year history of a diffuse itchy rash diagnosed as PN. She had tried various antihistamine and corticosteroid medications, to no avail. A treatment regimen using hypnosis and acupuncture (hypnopuncture) was initiated, with significant reduction in the itching, size and number of skin lesions. Hypnopuncture may offer a synergistic and augmented response to treatment, though further research is needed to understand the true benefits of this combined regimen.

Am J Clin Hypn. 2011 Apr;53(4):283-92. Samuels N, Sagi E, Singer SR, Oberbaum M. Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, P.O.B. 3235, Jerusalem 91031, Israel. refplus@netvision.net.il

Full title: Differential frontal-parietal phase synchrony during hypnosis as a function of hypnotic suggestibility.

Spontaneous dissociative alterations in awareness and perception among highly suggestible individuals following a hypnotic induction may result from disruptions in the functional coordination of the frontal-parietal network. We recorded EEG and self-reported state dissociation in control and hypnosis conditions in two sessions with low and highly suggestible participants. Highly suggestible participants reliably experienced greater state dissociation and exhibited lower frontal-parietal phase synchrony in the alpha2 frequency band during hypnosis than low suggestible participants. These findings suggest that highly suggestible individuals exhibit a disruption of the frontal-parietal network that is only observable following a hypnotic induction.

Psychophysiology. 2011 Apr 15. doi: 10.1111/j.1469-8986.2011.01211.x. Terhune DB, Cardeña E, Lindgren M. Department of Psychology, Lund University, Lund, Sweden Department of Experimental Psychology, University of Oxford, Oxford, UK.

Since hypnosis was popularly recognized in the nineteenth century, the phenomenon of hypnotizability has remained poorly understood. The capacity to increase hypnotizability has important implications because it may increase the number of people who can benefit from hypnotic interventions for psychological and medical conditions. Current theories emphasize that rapport between hypnotist and subject is pivotal to motivate the respondent to engage in strategies that allows them to suspend reality and respond to suggestions. The neuropeptide oxytocin is implicated in social bonding, and enhances a range of social behaviors in animals and humans. This study tested the proposal that oxytocin administration, which enhances social bonding in humans, may enhance hypnotic responding by administering intranasal spray of oxytocin or placebo prior to hypnosis in 40 low hypnotizable male subjects. When low hypnotizable individuals were administered oxytocin via nasal spray, their level of hypnotic responding increased significantly compared to hypnotic responding levels prior to oxytocin administration. This is the first demonstration of a neurochemical basis for hypnotic responding, and points to a potential neural mechanism to explain hypnotizability.

Psychoneuroendocrinology. 2011 Jun 6. Bryant RA, Hung L, Guastella AJ, Mitchell PB. School of Psychology, University of New South Wales, Sydney, New South Wales 2052, Australia.

Hypnotic suggestibility has been described as a powerful predictor of outcomes associated with hypnotic interventions. However, there have been no systematic approaches to quantifying this effect across the literature. This meta-analysis evaluates the magnitude of the effect of hypnotic suggestibility on hypnotic outcomes in clinical settings. PsycINFO and PubMed were searched from their inception through July 2009. Thirty-four effects from 10 studies and 283 participants are reported. Results revealed a statistically significant overall effect size in the small to medium range (r = .24; 95% Confidence Interval = -0.28 to 0.75), indicating that greater hypnotic suggestibility led to greater effects of hypnosis interventions. Hypnotic suggestibility accounted for 6% of the variance in outcomes. Smaller sample size studies, use of the SHCS, and pediatric samples tended to result in larger effect sizes. The authors question the usefulness of assessing hypnotic suggestibility in clinical contexts.

Int J Clin Exp Hypn. 2011 Jul;59(3):294-309. Montgomery GH, Schnur JB, David D. Mount Sinai School of Medicine, New York, New York, USA.

Hypnotic suggestibility has been described as a powerful predictor of outcomes associated with hypnotic interventions. However, there have been no systematic approaches to quantifying this effect across the literature. This meta-analysis evaluates the magnitude of the effect of hypnotic suggestibility on hypnotic outcomes in clinical settings. PsycINFO and PubMed were searched from their inception through July 2009. Thirty-four effects from 10 studies and 283 participants are reported. Results revealed a statistically significant overall effect size in the small to medium range (r = .24; 95% Confidence Interval = -0.28 to 0.75), indicating that greater hypnotic suggestibility led to greater effects of hypnosis interventions. Hypnotic suggestibility accounted for 6% of the variance in outcomes. Smaller sample size studies, use of the SHCS, and pediatric samples tended to result in larger effect sizes. The authors question the usefulness of assessing hypnotic suggestibility in clinical contexts.

Int J Clin Exp Hypn. 2011 Jul;59(3):294-309. Montgomery GH, Schnur JB, David D. Mount Sinai School of Medicine, New York, New York, USA.

This article examines issues raised by a recent UK legal case in which the defense argued that the accusations made by the highly hypnotizable plaintiff were likely based on false memories. The authors argue that the evidence related to hypnotizability and false memory production is inconsistent but may be illuminated by a sociocognitive perspective. They present 2 preliminary studies that indicate that when the instructions imply that accurate reporting is a feature of hypnosis, higher hypnotizables may actually be more resistant than low or medium hypnotizables to false memories arising from misleading information given during hypnosis. They conclude that, when memory accuracy is emphasized rather than productivity, there is little evidence to link high hypnotizability with a propensity to produce false memories.

Int J Clin Exp Hypn. 2011 Jul;59(3):310-26. Wagstaff GF, Wheatcroft JM, Jones AC. University of Liverpool, United Kingdom.

Full title: Responding to hypnotic and nonhypnotic suggestions: performance standards, imaginative suggestibility, and response expectancies.

This study examined the relative impact of hypnotic inductions and several other variables on hypnotic and nonhypnotic responsiveness to imaginative suggestions. The authors examined how imaginative suggestibility, response expectancies, motivation to respond to suggestions, and hypnotist-induced performance standards affected participants' responses to both hypnotic and nonhypnotic suggestions and their suggestion-related experiences. Suggestions were administered to 5 groups of participants using a test-retest design: (a) stringent performance standards; (b) lenient performance standards; (c) hypnosis test-retest; (d) no-hypnosis test-retest; and (e) no-hypnosis/hypnosis control. The authors found no support for the influence of a hypnotic induction or performance standards on responding to suggestions but found considerable support for the role of imaginativesuggestibility and response expectancies in predicting responses to both hypnotic and nonhypnotic suggestions.

Int J Clin Exp Hypn. 2011 Jul;59(3):327-49. Meyer EC, Lynn SJ. Binghamton University, State University of New York, USA.

Contemporary studies in the cognitive neuroscience of attention and suggestion shed new light on the underlying neural mechanisms that operationalize these effects. Without adhering to important caveats inherent to imaging of the living human brain, however, findings from brain imaging studies may enthrall more than explain. Scholars, practitioners, professionals, and consumers must realize that the influence words exert on focal brain activity is measurable but that these measurements are often difficult to interpret. While recent brain imaging research increasingly incorporates variations of suggestion and hypnosis, correlating overarching hypnotic experiences with specific brain substrates remains tenuous. This article elucidates the mounting role of cognitive neuroscience, including the relative merits and intrinsic limitations of neuroimaging, in better contextualizing trance-like concepts.

Int J Clin Exp Hypn. 2011 Jul;59(3):363-77. Raz A. McGill University, Montreal, Quebec, Canada.

Comment on: Conscious Cogn. 2010 Dec;19(4):1140-50.

This commentary reflects on the varieties of high hypnotizable subjects suggested in the works by Barber, Barrett, Pekala and colleagues, and Terhune and Cardeña (2010). These different studies point to the existence of different types of low, medium, and high hypnotizable subjects. However, types of high hypnotizables have received the most attention. Two main concerns are raised in this commentary: (a) drawing parallels between the suggested typologies is not without problems given methodological differences among different studies, and (b) the low base rates of these special types is likely not to appeal to a typical clinician, already resistant to testing for hypnotizability, to conduct initial assessments so as to tailor suggestion to fit specific typologies.

Conscious Cogn. 2010 Dec;19(4):1151-3; discussion 1154-5. Epub 2010 Apr 28. Kumar VK. Department of Psychology, West Chester University of Pennsylvania, West Chester, PA 19383, United States. Kkumar@wcupa.edu

Full title: Mood color choice helps to predict response to hypnotherapy in patients with irritable bowel syndrome.

BACKGROUND: Approximately two thirds of patients with irritable bowel syndrome (IBS) respond well to hypnotherapy. However, it is time consuming as well as expensive to provide and therefore a way of predicting outcome would be extremely useful. The use of imagery and color form an integral part of the hypnotherapeutic process and we have hypothesised that investigating color and how it relates to mood might help to predict response to treatment. In order to undertake this study we have previously developed and validated a method of presenting colors to individuals for research purposes called the Manchester Color Wheel (MCW). Using this instrument we have been able to classify colors into positive, neutral and negative shades and this study aimed to assess their predictive role in hypnotherapy.

METHODS: 156 consecutive IBS patients (aged 14-74, mean 42.0 years, 127 (81%) females, 29 (19%) males) were studied. Before treatment, each patient was asked to relate their mood to a color on the MCW as well as completing the IBS Symptom Severity Score, the Hospital Anxiety and Depression (HAD) Scale, the Non-colonic Symptom Scale, the Quality of Life Scale and the Tellegen Absorption Scale (TAS) which is a measure of hypnotisability. Following hypnotherapy all these measures were repeated with the exception of the TAS.

RESULTS: For patients with a positive mood color the odds of responding to hypnotherapy were nine times higher than that of those choosing either a neutral or negative color or no color at all (odds ratio: 8.889; p = 0.042). Furthermore,a high TAS score and the presence of HAD anxiety also had good predictive value (odds ratio: 4.024; p = 0.092, 3.917; p < 0.001 respectively) with these markers and a positive mood color being independent of each other. In addition, these factors could be combined to give an even stronger prediction of outcome. Twice as many responders (63, 77.8%) had a positive mood color or were anxious or had a high TAS score compared with 32 (42.7%) without these factors (p < 0.001).

CONCLUSION: A positive mood color, especially when combined with HAD anxiety and a high TAS score, predict a good response to hypnotherapy.

BMC Complement Altern Med. 2010 Dec 7;10:75. Carruthers HR, Morris J, Tarrier N, Whorwell PJ. Department of Medicine, University of Manchester, Manchester, UK.