The aim of this study was to investigate the analgesic effects of hypnotic pain control on experimental pain by measuring pupil reactions as an objective psycho-physiologic parameter. Twenty-two healthy volunteers (11 female and 11 male) aged between 22 and 35 years participated in the study. Pupil diameter was measured as baseline measurement (i.e., static measurement) in the non-hypnotic and in the hypnotic state. Pupil diameter changes to a standardized pain stimulus were measured in the non-hypnotic and hypnotic state and compared. Additionally, a Fourier analysis of pupil oscillations reflecting central nervous activation during the static measurement (25.6 sec) was calculated. During the hypnotic state the pain related pupil dilation was significantly smaller than during the non-hypnotic state. Pupil oscillations were significantly reduced during hypnosis.

Medical University of Vienna, Dept. of Psychiatry, Austria. henriette.walter@meduniwien.ac.at

During hypnosis it is easy to induce hallucinations having, for the hypnotized subject, the characteristics and the concreteness of reality. This study was performed to put in evidence the physical effects of hypnotic suggestion of warm tub bathing. 18 volunteers screened for high hypnotizability were studied. They underwent suggestion of forearm in warm water (30 min), suggestion of body in warm water (30 min), and hypnosis without any thermal suggestion (30 min), while blood pressure, heart rate, body temperature, forearm flow and resistance, stroke volume, cardiac index and total peripheral resistance were monitored. During suggestion of forearm in warm water, local vasodilation was recorded, with decrease of forearm resistance (-18%, P<0.01) and increase of forearm blood flow (+43%, P<0.01) like in real local passive warming. During suggestion of whole-body in a warm water tub, there was a systemic vasodilation with decrease of total peripheral resistance (-29%, P<0.01) and increase of cardiac index (+54%, P<0.01), like in real total-body passive warming. Body temperature, arterial blood pressure and heart rate were unchanged. During simple hypnosis (sham procedure) no haemodynamic variations were observed. These results are in keeping with the possibility to induce through hypnotic suggestion of heat a physical pattern that is typical of hyperthermia, even without increase in body temperature.

Department of Clinical and Experimental Medicine, University of Padova, Via Giustiniani No. 2, Padova, Italy. edoardo.casiglia@unipd.it

Department of Oral Medicine, School of Dental Medicine, The Hebrew University-Hadassah, Jerusalem, Israel. sharav@cc.huji.ac.il

Suggestion for hypnotic analgesia aimed at a specific body area is termed "focused hypnotic analgesia". It is not clear, however, whether this analgesia is limited to a specific body location or spread all over the body. Focused hypnotic analgesia was studied, in response to ascending electrical stimuli, when analgesia and stimulation were applied to the same area (local), and when analgesia was applied to one location and stimulation was delivered to a different area (remote). The face or leg served alternately as the local or remote areas, and the effect was tested in 12 high-hypnotizable (HH) and 13 low-hypnotizable (LH) subjects. Hypnotic analgesia in the local site produced a significant pain reduction compared to the remote site in HH subjects (P<0.0001) but not in LH subjects (P=0.68). As stimuli increased in intensity the reduction in pain as a result of hypnosis was larger both in HH and LH subjects (P<0.0001). Nevertheless, significant analgesia occurred in the 3 highest intensities in the local and remote location of HH subjects, but only in 2 highest intensities in the local and 1 in the remote of LH subjects. We conclude that in HH subjects focused hypnotic analgesia is mostly confined to the area aimed at, but some spread of analgesia to remote areas cannot be dismissed all together. Alternatively, this "spread" of analgesia could be due to a placebo effect in the remote area. Focused hypnotic analgesia requires increased attention to the body area aimed at, unlike analgesia achieved by distraction of attention.

Two groups of tinnitus patients (n=93) were recruited, one of which was treated with standard infusion therapy and further acute medical intervention, while the other obtained an additional psychotherapeutic intervention. Questionnaires and interviews were taken at beginning of the treatment, and 9 days and 3 years after treatment. The accompanying psychotherapeutic intervention consisted primarily of client-centered counseling, guided relaxational techniques from clinical hypnosis, and some standard and tinnitus-related methods for a better coping with stress. After 9 days, both treatment groups showed significant improvement in several psychological characteristics. However, there was no evidence for the superiority of the combined treatment with psychological intervention. Psychotherapeutic treatment accompanying the acute medical treatment probably shows better effectiveness in an ambulant setting with both patients and medical healthcare professionals rating it as 'very helpful'.This pilot study has contributed initial results for the integrated treatment of the acute tinnitus and has helped in the development of further therapeutic strategies as well as an evidence based concept for further evaluation. This study received one of the two scientific first prizes of the "German Tinnitus League".

Fachbereich Psychologie, Universitat Hamburg

In an investigation of the role of cognitive effort in hypnotic responding, high and low hypnotizable participants produced emotionally neutral imagery in response to effortful versus effortless hypnotic suggestions. Heart-rate increase served as an objective index of cognitive effort, and subjective ratings of imagery vividness, absorption, effort, and control were collected. Compared to lows, high hypnotizable participants experienced their imagery as more vivid and absorbing, yet their heart rates indicated no higher level of cognitive effort than lows. Compared to effortless wording, effortful wording of suggestions increased cognitive effort in lows, as indexed by heart-rate increase, but had no effect on the effort expended by highs. Ratings of subjective control were strongly correlated with subjective effort for lows but unrelated for highs. These results support the dissociated-control theory of hypnosis rather than the dissociated-experience or social-cognitive theories.

Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada. psadler@wlu.ca

This study explored using hypnosis for pain and anxiety management in 6 colonoscopy patients (5 men, 1 woman), who received a hypnotic induction and instruction in self-hypnosis on the day of their colonoscopy. Patients' levels of anxiety were obtained before and after the hypnotic induction using Visual Analogue Scales (VAS). Following colonoscopy, VASs were used to assess anxiety and pain during colonoscopy, perceived effectiveness of hypnosis, and patient satisfaction with medical care. Hypnotizability was assessed at a separate appointment. The authors also obtained data (time for procedure, number of vasovagal events, and recovery time) for 10 consecutive patients who received standard care. Results suggest that hypnosis appears to be a feasible method to manage anxiety and pain associated with colonoscopy, reduces the need for sedation, and may have other benefits such as reduced vasovagal events and recovery time.

Department of Psychology & Neuroscience, Baylor University, Waco, Texas 76798-7334, USA. Gary_Elkins@baylor.edu

Case study research suggests that hypnosis treatment may provide benefits that are not necessarily the target of specific suggestions. To better understand satisfaction with and the beneficial "side effects" of hypnosis treatment, questions inquiring about treatment satisfaction and treatment benefits were administered to a group of 30 patients with chronic pain who had participated in a case series of hypnotic analgesia treatment. The results confirmed the authors' clinical experience and showed that most participants reported satisfaction with hypnosis treatment even when the targeted symptom (in this case, pain intensity) did not decrease substantially. Study participants also reported a variety of both symptom-related and nonsymptom-related benefits from hypnosis treatment, including decreased pain, increased perceived control over pain, increased sense of relaxation and well-being, and decreased perceived stress, although no single benefit was noted by a majority of participants.

Department of Rehabilitation Medicine, University of Washington, Seattle, Washington 98195-6490, USA. mjensen@u.washington.edu

BACKGROUND: Needle-related procedures are a common source of pain and distress for children. Several psychological (cognitive-behavioral) interventions to help manage or reduce pain and distress are available; however, a previous comprehensive systematic review of the efficacy of these interventions has not been conducted. OBJECTIVES: To assess the efficacy of cognitive-behavioral psychological interventions for needle-related procedural pain and distress in children and adolescents. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 4, 2005), MEDLINE (1966 to 2005), PsycINFO (1887 to 2005), EMBASE (1974 to 2005), the Cumulative Index to Nursing and Allied Health Literature (1982 to 2005), Web of Science (1980 to 2005), and Dissertation-Abstracts International (1980 to 2005). We also searched citation lists and contacted researchers via various electronic list-servers and via email requests. SELECTION CRITERIA: Participants included children and adolescents aged two to 19 years undergoing needle-related procedures. Only randomized controlled trials (RCTs) with at least five participants in each study arm comparing a psychological intervention group with a control or comparison group were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality. Included studies were coded for quality using the Oxford Quality Scale devised by Jadad and colleagues. Standardized mean differences with 95% confidence intervals were computed for all analyses using RevMan 4.0 software. MAIN RESULTS: Twenty eight trials with 1951 participants were included. Together, these studies included 1039 participants in treatment conditions and 951 in control conditions. The most commonly studied needle-procedures were immunizations and injections. The largest effect sizes for treatment improvement over control conditions exist for distraction (on self-reported pain, SMD -0.24 (95% CI -0.45 to -0.04), combined cognitive-behavioral interventions--reduced other-reported distress (SMD -0.88, 95% CI -1.65 to -0.12; and behavioral measures of distress (SMD -0.67, 95% CI -0.95 to -0.38) with hypnosis being the most promising--self-reported pain (SMD -1.47, 95% CI -2.67 to -0.27), with promising but limited evidence for the efficacy of numerous other psychological interventions, such as information/preparation, nurse coaching plus distraction, parent positioning plus distraction, and distraction plus suggestion. AUTHORS' CONCLUSIONS: Overall, there is preliminary evidence that a variety of cognitive-behavioral interventions can be used with children and adolescents to successfully manage or reduce pain and distress associated with needle-related procedures. However, many of the included studies received lower quality scores because they failed to describe the randomization procedure and participant withdrawals or drop-outs from the study. Further RCTs need to be conducted, particularly for the many interventions for which we could not locate any trials.

Dalhousie University, Department of Psychology, Life Sciences Centre, 1355 Oxford Street, Halifax, Nova Scotia, Canada. luman@dal.ca

The main objective of the present study was to empirically verify the effect of hypnotic training programs on the academic performance of students. A pre and posttest design was used. Two experimental and two control groups (total sample N=119) of volunteer second year psychology students at the University of Stellenbosch in South Africa comprised the sample. One of the experimental groups was exposed to active alert hypnosis and the other to relaxation hypnosis. One control group was exposed to progressive relaxation, while the other did not receive any intervention. The participants' April grades were used as a pretest, while their June grades served as a posttest. The two hypnotic training programs had a significant effect on the academic achievement of the participants, which was not found in the control groups. Regarding the efficacy of the two programs, however, no significant difference was found.

Department of Psychology, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa.