A study at the University of Kansas compares music, relaxation and silence on the energy levels, tension, fatigue, calmness and working memory of older adults.

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The aim of this review was to find the evidence for or against the use of hypnotherapy in the treatment of symptoms in terminally ill adult cancer patients. The title and abstract were evaluated following a search through Index Medicus/MEDLINE, EMBASE, CINHAHL, CancerLit, AHMED, Psychinfo, CISCOM, Cochrane and DARE. Search terms included hypnotherapy, cancer, terminal care and palliative care. Inclusion criteria included systematic reviews, randomized controlled trials, observational and prospective studies, retrospective surveys, case studies and reports. A total of 27 papers were evaluated. Two reviewers assessed the studies, one extracted the relevant data and 10% were evaluated independently by a third reviewer. The 27 papers comprised a randomized controlled trial, an observational study, a retrospective questionnaire and 24 case studies. Hypnotherapy was used to treat a variety of symptoms, including pain, anxiety and depression. The poor quality of the studies and heterogeneity of the study population limited further evaluation; further research is required to understand the role of hypnotherapy in managing symptoms.

Department of Palliative Care and Policy, King's College, London, UK. m9era@hotmail.com

Twelve mentally healthy women aged 21-38 years were studied in the state of consciousness and hypnosis. The main study method was electroencephalography with assessment of the spatial synchronization of brain biopotentials (SSBP). Suggestion of high-intensity attention delivered to subjects in the hypnotic state was found to lead to significant reorganization of SSBP, with increases in SSBP between both occipital areas, the right temporal area, and other parts of the brain. The dynamics of brain SSBP in intense attention were opposite in the hypnotic and conscious states, which appears to result from the temporary exclusion in the hypnotic state of the functions of the frontal areas of the cortex responsible for conscious control and regulation of ongoing activity.

Neurosci Behav Physiol. 2005 Jul;35(6):643-7

That auditory hallucinations are voices heard in the absence of external stimuli implies the existence of endogenous neural activity within the auditory cortex responsible for their perception. Further, auditory hallucinations occur across a range of healthy and disease states that include reduced arousal, hypnosis, drug intoxication, delirium, and psychosis. This suggests that, even in health, the auditory cortex has a propensity to spontaneously "activate" during silence. Here we report the findings of a functional MRI study, designed to examine baseline activity in speech-sensitive auditory regions. During silence, we show that functionally defined speech-sensitive auditory cortex is characterized by intermittent episodes of significantly increased activity in a large proportion (in some cases >30%) of its volume. Bilateral increases in activity are associated with foci of spontaneous activation in the left primary and association auditory cortices and anterior cingulate cortex. We suggest that, within auditory regions, endogenous activity is modulated by anterior cingulate cortex, resulting in spontaneous activation during silence. Hence, an aspect of the brain's "default mode" resembles a (preprepared) substrate for the development of auditory hallucinations. These observations may help explain why such hallucinations are ubiquitous.

Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Division of Genomic Medicine, University of Sheffield, Sheffield S5 7JT, United Kingdom. m.d.hunter@sheffield.ac.uk

This study examined the types of strategies people use to verify putative childhood memories and the degree to which their preferred strategies are restricted in typical memory implantation studies. We asked subjects to describe a situation in which they recalled a false childhood experience and a hypothetical situation in which they pretended to have developed a false memory after taking part in a memory implantation study. We also asked them how they did (or would) determine the source of the event. We found that subjects relied primarily on other people and cognitive strategies to verify their experiences. These results suggest that laboratory situations cultivate false memories in part because they prevent people from talking to others about the false event, which causes them to rely on less optimal strategies.

Victoria University of Wellington. k.a.wade@warwick.ac.uk

This study investigated the influence of question repetition and question type (answerable, unanswerable, or opinion seeking) on children's recall. A total of 136 children (5-, 7-, and 9-year-olds) watched a live 15-min presentation. One week later, the children were asked 20 questions that were repeated an additional two times within the interview. Accuracy of children's responses to unanswerable questions declined with repetition. Children were more likely to change a response to an unanswerable question than to an answerable question. Overall, children maintained the same answers to only three-quarters of the repeated questions. The most common pattern of change was for children to change their answer the second time a question was asked and then to maintain that answer when questioned again. The high percentage of changed answers within a single interview has important implications for forensic interviewing.

Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK. s.krahenbuhl@shef.ac.uk

Presents an obituary for Theodore Xenophon Barber (1927-2005), one of the most prolific and influential researchers in the field of hypnosis. At the time of his death he was an active scholar in his private research enterprise, the Interdisciplinary Science Research Institute. A brief biography of Barber is followed by an overview of his published work, his theories and other influential accomplishments. Although hypnosis was the main focus of Barber's research, his interests and research encompassed other topics, including the phenomenon of investigator bias, psychical phenomena, and even comparative psychology.

State University of New York at Stony Brook, Stony Brook, NY, USA.

A new perspective on how therapeutic hypnosis and neuroscience may be integrated on the molecular-genomic level is offered as a guide for basic research and clinical applications. An update of Watson and Crick's original formulation of molecular biology is proposed to illustrate how psychosocial experiences modulate gene expression, protein synthesis, and brain plasticity during memory trace reactivation for the reorganization of neural networks that encode fear, stress, and traumatic symptoms. Examples of the scientific literature on DNA microarrays are used to explore how this new technology could integrate therapeutic hypnosis, neuroscience, and psychosocial genomics as a new foundation for mind-body medicine. Researchers and clinicians in therapeutic hypnosis need to partner with colleagues in neuroscience and molecular biology that utilize DNA microarray technology. It is recommended that hypnotic susceptibility scales of the future incorporate gene expression data to include the concept of "embodied imagination" and the "ideo-plastic faculty" on a molecular-genomic level as well as the psychological and behavioral level of ideomotor and ideosensory responses that are currently assessed.

Ernest@ErnestRossi.com

Although conceptualized as a normal reaction to loss and not classified as a mental disorder, grief can be considered a focus of treatment. When grief complicates and becomes pathological by virtue of its duration, intensity, and absence or by bizarre or somatic manifestation, a psychiatric diagnosis is in order. Childhood PTSD in Complicated Bereavement is a condition derived from the loss of a loved one when the nature of death is occasioned through traumatic means. The traumatic nature of the loss engenders trauma symptoms, which impinge on the child's normal grieving process and his/ her ability to negotiate the normal grieving system. The 2 cases presented herein constitute single session treatment with clinical hypnosis of PTSD, a result of the traumatic loss of the paternal figures. The setting in which these cases took place was rural Guatemala. Treatment consisted of single session hypnosis with the Hypnotic Trauma Narrative, a tool designed to address the symptomatology of PTSD. Follow-up a week later and telephone follow-up 2 months later demonstrated the resolution of traumatic manifestations and the spontaneous beginning of the normal grief process.

PhDALEX@aol.com

Thirty years ago, the integration of complementary medicine into cancer care almost was dismissed as quackery. Today, a whole range of complementary and alternative medicine (CAM) techniques have been integrated into the management of cancer, which are often of benefit to patients, when conventional treatment is deemed to have failed or caused intolerable side effects. Health care workers need to inquire about the use of CAM in their patients routinely in a sensitive and nonjudgmental way, and may need to advise patients to stop certain therapies. Yet in advanced cancer, a sensible balance needs to be struck between fear about adverse effects and interactions and the importance of making the remaining weeks/days/months as comfortable and enjoyable as possible.

Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK. jacqueline.filshie@binternet.com

This study examined how an erroneous rumor circulated among preschoolers can influence their memory. One fourth of the children overheard a rumor from an adult conversation in which it was alleged that an event the children had not experienced themselves had occurred. A second fourth were the classmates of those who overheard the rumor. A third group had no exposure to the rumor. The remaining children actually experienced the event suggested by the rumor. One week later, the children were interviewed in either a neutral or a suggestive manner. Results from a second interview after a 2-week delay revealed that under both interview conditions, children who overheard the rumor, either from the adult conversation or during naturally occurring interactions with classmates, were as likely to report experiencing the rumored but nonexperienced event as were those who actually experienced it. Most reports of the rumored but nonexperienced event were in children's free recall and were accompanied by high levels of fictitious elaboration.

Department of Psychology, Ursinus College, P.O. Box 1000, Collegeville, PA 19426-1000, USA. gprincipe@ursinus.edu

Participants (6- and 7-year-olds, N=130) participated in classroom activities four times. Children were interviewed about the final occurrence (target event) either 1 week or 4 weeks later, during which half of the event items were described inaccurately. Half of these suggestions were consistent with the theme of the detail across the occurrences (e.g., always sat on a kind of floor mat) or were inconsistent (e.g., sat on a chair). When memory for the target event was tested 1 day later, children falsely recognized fewer inconsistent suggestions than consistent suggestions, especially compared with a control group of children who experienced the event just one time. Furthermore, the longer delay reduced accuracy only for consistent suggestions. Source-monitoring ability was strongly and positively related to resistance to suggestions, and encouraging children to identify the source of false suggestions allowed them to retract a significant proportion of their reports of inconsistent suggestions but not of consistent suggestions. The results suggest that the gist consistency of suggestions determines whether event repetition increases or decreases suggestibility.

Department of Psychology, Wilfrid Laurier University, Waterloo, Ont., Canada N2L 3C5. kroberts@wlu.ca

In a previous study we showed that healthy highly hypnotizable subjects, during the suggestion of a moderately unpleasant situation administered in awake conditions, exhibited a sympathetic response greatly attenuated with respect to non-hypnotizable individuals. This was interpreted as a natural protection of hypnotizable subjects against the cardiovascular effects of cognitive stress. Aim of the present study was to investigate whether the hypnotic trait is able to modulate the autonomic and cerebral activities also in specific phobic awake hypnotizable (Highs) and non-hypnotizable (Lows) subjects. Electroencephalogram, electrooculogram, electromiogram of corrugator muscle, electrocardiogram, respirogram and tonic electrodermal activity were recorded during a guided mental imagery of an animal phobic object. Phobic stimulation induced in both groups the rise of heart and respiratory frequency and the lowering of skin resistance. These changes are less pronounced in Highs than in Lows and are sustained by a different modulation of the sympatho-vagal balance. During phobic stimulation both groups exhibited a similar significant increase of EEG gamma relative power. At variance, significant stimulation-related decrements of alpha1, theta1 and theta2 activities were found only in Highs that exhibited similar changes during the control and phobic stimulation. Results suggest that hypnotizability is able to modulate cerebral and autonomic responses also in specific phobic subjects. However, the presence of a specific phobia attenuates the effectiveness of hypnotizability as a protective factor against possible stress-related cardiac illness.

Department of Physiology and Biochemistry, G. Moruzzi, University of Pisa, Via San Zeno 31, 56127 Pisa, Italy. gemignan@dfb.unipi.it

This paper reports a study to determine the effectiveness of autogenic training in reducing anxiety in nursing students. BACKGROUND: Nursing is stressful, and nursing students also have the additional pressures and uncertainties shared with all academic students. Autogenic training is a relaxation technique consisting of six mental exercises and is aimed at relieving tension, anger and stress. Meta-analysis has found large effect sizes for autogenic trainings intervention comparisons, medium effect sizes against control groups, and no effects when compared with other psychological therapies. A controlled trial with 50 nursing students found that the number of certified days off sick was reduced by autogenic training compared with no treatment, and a second trial with only 18 students reported greater improvement in Trait Anxiety, but not State Anxiety, compared with untreated controls. METHODS: A randomized controlled trial with three parallel arms was completed in 1998 with 93 nursing students aged 19-49 years. The setting was a university college in the United Kingdom. The treatment group received eight weekly sessions of autogenic training, the attention control group received eight weekly sessions of laughter therapy, and the time control group received no intervention. The outcome measures were the State-Trait Anxiety Inventory, the Maslach Burnout Inventory, blood pressure and pulse rate completed at baseline, 2 months (end of treatment), and 5, 8, and 11 months from randomization. RESULTS: There was a statistically significantly greater reduction of State (P<0.001) and Trait (P<0.001) Anxiety in the autogenic training group than in both other groups immediately after treatment. There were no differences between the groups for the Maslach Burnout Inventory. The autogenic training group also showed statistically significantly greater reduction immediately after treatment in systolic (P<0.01) and diastolic (P<0.05) blood pressure, and pulse rate (P<0.002), than the other two groups. CONCLUSION. Autogenic training has at least a short-term effect in alleviating stress in nursing students.

Faculty of Health Studies, Buckinghamshire Chilterns University College, Buckinghamshire, UK. n.kanji@bcuc.ac.uk

Researchers from The University of Cincinnati analyzed data from ten different guided imagery studies to assess the trajectory of effect size with continued imagery practice, and the relationship between practice duration and strength of outcomes. .

Statistical findings of the ten different studies of various durations were converted to "d" statistics and plotted against the duration of study. The results showed an increase in the effect size of guided imagery over the first 5 to 7 weeks. However, it appeared that the effect was decreased at 18 weeks.

Citation: Van Kuiken D. A meta-analysis of the effect of guided imagery practice on outcomes. Journal of Holistic Nursing. 2004 Jun; 22 (2): pages 164-79.

This study is the first to use virtual-reality technology on a series of clinical patients to make hypnotic analgesia less effortful for patients and to increase the efficiency of hypnosis by eliminating the need for the presence of a trained clinician. This technologically based hypnotic induction was used to deliver hypnotic analgesia to burn-injury patients undergoing painful wound-care procedures. Pre- and postprocedure measures were collected on 13 patients with burn injuries across 3 days. In an uncontrolled series of cases, there was a decrease in reported pain and anxiety, and the need for opioid medication was cut in half. The results support additional research on the utility and efficacy of hypnotic analgesia provided by virtual reality hypnosis.

University of Washington School of Medicine, Seattle, Washington, USA. davepatt@u.washington.edu

The present study closely examines subject response to the arm-rigidity item of the HGSHS:A. Subject behavior, subject self-report, and surface EMG of the biceps and triceps muscles were monitored. Two distinct ways of passing the item were observed and verified by EMG recordings: some subjects (tremblers) exerted muscular effort to bend the arm and kept it rigidly straight. Others (nontremblers) passively kept the arm straight without exerting muscular effort to bend, even though they reported exerting effort to bend their arm. These two behaviorally and physiologically different methods of passing the item support the idea of individual differences in hypnotic responding and suggest that subjects may be using different mental processes to pass the item.

Department of Psychology, University of Tennessee, Knoxville, Tennessee 37996, USA. Jwinkel@utk.edu

Hypnotic suggestions describing an altered perception induce congruent changes in the subject's experience and behavior. However, it is not known whether an implicit suggestion, only indirectly referring to an altered perception, induces a behavioral response corresponding to that of the real situation. In this study, an implicit suggestion of backward falling (IMP) was given to high hypnotizable participants not exposed (W-Highs) and exposed (H-Highs) to a hypnotic induction and a group of low hypnotizable individuals (W-Lows). Their posture was evaluated through an elite system. The results after the IMP were compared with those after an explicit suggestion of backward falling (EXP). In both W-Highs and H-Highs, the IMP elicited the backward body sway expected in the corresponding real situation, whereas no response was found in W-Lows. The results are discussed in terms of a possible equivalence of imagery and perception or of a lack of the motor inhibition normally associated with motor imagery.

Siena University, Siena, Italy.

The NHS must be smoke free by the end of 2006 (Department of Health, 2004). The necessary elements to introducing a smoke-free policy, which is workable and equitable, are the management of the policy and offering support to smokers. Smoking and second-hand smoking are responsible for many illnesses, premature deaths and reduced productivity. Employers have a responsibility to ensure the health of their employees by protecting them from exposure to cigarette smoke in the workplace. Although smoking restrictions in the workplace are popular, it is important to ensure good communication with everyone who will be affected, since there are many fears associated with the introduction of the policy. Help must be offered to people who wish to quit through behavioural and pharmacological interventions and support must also be given to the smoker who must abstain from smoking on the premises during work or hospital stay.

Charing Cross Hospital, Fulham Palace Road, London.

No data are available on the effect of hypnosis on gastric emptying. AIM: To determine the effect of a hypnosis session on gastric emptying and dyspeptic symptoms. METHODS: We studied emptying by ultrasonography and epigastric sensations in 11 healthy subjects and in 15 patients affected by functional dyspepsia under three conditions according to a fixed schedule: (a) basal, (b) after cisapride and (c) during a 90 min hypnotic trance. Eight healthy subjects repeated an emptying study listening to relaxing music. Statistical analysis was performed using the Friedman test or RM-ANOVA. RESULTS: In dyspeptics, the postprandial increase in the antral area was significantly smaller during the hypnosis trance than under the basal and the cisapride conditions. For the patients gastric emptying was significantly shortened by cisapride, and even more by hypnosis (basal 274 +/- 16.8 min; cisapride 227 +/- 13.2; hypnosis 150 +/- 9.7) whereas for healthy subjects it was shortened only by hypnosis. The repeated study in healthy subjects listening to relaxing music showed no significant difference compared with the basal. Epigastric sensations were improved in dyspeptics by hypnosis, but not by cisapride. CONCLUSIONS: Gut-oriented hypnosis is effective in shortening gastric emptying both in dyspeptic and in healthy subjects.

Department of Gastroenterology, Rehabilitation Hospital of Valeggio s/M, University of Verona, Verona, Italy. chiarioni@tin.it

We investigated the effect of autogenic training (AT) on cardiac autonomic nervous activity in fire services workers with the use of the questionnaire of the Japanese-language version of Impact of Event Scale-Revised (IES-R-J) and indexes of heart rate variability. METHODS: We studied 22 male fire services workers who were divided into posttraumatic stress disorder (PTSD)-related stress group (n=10) and control group (n=12). They underwent AT twice or three times a week for 2 months. RESULTS: Posttraumatic stress disorder-related stress group showed a significantly higher cardiac sympathetic nervous activity and a significantly lower cardiac parasympathetic nervous activity than control group at baseline. Autogenic training significantly decreased cardiac sympathetic nervous activity and significantly increased cardiac parasympathetic nervous activity in both groups. These changes were accompanied by a significant decrease in the total points of IES-R-J. CONCLUSION: Autogenic training is effective for ameliorating the disturbance of cardiac autonomic nervous activity and psychological issues secondary to PTSD.

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Public Health, Yoshida-Konoe cho, Sakyo-ku, Kyoto 606-8501, Japan.

Functional abdominal pain syndrome (FAPS) differs from the other functional bowel disorders; it is less common, symptoms largely are unrelated to food intake and defecation, and it has higher comorbidity with psychiatric disorders. The etiology and pathophysiology are incompletely understood. Because FAPS likely represents a heterogeneous group of disorders, peripheral neuropathic pain mechanisms, alterations in endogenous pain modulation systems, or both may be involved in any one patient. The diagnosis of FAPS is made on the basis of positive symptom criteria and a longstanding history of symptoms; in the absence of alarm symptoms, an extensive diagnostic evaluation is not required. Management is based on a therapeutic physician-patient relationship and empirical treatment algorithms using various classes of centrally acting drugs, including antidepressants and anticonvulsants. The choice, dose, and combination of drugs are influenced by psychiatric comorbidities. Psychological treatment options include psychotherapy, relaxation techniques, and hypnosis. Refractory FAPS patients may benefit from a multidisciplinary pain clinic approach.

Division of Gastroenterology, Washington University, St Louis, Missouri 63110, USA. rclouse@im.wustl.edu

This study quantified health-related quality of life in a group of irritable bowel syndrome patients and measures changes following a treatment programme of nurse-led gut-directed hypnotherapy. BACKGROUND: It is well recognized that health-related quality of life can be severely impaired in patients suffering form the irritable bowel syndrome. Current conventional treatment for irritable bowel syndrome is often unsatisfactory. In contrast it has been shown that gut-directed hypnotherapy is an effective treatment of irritable bowel syndrome with up to three-quarters of patients reporting symptomatic improvement. DESIGN/METHOD: Seventy-five patients (55 females/20 males, median age 37.1 years, age range 18-64) comprised the study group. Physical symptoms of irritable bowel syndrome were recorded using seven-day diary cards. On presentation the predominant symptoms were abdominal pain (61%), altered bowel habit (32.5%), and abdominal distension/bloating (6.5%) in the patient group. An irritable bowel syndrome quality of life questionnaire was used to define health-related quality of life. Psychological well-being was measured using the Hospital Anxiety and Depression Scale. Data analysis was carried out using MINITAB, Release 12 for Windows. RESULTS: Physical symptoms statistically improved after hypnotherapy. There were also significant statistical improvements (P < 0.001) in six of the eight health-related quality of life domains measured (emotional, mental health, sleep, physical function, energy and social role). These improvements were most marked in female patients who reported abdominal pain as their predominant physical symptom. Anxiety and depression improved following treatment. CONCLUSION: Gut-directed hypnotherapy has a very positive impact on health-related quality of life with improvements in psychological well-being and physical symptoms. It appears most effective in patients with abdominal pain and distension. Relevance to clinical practice. This study demonstrates that by integrating complementary therapies into conventional care that gastrointestinal nurses have a potential role in the management of irritable bowel syndrome.

School of Health in Social Science, University of Edinburgh, Old Medical School, Edinburgh, UK. graeme.smith@ed.ac.uk

Theories about dreams have shaped our thinking about mind-body unity and the influence of thought on the body. In this article, the authors review the sparse literature regarding the use of hypnosis with children's dreams and nightmares, summarize how hypnotically induced dreams have been used to resolve psychological symptoms, and note five themes in the literature worthy of further investigation. Building on the value of both dreams and hypnosis for working through conflicts, the authors united mind-body medicine and hypnotically induced dreaming in a pediatric pulmonary practice. A case series is presented of 11 patients who were offered an opportunity to review their reported nightmares through hypnosis in order to uncover their potential meaning. The recurrent nightmares among these patients decreased greatly in frequency or resolved following the hypnosis enhanced dream review. Thus, we demonstrate that hypnotically induced dream review may be useful in a pediatric population.

jhlinden@cs.com

To determine the degree and duration of pain relief provided by specific pain treatments used by individuals with spinal cord injury (SCI) who have chronic pain. DESIGN: Postal survey. SETTING: Community. PARTICIPANTS: Participants were 117 individuals who had traumatic SCI, were 18 years of age or older, and reported a chronic pain problem. MAIN OUTCOME MEASURES: Questions assessing current or past use of 26 different pain treatments, the amount of relief each treatment provided, and the length of time that any pain relief usually lasts. RESULTS: The medications tried most often were nonsteroidal anti-inflammatory drugs (tried by 71%) and acetaminophen (tried by 70%); these medications were still being used by more than one half of the patients who had tried them. Opioids produced the greatest degree of pain relief on average (mean, 6.27 +/- 3.05 [SD] on a 0-10 scale, with 0 = no relief and 10 = complete relief) but were unlikely to be continued by those who tried them. Although 38% of respondents with pain had tried gabapentin, only 17% were still using it, and average pain relief was only moderate (mean, 3.32 +/- 3.03 on the 0-10 relief scale). Seventy-three percent of the respondents had tried at least 1 of 7 alternative pain treatments, and the most frequently tried were massage, marijuana, and acupuncture. The most relief was provided by massage (mean, 6.05 +/- 2.47] on the 0-10 relief scale) and marijuana (mean, 6.62 +/- 2.54 on the 0-10 relief scale). The relief from the various treatments, including most medications, tended to last only minutes or hours; however, pain relief from alternative treatments such as massage, acupuncture, and hypnosis was reported to last for days in 25% to 33% of those who tried these treatments. CONCLUSIONS: Many patients are not finding adequate pain relief from commonly prescribed medications. Alternative therapies should be considered as additional treatment options in this population.

University of Washington, Department of Rehabilitation Medicine, Box 356490, Seattle, WA 98195, USA. dianamac@u.washington.edu

In the aftermath of the human genome project, genotyping is fast becoming an affordable and technologically viable complement to phenotyping. Whereas attempts to characterize hypnotic responsiveness have been largely phenomenological, data emanating from exploratory genetic data may offer supplementary insights into the genetic bases of hypnotizability. We outline our genetic and neuroimaging findings and discuss potential implications to top-down control systems. These results may explain individual differences in hypnotizability and propose new ideas for studying the influence of suggestion on neural systems.

Two studies investigated management of conflict in hypnosis by subtly increasing the brightness of a visual stimulus during a suggestion for hypnotic blindness to the stimulus. In Study 1, 23 high hypnotizable participants were administered a hypnotic suggestion for blindness to a projected light. For half the participants, the brightness of the light was intensified during the suggestion. Behavioral ratings and online analog-dial measurement indicated that participants reported decreased hypnotic blindness during the increased conflict condition. In Study 2, 20 participants were administered the nonexperimental procedure to investigate the impact of demand characteristics in this paradigm. Parallel findings in Studies 1 and 2 indicated that demand characteristics may explain the response to hypnotic conflict. Limitations in applying the nonexperimental procedure to this paradigm and the need for further investigation are discussed.

University of New South Wales, Sydney, Australia. r.bryant@unsw.edu.au

It was hypothesized that dental anxiety, which leads to neurophysiologic alterations in heart rate, respiratory rate and blood pressure prior, during and subsequent to dental treatment, can be influenced by medical hypnosis. We report the positive impact from non-invasive hypno-sedation during dental implant surgery on a 54-year-old female patient who experienced neurophysiologic reactions as a result of the psychosomatic process of dental anxiety (dental anxiety scale value = 13). The neurophysiologic changes during dental surgery performed with and without hypnosis were compared after the patient underwent the same surgical treatment protocol. This case report was part of a study designed to evaluate hypnosis as a non-invasive therapy for dental-anxious patients over six sessions using subjective experience and objective parameters, which included electroencephalogram, electrocardiogram, heart rate, blood pressure, oxygen saturation of the blood, respiration rate, salivary cortisol concentration and body temperature.

Department of Prosthodontics, Maxillofacial Surgery and Neurology and Psychiatry, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany. seitner@prothetik-erlangen.de

The paper promotes the view that the alert brain alternates between operating in an action mode, based on frontal lobe function, and a receptive mode, involving cholinergic system activity. Their alternation forms a conversation with the environment. It is hypothesized that competition between the modes centers on control over excitability of neurons in the CA1 field of the hippocampus. Increased excitability enhances the flow of hippocampal output through the subiculum resulting in support for frontal lobe function and the action mode. Decreased excitability, on the other hand, reduces this output and that support, leading to a disconnection between frontal lobes and hippocampus. At the same time, correlated cholinergic activity enhances receptive mode processes, indicated by the occurrence of the hippocampal theta rhythm. It is suggested that the hypothesis provides a conceptual framework for considering various phenomena including REM sleep, schizophrenia, and hypnosis. In REM sleep the receptive mode remains dominant as cholinergic activity supports the hippocampal integration of experience into a composite view of reality. In schizophrenia, the action and receptive modes are not properly coordinated because of a dysfunction in anterior hippocampal output. And hypnosis might be seen as a process in which conditions and suggestions are able to induce in some people a prolonged occurrence of the receptive mode allowing a normal view of reality to be altered.

2021 Jolly Road, Okemos, MI 48864, United States. johns127@msu.edu

Bispectral index (BIS) and state entropy (SE) monitor hypnosis. We evaluated the correlation and the agreement between those parameters during propofol anaesthesia and laryngoscopy with and without muscle relaxation. METHODS: A total of 25 patients were anaesthetized with propofol. At steady state (SS: BIS 40-50), they randomly received rocuronium (R) or saline (S); 3 min thereafter, a 20 s laryngoscopy was performed. Correlation (regression analysis) and agreement (Bland-Altman analysis) were evaluated before induction (baseline), at loss of eyelash reflex (LER), at SS and during the first 3 min after laryngoscopy (L). RESULTS: The correlation coefficient r (95% CI), the mean difference (MD) (95% CI), and the limits of agreement [lower-upper limits of 95% CI of MD (sd 1.96)] between BIS and SE were as follows. Overall recordings: 0.87 (0.83 to 0.90), 2.5 (1.2 to 3.0), and [-19.5 to 24.6]; Baseline: 0.45 (0.06 to 0.72), 7.6 (6.0 to 9.2), and [-2.7 to 17.9]; LER: 0.74 (0.47 to 0.88), 8.3 (3.5 to 13.2), and [-22.6 to 39.3]; SS, all patients: 0.41 (0.14 to 0.63), 2.0 (-0.5 to 4.6), and [-19.0 to 23.3]; SS, Group S: 0.36 (-0.07 to 0.68), 1.9 (-2.5 to 6.3), and [-25.0 to 28.8]; SS, Group R: 0.63 (0.32 to 0.82), 0.2 (-2.0 to 2.3), and [-14.0 to 14.4]; L, all patients: 0.49 (0.32 to 0.63), 0.7 (-1.6 to 3.0), and [-25.6 to 27.1]; L, Group S: 0.41 (0.13 to 0.63), 2.3 (-2.4 to 7.1), and [-36.7 to 41.3]; L, Group R: 0.72 (0.56 to 0.83), -0.6 (-2.2 to 1.0), and [-14.3 to 13.1]. The correlation was good except for SS in Group S. The MD was significantly different from 0 for overall recordings, during baseline and LER, but not for the other conditions. The agreement was poor except for baseline, and SS and L in Group R. CONCLUSIONS: BIS and SE are globally well correlated. In contrast, agreement is poor as differences of more than 20 units are frequently observed, except for awake and paralysed patients.

University Department of Anaesthesia and Intensive Care Medicine, CHR de la Citadelle Liege, Belgium. vincent.bonhomme@chu.ulg.ac.be

Individual differences in wound healing have long been recognized. Clinical observation has suggested that negative mood or stress is associated with slow wound healing. Basic mind-body research is now confirming this observation. Matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs), whose expression can be controlled by cytokines, play a role in wound healing. Using a blister chamber wound model on human forearm skin exposed to ultraviolet light, researchers have demonstrated that stress or a change in mood is sufficient to modulate MMP and TIMP expression and, presumably, wound healing. Activation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal medullary (SAM) systems can modulate levels of MMPs, providing a physiological link among mood, stress, hormones, and wound healing. This line of basic research suggests that activation of the HPA and SAM axes, even in individuals within the normal range of depressive symptoms, could alter MMP levels and change the course of wound healing in blister wounds.

When a hypnotist appears on screen, expect evil. If his induction features 'magnetic' hand passes, he's probably about to compel someone to commit a crime. Ifhe hypnotizes with an intense stare, his intent is likelier seduction-in fact many screen inductions are identical to the eye contact ethologists have labeled "the copulatory gaze." This paper explores to role of hypnosis in more than 230 films in which it has been depicted and categorizes the--mostly negative--stereotypes about it. A handful of exceptions in which hypnosis is positive and/or realistic are examined. The discussion compares this to the role of psychotherapy and dreams in cinema. It discusses why hypnosis is so maligned and whether there is anything practitioners can do to alter the stereotype.

Harvard Medical School, USA. Deirdre_Barrett@hms.Harvard.edu

This article argues for and illustrates incorporating complementary and alternative medicine (CAM) interventions into pain treatment plans. Two CAM treatments, cranial electrotherapy stimulation (CES) and self-hypnosis training, are offered in a multidisciplinary pain treatment program. Because these interventions focus on pain relief, they may be of particular interest to patients who have chronic pain who begin treatment with a primary interest in pain reduction. Two cases that illustrate the clinical application of CES and self-hypnosis are presented. When effective, these interventions can help patients have greater confidence in treatments offered by psychologists for pain management and may help make them more open to participating in other psychological interventions that have established efficacy for pain management (e.g., cognitive-behavioral therapy). Because of their brevity, these treatments also can be offered alone to patients who may not have the resources or time to participate in more time-intensive treatment. (c) 2006 Wiley Periodicals, Inc. J Clin Psychol: In Session 62: 1419-1431, 2006.

Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine.

Much research indicates that attempts to suppress thoughts lead to increased accessibility of those thoughts, especially when additional cognitive load is present. On the premise that hypnosis may permit more effective management of cognitive load, it was hypothesized that hypnosis may enhance more effective thought suppression. The present research examined whether the obstacle of cognitive load could be bypassed using hypnosis to facilitate successful thought suppression. Thirty-nine high and 40 low hypnotizable participants were hypnotized and received either a suppression instruction or no instruction for a memory of an embarrassing experience and subsequently completed a sentence-unscrambling task that indexed accessibility of embarrassing thoughts. Whereas lows instructed to suppress displayed a delayed increase in suppressed thoughts, highs did not. These findings support the proposition that hypnosis facilitates thought suppression.

School of Psychology, University of New South Wales, Sydney, Australia. r.bryant@unsw.edu.au

In contrast with most inhalational anesthetics, the anesthetic gases xenon (Xe) and nitrous oxide (N2O) act by blocking the N-methyl-D-aspartate (NMDA) receptor. Using X-ray crystallography, we examined the binding characteristics of these two gases on two soluble proteins as structural models: urate oxidase, which is a prototype of a variety of intracellular globular proteins, and annexin V which possesses structural and functional characteristics that allow it to be considered as a prototype for the NMDA receptor. The structure of these proteins complexed with Xe and N2O were determined. One N2O molecule or one Xe atom binds to the same main site in both proteins. A second subsite is observed for N2O in each case. The gas binding sites are always hydrophobic flexible gas cavities buried within the monomer. Comparison of the effects of Xe and N2O on urate oxidase and annexin V reveals an interesting relationship with the in vivo pharmacological effects of these gases, the ratio of the gas binding sites volume expansion and the ratio of the narcotic potency being similar. Given these data, we propose that alterations of cytosolic globular protein functions by general anesthetics would be responsible for the early stages of anesthesia such as amnesia and hypnosis, while additional alterations of ion-channel membrane receptor functions are required for deeper effects that progress to "surgical" anesthesia.

CNRS UMR 6185, Centre Cyceron.

The study group included 17 cancer patients, aged 25-55, (stage III-IV), mostly suffering melanoma. All of them received hypnosuggestive therapy to correct psycho-emotional disorders. Significant decrease in anxiety-related indices (p < 0.001) due to therapy pointed to rehabilitation of psychological defenses. Clinical rehabilitation was manifested by improved quality of life (p < 0.01), better habitus and adaptation (p < 0.01). The modulating effect on the macrophageal and phagocytic components of the immune system (p < 0.05) was matched by a significant correlation between psychological defense indices and those of immunological status. Our data have contributed to the existing knowledge about relationships of mind and immunity in cancer patients.

Memory decline and mental confusion frequently complicate the clinical presentation of fibromyalgia; however, formal cognitive examination often does not support deterioration. This paradox was examined in the context of dissociation, a condition with many cognitive similarities. Dissociation refers to the separation of parts of experience from the mainstream of consciousness. A common example is highway hypnosis. Eighty-nine fibromyalgia (FM) patients and 64 other rheumatic disease patients were screened for memory decline and mental confusion using a questionnaire format. Pain, dissociation, affective distress, fatigue, sleep difficulty, and mental confusion were also assessed.Cognitive complaints (76.4%-43.8%) and dissociative symptoms (37.1%-1.9%) were overrepresented in patients with FM. Among FM patients with high dissociation, cognitive difficulties were reported by 95%; 100% of these cases reported that both memory and mental clarity were affected, a condition referred to as fibrofog. Dissociation in combination with fibrofog was associated with higher levels of FM symptom intensity and decreased mental well being. These findings suggest that dissociation may play a role in FM symptom amplification and may aid in comprehending the regularity of cognitive symptoms. Separating cases of fibrofog from cognitive conditions with actual brain damage is important. It may be prudent to add a test of dissociation as an adjunct to the evaluation of FM patients in cases of suspected fibrofog. Otherwise, test results may prove normal even in patients with disabling cognitive symptoms.

Department of Psychology (FL, MM) and Section of Rheumatology, Department of Internal Medicine (RSK), Rush Medical Center, Chicago, Illinois, and Department of Psychiatry and Behavioral Sciences (ARH), University of Washington Medical Center, Seattle, Washington.

BACKGROUND: Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined currently available evidence supporting the use of alternative and complementary therapies for pain management in labour. OBJECTIVES: To examine the effects of complementary and alternative therapies for pain management in labour on maternal and perinatal morbidity. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006) and CINAHL (1980 to February 2006). SELECTION CRITERIA: The inclusion criteria included published and unpublished randomised controlled trials comparing complementary and alternative therapies (but not biofeedback) with placebo, no treatment or pharmacological forms of pain management in labour. All women whether primiparous or multiparous, and in spontaneous or induced labour, in the first and second stage of labour were included. DATA COLLECTION AND ANALYSIS: Meta-analysis was performed using relative risks for dichotomous outcomes and mean differences for continuous outcomes. The outcome measures were maternal satisfaction, use of pharmacological pain relief and maternal and neonatal adverse outcomes. MAIN RESULTS: Fourteen trials were included in the review with data reporting on 1537 women using different modalities of pain management; 1448 women were included in the meta-analysis. Three trials involved acupuncture (n = 496), one audio-analgesia (n = 24), two trials acupressure (n = 172), one aromatherapy (n = 22), five trials hypnosis (n = 729), one trial of massage (n = 60), and relaxation (n = 34). The trials of acupuncture showed a decreased need for pain relief (relative risk (RR) 0.70, 95% confidence interval (CI) 0.49 to 1.00, two trials 288 women). Women taught self-hypnosis had decreased requirements for pharmacological analgesia (RR 0.53, 95% CI 0.36 to 0.79, five trials 749 women) including epidural analgesia (RR 0.30, 95% CI 0.22 to 0.40) and were more satisfied with their pain management in labour compared with controls (RR 2.33, 95% CI 1.15 to 4.71, one trial). No differences were seen for women receiving aromatherapy, or audio analgesia. AUTHORS' CONCLUSIONS: Acupuncture and hypnosis may be beneficial for the management of pain during labour; however, the number of women studied has been small. Few other complementary therapies have been subjected to proper scientific study.

The University of Adelaide, Discipline of Obstetrics and Gynaecology, Level 6, Medical School North, Frome Road, Adelaide, South Australia, Australia. caroline.a.smith@adelaide.edu.au

Nurses have used complementary therapies for many years to relieve anxiety, promote comfort, and reduce or alleviate pain. Physical therapies are most commonly used in our scenario but behavioral approach had been less customary, since familiarity of health personnel is very less (36%) with these techniques (Zaza et al, 1999). Hypnosis is empirically proved best therapy for pain management. Hypnosis is a process involving a hypnotist and a subject who agrees to be hypnotized. Being hypnotized is usually characterized by intense concentration, extreme relaxation and high suggestibility. This paper initially address hypnosis from an historical perspective to give the reader a decent background in which to view current trends in research in the field. Then will explain how hypnosis work followed by the empirical evidences and problems encountered in use of hypnosis when used for pain management.

College of Nursing, Dayanand Medical College & Hospital, Ludhiana.

This case report discusses a patient who experienced frequent nightmares and chronic low-level anxiety during his 3 1/2 year imprisonment. He developed post traumatic stress disorder (PTSD), in part because he adamantly insisted that he had been wrongfully incarcerated. The literature supports the use of hypnotic imagery rehearsal for treating nightmares that stem from PTSD. Due to the patient's distrust of others and trauma history, it was uncertain whether hypnotic intervention would be effective. It is of note, there is no indication in the literature that hypnosis has been used with people on parole, let alone individuals who believe they were wrongly accused of committing a crime.

NYU Student Health Center 726 Broadway, Ste. 471 New York, NY 10003, USA. brooke.donatone@nyu.edu