Hypnosis became popular as a treatment for medical conditions in the late 1700s when effective pharmaceutical and surgical treatment options were limited. To determine whether hypnosis has a role in contemporary medicine, relevant trials and a few case reports are reviewed. Despite substantial variation in techniques among the numerous reports, patients treated with hypnosis experienced substantial benefits for many different medical conditions.

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Researchers at the Oregon Health and Science University tested the effects of hypnotic-guided imagery on immune function and general psychological well-being in 25 women being treated for Stage I or II breast cancer. Subjects were given one-on-one training for 8 weekly imagery sessions, and each participant was encouraged to practice at least 3 tiems weekly, using audiotapes of their sessions.

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A group of London researchers at Marie Curie Cancer Care conducted randomized, controlled, clinical trials to compare the effects of massage alone to massage with essential oils (aromatherapy) on cancer patients in palliative care.

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About 20% of people in the UK have functional gastrointestinal disorders such as irritable bowel syndrome and functional dyspepsia.

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Researchers from the State Research Institute of Physiology at the Russian Academy of Medical Sciences in Novosibirsk, Russia, mounted a controlled, randomized clinical trial to examine how long-term meditation practice can effect EEG activity during non-emotional arousal (eyes-closed and eyes-open periods, viewing emotionally neutral movie clip) and while experiencing experimentally induced negative emotions (viewing an aversive movie clip).

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Hypnosis can be a useful adjunct to other treatment modalities. For example, hypnosis may induce a level of relaxation that allows patients to cooperate more easily with conventional treatment.

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Many studies have suggested that conflict monitoring involves the anterior cingulate cortex (ACC). We previously showed that a specific hypnotic suggestion reduces involuntary conflict and alters information processing in highly hypnotizable individuals.

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The relevance of hypnosis to the treatment of sexual assault derives from two sources: the fact that hypnotic phenomena are mobilized spontaneously as defenses during assault, becoming part of the syndrome of posttraumatic stress disorder (PTSD) and the usefulness of formal hypnosis in treating PTSD. The role of dissociative defenses during and after traumatic experiences is reviewed; an analogy between the major elements of formally-induced hypnosis--absorption, dissociation, and suggestibility, and the major elements of PTSD--is drawn. Special problems relevant to sexual assault in childhood are discussed, including extreme self-blame and a profound sense of personality fragmentation. Uses of hypnosis in the treatment of sexual assault victims are reviewed, with an emphasis on helping such patients restructure their memories of the experience, both by reviewing them with greater control over their physical sense of comfort and safety and by balancing painful memories with recognition of their efforts to protect themselves or someone else who was endangered. The use of a split-screen technique in hypnosis is described with a clinical example. Special considerations in such treatment, including the traumatic transference and forensic complications of such psychotherapeutic work, are enumerated.

Stanford University School of Medicine, California.

Hypnosis has been used as a therapeutic tool for centuries, but only in the past 50 years have the clinical applications been delineated. As evident in the medical literature, the use of hypnosis by the medical community has increased, partly as a result of a growing awareness of hypnotherapy as an available treatment modality, and also as a result of major improvements in research methodology through strict standardization. Hypnotherapy, once considered to be limited to entertainment, has now proven useful in the treatment of a wide variety of medical illness.

Researchers at the Tom Baker Cancer Centre in Calgary, Canada studied the effects on early stage breast and prostate cancer patients of a mindfulness-based stress reduction meditation program, on quality of life, mood states.

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A new study from the National Institute on Aging finds that guided imagery helps elderly patients to remember to take their medicine. Researchers Linda Liu, Ph.D., of the University of Michigan, and Denise Park, Ph.D., of the University of Illinois found that older adults who spent a few minutes imagining and picturing how they would test their blood sugar were 50 percent more likely to actually do these tests on a regular basis than those who used other memory techniques requiring far more conscious effort.

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Increasing scientific study and attention is being directed to mind-body interactions, particularly to the interrelationships between the brain and the immune system. This effort has created a new interdisciplinary field, psychoneuroimmunology.

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This study was a pilot project to explore the effect of an autogenic training program (AT; a relaxation intervention) on the health-related quality of life (HRQOL) and well-being for people with multiple sclerosis.

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This paper makes the case that hypnotic phenomena are liminal in nature and that hypnotic practitioners (such as Milton Erickson) share many traits with traditional societies' "tricksters." The ambiguous nature of hypnosis has been apparent since the days of Mesmer's animal magnetism. Hypnotized people often report hallucinations that confound their ordinary distinctions between reality and illusion, external and internal processes, and many other binary oppositions, including time and space as well as mind and body. In addition, hypnosis can obscure the distinction between fact and fiction in one's memory, as is evident in the "recovered memory" controversy. The role played by imagination is central to both indigenous rituals and hypnosis, and hypnosis is a multifaceted phenomenon requiring explanation at multiple levels. Some investigators and practitioners have missed the importance of the social context in which hypnosis occurs, while others have come close to destroying the most interesting and useful hypnotic phenomena under the guise of objectivity.

Saybrook Graduate School and Research Center, San Francisco, California 94111, USA. skrippner@saybrook.edu

Although hypnotizability can be conceptualized as involving component subskills, standard measures do not differentiate them from a more general unitary trait, partly because the measures include limited sets of dichotomous items. To overcome this, the authors applied full-information factor analysis, a sophisticated analytic approach for dichotomous items, to a large data set from 2 hypnotizability scales. This analysis yielded 4 subscales (Direct Motor, Motor Challenge, Perceptual-Cognitive, Posthypnotic Amnesia) that point to the building blocks of hypnotic response. The authors then used the subscales as simultaneous predictors of hypnotic responses in 4 experiments to distinguish the contribution of each component from general hypnotizability. This analysis raises interesting questions about how best to conceptualize and advance measurement of the ability to experience hypnosis.

Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada. ewoody@uwaterloo.ca

Although attention is a central theme in psychological science, hypnosis researchers rarely incorporate attentional findings into their work. As with other biological systems, attention has a distinct anatomy that carries out basic psychological functions. Specific brain injuries, states, and drugs can all influence attentional networks. Investigation into these networks using modern neuroimaging techniques has revealed important mechanisms involved in attention. In this age of genomics, genetic approaches can supplement these neuroimaging techniques. As genotyping becomes an affordable and technologically viable complement to phenotyping, exploratory genetic assays offer insights into the genetic bases of both attention and hypnotizability. This paper discusses relevant aspects of attentional mechanisms and their underlying neuroanatomy as they relate to hypnosis. Underlining data from attentional networks, neuroimaging, and genetics, these findings should help to explain individual differences in hypnotizability and the neural systems subserving hypnosis.

Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, New York, NY 10032, USA. ar2241@columbia.edu

Alternative descriptors of the capacity to experience hypnosis, intended to describe the same phenomenon, appear in the current literature. Published members of the Society for Clinical and Experimental Hypnosis (SCEH) were surveyed to determine their preferences. The descriptors were empirically derived from recent International Journal of Clinical and Experimental Hypnosis articles and input from the executive committee of SCEH. Participants also indicated their primary theoretical conceptualization of hypnosis. Hypnotizability was chosen nearly 4 times more frequently than the next most favored choice (susceptibility) as a descriptor of hypnotic talent. Hypnosis as an "identifiable state" was chosen more than 4 times more frequently than the socio-cognitive version. This latter finding suggests that the notion of the continued debatability of hypnosis as primarily a state is now shared by only a few.

Washington State University, Pullman 99164-2114, USA. ciara_christensen@yahoo.com

By Carol Tuttle, Master Energy Therapist and the author of the best-selling book, Remembering Wholeness: A Personal Handbook for Thriving in the 21st Century

What do you think and believe about your body? Do you look in the mirror with disgust? Are you dissatisfied with your weight and body shape? This technique will help you clear the negative mental programming you have about your body, which will free your body up to achieve greater results faster and in less time.

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Preliminary findings are in from Traci Stein, MPH, Director of The Columbia Integrative Medicine Program and whiz statistician, Peri Nemerow, both from Mehmet Oz's group at Columbia Presbyterian. They tested out our new guided imagery for cardiac ICU & cardiac rehab on 20 patients (average age = 63) who'd undergone by-pass, valve replacement and transplant surgeries, and surveyed them for feedback on the imagery. It turned out that 90% liked listening to the tape; 79% would recommend the tape to a friend; 71% thought it made their hospital stay more pleasant; 83.3 % felt it increased their appreciation for being alive; 80% thought it helped them to better savor the things that they loved; 80% thought it gave them confidence they would regain their strength; 66.7% said it made them feel more positively about their scars; 75% felt it made them less depressed; and 80% felt it made them more relaxed. We also think it only fair to tell you that some thought it was weird. Interestingly enough, patients reported similar levels of satisfaction regardless of age or gender, or whether they'd listened to imagery before. Most patients listened to the tape just once. The team is now looking to do further research with a larger sample size, going for more objective outcome measures of things like blood pressure, heart rate, pain and length of stay.

Researchers from the University of Connecticut Health Center in Farmington randomly assigned 128 alcohol dependent men and women receiving 26 weeks of group treatment into one of two modalities: Cognitive-behavioral treatment (CBT) intended specifically to develop coping skills or interactional therapy intended to examine interpersonal relationships. Coping skills and drinking were assessed prior to and after treatment and up to 18 months after intake. Results indicated that both treatments yielded very good drinking outcomes throughout the follow-up period. Increased coping skills was a significant predictor of outcome. However, neither treatment effected greater increases in coping than the other. Specific coping-skills training was not essential for increasing the use of coping skills.

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