Hypnosis in the management of intractable pain is a valuable but frequently overlooked tool for the practicing physician. Two cases are presented which illustrate some of the benefits and limitations of hypnosis in pain management. Hypnosis is most effective when the patient is motivated, and pain is a strong motivating force. Secondary gain from the pain and underlying psychiatric illness must be considered when seemingly routine pain problems do not respond to hypnosis. Hypnosis may be equally effective for pain of organic or psychogenic origin. Ancillary benefits from hypnosis may include a diminution of secondary anxiety and depression. The technic is impractical for some patients because of the time requirements, but proper patient selection can obviate much of this objection. Self-hypnosis and/or the supervised use of a relative as a substitute for the physician enhances effectiveness. Training in hypnosis for adjunctive use in the management of pain is available to primary care physicians.

South Med J. 1980 Mar;73(3):362-4.

Emergency ward physicians are presented daily with patients in pain. Provisions of safe, quick pain control remains one of their major duties. Hypnosis can be used as an effective adjunct or substitute for analgesic medications when these drugs prove to be ineffective or contraindicated. Four such illustrative cases of attempted pain control are presented. The psychological foundations of pain and its assessment are discussed. The emergency ward physician can obtain facility in hypnotic techniques with only modest training. Hypnosis may then become a valuable tool in helping him provide safe and effective pain management.

Postgrad Med J. 1984 Apr;60(702):263-6

by Richard Kuhns, B.S.Ch.E.

How to shift Jane from her conditioned response of anxiety to freedom was my challenge.

From Clara Weaks' book, Healing Your Bad Nerves (out of print), I remembered that there were three phases to panic and an anxiety attack. First there's an alarm. This is also true of the general adaptation syndrome (GAS). The alarm is what takes us away from our homeostatic level. It is a stressor. The next phase is the reaction which is usually physical--activation of the fight/flight. At this point, muscles tighten, breathing quickens and becomes upper chest, extremities become cooler, heart rate quickens, blood pressure raises... preparing the individual to either fight or run.

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The autonomic and EEG correlates of the response to a cognitive unpleasant stimulation (US) verbally administered to awake hypnotizable and non hypnotizable subjects were studied. They were compared with the values obtained during a resting condition immediately preceding the stimulus and with those produced by a cognitive neutral stimulation (NS), also administered after a basal resting period. Results showed hypnotic trait effects on skin resistance, heart and respiratory rate as well as on EEG theta, alpha, beta and gamma relative power changes. The autonomic and EEG patterns observed indicated different strategies in the task execution for hypnotizable and non hypnotizable subjects and a discrepancy between the autonomic and EEG changes associated to the US in susceptible subjects. Results support dissociation theories of hypnosis and suggest for hypnotizable persons an active mechanism of protection against cardiac hazard.

Department of Physiology and Biochemistry G. Moruzzi, University of Pisa, Via S. Zeno 31, 56127 Pisa, Italy.

Brain Res Bull. 2003 Apr 15;60(1-2):151-60

The purpose of the present research was to find physiological and cognitive correlates of hypnosis, imaginative suggestibility and emotional experiences. After the administration of a standard hypnotic induction, the EEG and heart rate (HR) were recorded during self-generated happy and sad emotions using a relaxation condition as a control. Physiological recordings were also obtained during three eyes-open and eyes-closed baseline periods: (1) waking rest; (2) early-rest in hypnosis (just after the hypnotic induction); (3) late-rest hypnosis (at the end of hypnotic condition). EEG was recorded at frontal (F3, F4), central (C3, C4), and posterior sites (middle of O1-P3-T5 and O2-P4-T6 triangles). Using log transform of mean spectral amplitude, eight EEG frequency bands (4-44 Hz) were evaluated. High hypnotizable subjects, as compared to the lows, produced a higher theta1 amplitude (4-6 Hz) across both left- and right-frontal and right-posterior areas. These subjects also produced smaller alpha1 amplitude (8.25-10 Hz) over both left and right frontal recording sites. High suggestible subjects, during resting conditions, disclosed higher theta2 (6.25-8 Hz) and alpha1 amplitudes in eyes-closed as compared to an eyes-open condition than did low suggestible subjects. High suggestible subjects also showed, in hypnosis-rest condition, higher 40-Hz amplitudes (36-44 Hz) and HR activity than did low suggestible subjects. Hypnotizability and not suggestibility was found to moderate emotional processing: high hypnotizable individuals self-reported greater levels of emotional experiences than did low hypnotizables especially in terms of negative emotion. High hypnotizables, during processing of emotional material, also disclosed opposite 40-Hz hemispheric asymmetries over anterior and posterior regions of the scalp. These subjects during happiness showed an increased production of 40-Hz activity in the left frontal and central regions of the scalp, while during sadness they showed an increased activity in the right central and posterior regions. The hemispheric asymmetries for relaxation condition were similar, but less marked, to those obtained for happiness. No significant interactions involving both hypnotizability and imaginative suggestibility were found for physiological variables considered in this study. This demonstrates that hypnotizability and suggestibility reflect different underlying psychophysiological activities.

Department of Psychology, University of Rome, Italy.

Int J Psychophysiol. 1998 Aug;29(3):255-75

This study evaluates the effects of hypnotic analgesia and hypnosis on bilateral EEG activity recorded from frontal, central and posterior areas during three painful electrical stimulation conditions: waking, hypnosis/no-analgesia, hypnosis/analgesia. Eight high-hypnotizable and eight low-hypnotizable (right handed) subjects participated in the experiment. The following measures were obtained: pain and distress tolerance ratings; EEG spectral amplitudes for the frequency bands: delta (0.5-3.75 Hz), theta 1 (4-5.75 Hz), theta 2 (6-7.75 Hz), alpha 1 (8-9.75 Hz), alpha 2 (10-12.75 Hz), beta 1 (13-15.75 Hz), beta 2 (16-31.75 Hz), total band (0.5-31.75 Hz), '40-Hz' (36-44 Hz); cardiac interbeat interval (ms); mid-frequency and high-frequency peaks from power spectral analysis of heart period variability. During hypnosis/analgesia, high hypnotizable subjects displayed significant reductions in pain and distress scores compared to hypnosis/no-analgesia and waking conditions. In each experimental condition these subjects displayed significant lower total and beta 1 amplitudes compared to low hypnotizables. High hypnotizables, on central and posterior recording sites, during both hypnosis/analgesia and hypnosis/no-analgesia conditions also showed total and delta EEG amplitude reductions in both hemispheres and a theta 1 amplitude reduction in the left hemisphere. However, for total, delta and beta 1 bands in the hypnosis/analgesia condition the amplitude reduction was more pronounced in the right hemisphere as shown by hemispheric asymmetry in favor of the left hemisphere. Low hypnotizables, on posterior recording sites, displayed a delta amplitude reduction during hypnosis/no-analgesia and hypnosis/analgesia conditions. These subjects also showed, for all recording sites, a reduction in theta 1 amplitude during hypnosis/no-analgesia compared to the waking condition. Lows, however, failed in evidencing amplitude differences between hypnosis/no-analgesia and hypnosis/analgesia conditions. During hypnotic analgesia the hemispheric asymmetry found in high hypnotizables was parallel to a significant reduction in the spectral mid-frequency peak of heart period variability which indicated a decrease in the level of sympathetic activity. In contrast, during hypnosis/no-analgesia the EEG amplitude reduction was not paralleled by a decrease in sympathetic activity.

Department of Psychology, University of Rome La Sapienza, Italy.

Int J Psychophysiol. 1996 Feb-Mar;21(2-3):163-75.

EEG was recorded monopolarly at frontal (F3, F4), central (C3, C4) and posterior (in the middle of O1-P3-T5 and O2-P4-T6 triangles) derivations during the hypnotic induction of the Stanford Hypnotic Clinical Scale (SHCS) and during performance following suggestions of hypnotic dream and age-regression as expressed in the before-mentioned scale. 10 low-hypnotizable and 9 highly-hypnotizable and right-handed female students participated in one experimental session. Evaluations were Fast-Fourier spectral analyses during the following conditions: waking-rest in eyes-open and eyes-closed condition; early, middle, and late phases of hypnotic induction; rest-hypnosis in eyes closed condition; hypnotic dream and age regression. After spectral analysis of 0 to 44 Hz, the mean spectral amplitude estimates across seven Hz bands (theta 1, 4-6 Hz, theta 2, 6-8 Hz; alpha 1, 8-10 Hz; alpha 2, 10-13 Hz; beta 1, 13-16 Hz; beta 2, 16-20 Hz; beta 3, 20-36 Hz) and the 40-Hz EEG band (36-44 Hz) for each experimental condition were extracted. In eyes-open and -closed conditions in waking and hypnosis highly-hypnotizable subjects produced a greater 40-Hz EEG amplitude than did low hypnotizable subjects at all frontal, central and posterior locations. In the early and middle hypnotic induction highly-hypnotizables displayed a greater amount of beta 3 than did low hypnotizables and this difference was even more pronounced in the left hemisphere. With posterior scalp recordings, during hypnotic dream and age regression, high hypnotizables displayed, as compared with the rest-hypnosis condition, a decrease in alpha 1 and alpha 2 amplitudes. This effect was absent for low hypnotizables. Beta 1, beta 2 and beta 3 amplitudes increased in the left hemisphere during age regression for high hypnotizables; low hypnotizables, in contrast, displayed hemispheric balance across imaginative tasks. High hypnotizables during the hypnotic dream also displayed in the right hemisphere a greater 40-Hz EEG amplitude as compared with the left hemisphere. This difference was even more evident for posterior recording sites. This hemispheric trend was not evidenced for low hypnotizable subjects. Theta power was never a predictor of hypnotic susceptibility, 40-Hz EEG amplitude displayed a very high main effect (p < 0.004) for hypnotizability in hypnotic conditions by displaying a greater 40-Hz EEG amplitude in high hypnotizables with respect to lows.

Department of Psychology, University of Rome La Sapienza, Italy.

Int J Psychophysiol. 1993 Sep;15(2):153-66

Among breast cancer survivors, we identified the prevalence and correlates of use of different types of complementary and alternative medicine (CAM). PATIENTS AND METHODS: We included 2,022 women diagnosed with breast cancer 1998-2003 who responded to a survey about CAM use. We performed logistic regression to determine demographic and disease factors associated with use of different CAM therapies (including relaxation/imagery, spiritual healing, yoga, energy healing, acupuncture, massage, chiropractic, high-dose vitamins, herbs, and homeopathy). We also measured quality of life (QoL) using the SF36 and optimism using LOT-R and fit linear regression models to compare mean scores among CAM users and nonusers. RESULTS: Sixty-two percent of respondents used CAM. Younger age was the most consistent correlate of CAM use, but factors associated with CAM use varied by type of CAM. Chemotherapy was associated with use of relaxation/imagery (OR 1.3 95%CI 1.1-1.7). Radiotherapy was associated with use of high-dose vitamins (OR 1.5 95% CI 1.2-2.0). Tamoxifen or anastrozole treatment was associated with use of homeopathy (OR 0.5 95%CI 0.3-0.9). Users of most types of CAM had worse QoL scores than nonusers, but better QoL was found among users of yoga. The lowest QoL scores were associated with the use of energy healing. Optimism was higher among users of relaxation/imagery. CONCLUSIONS: Factors associated with CAM use varied according to type of CAM. Our finding of worse QoL among women using energy healing and better QoL among women using yoga suggests the need for longitudinal studies to determine the temporal relationships between these therapies and QoL.

Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, MA, 02215-3325, USA, catherine_buettner@hms.harvard.edu.

Breast Cancer Res Treat. 2006 Nov;100(2):219-27. Epub 2006 Jul 5.

by Paul I. Mostman, Ph.D.

Since 1993 I have been using and teaching a new technique which I call Emotional Release Therapy©. This technique is a most effective method for assisting clients to remove old negative emotions and feelings without the necessity of the client having to remember or re-live any or all of the events which caused the negativity. I believe that It is probably one of the best techniques a hypnotist can use in his repertoire.

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Subjects highly (Highs) and low susceptible to hypnosis (Lows) show different imagery and attentional capabilities and also peculiar somatomotor, vegetative and electroencephalographic differences in basal and task conditions. Since attention is one of the main component of hypnotic susceptibility and also a relevant factor for postural control, the aim of the experiment was to study actual differences between Highs and Lows at the eyes closure during upright stance. Visual and motor imagery as well as attentional/disattentional capabilities were evaluated through psychological tests. Posture was monitored though Elite systems during upright stance with open and closed eyes. At the eyes closure, Highs and Lows exhibited a different body sway modulation. Possible different compensation mechanisms are suggested for the two groups and interactions between attentional/arousal systems responsible of hypnotic phenomenology and postural control are underlined.

Department of Physiology and Biochemistry, University of Pisa, Italy. enricals@dfb.unipi.it

Arch Ital Biol. 2004 May;142(3):285-96

It is well accepted that pain is a multidimensional experience, but little is known of how the brain represents these dimensions. We used positron emission tomography (PET) to indirectly measure pain-evoked cerebral activity before and after hypnotic suggestions were given to modulate the perceived intensity of a painful stimulus. These techniques were similar to those of a previous study in which we gave suggestions to modulate the perceived unpleasantness of a noxious stimulus. Ten volunteers were scanned while tonic warm and noxious heat stimuli were presented to the hand during four experimental conditions: alert control, hypnosis control, hypnotic suggestions for increased-pain intensity and hypnotic suggestions for decreased-pain intensity. As shown in previous brain imaging studies, noxious thermal stimuli presented during the alert and hypnosis-control conditions reliably activated contralateral structures, including primary somatosensory cortex (S1), secondary somatosensory cortex (S2), anterior cingulate cortex, and insular cortex. Hypnotic modulation of the intensity of the pain sensation led to significant changes in pain-evoked activity within S1 in contrast to our previous study in which specific modulation of pain unpleasantness (affect), independent of pain intensity, produced specific changes within the ACC. This double dissociation of cortical modulation indicates a relative specialization of the sensory and the classical limbic cortical areas in the processing of the sensory and affective dimensions of pain.

Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec H3G 1Y6, Canada.

J Neurophysiol. 2001 Jul;86(1):402-11.

by Richard Kuhns, B.S.Ch.E.

If you recall, in part I of this article, Jane, my client who dictated her treatment plan to be biofeedback and freaked out in her first biofeedback session with a full blown panic attack. After she left with her husband I thought I'd never see her again and hoped I wouldn't hear from her attorney in the form of a law suit. Actually as apologetic and embarrassed as she was, a law suit was a very remote possibility. But I wonder how many clients in similar situations might not be considering law suits against clinicians using inward focusing techniques that can bring on panic attacks. Then again, their personality is not that of a trouble maker and as long as they continue suffering from anxiety, they would never allow themselves to be in a court room for fear of having an anxiety attack and having to run away.

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Understanding the complex nature of pain perception requires the ability to separately analyze its psychological dimensions and their interaction, and relate them to specific variables and responses. The present study, therefore, attempted to selectively modulate the sensory and affective dimensions of pain, using a cognitive intervention, and to assess the possible relationship between these psychological dimensions of pain and changes in physiological responses to the noxious stimuli. In three experiments, normal subjects trained in hypnosis rated pain intensity and pain unpleasantness produced by a tonic heat-pain stimulus (1-min immersion of the hand in 45.0-47.5 degrees C water). Two experiments were designed to test hypnotic suggestions to decrease (Experiment one (Section 2.5.1)), or increase and decrease (Experiment two (Section 2.5.2)) pain affect. Suggestions in Experiment three (Section 2.5.3) were directed towards an increase or decrease in pain sensation. In Experiments one and two (Sections 2.5.1 and 2.5.2), the significant modulation in pain unpleasantness ratings was largely independent of variations in perceived pain intensity. Moreover, in Experiment two (Section 2.5.2), there was a significant correlation between the stimulus-evoked heart-rate increase and ratings of pain unpleasantness, but not of pain intensity, suggesting a direct functional interaction between pain affect and autonomic activation. In Experiment three (Section 2.5.3), suggestions to modulate the sensory aspect of pain produced significant modulation of pain intensity ratings, with secondary changes in pain unpleasantness ratings. Hypnotic susceptibility (Stanford Hypnotic Susceptibility Scale form A) was specifically correlated to pain unpleasantness modulation in Experiment two (Section 2.5.2) and to pain intensity modulation in Experiment three (Section 2.5.3), suggesting that this factor relates to the primary process toward which hypnotic suggestions are directed. The specific pain dimension on which hypnotic suggestions act depends on the content of the instructions and is not a characteristic of hypnosis itself. Results are consistent with a successive-stage model of pain perception (e.g. Wade JB, Dougherty LM, Archer CR, Price DD. Assessing the stages of pain processing: a multivariate analytical approach. Pain 1996;68:157-167) which provides a conceptual framework necessary to study the cerebral representation of pain perception.

Departement de Psychologie, Universite de Montreal, Quebec, Canada.

Pain. 1999 Aug;82(2):159-71

by Brian Walsh, Ph.D.

You can significantly enrich your learning by incorporating the following building blocks.

1. Prepare & Organize

Define your goal as outlined above. In Stephen Covey's book, The 7 Habits of Highly Effective People, his second habit is to begin with the end in mind.

Identify your barriers and create a strategy to eliminate them. If you have a challenge finding barriers, review my article Be Aware of Obstructions to Your Learning.

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This study evaluated the efficacy of hypnosis- and relaxation-induced suggestions for analgesia for reducing the strength and unpleasantness dimensions of pain evoked by noxious tooth pulp stimulation and by cold pressor stimulation. The Tellegen Absorption Questionnaire was used to assess hypnotic susceptibility for 28 subjects in order to match treatment groups according to sex and susceptibility scores. Tooth pulp stimulation consisted of a 1 sec train of 1 msec pulses at a frequency of 100 Hz, applied at 20 sec intervals to the central incisor. Six stimuli, selected between subject's pain and tolerance thresholds, were presented 3 times each in random order. Cold pressor stimulation consisted of forearm immersion in a circulating water bath maintained at 0-1 degrees C. Subjects made threshold determinations of pain and tolerance and used Visual Analogue Scales to rate the strength and the unpleasantness of both noxious stimuli before and after receiving either hypnosis- or relaxation-induced analgesia. There were no significant differences in pain reductions between hypnosis- and relaxation-induced interventions. However, the percent reduction in both strength and unpleasantness varied significantly as a function of the type of pain. Both hypnosis and relaxation significantly reduced the strength and the unpleasantness of tooth pulp stimulation, but only the unpleasantness dimension of cold pressor pain. The pain reductions were not correlated with subjects' hypnotic susceptibility levels. The results indicate that the extent and the quality of the analgesia produced by these cognitive-based therapies vary not only according to subjects' characteristics and the efficacy of the intervention, but also according to the nature of the noxious stimuli. Tooth pulp and cold pressor stimulation represent qualitatively different stimuli with respect to both the type of nerves activated and the mode of stimulus application. Discrete, randomly presented levels of noxious electrical stimulation to the teeth activate predominantly small fibers and produce brief pain sensations that vary unpredictably in intensity. In contrast, continuous cold stimulation to the forearm activates a variety of nociceptive and non-nociceptive fibers and produces progressive cold and pain sensations with a predictable increase in intensity from cold sensations to paresthesia and severe pain.

Pain Research Program, Faculty of Dentistry, University of Western Ontario, London, Canada.

Pain. 1988 May;33(2):241-51.

Within the framework of multidimensional pain assessment, this study extended an earlier finding that hypnotic analgesia and relaxation suggestions have differential effects on pain reduction by evaluating these strategies in subjects undergoing a cold pressor protocol. Thirty-two highly susceptible subjects were randomly assigned to an analgesia or a relaxation suggestion treatment group. Six pain reports were taken at 10-sec intervals for each experimental condition. The baseline measures served as covariates. A 2 x 2 x 2 x 6 repeated-measures analysis of covariance (ANCOVA) revealed a significant group (analgesia, relaxation) by pain dimension (intensity, unpleasantness), by condition (suggestion alone, hypnotic induction plus suggestion) interaction. Analysis of the simple-simple main effects, holding both group and condition constant, revealed that application of hypnotic analgesia reduced report of pain intensity significantly more than report of pain unpleasantness. Conversely, hypnotic relaxation reduced pain unpleasantness more than intensity. The clinical implications of the study are discussed.

Department of Psychology, Washington University, St. Louis, Missouri 63130, USA.

J Pain Symptom Manage. 1995 Aug;10(6):464-70

For the first time, the therapeutic effects on subacute and chronic tinnitus of an inpatient multimodal treatment concept based on principles of Ericksonian hypnosis (EH) were examined by standardized criteria of the Tinnitus Questionnaire (TQ) and Health Survey (SF-36) within a controlled prospective, longitudinal study. A total of 393 patients were treated within an inpatient closed-group 28-day-setting based on a resource-oriented, hypnotherapeutic concept. The severity of tinnitus was assessed by TQ at times of admission, discharge and also at a 6- and 12-month follow-up. Health-related quality of life was evaluated before and after therapy using the SF-36. After therapy, a decrease in TQ score was seen in 90.5% of the patients with subacute tinnitus and in 88,3% of those with chronic tinnitus. Assessment of the TQ score at the end of therapy revealed highly significant improvements of 15.9/14.1 points in mean. Effect sizes in the treatment groups (0.94/0.80) were superior to those in the waiting-list controls (0.14/0.23). The TQ score remained stable in the follow-up controls. Significant improvement in health-related quality of life has been observed within the treatment groups depending on initial level of tinnitus serverity I-IV according to TQ. Using a multimodal treatment concept with emphasis on resource-activating approaches of EH the annoyance of tinnitus can be significantly reduced while health-related quality of life is enhanced within a comparatively short treatment period of 28 days.

Practice for Otorhinolaryngology and Psychotherapy, Luisenstrasse 6, 79098, Freiburg, Germany, Dr-Ross@web.de.

Eur Arch Otorhinolaryngol. 2007 May;264(5):483-8. Epub 2007 Jan 6

by Brian Walsh Ph.D.

It is important to write down your goals, since that action imprints them on your brain. Before writing your goals, identify what price you are willing to pay to achieve them. These may be material, emotional, or spiritual. At some point, expose your barriers and excuses; write them on a separate piece of paper. This list is not meant to be dwelled on; it is meant merely as acknowledgement – celebrate as you conquer each barrier or excuse.

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The principal stages in the history of hypnosis are reviewed, from the forerunners of Mesmer to the founder of "animal magnetism" himself, to Braid, and the entire hypnological movement of the nineteenth century. The work of Freud and the then and later relationships between hypnosis and psychoanalysis are discussed. A personal interpretation is offered for the phenomenon of the ups and downs of the popularity of hypnosis and reasons given for why its application should never decline again. After a brief review of modern theories of hypnosis and hypnotic techniques, the importance of the subject, over and above its uses in medical treatment, is emphasized, for hypnosis can be used as an invaluable tool for investigating the extraordinary reconstructional and creative possibilities inherent in the outer reaches of the human psyche.

The neurophysiological mechanisms of hypnotic analgesia are still under debate. It is known that pain occurring in one part of the body (counterstimulation) decreases pain in the rest of the body by activating the diffuse noxious inhibitory controls (DNICs). The aim of this study was to explore the effects of hypnosis on both pain perception and heterotopic nociceptive stimulation. The A forms of both the Harward Group Scale of Hypnotic Susceptibility and the Stanford Hypnotic Susceptibility Scale were administered to 50 healthy students. Twenty subjects were selected and assigned to two groups: group A, consisting of 10 subjects with high hypnotic susceptibility; and group B, consisting of 10 subjects with low hypnotic susceptibility. The subjects were then randomly assigned first to either a control session or a session of hypnotic analgesia. The nociceptive flexion reflex (RIII) was recorded from the biceps femoris muscle in response to stimulation of the sural nerve. The subjective pain threshold, the RIII reflex threshold, and the mean area with suprathreshold stimulation were determined. Heterotopic nociceptive stimulation was investigated by the cold-pressor test (CPT). During and immediately after the CPT, the subjective pain threshold, pain tolerance, and mean RIII area were determined again. The same examinations were repeated during hypnosis. Hypnosis significantly reduced the subjective pain perception and the nociceptive flexion reflex. It also increased pain tolerance and reduced pain perception and the nociceptive reflex during the CPT. These effects were found only in highly susceptible subjects. However, the DNIC's activity was less evident during hypnosis than during the CPT effects without hypnosis. Both hypnosis and DNICs were able to modify the perception of pain. It seems likely that DNICs and hypnosis use the same descending inhibitory pathways for the control of pain. The susceptibility of the subject is a critical factor in hypnotically induced analgesia.

Department of Neurological Sciences, University Center for Adaptive Disorders and Headache, IRCCS, C. Mondino Foundation, University of Pavia, Via Palestro 3, 27100, Pavia, Italy. gsandrin@unipv.it

Physiol Behav. 2000 May;69(3):295-300

by Richard Kuhns, B.S.Ch.E.

Very little progress is possible without addressing diet. In fact many professionals believe that addressing diet is the total cure for overcoming panic and anxiety. However, you'll find in the upcoming parts of the program that there are many factors that get intertwined. In future parts I'll be addressing those.

Let's begin with diet. I dislike being redundant, but let me again say, diet is the foundation of improvement and without it we can not expect any improvement.

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Lynda Hudson is a clinical hypnotherapist who, in addition to her work with adults, specialises in using hypnotherapy with children. She has produced an innovative series of CDs for children (which can be purchased from the First Way Forward shop, or from her website) helping them to overcome a variety of problems which are anxiety based. She gives masterclasses on using hypnosis with children for the London College of Clinical Hypnosis and is an examiner for their Certificate and Diploma courses.

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The implications and effects of the French commission that passed judgment on Mesmer's work is examined in light of the pioneering role of hypnosis as the first Western conception of a psychotherapy, the ancient philosophical debate between idealism and empiricism, and the conflict in modern medicine between biotechnological emphasis on cure and the need for care as many previously terminal illnesses are converted to chronic diseases. The panel's report is interpreted as negative about the literal theory of animal magnetism but actually supportive of the potential therapeutic power of suggestion and "positive thinking." This aspect of hypnosis is described as a forerunner of modern cognitive therapies of depression and other illnesses. The panel exerted a constructive effect in applying scientific method and rigorous evaluation to hypnotic treatment, an application of Enlightenment philosophy that presaged the Flexner era in modern medicine. Both hypnosis and medicine ultimately benefited.

Stanford University School of Medicine, California 94305-5718, USA. dspiegel@leland.stanford.edu

Int J Clin Exp Hypn. 2002 Oct;50(4):397-406

Hypnosis has been defined as the induction of a subjective state in which alterations of perception or memory can be elicited by suggestion. Ever since the first public demonstrations of "animal magnetism" by Mesmer in the 18th century, the use of this psychological tool has fascinated the medical community and public alike. The application of hypnosis to alter pain perception and memory dates back centuries. Yet little progress has been made to fully comprehend or appreciate its potential compared to the pharmacologic advances in anesthesiology. Recently, hypnosis has aroused interest, as hypnosis seems to complement and possibly enhance conscious sedation. Contemporary clinical investigators claim that the combination of analgesia and hypnosis is superior to conventional pharmacologic anesthesia for minor surgical cases, with patients and surgeons responding favorably. Simultaneously, basic research of pain pathways involving the nociceptive flexion reflex and positron emission tomography has yielded objective data regarding the physiologic correlates of hypnosis. In this article I review the history, basic scientific and clinical studies, and modern practical considerations of one of the oldest therapeutical tools: the power of suggestion.

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida 32610-0254, USA. awobst@anest.ufl.edu

Anesth Analg. 2007 May;104(5):1199-208

Relieving abdominal pain is the principal treatment objective for patients with irritable bowel syndrome. No single drug stands out in the treatment strategy for this illness. Antispasmodics, magnesium aluminum silicates, and alverine citrate drugs all remain initial options for treatment, although their prescription is impeded by the fact that an increasing number are no longer approved for reimbursement. Increased dietary fibers often have a harmful effect on symptoms. Some patients are probably intolerant to some foods but there is no satisfactory proof on which to base a restrictive diet. Improved knowledge of the pathophysiology of irritable bowel syndrome has made it possible to diversify treatments that act first on one of the key pathophysiologic elements, visceral hypersensitivity. Antidepressants (especially tricyclics) can be used at low doses. Among the serotonergic drugs, serotonin 5-HT4 receptors agonists (tegaserod) may be available soon, but the development of 5-HT3 antagonists (alosetron, cilansetron) has been stopped for safety reasons (ischemic colitis and severe constipation). Non-drug options such as hypnosis, psychotherapy, relaxation, or yoga, may also be proposed to some patients. Probiotics are a possible treatment in the future.

Departement d'hepatogastroenterologie et de nutrition, Centre hospitalier, ADEN EA 3234 / IFRMP 23, Rouen (76). Presse Med. 2007 May 7

Comment from Tim Brunson DCH: Although this article does not specifically mention hypnosis or other mind/body modalities, I thought that it was significant since many hypnotherapists provide services with IBS. Note that relaxation and slower breathing helps the brain stem stimulate serotonin. Since activation of the parasympathetic nervous system and serotonin production are significant to GI functioning, hypnosis, guided imagery, and relaxation are significant. The article focuses on pharmacological interventions and unfortunately does not discuss the significant of hypnosis, et. al., as an adjunctive treatment.

by Annie H. Spencer, Ph.D.

You have healing power! This is a truism that everyone can honor if they will let the energy flow. Mother's rub their babies back and the little child falls into a peaceful sleep. Nurses stroke infants in Intensive Care and they rest easily. Daddies kiss skinned knees and they are all better. Sisters hold the dying and they slip into heavenly bliss. Therapists touch clients and relaxation occurs. What is this "Mystical Power?"

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Many theories of hypnotic responding have proposed that differences in hypnotic trait rely on differences in frontal attentional functions. Evidence of hypnotizability-related attentional abilities are, however, very scant. This study was designed to investigate the relationship between hypnotizability and executive control components of attention in the spatial domain. We chose the Attention Network Test that enables to analyze alerting, orienting and executive control functions by measuring reaction times (RTs) to targets cued for different locations in space. According to Posner theory, alerting, orienting and executive control effects were found in both groups. No differences between highly susceptible (Highs) and low susceptible individuals (Lows) on executive control functions were found. However, in Highs alerting was significantly smaller than in Lows and Highs were significantly faster than Lows in the no and central cue conditions. These findings suggest that Highs would be endowed with a basal higher efficiency in achieving and maintaining their readiness to respond to incoming stimuli. This relation between hypnotizability and alerting, is discussed in terms of a possible more efficient noradrenergic activity driven by frontal attentional systems.

Castellani E, D'Alessandro L, Sebastiani L. Department of Physiology and Biochemistry, University of Pisa, Via S. Zeno 31, 56127 Pisa, Italy.

Book Review by Judith E. Pearson, Ph.D.

Self-Hypnosis for Cosmic Consciousness by Ronald A. Havens, Ph.D.

Cosmic consciousness is an altered, mystical state of peace, awe, enlightenment and clarity of awareness that creates new understandings, insights, and attitudes about life, self, love, truth, beauty, and spirituality. All cultures have stories of individuals who have experienced cosmic consciousness spontaneously, others who sought it, and those who could induce such a state in oneself and others. In Self Hypnosis for Cosmic Consciousness psychology professor Ronald A. Havens explores how cosmic consciousness can be achieved via Ericksonian Hypnosis. This is Haven's fourth book on hypnotherapy as practiced by the late Dr. Milton H. Erickson, and it is, by far, his best.

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The human brain seems to hum along quite nicely, and without too much effort or complaint, thank you, just using established patterns and routine. However, learning expert and bestselling author Dr. Brian E. Walsh suggests that it can easily do so much better with novelty and random activity added to help build neuronal connections. "In school we had to memorize all sorts of stuff, good for training our young minds, but just memorizing poems, formulae, dates and suchlike wasn't alone enough to enable us to appreciate literature, wonder at science, or gain historical perspective."

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by Richard Kuhns, B.S.Ch.E.

This is the first of an ongoing series of articles for the effective treatment of anxiety and panic attacks and agoraphobia. The articles are based on a technique which demonstrated an 80% success rate in the participants with whom the technique was used. For the study and data that surveyed 84 clients, go to http://www.panicbusters.com/80%25%20Success%20Rate.htm

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by Brian Walsh Ph.D.

There is a biorhythm operating 24/7 in our body known as the Basic Rest-Activity Cycle (BRAC). While some biological cycles last for many days, the BRAC oscillates consistently at between 90 and 120 minutes.

Rest portion: During this healing response portion of the cycle, there is more right hemispheric electrical activity, a spatial cognitive mode, and a settling down of the autonomic nervous system. Midway through the rest cycle is a trough of about twenty-minutes. This is when many cells of the brain that hold critical messenger molecules, such as adrenaline, are nearing empty. At this point, all the cells in the body are taking time out to replenish, rejuvenate, and rebalance. It is during this part of the cycle that people daydream, and can be most creative. Active portion: During this peak performance period of the cycle, there is greater electrical activity in the left hemisphere, a verbal cognitive mode, and the autonomic nervous system is in a phase of sympathetic predominance. This means that it is "open for business." Heightened physical activity, mental alertness, and energy means that logic, rationality, and a black and white approach are being exercised.

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Anticipatory nausea and vomiting (ANV) is associated with a significant reduction in the quality of life for many chemotherapy patients. The use of 5-hydroxytryptamine type 3 receptor antagonists provides some relief for chemotherapy-induced nausea and vomiting, but does not seem to control ANV. Nonpharmacologic approaches, which include behavioral interventions, may provide the greatest promise in relieving symptoms. Little evidence supports the use of complementary and alternative methods, such as acupuncture and acupressure, in relieving ANV. Behavioral interventions, especially progressive muscle relaxation training and systematic desensitization, should be considered important methods for preventing and treating ANV.

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INTRODUCTION: Vulvar vestibulitis syndrome (VVS) is a common cause of vulvar pain. Therapeutic options target different pain systems believed to be involved in its development and maintenance. Most treatments target the pain component with the assumption that sexual function will increase once the pain has decreased, yet this is not necessarily the case. AIMS: Research has supported the effectiveness of hypnosis for many chronic pain disorders, and a case report demonstrated pain reduction and an increase in intercourse pleasure in a woman with VVS. This preliminary study examined the effectiveness of hypnosis on pain and psychosexual function in VVS. METHODS; Eight women suffering from VVS completed a hypnosis screening assessment, an interview, pain and psychosexual questionnaires, a gynecologic examination, vestibular pain threshold measurement, a psychosexual assessment, and six hypnotherapy sessions. The physical examinations, interview, and questionnaires were repeated at 1 and 6 months posttreatment. MAIN OUTCOME MEASURES: These included pain ratings during the gynecologic examination, vestibular pain thresholds, scores on the McGill Pain Questionnaire and Pain Catastrophizing Scale, and responses to questions on intercourse-related and nonintercourse-related pain. Measures of psychosexual function included the Female Sexual Function Index, State-Trait Anxiety Scale, Beck Depression Inventory-II, and the Brief Symptom Inventory. RESULTS: Results indicated significant decreases in gynecologic examination pain and in several measures assessing intercourse pain, and nonsignificant increases in threshold. Some indices of noncoital vulvar pain decreased. Overall sexual function, particularly sexual satisfaction, increased at posttreatment. There were no differences on any psychological measure. Participants reported satisfaction with the treatment and rated their VVS pain reduction as average. CONCLUSIONS: Hypnotherapy appears to be a promising treatment for reducing intercourse pain and some aspects of noncoital vulvar pain, and for restoring sexual function in women with VVS. These results suggest that a large controlled trial should be considered.

Pukall C, Kandyba K, Amsel R, Khalife S, Binik Y. Department of Psychology, Queen's University, Kingston, Ontario, Canada. pukallc@post.queensu.ca

by Casey Chua, MDiv PhD CH CI BCH MNCH(UK)

It is well known that the brain is an electrochemical organ. Researchers have speculated that a fully functioning brain can generate as much as 10 watts of electrical power (enough to light a flash light bulb).

When the brain is working, millions of nerve cells communicate with each other, with the help of tiny electrical impulses. In this way, the brain is electrically active night and day throughout one's life.

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PURPOSE: To review the available literature on the use of complementary and alternative medicine (CAM) treatments for cancer-related fatigue with an aim to develop directions for future research. METHODS: PubMed, EMBASE, CINAHL, PsycINFO, and SPORTDiscus were searched for relevant studies. Original clinical trials reporting on the use of CAM treatments for cancer-related fatigue were abstracted and critically reviewed. RESULTS: CAM interventions tested for cancer-related fatigue include acupuncture, aromatherapy, adenosine triphosphate infusions, energy conservation and activity management, healing touch, hypnosis, lectin-standardized mistletoe extract, levocarnitine, massage, mindfulness-based stress reduction, polarity therapy, relaxation, sleep promotion, support group, and Tibetan yoga. Several of these interventions seem promising in initial studies. CONCLUSION: Currently, insufficient data exist to recommend any specific CAM modality for cancer-related fatigue. Therefore, potentially effective CAM interventions ready for further study in large, randomized clinical trials (eg, acupuncture, massage, levocarnitine, and the use of mistletoe) should be pursued. Other interventions should be tested in well-designed feasibility and phase II trials.

Sood A, Barton DL, Bauer BA, Loprinzi CL. Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. sood.amit@mayo.edu

Use of mind-body therapies in psychiatry and family medicine faculty and residents: attitudes, barriers, and gender differences.

BACKGROUND: Mind-body medicine (MBM) approaches to many health problems have been well documented in the literature, including through multiple meta-analyses. Efficacy has been well demonstrated in conditions such as headache, irritable bowel syndrome, anxiety, fibromyalgia, hypertension, low back pain, depression, cancer symptoms, and postmyocardial infarction. However, an apparent disconnect (ie, translational block) prevents more widespread adoption of such therapies into practice. Biofeedback, relaxation therapy, hypnosis, guided imagery, cognitive behavioral therapy, and psychoeducational approaches are the domain of MBM we examined in assessing physician attitudes, beliefs, and practices. METHODS: Using a Web-based survey, we obtained responses from 74 faculty and resident physicians in the Department of Family Medicine and the Department of Psychiatry. Our response rate was 69%. We conducted descriptive statistics, bivariate analysis, and multivariate analysis using a logistic regression model. Various statistics were chosen depending on the nature of analyzed variables. Synoptic tables are presented. RESULTS: Comparing these cohorts, we found little difference between physicians in the two specialties, but substantial reports that barriers to the use of MBM were largely based on lack of training, inadequate expertise, and insufficient clinic time. Lack of expertise and insufficient clinic time were higher among family physicians than among psychiatrists. There was a high interest in both groups in learning relaxation techniques and meditation and lower interest in biofeedback and hypnosis. Female physicians were significantly more likely to use MBM, both with patients and for their own self-care, and were less likely to be concerned that recommending these therapies would make patients feel that their symptoms were being discounted. Female physicians also had significantly higher beliefs about the benefits of MBM on health disorders in several of the conditions examined, with a consistent though nonsignificant trend in others.

Sierpina V, Levine R, Astin J, Tan A. University of Texas Medical Branch, Galveston, TX 77555-1123, USA. vssierpi@utmb.edu

Rupert Sheldrake, Ph.D., and Tim Brunson DCH

by Tim Brunson DCH

I recently attended the Ninth Annual International Energy Psychology Conference, which was held April 18 through 25, 2007, at the Westfield's Marriott in Chantilly, Virginia. This was the annual conference for The Association for Comprehensive Energy Psychology, a leading-edge organization of psychologists and other professions. It was good to see old friends and colleagues as well as meet many new ones. I've been interested in the fields of energy psychology and medicine since I met Fred Gallo Ph.D., David Feinstien Ph.D., and Donna Eden at The National Institute for the Clinical Application of Behavioral Medicine (NICABM) conference four years ago.

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To investigate the effectiveness of cognitive hypnotherapy (CH), hypnosis combined with cognitive-behavioral therapy (CBT), on depression, 84 depressives were randomly assigned to 16 weeks of treatment of either CH or CBT alone. At the end of treatment, patients from both groups significantly improved compared to baseline scores. However, the CH group produced significantly larger changes in Beck Depression Inventory, Beck Anxiety Inventory, and Beck Hopelessness Scale. Effect size calculations showed that the CH group produced 6%, 5%, and 8% greater reduction in depression, anxiety, and hopelessness, respectively, over and above the CBT group. The effect size was maintained at 6-month and 12-month follow-ups. This study represents the first controlled comparison of hypnotherapy with a well-established psychotherapy for depression, meeting the APA criteria for a "probably efficacious" treatment for depression.

Alladin A, Alibhai A. University of Calgary, Calgary, Alberta, Canada. assen.alladin@calgaryhealthregion.ca