CONTEXT: Focused hypnotic concentration is a model for brain control over sensation and behavior. Pain and anxiety can be effectively alleviated by hypnotic suggestion, which modulates activity in brain regions associated with focused attention, but the specific neural network underlying this phenomenon is not known.

OBJECTIVE: To investigate the brain basis of hypnotizability.

DESIGN: Cross-sectional, in vivo neuroimaging study performed from November 2005 through July 2006.

SETTING: Academic medical center at Stanford University School of Medicine.

PATIENTS: Twelve adults with high and 12 adults with low hypnotizability.

MAIN OUTCOME MEASURES: Functional magnetic resonance imaging to measure functional connectivity networks at rest, including default-mode, salience, and executive-control networks; structural T1 magnetic resonance imaging to measure regional gray and white matter volumes; and diffusion tensor imaging to measure white matter microstructural integrity.

RESULTS: High compared with low hypnotizable individuals had greater functional connectivity between the left dorsolateral prefrontal cortex, an executive-control region of the brain, and the salience network composed of the dorsal anterior cingulate cortex, anterior insula, amygdala, and ventral striatum, involved in detecting, integrating, and filtering relevant somatic, autonomic, and emotional information using independent component analysis. Seed-based analysis confirmed elevated functional coupling between the dorsal anterior cingulate cortex and the dorsolateral prefrontal cortex in high compared with low hypnotizable individuals. These functional differences were not due to any variation in brain structure in these regions, including regional gray and white matter volumes and white matter microstructure.

CONCLUSIONS: Our results provide novel evidence that altered functional connectivity in the dorsolateral prefrontal cortex and dorsal anterior cingulate cortex may underlie hypnotizability. Future studies focusing on how these functional networks change and interact during hypnosis are warranted.

Arch Gen Psychiatry. 2012 Oct;69(10):1064-72. doi: 10.1001/archgenpsychiatry.2011.2190. Hoeft F, Gabrieli JD, Whitfield-Gabrieli S, Haas BW, Bammer R, Menon V, Spiegel D. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.

BACKGROUND: This review is one in a series of Cochrane Reviews investigating pain management for childbirth. These reviews all contribute to an overview of systematic reviews of pain management for women in labour, and share a generic protocol. We examined the current evidence regarding the use of hypnosis for pain management during labour and childbirth. This review updates the findings regarding hypnosis from an earlier review of complementary and alternative therapies for pain management in labour into a stand-alone review.

OBJECTIVES: To examine the effectiveness and safety of hypnosis for pain management during labour and childbirth.

SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 January 2012) and the reference lists of primary studies and review articles.

SELECTION CRITERIA: Randomised controlled trials and quasi-randomised controlled trials comparing preparation for labour using hypnosis and/or use of hypnosis during labour, with or without concurrent use of pharmacological or non-pharmacological pain relief methods versus placebo, no treatment or any analgesic drug or technique.

DATA COLLECTION AND ANALYSIS: Two assessors independently extracted data and assessed trial quality. Where possible we contacted study authors seeking additional information about data and methodology.

MAIN RESULTS: We included seven trials randomising a total of 1213 women. All but one of the trials were at moderate to high risk of bias. Although six of the seven trials assessed antenatal hypnotherapy, there were considerable differences between these trials in timing and technique. One trial provided hypnotherapy during labour. No significant differences between women in the hypnosis group and those in the control group were found for the primary outcomes: use of pharmacological pain relief (average risk ratio (RR) 0.63, 95% confidence interval (CI) 0.39 to 1.01, six studies, 1032 women), spontaneous vaginal birth (average RR 1.35, 95% CI 0.93 to 1.96, four studies, 472 women) or satisfaction with pain relief (RR 1.06, 95% CI 0.94 to 1.20, one study, 264 women). There was significant statistical heterogeneity in the data for use of pharmacological pain relief and spontaneous vaginal birth. The primary outcome of sense of coping with labour was reported in two studies as showing no beneficial effect (no usable data available for this review). For secondary outcomes, no significant differences were identified between women in the hypnosis group and women in the control group for most outcomes where data were available. For example, there was no significant difference for satisfaction with the childbirth experience (average RR 1.36, 95% CI 0.52 to 3.59, two studies, 370 women), admissions to the neonatal intensive care unit (average RR 0.58, 95% CI 0.12 to 2.89, two studies, 347 women) or breastfeeding at discharge from hospital (RR 1.00, 95% CI 0.97 to 1.03, one study, 304 women). There was some evidence of benefits for women in the hypnosis group compared with the control group for pain intensity, length of labour and maternal hospital stay, although these findings were based on single studies with small numbers of women. Pain intensity was found to be lower for women in the hypnosis group than those in the control group in one trial of 60 women (mean difference (MD) -0.70, 95% CI -1.03 to -0.37). The same study found that the average length of labour from 5 cm dilation to birth (minutes) was significantly shorter for women in the hypnosis group (mean difference -165.20, 95% CI -223.53 to -106.87, one study, 60 women). Another study found that a smaller proportion of women in the hypnosis group stayed in hospital for more than two days after the birth compared with women in the control group (RR 0.11, 95% CI 0.02 to 0.83, one study, 42 women).

AUTHORS' CONCLUSIONS: There are still only a small number of studies assessing the use of hypnosis for labour and childbirth. Although the intervention shows some promise, further research is needed before recommendations can be made regarding its clinical usefulness for pain management in maternity care.

Cochrane Database Syst Rev. 2012 Nov 14;11:CD009356. doi: 10.1002/14651858.CD009356.pub2. Madden K, Middleton P, Cyna AM, Matthewson M, Jones L. School of Psychology, University of Tasmania, Private Bag 30, Hobart, Tasmania, Australia, 7001.

by Tim Brunson PhD

When demonstrating or teaching NLP Eye Accessing Cues, I've often stated that our eyes are not only windows to our mind, but probably they should be considered an integral part of the brain itself. By studying that special relationship we may also discover some secrets about the functioning of our subconscious mind.

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by Tim Brunson PhD

The repetition of ideas and concepts is most definitely a significant aspect of how humans communicate and greatly affects how we acquire knowledge and skills. Advertising agencies use it – although in ways that too often annoy their intended audiences. When studying Tai Chi in Nuremberg many decades ago, I remember my Chinese-Malaysian master using the German phrase Übung macht den Meister, which roughly translates as "Practice makes perfect." This was ever so true when as a student helicopter pilot I practiced shutting down my engine and successfully auto-rotating to the ground at least a hundred times before my instructor considered me ready to take my flight exam. So, repetition obviously plays a very big role in the acceptance of a message and how mastery is achieved. As all communication and skill mastery needs to be considered in the context of how the brain is affected, it is no wonder that repetition plays a role in the practice of hypnotherapy.

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Heart rate variability (HRV) biofeedback has been reported to increase HRV while decreasing symptoms in patients with mental disorders. In addition, associations between low HRV and lowered self-regulation were found in non-clinical samples, e.g., in individuals with strong chocolate cravings or unsuccessful dieting. The current study aimed at decreasing food cravings with HRV-biofeedback in individuals frequently experiencing such cravings. Participants (N = 56) with strong or low food cravings associated with a lack of control over eating were selected from the local community. Half of the participants with strong cravings (craving-biofeedback; n = 14) performed 12 sessions of HRV-biofeedback while the other half (craving-control; n = 14) and a group with low cravings (non-craving-control; n = 28) received no intervention. Subjective food cravings related to a lack of control over eating decreased from pre- to post-measurement in the craving-biofeedback group, but remained constant in the control groups. Moreover, only the craving-biofeedback group showed a decrease in eating and weight concerns. Although HRV-biofeedback was successful in reducing food cravings, this change was not accompanied by an increase in HRV. Instead, HRV decreased in the craving-control group. This study provides preliminary evidence that HRV-biofeedback could be beneficial for attenuating dysfunctional eating behavior although specific mechanisms remain to be elucidated.

Appl Psychophysiol Biofeedback. 2012 Dec;37(4):241-51. doi: 10.1007/s10484-012-9197-y. Meule A, Freund R, Skirde AK, Vögele C, Kübler A. Department of Psychology I, University of Würzburg, Marcusstrasse 9-11, Würzburg, Germany. adrian.meule@uni-wuerzburg.de

he concept of dissociation was developed in the late 19th century by Pierre Janet for conditions of "double consciousness" in hypnosis, hysteria, spirit possession and mediumship. He defined dissociation as a deficit in the capacity of integration of two or more different "systems of ideas and functions that constitute personality", and suggested that it can be related to a genetic component, to severe illness and fatigue, and particularly to experiencing adverse, potentially traumatizing events. By the late 20th century, various and often contradictory concepts of dissociation were suggested, which were either insufficient or exceedingly including when compared to the original idea. Currently, dissociation is used to describe a wide range of normal and abnormal phenomena as a process in which behaviour, thoughts and emotions can become separated one from another. A complete presentation of mechanisms involved in dissociation is still unknown. Scientific research on basic processes of dissociation is derived mainly from studies of hypnosis and post-traumatic stress disorder. Given the controversies in modern concepts of dissociation, some researchers and theorists suggest return to the original understanding of dissociation as a basic premise for the further development of the concept of dissociation.

Psychiatr Danub. 2012 Oct;24 Suppl 3:S367-72. Avdibegovi? E. Clinic of Psychiatry, University Clinical Centre Tuzla, 75000 Tuzla, Bosnia and Herzegovina. esmina@bih.net.ba

BACKGROUND: In the United States (US) a shortage of primary care physicians has become evident. Other health care providers such as chiropractors might help address some of the nation's primary care needs simply by being located in areas of lesser primary care resources. Therefore, the purpose of this study was to examine the distribution of the chiropractic workforce across the country and compare it to that of primary care physicians.

METHODS: We used nationally representative data to estimate the per 100,000 capita supply of chiropractors and primary care physicians according to the 306 predefined Hospital Referral Regions. Multiple variable Poisson regression was used to examine the influence of population characteristics on the supply of both practitioner-types.

RESULTS: According to these data, there are 74,623 US chiropractors and the per capita supply of chiropractors varies more than 10-fold across the nation. Chiropractors practice in areas with greater supply of primary care physicians (Pearson's correlation 0.17, p-value < 0.001) and appear to be more responsive to market conditions (i.e. more heavily influenced by population characteristics) in regards to practice location than primary care physicians.

CONCLUSION: These findings suggest that chiropractors practice in areas of greater primary care physician supply. Therefore chiropractors may be functioning in more complementary roles to primary care as opposed to an alternative point of access.

Chiropr Man Therap. 2012 Nov 21;20(1):35. Davis MA, Mackenzie TA, Coulter ID, Whedon JM, Weeks WB.

This paper examines the fortunes of the controversial use of hypnosis to 'enhance' autobiographical memories in postwar America. From the 1950s through the early 1980s, hypnosis became increasingly popular as a means to exhume information thought to be buried within the mind. This practice was encouraged by lay understandings of memory drawn from a material culture full of new recording devices (motion pictures, tape and then video recorders); and during the years when the practice was becoming most popular and accepted, academic psychologists developed a contrary, reconstructive, account of memory that was put to use in a series of battles meant to put an end to hypnotic recall. But popular commitment to the idea of permanent memory 'recordings' sustained the practice and the assumptions about memory and self that were associated with it, and in the face of a culture of academic psychology fully committed to the idea of 'reconstructive', malleable memory, a tidal wave of 'enhanced' memories swept America in the late 1980s and 1990s, in the so-called 'memory wars'. These, in turn, provoked academic psychologists to research the claims and counter claims central to the memory wars. The paper will also make an argument about the importance of lay knowledge in the psychological sciences explored in this paper: that popular psychological beliefs played a significant, even formative role in defining the nature of forensic psychological expertise, and also the framing of elite academic psychological research.

Stud Hist Philos Biol Biomed Sci. 2012 Nov 8. pii: S1369-8486(12)00105-7. doi: 10.1016/j.shpsc.2012.09.011. Winter A. Department of History, The University of Chicago, 1126 E. 59th Street, Chicago, IL 60637, USA. Electronic address: awinter@midway.uchicago.edu.

by Tim Brunson PhD

An issue that often comes up with new subjects involves fear and concerns about being led by the hypnotic operator to perform acts, which would be against that their moral or ethical values. This phenomenon is normally called hypnocontrol. This is a myth. Having performed hypnosis sessions since 1992, I've never seen anyone do anything that was against their will.

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Although insufficiently studied, schools of complementary and alternative medicine (CAM) provide substantial insight into the transformation of medicine in the United States. Scholars have suggested that the increasing acceptance of CAM is due to its alignment with biomedical models of professionalization, education, research, and practice. At West Coast University, students of acupuncture and Oriental medicine learn to straddle both Western and Eastern medical worlds through an increasingly science-oriented curriculum and the inculcation of professional values associated with West Coast University's emphasis upon integration with Western medicine as a means of achieving professional status and legitimacy vis-à-vis the dominant biomedical paradigm. The implications of integration with biomedicine for the identity of Chinese medicine are discussed: from the perspective of critical medical anthropology, integration reproduces biomedical hegemony; paving the way toward co-optation of Chinese medicine, the subordination of its practitioners, and, ultimately, the constraint of medical pluralism in the United States.

Med Anthropol. 2013 Jan;32(1):8-24. doi: 10.1080/01459740.2012.694930. Flesch H. a McMaster University , Hamilton , Ontario , Canada.

Guided imagery is an established intervention in integrative oncology. This study was initiated to evaluate the impact of guided imagery on patients undergoing radiation therapy for breast cancer. Eligible patients receiving guided imagery sessions were monitored via biofeedback before and after each session. Monitored measures included blood pressure, respiration rate, pulse rate, and skin temperature. In addition, the EuroQoL Group's EQ-5D questionnaire was used for subjective assessment and patient feedback was collected at the end of radiation therapy through a satisfaction survey. Measured parameters revealed statistically significant improvement from baseline, with decreases noted in respiration rate and pulse rate as well as systolic and diastolic blood pressure. Skin temperature increased, indicating more peripheral capillary flow secondary to a decrease in the sympathetic response. Overall, 86% of participants described the guided imagery sessions as helpful, and 100% said they would recommend the intervention to others. The results of this study illustrate the positive impact of guided imagery as measured through subjective and objective parameters. Improving the overall care for patients with breast cancer supports the value of incorporating practices of integrative oncology into standard practice.

Clin J Oncol Nurs. 2012 Dec;16(6):617-23. doi: 10.1188/12.CJON.617-623. Serra D, Parris CR, Carper E, Homel P, Fleishman SB, Harrison LB, Chadha M. Continuum Cancer Centers of New York, Beth Israel Medical Center.

A book review by Tim Brunson PhD

If every decision you ever made was flawless, how would your life be today? Of course, this assumes that you could accurately predict all of the consequences of taking a particular course of action. I'm sure that the mere possibility of perfect decision making immediately brings up fantasies of great relationships, career successes, and even unlimited financial wealth and prosperity. However, although no matter how much a person has achieved - I doubt that anyone can claim a perfect record - can we at least aim for having a much improved track record in the future?

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by Coach Cary Bayer

"How often should I see you?" It's a question that just about every alternative therapist is typically asked by new clients or prospective clients with regard to the ideal frequency for treatments. It's a terrific question for any healer to be asked for a number of reasons, the least of which is that it generally means that the person doing the asking will soon be doing the receiving of your healing hands, deep insights, and expanded perception, and she'll be revitalizing her achy body, tired mind, and worried heart. Unfortunately, I have seen far too many healers answer this important question in ways that sound something along the lines of:

• "Whenever you think best." or
• "Once a month is usually a good frequency."

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Color-naming interference on an emotional Stroop task was measured to assess attentional bias in information processing by 60 individuals diagnosed with generalized social phobia. Differential effects of three group treatments (exposure, cognitive restructuring + exposure, and cognitive restructuring + exposure + hypnosis), as well as their combined effect, and a no-treatment/wait-list control condition on color-naming interference were investigated after pre- and post-treatment and a 3-mo. follow-up. Differences among four treatment conditions (the three active treatments and the wait-list control condition) at the three assessment stages were not statistically significant in two-way repeated measure analyses of variance. The combined effect of the three treatment conditions was, however, statistically significant. Effect size analyses indicated to cognitive restructuring + exposure being the most effective treatment, but low statistical power prevented definite conclusions. Clinical and theoretical implications of the findings are discussed.

Psychol Rep. 2012 Oct;111(2):461-71. Nortje C, Posthumus T. Department of Psychology, University of Stellenbosch, Matieland, South Africa. cn3@sun.ac.za

PURPOSE: A randomized controlled trial was conducted to evaluate outcomes of a multimedia instructional program for family caregivers in simple touch-based techniques to provide comfort to cancer patients at home.

METHODS: A multilingual 78-min DVD and 66-page manual were produced for homebased instruction. Content addresses attitudes and communication about touch in cancer, psychological preparation for giving and receiving touch, safety precautions, massage techniques for comfort and relaxation, acupressure for specific cancer-related symptoms, and practice in the home setting. Materials were produced in English, Spanish, and Chinese versions. A community-based multiethnic sample of 97 adult patient/caregiver dyads was randomized to experimental (massage) or attention control (reading) groups for 4 weeks. Massage dyads received the program and instructions to practice at least three times per week, while control caregivers read to their patients for the same frequency. Self-report instruments assessed change in symptom severity, quality of life, perceived stress, and caregiver attitudes.

RESULTS: Significant reductions in all symptoms occurred for patients after both activities: 12-28 % reductions after reading vs. 29-44 % after massage. Massage caregivers showed significant gains in confidence, comfort, and self-efficacy using touch and massage as forms of caregiving.

CONCLUSIONS: Multimedia instruction in touch and massage methods may offer family members a viable means of enhancing self-efficacy and satisfaction in caregiving while decreasing patient pain, depression, and other symptoms. Family members may be able to learn and apply safe and simple methods that increase patient comfort and reduce distress.

Support Care Cancer. 2012 Dec 21. Collinge W, Kahn J, Walton T, Kozak L, Bauer-Wu S, Fletcher K, Yarnold P, Soltysik R. Collinge and Associates, 3986 N Shasta Loop, Eugene, 79405, OR, USA, william@collinge.org.

Full title: A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity.

BACKGROUND: This study examined the effects of brief daily yogic meditation on mental health, cognitive functioning, and immune cell telomerase activity in family dementia caregivers with mild depressive symptoms.

METHODS: Thirty-nine family dementia caregivers (mean age 60.3?years old (SD?=?10.2)) were randomized to practicing Kirtan Kriya or listening to relaxation music for 12?min per day for 8?weeks. The severity of depressive symptoms, mental and cognitive functioning were assessed at baseline and follow-up. Telomerase activity in peripheral blood mononuclear cells (PMBC) was examined in peripheral PBMC pre-intervention and post-intervention.

RESULTS: The meditation group showed significantly lower levels of depressive symptoms and greater improvement in mental health and cognitive functioning compared with the relaxation group. In the meditation group, 65.2% showed 50% improvement on the Hamilton Depression Rating scale and 52% of the participants showed 50% improvement on the Mental Health Composite Summary score of the Short Form-36 scale compared with 31.2% and 19%, respectively, in the relaxation group (p? CONCLUSION: This pilot study found that brief daily meditation practices by family dementia caregivers can lead to improved mental and cognitive functioning and lower levels of depressive symptoms. This improvement is accompanied by an increase in telomerase activity suggesting improvement in stress-induced cellular aging. These results need to be confirmed in a larger sample. Copyright © 2012 John Wiley & Sons, Ltd.

Int J Geriatr Psychiatry. 2013 Jan;28(1):57-65. doi: 10.1002/gps.3790. Epub 2012 Mar 11. Lavretsky H, Epel ES, Siddarth P, Nazarian N, Cyr NS, Khalsa DS, Lin J, Blackburn E, Irwin MR. Department of Psychiatry and Biobehavioral Sciences and the Semel Institute for Neuroscience, University of California, Los Angeles, CA, USA.

Background How change comes about is hotly debated in psychotherapy research. One camp considers 'non-specific' or 'common factors', shared by different therapy approaches, as essential, whereas researchers of the other camp consider specific techniques as the essential ingredients of change. This controversy, however, suffers from unclear terminology and logical inconsistencies. The Taxonomy Project therefore aims at contributing to the definition and conceptualization of common factors of psychotherapy by analyzing their differential associations to standard techniques. Methods A review identified 22 common factors discussed in psychotherapy research literature. We conducted a survey, in which 68 psychotherapy experts assessed how common factors are implemented by specific techniques. Using hierarchical linear models, we predicted each common factor by techniques and by experts' age, gender and allegiance to a therapy orientation. Results Common factors differed largely in their relevance for technique implementation. Patient engagement, Affective experiencing and Therapeutic alliance were judged most relevant. Common factors also differed with respect to how well they could be explained by the set of techniques. We present detailed profiles of all common factors by the (positively or negatively) associated techniques. There were indications of a biased taxonomy not covering the embodiment of psychotherapy (expressed by body-centred techniques such as progressive muscle relaxation, biofeedback training and hypnosis). Likewise, common factors did not adequately represent effective psychodynamic and systemic techniques. Conclusion This taxonomic endeavour is a step towards a clarification of important core constructs of psychotherapy. Copyright © 2012 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: This article relates standard techniques of psychotherapy (well known to practising therapists) to the change factors/change mechanisms discussed in psychotherapy theory. It gives a short review of the current debate on the mechanisms by which psychotherapy works. We provide detailed profiles of change mechanisms and how they may be generated by practice techniques.

Clin Psychol Psychother. 2012 Nov 6. doi: 10.1002/cpp.1822. Tschacher W, Junghan UM, Pfammatter M. Department of Psychotherapy, University Hospital of Psychiatry, University of Bern, Bern, Switzerland. tschacher@spk.unibe.ch.

BACKGROUND:

Bruxism may be described as a diurnal or nocturnal parafunction, characterised by clenching, bracing, gnashing or grinding of the teeth and jaws. The aim of the management of bruxism should be to control or reduce the level of activity where possible. A variety of treatment strategies have been employed to achieve this including hypnosis, occlusal equilibration, splint therapy, physiotherapy and acupuncture. A more recent approach is the use of biofeedback.

METHOD:

Nineteen consecutive patients were recruited from the temporomandibular joint dysfunction (TMD) clinic at Manchester Dental Hospital, all of whom were known bruxists. They were supplied with the Grindcare® device (Medotech) and instructed to wear it every night over the five-week observation period. By monitoring electromyographic (EMG) muscle activity, the device is able to emit low-voltage electrical impulses as it senses a clenching or grinding episode, bringing about muscle relaxation.

RESULTS:

Eleven of the nineteen patients (58%) reported a major reduction in the occurrence of headaches and discomfort of the masticatory muscles on waking. Female and younger subjects responded more favourably than male and older subjects respectively.

CONCLUSION:

The use of biofeedback could reduce the level of parafunctional activity and bring about meaningful symptomatic improvement. No adverse effects occurred throughout the study period.

Br Dent J. 2013 Jul;215(1):E1. doi: 10.1038/sj.bdj.2013.653. Needham R, Davies SJ. The Turner Dental Hospital, Higher Cambridge Street, Manchester, M15 6FH, UK. richard.needham@postgrad.manchester.ac.uk;

By Tim Brunson PhD

I recently made a comment to a local university psychology instructor that even poorly done hypnosis can produce positive results. This statement was made based upon reading several thousand research articles and summaries outlining studies which discussed the efficacy of hypnotherapy for physiological or medical pathologies. Although I welcome the fact that most of the results indicate the value of such mind-body techniques as an adjunct to therapy, psychology, and medical protocols, I often cringe when I notice the incomplete application, limited approaches, or the relative inexperience of the hypnotic operator.

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The purpose of this study was to investigate the effect of aromatherapy massage on dysmenorrhea. The study used a quasiexperimental design with the subjects as their own control. Every participant applied both aromatherapy massage with lavender oil and placebo massage with odorless liquid petrolatum [soft paraffin]. The population comprised 438 midwifery and nursing students. The 150 students who had declared that they had suffered from dysmenorrhea used a visual analog scale to indicate their level of pain. Higher scores reflected a greater severity of dysmenorrhea. Forty-four students volunteered to participate in the study. When the lavender massage and the placebo massage were compared, the visual analog scale score of the lavender massage was found to decrease at a statistically significant rate. This study showed that massage was effective in reducing dysmenorrhea. In addition, this study showed that the effect of aromatherapy massage on pain was higher than that of placebo massage.

Pain Manag Nurs. 2012 Dec;13(4):236-40. doi: 10.1016/j.pmn.2010.04.002. Epub 2010 Sep 15. Apay SE, Arslan S, Akpinar RB, Celebioglu A. Department of Midwifery, Faculty of Health Sciences, Atatürk University, Erzurum, Turkey. Electronic address: sejder@hotmail.com.

An adolescent with a persistent frontal lisp participated in a two-part 11-session intervention case study. The first phase used ultrasound imagery and acoustic, phonetic and voice education to provide information about articulatory setting (AS) and general awareness of the speech production process. The second phase used traditional articulation therapy, online visual-acoustic biofeedback and fluency strategies to target the frontal lisp directly (specifically /s/, /z/, /?/ and /?/). Trained listener evaluations of pre-intervention, post-phase 1 and post-phase 2 assessments showed no improvement after phase 1, but notable improvement in all treatment targets immediately after phase 2. These improvements were substantially maintained at assessment 4 months post-intervention. The outcomes suggest that direct training was more effective than the AS approach; however, the client's ability to self-monitor in phase 2, rapid acquisition of the targets and maintenance at 4 months post-intervention possibly reflected the knowledge gained in phase 1 about AS.

Clin Linguist Phon. 2013 Jan;27(1):1-17. doi: 10.3109/02699206.2012.734366. Lipetz HM, Bernhardt BM. School of Audiology and Speech Sciences , University of British Columbia, Vancouver, BC , Canada V6T 1Z3.

by Tim Brunson PhD

A chief characteristic of any highly civilized society requires that its members be capable of an elevated level of discernment regarding the prevailing language and symbols. If we are to consider that the wide acceptance of hypnotherapy as an evolutionary force, we must likewise become more sensitive to how clearly we communicate. Thus, we must be able to make distinctions between various concepts – such as the difference between education and training as it applies to our field.

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INTRODUCTION: According to the cold control theory of hypnosis (Dienes and Perner, 2007), hypnotic response occurs because of inaccurate higher order thoughts of intending. The dorsolateral prefrontal cortex (DLPFC) is a region likely involved in constructing accurate higher order thoughts. Thus, disrupting DLPFC with low frequency repetitive transcranial magnetic stimulation (rTMS) should make it harder to be aware of intending to perform an action. That is, it should be easier to respond to a hypnotic suggestion.

METHOD: Twenty-four medium hypnotisable subjects received low frequency rTMS to the left DLPFC and to a control site, the vertex, in counterbalanced order. The hypnotist was blind to which site had been stimulated. Subjects rated how strongly they expected to respond to each suggestion, and gave ratings on a 0-5 scale of the extent to which they experienced the response, for four suggestions (magnetic hands, arm levitation, rigid arm and taste hallucination). The experimenter also rated behavioural response.

RESULTS: Low frequency rTMS to the DLPFC rather than vertex increased the degree of combined behavioural and subjective response. Further, subjects did not differ in their expectancy that they would respond in the two conditions, so the rTMS had an effect on hypnotic response above and beyond expectancies.

CONCLUSIONS: The results support theories, including cold control theory, postulating a component of hypofrontality in hypnotic response.

Cortex. 2012 Sep 20. pii: S0010-9452(12)00249-3. doi: 10.1016/j.cortex.2012.07.009. Dienes Z, Hutton S. School of Psychology, Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK. Electronic address: dienes@sussex.ac.uk.

The aim of the present study was to assess the use of complementary and alternative medicine (CAM) treatments in outpatients with cardiovascular disease and their interest in future use. The increasing popularity of CAM therapies highlights the need to explore their use among patients with cardiovascular disease. Data were collected with a prospective, point-of-care, anonymous, 17-question survey about basic medical information and previous use and interest in the future use of dietary supplements and other CAM interventions among patients undergoing outpatient cardiology evaluation at a Midwestern tertiary care center. The survey was completed by 1,055 patients (655 men, 351 women; mean age 63.5 years) of whom 98.1% were white. Of these, 36.8% had cardiac symptoms for >10 years, 48.2% had coronary artery disease, and 82.5% reported use of CAM therapies. Of these patients, 75.4% reported using dietary supplements, 31.5% chiropractic therapy, 23.9% mind-body therapies, and 19.2% massage. Only 14.4% had discussed the use of CAM treatments with their physicians. The top 4 treatments used for cardiac symptoms were relaxation techniques, stress management, meditation, and guided imagery. Also, 48.6% were interested in participating in a future clinical trial of an alternative treatment. The great majority of patients seen in current practice use CAM therapies, and a large proportion expressed an interest in participating in research with CAM therapies. In conclusion, research directed with an integrative approach to cardiovascular care might prove beneficial when designing future studies.

Am J Cardiol. 2012 Nov 24. pii: S0002-9149(12)02287-4. doi: 10.1016/j.amjcard.2012.10.010. Prasad K, Sharma V, Lackore K, Jenkins SM, Prasad A, Sood A. Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: prasad.kavita@mayo.edu.

Full title: Nocturnal mouthpiece ventilation and medical hypnosis to treat severe obstructive sleep apnea in a child with cherubism.

A 4-year old boy presented severe obstructive sleep apnoea due to complete nasal obstruction secondary to cherubism. Because of anticipatory anxiety due to numerous surgical interventions, medical hypnosis was proposed to facilitate non-invasive continuous positive pressure ventilation (CPAP) acceptance. CPAP by means of an oral interface was completely accepted after three hypnosis sessions and resulted in the correction of his obstructive sleep apnea (OSA) syndrome. This report highlights the benefit of medical hypnosis in facilitating CPAP acceptance as well as the efficacy of mouthpiece ventilation in a severe form of cherubism with complete nasal obstruction. Pediatr Pulmonol. © 2012 Wiley Periodicals, Inc.

Pediatr Pulmonol. 2012 Nov 5. doi: 10.1002/ppul.22686. Khirani S, Kadlub N, Delord V, Picard A, Fauroux B. Inserm U 955 Pierre et Marie Curie-Paris 6 University, Paris, France.

by Tim Brunson PhD

If you have ever encountered a client or patient who consistently behaved counter to their best interests and did not realize it, you could be noticing a red-flag that the case may be beyond your scope of practice, license, or professional ethics. For example, consider a person who comes to you to cease a bad habit which is negatively affecting their emotions, relationships or health.

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This randomized, controlled trial contrasted the effects of 5 not-standardized sessions of hypnosis over 2 months in 59 women with fibromyalgia who were randomly assigned to treatment (n?=?30) or a wait-list control group (n?=?29). Patients in the treated group were encouraged to practice self-hypnosis. Fibromyalgia Impact Questionnaire (FIQ), MOS-Sleep Scale, Multidimensional Fatigue Inventory (MFI), Cognitive Strategy Questionnaire (CSQ), and Patient Global Impression of Change (PGIC) were administered at baseline, 3 months (M3), and 6 months (M6) after inclusion. Compared to the control, the hypnosis group reported better improvement on PGIC (p = .001 at M3, p = .01 at M6) and a significant improvement in sleep and CSQ dramatization subscale (both at M6).

Int J Clin Exp Hypn. 2013 Jan;61(1):111-23. doi: 10.1080/00207144.2013.729441. Picard P, Jusseaume C, Boutet M, Dualé C, Mulliez A, Aublet-Cuvellier B. a CHU Clermont-Ferrand, Pain Clinic , France.

Application of electricity for pain treatment dates back to thousands of years BC. The Ancient Egyptians and later the Greeks and Romans recognized that electrical fishes are capable of generating electric shocks for relief of pain. In the 18th and 19th centuries these natural producers of electricity were replaced by man-made electrical devices. This happened in following phases. The first was the application of static electrical currents (called Franklinism), which was produced by a friction generator. Christian Kratzenstein was the first to apply it medically, followed shortly by Benjamin Franklin. The second phase was Galvanism. This method applied a direct electrical current to the skin by chemical means, applied a direct and pulsed electrical current to the skin. In the third phase the electrical current was induced intermittently and in alternate directions (called Faradism). The fourth stage was the use of high frequency currents (called d'Arsonvalisation). The 19th century was the "golden age" of electrotherapy. It was used for countless dental, neurological, psychiatric and gynecological disturbances. However, at beginning of the 20th century electrotherapy fell from grace. It was dismissed as lacking a scientific basis and being used also by quacks and charlatans for unserious aims. Furthermore, the development of effective analgesic drugs decreased the interest in electricity. In the second half of the 20th century electrotherapy underwent a revival. Based on animal experiments and clinical investigations, its neurophysiological mechanisms were elucidated in more details. The pain relieving action of electricity was explained in particular by two main mechanisms: first, segmental inhibition of pain signals to the brain in the dorsal horn of the spinal cord and second, activation of the descending inhibitory pathway with enhanced release of endogenous opioids and other neurochemical compounds (serotonin, noradrenaline, gamma aminobutyric acid (GABA), acetylcholine and adenosine). The modern electrotherapy of neuromusculo- skeletal pain is based in particular on the following types: transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS or electro-acupuncture) and spinal cord stimulation (SCS). In mild to moderate pain, TENS and PENS are effective methods, whereas SCS is very useful for therapy of refractory neuropathic or ischemic pain. In 2005, high tone external muscle stimulation (HTEMS) was introduced. In diabetic peripheral neuropathy, its analgesic action was more pronounced than TENS application. HTEMS appeared also to have value in the therapy of symptomatic peripheral neuropathy in end-stage renal disease (ESRD). Besides its pain-relieving effect, electrical stimulation is of major importance for prevention or treatment of muscle dysfunction and sarcopenia. In controlled clinical studies electrical myostimulation (EMS) has been shown to be effective against the sarcopenia of patients with chronic congestive heart disease, diabetes, chronic obstructive pulmonary disease and ESRD.

Clin Nephrol. 2013 Sup;79(13):12-23. Heidland A, Fazeli G, Klassen A, Sebekova K, Hennemann H, Bahner U, Di Iorio B. Department of Internal Medicine, University of Würzburg, KfH-Kidney Center, Institute of Pharmacology and Toxicology, University of Würzburg, Würzburg, Germany, Institute of Molecular Biomedicine, Medical Faculty, Comenius University, Bratislava, Slovakia, KfH Kidney Center Coburg, Coburg, Germany, and Faculty of Medicine and Surgery, Seconda Universita di Napoli, Italy.

Full title: Preclinical Profile of Bacopasides from Bacopa Monnieri (BM) As an Emerging Class of Therapeutics for Management of Chronic Pains.

Chronic pains management costs billions of dollars in medical exchequer to the world population. Additionally, 77% of people with chronic pains also have a degree of medically treatable depression. Opioids have a narrower safety index due to their side effects associated with its tolerance, hyperalgesia and subsequent dependence. Likewise, non steroidal anti-inflammatory drugs and anticonvulsants, also have limited safety and tolerability profile in the management of chronic pains. Bacopa monnieri, a renowned ayurvedic medicine has a strong antidepressant effect and significant antinociceptive effect, which is comparable to the effect of morphine via adenosinergic, opioidergic, and adrenergic mechanisms. BM has been also reported to be effective in neuropathic pains. Additionally, it has a strong anti-inflammatory effect mediated via COX-2 inhibitory mechanism. Apart from its effect of augmenting morphine analgesia, BM also inhibits opioid-withdrawal induced hyperalgesia, and acquisition and expression of morphine tolerance. BM is reported to have a strong protective effect against toxic effects of opiates on major organs like brain kidneys and heart. BM is well documented to be safe and well tolerated herbal therapy in multiple clinical trials including various age groups. This minireview evaluated the preclinical data that highlights potential of BM as a future candidate for clinical management of chronic pains.

Curr Med Chem. 2012 Dec 3. Rauf K, Subhan F, Al-Othman AM, Khan I, Zarrelli A, Shah MR. Department of Pharmacy, University of Peshawar, Peshawar, Pakistan. inamullah@upesh.edu.pk.

The authors devised and validated a questionnaire assessing the various possible motivations for learning and using hypnosis and administered it to 125 Israeli psychologists, physicians, and dentists who study and/or use hypnosis in their clinical work. The results suggest that most professionals were motivated by a desire to improve their professional performance and that a majority of professionals were primarily influenced in their desire to learn hypnosis by colleagues in academically or clinically oriented settings.

Int J Clin Exp Hypn. 2013 Jan;61(1):71-80. doi: 10.1080/00207144.2013.729437. Meyerson J, Gelkopf M, Golan G, Shahamorov E. a Tel Aviv University , Israel.