by Katherine Zimmerman, PhD, CHT

In my private practice I have found several starting points with clients that are very effective. One of my standard approaches with a new client is to reframe their issue. It might be stress, panic, negative emotions or even physical pain. A reframe is simply looking at the problem from a different perspective. It's natural to reframe experiences for our friends and family. For example, here's one that I found recently: "Laziness is nothing more than the habit of resting before you get tired."

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BACKGROUND: The health benefits of physical activity and exercise are well documented and these effects could help people with schizophrenia. OBJECTIVES: To determine the mental health effects of exercise/physical activity programmes for people with schizophrenia or schizophrenia-like illnesses. SEARCH STRATEGY: We searched the Cochrane Schizophrenia Group Trials Register (December 2008) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We also inspected references within relevant papers. SELECTION CRITERIA: We included all randomised controlled trials comparing any intervention where physical activity or exercise was considered to be the main or active ingredient with standard care or other treatments for people with schizophrenia or schizophrenia-like illnesses. DATA COLLECTION AND ANALYSIS: We independently inspected citations and abstracts, ordered papers, quality assessed and data extracted. For binary outcomes we calculated a fixed-effect risk ratio (RR) and its 95% confidence interval (CI). Where possible, the weighted number needed to treat/harm statistic (NNT/H) and its 95% confidence interval (CI), was also calculated. For continuous outcomes, endpoint data were preferred to change data. We synthesised non-skewed data from valid scales using a weighted mean difference (WMD). MAIN RESULTS: Three randomised controlled trials met the inclusion criteria. Trials assessed the effects of exercise on physical and mental health. Overall numbers leaving the trials were similar. Two trials (Beebe 2005 and Marzaloni 2008) compared exercise to standard care and both found exercise to significantly improve negative symptoms of mental state (Mental Health Inventory Depression: 1RCT, n=10, MD 17.50 CI 6.70 to 28.30, PANNS negative: 1RCT, n=10, MD -8.50 CI -11.11 to -5.89). No absolute effects were found for positive symptoms of mental state. Physical health improved significantly in the exercise group compared to those in standard care (1RCT, n=13, MD 79.50 CI 33.82 to 125.18), but no effect on peoples' weight/BMI was apparent. Duraiswamy 2007 compared exercise with yoga and found that yoga had a better outcome for mental state (PANNS total: 1RCT, n=41, MD 14.95 CI 2.60 to 27.30). The same trial also found those in the yoga group had significantly better quality of life scores (WHOQOL Physical: 1RCT, n=41, MD -9.22 CI -18.86 to 0.42). Adverse effects (AIMS total scores) were, however, similar. AUTHORS' CONCLUSIONS: Results of this Cochrane review are similar to existing reviews that have examined the health benefits of exercise in this population (Faulkner 2005). Although studies included in this review are small and used various measures of physical and mental health, results indicated that regular exercise programmes are possible in this population, and that they can have healthful effects on both the physical and mental health and well-being of individuals with schizophrenia. Larger randomised studies are required before any definitive conclusions can be drawn.

Cochrane Database Syst Rev. 2010 May 12;5:CD004412. Gorczynski P, Faulkner G. Faculty of Physical Education and Health, University of Toronto, 55 Harbord St, Toronto, Canada, On M5S 2W6

This article describes how hypnosis can be used as an efficient technique in treating patients with anxious disorders. Hypnosis can be used to achieve a better control of the anxious symptoms through relaxation. It allows the patient to anticipate the anxiety triggering events. This technique also allows the patient to mentalise and integrate traumatic events, therefore helping him to prevent the post-traumatic anxious symptoms.

Rev Med Suisse. 2010 Feb 17;6(236):330-3. Smaga D, Cheseaux N, Forster A, Colombo S, Rentsch D, de Tonnac N. HUG, Département de psychiatrie, Avenue Krieg 15, 1208 Genève. smaga@infomaniak.ch

Cognitive hypnotherapy (CH) is a comprehensive evidence-based hypnotherapy for clinical depression. This article describes the major components of CH, which integrate hypnosis with cognitive-behavior therapy as the latter provides an effective host theory for the assimilation of empirically supported treatment techniques derived from various theoretical models of psychotherapy and psychopathology. CH meets criteria for an assimilative model of psychotherapy, which is considered to be an efficacious model of psychotherapy integration. The major components of CH for depression are described in sufficient detail to allow replication, verification, and validation of the techniques delineated. CH for depression provides a template that clinicians and investigators can utilize to study the additive effects of hypnosis in the management of other psychological or medical disorders. Evidence-based hypnotherapy and research are encouraged; such a movement is necessary if clinical hypnosis is to integrate into mainstream psychotherapy.

Int J Clin Exp Hypn. 2010 Apr;58(2):165-85. Alladin A. University of Calgary Medical School, Alberta, Canada. assen.alladin@albertahealthservices.ca

Full Title: Hypnosis in the treatment of depression: considerations in research design and methods

Depressive disorders constitute a serious problem in the United States and around the world. The appearance of practice guidelines and lists of evidenced-based therapies suggests that adequate treatments for depression exist. However, a careful consideration of what is known and not known about the treatment of depression leaves plenty of room for improved approaches to addressing this condition. Although there has been a dearth of research on the treatment of depression using hypnosis, there are several compelling arguments for the inclusion of hypnotic approaches in the array of current strategies for dealing with depression. However, traditional "gold-standard" research methods, namely randomized controlled trials, have many shortcomings for identifying the potential impact of hypnosis on depression. Other strategies, notably single-case design and benchmarking approaches, may offer a more practical solution to the problem of determining "what works for depression."

Int J Clin Exp Hypn. 2010 Apr;58(2):147-64. McCann BS, Landes SJ. Department of Psychiatry, University of Washington School of Medicine, Seattle 98195, USA. mccann@u.washington.edu

Full Title: Hypnotically catalyzing experiential learning across treatments for depression: actions can speak louder than moods

A number of psychotherapeutic approaches for the treatment of major depression have received empirical support in the literature, most notably cognitive-behavioral and interpersonal therapies. Recent studies have shown the therapeutic value of the behavioral activation component of such interventions. Depressed individuals actively learning and applying new skills on their own behalf is widely considered a critical component of recovery. This article describes the use of hypnosis to catalyze experiential learning and to encourage behavioral activation in the depressed client by directly addressing and transforming cognitive and perceptual patterns that can impede such behavioral activation, especially global thinking and ruminative coping styles.

Int J Clin Exp Hypn. 2010 Apr;58(2):186-201. Yapko MD. michaelyapko@roadrunner.com

Full Title: Hypnosis, rumination, and depression: catalyzing attention and mindfulness-based treatments

Over the past 30 years, mental health practitioners, encouraged by rigorous empirical studies and literature and meta-analytic reviews, have increasingly appreciated the ability of hypnosis to modulate attention, imagination, and motivation in the service of therapeutic goals. This article describes how hypnosis can be used as an adjunctive procedure in the treatment of depression and rumination symptoms, in particular. The focus is on attention-based treatments that include rumination-focused cognitive behavioral therapy, cognitive control training, and mindfulness-based cognitive therapy. The authors provide numerous examples of techniques and approaches that can potentially enhance treatment gains, including a hypnotic induction to facilitate mindfulness and to motivate mindfulness practice. Although hypnosis appears to be a promising catalyst of attention and mindfulness, research is required to document the incremental value of adding hypnosis to the treatments reviewed.

Int J Clin Exp Hypn. 2010 Apr;58(2):202-21. Lynn SJ, Barnes S, Deming A, Accardi M. Psychology Department, Binghamton University, Binghamton, New York 13905, USA. slynn@binghamton.edu

by Jef Gazley, MS, LMFT, DCC

Post-Traumatic Stress Disorder or PTSD is a mental and emotional condition that has its origins in a physical and/or mentally traumatic event that occurred anywhere from a few days to several years in the past. PTSD can develop by one overwhelming trauma as in 9/11 or by a series of smaller traumas or abuses occurring over several years such as living in an alcoholic home. It can be recognized from symptoms such as recurrent and persistent recollections of the traumatic event and recurring dreams of the event.

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Self-hypnosis training represents a rapid, cost-effective, nonaddictive and safe alternative to medication for the treatment of anxiety-related conditions. Here we provide a review of the experimental literature on the use of self-hypnosis in the treatment of anxiety and stress-related disorders, including anxiety associated with cancer, surgery, burns and medical/dental procedures. An overview of research is also provided with regard to self-hypnotic treatment of anxiety-related disorders, such as tension headaches, migraines and irritable bowel syndrome. The tremendous volume of research provides compelling evidence that hypnosis is an efficacious treatment for state anxiety (e.g., prior to tests, surgery and medical procedures) and anxiety-related disorders, such as headaches and irritable bowel syndrome. Although six studies demonstrate changes in trait anxiety, this review recommends that further randomized controlled outcome studies are needed on the hypnotic treatment of generalized anxiety disorder and in documenting changes in trait anxiety. Recommendations are made for selecting clinical referral sources.

Expert Rev Neurother. 2010 Feb;10(2):263-73. Hammond DC. University of Utah School of Medicine, PM&R, 30 No. 1900 East, Salt Lake City, UT 84132-2119, USA. d.c.hammond@utah.edu

Three pediatric cases of Trichotillomania were treated with direct hypnotic suggestion with exclusive emphasis on sensitizing and alerting the patients to impending scalp hair pulling behaviors. These children had presented with total lack of awareness of their scalp hair pulling behaviors until they had actually twisted and pulled off clumps of hair. It was also suggested, under hypnosis, that upon learning to recognize impending scalp hair pulling behaviors, the patients would become free to choose to willfully pull their hair or to resist the impulse and not pull. At no point was the explicit suggestion given that they stop pulling their hair. A preliminary condition was agreed to by the parents that redefined the patients' hair as their own property and affirmed their sole responsibility for its care and maintenance. An element of secondary gain was identified in each of these cases. Scalp hair pulling was hypothesized to provide these particular patients with a vehicle with which to oppose their overbearing and over-involved parents. The technique of direct suggestion under hypnosis, aimed at alerting the patients to impending scalp hair pulling behaviors was combined with forming contracts with the parents to relinquish their authority over matters regarding the patients' hair. This combination provided an effective treatment that extinguished the scalp hair pulling in 7 visits or less. These cases received follow-up at intervals up to 6 months and no evidence of relapse was found.

Am J Clin Hypn. 2003 Oct;46(2):129-37. Iglesias A.

by Jon Rhodes

The fear of crowds is an anxiety disorder which can severely limit the lifestyle of the sufferer. Those who suffer from this fear usually have several symptoms when in or approaching a crowd. These include heightened alertness, increased anxiety, nausea, headaches, excessive sweating, shortness of breath, shaking, and chest pains.

This leads to those who have a fear of crowds avoiding situations where they may have to confront there fears. Crowded places such as public transport, shopping malls and busy streets are avoided at all cost. If this fear is left untreated, sufferers can find smaller and smaller groups of people affecting them to the point where just a handful of people is perceived as a 'crowd' that must be avoided. This can lead to isolation and depression. This is why it is so important to treat a fear of crowds as soon as possible.

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by Tim Brunson, PhD

Trichotillomania, which is also referred to as trich or TTM, is an impulse control disorder, which involves recurrent hair pulling, resulting in a noticeable loss of hair. It includes compulsive and habitual pulling of eye lashes, eye brows, head hair, and pubic hair. Tension before the act and feelings of pleasure immediately thereafter are typical affect conditions. The obvious hair loss results in increased anxiety and often may lead to an avoidance of social situations and even intimate relationships. Reduced self-esteem is also a factor. Hypnotherapy is a valid clinical intervention for trich treatment.

The pervasiveness of trich is unknown. One study indicated that 11% of surveyed college students reported symptoms. 92 to 93% of sufferers are female. Scalp hair puling (80%) is the most prevalent form of trich. This is followed by lash pulling (46%) and brow pulling (43.5%).

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The aim of this study was to describe the use of complementary and alternative medicine (CAM) in patients with Tourette syndrome (TS) and explore associations with CAM use. In recent years CAM use has increased, but rates of CAM use in TS patients are not reported. Consecutive TS patients or their parent(s), seen in an academic movement disorder center, completed a questionnaire regarding their use of CAM. One hundred TS patients or parents completed the questionnaire, mean age 21.5 +/- 13.5, 76 males, 87 Caucasians. Sixty four patients had used at least one CAM modality. CAM treatments used were prayer (28), vitamins (21), massage (19), dietary supplements (15), chiropractic manipulations (12), meditation (10), diet alterations (nine), yoga (nine), acupuncture (eight), hypnosis (seven), homeopathy (six), and EEG biofeedback (six). Fifty six percent of patients using CAM reported some improvement. Users paid out of pocket for 47% of treatments pursued, and 19% of these payers received partial reimbursement by third party payer. Users and non-users did not differ in age, gender, race, income, educational level, general health, tic severity, medication use for TS, current satisfaction from medications or experience of side effects from medications. CAM use was associated with the presence of affective disorder (P = 0.004), but not with either ADHD or OCD. Among CAM users, 80% initiated CAM without informing their doctor. CAM is commonly used in children and adults with TS, and often without the neurologist's knowledge. Physicians should inquire about CAM to understand the spectrum of interventions that patients with TS use. (c) 2009 Movement Disorder Society.

Mov Disord. 2009 Aug 24. Kompoliti K, Fan W, Leurgans S. Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.

Full Title: Post-traumatic stress disorders in medical practice: diagnostic and therapeutic guidelines in primary care

Posttraumatic stress disorder (PTSD) is a prevalent and disabling condition. The patients suffering from PTSD often consult primary care clinician for non-specific symptoms. The aim of this work is to find out useful clinical guidelines for diagnosis and therapy in primary care, starting from a literature review (1981-2009) and a preliminary observational study. 20 patients with PTSD had a specific trauma-focused psychotherapy, called "Trauma and Reintegration Psychotherapy (TRP)". This is a psychodynamic eclectic treatment combining Ericksonian Hypnosis and EMDR techniques. The results show a more important decrease of PTSD symptoms in patient's beneficiating of the TRP, than the average of the usual clinical studies. This could be linked to an early diagnosis made by the primary care general practitioners.

Bull Soc Sci Med Grand Duche Luxemb. 2009;(1):67-78. Miller N, Lazignac C, Jecker F, Zürcher M, Damsa C. Espace Psychothérapeutique Hogan, 86 Grand Rue, Montreux.

by Mark Gorkin, LICSW

With these basic functions and words of wisdom in mind, let me illustrate the purposes and dramatic consequences of the healing, harmonizing, and harnessing power of motivational humor. The following four morale-ity tales demonstrate how this mirthful and memorable intervention technique relaxes, reenergizes and rejuvenates team performance. And, hopefully, you'll also discover how humor theory and practice come together and play.

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By Iain B. McIntosh BA (Hons), MBChB, DGMRCP, DRCOG, FTTMRCPS(Glas)

Fears and phobias are common. Fear and anxiety can be the psychological stimuli to drive personal behaviour. Phobias however may prove an annoying inconvenience or a major disability. Fear is a normal condition of life and a response to a real or imagined threat. Minor fears are within the cultural norm, with a continuum of fear between mild and intense phobia- a morbid response disproportionate to causative stimulus. Phobias can be simple and specific, or be associated with panic reaction and wider ranging agoraphobia.

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Full Title: Positron tomographic emission study of olfactory induced emotional recall in veterans with and without combat-related posttraumatic stress disorder.

OBJECTIVE: Memory for odors is often associated with highly emotional experiences, and odors have long been noted by clinicians to be precipitants of trauma symptoms in posttraumatic stress disorder (PTSD). Primitive brain systems involved in fear responsivity and survival also mediate smell, including the olfactory cortex and amygdala. The purpose of this study was to measure neural correlates of olfaction in PTSD. METHODS: We exposed male combat veterans with PTSD (N = 8) and without PTSD (N = 8) to a set of smells, including diesel (related to traumatic memories of combat), and three other types of smells: odorless air, vanilla/coconut, and hydrogen sulfide (H2S) (respectively, a neutral, positive, and negative hedonic nontraumatic smell) in conjunction with PET imaging of cerebral blood flow and assessment of psychophysiological and behavioral symptoms. All subjects also underwent a baseline of olfactory acuity. RESULTS: PTSD patients rated diesel as unpleasant and distressing, resulting in increased PTSD symptoms and anxiety in PTSD versus combat controls. Exposure to diesel resulted in an increase in regional blood flow (rCBF) in amygdala, insula, medial prefrontal cortex, and anterior cingulate cortex, and decreased rCBF in lateral prefrontal cortex in PTSD in comparison to combat controls. Combat controls showed less rCBF changes on any smell, and did not show amygdala activation upon diesel exposure. CONCLUSIONS: These data support the hypothesis that in PTSD trauma-related smells can serve as strong emotional reminders. The findings indicate the involvement of a neural circuitry that shares olfactory elements and memory processing regions when exposed to trauma-related stimuli.

Psychopharmacol Bull. 2007;40(1):8-30.Related Articles, Links Vermetten E, Schmahl C, Southwick SM, Bremner JD. University Medical Center, Utrecht, The Netherlands. e.vermetten@umcutrecht.nl

by Andrew Hagley and Robert Kelly

Clients who had completed a course of pure hypnoanalysis (PHA) were invited to participate in an online survey indicating the degree to which their original presenting 'complaint' had been affected following the course of therapy. The initial feedback indicated that all participating clients (n=63) had reported a reduction in, or resolution of their original symptoms. Respondents also produced detailed additional comments regarding their experiences of therapy. A follow up is planned at twelve months.

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by Mark Gorkin, LICSW

During a recent professional networking dinner, two familiar questions surfaced. A colleague who had attended my conference workshop wanted to know, "How did you develop an ability to use humor in your presentations?" And, "Were you always a comic or class clown?" An occasional public presenter herself, the implicit message was clear: "How can I use humor more effectively; can I learn to be funnier?"

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by William Berry, MS, CAP

"What we call normal in psychology is really a psychopathology of the average, so undramatic and so widely spread that we don't even notice it ordinarily." This is a quote by Abraham Maslow, the theorist who gave us the idea of the hierarchy of needs (once your basic needs are met you begin to seek higher needs) and the idea of self-actualization.

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by Robert DeMaria DC, DABCO, FASBE, NHD

Imagine that you are a ten-year-old child. You have a child's nervous, excited energy...even more so than other children your age. You are just as bright as your classmates, but your grades don't reflect it. You just can't seem to focus on your classes. While your teacher is talking, your eyes dart around the room. Perhaps your foot taps anxiously or you doodle incessantly when you should be taking notes. You are frequently called down in your class for being disruptive. Your teachers and parents become frustrated with you--you become frustrated with yourself. You begin to feel that you're just stupid. Try as you might, you just can't seem to pay attention.

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by Mark Gorkin, LICSW

In crisis-driven, 24/7, relentlessly upgrading and unpredictably downsizing (or reorganizing) world, it's no surprise that individuals, teams, divisions, and even entire companies can become "stress carriers" or high stress environments. A critical challenge for the organization is helping personnel, and especially the foundational task and support system -- the work team -- maintain both productivity and morale in these "do more with less" times. How can the HR professional along with all levels of management as well as formal and informal leaders help: (a) fight the "burnout blues," (b) prevent a "lean-and-MEAN" attitude from becoming the department or company mantra, and (c) disarm an "us against them" environment that invariably breeds hostile competition or in-house territoriality?

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by Robert Puff, PhD Part of "going with the flow" is keeping your expectations appropriate to what is. Just be, and at the same time learn to love what is. Here's an example of something that taught me the meaning of "going with the flow." Because of poor decisions made by a lending institution, I unexpectedly had a major financial line of credit closed. It's easy to go into panic mode when a crisis like this hits, especially when it comes to monetary issues. Although I felt the disturbing event and acknowledged my initial panic, I set about doing what needed to be done to remedy the situation. First I called the financial institution and tried to fix things there, but to no avail. So I simply opened up an account at a more stable institution, and a month later everything was back to normal. I spent less than six hours fixing the situation over a several-week period. Of course, I could have easily spent countless hours worrying and fretting about it. But I chose not to; instead I chose to accept it and move on.

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by Robert DeMaria DC, DABCO, FASBE, NHD

We live in a day and age where everything from food preparation to treatment of health conditions is expected to be fast, extremely fast. The consumer is subliminally manipulated by the pharmaceutical and food manufacturers with a mind set that sickness is common, and you deserve to reward yourself with food.

The food designed today has been formulated to compliment the current research on health conditions that are destroying us; ironically the food being produced is actually the cause of most health ailments. The most blatant example of this is hydrogenated fat; or Trans fat was suppose to be good for heart function.

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by Robert Puff, PhD

What does peace of mind mean to you? Perhaps you feel that if you could land a high-power job; earn your college degree; find the perfect mate; get married and have children; retire with plenty of money in the bank; or...well, you fill in the blank. Then you could enjoy self-satisfaction and, ultimately, peace of mind.

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by Paul G. Durbin Retired Director of Clinical Hypnotherapy, Methodist Hospital, New Orleans, LA

Paradoxical Intension: It is commonly observed that anxiety often produces precisely what the patient fears. Frankl calls this "anticipatory anxiety". For instance, in cases of insomnia, the patient reports that she has trouble going to sleep. The fear of not going to sleep only adds to the difficulty of trying to go to sleep. Many sexual problems may be traced back to the forced intention of attaining the goal of sexual intercourse: as in the male seeking to prove his potency or the female her ability to experience orgasm. It seems that anticipatory anxiety causes precisely what the patient fears.

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by Sharon S. Esonis, PhD

It's hard to emphasize strongly enough the importance of breathing in your quest to manage the stress response and take control of your life. You have a choice: deep abdominal breathing or shallow chest breathing. The diaphragm, which is under the lungs and just above the abdomen, is the most efficient breathing muscle and is connected to the relaxed nervous system, also known as the parasympathetic nervous system (PNS). Deep, slow abdominal breathing promotes mental concentration, decreases body tension and anxiety, and provides a greater supply of oxygen to the brain. This article provides a practical, useful routine for learning diaphragmatic breathing that can be provided to patients and clients. At the end of the article is a link to an online audio exercise that I've used with many of my clients.

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The authors developed a technique, which they call hypnotherapeutic olfactory conditioning (HOC), for exploiting the ability of scents to arouse potent emotional reactions. During hypnosis, the patient learns to associate pleasant scents with a sense of security and self-control. The patient can subsequently use this newfound association to overcome phobias and prevent panic attacks. This may be especially effective for posttraumatic stress disorder (PTSD) with episodes of anxiety, flashbacks, and dissociation triggered by smells. The authors present 3 cases, patients with needle phobia, panic disorder, and combat-induced PTSD who were successfully treated with the HOC technique.

Int J Clin Exp Hypn. 2009 Apr;57(2):184-97. Abramowitz EG, Lichtenberg P. Mental Health Division, Israel Defense Forces, Israel.

by Paul G. Durbin Retired Director of Clinical Hypnotherapy, Methodist Hospital, New Orleans, LA

Viktor Frankl was one time Professor of Psychiatry at the University of Vienna Medical School and later taught at a number of schools in the United States. Frankl's first book in English was Man's Search for Meaning, which he wrote while in a Nazi prison during World War II. He spent three years in various Nazi prison camps and experienced incredible suffering and degradation, but through those experiences further developed his theory of Logotherapy. Dr. Frankl's "Logotherapy" has had a profound influence on my life and therapy.

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Currently, there are no neurobiological markers of clinical response for cognitive behavioural therapy (CBT) used in clinical practice. We investigated the neural pattern of activity to implicit processing of sad facial expressions as a predictive marker of clinical response. Sixteen medication-free patients in an acute episode of major depression underwent functional magnetic resonance imaging scans before treatment with CBT. Nine patients showed a full clinical response. The pattern of activity, which predicted clinical response, was analysed with support vector machine and leave-one-out cross-validation. The functional neuroanatomy of sad faces at the lowest and highest intensities identified patients, before the initiation of therapy, who had a full clinical response to CBT (sensitivity 71%, specificity 86%, P = 0.029).

Neuroreport. 2009 Mar 31. Costafreda SG, Khanna A, Mourao-Miranda J, Fu CH. Institute of Psychiatry, King's College London, De Crespigny Park, London, UK.

by C. Norman Shealy, M.D., Ph.D.

In 1973 when I met Jack Schwartz, one of the best known intuitives of that time, he introduced me to his I.S.I.S, a pair of half egg-shaped eye cups with blinking lights, alternating left to right. Jack assured me that using these flashing light goggles regularly would enhance one's ability to see the human "aura." He had arranged frequencies in the beta, alpha, theta and delta range. I bought a dozen devices and had an electronic expert convert them to simultaneous flashing for both eyes, as I recognized the potential benefit for deep relaxation in my chronic pain and very stressed patients.

Over the next few years I explored a wide variety of methods of applying the photostimulator and in 1975 I encountered the Schneider Brain Wave Synchronizer (BWS), introduced in the early 50's. There were half a dozen articles from that decade on the benefits of BWS on labor, decreased need for anesthesia in surgery, and even on lowering blood pressure. Nothing had been published since those days, as tranquilizers had taken over! Incidentally, the BWS was developed to assist hypnotherapists induce a trance.

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Public speaking anxiety (PSA) is a common phobia. Although cognitive behavior therapy (CBT) is preferred, difficulties arise with the exposure component (lack of therapist control, patient's inability to imagine, self-flooding, loss of confidentiality resulting from public exposure). Virtual reality CBT (VRCBT) enables a high degree of therapist control, thus overcoming these difficulties. This study examined whether VRCBT is an alternative to CBT. Participants with PSA were randomly assigned to VRCBT (28 participants), CBT (30 participants), and wait list control (WLC; 30 participants). VRCBT and CBT were significantly more effective than WLC in anxiety reduction on four of five anxiety measures, and on subject's self-rating of anxiety during a behavioral task. No significant differences were found on observer ratings of the behavioral task. However, twice as many participants dropped out from CBT than from VRCBT. Our results demonstrated that VRCBT is an effective and brief treatment regimen, equal to CBT.

Behav Modif. 2009 Mar 25. Wallach HS, Safir MP, Bar-Zvi M. University of Haifa.

This investigation assessed the effectiveness of a self-help, self-hypnosis treatment in a primary-care setting in Edinburgh, UK. A partially randomized preference (PRP) study design was used, with benchmarking results to trials of CBT and counseling. Patients seeing their general practitioner for depression were offered randomization to, or their treatment preference of, either self-help (self-hypnosis) or antidepressant medication. Evaluation measures were Becks Depression Inventory, Brief Symptom Inventory, and SF-36. Of the 58 patients recruited, 50 chose self-hypnosis, 4 chose antidepressants, and 4 were randomized. The preference groups demonstrated similar demography, baseline measurements, and outcome effects to benchmarked trials. This feasibility study of a self-help, self-hypnosis program for depression showed promise for its future use in primary care. Benchmarking improved validity and reliability. A PRP study design appeared useful in a primary-care setting, where past studies have experienced problems of recruitment, concordance, and compliance.

Int J Clin Exp Hypn. 2009 Jul;57(3):293-318. Dobbin A, Maxwell M, Elton R. National Health Service, United Kingdom. alastair.dobbin@lothian.scot.nhs.uk

Well-being therapy (WBT) aims to enhance psychological well-being based on Ryff's (1989) six dimensions: autonomy, personal growth, environmental mastery, purpose in life, positive relations, and self-acceptance. Previous studies have documented the efficacy of this psychotherapy in treating patients with mood and anxiety disorders and in preventing relapse in recurrent depression. We discuss and illustrate the use of WBT in generalized anxiety disorder. We present a case of a patient suffering from generalized anxiety disorder treated with cognitive-behavioral therapy followed by WBT. (c) 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65: 1-10, 2009.

J Clin Psychol. 2009 Mar 17;65(5):510-519. Ruini C, Fava GA. Department of Psychology, University of Bologna.

There is great heterogeneity of clinical presentation and outcome in paediatric depression. AIMS: To identify which clinical and environmental risk factors at baseline and during treatment predicted major depression at 28-week follow-up in a sample of adolescents with depression. METHOD: One hundred and ninety-two British adolescents with unipolar major depression were enrolled in a randomised controlled trial (the Adolescent Depression Antidepressants and Psychotherapy Trial, ADAPT). Participants were treated for 28 weeks with routine psychosocial care and selective serotonin reuptake inhibitors (SSRIs), with half also receiving cognitive-behavioural therapy (CBT). Full clinical and demographic assessment was carried out at baseline and 28 weeks. RESULTS: Depression at 28 weeks was predicted by the additive effects of severity, obsessive-compulsive disorder and suicidal ideation at entry together with presence of at least one disappointing life event over the follow-up period. CONCLUSIONS: Clinicians should assess for severity, suicidality and comorbid obsessive-compulsive disorder at presentation and should monitor closely for subsequent life events during treatment.

Br J Psychiatry. 2009 Apr;194(4):334-41. Wilkinson P, Dubicka B, Kelvin R, Roberts C, Goodyer I. Developmental Psychiatry Section, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge CB2 8AH, UK. pow12@cam.ac.uk

Adjunctive psychosocial interventions are increasingly recognized as an important aspect of comprehensive treatment for bipolar disorder (BPD) in childhood and adolescence. Research in this area is relatively new, but psychosocial interventions being developed and tested include: multi-family psychoeducation groups for school-aged children with either BPD or depressive disorders; family-focused treatment, dialectical behavior therapy, and interpersonal and social rhythm therapy for adolescents with BPD; and child and family-focused cognitive-behavioral therapy for school-aged children with BPD. Preliminary evidence, where available, indicates that these interventions are feasible, well-received by families, and associated with positive outcomes. The continued study of adjunctive psychosocial interventions will help identify critical treatment ingredients that target specific areas of functioning and enhance overall treatment effectiveness for children and adolescents with BPD and their families.

Child Adolesc Psychiatr Clin N Am. 2009 Apr;18(2):471-82, x-xi. West AE, Pavuluri MN. University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL 60608, USA. awest@psych.uic.edu

This report described a phased-oriented treatment of complex trauma in four Chinese women. Two women were survivors of childhood sexual abuse, one was a rape victim, and the other was a battered spouse. A phased-oriented treatment that tailored to the needs of the clients was used. The treatment framework consisted of three phases: stabilization, trauma processing, and integration. Hypnotic techniques had been used in these phases as means for grounding and stabilization, for accessing the traumatic memories, and for consolidating the gains. Data from self-reports, observation and objective measures indicates a significant reduction in the trauma symptoms after treatment.

Am J Clin Hypn. 2009 Jan;51(3):263-71. Poon MW. Clinical Psychological Unit 3, Social Welfare Department, 14/F Cornwall House, Taikoo Place, 979 King's Road, Quarry Bay, Hong Kong. maggie@cuhk.edu.hk

Fear of heights, or acrophobia, is one of the most frequent subtypes of specific phobia frequently associated to depression and other anxiety disorders. Previous evidence suggests a correlation between acrophobia and abnormalities in balance control, particularly involving the use of visual information to keep postural stability. This study investigates the hypotheses that (1) abnormalities in balance control are more frequent in individuals with acrophobia even when not exposed to heights, that (2) acrophobic symptoms are associated to abnormalities in visual perception of movement; and that (3) individuals with acrophobia are more sensitive to balance-cognition interactions. METHOD: Thirty-one individuals with specific phobia of heights and thirty one non-phobic controls were compared using dynamic posturography and a manual tracking task. RESULTS: Acrophobics had poorer performance in both tasks, especially when carried out simultaneously. Previously described interference between posture control and cognitive activity seems to play a major role in these individuals. DISCUSSION: The presence of physiologic abnormalities is compatible with the hypothesis of a non-associative acquisition of fear of heights, i.e., not associated to previous traumatic events or other learning experiences. Clinically, this preliminary study corroborates the hypothesis that vestibular physical therapy can be particularly useful in treating individuals with fear of heights.

Eur Arch Psychiatry Clin Neurosci. 2009 Mar;259(2):114-9. Epub 2008 Sep 19. Boffino CC, de Sá CS, Gorenstein C, Brown RG, Basile LF, Ramos RT. Institute of Psychiatry and Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil.

The metacognitive model of obsessive-compulsive symptoms [Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley] emphasizes three types of metacognitive knowledge in the etiology and maintenance of symptoms: thought fusion beliefs, beliefs about the need to perform rituals, and criteria that signal rituals can be stopped. We tested the model using a series of hierarchical regression analyses. Results showed that each metacognitive domain when entered in their hypothesized causal sequence explained incremental variance in two different measures of obsessive-compulsive symptoms, with worry controlled. These incremental relationships remained when non-metacognitive beliefs (e.g., responsibility and perfectionism) which have been linked to obsessive-compulsive symptoms in other theories were controlled. Results provide further support for the metacognitive model.

J Anxiety Disord. 2009 May;23(4):436-42. Myers SG, Fisher PL, Wells A. Academic Division of Clinical Psychology, University of Manchester, Rawnsley Building, MRI, Oxford Road, Manchester M13 9WL, UK. samuel.myers@manchester.ac.uk

The role of meta-memory and meta-cognition in obsessive-compulsive disorder (OCD) symptoms and checking was examined in a student sample, using the memory and cognitive confidence scale (MACCS; Nedeljkovic, M., & Kyrios, M. (2007). Confidence in memory and other cognitive processes in obsessive-compulsive disorder. Behaviour Research and Therapy, 45, 2899-2914). Confirmatory factor analysis supported the MACCS's previously reported structure, and hierarchical regression supported its relationship to OCD symptom severity over-and-above depression and other OCD-related beliefs. Specifically, general confidence in memory was found to be a unique predictor of overall OCD severity. Implications for theory and research are discussed.

J Anxiety Disord. 2009 May;23(4):463-8. Nedeljkovic M, Moulding R, Kyrios M, Doron G. Swin-PsyCHE Research Unit, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia. MNedeljkovic@swin.edu.au