by Tim Brunson PhD

There are three very simple two word statements that can sum up how we humans experience our universe. Indeed, these statements, which pretty much respectively follow the three major philosophical epochs of the past few centuries – and especially our last one hundred years – dramatically influence the totality of our subjective experiences to include what we believe to be true, how we act, and how we think (and create). Furthermore, it seems that entire populations of psychologists (and other mental health experts), medical doctors, educators, counselors, sociologists, and social workers ply their trades more so as a result of their affiliation and a priori values as they guide their charges back toward what they presumptively feel and believe to be congruent with their theory of the mind as it may be aligned with one of these statements.

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Numerous creative methods have been developed to incorporate computer technology into cognitive behavior therapy for anxiety disorders. In contrast, little has been written about the role that computer technology might play in therapy with hypnosis. This article is an exploration of some basic ways that clinicians can use images from computer search engines and YouTube to enhance exposure therapy for phobias. These adaptations may be particularly useful for the subgroup of patients who have difficulty re-creating and experiencing vivid and compelling aversive imagery in hypnosis, and consequently are reluctant to pursue in vivo exposure. Three cases are presented that illustrate ways in which computer images of fear inducing stimuli can be used with traditional permissive hypnosis to amplify exposure therapy.

Am J Clin Hypn. 2012 Oct;55(2):174-83. Spiegel SB. shaspi@gmail.com

Full title: Virtual reality exposure therapy and hypnosis for flying phobia in a treatment-resistant patient: a case report. Flying phobia is a problem that affects a significant portion of the population. There are a number of therapeutic approaches but no one is universally accepted as the gold standard. One therapy is hypnosis. A recent addition to the armamentarium is virtual reality exposure (VRE) therapy. Both therapies are short-term and compare favorably to in vivo desensitization. Heretofore a combination of both approaches has not been reported. This article presents a case of a 50-year phobia to flying that was refractory to traditional methods including pharmacotherapy, systematic desensitization, and cognitive behavioral therapy but was successfully treated using VRE therapy and hypnosis as the primary modalities. This treatment was supplemented by other approaches. The rationale for this multimodal therapy and possible mechanisms involved are discussed.

Am J Clin Hypn. 2012 Oct;55(2):168-73. Hirsch JA. josephhirsch1@me.com

OBJECTIVE: Dissociation is a mental process with psychological and somatoform manifestations, which is closely related to hypnotic suggestibility and essentially shows the ability to obtain distance from reality. An increased tendency to dissociate is a frequently reported characteristic of patients with functional neurological symptoms and syndromes (FNSS), which account for a substantial part of all neurological admissions. This review aims to investigate what heart rate variability (HRV), EEG and neuroimaging data (MRI) reveal about the nature of dissociation and related conditions.

METHODS: Studies reporting HRV, EEG and neuroimaging data related to hypnosis, dissociation and FNSS were identified by searching the electronic databases Pubmed and ScienceDirect.

RESULTS: The majority of the identified studies concerned the physiological characteristics of hypnosis; relatively few investigations on dissociation related FNSS were identified. General findings were increased parasympathetic functioning during hypnosis (as measured by HRV), and lower HRV in patients with FNSS. The large variety of EEG and functional MRI investigations with diverse results challenges definite conclusions, but evidence suggests that subcortical as well as (pre)frontal regions serve emotion regulation in dissociative conditions. Functional connectivity analyses suggest the presence of altered brain networks in patients with FNSS, in which limbic areas have an increased influence on motor preparatory regions.

CONCLUSIONS: HRV, EEG and (functional) MRI are sensitive methods to detect physiological changes related to dissociation and dissociative disorders such as FNSS, and can possibly provide more information about their aetiology. The use of such measures could eventually provide biomarkers for earlier identification of patients at risk and appropriate treatment of dissociative conditions.

J Neurol Neurosurg Psychiatry. 2012 Nov 22. van der Kruijs SJ, Bodde NM, Carrette E, Lazeron RH, Vonck KE, Boon PA, Langereis GR, Cluitmans PJ, Feijs LM, Hofman PA, Backes WH, Jansen JF, Aldenkamp AP. Epilepsy Centre Kempenhaeghe, , Heeze, The Netherlands.

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

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

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.

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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Tourette syndrome (TS) is a disorder characterized by childhood onset multiple motor and vocal tics often accompanied by features of obsessive compulsive disorder, attention deficit hyperactivity disorder (ADHD), or other behavioral manifestations. Tics may be simple or complex, and may include motor and vocal components. Abnormal function of the basal ganglia is thought to be an important underlying cause of tics and other movement disorders. Treatment of TS requires a thorough understanding of the phenomenology of the disease for the individual patient, and should focus on symptoms that are especially troubling. Some nonpharmacologic approaches may help to improve tic severity, including conditioning techniques, relaxation training, and hypnosis. Options for pharmacotherapy include dopamine blockers and depleters, benzodiazepines, central alpha-adrenergic blockers, and botulinum toxin. Many patients require therapy for comorbid conditions such as anxiety, depression, or ADHD. In case studies and small patient series, deep brain stimulation has been shown to markedly reduce tic severity and functional impairment associated with TS. While onset is most frequently in childhood, TS should not be considered exclusively a disorder of pediatric patients. The complications and comorbidities that are encountered in children and adolescents often persist into adulthood.

Cleve Clin J Med. 2012 Jul;79 Suppl 2:S35-9. Galvez-Jimenez N. Department of Neurology, Chief, Movement Disorders Section, Cleveland Clinic Florida, Weston, FL 33331, USA. galvezn@ccf.org

by Tim Brunson PhD

It should be no surprise that our brain responds to novelty and surprise. This is because the neural centers that define our consciousness receive sufficient stimuli to be activated. However, what happens when our mind is lulled into complacency by routine sensory input? The answer is simple. It is ignored because this activation does not occur. Then there is no impact. Or, so we think.

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Following brain damage, typically of the right hemisphere, patients can show reduced awareness of sensory events occurring in the space contralateral to the brain damage. The present work shows that a hypnotic suggestion can temporarily reduce tactile extinction to double bilateral stimulation, i.e., a loss of contralesional stimuli when these are presented together with ipsilesional ones. Patient EB showed an improved detection of contralesional targets after a single 20-min hypnosis session, during which specific suggestions were delivered with the aim of increasing her insight into somatosensory perception on both sides of the body. Simple overt attention orienting toward the contralesional side, or a hypnotic induction procedure not accompanied by specifically aimed suggestions, were not effective in modulating extinction. The present result is the first systematic evidence that hypnosis can temporarily improve a neuropsychological condition, namely Extinction, and may open the way for the use of this technique as a fruitful rehabilitative tool for brain-damaged patients affected by neuropsychological deficits.

Front Hum Neurosci. 2012;6:210. Epub 2012 Jul 17. Maravita A, Cigada M, Posteraro L. Department of Psychology, University of Milano-Bicocca Milano, Italy.

Full title: Delsartean hypnosis for girls' bodies and minds: Annie Payson Call and the Lasell Seminary nerve training controversy.

In the summer of 1890, news that two students at Lasell Seminary for Young Women in Auburndale, MA had suffered a complete nervous collapse as a result of being hypnotized by an instructor in a nerve training class caused a brief but sharp national sensation regarding hypnotism and nerve training in girls' education. The instructor, Annie Payson Call, denied practicing hypnotism, and the seminary's principal defended both Call and the "mind concentration" course she taught at Lasell. Call's approach to nerve training blended Delsartean relaxation exercises, New Thought psychology, and self-hypnotic techniques into a therapeutic regimen which can be termed "Delsartean hypnosis." Developed further in her 1891 popular self-help handbook, Power Through Repose, Call's variety of Delsartean hypnosis was incorporated into the procedures of proponents of suggestive therapeutics, and it served as a model for subsequent relaxation training programs in the early- and mid-20th century.

Hist Psychol. 2012 May;15(2):124-44. Andrick JM. Department of History, University of Illinois at Urbana-Champaign, Oak Street Library Facility, 809 S. Oak St., Champaign, IL 61820, USA. andrick@illinois.edu

Speculations about the neural substrates of hypnosis have often focused on the right hemisphere (RH), implying that RH damage should impair hypnotic responsiveness more than left-hemisphere (LH) damage. The present study examined the performance of a patient who suffered a stroke destroying most of his LH, on slightly modified versions of two hypnotizability scales. This patient was at least modestly hypnotizable, as indicated in particular by the arm rigidity and age regression items, suggesting that hypnosis can be mediated by the RH alone - provided that the language capacities normally found in the LH remain available. A further study of 16 patients with unilateral strokes of the LH or RH found no substantial differences in hypnotizability between the two groups. Future neuropsychological studies of hypnosis might explore the dorsal/ventral or anterior/posterior dichotomies, with special emphasis on the role of prefrontal cortex.

Cortex. 2012 May 15. Kihlstrom JF, Glisky ML, McGovern S, Rapcsak SZ, Mennemeier MS. University of California, Berkeley, CA, United States.

Thumbsucking is a common habit among younger children. Usually, the child outgrows this habit by age 6. When a child over the age of 6 continues to suck his or her thumb, it can be a cause of potential harm due to peer pressure, ridicule, and shunning. It can also lead to malocclusions requiring eventual orthodontic interventions. In this case study, the author demonstrates a hypnotic intervention in a 7-year-old girl. Validation of her habit and imaging a role model sucking her thumb were employed in trance. Using this approach, the child was able to end her dependence on thumbsucking in 1 session.

Am J Clin Hypn. 2012 Jan;54(3):195-201. Grayson DN. Dental Hypnosis Center of New Jersey, 1020 Littleton Road, Parsippany, NJ 07054, USA. dr@graysondds.com

BACKGROUND: Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15% to 20% of five year olds, and up to 2% of young adults.
OBJECTIVES: To assess the effects of complementary interventions and others such as surgery or diet on nocturnal enuresis in children, and to compare them with other interventions.

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A large number of studies have provided evidence for the efficacy of psychological and other non-pharmacological interventions in the treatment of chronic pain. While these methods are increasingly used to treat pain, remarkably few studies focused on the exploration of their neural correlates. The aim of this article was to review the findings from neuroimaging studies that evaluated the neural response to distraction-based techniques, cognitive behavioral therapy (CBT), clinical hypnosis, mental imagery, physical therapy/exercise, biofeedback, and mirror therapy. To date, the results from studies that used neuroimaging to evaluate these methods have not been conclusive and the experimental methods have been suboptimal for assessing clinical pain. Still, several different psychological and non-pharmacological treatment modalities were associated with increased pain-related activations of executive cognitive brain regions, such as the ventral- and dorsolateral prefrontal cortex. There was also evidence for decreased pain-related activations in afferent pain regions and limbic structures. If future studies will address the technical and methodological challenges of today's experiments, neuroimaging might have the potential of segregating the neural mechanisms of different treatment interventions and elucidate predictive and mediating factors for successful treatment outcomes. Evaluations of treatment-related brain changes (functional and structural) might also allow for sub-grouping of patients and help to develop individualized treatments.

Neurosci Lett. 2012 Mar 14. Jensen KB, Berna C, Loggia ML, Wasan AD, Edwards RR, Gollub RL. Department of Psychiatry, Massachusetts General Hospital (MGH)/Harvard Medical School (HMS), Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, USA.

INTRODUCTION: The present study was performed to evaluate the efficacy of Ericksonian hypnosis in reducing the impact of tinnitus on patients' quality of life. PATIENTS AND METHODS: A controlled prospective longitudinal study was designed. The severity of tinnitus was assessed with Tinnitus Handicap Inventory (THI) before hypnotherapy and then 1 week, 1 month, 3 months, and 6 months after therapy. Health Survey SF-36 was used to assess health-related quality of life before and after hypnotherapy. Thirty-nine patients with severe idiopathic subjective tinnitus were enrolled in the study. RESULTS: The mean SD age of the patients was 44.5 +/- 12.5 years, ranging from 21 to 65 years; 48% were female. Mean THI scores assessed at the beginning and 4 times after commencement of therapy were evaluated. The changes in THI scores were significant. Health Survey SF-36 was assessed separately. The greatest increases were seen in physical role followed by emotional role difficulty. CONCLUSION: The preliminary results of our study demonstrated the effectiveness of Ericksonian hypnosis in the study group.

B-ENT. 2012;8(1):7-12. Yazici ZM, Sayin I, Gökku? G, Alatas E, Kaya H, Kayhan FT. Bakirköy Education and Training Hospital, Clinic of Otorhinolaryngology, Head and Neck Surgery, Istanbul, Turkey. minealmaz@yahoo.com

Recent research on recovered memories of childhood sexual abuse has shown that there are at least two types of recovered memory experiences: those that are gradually recovered within the context of suggestive therapy and those that are spontaneously recovered, without extensive prompting or explicit attempts to reconstruct the past. These recovered memory experiences have different origins, with people who recover memories through suggestive therapy being more prone to forming false memories, and with people who report spontaneously recovered memories being more prone to forgetting prior instances of remembering. Additionally, the two types of recovered memory experiences are linked to differences in corroborative evidence, implying that memories recovered spontaneously, outside of suggestive therapy, are more likely to correspond to genuine abuse events. This chapter highlights the background of the recovered memory debate, summarizes recent studies with individuals reporting recovered memory experiences and points towards applications in the justice system and in clinical practice.

Nebr Symp Motiv. 2012;58:175-91. Geraerts E. Erasmus University Rotterdam, Rotterdam, The Netherlands. geraerts@fsw.eur.nl

Since the publication of the special issue on cognitive hypnotherapy in the Journal of Cognitive Psychotherapy: An International Quarterly (1994), there have been major developments in the application of hypnosis to the treatment of depression. However, there is no "one-size-fits-all" treatment for depressive disorders as the conditions represent a complex set of heterogeneous symptoms, involving multiple etiologies. It is thus important for therapists to promote a multimodal approach to treating depressive disorders. This article describes cognitive hypnotherapy (CH), an evidence-based multimodal psychological treatment that can be applied to a wide range of depressed patients. CH combines hypnosis with cognitive behavior therapy as the latter provides the best integrative lodestone for assimilating empirically supported treatment techniques derived from various psychotherapies.

Am J Clin Hypn. 2012 Apr;54(4):275-93. Alladin A. University of Calgary, Calgary, Alberta, Canada. Assen.Alladin@albertahealthservices.ca

Full title: Post-traumatic stress disorder: cognitive hypnotherapy, mindfulness, and acceptance-based treatment approaches.

In this article, we describe how cognitive hypnotherapy can be used in conjunction with evidence-based practices for the treatment of post-traumatic stress disorder (PTSD). We review cognitive-behavioral interventions for PTSD, including mindfulness and acceptance-based approaches, and contend that (a) empirical support for the use of hypnosis in treating a variety of conditions is considerable; (b) hypnosis is fundamentally a cognitive-behavioral intervention; (c) psychological interventions with a firm footing in cognitive-behavioral therapy (CBT) are well-suited to treat the symptoms of PTSD; and (d) hypnosis can be a useful adjunct to evidence-based cognitive-behavioral approaches, including mindfulness and acceptance-based interventions, for treating PTSD.

Lynn SJ, Malakataris A, Condon L, Maxwell R, Cleere C. Am J Clin Hypn. 2012 Apr;54(4):311-30. Psychology Department, Binghamton University (SUNY), Binghamton, New York 13902-6000, USA. stevenlynn100@gmail.com

Research on the efficacy of hypnosis in the treatment of bulimia nervosa has produced mixed findings. This is due in part to the interplay between the characteristics of people with bulimia and the wide variety of hypnosis interventions that have been employed. Several authors have noted that methodological limitations in hypnosis research often make evaluation of treatment efficacy difficult. Many of the studies extant provide insufficient information regarding the specifics of participants' hypnotizability, the hypnotic induction, or the hypnotic suggestion(s) employed. Such limitations preclude replication and clinical implementation. This article reviews the literature with replicable methodologies and discusses the implications for evaluating treatment efficacy.

Am J Clin Hypn. 2012 Apr;54(4):353-64. Barabasz M. Washington State University, Pullman, Washington 99164-2136, USA. mbarabasz@wsu.edu

A person who is asked to think aloud while trying not to think about a white bear will typically mention the bear once a minute. So how can people suppress unwanted thoughts? This article examines a series of indirect thought suppression techniques and therapies that have been explored for their efficacy as remedies for unwanted thoughts of all kinds and that offer some potential as means for effective suppression. The strategies that have some promise include focused distraction, stress and load avoidance, thought postponement, exposure and paradoxical approaches, acceptance and commitment, meditation, mindfulness, focused breathing, attention training, self-affirmation, hypnosis, and disclosure and writing. Many of these strategies entail thinking about and accepting unwanted thoughts rather than suppressing them--and so, setting free the bears.

PsycINFO Database Record (c) 2011 APA, all rights reserved.

Am Psychol. 2011 Nov;66(8):671-80. Wegner DM. Department of Psychology, Harvard University, 33 Kirkland Street, WJH 1470, Cambridge, MA 02138, USA. wegner@wjh.harvard.edu

This study tests the proposal that hypnotic responding is effortless. The authors compared the responses of high and low hypnotizable participants (N = 70) in and out of hypnosis on a dual-task paradigm in which they were required to maintain hypnotic blindness during presentation of visual stimuli of varying salience intensities while simultaneously completing a secondary task. Whereas high hypnotizable participants in both hypnosis and wake conditions reported comparable levels of conviction in the hallucination suggestion, hypnotized highs performed poorer on the secondary task when the stimulus was present. Performance on the secondary task deteriorated when the visual stimulus was intensified. These findings contradict the notion that hypnotic response is not demanding on cognitive resources and suggest that increased effort is required to resolve the extent of conflict between reality and suggestion.

Int J Clin Exp Hypn. 2012;60(1):67-80. Wyzenbeek M, Bryant RA. University of New South Wales, Sydney, Australia.

BACKGROUND: Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15% to 20% of five year olds, and up to 2% of young adults. OBJECTIVES: To assess the effects of complementary interventions and others such as surgery or diet on nocturnal enuresis in children, and to compare them with other interventions. SEARCH METHODS: We searched PubMed (1950 to June 2010), EMBASE (1980 to June 2010), the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) (1984 to June 2010), Chinese Biomedical Literature Database (CBM) (1975 to June 2010), China National Knowledge Infrastructure (CNKI) (1979 to June 2010), VIP database (1989 to June 2010), and the reference lists of relevant articles, all last searched 26 June 2010. No language restriction was used. SELECTION CRITERIA: All randomised or quasi-randomised trials of complementary and other miscellaneous interventions for nocturnal enuresis in children were included except those focused solely on daytime wetting. Comparison interventions could include no treatment, placebo or sham treatment, alarms, simple behavioural treatment, desmopressin, imipramine and miscellaneous other drugs and interventions. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the quality of the eligible trials, and extracted data. MAIN RESULTS: In 24 randomised controlled trials, 2334 children were studied, of whom 1283 received a complementary intervention. The quality of the trials was poor: 5 trials were quasi-randomised, 5 showed differences at baseline and 17 lacked follow up data.The outcome was better after hypnosis than imipramine in one trial (relative risk (RR) for failure or relapse after stopping treatment 0.42, 95% confidence interval (CI) 0.23 to 0.78). Psychotherapy appeared to be better in terms of fewer children failing or relapsing than both alarm (RR 0.28, 95% CI 0.09 to 0.85) and rewards (RR 0.29, 95%CI 0.09 to 0.90) but this depended on data from only one trial. Medicinal herbs had better results than desmopressin in one trial (RR for failure or relapse after stopping treatment 0.35, 95% CI 0.14 to 0.85). Acupuncture had better results than sham control acupuncture (RR for failure or relapse after stopping treatment 0.67, 95% CI 0.48 to 0.94) in a further trial. Active chiropractic adjustment had better results than sham adjustment (RR for failure to improve 0.76, 95% CI 0.60 to 0.95). However, each of these findings came from small single trials, and must be verified in further trials. The findings for diet and faradization were unreliable, and there were no trials including homeopathy or surgery. AUTHORS' CONCLUSIONS: There was weak evidence to support the use of hypnosis, psychotherapy, acupuncture, chiropractic and medicinal herbs but it was provided in each case by single small trials, some of dubious methodological rigour. Robust randomised trials are required with efficacy, cost-effectiveness and adverse effects clearly reported.

Cochrane Database Syst Rev. 2011 Dec 7;12:CD005230. Huang T, Shu X, Huang YS, Cheuk DK. Branch of Cooperative Research Center on Evidence-based Medicine of Ministry of Education, Department of Preventive Medicine, Jinggangshan University, 23 Jifu Road, Ji'an, Jiangxi, China, 343000.

Somatoform disorders among children and adolescents may cause impairment in educational and social functioning and generate a great deal of psychosocial distress. The diagnosis of such disorders is complex due to the fact that they may appear as medical conditions. Hence, most of somatoform patients do not seek psychiatric assistance. The common feature of somatoform disorders as described in DSM-IV-TR is the presence of physical symptoms suggesting an underlying medical condition that is either not found or does not account for the level of functional impairment. The diagnostic criteria for the somatoform disorders were established for adults and are applied to children for lack of child-specific research base and a developmentally appropriate alternative system. The most common somatoform disorders in children and adolescents are recurrent abdominal pain and tension headache. Other disorders in the category include: somatization disorder, undifferentiated somatoform disorder, conversion disorder, hypochondriasis and body dysmorphic disorder Treatment is applied through a combination of pharmacotherapy and psychotherapy. SSRI'S are effective in somatoform disorders that have co-morbidity with anxiety and depression as well as in body dysmorphic disorder and hypochondriasis. Conversion disorder is usually treated with benzodiazepines and pain disorder with light analgesics, tricyclics and tegretol. In terms of psychotherapy, treatments most effective for somatoform disorders have been found to be cognitive-behavioral therapy, hypnosis and biofeedback.

Harefuah. 2011 Feb;150(2):180-4, 203. Konichezky A, Gothelf D. Child Psychiatry Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. andres_k_il@yahoo.com

by Tim Brunson, PhD

There are two unquestionable conclusions, which emanate from my just over a half a century ponderance and exploration into the human condition. The first is that subjective experience is related to behaviors, values, and attitudes, which are the results of a mixture of innate characteristics forced upon us by our heritage and the results of external influences and programming. Secondly, our use of the qualitative perceptions with which we experience space and time indubitably shapes how we progress on our journey through life.

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Difficult asthma is defined as the persistence of asthma symptoms, abnormal pulmonary function showing airway obstruction, and continued requirement for short-acting bronchodilator therapy, despite adequate treatment with inhaled corticosteroids. It calls for a thorough evaluation of the patient to look into alternate and complicating diagnoses. The authors report a case of a 9-year-old patient with difficult asthma who failed to respond to conventional therapy. Although it was recognized that he had a number of potential medical complicating factors including allergies, chronic sinusitis, and astroesophageal reflux, a psychological intervention using hypnosis ultimately appeared to help alleviate his symptoms completely. Thus, psychological evaluation and intervention should be considered early in the course of management of a patient with difficult asthma, because it may help avoid time-consuming and expensive investigations of potential complicating factors, and it may yield rapid improvement in the patient's clinical condition.

Am J Clin Hypn. 2011 Jul;54(1):47-55. Anbar RD, Sachdeva S. Upstate Medical University, State University of New York, Syracuse, New York 13210, USA. anbarr@upstate.edu

Full title: Childhood anxiety, worry, and fear: individualizing hypnosis goals and suggestions for self-regulation.

Determining hypnosis goals and specific suggestions for childhood anxiety, worry, and fear can be enhanced by a developmental psychopathology perspective. This article examines underlying causal risk factors that guide a focused assessment and individualized interventions, targeting self-regulation of emotional, cognitive, behavioral, and psychophysiological arousal and reactivity. The author summarizes current knowledge about childhood anxiety disorders and outlines a hypnotic approach when encountering anxious children and youth, including strategies to use spontaneous trance states and enhance underdeveloped resources (e.g. locus of control, discrimination of realistic risk appraisal, coping capacities).

Am J Clin Hypn. 2011 Jul;54(1):16-31. Kaiser P. drpkaiser@earthlink.net

This case report describes a psychospiritual intervention utilizing hypnosis with a client seeking help for problems with involuntary movement of the right arm and hand, accompanied by a great deal of pain. Doctors had diagnosed her condition as dystonia with the presumption that it was primarily physical in nature. She came to Carolinas Integrative Health seeking an integrative approach to her problem, one that brings together conventional and complementary medicine. The client was referred to the author by the Medical Director for a mind/body/spirit approach, including hypnosis. Initial evaluation suggested there might be a psychogenic component to the problem. The client also revealed a spiritual worldview, theistic in nature. Utilizing hypnosis, together with a process the author calls "Centering in Self," the client's spiritual beliefs and resources were accessed and utilized in bringing about resolution of pain and almost complete cessation of involuntary movements.

Explore (NY). 2011 Sep-Oct;7(5):326-8. Benoff-Nadel P.

Full title: Mirrored-self misidentification in the hypnosis laboratory: Recreating the delusion from its component factors.

Introduction. Mirrored-self misidentification is the delusional belief that one's reflection in the mirror is a stranger. According to Langdon and Coltheart's (2000) "two-factor" theory of monothematic delusions, the delusion can arise from deficits in face processing (Factor 1) and belief evaluation (Factor 2). This study gave participants separate hypnotic suggestions for these two factors to create a hypnotic analogue of the delusion. Method. Forty-six high hypnotisable participants received a hypnotic suggestion for either Factor 1 alone or for Factors 1 and 2, either with hypnosis (hypnosis condition) or without (wake condition). Participants were asked to look into a mirror and to describe what they saw. Participants who reported seeing a stranger in the mirror also received a series of challenges. Results. Overall, 70% of participants in the hypnosis condition passed the delusion; only 22% of participants in the wake condition passed. Importantly, in hypnosis, the Factor 1 alone suggestion was just as effective in creating the delusion as the combined Factor 1 and Factor 2 suggestion. Conclusion. These results suggest that hypnotic suggestion can recreate the mirrored-self misidentification delusion from its component factors. Notably, the hypnotic context, itself known to disrupt belief evaluation, can act as Factor 2.

Cogn Neuropsychiatry. 2011 Sep 14. Connors MH, Barnier AJ, Coltheart M, Cox RE, Langdon R. a ARC Centre of Excellence in Cognition and its Disorders , Macquarie Centre for Cognitive Science, Macquarie University , Sydney , Australia.

OBJECTIVE: This study investigated the relationship between acute dissociative reactions to trauma and hypnotizability. METHOD: Acutely traumatized patients (N=61) with acute stress disorder, subclinical acute stress disorder (no dissociative symptoms), and no acute stress disorder were administered the Stanford Hypnotic Clinical Scale within 4 weeks of their trauma. RESULTS: Although patients with acute stress disorder and patients with subclinical acute stress disorder displayed comparable levels of nondissociative psychopathology, acute stress disorder patients had higher levels of hypnotizability and were more likely to display reversible posthypnotic amnesia than both patients with subclinical acute stress disorder and patients with no acute stress disorder. CONCLUSIONS: The findings may be interpreted in light of a diathesis-stress process mediating trauma-related dissociation. People who develop acute stress disorder in response to traumatic experience may have a stronger ability to experience dissociative phenomena than people who develop subclinical acute stress disorder or no acute stress disorder.

Am J Psychiatry. 2001 Apr;158(4):600-4. Bryant RA, Guthrie RM, Moulds ML. School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia. r.bryant@unsw.edu.au

OBJECTIVE: The authors propose a diathesis-stress model to describe how pathological dissociation may arise from an interaction between innate hypnotizability and traumatic experience. METHOD: To support the proposition that pathological dissociation may reflect autohypnotic process, the authors highlight clinical and research data indicating parallels between controlled hypnotic dissociative states and uncontrolled pathological dissociative symptoms and summarize evidence of hypnotizability in persons with psychiatric disorders that manifest these symptoms. The authors present this evidence by examining dissociative symptomatology in four psychological domains: perception, behavior and will, affect, and memory and identity. In addition, modern cognitive and neuropsychological models of dissociation are briefly reviewed. RESULTS: Several lines of evidence converge in support of the role of autohypnosis in pathological dissociation. There is considerable evidence that controlled formal hypnosis can produce a variety of dissociations of awareness and control that resemble many of the symptoms in uncontrolled pathological dissociative conditions; and it is possible to discern in dissociative pathology the features of absorption, dissociation, and suggestibility/automaticity that characterize formal hypnotic states. There is also accumulating evidence of high levels of hypnotic capacity in all groups with dissociative symptomatology that have been systematically assessed. In addition, the widespread and successful therapeutic use of hypnosis in the treatment of many dissociative symptoms and conditions (and the potential for hypnosis to induce dissociative symptomatology) also supports the assumption that hypnosis and pathological dissociation share an underlying process. CONCLUSIONS: High hypnotizability may be a diathesis for pathological dissociative states, particularly under conditions of acute traumatic stress.

Am J Psychiatry. 1996 Jul;153(7 Suppl):42-63. Butler LD, Duran RE, Jasiukaitis P, Koopman C, Spiegel D. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Calif, USA.

Neglect patients are not aware of stimuli in the contralesional space. We aimed to simulate neglect-like behaviour in healthy participants, by asking them to orient their visuospatial attention in two conditions: non-hypnotic suggestion and post-hypnotic suggestion. Results showed that directing visuospatial attention to one side of space caused neglect of stimuli in the opposite side of space, but only when participants were under post-hypnotic suggestion. Furthermore, directing visuospatial attention to the right side of space caused more neglect of left-sided stimuli than directing visuospatial attention to the left side of space did for right-sided stimuli. We propose that post-hypnotic suggestion can be a useful tool for (de)activating neurocognitive mechanisms underlying visuospatial awareness, a function that is fundamental for our survival. The use of post-hypnotic suggestion could be applied to the study of many domains of cognitive neurosciences (e.g., neurocognitive rehabilitation).

Neuropsychologia. 2011 Aug 30. Priftis K, Schiff S, Tikhonoff V, Giordano N, Amodio P, Umiltà C, Casiglia E. Department of General Psychology, University of Padova, Italy; Laboratory of Neuropsychology, IRCCS San Camillo Hospital, Lido-Venice, Italy.

Abstract The authors describe 3 studies in which hypnosis itself is not studied but instead used to create anomalous states in the laboratory that can be studied under controlled conditions. The 1st article is a comprehensive review of programmatic research using hypnosis to elicit and study clinically relevant delusions. The 2nd article reviews studies comparing the brain activity of hysterical/dissociative patients with nonpatients hypnotized and given suggestions for sensory-motor and cognitive anomalies typical of the clinical syndromes. The authors conclude that the hypnosis analogues are relevant and revealing. The 3rd article describes a single experiment using hypnosis to elicit distressing and intrusive memories, typical of acute anxiety disorders. Findings with hypnotic subjects are in keeping with those from patients suffering intrusive memories. Across all 3 papers, hypnosis is shown to be a viable and helpful tool for experimental psychopathology.

Int J Clin Exp Hypn. 2011 Oct-Dec;59(4):469-76. Nash MR, Wong A. a University Of Tennessee , Knoxville , USA.

Hypnotherapy and training in self-hypnosis can help persons achieve remarkable success in alleviating anxiety, not only in anxiety disorders, but also in any problem involving anxiety. The author describes the role of hypnosis in the treatment of several disorders and provides clinical examples illustrating treatment of generalized anxiety, phobias, and posttraumatic stress disorders. He concludes that because hypnosis exploits the intimate connection between mind and body, it provides relief through improved self-regulation and also beneficially affects cognition and the experience of self-mastery.

Bull Menninger Clin. 1990 Spring;54(2):209-16. Smith WH. Menninger Clinic, Topeka, KS 66601-0829.

Full title: Single-Session Manualized Ego State Therapy (EST) for Combat Stress Injury, PTSD, and ASD, Part 1: The Theory.

Abstract Ego state therapy (EST) evolved from a psychodynamic understanding of personality as a product of an individual's ego states to a conceptualization of how ego-energized and object-energized elements are bound together to cope with a traumatic event. Neurobiological studies now substantiate Watkins's war neuroses conceptualizations. Because of their severity, trauma memories are encoded in the subcortical-subconscious brain regions that are accessed by the single-session manualized EST procedure but not by the popular cognitive-behavioral management therapies. The imprint of the trauma is not accessible or resolvable by such top-down verbal understanding or reframing; EST is a bottom-up therapy. Abreactive hypnosis facilitates ego state expression at physiologically and psychologically intense levels sufficient to activate subcortical processes to release affect in the presence of the therapist, who adds ego strength to the patient. This is followed by interpretation and reintegration. The result is a reconstructed personality that is adaptive and resilient.

Int J Clin Exp Hypn. 2011 Oct-Dec;59(4):379-91. Barabasz AF, Barabasz M, Watkins JG. a Washington State University , Pullman , USA.

by Tim Brunson, PhD

Just about all mental pathologies involve some level of dysfunctional space/time perceptual orientation. In fact, an honest investigator would probably have considerable difficulty finding any mental condition listed in the current diagnostic and statistical manual that did not involve the client's or patient's space and time orientation. This is especially true of traumas, which include an overly intense past orientation, and fears, phobias, and anxieties, which normally primarily involve an excessive future orientation. Space/time perceptions are implicated even with bad habits, personality disorders, and delusions, which often are associated with bipolar and schizophrenia. Furthermore, these concepts also come to play when coaching a person for performance improvement. Therefore, any protocol must take into consideration the adjustment of the subject's orientation or perceptions.

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BACKGROUND: Anxiety during pregnancy is a common problem. Anxiety and stress could have consequences on the course of the pregnancy and the later development of the child. Anxiety responds well to treatments such as cognitive behavioral therapy and/or medication. Non-pharmacological interventions such as mind-body interventions, known to decrease anxiety in several clinical situations, might be offered for treating and preventing anxiety during pregnancy. OBJECTIVES: To assess the benefits of mind-body interventions during pregnancy in preventing or treating women's anxiety and in influencing perinatal outcomes. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2010), MEDLINE (1950 to 30 November 2010), EMBASE (1974 to 30 November 2010), the National Center for Complementary and Alternative Medicine (NCCAM) (1 December 2010), ClinicalTrials.gov (December 2010) and Current Controlled Trials (1 December 2010), searched the reference lists of selected studies and contacted professionals and authors in the field. SELECTION CRITERIA: Randomized controlled trials, involving pregnant women of any age at any time from conception to one month after birth, comparing mind-body interventions with a control group. Mind-body interventions include: autogenic training, biofeedback, hypnotherapy, imagery, meditation, prayer, auto-suggestion, tai-chi and yoga. Control group includes: standard care, other pharmacological or non-pharmacological interventions, other types of mind-body interventions or no treatment at all. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion all assessed risk of bias for each included study. We extracted data independently using an agreed form and checked it for accuracy. MAIN RESULTS: We included eight trials (556 participants), evaluating hypnotherapy (one trial), imagery (five trials), autogenic training (one trial) and yoga (one trial). Due to the small number of studies per intervention and to the diversity of outcome measurements, we performed no meta-analysis, and have reported results individually for each study. Compared with usual care, in one study (133 women), imagery may have a positive effect on anxiety during labor decreasing anxiety at the early and middle stages of labor (MD -1.46; 95% CI -2.43 to -0.49; one study, 133 women) and (MD -1.24; 95% CI -2.18 to -0.30). Another study showed that imagery had a positive effect on anxiety and depression in the immediate postpartum period. Autogenic training might be effective for decreasing women's anxiety before delivering. AUTHORS' CONCLUSIONS: Mind-body interventions might benefit women's anxiety during pregnancy. Based on individual studies, there is some but no strong evidence for the effectiveness of mind-body interventions for the management of anxiety during pregnancy. The main limitations of the studies were the lack of blinding and insufficient details on the methods used for randomization.

Cochrane Database Syst Rev. 2011 Jul 6;(7):CD007559. Marc I, Toureche N, Ernst E, Hodnett ED, Blanchet C, Dodin S, Njoya MM. Département de pédiatrie, Université Laval, Centre Hospitalier Universitaire de Québec, 2705 boulevard Laurier, Québec, Québec, Canada, G1V 4G2.