MEDICAL USES OF HYPNOSIS: VOL 1

TABLE OF CONTENTS
1. HYPNOSIS CAN BE GREAT AID TO MEDICINE: HYPNO-GRAM

1
2. MEDICAL HYPNOSIS: LATEST RESEARCH: DR. ROBERTA TEMES

2
3. HOW TO GET MD REFERRALS BOOK: MELISSA ROTH, Cht. Ph.D.

4
A. FINDING PHYSICIANS

6
B. TELEPHONE SCREENING SCRIPT

7
C. THERAPIES THAT WILL GET REFERRALS

7
D. PROFESSIONAL CONDUCT

11
E. HANDOUTS
 13
4. PRACTICING HYPNOSIS IN A CLINICAL SETTING: SCOTT GILES

17
A. WORKING IN THE MEDICAL ENVIRONMENT-THE MEDICAL MODEL18
B. IMAGERY AND PATTER HAVE TWO BASIC FORMS

20
C. COMPLEMENTARY MEDICAL HYPNOTISM

23
5. MARKETING MEDICAL HYPNOSIS: SCOT GILES

29
A. MAKE A DECISION TO WRITE ONLY SUCCESSFUL ADS

32
B. BUILDING YOUR PRACTICE WITH FREE EDUCATIONAL SEMINARS 34
6. HYPNOTIC TECHNIQUES TO ASSIST CLIENTS WITH MEDICAL PROBLEMS:
SCOT GILES

35
A. FRAMING AND REFRAMING OF TREATMENT
 39
B. AGE-PROGRESSION

40
7. HYPNOTIC ANALYSIS: SCOT GILES

41
8. MEDICAL HYPNOSIS SCRIPTS: SCOT GILES

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A. SCRIPT: INNER CHILD EXPLORATION

44
B. SCRIPT: THE HALL OF THE MOUNTAIN KING

48
C. SCRIPT: THE FREEZER OF FROZEN FEELINGS

50
D. SCRIPT: INNER ADVISOR SKELETON FORMAT

51
E. SCRIPTLETS FOR VARIOUS ILLNESSES
 52
9. HYPNOSIS PROVIDES THERAPEUTIC TOOL FOR PATIENT MANAGEMENT:
RICHARD S. LEWIS

54
10. HYPNOTHERAPY AND PSYCHOTHERAPY WITH CERTAIN DISEASES 58
11. HYPNOSIS IN MEDICINE: CORNELIA MARE PINNELL

68
A. ANXIETY RELATED TO MEDICAL PROCEDURES

69
B. DISEASES WORKED WITH

71
C. DISCUSSION

79
12. THE HEALING POWER OF HYPNOSIS: CATHERINE MCNAUGHT
 83
13. MEDICAL HYPNOSIS: USES, TECHNIQUES AND
CONTRAINDICATIONS OF HYPNOTHERAPY: CAROL WATKINS

86
14. HYPNOSIS & MEDICAL RESEARCH: THE STANDING OF HYPNOTHERAPY 89
15. HYPNOSIS IN MEDICINE: DAVE BRAGER: JAN 2001

92
16. HYPNOSIS IN NURSING: ETHEL PERCELAY: HYPNOSIS VOL 1 # 1: 1954 96
17. HYPNOSIS AND ITS MEDICAL INDICATIONS: WILLIAM S. KROGER

99
18. NO ONE HAS A MONOPOLY ON HYPNOSIS: WILLIAM S. KROGER

103
19. HYPNOTHERAPY IN GENERAL PRACTICE: WILLIAM KROGER

103
20. HYPNOTHERAPY IN MEDICINE: PAUL GUSTAFSON

106
21. HYPNOSIS AIDS IN MEDICAL TREATMENTS: GILDA A. HERRERA

107
22. FREQUENTLY ASKED QUESTIONS ON HYPNOSIS FOR
MEDICAL PURPOSES

108
23. HYPNOSIS ALLIES ARE URGING INSURERS TO RAISE COVERAGE:
JEANINE MJOSESTH
 111
24. OBTAINING MEDICAL REFERRALS: MELISSA ROTH

113
25. NURSES AND HYPNOSIS: A PERFECT MATCH: AJAMU AYINDE

114
26. WARMTH RELAXATION FOR REYNARD’S DISEASE: THERESA TEMPER 115
27. HYPNOSIS CAN BE GREAT AID TO MEDICINE: MELVIN POWERS

117
28. HYPNOSIS CONTRIBUTIONS TO MEDICAL PRACTICE: GEORGE J. PRATT

118
29. KEY CONCEPTS OF MEDICAL HYPNOANALYSIS: RYAN ELLIOT

120
30. HYPNOSIS USED TO TREAT PATIENTS: DONNA G. SMITH

120
31. MEDICAL USES OF HYPNOSIS: ROBERT G. MEYER

121
32. HYPNOSIS FOR AIDS THERAPY: FROM THE INTERNET

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33. SOME MEDICAL USES FOR HYPNOSIS: UNIVERSITY EDINBURGH
STUD
Y

128
34. HYPNOTHERAPY EFFECTIVE FOR FUNCTIONAL DYSPEPSIA:
MARK EBELL
 133
35. SCIENTIFIC RESEARCH ON HYPNOSIS: MARIE RHODES

134
36. HEART PATIENT’S ANXIETY REDUCED BY HYPNOSIS TRAINING:
JAMES BAIRD

137
37. MEDICAL HYPNOTHERAPY: LONDON D’ARCY

137
38. HYPNOSIS LESSENS DISTRESS: KRISTA CONGER: FEB 2005

141
39. HYPNOTHERAPY IN CHRONIC AND TERMINAL ILLNESS:
HARTMAN’S MEDICAL & DENTAL HYPNOSIS: DAVID WAXMAN

142
40. HYPNOSIS PAST, PRESENT AND FUTURE: ITS MEDICAL
AND PSYCHIATRIC APPLICATIONS: HOWARD M DITKOFF

146
41. HYPNOSIS AND MAINSTREAM MEDICINE: MICHAEL WALDHOLZ
 158
42. DR. ALAN M MATEZ MEDICAL HYPNOSIS

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A. TAKE CONTROL OF YOUR MIND, YOUR BODY, AND YOUR LIFE

162
B. WHAT IS CLINICAL GUIDED MENTAL IMAGERY

163
43. KEEPING HYPNOTISM SAFE: JULIE GRIFFIN: NGH JOURNAL: SEPT
2004

164
44. MEDICAL HYPNOSIS: DR DAN ZELLING

166
45. MEDICAL HYPNOTHERAPY: LEIGH PERRY

168
46. CALL THE MEDICAL HYPNOTIST: APPLIED BEHAVIORAL HEALTH
CARE

171
47. HIGHMARK BLUE CROSS BLUE SHIELD SUPPORTING “WHOLE
PERSON”
 CANCER CARE

173
48. COST ANALYSIS OF ADJUNCT HYPNOSIS WITH SEDATION DURING
OUTPATIENT INTERVENTIONAL RADIOLOGIC PROCEDURES

174
49. PAIN MANAGEMENT AND IMPROVING QUALITY OF LIFE IN
TERMINABLY ILL: ALBERT GRAZIA

183
50. GOING UNDER: SELF HYPNOSIS FOR PAIN RELIEF: CHRISTINE HAREN

187
52. BLUE CROSS STARTS HYPNOTHERAPY REFERRAL NETWORK: HMI

194
53. MEDICAL HYPNOTHERAPY OUTLINE: PAUL DURBIN & MELISSA ROTH 194
54. MEDICAL APPLICATIONS: BERYLE SILVERMEN

213
55. APPLICATIONS IN INTERNAL MEDICINE: BERYLE SILVERMEN

214
56. OTHER MEDICAL APPLICATIONS: BERYLE SILVERMEN

219
57. WHY ARE MEDICAL PROFESSIONALS SEEKING ADVICE ABOUT HYPNOSIS 225
58. HYPNOSIS IN CONTEMPORARY MEDICINE REVIEW: JAMES H. STEWART 226
A. CHARACTERISTICS OF HYPNOSIS AND A HYPNOSIS SESSION

226
B. ACCEPTANCE OF HYPNOSIS IN MEDICINE

228
C. RISKS OF HYPNOSIS

229
D. CLINICAL TRIALS OF HYPNOSIS OF VARIOUS ILLNESSES

230
E. HEALING FROM SURGERY OR INJURY

234
 MEDICAL USES OF HYPNOSIS: VOL 1
1. HYPNOSIS CAN BE GREAT AID TO MEDICINE: HYPNO-GRAM: APRIL/MAY 1992:
LONDON. - Make no mistake about it, hypnotism is a matter of vital importance, affecting
nearly everyone. Statistics show that 80 to 90 percent of people can be hypnotized, and can
derive benefit from its use for a wide variety of ailments.
Hypnotism can help in cases of asthma, migraine, duodenal ulcers, blood pressure, skin
diseases, allergies, hysteria, neurasthenia and insomnia. By the use of hypnosis more and more
women are bearing children without feeling the slightest pain, and there even is a case on record
of a woman being cured of warts by hypnotic suggestion after months of medical X-ray
treatments failed.
When we consider that a wart, which is only a growth, can be made to disappear by
suggestion, we are entitled to ask: May we be able to influence other growths? It is only a
possibility, and only years of painstaking work, experiments and research can supply the answer.
Let me hasten to explain that hypnotism is not a cure-all for human ills. It can be used in
widely varying conditions, and nobody, no matter how fanatically opposed to hypnotism, can
deny that in this science we have the most powerful and effective method of controlling the
mind and, through the mind, the whole body.
When a few words, suggesting paralysis, can make a hypnotized person powerless to
move, though fully conscious and able to reason, who can doubt the power of hypnotism? Then
hypnotic suggestion can cause the mouth to water, change the heart rate, or cause sweat glands
to function, who can fail to be impressed with its possibilities in medicine?
Hypnosis may be regarded as the key to the mind of man. Neuroses, illusions, delusions,
and hallucinations can be induced experimentally under hypnosis, and as quickly removed.
Surely such a powerful weapon must be of the utmost importance in investigating the
cause of mental disorders.
Fortunately there are signs that the medical world is beginning to realize the immense
potentialities of the science which, stripped of all its nonsensical and mysterious trappings can be
presented as a simple, serious and straightforward method of medical treatment. Hypnosis, after
all, is providing to be of immense value in the treatment of many diseases.
Ulcers, goiter and high blood pressure are known as “stress diseases” the unfortunate, but
growing, products of the stresses and stains of modern civilization. When life was calmer and
more
leisurely, such diseases were very rare. With the rush and hurry of today, they are becoming
more prevalent.
Unfortunately, they attack the most useful members of society. They are common
among the more intelligent, ambitious and hard working. Those who are lazy, placid and
without ambitious seldom suffer.
Hypnosis is helping, on an ever growing scale, large numbers of suffers from this group
of diseases.
The hypnotist need possess no “mysterious gift” or “hypnotic power” whatever. Such a
power, if it can be called that, lies within the subject or patient - the hypnotist merely has the
technical knowledge of how to manipulate it.

2. MEDICAL HYPNOSIS: LATEST RESEARCH: DR. ROBERTA TEMES PhD, 262

Coleridge Street Brooklyn, New York 11235, (718) 646-5537:
Hypnosis is the original mind/body medicine and every year many clinical trials are
conducted to prove the usefulness of hypnosis in specific situations. Here are some recent
outcomes: Would you take a pill that promised to speed you through surgery? Would you take
a pill that's been tested on hundreds of surgical patients and all but one of them maintained stable
vital signs during their operation - no sudden high blood pressure- and all needed far less pain
medication than patients who did not take the pill-much reduced pain after surgery, and there's
more. The surgeons were able to complete the operation quicker in the patients who had the pill.
I suspect if there was such a pill every HMO would insist upon it. After all, they'd save money
on medications and on time spent in
the operating room. The 'pill' that's been proved to have this effect is hypnosis!
In the April 29, 2000 edition of the scholarly medical journal, the Lancet, Dr. Elvira
Lang of Harvard University published her study of clinical trials using hypnosis before surgery.
People who had been hypnotized prior to surgery needed less pain medication, left the operating
room sooner, and had more stable vital signs during their operation.
A study of children with trichotillomania appeared in the medical journal, Acta
Paediatrica, 88 (4) pp. 407-410. Children who were hypnotized to stop pulling their hair
remained able to refrain from doing so for 16 months, after just a few hypnotic sessions. The
authors, H. Cohen, A. Barzilal, and E. Lahat at the Pediatric Ambulatory Center, in Petach
Tikva, Israel, suggest that doctors consider hypnosis and not medication as the primary treatment
for
Patients with migraine headaches had a group hypnosis session and then were given
pre-recorded self-hypnosis tapes to take home. On the self-hypnosis tapes they were given
imagery of wearing a helmet that was very cold because it had freezer coils inside it. They were
also taught how to relax themselves using hypnosis. Before joining this research study all the
patients agreed to keep written records for three months. During those three months they
listed every migraine they had and how long it lasted, how severe it was, and how much
medication they needed.
 For three months the patients listened to their hypnosis tapes, which put them into a
hypnotic state. At the end of three months the data from the first three months was compared to
the data of the three months during which they used self-hypnosis. During those last three
months: The headaches occurred less often. When the headaches did appear they went away
quicker. The headaches were less severe. Medication use was cut in half.
Hypnosis is an effective treatment for migraine headaches. More information about this
study can be obtained from Dr. Gordon Emmerson, Psychology Department, Victoria
University of Technology, PO Box 14428 MCMC, Melbourne, Victoria 8001, Australia
Before having dental surgery patients listened to a 20 minute hypnosis audio tape. The
tape put them into a hypnotic state and then told them that during the procedure they would be
able to control bleeding from their gums, they would heal rapidly, and would easily cope with
pain. Patients were told to listen to their tape every day for one week prior to the surgery. The
dental surgeon performed similar operations on patients who listened to the tape and patients
who were not given a tape. The dentist did not know which patients had tapes and which did not.
After the surgery it was determined that patients who had been hypnotically prepared
experienced less anxiety, and needed much less pain medication. This study proves that a
properly designed audio tape can be an effective intervention. This study was conducted by
Bjorn Enqviast, DDS, in Stockholm, Sweden.
Fifty patients suffering from irritable bowel syndrome were asked to fill out
questionnaires about their symptoms. Half of the patients were hypnotized and half were not.
After a few months new questionnaires determined that the patients who had been hypnotized
had less abdominal pain, less bloating, less nausea, less gas pain, and fewer backaches.
Additionally, the hypnotized patients said they felt more in control of their lives and did not call
in sick as often as they did before having the hypnosis. Also, they did not need to visit their
doctors as often as they did before the hypnosis. The patients in the study who did not receive
hypnosis did not show these improvements. This study proves that hypnosis not only relieves
symptoms of irritable bowel syndrome, but also improves quality of life for those patients. This
study was conducted by Dr. Whorwell, University Hospital of South Manchester, in the United
Kingdom.
Research was done to determine the effectiveness of hypnosis in treating
trichotillomania, compulsive hair pulling, in children. The children were hypnotized and then
taught self-hypnosis so they could re-hypnotize themselves at home on a daily basis. The
children who had trichotillomania without depression recovered well. Those who had depression
were only partially successful. This study was done by Dr. Daniel Kohen, University of
Minnesota in Minneapolis.
(This next study replicated the results of a previous, similar research study) Patients
suffering from irritable bowel syndrome were treated with hypnosis. Eighty two percent of the
patients improved. Patients were less anxious, had less abdominal pain, less bloating, less
constipation and less gas. Even those patients who were not very hypnotizable had good results.
Hypnosis is an effective treatment for irritable bowel syndrome. For more information please
contact: Dr. Edward Blanchard, Center for Stress and Anxiety Disorders, 1535 Western Avenue,
Albany, NY 12203
Patients suffering from psoriasis were hypnotized and some patients had quite an
improvement. The patients who improved were those who were very hypnotizable. Those who
were moderately hypnotizable did not improve. Hypnosis may be useful with psoriasis patients
who are very hypnotizable. Contact Dr. Francisco Tausk, Department of Dermatology, Johns
Hopkins School of Medicine, 601 N. Caroline St., Baltimore, MD 21287
Pregnant women who begin to go into labor long before their ninth month are said to
have preterm labor. Patients who had preterm labor were hypnotized and given suggestions to
keep their cervix firm and hard to hold the baby in the uterus. Hypnosis was continued until the
contractions stopped. Patients were seen for hypnosis two or three times each day and then given
audio tapes to play several times a day. Seventy percent of the hypnotized patients were able to
prolong their pregnancies. Only twenty percent of the women who were not hypnotized were
able to prolong their pregnancies. Hypnosis can help prevent premature births.
Hypnosis has been used to help bereaved people get through mourning. In this article a
widow is treated with hypnosis. Hypnotic relaxation is recommended for the first stages of grief,
then supportive suggestions, and finally a new way to look at her relationship with her husband
is recommended. All the above is done with the aid of hypnosis, and then the patient is
hypnotized to strengthen her ego and look toward the future. Hypnosis is an effective tool in
bereavement counseling. Dr. Gary Elkins is the author of this paper. He can be reached at:
gelkins@bellnet.tamu.edu.
Prior to surgery twenty six children were hypnotized and twenty six others, who were the
same age and having the same surgery, were not hypnotized. The hypnosis group was taught
self-hypnosis (guided imagery) and given the hypnotic suggestion that they would recover easily
and quickly. After all the children were recovered it was determined that those who had been
hypnotized had less pain, needed fewer pain killers, and went home days earlier than those in the
non-hypnosis group. Also, those in the hypnosis group were calm, while those in the other group
were anxious, even after the surgery. This study was done by Sally Lambert at the Rainbow
Babies and Children’s Hospital in Cleveland, Ohio.
Patients who were healthy, but had a broken bone in their foot, were recruited from an
orthopedic emergency room. They all received regular orthopedic care, but half of them were
given hypnosis, too.
The hypnosis consisted of individual sessions and a hypnosis audio tape to be played at
home. After 9 weeks, x-rays and clinical assessments of the foot showed that the patients who
were hypnotized were healing faster. The hypnotized patients had improved ankle mobility, an
easier time walking down stairs, and had a decreased need for painkillers. Hypnosis can be used
to enhance fracture healing. This study is from: C.S.Ginandes, Dept. of Psychiatry, Harvard
Medical School,Cambridge, MA
Severely burned patients were hypnotized to feel less pain, in addition to receiving their
regular dosages of morphine and other pain medications. The patients who most benefitted from
hypnosis were those who were in the most pain. Hypnosis worked best when it was administered
by the hypnotist and didn’t work as well when the patient was told to rely on self-hypnosis.
Hypnosis is an effective adjunct to treatment in burn patients. This study was done by Dr.
David Patterson at the University of Washington School of Medicine, Seattle, Washington.

3. HOW TO GET MD REFERRALS BOOK: MELISSA ROTH, Cht. Ph.D.

INTRODUCTION: A survey done by the American Medical Association found that
58% of physicians were in favor of their patients using complimentary therapies. We also know
that more and more patients are asking their physicians for information on various
complimentary therapies. With all this heightened awareness about complimentary therapies, are
you getting referrals from half of the physicians in your area?
 Another recent survey documented that as many as 66% of patients are trying
complimentary therapies. The highest percentages of utilization are among people with chronic
illnesses for which traditional therapies offer little relief or hope. This is the same patient
population that the physician has the greatest difficulty with and the ones he/she are most likely
to refer out.
Unfortunately, the average physician does not know to whom to refer the patient or how
to make a referral for complimentary therapies. And, when they don't know to whom or how,
they usually keep quiet and do nothing. (p 1)
Those physicians who suggest complimentary therapies usually tell their patients that
they should consider hypnosis or acupuncture or some other modality and leave it up to the
patient to find an appropriate therapist. At that point, the patient usually turns to the yellow
pages or an advertisement. Basically, they pick the therapist whose ad looks the most appealing
that day. They have no confidence level and no direction. They mayor may not make the most
appropriate choice.
Possibly you already get referrals from your personal physician and maybe even a couple
of other physicians you know. Getting physician referrals insures a steady stream of interesting
clients and it sets you apart from everyone else who are advertising. The patient automatically
transfers to you the same level of esteem and regard he or she has for their physician. And,
unlike expensive advertisements, all it costs you to get these referrals is your brochure and
telephone. This course teaches you step-by step how to become known to any physician of any
specialty and how to secure their referrals. (p 2)
Getting Started: First, compile a comprehensive listing of physicians in your area. Next
invest the time on the telephone to screen each physician's office. Judging by the answers and
reception you get during the telephone screen, sort them by those physicians you want to see
first, second, third and so forth. Obviously, those who say they already refer to complimentary
providers will be ones you want to see first.
Although the receptionist may state that her doctor would not be interested in your
services, you still want to put them on your call list. Do not make a special trip to see them. But,
make a point of leaving brochures and literature when calling on someone else in their building
or neighborhood. I had a case like that recently. The receptionist told me plainly that her doctor,
a Rheumatologist, would not be interested in referring patients for hypnotherapy.
When I was in her neighborhood I stopped by to see if I could see the physician anyway.
The receptionist was even more emphatic. So, I left my brochure on fibromyalgia and a study
published in the Journal of Rheumatology advocating hypnotherapy for alleviating (p 7)
symptoms of fibromyalgia. I never spoke with this physician. However, two weeks later I
received an email from her referring a patient.
After you have sorted them into groups by interest levels, further sort them into
geographical areas so that you can call on as many as possible during each trip. Many physicians
have offices in large medical buildings owned and operated by hospitals. This allows you to see
several people in a short amount of time. Driving to remote locations will be necessary to see all
the people on your list but it eats up time. When you are seeing physicians on this initial visit,
time is a valuable commodity. After you have worked through all the physicians in your area
who are appropriate for you to call on, you will periodically return to visit those who have
shown an interest in your services or who have referred patients to you. Each time you call a
physician's office, make an office visit or have any contact with a physician's office make a note
on that M.D.'s page. You want to keep brief notes about whom you talked to, their interest leve1,
what you discussed and if you left brochures and literature. Each time you get a referral make a
note of the patient's name and reason for referral on that M.D.'s page in your (p 8) workbook.
You want to have adequate notes to tell at a glance what your experience with this physician has
been. And each time you call on this physician you want to discuss a different topic and leave
different literature. Be sure to take them new information that has value for their practice each
time you visit. If-vou can do for them what they need done, they will refer to you If you are
talking about services for which they have no need, you are wasting everyone's time and costing
yourself money in lost productivity.
Make notes immediately after visiting with each physician. When you get back to your
car take a few moments to make notes when things are fresh on your mind. If you postpone this
step you
may forget important details.
Follow up with those physicians who showed an interest in your services. If you
promised to bring back literature on atopic, bring it back promptly. If you spoke with the doctor
about atopic and later you find you have a brochure or literature discussing that topic, drop it in
a brief note to his office. It is best if these notes are hand written. It can be something as simple
as, thought you might be interested." It should always be on your letterhead. I have (p 9) special
note size letterhead for such notes. If the doctor referred a patient to you, send letters and
progress reports for their chart.
For each day you plan to make office visits, put 15 - 20 M.D.'s on your call lists. Prepare
two to three possible presentations per physician. Take a brief case with enough brochures and
literature to supply at least four or five M.D.'s before you have to return to your car to restock.
It is a good idea to take a "cheat sheet" listing the M.D.'s specialty. If you are unable to see the
physician, give your presentation to his/her nurse. (p 10)
FINDING PHYSICIANS: Of course, the first place to start compiling your list of area
M.D.'s is the yellow pages. In large cities you will find them listed alphabetically and by practice
specialty. Just because an M.D. is listed under Internal Medicine doesn't mean they are a
generalist. Many of them have a sub-specialty. When you do the telephone-screening step be
sure to ask if Dr. XX has a sub-specialty or what type of patients he/she sees.
If you only look in the yellow pages of the telephone book you are missing many of the
physicians in your area that might become excellent referral sources. There are many physicians
who do not have private practices and are, therefore, not listed in the yellow pages. You may
miss important contacts if you do not ferret out these health providers and add them to your
contact list.
Consider the hospital-based physicians. They have their offices in the hospital. They may
see only in-patients or a combination of in-patients and outpatients. An example of this type of
physician would be a Physiatrist or Physical Medicine doctor. These professionals typically
work in rehab units or rehab hospitals. (p 11) This type of physician is taught to take a team
approach to treating the whole patient. They have little hesitation adding you to the team. In
addition, you can provide a valuable service for their patients.
Another example would be the Radiologist. Common problems associated with an MRI
are the anxiety and fear of being immobile in a small tube. Open MRI units do not give as clear
a picture as the traditional tube. Many patients simply can not handle being in such a small
enclosed space and must be rescheduled and sedated. This takes a lot of valuable time. If you can
lessen a patient's anxiety and fears to allow them to be comfortable in the tube, you will be
considered a very valuable resource.
 Another source of physicians is university-based physicians. These doctors usually see
patients in various specialty clinics within the university or teaching hospital. Also, within the
university, are the physicians in the student health department. The students are their patients.
But not ail students are the typically healthy 18-22 year olds. They encompass all ages and all
health problems. And, if it is a large university, they probably include patients of various (p 12)
ethnic backgrounds and countries of origin, for whom pharmaceuticals constitute alternative
medicine.
There are also the public health physicians. They serve the lower economic levels of
society. The majority of their patients are Medicare and Medicaid recipients. Medicare will
reimburse for hypnosis for certain medical conditions. Do not exclude this group of physicians.
There are also company physicians. These doctors treat only employees of the company.
Sometimes they also see dependents or family members of the employee. You can usually obtain
a listing of these physicians by calling the company or by walking into the clinic and picking up
cards.
In addition to looking in the yellow pages, you can call the hospitals for a listing of the
physicians who are credentialed to practice there. You will find that many physicians have
privileges at more than one hospital. In other cases, the physicians will be polarized around one
hospital and will not or cannot work at another one. All of these are good resources to help in
compiling a comprehensive listing of physicians in your area.(p 13)
TELEPHONE SCREENING SCRIPT: How do you get all the information about each
physician? Most of it can be obtained by calling his/her office and talking with the receptionist
and for nurse. Simply explain to the receptionist that you are a new professional representative
in the area and need to get some information. They are experienced with pharmaceutical
representatives asking for information and calling on the doctor. Usually, the receptionist can
give you most of the information you need. Simply go down your list and ask the following
questions.
1) What is Dr. X's nurse's name? Does she have a direct phone number or extension?
2) What is the fax number for Dr. X's office?
3) Does Dr. X see pharmaceutical reps?
4) Do I need an appointment or do I just come and wait to be seen?
5) What is the best time of day and the best day of the week to be seen quickly?
6) Are there certain days or times to avoid? (p 14)
7) Does Dr. X see patients with (specific diagnosis)?
8) Does Dr. X ever recommend complimentary therapies such as physical therapy, acupuncture
or hypnosis?
9) Does Dr. X have any special interests such as Fibromyalgia or mitral valve prolapse
(substitute indications you know you want to target?
10) If you need an appointment to see this physician, go ahead and set one up now. (p 15)
The Presentation: Your presentation should be no longer that two minutes. If the
physician wants to talk longer than two minutes then be prepared to spend as long as they desire.
Be sure you have answered their questions to their satisfaction. Remember that brief answers are
best. This is no time to launch into a detailed description of hypnosis and how it works. This
takes more practice to achieve than it sounds.
How do you know if you have answered questions to their satisfaction? Ask, "Is that
what you wanted to know?" or "Did that answer your question?" Be aware of their interest level.
When it drops off, stop talking.
 You should make three points about the topic in your presentation. Numerous studies
document that people do not remember more than three points. Don't waste your precious two
minutes on material they will not recall. Save it for the next visit.
Question your way to agreement. You must ask questions to determine if your planned
presentation is valuable to this M.D. If this M.D. is in Internal Medicine but specializes in
pulmonary (p16) comfortably discuss with your patients?” “Would you be interested in having
more brochures for your waiting room? It’s that simple. (p 18)
THERAPIES THAT WILL GET REFERRALS: There are several therapies that a
physician will readily refer to you. Basically, these are therapies for which there are either no
conventional treatments or the conventional treatments have not worked for this patient. Also,
there is a growing class of patients who do not want to take medications. Pharmaceuticals,
physical therapy and surgery constitute the majority of conventional treatments available to a
physician. If the patient either rejects these or is not a candidate for one of these, the physician
has little else to offer them. This is where you come in. Also, do not forget that medications have
a price to pay in side effects. Sometimes, the reward is worth the price you have to pay.
Sometimes, it is not.
The following conditions are ones which the physician will refer patients to you. This is
not an all inclusive list. However, it will be a good place for you to start. Develop a script
educating the physician how you can help his/her patients alleviate the objectionable symptoms
of each of these conditions. (p 19)
* Anxiety- Typically, when a patient has high levels of anxiety, or generalized anxiety disorder,
the physician prescribes an antidepressant. Unfortunately, antidepressants do nothing to alleviate
anxiety. Paxil is the antidepressant that works best for anxiety and it provides inadequate relief.
When the patient comes back complaining of anxiety symptoms they are then referred to a
psychologist for therapy. Cognitive-behavior therapies, like hypnosis, work best for anxiety. But
that is not what most mental health professionals do. Psychiatrists rarely do any therapy. They
prescribe medications and monitor psychotherapy done by the psychologists. Tradition
psychotherapy is a slow, sometimes agonizing process. Anxious patients want and need relief
NOW.
* Hypertension: - There are hundreds of anti-hypertensive medications on the market. Finding
the one that works best for the individual patient is similar to shopping for new shoes. You try
one and then another until you find the right fit. In addition, most of the anti-hypertensive
medications have an undesirable side effect. They cause impotence in males. The choice is to
live longer but without sex or not take the medication, risk death by stroke or heart (p 20)
attack, but continue to have a sex life. Hypnosis, however, can reduce hypertension in mild to
moderate cases without medications. Also, hypnosis can make it easier for the patient to adhere
to recommended lifestyle changes that will lower their blood pressure. Specifically, hypnosis can
help the patient maintain dietary changes and exercise programs.
* Irritable Bowel Syndrome - IBS is a chronic illness characterized by chronic diarrhea, chronic
constipation or both. It effects up to 20% of the population striking one out of three women.
Conventional medical therapies consist of medications and dietary changes. These are only
effective for 25% of patients with this condition. And the side effects of the medications are so
noxious that most patients quit taking them. Whether the medications worked or not, when the
patients quits taking them, the symptoms return. However, with as few as six sessions of gut
specific hypnotherapy, the patient can become symptom free and the symptoms do not return
when the sessions end. (p 21)
* Chronic Pain - As much as 90% of the population experiences some type of pain every day.
The number one complaint seen in the physician's office is PAIN. Narcotic pain medications are
very addictive. Routinely, several pain medications head the list of most commonly abused
prescription medications. Every physician has heard urban legends of some other physicians in
the community who had his license reviewed or even pulled due to over prescribing of narcotic
pain medications. They are, therefore, hesitant to prescribe adequate amounts of narcotic
medications to provide the chronic pain patient with relief. Further complicating the picture is
that after a fairly short time the patient develops a tolerance to the medications and requires
higher and higher dosages just to achieve the same levels of relief. Due to its relentless nature,
most chronic pain becomes debilitating to some extent. It disrupts sound, restorative sleep. It
impairs cognitive functioning. It creates depression and anxiety. Hypnotherapy can reduce pain
levels, relieve anxiety and depression. It can he1p the patient achieve refreshing, restorative sleep
patterns. At the very least, it can alleviate enough of the chronic pain to allow the patient to
reduce (p 22) the amount of medication necessary to remain comfortable. This is of major
importance to physicians and patients alike.
* Acute Pain - Hypnotherapy can sometimes relieve all of the pain. For other patients it can
alleviate enough acute pain to allow the patient to be comfortable with greatly reduced needs for
pain medications. The medical literature is full of reports citing as much as a 60% reduction in
analgesic usage after surgery.
* Diagnostic Testing- Many diagnostic tests can be performed using hypnotherapy instead of
analgesic or sedating medications. Not only does this save the hospital money by speeding up the
process; it produces a happier patient who is more willing to comply with doctors' orders
afterwards. It also produces more accurate test results. For example, many people have great
difficulty with closed
MRI tubes. The top of the tube is only three to four inches from their face. This causes
claustrophobia in people who have never suffered with jt before. These machines are expensive to
own and operate. Therefore, the hospital must keep then operating in a time efficient manner. A
patient who hesitates or can not tolerate being (p 23) in the MRI tube costs the hospital money
that they can not pass along to the insurance company. They can only bill the insurance company
for the procedure, not how much time it took to get the patient to cooperate.
* Pain Free Childbirth- The most desirable scenario for both mother and doctor is an
unmedicated birth following an uncomplicated pregnancy. Hypnosis for childbirth can allow
them to achieve this scenario. The greatest risk of birth defects is from anesthesia during
childbirth. OB/GYNs are interested in reducing their patient's need for anesthesia and pain
medications. In addition, the time of labor for most first pregnancies is eleven to fourteen hours.
If a woman has practiced a method of relieving childbirth pain by utilizing breathing exercises,
she is fatigued when it is time to push. If she has utilized hypnosis, she is rested and can actively
participate by pushing. This is pleasing to both mother and doctor and safer for the baby.
* Eibromyalgia- FMS accounts for 10% of all conditions seen in a general physician's practice. It
is characterized by widespread pain, (p 24) fatigue, sleep disturbance and cognitive dysfunction.
While this illness is not life threatening, it is progressive to the point of becoming disabling.
Currently, 36% of all social security disability payments go for FMS. This one illness is capable
of bankrupting the social security system. Twelve sessions of system specific hypnotherapy can
alleviate most of the symptoms of FMS and return the patient to a higher state of functioning with
significantly reduced needs for narcotic medications. Nothing, other than hypnotherapy, provides
lasting relief for the FMS sufferer.
* Smoking Cessation - Multiple times a day the average physician tells his/her patients who
smoke to stop. For most patients this is easier said than done. The physician can prescribe
Wellbutrin (Zyban) for those patients who can tolerate it. However, not everyone can tolerate this
drug and not everyone is successful using it. When everything else fails or when the patient
doesn't want drugs, the physician will refer patients to you for smoking cessation therapy. Know
your success rate with this therapy. It is not enough to say that most people don't come back for
the free follow up. You can not assume that the person quit smoking just because they didn't (p
25) come back for the free session you offered. A physician wants to know numbers and
percentages before they feel comfortable referring their patients to you. There is no faster way to
end your referrals than from a dissatisfied patient telling their doctor that they quit for a month or
two and then resumed smoking.
* Weight Reduction - Just like with smoking cessation, you need to know your percentage
success rate. You need to know exactly the number of sessions you typically see someone for
weight reduction
of X number of pounds. For example, if someone needs to lose 35 pounds, you need to be able to
tell the physician it typically takes X number of sessions. A weight loss of 100 pounds typically
will require XX number or sessions.
* Somatoform Disorders - These are sometimes called Conversion Disorders. There are no
conventional treatments for these. Also there are no psychological interventions that are effective
for conversion disorders. Hypnosis is both effective and produces relatively quick results. (p 26)
Listed below are a number of other therapies which a physician will refer his/her patients.
This is not a comprehensive list. However, it will get you started.
* Needle Phobia
* Depression Tinnitus
* Stress Management
* Headaches
* Migraines
* Memory Enhancement
* Insomnia
* Phobia Relief
* Nail Biting
* Concentration
* Sexual Enhancement
* Unexplained Infertility
* Treatment Compliance
* Exercise Motivation & Compliance
* HIV/AIDS
* Immune System Boosting
* Wound Healing
* Erectile Dysfunction
* Dysmenorrhea (Menstrual Cramps)
* Bashful Bladder
* Enuresis
* Nausea/Vomiting (Chemotherapy & Pregnancy) (p 27)
 Indications by Specialty: Listed below are some of the indications for which an M.D.
will
refer patients to you. They are broken down by specialty. While this is not a complete listing, it
will get you started. Use this list to develop presentations that are tailored to each medical
specialty. There are certain conditions that are so pervasive in our society that they are seen by
every specialty. These conditions are pain, stress, anxiety, smoking and weight control.
* Allergy rashes, allergies, asthma
* Anesthesiology decreased amount of anesthesia needed during surgery, pain management
* Bariatric Medicine: weight loss, exercise motivation, behavior modification
* Burns: pain control, anxiety, healing
* Cancer (Ontology): pain relief, boosting the immune system, nausea control
* Cardiovascular Disease (Heart): angina, anxiety, hypertension, diet and exercise (p 28)
* Dermatology: pruritus, warts
* Endocrinology: diabetes, diet and exercise, weight loss
* ENT: tinnitus
* Family Practice: pain, irritable bowel syndrome, fibromyalgia, chronic illnesses, hypertension,
stress reduction, anxiety, panic attacks, insomnia, migraines
* Gastroenterology (Digestive Disorders) irritable bowel syndrome, chron's disease
* Gynecology (OB/GYN): pain free childbirth, PMS relief, nausea control, unexplained
infertility, dysmenorrhea, anorgasmia
* Inertial Medicine: hypertension, irritable bowel syndrome, fibromyalgia, mitral valve prolapse,
stress, anxiety, somatoform disorder, pain, insomnia
* Maxillofacial & Cosmetic Surgery: minimize scaring, anxiety
* Neurology: pain, multiple sclerosis
* Neurosurgery. pain, healing, pre and post surgery
* Orthopedics (Bone & Joint): healing, pain, exercise motivation
* Pain Management: pain, exercise motivation, anxiety, depression
* Pediatrics: study skills, needle phobia, enuresis, thumb sucking, asthma, bashful bladder, nail
biting
(p 29)
* Physical Medicine (Rehabilitation): exercise motivation, healing, anxiety, somatoform disorders
* Psychiatry: panic disorder, anxiety, depression, somatoform disorders
* Radiology: anxiety, claustrophobia, relaxation
* Rheumatology: Fibromyalgia, pain, lupus (SLE)
* Surgeons: anxiety, pain, healing
* Urology: bashful bladder, enuresis, urinary incontinence, erectile dysfunction, premature
ejaculation
(p 30)
Dentists: Dentists have as much need for the services of a hypnotherapist as physicians
do. Open your telephone book to the section for dentists. Many of the ads are stressing the fact
that their dentist is painless or gentle. Dento-phobia, fear of the dentist, is universal in our
society. The severity of this fear ranges from mild anxiety to total avoidance of the dentist. I have
had a number of clients who are so fearful of the dentist that they have not been for ten years or
longer. The only reason they were considering going back was due to the intense pain of an
abscessed tooth or for another dental emergency. When you are developing you referral network,
do not overlook dentists. Some of the indications that a dentist would refer patients to you
include:
Gagging, vomiting, TMJ, clenching, bruxism, pain, anxiety and phobias, stress, smoking,
dipping snuff or chewing tobacco. (p 31)
PROFESSIONAL CONDUCT: Understand that when a physician refers a client to you,
they are putting a tremendous amount of trust in you to conduct yourself professionally and
ethically. It generally requires a great leap of faith on their part. Not only do they stand to lose the
patient if the patient does not trust you, but they risk losing the patient's family and close friends
also. A physician only has to lose one patient or get a complaint from one patient about your
conduct to stop your
flow of referrals. They do not expect you to be successful with 100% of the patients they refer.
They do expect you to conduct yourself professionally 100% of the time.
What constitutes professional conduct?
#1. The referring physician makes ALL referrals and recommendations. The patient always
belongs to the physician who referred them. The physician always remains in charge. Any
additional referrals or recommendations must come from the physician. If you think the patient
needs massage therapy in addition to hypnotherapy, you must contact the physician and (p 32)
recommend that the physician refer them to a massage therapist. If you think the patient would
benefit from herbs or supplements, you must contact the physician and allow the physician to
make the recommendation. If you think the physician has made a misdiagnosis or has not
diagnosed some other problem with this patient, you may not tell the patient to go see Dr. So and
So instead. You must either remain quiet, call Dr. X who referred the patient and suggest he/she
take another look at the patient for the possibility of ----- condition, or you can suggest to the
patient that they return to Dr. X for further evaluation emphasizing the symptoms to discuss. No
matter what you think, you may not refer this person to another doctor or another therapist.
#2. You may only do therapy for the condition indicate prescription or referral form. If you
do not agree with the diagnosis or if some other problem is uncovered during the course of
therapy, you must contact the physician and have them write anew prescription or referral form.
This does not mean that you can't work on weight loss as part of the therapy process for bringing
the patient's hypertension under control. However, if the patient has (p 33) been referred to you
for smoking cessation, you are not entitled to do past life regression. In the past, I have had a
number of patients who were referred to me for various conditions who were interested in
regression work to uncover suspected past abuse, past life regression or a personal growth
therapy. In each case, I have told them that I would happily work with them on those issues but
they would have to pay for those sessions out of pocket. They would be in addition to and
separate from the sessions we were having for whatever condition they had been referred to me.
Since I also want to keep my relationship with them and the referring physician clean and above
board, I will only do those other therapies after I have completed the work they were referred
for .
#3. Do not discuss the more esoteric aspects of hypnotherapy with the physician or the
patient. I like to think all physicians are enlightened and a few of them even have the lights on.
However, they have a11 been trained in allopathic or conventional medicine. They do not want to
think you are going to talk to their patients about angels or past lives or the other esoteric aspects
of our profession. (p 34) Patients will bring up these topics to you. It is okay to acknowledge
this with them and discuss it to the point where you discern the patient's model of the world. And,
as always, you must honor the patient's representations. But, it is NOT okay for you to initiate the
conversation or otherwise direct the conversation to these topics. The same holds true with
physicians. Do not initiate the conversation of these topics. Often, I have physicians ask me what
I think about past lives, reincarnation, angels, etc. I always tell them I honor the patient's
representation of reality-whatever that may be and that my personal belief system has no place in
therapy. Other than that, I do not elaborate. Certainly, I have done past life therapy to relieve
chronic pain. I use angels, tapping, divine energy, colors, Reiki, etc., in my therapies. But I do
not initiate the conversations about them. I utilize the patient's belief system only. We always
seek the Source Cause however and wherever we find it. Once we resolve the initial problem for
which they were sent to me, we stop. This area has the potential to become a roadblock in the
referral pathway. Decide how you are going to handle the inevitable (35) questions. Practice your
responses until they sound natural and sincere. Be sure it sounds like you understand the
physician's concerns and have the sensitivity to honor them.
#4. Professional Dress Code: Notice how the physicians in your area dress and dress yourself
accordingly. For men, that means leather shoes with hard soles, a tie, a solid color button down
shirt and a sport jacket or suit. For women, it means a conservative dress or skirt or a dressy
pantsuit. It means conservative dress shoes. It does not mean jeans, shorts, casual clothes or
casual shoes. It also means a conservative hairstyle and a clean-shaven face. Mustaches are
acceptable. Beards are usually not. We put effort into creating repoire with our clients. Strive to
create that same repoire with the M.D.'s you call on. People prefer to do business with people
they believe to be like them. One quick way to begin gaining that repoire is to look the same.
That means the same type of clothing and the same hairstyles. What your mother to1d you is
correct, "You will never get a second chance to make a good first impression." (p 36)
#5. Professional Presentation: Write out the script for your meeting with the physician. Polish
it on
paper first. Then practice saying it out loud. Listen to how you sound. Do you sound natural?
Smooth? Or, are there pauses where there should not be. The points you desire to make should
flow smoothly from one to the next. You should anticipate the physician's objections or
discomforts and formulate your presentation accordingly. Rehearse your presentation over and
over until you can say it automatically.
#6. Limitations: Know what you do not do well and be honest about it, if asked. Know when
your therapy modality is not the best option and be up front about it when asked. Obviously,
antibiotics are the smartest choice for strep throat. Massage therapy is a wiser choice for a pulled
muscle. Know what your part of the healing process is and convey that you can do that part well.
But you do not want to come across as though hypnosis, NLP or whatever other therapies you can
do are all the patient needs. The rule of thumb is to always conduct yourself as a team player. (p
37)
Follow Up: Once a physician refers a patient to you, follow up with progress reports for
the patient's file. This is professional courtesy. It also constitutes good business practices. Each
time that M.D. receives a letter documenting that patient's progress, it makes them more receptive
to referring additional patients.
What do you include in this letter? First, you name the patient and describe the indication
or condition for which they were referred. For example, "Thank you for referring Mary Smith for
hypnotherapy to alleviate the symptoms of Irritable Bowel Syndrome." Next, you describe the
patient. "Mary is a 43-year-old white female who developed IBS symptoms following a complete
hysterectomy in 1996."
Then, you rank the severity of symptoms on the patient's first visit. You want to rank their
level of symptomology before you begin therapy to establish a base line or benchmark against
which you can judge the effectiveness of your therapy. For example, initially, Mary ranked her
symptoms on a scale or zero to ten as (p 38) follows: diarrhea 8, constipation 3, gut pain 6,
spasms 7, bloating 9, gas 8.
Next, outline your proposed therapy plan. "The proposed therapy plan consists of a series
of six gut specific sessions held two weeks apart combined with behavior modification
suggestions concerning diet and exercise. The first of those sessions was held MM/DD/Year.
Mary was re-appointed for MM/DD/Year for the next session In sequence.
It is a good rule of thumb to send follow up notes for the patient's file after three sessions.
Each note should document objectively judged progress. You get this data by ranking the patient's
level of symptomology on each visit and having the patient rank their symptoms on a daily basis
between visits. This provides you with documented, objective progress results. Example, "Today
was Mary Smith's fourth session for relief of IBS symptoms. After three sessions she was
reporting symptoms as follows: diarrhea 2, constipation 0, gut pain 1, spasms 2, bloating 4 and
gas 3. This represents a XX% reduction in her overall IBS symptoms. She also reported that she
has resumed grocery shopping for her family and (39) has gone to her son's baseball games for
the first time in two years. We expect continued progress."
After the final session that the physician has prescribed, send a note thanking him/her for
allowing you to work with their patient. Document the patient's progress. If you think the patient
could make additional gains in symptom alleviation, write a note stating what you expect to
accomplish in additional sessions. Include an estimate of the number of additional sessions it
would take to accomplish this goal. Be sure to include a revised therapy plan as part of th is note.
If the patient fails to keep appointments or does not comply with the therapy program,
you need to document this in a note to the referring physician. If you do not report that the patient
failed to comply with the treatment plan, the physician, having no other knowledge, will think
your treatment failed. Whatever happens with that patient needs to be reported to the referring
physician.
Periodic follow up on each patient insures repeated referrals. It establishes you as a
member of the health care team. 1n my office, we ask each client for the name of his or her
personal physician. Whenever possible, we have the client sign a release to (p 40) report their
therapy progress to their physician. It is good practice to keep their physician informed of
therapies the patient is utilizing. It also put our clinic name in front of physicians more
frequently that I can personally visit with them. (p 41)
HANDOUTS: You want to leave something behind when you leave the physicians office
that will be a continuing reminder of your services. The most important things to leave are your
brochures and your business card. Your brochures are easy for the doctor to hand to a patient. It
not only tells them how to find you but also should give them some basic information about
hypnotherapy and how it can help with the condition they have. This means you must prepare
specialty brochures for all the indications your therapies address instead of one general brochure.
I leave brochures for smoking cessation and weight loss regardless of what else I have discussed.
In addition to brochures and my business card, I also leave printed prescription blanks.
Why? Because most physicians do not know how to write a prescription for hypnotherapy. They
did not know how to write a prescription for physical therapy until recently and, therefore, did
not utilize it to its fullest potential. Don't let the reason they don't refer to you be due to them not
knowing how to write a prescription for your services. An example of a prescription blank that I
leave for physicians is enclosed in the booklet. All the (p 42) physician needs to do is check off
the appropriate areas and either send it by the patient or fax it back. If they have to create a
format for a prescription, it may not happen and you may not get the referral.
I also went to one of the office supply houses and bought the blanks for business size
refrigerator magnets. Them I made my own refrigerator magnets out of my business cards. They
are inexpensive and they have staying power. Think of your own refrigerator and the magnets on
it. Whether you like them or not, they are still there year after year and you still see them every
day.
These are the only things I leave with a physician. If you want to leave other reminders I
would recommend pens, pencils and note pads. No office ever has enough of these and they never
throw them away. Your name will constantly be in their face. Just make sure they are
conservative and professional. A (p 43)
Medical Journal Abstracts: During the telephone screen part of this process you asked
what medical journals the physician read. You want to know so that you can search the medical
abstracts in those journals for articles about hypnotherapy. More and more frequently in the
medical literature are reports that hypnotherapy has been proven effective or beneficial for one
condition or another. Several times a year some journal has an article on hypnotherapy. The
National Institute of Health (NIH) has added an entire division to discerning the efficacy of
alternative and complimentary therapies. This research is being done at major universities and
teaching hospitals around the U.S. and the results are being published in medical journals. If it
hasn't been published in a medical journal, it may have been published on the web site for the
NIH.
Every time you go out to meet a physician with the intent of discussing how hypnotherapy
can benefit his/her patients you should take a copy of a medical journal article documenting the
efficacy of what you are claiming. If you take an article from (p 44) Readers Digest or
Newsweek it doesn't evoke the same respect as a peer reviewed journal. If the article was
published in a respected medical journal it will gain the most credence. Examples of respected
medical journals are JAMA: The New England journal of Medicine, Southern Medical journal,
The Lancet and those journals published by the various specialty boards.
How to Find Medical Journal Articles on Hypnosis: The easiest way to locate medical
journal articles is on the internet. Popular medical journal search engines are:
* Ovid (subscription)
* Medscape (free)
* Medline (free)
* National Institute of Health
If you do not have internet access you can use the internet in any public library. Most
public libraries do not subscribe to monthly medical journals. You would need a medical library
for that. However, you can usually print a synopsis of the article off the internet.
Alabama Hypnotherapy Center
211716th Avenue South. Birmingham, Alabama 35025 (205)933-5705
Fax: (205)933-5041 . E-mail-hypnosis@mindspring.com
Date:
Dear Doctor ,
 I am a Doctor of Clinical Hypnotherapy candidate, certified by the American Board of
Hypnotherapy and the National Guild of Hypnotists with a private practice in Birmingham,
Alabama.
Your patient _____________________ has requested help in the area of
_____________________
I do not attempt to treat or diagnose disease or mental disorders of any kind. Hypnosis in
no way replaces standard medical procedures, but works in conjunction with them by freeing the
patient of feelings and attitudes that may be inhibiting his or her response to them. Through
hypnosis, one uses the natural facilities of the mind to create a positive attitude and boost the
immune system, allowing the client to make the most of the medical help available. Hypnosis
helps to create strong positive expectancy and reduces stress, thereby normalizing the action ot~
the autonomic ne[\'ous system.
Your signature below allows me to help your patient to increase his/her own natural
resources through visualization and progressive relaxation.
Thank you,
Melissa J. Roth, CHt., PhD(c)
Doctor's Name
Doctor's Signature Date
Patient Name (p 48)
Sample: Stop Smoking Script: [Every physician has smoking patients who need to stop
smoking. The nicotine replacement patches and Zyban are contraindicated in many patients.
And, for many more patients, they either don't work or they have undesirable side effects. In
addition, the patches, the gum and the pills are all invasive therapies. Hypnotherapy is
noninvasive and therefore safer.]
Hello, Dr. XX. My name is {your name). I'm with (name of your practice). Do you ever
recommend to your patients that they should stop smoking? (Obviously, the answer will be "Yes.
') For those patients who have tried "everything else" or who can not tolerate Zyban or for whom
the patches are contraindicated, please consider recommending hypnosis to them. I have an XX%
success rate in helping people quit smoking. It isn't necessary for them to believe it will work or
even for them to believe in hypnosis for them to stop smoking using my techniques. And
hypnotherapy is non-invasive.
I use a three session approach which disconnects them from the cravings for nicotine and
helps to re-pattern the hand to mouth habit. (p 50)
Invariably the physician almost always ask the same two questions:
1) How much does it cost? rell them how much you charge for your program and compare it to
the cost of Zyban, the patches or the nicotine replacement gum. You will find you are much less
expensive than any of these methods. You find out what the others cost by going to your local
pharmacy or discount store and asking the prices.
2) Will insurance reimburse it? Know whether the insurance companies in your area will
reimburse for hypnosis for smoking cessation or not. Several insurance companies will reimburse
for behavior modification classes for smoking cessation.
Many insurance companies will reimburse for hypnotherapy and many more will
reimburse for behavior modification classes for smoking cessation. When that is the case, I give
the client a receipt for "behavior modification for smoking cessation." The best way to get an
insurance company to reimburse the patient is with your prescription so I have prepared
prescription blanks for that. Would you like some? Would you recommend hypnotherapy for
smoking cessation to your patients? Would you like some brochures to give your patients? (p 51)
Sample: Irritable Bowel Syndrome Script: Hello, Dr. XX. My name is (your name).
I'm with (name of your practice). Do you see patients with Irritable Bowel Syndrome that don't
respond to drug and diet therapy? (Obviously, the answer will be Yes.) By now you may have
read in some of your professional journals that hypnotherapy is an effective treatment to alleviate
the symptoms of IBS. My therapy approach consists of SIX sessions, spaced two weeks apart.
Using this approach, 94% have gotten greater than a 50% reduction in symptoms and 86% have
become symptom free and remained that way even after the sessions ended. In addition, by
coordinating with their physician, they have been able to reduce or eliminate the medications they
were taking for IBS symptoms. Would this be valuable for your IBS patients?
Now is the time for two questions you have learned to anticipate:
1) How much does it cost?
2) Does insurance cover this? (p 52)
Sample: Fibromyalgia Script: Fibromyalgia accounts for l0% of the patients seen in a
general practice and for one third of the patients seen in a rheumatology practice. There is no
more effective treatment for fibromyalgia than hypnotherapy.
Hello, Dr. XX. My name is (vour name) and I am with (name of your practice). Do you see
Fibromyalgia patients? I use a progressive twelve session, system specific hypnotherapy program
for fibromyalgia that produces 50% or greater symptom reduction in over 86% of patients. They
are able to reduce their dependence on and use of pain medications anywhere from 30% to 60%.
Their sleep improves without the necessity for sleep medications. They awaken refreshed and, as
a result, the fatigue and mental fog improves. They are able to resume many of the activities they
have stopped. I've even had two who came off disability and returned to work. This therapy
approach was tested at UCLA Medical School. They used the same type of approach and verified
the same things I see in my practice. The only symptom that does not improve significantly is the
tender point sites. But, the pain, the fatigue, the (p 53) sleep disturbance and the mental cognition
problems all improve significantly and remain that way when the sessions end. No matter how
well controlled your fibromyalgia patients are, when they come off their medications, their
symptoms return full force.
Hypnotherapy is non-invasive. And, unlike medications, it will not mask symptoms. Do you
think this would be valuable to your fibromyalgia patients? Would you like to know how to
prescribe hypnotherapy sessions for your patients? (p 54)

4. PRACTICING HYPNOSIS IN A CLINICAL SETTING: SCOTT GILES

If you are going to practice hypnotism in a medical or clinical setting, you need to know
the scientific theory behind hypnotism. The other professionals with whom you will interact, and
whose support you will need, will expect you to be able to explain what you are doing in
scientific terms they understand. If you cannot, you will not be taken seriously. If you can explain
your work in scientific terms, you will get referrals and your practice of complementary medical
hypnotism will grow.
This section of the curriculum introduces you to a comprehensive theory of hypnotism as
practiced in the medical setting. You will learn:
· How to practice in accord with the Medical Model;
· How to explain hypnotism to medical professionals in a way they understand;
· The format of the hypnotic encounter with a client in the Medical Setting;
· The Neurophysiologv of Hypnotism - the physical basis for hypnotism, trance, suggestion
in brain structure and physiology;
· Cautions and contraindications for hypnotism in the medical environment;
· General Mind-Body Theories and Research,
· How to understand a mental health diagnosis made hy another professional,
· The Hypnotic Induction Profile (HIP) -a proven, scientific method for hypnotism in the
medical setting,
· A simple theory of personality based on the HIP and how to use it to help clients manage
stress related to medical condition;
· A comprehensive theory of personality called the Enneagram, which can help you develop
a longer-term helping relationship with clients you meet as part of your practice of
complementary medical hypnotism.
WORKING IN THE MEDICAL ENVIRONMENT-THE MEDICAL MODEL
The Medical Model forms the "culture" of the Medical Environment. This culture is very
strong and professionals who do not use this model to explain what they do are discounted.
· For the physician: Testing, Diagnosis, Treatment, and Follow-up
A hypnotist working in the medical environment needs to present his or her work in accordance
with the medical model, but using terminology that is lawful for a non-physician. Fortunately, the
curriculum of the National Guild of Hypnotists contains everything needed:
· assessment through BASIC and Suggestibility testing.
· These elements can be easily assembled into a variation of the medical model for the
hypnotist:
· Goal-setting and GIFT;
· Techniques of Hypnotism through Trance Induction, Imagery and suggestion
management;
· Methods for Follow-up through Reinforcement and Encouragement.
· Your work in the medical setting will be better received if you are able to explain what
you do in terms of this model.
Unfortunately, hypnotists who have obtained National Guild of Hypnotists Certification
through reciprocity with other hypnosis organizations may not have been exposed to equivalent
materials as part of his or her training. In such cases we recommend arranging to review this
material with a National Guild of Hypnotists Certified Instructor.
The Format of the Hypnotic Encounter
The model of hypnotism advocated by this curriculum is based on the principle that all
hypnosis is self-hypnosis, and on the use of the Hypnotic Induction Profile. This theory ,j and the
profile are best articulated by their creators, Herbert Spiegel, MD, and David Spiegel, MD, in
their book TRANCE AND TREATMENT. We use this theory because the experience of Guild
hypnotists strongly suggests that it is valid. We note that we have modified this theory somewhat
from its original presentation by Drs. Spiegel, and students are encouraged to explore the original
theory and profile as published by these physicians. We do not know if Drs. Spiegel would
approve or disapprove of the modification to their work that we present here.
Hypnosis is not something the hypnotist does to the client; rather it is something that the
client does to him or herself. The following categories are one way to think about this process.
The hypnotic encounter has three parts: aura, enhancement and plunge. These terms were first set
forth by Herbert and David Spiegel, MD. The use of the term "aura" is unfortunate as the word
has come to have other meanings in some forms of spiritual literature, such as a proposed
energetic field around the body. This is not the sense in which the word is used here. As used
here, the word "aura" refers only to the mental state of the client. We continue to use the word
"aura" in this specialized sense as there is a tradition of this usage in medical literature.
· Aura - the set of Expectations brought to the hypnotic encounter by, the client. The aura is
shaped by the conversation held between client and hypnotist, and if the hypnotist does
his or her job well, many or all of the hypnotic suggestions can he delivered to the client
as part of this conversation. Provided the client has a good subsequent hypnotic
experience, suggestions delivered during the shaping of the client's aura will take hold and
will be effective.
· Encouragement - the ceremony, performed by the hypnotist to encourage the client to
hypnotize him or herself. The methods of trance induction and scripting taught within the
Guild are examples of typical enhancement procedures.
· Plunge - the act of entering hypnosis by the client. The nature of the plunge taken by the
client will depend the client’s feelings about the enhancement performed by the
practitioner
Points to Remember:
The hypnotic pre-talk, your office setting, and your appearance and manner influence the
client's aura. It is critically important that your client begin the hypnotic encounter with a
positive aura, that is, a positive expectation that you can help him or her resolve the presenting
problem. You are justified in using any legal and ethical technique to help create a strong,
positive aura in the client's mind.
All normal hypnotic procedures such as the induction, deepening, suggestion
management, imagery patter and closing, are forms enhancement. .Provided the enhancement you
select is appropriate to the client's aura, the client will have a good experience. It does not matter
if you use rapid or slow induction procedures, direct or indirect suggestion, hypnodisks or incense
fumes. If what you do matches what the client believes you should be doing, the client will enter
a trance. If the enhancement you select is not in keeping with the client's aura, it is unlikely that
the client will cooperate by hypnotizing him or herself.
If the client's aura is strong and positive, and the enhancement you perform is
unobjectionable to the client, the client will take the plunge into a good trance and will have a
good experience. If the enhancement you perform is impressive to the client, the experience is
correspondingly strengthened.
When engaging in the practice of complementary medical hypnotism, it is wise to utilize a
setting, appearance and manner that are similar to what the client has experienced elsewhere in
the medical environment. Therefore, while one must not imply to a client that one is a physician,
a professional appearance, the use of electronic monitoring equipment, and familiarity with
scientific and medical terminology will often help the client experience a good aura about the
hypnotic practitioner.
Want to know more ? Read TRANCE AND TREATMENT, by Herbert Spiegel MD and
David Spiegel MD.
An Extended Model
· More completely, your Encounter with the Client can also be understood to have the
following parts:
· Pre-Talk - This is used to shape and clarify, the client's aura, and may also he used to
deliver pre-hypnotic suggestions.
· Induction - This begins the enhancement and assists the client in taking the plunge from
ordinary awareness into light trance.
· Deepening - This assists the client in deepening the trance from light to the maximum
possible trance the client feels is appropriate and safe.. There is debate among medical and
psychological hypnotists regarding deepening. Some researchers argue that deepening is a
normal process in hypnosis that cannot be guided by the hypnotist. However, it is the
position of this curriculum that a deepening phase in the hypnotic encounter encourages a
good trance experience for the client.
· Suggestion Management - Conversation between the hypnotist and the hypnotized client
to reinforce any pre-hypnotic suggestions and may also he used to add additional
suggestions for behavioral, cognitive or emotional change. The imagery and patter (see
below) can he used as a vehicle for suggestion at this phase of the hypnotic experience.
· Closing - This assists the client in returning to normal awareness. This ends the
enhancement ceremony.
· Post-Talk - This is a debriefing of the client on the experience and may include items to
“ratify” the trance experience for the client to help convince the client that he or she
experienced something extraordinary. Examples of such ratification might including
pointing out to the client that he or she has experienced time compression or has amnesia
about parts of the hypnotic experience.
The elements of the enhancement ceremony (the act of hypnotizing the client) listed
above may be used alone. However, it is common for a hypnotist to add two additional elements
to make the hypnotic encounter more pleasing to the client. If added, these elements are used to
embed the parts of the hypnotic experience.
· The first of these elements is the "Patter," or the gentle, soft flow of words that can soothe
the client and serves to unite the parts of the hypnotic experience. The second of these
elements is the "Imagery," or a narrative of pleasant sensory experiences the client is
asked to imagine to help distract the consciousness of the client. For example, a hypnotist
might use a pleasant story of walking down a forest path (Imagery) to embed the
deepening or induction process for the client. Similarly, during the suggestion
management section, the hypnotist might fill the time between suggestions with soft
words (Patter) such as, "You are doing fine, everything is going wonderfully.’ Imagery
and Patter are not parts of the hypnotic experience; rather they are techniques a skillful
hypnotist may to facilitate the delivery of the parts of the hypnotic experience. Adjusting
the imagery and patter can transform the entire nature of a hypnotic experience, and it is
possible to use imagery and patter to indirectly make suggestions to the client. As an
analogy, patter and imagery are like the color and lines a painter uses to compose a
painting. The painting still has separate parts (foreground, background, and center of
perspective) but the painter uses color and lines to create them.
In recent years there has been a growing movement to use a process called "Guided
Meditation " or "Guided Imagery" in the medical environment. Many medical
professionals have received training in it. These techniques use Imagery to gently
encourage a client to enter a self-hypnotic state, and may also use Imagery to deepen this
stale and to offer suggestions (for example, a client may be asked to imagine seeing a
 wound heal in a magic mirror in the mind). In general, these techniques amount to a form
of loosely structured hypnotic practice. However, the professional practice of hypnotism
is a more complex and encompassing study. Hypnotism may use Imagery as a part, but
also has many other techniques that are more appropriate in specific cases. The difficulty,
with "one-size fits all " Guided Imagery techniques is that the are, by, definition, limited.
Practitioners of Guided Imagery are like a craftsperson who has only one tool - hammer -
in his or her toolkit and therefore decides that everything encountered is in need of a nail.
Typically, clients need to work with a professionals who has a larger and more nuanced
set of tools to accomplish the complex tasks set forth.
IMAGERY AND PATTER HAVE TWO BASIC FORMS:
General - imagery or patter that seeks to communicate an impression of a better future or
overall improvement.
Specific - imagery that employs metaphors that directly relate to the specific disease
process underway. This sort of imagery or patter requires an accurate understanding of what is
taking place with the disease process. For example, it requires that the hypnotist understand that
rheumatoid arthritis involves the body moving into a joint material that should not be there; while
osteo arthritis involves the body moving into a joint material from that should not be there.
Specific imagery or patter is perilous if the disease mechanism is not understood Hypnotists using
specific imagery or palter would be wise to consult a standard reference work such as the
MERCK MANUEL to learn exactly what is going on with a specific disease.
Finally, many hypnotists mistakenly restrict imagery to the visual channel and use it only
to suggest imagining pictures or scenery in the client's mind. While most people can imagine
pictures, some cannot, and all people have more capacity for imagery than just the visual sense.
Remember to suggest how things, smell, taste, feel, and sound, not just how they look. For
example, a "protective shield" can be imaged as a sphere of light around the body. But it can also
be imaged as a feeling of power, like a static electric charge, around the body. Do not restrict
imagery to visualization. Use the other sensory channels as well.
Want to know more? Read STAYING WELL WITH GUIDED IMAGERY by Belleruth
Naparstek, and the MERCK MANUAL by Mark Beers, MD, and Robert Berkow MD, editors.
The current edition of the MERCK is edition Seventeen.
The Neurophysiology of Hypnotism
If hypnotism is real, it must be possible to explain the mechanism of trance and
suggestion in terms of real events that happen in the body. It is a point of contemporary medical
science that no powerfUl experience can occur in the mind without some measurable influence on
the body. A hypnotist working in a medical setting must be able to explain what he or she does in
terms of human physiology in order to be taken seriously.
How Hypnotic Suggestion Works: Neurological Potentiation (Kindling)
The mechanism of hypnotic suggestion can be explained in terms of neurological programming.
The parts of a nerve cell:
· Axion (conducts impulses away from the cell)
· Dendrite (conducts impulses into the cell)
· Cell Body (maintains the metabolic processes of the cell)
Habits as Events in the Mind
· Habit Formation: Habits are automatic thoughts, feelings or behaviors governed by the
subconscious process of the mind.
Habit formation is essential for successful living. No one could consciously "think" his or her
way through every aspect of life. We use habits to automate all the routine aspects of life. For
example, a man does not "decide" each morning which side of his face to start shaving on. Once
upon a time, the man did make a conscious decision about it, but has repeated the behavior so
often that it has now become a subconscious behavior (a habit).
· Habits
may be
of
behavio
r, of
thought
or of
feelings
.

Habits as Events in the Body; The Physical Basis of Suggestion

On average, any given nerve cell in the human brain interconnects with 5000 other nerve
cells. The number of possible interconnections between the nerve cells in the human body is
finite, but huge.
The body must have some way to simplifl this complexity. Kindling is believed to provide the
most plausible explanation.
· The All-Or-Nothing Principle: a false model drawn from computer programing.
· Kindling (Potentiation, Programing)” a model that explains the formation of personality,
preference, habit and learning. Kindling also explains how hypnotic suggestions work,
and why trance enhances suggestion.
The Structure of the Human Brain:
· The Right and Left Hemispheres
· The Corpus Callosum
· The Hippocampal Cortex:
· The R-Complex:
· The Optic Chasm:
· The Limbic System:
· The Cortex:
· The Neo-Cortex:
The Mechanism of Trance in the Brain
· During hypnotic induction changes occur in the Hippocampal Cortex within the
R-Complex. These changes can be stimulated by impulses sent to the Optic Chasm, or
through other methods.
· These changes cause the Hippocampal Cortext to produce chemicals that saturate the
Corpus Callosum (also called "profusing"). These chemicals make the cells in the Corpus
Callosum more conductive, resulting in better flow information between the hemispheres
of the brain.
· When neurological activity in both hemispheres has equalized, or come into a new
 equilibrium, trance occurs.
· In this model, trance can he understood to be not so much a state of relaxation as a
different kind of concentration, in which information is processed democratically, by both
sides of the brain.
· As the non-dominant hemisphere has a poor sense of linear time and difficulty recording
information into long-term memory, information processed there during trance tends to
stay there. Subjects leaving trance often report that they do not know how much time has
passed (time compression and cannot remember what happened in trance after a few
minutes has passed (amnesia).
· The non-dominant hemisphere tends to be the part of the brain that controls habits of
thought, feelings and behavior.
Summary: In hypnotic trance a change occurs in the structure of the brain that links the
two halves of the brain. This change causes more information to flow from one side of the brain
to the other than would normally be the case. During this time, nerve cells in the part of the brain
that controls habits lose some of their electrical charge and the mind of the client becomes more
subject to change. Using imagery and suggestion, new connections among the nerve cells can be
formed. This is why trance increases susceptibility to suggestion and explains how suggestion
works.
Want to know more? Read: BEYOND THE RELAXATION RESPONSE, by Herbert Benson,
MD., TRANCE AND TREATMENT by Herbert Spiegel, MD and David Spiegel, MD, and
CLINICAL AND U(PERIMENTAL HYPNOSIS, SECOND EDITION, by William S. Kroger,
MD.
IMPORTANT CONSIDERATIONS ABOUT COMPLEMENTARY MEDICAL
HYPNOTISM
· While there is more research becoming available about the effectiveness of
hypnotism in medical practice, most of this research is helping conducted by medical
professionals, not certified hypnotists. Therefore, it is wise to maintain a sense of humility
about one when interacting with medical professionals. Do not tell physicians how to
practice medicine, or other professionals how to practice their profession,
· Many physicians or other medical care givers may assume that a hypnotist knows
more about medicine than is appropriate. Therefore, when following a physician's referral
to work with a client, be sure you have understood what the physician wants you to do.
For example, the physician referring a patient for pain control hypnoss prior to heart
surgery assume the hypnotist knows not to do anything that would affect chest pain,
However, if the hypnotist has not understood this, the hypnotist might inadvertently mask
life-threatening symptoms that could result in harm to the patient.
· Complementary medical hypnotism is complicated if the client has a history of
schizophrenic mental illness, and may be unwise if the client has been diagnosed with a
Borderline Personality Disorder.
Increasingly it is unlawful for a hypnotist to work with a client with a medical problem
without a referral from a licensed medical care provider. It is best to get such a referral in
writing, and to acknowledge the referral with a letter back to the referring medical provider.
Make up standard forms for this purpose.
· Tip: Ask for a prescription that says, “Hypnotism for stress and issues related to (insert
medical problem of the client). CPT#90880.” By putting the CPT (Current Procedural
 Terminology) number in request for a prescription you remind that physrcian that
hypnotism is an approved procedure of the Americarl Medical Association and that he or
she will not get into trouble for prescribing it.
Mind-Body Theories
It is easy to demonstrate that the mind can affect the body. For example, most people will
salivate when they think about biting a lemon. How the mind affects the body is one of the great
mysteries of philosophy.
It is possible to show how the brain affects the rest of the body. The brain and the
endocrine system produce almost 200 “Information carrying substances" that flow through the
body and change how the body operates. But there is no agreement on how the mind (our
consciousness) affects the brain (a physical organ located inside the skull)
One theory is that the mind really doesn't exist as something separate from the body That
is, that what we think of as our "mind" is really just the activity of the brain. This is a
materialistic view common in medical environments.
Another theory is that the brain acts as a "receiver" for an energy field produced by some
other action in the universe. That is, our brain "tunes" this energy field in a manner similar to a
radio tuning in on a station, and our local consciousness results. This somewhat metaphysical
explanation is also popular in some areas of the medical community and there is some research
(some of it funded by the National Institutes of Health) to support it.
Want to know more about both of these theories? Read: THE PSYCHOBIOLOGY OF
MIND/BODY HEALING: NEW CONCEPTS IN THERAPEUTIC HYPNOSIS, Second Edition,
by Emest Rossi, Ph.D., and HEALING WORDS by Larry Dossey, M.D.
How to Understand the Multi-Axial Psychiatric Diagnosis
If a mental health professional asks you to assist him or her in the care of a patient with a
psychiatric diagnosis, he or she will probably communicate information in the format of a
DSM-IV diagnosis. You will appear foolish if you do not understand it. However, as a certified
hypnotist you are not authorized to make such a diagnosis yourself.
The American Psychiatric Association publishes, and periodically revises, a manual of
diagnostic terminology. This manual is called THE DIAGNOSTIC AND STATISTICAL
MANUAL OF MENTAL DISORDERS. The fourth edition is the current edition in 1999.
Therefore, the manual is often referred to as DSM-IV. A DSM-IV diagnosis is presented as a
"Multiaxial System." That is, it has several parts:
· Axis I: Major Clinical Problems (typically obvious, acute issues such as major depression;
many are commonly treated with a combination of medication and psychotherapy.
· Axis II: Personality Disorders or Mental Retardation (these tend to he low-level, chronic
problems that people have to learn to live with; thy are commonly treated by counseling.
· Axis III: General Medical Conditions (this is a list of relevant medical problems)
· Axis IV: Psychosocial or Environmental Problems (such as family, edcuational or
occupational problems)
· Axis V: Global Assessment of Functioning (an assessment of how well a person is
functioning in society overall; it is rated from 0 [no information] to 100 (superior
[function])
Remember, hypnotists cannot lawfully make a Multiaxial Diagnosis. However, if you are
going to work alongside medical professionals, you need to be able to speak their language and
understand their conventions.
 Want to know more? Read THE DIAGNOSTIC AND STATISTICAL MANUAL OF
MENTAL DISORDERS, by the American Psychiatric Association. The current edition is edition
4.
Tests and Inventories Appropriate to the Medical Environment
As the medical model includes testing the client to determine how best to approach
resolution of the client's problem, it is appropriate to use formal assessment tools as part of your
work. The use of such tools will give your work a professional appearance, and will allow you to
relate better to other professionals.
· The Guild Standard Challenge Test
· The Stanford Inventories
· The Hypnotic Induction Profile
The HIP is an ideal instrument to use for complementary medical hypnotism
· The authors are physicians, and therefore the method is well accepted by other physicians.
· It lends itself to the medical model.
· There is research to back up its effectiveness.
· The HIP is similar to other assessment instruments used in the medical environment.
The Hypnotic Induction Profile (HIP) and Eye -Roll
The Hypnotic Profile is a comprehensive, scientifically proven, objective assessment of a
patient's hypnotizability created by Drs. Herbert and David Spiegel. This instrument is backed by
research, and not only convinces the patient of the effectiveness of your work, it predicts the kind
of result you can expect. As a side benefit, the Profile easily teaches the patient self-hypnosis.
The complete HIP is too complex to teach during this training program. However, this
curriculum contains a complete script for administering the HIP to a client, and if time permits
the HIP will be demonstrated in class. It is an excellent tool and will repay those who take the
time to read more about it in the cited textbook and who learn and practice it on their own. To
administer the HIP you will need:
The Scoring Form and Script
· A container of Ammonia
· A stopwatch or other time-measuring device
· To know how to score the Eye-Roll
The Eye-Roll
The HIP is built around a gesture made with the eyes, called the Eye-Roll. During this
certification class you will be completely instructed in how to score and understand this gesture.
It is something you should do with every client.
While used alone it does not give you as much information as the complete HIP, it still
gives you two important items of information. First, you use the Eye-Roll to get a quick sense of
how deeply your client is likely to be hypnotized. Second, you use the Eye-Roll to understand
how your client is likely to respond to stress.
Much of the work you will be asked to do when practicing medical hypnotism is to help
your clients manage the particular stress that goes along with having a medical problem. The
Eye-Roll, and the Theory of Decompensation and Compensation explained below, are the key to
understanding this unique stress. Using these tools you will be able to quickly improve the mental
condition of your client, with a corresponding increase in client loyalty. Also, you will teach your
client a rapid method of self-hypnosis that he or she will be able to use to deal with the
discomfort and stress of the medical experience.
 Some hypnotists discount the importance of the Eye-Roll Typically, these are persons
who have only read about it, not persons who have received actual instruction in how to score it.
My personal experience is that those who critique the method either are not doing it correctly and
therefore obtain indifferent results or do not understand how to use it with clients.
What you measure with the Eye-Roll is the amount of the sclera that you can see between
the bottom of the Iris and the top of the lower eyelid. You are not measuring the amount of the
Iris that disappears under the top eyelid. Draw an eye and mark what you are scoring with the
Eye-Roll
Spiegel Eye-Roll Induction Exercise
This is the actual method of hypnotism employed by David Spiegel, MD during his
experiment with cancer patients. It is a simple process and is ideal for hypnotism in the medical
environment. It is rapid, relatively free of problematic imagery, and quite effective .
Start with the Eye-Roll
· First, guide the client to hold his or her breath, and to elevate his or her eyes in their
sockets -- as if he or she was trying to look at the top of his or her head from the inside.
· Second, with the eyes still elevated, close the eyelids down.
· Third, when the eyelids are closed, guide the client to release his or her breath, and to
allow his or her eyes to return to normal behind the closed eyelid.
Next, use the downward float
· Guide the client to imagine him or herself floating, safely, gently, downward. Ask the
client to adjust the image however he or she needs so that the image feels comfortable,
appropriate and safe.
· As the client imagines him or herself floating downward, suggest that the left arm and
hand will want to float buoyantly into the air, until it assumes a fixed levitation position.
· Ask the client to imagine that he or she comes to rest in a shallow pool of comfortable,
warm water, which relaxes all his or her muscles and brings rest and peace.
Modifications
· If the client is in pain, the water in the pool can be imagined as cool enough to chill the
area of the body that is experiencing discomfort.
· If the image of a shallow pool of water is not comfortable to the client, you can substitute
the image of relaxing into a cloud or a comfortable recliner.
· If the client is experiencing insomnia, you can ask the client to imagine him or herself
floating downward into the bed where he or she has experienced the best night 's sleep he
or she ever had,
Hypnotic Induction Profile Script (modified)
(This is a complete script for administration of the Hypnotic Profile. II is included for
demonstrational purposes as part of a recommendation to study it further on your own. We will
not teach this in class. Remember, we have modified the presentation of the Eye-Roll and the
following HIP script for presentation here. This material and the corresponding theory are based
on the book TRANCE AND TREATUENT by Drs. Spiegel, as cited in the Bibliography
[primarily from Chapters 2 and 4.] While this material is not a quotation, we do not claim it as
our original work, mid recommend the book for serious study.)
This (container) holds a diluted solution of ammonia and water, one part ammonia to ten
parts water. It has a definite ammonia aroma, but because it is diluted, it is not unpleasant. At one
point during this process I am going to ask you to smell it. Some people find that it smells sweet,
and if that is the case for you, that is significant, and we will discuss what that means then.
During this process 1 will need to touch you on the (left/right) arm and hand, just like this
(demonstrate). I will not be touching you anywhere else, but when 1 do that don't be surprised .
Have you ever had optical surgery? Are you wearing contact lens?
As we begin 1 would like to exercise your eye muscles. Look at my (pen, finger) and
without moving your head, follow it with your eyes (raise target as high as possible, and score UP
GAZE).
Now I will demonstrate the eye roll. After I have demonstrated it, you can try it a couple of times
until we get a good reading. Now watch (demonstrate as you recite the following). First you hold
your head level If you look up or down you will throw off my reading. Then you take a deep
breath and hold it, then with your head level, look up as high as you can Then with your eyes
raised, close your eyelids down over your raised eyes. It may feel odd. Then, when you have
closed your eyelids, let your breath out, let your eyes return to normal behind your closed eye
lids, and just relax.
As you relax you will discover that a wave of relaxation goes over your body. It is
possible to fight it, but that defeats the purpose of the test. I would like you to just go along with
it, then I will deepen it and do something with your (left/right) hand. Then I will ask you to open
your eyes and I will have some questions for you. Is this clear? Good, then let's begin.
Take a deep breath and hold it. Look up as high as you can, then with your eyes still
raised, close your eyelids down over your raised eyes (score EYE ROLL, SQUINT and EYE
ROLL SIGN). When your eyes are closed, let your breath out and just relax. Now I would like
you to image yourself floating, gracefully, gently, downward. Adjust the image however you
need so that it feels comfortable, pleasing, appropriate and safe. Imagine yourself floating down.
Any cares and concerns that you have, if they are important, can still be there for you at the end
of our time together. So, for now, give yourself the gift of a time of relaxation. To make the
process easier, I will count from 5 to 1, and as I count from 5 to 1, I invite you to be as
comfortably and as completely relaxed as you feel appropriate at this place, at this time. 5,4,3,2,
1, comfortably and completely relaxed.
Now I am going to work with your (left/right) hand and arm (touch), and as I work with
your (left/right) hand and arm I would like you to imagine that your (left/right) hand and arm feel
different from your (opposite) hand and arm. In fact, 1 would like you to imagine that your
(left/right) hand and arm feel lighter than your (opposite) hand and arm. In fact, I would like you
to imagine that your (left/right) hand and arm feel so much lighter than your (opposite) hand and
arm that it wants to leave the arm of the chair and float upward, just as if it were the arm of a
ballet dancer or that of an astronaut floating in space (If arm rises, score E as 2. If arm does not
rise go on to the next sentences). In fact, I would like you imagine that present in the room is a
helium-filled balloon, and from the balloon is a string, and the string is attached to your wrist
(touch client's wrist lightly with your thumb and forefinger), and the balloon gets lighter, and
lighter, and it pulls your arm higher and higher (assist the arm levitation, and score E as 1), and
now I am going to arrange your hand and arm just like so (move arm and hand into level,
elevated position). I would like you to leave your arm and hand in this elevated position for the
time being (if arm and hand drop, score E as O and end the Profile).
In a few moments we are going to do the eye-roll in reverse, and when we've done the
eye-roll in reverse your eyes will be open, but your arm and hand will still be in the elevated
position, and I will have some questions for you. Then I will move your hand and arm down to
touch the arm of the chair. When I do this I would like to suggest that you will be pleased and
surprised to discover that your arm and hand will want to rise back into the air, until they are
approximately in the position that they are in now, and that you will allow that to happen. In fact,
I would like to suggest that your arm and hand will want to stay in this elevated position until
such time as I touch your elbow, just like this (touch elbow). At that time, and not before, your
(left/right) hand and arm will go back to feeling the same as your (opposite) hand and arm.
Now take a deep breath and hold it, roll your eyes up as high as you can behind your closed
eyelids, then open your eyes up, open them up, let your breath out and let your eyes return to
normal while still keeping your arm and hand raised.
Notice what this smells like (wave the ammonia under the subject's nose, and score the
INDIRECT SUGGESTION POSITIVE check box). That's fine.
Do you have a tingling sensation anywhere in your body right now (score F as 2 if the
subject says a definite “Yes," score 1 if the answer is “Yes," but less firmly, and score O if the
subject does not report any tingle)?
Does your (left/right) hand and arm feel the same as your (opposite) hand and arm (score
G as 2 if the answer is a definite "no," score 1 if the answer is "no," but less firmly, and score O if
the subject reports no difference in sensation)?
Now (Push the elevated arm and hand down to touch the arm of the chair. If the arm and
hand float back upward immediately, score H as 4 If the arm and hand elevate without assistance
within 5 seconds, score H as 3, using the top number on the form. If the arm and hand elevate
within 10 seconds, score H as 2, using the top number on the form. If the arm and hand elevate
within 15 seconds, score H as 1 using the top number on the form. If, after 15 seconds has
elapsed the tester believes that the hand and arm will not elevate on its own, apply a gentle
upward pressure using the thumb and forefinger. Score as above, but use the lower numbers on
the form scale for this item to indicate that the levitation was assisted.).
Do your (left/right) hand and arm feel different from your (opposite) hand and arm (score
I as 2 if the answer is a definite "no," score 1 if the answer is "no," but less firmly, and score O if
the subject reports no difference in sensation)? Now(touch the subject's elbow and push the
elevated hand and arm down to the arm of the chair). Do your (left/right) hand and arm feel the
same as your (opposite) hand and arm (score J as 2 if the answer is a definite “Yes," score 1 if the
answer is “Yes," but less firmly, and score O if the subject reports that the two arms and hands
continue to feel different)?
Your (left/right) hand and arm are now down touching the arm of the chair. Did I do
anything to explain that (Score K as 2 if the subject says "no." If the subject says “Yes" ask
"What did I do?" If the subject says anything other than “You touched my elbow," score K as 1.
If the subject says “You touched my elbow," score K as O)?
Do you have a floating sensation anywhere in your body right now (score L as 2 if the
answer is a definite “Yes," score 1 if the answer is "yes," but less firmly, and score O if the
subject reports no floating sensation)?
(If the subject scored 4 on D [EYE-ROLL SIGN] ask questions regarding spontaneous
dissociation, positive and negative hallucinations and age regressions. If subject confirms such
phenomena, check the 5 box on D.)
(Conclude the Profile by calculating the Induction Score, recording the Profile Score,
recording the time elapsed, and determining the nature of the Profile Score.)
Formal Scoring of the HIP (from Trance and Treatment)
· Scoring (ER=eye roll sign [D], LEV=levitation no reinforce [Hi, CD=control differential
[I]:
· Regular Zero: ER=O, LEV=O, CD=O
· Special Zero: ER=O, but either LEV or CD are greater than O
· Regular Intact: ER LEV and CD are greater than 0, and LEV is not more than 1.75 points
higher than ER
· Special Intact: ER LEV and CD are greater than 0, and LEV is 2 or more points higher
than ER.
· Soft: ER and CD are greater than 0, but LEV is O
· Decrement: ER is greater than O but LEV and CD are O
Informal Scoring of the HIP (the Giles modification)
· If Induction Score and Profile Score are approximately the same, score as Intact. If
Induction Score is significantly higher than Profile Score, score as Special Intact. If
Induction Score is significantly lower than Profile Score, score as Soft
· If Induction Score and Profile Score are both O, score as Zero. In Induction Score is
greater than O and Profile Score is O, score as Special Zero If Profile Score is greater than
0, and Induction Score is Zero, score as Decrement. You may safely work with Intact and
Special Intact clients, and you may expect a good result.
· If a client's profile is Soft, the client is resisting and you need to work to resolve the
client's unfortunate aura.
· If the profile is Decrement, the client may have a mental problem and should be referred
for a mental status examination by a mental health professional.
· If the client is Zero or Special Zero, the client poses a problem. Many hypnotists report
good results with clients that have a Special Zero profile (they can be considered an
"exception to the rule"). The writer is not aware of anyone who has had a successful
hypnotic encounter with a client whose profile was Zero. However, such persons are very
rare and almost always exhibit obvious signs of mental disorder.
Want to know more? Read TRANCE AND TREATMENT, by Herbert Spiegel, MD and David
Spiegel, MD.
The Spiegel Personality Classification System
· Lows - Profile (Eye-Roll) Score between O and 1.
· Middles - Profile (Eye-Roll) Score between 2 and 3.
· Highs - Profile (Eye-Roll) Score between 4 and 5.
The Theory of Compensation/Decompensation
As we go through life, we develop a personality style. Our style is good for some things,
not so good for others. Over time, we learn to enjoy the things we do well, and to compensate in
various ways for the things we don't do well. For example, a person who doesn't handle details
well, learns to make notes and to copy them into a personal computer.
However, when we are placed under stress we do more of whatever feels most
comfortable. In so doing we cease to compensate for the "down side" of our personality style.
This means that our personal characteristics become exaggerated and start to cause problems. For
example, a stressed person who is bad with details starts to forget to bring along his or her
notepad and doesn't get around to typing notes into his or her computer. Such a person is said to
be "decompensated."
Many, perhaps most, non-clinical emotional problems presented for hypnotic problem
solving by a medical patient are the result of decompensation. To deal with them, all one needs to
do is to teach the client stress-management techniques through hypnotism. Once the stress is
alleviated, compensation returns and the emotional problem will go away.
· Lows - Apollonians - decompensate with excessive focus on control issues, and become
excessively driven people who take no joy in life. Excessive decompensation may result
in a mental health cognitive disorder. Such clients should be referred for medical health
care.
· Middles -- Odysseans -- decompensate with sadness, fear and worry about the opinions of
others. Excessive decompensation may result in a mental health mood disorder. Such
clients should be referred for mental health care.
· Highs-- Dionysians -- decompensate with wild images, escape into fantasy and odd belief
systems. Excessive decompensation may result in a mental health dissociative disorder.
Such clients should be referred for mental health

5. MARKETING MEDICAL HYPNOSIS: SCOT GILES

No matter how sophisticated your understanding of hypnotic theory, if you do not
properly market your services to the medical community you will not be able to build your
practice of complementary medical hypnotism.
In this section you will learn:
· How to create and use a set of professional forms for your hypnotism practice,
· How to set up a referral acknowledgment system,
· How to create a marketing packet you can give to physicians and medical professionals,
· How to create handouts that you can use for community education workshops,
· How to plan what services you will offer as part of your complementary medical practice.
Medical Hypnotism Forms
Included in this curriculum is a set of 14 forms for your professional use. The forms are provided
to you. You are welcome to modify and adapt these forms for your own unlimited use. If you use
the electronic forms, you may have to adjust margins, fonts, or frame sizes as your printer will
likely use slightly different settings. However, this takes only a moment to do and only needs be
done once.
The forms included are:
· BASIC Assessment - this is a version of the standard form from the National Guild of
Hypnotists Certification Curriculum, It adds two additional categories to the BASIC
Assessment. These are Interactions (a place to record issues about a marriage or family
life) and Drugs (a place to record medical informatiorl), This makes the acronym
BASICID.
· GOAL Setting - there are two versions of this form included. The first is almost identical
to that contained in the Guild Certification Curriculum. The second is a very different
form that experienced hypnotists may prefer. This form allows statements made during
the give-and-take of the Intake Session to be simply, listed and numbered. Then the
hypnotist can go over the form to add marks to indicate if the statements was about a
Problem, a Goal or an Objective on the way to achieving a goal. Problems and Goals are
indicated by a check mark in the appropriate column. An Objective is indicated by placing
the line number of its Goal in the column provided. As Objectives and Goals are
accomplished, they can he checked off in the column marked with the Greek letter Delta.
· House, Tree, Person - this form is used to record observations about the drawings made
by a client that often are useful in gaining an insight into a client 's imagery. The standard
drawings include a person, a house, a tree and some object selected by the client at
random, The use of drawings is not included as part of this curriculum. However, the
practice has become so common among hypnotists that this form is included as a
convenience.
· Time-Line - this form is a convenient way to record information about a client 's history,
from birth to the present date. Simply place brief notes about when events happened along
the diagonal line.
· Hypnotic Induction Profile - this form is required to use the HIP detailed in this
curriculum.
· Eye-Roll Scoring - this form is a simplified version of the HIP that you can use to record
the results of the eye-roll.

· Progress Notes - this form allows you to record the progress and session notes about the
time you spend with a client. Instructions for its use are included in the Guild Ethics and
Legal Issues Workshop. Briefly, you classify the kind of information you are recording
about a client by writing that information in a block of text indented to the appropriate
column. The columns stand for Subjective (most of what a client tells you), Objective
(The specific hypnotic work you did with a client), Assessment (in this case, the
suggestions you gave the client you feel will help the client solve his or her problem), and
Plan (what you plan to do next). This is the SOAP format and it is the standard way
records are kept in the medical setting. You will probably want to print this form in bulk
as several will be needed to record your work with clients over time.
· Enneagram - this form is a convenient way to record information about your Enneagram
Profile of a client.
· Self-Suggestions - this form assists a client in doing self-hypnosis. It gives a standard
self-hypnotic induction al the top, and provides a space al the bottom where you can type
or write affirmations for a client to use or his or her own.
· Hypnoanalysis - this form is a convenient way to record the different parts of a hypnotic
analysis if you decide to use that technique with a client.
· Release of Confidential Information - this form is used by a client to authorize you to
disclose information to another professional care giver or to an insurance company. You
indicate whether the form is a one-way or a two-way release by checking the appropriate
boxes, and then have the client sign at the bottom.
· Tape Summary - if you give a client tapes for his or her on-going self-hypnosis, this form
provides a way to record information about those tapes.
· Subliminals - if you employ subliminal suggestion as part of your hypnotic work with a
client, this form provides you with a way of having the client explicitly authorize this
form of suggestion.
Handouts
Included in this curriculum is a set off handouts for your professional use. are welcome to
modify and adapt these forms for your own unlimited use. If you use the electronic forms, you
may have to adjust margins or frame sizes as your printer will likely use slightly different
settings. However, this takes only a moment to do and only needs be done once.
 These handouts form a simple, inexpensive packet that you can print in bulk to hand out
at a community education workshop at a hospital or other appropriate setting. You should bind
the handouts with a paperclip, and attach about nine inches of thread to the paperclip. After the
handouts have been distributed, the thread and the paperclip are assembled into a simple Chevruel
Pendulum
Advertising Techniques:
Most Advertising principles apply whether in ads, letters, or brochures. The reader's
attention must be captured, focused, and they must be motivated to take immediate action. The
following techniques are all tools that can be adjusted to the method of advertising you use.
· Fear of loss: This is one of the most powerful tools you can use. It not only strikes the
emotions; it stirs a basic instinct. Create fear of loss in your advertising at every
opportunity and success is yours, i. e. buffet lines, something free, offering something to
someone when someone else is present. Fear of loss is so strong that people that know and
use it well are still susceptible to it.
· Institutional Advertising: This type of advertising is generally a waste of money. Ads that
only list your services and location, phone etc., do not move readers to act. There's always
a temptation to try ads like this but unless you're selling ten-dollar bills for one dollar,
your money is best spent in more productive advertising. This is especially true if
someone else offers the same services that you do. Your advertizement must he
compelling enough to make them respond to your ad rather than the others. Just a
description of your services won't do that for you. The response to institutional
advertizement in any media is always poor in relation to the dollars spent.
· Be Careful of what I call “ego add” These are ad that are geared by sharp advertizing
salespeople to appeal to the new entrepreneur or businessperson that is eager to see or hear
their name in public. They 're gasifying the first time you see or hear them. Their appeal is
that they can make you feel as though your business has "arrived. " Someone not familiar
with marketing their practice might be enticed by a "reasonable offer to get their name on
the air in the form of a public service announcement. Or possibly on a local football
program card, business directory, theater program, or any other public announcement or
communication. If you 're tempted to risk your money anyway, the best way to invest in
this type of advertising is to slow, down enough to talk with someone who has used it
before and had a productive experience. Beware of the "special " deals with the last space
available that you have to act upon immediately, unfortunately this advertizing does
produce for anyone but the advertiser.
· Direct Response: Direct response is best for most practices/'small businesses. How are
Direct Response ads different They are always a call to action. The first thing to show in
all advertising is what's in it for the reader. Nothing else is more important. What is the
primary benefit you promote? Is it really the benefit? Are you missing the mark? Would
seeing it through your prospect's eyes in self-hypnosis clarify what the benefit should be?
People don't but quarter inch drill bits, they buy the ability to drill quarter inch holes.
They but the ability to drill holes where they want them. Can we find other examples of
this. What are they buying from you? Let’s analyze this on an individual basis. What do
your clients really want from you?
MAKE A DECISION TO WRITE ONLY SUCCESSFUL ADS
Upon certification for this course, you may add in to your ads: (depending on your state
regulation), "Medical Hypnotism with doctor referral."
Always give an explanation of benefits by:
· Writing a compelling headline - One that really catches the eye.
· Creating a compelling special offer - One that peaks the interest.
· Developing a convincing explanation of benefits - Simple - Brief - Believable.
· Create an aura of familiarization - Touch on things that the reader knows.
· Make it easy to contact you immediately - Phone - email - Web site - Address.
There's "Gold" in Your Junk Mail
Save your junk mail for your free time. Review it with scissors, and have a highlighter handy.
Advertisers spend a fortune on mailings and always test it thoroughly before spending more
money on a mail campaign. Why throw it out? Why not use their well tested attention-getting
phrases and concepts.
Keep an Advertising Idea File
Read all the sales letters and brochures for headlines and compelling statements. Highlight them
and save them in a file. When writing ad copy or sales letters, have your file beside you. In a
short while you will have a several files. These files will support you any time you're at a loss for
ideas.
Here are some ad ideas you're welcome to use.
· Fear of Needles?
· Hypnosis Works!
· We don't know who will appreciate us more - You ... or your dentist.
· Call today for a free consultation.
· John Trance, CH Certified in Medical Hypnotism
What If You Hadn't Read This?
Then you wouldn't know that hypnotism can be extremely helpful in reducing the stress of
medical conditions. Certified in Medical Hypnotherapy by Joy Trance, CH 321-123-4567 Doctor
referral required for medical conditions.
Planning Surgery?
Ask your doctor - Hypnotism can be helpful in reducing stress.
Pre and post-surgical hypnotism complements medical procedures.
You're invited to call right now and have all your questions answered.
Enjoy peace of mind.
John Trance, Certified Hypnotherapist
Certified in Complementary Medical Hypnotism 321-123-4567
FREE! FREE!
Self-Hypnosis Seminar
Hypnosis Works!
Learn how to use your mind in reducing stress to assist your body in getting well and staying
well.
"Each patient carries his own doctor inside, Doctors are at their best when we give the doctor who
resides within each patient a chance to go to work " World Renowned Albert Schweitzer, MD
You will learn to hypnotize yourself at this seminar
Ample time will be provided for questions and answers
10:00 A.M. Saturday, Nov. Third, at Holiday Inn, 103 First St.
Presented by: John Trance, Certified Hypnotherapist, Certified in Medical Hypnotism And
Healthy Foods Nutrition Center Hypnotism for specific medical conditions requires your doctor's
referral.
A free consultation can be arranged.
Help Your Mind Help Your Body
To prepare for surgery or dental work Hypnotism Works!
Enjoy Peace of Mind
Your next procedure can be your easiest.
Judy Trance, CH, Certified in Medical Hypnotism 321-123-4566
Ideas are a dime a dozen. People who put them into practice are exceptional.
Here's Eight Tips for Great Headline Writing
· The words you use should have an announcement quality to them.
· Start your headline using the words like “Announcing, At Last, Finally, Now”
· Use some of these words in the beginning of your headline: “why” or “which,” “how to,”
“now or new,” “at last.” (Refer to Most Powerful Words list)
· Attract the reader through their self-interest - use the words “You” and “Your” whenever
possible.
· Refer to the need to a need or situation using a two-word headline (i.e. “Quit Smoking,
Stress Relief, No Fear, or Pain Relief”.)
· Be sure to tell a story and paint a picture of benefits to the reader.
· Include a special offer or opportunity (e.g. “Free evaluation”)
· Include a date in your headline (e.g. “Until August 1" or “Only during July”.)
Special Note: Repeats of the same ad or headline by others indicates that they are working well.
Use what you can from them.
BUILDING YOUR PRACTICE WITH FREE EDUCATIONAL SEMINARS WHY FREE?
I placed five hundred thirty six dollars worth of newspaper ads that brought twenty-six calls
(that's calls not attendees). One free workshop without paid advertising brought twenty-four
attendees. I got weeks worth of exposure to new prospects in one fun workshop session and made
many new friends that were immediately added to my mailing list. And, more importantly, names
and addresses of people that met and now know me.
Planning Your Program
Smoking, stress, self-hypnosis, surgical fears, weight loss, guided imagery or others.
You must have an outline or a prepared structure for your presentation.
To begin your preparations carry a note pad and envelop with you everywhere.
When you have an idea, write it down. You'll hear things on the car radio, see things that prompt
ideas on billboards, and come up with great ideas while day dreaming.
When you read a useful article, cut it out and add it to your envelope.
When you're ready arrange and tape your notes, (Durbin, I prefer putting in my computer.)
newspaper and magazine articles together. It’ll take some room, but maybe your dining room
table or living room floor will provide enough space to arrange and rearrange your notes to create
a nice flow to your outline before taping them together.
Time To Pick Your Location - How About:
· Bookstore.
· Health care facility
· Health club.
· Library
· Health food store.
· Park district facility.
· Hotel meeting room. (Always carry your own sound system. Many good seminars have
been spoiled by a bad hotel system.)
· Church. With an appropriate topic you can do a church fund-raise (Durbin - Talks on
stress management and introduction to hypnosis will also be welcomed by many
churches.).
· Chamber of Commerce. They can line you up with service club meetings where speakers
are wanted.
· (Durbin - Look in phone book and call service clubs and offer to provide a program for
them. You will often if not all the time get someone as a client. Either a member or a
member refers someone to you.)
· Home seminar. Why not? You can send out announcements and invitations. Tell them a
guest will be hypnotized or given a free consultation, receive a free gift, or even a gift
discount certificate for each attendee. It can be a relaxed informal workshop. But,
remember that, whether in a hotel, a home, or a meeting place, you're on stage full time.
You 're being watched and opinions are formed about you. Even if you walk into a public
restroom, someone may hear your conversation.
Promoting Your Seminar/Workshop
Again, you can spend dollars or spend energy - your choice, whichever you have more of
A student gave me her fliers to take to meetings every month. She didn't want to attend the
meetings, so she asked me to bring them to the meetings and put them out for her. Needless to
say, they didn't do anything for her. Having a few fliers put out at a meeting does not build
relationships, which is so important. She ran a beautiful institutional type ad created by a
magazine's art department, which didn't work either. Armchair practice building just doesn't
work. You must get totally involved and committed.
Here's a good approach.
· Inexpensive three-up fliers.
· Get creative/place everywhere.
· inexpensive posters.
· Set up a route/place everywhere.

6. HYPNOTIC TECHNIQUES TO ASSIST CLIENTS WITH MEDICAL PROBLEMS: SCOT

GILES
The techniques in this section form a working tool kit that the hypnotist can use to assist
clients in dealing with medical problems. The skill of the individual hypnotist and his or her
success will depend on the ability to select the right tool for the job.
Chronic v. Acute Pain or Discomfort
Chronic pain is pain that cannot be completely resolved and will persist over a long period
of time. Acute pain is pain that the person knows will be gone soon.
Acute pain is by far the easiest to deal with hypnotically. Simple distraction and future pacing is
often sufficient. The client will not be deeply, troubled by this sort of discomfort as he or she
knows that the discomfort will have a beginning, a middle and an end.
Chronic pain is much more debilitating to a client than acute pain, even if the chronic pain may
be less "painful " than acute pain. The client knows that the pain will persist and may even be
lifelong. Such pain, even at low levels may trigger clinical depression at its worst, and almost
always creates deep
sadness. To deal hypnotically with chronic pain requires the hypnotist with all three “gates” of
pain. Anything less than this degree of completeness will result in failure.
Want to know more? Read HYPNOSIS IN THE RELIEF OF PAIN, by Emest R. Hilgard and
Josephine R. Hilgard.
Facilitating Sleep
Surprising though it may be, simply helping a client with a medical problem sleep better
can produce a dramatic improvement in his or her overall welfare. Indeed, some chronic medical
problems manifest when sleep is poor or interrupted.
The parts of sleep are:
· Beta
· Alpha
· Theta
· Delta
In general, persons experiencing emotional difficulties spend more time in theta sleep,
while those who are experiencing physical challenges (such as athletes or those who are ill) spend
more time in delta. Therefor it is generally contraindicated to do hypnosis that suggest the having
of dreams for persons who are in serious medical difficulty.
Promoting Appetite
Appetite is a universal sign of good healthy. Indeed, some disease (cancer, AIDS) are
“wasting” diseases, meaning that the mechanism through which they kill is to suppress appetite.
Anorexia kills more cancer patients than cancer does.
The mechanisms through which a wasting disease destroys a client’s appetite vary with
the disease. In some cases chemotherapy makes anorexia worse. Suggesting hunger to a patient
ind a wasting syndrome will almost always fail, and suggestion of siting down to feast may be
counter-suggestive. The best approach is to employ specific imagery that relates to the disease
process suppressing hunger. General future pacing is also effective.
Scar Tissue Incorporation and Wound Management
Physiology
Just beneath the skin there is a layer of smooth muscles that are controlled by the
autonomic, rather than the central, nervous system. That means that these muscles are generally
controlled by automatic and subconscious responses. While anyone can learn to control a body
system that is connected to the autonomic nervous system, it requires deliberate training.
The classic Chevruel Pendulum, known to every hypnotist, works because of this layer of
muscles. The unconscious process causes small changes in the layer of muscles in response to
questions and suggestions. The pendulum responds to these changes as the chain or string moves
slightly, causing a weight at the end of the string or chain to sway. Once in motion, the weight
tends to remain in motion (the principle of inertia) and the pendulum responds to unconscious
impulses.
Application:
When the skin has been wounded, the layer of smooth muscles responds to the injury by
attempting to pull away from the painful area of the negative stimuli. This primitive response
probably evolved as part of an attempt to minimize tissue damage during injury (the body seeks
to get as much tissue as possible away from the area being injured). This pulling away from the
site of the wound increases formation of scar tissue. The scarring effect of many forms of surgery
is one of the greatest emotional difficulties that a surgical patient experiences.
· You can minimize scarring by relaxing the layer of smooth muscles in the area of the
wound This will cause the edges of the wound to meet more perfectly and heal with
minimal scarring.
· Other forms of wounds (for example, a burn) will heal better if the wound is profused so
that blood cells that facilitate healing will be richly supplied to the area. This is also
accomplished through simple relaxation.
· When a wound is old and scar tissue has already formed, it is possible to assist the body to
incorporate the scar tissue. This is not accomplished through relaxation. Rather, this effect
can be achieved by the imagery and patter of massage, gently breaking down the scar
tissue an cleaning it away. Other effective suggestions can be healing oils that make the
scar more supple and help it blend with the rest of the tissues.
Presurgical Hypnotic Work
An underutilized facet of complementary medical hypnotism is the presurgical hypnotic
induction. I always make sure to obtain a prescription from the surgeon prior to doing this sort of
hypnotism with a client, even if one of the client's other physicians has already prescribed other
hypnotic work with the client. We do many of these each year from my office and the evidence
seems to be that clients experience significantly lower discomfort during the hospitalization.
· A presurgical hypnotic induction should be done as close to the surgery date as is
possible; ideally, the day before.
· Presurgical hypnotic work starts with a conventional indiction into trance and an
appropriate deepening, Then the hypnotist cues specific suggestions to take effect after the
patient experiences the characteristic sights and sounds of the operating theater.
· During the pretalk, the client's aura is adjusted so that he or she expects to he more
relaxed when arriving at the hospital than most other people would be. Suggestions can be
given that it is likely that the hospital staff will notice how well the patient is doing as he
or she is prepared for the operation.
· Suggest that as soon as the patient enters the operating theater, he or she will feel him or
herself relaxing (this will almost certainly happen as the patient has been given
presurgical medication, but the patient will notice the calm mood and the hypnotic aura
will be correspondingly strengthened).
· Give a time-limited suggestion (that will expire when the patient leaves the hospital) that
the patient can remember that he or she is not just a physical body, but a mind as well.
Therefore, things that happen to the body can be thought of as happening to something
that is only a part of who your are, and not the most important part. Therefore, the things
that happen to your body during the operation and recover can be experienced as
happening to a body, that is not necessarily your body.”
· Remember to suggest that new discomfort will be felt until the client has reported the
discomfort to his or her medical caregiver. Then, and only then, will the client’s mind
begin to change the discomfort into something that is less objectionable. This prevents
accidentally masking diagnostically significant pain with hypnotism.
Hypnotic Profusion of Organs and Tissue:
In medical practice, “profusion” means to “flood” or to richly supply with blood. Tissue
that has been profused is receiving the best possible supply of oxygen (from red blood cells), the
best possible benefits of the body’s immune system (from white blood cells and other killer and
helper cells) and the maximum possible benefit from any blood-born medication.
One way to assist in the healing of a sick or wounded body organ is to suggest through
hypnotic imagery and patter that the organ is being profused,
Secondary Gain
Secondary Gain is not really a technique of Complementary Medical Hypnotism as much
as a strategy for working with clients who have medical problems. The concept has been around
the psychological and counseling communities for many years and its often is not known.
However, Bernie Siegel, MD, is often cited in connection with it.
In his first popular book, LOVE, MEDICINE AND MIRACLES, Dr. Siegel seemed to
imply that a patient could cause an illness by mental or emotional behavior, and therefore was
responsible for getting sick. This produced widespread criticism in the health care community as
it seemed to "blame the victim," and (as stated elsewhere in this curriculum) there is no research
evidence for it. However, the criticism was unfair as Dr. Siegel did not intend to imply that
people are responsible for getting sick, except for those conditions known to have behavioral
components (such causing liver disease by drinking alcohol) He subsequently restated his
position. The restatement cited the phenomenon of Secondary Gain.
The human mind is a problem-solving mechanism. If a person has a symptom or an illness
for any length of time, the mind of the person will find a way to use it to solve some other
problem in living. This is called the "Secondary Gain" of an illness. For example, a person who
suffers from arthritis might use the pain caused by the disease as an excuse to hold physical or
emotional distance from a spouse he or she no longer loves or wishes to be close to. In this way,
the patient is “using" the disease to solve a marital problem.
Having Secondary Gain about an illness means that the patient "needs" the illness to solve
some other problem. The client who is doing this is unlikely to be motivated to resolve medical
problems if that also means giving up the solution. Therefore, it is good for a hypnotist to try to
get a sense of what Secondary Gains a person may have regarding a medical problem he or she
has come to a hypnotist to resolve. Then, work creatively using Hyperempiria or other techniques
to see if the patient can determine some other way to solve the secondary problem. For example,
the arthritis patient might be advised to seek marital counseling to resolve the tensions in the
marriage. Until this is done, pain management hypnosis is unlikely to be effective.
Medication Potentiation
This is an often-overlooked, but very effective strategy when doing hypnosis to assist with
a medical problem. While most hypnotic practitioners favor non-drug approaches to healing,
another valid approach is to strive to increase the effectiveness of medication so that the patient
needs less to achieve a good result. This is called potentiating the drug. You will need to know
how a specific medication works to do this form of intervention, and that can be found in any of a
number of commonly available books.
· You will not get medical cooperation to do this with drugs where dosages are set by fixed
protocols, such as immune suppression drugs taken by transplant patients, chemotherapy,
antiviral drugs or antibiotics. Any physician who knowingly prescribed too low a dose
hoping that hypnosis would make up the difference could lose his or her license to
practice medicine.
· You will get the most cooperation from medical practitioners to potentiate the effects of
pain medication.
· Physicians may lawfully cooperate with you in striving to potentiate medication when the
patient is having great difficulty with side effects (to the point where the physician would
otherwise have to cease prescribing the drug at all) or when the known effects of
medication are believed not to he sufficient to help the patient anyway. For example, it
would be proper for a physician to prescribe the usual doses of anti-viral medications to
help a person with AIDS, and to also authorize a hypnotist to do anything possible to
increase the effectiveness of the drugs.
Transplantation and Implant Management
The use of implants, artificial replacements for structural elements of the skeleton, is
becoming commonplace in contemporary medicine. Transplantation of organs or other body parts
is less common, but becoming more frequently encountered. Hypnotism can assist with either of
these procedures.
Implants
Implants (for example, dental, hip, or knee replacements) are well tolerated. However,
there is always a danger of rejection, especially with dental implants. Further, once an implant
has become well established, there is always the danger of infection that can cause rejection.
Clients who have received or who are about to receive an implant may seek out the services of a
hypnotist to help boost healing and retention. Do not forget to include lifestyle management
suggestions.
Transplants
Organ transplants (for example, of the liver, heart, lung) are major medical procedures.
Transplants of body parts (for example, bone, skin, cornea, and recently, limbs) are more
frequently encountered. A hypnotist can help in a number of ways. First, there will be discomfort
that can be controlled. Second, acceptance of the organ can be enhanced using the same technique
as for medical implants. Finally, the immune system of the patient can be influenced to recognize
the tissue of the implant as self, not as non-self.
FRAMING AND REFRAMING OF TREATMENT
How the patient thinks about medical treatment is an important predictor in how the
patient is likely to fare. For example, chemotherapy patients who image their treatment as a
healing balm do better than those who image the drugs as toxic. Similarly, radiotherapy patients
who see the radiation as concentrated, life-giving sunshine, do better than those who image it as a
deadly ray.
In general, you always want the patient to maintain a positive and optimistic view of his
or her treatment. If you work with a client before treatment you can work to help "frame" the
treatment in a positive way by being personally encouraging, and by using positive suggestion,
imagery and patter. If the client already has a poor attitude toward the treatment, you can assist
him or her in "reframing" so that the client's attitude shifts.
While there are a number of formulas for this procedure. The hypnotist needs to make an
appropriate selection of technique based upon the client's mood and preferences. In addition to
the techniques listed elsewhere in this curriculum, the following are some of the methods that
may be employed:
· Time-Line Imagery
· Explanatory Style Reformulation
· Sensory Fade Out and Fade in (the sensory images around the old frame fade out, and that
of the new frame intensifies.)
· Hypnoplasty and Hypnobioplasty
Cueing
Cueing is a simple and valuable technique that is used to increase client compliance with
medical treatment. It is so basic, it can be included in every hypnotic session you do with a
medical patient. Simply put, you use hypnotic suggestion to link in the client’s mind the act of
taking medication (or exercising, etc.) With some other act that the client is certain to do. Here
are some examples.
· To take a pill after brushing the teeth.
· To exercise after picking up the mail.
· To remember dietary restrictions when touching a shopping cart.
· To medicate after reading the newspaper.
Future Pacing and Age Progression Hypnosis
Many, perhaps most patients who have a life-changing medical condition find themselves
unwilling to image the future. Sometimes this is because a future of chronic discomfort depresses
them. Sometimes this is because they really do not believe they will have a future.
Future pacing is the hypnotic technique of encouraging a client to imagine him or herself in the
future, and that the future is happy. It is important that the future pacing suggestions be realistic
(for example, someone with two hip replacement implants is not going to become a professional
football player). You can future pace a client in many ways, but one of the easiest is just to get
the client to talk, think and imagine about what the future could be like. Here are some tips;
· Make images realistic.
· Use the language of possibility at first, then shift to speak about the image as if it were a
certainty.
· Humor is extremely helpful and should always be used.
· Do not shy away from sexual, familial or romantic imagery people need something to live
for and often they live to find a companion, watch children grow or to express themselves
in a loving way.
AGE-PROGRESSION
Age-progression hypnosis is a more intense and elaborate form of future pacing.
Basically, it is an age-regression in reverse. Instead of asking a client to mentally move back
through time, you ask the client to move forward in time and to see him or herself as he or she
will be.
· All regression techniques (calendar method affect-bridge, etc.) can he adapted for this
method.
· to imagine any sort of fut If you do an age-progression, you must not allow it to fail, The
client needs to experience something. If you cannot get the client ure that client may, be a
suicide risk and should be referred for mental health care.
Prognosis Reshaping
When a person is given a life-changing medical diagnosis he or she can go into a
spontaneous self-hypnotic trance (Milton Eickson, MD called this sort of traumatic trance a
"transdirvational search"). The unconscious mind of the client is searching for something in his or
her experience that might help cope with the information that has been received. If the physician
then delivers a negative prognosis (for example, 'We feel you have about 6 months to live."), the
physician has delivered what amounts to a hypnotic suggestion to die to a hypnotized person,
· Typically people are not aware of how profound influenced they are have the prognosis
 they have received in this manner.
· Most medical professionals are prone to what Andrew Weil, MD, called "medical
pessimism,
· One effective hypnotic intervention is to hypnotically regress a client to the time of
diagnosis. Then suggest to the client that the voice of the hypnotist can he heard as if it
were the voice of the physician, and give a positive prognosis.
What to know more? Read SPONTANEOUS HEALING by Andrew Well MD.
Disease Metaphors
Cautions
While it is fascinating to note how often a client's disease process seems almost to be a
metaphor for what is happening in the client's mind, it is not appropriate to ever suggest to a
client that he or she is responsible far getting an illness. Some people propose that the client is
responsible for getting sick as a way of dealing with their own anxiety about illness. While
medical research does show that once a person has an illness, his or her mental attitude is an
important component in determining how he or she will fare, there is no evidence that state of
mind is causal in the onset of disease.
· Healthy Reprobate argument can be used to illustrate the fallacy of thinking that mental
attitude is causal in the onset of illness. (Durbin, Mental attitude can play a very important
part in causing disease.)
· The only exception to this general prohibition is for those disease condition that have an
obvious behavioral competent (such as lung cancer brought on by smoking). In these
cases the client does have some responsibility for being ill.
In any case, many researchers have noted that illness does sometimes seem to be a
metaphor for emotional states. It can be helpful to point this out to a medical client and to include
suggestion, imagery or patter that helps counteract the metaphor This may increase a client's
sense of control over his or her situation and that can relieve tension. While there is a danger in
taking this too literally, here are same examples:
· Cancer.
· Heart Disease.
· Diabetes.
· Gastro-Intestinal Disorders.
· Fibromyalgia.
· Allergic Response.
· Ulcers:
· Hypertension:
· Hyperlipidemia:

7. HYPNOTIC ANALYSIS: SCOT GILES

Background, Cautions, and Description of the Classical Model
Some clients have a profound sense that their medical condition is either caused by, or is
deeply affected by, past experiences. Hypnotic analysis is an ideal technique for working with
such clients. It aims at uncovering some emotional trauma that has festered and given rise to the
client's problem.
Hypnotic analysis is a technique that has a broad range of applicability to different
hypnotic problems. However, the caution mentioned above must be kept in mind. There is no
evidence that mental states are directly causal in the onset of disease in the way that the theory of
hypnotic analysis implies. But some people believe that they are, and those people will benefit
from an analytic procedure.
The mechanism for many disease processes is unknown. It is not understood, for example,
why many people in a community may have a virus in their bodies, yet only some get sick.
Therefore, it may eventually be determined that emotional and mental factors play a much greater
role in the onset of disease than is now believed. It is certainly the case that long-term hypnotic
clients with medical problems will usually enjoy the opportunity to undergo hypnotic analysis.
It is believed that William Jennings Bryan, Jr., MD., Ph.D., JD, developed the theory of
hypnotic analysis. He elaborated it into a system called Medical Hypnoanalysis that makes use of
dream programming and interpretation, word-association tests, and a catalogue of "syndromes" to
categorize the client's underlying problem. However, the basic system of hypnotic analysis does
not require all of these elements.
The Parts of a Hypnotic Analysis
· Initial Sensitizing Event (ISE): In theory, an event occurs in early childhood that creates
the mental vulnerability that is at the root of the client 's problem. The ISE is always
unconscious by definition. If a client believes that prior to the hypnotic analysis he or she
knows what happened in childhood that has caused present day problems, she client is
mistaken.
· Subsequent Sensitizing Events (SSE): While all of us experience many emotional events
that could ultimately wound us sufficiently to cause a later problem, only some of these
get reinforced by other events. These reinforcing events are the SSE. When a client recalls
difficult experiences in childhood that may be responsible for present day problems, what
the client recalls are almost always actually SSE.
· Symptom Producing Event (SPE) As time passes. other events exploit the mental or
emotional vulnerability created by the ISE and SSE, A symptom emerges as an attempt by
the mind to cope with the stress. However, the client seldom seeks help at this point,
Instead, the client finds some way to cope with the symptom on his or her own.
· Symptom Intensifying Event (SIE): Finally, the coping mechanism the client had been
using fails, The client no longer can cope with the symptom on his or her own, and comes
for assistance.
HOW TO CONDUCT A HYPNOTIC ANALYSIS
The presenting problem of the client is understood to be the SIE. The hypnotist work
backward using age regressions or other probing techniques to uncover the SPE, the SSE and
finally the ISE. Only when the ISE is fully uncovered and understood by the adult mind of the
client is the analysis successful. Premature conclusion of the analysis before the ISE is resolved
will result in relapse or symptom shifting.
Example
A client (a 45-year-old, college educated white male) comes for help. He has been
diagnosed with emphysema and believes that hypnosis can help him cope. He is a good subject
and responds well to suggestion, patter and imagery to help him manage the discomfort of his
condition. He becomes intrigued by the hypnotic process and wishes to probe further to see if his
deep mind can assist him. A hypnotic analysis was then performed .
The presenting problem (emphysema) is understood to be the SIE. Prior to this diagnosis
he had several bouts of severe "smoker's cough" and warnings about Chronic Obstructive
Pulmonary Disease. He attempted to moderate his smoking and took to jogging in the hope this
would strengthen his lungs. This was the SPE.
Hypnotic regressions determined that he when he was a teenager he felt awkward and
lacked self-confidence. He vividly recalled that when he started smoking he thought he looked
"cool" and experienced better peer acceptance One regression showed that he took to smoking
largely to impress a particular girl, Janine. This was an SSE.
As the hypnotic work progressed, the client showed reactivity during trance when the
patter or imagery suggested themes of fatherhood. Hypnotic exploration using both regressions
and the Chevruel Pendulum showed that he disliked his father intensely, and sought support
primarily from his mother. His father was a non-smoker and was critical of anyone who did
smoke. Therefore, the client's smoking was an act of rebellion against his father. This was another
SSE.
Finally, in deep trance the client experienced images that showed him that his mother and
his teenage girl friend were actually much alike. When the client reached adolescence he reported
difficulty in "cutting the apron strings" with his mother and had a relationship with her that may
have been too close (although nothing untoward happened). When he met Janine he met someone
who was as supportive to him as his mother had been, but with whom he could have an
appropriate relationship. However, Janine smoked. By taking up the habit the client was able to
separate emotionally from his mother, while simultaneously rebelling against his father.
However, the urge to separate from his mother was by far the strongest motivating factor. This
was the ISE.
Having uncovered the ISE the client (who had ceased smoking some years earlier)
understood his behavior in a new light. He expressed anger at his parents and no longer felt so
guilty about being an emphysema patient. He continued to tolerate his treatment well, and lost the
angry feelings he had toward himself that had sometimes interfered with his treatment. The
hypnotic analysis was therefore successful.
Want to know more? Read ANSWER CANCER, by Stephen Parkhill.
The Unconscious Blueprint Theory; An Alternative Analytic Model
Another way to conduct a hypnotic analysis that is less formal than the method given
above is based on the work of Bernie Siegel, MD, who has written several best-selling books on
Mind/Body medicine This method differs in important ways from the classical method of
hypnotic analysis. Yet, there is much to recommend it.
This theory proceeds by proposing that the unconscious mind of the client contains a
positive image, "blueprint" or idea of what sort of life the client should be living. While classical
hypnoanalytic theory proposes that the unconscious mind contains a primal wound, the Siegel
approach proposes that the unconscious mind contains a primal wisdom. The degree to which the
client is able to discover and actualize the unconscious blueprint in his or her life is the degree to
which the client will be happy and well.
In this form of analysis, the hypnotized client is encouraged to fantasize about him or
herself, and the fantasy is analyzed for clues about '~hat sort of person the client was created to
be." Enneagram analysis is also very helpful and can provide the client with much insight. Once
the blueprint is understood, the client is coached to make relationship and lifestyle changes that
bring his or her life into conformity with that plan
This method of analysis is not, in fact, contradictory to classical hypnotic analysis. Long
term clients may enjoy doing both modes of analytic inquiry. One way to think of this is to
consider classic hypnotic analysis a method for releasing or purging the "bad" influences from the
unconscious mind, while the blueprint analysis is a way of discovering the wisdom that the
unconscious process has to offer.
Want to know more? Read LOVE, MEDICINE & MIRACLES by Bernie Siegel, MD or
his other more recent books. PEACE LOVE HEALING; HOW TO LIVE BETWEEN OFFICE
VISITS; and PRESCRIPTIONS FOR LIVING.

8. MEDICAL HYPNOSIS SCRIPTS: SCOT GILES

Persons receiving this advanced training in complementary medical hypnotism are
expected to be fully competent in trance induction, deepening procedures and suggestion
management. Accordingly, each practitioner should be able to create his or her own hypnotic
scripts to make use of the information contained in this curriculum.
However, the curriculum does contain script material that has been demonstrated to be
effective and adaptable for use in the medical setting. You are welcome to use these scripts in
your own practice of complementary medical hypnotism. While you may not publish these scripts
or sell recordings of them, you will find them helpful.
This curriculum contains the following scripts:
· The Inner Child Exploration (a mildly regressive induction that puts a patient in touch
with his or her ability to learn new coping skills, and illustrates use of classroom imagery.
· The Safety Shield (a powerful deep-relaxation induction originally, developed for use in a
battlefield clinic, that is adaptable to almost any circumstance and is more effective than
progressive relaxation);
· The Hall of the Mountain King (an induction using embedded metaphor to promote
patient acceptance of changed physical circumstances);
· The Freezer of Frozen Feelings (an induction to promote self-acceptance and to facilitate
healing by circumventing repressed feelings and emotions);
· The Inner Advisor in Script Skeleton (a variation on a classic hypnotic strategy used by O.
Carl Simonton, MD and Bernie Siegel MD, to help patients tap their own inner wisdom);
· Scriptlets (partial scripts for various disease conditions that you may, incorporate into
your own hypnotic material);
SCRIPT: INNER CHILD EXPLORATION
This is my own version of a script created by Bemie Siegel, MD. I learned it while
studying with the Exceptional Cancer Patients Organization (ECaP) founded by Dr. Siegel. I have
modified it much over the years, but do not claim it as my own work. Instead, I offer it here as
homage to the work of Dr. Siegel. I am told that the section in the "forest clearing" using the
numbers is the work of Joan Borysenko, Ph.D., but have been unable to confirm this. This script
is very adaptable and can be used as the basis for all sorts of trancework.
[Preface this script with your customary patter to obtain eye-closure and relaxed
breathing. Finish with a count fiom 10 to 1.]
And now, I invite you to imagine yourself in one of the classrooms you were in when you
were growing up. It can be any classroom. It can be one you remember or one you imagine.
You were seated at a desk, or table, or chair. Light was streaming in from large windows,
and where the light touched you, it was warm. There were sounds in the classroom, and aromas -
the scent of freshly sharpened pencils (a cedar-like aroma that is unique in all the world) and the
waxy smell of crayons (for back then beeswax was still used for crayons). Up in the front of the
room there is a blackboard, and other people have written on that blackboard what they want you
to know and believe.
Now this image of a classroom is not an image I am giving you. It is an image you have
created for yourself. It belongs to you, therefore, you can make of it what you wish. So imagine
that you have a power in this classroom. You can make the classroom become stuck in time, so
that you, and only you have the power to move.
Use your power to get up from your desk and walk up to the blackboard, where other
people have written the things they want you to believe and do. Take in your hand a soft felt
eraser--its back is stiff with cardboard--and use this eraser to erase the blackboard. Reduce to dust
the ideas, beliefs and opinions of other people. Then, notice over by the window there is a
shallow glass tray full of water. The sunlight has moved through the water and warmed it. As the
light has moved through the water the light has become defracted, and spectrums and rainbows
dance on the walls, floors and ceiling of the classroom. All of the colors of visible light are
present: red, orange, yellow, green, blue and violet. They are all there.
Take in your hand a natural sponge and dip it into the tray of water. Feel the sponge
become heavy and warm in your hand. Then use this sponge to wash the blackboard. Wash away
even the dust of what was written there by other people. Wash it until the surface of the
blackboard is clean, and refreshed, and new.
Then, imagine yourself moving through the blackboard--as if you could use it like a
doorway. And travel through it to somewhere safe.
I invite you to imagine yourself somewhere completely, totally and utterly safe. Your
place of safety can be somewhere you remember, or it can be a creation of your mind. It can be a
combination. It can change. You may have anyone or anything with you that you would like. But
imagine yourself somewhere, totally, and completely safe.
Now your place of safety isn't a place I am creating for you. It is a place you have created
for yourself. It is yours, and therefore it can be for you whatever you need it to be. So allow this
place of safety to also be a place of healing. Imagine that this place is full of energy that is
healing, renewing and good. Allow this energy to wash over you, and to move through you -
traveling in the spaces between the cells that form the molecules that form the atoms of your
body. Everywhere this energy touches you it brings healing, renewal and health. Disorder is
replaced by order. Just stay in this place of healing now (pause briefly).
Now I would like you to go on a journey. So dress yourself for your trip. Put on the
clothing that will keep you warm and comfortable. Imagine a bridge. It can be any bridge. It can
be one you remember or one you imagine, but let it be a safe bridge that you will be able to travel
over and back upon safely. Start over the bridge. At the far side of that bridge is a safe, lovely
forest clearing. As you walk toward it over the bridge you can hear the sound of your footsteps,
and perhaps birdsong.
Come off the bridge now into the forest clearing. It is beautiful - a green cathedral. Light
comes in from above and is filtered through the leaves of the trees. There is the scent of
evergreen, of flowers, and of the fresh, clean air.
Strange though it may seem I invite you to imagine, floating in the air before you, the
number 3. Allow the number 3 to fade, and replace it with the number 2. Allow the number 2 to
fade and replace it with the number 1. Allow the number 1 to fade and replace it with the integer
O. Allow the O to expand and become larger, until it forms an oval, and the oval has become a
free-standing mirror in which you can see yourself reflected.
 Then, like Alice through the Looking Glass, safely step through the mirror into an
imaginary landscape on the other side. I don't know where your mind will have taken you, but it
is not important that I know, because you know. You are the expert on you and so the experience
you are having is exactly the correct experience to have. Therefore, both your safety and success
are certain.
Look around this landscape. It may be clear to you, or it may be vague. It doesn't matter.
Whatever you are experiencing now is correct. In a few moments you will come upon a young
child. This child can be imagined to be yourself at a much earlier age. So find the child now.
Bend down so that you can look the child in the eyes, and make contact by hugging the
child or just by placing your hand on the child's shoulder. Look deeply into the child's eyes and in
this moment of communion, know what the child knows and feel what the child feels. It may be
that the child has something he or she wants to tell you or to show you. If so, that can happen
now. And in any case, tell the child that it is going to be okay. You and the child stand at opposite
ends ofa bridge of years that the child must yet cross. Tell the child that he or she will cross that
bridge, and will arrive safely at the other side. While childhood may not have been perfect, or
even good, at least it will be over, and there will be opportunities for a new start and more
happiness.
Find the oval doorway now. And take the child with you. If the child is small, you can
carry the child. If the child is larger, you can work hand-in-hand. But find the doorway and with
the child, walk through it back into the forest clearing. And the child is with you. Turn and look
at the oval mirror that was the doorway, and allow the oval mirror to become just an oval, and the
oval to become a O and the O to fade and be gone.
With the child, mount the bridge and begin to journey across it. And the child is with you.
Hear two sets of footsteps, and make the journey. Then come off the bridge back into your place
of safety and healing.
Here in your place of safety and healing the child must remain. But here he or she will be
safe and can heal, until it is time to move on to greater happiness. Allow your unconscious mind
to learn the way to this place of safety so that you can return here as often as you would like. So
the child will never again be alone, and will always have you for a companion.
Move back through the blackboard doorway now. Find yourself back in the classroom in
fiont of the clean slate. Perhaps there is something that you would like to write on that
blackboard, and if so, you can. Then, move back to your desk or table or chair, and use your
power to allow the classroom to become unstuck in time, and the day moves forward .
And now we make the return journey. I will count from 1 to 10, and as I count from 1 to
10 allow your trance to lighten until at about the time I reach the count of 10, your eyes can open
if they have not already done so, your mind can move back to ordinary awareness and all of the
parts of yourself can merge. [count the client out of trance]
Script: The Safety Shield
This is a wonderful, deep relaxation induction. The initial section was taught to me by my
first hypnosis instructor and is a sophisticated progressive relaxation method. My instructor did
not know the author of this section, but believed that it was developed by the German Medical
Corps for battlefield use during the First World War. The middle section uses a confusion
technique while the final section uses trance logic to create a sense of protection in the
unconscious mind of the client. This script is excellent for the control of worry, and I often use it
as the basis for presurgical work. The repetition of the sentences can get a bit confusing for the
hypnotist if. like me, you accompany the client into trance by going into a trance of your own. In
this state it is easy to lose count and forget how many times you have repeated the sentence. The
rule is simple: when you realize that you have forgotten the count, say the sentence twice more
and move on. Note how little imagery is used in this script. It is almost entirely patter and
suggestion.
[Preface this script with your customary patter to obtain eye-closure and relaxed
breathing. Finish with a count from 10 to 1.]
This induction works a bit differently from some of the others that we do. In this example
of hypnosis I'm going to ask you to focus your attention on some particular part or parts of your
body. Then I am going to say a sentence out loud. When I say the sentence out loud, I would like
you to repeat it silently to yourself, just in your mind. I will say each sentence about four times
and so you will repeat it about four times. Then, 1 will ask you to focus your attention on some
other particular part or parts of your body, and start to repeat a sentence about that. Now,
although I will continue to use my words to ask you to repeat the sentences, you may discover
that after a few minutes you really do not need to do that. Just hearing my words may be enough.
If so, that's fine.
So allow your attention to focus on your right arm and hand; and as your attention focuses
upon your right arm and hand, repeat to yourself silently as I say aloud, "My right arm, and hand,
are heavy and relaxed" [repeat section in quotes four times].
And now, allow your attention to focus on your left arm and hand; and as your attention
focuses upon your left arm and hand, repeat to yourself silently as I say aloud, "My left arm, and
hand, are heavy and relaxed" [repeat section in quotes four times].
And now, allow your attention to focus on both of your arms and both of your hands; and
as your attention focuses upon both of your arms and both of your hands, repeat to yourself
silently as I say aloud, “My arms, and hands, are heavy and relaxed" [repeat section in quotes
four times].
And now, allow your attention to focus on your right leg and foot; and as your attention
focuses upon your right leg and foot, repeat to yourself silently as I say aloud, "My right leg, and
foot, are heavy and relaxed" [repeat section in quotes four times].
And now, allow your attention to focus on your left leg and foot; and as your attention
focuses upon your left leg and foot, repeat to yourself silently as I say aloud, "My left leg, and
foot, are heavy and relaxed" [repeat section in quotes four times].
And now, allow your attention to focus on both of your legs and both of your feet; and as
your attention focuses upon both of your legs and both of your feet, repeat to yourself silently as I
say aloud, "My legs, and feet, are heavy and relaxed" [repeat section in quotes four times].
And now, allow your attention to focus on both of your arms and both of your hands and
both of your legs and both of your feet; and as your attention focuses upon both of your arms and
both of your hands and both of your legs and both of your feet; repeat to yourself silently as I say
aloud, “My limbs are heavy and relaxed" [repeat section in quotes four times].
And now, allow your attention to focus on the muscles of your neck and shoulders; and as
your attention focuses on the muscles of your neck and shoulders; repeat to yourself silently as I
say aloud,''My neck, and shoulders, are heavy and relaxed" [repeat section in quotes four times].
And now, allow your attention to focus on your torso; and as your attention focuses on the
muscles of your torso; repeat to yourself silently as I say aloud, “My body is heavy and relaxed"
[repeat section in quotes four times].
 And now, allow your attention to focus on your breathing; and as your attention focuses
on your breathing; repeat to yourself silently as I say aloud, “My mind is calm and relaxed"
[repeat section in quotes four times]. And now just drift for a while [pause about 30 seconds].
Now I invite you to image a yardstick that has somehow become attached to a wall. The
numbers on the yardstick are large, and easy to read. The yardstick is attached to the wall in such
a way that the number 1 is on the bottom and the number 36 is on top. Alongside the yardstick I
would like you to imagine a rod, arrow or some other pointer. The pointer is on top and points to
the number 36. In a moment I am going to count from 10 to 1 and as I count from 10 to one, I
invite you to imagine the pointer traveling down the scale until the pointer gets to the number
one. As the pointer travels down the scale, it moves in even measures, so that as I count from 10
to 1 the pointer will move from 36 down to one in exactly the correct way so that it will arrive at
the bottom on the scale at exactly the time I say the number 1. You can be pleased and surprised
to discover that your mind possesses the unconscious skill to make this complex calculation
happen in exactly the right way so that your timing is perfect. I wonder what other wonderful
skills your mind may have that you do not know it does. And so I say 10, 9, 8, 7, 6, 5, 4, 3, 2, 1.
Notice, that you are deeply and profoundly relaxed.
Now this feeling of relaxation is not something I am doing to you. It is something that you
are doing to yourself. Therefore, it is under your own control. So I'd like to suggest that this
feeling of relaxation you are creating for yourself can be for you a protective safety shield for
your mind and heart. From now on, when you have any thoughts or feelings that are upsetting,
your unconscious mind can raise your protective safety shield of relaxation and behind it you can
stand protected. For thoughts that are upsetting cannot coexist in the mind with this feeling of
relaxation. Now just drift, and be safe. [Pause for a few moments, and count the client out of
trance.]
SCRIPT: THE HALL OF THE MOUNTAIN KING
This is a favorite script of mine. It is used to teach a client that beauty comes from within
and it is no shame to have an illness. There are several implied sexual images (the phallic tower
and the womb-like cave) that I have found intensify the experience for most adults. The shattered
mirror image is historical--a dome in Iran was decorated with shattered glass fragments when the
original mirror intended for it was broken by accident. There are also several Biblical allusions in
this script. I created it using the Mind Mapping Technique that I sometimes teach at National
Guild of Hypnotists meetings. It involves using a Chevruel Pendulum to cull a list of free
association ideas to create the material for the induction.
[Preface this script with your customary patter to obtain eye-closure and relaxed
breathing. Finish with a count from 10 to 1.]
And now, I'd like you to imagine yourself going into a movie theater. Not one of the
modern theaters, rather one of the kind we used to have years ago when movie theaters were
palaces for the common people. Many beautiful lights that seemed to move and dance lighted the
outside of the theater. The marquee would have the name of the show that you would see, and the
colorful lights would make moving patterns on the ground.
As you enter the theater you notice that the red carpet is soft. The theater is large, and
there are marble staircases leading to the balcony. Even the stairs are covered with the soft, rich
carpet. There is the smell of popcorn, and the sound of laughter and animated chatter.
As you enter the auditorium you notice that the room is very large. Overhead you see that
the ceiling is a barrel vault, and that it has been painted the color of the evening sky. Inset in the
ceiling are small lights that twinkle like stars. In fact, they are arranged in constellations and you
may recognize some of the constellations like Orion, the Pleiades, and Ursa Major. Most of the
light comes from a chandelier of polished brass and crystal. As you look at it you can sometimes
catch a beam of light just right as it is defracted by an edge of one of the crystals, and then you
see light in one of the bright, primary colors.
The walls are decorated with murals. Perhaps patriotic scenes; perhaps the scenes from
classical antiquity such as the ancient physician Hypocrites teaching his students. The aisle slopes
down before you, flanked on either side with a light at the end of each row of seats. At the front
of the theater there is the silver screen, now covered by a red velvet curtain. On either side you
can see illuminated EXIT signs, and you know that if you need to leave the theater quickly you
will be able to do so, safely and easily. So your safety is assured.
You walk down the aisle until you find the seat that is just right for you. The seats are
large and comfortable. You take your seat, sinking into the comfortable padding. You settle your
arms on the armrests, and the lights in the theater dim as the curtain rises and the screen comes to
life.
On the screen, the show has begun. You can see a beautiful mountain scene with music
and color. Somehow you find yourself floating in the air above your seat and you can look down
and see yourself still watching the movie. Then, imagine that you move through the silver screen
and enter into the mountain scene.
You are now standing in a mountain meadow. It is a beautiful day. Up ahead there is an
ancient stone bridge that leads from the meadow to a grotto carved into the living rock of the
mountain. People who lived before history was made, cunningly made the bridge, and the stones
fit together without mortar or cement. The bridge is spacious and safe to walk upon. You step
onto the bridge and walk. You hear your footsteps, and high, high overhead an eagle cries.
You come off the bridge into the grotto. It is large, and a faire is in progress. Everywhere
you look there are booths selling crafts, drink, and savory foods. There is the sound of voices, the
happy sounds of children. It is a good faire.
You walk through the grotto and at the back you notice that there is a vertical split in the
living rock of the mountain. It is a tight fit but you can pass through the split in the rock and
discover on the other side a large dark cavern. It is warm, humid and safe here. Somehow light
streams in from above, and while the cavern is shadowy, you can see to move around.
There in the center of the cavern there is an erect stone tower. It is the Tower of the
Mountain King. It juts up high and rigid. A path leads from where you are now to the tower, and
you follow the path. It is important to always follow your path.
When you come to the tower you notice that there is a door at the base, and as if sensing
your approach the door opens and you enter the tower. Inside is a room, like the Common Room
of an inn. A fire burns safely, and cheerfully, behind a protective screen, and the room is full of
tables and chairs where people sit and feast. Serving wenches and lads move around the room
with trays of food and beverage. It is a happy time. You move through the room to a spiral
staircase you notice at the back of the room.
The staircase winds up, in a double helix, leading to an upper room above the common
room at the inn. You ascend while remaining relaxed. You can hear the soft "booming" sound of
your footsteps on the stairs as you ascend. At the top, you enter into the Throne Room of the
Mountain King.
The King is not here, but his throne is. It is beautiful and shimmers in the light like a
diamond. As you look at the throne you realize that it is made of thousands of pieces of broken
mirror, that have been put together with mortar and polished so that not a single sharp edge
remains. The throne is smooth, and glistens in the lights. As light touches the throne the mirrors
reflect the light so that the chair glows with rainbows of light.
You have been granted permission, and so you sit on the rainbow throne of the Mountain
King. And the colorful light wraps you like a coat of many colors, like Jacob's coat. As you sit
you learn of the wisdom of the Mountain King. Long ago the King declared that his throne
should be made of mirrors. But as the mirrors were carried over the bridge and toward the tower,
the workmen stumbled, and the mirrors shattered. Yet the King was wise beyond his years, and
gave orders that the broken fragments should be gathered together and fit so cunningly together
that they would decorate the surfaces of the throne like a mosaic of smooth, polished glass. And
so it came to be, and the throne was made. When the throne was brought into the sunlight for the
first time, people realized that it was more beautiful in its brokenness than it ever would have
been if it had been left
unbroken.
There is a beauty in brokenness that unbroken things never attain. It is true of us too, for
people are stronger at the broken places. If a bone is broken, and heals, the area of the break is
stronger than the surrounding bone, and will not easily break again. We are stronger at the broken
places; there is a beauty in brokenness. When we rise above adversity, we rise in quiet triumph,
even if no one notices but ourselves.
This is your throne now. Your unconscious mind can return here whenever it wishes and
know the secret of the wisdom of the Mountain King. You are more wonderful because you have
suffered and survived. There is a nobility to you.
Now you rise from the throne, and journey back. You depart the Throne Room, and move
through the inn below. Yet this time the people there take note of you, and acknowledge you with
a smile and a kind nod of the head. You leave the tower, and move through the cavern. You press
yourself through the split in the rock and walk through the faire. The bridge awaits, and you cross
it home.
Now imagine yourself back in the theater, and the show has ended. The curtain descends
and the lights come back on. You rise from your seat and find the aisle. You move up the aisle.
As you move up the aisle I will count from 1 to 10. As I count from one to ten allow your trance
to gently lighten, until at about the time when I reach the count of 10 when your eyes can open, if
they have not already, your mind can move back to ordinary awareness, and all of the parts of
yourself can merge. [Count the client out of trance.]
SCRIPT: THE FREEZER OF FROZEN FEELINGS
I have found this script useful to help decompensated persons recompensate and contact
feelings that may have been blocked. It is a 'permissive regression" as it permits, but does not
require, the client to contact information from childhood. The first five sentences are from the
classroom metaphor in the Inner Child induction given above, but then the script goes in a
completely different direction. I am doing this here to illustrate the flexibility of the classroom
metaphor for different purposes. Naturally, the hypnotist can delete this section and substitute
another induction of that he or she may prefer.
[Preface this script with your customary patter to obtain eye-closure and relaxed
breathing. Finish with a count from 10 to 1.]
And now, I invite you to imagine yourself in one of the classrooms you were in when you
were growing up. It can be any classroom. It can be one you remember or one you imagine .
You were seated at a desk, table, or chair. Light was streaming in from large windows,
and where the light touched you, it was warm. Often as the day would move forward there would
be times when the teacher was quiet, and students such as you were free to read, or draw or think
things through. This is one of those times. So let your gaze drift out the windows at the
playground that lies beyond.
Now imagine yourself in the playground. It is a beautiful day and there is no one here
who will bother you. If there is anyone with you, he or she is a friend. There are swings, and
slides to play on, and other amusements that are healthy, wholesome and good. You enjoy the
time [pause].
Now imagine that you have the ability to fly like a bird. You rise up into the sky if that is
a comfortable image. If it is not, simply imagine that you can watch a bird as it soars and flies,
taking with it part of your spirit. So in whatever way is comfortable for you, imagine yourself, or
part of yourself, in the air. You travel north. Now this image isn't an image I am creating. You
are in control, so the image can be whatever you need it to be. So imagine yourself traveling all
the way to the North Pole.
It is night here, the sort of night that lasts for months and months. You land, and
somehow you are warm and safe. The stars above you illuminate the heavens and you can see the
North Star shining amid the flickering of the Aurora Borealis, the Northern Lights which are
dancing curtains of lights in the sky. Up ahead there is a hill projecting out of the snow, and there
is a path along the hill leading to a doorway that opens into a room inside the hill.
You walk toward the hill, moving over snow. There is a layer of ice on the snow, as
during the daylight the top layer of the snow melts and then freezes again So as you walk you
break through this layer into the softer snow beneath. You sink down an inch or so into the soft
snow as you walk. As you do so, fragments of the ice layer slide away, slipping over the top of
the snow around you with a delightful, crunching sound.
You make your way up the path and enter the room within the hill Strange though it may
seem, in the center of the room there is a large, freestanding freezer. It is working, and it is very
cold inside. This is the Freezer of Frozen Feelings. You open the door, and mist flows out. Inside
are packages of different kinds. Some may be packages wrapped in freezer paper. Others may be
wonderful treasure chests and the sort of boxes that are used to hold jewelry. Perhaps there are
other kinds of packages as well.
Each of these packages represents a part of your past. Perhaps a few days, perhaps years,
or something in between. You have forgotten about these parts of your past because they were
difficult or painful. But they are a part of you, and so they have an infinite value. Your mind
would not discard them, but has placed them here in the Freezer of Frozen Feelings to preserve
them against the day when you would be strong enough to find them again.
Select any one package from the Freezer and take it with you. Close the door on the rest,
so that they will be safe until you return for them later. But carry the one package with you
outside I don't know what is inside the package, and perhaps your conscious mind doesn't know.
That does not matter. The deepest part of you knows, and has selected exactly the right package,
representing exactly the right part of yourself that you need to understand soon.
Take to the air again, and travel back to the schoolyard, and then find yourself back in
your seat in the classroom of your mind. Place the package on the desk, or table or student's chair,
and just leave it there. In time it will thaw, and you will open it then.
 But for now we make the homeward journey. I will count from 1 to 10. As 1 count from
one to ten allow your trance to gently lighten, until at about the time when I reach the count of 10
when your eyes can open, if they have not already, your mind can move back to ordinary
awareness, and all of the parts of yourself can merge. (Count the client out of trance.]
SCRIPT: INNER ADVISOR SKELETON FORMAT
This is a classic hypnotic technique of which there are hundreds of examples. It is here
presented in outline form to encourage you to craft your own variation of it. The 'Inner Advisor"
imagined during this hypnotic experience can be very helpful to a client dealing with a medical
problem and the advice received is often remarkably trustworthy. Like many hypnotists I use a
personal version of this method in my own spiritual life. The one distressing thing about this
method is that it can be humbling. Often the image of an Inner Advisor presented by the
unconscious mind is not at all what one expected. It can be surprising to expect to find an image
of Jesus or Buddha as one's Inner Advisor, and get a waitress from the local diner instead. You
must take whatever you get (Dr. Siegel got a young man named “George"). I first learned of this
method from O. Carl Simonton, MD. However, I soon discovered that it has been around in
different versions for a very long time. Most versions of this script are based on the “Hero's
Journey" as described by religious anthropologist Joseph Campbell, Ph.D. I set this outline forth
as a self-hypnosis exercise. However, it can readily be adapted for hetro-hypnosis.
This exercise should be done seriously. If you enter into it light-heartedly, you will get a
light-
hearted response. While that response may still be helpful, it will probably mean more to you if
you approach it with a more genuine frame of mind.
1. Enter self-hypnosis.
2. Deepen the trance using imagery or wording that you feel appropriate. For example, you can
imagine yourself traveling down a wonderful staircase, walking down a beach, traveling down a
forest path, or any similar metaphor. It is best to use a deepening technique that reflects a
journey.
3. Encounter an obstacle. It might a person, an animal, a frightening place or memory. Fight
your way past it, or find some way to move past it using cunning, spiritual power or some other
interior skill.
4. Travel further, and come to a place that is the home of a wise living creature. Often this is
done by moving down a path, or road, and through a symbol or portal that may have some special
significance for you. The creature itself can be a person (real or fictitious), an animal, a spiritual
being or almost anything else. Do not identify the creature at this time. Instead, simply arrive at
the place where this creature dwells.
5. Imagine that somewhere in the place is a dwelling, a cave, a throne, or some area where you
can rest and seek consultation. Then allow the wise creature to appear. Remember that it may not
at all be what you expected. Accept what you get. Ask this creature if he or she will be your
interior guide--if he or she will take responsibility for guiding your personal and spiritual
development in the best way possible .
6. If the creature refused, go to the next step. If the creature agrees, tell him or her something
about what you are struggling with at this point in your life Listen for any answer. The answer
might come as a voice, an imagination, an image or a feeling. Then ask if the Inner Advisor
wishes to set forth rules or hints that will govern your relationship with him or her.
7. Thank the creature, and depart. Retrace the steps all the way back to the point where you
began your deepening, and emerge from self-hypnosis. It is helpful to write down any insights
you gained during this trance experience. Experience teaches that unless you do so quickly, you
will forget much
SCRIPTLETS FOR VARIOUS ILLNESSES:

For Cancer
...Now let your attention focus on the part(s) of your body where you cancer (is/used to
be) and imagine what the disease (leaked/looks) like as it (is/was) being destroyed. Imagine the
cancer growing smaller and perishing from within. Feel what it would feel like for your body to
replace disorder with order. Feel what it would feel like for your body to cease the flow of all
blood, or other fluids, to the area of where the cancer (was/is) Remember times of health and
make the memory real within your body now. Allow confidence to build in your own
unconscious mind that you are a cancer survivor and imagine yourself in the future resting in the
sunlight, warm, healthy and sound..
For Poor Personal Boundaries or Limits with Others
...[First use imagery to construct the impression of an energy field surrounding the client;
this can be something seen or something felt] You are now protected by a shield the wraps your
spiritual body like a field of force that will protect you from the opinions, ideas and beliefs of
other people. When other people attempt to manipulate or control you by making you feel wrong
or bad about yourself, the energy they use to do this will bounce off your protective shield and
will just roll off and away. Inside your shield you will be calm...
...[First use imagery to create the sense of an interior room or place of protection] Your
unconscious mind has learned the way to this interior place of safety, calm and power. A part of
you can now return to this place, easily, naturally, without conscious effort, whenever someone
else attempts to manipulate or control you by making you feel bad about yourself. When part of
you returns to this place of safety, calm and power, you will relax deeply, and you will be able to
make decisions about how best to respond from this protected, calm place within...
For Burns
...You can feel beneath the part(s) of your body that have been injured, and you notice
that as you focus upon the discomfort, it seems to intensify. Yet your mind now understands that
if you can turn the feeling up, you can turn the feeling down, for in order to be able to turn it up it
must be something that you can control. Therefore, over the next several minutes, hours and days
you mind will control the feeling so that it is turned down and becomes something you can deal
with well. You will still feel discomfort, for discomfort will make you protect the injured part(s)
as (it/they) heal. But the discomfort will not matter to you as much. You imagine yourself in the
future at the time when all the discomfort will be gone. Now feel what it would feel like for
blood, and other healing and protective fluids in your body, to gather at the place of burning. As
they gather they speed healing, bringing protection with them, and carrying away the debris so
that soon your skin will be smooth and healthy and sound...
For Transplants
 ...As you learn to welcome the new part of yourself and give it the sort of loving home a
childless couple might give to a much wanted child, a part of your mind goes deep within and
finds a sense of the person who has given you this gift. Your mind now thanks this person for the
gift that has been given, and your mind now allows the image of that person to be released into
the spiritual world as that person goes on to whatever awaits all of us when we move completely
into the spiritual world. As the giver of the gift departs, the image of that person in your mind and
tissues dissolves, in the way that early memory dissolves, as the adopted child learns to love the
adopted parents and calls them his or her own ....
For Gastric and Intestinal Disorders
...[For constipation] Know that the bowel is a tube of muscle, and it is strong. The
muscles flex like the muscles flex in the body of an athlete has he or she lifts, stretches and
performs. Imagine a (beautiful/handsome) athlete glowing with health, muscles rippling beneath
oiled skin, full of power and strength. Take this power within and flex within, moving things
forward in the way that a runner pushes forward to the goal. Remembering as you do so the
importance of releasing and letting go of thoughts, feelings and moods that need to be released
for health to be achieved.
...[For inflammation] Know that parts of the body that are sore, can be soothed. Imagine
your bowel being soothed. Swelling passes away, wounds relax and heal. That which was red and
sore, becomes healthy flesh. You absorb from that which is healthy everything you need, and
slow the passing of time and matter so that you soon will be happy, healthy and well. You learn
to hold inside those things you need to retain to learn, benefit and change. Our mind acquires
knowledge and wisdom by holding ideas within. Our body acquires strength and health by
holding as well...
For Sleep Facilitation
...Now I invite you to remember the best night's sleep you have ever had. If you cannot
remember, just imagine what it would have felt like. You were resting in bed, and you can feel
the bed clothing around your body. If you were wearing pajamas or other night clothing, feel
them. If it was cold, you were snug and warm. If it was warm, you were comfortable and relaxed.
Feel yourself supported by the mattress, holding you. Imagine that you stretch with the lazy
comfort of one who has done a good day's labor, and now it is night, when all responsibilities
have been successfully discharged, and there is nothing you have to do, except rest. Relax into the
refreshing sleep that puts brackets around the cares of the day, and brings perspective. For most
things do indeed seem better in the morning ...
For Scar Tissue Incorporation
...Feel what it would feel like for some (beautiful/handsome) person to touch you in a
caring and loving way. Imagine what it would feel like for him or her to touch the scar gently to
apply a warm, fragrant oil. The scent of the oil fills the room. Now I do not know what the oil
smells like, but it is not important that I know, because you know. You are the expert on you, and
so your body knows what to do. The oil penetrates deep and allows things that have become
clotted and knotted to untangle. With gentle strokes of your mind you free your body's tissues and
the scar begins to untangle and unknot. Soon the scar will be less, your skin smooth, and the skin
will feel normal like it used to feel. Remember that feeling now, and take it deep within your
skin, like you have taken the fragrant, warm, healing oil...
For Cueing
...Each time, throughout the day, when you notice a flash of color anywhere in your life,
you will remember that you are becoming healthy and strong. You will say to yourself in your
unconscious mind, "I release by anger and my fear, I embrace my power and my joy." As you do
so, you will move yourself closer to that day when your words will be reality. For what you tell
yourself in your mind has the greatest power to affect what you will become ...
For Profusion
...Sense a warm feeling in the area of your body where your (organ name or body part) is.
Feel the warmth deep down, in the way that a sunbather might feel the warmth of the sunlight
touching his or her body on a beautiful day. Warm, relaxed, rich, deep. Imagine a golden light
touching that part of your body. Say to yourself silently, as I say aloud, "My (organ name or body
part) is healthy and strong (repeat four times)." Know that this warm, relaxed feeling shall
continue...

9. HYPNOSIS PROVIDES THERAPEUTIC TOOL FOR PATIENT MANAGEMENT:

RICHARD S. LEWIS, DMD The following article appeared in the Journal of the Massachusetts
Dental Society Volume 45, Number 2 - Summer, 1996
After dispelling some common myths about hypnosis, this author reveals how the trance
capacity in all of us can serve as a safe and powerful matrix for healing. Hypnotism is as old as
time, probably originating when humans first crawled out of the primeval mud. It has been used
in one form or another in all parts of the world. Less developed cultures still use the beat drum,
ritualistic dances, and tribal rites to induce trance-like states. The Bible contains several hundred
references to the use of hypnosis-like methods, such as the "laying on of hands," to obtain cures.
The monarch's "royal touch," or divine healing, during the Middle Ages was another
form of hypnosis. Receptive and suggestible individuals sought the touch of a godlike figure; a
hypnotic state was induced in a matter of seconds. In the East, yoga techniques involving
breathing and postural exercises to achieve physiologic responses in the body are another form of
hypnosis. Greek and Egyptian priests used hypnosis more than 2,000 years ago to treat various
ailments.
The recent use of hypnosis The modern history of hypnosis started with Franz Mesmer in 1773,
when he postulated that a fluid circulating in the body was influenced by the magnetic forces of
the astral bodies, a theory that sounded scientific at the time, coinciding as it did with the
discovery of electricity and advances in astronomy.
Mesmer later asserted that he had the force within him and that he could cure patients
when magnetic rays flowed from his fingers.
Although Mesmer later was discredited, he laid a foundation for modern dynamic
psychiatry. His investigations led to a better understanding of the relationship between rapport
and suggestion as it relates to psychotherapy. In 1841, English physician James Braid developed
an interest in hypnosis. He believed cures were due to suggestion. Because he first thought
hypnosis was identical to sleep, he used the term "hypnos," from the Greek word for sleep.
Later, he tried to change the name to monoideism, meaning concentration on one idea, but the
term hypnosis has persisted, despite the fact that it is a misnomer because participants are not
asleep.
In 1845, surgeon James Esdaile per formed hundreds of major and minor surgical
procedures under mesmeric anesthesia. Esdaile's book, Mesmerism in India, published in 1850,
describes more than 250 surgical operations and many of the phenomena of hypnosis as we know
them. This volume is a valuable scientific document even today.
 At about this time in Nancy, France, physician Ambroise-Auguste Liebault read about
Braid's work and became interested in hypnosis. His work was noted by Hippolyte Bernheim, a
famous neurologist, who referred a patient suffering from sciatica to Liebault, after
unsuccessfully treating the patient for more than 6 years. Liebault cured the patient after several
sessions of hypnosis. Together, the two physicians treated more than 10,000 patients. In 1866,
Bernheim wrote the first scientific treatise on hypnosis, Suggestive Therapeutics, an essential
entry on any reading list on the historical development of hypnotism. After hearing of Liebault's
and Bernheim's work, Freud visited Nancy in 1890. There is a basis for the belief that Freud
developed his insights into human behavior and the workings of the mind from his early work
with hypnosis. Although he later rejected hypnosis, Freud found that hypnotism was helpful in
recovering buried memories.
The merger of hypnotic techniques with psychoanalysis was one of the most important
medical developments of the First and Second world wars. What hypnosis is not
Let us consider some misconceptions about hypnosis.
1. Hypnosis is sleep. The calm, sleeplike appearance of the trance state is deceptive. In reality, the
mind is focused and ready for whatever comes next. Electroencephalogram, EEG, studies show
that none of the brainwave findings of sleep are present during hypnosis. The sleep myth has
been reinforced by the traditional terminology of hypnotists who often repeat, "You are going to
sleep a deep sleep. You are going deeper and deeper." Later, subjects are told to "wake up."
While many contemporary hypnotists no longer talk about sleeping and waking, they may
believe that with enough effort the trance can be "deepened."
2. Hypnosis is projected onto the individual. The hypnotist projects no force or magic. He or she
taps the natural capacity of individuals to experience trance.
3. Only mentally weak or sick people are hypnotizable. The capacity to be hypnotized is a
statement of relative mental health. In general, intelligent and better-educated persons are more
hypnotizable.
4. Hypnosis occurs only when the hypnotist decides to use it. Spontaneous or unintended trance
experiences are more frequent than is hypnosis facilitated by an expert.
5. Symptom removal means a new symptom. This is not necessarily so.
6. Hypnosis is dangerous. There is nothing dangerous about hypnosis. However, hypnosis can be
misused by careless practitioners or unscrupulous lay persons. The heightened suggestibility and
trusting character of a hypnotized person can be exploited.
7. Hypnosis is therapy. Healing is accomplished in hypnosis, not by hypnosis. Hypnosis alone is
not therapeutic. Just as anesthesia provides a setting for surgery, hypnosis serves as a matrix for
treatment.
8. The hypnotist must be charismatic, unique, or weird. A flamboyant or eccentric personality
might disturb the trusting atmosphere that serves to evoke a person's trance talent. A patient who
thinks the hypnotist is zany or a showman is less likely to ease into a state of relaxed
concentration. 9. Women are more hypnotizable than men. Men and women are equal in their
trance capacity.
10. Hypnosis is only a superficial psychological phenomenon. Hypnosis is as much a
neurophysiological as a psychological phenomenon.
Theories of hypnosis: Mention should be made of the various theories of hypnosis.
Hypnosis may be viewed as an increased susceptibility to suggestion; as a result, sensory and
motor capacities are altered to initiate appropriate behavior. The difficulty with most theories is
that they do not separate the trance- induction process from the phenomena resulting from the
hypnotic state, which are different entities. In hypnosis, the concern is with a segment or
phenome non of behavior that cannot be separated from the total realm of human behavior.
Whether consciously or unconsciously, individuals have used suggestion and/or hypnosis long
before they were aware of it. Hypnosis is part of everyday life. Many people have been
hypnotized thousands of times, although they may not have realized it.
Any repetitious visual, auditory, tactile, olfactory, or taste sensation can induce a state of
increased susceptibility to suggestion. Verbal and nonverbal stimuli can readily produce
relaxation when the stimulus is maintained repetitiously. Many of us have sat in a class room
while the professor droned monotonously, and we recall that these were times when our eyes
were heavy and our heads began to nod. We entered a hypnotic state. Trance awareness can
fluctuate across the broad spectrum of consciousness.
It is important to emphasize that hypnosis is not a sleep state. Electroencephalographic
studies, as well as tests of reflexes, circulation time, and blood pressure, are identical to such
measures in the waking state, but differ from those of the same individual in the sleep state.
Hypnosis and sleep are altered states of awareness, and one may merge into the other. Closing
the eyes, which often is associated with hypnosis, is used to block visual stimulation, producing
a concentration on the operator's verbalizations. This is a common phenomenon. Music lovers
who wish to concentrate at a concert, put their heads back and close their eyes to hear better.
Hypnosis becomes a powerful control mechanism in the presence of good rapport, since it
enables suggestions to be accepted uncritically. This affects responses. Hypnotic responses
Hypnosis and susceptibility to suggestion play an important role in every one's life. Radio
or television commercials repeated many times may become conditioned stimuli that ultimately
affect behavior towards desired response. Hypnosis is observed throughout the animal kingdom:
A snake hypnotizes a bird by its sinuous moments, and it can be hypnotized by stroking. Flute
players "charm" snakes into a hypnotic-like state. In reality, the to-and-fro motions -- not sound
-- cause the induction of the hypnotic-like state in the snake, since snakes are deaf. Animal
hypnosis has been described well on many occasions. The basis for understanding the nature of
hypnotic responses requires a knowledge of human nature. Although we are interested in
explanations of hypnosis itself, we are more concerned with understanding how it fits within the
framework of human behavior.
There are two categories of hypnosis: overt and covert. Covert hypnosis does not involve
formal trance induction. It is defined as direct suggestion. This type of hypnosis occurs almost
daily in dental practices, whether consciously or unconsciously. Telling a patient that an
injection or suture removal will be pain-free after the application of topical anesthetic is an
example. This direct suggestion prepares the patient to be more comfortable than he or she
would have been without this prior communication.
Overt hypnotic activity involves three phases: induction, the therapeutic message, and
arousal or re-orientation.
The induction phase is a calculated manipulation of the patient's consciousness to allow
the individual to accept uncritically the directives suggested to him or her during the second
phase of overt hypnosis. Examples of common induction techniques include eye fixation,
pendulum, and relaxation techniques. In the therapeutic message, or second, phase of overt
hypnotic activity, the patient is directed in clear and simple suggestions designed to bring about
desired changes. Directives should be placed in the present or not-too-distant future, and they
should be easily attainable goals. We use simple directives such as "you will choose foods that
are nutritious," "you can do without fattening junk foods," or "the thought of cigarette smoking is
repulsive to you and will make you nauseous."
The third phase of overt hypnosis is the arousal or re-orientation of the patient. This is
accomplished slowly and deliberately so that patients are not agitated and can achieve autonomic
quiescence. It should take at least half the time of the induction phase. One method is to count
slowly from one to five, telling patients to open their eyes when you reach five.
USING HYPNOSIS IN A DENTAL PRACTICE: I use hypnosis frequently in my
office to control gagging and apprehension. There are other uses, including to decrease salivary
flow, to control bleeding after surgery, to end smoking, and to control pain and diet. Hypnosis is
a useful adjunct for patient management. I have found it is safe and powerful. Because all
hypnosis in humans is self-hypnosis, we see the universality of hypnosis. When interacting with
patients, we become the guide for the images in which they participate. We do not force our
projections onto them.
This also means that hypnosis can be a powerful tool to control our own lives. Dr. Richard S.
Lewis, a former clinical instructor of oral diagnosis at Tufts University School of Dental
Medicine, is a national lecturer on hypnosis in dentistry.

10. HYPNOTHERAPY AND PSYCHOTHERAPY WITH CERTAIN DISEASES

REVIEW OF HYPNOSIS IN THE TREATMENT ASTHMA: Summary: Hackman
et al of the University of California in Davis, CA have reviewed previous studies of the possible
efficacy of hypnosis therapy in asthma. Their impression is that previous studies have sometimes
shown impressive symptomatic improvement following hypnotherapy in asthmatics. However,
hypnotherapy has been unequivocally shown to be effective as primary therapy. Impressive
improvement has been observed more commonly in: 1) children;2) those susceptible to this
treatment modality;3)when administered by experienced therapists; 4) following repeated
sessions; and 4) inclusion of patient Reference: J Asthma 2000;37:1-15 Editor's Comments
Trials of hypnosis therapy in asthma have been made for a number of years. As best I can
interpret findings of these predominantly uncontrolled studies, hypnotherapy may be beneficial
when anxiety and emotional triggers are major factors. As the authors of this review state, large
controlled randomized trials of hypnotherapy are required before a more definitive conclusion
about the value of this approach can be drawn.
ACUPUNCTURE & HYPNOSIS & BACK PAIN: Whilst it is now generally accepted
that both hypnotherapy and acupuncture can alleviate pain, the precise mechanism that triggers
the analgesic response remains unclear for both treatments. It was for this reason that researchers
at the Department of Anaesthesiology, Hospital Cantonal Universitaire of Geneva, Switzerland
recently investigated and compared the analgesic effect of hypnotherapy with acupuncture.
Experimental pain was induced by a cold pressor test in eight male volunteers. The analgesic
effects of hypnosis and acupuncture were assessed before and after double-blind administration of
a placebo or naloxone, in a prospective, crossover study.
The results showed that pain intensity was significantly lower with hypnotherapy as
compared with acupuncture, and the pain scores did not differ significantly when naloxone or
placebo was administered. The researchers concluded that:-
Both hypnosis and acupuncture can significantly reduce pain induced by cold pressor
tests.
Hypnotherapy is more effective than acupuncture, The effects of hypnotherapy and acupuncture
are not primarily induced by the opiate endorphin system, and plasmatic levels of
beta-endorphins are not significantly affected by either hypnotherapy or acupuncture, nor by
naloxone or placebo administration. Moret V; Forster A; Laverriere MC; Lambert H; Gaillard
RC; Bourgeois P; Haynal A; Gemperle M; Buchser E . Mechanism of analgesia induced by
hypnosis and acupuncture: is there a difference? Pain (NETHERLANDS) May 1991,45 (2)
p135-40
HYPNOTHERAPY & BULIMIA: Hypnotherapy and cognitive-behavioral therapies
are commonly used to help treat bulimia nervosa, the eating disorder, and may achieve quicker
results than the more traditional therapies, according to Australian researchers. 78 bulimia
patients participated in the study which took place over eight weeks. Their results were compared
with those on a waiting list who had not received any treatment at all. The two treatments were
found to be equally beneficial, and the data showed significant improvements in the participants
in the treatment groups which were not seen in the patients who were on the waiting list and had
received no treatment of any kind.
Both the hypnotherapy and the cognitive behavioral groups had similar low levels of
binging or purging after the treatment ended. Interestingly, the effects were similar to those
achieved by therapeutic approaches, which usually take much longer. Griffiths RA, et al. Eur
Eating Disord Rv, 1994; 2:202-20
HYPNOTHERAPY & COLITIS: A little over ten years ago an interesting research
study relating to the application of hypnotherapy in the treatment of colitis was published which
did not receive much publicity. It was a controlled study involving 266 patients which found that
hypnotherapy and psychotherapy techniques can significantly improve the results obtained
through conventional treatment of colitis (i.e.. drugs, diet and surgery.) the researchers found that
many chronic diarrhoeal disorders such as colitis and crohn's disease are very much influenced by
stress and emotional conflicts (e.g.. depression, mental lability and anorexia), and they found that
dealing with those stresses and anxieties through hypnotherapy and psychotherapy resulted in
significant improvements in the conditions of the patients. Whilst the researchers did not suggest
that these mind therapies should substitute other forms of treatment, they did demonstrate that
psychotherapy and hypnotherapy could augment the effects of other therapies and should be
considered for patients suffering from colitis and associated diseases who do not respond well to
conventional treat. (1) Psychotherapy of Crohn disease Zur Psychotherapie des M. Crohn.
Feiereis H Langenbecks Arch Chir 1984, 364 p407-11
HYPNOTHERAPY & CONSTIPATION: It is interesting to note that more and more
medical studies are confirming that stress and psychological disturbances are often related to
chronic constipation. Many psychologists concur with the Chinese system of medicine which
associates 'inability to let go of past hurts or memories, or difficulties in coming to terms with
grief and loss' as a common factor in patients with chronic constipation. In fact, in one study it
was said to be "a powerful determinant of outcome, shaping (the patients') response to treatment.
(1) Another study revealed that "psychological treatment is feasible and effective in two thirds of
those patients who do not respond to standard medical treatment."
(2) All the evidence suggests that psychological therapies are superior to medical management
alone.
(3) physical diseases including cancer, heart disease and even skin complaints have been helped
with Hypnotherapy and Psychotherapy.
 The power of suggestion and mental imagery is a tool all too often overlooked but which
can be of immense help to constipation sufferers. Remember also that constipation is a stress
related condition and Hypnotherapy and Psychotherapy are both excellent aids to help control
emotional stress.
A controlled study in Europe involving 266 patients found that psychotherapy can
improve the therapeutic possibilities of drugs, diet and surgery. Psychotherapy combined with
relaxation and removal of stress were considered along with the personality of the patient before
the outbreak of chronic digestive disorders . It was suggested that unknown emotional conflicts
such as depression and mental ability may influence the course of these diseases.
(1) Irritable bowel syndrome: assessment of psychological disturbance and its influence on the
response to fibre supplementation. Fowlie S; Eastwood MA; Prescott R Gastrointestinal Unit,
Western General Hospital, Edinburgh, U.K. J Psychosom Res (ENGLAND) Feb 1992, 36 (2)
p175-80
(2) A controlled trial of psychological treatment for the irritable bowel syndrome [see comments]
Guthrie E; Creed F; Dawson D; Tomenson B Department of Psychiatry, Manchester Royal
Infirmary, England. Gastroenterology (UNITED STATES) Feb 1991, 100 (2) p450-7
(3) Psychologic considerations in the irritable bowel syndrome. Whitehead WE; Cromwell MD
Johns Hopkins University School of Medicine, Baltimore, Maryland. Gastroenterol Clin North
Am (UNITED STATES) Jun 1991, 20 (2) p249-67,
BIOFEEDBACK & CONSTIPATION: It is well known that abnormal bowel
movements can be affected by the motions. Emotional stress is considered to be one of the main
underlying problems in constipation, and for this reason, researchers in the Netherlands decided
to investigate
whether biofeedback training may be a useful treatment for constipation.
Defecation dynamics and clinical out-comes in chronically constipated children were
observed in a randomized study comparing conventional treatment with conventional treatment
and biofeedback training.
Patients, 5 to 16 years old, were referred to the Academic Medical Center in Amsterdam
by general practitioners, school doctors, pediatricians, and psychiatrists. The children had to fulfil
at least two of four criteria for pediatric constipation and were included only if they had received
medical treatment for at least one month prior to the study. Patients had a medical history,
abdominal and rectal examination, and anorectal manometry at the start and end of the 6-week
intervention period.
The children in the conventional group received laxative treatment with additional dietary
advice, toilet training, and maintenance of a diary of bowel habits. The biofeedback group
received the same conventional treatment but also received five biofeedback training sessions.
During the first 3 weeks, patients visited the outpatient clinic weekly; two subsequent visits were
twice monthly.
94 patients were randomly assigned to conventional treatment (CT) and 98 to
conventional treatment with additional biofeedback training (CT+BF). Normal defaecation
dynamics increased in the CT group from 41% to 52% whereas the increase in the CT+BF group
was from 38% to 86%. At 6 weeks, more patients in the CT + BF group showed normal
defecation dynamics, compared to the CT group. Vander Plas RN.; Benninga MA.; Butler HA.;
Bnssuvt PM.; Akkermands L.M.A.; Redekop W.K.; Taminiau J.A. Biofeedback training in
treatment of childhood constipation: A randomized controlled study Lancet (United Kingdom),
1996, 348/9030 (776-780)
Biofeedback for outlet obstruction constipation has a varying success rate. The aim of this
study was to identify which patients are likely to respond to biofeedback.
Thirty patients with severe outlet obstruction constipation were treated by a specialist
nurse using three or four sessions of visual and auditory feedback of anal sphincter pressures. All
patients were assessed by evacuating proctography, whole-gut transit studies and anorectal
physiology before treatment.
Two patients did not complete the course of biofeedback. Nine patients improved. Before
treatment these patients had predominantly normal anorectal physiology and were all able to open
the anorectal angle at evacuating proctography. Nineteen patients did not improve, of whom only
three had no measured abnormality other than inability to empty the rectum. Ten of these patients
had abnormal anorectal physiology which may have been due to previous vaginal delivery.
The report concluded that Biofeedback for outlet obstruction constipation is more likely to
be successful in patients without evidence of severe pelvic floor damage. Br J Surg 1999
Mar;86(3):355-9 McKee RF, McEnroe L, Anderson JH, Finlay IG Department of
Coloproctology, Royal Infirmary, Glasgow, UK.
HYPNOTHERAPY/PSYCHOTHERAPY & CROHN’S DISEASE: All physical
diseases including cancer, heart disease and even skin complaints have been helped with
Hypnotherapy and Psychotherapy. The power of suggestion and mental imagery is a tool all too
often overlooked but which can be of immense help to Crohn's disease sufferers. Remember also
that Crohn's disease is a stress related disease and Hypnotherapy and Psychotherapy are both
excellent aids to help control emotional stress.
A controlled study in Europe involving 266 patients suffering from Crohn's disease
revealed that psychotherapy is an important element in the treatment of this disease. The
researchers found that psychotherapy can improve the therapeutic possibilities of drugs, diet and
surgery.
Psychotherapy combined with relaxation and removal of stress were considered along
with the personality of the patient before the outbreak of the disease. It was suggested that
unknown emotional conflicts such as depression, mental lability and anorexia may influence the
course of the disease. Psychotherapy of Crohn disease Zur Psychotherapie des M. Crohn.
Feiereis H Langenbecks Arch Chir 1984, 364 p407-11
HYPNOTHERAPY & PSYCHOTHERAPY & DERMATITIS: All physical diseases
including cancer, heart disease but particularly skin complaints have been helped with
Hypnotherapy and Psychotherapy. The power of suggestion and mental imagery is a tool all too
often overlooked but which can be of immense help to dermatitis and eczema sufferers by not
only alleviating irritation and controlling any pain, but also in helping heal the condition.
Remember that both dermatitis and eczema are considered to be stress-related diseases
and stress may be an important factor. If you suspect this may be the case, Hypnotherapy and
Psychotherapy are both excellent aids to help control emotional stress. (2) There has been several
studies reported in the medical journals all confirming the benefits of hypnotherapy,
psychotherapy and stress management (see yoga and meditation).
Psychological tests have revealed that dermatitis sufferers tend to be noticeably more
anxious than non-sufferers and as levels of anxiety are reduced the skin condition improves
proportionately. For this reason, most clinicians and researchers agree that stress affects the
course of dermatitis and eczema, and reducing stress levels has a positive effect on the course of
the disease. Emotional factors have been shown to have a strong correlation with onset of the
disease and also with flare-ups. Further more, several documented case studies have revealed that
hypnosis can offer a successful treatment for sufferers.(3) (2) Psychological stress and psoriasis:
experimental and prospective correlational studies. Gaston L; Crombez JC; Lassonde M;
Bernier-Buzzanga J; Hodgins S Psychiatry Department, McGill University, West Montreal,
Quebec, Canada. Acta Derm Venereol Suppl (Stockh) (SWEDEN) 1991, 156 p37-43 Can
psychotherapy help patients with psoriasis? Price ML; Mottahedin I; Mayo PR Department of
Dermatology, Brighton Health Authority, Sussex, UK. Clin Exp Dermatol (ENGLAND) Mar
1991, 16 (2) p114-7 (3) Stress and psoriasis. Kantor SD Psoriasis Research Institute, Palo Alto,
California 94301. Cutis (UNITED STATES) Oct 1990, 46 (4) p321-2
HYPNOTHERAPY & PSYCHOTHERAPY & DIARRHEA: A controlled study in
Europe involving 266 patients found that psychotherapy can improve the therapeutic possibilities
of drugs, diet and surgery. Psychotherapy combined with relaxation and removal of stress were
considered along with the personality of the patient before the outbreak of chronic diseases
related to diarrhoea such as crohn's disease and colitis. It was suggested that unknown emotional
conflicts such as depression, mental lability and anorexia may influence the course of these
diseases(1). (1) Psychotherapy of Crohn disease Zur Psychotherapie des M. Crohn. Feiereis H
Langenbecks Arch Chir 1984, 364 p407-11
ACUPUNCTURE & HYPNOTHERAPY & ECZEMA: Both acupuncture and
hypnotherapy have been shown to influence allergic responses which can cause eczema as well as
alleviate the typical symptoms (itching, irritation and general discomfort. A report in the British
Medical Journal as far back as 1963 (1) revealed that hypnosis could prevent hypersensitive skin
reactions to allergens and thereby prevent inflammation and irritation.
A report of the Royal College of Physicians Committee on Clinical Immunology and
Allergy in 1992 (2) acknowledged that acupuncture and hypnotherapy have a “role to play” in the
treatment of allergy-induced eczema. This is particularly significant bearing in mind that Studies
conducted at the Department of Paediatrics, St Goran’s Children’s Hospital, Karolinska Institute,
Stockholm,Sweden have demonstrated that an allergy to a specific yeast (P. orbiculare) plays an
important pathogenic role in many cases of eczema. (1) Black S. Inhibition of immediate-type
hypersensitivity response by direct suggestion under hypnosis. British Medical Journal (1963)1,
925-9. (2) Nordvall SL; Lindgren L; Johansson SG; Johansson 5; Fetrini B. IgE antibodies to
Pityrosporum orbiculare and Staphylococcus aureus in patients with very high serum total IgE.
Department of Paediatrics, St Goran’s Children’s Hospital, Karolinska Institute, Stockholm,
Sweden. Clin Exp Allergy (ENGLAND) Aug 1992, 22 (8) p756-61.
HYPNOTHERAPY & PSYCHOLOGY & EMPHYSEMA: What is Hypnotherapy &
Psychotherapy?: - Hypnotherapy and Psychotherapy use the power of the mind to help heal
physical
as well as emotional problems. They both help the patient discover the underlying emotional and
psychological causes to their ailments.
The theory of Hypnotherapy & Psychotherapy: - There is no doubt that our minds and
bodies work together, when one is under stress, the other suffers. We have all experienced it -
blushing when embarrassed, going pale with shock, having sweaty palms when nervous. These
are just small instances of the way in which our minds can affect our bodies. Medical literature is
now full of studies confirming that many diseases are psycho-somatic (caused in the mind) or
stress-related. From skin diseases (eg. psoriasis and eczema) to stomach ulcers and migraine.
Some doctors have estimated that as much as 75% of modern diseases and disorders are actually
induced through stress. Fortunately, the power of the mind has also been shown to be a primary
factor in healing many diseases, even cancer. It is therefore important in any physical or
emotional health problem not to overlook hypnotherapy and psychotherapy on the road back to
health.
What is involved in treatment?: - A Hypnotherapist or psychotherapist will attempt to find
out as much about you and your problem as possible during the first visit to try and establish the
relevant psychological factors and the appropriate mode of treatment. In hypnotherapy you will
be relaxed in a comfortable chair or couch and the therapist will put you into a hypnotic state -
neither asleep nor awake. The therapist will then try to extract information from your
subconscious mind in order to find the cause of your problem. Suggestions may be made to your
subconscious. At the end of the session you will be brought out of the hypnotic state feeling calm,
relaxed and re-energized.
Obtaining treatment: - Due to the intimate nature of hypnotherapy and psychotherapy, it is
extremely important to the success of the treatment that you carefully select the therapist to
ensure that you get on with him or her. Hypnotherapy has a wide application for all ailments in
which anxiety, depression or tension are involved.
Can Hypnotherapy and Psychotherapy help Emphysema?: - Whilst there have been no
reported studies specifically related to emphysema and hypnotherapy and psychotherapy, there
are many reported instances of asthma and chronic bronchial conditions having been helped
through these therapies. The power of suggestion and mental imagery is a tool all too often
overlooked but which can be of immense help to emphysema sufferers. The power of the mind
can help improve remaining respiratory function and minimize the damage caused to scarred lung
and bronchial tissues.
PSYCHOTHERAPY/PSYCHOTHERAPY & GOUT: There has been at least one
study involving hypnotherapy and arthritic conditions. In this instance (1), reported levels of
pain, anxiety, and depression, and plasma levels of beta-endorphin, epinephrine, norepinephrine,
dopamine, and serotonin were measured in 19 arthritic pain patients before and after hypnosis.
Correlations were found between levels of pain, anxiety, and depression and following
hypnotherapy, there were clinically and statistically significant decreases in pain, anxiety, and
depression and increases in beta-endorphin-like immunoreactive material. The study reveals that
hypnotherapy may well play an important role in conquering rheumatic conditions including
gout. (1) Biochemical correlates of hypnoanalgesia in arthritic pain patients. Domangue BB;
Margolis CG; Lieberman D; Kaji H - J Clin Psychiatry Jun 1985, 46 (6) p235-8,
HYPNOSIS & HAYFEVER: Forty-seven subjects with known skin sensitivity to
pollen and/or house-dust were divided into five groups and tested with four strengths of allergen.
The prick-test method was employed. In the first part of the investigation a group of
unhypnotized subjects were compared with a group who had suggestions made under hypnosis
that their skin reactions to the allergen would not occur when tested a second time. A significant
diminution in the size of the weal was obtained in the hypnosis group at the lower two strengths
of allergen. In the second part of the investigation the subjects were divided into three groups. All
were hypnotized, no suggestions regarding skin reactions were given to one group, the second
group were given suggestions that only on one arm would the skin reactions be less or not recur,
and in the third group the suggestion was made about the reactions on both arms. There was
found to be a similar decrease in the response to prick-tests after hypnosis in all three groups. Fry
L. Mason AA Pearson RS. Effect of hypnosis on allergic skin responses in asthma and hayfever.
BMJ 1964:114S.1 148.
BIOFEEDBACK & HYPNOSIS & HEADACHE: Biofeedback & headache:
Researchers at Ohio University, Athens Georgia have demonstrated that biofeedback is an
effective treatment for tension headaches. Forty four patients (young adults) suffering from
chronic tension-type headaches were randomly assigned to receive either 6 relaxation sessions
with electromyographic (EMG) biofeedback or to a control group. All of the patients were then
monitored using electromyographic (EMG) activity in the frontal and trapezius muscle
groups.The results revealed that the biofeedback training was effective in alleviating headaches.
51.7 per cent of the patients in the biofeedback group experienced a significant drop of at least
50% in headache activity whereas those patients in the control group did not experience any
improvements. Rokicki LA et al. Change mechanisms associated with combined relaxation/EMG
biofeedback training for chronic tension headache. Appl Psychophysiol Biofeedback. Mar 1997
22(1) pp.21 - 41.
Biofeedback and autogenic relaxation is effective in treating fainting, and headaches
according to a report from researchers at the Medical College of Ohio, USA. Ten patients with
histories of recurrent fainting or near fainting of unknown cause(s) , headaches and a poor
response to or tolerance for drugs, were treated with biofeedback, autogenic relaxation exercises.
Biofeedback-assisted relaxation treatment appeared to be most effective in younger
patients whose fainting was associated with a strong psychophysiological factors and whose
headaches were intermittent. McGrady AV et al. Outcome of biofeedback-assisted relaxation for
neurocardiogenic syncope and headache: a clinical replication series. Appl Psychophsyio
Biofeedback March 1997.
22(1) pp63-72.d chiropractic research institution.
HYPNOSIS AND HEADACHES: Researchers in the Netherlands have established that
hypnosis and autogenic training may offer hope for patients who regularly suffer from tension
headaches. Back in 1992, a carefully designed study(1) compared an abbreviated form of
autogenic training to a form of hypnotherapy known as “future oriented hypnotic imagery” which
was not presented to the patients as hypnosis, and then they compared both treatments to the same
future oriented hypnotic imagery, but this time explicitly presented as hypnosis.
Fifty six patients diagnosed by a neurologists as having chronic tension headaches took
part in the study. The results revealed that all three treatments were equally effective; during the
treatment the headaches was greatly alleviated in all treatment groups in significant contrast to the
control group; immediately after the treatment was given , the patients also experienced a
reduction in both the severity of the headache and the associated psychological stress, and after a
6-month follow-up period, the therapeutic improvement was maintained.
Short-term and long-term pain reduction were observed in all treatment groups but the
researchers found that those patients who attributed the pain reduction obtained during therapy to
their own efforts manifested greater long-term pain reduction than those patients who attributed
their improvement to the efforts of the therapist. Furthermore, patients who received the “future
oriented hypnotic imagery” (which had been explicitly presented as hypnosis) were found to
experience greater benefits than those who received autogenic training.
One other interesting finding of the study was that the therapists were shown to be as
effective with the treatment modality they preferred as with the treatment modality they felt to be
less remedial suggesting that the therapist’s personal beliefs about the efficacy of a treatment does
not affect the outcome of the treatment.
The researchers were so impressed with the results of the study that they pursued their line
of research by investigating the efficacy of autogenic training (AT) and cognitive self-hypnosis
training (CSH) for the treatment of chronic headaches in comparison with a waiting-list control
(WLC) condition. In this study 146 patients ( 58 of whom were referred by a neurological
outpatient clinic), 48 of whom responded to a n advertisement in a local newspaper, and a further
40 who were students who had responded to an advert in a university newspaper. All of the
patients were randomly assigned to receive autogenic training, self-hypnosis or put on a waiting
list and used as controls.During the treatments, there was a significant reduction in the Headache
Index scores of the subjects in contrast with the controls. Follow-up assessments indicated that
therapeutic improvement was maintained. Interestingly, the patients in both treatment groups who
were considered to be highly-hypnotizable were found to achieve a greater reduction in headache
pain at post-treatment and follow-up than did those who were considered to be low-hypnotizable
subjects.
These studies indicate that these relatively simple and highly structured relaxation
techniques of hypnotherapy and autogenic training may be of considerable help in the treatment
of chronic headaches. It also appears that a high level of hypnotic susceptibility is associated with
a better therapeutic outcome. (1) Zitman FG; Van Dyck R; Spinhoven P; Linssen AC. Hypnosis
and autogenic training in the treatment of tension headaches: a two-phase constructive design
study with follow-up. Department of Psychiatry, Catholic University, Nymegen, The
Netherlands. J Psychosom Res (ENGLAND) Apr 1992, 36 (3) p219-28 (2) Kuile MM;
Spinhoven P; Linssen AC; Zitman FG; Van Dyck R; Rooijmans HG Autogenic training and
cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups.
Department of Psychiatry, University of Leiden, The Netherlands. Pain (NETHERLANDS) Sep
1994, 58 (3) p331-40
MEDITATION & RELAXATION & INSOMNIA: It is commonly accepted that
people who are chronically tense and who cannot relax are prime candidates for all
cardio-vascular disorders, including hypertension. Researchers have shown that relaxation
techniques are demonstrably effective in stress control and in the treatment of insomnia. For
example, Dr Chandra patel, author of 'The Complete Guide to Stress Management' (Optima 1992)
reported several controlled studies in which patients with high blood pressure had significantly
improved (1).
Other investigators reported that relaxation techniques including yoga, transcendental
meditation and biofeedback have all been effective in helping reduce high blood pressure. (2)
Medical journalist, Audry Carli also described research in the American journal 'Bestways' in
which 21 Hypertensive patients were divided into two groups; one group was given drugs and the
other received drugs plus relaxation lessons.
Interestingly the former group had an average reduction in systolic blood pressure of 1.1
whereas the group who did relaxation exercises had an average reduction of 13.6 points! This
suggests that relaxation can make other treatments and therapies as much as 12 times more
effective. Added weight was given in two reports in the Lancet (3) which stated that
transcendental meditation was effective in inducing relaxation, lowering high blood pressure and
helping insomnia, and other researchers have demonstrated that
Biofeedback has also been shown to be an effective tool in overcoming insomnia(4). So
much so that Dr Stephen Fulder, author of the Complementary handbook wrote that Biofeedback
"is as good as other procedures in relieving stress-related conditions such anxiety, insomnia, high
blood pressure, tachycardia and tension headaches." (1) A Holistic Approach to cardiovascular
disease Dr C Patel - BJ Holistic Med 1984 1, 30 - 41 & Trial of Relaxation in reducing coronary
risk BMJ 1985 290, 1103-6. (2) New England Journal of Medicine 8/1/76 (3) 23/2/74 &
21/1/76 (4) Learning Visceral and Glandular responses - Science 163, 434-5 N.E.Miller ;
Instrumental conditioning of autonomically mediated behavior- Psychological Bulletin 67, 337
Relaxation & Insomnia: This study explores the usefulness of relaxation and gradual
medication withdrawal in weaning insomniacs from sleep (hypnotic) medication. We recruited 40
volunteers from the community who had insomnia, half of whom were chronic users of hypnotics
while the other half were non-medicated. Half of all participants (10 medicated and 10
non-medicated) received progressive relaxation. All medicated participants received a standard
gradual drug withdrawal program. Medicated participants reduced sleep medication consumption
by nearly 80%. Participants who received relaxation obtained additional benefits in sleep
efficiency, rated quality of sleep, and reduced withdrawal symptoms. Medicated and
non-medicated participants attained comparable, improved sleep by post-treatment and follow-up.
Hypnotic withdrawal was accompanied by serious worsening of insomnia, but this dissipated by
the end of the withdrawal period. The psychological treatment of hypnotic-dependent insomnia
has high potential for making an important clinical contribution. Behav Modif 1999
Jul;23(3):379-402 Lichstein KL, Peterson BA,
Riedel BW, Means MK, Epperson MT, Aguillard RN Department of Psychology, University of
Memphis, TN 38152, USA.
HYPNOTHERAPY & PSYCHOTHERAPY & IBS: All physical diseases including
cancer, heart disease and even skin complaints have been helped with Hypnotherapy and
Psychotherapy. The power of suggestion and mental imagery is a tool all too often overlooked
but which can be of immense help to diarrhoea sufferers. Remember also that diarrhoea is a stress
related condition and Hypnotherapy and Psychotherapy are both excellent aids to help control
emotional stress.
A controlled study in Europe involving 266 patients found that psychotherapy can
improve the therapeutic possibilities of drugs, diet and surgery. Psychotherapy combined with
relaxation and removal of stress were considered along with the personality of the patient before
the outbreak of chronic diseases related to diarrhoea such as crohn's disease and irritable bowel
syndrome. It was suggested that unknown emotional conflicts such as depression, mental lability
and anorexia may influence the course of these diseases (1). (1) Psychotherapy of Crohn disease
Zur Psychotherapie des M. Crohn. Feiereis H Langenbecks Arch Chir 1984, 364 p407-11
Patients suffering from irritable bowel syndrome and other gastrointestinal disorders are all too
often treated with steroids or anti-inflammatories to alleviate the symptoms. It is well known that
diet and nutrition play an important part in the treatment of gastro-intestinal disorders but it is not
commonly appreciated that hypnotherapy and psychotherapies offer extremely effective
therapeutic options that should not be overlooked when considering the appropriate remedial
treatment.
In a recent review of available controlled studies in the field of gastroenterology
conducted at the University Hospital of South Manchester, West Didsbury UK, scientists
discovered that hypnotherapy is unequivocally beneficial for patients suffering from
gastrointestinal disorders including irritable bowel syndrome and peptic ulceration (1).
German researchers also recently demonstrated that emotional stress plays a significant
role in irritable bowel syndrome(2). The researchers compared drug therapy with psychotherapy
and acupuncture on patients who were diagnosed with and shown to be suffering from irritable
bowel syndrome. Their results of the study revealed that psychotherapies helped to successfully
alleviate the symptoms in 74 per cent of the patients - a far higher number than was noted in any
of the other therapies. However, acupuncture was also found to be effective, albeit to a lesser
degree, achieving long term success in 31% per cent of the patients treated which was markedly
better than placebo acupuncture treatment which only produced success in 17.2 per cent of the
patients. Drug
therapy (papaverine) resulted in a long-lasting status free of symptoms in 17.2% of the patients
but this was significantly better than the results of the papaverine-placebo-therapy which
produced no improvement at all. The researchers concluded that the psychotherapies played by
far the most significant role in treating the disorder than had previously been suspected.
Scientists at the Gastroenterology Unit, Frenchay Hospital, Bristol came up with similar
results(3). 33 patients with refractory irritable bowel syndrome were treated with four 40-minute
sessions of hypnotherapy over a period of 7 weeks. Twenty of the group (60%) improved, of
whom eleven were shown to be completely free of all symptoms. Short-term improvement was
maintained for 3 months without the need of further formal treatments and the researchers
concluded that hypnotherapy in groups of up to 8 patients was as effective as individual therapy
in the treatment of irritable bowel syndrome..
Finally a research study reported in the Lancet also confirmed the importance of
hypnotherapy and psychotherapies in the treatment of irritable bowel syndrome. In this study,
thirty patients with severe refractory irritable-bowel syndrome were randomly allocated to
treatment with either hypnotherapy or psychotherapy and placebo.
The psychotherapy patients showed a small but significant improvement in abdominal
pain, abdominal distension, and general well-being but not in bowel habit. However, the patients
who received hypnotherapy treatment showed a dramatic improvement in all features, and the
difference between the two treatments was found to be highly significant. Patients in the
hypnotherapy group showed no relapses during the 3-month follow-up period, and no substitution
symptoms were observed either.
These reports provide strong evidence to support a more integrated approach in the
treatment of gastro-intestinal disorders in which hypnotherapy and psychotherapy should be
considered in the initial stages of the disorder as valuable aids and alternatives to conventional
treatment. (1) Whorwell PJ.Use of hypnotherapy in gastrointestinal disease. Br J Hosp Med
(ENGLAND) Jan 1991, 45 (1) p27-9 (2) Kunze M; Seidel HJ; Stube G [Comparative studies of
the effectiveness of brief psychotherapy, acupuncture and papaverin therapy in patients with
irritable bowel syndrome] Vergleichende Untersuchungen zur Effektivitat der kleinen
Psychotherapie, der Akupunktur und der Papaverintherapie bei Patienten mit Colon irritabile.
Klinik fur Innere Medizin, Bereich Neuropsychiatrie, Bezirkskrankenhauses Suhl.Z Gesamte Inn
Med (GERMANY) Oct 15 1990, 45 (20) p625-7 (3) Harvey RF; Hinton RA; Gunary RM; Barry
RE Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome.
Lancet (ENGLAND) Feb 25 1989, 1 (8635) p424-5 (4) Controlled trial of hypnotherapy in the
treatment of severe refractory irritable-bowel syndrome.Whorwell PJ; Prior A; Faragher EB.
Lancet (ENGLAND) Dec 1 1984, 2 (8414) p1232-4
R, Guo A, Ngu M Research Unit for Complementary Medicine, University of Western Sydney
Macarthur,Campbelltown, New South Wales, Australia. a.bensoussan@uws.edu.au
 HYSTERECTOMY & HYPNOTHERAPY: (POSITIVE SUGGESTIONS ON
AUDIOTAPE: It wasn't long ago that people who believed in the power of affirmations and
positive suggestions to improve their health (or any area of their life for that matter) were
considered to be one sandwich short of a picnic. However, today it is generally acknowledged
that the patient's mental state can play a significant role in the efficacy of their treatment and thus
recovery.
Researchers in the Middle East recently investigated the use of positive suggestions to
help reduce and alleviate the incidence of post-operative nausea in patients undergoing elective
surgery. Fifty women undergoing elective abdominal hysterectomy were randomly assigned into
two groups; the women in group one were played a blank audio cassette and the second group
were played a tape containing positive suggestions relating to their condition.
The results showed that the patients in group two experienced a 36% reduction in
vomiting compared to 60% experienced by the women in group one. the number of vomiting
episodes in group one was 3.1 per patient compared to 1.7 in group two. Furthermore, patients in
group
one required a significantly higher amount of antiemetic medication (66.6%) compared to
patients in group twp (22.2%). The researchers concluded that positive suggestions played to
patients by audio tape has a statistically significant beneficial effect on reducing and alleviating
post-operative nausea and vomiting in patients who have undergone abdominal hysterectomy
elective surgery. Maroof M et al. Intra-operative suggestions reduce incidence of post
hysterectomy emesis. Journal of Pak. Medical Association 47(8) August 1997. 202-4.

11. HYPNOSIS IN MEDICINE: CORNELIA MARE PINNELL

A Critical Review: CORNELIA MARE` PINNELL' Arizona School of Professional
Psychology and NICHOLAS A. COVINO Beth Israel Deaconess Medical Center and Harvard
Medical School: The International Journal of Clinical Hypnosis and Experimental Hypnosis:
April, 2000:
Abstract: Recent changes in health care have been characterized by an increased demand
for empirically supported treatments in medicine. Presently, there is moderate support for the
integration of hypnotic techniques in the treatment of a number of medical problems. This critical
review of the research literature focuses on the empirical research on the effectiveness of
hypnotic treatments as adjuncts to medical care for anxiety related to medical and dental
procedures, asthma, dermatological diseases, gastrointestinal diseases, hemorrhagic disorders,
nausea and nemesis in oncology, and obstetrics/gynecology. Wider acceptance of hypnosis as an
intervention to assist with medical care will require further research.
Hypnotic interventions are some of the oldest adjunctive treatments in medicine (Gauld,
1992). Hypnotic techniques alter sensory awareness, perception, memory, and behavior and
therefore have the potential to influence physiological functioning and the course of medical
conditions. Hypnotic suggestions have been employed to instill positive attitudes in patients, to
facilitate compliance with treatment regimens, to foster distraction from alarming thoughts or
stimuli, and to promote relaxation, rehearsal of adaptive behaviors, and openness to new ideas.
Putative mechanisms for the success of hypnotic interventions in the medical arena include the
influence of suggestions, dissociation, and relaxation on autonomic nervous system activity,
immune function, and behavior change (Covino & Frankel, 1999).
 During the 1980s, clinicians expressed great optimism regarding the successful
application of hypnosis to the treatment of a variety of physical illnesses (Baker, 1987; Brown &
Fromm, 1987; Manusov, 1990). However, most recommendations for the utilization of hypnosis
as an adjunct to medical treatment were based on anecdotal reports and isolated case studies.
Researchers and clinicians alike lamented the paucity of outcome studies utilizing clinical
hypnosis and noted the need for well-designed clinical research, despite the limitations imposed
by clinical settings, conceptual differences, and impoverished dialogue between clinicians and
researchers (Brown & Fromm, 1987; Frankel, 1987; Lynn, 1994; Spinhoven, 1987). To date, in
behavioral medicine, there is more support for the effectiveness of behavioral and
cognitive-behavioral than for other types of psychological interventions (Compas, Haaga, Keefe,
Leitenberg, & Williams, 1998). Empirical support for the utility of hypnobehavioral interventions
would promote their wider acceptance in medicine.
Powerful economic, political and social forces in the managed health care environment of
the 1990s have demanded the identification of effective treatments based on empirical standards.
In 1995, the American Psychological Association Division 12 Task Force on Promotion and
Dissemination of Psychological Procedures responded to this pressing social demand with a
report that identified a set of criteria for empirically validated psychological treatments and listed
psychological procedures that were in compliance with these criteria (Beutler, 1998). The Task
Force report effected heated debates in the field and concerns regarding the stringency of the
criteria for "empirically validated treatment." Consequently, Chambless and Hollon (1998)
proposed a revision of these criteria and suggested the use of the term "empirically supported
therapies" (EST) for treatments that were "shown to be efficacious in controlled research with a
delineated population" (p. 7). They contended that the best way to demonstrate treatment efficacy
is through randomized clinical trials (RCT) with well-defined clinical populations and through
carefully controlled and methodologically sound single-case experiments. The importance of a
treatment manual, with carefully defined and specified procedures, was also stipulated as integral
to establishing a treatment's empirical foundation.
An empirically supported treatment (EST) can receive one of three designations: possibly
efficacious, efficacious, and efficacious and specific. The designation of "possibly efficacious"
encompasses the least stringent set of criteria, and it is warranted if there are findings from "only
one study supporting a treatment's efficacy, or if all of the research has been conducted by one
team"(Chambless & Hollon, 1998, p. 8) in the absence of conflicting evidence. More specifically,
the criteria require that the treatment be shown to be superior to a no-treatment control, placebo
group, or alternate treatment, or that the treatment in question matches the effectiveness of an
alternative treatment of established efficacy. A treatment can also receive the designation of
"possibly efficacious" based on findings from single case experiments with at least three
participants conducted by one research team.
Replication by independent investigators is necessary to consider ESTs "efficacious" or
"efficacious and specific." In the case of an efficacious treatment, two studies must demonstrate
the treatment's efficacy, and, in the case of a treatment that is specific and efficacious, it must be
shown that the treatment is superior to a pill or psychological placebo or an alternate established
treatment. Additionally, Chambless and Hollon (1998) recommended sample sizes of 25 to 30 in
each condition in controlled studies to insure adequate statistical power. To meet the more
stringent criteria of efficacious and specific, the treatment's effectiveness must exceed a pill or
psychological placebo, or an alternative established treatment.
 In recent years, hypnosis researchers have begun to examine the effectiveness of
hypnobehavioral interventions in the treatment of various medical conditions by way of
well-designed and carefully controlled studies. This article is a critical review of the empirical
research on the effectiveness of hypnobehavioral interventions in medicine and includes an
evaluation of the efficacy of hypnotic treatments for specific medical problems based on the
criteria proposed by Chambless and Hollon (1998). For this review, we identified relevant articles
by using MEDLINE and PsycINFO databases, and we consulted previous reviews for additional
references. The articles (mostly experimental designs and a few collections of case reports with N
2 3) were selected because the studies contained many of the design features recommended by
Chambless and Hollon, thus increasing the possibility that the treatments under investigation
might qualify for a designation of empirically supported. Most articles reviewed here were
published after 1980, and all of the studies presented were conducted prior to the publication of
the criteria for empirically supported treatments outlined by Chambless and Hollon. The review is
organized by clinical problems: anxiety in medical settings related to medical/dental procedures,
asthma, dermatological diseases, gastrointestinal diseases, hemorrhagic disorders, and nausea and
nemesis in oncology and obstetrics / gynecology. The effectiveness of hypnosis for smoking
cessation is covered in another article included in this issue (Green & Lynn, 2000).
ANXIETY RELATED TO MEDICAL PROCEDURES AND PREPARATION FOR
SURGERY: Most patients view medical procedures and surgery as sources of psychological and
physiological stress. They are likely to experience high levels of anxiety and somatic distress
prior, during, and after many medical procedures. Several researchers have reported a number of
beneficial effects of psychological interventions aimed at reducing anxiety in patients undergoing
medical procedures (Blankfield, 1991; Kessler & Dane, 1996; Lang, Joyce, Spiegel, Hamilton, &
Lee, 1996). In the contexts of medical and dental treatments, hypnobehavioral interventions have
been used to alleviate patients' anxieties related to medical procedures, as adjuncts to
pharmacological analgesia, and to teach patients novel coping behaviors (e.g., preparation for
surgery and mental rehearsal). Other hypnotic interventions have been aimed at the reduction of
the amount of pre- and postoperative pain medication, bleeding, and length of hospitalization, as
well as the facilitation of healing and recovery. Hypnosis has been used alone and in conjunction
with patient education, relaxation training, and emotional support. Preoperative hypnobehavioral
interventions have been employed to prepare patients for procedures such as laparotomies,
thyroidectomies, mastectomies, cholecystectomies, colectomies, as well as cardiac and orthopedic
surgeries (Kessler & Dane, 1996).
Blankfield (1991) critically reviewed the research literature, which spanned more than
two decades, on the role of suggestions, relaxation, and hypnosis as adjuncts to the medical care
of surgery patients. The 18 articles, reviewed in detail, included studies characterized by great
variability in their overall methodological quality. Among the methodological problems noted
was the lack of clarity of the type and quality of suggestions used by various researchers.
Blankfield concluded his review by indicating that overwhelming empirical data from case,
randomized, and nonrandomized studies provided support for the effectiveness of psychological
interventions on the recovery of surgical patients. "With only two exceptions, they all credit
hypnosis, suggestions, or relaxation with having a positive effect on surgery patients, either in
terms of physical or psychological recovery following surgery" (p. 182).
In a recent, methodologically sound study, Lang et al. (1996) investigated the effects of
hypnotic relaxation on intravenous drug use for anxiolysis and analgesia during interventional
radiologic procedures. Thirty surgical patients were randomized to a self-hypnosis relaxation or a
control group. Self-hypnosis was defined as a state of heightened and focused concentration
during which patients could use their own abilities to gain control over their anxiety and pain
perception. Patients were instructed to take a deep breath, spread the relaxation throughout the
body, and utilize imagery to transform and neutralize unpleasant experiences. When potentially
painful stimuli were imminent, competing feelings of fullness, numbness, coolness, or warmth
were suggested. Outcome measures included Beck's Anxiety Inventory, a numerical linear pain
rating scale, blood pressure, heart rate, and intravenous patient-controlled analgesia (PCA). The
patients in the self-hypnosis group had significantly fewer procedural interruptions and received
seven times fewer drug units than the patients in the control group. In addition, significantly
fewer patients in the self-hypnosis group self-administered analgesic medication. Hypnotizability,
measured with the Hypnotic Induction Profile (HIF; Spiegel & Spiegel, 1978) after the patients
had fully recovered from the interventional procedures, was not related to outcome. The findings
of this study provided support for the effectiveness of self-hypnotic relaxation in reducing the
requirement for analgesic and anxiolytic intravenous medication, as well as the incidence of
adverse effects and procedural interruptions.
Lambert (1996) investigated the effects of hypnosis and guided imagery on the
postoperative course of pediatric surgical patients. He used a convenience sample of 52 pediatric
patients who had been scheduled for elective surgery. The participants were matched for gender,
age, and diagnosis. Hypnotizability was not measured. The 26 pairs of children were randomly
assigned to either hypnosis or a control group. In addition to the standard preoperative teaching
and preparation for a hospital stay, the participants in the control group discussed issues related to
surgery and topics of interest for the children. The participants in the hypnosis group met for one
30-minute session one week prior to surgery. During the hypnosis session, they received
instructions for relaxation, individually tailored guided imagery based on pleasant images
previously selected by the patients, and imaginable rehearsal of the surgical procedure, followed
by suggestions for minimal pain, uncomplicated recovery, and healing. Outcome measures
included hourly postoperative pain ratings, amount of pain medication administered, and the
Spielberger State Anxiety Inventory. The pediatric patients in the hypnosis group had
significantly lower postoperative pain ratings and shorter hospital stays than those in the control
group.
ASTHMA: Asthma is a reversible obstructive airway disease that can be triggered by
infections, allergens, exercise, or heightened emotion. The hallmark of asthma is hyperirritability
of the pulmonary airways. Patients with asthma usually present with bronchoconstriction,
shortness of breath, wheezing, congestion, and bronchospasm More than a century ago,
MacKenzie (1886) reported that a patient's expectations, as well as waking suggestions, could
trigger an asthma attack.
The advantage of conducting laboratory studies with patients with asthma is the
possibility of comparing the effectiveness of treatments that include placebo, bronchodilating, or
bronchoconstricting drugs. About 23 laboratory studies have demonstrated reactivity of
pulmonary airways to waking suggestions in patients with asthma, and decreases in pulmonary
function of more than 20% were commonly reported. However, such exacerbation of symptoms
seems to take place only in a subset of patients with asthma, approximately 25% to 40% of
persons already experiencing the disease (Isenberg, Lehrer, & Hochron, 1992).
Researchers of patients with asthma have compared the effectiveness of treatments with
hypnosis and bronchodilators and have evaluated the effectiveness of suggestions for relaxation,
desensitization, distraction, and increased self-control on a variety of outcome measures, such as
self-report of symptom reduction, utilization of medical services, and return to work.
The largest randomized, controlled, and prospective study to date was conducted by the
British Tuberculosis Association (Research Committee of the British Tuberculosis Society,
1968).Researchers compared the effectiveness of hypnosis and progressive muscle relaxation in
the treatment of 252 patients with asthma. The treatment consisted of monthly sessions for 1 year
and home-based daily practice of newly acquired skills. The patients in the hypnosis group were
taught self-hypnosis and received direct suggestions that their breathing would become and
remain free. The patients in the relaxation group received progressive muscle relaxation training.
The authors provided an illustrated book for the relaxation instructions. The results of the study
were that both interventions were effective in reducing asthma symptoms as measured by
independent physician ratings, diaries of medication use, and frequency of wheezing, as well as
regular pulmonary function measurements. The participants in the hypnosis group reported
significantly less wheezing and medication usage at the conclusion of treatment, and they were
considered, by physicians who were blind to their treatment condition, to be more improved than
the relaxation group. There was a gender effect in the hypnosis condition, with reports of greater
symptom reduction among women with asthma.
Ben-Zvi, Spohn, Young, and Kattan (1982) conducted a study of 10 patients with stable
asthma. Exercise-induced asthma (EIA) was provoked by a treadmill run on 5 successive days.
The patients' breathing was tested while they were running, and a variety of standard pulmonary
function measures were taken before and after each run. Hypnotizability was measured by the
HIP (Spiegel & Spiegel, 1978), and all subjects received a score of 2 or 3, which placed them in
the moderate range of hypnotizability. Ben-Zvi and colleagues found that medium hypnotizable
patients with EIA were able to control bronchospasm with hypnosis significantly better than with
cromolyn inhaler, saline mist placebo, or waking suggestions.
Ewer and Stewart (1986) classified 39 adult patients with mild and moderate asthma as
high or low hypnotizables, based on their scores on the Stanford Hypnotic Clinical Scale (SHCS;
Morgan & Hilgard, 1975). The patients were randomized to either hypnosis training or an
attention control condition, with equal numbers of high and low hypnotizable patients in each
condition. The hypnosis condition consisted of six weekly 30-minute sessions of self-hypnosis
training and guided imagery. The attention control condition consisted of six weekly 30minute
sessions with a nurse who reviewed patients' breathing diaries. Only the high hypnotizable
patients in the hypnosis training condition achieved significant improvement in self-reported
symptoms, bronchodilators usage, and pulmonary function. The high hypnotizable patients also
demonstrated an ability to overcome a methacholine challenge, but only after receiving training
in hypnosis. The findings of this study provide qualified support for the effects of hypnosis on
improved pulmonary functioning in high hypnotizable patients with asthma.
DERMATOLOGICAL DISEASES: There have been numerous anecdotal reports of
successful hypnotic interventions for a variety of dermatological conditions such as eczema,
ichtyosis, warts, psoriasis, (see reviews by Ewin, 1992, and Zachariae, Oster, Bjerring, &
Kragballe, 1996). This review will address the empirical evidence for the hypnotic treatment of
dermatological conditions that have been studied most extensively, namely psoriasis and warts.
Psoriasis. Psoriasis is a common benign, acute, or chronic inflammatory skin disease with
hypothesized psychoneuroimmunologic involvement. The most common sites for psoriasis
lesions are the elbows, knees, and scalp. The psoriasis lesions are dull and red, often symmetrical,
sharply outlined plaques covered with silvery scales. The course of psoriasis tends to be chronic
and unpredictable and is influenced by stress, injury, or skin irritation. Medical treatments include
corticosteroids, lotions, and ointments, as well as exposure to solar or ultraviolet light.
Psychological treatments of psoriasis have included cognitive-behavioral therapy, guided
imagery, hypnosis, operant conditioning, relaxation, and skin temperature biofeedback (Kantor,
1990; Tsushima, 1988). Two literature reviews spanning a period of four decades (Winchell &
Watts, 1988; Zachariae et al., 1996) revealed a few case reports and one experimental study
suggesting beneficial effects of psychological interventions in the treatment of psoriasis.
Zachariae et al. (1996) conducted a study to investigate the effectiveness of psychological
treatment of psoriasis. The 51 patients diagnosed with psoriasis vulgaris who participated in the
study were instructed to discontinue medication 2 weeks prior to baseline testing at week O. The
patients were randomly assigned to either a psychological treatment or a no-treatment control
condition. The psychological treatment consisted of ... Although Zachariae and colleagues did not
use the term hypnosis in describing the intervention, the treatment contained elements defined by
other researchers as hypnosis. Specifically, the psychological treatment consisted of
cognitive-behavioral stress management, relaxation training, and specific suggestions of imagery
for symptom control (e.g., instructions to imagine a pleasant inner space, a pleasant beach scene,
sunbathing, bathing in salt water). In addition, the authors were interested in the role played by
hypnotizability in treatment outcome. Participants were given audiotapes containing similar
suggestions to use at home several times between treatment sessions. Psychological
measurements and measurements of psoriasis activity were taken at baseline, and at Weeks 4, 8,
and 12. Findings provided support for the effectiveness of psychological treatment of psoriasis.
Only the patients in the psychological treatment condition were assessed for vividness of sensory
imagery with the Clinical Imagery Scale (Zachariae, 1993). Their hypnotizability was measured
on the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A; Shor & Orne, 1962)
six months after the completion of the investigation. Hypnotizability was not found to be related
to treatment response. The authors recommended further investigation of the mechanisms
involved, particularly of the role played by imagery and waking suggestions.
WARTS. Warts are benign tumors of the skin caused by infection with the human
papilloma virus. More than 50 types of such viruses have been identified (e.g., Verrucca vulgaris,
Verruca plantaris, Verruca plana juvenilis, etc.). It is not understood why they locate in a
particular area (i.e., plantar, venereal, etc.), and why their course is characterized by spontaneous
regression and reoccurrence. The conventional medical treatments of warts have included
chemical burning, electrocautery, freezing, interferon injections, laser therapy, and surgical
removal. The psychological treatments of warts have included the analysis of the meaning of
warts, waking suggestions for wart removal, heterohypnosis, imagery, and self-hypnosis. There
are anecdotal reports that hypnotic treatments result in reduced itching and discomfort, structural
changes, and reduction of skin lesions.
Spanos, Stenstrom, and Tohnston (1988) and Spanos, Williams, and Gwynn (1990)
conducted a series of well-controlled experiments to investigate the role of hypnosis and
hypnotizability in wart regression. One hundred and eighty individuals participated in three
studies. In each of the studies, the participants were included on the basis of having at least one
wart. They were randomly assigned to experimental and control conditions, with the number of
participants ranging from 10 to 24 per condition. The hypnotic treatment consisted of a 2-minute
protocol that contained a hypnotic induction followed by direct suggestions for wart elimination.
Participants were instructed to count their warts daily and vividly imagine tingling sensations and
warmth in their warts, followed by images of warts shrinking and falling off. The control
conditions consisted of: cold laser placebo and no-treatment/waiting list (Spanos et al., 1988,
Study 1); suggestions for wart elimination following relaxation instructions, suggestions for wart
elimination alone (i.e., without relaxation or hypnosis induction), and no-treatment/waiting list
(Spanos et al., 1988, Study 2); and topical placebo, topical salicylic acid, and
no-treatment/waiting list (Spanos et al., 1990, Study 3). Treatment outcome was measured by
number of warts lost and by the percentage of wart loss at a 6-week follow-up after the initiation
of treatment (Spanos et al., 1988; Spanos et al., 1990).
In order to avoid inadvertent effects of hypnotizability testing on treatment results,
participants' hypnotizability was assessed at the end of the follow-up period with the Carleton
University Responsiveness to Suggestion Scale (CURSS; Spanos, Radtke, Hodgins, Stam, &
Bertrand, 1983). Spanos et al. (1988) reported a cure rate of 50% in the participants who received
hypnotic suggestions for wart removal, which was significantly higher than in the placebo and
no-treatment control groups. However, the cure rate was comparable across the groups of
participants who received direct suggestions for wart removal with and without hypnotic
induction or relaxation instructions (Spanos et al., 1988).
Ewin (1992) reported on 41 case studies of patients previously clinically diagnosed with
warts who had 1 to 12 failed medical therapeutic interventions. The hypnotherapeutic treatment
employed by Ewin was highly idiosyncratic. It included: (a) ideomotor signaling to elicit a
patient's preference for a particular type of suggestions (e.g., "warm," "cold," or "tingling"); (b)
direct suggestions in hypnosis (DSIH) aimed at wart removal; (c) analysis, with hypnotic age
regression to the time of onset, and exploration of secondary gains and meaning of warts; and (d)
suggestions for healing. The duration of the treatment was variable, ranging from 2 to 16 weekly
sessions. The outcome of hypnotherapy was determined through visual inspection and
comparisons of pictures taken pretreatment, at the conclusion of treatment, and at 6-month
follow-up. Ewin reported a cure rate of 80%. Patients' hypnotizability was not measured.
GASTROENTERO INTESTINAL DISORDERS: Irritable bowel syndrome (IBS) is
the most common functional disorder encountered in the gastroenterologist's (GI) practice, with
about 30"/0 of patients suffering from nonorganic abdominal pain, distension, diarrhea/
constipation, urgency of bowel movement, and other abnormalities (Mitchell & Drossman, 1987).
Psychological factors such as anxiety, depression, and anger have been found to negatively
impact gastric secretion, motility, and emptying (Goldberg & Davidson, 1997; Mitchell &
Drossman, 1987). Interestingly, 25% to 50% of patients with a lifetime history of IBS have been
diagnosed with comorbid phobic disorders (Goldberg & Davidson, 1997). Several researchers
have reported that between 20% to 80% of patients with IBS have demonstrated placebo
responses to a variety of suggestions (Drossman & Thompson, 1992; Thompson, 1989). A
somewhat surprising result from a research group that tested a cognitive-behavioral intervention
for IBS was the 500~, improvement of 60% of those patients who were on the waiting list to
enroll in the study (Blanchard, Schwartz, & Suls, 1992).
Klein and Spiegel (1989) investigated the role played by hypnosis in influencing gut
physiology. Volunteers were screened with the HGSHS:A (Shor & Orne, 1962) and the HIP
(Spiegel & Spiegel, 1978). The study participants were 28 healthy men and women with no
history of gastrointestinal disease who had scored in the high range of hypnotizability. Gastric
acid secretion was measured during the baseline hour, when participants were instructed to read
and relax. During the second hour, the participants were hypnotized and asked to imagine eating
the most delicious of possible meals. Mean acid output during hypnosis increased by 89% over
baseline. A subsequent effort to suppress acid output was also successful, but was only obtained
in 17 of the study participants. The findings suggested that hypnosis might influence gut
physiology in high hypnotizable individuals.
Researchers from Great Britain (Whorwell, Prior, & Faragher, 1984) conducted a clinical
study with 30 patients diagnosed with severe IBS that had been refractory to a variety of standard
medical treatments of at least 1 year's duration. The diagnosis of IBS was derived from physical
examination by a gastroenterologist. The patients were randomly assigned to either treatment
with hypnosis or psychotherapy plus placebo medication. Patients' hypnotizability was
determined by observation of responses to a hypnotic suggestion for arm catalepsy. The treatment
was conducted in seven 30-minute sessions conducted by the same doctor. The psychotherapy
treatment involved symptom review, stress reduction techniques, and supportive discussion. The
hypnotic treatment included specific suggestions aimed at the control of smooth muscles, gut
motility, and improvement of bowel function. Outcome measures consisted of diary card records
of daily frequency and severity of abdominal pain, abdominal distention, and bowel habit, as well
as weekly overall symptom improvement and well-being. At a 12-week follow-up, the patients
treated with hypnosis demonstrated significant decreases in pain reports and distension and
increased well-being, as compared to the patients who were treated with psychotherapy. The
authors contacted the 15 patients who had been treated with hypnosis for a follow-up at 18
months. All 15 patients continued to report complete recovery (Whorwell, Prior, & Colgan,
1987). Harvey, Hinton, Gunary, and Barry (1989) conducted a study to examine the effectiveness
of group and individual hypnotic treatment of 33 patients diagnosed with IBS. These researchers
employed the same hypnotic suggestions that had been utilized by Whorwell and his collaborators
(1984). Patients in the two hypnotic treatment conditions showed comparable improvements.
HEMORRHAGIC DISORDERS: Hemophilia. Classic hemophilia (hemophilia A) is a
disease due to a genetic deficiency of coagulation occurring primarily in males. Bleeding varies
in frequency and amount and it can be triggered by surgery or minor trauma. Medical treatments
of hemophilia involve infusions of factor concentrate. Early clinical reports and pilot studies
suggested that psychological interventions, such as psychotherapy, relaxation training, and
hypnosis, could be used effectively as a prophylactic treatment for patients with hemophilia
(LeBaron & Zeltzer, 1984). In their review of the literature, LeBaron and Zeltzer discussed the
lack of evidence for a relationship between hypnotizability and treatment outcome in hypnosis
research with patients with hemophilia. However, data from a number of pilot studies reviewed
provided tentative support for the effectiveness of self-hypnotic suggestions in the reduction of
frequency and severity of bleeding in hemophiliacs. LeBaron and Zeltzer underscored the
importance of well-designed empirical research in this area.
Swirsky-Sacchetti and Margolis (1986) investigated the effects of a comprehensive
psychological treatment of male hemophiliacs. Thirty patients with hemophilia were randomly
assigned to treatment or waiting list control groups. Treatment cconsisted of six consecutive
weekly 75to 90-minute sessions. During the treatment sessions, patients received information
about stress and its relationship to spontaneous bleeding and were taught hypnotic strategies for
stress management. They also received audiotapes with hypnotic suggestions for relaxation, ego
strengthening, and decreased bleeding. Psychological interventions significantly reduced factor
usage in patients with hemophilia. Hypnotizability, measured by the HGSHS:A (Shor & Orne,
1962), was reportedly unrelated to treatment outcome. Self-hypnosis was part of a comprehensive
treatment program along with relaxation, education, and support.
LaBaw (1992) discussed the role played by anxiety as a major aggravator of spontaneous
bleeding in patients with hemophilia, through its influence on platelet aggregation. He
hypothesized that hypnosis could be used to induce relaxation and to reduce patients' anxiety.
LaBaw reported promising results from an experiment conducted with 20 patients with
hemophilia who were randomly assigned to a control or a treatment condition. In addition, he
utilized data from three case studies to illustrate the effectiveness of his treatment approach in
reducing spontaneous bleeds and the need for transfusions for patients with hemophilia. LaBaw's
Contemporary Suggestive Therapy (CST) consisted of psychoeducation--a rationale for a
treatment that involves self-hypnosis, training in self-hypnosis to achieve relaxation, and
home-based daily practice. CST has been reportedly successfully used in the treatment of
hundreds of patients with hemophilia at the University of Colorado Health Sciences Center.
Patients with hemophilia were treated in weekly sessions over a period of 3 months. During the
treatment sessions, they received information about hemophilia, trance, and CST; additionally, a
hypnotic induction was followed by suggestions to practice self-hypnosis at home two to three
times daily to achieve relaxation and reduce anxiety. LaBaw did not consider hypnotizability
relevant to treatment outcome, and, thus, he did not measure it. He reported that all 3 patients
who were treated with CST showed symptomatic improvement. LaBaw's research has been
criticized for lacking methodological rigor (e.g., sample size, questionable randomization
procedures, changes in the experimental protocol, questionable statistical analyses of the research
data, type of outcome measures). LaBaw acknowledged that his research "lacked the rigor of true
experimental design" (p. 96), claiming that this was due to his primary concern for the welfare of
the patients. It is noteworthy that this treatment program appears to have common features with
the treatment proposed by Swirsky-Sacchetti and Margolis (1986) and merits further attention
from other research groups.
Hemorrhage during surgery. Additional empirical support for the effectiveness of
hypnosis in the reduction of blood loss comes from research on the effectiveness of hypnotic
preparation for surgery. Blankfield (1991) reviewed literature, which spanned 3 decades, on the
role of suggestion,relaxation, and hypnosis as adjunct to the medical care of surgery patients.
Only two of the reviewed studies, one randomized and one nonrandomized, provided support for
the effectiveness of preoperative taped suggestions for relaxation with or without hypnotic
induction in reducing the number of blood transfusions during surgery.
Enqvist, von Konow, and Bystedt (1995) conducted a pilot study to investigate the effects
of hypnotherapy on somatic responses of 60 surgical patients during maxillofacial surgery and
postoperative recovery. The study participants were randomly assigned to one of three
experimental conditions: preoperative hypnotic suggestions, preoperative hypnotic suggestions
(i.e., given during general anesthesia), or a combination of preoperative and preoperative
hypnotic suggestions. The patients who received preoperative hypnotic suggestions were
instructed to listen to a taped hypnotic induction followed by instructions for relaxation and
self-hypnosis, direct and indirect suggestions, metaphors directed at improved healing,
maintenance of low blood pressure and reduced bleeding during the surgical intervention, and
faster recovery. The preoperative tape contained similar suggestions and was played continuously
during the operation while patients were under general anesthesia. Preliminary findings suggested
that preoperative hypnotic suggestions might be effective in reducing blood loss and in
facilitating postoperative recovery.
Nausea and Hypermesis in Oncology and Obstetrics/Gynecology: Nausea and nemesis
can result from a number of unconditioned stimuli (UCS), such as hormonal shifts,
chemotherapeutic agents, and certain anesthetics. Carey and Burish (1988) reported that a history
of food aversion, motion sickness, and heightened anxiety could render patients more vulnerable
to conditioning to nausea. Uncontrolled nausea and vomiting are prominent parts of the
experience of pregnant women, patients with cancer, and surgical patients. These symptoms
create electrolyte imbalance, nutrition deficits, and weakness. They produce such misery that
patients tend to terminate pregnancies, discontinue cancer treatments, or avoid surgical
interventions.
Postoperative nausea and vomiting (PONV) is a common consequence of general
anesthesia. Enqvist, Bjorklund, Engman, and Jakobsson (1997) conducted a study with 50 female
surgical patients who were randomly assigned to either hypnosis or a control condition of care as
usual. The researchers administered preoperative hypnotic suggestions for relaxation and
postoperative thirst and hunger via audiotape. The patients were instructed to listen daily to their
tape for 6-8 days prior to surgery, and to practice self-hypnotic strategies for pain, stress, and
anxiety reduction. Measures of analgesic use, postoperative nausea, vomiting, and well-being
were obtained from nurses' records, as well as from questionnaires completed by the patients.
Patients receiving the hypnotic suggestions experienced significantly less postoperative nausea
and nemesis and made fewer requests for analgesic medication.
Antiemetic drugs are effective in reducing postchemotherapy nemesis in cancer patients;
however, they result in side effects such as headaches, sedation, and extrapyramidal reactions and
cannot prevent anticipatory nemesis. Several researchers have investigated the effectiveness of
hypnosis in the treatment of nausea and vomiting. Lyles, Burish, Krozely, and Oldham (1982)
conducted a randomized controlled study with 50 cancer patients who experienced nausea
following chemotherapy treatments. Patients in the relaxation condition received progressive
muscle relaxation training and instructions to use guided imagery to manage their anticipatory
anxiety and reduce their postchemotherapy treatment nausea. Although the authors did not label
this intervention hypnosis, the treatment consisted of instructions for relaxation and imagery of
relaxing scenes that were embellished in much detail by the therapist, similar to what other
researchers call hypnosis. The control groups consisted of a no-treatment condition in which
patients were advised to relax on their own before chemotherapy and a therapist-contact group in
which patients could talk to someone during the chemotherapy treatments. The investigators
found that cancer patients who received the relaxation training and guided imagery managed their
anxiety better, demonstrated less physiological arousal during treatment, and had significantly
less severe and protracted nausea and vomiting at home following chemotherapy treatments.
Zeltzer, Dolgin, LeBaron, and LeBaron (1991) conducted a study with 54 children and
adolescent patients with cancer who experienced nausea, vomiting, and disruptions of eating,
sleeping, play, and school activities resulting from cancer treatments. Baseline measurements
were taken for all these variables. The study participants were randomly assigned to one of three
conditions: hypnosis, distraction and relaxation, or casual conversation. The participants in the
hypnosis group were instructed in the use of fantasy and imagination to increase their feelings of
security, well-being, hun ger, and social interaction. The investigators solicited favorite fantasies
from the participants. The participants in the control groups had an opportunity to practice
relaxation and distraction techniques or received attention from a therapist prior to and during
chemotherapy. The patients and their parents were interviewed after treatment by telephone
regarding the severity and duration of nausea and vomiting. The participants in the hypnosis
condition achieved the greatest reduction in the duration of anticipatory nausea and vomiting. The
researchers cautioned that within-group variance regarding hypnotizability, treatment preference,
and pharmacological treatments must be further evaluated before effectiveness of the hypnosis
treatment for nausea can be established.
Jacknow, Tschann, Link, and Boyce (1994) conducted a randomized, controlled,
single-blind, prospective study with 20 pediatric patients recently diagnosed with cancer to
evaluate the effectiveness of hypnosis on antiemetic drug usage. The patients were randomly
assigned to either a self-hypnosis or a casual conversation group. The children in the hypnosis
group were instructed and treated in a manner similar to the Zeltzer et al. (1991) study. Outcome
data were collected from the medical chart, patient and parent interviews, and questionnaires. At
1 month and 2 months postdiagnosis, the patients who received hypnotic suggestions experienced
significantly less nausea and took significantly fewer antiemetic drugs than the patients in the
control condition.
Syjala, Cummings, and Donaldson (1992) conducted a randomized study with 67 bone
marrow transplant patients to assess the role o~ hypnosis in the reduction of postchemotherapy
pain, nausea, and nemesis among cancer patients. Outcome measures consisted of opioid use,
pain reports, and frequency of nausea and vomiting assessed by review of medical charts, patient
self-reports, and daily questionnaires. The participants in the hypnosis group were invited to
create their own imagery for pain control and relief of emotional distress and nausea. The
therapist added some suggestions for well-being and self-control, and the session was audiotaped.
The patients were asked to play the audiotape at home, daily. The three control groups consisted
of relaxation and cognitive restructurin8, care as usual, and nonspecific attention consisting of
informal discussion of daily activities and of the patients' interests (e.g., TV programs). While the
participants in the hypnosis group significantly reduced their pain experience, there were no
significant differences among the groups on any other measure.
OBSTETRICS/GYNECOLOGY: Several researchers have investigated the use of
hypnosis by women during childbirth to facilitate delivery. Variability in maternal age, number of
previous deliveries, and medication use are significant influences on the duration of labor. Brann
and Guzvica (1987) indicated that a sample size of at least 100 is necessary to control for the
variability in length of time in labor.
Freeman, MacCauley, Eve, and Chamberlain (1986) conducted a study with 65 first-time
(primigravid) women with normal pregnancies, who were invited to use self-hypnosis (n = 29) or
standard care (n = 36) to manage pain and shorten the duration of labor. The participants were not
randomized. Those in the self-hypnosis group were instructed to create sensations of relaxation,
warmth, and pain relief in a hand and then to transfer these sensations to the abdomen.
Hypnotizability of the participants in the self-hypnosis group was measured with the SHCS
(Morgan & Hilgard, 1975). The participants in the self-hypnosis group reported greater
satisfaction with the experience of childbirth; however, the groups were comparable in the pain
ratings, and the mean duration of labor of the participants in the self-hypnosis group was
significantly longer.
Brann and Guzvica (1987) studied 96 volunteer first- and several-time mothers who were
not randomized but were invited to choose between hypnosis training or a prophylactic
intervention, which consisted of breathing and cognitive distraction training. The participants in
the hypnosis group received a hypnotic induction with eye fixation, followed by direct
suggestions aimed at the labor experience (e.g., contractions likened to waves rolling on the sea)
to promote a sense of comfort and accelerate the speed of delivery. Hypnotizability was
determined by eye-roll measurement. Between-group analyses revealed important obstetric
differences, with the participants in the prophylaxis group being on average 1.5 years younger
than the participants in the hypnosis group, and the prophylaxis group containing more veteran
(multipara) mothers. The mothers in the hypnosis group had shorter labor (on average, the
primigravid mothers in this group had a shorter delivery by 98 minutes).
Jenkins and Pritchard (1993) conducted a nonrandomized study with 126 first-time
(primigravid) and 136 second-time (parous) pregnant women to investigate the effects of
hypnosis on the duration of labor and the use of analgesic medication during normal childbirth.
The study participants were volunteers who were offered six sessions of training in relaxation and
analgesia from a trained hypnotist. Two groups of agematched controls (300 first-time and 300
second-time mothers) served as comparisons for length of time spent in the first and second
stages of labor, as well as the use of analgesic medications. The primigravid pregnant women
who had received hypnosis treatment spent significantly less time than the matched controls in
the first and second stages of labor and were comparable to the parous pregnant women in
duration of labor and medication use. Additionally, the participants in the hypnosis treatment
groups used significantly less analgesic medications than the
DISCUSSION: We encountered a number of challenges in this review of the research
literature on the effectiveness of hypnosis in behavioral medicine. Specifically, the medical
illnesses we addressed were quite heterogeneous and involved various organ systems and diverse
physiological mechanisms, which precluded the possibility of a unified discussion of a single
entity. The types of medical treatments employed for the different disorders varied greatly as
well, the common denominator being the inclusion of hypnotic techniques and suggestions as part
of the medical interventions. The participants in the majority of the studies were medical patients,
and the clinical populations were defined based on a common medical diagnosis. Our task was
further complicated by the fact that few researchers indicated the procedures used to arrive at the
diagnosis. Moreover, clinical populations are likely to be heterogeneous in terms of age of onset,
duration of illness, comorbidity, treatment history, or current medications, and such
characteristics were not addressed in detail by any of the studies reviewed here. Such diversity
reflects and closely resembles the complexity of the actual clinical work, while complicating the
pragmatic aspects of conducting research in clinical settings and the analysis of the efficacy of
hypnosis in clinical medicine.
In addition to the difficulties inherent to research in clinical settings with medical populations,
there are difficulties inherent to the field of hypnosis. Clinicians and researchers of hypnosis have
not yet arrived at a consensus regarding concepts relevant to hypnosis, begging the question of
what is under investigation. Numerous difficulties have emerged from the interchangeable use of
terms such as hypnosis, relaxation, and guided imagery. Research methodological difficulties are
part and parcel of such conceptual fuzziness. Many different treatments were categorized as
hypnosis, despite significant differences among them. Psychological treatments included hypnotic
interventions, which ranged from specific direct suggestions for symptom control following a
hypnotic induction (Brann & Guzvica, 1987; Spanos et al., 1988; Spanos et al., 1990; Whorwell
et al., 1984) to a complex sequence of suggestions for relaxation, guided imagery, and well-being
(Enqvist et al., 1995; Enqvist et al., 1997; Ewer & Stewart, 1986; Ewin, 1992; Lambert, 1996;
Lang ct al., 1996; Zeltzer et al., 1991). At times, the hypnotic interventions were a component of
a more complex treatment, which included cognitive-behavioral interventions for stress
management and other interventions (Swirsky Sacchetti & Margolis, 1986). There were instances
when treatments involving hypnotic techniques and suggestions were not defined as hypnosis
(Lyles et al., 1982; Zachariae et al., 1996). The lack of a consensual definition of hypnosis and
the heterogeneity of the psychological treatment packages make it difficult to tease apart the
specific and unique role played by hypnosis in the treatment outcome.
Additional difficulties emerged from the lack of agreement regarding the role played by
hypnotizability in treatment outcome and the importance of measuring hypnotizability in medical
hypnosis. Several researchers did not consider hypnotizability to play a role in treatment
outcome, and therefore they did not measure it (Ewin, 1992, 1994; LaBaw, 1992; Lambert,
1996). Others did not provide a rationale for not measuring hypnotizability (Jacknow et al., 1994;
Zeltzer et al., 1991). In those situations when hypnotizability was assessed, there was a lack of
agreement regarding the best instrument to be used in a clinical setting. Whorwell et al. (1984)
determined patients' hypnotizability by observing their responses to the hypnotic suggestion for
arm catalepsy, whereas Brann and Guzvica (1987) measured the patients' eye-rolls. Other
researchers reported the use of a variety of standardized hypnotizability scales, among them the
HIP (Spiegel & Spiegel, 1978), utilized by Ben-Zvi et al. (1982) and Lang et al. (1996); the
SHCS (Morgan & Hilgard, 1975), utilized by Ewer and Stewart (1986) and Freeman et al.
(1986); the HGSHS:A (Shor & Ome, 1962), utilized by Swirsky-Sacchetti and Margolis (1986)
and Zachariae et al. (1996); and the CURSS (Spanos et al., 1983), utilized by Spanos et al. (1988,
1990). Interestingly, when hypnotizability was assessed at a later time, after the conclusion of the
treatment, and in a context seemingly unrelated to treatment, hypnotizability was not found to be
related to treatment outcome.
Despite the theoretical and pragmatic difficulties mentioned above, we would like to
underscore that, during the past 2 decades, there has been an overall improvement in the
methodological rigor of hypnosis research. Generally, the research studies were conducted with
well-defined clinical populations and were carefully controlled. To illustrate, the patients were
randomized to either a treatment that included hypnosis or to a control group (Enqvist et al.,
1995; Ewer & Stewart, 1986; Lambert, 1996; Lang et al., 1996; Spanos ct al., 1988, 1990;
Swirsky-Sacchetti & Margolis, 1986; Whorwell et al., 1984). Ewin (1992) and Whorwell et al.
(1984)conducted follow-ups several months after the conclusion of the treatment. Whereas some
studies included large enough samples to ensure statistical power (Research Committee of the
British Tuberculosis Society, 1968; Enqvist et al., 1997; Lambert, 1996), the number of patients
per group was typically below the 25 to 30 recommended by Chambless and Hollon (1998).
With the caveat that most researchers have used small sample sizes and that treatment
manuals are notably absent, some studies appear to satisfy the Chambless and Hollon (1998)
criteria for "possibly efficacious" treatments (Enqvist et al; 1997; Lambert, 1996; Lang et al.,
1996; Spanos et al., 1988; Swirsky Sacchetti & Margolis, 1986; Whorwell et al., 1984; Zachariae
et al., 1996; Zeltzer et al., 1991).
The studies investigating the effectiveness of hypnosis in the preparation of surgical
patients were methodologically sound (Lambert, 1996; Lang et al., 1996). Findings from
randomized, controlled experiments suggested that se~f-hypnosis was superior to the control
conditions in reducing the incidence of adverse effects and procedural interruptions (Lang et al.,
1996) and in reducing hospital stay (Lambert, 1996). However, the conclusion that the hypnotic
interventions may be "possibly efficacious" is qualified by the small sample size of the Lang et al,
study.
Despite an impressive sample size, the study conducted by the Research Committee of the
British Tuberculosis Society (1968) has a number of limitations: lack of objective outcome data,
lack of control for the natural course of the disease, inadequate presentation of results, over
reliance on descriptive statistics, and the fact that the researchers did not assess patients'
hypnotizability. Additionally, the small sample size and inadequate description of hypnotic
interventions (Ewer &Stewart, 1986) prevent us from concluding that hypnosis can be considered
a possibly efficacious treatment for patients with asthma.
Zachariae et al.'s (1996) study was methodologically sound. Its findings provided support
for the effectiveness of psychological treatment of patients with psoriasis; however, the treatment
was not defined as hypnosis, and it included a number of different interventions, which makes it
impossible to determine the role played by specific interventions in treatment outcome.
The studies conducted by Spanos and his collaborators (1988, 1990) on the effectiveness
of hypnosis in the treatment of warts were well designed. Hypnotizability, as measured by the
CURSS, failed to predict wart loss, whereas vividness of suggested imagery correlated
significantly with wart regression (Spanos et al., 1988; Spanos et al., 1990). The theoretical
implications of the findings from this series of studies were that psychological factors could
facilitate physiological changes that lead to wart remission. The mechanisms involved are not yet
under stood and require further investigation. The practical implications of the findings are that
the psychological treatment for warts may not require the employment of a hypnotic induction,
and that direct suggestions for wart removal may suffice.
In the Ewin (1992) study, the outcome of hypnotherapy was determined through visual
inspection of psoriasis skin lesions and comparisons of pictures taken at baseline, post -treatment,
and 6-month follow-up. It was unclear whether evaluations were made by independent observers.
It is noteworthy that the treatment proposed by Ewin contains direct suggestions aimed at wart
removal, which represented the hypothesized active ingredient in the treatment investigated by
Spanos and his collaborators (1988, 1990).
The Whorwell et al. (1984) study investigating the effectiveness of hypnosis in the
treatment of patients with IBS was designated as possibly efficacious by Compas et al. (1998).
However, there are a number of limitations to this work. The participants in this study were
nonconsecutive volunteers, almost all female, and the sample size was small (N = 15).
Hypnotizability was not measured. Furthermore, the "psychotherapist" for the comparison group
appeared to be a gastroenterologist, and his credentials as a mental health provider, if any, were
not specified. These limitations suggest qualified support for the effectiveness of hypnotic
interventions in the treatment of patients with IBS.
LaBaw's research (1992) on the hypnotic treatment of patients with hemophilia lacks
methodological rigor. Moreover, the study conducted by Swirsky-Sacchetti and Margolis (1986)
provides only qualified support for the effectiveness of hypnosis in the treatment of patients with
hemorrhagic disorders, given the complexity of the psychological intervention employed and the
inherent difficulty in teasing apart the role played by hypnosis. It is noteworthy that LaBaw's
treatment program appears to have common features with the treatment proposed by
Swirsky-Sacchetti and Margolis, and findings from both studies suggest that further research in
this area is warranted.
 The empirical evidence to date regarding the effectiveness of hypnosis in the treatment of
nausea and vomiting is inconsistent. The fact that these symptoms are common to a number of
medical conditions, or the unfortunate consequences of various treatments, and have complex and
unclear neurophysiological mechanisms, limits the comparability of study results and the
generalization of findings. The failure to find appropriate studies regarding the treatment of
hyperemesis in pregnancy is clinically disappointing and limits our discussion to oncology.
Tacknow et al. (1994) and Zeltzer et al. (1991) conducted randomized, controlled,
prospective studies in pediatric oncology, with well-described hypnotic interventions, appropriate
and well-defined outcome measures, and proper statistical procedures. They found hypnosis to be
superior to standard treatment aacknow et al.) and to distraction/ relaxation (Zeltzer et al.) in the
management of anticipatory nemesis and of the debilitating side effects of chemotherapy.
However, the support for the effectiveness of hypnotic interventions is limited by patient
heterogeneity, small sample size, absence of treatment manuals or protocols, lack of
hypnotizability ratings, and the heterogeneity of medical treatments.
At the time when we conducted our review, we could not find studies that included
hypnosis in the treatment of patients with eating disorders. However, several researchers have
reported increased incidence of high hypnotizability among patients with bulimia (Barabasz,
1991; Covino, Jimerson, Wolfe, Franko, & Frankel, 1994; Pettinati, Home, & Staats, 1985).
While no conclusion can be reached regarding this finding, further investigation of the
relationship between hypnotizability and bulimia, as well as of the potential efficacy of hypnotic
interventions in the treatment of eating disorders, seems warranted.
CONCLUDING REMARKS: More than a decade ago, Frankel (1987) concluded his
review of the applications of hypnosis in medicine by posing two questions: "How effective is the
intervention and what part of it belongs to hypnosis?" (p. 233). Today, we have a tentative answer
for Frankel's first question. In many of the studies reviewed, there is empirical evidence to
support the effectiveness of psychological treatments that include hypnotic interventions. To date,
there is qualified evidence supporting the use of hypnosis in the preoperative preparation of
surgical patients (Blankfield, 1991; Enqvist et al., 1995; Lambert, 1996; Lang et al., 1996), in the
treatment of a subgroup of patients with asthma (Ewer & Stewart, 1986) and in the treatment of
patients with dermatological disorders (Spanos et al., 1988, 1990; Zachariae et al., 1996), irritable
bowel syndrome (Whorwell et al., 1984), hemophilia (Swirsky-Sacchetti & Margolis, 1986),
postchemotherapy nausea and nemesis (Lyles et al., 1982; Zeltzer et al., 1991), and with
obstetrical patients.However, there is not enough information at present to adequately address
Frankel's second question. To date, it is unclear whether hypnosis adds anything to treatment
effectiveness above and beyond information, relaxation training, or suggestions provided without
a hypnotic induction. The specific role of hypnosis and hypnotizability is yet to be determined.
Interestingly, Wickramasekera (1995) hypothesized that high hypnotizability may contribute to
the exacerbation of anxiety associated with medical procedures and can serve as a symptom
amplifier for patients with a variety of autonomically mediated illnesses (e.g., asthma, bulimia,
dermatological diseases, hyperemesis, irritable bowel syndrome, pain). Wickramasekera, Pope,
and Kolm (1996) posited hypnotizability as an important variable in the development and
maintenance of certain medical illnesses. Thus, patients' high hypnotizability could be interpreted
as a liability rather than an asset, as interfering with, rather than facilitating, treatment outcome.
Assuming that researchers will be able to determine in the future that hypnosis indeed
adds something above and beyond other psychological interventions, the next step will be to
determine the mechanisms through which psychological and hypnotic interventions effect
physiological changes. Currently these mechanisms are not understood. Advanced hypotheses
include changes in immune functioning, autonomic control of blood supply, and an increased
subjective sense of cognitive involvement and control. Undoubtedly, this is a fertile area for
future research.
There are additional theoretical and pragmatic questions that await elucidation. These
questions concern the role played by individual differences in hypnotizability, vividness of
imagery, coping styles, prior medical/surgical history, treatment preferences, and motivation to
participate in a study. They also concern the complex interactions between such individual
differences and differing demand characteristics of various treatment contexts. Questions remain
as to the relative effectiveness of relaxation versus hypnosis, suggestions by a live therapist
versus tape-recorded suggestions, hetero-hypnosis versus self-hypnosis- Still others pertain to the
content, wording, and timing of suggestions to maximize positive outcomes. The identification of
the variables that mediate treatment effectiveness could assist clinicians in the development of
individualized interventions, with the potential to optimize treatment outcome. It is noteworthy
that physicians and other health care professionals are accustomed to studies with much larger
sample sizes to inform their selection, prescription of treatment╖ It is crucial that future
researchable conducted with larger samples than has been customary in hypnosis research.
Chaves and Dworkin (1997) underscored that research in hypnosis and
cognitive-behavioral modification has proceeded along parallel pathways with little interaction
The cross-fertilization of clinical and research efforts might be mutually beneficial to clinicians
and researchers in the area Of behavioral medicine. In the future, researchers need to be guided
by the methodological standards set forth by Chambless and Hollon (1998) and by conceptual and
assessment advances in the general field of behavioral medicine research.

12. THE HEALING POWER OF HYPNOSIS: CATHERINE MCNAUGHT: TALLAHASSEE

DEMOCRAT
Charles Evans has broken his back in two places and crushed two discs in his neck. He's
suffered through 11 major back surgeries and can be considered an expert on modern pain
medication. "I lived in so much pain, I couldn't tolerate being around myself, couldn't stand
being around other people," the 51-year-old Tifton, Ga., resident says. But now he's got a grip on
the pain -- by flexing the muscles of the mind. Evans uses self-hypnosis to battle the chronic,
disabling pain that is the legacy of the damage he sustained bending over to lift, of all things, a
30-pound bag of dog food. Evans also deals on a daily basis with the residual pain from two
vertebrae that broke while rough-housing with a co-worker in 1991. "A highly hypnotizable
person can really do amazing things," says Dr. Chris Lartigue, noting cases where people in a
deep trance state who have been told they have been burned actually develop blisters.
Dr. Chris Lartigue, director of the Human Growth Institute, a psychiatry office, taught
him how. "I can sit there and run that through my mind and it gets everything else off my mind,"
Evans says. "The pain seems like it's off in the distance," he says, likening it to reducing the
agonizing pain of a migraine to the dull thud of a slight hangover."Most of the time, (the pain) is
gone the rest of that day," he says. "Dr. Lartigue, he saved my life when you come right down to
it." Exacerbating Evans' constant physical pain was the mental anguish of knowing he would
never work again. "I was a workaholic," says Evans, formerly a grocery-store manager. "I loved
to work."
 He consulted several doctors. They all told him he would never work again. "I was highly
depressed," he says. He began considering suicide. That's when one of his doctors referred him
to Lartigue. Though he was skeptical, Evans gave hypnosis a try. He says it gave him his life, if
not his job, back. He remains on disability. Most hypnotherapists modestly protest that they
simply give patients the tools to heal themselves. "A highly hypnotizable person can really do
amazing things," Lartigue says, noting cases where people in a deep trance state who have been
told they have been burned actually develop blisters.
What medical professionals are learning is that mental power can be harnessed to heal.
"People who are highly hypnotizable -- and not everybody is -- are generally able to control
bodily functions that are usually thought to be outside of their control," Lartigue says. People in
a deep trance may be led to hallucinate, suppress or uncover memories, suppress impulses or food
cravings, even get rid of warts or psoriasis. But on who it works, and how and why, is still largely
a mystery.
Once considered a party trick of charlatans, hypnosis is just starting to open the eyes of
the medical community to its therapeutic effects. It's just been in the past five years that Florida
has required those practicing hypnotherapy to complete different levels of training and obtain a
license through the Department of Business and Professional Regulation.
Now, doctors and mental-health professionals are using hypnosis for anything from pain
management to maximizing athletic prowess. Hypnosis can help alleviate cancer pain.
Hypnotherapy falls into two basic categories: symptom suppression and psychotherapy.
"Symptom suppression can include such things as physical ailments, impulses, anxiety and
cravings," Lartigue says. "Exploratory hypnotherapy tries to uncover repressed conflicts often
times relating to early trauma that hinder coping with ongoing day-to-day life."
A common use of symptom-suppression hypnosis is in healing skin conditions. Through
"guided imagery where a person visualizes the skin healing and devotes daily sessions to
self-hypnosis," warts and other skin ailments can disappear. A technology assessment panel of
the National Institutes of Health recently found "strong evidence for the use of relaxation
techniques in
reducing chronic pain in a variety of medical conditions." It also specifically noted "strong
evidence for the use of hypnosis in alleviating pain associated with cancer." The panel's findings,
reported in a July issue of the Journal of the American Medical Association, found that hypnosis
helps reduce several types of pain -- lower back, burns -- by changing pain perception through
intense relaxation.
This appears to happen physiologically when the intense relaxation decreases breathing
rate and oxygen consumption, lowers the heart rate and blood pressure, and increases alpha brain
waves -- the brain wave pattern of an awake, relaxed adult whose eyes are closed. The effect is
essentially the same achieved by transcendental meditation,
Steven Zahn, a licensed marriage and family therapist, social worker and mental-health
counselor, says the bulk of his hypnotherapy work involves helping people quit smoking, lose
weight and reduce stress. Hypnosis works, he says, by letting suggestions enter the subconscious
without having to pass through any analytical gateway of the mind. "The conscious mind
analyzes everything," Zahn says. It picks suggestions apart, finds reasons not to believe them.
"We are today everything that happened to us before this moment," he says. If the analytical part
of the mind can be bypassed, then suggestions can take root in the subconscious. Often, smokers
who have failed to quit in the past have been sabotaged by the analytical part of their minds,
which constantly reminds them of the failure. "If I help you get into an altered state -- hypnosis
-- very similar to where you're daydreaming when you're in a trance, your mind is out there," he
says, waving in the direction of his office's window. "It is not in here listening to me," he says.
"You don't analyze it because it is something that you really want -- it goes directly into the
subconscious."
He has seen it work with patients -- he says the success rate of people he helps quit
smoking is about 93 percent after a year -- and he's also personally experienced the power of
hypnosis. Before he underwent triple bypass heart surgery, he prepared a personalized
continuous self-hypnosis tape and asked hospital staff to turn it on and put his earphones on him
after he left the operating room. He underwent surgery on a Wednesday morning. "By Saturday
morning I was home vacuuming the pool," Zahn says. "I didn't ring the nurse's button once. I
didn't ask for pain medication once." It wasn't because he played the stoic, Zahn says. It was the
self-hypnosis and visual imagery that helped him heal faster and overcome the pain. "If you can
picture these malformations healing themselves, they will do that," he says. People differ in
ability to enter a trance state Though most people don't realize it, they slip in an out of hypnosis
all the time.
Whether it's being on auto-pilot driving along I-10, numbly running a marathon or
becoming engrossed in thought while staring blankly at a computer screen, hypnosis is a daily
part of most people's lives. "You don't remember every curve of the road, every exit" along the
interstate, Zahn says. "By the time you know it, you're passing your exit." he says. "We are
constantly shifting in and our of these altered states. Your instinct is driving."
The actual mechanics of inducing hypnosis are not difficult, though people's ability to
attain trance state differ. Younger people are easier to hypnotize than the elderly. And "certainly
personality has much to do with it," Lartigue says. "Entry into the state requires the ability to trust
the hypnotist. And people with conflicts about trust will have a hard time letting themselves enter
into a deeper trance." The person also has to trust themselves enough to let go, Lartigue says. "If
one fears something deep down inside, he will erect barriers from entering trance state."
Though a rough correlation between intelligence and a person's ability to be hypnotized
have been made -- the more intelligent, the more likely a person is to attain a deep trance state --
Lartigue says it has been his experience that "people who have to shake themselves away from a
movie or people who don't hear their name being called because they're engrossed in a book,"
usually are highly susceptible to being hypnotized. There are various techniques to help a person
into hypnosis. "Traditionally in Western culture the state is entered into by imagery involving
relaxation and mental clearing, but in other cultures the trance states can be very active," Lartigue
says. In Arabic cultures, he says, "whirling dervishes . . . dance themselves into exhaustion" while
in hypnosis.
In the United States, most hypnotherapists have the patient relax with closed eyes and
visualize a soothing image. "We think in pictures, so I'm painting you a picture," Zahn says.
Soon, patients begin to tune out the hypnotherapist's words and "paint their own picture."
Essentially, when patients become so engrossed in the picture that they are not distracted
by immediate surroundings, the hypnotherapist can then use the power of suggestion. Zahn tapes
the sessions and has the patient listen to the tapes and practice self-hypnosis. Then patients can
continue the hypnotherapy at home. "The more someone practices, the better they get, the deeper
they get, and the benefit is that you learn more and learn faster," he says. Generally, he'll see a
patient four times in a month for reinforcement. By the end of the month, they should have all the
skills to carry on the hypnosis at home.
Applications for self-hypnosis run the gamut, Zahn says.He used it improve his grades
when he went back to school. By using hypnosis to put himself in a state of mind conducive to
learning, he made more effective use of study time and began getting A's, he says. He has taught
would-be attorneys to use hypnosis to study for the bar and taught patients how to use hypnosis to
promote healing before and after surgery. He's even helped people improve their golf game
through hypnosis.
Doctors, insurers resist use of hypnosis: "Hypnosis is (considered) a kind of witchcraft
sort of thing," Zahn says. "It's not real accepted, and it's a great tool. It's unfortunate that it's not
more accepted than it is." The Journal of the American Medical Association noted in its article
on hypnosis that it it remains the medical community's skepticism and focus on conventional
medicine that undermines the use of hypnosis. It's also time-intensive and requires the patient to
devote continuing time and effort, JAMA notes, so patients may not follow through. Also,
insurance companies largely are still not convinced they ought to pay for hypnosis. Zahn is
convinced that if both patients and the medical community knew how easy and effective hypnosis
is, the walls would crumble. "It almost sounds like magic because we're just not used to having
that power over ourselves, he says."
Catherine McNaught graduated from Macalester College in St. Paul, Minn. with a degree
in English, speech communication and journalism. Before joining the Tallahassee Democrat in
October as its health reporter, she worked at The News Herald in Panama City as a legal-affairs
staff writer.
This story was published Jan. 13, 1997 in the Tallahassee Democrat.

13. MEDICAL HYPNOSIS: USES, TECHNIQUES AND CONTRAINDICATIONS OF

HYPNOTHERAPY: CAROL WATKINS, M.D.
What is Hypnosis? There is no definite dividing line between a normal waking state and
a hypnotic or trance state. Examples of alterations in consciousness occur frequently and most
people experience some of them. Both children and adults can become so absorbed in
daydreaming that they lose track of what is going on around them. Some people consciously use
daydreams to divert themselves from certain aspects of their existence. When someone is
concentrating intently on a work project, the hyperfocusing that aids the work may also shut out
noises and other distractions. Someone who is absorbed in an activity may, when the activity
ends, need to take a moment to reorient to the external world
What hypnosis is not: Sleep. Adults who are hypnotized often prefer to have their eyes
closed. This is not necessary in order to have a deep trance state. In fact, many children prefer to
have
their eyes open and even to walk around during hypnosis. While in hypnosis, one's attention and
concentration is more focused. During sleep, this is not usually the case. EEG patterns during
hypnosis and during sleep differ. Hypnosis is intense focused concentration, with the partial or
complete exclusion of awareness of peripheral phenomenon. Some feel that individuals who are
able to become intensely absorbed in an activity or daydreaming make the best hypnotic subjects.
Hypnotic or trance states can occur spontaneously both inside the therapy room and in every day
life. Individuals may feel disappointed and say, "I didn't feel like I was under hypnosis." They
expect their eyes to close automatically and expect to feel a floating or tired state. Despite this,
within a few days, their target symptoms seem to get better. This may actually be good hypnotic
treatment. Individuals experience trance in their own way. Many, particularly children, do not
close their eyes or even remain seated, during the hypnosis. Some people may continue their
work consciously or unconsciously after they leave the session. Other individuals consider
medical hypnosis a failure because they have unrealistic expectations or goals. While hypnosis
may be the primary treatment of choice for certain symptoms and disorders, it is often
appropriate as an adjunct to other biological or psychotherapeutic techniques
Medical versus "Amateur" Hypnosis: When I explain hypnosis to a new patient, I
often have to explain how my procedures differ clinically and ethically from amateur stage
hypnosis. Stage hypnosis depends on a certain amount of peer pressure and a given individual's
conscious or unconscious wishes to perform. Frequently it is not done with consideration for the
subject's needs or vulnerabilities. I see hypnosis as a specific medical or psychological procedure
that should be done within the context of a therapeutic relationship. Recently a clinician from
another state asked for advice about branching out from clinical hypnosis to hypnosis for public
entertainment. I advised her to avoid this completely. It is important for licensed mental health
practitioners to use care in determining the appropriate venue for hypnosis.
Indications for Medical Hypnosis: Pain: Some patients worry that if hypnosis helps
their pain that it means that the pain in "all in my head." Actually, that is true because ALL pain
is mediated through the brain. Pain related to surgery or medical conditions such as shingles can
respond well to hypnosis. I usually work with the patient to build in safeguards so that he or she
will be alerted to any change or increase in the pain.
Habit Disorders: Hypnosis has been shown to be effective bruxism (repetitive teeth
grinding) I have used it successfully to help individuals stop smoking. For individuals with
alcoholism or other chemical dependency, I strongly suggest that if they are seeing me for
hypnosis, they also attend 12 step meetings.
Nausea and other Conditions in Pregnancy: I have had good results using hypnosis to
attenuate nausea associated with cancer chemotherapy. An added benefit in one individual was
the ability to learn to dilate small veins prior to a needle stick.
"Morning sickness," the nausea associated with pregnancy, can range from mildly
annoying to medically dangerous. Pregnant women often wish to avoid medication unless
absolutely necessary. I do not see hypnosis, in isolation, as a substitute for childbirth preparation
classes such as Lamaze or Bradley. However, it can work in combination with these approaches.
Women with anxiety disorders, who wish to avoid medication during early pregnancy, can often
use these techniques to decrease anxiety and minimize panic attacks.
Relaxation: Almost by definition, hypnosis induces a state of relaxation. This can be
short term, as when used to interrupt panic. When used with self-hypnosis, a motivated individual
can often achieve longer-term results.
Anxiety states: Hypnosis can help anxiety disorders in more than one way. It can
directly decrease anxiety and panic by inducing a state of relaxation. The therapist can also use
the hypnotic state to help the patient focus more clearly on issues that might be causing the
anxiety. Often the use of fictional stories, used as metaphors, can give the patient a new way of
looking at his or her problems. Story telling is more permissive than direct suggestions. It gives
the patient a chance to accept or reject the suggestion without feeling that he is being
non-compliant."
Interruption of strong emotional state: Individuals in crisis are often more susceptible
to suggestion.. Susceptible individuals may actually dissociate spontaneously during a trauma or
crisis. This tendency may be used therapeutically in emergency situations.
Psychotic Disorders: I do not use hypnosis as the primary treatment of schizophrenia or
bipolar disorder. However, I occasionally will use hypnosis to interrupt an intense emotional state
while waiting for other medical treatments to take effect. One must use caution when using
hypnosis with these individuals, but hypnosis is not absolutely contraindicated.
Psychotherapy: Hypnosis can be a useful part of exploratory psychotherapy. The
therapist often makes use of metaphorical stories to help the patient develop another way of
looking at certain situations.
Hypnotizability: Some, such as the Speigels, feel that each individual has an innate
capacity for achieving trance state. They see this capacity as relatively stable over time. They
suggest that there may be inheritability of this capacity. Thus, they do not use deepening
techniques as much as other clinicians. They do note that expectations and rapport with the
therapist can influence the success of the hypnosis. Milton Erickson emphasized less a
biologically determined capacity for hypnosis. He attempted to find metaphors suitable for each
individual. He also would use deepening techniques. He felt that individuals who seemed to have
a limited capacity for trance could still achieve trance states with proper technique. Many
clinicians approach their hypnotic work from a middle ground. It is useful to get a sense of the
patient's capacity to easily achieve trance. However, much can be done to deepen and enhance the
trance state. Additionally, a great deal of productive work can be done while an individual is in a
light trance state.
Hypnotic Induction: The induction is essentially a ritual that helps formalize a
transition to a more focused state of consciousness. Deep or light trance states can occur
spontaneously. The formal induction process serves to organize and structure the process so that
the trance state can be more efficiently used in therapy. There are a wide variety of types of
hypnotic inductions. Some therapists tend to use a particular type of induction most of the time.
Others vary the type of induction depending on the personality type and preferences of the
patient. Brief induction techniques can be more practical because the patient can often learn to
use it himself in "real world" situations.
Self Hypnosis: I will often teach patients how to use self-hypnosis so that they can gain
more control over the process. They can use it between sessions as boosters. Often I teach them a
long induction for when they have time and a shorter induction for quick use in crisis situations.
Individuals who have difficulty doing the self hypnosis may benefit from hypnosis tapes. I will
often make up custom tapes for certain patients.
Hypnosis and Children: Children are actually more easily hypnotized than adults. They
may become bored with a slow adult-type progressive relaxation induction. If one expects to see
a hypnotized child lie still with his eyes closed, one may conclude that the child is incapable of
trance.
Pain Children: When children experience pain, they may not understand what is going
on. Thus, the pain may be complicated by anxiety. Hypnosis along with sensitive, age appropriate
explanations, can result in good pain relief. In severe or chronic pain, the psychiatrist may want
to coordinate treatment with other medical specialists.
Anxiety Disorders: In separation anxiety, hypnosis can compliment a comprehensive
approach which may also include specific family guidance, psychotherapy and sometimes
medication. The hypnosis may help decrease the child's anxiety during separation by helping him
or her to carry an internalized representation of a parent with them. In reactive anxiety, (anxiety
directly related to stress) hypnosis may be the treatment of choice and further treatment may not
be necessary.
OCD: Cognitive psychotherapy can help a child or adolescent with OCD as it can an
adult.
ADHD: I do not use hypnosis as a primary treatment for ADHD or learning disorders.
Primary treatments for this condition include parent training, medication, educational
intervention, psychotherapy, and the use of support groups. Hypnosis can sometimes augment
these treatments by improving self-esteem, anxiety, and focusing.
Behavior disorders. When one is treating a child or adolescent, the goals of the parent
and school may be different from those of the child. In such situations, control issues may be
prominent. When I use hypnosis in such situations, I emphasize the permissive nature of the
trance state. I do not try to use the hypnosis to make a child do things he does not want to do. I
try to use the hypnosis to help the individual focus on the positive things he or she wants to
achieve. The trance state may help the child or adolescent break out of an oppositional stance by
encouraging him or her to think of creative solutions.
Contraindications for Hypnosis: is a controversial subject. Different clinicians have
varying opinions about the appropriate uses of hypnosis. I tend to be more conservative than
some other experienced clinicians. Most licensed clinicians agree that they should not use
hypnosis for public entertainment. It is not a good idea to try to induce hypnosis in a patient who
does not want it. One should not use hypnosis to try to achieve goals other than the patient's
wishes. Generally, it would be difficult to use hypnosis in this way. However, there have been
reports of manipulation of ambivalent patients in hypnotherapy and other forms of therapy.
There are a number of specific patients who I might feel would benefit more from
another type of psychiatric intervention. In such cases, I will discuss a range of treatments and
their potential risks and benefits. Hypnosis is one of a number of psychiatric treatment
techniques. The person doing the hypnosis should first be a well-rounded clinician with a
knowledge of psychiatric diagnosis and treatment.

14. HYPNOSIS & MEDICAL RESEARCH: THE STANDING OF HYPNOTHERAPY

Hypnosis was first developed as a therapeutic discipline by the Scottish physician James
Braid. Braid, who coined the term “hypnotism”, categorically rejected any supernatural
explanations of trance and grounded the study of hypnotherapy on a firm empirical and scientific
basis, publishing his research in Neurypnology (1843).
Hypnosis, Medical Research & the BMA: In 1892, the British Medical Association
(BMA) responded to growing interest in hypnotherapy by commissioning a special committee of
eleven doctors “to investigate the nature of the phenomenon of hypnotism, its value as a
therapeutic agent, and the propriety of using it.” Their report was received and published by the
BMA, it opens with a clear recognition of the phenomenon of hypnotic trance:
“The Committee, having completed such investigation of hypnotism as time permitted,
have to report that they have satisfied themselves of the genuineness of the hypnotic state.”
(BMA, 1892)
The BMA Committee proceeded to outline a detailed and accurate account of the physical and
mental characteristics of hypnotic trance, concluding with a summary of its principal therapeutic
benefits,
“The Committee are of opinion that as a therapeutic agent hypnotism is frequently
effective in relieving pain, procuring sleep, and alleviating many functional ailments.” (BMA,
1892) (More on the 1892 report follows this article)
In 1955 the Psychological Medicine Group of the BMA commissioned a Subcommittee
of experts to a deliver second report which was published in the British Medical Journal (BMJ)
the same year under the title of “Medical use of hypnotism”. Its terms of reference were: “To
consider the uses of hypnotism, its relation to medical practice in the present day, the advisability
of giving encouragement to research into its nature and application, and the lines upon which
such research might be organized.” (BMA, 1955)
The 1955 Subcommittee endorse the previous 1892 report, republishing it in the appendix
to their work, they comment that its conclusions “showed remarkable foresight and are mainly
applicable today.” They also provide a more extensive statement on the medical uses of hypnosis
and conclude that it is definitely an effective technique in the psychotherapy of neurosis,
psycho-somatic conditions and in the alleviation of physical pain:
“The Subcommittee is satisfied after consideration of the available evidence that
hypnotism is of value and may be the treatment of choice in some cases of so-called
psycho-somatic disorder and psychoneurosis. It may also be of value for revealing unrecognised
motives and conflicts in such conditions. As a treatment, in the opinion of the Subcommittee it
has proved its ability to remove symptoms and to alter morbid habits of thought and behaviour. In
addition to the treatment of psychiatric disabilities, there is a place for hypnotism in the
production of anaesthesia or analgesia for surgical and dental operations, and in suitable subjects
it is an effective method of relieving pain in childbirth without altering the normal course of
labor.” (BMA, 1955)
Following this report the British Society of Medical & Dental Hypnosis (BSMDH) was
formed and its training officially approved by the BMA. The BSMDH was subsequently
recognized by the General Medical and Dental Councils, the Medical Protection Society and the
Medical Defence Union. The Royal Society of Medicine now has a section devoted to the
dissemination of research on “Hypnosis and Psychosomatic Medicine”.
Hypnosis & Current Medical Research: Over its 150 year history, hypnotherapy has
been subject to innumerable research studies which lend clear support to its various therapeutic
applications. For example, one of the most recent clinical reviews of hypnosis and “relaxation
therapies” published in the BMJ reports the following evidence:
* “There is good evidence from randomized controlled trials that both hypnosis and relaxation
techniques can reduce anxiety, particularly that related to stressful situations such as receiving
chemotherapy.”
* “They are also effective for panic disorders and insomnia, particularly when integrated into a
package of cognitive therapy,”
* “A systematic review has found that hypnosis enhances the effects of cognitive behavioral
therapy for conditions such as phobia, obesity, and anxiety.”
* “Randomised controlled trials support the use of various relaxation techniques for treating both
acute and chronic pain,”
* “Randomised trials have shown hypnosis to be of value in asthma and in irritable bowel
syndrome,”
* “There is strong evidence from randomized trials of the effectiveness of hypnosis and
relaxation for cancer related anxiety, pain, nausea, and vomiting, particularly in children.” [BMJ
1999;319: 1346-1349 “Hypnosis and relaxation therapies,” Vickers & Zollman]
 However, these conclusions would be considered by many hypnotherapists to be
extremely conservative in their scope as they deal primarily with the use of rather basic
therapeutic techniques and with a narrow range of conditions. More and more benefits to
hypnotherapeutic treatment are being established as new methods are introduced from current
research in psychology and clinical psychotherapy.
Hypnosis, Hypnotherapy & Hypno-Psychotherapy: More recently there has been a
shift toward classifying the profession of hypnotherapy as a branch of psychotherapy, rather than
complementary medicine. Whereas the BSMDH is mainly composed of doctors and dentists,
there are many hypnotherapists who approach their practice from a background in psychology or
psychotherapy.
In 1992 the UK Council for Psychotherapy (UKCP) was formed to act as an “umbrella
body” for psychotherapy organizations of all orientations. A section was established for
‘hypno-psychotherapy”, i.e., the practice of hypnosis as a technique integrated within a broader
program of psychotherapy. “Hypno-psychotherapy is the branch of psychotherapy which uses
hypnosis. It rests on an extensive body of work and publications over the last three hundred
years, leading to that of Milton Erickson and those influenced by him. It understands that we
have a learned model of the world which can restrict the way we feel, what we understand, our
attitudes and behavior. Hypnosis is a state of relaxation which people enter voluntarily, during
which there occurs an altered state of conscious awareness. The therapist can intervene to draw
the individual’s attention to new possibilities, to alternative patterns of thought, emotions and
behavior. The methods and strategies used in therapy are designed to make use of the resources
and capabilities that reside within all people, and do not require the individual to fit into a
standardized pattern. Hypnotherapy may be invaluable for anyone seeking to resolve specific
problems, or for personal development.” (UKCP, 1999)
Techniques employed in hypno-psychotherapy may range from analytic methods aimed
at achieving personal insight, such as regression or dream interpretation, to future-focused
techniques aimed at directly removing symptoms or modifying behaviour. It seems increasingly
likely that in the future the hypno-psychotherapy profession will be regulated so that only
practitioners trained in psychotherapy will be qualified to practice.
1892 BRITISH MEDICAL ASSOCIATION REPORT ON HYPNOTISM: 1892
BMA Committee Report on Hypnotism: In 1891, the British Medical Association (BMA)
appointed Sir William Broadbent, Sir William Gairdner, and a committee of nine doctors æto
investigate the nature of the phenomenon of hypnotism, its value as a therapeutic agent, and the
propriety of using it. It is worth noting that the technique of “hypnotism” evaluated was probably
some version of the classical Braid method, although the Committee also sent a representative to
investigate the methods of hypnosis used in the Paris and Nancy schools, i.e., the techniques of
Charcot and Bernheim. At the Annual Meeting of the BMA, in 1892, the committee presented
and unanimously endorsed the following report which was referred back once for further
consideration. In 1893 the committees report was resubmitted along with an appendix containing
further documentary evidence. The committee were thanked for their work and the report, which
accepts the therapeutic use of hypnosis and rejects the theory of Mesmerism (“animal
magnetism”), was officially received by the BMA.
1892 BMA Report on Hypnotism: The Committee, having completed such
investigation of hypnotism as time permitted, have to report that they have satisfied themselves
of the genuineness of the hypnotic state. No phenomena which have come under their
observation, however, lend support to the theory of “animal magnetism”. Test experiments
which have been carried out by members of the Committee have shown that this condition is
attended by mental and physical phenomena, and that these differ widely in different cases.
Among the mental phenomena are altered consciousness, temporary limitation of
will-power, increased receptivity of suggestion from without, sometimes to the extent of
producing passing delusions, illusions, and hallucinations, an exalted condition of the attention,
and post-hypnotic suggestions. Among the physical phenomena are vascular changes (such as
flushing of the face and altered pulse rate), deepening of the respirations, increased frequency of
deglutition, slight muscular tremors, inability to control suggested movements, altered muscular
sense, anaesthesia, modified power of muscular contraction, catalepsy, and rigidity, often
intense. It must, however, be understood that all these mental and physical phenomena are rarely
present in any one case. The Committee take this opportunity of pointing out that the term
hypnotism is somewhat misleading, inasmuch as sleep, as ordinarily understood, is not
necessarily present.
The Committee are of opinion that as a therapeutic agent hypnotism is frequently
effective in relieving pain, procuring sleep, and alleviating many functional ailments. As to its
permanent efficacy in the treatment of drunkenness, the evidence before the Committee is
encouraging, but not conclusive. Dangers in the use of hypnotism may arise from want of
knowledge, carelessness, or intentional abuse, or from the too continuous repetition of
suggestions in unsuitable cases.
The Committee are of opinion that when used for therapeutic purposes its employment
should be confined to qualified medical men, and that under no circumstances should female
patients be hypnotized, except in the presence of a relative or a person of their own sex.
In conclusion, the Committee desire to express their strong disapprobation of public
exhibitions of hypnotic phenomena, and hope that some legal restriction will be placed upon
them.
F. Needham, Chairman. T. Outterson Wood, Hon. Sec.

15. HYPNOSIS IN MEDICINE: DAVE BRAGER: JAN 2001

Throughout history, there has been a struggle for each human to overcome fear in his or
her attempt to survive pain. This survival has taken place through a variety of discoveries, both
internally, through reason and thought, and externally, through machines and constructions.
The limits of our abilities have been tested by experimentation, trial and tragedy. Of these
limitations, fear of the unknown has been the gravest limitation of growth.
Discoverers and explorers have pushed our knowledge of the outer world while doctors
and philosophers increased our knowledge of the inner world. With each new discovery, society
has tested theories, accepted a few as consistent, adapted these into practice, and transcended the
fears of old with a fresh, bold hunger to learn more.
Over time, unusual mental phenomena have occurred which allow people to overcome
pain by turning off their abilities to sense stimulations. Such controls have allowed people to
survive what would otherwise be undesirable or unbelievably cruel levels of pain.
Phenomena of survival have commonly been dismissed as miracles or freaks of nature.
For centuries, such were never seriously considered as solid scientific discovery (BSMDHW).
Ever since 1836, when a method was developed by which one could induce the
phenomenon, a new terminology was coined to describe this thought-provoking process. The
term has been in use to describe it to this very day: "Hypnosis" (BSMDHW).
Hypnosis is the ability to put oneself into a trance-like state by autosuggestion (Mosby).
So, as defined by Mosby, "autosuggestion by oneself" means that hypnosis is actually self-
induced. Therefore all hypnosis is self-hypnosis.
Hypnosis use in the medical field needed to radiate more authenticity. Thus, in the use
specifically for the reduction of pain, the medical terminology is called "hypnoanesthesia"
(Defechereux, 1938).
For a patient to achieve pain reduction through hypnosis, the patient must become an
integral member of the surgical team (Mutter, 705 [4]), for the patient becomes his or her own
anesthesiologist. However, in the rare case that a patient slips out of hypnoanesthesia, the
standard anesthesiologist will step in and administer general anesthesia (Defechereux, 1938).
Based upon the procedures noted, there were basically two types of induction approaches used,
both of which induce intense levels of boredom (the key which unlocks the entrance to the
subconscious):
Eyes open suggestion/fixation (Whorell, 69[4]) or Erickson's method (Defechereux, 1938;
Havens) require the patient to focus his or her eyes on a single point or spot on the wall (often a
single beam of light on a wall in a dark room) until the patient is bored into a subconscious state.
Eyes closed suggestion (Halligan, 986) or scripted (Lang, 1486), which also place a patient in a
calm or dark room (Loitman, 118), but allow the patient to use his or her imagination while a
monotonous repetition of words (Mosby "Self-Hypnosis") coax a person into a subconscious
state. It has been found that hypnosis does not increase endorphin production as it was once
thought to occur (Anonymous, 313[6]). In plain language, this means that the brain is not being
affected by the morphine-like drug, endorphin, that the brain is known to have the ability to
create. Thus, such pain relief is not clearly understood, though there are many technical theories.
One theory has been hypothesized that hypnosis blocks pain from entering the consciousness by
activating frontal-limbic attention systems to inhibit pain impulse transmissions (Anonymous,
313[6]). What this means is that the state-of-mind which is created by hypnosis keeps the signal
of pain from entering the conscious mind. The hypnosis does this by shifting the attention
systems away from the stimulation that pain creates. By shifting attention, the brain does not
process the stimulation or note that anything in the body's operating environment is abnormal.
Under normal conditions, when the body notes a problem, it will then turn on the signaling
sensation of pain, noting that some part of the body is hurt, broken, or ill.
It has been found that hypnosis does not actually stop the signaling of pain. When this
discovery was first made, there was a concern that people who underwent hypnosis were actually
feeling the pain but masking their emotions. However, further studies revealed that although the
pain signals were being generated by the body, these sensations were not being processed by the
brain. Thus, the patient was not "feeling" the pain. It is this distinction which is essential to
understand how a patient, who has had hypnoanesthesia, does not go into post-surgical shock
(Wolkes, 22[6]).
Hypnosis began its use in surgery in 1837 when Dr. James Esdaile, a Scottish surgeon,
adapted and used it as his sole anesthesia for painless surgery in India (Mutter, 705(4);
BSMDHW). From his experimentation and use, post-surgical shock dropped from 50% to only
5%, but his credibility amongst his peers lapsed, due to their distrust of something as mysterious
as hypnosis(BSMDHW). The stigma hypnosis has had was recently shattered by medical doctors
who tested it extensively and found similar successes.
 Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for
hyperparathyroidism were performed under hypnoanesthesia using Erickson's method. The
surgeons all reported better operating conditions for certivotomy using hypnoanesthesia, with
only two (1%) requiring General Anesthesia (Defechereux, 1938).
Biobehavioral "non-pharmacological" analgesia in the form of imagery, relaxation
training and hypnosis has been used successfully to treat procedural pain (Lang, 1486). Clinical
practice guidelines for acute pain management, published by the U.S. Public Health Service,
mention relaxation exercises and cognitive approaches. However, other uses are now being
explored.
Eighteen patients, ranging from ages 20 to 48, were monitored for the effects of hypnotically
induced emotions of excitement, anger, and happiness on colonic motility (spontaneous motion).
Each patient had a solid-state catheter entered into their anus via an colonoscope. After each
patient was hypnotized, he or she was then suggested to feel each intense emotion. During the
suggestion of a specifically intense emotions, the patient's colon motility was then measured.
During the test, the suggestion of anger, and then of excitement, each revealed high motility.
However, the suggestion of happiness caused a measurement which was so low, it equated to the
baseline (pre-hypnosis, fasting) measurement. The study purported to have proven that
hypnosis-based emotional suggestions indeed had effects on colonic motility. The authors further
suggested that hypnosis might be effective for patients with irritable bowel syndrome (Whorell,
69[4]).
In another case study, a patient with longstanding conversion hysteria, which is a medical
term for psychosomatic leg paralysis, was monitored by using Positronic Imaging Tomography,
which is known in the medical field as a "Pet Scan." It was discovered that two distinct
prefrontal areas of the brain were activated.
The doctors in the study hypothesized that if someone was hypnotized to believe he or
she had leg paralysis, thereafter, that person's brain would, by Pet Scan, reveal similar prefrontal
activity. So, a second patient, who did not suffer from conversion hysteria, was hypnotized using
an eyes-closed relaxation and deepening involving visual imagery and the sensation of descent.
After the induction, the patient was suggested that his left leg was paralyzed. The patient
believed the suggestion and found he could not move his leg. After the hypnosis suggestion was
made, the PET scan that was done which revealed similar prefrontal activity in the hypnotized
patient as to that of the non-hypnotized patient with actual hysterical paralysis. Thus, it was
considered that this conclusion supports the growing body of evidence that shows hysterical and
hypnotic paralysis share common neural systems (Halligan, 986). On the other hand, in treating
psychosomatic conversion hysteria, hypnosis also been shown to provide a cure. A patient from
Libya, who was suffering from leg paralysis, had been in and out of medical hospitals all over
Europe, but no possible organic explanation or solution could be found to explain his illness. In
Paris, it was suggested that his illness may be psychosomatic, and was thus seen by Chawki
Azouri, a Lebanese psychoanalyst from the Centre de Formation et de Recherche
Psychanalytiques. While in a hypnotic state, it was discovered that the patient's father had abused
him, both with mind-altering drugs and tormentation, in an attempt to control his behavior into
accepting an arraigned marriage. He resisted, and in the process, paralyzed himself with fear, on
a subconscious level, which removed him from having to deal with the situation. After two
months of sessions, wherein the patient overcame his mental anguish in relation to his family
problems, his paralysis disappeared, and he was deemed "cured."One of the greater benefits of
using hypnosis in medical procedures is to effect and shorten the patient's time to recover. This is
not only beneficial for the patients but also for the doctors, staff, and hospitals, for every minute
one patient is moved out, there is room for the next patient to move into place, especially in
operating rooms.
Replacing or supplementing anesthesia with the relaxation techniques reduced the
average procedure time by 17 minutes (20% of total procedure time). This, in turn, reduced the
average procedure cost by $130 per patient (Lang, 3097). Such reduction in cost was primarily
the result of fewer interruptions during the procedures and avoiding over- or under-sedation of
the patient that usually results in the patient being held overnight instead of being released in a
few hours.
Consider Kadlec Medical Center, which has eight operating rooms. During a twenty-four
hour period, assuming the average data from Lang is correct, each operation normally takes
eighty-five minutes. Thus, at maximum in a single day, there are roughly sixteen completed
operations per room.
If twenty percent of the operating time was eliminated by using hypnoanesthesia, the
average time per operation would then be sixty-eight minutes. At this rate, a room could
maximally host roughly twenty-one sessions in a twenty-four hour period.
When taken to the fact that Kadlec has eight operating rooms, the cost effects on the
profitability of a hospital become clearer. Without hypnoanesthesia, the maximum number of
operations in a single day Kadlec can perform is 128, but if they adapted hypnoanesthesia, they
could deliver 168 surgeries per day. This is approximately a 30% increase in overall operating
room effectiveness. In the case of the 197 thyroidectomies and 21 cervical explorations for
hyperparathyroidism, all patients having hypnoanesthesia reported a pleasant experience and had
significantly less postoperative pain and analgesic use (Defechereux, 1938). This is of recent
major benefit, for drug addiction, especially for prescription drugs, is often implicated from
dependency on painkillers.
Hospital stay was also significantly shorter, providing a substantial reduction in the costs
of medical care(Defechereux, 1938). Using figures from Kadlec Medical Center, when a patient
has to be moved to a room, even for an eight-hour stay, a room rate of $500 is tacked on the
patient's bill. When a patient recovers enough to be released without being checked into a room,
the savings become very clear.
When considering pain management, dentists have found hypnosis to be effective for
patients with painful toothroot sensitivity. In a study done by the United States Air Force Dental
Corps, eight patients, all of whom had suffered with this problem for an average of four and a
half years, were induced into hypnosis and told that they could tolerate or ignore pain on one
side of their mouth. The hypnotic suggestion was implanted once a week for three weeks, and in
all, seven of the eight patients' pain sensitivity decreased, as this result was tested, and lasted for
over six months.
Hypnosis has even been found useful in increasing the blood content of white blood cells.
In a study done at Washington State University by Professor Arreed F. Barabasz, Ph.D.,
sixty-five volunteer college students were selected, had blood samples taken to determine current
white blood counts, and categorized into two groups. One group of 33 students were easily able
to achieve hypnosis while the other 32 had great difficulty. All volunteers then watched a video
describing the immune system. Afterwards, they then listened to a hypnotic induction asking
them to imagine their white blood cells attacking "germ cells," and for them to repeat the
self-hypnosis process on their own time twice a day. Students who easily underwent hypnosis
revealed, in blood tests taken at the end of the study, a larger increase in two major classes of
white blood cells than those students who did not take well to hypnosis. Thus, the study
purported that hypnosis may prove to be helpful in the treatment of Cancer and AIDS (Bower,
152[1]).
With so many discoveries on the use of hypnosis, there has been more emphasis on
learning and disseminating these approaches to others. One of the pioneers in this field has been
Stanford University Professor Emeritus Ernest R. Hilgard, who opened Stanford's Laboratory of
Hypnosis Research in 1957 (Wolkes, 22[6]). Dr. Hilgard believes that hypnosis is a technique,
like using a stethoscope. It is based in a routine skill, which require minimal abilities to be
delivered to a patient.
One who delivers hypnosis must develop an acute awareness of the responses a
hypnotized patient will deliver more precisely over that a non-hypnotized patient. According to
Dr. Hilgard, who has produced the most widely used experimentally derived scales for
measuring hypnotic susceptibility, there are three primary differences a hypnotized patient
delivers which a non-hypnotized patient will not:
Intensely controlled muscular action, such as inducing temporary paralysis, is easily
produced in the hypnotized patient. As noted above, a patient who accepts paralysis under
suggestion will create the same neurological processes as are involved with actual conversion
hysteria to induce such paralysis. Secondly, hallucinations that alter a patient's field of vision are
accepted as real. Such suggestions test how deep the patient's belief in the hypnosis really is. A
hypnotized patient, with eyes open, can either "see" things that are not real, or edit out things, that
others around them can see, from their own sight.
Finally, a patient's acceptance of a suggested imaginary activity or ability is effortless. By
watching how a patient adapts, accepts, and believes in the suggested activity, the patient delivers
visual signals to the hypnoanesthesia team on just how hypnotized the patient is. So, if a patient is
told that he or she had just climbed Mt. Everest and needed to tell about it, the patient's
imagination would rationalize the suggestion as real, augment a false memory with details so the
patient would be professing "truth" because the patient was unaware the story was being
generated merely by a working suggestion. With the dissemination of information expanding on
the use and acceptance of hypnosis among medical practitioners, especially with the help of
internet sources, the trend for more adaptation of these techniques appears to be well supported.
Combined with the testing for new avenues of use, the future of hypnosis in medicine looks to be
an enterprising field.
As health care costs have skyrocketed, when one considers how hypnosis aids shorter
surgical procedures, decreased anesthesia use, and faster recovery time, the financial benefits
become abundantly clear. Any process which factors into lower medical costs, better pain
reduction, and higher survivability for the patient must have more information generated to
educate and aid the general public's acceptance and request for its use in their own medical
therapy. Hypnosis should become a standard practice in the medical field. In this way, it can
better aid the survival of humankind.

16. HYPNOSIS IN NURSING: ETHEL PERCELAY: HYPNOSIS VOL 1 # 1: 1954

At first glance, it might appear incongruous to couple hypnosis with nursing. Tho word hypnosis
popularly brings to mind a long-bearded, beady - eyed, Svengali - like figure, which one pictures
as wielding all undue influence over its weak-willed, weak-minded victims, powerless Lo resist.
This picture is as overdrawn and fallacious as the popular conception of the nickelodeon villain in
the gaslight era. They are both ridiculous caricatures when viewed in the light of current
knowledge. Unfortunately, many misconceptions about hypnotists and hypnotism continue to
persist, due to ignorance, and are grossly unfair to the men doing such valiant work in the field
today.
The leaders employing hypnosis currently are more and more apt to be men with a good
basic knowledge of psychology, frequently professional men from the medical, dental and allied
fields who realize the potential value of hypnosis when used in therapeutics. It is preferable, in
fact ideal, if the hypnotist has the background of a Ph.D.. M.D., etc., but this does not preclude a
beneficial use of the hypnotic principle by intelligent persons in many fields. Bc it then conceded
that it can be applied successfully in many varied areas of endeavor wherein one human being has
social intercourse with others. This may encompass such divergent careers as teaching, medicine,
salesmanship, transportation, public affairs, etc. Basically, contact between humans in any work
necessitates salesmanship of a sort, whether it be merchandise, ideas or personality, and
salesmanship to be successful avails itself of psychological application. In other words, there is
no facet of human relationships that could not be enhanced advantageously by use of the
hypotonic principles.
For the sake of clarification, let us try to define hypnosis very briefly. The nearest
synonym of hypnosis is suggestion. Actually, there are many depths of trance, all of them
characterized by the presence of varying degrees of suggestibility. In the narrow meaning,
hypnosis call be defined as a trance state, in which the subconscious becomes more acute,
becomes capable of accepting and credulating the suggestions offered, unopposed by any
conscious resistance or rationalization. The deeper the trance state, the more spectacular the
results; however, the general tenets of hypnosis (or suggestion) work efficiently on receptive
individuals. In fact, suggestion can be accepted and acted upon by a subject not obviously
hypnotized at all.
Herein then is the area, a fertile one indeed, in which the nurse can avail herself of the
value inherent in the application of hypnotic principles, thereby affording considerable benefit
and comfort to the patient. Clever hypnotic technicians are able to induce hypnosis by the indirect
or disguised method, in which the subject is unaware that he is hypnotized. While no one suggests
that every nurse be a hypnotist, it is both practical and feasible for the nurse to use suggestion of
the direct and indirect variety to the fullest possible degree.
A person when ill has an even greater degree of suggestibility than when healthy and
active. Understandably, the patient has an exaggerated interest in and awareness of his body and
its physiology. This self interest heightens his reactions to positive or adverse suggestion.
Everyone is familiar with the tabloid comic story in which the feature character leaves home in a
fit state, but after being bombarded with one suggestion after another by his cronies, of how
poorly he looks, he ends up in a highly disturbed state in the doctor's office. If suggestion can be
used to make the healthy feel ill, it can also promote the recovery of an ill patient. The
incarcerated patient particularly is ever alert for any clues that would divulge his condition or
prognosis. He is alert to every nuance of the doctor's or nurse's conduct, watches for any
meaningful glance that passes between them, and constantly is ready to jump to premature
conclusions. If the nurse manifests a confident, serene manner it is transferred to the patient and
is reflected in his attitude towards his illness. Conversely, indecision, escalation, or any unduly
alarming actions on the part of the nurse, is a threat to the patient's sense of mental and physical
well-being.
All phases of nursing require the nurse to inspire confidence in her innate kindness,
human understanding and professional know-how. A nurse, despite her proficiency, technical
skill and knowledge, can unwittingly be a liability to a patient if she applies detrimental
psychology in her nursing. It is a recognized premise in the medical profession today that all
illnesses, to a lesser or greater degree, are psychosomatic in character. That is, the clinical
physical picture is accompanied by a corresponding trauma on the psychic or emotional side, and
by the same token, emotional ills give rise to somatic ( physical) symptoms. Very often the two
are dovetailed so closely as to be indistinguishable. But to the patient, ills are ills, with real pain
and discomfort, and that being so he has no concern with the source of his distress, be it organic
or functional - real imagined.
Positive, constructive suggestion, given at the propitious time, can be a tremendous
element in the patient's recovery. The judicious doctor invariably instills this feeling of
confidence in his patient in his daily visits, but these, of necessity, are very fleeting, and so is the
duration of the perking up. The nurse, being with the patient for lengthy periods, has an enviable
opportunity to establish this rapport and draw a full measure of benefit out of the situation.
I would like to illustrate the aforementioned theory by citing an authentic situation I
observed recently. We have, in this instance, a semi-private room in a general hospital, occupied
by two male patients, both being attended by private duty nurses. The diagnosis of the patients is
the same-coronary occlusion, a condition directly affecting the coronary arteries, the vessels
which carry blood to feed heart muscle tissue. This is a serious illness, since the heart (or pump)
is the organ responsible for blood circulation of the entire body. It follows then that any
malfunction or pathology of the heart has serious consequences systemically. The nervous 8ystem
directly affects the action of the heart and its auxiliary vessels so that a prime requirement in the
nursing care of this type of patient is to establish an optimistic attitude, and allay the
apprehensions so characteristic of the coronary patient.
Patient A was a 68 year old male who had always been extremely active and
hard-working and had never allowed himself the luxury of a vacation in the past 45 years.
Despite this history, his nurse was able to teach him to relax. She explained to him that undue
worry or exertion, mental of physical, could only cause further wear and tear, that henceforth his
activities should be geared to a slower tempo in keeping with his physical ability. This patient
accepted his new status and was very cooperative. Though there was the incidence of a
complication or two during his hospitalization, thc nurse was careful to assume an attitude
indicating to the patient that it was a foregone conclusion that he would recover, that any new
developments or symptoms were only temporary in nature. The suggestion that all important
organs and functions were progressing favorably was reenforced by her frequently. The patient
recovered and after his first week began to enjoy certain phases of his "rest." He took an active
interest in ordering his food, was insistent that the barber make daily visits, and assumed the air
of a good host to his visitors.
Patient B was a 4,9 year old male, the head of his own business, who appeared very
apprehensive, very insecure, and admitted that he felt driven by a terrific obsession to make more
and more money, though he had already amassed a sizeable fortune. He wanted his hand held
whenever he felt the slightest twinge of pain, and generally reminded me of a small boy who is
afraid of the dark.
 It was his misfortune to have a nurse who only added to his general apprehensiveness. She
was well intentioned, very concerned for his welfare, and very excitable; when the patient wasn't
frightened at the possibility of an "impending attack," the nurse was. She would question him
repeatedly in the following vein: "Do you feel any pain around the heart?-Do you think you are
getting enough air?-Maybe you should have some oxygen now?" etc. She kept up a constant flow
of questions of this nature; in effect, she kept plying him with negative, destructive suggestion,
which conspired to worsen the patient's own fears. Her sympathy, the sympathy of his family,
literally swamped him in self-despair. He became progressively more irritable and defiant of the
advise given by his doctor. His hospitalization was much longer than would otherwise have been
necessary. When he was finally discharged, he had the appearance and attitude of an invalid, and
bid fair to continue dramatizing his situation out of all proportion to reality and living in constant
fear of further attacks.
There are many other phases of nursing in which the application of hypnotic principles
has proven efficacious. Patients in a hospital at night have very distorted ideas of the passage of
time; brief periods of wakefulness are magnified manifold in their minds. The average patient
receives a sedative at the hour of retiring. Very frequently after receiving the maximum dosage of
a hypnotic or sedative drug a!! prescribed by the physician he continues to complain of either
pain or inability to fall asleep. Giving the patient a placebo-a sugar pill or a sterile water
hypodermic with the suggestion that this is a very strong medicine which works quickly and
effectively-almost invariably produces the desired result. In other words, it is the suggestion itself
, accepted unconditionally by the patient, that relaxes him and produces the ensuing sleep.
In the case of a post-operative patient who is to get out of bed and be ambulatory on the
same day of operation, it can be suggested in a positive and confident manner that he can
accomplish this without pain or ill effects. The suggestion can be rendered more effective by
pointing out that this procedure prevents the "gas pains" that formerly accompanied the first three
days post operative. When these assertions are made in a natural, matter-of-fact manner, the
patient loses his fears, gets out of bed with a minimum of difficulty and enjoys a comparatively
uneventful recovery.
The high incidence of cancer patients admitted to the general hospital is a constant
challenge to the nurse. In many cases these patients return a second and third time after initial
treatment was instituted. Though many of them are not aware of the diagnosis, they often are
suspicious of it, especially in the terminal stages when they become aware of severe pain. Above
all the nurse should be the agent who, by her words and actions, helps to sustain the morale and
emotional economy that these patients so sorely need. Neither the assumption of a ridiculous
optimism nor a simpering sympathy would serve these patients well. They deserve a realistic
evaluation of their illness and prognosis and an understanding tempered with a sincere effort to
help in every way possible.
It has been stressed that the hypnotic situation is based on a strong interpersonal
relationship between the hypnotist and his subject. This same rapport can be realized between the
patient and nurse to the extent that the former finds a source of comfort and strength. Also,
indirectly, the nurse's contact with the patient's family, who are usually informed of his clinical
status, can make her a valuable ally in the difficult period ahead. In summation, it should be
apparent that the application of sound psychological principles, a component part of hypnosis, is
a valuable asset to the practicing registered nurse.
17. HYPNOSIS AND ITS MEDICAL INDICATIONS: WILLIAM S. KROGER: JOURNAL OF
PSYCHOPHYSICAL SCIENCES AND HYPNOSIS: 1967
There is increasing recognition that various types of suggestion and/or medical hypnosis
are particularly effective tools for treating psychosomatic conditions.
First, may I define these terms as used in this particular frame of reference. “Suggestion”
refers to the uncritical acceptance of an idea perceived through any and all sensory modalities.
Thus signs and messages can impinge on the cortex not only through the five senses but as the
result of kinesthetic, proprioceptive, thermal and about a dozen other types of stimulation arising
from within or without the organism. Suggestions may be verbal. non-verbal (facial expression).
intraverbal (the intonation of the voice) and extraverbal ("are you not tired of standing?" Instead
of, "Why don't you sit down".)
A good operational definition of hypnosis is the induction of state in the organism
wherein there is increased susceptibility to suggestion which alters sensory and motor activities
and as a result, initiates appropriate responses. All physicians, consciously or unconsciously.
employ various forms of suggestion in their therapy. Yet, they seldom realize that faith and
confidence in the doctor is the curative force. Voltaire once stated, "There is more cure in the
doctor's words than in the drugs he prescribes. " The validity of this trite observation is supported
by the fact that many symptoms often can be relieved by placebo medication. Hence, if the effect
of simple suggestion as embodied in these procedures, is so efficacious. then hypnotherapy, the
acme of scientifically controlled suggestion, should even be more helpful for the relief of a wide
variety of psychosomatic symptoms. The author is not a therapeutic nihilist, but firmly believes
that if a doctor is given the antibiotics, the immunologic agents and a choice of about fifteen
drugs, along with a good knowledge of differential diagnosis and a profound knowledge of
suggestion, he will be a good physician.
It must be emphasized that hypnotherapy refers to symptom removal and is directed only
to the functional component of psychosomatic ailments, and only of course, after a thorough
physical examination has ruled out organic factors. The term psychosomatic refers to the
interaction and interdependence of emotions and bodily functions in the production of symptoms,
and it is obvious that in nearly every disease, the psyche must be treated as part of the total
approach to the patient. Hence psychosomatic medicine is not a specialty but a point of view that
can influence the physician's ministrations. Hypnotherapy thus becomes just another arrow in the
doctor's quiver or therapeutic armentarium.
During the last decade there has been more research and clinical applications of
hypnotherapy to all branches of medicine than in its entire history. The British Medical
Association, after a thorough taught the fundamental principles of hypnosis as it was particularly
valuable in the treatment of the psychoneuroses, and for an adjunct to obstetrical and surgical
anesthesia. In the United States, the A.M.A. Council on Mental Health is now considering how
hypnosis can be integrated into the medical curriculum.
Despite all the medical and lay publicity, there are still many misconceptions about
hypnosis. Namely, that only weak-minded people can be hypnotized; that the hypnotist must be a
very powerful figure; that one is rendered unconscious and made subservient to the will of the
operator and might be made to do something contrary to his moral code. All of these are
fallacious. THE ONLY DANGER FROM THE USE OF HYPNOSIS IS THAT IT IS NOT
DANGEROUS ENOUGH! Most physicians believe that the main problem is learning to induce
the hypnotic trance. This knowledge is readily achieved. Actually, hypnosis is a double edged
scalpel which can be utilized as a therapeutic and diagnostic technic. Also, hypnosis has definite
limitations and, similar to the surgeons scalpel, its use requires training, experience and
judgement to determine when and where it will be of value. Its injudicious use has led to
disillusionment twice during the last century. Fortunately, the latest resurgence is being
controlled by reputable scientists, who are deriving their data from carefully conducted
investigations.
The revitalization of hypnosis began when a few psychiatrists decided to try it in the
treatment of battle fatigue, hysteria, anxiety, neuroses, and other depressive reactions which were
rampant during World War II. At this time it was noted that when hypnosis was combined with
dynamic psychotherapy (hypnoanalysis), the time for treatment was materially shortened. Indeed,
so incisively did hypnosis cut to the core of psychosomatic disorders that physicians came to the
inescapable conclusion that it was a valuable adjunctive psychotherapeutic procedure. At present
many psychiatrists employing hypnosis are convinced that rapport, transference, or empathy in
the doctor-patient relationship are, to a degree, a form of hypnosis.
The literature indicates there is a growing awareness that all "schools" of psychotherapy,
regardless of methodology, achieve approximately the same results. It has been postulated,
therefore, that many of the accepted methods of psychotherapy are merely due to suggestion and
are actually due to "hypnosis in slow motion". This would seem to prove that the strength of the
interpersonal relationship between psychiatrist and patient is the most important factor in
affecting a cure.
Hypnosis enhances this relationship and there is no reason why every physician cannot be
his own psychiatrist for the therapy of the milder types of psychoneuroses. Some psychiatrists
contend that hypnosis fosters extreme dependency on the therapist. This is undoubtedly true in
some cases, but this is the aim of all doctor-patient relationships to keep resistant patient in
therapy. This dependency is always worked through in the latter stages of therapy. Modern
hypnotherapists seldom use the classical or authoritarian technics to remove symptoms
dramatically, but, but rather allow the patient to go into a hypnotic state in his own manner and at
his pace. These symptoms usually serve a defensive need in the patient’s personality structure
and they are discussed until they are self-revealing to the patient. This type of patient-oriented
hypnosis allows the patient to “save face” and take an active part in his own recovery without
being overwhelmed by material dredged up by the therapist. In some cases it may not be
necessary for the patient to understand the actual mechanisms responsible for symptoms, but it is
extremely important how they patients feel about anxiety-producing situations and how they react
to them emotionally.
The psychiatrically oriented physician can utilize hypnoanalysis even for deep-seated
personality disorders. Hypnoanalysis differs from psychoanalysis only in degrees. Both utilize
interpretation of material which is brought to light through strong rapport, and reintegration of
hitherto repressed material into consciousness. In addition, hypnoanalysis uses post-hypnotic
suggestions, amnesia, age regression, automatic writing and time distortion to speed the therapy.
Post-hypnotic suggestions can redirect the pent-up energy employed by the symptom-complex
into productive channels.
During hypnoanalysis, the patient's thoughts (free association) are spontaneous and unfold
with ease and maximum latitude of expression. With adequate insight, the nature of his
resistances and defenses are unmasked, the result being a significant change in personality and an
alteration of behavior. During age regression the patient's verbalizations indicate the vividness
with which traumatic experiences can be relived. In some cages, though not always necessary, the
symptoms can be traced to their origin and linked up with current behavior patterns.
Hypnotherapy is valuable for harmful habits, including alcoholism, morphinism, obesity
due to overeating, excessive smoking, anc' insomnia. Tic douloureaux and habit spasms often
respond to hypnotherapy. Symptom-substitution can be used if the patient is willing to accept a
less harmful symptom. For example, blepharospasm of long standing or a facial tic can be
transformed to the twitching of one finger, the patient usually being willing to yield his deeply
ingrained symptom for one that is not ro bothersome and obvious. When the dynamics
responsible for the symptom-complex are elicited, then the twitching of the finger which has not
had time to become firmly established, can be easily removed. Naturally, as mentioned, organic
factors responsible for all dymptoms should always be ruled out by careful differential diagnosis.
Cardiovascular conditions such as paroxysmal tachycarnia, pseudoangina pectoris,
idiopathic hypertension, neurocirculatory asthenia, and other cardiac neuroses yield readily to
reassurance 1n the hypnot1c state. Hypnotherapy is valuable for the psychogen1c component of
asthma, allergy and migraine headaches. It is very effective in neurologic disorders - many
remissions have occurred after 1ts use in multiple sclerosis, chorea, paralysis ag1tans, epilepsy
and phantom limb pain. Gastrointestinal symptoms of chronic gastritis, mucous co1itis, chronic
constipation, duodenitis, pylorospasm, irritable colon, and anorexia nervosa also have been
alleviated. Since ch11nren are part1cularly amenable to hypnos1s, na11b1t1ng, stammer1ng,
enures1s and other behav1or problems are more eas11y allev1ated by th1s method.
Many other disorders stemm1ng wholly or partly from emot1onal factors can be helped
by hypnotherapy. Among these are neurodermatitis, neurogenic eczema, psoriasis, pruritus and,
hysterical contractures, spasmodic torticollis, rheumatic arthrit1i, low-back pa1n, Meniere's
syndrome, tinnitus, glaucoma, and globus hystericus.
In the f1eld of gynecology and obstetrics, hypnosis reaches its highest potential, frigidity,
functional menstrual disorders, premenstrual tension, functional low back and pelvic pain,
vasomotor symptoms of the menopause, psychogenic pruritis vulvae, the tubal spasm associated
with infertility often respond readily to hypnotherapy response is also indicative for the relief of
the intractable pain suffered by the patient dying of carcinoma.
Hypnosis is a valuable adjunct for rapidly controlling nausea and vomiting, heartburn and
salivation during pregnancy. It is especially valuable during labor and delivery, alleviating fear,
tension, and apprehension, and thereby raising the pain threshold. When combined with
chemoanesthesia, preferably local infiltration, this "balanced approach" can reduce fetal anoxia
by 50 to 75 per cent. Approximately 25 per cent of primiparae can be delivered without analgesia
and anesthesia. Another 50 per cent require minimal amounts of sedation, and the remaining 25
percent will need conventional procedures. With group train1ng, motivation is heightened and the
numbers of patients responsive to hypnosis are increased.
The advantages of hypnosis are the shortening of the first stage of labor by several hours,
marked reduction in maternal exhaustion, heightened pain threshold, and the ready control of
anesthesia and analgesia. Pain perception during labor is optional. There is no danger to either
mother or baby or interference with natural process of labor. The disadvantages of hypnosis in
obstetrics include the added time needed for prenatal conditioning; the fact that trance depth may
be affected by psychosocial factors and therefore, render disturbed patients unsuitable for the
procedure. There is also danger of precipitating a latent psychosis in those women who are
seeking to overcome deep-seated inadequacies in their personality through a self-glorifying
experience. This type should not be accepted for childbirth under hypnosis. Therefore, a
persona1ity appraisal is as important as mensuration of the pelvis! Here, of course, the hypnosis
is not to be blamed for the psychoses, but what was done under hypnosis can be held responsible.
From time immemorial, hypnosis has masqueraded under a multiplicity of labels. Natural
childb1rth, psychoprophylactic relaxation, auto-conditioning, autogenic training, Christian
Science, Yogism and progressive relaxat1on - all are based on hypnotic technics.
Hypnoanesthesia in obstetrics is not an all or none method and all patients are informed that they
can have analgesia or anesthesia when necessary.
Although hypnosis is limited to less than 10 per cent of patients requiring major surgery,
1t can be used to lessen preoperative fears; it can potentiate or reduce chemoanesthesia by 50 to
75 per cent. When narcotics which cause respiratory depression are reduced or eliminated by
hypnosis, danger or anoxia is also reduced. Neurogenic shock is definitely diminished.
Postoperatively, atelactasis and pneumonitis can be prevented by hypnotic relaxation even
when chemoanesthesia had been used. Here it facilitates passage of a catheter for aspirating
tracheobronchial secretions. The breathing and cough reflex can be regulated through
posthypnotic suggestions, and excess1ve postoperat1ve pa1n and vom1t1ng usually can be
decreased. In good hypnotic subjects, these annoying complications can be prevented entirely.
Dur1ng the past year the author has induced hypnoanesthesia for a Caesarian-hysterectomy, a
thyro1dectomy, several excision biops1es of breast tumors, and many minor surgical Procedures -
all without analgesia or anesthesia. These were not performed for definite contraindications to
chemoanesthesia but also to demonstrate its usefulness to skept1cal physicians.
In conclusion, hypnosis is not a panacea but can be multifaceted diagnostic and
therapeutic tool Its util1broadened if it is used judiciously as an adjunctive in the framework of
holistic medicine.
18. NO ONE HAS A MONOPOLY ON HYPNOSIS: WILLIAM S. KROGER: HYPNOSIS
1966: (FROM AN ADDRESS TO AAEH CONVENTION IN 1966)
An unexpected but most welcome feature on the program was the
impromptu appearance of Dr. William S. Kroger, the author of the Number
One book on hypnosis today, CLINICAL AND EXPERIMENTAL HYPNOSIS,
and probably the foremost authority on hypnosis in the country. In his talk,
Dr. Kroger likened hypnosis to faith, and pointed out that just as no one has
a monopoly on faith, so does no one have a monopoly on hypnosis.
"Hypnosis has no boundaries," said Dr. Kroger. He pointed out that
hypnosis, the essence of which is suggestion, pervades every phase (of life, and
includes advertising and selling. The "soft sell" especially, he said, is a form of
indirect hypnosis. His description of hypnosis, which is really a form of
communication, concluded with the statement, "No one knows where
suggestion ends and hypnosis begins."
 Dr. Kroger expressed concern with the attempts of some hypnotists
who feel "omnipotent" to exclude people in other fields who may logically and
ethically use certain forms of hypnosis. He also felt irked with those who,
lacking proper credentials and training, used hypnosis in an illegal or
improper manner and in an area in which they were not legally qualified to
practice. He felt that "knowing our place" in the field is important. In this
regard he expressed succinctly the basis principle of the Association to
Advance Ethical Hypnosis.

19. HYPNOTHERAPY IN GENERAL PRACTICE: WILLIAM KROGER: JOURNAL OF THE

AMERICAN INSTITUTE OF HYPNOSIS: 1967:
During the past decade there has been a tremendous world-wide resurgence of hypnosis in
all branches of medicine. This is, in part, due to the official endorsement tool by the British and
American Medical Societies. At present, the A.M.A. Council on Mental Health through its
Committee on Hypnosis is formulating plans by which hypnosis can be integrated into the
medical curriculum and also taught at the postgraduate level.
It should be emphasized that hypnosis is not a trance, state of sleep, or unconsciousness,
but rather a communication process which utilizes everyday behavioral response mechanisms.
These merely enable a patient to better achieve new learnings and understandings. It is not
produced by passes, gestures, or a fixed stare although these methods are useful in some cases.
The increased relaxation, concentration, and greater receptivity and objectivity upon the words of
the hypnotist lead to hypnosis, especially when criticalness is bypassed. It is the latter which
differentiates hypnosis from strong suggestion and persuasion which only mobilize resistant
attitudes.
Wittingly or unwittingly, hypnosis has been utilized under one guise or another since
antiquity by both medical and religious healers - the common denominator of these approaches
makes full use of the imaginative processes to expect a cure. Conviction of cure leads to cure.
In general, even though variants are used, most methods for inducing formal hypnosis use
some type of eye-fixation and monotonic method of speaking. All make use of the ideomotor
and ideosensry activities ( the unborn or built-in reflexes ) . They depend chiefly on ritual and
expectancy of success these determined to a large degree by cultural attitudes.
Contraindications and Limitations: A physician does not have to be a psychiatrist to
employ hypnotherapy, especially for symptom removal. However, he should have a basic
orientation in the subject, common sense, judgment, intuition, and a rich clinical experience in
dealing with human ailments. If he lacks the necessary confidence, he will only make the sick
patient sicker. The generalist should not employ hypnosis on the psychotic unless he has
experience in dealing with such patients.
The purported dangers are not due to hypnosis but rather to what is said during the
communication process. The same words, at nonhypnotic levels, would be dangerous. The only
danger to hypnosis is that it is not dangerous enough. No one has ever died from it. Can the same
be said about steroids, tranquilizers, and shock therapy? Since the bulk of medical practice is
directed to symptom removal, hypnosis, for proper indications, can be prescribed like a drug.
Most physicians are happy if they can get symptom removal.
When the patient is trained in autohypnosis, he is the one who removes the symptom. This
is different than direct symptom removal by an authoritarian technique. This also obviates the
oft-repeated criticism that hypnosis fosters extreme dependency. Most of the contraindications
and limitations are based on the type of hypnosis used during the latter part of the last century.
Today, permissive and sophisticated techniques have been developed.
The physician should not promise more than can be reasonably accomplished - hypnosis
is not a panacea. The patient should be told that he is not being treated by hypnosis, but in
hypnosis; that hypnosis itself does not cure, but allows a clearer view of the self with the ability
to meet one's needs with new understandings. This, in psychotherapy, is of the utmost importance
and yet difficult of achievement.
Clinical Applications: Hypnotherapy is valuable for harmful habits, including
alcoholism, morphinism, obesity due to overeating, excessive smoking, and insomnia. Tic
douloureux and habit spasms often respond to hypnotherapy. Symptom substitution can be used if
the patient is willing to accept a less harmful symptom. For example, blepharospasm can be
transformed to the twitching of one finger, the patient usually being willing to yield his deeply
ingrained symptom for one that is not so bothersome and obvious. The recently acquired reflex
can more easily be removed by posthypnotic suggestion.
Cardiovascular conditions such as paroxysmal tachycardia, pseudoangina pectoris,
idiopathic hypertension, neurocirculatory asthenia, and other cardiac neuroses yield readily when
hypnosis is used as the method of reassurance. Hypnotherapy is valuable for the psychogenic
component of asthma, allergy, and migraine headaches. It is a helpful aid in neurologic disorders
- many remissions have occurred after its use in multiple sclerosis, chorea, paralysis agitans,
epilepsy, and phantom-Iimb pain. Gastrointestinal symptoms of chronic gastritis, mucous colitis,
chronic constipation, duodenitis, pylorospasm, irritable colon, and anorexia nervosa also have
been alleviated. The fact that placebos have been successfully used in these disorders indicates
why hypnosis - the acme of scientifically applied suggestion - proves even more helpful.
Particularly amenable to hypnotherapy are nailbiting, stammering, enuresis, and other behavior
problems in children.
Many other disorders stemming wholly or partly from emotional factors can be helped by
hypnotherapy. Among these are neurodermatitis, neurogenic eczema, psoriasis, pruritis ani,
hysterical contractures, spasmodic torticollis, rheumatoid arthritis, low-back pain, Meniere's
syndrome, tinnitus, glaucoma, and globus hystericus.
In the field of gynecology and obstetrics, hypnosis reaches its highest potential.
Functional menstrual disorders and frigidity often respond readily to hypnotherapy. Hypnosis is a
valuable adjunct in childbirth, especially for alleviating fear, tension, and apprehension, and
thereby raising the pain threshold. When combined with chemoanesthesia, preferably local
infiltration, this "balanced approach" can reduce fetal anoxia by 50 to 75 per cent. Approximately
25 per cent of primiparae can be delivered without analgesia and anesthesia. Another 50 per cent
require minimal amounts of sedation, and the remaining 25 per cent will need conventional
procedures. With group training, motivation is heightened and the number of patients responsive
to hypnosis is increased. It should be added that some women, seeking to overcome deep-seated
inadequacies in their personality through a self-glorifying experience, should not be accepted for
childbirth under hypnosis. Therefore, a personality appraisal is as important as mensuration of the
pelvis!
The advantages of hypnosis are the shortening of the first stage of labor by several hours,
marked reduction in maternal exhaustion, heightened pain threshold, and the reduction of
analgesia and anesthesia. Pain perception is optional. There is no danger to either mother or baby
or interference with natural process of labor. The disadvantages of hypnosis in obstetrics include:
( 1) added time needed for prenatal conditioning, (2) the fact that hypnosis depth may be affected
by psychosocial factors and therefore render disturbed patients unsuitable for the procedure as
there is danger of precipitating a latent psychosis.
Natural childbirth, psychoprophylactic relaxation, autoconditioning, autogenic training,
Christian Science, and progressive relaxation- all are based on hypnotic techniques.
Although hypnosis is limited to less than 10 per cent of patients requiring major surgery,
it can be used to lessen preoperative fears; it can reduce chemoanesthetic needs by from 50 to 75
per cent. When narcotics, which cause respiratory depression are reduced or eliminated by
hypnosis, danger of anoxia is also reduced. Neurogenic shock is definitely diminished.
Postoperatively, atelectasis and pneumonitis can be prevented by hypnotic relaxation even
when chemoanesthesia has been used. Here it facilitates passage of a catheter for aspirating
tracheobronchial secretions. The breathing and cough reflex can be regulated through
posthypnotic suggestions, and excessive postoperative pain and vomiting usually can be
decreased. In good hypnotic subjects, these annoying complications can be prevented entirely.
The author has performed cesarianhysterectomy, thyroidectomy, breast tumor biopsies,
and many minor surgical procedures such as curettements, culdoscopies, and other painful
procedures - all without analgesia or anesthesia. Others have performed lobectomy, plastic
surgery, amputations, and numerous major procedures. Its effectiveness in severe burn cases, the
dumping syndrome, and postoperative anuria has been demonstrated by numerous investigators.
Summary: There is a growing awareness among psychiatrists that all schools of
psychotherapy, regardless of their methodology , achieve approximately a 60 per cent recovery
rate. This indicates that there is a powerful placebo effect to all psychotherapy. In all probability
the therapeutic effects of conventional psychotherapies are due to subtly concealed suggestion or
"hypnosis in slow motion." The therapeutic goal is not so much to have the patient understand the
mechanisms supposedly responsible for his symptoms, but rather how he feels about his
anxiety-producing tensions, and how he can react to them emotionally on a more mature level.
At present, scientific interest in hypnosis is stronger than ever. This is not surprising as the
physician's personality has for centuries been his greatest therapeutic agent. Thus, it is obvious
that hypnosis, the acme of scientifically applied suggestion should have a salutary effect in
treatment of psychosomatic disorders. Hypnosis is not a panacea but can be used as a
multifaceted diagnostic and therapeutic tool. Its utility can be broadened if it is used judiciously
as an adjunctive procedure within the framework of comprehensive medicine.

20. HYPNOTHERAPY IN MEDICINE: PAUL GUSTAFSON

[Paul Gustafson RN, BSN, CH runs Healthy Hypnosis of Burlington, Massachusetts. He
has ten years of nursing experience and eight years specializing in the field of hospice nursing.
His medical background offers a solid foundation supporting his clinical approach to
hypnotherapy. Healthy Hypnosis is www.myhypno.com.]
Acceptance: In spite of tremendous medical advances there remains the consistent
question as to why some clients recover and flourish while others don/t. The healthcare assembly
line is rolling faster now than ever before. Despite technical success there is underlying concern
about a client’s emotional state, how they view themselves being ill, and what expectations they
may have for recovery.
The model of modern medicine is quite authoritarian. Our culture has taught us to look
outside of ourselves for healing. We believe that we get health from others, that the healer or
physician has all the power, we hope. This model minimizes the importance or even the
consideration of our own abilities. It also creates the expectation that everything is achieved on a
conscious level. This approach can leave us feeling dependent and vulnerable. Until recently
hypnosis had been on the outside looking in. It has mostly been viewed as dark and mysterious or
as a manipulative stage act going for the cheap laughs. Things are changing quickly. Research is
bearing out what many have been claiming for decades. Hypnotherapy is now widely practiced in
21st century medicine, psychiatry, dentistry, athletics and business.
How It Works: Our bodies routinely fight off illness. We self-heal and repair in spite of
how we often disregard our own health. With hypnosis we are able to enhance our ability to heal
and recover. We can manage symptoms with less medication, control own comfort and level of
relaxation and use creative imagery to look forward in time envisioning resolution.
The subconscious mind is our storage facility as well as our control center. It balances our
breathing, heart rate, blood pressure and co-ordinates every step we take. It’s a very powerful
place. Once ideas or beliefs hang around long enough they begin to take root and grow into
action.
Think of the subconscious mind as a greenhouse. In a fertile climate you can grow roses
or poison ivy with equal success. Hypnotherapy is the process of stepping into the greenhouse,
pulling out the weeds by the roots and leaving positive healthy replacements. What our mind
conceives or body achieves.
All About You: The healing potential of hypnosis lies within. It’s not something
administered to you from a hypnotherapist, but rather this power resides in all of us. The therapist
is the tour guide helping you tap into your own skills and abilities. We all go in and out of
hypnotic trance several times a day. It’s a very natural thing. Hypnosis is just the act of enabling
this process and then offering suggestions and imagery supporting the desired change or
improvement. Once you understand how easy it is, self-hypnosis is an effective way to either
augment medical intervention or to fine tune and improve many areas of your life.
Applications: There has been resurgence in the medical use of hypnosis as well as an
increased knowledge and sophistication with how it is used for both inpatient and outpatient
clinical applications. With better understanding the shift is going from authoritarian to
empowering clients to add their own healing touch to the plan of care.
Clients in an Intensive Care setting benefit from hypnosis with a deeper more quality rest
speeding up their recovery process. Cardiac clients are better able to balance their blood pressure,
regulate their breathing and heart rate.
Hypnosis helps Oncology clients make immediate inroads with symptom management
issues such as reducing stress and anxiety, altering sensory perception, minimizing pain or
pressure, relieving nausea, vomiting, respiratory distress and even preventing hair loss.
In addition hypnosis offers clients increased confidence and self-image as well as helping
them look forward in time to either envision a healthy resolution, accepting a chronic condition
or even finding the inner peace and guidance to manage end of life transition.
In the Pediatric setting hypnosis can be very helpful. Children have amazing imaginations
and the process of hypnosis activates the subconscious mind where our imagination lives. What
better gift to offer a frightened child than control during a time of crisis. It’s a tremendous
advantage to melt away fear and explain procedures and treatments in identifiable terms when
children are relaxed, comfortable and able to learn and succeed.
Clients in the Obstetric or Gynecology settings can benefit from hypnosis in the areas of
increased fertility, relieving heartburn related to pregnancy, lessening pain, pressure, or
premenstrual syndrome symptoms and supporting a comfortable natural child birth.
Hypnosis helps Internal Medicine clients reverse the effects of coronary artery disease,
improving immune response, diminish inflammation from arthritis and rheumatism, relieve
tension and migraine headaches, lose weight, raynauds disease, anorexia nervosa, gastrointestinal
disorders and stress related issues. Hypnosis supports Mental Health clients by relieving stress,
anxiety, depression, fears, phobias and addictions. Hypnosis puts the client in control. They play
a big role in their own recovery, which adds to increased fulfillment and long term success.
Hypnosis helps Dentistry clients as an effective analgesic adjunct, it relieves anticipatory anxiety,
distorts time perception speeding up the procedure, minimizes bleeding, excessive salivation and
gagging. And Dermatology clients can be helped with clearing up of warts, pruritis, herpes, and
pain relief from burns.
Summary: Medical hypnosis has quietly placed its foot inside the door of mainstream
medicine and is beginning to show what it has to offer. It’s now perceived as a treatment with the
capacity to support a wide range of physical, emotional and psychological concerns in the
healthcare setting.
As medical science pushes forward so does the need to explore complimentary modalities
of support. Today’s clients face an overwhelming array of technology. By also considering our
own natural healing abilities and pursuing health and wellness from within, we blend nature and
science leading to better understanding, empowered health and well-being.

21. HYPNOSIS AIDS IN MEDICAL TREATMENTS: GILDA A. HERRERA

The patient must combat the disease along with the physician. Hippocrates, Aphorisms .
This adage aptly describes the use of hypnosis in medicine. Working together, the hypnotist and
the patient can use effective methods to treat a variety of ills. The Psychiatric Consultation
Liaison Services Clinic is one area at Walter Reed Army Medical Center which uses hypnosis.
Dr. Harold J. Wain, director of the PCLS clinic, says hypnosis is an adjunct treatment to other
treatments physicians employ.
The PCLS clinic provides psychiatric assistance and consultation for military
beneficiaries. Clinic personnel work with medical and surgical inpatients (and some outpatients)
referred by physicians to the clinic because of psychiatric and psychological problems overlayed
from their medical situations. The clinic offers consultations in every area of medical care in the
hospital.
According to Wain, hypnosis has been successful in the treatment of phobias, pain (how to
cope); depression (arising from illness); dementia (defined in psychiatry as a severe organic
mental deficiency or impairment (distinguished from amentia, or mental retardation).
As a preventive service, hypnosis helps with the childbirth anxiety, dealing with the side
effects of chemotherapy, habit control (smoking cessation, weight control), dealing with
traumatic events and with sports medicine. "Hypnosis can help patients get their problems in
control," Wain says. "There is not a ward in the hospital where hypnosis has not been used."
Wain said there is a "myth understanding of hypnosis." "It is not the gullible who can be
hypnotized," he explains. "It is not the syndrome that responds (to hypnosis), but the patient."
Wain said it is the "gift of the receiver" to have the "ability to have the internal form of
discipline" to be receptive to hypnosis treatment. "Hypnosis is an altered state of awareness,"
Wain continued. "The EEG pattern suggests hypnosis is more of a wake-like state, than a
sleep-like state." Only 15 to 20 percent of people are able to go into a deep state of hypnosis.
The hypnosis deep state is the state a patient must be in, in order to use hypnosis as an anesthetic
in surgery. However, patients need not go into the hypnosis deep state for other hypnosis
treatments such as habit and pain control. Wain pointed out that in medicine and psychiatry,
hypnosis treatment is very different from the familiar stage hypnosis.
A hypnosis-screening process is used to ascertain the patient's ability/level/degree of
hypnosis ability. "The patient must be willing," Wain stressed, "to share control with the
hypnotist. "Patients are not asleep, not a zombie -- they are able to speak," he said.
Daydreaming, is a benign state of the hypnosis state. According to Wain, children are the
best hypnotic subjects, but this ability usually declines after the age of 14. People who have
difficulty with concentration are the hardest to hypnotize.
Wain emphasizes that hypnosis is not a treatment by itself, but is an adjunct technique in
patient care. Historically hypnosis as a medical tool has been in use for over 200 years. The
British Medical Association in 1955 and the American Medical Association in 1958 officially
recognized hypnosis as bona fide medical treatment.
Through hypnosis patients are taught relaxation techniques for pain and habit treatment.
A complex procedure, hypnosis allows for increased memory and increased concentration. It is a
medical method that crosses all personality-economic, and intellectual lines, and also provides
psychiatric treatment of more severe mental problems such as dementia and depression. Current
research in hypnosis involves which part of the brain, what stages of awareness people enter into.
Standardization of treatment is one goal of this research, Wain said.
PCLS trains interns, residents and fellows in hypnosis techniques. "Hypnosis is not a
panacea," Wain said. "It is a wonderful tool in the hands of people who know how to use it."

22. FREQUENTLY ASKED QUESTIONS ON HYPNOSIS FOR MEDICAL PURPOSES

What about the use of hypnosis to cure allergies? Actually, we must emphasize that
hypnosis doesn’t "cure" anything! Allergic reactions are frequently associated with stress
situations, and these cases can be helped with hypnosis. Although the suppression of allergic skin
reactions by hypnosis has not been confirmed, there is definite evidence that hypnotic suggestion
does influence cutaneous allergic reactions. Hypnosis can be employed to alleviate asthmatic
attacks in individuals susceptible to certain allergies.
Most physicians estimate that a good percentage of their practice is at least in part
psychosomatic. Since hypnosis is a state of mind, it can influence those conditions which are due
to this state of mind. When pain is not serving a useful purpose, it can be reduced, and often
eliminated, by hypnosis. Hypnosis is being used more and more to lessen suffering in such cases
as terminal cancer.
The greater usage of hypnosis for health purposes, for the largest number of people, is that
a simply training people to relax and stop worrying! Again, we remind our readers that a
physician’s referral is required, in most situations, before undertaking hypnotic conditioning for
self-improvement.
 Can hypnosis help relieve the aches of arthritis and bursitis? Dr. Lester A. Millikin, of
St. Louis, presented a significant paper, complete with case histories and film, proving that many
arthritic conditions have a psychosomatic origin. Such emotions as fear, jealousy, worry, love,
etc.-one or all-may lead to conflict tensions. This can cause painful muscle spasms. Dr. Millikin’s
theories have convinced many observers to feel that many sufferers are undergoing
psychosomantic reactions which can be alleviated with hypnosis.
Dr. John LeHew, of Oklahoma, experience with 79 patients suffering from various types
of musculoskeletal disorders, such as bursitis, arthritis, etc., and almost all-including 9 patients
with painful bursitis of long standing-responded well to hypnosis. Of 17 rheumatoid-arthritis
patients, 12 responded well with relief of pain and improved motion of the joints involved. A
major advantage with hypnosis is that the subjects can be taught self-hypnosis which they can use
whenever necessary. Hypnotic suggestion is often effective for symptom-relief and can
dramatically relieve distress; for certain, hypnosis can sharply reduce need for narcotics and
analgesic drugs.
* Can hypnosis cure asthma? Hypnosis cures nothing, since the word "cure" implies physical
illness. Illnesses can be complicated (even caused, sometimes) by emotional factors, and asthma
may well be included. Asthma is often attributed to an allergy, but it is certain that some
psychological factors complicate it. Anxieties and fears which accompany an attach can be
controlled through hypnotic conditioning and later attacks will lessen in severity. Part of the
difficulty is caused by tensions in the breathing muscles and, by relaxing these muscles through
hypnosis, the attack will end. Often aggravating the attacks are environmental conflicts; i.e.,
children vs. parents, etc.
I still cannot understand how hypnosis can alleviate pain (such as migraine
headaches, etc.)? Pain is a sensation which is dependent on the conscious mind. It is a
well-known fact that distraction from attention will exclude from the conscious many
sensationsincluding that of pain. Pain is an emotional and physical makeup of the subject.
Since pain may originate through the activity of the emotional and intellectual functions of the
brain, hypnosis can be used to obtain relief. In many case-and we do work with these cases quite
often-even after complete investigation and through examination-the origin of the pain, or rather
the cause of the pain, cannot be determined, nor can failure to obtain relief be explained.
Personality difficulties, tensions, anxieties, and other emotional disturbances may become
so prominent that the cause of the pain is masked. And, because the emotional factor may be so
prominent, hypnosis can often be used, rather than surgical methods and rather than subjecting
someone to a life with tranquilizers, sleeping pills, etc. We repeat, as we constantly do, as
physician’s approval must be had. Under the influence of hypnosis, the sensory end organs do
continue to function; however, the subject’s attitudes are so altered that the pain is no longer
experienced. Intractable pain is not responsive to conservative methods and, although drugs will
give relief, continued usage will find that the severity of the pain has no relationship to the
amount of narcotic necessary.
A recent case in our office dealt with a woman who suffered with headaches for four
years and had to live under constant sedation. Her physician finally recommended hypnosis as an
alternative to surgery, and, happy to say, she responded nicely. Her first session relieved the
headache and we taught her self-hypnosis in three more sessions. This lady not was completely
eliminated tranquilizers and sleeping pills, sleeps well and is completely free of her headaches.
The advantages of hypnosis are many, in cases of intractable pain. Drug requirements are
lessened and may be completely removed, appetite is increased and the desire to live becomes
apparent. Depression, anxiety and fear of impending death (particularly with cases of inoperable
carcinoma), is removed and the patient approaches a more normal frame of mind. He is a rational
thinking human, rather than a vegetating invalid, as often happens, and there is no danger of drug
addiction.
Unfortunately, many doctors still have an aversion to hypnosis, probably because they are
not sufficiently knowledgeable in its use, and so must resort to the use of large dosages of
narcotics to make their patient comfortable. Continued education has to be undertaken before
hypnosis will be a completely accepted procedure. Hippocrates, himself, said, "Nothing should
be omitted in an art which interests the whole world, one which may be beneficial to suffering
humanity and which does not risk human life or comfort."
Can pain from surgery be relieved by hypnosis? Yes. In fact, postoperatively,
hypnosis can be inestimable value. For instance, when surgical patients wake up, they are often
afraid to cough because of excessive pain, especially those having upper abdominal operations.
The surgical patient can easily be trained to induce the "state" himself (self-hypnosis). Relaxation
is enhanced, breathing can be regulated and the "cough reflex" can be eliminated. Self-hypnosis
can be taught and then one can enter hypnosis quickly, eradicating the pain and accompanying
fears.
Can hypnosis relieve pain? Yes, it canbutpain is often a signal of danger and
serves protective purposes. It would, of course, be pleasant to have a life free of pain, but then
you would have no warning of organic disorders. However, 20th century medicine recognizes
that sometimes there is no physical reason for the failure of a body to function. This is known as
a "psychosomatic" situation and refers to the interaction of emotions and other mental processes
with physical factors to influence the body’s performance. In other words, the real root of certain
difficulties might be more mental than physical. The list of such illnesses continues to grow.
Hypnosis can be of definite valueif your physician approves.
Is there such a thing as "dual" personality? Can hypnosis help? Yes, and this occurs
more frequently than commonly supposed. We mustn’t confuse true "split" personalities with
hallucination brought about by hypnosis. In true cases, the "other" personality usually has no
knowledge of the first; however, in hypnosis one may have a fragmentary knowledge of the
memories of the other. Through hypnosis, the relationship of one personality to the other can be
understood more readily. Readers may remember the book, "Three Faces of Eve," which
dramatically described the switching personalities involved. Such cases must be handled by
qualified persons such as psychiatrists, clinical psychologists, etc., and not by a hypno-technician
alone.
Can hypnosis be used to induced dreams? Yes. In fact, in the hands of a properly
qualified therapist, this can be a useful tool. The induced dream would be analyzed and,
posthypnotic suggestion can, in many cases, be employed to have the subject interpret his own
dream. You may be familiar with the term "psychodrama," where conflict situations are
dramatized with the subject playing one part and the practitioner another. This can be done under
hypnosis ("hypnodrama") and the subject will actually re-enact his own inner conflicts. Of
course, a psychiatrist, or clinical psychologist, would have to supervise such a technique.
According to the movie, Freud utilized hypnosis, but I am told he gave it up. Can you say why?
Frankly, although there are various opinions and conjectures, I doubt that anyone really
knows why Dr. Freud gave up hypnosis. Chances are, had he not, there would be fewer
objections to its use today. Some authorities believe he gave it up due to a problem with
"transference," involving a female patient; others believe it had something to do with his false
teeth. Take your choice! He did believe that deep hypnosis was required, which isn't true. In those
days, scientific hypnosis was in its infancy and Freud, as well as others, was naive. Hypnosis,
through the years, has been a "whipping boy" for various reasons, by misguided individuals.
However, there is no truth to such allegations, any more than there would be validity in censuring
physicians for using tranquilizers to control symptoms of their patients.
Can hypnosis be of value in overcoming hysterical blindness? Usually this problem is
a reaction to some unpleasant event. The condition does resemble actual blindness, except that it
comes and goes. Hypnosis can be of definite help in a couple of ways. If the referring physician
believes it necessary, through hypnotic procedures the unpleasant event which stirred the
emotions, causing the "blindness", can be uncovered and dealt with in a rational manner. Another
technique would be to merely use direct suggestion, under hypnosis and restore the vision. The
latter continuing conditioning would obviate recurrence, although it would probably be better to
teach the subject to content with problem situations with equanimity.

23. HYPNOSIS ALLIES ARE URGING INSURERS TO RAISE COVERAGE: JEANINE

MJOSESTH
A unique alliance of psychologists, physicians, dentists and social workers is launching a
campaign to educate insurers about hypnosis’ ability to improve mental health and medical
outcomes, reduce patient suffering and cut the costs of providing care.
Members of the group, namely APAÆs Div. 30 (Psychological Hypnosis), the Society of
Clinical and Experimental Hypnosis (SCEH) and the American Society for Clinical Hypnosis
(ASCH), hope insurers will follow Medicare’s lead of reimbursing for hypnosis and even expand
covered treatments. The three groups are the principal associations for health-care providers who
use hypnosis. The alliance will present to insurers outcome studies that document the success of
hypnosis in treating a variety of medical and health-threatening behavioral problems. Research
shows, for example, that smoking-cessation treatments using hypnosis are twice as effective as
treatment without hypnosis, and patients require much less pain medication during invasive
medical procedures when using self-hypnosis, says Edward Frischholz, PhD, president-elect of
Div. 30. The alliance also will present a meta-analysis of 18 studies, which indicates that the
average client treated by hypnosis-enhanced cognitive-behavioral therapy showed greater
improvement than at least 70 percent of clients receiving nonhypnotic cognitive behavioral
therapy. The analysis was performed by Irving Kirsch, PhD, noted research psychologist at the
University of Connecticut, and lead editor of an upcoming APA book called 'Clinical Hypnosis
and Self-Regulation: Cognitive-Behavioral Perspectives.'
Breaking the stigma: During a clinical hypnosis induction, a therapist usually instructs a
client to relax deeply and then suggests the client experience changes in sensation, perception,
thought or behavior corresponding to his or her mental or physical health needs. Kirsch says he
hopes his book on clinical hypnosis, co-edited by Salvador Amig, Etzel Cardea and Antonio
Capafons, will overturn the negative connotations that have inhibited clinicians from using the
powerful clinical tool. Despite the fact that APA, the American Medical Association, the
American Psychiatric Association and the American Dental Association all support the use of
hypnosis in treatment, many Americans still regard it with apprehension, says Kirsch. So do
many third-party payers. Hypnosis still is considered an alternative therapy that falls outside the
mainstream scope of practice, according to a medical director for a large Washington, D.C.,
health plan who requested anonymity. 'If there are good scientific studies and the public and the
employers wanted it, we’d be willing to take a look,' the director said. 'It’s not that we’re
mean-spirited, but we have to prioritize what we pay for, and antibiotics come first.'
Medicare appears to have largely overcome the bias against hypnosis. Since 1992, the
federal health insurance program for the elderly and people with disabilities has reimbursed for
hypnotherapy. Under code 90880, properly trained psychologists can bill for hypnotherapy when
treating such conditions as phobias, psychogenic pain, and conversion and dissociative disorders.
In fact, current Medicare reimbursement rates are higher for hypnotherapy sessions than for a 45-
to 50-inute individual session. This is due in part to the higher 'work value' assigned to
hypnotherapy under Medicaid schemes. In Chicago, for instance, Frischholzùwhile encountering
some delays in reimbursement that APA helped him eventually resolve, received a higher
Medicare reimbursement rate for a single therapy session using hypnosis than for a typical 45-
to 50-minute individual psychotherapy session. Hypnosis studies
According to Gary Neuger, PhD, a Colorado Springs psychologist, health insurers are
enthusiastic about clinical studies that confirm how quickly and effectively hypnosis can correct
often intractable medical and behavioral problems. While the success of hypnosis sometimes
depends on a patientÆs ability or willingness to be hypnotized, it has been used effectively in the
treatment of obesity, smoking, insomnia, acute and chronic pain, anxiety and depression and
during dental and surgical procedures. It also has proven useful in treating such conditions as
irritable-bowel syndrome and tension headaches, says a 1996 National Institutes of Health
Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches (Journal
of the American Medical Association, Vol. 276, No. 4, p. 313-318).
In a 1993 study, more than half of the 226-person study group completely abstained from
smoking one week after a single-session habit-restructuring intervention involving self-hypnosis.
The participants were taught how to enter self-hypnosis and to use it when they wanted to
smoke. Clinicians presented a strategy involving a positive commitment to respect and protect
one’s body, rather than the conventional strategy of fighting the urge to smoke. Cessation rates
at six months climbed to 66 percent for individuals who completed a hypnosis-based treatment
program according to research published in the American Journal of Clinical Hypnosis (Vol. 40,
No. 2, p. 146û156, 1997). A major point to make to insurers, says Neuger, is that even relatively
modest increases in smoking-cessation rates mean huge health-care savings. The costs directly
caused by smoking totaled $50 billion in 1993, according to the Centers for Disease Control and
Prevention. Of that amount, Medicare paid more than $10 billion and Medicaid more than $5
billion in tobacco-related health costs. In pain management, hypnotic suggestions can reduce an
individual’s perception of pain and anxiety and, as a result, reduce the need for pain medication,
says Elvira Lang, MD, a radiologist at the University of Iowa Medical School and recent
co-chair of a SCEH/University of Iowa conference on pain management. Alliances with
physicians
Such medical benefits of hypnosis provide an additional argument for psychologists’
inclusion on interdisciplinary health-care teams, says Lang, who regularly uses hypnosis during
procedures. Lang and David Spiegel, MD, collaborated on a 1996 pilot study of 30 patients
who were trained to use self-hypnosis during invasive medical procedures, which included
arteriograms, trans-catherter revascularization and a cholecystomy. Spiegel teaches at the
Stanford University School of Medicine’s Department of Psychiatry and Behavioral Sciences.
 Patients were able to self-administer pain medication; four of 16 test patients using
self-hypnosis self-administered medication during their procedure, compared with 13 of the 14
control patients. Overall, test patients reported significantly less pain than control patients and
fewer interruptions of their procedures. Lang has expanded her inquiry to a 200-patient study
funded by the National Institutes of Health’s National Institute of Mental Health and its Office
of Alternative Medicine. 'When you involve psychologists [using hypnosis] in an integrated
treatment approach, there are tremendous costs savings,' Lang says. 'Medicine is headed toward
more integrated care practices because it is the most economical approach.'

24. OBTAINING MEDICAL REFERRALS: MELISSA ROTH

From physicians, chiropractors, dentists. Don't forget naturopaths, osteopaths and massage
therapists.
Locate the potential referral source:
* Yellow pages,
* Hospital based physicians from hospital directories
* University health centers
* Corporate health centers
* Teaching hospitals
Gather Information:
* Call receptionist for information
* Telephone numbers and addresses
* Fax number, email if available
* Nurse's name and # or extension
* Best day, best time
* Off day Appointment/walk-in
* Do they refer to complimentary therapists?
* Do they refer to pain clinics?
Sort by geography/importance:
* Professional Office Buildings
* Those that refer to complimentary therapists already
Personal Visit:
* Three 2 minute scripts
* Question your way to success/target your delivery
* Only talk about what vou can do for them that they need done
* Individual brochures for each topic
* Practice, practice, practice-your delivery. . . .out loud
* Anticipate questions and practice overcoming objections
* Show how to fill out a prescription for hypnotherapy
* Leave prescription blanks, brochures, refrigerator magnet
Follow Up:
* Send progress reports for patient files
* Repeat calling on the referral source every 3 months

25. NURSES AND HYPNOSIS: A PERFECT MATCH: AJAMU AYINDE

When many people think of the word “hypnosis”, images of older men with goatees,
funny accents and pocket watches may come to mind. Nothing could be further from the truth.
In the twenty-first century, hypnosis is coming into a new light of understanding. In the very
early days of its use, the prestige factor was overly emphasized and it was believed that only men
could induce hypnosis.
In fact, many doctors who would learn hypnosis to help others would not allow
themselves to be hypnotized. It seems that male pride and professional hubris made it impossible
for many doctors in the 1950’s and 1960’s to personally experience the wonders of hypnosis. In
those days, hypnotists would use nurses as subjects while the doctors watched. Today, two of the
major hypnosis organizations training health professionals in the therapeutic use of hypnosis are
women.
What is hypnosis and why are nurses so ideally suited to use it? Hypnosis can be simply
defined as a focused state of attention. While a person is in that wonderful relaxed state they are
given beneficial suggestions that aid the healing process. No one is completely sure why it works
but the consensus is that by bypassing the conscious mind positive suggestions that could be
ignored during the normal waking state are more readily accepted. Words have healing power
and even when patients are under anesthesia are able to hear on a certain level. Hypnosis just
involves speaking, something nurses already do, formal training helps them use their words more
precisely to bring about desired results with patients.
Due to the factors brought about by managed care, doctors must see many patients in the
course of a day, spending only a few minutes with each. Increasingly, it is the nurse who has the
greatest opportunity to connect with the patients.
Although nurses have many responsibilities making their rounds, patients seek them out
asking them questions and opening up about feelings, fears and concerns. This is true of patients
who may have long or short-term hospital stays. The experienced nurse has the confidence born
of the training and technical knowledge to gain the trust of the patient.
Trust equals relaxation and acceptance of suggestions in hypnosis. The majority of nurses
are female and many patients view them as a mother substitutes. Many patients’ early experience
with being sick involves a mother dispensing comfort and aspirins. Often patients who are
normally very mature and capable will revert to an almost child- like state when they are sick.
This works to a nurse’s benefit since most of us feel vulnerable when we are sick and want to
know that there is someone near who cares and knows what to do to help us get well. Hypnosis
can happen in a very informal way. Nurses can provide instruction on how to relax and enter
trance state and once the patient is there she can offer beneficial suggestions.
There are different approaches to hypnosis that can be defined simply as permissive and
authoritarian. Neither is more right than the other. Some may be more suited to your personality
and to the needs of the individual patient. Patients may experience feelings of dependency and
helplessness during their hospital stay.
Nurses taking the authoritarian approach can tell the patient directly, in a matter of fact
way, what he or she can expect in terms of a quick recovery. The permissive involves telling
stories. This works really well with children but adults are surprisingly open to the approach.
These uncertain patients can have their fears easily put to rest by a nurse who is able tell them
happy stories that take their minds off the health challenge he or she is facing.
Nurses can also tell stories about patients, just like them who made great progress as a
result of this new medicine, procedure or life style change. It becomes a self-fulfilling prophecy
either way. Nurses can help us to give ourselves permission to heal. That is all we really need.
26. WARMTH RELAXATION FOR REYNARD’S DISEASE: THERESA TEMPER: From
SCRIPTS, SUGGESTIONS, INDUCTIONS AND SUCH: ROBERT OTTO SEMINARS
Sit or lie back.. take a deep breath.. hold for the count of 4. Now slowly exhale to the
count of 6. As you exhale, feel the tension and stress leaving your body.. every time you exhale
feel all tension and stress leaving your body.. As You breathe in, feel the relaxation, warmth, and
peacefulness. With every breath you take your body is relaxing more deeply, becoming more
comfortably warm, and very peaceful. Allow this relaxation to flow so gently and comfortably to
YOU' forehead. Feel your forehead smooth as all the tiny lines are gone and relaxed now. Your
eyelids are so comfortable and relaxed.. so heavy., they are so relaxed. yo, may close them., let
them close gently and comfortably.. very good. Notice how very comfortable your body is
beginning to feel. As you continue breathing fully and comfortably, feel the relaxation as it flows
into your jaw.. release any tension from this area. This is an area where you tend to hold tension,
so focus on relaxing this area, and it will relax very comfortably.. very safe. As you breath
fully, you can feel the tension floating from your jaw., your teeth may part slightly.. and
that's fine. Feel how smooth and relaxed your face feels. Very comfortable.. very safe.. very
relaxed. Be aware of normal sounds around you. These sounds are unimportant. Whatever
you hear from now on will only help you to relax deeper and more comfortably.
 Take another full breath.. as you feel yourself relaxing very comfortable., very safe..
very relaxed. Feel your be releasing any tension and stress from your neck and shoulders. Feel
your neck and shoulders go limp in the chair. You completely, comfortably supported by the
chair. As you continue to relax more deeply.. very comfortably.. very safe.. your upper arms,
elbows, forearms, hands and fingers are so comfortable.. so relaxed.. as you continue to feel more
comfortable. . me relaxed.. with every breath and every beat of your heart. can reel your arms.,
all the way to your fingertips.. vi comfortable.. very relaxed.. pleasantly warm.. you are feel so
good.. more relaxed than ever before.. You can reel as t: wonderful relaxation is spreading into
your chest.. and abdomen With every breath you take your body is relaxing m comfortably.,
very safe.. feeling so wonderful.. With every beat of your heart you now know your body, mind
and spirit healing., rebuilding.. and repairing.. more healthy and vi than ever before.. As you
notice your hips., heavy in chair.. so relaxed and comfortable.. You are completely
supported by the chair so you can just let go., allow your t to relax completely., so safe.. so
comfortable.. so relaxed It's not often we allow ourselves to relax this completely go ahead., let
yourself relax., as you continue to enjoy t wonderful, safe, pleasant, state of relaxation.. Feel
comfortable warmth as it continues to spread throughout entire body.. As you let your muscles
go.. relaxing more.. and more.. with every breath you take.. You can feel this wonderful
relaxation spreading to your thighs.. knees.. lower legs.. ankles.. feet.. and toes.. your legs feel so
comfortable.. warm.. relaxed.. Your entire body now.. so comfortable. . so relaxed.. so
comfortably warm all over.. As your blood is circulating to every area of your body.,
nourishing.. warming.. rebuilding.. and repairing., giving you the most healthy.. vital body.. You
feel so cozy.. as if you were sitting by a cozy, warm, fire., or perhaps basking in the sand of a
sunny tropical beach.. As you continue to breathe fully relaxing.. warming.. healing.. with every
breath you take and every beat of your heart.. very comfortable., very safe.. very relaxed..
Allow yourself to feel the wonderful warmth.. Feel the relaxation.. Enjoy these good comfortable
feelings.. throughout your entire body.. Know that if any time during this relaxation, it should
become necessary for you to become awake and alert to your surroundings, you will be able to
do so., and you will be very capable to handle any and all situations appropriately.. As you
continue to breath fully., exhaling slowly.. and evenly.. notice your breathing., so relaxed.. so
comfortable., healing your entire being with every breath.. I'd like you now to visualize a
beautiful staircase.. The staircase is carpeted with a plush, soft, warm, red carpet.. There are
ten steps on the staircase.. These steps will lead you down to a special.. beautiful.. safe., warm
place. In a moment (clients' name) you will begin to imagine yourself taking a safe, gentle, and
easy step down.. down.. down.. each step of the beautiful, soft red staircase.. Leading you to a
very peaceful.. a very special.. a very cozy, warm and comfortable place just for ye In a moment
I am going to count backwards from 10 to t and 4 will see yourself safely stepping down each
step. As you down each step.. You will feel your body relaxing ma comfortably.. more
completely.. as you descend deeper a deeper., feel your body gently and safely drift down..
deeper and deeper. 10 very comfortable.. g very safe.. 8 more relax than ever before.. 7 it feels so
good to just let go.. 6 deeper and deeper.. 5 comfortable.. 4 safe., j relaxed.. 2 feeling so cozy and
warm.. 1 more deeply relaxed than ever before. As you now enter into your special, peaceful,
safe, warn comfortable room.. your special room where you are alone. with no one to disturb
you.. you see a very soft, cozy looking red, chair.. Go over and sit in this very comfortable
chair. allow yourself to relax.. kick off your shoes.. put your feet up. Enjoy the warmth from the
crackling fire in the fireplace next to the chair.. Through the sun roof, the sun is shining in..
flowing gently into this warm, cozy room., filling the room with warmth and peace.. The room
is decorated in shader Of red.. Red is a color that raises your body's temperature. and energizes
your blood.. I want you now to feel yourself so warm.. so comfortable.. from the very tips of
your toes and fingers,. to the top of your head.. Enjoy this wonderful warmth and peacefulness..
Feel your bloods warmth and energy as it pulsates throughout your body.. Feel your body
temperature rising to it's normal level as your blood is being energized and warmed by the colors
of your very special, safe, comfortable room. Allow yourself to enjoy the warmth, the comfort,.
This is the most Peaceful place in the world for you. Imagine yourself in your special,
peaceful, warm room of soft reds. Feel the sense of peace flowing through Your body. Feel and
sense your well-being.. allow Yourself to enjoy these wonderful feelings., And know you will
keep these feelings with you after this session is completed. For the rest of this day and
evening, you will continue to let these feelings grow stronger,. You will continue to maintain
your excellent circulation and warmth in your body, fingers, and toes through this evening and
into tomorrow,. As you allow these wonderful feelings and warmth to spread and grow stronger..
filling Your life with goodness,, you now feel at peace., with a Sense of well-being., Enjoy these
feelings,, You enjoy these feelings so much, you make sure to make time for yourself every day
to listen to your reinforcement tape.. Because you know by reinforcing these good feelings,
you are becoming stronger and healthier each and every day.. Each and every time you do
this relaxation.. you will relax more deeply.. more comfortably.. more quickly.. incorporating all
the goodness into your life. . regardless c the stress and tension that may surround your life. You
will now remain more at peace.. more calm.. more relaxed in every situation. You will simply
allow tension and stress to bounce off and away from you.. These wonderful, warm, good
feelings will stay with you and continue to grow stronger and stronger throughout the day.. as
you continue to relax deeper.. and deeper. If you are listening to this tape at your regular sleep
time, you will continue to sleep peacefully.. dreaming pleasant dreams.. warm and comfortable..
until your regular schedule time to awaken.. You will awaken feeling refreshed, energize and
healthy. Otherwise you may continue to enjoy your special room for a few moments longer..
Soon I will begin to count from 1 to 5.. at the count of 5 you will be wide awake an refreshed..
feeling as if you had a long, comfortable rest. You will come back feeling alert, yet relaxed.. and
comfortably warm.. Begin returning to full consciousness.. 1 becoming more aware of your
surroundings.. 2 feeling comfortably health and good.. 3 more aware of your body.. 4 feeling
strong, confident and in control.. 5 WIDE AWAKE ALERT AND VERY HEALTH AND
HAPPY.

27. HYPNOSIS CAN BE GREAT AID TO MEDICINE: MELVIN POWERS

Make no mistake about it hypnotism is a matter of vital importance, affecting nearly
everyone. Statistics show that 80 to 90 per cent of people can be hypnotized, and can derive
benefit from its use for a wide variety of ailments.
Hypnotism can help in cases of asthma, migraine, duodenal ulcers, blood pressure, skin
diseases, allergies, hysteria neurasthenia and insomnia. By the use of hypnosis more and more
women are bearing children without feel the slightest pain, and there even is a case on record of a
woman being cued of warts by hypnotic suggestion after months of medical and X-ray treatments
had failed.
When we consider that a wart, which is only a growth, can be made to disappear by
suggestion, we are entitled to ask: May we be able to influence other growths? It is only a
possibility, and only years of painstaking work, experiments and research can supply the answer.
Let me hasten to explain that hypnotism is not a cure-all for human ills. It can be used in
widely varying conditions, and nobody, no matter how fanatically opposed to hypnotism, can
deny that in this science we have the most powerful and effective methods of controlling the
mind and, through he mind, the whole body.
When a few words, suggesting paralysis, can make a hypnotized person powerless to
move, through fully conscious and able to reason, who can doubt the power of hypnotism. When
hypnotic suggestion can cause the mouth to water, change the heart rate, or cause sweat glands to
function, who can fail to be impressed with its possibilities in medicine?
Hypnosis may be regarded as the key to mind of man. Neuroses, illusions, delusions, and
hallucinations can be induced experimentally under hypnosis, and as quickly remove. Surely
such a powerful weapon must be the utmost importance in investigating the cause of mental
disorder.
Fortunately there are signs that the medical world is beginning to realize the immense
potentialities of the science which, stripped of all its nonsensical and mysterious trappings, can be
presented as a simple, serious and straightforward method of medical treatment. Hypnosis, after
all, is proving to be of immense value in the treatment of many diseases.
Ulcers, goiter and high blood pressure are known as "stress diseases," unfortunate, but
growing, products of the stresses and strains of modern civilization. When life was calmer and
more leisure, such disease were very rare. With the rush and hurry of today, they are becoming
more prevalent. Unfortunately, they attack the most useful members of society. They are
common among the more intelligent, ambitious and hard working. Those who are lazy, placid,
and without ambitions seldom suffer. Hypnotism is helping, on an ever-growing scale, large
numbers of sufferers from this group of diseases.
The hypnotist need possess no "mysterious gift" or "hypnotic power" whatever. Such a
power, if it can be called that, lies within the subject or patient -- the hypnotist merely has the
technical knowledge of how to manipulate it. (p. 122-123)

28. HYPNOSIS CONTRIBUTIONS TO MEDICAL PRACTICE: GEORGE J. PRATT

1) To contribute to overall patient management. Hypnosis is a means of motivating and
encouraging the patient, reducing fear and anxiety, exploring the etiology of an illness, and even
communicating with unconscious patients.
2) To control habits or behavior that interfere with treatment.
3) To contribute to multimodal approaches to treating a variety of problems as in Crasilneck and
Hall's work with burn patients. They reported the effective use of hypnosis to mange the pain of
the burn as well as the associated with skin grafting and dressing changes, and to increase the
patient's food intake, which is essential to the regeneration of tissue.
4) To eliminate of ameliorate symptoms. The removal of warts through hypnotic suggestion is a
good example of the use of hypnosis in direct treatment. (p. 118)
5) To assist patients in recovering from life-threatening diseases, such as cancer.
6) To control pain. (p. 119)
SYMPTOM REMOVAL: As hypnosis has gained wider acceptance among the medical
community, its original use - that of symptom removal - has been called into question. Some
practitioners are concerned that the removal of a symptom without treatment of its underlying
cause will lead to the formation of a substitute symptom or recurrence of the original symptom.
Most practitioners today have found that those fears are not born out by clinical
experience. Kroger, Cheek and LeCron pointed out that most medical treatment is directed
toward the removal of symptoms, whether it be aspirin for a headache or prochlorperazine
(Compazine) for nausea. Hartland, Cheek and LeCron stated that patients using hypnosis would
abandon symptoms only when they were psychologically prepared to do without them. As
discussed in he first chapter of this book, hypnotic suggestions can be effective only when they
are acceptable to the patient. There is no such thing as a forced removal of a symptom through
hypnosis. (p. 119)
Because pain is experienced psychologically as well as physiologically, hypnosis can help
people alter the perception of pain. While actively engaged in hetero- or self-hypnosis, a patient
can block pain to specific areas of the body, lessen the sensation of pain, or move pain from one
area of the body to another. This ability is useful in the management of many types of pain,
including chronic back pain, post-operative pain, and the pain associated with illness, migraine
headache, burns, childbirth and medical procedures. (p. 138)
There are two basic hypotheses about the way hypnotic suggestion, acting on the autonomic
nervous system, results in the disappearance of warts:
(a) by altering the blood flow to the warts, thus influencing them directly, and
(b) by influencing the body's immune response, thus acting upon the wards indirectly. (p; 140)
Over the past several years, the Simontons have based their cancer treatment program on
the premise that unless the mind, body, and emotions are all striving toward health, a purely
physical intervention (radiation therapy, in this case) will not be effective. Their relaxation and
mental imagery procedure embodies the techniques of modern clinical hypnosis. The building
block of the Simonton's approach are progressive relaxation, fololwed by imagining oneseld ina
pleasent, quiet place, and then visualizing the cancer the treatmet destorying it, and the body's
defenses mobilizing to enhance recovery. (p. 142)
Preoperative hypnotic preparations:
1) Less premedication is needed to alleviated preoperative stress.
2) Less chemical anesthesia is needed and , therefore, the patient suffers fewer toxic effects.
3) There is less blood loss during surgery and, therefore, less need for replacement.
4) Patients experience less post operative nausea and vomiting.
5) There is a prompt return of physiological functions, such as urination and defecation.
6) Wounds heal more rapidly, and patients have a smoother and shorter convalescence. (p.160)
Hypnoanesthesia may be indicated:
(a) in older patients for whom chemical anesthesia would be risk,
(b) for emergence cases where the patient has a full stomach and thus cannot receive a general
anesthetic,
(c) in cases of pulmonary infection, which increases risks inherent in inhalation anesthesia, and
(d) in neurosurgical procedures that require the patient's conscious cooperation. (p. 164)
There are two major ways in which hypnosis is used postoperatively. First, pre- and
intraoperative suggestions for relaxation, comfort, and healing can be reinforced following
surgery while the patient is in the recovery room. Second, psychological problems arise from
surgical procedures or poor patient management can be treated with hypnosis after the patient has
been released from the hospital. (p. 165)
Sex therapy is a field with a high success rate. (p. 268) Hypnosis can be an effective technique
for furthering the following major goals of sex therapy:
(a) to reduce performance anxiety,
(b) to enhance confidence and comfort,
(c) to replace negative conditions with positive ones,
(d) to provide successful experience in vitro that generalize to behavior, and
(e) to increase touching and communication between a couple and at the same time decrease the
emphasis on orgasm to the exclusion of other aspect of sexual functioning. (p. 269)

29. KEY CONCEPTS OF MEDICAL HYPNOANALYSIS: RYAN ELLIOT

(1) Medical hypnoanalysis always begins with the taking of a complete patient history.
(2) Within the first two or three sentences of the history, a patient may reveal information that
often turns out to be related to the basic diagnosis.
(3) If one refuses to answer questions about some areas of one's past, there is a diminution of
hope in solving one's problem.
(4) The history taking helps to establish trust and understanding between the patient and the
hypnoanalyst.
(5) By communication with the subconscious, hypnoanalysts are able to uncover the underlying
reason behind a patient's problem, addiction, or phobia.
(6) People of above-average intelligence make the best hypnotic subjects.
(7) At any given time, we are functioning at one of four mental-activity levels: beta, alpha, theta,
or delta.
(8) Within the alpha-theta mind-activity level, hypnosis occurs on three different planes or
trances: light, medium, or somnambulistic.
(9) Most hypnoanalysis prefer to work at the medium-trance level.
(10) The hypnoanalyst's goal is equal to the patient's goal not to treat every little idea and review
everything that happened in their lives.
(11) Medical hypnoanalysis is successful because it treats the underlying reason for the problem,
and not only the symptom.
(12) We subconsciously control our lives and our well-being, our health, and our habits. The key
is to accept that we are in control and use that strength to determine our directions.
(13) Our bodies manufacture their own anticancer drugs, tranquilizers, and antibiotics; but when
we are sad, angry, or under stress, we interfere with our internal pharmacies. (p. 53)
Charles Reade, a nineteenth-century philosopher said, "Sow an act, and you reap a habit.
Sow a habit and you reap a character. Sow a character and you reap a destiny." The path most of
us take in developing our character passes three milepost: Attitudes leads to actions, actions lead
to habits, and habits lead to life-style. (p. 57)

30. HYPNOSIS USED TO TREAT PATIENTS: DONNA G. SMITH: TAMPA TIMES OCT
1980
PLANT CITY - South Florida Baptist Hospital is the only hospital in the country with a
staff hypnotherapist. (Note: article written in 1980) Hypnotherapy, the use of hypnosis for medial
purposes, is a relative newcomer to the medical field. Although a few doctors used it during the
50's and 60's, it was not until just a few years ago that doctors nationwide began to study
hypnotherapy. (p. 108) Dot Nason, 44, is a nurse anesthetist at the hospital who became
interested in hypnology in 1975. She decided to take a course in hypnotherapy, offered at the
Academy of Clinical Hypnosis in New Orleans, after learning it was on the continuing education
list for nurses. "I've never sat and just been so completely eyes and ears as I was during that
course," she recalled. "The potential of what they're doing with hypnosis just sprung out at me."
(p. 108-109)
After the course, Nason came back to Plant City and slowly established the Professional
Hypnotherapy Clinic, which operates out of the hospital. She said business was sparse at first, but
over the years people have responded well to their therapy and told others about it. Although the
clinic operates only during evening hours, Nason is often called by hospital surgeons to work
with patients who are extremely nervous about surgery. Though slow, quiet repetitious talking
Nason is able to relax the patient, which in turn helps the surgeon.
But the bulk of Nason's patients come during the evening. Most of her patients are either
trying to quit smoking or lose weight. However, not matter what the problem is, the key to
solving it, according to Nason, is replacing the bad with the good. "In hypnotherapy we simply
help them get wrong information out of their mind and replace it with positive suggestions."
explained Nason. "We are careful to phrase all our suggestions to the positive because the
positive is stronger than the negative suggestions." Many times the negative suggestions in her
patients' mind concern their inability to do something which often stems from a lack of
confidence. So while her patients are in a hypnotic or highly relaxed state Nason give them a
post-hypnotic suggestion. To reinforce it, Nason supplies them with cards to read throughout the
day. These care say things like, "I am calm and confident at all times," "I can do anything I want
to do." and "I admire my own abilities." There a cards which say things to help a person lose
weight or quite smoking, but all of them are used to place things in a positive light. "It gives
them something to hold on to," said Nason. "And it helps me because every time a patient looks
at one of those cards it waters the seed that I planted in his mind earlier.
When a patient first comes to the clinic he is asked to fill out a form which supplies Nason
with a very general psychological profile. The patient is also asked whether he has been
hypnotized before. After filling out the form the patient will sit down with Nason or Associate
Director Iris Lastinger for an interview. After the interview, which is taped, there is feedback
sessions in which the patient responds to the interview. Nason says these sessions are essential
before hypnotherapy is begun because it supplies the patient with an outlet.
"Sometimes all they need to do is to talk with somebody," she said. If further sessions are
warranted, Nason will proceed and teach the patient how to relax and at that point she is able to
begin hypnotherapy. It is then that Nason is able to place post-hypnotic suggestions in her
patient's subconscious mind. One of the biggest problems Nason has encountered so far has been
misinformation. "People are afraid they will do crazy things when hypnotized but that is not so.
No one will do something in a relaxed state that they would not do while awake." said Nason. (p.
109)

31. MEDICAL USES OF HYPNOSIS: ROBERT G. MEYER

Hemophilia (This disease is characterized by uncontrolled bleeding): (p. 257) The focus of
hypnotic intervention can be directed toward five areas:
(1) Management of emotional stressors to reduce the frequency of spontaneous bleeds, either
through relaxation or using hypnotherapy to address underlying personality structures.
(2) Control over peripheral vascular constriction, to reduce the severity of the bleed, either
through direct suggestion to stop the bleeding and/or to constrict the blood vessels or through
indirect suggestions of cold and/or the use of creative imagery.
(3) Suggestions aimed at increasing self-confidence and promoting the practice of other
techniques. (4) Psychoeducation and imagery approaches designed to increase the hemophiliac's
production of the necessary factor.
(5) Pain control techniques designed to treat the pain with the arthritis and the injections. (p.
258)
Surgical Applications: Hypnotic suggestion is used in the surgical process preoperatively to:
(1) Reduce anxiety.
(2) Induce relaxation.
(3) Educate the patient about the operation protocol.
(4) Improve the patient's self-confidence.
Hypnosis is used intraoperatively to:
(1) Induce hypnoanesthesia in patients where traditional chemoanesthesia is contraindicated
(2) Reduce the quantity of any required chemoanesthesia.
(3) Give the patient suggestions to assist in staunching bleeding or other actions that the patient
can take to assist the surgery.
(4) Give posthypnotic suggestions to assist in staunching bleeding or other actions that the patient
can take to assist the surgery.
(5) Give posthypnotic suggestions of postoperative comfort, relaxation, and lack of pain.
Hypnosis is used postoperatively to:
(1) Facilitate recovery through direct suggestions of compliance with treatment and relaxation,
increasing the patient's active involvement in recovery and perceived self-efficacy.
(2) Manage postoperative pain and avoid extensive use of chemical analgesics.
(3) Manage anxiety and boredom and effective disturbances through creative use of relaxation
imagery.
(4) Supplement the functioning of the immune system through psychoeductional techniques and
direct suggestion, thereby reducing the possibility of postoperative iatrogenic complications, such
as infection and secondary illnesses. (p. 259)
Use of hypnosis in Obstetrics:
(1) May be maintained for a long period of time.
(2) Allows the mother to be fully conscious and cooperative with the physician.
(3) Allows the mother to speed up or slow down her labor, and premature labor may be prevented
by hypnotic suggestion.
(4) Reduces chemoanalgesia and anesthesia or completely eliminates them.
(5) Reduces postoperative nausea, vomiting, anoxia, and other side effects of chemical
anesthetics. (6) Unlike medication, places no extra stress on the circulatory, respiratory, hepatic
or renal system. (7) Reduces or eradicates fear, tension and pain before and during labor.
(8) Produces resistance to fatigue.
(9) Controls painful uterine contractions.
(10) Shortens labor time by approximately three hours in primiparae women and approximately
two hours in multiparae women.
(11) Eases delivery, episiotomy, and suturing to the perineum.
(12) Requires no elaborate education. (13) Allows for quicker healing since many anesthetics
slow the healing process. (p. 265)
Terminal Patients: The hypnotic script should always include the idea of freedom form tension,
tightness, stress and strain; of being relaxed and at ease; and of the body as relatively free from
discomfort. (Durbin: Before using this script, I would drop the "wills" for I believe suggestions
should be in present tense.) You will have a minimum of discomfort. You feel relaxed and at
ease. You feel your muscles relax. The tension and tightness in your muscles lessens and flows
out of your body. You feel a sense of well-being. You will be able to sleep when you desire.
You will be able to reinforce these suggestions yourself. As frequently as you desire, you will be
able to reinforce these suggestions. You will be able to relax yourself and remind yourself of
these suggestions. You can eat well and enjoy food the doctor has ordered for you. Discomfort,
anxiety, and tension will be minimized and be under control most of the time. You will be free
of excessive tension and any physical or psychological discomfort.(p. 277)
Children shift quickly from fantasy to reality and vice versa. This make a child's hypnotic
experience different from an adult's in several ways. First, because of this ability to shift form
reality to fantasy, children may go into hypnosis without a formal induction. Second, the
deepening phase is often shorter for children than for adults because children ar able to shift
quickly to the hypnotic state. Third, because of their ability to shift quickly from fantasy to
reality, children may come out of a trance state quickly.
Compared to adults, children are more physically active, more likely to open their eyes or
refuse to shut them, and more likely to speak spontaneously during hypnotic inductions. Some
clinicians view these behaviors as indicating that the child is not experiencing the hypnotic state.
However, it is possible to induce an active, alert hypnosis when the subject is involved in physical
activity. Thus, children may accomplish a hypnotherapeutic goal while engaging in play activity.
The therapist should not insist that children close their eyes for hypnosis. Eye closure for children
may trigger negative attitudes about sleep. It is best to merely suggest to the child that it may be
easier to concentrate with eyes closed, but that the decision is the child's. (p. 293) Choice of
words is important. Words like sleepy, tired, and drowsy should be avoided because many
children have negative attitudes about sleep and going to bed. Also children may equate the terms
with a favorite pet who had been "put to sleep" Words like try implies the possibility of failure.
(p. 294-294) The therapist should not make sudden changes in the tone or content of the
suggestions. This could make the child anxious. Smooth transitions are better. (p. 294)
Sexual Abuse: Hypnosis with sexual abused children may be used to help them experience a
relaxed state, is an antagonist to the anxious state to which the abused child has been accustomed.
This can provide the child a sense of competence and mastery over his or her environment.
Storytelling with sexual abused children to provide comforting hypnotic suggestions, symbolism,
and metaphors that help children emotionally distance themselves from the trauma of the abuse.
Any of the induction or therapeutic techniques outlined involving a relaxation component may be
used. (p. 310-311)
Warts: Hypnosis has been successfully used in the treatment of warts. Tasini and Hackett (1977)
had children in a trance state imagine that their warts felt dry, were turning brown, and feel off.
Noll (1988) suggests the following procedure. Prior to hypnotism, the child is instructed that
warts are caused by viruses living inside the child's body. The child is told that he or she has
"soldier and guard cells" that he or she can control by using hypnosis. During hypnosis, the child
is told to set the guard and soldier cells into action and kill the warts. The child may also imagine
that a magic cream is being put on the wart by the therapist, or some device can be introduced as
something like a "magic ultra-ray machine" that will cause the warts to dry up. (p. 314)
32. HYPNOSIS FOR AIDS THERAPY: FROM THE INTERNET
SESSION I: Now, as you sink deeper and deeper, completely relaxed, I'm going to talk
about tension, anxiety and fear. How unnecessary these feelings are and how you, yourself, are
going to eliminate them. When we come down with a cold, the general emotion we feel is
inconvenience. Inconvenience, because you miss work, have little or no energy to accomplish
daily tasks, and in general - this cold just throws a wrench into our life. The same holds true for
anxiety, tension and fear. These are also inconveniences. If we go to work full of tension and
anxiety, our work performance drops and it can cause tension among co-workers and make the
day very uncomfortable.
Tension is the opposite of relaxation and if tense or nervous our energy is sapped and we
go through the day yawning and looking at the clock. Emotional tension drains our minds of
much needed energy to accomplish the most trivial tasks. If fearful, we tend to slip into
depression, bringing
on these tensions and anxieties once again. Tension, anxiety and fear are as much inconvenience
as a cold, if not more. Tension, anxiety and fear also bring on other inconvenience, the main one
being illness and disease.
Our immune system will not work for us properly if its bombarded with negative energy.
Your body involuntarily responds almost immediately to whatever crosses your mind. Think a
pleasant thought and you smile. Think a melancholy thought and you feel sad. Think an angry
thought and you
frown. Think an embarrassing thought and you blush. Think a fearful thought and you tense. But
tension cannot exist when the mind is calm. If we replace thoughts of fear with thoughts of calm
and peace, our tension soon subsides and our minds healing power continues working for us. In
essence, we are what we think. One of the most important medical findings is that the stress of
inner conflicts suppress the body's defense system, which then becomes unable to fight off
disease. Also, keep in mind that the body and mind are a single integrated organism. As the
saying goes "You have nothing to fear but fear itself". You have no reason to fear a life
threatening disease because you have the power to reject invasion in your body.
The responsibility of your health and your well-being is in you. You have the power to
remain well as long as you have your mind and the determination. We each create our own
miracles and we create our own downfalls, and as you sit here, completely relaxed and at peace
with your
body, you realize this. And this realization of a healthy body and strong, indestructible immune
system, now becomes a permanent fact in you mind. You have no reason to feel tension, anxiety
or fear because you know disease doesn't have a chance of surviving with a strong healthy
immune system. With visual imagery, which we will soon be working with, your physical health
will remain as strong and pure as ever and with your new realization that you have no use for the
inconvenience of tensions and fears, your immune system can concentrate only on being strong
and powerful against any disease.
Now, I want you to visualize those two warriors you drew. Two vicious, strong, mean
warriors. One standing guard inside each temple in your mind. These guards are now a
permanent part of you. Each and every time a negative thought such as fear, or an anxious tense
thought, starts to work its way into your mind, these warriors will savagely spear the negative
thought out of your mind. Out of your immune system process. These warriors are guarding your
immune system for you and will never, ever, let negative thoughts into your mind to harm you or
to disrupt your immune systems strength which is fighting inside of you every second. I am going
to show you how strong these guards are. Picture in your mind the drawing of the sluggish.
confused, disoriented disease which you have been fearing. Picture it creeping towards your
mind, trying to put fear and
distress into you. Now, see your personal warriors raise their spears, puffing up their chests in
victory and are ready and standing guard again. Each and every time a negative thought tries to
invade your mind, every time a negative thought about disease tries to invade your mind, these
warriors will fight and win ... every time! Without fail! Now, lets get rid of that dead disease
lying there, having lost that battle. From the tip of your toes I want you to visualize a violet
cleansing flame, flowing inside your body, working its way up through your body, up your spine,
through your shoulders and neck. Feel it flowing throughout your body, cleansing and purifying
until it reaches your head, where it flows out through your head and cascades down over your
entire body, giving it a strong, protective shield of light. And, as this shield is cascading down
over your body, you sink deeper and deeper into relaxation with the absence of tension and fear.
Feel the tension and fear fading away with every breath you take ... feel the hope and joy which
replaces these negative emotions. Every breath you take brings you closer and closer to relaxation
and contentment.
Now, as you are completely relaxed, I am going to give you some suggestions that are
going to take thorough and complete effect on your mind, body and spirit ... permanently in your
mind. One ... each and every time a negative thought such as tension, anxiety or fear tries to enter
your mind, your two warriors will effectively kill them off. Two ... these warriors, as of this
moment, have become a permanent part of your being, always with you and always killing off
negative thoughts.
Three ... each and every time a negative thought has been killed, it will be removed from your
body by the violet cleansing flame.
Four ... the violet, cleansing flame will not only remove the dead, negative thought but
will flow from inside of your body, through the top of your head and will cascade over your
whole body leaving a powerful white shield of protection from negative thoughts and disease.
Five ... because you are now aware of your own power of rejecting negative thoughts, you are
becoming, with every breath you take, more and more relaxed. Your relaxation is so complete
that you now make it a permanent part of your life.
I'm going to give you a few moments of silence to let these suggestions take full effect
upon you ... mind, body, and spirit.
SESSION II: As you sink deeper and deeper into relaxation, you are feeling calm and at
peace with yourself. During your last visit I talked about your ability to fight off and eliminate
tensions and how this can be accomplished. As you remember, tension and anxieties bring about
a breakdown in your immune system and how this can lead to disease and illness. Today you are
going to learn, effectively and permanently how you can rid yourself of the disease that has been
allowed to invade your body. Through visual imagery, you are going to tell your
subconscious to strengthen your body's immune system and to fight against the invading disease.
The disease in your body become helpless against the revived immune system. Your mind power
is going to overpower and destroy your diseased cells. I want you to visualize the picture you
drew of the disease in your body. Visualize its
disorientation ... visualize its weakness ... visualize its sluggish, disorganized shape ... visualize
its frightened and scared expression ... that's right ... very good. Now I want you to visualize the
current
treatment you are receiving from your doctor. If you are taking medication, picture it as an
orange fluid surging throughout your system towards the diseased cells ... plunging through your
body and attacking these cells ... Good, very good. Visualize this medication successfully killing
off these cells, hundreds at a time, shrinking them until they have lost all life and leaving your
white cells safe and untouched. Visualize these diseased cells shrinking and afraid because they
know your immune system is much stronger than they are. Visualize this medication
succeeding ... that's right, very good.
Now I want you to visualize the picture you drew of your immune system ... powerful,
aggressive, invincible. Visualize its viciousness, its strength, ready to attack and kill all disease.
Now, visualize your immune system zeroing in on one, only one, of these diseased cells ... zero in
on one of those weak, small cells. See how frightened and disoriented it is ... how difficult it is
for it to run of even move because of its soft, sluggish shape ... see how it reacts to the knowledge
that it's going to be attacked by your vicious, fierce and ferocious immune system, your white
cells that are so strong and unbeatable. Alright, now attack that diseased cell ... Visualize your
immune system destroying, powerfully destroying, bursting with energy and conquering that
frightened diseased cell ... See how angry your immune system is and how it rushes viciously up
to the diseased cell, with no mercy or gentleness, and destroys it ... tearing it to pieces. The
number of white cells in your body are limitless and the diseased cells are outnumbered. You
can't lose! You have billions in reserve. Now visualize that dead cell and feel triumphant. Look
around you .. see the other diseased cells cowering from this successful attack.
They know that they too are going to be destroyed. Alright, now zero in on another one ...
visualize your white cells readying for another attack ... and charge forth ... striking, tearing apart,
destroying, bursting with energy ... See that diseased cell being torn apart, destroyed, ripped to
pieces ... See how easy the diseased cell is destroyed ... how its soft, sluggish body crumpled and
died at your immune system attack. Now again, zero in on another one ... and charge! ... attack
that weakling of a cell. A weak, confused disease of that sort has no use in a strong body such as
yours ... get it out of there ... destroy it ... attack ... viciously attack ... its place is not in a strong
body such as yours ... rip it apart ... show no mercy to this ridiculous mush that's not welcome in
this powerful body ... your white cells are screaming at the diseased cell saying 'I'll show no
mercy and I enjoy destroying you' You're nothing but small, weak and confused. What's more ...
there are many, many more of me
than you!
Alright, now you are going to get into the picture. I want you to visualize yourself as a
white knight, in charge of this tremendous army of white cells. You are in charge of your
immune system ... giving orders ... leading the attack. Feel the hatred towards these diseased cells
... feel the anger ... and begin helping your white cells hack and rip to pieces the diseased cells,
one by one. Destroy these diseased cells, one by one. Give your white cells orders. Ready them
for the attack. Tell them to "Charge! Attack! Destroy!" Tear the cell to pieces ... visualize your
sword plunging right through each diseased cell. Visualize this as you hack and cut and twist and
slash with your sword. Feel the disgust for these diseased cells ... feel no mercy ... order your
white cells to carry away the dead remains of these diseased cells ... flush them out through your
kidneys or bowel ... they're gone ... gone and will never return.
Keep attacking diseased cells, one by one. Say to yourself, 'I hate this diseased cell ... I'm
killing this cell, I hate it so much ... All of these cells are dead ... dead cells, never to invade my
body again. Now, as you are killing off these diseased cells, I want you to also visualize the
healing medicine and treatment you are receiving from your doctor. Visualize the healing, orange
medicine fighting right alongside your strong, white cells ... fighting right alongside you ... the
white knight
... the strong leader and commander of your white cells. See your white cells and the healing
medicine fighting side by side. The healing medicine surging through the diseased cells ...
weakening them. These diseased cells don't have a chance now ... your army of vicious white
cells, the forceful, healing medicine and your strong leadership doesn't give these diseased cells
any chance at all ... Alright, now I want you to order your white cells to form into groups of 50
each ... hundreds of these groups
are forming in packs of 50 each ... getting ready for a ruthless, heartless attack ... 50 to 1 ... the
diseased cells don't have a chance
.. alright, now give the order to attack ... attack ... attack one cell at a time with your pack of 50
strong, vicious, white cells ... kill, destroy, rip apart ... savagely kill those diseased cells ... that's
right
... good. A victory each and every time your white cells attack these weak, spineless, frightened
diseased cells.
Now look around your system that was once invaded by these weak, disorganized cells ...
see how healthy and glowing it is ... see the healthy, pink glow ... free of disease ... free of any
disorder. See the white cells, bursting with strength ... free to move throughout your body without
any cumbersome diseased cells ... visualize your healthy blood pumping through your body ...
surging life through every pore, every vein, every artery ... giving you vitality and perfect health.
Now, as you visualize your body in perfect health, glowing with vitality and pureness, I
want you to visualize yourself walking down a white
stretch of beach ... walking easily ... strolling down a beautiful, peaceful beach ... You see
yourself in perfect, harmonious health ... in a super-healthy state, completely in harmony with
nature, knowing that your body can fight off every kind of human ailment. Picture that you are
walking along this beach, fully aware that your life's goals have been accomplished ...
accomplished through your own efforts ... feel how proud you feel ... how wonderful it is to
know you have the power to make life work for you ... Feel a very strong love for yourself ...
picture yourself having accomplished everything you've ever wanted to accomplish ... take a few
seconds out now to visualize this ... visualize accomplishment ... enjoying life!
Now, it's time for congratulations. It's time to congratulate yourself for taking an active
role in your own recovery. Repeat, to yourself this suggestion: 'Every day in every way I am
getting better and better.' Repeat this now, to yourself, a few times ... and as you say it, feel
yourself being well, cheerful, optimistic, and full of renewed energy. Now, I'm going to give you
some suggestions that are going to take complete and thorough effect on you mind, body, and
spirit. These suggestions are also guided rules for you to follow every day, 15 minutes each time.
You are going to follow these seven steps for your own guided imagery, for you to practice every
day, and you are to follow them exactly in sequence, as I relate them to you.
One - Visualize your ailment exactly as you drew the picture of it. Do this for thirty
seconds. Two - Visualize the medical treatment you are receiving and see it destroying the cause
of your illness. This session will last approximately 75 seconds. Three - Visualize your body's
healing powers destroying the cause of your illness. These are your white cells. This session
should last about 8 minutes. Four - Visualize the afflicted area as already healed and restored to
health. This visualization should last around 90 seconds. Five - Visualize yourself in perfect
health. 75 seconds for this period. Six - Picture you life goals as fulfilled and visualize a good
self-image. This also 75 seconds. Seven - Congratulate yourself for taking an active part in your
own recovery. Tell yourself you are feeling great. Maintain a positive feeling. This last session is
also 75 seconds.
You are to use this program of guided imagery 3 times a day for a full 15 minutes each
time. You will find that your body will be in a better state of health than it was before each
session ... full of vitality, full of life.

33. SOME MEDICAL USES FOR HYPNOSIS: UNIVERSITY EDINBURGH

STUDY
ASTHMA: Asthma has a complex aetiology but it is believed to have a
significant psychological element1. Additionally, there is evidence that in
asthmatics, stress tends to lead to broncho constriction rather than the
normal response of bronchodilation1. Hence, hypnosis may be able to reduce
this response in asthmatics by addressing the underlying cause of stress.
A randomized controlled trial in 1968 2 showed that airway FEV1
(the volume of air able to be forcibly exhaled in one second) was significantly
increased in asthmatic patients treated with monthly hypnotherapy sessions
followed by daily self-hypnosis over the course of a year. In a control group
treated with relaxation exercises there was no significant increase. However,
when the two groups were compared there was no significant difference
detected in FEV1 or the amount of medication required per day. This
suggests that, although hypnosis may help asthmatic patients, there is no
significant benefit above simple relaxation.
The evidence for the benefits of hypnosis in asthma remains very sparse
and, until further research is performed, the idea of using it as a treatment
will remain a distant and unproved aspiration. However, those who do
advocate its use suggest that although many attacks are brought on by
specific allergens, in some cases the attacks are related to stress. Additionally,
many asthmatics have high levels of anxiety regarding the next attack and
fear the prospect of death whilst having an attack. Hypnosis may yet be
proven to have significant effects on these psychological symptoms occurring
both before and during attacks.
DERMATOLOGY: Many dermatological complaints have psychological
or stress-related components which may be targeted by using hypnosis,
usually as an adjunct to other treatments. Research in this area is at a very
early stage1 and hence only a little evidence exists as to its effectiveness. In
1978, Griesemer studied to what extent dermatological complaints had
emotional triggers, the results of which are shown in the table below. By
implication, the high levels of psychological association mean that the
conditions towards the top of the table may be particular susceptible to
treatment with hypnosis.
Much research in this area remains anecdotal, but a few randomized
controlled trials do exist. In the case of psoriasis, a randomized controlled
trial by Taust and co-workers showed a significant improvement in patients
with psoriasis over those in a control group, although the effects were only
significant in those who could be highly hypnotized. The largest area of
research has been into the treatment of warts, which appears to have been
contradictory at times4. In these cases, much of the hypnotic suggestion is
aimed at changes to the circulation in the area. This may either be
vasoconstriction which is believed to reduce the blood supply to the warts,
leading to their death, or vasodilation, which provides larger numbers of
white blood cells which help to control the infection1. Such techniques may
make the lesions resolve completely.
As the dermatological conditions discussed have such an emotional
aspect, hypnotic techniques such as ego-strengthening therapies may be used
which aims to restore the patient’s self-esteem. Direct suggestions aimed at
stopping the patient scratching have also proved effective. This may also be
achieved through symptom substitution in which, when the need to scratch
arises, the patient is trained to carry out a different physical activity instead
such as clutching a nearby object.
In the case of children with emotionally-triggered dermatological
symptoms, metaphors are often used to rebuilt self esteem instead of direct
suggestion and overt ego strengthening1. Such methods may involve story
telling in which characters with skin conditions overcome both their
symptoms and their social problems. This aims to change the child’s
perceptions towards their skin conditions and develop a realization that it is
possible to integrate fully with their peers.
EATING DISORDER: OBESITY & ANOREXIA: Obesity and anorexia
nervosa, the two most common eating disorders in the developed world,
both have a considerable psychological component. Obesity is thought to arise
in many cases from low self-esteem, which may cause an individual to seek
personal solace in food. The obesity that results further contributes to
low-self-esteem, setting up a viscous cycle. Similarly, anorexia nervosa – a
refusal to eat that results in severe, often debilitating, weight loss – is
believed to arise from a low self-image. Refusal to eat is seen by the anorexic
individual as a means of boosting that image physically and of gaining
self-control mentally. Given the strong psychological roots to these
conditions, it is not surprising that hypnotherapists have targeted them for
treatment. Several techniques are used by hypnotherapists in an attempt to
explore the causes of an individual’s eating disorder and to provide effective
treatment suggestions. These techniques include: general relaxation and
calmness; guided imagery; teaching self-hypnosis; ego-strengthening; direct
and indirect suggestions for healing and recovery; cognitive restructuring
and reframing; symbolic guided imagery; age progression; metaphorical
prescriptions; age regression and abreactions; and ego state therapy. Studies
into the effectiveness of hypnotherapy as a treatment for eating disorders,
however, have so far proven inconsistent and inconclusive.
OBESITY: Some studies, such as the one carried out by Bolokofsky et
al in 1985, suggest that hypnosis is effective at both stimulating and
maintaining weight loss in obese individuals when used as an adjunct to
behavioral therapy methods. A meta-analysis of 18 studies was conducted
by Kirsch et al in 1995 and seemed to support this strongly.3 The
meta-analysis showed that over 70% of clients who used hypnosis as an
adjunct to cognitive-behavioral therapy had better outcomes than those
clients receiving only nonhypnotic cognitive-behavioral treatment. A more
recent study conducted be Allison et al, however, refutes the claims made by
Kirsch.4 Allison corrects for "several transcription and computational
inaccuracies in the original meta-analysis" and also removes "1 questionable
studyfrom the analysis" and showed that hypnosis does not significantly
improve patient outcome. Allison’s study concludes that "at most, hypnosis
results in a small enhancement of treatment outcome." The benefit of
hypnotherapy as a treatment option for obesity is therefore still largely
debatable.
ANOREXIA: Less studies have been published about the effectiveness of
hypnotherapy in curing anorexia nervosa. This is complicated by the fact
that recovery from anorexia is a more difficult process to quantify, when
compared with weight-loss in obese patients, which is far more quantifiable.
Crasileck and Hall, however, reported in their study that more than half of
70 anorexia cases treated with hypnosis showed marked improvement.
Unfortunately, what the study fails to take account of is that many patients
with anorexia nervosa have no overt acknowledgment of the disease and by
extension no cooperation or motivation to work hypnotically. For this
reason, if nothing else, its practicality in many instances is questionable.
ENURESIS: Enuresis is the involuntary passing of urine, most
commonly seen in children nocturnally (i.e. bed-wetting). Children with
nocturnal enuresis tend not to wake to the sensations of a full bladder.
Strategies have been developed to overcome this problem, such as the ‘bell
and pad’ method in which an alarm sounds when the bed it wetted, and
also the ‘lifting’ method in which the child is awoken a few hours after going
to bed to allow them to relieve themselves.
However, neither of these methods addresses the underlying problem of
not responding to the signal that the bladder is full. Hypnosis has been
suggested as a method of stimulating the ‘wake-up’ response. Researchers
realized the need for ego-strengthening, the removal of anxiety and building
of confidence. In 1975, Olness2 carried out research which used hypnosis as
a treatment. In this research, 31 out of 40 children in the trial stopped
wetting the bed, most within a month. Additionally, other research has
shown that hypnosis can provide a cure when other treatments have failed.
For example, Kohen and colleagues3 found that, in children where bell and
pad and drug therapies had failed, treatment with hypnosis led to 44% of
children being cured and an improvement in a further 31%. However, much
of this research remains anecdotal or single-case reports, and often fail to
include a study group. Hence, although there is some evidence as to the
effectiveness of hypnosis in the treatment of nocturnal enuresis, further
research is needed.
SMOKING: Many habits that are detrimental to health are treated
with hypnotherapy. The habit of smoking, like so many others, is both a
physical and a mental process.1 In smoking, there is the physiological
addiction caused by nicotine, which acts mainly as a ligand for acetylcholine
receptors of the nervous system. Then there is the mental addiction that can
be created by a host of personal and social factors. For example, smoking
can be started as a means of fitting into a particular social group, or as a
means of replacing pre-existing personal problems such as lack of
companionship, love or self-esteem. Hypnotherapists aim to address both
processes, but most especially the psychological aspects of addiction.
To address these psychological aspects, the therapist usually begins with
an evaluation of why the person started smoking and what purpose it serves
in their life. For the smokers who began by identifying the habit with a
particular social group or role model, suggestions aimed at strengthening a
person’s perception of his/her individuality are helpful. 1 For those who have
begun in order to replace missing love, companionship or self esteem, more
exploration is required but often suggestions aimed at building
self-confidence are used. To counter the physical addiction of nicotine,
hypnotherapists usually make suggestions that will change the perception of
the taste of smoke from pleasant to unpleasant. The individual is told to
imagine cigarettes as unappealing, bad tasting, foul smelling and revolting.
Many studies have been published assessing the effectiveness of hypnosis
in the cessation of smoking. One large study 2 consisting of a sample of
2,810 smokers, showed that one month after hypnotherapy treatment,
22% of individuals had remained off of cigarettes compared to 20% who
opted for pharmaceutical options. However, not all reports are optimistic. A
paper published in 2000 attempted to perform meta-analysis on individual
studies dealing with the effect of hypnosis on smoking cessation. However,
they found that "there was significant heterogeneity between the results of
the individual studies" and, in the end, that hypnotherapy had "no greater
effect on six month quit rates than other interventions or no treatment."
Another report in 2000, which compiled the results of 59 separate studies
found that those smokers who underwent hypnosis fared better in terms of
abstaining from smoking than did smokers who had no intervention but
there was no benefit above and beyond other treatments.
GASTRO-INTESTINAL DISORDERS: The activity of the
gastro-intestinal (GI) tract has, for centuries, been linked to psychological
and emotional states. Even in our language, metaphors abound connecting
the functions of the GI tract with our state of emotion. "I cannot stomach
the idea" or "he has lots of guts" are some of the many common expressions
that attest to this age-old linkage. The connections made between
psychology and GI functions have become more specific over the years, with
certain psychological states linked to quite specific GI-tract symptoms.
Depression, for example, often leads to a lack of appetite, decreased
salivation, constipation, and weight loss. Angry states are sometimes
accompanied by aerophagia, and anxious states are often associated with
diarrhoea.1 Given the long-established and increasingly understood link
between emotional states and GI functioning, it should not be surprising to
learn that many GI disorders have a substantial psychosomatic element and,
by extension, have become targets for hypnotherapuetic treatment. Two
major GI disorders – irritable bowel syndrome and peptic ulceration – are
discussed in more detail below.
PEPTIC ULCER: Peptic ulcers are manifested by chronic ulceration of
the mucosa lining the oesophagus, stomach, or duodenum and are
commonly caused by the hyper secretion of gastric acid. Ulcers in the
duodenum have been more convincingly linked to psychological factors than
ulcers in any other part of the GI tract and have therefore been the target,
more than any other, of hypnotic therapy. 1 In recent times, however,
interest in hypnotic treatments for peptic ulcers (even duodenal peptic
ulcers) has declined. Instead, a new syndrome called functional dyspepsia is
now recognized in which ulcer like symptoms occur without ulcer and
frequently in association with psychological symptoms. Much of the current
hypnotherapy and hypnotic research has been focused on this particular
condition.
Patients with duodenal peptic ulcers and more recently functional
dyspepsia have been found to have particular personality traits. They are
often "individuals with strong needs to be taken care of, to be nurtured, and
to have close body contact." 1 The individual compensates for these needs
with outward personality traits of independence, self-reliance, and
aggressiveness. The hypnotherapist, then, in his evaluation of the duodenal
ulcer or functional dyspepsia patient, tries to gain an understanding of a
patient’s "emotional dynamics." In particular, what unconscious emotions are
experienced and what symptoms do they cause? What conditions make these
symptoms flare up? The patient is then "shown how to recognize putative
emotions early on and how to process them more constructively, that is,
through assertiveness training."
Exactly how effective is hypnotherapy for treating peptic ulceration and
functional dyspepsia? This is debatable. A recent study by the Manchester
group of Calvert et al showed that both in the short term (16 weeks) and
long-term (56 weeks) hypnosis was more effective than either "supportive
treatment" or medical treatment at improving symptoms of functional
dyspepsia.
INFLAMMATORY BOWEL DISEASE: Inflammatory bowel disease is a
generic term for an inflammation of the lower regions of the GI tract, which
gives rise to symptoms such as increased frequency and urgency of
defecation, diarrhea and bloody stools. It is most commonly caused by two
pathologically distinct conditions called Crohn’s disease and ulcerative colitis.
Both conditions have been targeted by hypnotherapy. According to Schafer,4
both conditions can be treated as autoimmune diseases, which are
"characterized by a high normal amount of the aggressive instinctual drives
and ambivalence about their realization. Each patient's personality causes the
ambivalence to be somaticized into specific autoimmune bodies that
aggressively are overproduced and then attack specific tissues." Hypnosis, it
is claimed, "helps in gaining insight, reinforcing interpretations, handling
stress, visualizing normal intestinal areas, and controlling of the autoimmune
antibodies to the normal level." A lot of research has been directed at
determining the effectiveness of hypnosis in treating the symptoms of IBD.
Much of it has been anecdotal, but in recent years, more convincing analyses
have been made possible. At the University Hospital of South Manchester, for
example, the first hypnotic unit in the United Kingdom was recently
established staffed by six specially trained therapists providing hypnotherapy
as a clinical service for patients with IBD. The first large study 5 published
by this group, in 2002, showed promising results. It was an audit on the
first 250 patients treated and the large number allowed several forms of
analysis to be performed. The results showed that patients receiving
hypnotherapy had "marked improvement in all symptom measures,
quality of life, and anxiety and depression (all ps < 0.001), in keeping with
previous studies." 5 More such studies will be needed to determine the
effectiveness and utility of hypnotherapy in inflammatory disorders of the
lower GI tract.
DENTAL HYPNOSIS: Fear and anxiety are noted as important factors
in a patient’s experience of dental treatment1. Hence it has been speculated
that hypnosis could help alleviate these problems. The most basic method by
which hypnosis can achieve positive results in dentistry is through simple
relaxation, which can reduce behaviors in the examination room such as
gagging2. Additionally, hypnosis may aid in the reversal of phobias, such as
that experienced towards needles. This can either involve desensitization
towards the object of the phobia by gradually introducing it in increasingly
intrusive ways, or by the process of ‘reformulation’ in which a memory of an
event which may have triggered the phobia is replaced.
Other areas in which hypnosis may be used in a dental forum include
habit behaviors. For example, tongue thrusting can lead to a lisp. Hypnosis
can enable the patient to adapt their tongue thrusting and hence learn to
reduce lisping. Hypnosis can also help in allowing the patient to tolerate
appliances such as braces and false dentures.
In areas of oral and dental surgery, hypnosis can help reduce pain
through glove anaesthesia, hence reducing the need for chemical anaesthesia.
This may be of particular help if chemical sedation is contraindicated, such
as in the presence of allergies, obstructed nasal passages or airways, and in
pregnant women. Additionally, it can help reassure the patient in cases
where sedation through inhaling gases, such as nitrous oxide, may be needed.
During a dental procedure, there is some evidence that salivary flow and
bleeding can be reduced by hypnotic suggestion, which can greatly aid a
surgeon1,4. Such hypnosis involves suggestions of a hot, dry environment and
the mental tying off of a blood vessel1.
RESEARCH: In 1998, Fabian and Fabian published research into the
effects of hypnosis on patient anxiety5. This pair defined two mechanisms
by which anxiety occurred. Firstly are those who have a simple fear or
phobia of dental treatment, caused by unfavorable experiences earlier in life.
The other group suffers from psychosomatic dental disease caused by
anxiety, such as burning-mouth syndrome and salivatory problems, and
typically find themselves concerned with morbidity resulting from dental
treatment5. The groups were split in two into a control group and a
hypnotic relaxation group. The hypnosis group were induced into a trance
and then asked to remove their anxiety as if throwing it out of a moving
vehicle. The treatment was then performed. Afterwards, the patients were
assessed to see if they showed any evidence of: amnesia regarding the
procedure; a lack of recognition of pain; and any significant distortion of
perceived time.
In the groups which suffered from simple phobias, a significant
difference was found in the occurrence of analgesia, it being higher in the
hypnosis group. However, there was no evidence of time distortion or
amnesia. Additionally, experiments on people with phobias such as needle
phobias found that hypnosis significantly reduced related anxiety, and also
had beneficial effects on other occurrences such as collapse.
The patients with psychosomatic problems were treated through the
use of a technique similar to glove anaesthesia. The subjects were asked to
place their hands on their faces whilst hypnotized and were then given
suggestions that their breathing gathered in ‘inner energy’ which should be
passed from the arms and hands and into their oral area, ‘filling it’ with
energy. It was hypothesized that this would aid their symptoms. This was
performed before a session of psychotherapy. All but one of the seven
patients in this part of the trial showed some improvement, with one
showing a complete recovery from their symptoms. However, the lack of a
control group and also the small numbers involved make it difficult to know
how much the hypnosis aspect of the treatment aided the patients’
improvements, and more research is needed in this area.

34. HYPNOTHERAPY EFFECTIVE FOR FUNCTIONAL DYSPEPSIA: MARK

EBELL, M.D., M.S.
Clinical Question: Is hypnotherapy effective in the treatment of
functional dyspepsia? Setting: Outpatient (specialty) Study Design:
Randomized controlled trial (single-blinded)
Synopsis: Study investigators recruited patients referred for endoscopy
because of dyspepsia. All had negative results on endoscopy and fulfilled the
Rome I criteria for functional dyspepsia. Patients with predominant reflux
symptoms, a history of peptic ulcer disease, recent gastrointestinal surgery,
current Helicobacter pylori infection, or who were using nonsteroidal
anti-inflammatory drugs were excluded. This left 126 patients who were
randomized to receive hypnotherapy, supportive therapy plus placebo
medication, or ranitidine in a dosage of 150 mg orally twice a day.
Hypnotherapy and supportive therapy took place during 12
30-minute visits during the first 16 weeks of the study. All patients also
had follow-up visits at 28 and 56 weeks. Remember, ranitidine is not
effective for functional dyspepsia without reflux, so this was basically an
untreated control group. We are not told how randomization was performed
or how allocation was concealed; analysis was by intention to treat. Outcome
assessors were masked to treatment assignment, and efforts were made to
maintain this blinding. Hypnotherapy involved positive imagery of symptom
reduction; the supportive therapy involved a discussion of the patient's
symptoms and general advice. Quite a few patients were lost to follow-up (n
= 14), did not complete treatment because they believed it was not
working (n = 26), or did not receive therapy because of the time
commitment (n = 8). Fewer patients in the hypnotherapy group withdrew
because it was not working than did patients from the supportive or
ranitidine groups (zero versus 13 and 10, respectively; P <.001).
The primary outcomes were a symptom score and quality of life.
Symptoms improved more in the short term and long term for patients in
the hypnotherapy group than for the other two groups. Quality of life
improved significantly more for the hypnotherapy group than for the other
groups in the short term, but in the long term, patients in the supportive
therapy group caught up. This occurred after treatment ended and is
difficult to explain, although the authors postulate that it was because five
of the remaining 24 patients in that group were taking antidepressants,
versus none in the other groups. Interestingly, 81.8 percent of patients in
the supportive group and 89.7 percent in the medication group were taking
a medication at the end of one year, compared with none in the
hypnotherapy group (P <.001). These patients also had fewer consultations
(one versus four; P <.001). Bottom Line: It's all in your head! This small
study found that hypnotherapy was more effective than medication (which
we know does not work) and supportive therapy (which may not work) for
functional, nonreflux dyspepsia. Given the number of patients lost to
follow-up and the specialty setting, it would be good to see this scenario
repeated in a larger study in the primary care setting. Nevertheless, for
patients with chronic functional dyspepsia without reflux symptoms,
intensive hypnotherapy may be worth a try. (Level of Evidence: 2b)

35. SCIENTIFIC RESEARCH ON HYPNOSIS: MARIE RHODES

Though I am including research here for you to enjoy, please note that
I am making this available to only to let you know what exciting research
there is on this fascinating subject. Every human being is unique and no one
person is "the average person". In every research study, even with promising
new drugs, there are some folks who are not helped by the treatment. Yet at
the same time, note the incredible number and variety of things which
helped the majority of the participants in these studies on hypnosis. There
are thousands of research articles on hypnosis, this is just a taste of some of
the public ones.
As a medical person I can tell you also that the numbers of people
helped by the hypnotic approach in these studies is high by traditional
standards. It is not uncommon for a drug to come to the market place with
improvement numbers in the 35% range. Keep this in mind as you read!
Traditional medicine used to believe that the mind was incapable of affecting
many systems in your body, for example, your immune system. Now it is
known that your immune system is at least partly under the control of your
mind. This field of medicine is called Psychoneuroimmunology or PNI and
researchers in the field are just beginning to grasp the implications of the
mind-body complex.
A Cool Rat study: In a study on rats, researchers gave the rats
chemotherapy, which you may know causes a decrease in white blood
counts. They also gave saccharin at the same time. After a while they gave
the rats only the saccharin, and guess what? Their blood counts still went
down as if they'd had the chemotherapy!
Now, you and I both know that rats can't think about things so it's not
a placebo effect. It appears to be more that the mind is capable of learning
things we don't consciously perceive, in this case, that the sweet taste of
saccharin is going to be accompanied by a decrease in blood counts. In a
related story, a young girl with lupus, which is best treated with steroids,
was treated using the same method. She was given a noxious odor to sniff
along with the steroids, then the steroids were withdrawn so she could be
treated with the noxious scent alone. It worked! Her disease was controlled
without the growth stunting effects of steroids on her young body.
We may not be consciously aware of our blood counts and the delicate
systems of our bodies, but obviously on a subconscious level we are. It is a
fact that living beings were created with this capability to have the mind
impact the body. A wonderful book on this subject is "The Balance Within"
By Esther Sternburg, MD. She explains many studies such as the rat one I
mentioned above.
ASTHMA: J Asthma. 2000 Feb;37(1):1-15. Hypnosis and asthma: a
critical review. Hackman RM, Stern JS, Gershwin ME. University of
California, Davis 95616, USA. Asthma is among the most common chronic
diseases of the western world and has significant effects on patients' health
and quality of life. Asthma is typically treated with pharmaceutical
products, but there is interest in finding nonpharmaceutical therapies for
this condition. Hypnosis has been used clinically to treat a variety of
disorders that are refractive to pharmaceutical-based therapies, including
asthma, but relatively little attention has been given recently to the use of
clinical hypnosis as a standard treatment for asthma. Significant data
suggest that hypnosis may be an effective treatment for asthma, but it is
premature to conclude that hypnosis is unequivocally effective. Studies
conducted to date have consistently demonstrated an effect of hypnosis with
asthma. More and larger randomized, controlled studies are needed. Existing
data suggest that hypnosis efficacy is enhanced in subjects who are
susceptible to the treatment modality, with experienced investigators, when
administered over several sessions, and when reinforced by patient
autohypnosis. Children in particular appear to respond well to hypnosis as a
tool for improving asthma symptoms.
IBS: Hypnosis treatment for severe irritable bowel syndrome:
investigation of mechanism and effects on symptoms. Palsson OS, Turner
MJ, Johnson DA, Burnelt CK, Whitehead WE. University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina 27599-7080 USA.
Hypnosis improves irritable bowel syndrome (IBS), but the mechanism is
unknown. Possible physiological and psychological mechanisms were
investigated in two studies. Patients with severe irritable bowel syndrome
received seven biweekly hypnosis sessions and used hypnosis audiotapes at
home. Rectal pain thresholds and smooth muscle tone were measured with a
barostat before and after treatment in 18 patients (study I), and treatment
changes in heart rate, blood pressure, skin conductance, finger temperature,
and forehead electromyographic activity were assessed in 24 patients (study
II). Somatization, anxiety, and depression were also measured. All central
IBS symptoms improved substantially from treatment in both studies. Rectal
pain thresholds, rectal smooth muscle tone, and autonomic functioning
(except sweat gland reactivity) were unaffected by hypnosis treatment.
However, somatization and psychological distress showed large decreases. In
conclusion, hypnosis improves IBS symptoms through reductions in
psychological distress and somatization. Improvements were unrelated to
changes in the physiological parameters.
PAIN: Self-hypnosis for the treatment of functional abdominal pain in
childhood. Anbar RD. Department of Pediatrics, State University of New
York, Upstate Medical University, Syracuse 13210, USA. Functional
abdominal pain, defined as recurrent abdominal pain in the absence of an
identifiable physiologic cause, can respond to psychological intervention in
appropriate patients. In this patient series, functional abdominal pain of 4 of
5 pediatric patients resolved within 3 weeks after a single session of
instruction in self-hypnosis. The potential impact of widespread application
of such hypnotherapy may be large, because abdominal pain is thought to be
the most common recurrent physical symptom attributable to psychological
factors among children and adolescents.
* Background: A number of regions of the brain are associated with the
subjective experience of pain. This study considers the relations between
cortical oscillations in response to pain, with and without hypnosis and
hypnotic analgesia, and the experience of pain.
* Methods: 33 subjects' neural responses (EEG) were measured in the
40-540 msec period following electrical stimulation to the right hand,
under control and hypnosis conditions. Resultant FFT amplitudes for
frequencies ranging from 8 to 100 Hz were computed. These were grouped
into 7 scalp topographies, and for each frequency, relations between these
topographies and pain ratings, performance and stimulus intensity measures
were assessed. Results: Gamma activity (32-100 Hz) over prefrontal scalp
sites predicted subject pain ratings in the control condition (p = 0.004), and
no other frequency/topography combination did. This relation was present
both in high and low hypnotizable subjects and was independent of
performance and stimulus intensity. This relation was unchanged by
hypnosis in low hypnotizable subjects but was not present in high
hypnotizable subjects during hypnosis, suggesting that hypnosis interferes
with this pain/gamma relation.
* Conclusions: This study provides evidence for the role of gamma oscillations
in the subjective experience of pain. Further it also supports the view that
hypnosis involves the dissociation of the prefrontal cortex from other neural
functions. Croft RJ, Williams JD, Haenschel C, Gruzelier JH. Pain perception,
hypnosis and 40 Hz oscillations. International Journal of Psychophysiology
46 (2): 101-108, Nov 2002.
 Immunity, Hypnosis and Stress:
* Methods: Subjects were 33 medical and dental students, selected
according to their hypnotic susceptibility. Blood samples were taken during a
'lower stress' period and again 3 days before their first major exam of the
term. Half of subjects were randomly assigned to receive hypnotic-relaxation
training in the period between blood sampling.
* Results: Control subjects showed stress-related decreases in immune cell
proliferative responses to two mitogens and percentages of CD3+ and CD4+
T-lymphocytes and interleukin-1 production by peripheral blood leukocytes.
Subjects who underwent hypnosis-relaxation were, on average, protected
from these immunological changes. More frequent hypnotic-relaxation
practice resulted in higher percentages of CD3+ and CD4+ T-lymphocytes.
* Conclusion: The results provide encouraging evidence that hypnosis-
relaxation can reduce detrimental immune function changes associated with
acute stress. Kiecolt-Glaser JK et al. Hypnosis as a modulator of cellular
immune dysregulation during acute stress. Journal of Consulting and Clinical
Psychology 69 (4): 674-82. Aug 2001.
Another one on immunity.....
* Methods: Hypnosis involved relaxation and imagery directed at improved
immune function and increased energy, alertness and concentration.
Hypotheses were made about activated and withdrawn personality
differences. Eight high and eight low hypnotically susceptible participants
were given 10 sessions of hypnosis, one live and nine tape-recorded, and
were compared with control subjects (n=12). CD3, CD4, CD8, CD19 and
CD 56 natural killer (NK) cells and blood cortisol were assayed. Lifestyle,
activated versus withdrawn temperament, arousal and anxiety
questionnaires were administered.
* Results: Self-hypnosis buffered the decline found in controls in NK
(p<0.002) and CD8 cells (p<0.007) and CD8/CD4% (p<0.06) (35-45%
order of magnitude differences), while there was an increase in cortisol
(p<0.05). The change in NK cell counts correlated positively with changes in
both CD8 cells and cortisol. Results were independent of changes in lifestyle.
Energy ratings were higher after hypnosis (p<0.01), and increased calmness
with hypnosis correlated with an increase in CD4 counts (p<0.01). The
activated temperament, notably the cognitive subscale (speaking and
thinking quickly), was predictive of exam levels of T and B lymphocytes and
reached r=0.72 (p<0.001) in the non-intervention control group.
Conclusion: The sizeable influences on cell-mediated immunity achieved by a
relatively brief, low-cost psychological intervention in the face of a
compelling, but routine, stress in young healthy adults have implications for
illness prevention
Scientific Articles on Hypnosis: This article is on PNI and the growing
field. It details a number of studies and their fascinating findings PNI
research Here is an article hypnotic research at Harvard. Several studies on
hypnosis and healing after surgery are outlined in this easy to read,
magazine style article. The terrific thing is that the evidence is very clear in
these well designed studies that hypnosis was what made the difference.
Harvard Gazette This article urges the medical profession to adopt
hypnotherapy, biofeedback and other cognitive modalities based on the
preponderance of evidence of their usefulness in patient care.

36. HEART PATIENT’S ANXIETY REDUCED BY HYPNOSIS TRAINING:

JAMES BAIRD SOCIETY APRIL 2004
Medical researchers have confirmed that hypnotherapy can help reduce
anxiety amongst heart patients about to undergo treatment. A team from
the Peninsula Medical School, Exeter, found anxiety amongst patients with
coronary artery disease awaiting coronary angioplasty, a process to enlarge
the blood vessel and allow the blood flow more easily, was significantly
reduced by a form of hypnosis known as autogenic training.
Patients were taught six mental exercises aimed at relieving anger,
tension and stress. The study cover a five month period during which 59
patients were either given standard care or care supplemented with
autogenic training.
Those receiving hypnosis were first supervised by an instructor after
which they carried out their own exercises on a daily basis. The researched
was headed by Professor Edzard Ernst, director of complementary medicine
at the school who concluded that the hypnosis helped patients at a
particularly difficult time in their lives. He explained: "Coronary angioplasty
is associated with a high level of anxiety due to the complex nature of the
procedure. "This is the first study of its kind - and autogenic training was
shown to reduce this anxiety for the patient and improve their quality of
life."

37. MEDICAL HYPNOTHERAPY: LONDON D’ARCY

What is Hypnotherapy? Hypnotherapy is a healing therapy carried out
whilst in hypnosis, an altered state of consciousness experienced as a trance
that empowers you to facilitate rapid change. Imagine the mind in two
halves, the conscious with its limiting beliefs and the subconscious with its
infinite power where all things are possible.
Hypnosis works by plugging into the subconscious mind, and
programming positive suggestions which once assimilated allow freedom
from negative thought patterns and behaviors allowing you to take control
of your life. To stop smoking, lose weight, overcome addictions, become
orgasmic, fly without fear, break free from self-imposed beliefs, changing
your life for the better and liberating you to be the best that you can be
enjoying life to the full. "hypnotherapy empowering you to free yourself"
Research shows that there is more scientific evidence for hypnotherapy than
any other complementary therapy by using hypnosis people can perform
prodigious feats of willpower and self-healing"-The Health Education
Authority
Who can be Hypnotized? People from all walks of life, age groups and
genders find hypnosis very effective with long-term results. It is deeply
relaxing and very safe. The best results are for individuals who have a real
desire for change and willing to be open minded to explore the power of
hypnotherapy. Who should not be Hypnotized? People with severe mental
health problems like schizophrenia and conditions such as epilepsy. Concerns
about being Hypnotized?
The most common is that you will lose complete control and be under
the power of the Hypnotherapist who can get you to do anything at will.
Staged game shows are great inducers to such believes, but they are just
that staged and the contestants are fully participating in the process so
open to all suggestion. However when one is dealing with specific issues such
as stop smoking this is what the individual is open to and would become
tense and defensive to suggestions that are inappropriate making it
ineffective.
Hence the reason that for the best results you need have a strong
desire to make changes and be positive towards your outlook on
Hypnotherapy. If for instance you are of a mindset to prove that
Hypnotherapy does not work then for you it will not and you will stay
imprisoned in your negative self- beliefs and behavior.
However if you are open to the possibilities and want to resolve an issue
then hypnotherapy is the most powerful facilitator to change and healing, in
today's world where everything is we want it now and fast it fits in
perfectly. The experience is deeply relaxing and safe. Moving you forward
and transforming your life in the most uplifting and truly liberating ways to
express yourself and let go of limiting beliefs and behaviors. "take steps make
changes" "Empowering you to free yourself"
Infertility: There can be many causes for infertility sometimes physical
and also psychological. Hypnosis can help in a number of ways by syncisising
the body and mind so that they work in harmony to achieve the desired
goal, pregnancy. Often in the case of psychological deep fears buried in the
unconscious maybe causing a blockage to fertility, literally you are often not
aware of what these may be fear of being unattractive fear of being
vulnerable these can be the obvious choices but maybe there is more deep
rooted issues that need to be resolved and these can be facilitated safely and
effectively whilst in hypnosis. This applies to both partners so you can both
have a positive mental attitude that is working towards creating new life if
you are both going in the same direction mentally physically you will arrive
together. "It takes two baby."
IVF: If you are going into the IVF program then to have the best
possible outcome is paramount to your success. Hypnosis can assist by
preparing you mentally and physically. The body does what the mind
instructs making you more relaxed at the time of implantation and receptive
to the pregnancy by preparing the body and mind with hypnotic suggestion
that supports successful embryonic implantation and pregnancy the full nine
yards which is what every person wants when entering into this treatment.
Its expensive both financially and emotionally so to prepare for this
journey give yourself the best possible outcome by using hypnosis as a tool,
along with other therapies that nurture and support you so you can be the
best you can be.
I have had success in this area I would love to think I played my part
and I am sure it made a difference being a Mother myself I understand the
journey the miracle of life is a gift from the heavens that I will treasure all
my life. God bless my friends and may the stork bring blessings, "
Empowering you to free yourself "
 Smoking - I guarantee that you will quit in one 90 min session or
your money back. WHY STOP?? Because the benefits to you are ENORMOUS,
for a start you don't STINK. Did you know there are around 600 poisons in
every cigarette with a toilet cleaner being one of them? NASTY!!!!! Would
you drink toilet cleaner, arsenic or put your mouth over an exhaust pipe?
Nah, I think not. Smoking kills about 120,000 people per year, the biggest
killer in this country while the government makes a tidy profit of 13 billion
plus in taxes. Do you think they want you to stop? The cigarettes companies
are worth billions rich old money that has prospered on death. Do you want
to pay these people to kill you? They are know looking at targeting children
because adults are wiseing up so to entice them in they want to make them
taste good by adding vanilla and chocolate to their cigarettes how evil is
that?
Challenge your thinking then you can change and get out of the
nicotine trap. Smoking is like playing Russian roulette you never know which
one it is that leads to premature death. Let me empower you to QUIT, It
will be easy effortless and you will feel FREE of the habit forever. I Promise,
imagine how happy you will be? Women More women died of lung cancer in
2002 than of breast, uterine, and ovarian cancer combined. Please beautiful
Goddesses do not hang on to smoking because you think it keeps you slim.
One of the main reasons women continue to smoke. Let me reprogram your
mind so that you have no desire to smoke or overeat. Just be free to be your
natural beautiful self. Men Smoking does not make you big and hard, in fact
it causes impotence along with heart disease, cancer to name but a few. If
like a lot of people you picked up the habit as a teenager then join the club.
Now though it is seriously affecting your life, feeling tired, headaces,
breathing difficulties, no time or wasting time because you are always
thinking about putting that toxic stick in your mouth or maybe a
smokescreen because you do not want to look at other issues in your life that
is causing you pain. Well none of it is worth destroying your health. Let me
Empower you to FREE yourself you will be amazed at how liberating the
experience is giving you confidence to live the life you want.
Weight Management- Become slimmer and trimmer with my four
session weight loss treatment. Be Slim4Life with my four session weight
management program giving you health and vitality. As a woman I know
what I am talking about having done the diets tried the pills smoked and all
sorts of weird and wacky ways only to end up back at square one. I often
find that emotional issues lay behind comfort eating and this can be
effectively dealt with releasing the negative emotions stored in the body and
liberating you to be slim healthy fit and happy. My weight management
hypnosis session supports any weight loss plan working in harmony and can
be tailored to suit. So for instance if you are doing the Atkins then hypnosis
works in sync reducing your appetite for carbs. It also deals with
metabolism-comfort eating -excesses- stomach stapling-hunger monitor
only eating when you are hungry and stopping when you are full. Most of us
have forgotten this feeling or never know it as food is in abundance. A
complete program that has fantastic results not by magic but with a long
term plan. Don't expect to come along for one session and see overnight
results be realistic if you have two stone to lose it might well take 4/6
months the difference being its lasting Slim4Life.
Stress Management: Did you know that 80% of all illness is stress
related? Stress Management teaches you to balance your life and change
your patterns and programming so you can increase your capacity to handle
stress more effectively and cope with the challenges of life. We all have stress
in our lives and it can be a good thing moving us to action however when
stress turns negative we get a rush of the flight or fight response and this
can build up to cause a toxic overload on our systems resulting in illness
which goes something like this; Tiredness, extreme fatigue, headache, dry
mouth, anxiety, loss of libido, depression, feelings of no joy in life, pain in
the body, sleep disorders, poor concentration, relationships breaking down,
low self esteem, migraine the list goes on and on and if ignored negative
stress spiritually and physically kills us literally. It’s a long way to bounce
back up so what we need to do is manage stress to create a life/work
balance harmony and that is what my stress management program does it
educates and gives you the power to take control of your life your health
and well being plus the relaxation therapy is bliss. Confidence/Self Esteem
Confidence self esteem affects us in many ways when our self esteem is low
we stay trapped in unhealthy relationships, outdated jobs, abuse ourselves
with destructive habits its all down to some old programming locked away
in our minds telling us we are not good enough. Confidence/self esteem
therapy unlocks the old and reprograms the new so you can get that career
you always dreamed of, start a new business, travel the world do what you
want to do have the confidence to achieve your dreams with my fast track
hypno session. No limits only
possibilities.
Fears, Phobias and Anxiety: Boost your confidence and overcome any
phobia easily such as flying, heights, spiders needles, dentist, public speaking
as well as annoying habits like nail biting and twitching. A one- hour
Hypnotherapy session can liberate you from all of the above. Fears and
Phobias affect our live in many ways for instance the fear of flying this can
be resolved in one relaxing session freeing you to go on holiday as my many
clients have found flying was a breeze. Enjoy your life do not let your
fears/phobias trap you break free whatever it is Fear of the dark, Fear of
water, the list goes on and on it will be easy effortless and safe give it a go
expand your life you will be so happy with the result. Anxiety is a word used
to describe feelings of uncertainty and often leads to panic attacks as the
heighten feelings of fear take hold terrifying to those that suffer as you do
believe you are going to die in some cases. Hypnotherapy and NLP can
resolve the above issues often in one or two session by hypnotic suggestion
communicating with the unconscious and dissolving the fear based obsessive
thinking that causes anxiety.
Irritable bowel syndrome (IBS): Irritable bowel syndrome as commonly
know is a very uncomfortable stomach and bowel problem that causes great
distress and is very unsociable often laying the suffer in bed with bouts of
discomfort and pain. In my experience anxiety is almost always a
contributory factor the person tends to worry unnecessarily about life and
fear what is up ahead or in the present moment. It's fair to say a control
issue except we can not control every area of our life which is a very
distressing thought to some people and the fear magnifies.
Hypnosis helps by letting go of old ideals and unresolved pain fear
allowing the person to have a new attitude to life that helps them to
manage the normal stress and strains of life without throwing them into
blind panic which in turn causes stomach upset and bowel irritability. Some
foods can cause symptoms but you know what these are and what's
important is to relax and find ways to comfort the mind and body. Holistic
therapies are excellent and well worth the investment in you. I teach you
relaxation techniques that you can do anywhere and pain management with
NLP all supported with the hypnosis therapy two/four sessions brings much
relief and comfort. Pain Management Pain relief including migraine is one of
the most well know issues to be resolved with hypnotherapy and can provide
lasting benefits. Some pain is not completely resolve but can become more
manageable and this is a welcome relief for many of my clients. Before you
see me for this type of treatment please get your doctors approval so we
may work in harmony to whatever treatment has been provided. If I feel
you would benefit from other healing therapies I may well refer so you can
have the full benefit of a plan treatment program. Bereavement Therapy
Unresolved Pain Grieving is a process that people journey through in stages
and every one is different in how grieve affects them. We will always miss
the ones we love but sometimes we get stuck in the process of separation
and our whole life is dark and miserable longing for our love ones to return.
We are unable to let go and move on with life or relationships this can be
very depilating and we become ghosts trapped in sorrow. Hypnosis helps us
to let go of the negative emotions and breaths new life so we may live again
to journey on with our love ones forever in our treasured memories we are
able to let go of the past and move on. As those we have lost would wish
they are always with us in spirit and the time will come when we are
reunited. God bless.

38. HYPNOSIS LESSENS DISTRESS: KRISTA CONGER: FEB 2005

Elaine Miller desperately wanted to find a way to help her daughter,
Hannah, endure an awkward and painful medical examination in which
doctors insert a catheter into her bladder, inject a dye and ask her to
urinate while being X-rayed.
The girl had been through the procedure four times by age 7, and she
dreaded going through it again. So when researchers at the Stanford
University School of Medicine offered hypnosis, Miller welcomed the chance. "I
had tried every angle I could to either avoid the test for my daughter or
make it less traumatic," she said.
Researchers found that hypnosis lessened distress in Hannah and other
young patients who, because of an anomaly in their urinary tracts, must
undergo the difficult annual exam called voiding cystourethography, or
VCUG, to see if urine is backing up into their kidneys. "Hypnosis was really
the only thing that helped," said Miller.
Many clinical reports suggest that hypnosis can make it easier to quit
smoking, reduce the pain of cancer and giving birth and help reduce the
stress of medical procedures, but reviews of the literature call for
better-designed, randomized studies that place such uses of hypnosis squarely
in the domain of evidence-based medicine. The Stanford study, published
Jan. 3 in the online version of Pediatrics, is one of only a handful of
randomized trials to look at whether hypnosis reduces pain and stress during
medical procedures in children.
Four or five patients undergo the stressful VCUG catheterization on any
given day at Lucile Packard Children's Hospital at Stanford. Many doctors
wish that they could avoid putting children through the procedure, as it is so
unpleasant, but there's no alternative. And sedation is out of the question
because children have to be alert enough to urinate during the VCUG. "It's
abusive, almost," said Linda Shortliffe, MD, professor of urology and the
hospital's chief of pediatric urology. "It involves using some force in a sensitive
place, but we can't do the exam without the catheter."
Hypnosis, the researchers hypothesized, would give the children more
control of their experience by teaching them to focus on being somewhere
else, potentially helping them to deal with the anxiety and pain caused by
the catheterization.
Forty-four children participated in the study. All had been through at
least one distressing VCUG in the past. About half, including Hannah,
received self-hypnosis training while the other half received routine care,
which included a preparation session with a recreational therapist who
taught some breathing techniques and demonstrated the VCUG using a doll.
According to the paper, the use of hypnosis reduced the procedure's
duration from an average of 50 minutes down to 35. Although children in
the study did not report experiencing less fear or pain after hypnosis,
researchers suggested that this result might be due to kids' desire to assert
their displeasure in a bid to discourage being subject to another VCUG in the
future. And, indeed, attending parents and neutral observers participating in
the study reported less
distress in hypnotized children compared with those given recreational
therapy.
"With hypnosis we saw less crying, less distress during the
preparation for the procedure and the technicians said the procedure was
much easier to perform," said David Spiegel, MD, the Jack, Lulu and Samuel
Willson Professor in Medicine and associate chair of psychiatry and behavioral
sciences. Spiegel also directs the Stanford Center for Integrative Medicine and
the Psychosocial Treatment Laboratory at Stanford and is an attending
psychiatrist at the children's hospital.
To learn self-hypnosis, Hannah Miller met with Spiegel a week before
she was due for a VCUG. As Hannah remembers it, Spiegel asked her to
imagine that a balloon tied to her wrist could take her anywhere she wanted
to go and to picture doing her favorite things in that place. "So I pictured
myself ice-skating in Hawaii," she said, "and swimming and snorkeling." After
practicing self-hypnosis at home with her mother's help during the ensuing
week, Hannah said the examination went much better than it had in the
past. "We narrowed down the worst 30 seconds of the test, and that's when
the visualization really helped," she said.
The study is one more step toward getting hypnosis covered by health
plans. Although insurers do not reimburse for such stress-relief therapy -
research funds paid for the hypnosis involved in this study - that could
change if more evidence is developed that documents the benefits of hypnosis.
Funding for the research was provided by the Innovations in Patient
Care Program at Lucile Packard Children's Hospital. Stanford University
Medical Center integrates research, medical education and patient care at its
three institutions - Stanford University School of Medicine, Stanford Hospital
& Clinics and Lucile Packard Children's Hospital at Stanford. For more
information, please visit the Web site of the medical center's Office of
Communication & Public Affairs at Lucile Packard Children's Hospital at
Stanford is a 264-bed hospital devoted to the care of children and expectant
mothers. Providing pediatric and obstetric medical and surgical services and
associated with Stanford School of Medicine, LPCH offers patients locally,
regionally and nationally the full range of health-care programs and services
- from preventive and routine care to the diagnosis and treatment of serious
illness and injury.

39. HYPNOTHERAPY IN CHRONIC AND TERMINAL ILLNESS: HARTMAN’S MEDICAL & DENTAL
HYPNOSIS: DAVID WAXMAN
Hilgard and Hilgardl have identified two major components pain. These
are sensory pain and suffering. The relevance of this is that pain and
suffering are so often associated with. illness. To the patient, pain and
suffering is one. It is the threat and expression of approaching death and
inevitably anxiety will in- crease. Hypnotherapy can do much to lower the
level of anxiety but must also be directed towards the reduction of the
awareness of any associated pain. It is a mistake to assume that the reduction
of anxiety per Be is the same as the reduction of felt pain. Particular
attention must be given to both aspects of the experience.
It may be that the level of pain and fear of the inevitable out- come
will be denied by the patient. Close observation must be kept on the situation
and no attempt may be made to reduce the patient's defenses.
In addition, in any approach to therapy we may be met with anger,
hostility and resistance. Perhaps because of the failures of other modalities
already attempted, a negative attitude will be maintained to any further
intervention. The feelings of the patient must be respected. There must be no
suggestion of an intrusion into his very personal inner world. A slow and
gentle approach is essential so that in a sense, the patient gives the (p 432)
doctor permission to enter. Now over and above all these problems it would be
surprising indeed if the patient was not additionally depressed. Depression
will compound the pain which will increase the anxiety. The possible
prescription of some antidepressant medication must be seriously considered
and probably one of the non-activating tricyclic drugs would be indicated.
The use of hypnosis for the treatment of pain has been fully discussed
in an earlier chapter. In chronic pain however, which is associated with
terminal illness, apart from direct and various in- direct suggestions of
analgesia which may be given, many other aspects of the patient's situation
must be taken into account. Additional procedures may therefore be indicated.
The doctor is not only involved with the patient as a person who is in pain,
not only is a very special relationship established through the particular use
of hypnosis, but the doctor must also have the understanding to guide the
patient and all who are involved, into a peaceful acceptance of the
inevitable.
Whenever a patient becomes physically ill, without doubt many powerful
emotional factors as have been mentioned, will enter into the picture. These
will tend both to influence his symptoms and, in many instances, to retard his
recovery. The extent to which they do this will depend largely upon the way in
which the patient regards his illness, and if such factors are also taken into
account and treated adequately, a great deal can be achieved in increasing the
patient's incentives and accelerating the process of healing.
Hypnosis can be extremely useful in chronic, incapacitating diseases in
helping the patient to accept both his illness and his limitations
philosophically. He can be encouraged to accept the fact that whilst there are
certain things that he may not be able to do again, there are others that he
will be able to achieve successfully despite the handicap imposed by his
illness. Even when little more than this can be accomplished, the resulting
improvement in his morale and general outlook will frequently prove most
gratifying.
In incurable, painful and ultimately fatal conditions, hypnosis may
often be used advantageously to alleviate pain and suffering (p 433) In
addition to helping the patient to accept his illness. When employed in this
way the greatest success is likely to be achieved when the depth of hypnosis
is sufficient to secure complete analgesia. Unfortunately this is not easily
obtained; even so, considerable degree of relief from pain can often be
secured, as a result of which the amount of analgesic and sedative drugs
ministered can frequently be substantially reduced. Even in cases of
inoperable cancer, hypnosis can sometimes augment and prolong the action of
the milder pain relieving drugs and thus delay considerably the need to resort
to more powerful analgesia.
In our approach to this type of case we often tend to adopt too
perfectionistic an outlook, and the fact that the pain seems so in- tense and
the possibility of securing any significant degree of an- analgesia so remote
only too frequently discourages us even from considering the use of hypnosis.
Such- an attitude is entirely wrong, for we should always remember that even
when hypnosis I can only be used to minimize the distress suffered by the
patient, , the pain itself tends to become rather less severe and more easily
tolerated. Relaxation and the reduction of tension, worry and I anxiety, all
of which can be achieved in the light or medium stages of hypnosis, can afford
some relief to the sufferer. In many cases, this alone will reduce the amount
of medication necessary, with-
out resort to additional techniques required for the production of analgesia.
In addition to the reduction of anxiety and the production of analgesia,
there are a number of other methods which may be use- fully attempted in order
to help the patient. 'Distraction' will sometimes succeed for we all know that
it is possible to forget pain, just as we can forget a headache for example,
whilst watching an exciting film. We should also be more willing to settle for
things that can be endured, rather than to fail to change things that cannot
otherwise be changed. Indeed, one of the things we can sometimes do is to
substitute or replace pain by a lesser or altered sensation. It may be
possible to transform a distressing pain into a feeling of unpleasant, but not
painful, warmth which is much more easily tolerated and infinitely preferable
to the original pain. Indeed in a receptive patient in a reasonably deep
trance, pain can be 'displaced' for it need not necessarily be (p 434)
experienced at the site of the lesion or disease. After all, a gall bladder
pain is felt between the shoulders, and a cardiac pain in the upper arm. Under
these circumstances, whilst in hypnosis, a patient can be told that the pain
he is feeling in his stomach, would be tolerated better if it were in his left
hand, and proceed to in- duce it in the latter as a replacement of the former.
In certain in- stances, 'time distortion' can afford relief from pain. When
friends visit, time passes quickly, but when unwelcome visitors arrive one
wonders whether the day will ever end. This is a common example of ' time
distortion' or subjective time. Using this principle, the patient can be
taught how to experience 20 minutes of pain in only 10 seconds of actual time,
thus decreasing its duration to such an extent that the painful periods appear
very short in comparison with the time he is pain free.
It may also be suggested to the patient that he can achieve a slowly
progressive diminution of his pain. In this case, tell him that if the 100 per
cent of pain he is suffering were reduced to 90 per cent he would hardly be
able to notice any difference. That the level might even drop to 85 per
cent...or 80 per cent...75 per cent...or even 70 per cent...and so on, and the
patient will often go along with this idea because he has not been asked to
perform a major task. In deeper hypnosis of course 'dissociative' procedures
may be most effective.
In a masterly review of the subject, Sacerdote, drawing attention to the
distinction between pain and suffering, pointed out that patients with
advanced illness often function at two levels of awareness. At one level,
every kind of rationalization and reassurance is used to sustain faith in an
optimistic outcome and at another level there is the awareness of the
inevitability of further suffering and of ultimate death. The danger may
therefore be, he suggests, that hypnosis will help a patient to have a clearer
perception of the inevitable end and as a result will refuse further
hypnotherapy.
Ewin attaches a special psychological meaning to the com- plaint of
constant pain and utilizes this in his treatment. When a patient gives a
history of pain that is constant, continuous, al- ways there and never goes
away and when he says 'I live with it', he is often expressing a subconscious
corollary, 'If I did not have (p 435) it, I would be dead'. ‘Obviously', Ewin
says, 'if the pain proves he is alive, it cannot be relinquished completely
for even five minutes...even when he is asleep'. From this interesting
hypothesis, it follows that any person that attempts to take the pain away
from the patient is his enemy. Treatment would consist of regressing the
patient to some precipitating incident, perhaps one in which he actually
experienced some life-threatening event which was associated with pain and
then showing him, whilst in hypnosis, that he can be free from pain and yet
alive.
O'Connell pointed to the rapport which develops between the doctor using
hypnosis and the dying patient. Not only does this provide the necessary
emotional support but also can reduce the need for analgesic drugs and
ameliorate other symptoms such as nausea, insomnia, dyspnoea and itching.
It is preferable to avoid the use of the word 'pain', if possible
choosing some word which has less significant connotations. Perhaps
substituting the word 'colic', if it is abdominal or 'tension' or
'sensitivity' if it is elsewhere.
In conclusion let us summarize the objectives of any treatment of
chronic or terminal illness associated with intractable pain and as agreed by
the many experts in this field of hypnotherapy. These are as follows:
1. To reduce anxiety.
2. To diminish the awareness of pain.
3. To decrease the dependence on analgesics and thus increase their
effectiveness when required.
4. To improve the patient's attitude to his illness and his general outlook.
5. To encourage and enhance any available and remaining capabilities.
6. To counsel family and friends.
7. To prepare the patient for the inevitable..
Hypnosis may be used to achieve these ends in the following way:
1. The reduction of anxiety by suggestion under hypnosis, instruction in self-
hypnosis and the production of a tape recording if necessary to assist with
and reinforce the latter. (P 436)
2. The direct suggestion of pain relief coupled with progressive relaxation
and decrease in sensitivity.
3. The production of analgesia by suggestions, if appropriate, of glove
anaesthesia. For example immersing the hand in an imaginary bucket of ice
until it is numb with cold and transferring the numbness to the affected area.
4. Suggestions that the hand of the doctor, placed on the pain- ful part of
the body, will remove, absorb or diminish the pain. If the technique is
effective, the patient may be taught to accept the hand of the nurse, or of
some loved member of the family. By practice in self-hypnosis, he may be
taught that his own hand will be equally effective.
5. By substitution of the feeling of pain for something more tolerable such as
pressure.
6. By displacement of the symptoms to another part of the body, for example
from the abdomen to the arm or leg where it. would be more easily tolerated.
7. By dissociation. In deep trance the 'hidden observer' technique may be
used. The patient will 'observe' what is happening to his body without the
actual perception of painful subjective sensations.
8. By the use of the phenomenon of time distortion in hypnosis so that the
patient perceives the period of pain as much shorter than it really is. This
may be coupled with suggestions of progressive diminution of the pain.
9. By hallucination. That is the patient seeing himself in some pleasurable
setting of his own choice or by guided age-regression into one which he has
previously experienced and enjoyed.
10. By guided age-progression. This may be used to suggest some future time
where discomfort and illness will have been left behind. This is a very
sensitive area however. The patient may perceive no future at all and extra
care must be used if this particular technique is applied.
If these techniques are carefully studied, there is no doubt that the doctor
can provide what is certainly the most valuable service of his profession,
namely the relief of pain and suffering. (P 437) For further understanding of
this highly emotive subject the reader is advised to consult the classic work
of John Hinton entitled ‘Dying.’ (P 438)

40. HYPNOSIS PAST, PRESENT AND FUTURE: ITS MEDICAL AND

PSYCHIATRIC APPLICATIONS: HOWARD M DITKOFF
[In January, 2000, during my last year of medical school, I did a
rotation in child psychiatry with Dr. David Rosenberg, Director of Wayne
State University's Child and Adolescent Research Services. During the
rotation I had the task of writing a paper related to psychiatry and, due to
my interest in hypnosis and neurolinguistic programming, I chose to do it on
the topic of hypnosis and its use in medicine and psychiatry. Wayne State
University School of Medicine, Year 4 Child Psychiatry Rotation with Dr.
Rosenberg. January, 2000]
As we enter the new millennium, medicine is in a transitory period.
Changes abound in both the practice, as well as the atmosphere in the field.
Of these changes, one of the most pervasive is the demand for patient
autonomy. This demand comes from both sides of the table. Patients scour
the internet in an effort to be well informed on the latest cutting edge
knowledge. Doctors are trained increasingly to be aware of the
doctor-patient relationship as a partnership, no longer the paternalistic
practice of yesteryear.
As we have seen in many areas before, it is not always new technology
that improves a new situation, but often the application of an old tool in a
new way. Such is the case with hypnosis. It is a method of giving the patient
more control over their health, bridging the mind-body gap and opening up
doors to parts of the mind that hold yet uncharted treasures. Therefore, its
uses are widespread throughout both the medical and mental health fields,
indeed lying squarely between the two, bringing into question the very split
that has so long existed between them.
When speaking in such terms, one would expect to be discussing a
technique born in our modern age of electron microscopy and molecular
biology by a Harvard trained scientific wizard. However, this would not be
the case with hypnosis. For all of its potential uses, it is nonetheless an
ancient technique. Evidence of its use dates back to the early Egyptians and
Greeks, and images of hypnotic trances can be found in art from such
cultures dating back thousands of years.
In the modern age, hypnosis enjoyed a revival of sorts through the
work of Franz Anton Mesmer. An 18th century Austrian physician, Mesmer
applied his hypnotic method of "animal magnetism", raising controversy in
his path, and leaving his legacy in the phrase "to mesmerize". Many labeled
his work as fraud, claiming any cures brought about were due to the
patient's imagination, leading Charles d'Eslon, a pupil of Mesmer, to exclaim,
"If the medicine of imagination is the best, why should we not practice the
medicine of imagination." In a fascinating historical note, the head of the
committee who investigated Mesmer's claims and eventually dismissed them
was none other than Benjamin Franklin, the ambassador to France from the
newly founded United States, and an expert on magnetics and electricity.
Sadly, Franklin was more interested in dismissing the attribution of cures to
magnetism specifically, rather than in investigating what the actual
explanation was in the very real cures that Mesmer was able to effect. Thus,
Mesmer's belief that it was magnetism, rather than the patient's own mind,
that created his outcomes turned out to be a setback for the field of hypnosis
that would take some time to overcome. Nonetheless, Mesmer's work brought
a newfound interest in understanding what exactly was behind these
mysterious cures.
Hypnosis was further explored by James Braid, who, in the late 19th
century, developed the eye fixation or swinging watch technique which many
today consider almost synonymous with hypnotism. And indeed it was Braid
who coined the term "hypnosis", after the Greek word for sleep, “hypnos”.
Braid initially felt the trance was a form of sleep, but later grew to
understand it as a different state entirely. He also brought to light the
understanding that hypnosis is a state that a person reaches internally, with
the therapist serving merely as a guide.
Emile Coue, a Frenchman, was an advocate of hypnosis near the turn
of the century. Coue felt that the patient's own resources were most
important in healing, and thus he became a pioneer in the area of
autosuggestion. He would have his patients engage in affirmations, repeating
mantras such as "Every day, in every way, I get better and better." twice a
day. Coue's ideas foreshadowed the increasing focus that medicine is
beginning to place, once more, on the patient's innate ability to heal himself.
Perhaps the largest luminary in the field of mental health is Sigmund
Freud. Freud's involvement with hypnosis is an interesting one. The eminent
neurologist initially was enamored with the methods, having learned them
from his mentor Jean-Martin Charcot, who used them extensively in dealing
with hysteria patients in his Paris practice. Indeed, this early exposure to the
powers of the mind may have greatly shaped. Freud's future ideas on the
unconscious.
Freud's interest in the specifics of hypnosis eventually faded, though he
did at one point deliver two papers about the topic. Nonetheless, Freud's
contributions to the understanding of the mind have helped to create a
household name for the unconscious and its inner workings. In fact, the
father of psychoanalysis once quipped, "If ever we are to develop the perfect
form of mental therapy, it would, by necessity, have to include hypnosis".
On the medical front, hypnosis has been used in some of the most
widespread and common problems. Furthermore, it is applicable both
diagnostically, as well as therapeutically. It can be applied to some of the
most fierce enemies of humanity, such as cancer, and similarly applied to
some of the more common garden variety nuisances such as warts, where
some claim hypnosis is first line therapy.
It has been 42 years since the American Medical Association's 1958
endorsement of hypnosis as a valid medical therapy, and while different
patients have different results with hypnosis, it can be a Godsend for those in
whom it is successful. This is so because hypnosis can be applied in some of
those situations for which medicine has never truly found a reliable solution.
Some of these areas are pain control, cancer treatment, obstetrics and
rehabilitation.
Pain is one of the most common symptoms seen by health care
professionals, and it is seen throughout the entire spectrum of disease. Its
burden on a patient can be immense, especially when pain is chronic. One of
the most distressing aspects of pain is the loss of control the patient feels.
Through hypnosis we are able to show patients how they can use their own
mind to change the subjective feeling of pain, restoring that sense of control.
In addition, while hypnosis can be combined with analgesic
medications, it holds several advantages over drugs. When done properly, it
has no side effects, and while drugs often leave a sense of dependence for the
patient, hypnosis shows them that they are the master of their pain. All
hypnosis is truly self hypnosis with the therapist as a coach and patients can
learn how to employ these techniques on their own. This not only gives the
ability to relieve pain when it comes, but removes the ever-present fear of
pain's return that so many patients feel even when they are currently feeling
well.
Hypnosis has long been used for pain control. It has been used for
surgical anesthesia for hundreds of years. For example, the well documented
case exists of a Dr. Ephraim McDowell who removed an ovarian tumor from
the patient, Mrs. Jane Todd Crawford as she repeated scripture verses,
rendering an altered state of consciousness. Dr. James Esdaile performed and
documented numerous surgeries in the 1840's using hypnotic anesthesia.
Strikingly, his mortality rate of 5% in these cases compares with the average
of 50% in that era.
Hypnosis may also be used effectively to continue pain control after
surgery, aiding in recovery. In a more recent case, Lynch in his aptly titled
article "Empowering the patient: Hypnosis in the management of cancer,
surgical disease and chronic pain" describes the use of hypnosis in his urologic
practice. For example, he describes one woman who required surgery for a
transitional cell carcinoma who used breathing techniques along with
audiotaped hypnotic programs in all phases of her case. She used it in
advance of the operation for mental rehearsal, during the procedure, and
then postoperatively, along with patient controlled morphine. It was noted
that she required only half the anticipated dose of analgesic, only one day in
the ICU instead of the usual two and her bowel function returned two days
earlier than anticipated. In short, almost every part of her recovery was cut
in half.
Lynch goes on to describe a set of audiotapes produced by Rogers
specifically tailored to the surgical patient. It consists of specific tapes to be
used preoperatively, intraoperatively and postoperatively. The use of hypnosis
is not limited to any particular type of surgery, and it is particularly widely
used in the dental field. But, surgical and post-surgical anesthesia is only the
tip of the iceberg in the use of hypnosis for pain control. Indeed, it can be
used regardless of the source of pain. For all pain of any origin ultimately
must travel through and be perceived by the brain. Thus, a patient trained to
control pain at the level of his subjective perception will be a master to his
pain. Some of the common areas that hypnotic pain control applies to are
migraines, arthritis and, as we shall discuss, cancer.
Pain is dealt with hypnotically in a variety of ways. It is telling that
studies show that pain control is not obtained simply through the process of
hypnosis, but only when the hypnotic state is then utilized to give specific
suggestions. There are countless types of suggestions that can be given once a
trance is induced. The patient can be instructed that he or she will no longer
feel pain, the pain can be changed to a numb feeling, time distortion can be
used to shorten the duration of pain or lengthen the pain-free intervals.
Patients can even be age-regressed back to a time before the pain started.
The part of the body that is in pain can be dissociated so that it is no longer
internally viewed as part of the person.
Imagery and visualization are also key factors in pain control. Once in
trance, the patient is often asked to visualize the pain as an image, or the
region of the body in pain. The patient is then asked to imagine his immune
system attacking the source of pain. Metaphor can be used, and the pain can
be seen as an enemy, with the patient's innate healing resources seen as a
friend or a warrior that fights off the unwanted threat. Such story-like
imagery can be especially effective in children.
In each case, it is the job of a trained hypnotic coach, be it a therapist,
physician, or any other professional, to determine the most beneficial and
safe application for each individual patient. Given the need for choice among
the many methods, the wide variety of techniques and options makes
hypnosis applicable to an immense range of patients.
 Many studies have been done on the physiologic routes through which
hypnosis affects pain. For instance, one pathway is through preventing the
usual rise in cortisol that accompanies pain. However, previous theories that
hypnosis worked through the endorphin pathways used by opiates have not
been supported. Moret and associates showed, in their 1991 study, that
naloxone, the opioid receptor antagonist, did not reverse hypnotic analgesia.
Further research will be needed to elucidate more clearly the physiologic
correlates of hypnotic analgesia. This is yet another medical case of knowing
what works, while being unsure why it works. In the past, this has been the
case in therapies ranging from antibiotics to psychiatric medications. We have
a duty to our patients both to use what we know works, as well as to
continue questioning in order to understand further why it works. This is the
link of research and clinical medicine that is so important to progress.
Cancer is the second leading killer of man and a source of innumerable
morbidities, both physical and mental. The relationship of cancer and stress
has been known since the time of Galen in the second century, and the
cancer patient is one who poses challenges that clearly cross the mind-body
gap. The physical toll cancer takes on a patient is striking to anyone who
has witnessed the emaciated state of an advanced cancer patient. But,
patients themselves will often mention the emotional devastation of the
illness as its worst symptom. Thankfully, hypnosis offers avenues to deal with
both sides of this horrible illness.
We have already discussed the vast applications of hypnosis to pain
control, and pain is one of the most feared symptoms of cancer. For many,
even dying of cancer is acceptable if only the horrid pain can be alleviated.
The treatment of cancer pain is a study unto itself, and is often accomplished
with doses of opioids that leave the patient in a state that, while alive, is
functionally hardly worth calling that. Through hypnosis, we can use the
various options discussed, alone or in combination with lower doses of these
medications, to allow the patient more comfort, while still remaining in a
functional state to attend to the many things that a person on death's door
would like to be able to reconcile.
In addition to pain, the other symptoms of cancer can be addressed by
hypnosis. Some forms of cancer have very specific symptoms. For example,
the intense pruritus experienced in some biliary tract malignancies can be
diminished. Also, many of the iatrogenic symptoms of cancer can be aided.
The extreme nausea experienced by many patients on chemotherapy can be
reduced. And even nuisances such as the unpleasant taste left by many of the
drugs used in cancer treatment can be alleviated. Thus, one could say that
hypnosis can help cancer to not leave quite as bad a taste in one's mouth.
However, it is uncertain if hypnosis can help diminish the obvious pain a pun
that bad must create.
As mentioned, death is an inseparable part of a disease such as cancer.
Even in cases where the disease is ultimately cured, the patient nonetheless
must deal with the specter of death and the fear that often accompanies it.
In trance, a patient can be guided to more reasonably discuss his feelings and
fears of death in an objective manner. In doing so, we can then help the
patient to determine a new way of looking at death. We can also help the
patient prepare more thoroughly, in dealing with issues such as creating a
will, determining what impression they would like to leave with their family,
and so on, so that these issues can be dealt with in a timely fashion.
The sudden shock of cancer and the often quick death it causes may
leave a person to die in a helpless state, leaving many things unsaid and
undone. Hypnosis can help a person look more objectively at death, become
more accepting and comfortable with it, and by lifting that veil of denial
that so often accompanies the topic in our culture, allow the patient to die
with dignity in a way that he or she chooses rather than has thrust upon
him.
 A similar approach can be taken with the many other emotional and
psychiatric issues involved in cancer. Depression, anxiety and guilt are closely
tied to a disease of this nature. This can be clearly seen in the simple gut
reaction most of us have to the very idea of cancer. Thus, for a patient who
has been diagnosed, hypnosis offers a chance to bring out and deal with these
issues.
It is not surprising that many terminal patients contemplate suicide.
Levitan discussed how he used hypnosis to deal with this. He would have the
patient imagine committing the act, and then objectively discuss, under
trance, the consequences. He would then have the patient imagine his family's
reaction and the type of legacy and memory that this would create. He
would finally have the patient imagine all of the things that he could yet say
and do to make these areas better. Such a practice often helps a patient
realize the desire to make the most of the time that is still remaining.
Hypnosis also gives us a chance to understand the motives behind the
patient's contemplation of suicide, offering the clinician a chance to further
improve the patient's quality of life. For instance, many of those who seek to
end their lives in these circumstances do so out of miseducation. Under
hypnosis it may be found that, for example, a patient wants to die because
he feels he will be forced to experience horrible pain. Once we are aware of
this fact, we can then give the patient more knowledge as to all of the ways
that we can help him to deal with pain so that it can be tolerable.
Lynch found in his work that hypnosis was an invaluable tool in many
facets of cancer treatment. In one case, a patient with metastatic breast
cancer, he used hypnotic inductions both in person, as well as through
audiotapes in order to enhance many aspects of the patient's recovery.
Specifically, he cites stress and anxiety management, pain modulation, and
mitigation of disease and treatment-induced anorexia, nausea and vomiting.
His work confirms the earlier work of Spiegel who found hypnotic techniques
were able to nearly double the duration of survival in patients with
metastatic breast cancer. Lynch also found hypnosis particularly useful in
patients who required repeated stressful procedures, including bone marrow
biopsies and blood draws.
Lynch focuses much attention towards the importance of a sense of
control in a cancer patient's sense of well being. "Perhaps equally as
important, successful mastery of hypnosis and self-hypnosis skills to manage
cancer-related symptoms and side effects gives many patients the sense that
they are back in control of their cancer, not simply reacting to it," he states.
Later he reinforces the point eloquently. "An important but often overlooked
benefit of hypnosis in cancer management is the sense of control and
mastery of the disease it may provide. Patients with cancer, whose lives often
become a confusing succession of doctor's appointments, radiation
treatments, chemotherapy sessions, emergency room visits, and hospital
admissions frequently describe their lives spinning out of control. Mastery of
self-hypnosis provides the patient with a simple, portable, self-contained
therapeutic technique by which they themselves can exert some control over
their illness. The sense of mastery is often as important as the benefits of
symptom and pain management in allaying the dread and depression which
are often accompaniments to the diagnosis of cancer."
As we often hear, it is difficult to achieve a result until the mind can
imagine it. This is why Einstein felt that imagination was far more important
than intelligence. In this vein, patients are often guided to imagine
themselves the way they would like to be. Through training the mind to
imagine the desired outcome, patients can learn to then bring the reality
closer to their thoughts, rather than being a slave to fear and doubt. Many
patients spend most of their thoughts visualizing exactly the outcome they
most fear. Hence, they are often aiding the disease in diminishing their full
potential. Changing their internal imagery towards the desired outcome can
help bring about the desired results. This conceptual way of looking at
recovery and achievement has been utilized in the field of physical medicine
and rehabilitation, often with great success.
It is said that rehabilitation must address four aspects: the physical,
the affective, the cognitive and the sensory. Hypnosis can aid in each of
these aspects. This is why Martin says "It behooves all care providers to
include hypnotic techniques in their treatment arsenal" For instance, a
common type of patient seen in rehabilitation is the post-stroke patient. In
returning motor function, the patient can be guided through hypnosis to use
imagery and visualization to train the mind for the actions that the patient
would like to regain. This is a technique that athletes have used for years to
achieve peak performance in their given sport. For example, a basketball
player may use visualization to slow down the action of shooting a basketball
and focus in the mind on the proper form in each step, culminating in a
perfect shot. Similarly, the stroke patient can use visualization to see in the
mind's eye the paralyzed limb again moving.
This type of activity has helped patients in various motor functions such
as increasing range of motion, decreasing muscle tone and spasticity and
regaining bowel and bladder control. It can help the patient relearn old tasks
such as their general activities of daily living, as well as learning new tasks
such as how to walk using a new prosthesis. The same type of motor
rehabilitation through imagery and hypnosis has been applied to Parkinson's,
multiple sclerosis, cerebral palsy, and traumatic brain injury patients.
In the affective and cognitive realms, we have discussed in other areas
how hypnosis can be used to uncover a patient's emotions and thoughts about
their situation. The types of conditions that lead a patient to rehabilitation
are often ones that take a great toll on a patients self-image. Thus the
emotional and cognitive components can create a great burden on a patient.
In using hypnosis to deal with these areas of the disease, we see the complex
interconnections of mind and body once more. For, as the patient is guided
under trance to deal with his feelings and learn a more effective way of
thinking, we see the effects in improved physical performance. As the
patient, sees improvement in one area, his sense of overall control and
motivation improve, and extend to all other areas. Much like a drop of water
in a pond can lead to ripples throughout the entire pond, so does improving
a patient's general mindset in any area improves the whole person and his
performance.
Sensory disturbance is very common in the patients seen by the PM&R
specialist. Multiple sclerosis and stroke are good examples of disorders that
can create loss of sensation, burning, paresthesias or any number of sensory
sequelae. As we saw earlier, hypnosis can be used to change in many
beneficial ways the subjective sensory experience. Thus, not only can it help to
reduce pain, but in contrast, it can also be used to amplify sensation. A
patient with diminished sensation can learn to more fully appreciate the little
sensation that may be left in a limb and learn to focus more completely on
it. In this way, sensation can be regained, just as, in pain control, sensation is
taken away..
All sensation occurs in the mind. If a person is hit, he will usually feel it.
Yet in the middle of a fire, the same person may not even notice that same
stimulus. The difference is in the mind and through hypnosis we can work
directly with the mind to improve sensation for our rehabilitation patients.
Childbirth, to many of us, is synonymous with pain. Often as physicians, we
ask a patient to rate her pain on a scale of 1 to 10, with 10 being
childbirth. Thus, giving birth has become in a way the gold standard for
excruciating discomfort. And yet, it is not the only type of discomfort that
the obstetrician handles in his or her pregnant patients. Hence, pregnancy
offers a number of scenarios in which to apply hypnosis to the benefit of the
patient.
 Indeed, it was the esteemed obstetrician J.B. Delee who, in 1939, said
"The only anesthetic that is without danger is hypnotism." And even today,
lamaze, one of the most utilized methods of pain control in childbirth deals
with psychological control through relaxation and breathing. Hence, it is well
established that the pain of childbirth can be managed through the patient's
conscious control of the mind. Often this control in itself is a relief. It is
widely held that there is a cycle of pain expectation, which leads to stress,
intensifying the pain, and further reinforcing the expectation of more pain.
Though hypnosis we break this cycle.
The patient is educated as to the meaning and cause of contractions
and that they need not be accompanied by pain. This understanding of the
physical leads to mental relief, which then translates back into improved
physical comfort. The teaching begins at 28 weeks, giving ample time for the
patient to mentally rehearse a new response to labor. This can be seen much
like the athlete who mentally rehearses for the big contest or game. Such
training has been shown to diminish the cesarean section rate from the usual
20-30% down to only 5%, making an ironic statement about the overuse of
cutting edge technologies. This combination of one of the oldest forms of
mental health combined with the even older activity of childbirth is a prime
example of the complex entwinement of mind and body.
But the uses for hypnosis begin long before labor ensues. In fact, it can
be helpful in ensuring that it does not ensue too soon. It can be used, in
combination with medications or alone, to prolong pregnancy. Studies have
shown that patients using hypnosis can prolong pregnancy 18.8% longer
than with medications alone. This is due again to a strengthening of the
mind-body connection. The woman is made more aware of her contractions,
thus knowing sooner when to take the medication and also needing less
medication to accomplish the task of preventing premature labor.
While prolonging pregnancy is an admirable goal, the woman may at
times feel otherwise in the midst of the common complaints of nausea and
vomiting and the trials of pregnancy induced hypertension. Therefore, it is
helpful to understand the uses of hypnosis in making pregnancy more
comfortable for the patient. As for the case of hyperemesis gravidarum,
hypnosis is used both in diagnosis and treatment. Initially, it is used to assess
the cause of the vomiting, specifically searching for any underlying gain seen
by the patient. For instance, it has been widely found that women hold a
belief that more vomiting signifies a healthier baby. This is especially true in
patients who have miscarried before. Hence, there are unconscious motives
for the woman to continue vomiting. Under hypnosis, this type of belief can
be uncovered and a more empowering belief can be instilled. Fuths, et al.
found in 1989 that of 138 patients studied, 88% stopped vomiting
completely after only one to three sessions of hypnosis.
In the patient with pregnancy induced hypertension, it is often said
that delivery is the only cure. However, with hypnosis these patients have
been shown to have half the number of hospital visits and a decrease in
systolic and diastolic blood pressure, leading to a much more comfortable and
safe pregnancy.
Incidentally, the other medical uses of hypnosis are various and
interesting. It can be especially useful in certain infectious scenarios, as one of
its main functions can be immune stimulation. The Psychoneuroimmunology
Research Society was incorporated in 1993 as a non-profit organization
devoted to "the study of interrelationships among behavioral, neural,
endocrine and immune processes and to encourage collaborations among
immunologists, neuroscientists, clinicians, health psychologists and behavioral
neuroscientists." The field of psychoneuroimmunology is beginning to show
certain very direct correlations between relaxation and immune function.
Thus, in cases such as herpes and venereal warts, where constant immune
suppression is the goal, hypnosis can be quite helpful.
 It is also extremely useful in cases, much like the rehabilitation cases
discussed above, in which the patient is affected on many levels. An example
is that of a disfigured burn patient. In such a case, hypnosis can be utilized to
deal with the pain, the need for an immune response to fight off infection, as
well as the often devastating effects on the psyche. Severe burn patients
often have serious psychiatric sequella and must adjust both to living with the
memory of the trauma, as well as adjusting to a new body image.
Members of the psychiatric community, predictably, have tended to be
more open-minded than their medical colleagues towards the notion of the
subconscious mind and its powers. Thus, hypnosis has been applied in a great
variety of situations. Some of the most interesting disorders in which
hypnosis has been used are the anxiety disorders, the dissociative disorders,
post-traumatic stress disorder and eating disorders.
Two main features of anxiety disorders are an inability to consciously
create relaxation and a subjective sense of loss of control. Patients will report
feeling that the anxiety comes on despite their desires for relaxation, whether
on its own in a panic disorder or generalized anxiety disorder, or when
triggered by a specific phobia. As we have seen again and again, one of the
main features of hypnosis that makes it so empowering is the sense of control
it can give back to the patient. In fact, anxiety may be seen in a similar
framework to the pain in childbirth, where the expectation of the symptom
makes the symptoms more likely to occur and more severe, which further
reinforces the continued expectation in a vicious cycle. As we saw in the case
of obstetrics, hypnosis can be used with anxiety disorder patients in order to
break this cycle.
Relaxation is the name of the game with treating an anxiety disorder,
and it is no surprise that the first goal of treatment with such a patient
should be working on the conscious ability to relax. This is done in a trance
state by guiding the patient through internal imagery, visualization and a
number of other techniques. For some patients, it will be the first time they
have felt fully relaxed in a very long period. Once the patient is able to get to
that state, then the goal becomes lengthening the periods of relaxation and
teaching the patient how to control these internal images on his own.
This type of therapy overlaps with classical conditioning. An
unconditioned subjective response to anxiety, such as tachycardia or a lump
in the throat, can be used as a trigger for a new conditioned response of
relaxation. Such a patient may be taught to rehearse so that every time they
begin to get the racing heart signifying panic to that person, they begin to
use their learned techniques of imagery to put their mind in a more relaxed
place. After time, this will become their new unconscious response and
relaxation can become the rule rather than the exception.
Not surprisingly, when there is a clear cut trigger, as in a specific
phobia, it becomes that much simpler to know exactly when the new
conditioned response is needed and responses in these cases tend to be even
more successful than in generalized anxiety disorders. Somer describes how,
along with biofeedback, patients may be assisted who are too fearful to
attempt exposure to the object of their phobia even in a controlled setting.
Such a patient clearly cannot be treated with systematic desensitization
alone.
Somer also explains how "negative expectancies related to controllability
function as self-fulfilling prophecies," repeating yet again the importance of
instilling a sense of self-control in the patient. He cites Sanderson, Rapee and
Barlow's 1989 study which showed that when patients were given even the
illusion of control over CO2/O2 inhaled, panic diminishes greatly with only
20% panicing. Contrastingly, when the illusion of such control is taken away,
80% panic. Biofeedback is a tool which gives immediate and objective
evidence to the patient of his ability to control such processes as heart rate,
breathing rate, skin temperature, skin resistance, and blood pressure
consciously. Hence, its success in creating the feeling of self control so
important in diminishing stress and anxiety.
Somer found that many of the more intractable phobic patients
showed a pattern of attributing early therapeutic successes to the therapist's
presence, thus not receiving the benefit of improved feelings of self-reliance.
Through a combination of hypnosis, cognitive restructuring and biofeedback,
he was able to use what he terms "biofeedback-aided hypnotherapy" to help
these patients overcome their fears. Patients were hooked up to a biofeedback
monitor using a tone. The tone was set to decrease in pitch or volume in
conjunction with increased relaxation. Subjects were then hypnotized using
relaxation and imagery. As the tone diminished, patients became increasingly
aware of their ability to create relaxation as defined by the heart rate, skin
temperature, or galvanic skin response.
The patients then worked on maintaining this relaxation in the face of
more and more stressful imagery, culminating in the ability to relax even
while imagining the specific phobic trigger. Cognitive coaching from the
therapist was used to praise improved relaxation and to restructure "failures"
as simply learning opportunities, cutting off at the head irrational thoughts
that may accompany any increase in the tone.
The dissociative disorders bring up an interesting issue. Dissociation is in
many ways a hypnotic state of its own, in which the patient enters and
often remains in somewhat of a trance state, often in response to a
traumatic occurrence. Perhaps the most commonly known example of this is
in dissociative identity/multiple personality disorder. Evidence has suggested
that this is quite often the result of childhood abuse or trauma. Hence, we
can imagine a scenario in which a child exposed to such occurrences, and
unable to psychologically handle the situation, enters what amounts to an
altered state of consciousness during or after the events. In such a way the
child can create different states of consciousness, or personalities, to handle
different aspects of a troubling life. This is why Bliss described the disorder in
1986 as "an unwitting abuse of autohypnosis." In therapy, we can help by
working on the unwitting and abusive nature of the disorder, leaving the
patient in a more tolerable and functional state.
Experience with these types of cases led Coons to conclude in his 1986
study that hypnosis is the "treatment of choice" in multiple personality
disorder. Whether one agrees with this assessment or not, it is advisable to
keep it as one of the tools in our arsenal against this disorder. Its uses include
age regression in which a patient can go back and examine the events that
may have initially caused dissociation, in order to reintegrate any lost
memories. We can maneuver between the separate personalities more freely,
integrating them and substituting them for each other in various ways. We
may even arrange for a "slow leak" type of debriefing in which the patient
will become more and more conscious of certain information as his
unconscious deems him ready to accept it.
In this way, the patient can deal, in a controlled setting guided by a
trained professional, with ideas that have been repressed deeply. Upon
discussing these topics and feeling a sense of understanding, the patient's
sense of control is improved. The patient begins to feel stronger and more
able to deal with the events, and use them as a learning tool rather than
remaining a slave to their unconscious effects. Boyd discusses a case with a
23 year old university graduate with dissociative identity disorder as
diagnosed on a number of different scales and tests. He describes how
hypnosis was used, in conjunction with other therapy and medication, to
achieve a very successful outcome. He used 23 hypnotic techniques over a
course of 19 sessions, and, overall, hypnosis was used in 35% of the sessions.
For example, after inducing trance using a combination of relaxation
and downward counting along with explicit instructions for the patient to
turn her attention inward, he questioned her subconscious mind, eliciting
answers in the form of finger signals from the patient. This method was used
to question the various personalities as to the meaning of a particularly
disturbing nightmare the patient had experienced. Such methods were used
to further probe for the source of dissociation.
In a more therapeutic light, he describes the "clenched fist technique"
popularized by Hammond, in which, under trance, the patient is allowed to
fully experience her repressed rage and direct those feelings into her fist.
After a time, the fist is then opened, and the patient is guided back to
relaxation. The patient can then be taught to do this type of maneuver on
her own in self-hypnosis. Through this and many other types of treatment,
the patient showed steady improvement as related by the Dimensions of
Therapeutic Movement Instrument. Boyd discusses how such treatment
empowered the patient, through sequentially handling more and more
disturbing issues, thus creating a growing sense of control and strength. After
using Boyd's Macroabreaction Integration Technique, the patient related the
removal of the memories from her subconscious to the removal of a tooth
and to a bursting pillow, whose feathers spread to their proper places.
Such treatment led to a full unification of the patient's identities in 54
sessions over 10 month. So surprised was Boyd at this relatively speedy
recovery, that he assessed the patient's status using no less than five different
tests, each of which supported the patient's claim of unification. The tests
included the DES, MMPI-2, questions from Lowestein's mental status
interview, the SCID-D and Kluft's Hypnotic Inquiry Protocol. Hypnosis was
then found useful yet again to make one last subconscious search for any
secondary personalities that lingered. None were found.
Post-traumatic stress disorder, while not classified as a dissociative
disorder, per se, can be looked at in a similar light. Patients who have been
in combat, raped, or exposed to other trauma, often dissociate from it. For
example, a woman may describe floating above herself and watching herself
being raped as if from afar, an objective observer. Furthermore, these
patients tend to live internally, constantly reliving the event in spite of very
different external events taking place around them. In fact, the evidence
shows that patients who have been in trauma are more hypnotizable, lending
some credibility to the idea of dissociation and trauma as related to a
hypnotic type of state. For this reason, hypnosis has been used to treat
combat stress for many years, and veterans with PTSD are among the most
easily hypnotized subjects.
Indeed, this brings up the fear of whether hypnosis could actually harm
these patients who are already too dissociated by making them further so.
However, experience has shown that generally hypnosis helps these patients
to learn to make better use of the hypnotic state that they are already in.
The idea is that if these patients are going to be in a trance, any ways, it is
better to make them aware of it and use it to their benefit, rather than have
them walking around being suggestible to anything that happens to come
their way. An interesting controversy raised is that of the repressed
memories and their validity. It is wise to keep a healthy sense of skepticism
about issues that come out in trance.
While the majority of information obtained is shown to be accurate,
there are definitely cases in which patients report events which can not be
confirmed or which can even be refuted subsequently. While of some
significance in therapy, this can take on even greater importance when legal
interests or forensics come into play. Thus, the wise clinician keeps an open
mind, while not always taking the patient's words at face value. It may also
be valuable to consider checking other sources to confirm certain information
as appropriate and with the patient's consent.
Some have hypothesized that eating disorders also contain a
component of dissociation. It is not difficult to see, for example, how a person
who is emaciated, yet feels overweight, has created a mental split of sorts
between mind and body. Thus, it is understandable that hypnosis has been
applied in cases of anorexia nervosa and bulimia nervosa. Reports of such
application date back to the early 1900's when a French psychiatrist named
Pierre Janet used hypnosis to treat eating disorders. More recently, the
Australian researcher Griffith found a significant reduction in binge and
purge behavior in bulimics after a nine month course of hypnotherapeutic
treatment.
Hypnosis has both a diagnostic and therapeutic role in eating disorders.
Torem describes the importance of delving more deeply into the underlying
etiology of the eating disorder. In doing so, he has come across some
interesting findings. For example, using hypnosis he often uncovered in these
patients past traumas, a struggle for autonomy from the family, or a feeling
of deserving self-punishment. More interesting still, Torem found again and
again evidence of dissociative qualities in these patients. In keeping with our
earlier discussion, he also found that patients who had been involved in
trauma were more hypnotizable. Therefore, hypnosis can be a significant aid
in determining the underlying causes of the eating disorder. Once these are
determined, they can then be helpful in determining how successful hypnosis
will be for that particular patient.
Therapeutically, Torem describes introducing hypnosis to eating
disorder patients initially in the form of self-hypnosis, framed as a technique
to improve calmness and relaxation. As we have seen repeatedly, the ability
for the patient to learn conscious relaxation is the first step in a feeling of
control. After some time, Torem begins to utilize the hypnotic state for
several very specific goals. These include ego-strengthening, healing
suggestions, cognitive restructuring and reframing and symbolic guided
imagery.
He mentions that the behavior is often a metaphor for something the
patient cannot consciously express. For example, a bulimic may binge and
purge as a symbolic gesture indicating her dissatisfaction with a home life, a
purging of her parents' values and rules, if you will. Therefore, under trance,
it is very helpful to address the underlying cause of the behavior, and work
with the patient to find a better way of expressing that dissatisfaction. In
this way, the patient's need for expression is appreciated and fulfilled, while
doing it in a more healthy way.
One area that Torem talks about in detail is the need to "meet the
patient where the patient is at." Techniques abound throughout hypnosis
dealing with this basic principle. I have found it helpful to imagine the
hypnotic process as that of a magnet and a piece of metal. In order for the
magnet to lead the metal to where it wants, it must first go pick up the
metal where it is at. Similarly, the therapist must go to where the patient is
and not expect the patient to make the first move.
In following with this idea, Torem explains how, rather than explain
the need to gain weight to the patient, we acknowledge her fear of this and
instead talk in terms of strength units. Eating disorder patients are far more
likely to be willing to improve strength than to agree to gaining weight.
Weight gain may seem beneficial to the therapist, but to the eating disorder
patient it may be seen as the ultimate failure. Thus, rather than force our
views on the patient, we work from her perspective, reframing goals in a
form that she can relate to.
This method of working with the patient in a way that acknowledges
and takes into full account all of her fears and desires is far more effective
than trying to simply lead the patient to where you want. Hypnosis must be
seen as a partnership, and the patient must be met where he or she is. For a
moment, I would like you to simply read this paper, and while you are doing
so, make sure that you do not picture in your head a pink elephant. What
happened when you read that last line? If you are like most humans, you
immediately conjured up a picture of a pink elephant. This brings up an issue
Torem and many in the field of hypnosis deal with, and that is language and
how it is used most effectively in dealing with the subconscious mind.
The subconscious mind is extremely literal, and works in images,
sounds, feelings, tastes and smells. It does not register words such as "don't"
and "not". Therefore, it is quite ineffective, for instance, when a patient with
an eating disorder constantly engages in self talk such as "don't binge" or
"you have to stop purging". The subconscious cannot create an image of a
person NOT binging. However, it can create an image of a person eating
healthy and nutritious food. It can create an image of a person treating her
body with respect.
When using hypnosis, the specific words you choose to get across an
idea can be the difference between success and failure. That is because the
subconscious mind speaks its own language, and you must speak in terms it
can understand. When you go from speaking to the conscious mind to the
unconscious, it is much like switching between people who speak different
dialects. The subconscious responds to specific ways of structuring sentences,
specific types of commands, metaphors, and a host of other methods to
which the conscious mind would not respond. In fact, in hypnosis it is often
advisable to speak in such a way that the conscious mind cannot understand,
because in this way we avoid its power to reject the statement. Hypnosis is
about speaking not to the conscious mind, but past it, to the level where
deeper understanding and change takes place.
The concepts of specific language patterns and their effects on the
unconscious mind have been studied extensively. There is an entire field,
progressively growing in popularity, known as neurolinguistic programming,
which addresses the specific applications of language to unconscious change.
Developed in the 1970's by Richard Bandler, a graduate student at UC
Santa Cruz, and John Grinder, a linguist and professor at the same school, it
models the language patterns used by some of the most effective therapists
and hypnotherapists in creating desired outcomes.
Some of the initial therapists modeled included Milton Erickson, M..D.,
the father of medical hypnosis, founder of the American Society for Clinical
Hypnosis, a former assistant professor of psychiatry at Wayne State
University's School of Medicine, and one of the most fascinating characters in
the history of hypnosis. On one hand tone deaf, color blind, and left with a
permanent limp by polio as a child, Erickson honed his observation skills to
the point of legend among those who worked with him. Other therapists
modeled included Fritz Perls, the father of gestalt therapy, and Virginia
Satir, a very well known family therapist. Bandler and Grinder made an
effort to make conscious the techniques and patterns of language that these
therapists had grown to use instinctively without even realizing it themselves.
In doing so, they were able to then systematically teach some of the most
compelling ways to effect change in an individual.
Torem again uses these types of principles when he uses symbolic
guided imagery. This is where he uses metaphors in order to create change in
the eating disorder patient while in trance. He uses several different
metaphors for the patient's body such as a room which they then decorate in
a more pleasing way, a pet that they must take care of or a caterpillar who
then grows and matures into a beautiful butterfly. While the conscious mind
may make little sense of these metaphors, the unconscious quickly picks up
on the connection to the patient's own body and works from that
standpoint. To further reinforce the metaphors, he may even have the
patient fulfill one of these tasks, actually redecorating her room or getting a
pet, so that the unconscious becomes even further engaged by the similarities
with the patient's own situation.
An issue that comes up frequently in hypnosis is time distortion. While
in trance, there is a lost sense of time. Patients often report being unable to
remember if they were in trance for 10 minutes or an hour. Therapeutically,
the distortion of time can be used in many ways for the patient's benefit. In
the case of eating disorder patients, they can be swung back and forth
through time in order to bring out certain valuable lessons. For instance, age
regression can be used to travel back in time to examine when the disorder
first began. Or, on the other hand, the patient can be swung way into the
future to examine how her life will be if she continues this behavior compared
with if she stops it, offering a striking contrast between the different
endpoints of two diverging paths. Using this "Back from the future"
technique, she becomes more aware of how every day living this way is
leading her further and further from what she really wants her life to
become.
It has been said that great thinkers tend to see the interconnectedness
of all things. In hypnosis, we have a technique which helps us to do just that.
Hypnosis connects modern medicine with practices that have been used by
the ancient Egyptians and enlightened Zen masters. It informs our
understanding of how the mind connects with the body, as well as how the
conscious mind connects with the unconscious. New studies are showing how
the subjective experiences of patients in altered states connect with objective
markers such as EEG readings and skin resistance. And the future of hypnosis
offers an opportunity for strengthening the connection between research and
clinical application.
A human being, as a whole individual, with all of his or her physical,
mental and spiritual attributes is, by any definition, a miraculous creation.
With this in mind, should it come as any surprise that in spite of all of our
medical and technological advances, some of the most important answers for
which we are searching lie within the person himself? The body and mind
have been healing themselves since long before humans walked the face of the
earth. And while medications and surgery surely have their place in our
arsenal against disease, let us never forget that nature is the original healer
and often the most powerful. Through hypnosis, we are able to connect to
this ultimate healer, giving power back to the patient, and in the process,
empowering ourselves with the ability to improve life in an infinite number of
ways.

41. HYPNOSIS AND MAINSTREAM MEDICINE: MICHAEL WALDHOLZ: THE

WALL STREET JOURNAL
[Hypnosis, often misunderstood and almost always controversial, is
increasingly being employed in mainstream medicine. [Mainstream medicine
wouldn't be using it if it was "almost always controversial"] Numerous
scientific studies have emerged in recent years showing that the hypnotized
mind can exert a real and powerful effect on the body. The new findings are
leading major hospitals to try hypnosis to help relieve pain and speed
recovery in a variety of illnesses.
At the University of North Carolina, hypnosis is transforming the treatment
of irritable bowel syndrome, an often-intractable gastro-intestinal disorder,
by helping patients to use their mind to quiet an unruly gut. Doctors at the
University of Washington's regional burn center in Seattle regularly use it to
help patients alleviate excruciating pain. Several hospitals affiliated with
Harvard Medical School are employing hypnosis to speed up postsurgical
recovery time. In one of the most persuasive studies yet, a Harvard
researcher reports that hypnosis quickened the typical healing time of bone
fractures by several weeks.
"Hypnosis may sound like magic, but we are now producing evidence
showing it can be significantly therapeutic," says David Spiegel, a Stanford
University psychologist. "We know it works but we don't exactly know how,
though there is some science beginning to figure that out, too."
Hypnosis can't help everyone, many practitioners say, and some
physicians reject it entirely. Even those who are convinced of its effect say
some people are more hypnotizable than others, perhaps based on an
individual's willingness to suspend logic or to simply be open to the potential
effectiveness of the process. [95% of all people are hypnotizable, see
"Qualities of a Hypnotizable Person" and "The Power of Hypnosis" ]
These days, legitimate hypnosis is often performed by psychiatrists and
psychologists though people in other medical specialties are becoming licensed
in it, too. [Except Indiana, there is no ælicensing' for hypnotherapists. I
believe that the majority of Hypnotherapists come from the "alternative
medicine" arena rather than the traditional medical model.] It can involve
just one session, but often it takes several -- or listening to a tape in which
a therapist guides an individual into a trance-like state. Whatever the form,
it is increasingly being used to help women give birth without drugs, for
muting dental pain, treating phobias and severe anxieties, for helping people
lose weight, stop smoking or even perform better in athletics or academic
tests. Until the last decade, many traditional science journals regularly
declined to publish hypnosis studies, and research funding was scarce. That's
changing. Dr. Spiegel, for instance, is co-author of a widely referenced
randomized trial involving 241 patients at several prestigious medical
centers. Published several years ago in the Lancet, a respected medical
journal, it found that patients hypnotized before surgery required less pain
medication, sustained fewer complications and left the hospital faster than a
similar group not given hypnosis.
Using new imaging and brain-wave measuring tools, Helen Crawford,
an experimental psychologist at Virginia Polytechnic Institute in Blacksburg,
Va., has shown that hypnosis alters brain function, activating specific regions
that control a person's ability to focus attention. "The biological impact is
very real and it can be quantified," Dr. Crawford says.
Still, proponents say they typically spend a great deal of time dispelling
commonly held myths and answering skeptics. Hypnosis, they say, cannot
make people do or say something against their will. Credible hypnotists don't
wave a watch in front of their clients, as portrayed in many old movies.
People who enter into a so-called hypnotic trance [either a trance is a
trance or it is not, but it cannot be called a æso-called' trance.] are not,
generally [never], put to sleep. On the contrary, practitioners say, they
refocus their concentration to gain greater control.
 Even so, the field continues to be hurt by quacks, says Marc Oster,
president of the American Society of Clinical Hypnosis. [There are
incompetents and quacks in any profession who make a black mark on that
group.] His group, along with the Society for Clinical and Experimental
Hypnosis, publishes research studies, conducts educational seminars for
health providers and certifies those who complete course work and meet
other standards. Dr. Oster suggests that people interested in hypnosis see a
health provider licensed in a medical discipline, who is also certified by one
of the hypnosis societies -- someone who "uses hypnosis as an adjunct" to a
principal medical practice. [Most doctors and other health providers feel
they do not have the time to spend using hypnosis. An alternative to them
is to utilize the skills of a person trained in hypnosis, who may not be
medically trained. The cooperation and collaboration of the two
professionals can greatly improve the patient's outcome.] Everyday Trances
Researchers say that most [virtually all] people unwittingly enter into
hypnosis-like trances on their own in everyday life. When reading a riveting
novel or watching a film or TV, many people are experiencing a trance-like
state when they are so focused they become only vaguely aware of nearby
noise, conversation or activity. In a dream, when someone imagines falling
off a cliff and is startled awake by the sensation of falling, they are
triggering the same mental machinery that in hypnosis allows the mind to
influence the body, says Dabney Ewin, a psychiatrist at Tulane University
Medical School. Katie Miley used self-hypnosis taught to her by a
Chicago-area psychologist to help her give birth "without being so anxious
and without pain medication." For weeks preceding the delivery Dr. Miley,
herself a psychologist, used tapes provided by the therapist to practiced
slipping into a hypnotic state. During the birth, and as suggested by the
therapist, she muted the pain by imagining the contractions "as a warm
blanket enveloping me," she says. [HypnoBirthing« Moms do not “mute
pain”, they just relax and let nature take over. When free from fear and
relaxed, most births can be drug and pain free.] "It was weird," she says. "I
was aware of everyone in the room and I was interacting, but mentally my
focus was elsewhere and I just allowed the process to unfold." [These type
stories are typical of HypnoBirthing« Moms' experiences.]
Some of the clearest clinically measured results come from using
hypnosis to mute severe and chronic pain -- as the University of
Washington's regional burn-treatment center in Seattle is doing with burn
patients. Patients sent there must undergo frequent therapy to sterilize their
damaged skin, and get new grafts. They must be awake and alert during
the treatment, and even the most powerful narcotics rarely diminish the
intense pain.
David Patterson, a psychologist at the center, induces a hypnotic
trance with a typical and relatively quick technique. Patients are told to
close their eyes, breath deeply, and imagine they are floating. Through a
variety of verbal suggestions, Dr. Patterson then helps the patient imagine
themselves elsewhere, away from the treatment. "The pain is still there, of
course, but patients simply don't experience it as before," he says. [If the
patients simply don't experience, how can the pain still be there? That logic
is illogical!] While relieving physical pain is one of the more common uses of
hypnotism, it is also the hardest to explain. Dr. Patterson and others report
that hypnosis doesn't appear to act on the body's natural pain-killing
chemicals, the way drugs do. Instead, scientists believe, through hypnosis a
person can be trained to focus away from the pain, not on it as most people
usually do. Many athletes often unconsciously use such a technique to play
through severe pain, concentrating their attention on the game or task
ahead, instead of on their injury.
Recently, Dr. Patterson added another tool to transport hypnotized patients
to a "safer emotional environment." He and his colleagues created a virtual
reality film; patients placed in a helmet during therapy watch a
three-dimensional depiction of a snow-covered set of mountains and
canyons. By interacting with the film, patients can feel they are suspended
over a cool and calming world. Michael "Mac" MacAneny, one of the first
burn patients to use the 3-D film, says he is certain that "it saved my life."
[Hypnosis can provide the ævirtual reality' without all the hardware. The
clients see virtual reality in their minds.]
Early last year, Mr. MacAneny sustained deep burns over 58% of his
body when building a bonfire for his sons in his backyard. A gas tank he was
using suddenly exploded, enveloping him in flames. Before Dr. Patterson
began treating him, the 39-year-old Mr. MacAneny says he dreaded his
daily therapy, "freaking out" whenever the nurses came to get him.
Hypnotized and inside the 3-D virtual world, "I knew what was going on,
but I just didn't pay attention to it," he says.
Hypnosis, in some form or another, has been used for more than 200 years.
It began gaining credibility as a medical tool in the early decades of the last
century as psychiatry and psychoanalysis began to show how the unconscious
mind often rules daily life. Its usefulness was cemented when combat
physicians reported using it during World War II for the wounded.
By 1958, as more doctors described their experiences in the war, the
American Medical Association certified the technique as a legitimate
treatment tool. Nevertheless, few doctors employed it. But in 1996, a
National Institutes of Health panel ruled hypnosis as an effective intervention
for alleviating pain from cancer and other chronic conditions. These days, as
many people accept that stress can exacerbate illness, the potential curative
power of hypnosis is becoming more acceptable, too.
Healing the Body: Carol Ginandes, a Harvard psychologist at McLean
Hospital in Boston, is trying to prove that "through hypnosis, the mind can
have a potent effect not only on mental well-being but also on the
acceleration of bodily healing itself." She has co-written a study showing
ankle fractures among patients receiving a hypnotic protocol healed weeks
faster than usual and another study showing wound-healing benefits for
hypnotized breast-cancer surgery patients. Though these studies were
preliminary, Dr. Ginandes believes that hypnosis enabled her subjects to
stimulate the body's own healing mechanism to work more efficiently.
Elvira Lang, director of interventional radiology at Beth Israel
Deaconess Medical Center in Boston, has made similar findings. She recently
reported that hypnotized patients who must remain awake during certain
vascular and kidney procedures fared measurably better than similar
patients who didn't undergo hypnosis.
Still, says Dr. Lang, until very recently, "I didn't dare use the 'H' word
around here." [I look forward to the day when the great power of hypnosis
will be eagerly embraced by all medical and healing people to improve the
health of their patients.]

42. DR. ALAN M MATEZ MEDICAL HYPNOSIS

Meet Dr.Alan M. Matez: Alan M. Matez, D.O., is a physician and
psychotherapist with over 25 years of clinical experience and specializing in
Medical Hypnosis. He is Board Certified in Medical Hypnoanalysis and
Certified in Interactive Guided Imagery. He is a 1966 graduate of the
University of Osteopathic Medicine and Health Sciences/College of
Osteopathic Medicine and
SURGERY. After completing a medical/surgical internship, he was in a
family/general medical practice, and served as a physician in the United
States Navy. Dr. Matez is committed to the care and well-being of his
patients and to their successful treatment. He is licensed to practice medicine
and surgery in the States of California and Nevada.
"D.O.s: Physicians Treating People - Not Just Symptoms."Dr. Matez is a
member of numerous professional organizations including: The American
Academy of Medical Hypnoanalysts, The American Society of Clinical
Hypnosis, The Academy for Guided Imagery, The San Diego Society of
Clinical Hypnosis, The American Osteopathic Association, The Osteopathic
Physicians and Surgeons of California and The San Diego Osteopathic Medical
Association. He is a Diplomate of The American Academy of Medical
Hypnoanalysts, The National Board of Certified Clinical Hypnotherapists, The
American Academy of Experts in Traumatic Stress, and The National Board
of Osteopathic Examiners. He has been a Clinical Training Hypnoanalyst with
The American Academy of Medical Hypnoanalysts since 1980, on the
editorial board of the Medical Hypnoanalysis Journal since 1986, and
President of the AAMH from 1986 to 1990. He has taught courses in
Medical Hypnosis and Guided Imagery with all of the above organizations and
in a number of colleges and medical schools throughout the United States,
Canada and South Africa.
A dynamic speaker, Dr. Matez is available for speaking engagements to
interested professionals, groups, civic clubs and organizations, and academic
classes. His extensive knowledge of Mind-Body Medicine, Medical Hypnosis,
Subconscious Hypnoanalysis, Interactive Guided Imagery, Behavioral Medicine
and Psychology is shared in professional
TAKE CONTROL OF YOUR MIND, YOUR BODY, AND YOUR LIFE
WITH:
* Mind-Body Medicine
* Medical Hypnosis
* Subconscious Analysis
* Medical Hypnotherapy
* Interactive Guided Imagery
* Psychophysiological and Behavioral Medicine
Clinically proven methods of individual, dynamic, safe, natural, effective and
goal-oriented therapy, that is short-term and inexpensive.
Medical Hypnosis Recognized by AMA: The phenomenon of hypnosis
has been known to medical sciences for centuries. Modern medical technology
realized the benefits of hypnosis in treating a wide variety of disorders. It was
officially endorsed by the American Medical Association in 1958 as an
ethical, legitimate and safe therapeutic approach to medical and
psychological problems. Today more people recognize that the mind and the
body interact. Mind and Body are integrated parts of a whole human being .
. . a change in one part affects the other.
A New Approach to Medicine and Life! What Is Hypnosis? Hypnosis is
a highly relaxed state of mind and body, an altered state of consciousness. It
is a normal and natural phenomenon that we experience every day. Hypnosis
can be described as concentrated and directed day-dreaming. A person in
hypnosis is always in control, fully aware of his or her surroundings in a
detached sort of way, hears everything the physician is saying, and is more
receptive to acceptable suggestions given by the Medical Hypnotherapist.
Actually, all hypnosis is really self-hypnosis. The patient achieves his or
her own hypnotic state; the Medical Hypnotherapist is only the guide.
Anyone who wants to be hypnotized, can be hypnotized. A person in the
state of hypnosis cannot be made to say or do something that is against
his/her upbringing, morality, religious beliefs, or against "his grain". The mind
and body relaxation that is experienced is enjoyable, pleasant, energizing and
refreshing. "Imagination is more important than knowledge."- Albert
Einstein
WHAT IS MEDICAL HYPNOSIS AND SUBCONSCIOUS
HYPNOANALYSIS? Medical Hypnosis utilizes positive suggestions in the
treatment of both physical and emotional disorders. Hypnosis is a state of
deepened physical relaxation and heightened concentration of the mind in
which the learning process is greatly enhanced. Direct communication with
the subconscious mind greatly increases the effectiveness of positive
suggestion. The practitioner of Medical Hypnoanalysis requires a training
background in the basics of psychology, developmental psychology,
psychopathology, psychotherapy, psychiatry and medicine as well as in
hypnosis.
Medical Hypnoanalysis is dynamic, short term, and directed. It is
dynamic in that the treatment approach emphasizes causes rather than
symptoms, explanations rather than descriptions, and unconscious forces
rather than conscious forces as being the ultimate origin of the
psychopathology.
It is short term in that in most situations twenty or less sessions are
required for the completion of treatment. It is directed therapy in that the
psychotherapist, upon making a diagnosis, follows a medical model of
psychotherapy aimed at resolving the underlying unconscious causes
responsible for the physical or emotional symptoms, negative thinking and
unwanted behavior.
Hypnoanalysis is a search of the subconscious mind through the use of
hypnosis. Hypnosis opens the door into the subconscious mind; analysis helps
one to understand and resolve the root cause of the problem . . . hence the
term, Hypnoanalysis.
The techniques used by Dr. Matez are the most effective means of
utilizing hypnosis today. Medical science is combined with Medical Hypnosis to
achieve a uniquely effective form of therapy. It is extremely helpful in
determining the origin/root cause of a person’s problem, because it reaches
regions of the mind that cannot be easily reached in the normal waking
state. Specific suggestions aimed at solving the problem are able to reach the
patient’s subconscious mind where they are most effective.
Dr. Matez’s instruments are not scalpels and drugs, ut words and
experiences . . . images and memories . . .techniques which teach people to
relax and inspire them to awaken the healer within, to take charge of their
lives, and realize their full potentials.
WHAT IS CLINICAL GUIDED MENTAL IMAGERY? This natural way of
thinking draws on your inner wisdom, becoming a powerful force for insight,
self-healing and growth. Imagery can make you deeply aware of how your
thoughts, feelings, and habits influence your health and your life. Using
Interactive Guided Imagery, you will learn how to focus within, and draw on
the wisdom of your mind and body, understand your health needs and
symptoms, and become aware of your powerful inner resources to awaken
your own natural healing powers.
A growing body of medical research in the new and rapidly expanding
field of Psycho-neuroimmunology shows that the inner mind has a powerful
influence on every major control system of the brain and body - stimulating
vital functions like heart rate, blood pressure, local blood flow, internal organ
functioning, wound healing, pain control, immune system functioning and
much more.
Using easy to learn imagery skills, you can deeply relax mentally and
physically, control pain, recover more quickly from surgery and illness,
tolerate difficult medical procedures and treatments like chemotherapy more
comfortably, and speed healing of injuries and wounds. "Interactive Guided
Imagery is a remarkably creative and effective way to take advantage of the
mind-body connection. It is one of the Andrew Weil, M.D.
Author, Spontaneous Healing
What Is Imagine Health!? Imagine Health! is an innovative Stress
Management Program utilizing Interactive Guided Imagery . . . an extremely
valuable clinical tool for stress reduction, creative problem solving, peace of
mind, body awareness, improve health and wellness, performance
enhancement and planning for success. You will learn how to use the Power
of Your Mind/Body Connection for Practical Life Skills for Stressful Times.
Stress is a part of life . . . but excessive stress is dangerous to our mental,
emotional and physical health. Our lifestyle demands that we use our time
and energy wisely . . . that we use our minds well . . . to succeed, to relax, to
heal, to enjoy.
Imagine Health! was developed by the Academy for Guided Imagery,
which will show you how to use your mind for relaxation, creative
problem-solving and effective action planning. You will learn simple, effective
methods for reducing, eliminating or better managing the stresses of life. This
6-Session program provides practical training in real life skills that make use
of the power of the imagination for better health through stress reduction.
"Your imagination is a critical factor in how you handle stress. It can make
you sick with worry, or it can be the key to your health, happiness and
success" Martin L. Rossman, M.D Co-Director, Academy for Guided Imagery
What Problems Can Be Treated By These Methods? As we learn more
about the power of the subconscious mind, we can see just how Medical
Hypnosis can improve the quality of our lives. Dr. Matez will skillfully combine
Medical Hypnosis and Clinical Guided Imagery Techniques, teaching you how
you can empower yourself to assume an important role in promoting your
own inner peace, healing and well-being . . .To Take Control of your Mind,
Your Body, and Your Life. Some of the problem areas that can be
successfully treated by
Medical Hypnosis and Guided Mental Imagery include:
* Depression
* Anxiety, Nervous Tension
* Stress Management, Post-Traumatic Stress Disorder
* Stop Smoking with the Smoking Cessation Program
* Obesity and Eating Disorders
* Pain Modification and Pain Control; Learn Hypnoanesthesia and
Hypnoanalgesia for Pain Relief
* Phobias and Panic Attacks, Agoraphobia, Claustrophobia
* Fears such as: Flying, Driving, and all others
* Low Self-Esteem and Confidence Building
* Spiritual Conflicts

43. KEEPING HYPNOTISM SAFE: JULIE GRIFFIN: NGH JOURNAL: SEPT

2004
The Benefits of Working with the Medical Community: When I was a
newly certified hypnosis professional, I can remember a feeling of dread come
over me, when one of my instructors, vehemently stated that no hypnotist
should work on a client who was already being assisted by a
physician-without a written referral. I had many concerns about approaching
the medical community the main concern being that a physician might not
believe in hypnosis and, as a result, might deny me access to the client. I first
heard of this law approximately ten years ago. At the time, the rule seemed
unfair and slanted toward the medical community.
Very soon after being made aware of this rule, I developed a keen interest in
medical hypnotism. After taking both a medical hypnosis certification course
and a hypnoanesthesia certification training, my deeper understanding of the
need for written medical referrals surfaced. Now after a decade immersed in
this arena of hypnotism, I realize that there are many compelling reasons for
hypnotists and medical doctors to work collaboratively.
Benefits of Collaboration between Hypnotists and the Medical
Community: Collaboration with the client's physician is necessary to ensure
that your hypnosis suggestions do not accidentally conflict with medical
interventions and medications that the client is already receiving. Below are
some examples of problems that can arise when a hypnotist facilitates
medical hypnotherapy without a referral. If the client's physician is unaware
that you are employing hypnosis suggestions designed to help regulate the
client's blood pressure, the combination of medication and hypnosis
suggestions could accidentally cause the client's blood pressure to become too
low or too high.
If you are facilitating a hypnosis session for a client to improve the
client's sex drive, certain medications that the client's physician may
prescribe could inadvertently cause your hypnotherapy to fail. For example, a
common side effect of prescription drugs for hypertension and depression is
diminished libido. If you are facilitating a hypnosis session for a client for
relief of pain, you might accidentally block a pain signal that the physician
needs to be aware of to properly diagnose a client's condition.
Hypnotized clients typically present with lower than normal blood
pressure readings before and after their surgery. If you are facilitating
pre-surgical hypnosis without the consent of the client's surgical team, the
anesthesiologist might be misled by the client's blood pressure reading and
might give an incorrect amount of anesthesia to facilitate the client's
procedure.
Additionally, the anesthesiologist might also fail to give the client enough pain
medication after the procedure.
If the anesthesiologist does not under stand that it is normal for a
hypnotized client's blood pressure to appear low, he might be afraid that
additional pain medication might cause the client's blood pressure to reach
dangerously low levels. If the client's physician is unaware that you are giving
hypnosis suggestions designed to help balance the client's blood sugar, the
combination of medication and hypnosis suggestions could accidentally cause
the client's blood sugar to become too low or too high.
If a client comes to you for hypnosis to overcome or manage diabetes.
it is essential that you know exactly what type of diabetes the client has. In
many cases. the client may not know if they have Diabetes Mellitus or
Diabetes Insipidus. Diabetes Mellitus involves the pancreas whereas Diabetes
Insipidus involves the hypothalamus. Since these are two completely different
diseases. they would require very different hypnosis suggestions for successful
hypnotherapy. Even if the client knows that he has Diabetes Mellitus. he
might not know if it is Type One or Type Two. To complicate matter more
often a client will want help with "Borderline.. Diabetes. Without a written
referral that includes an exact clinical diagnosis. you could be acting upon
erroneous information from your client. The written referral and diagnosis
prevents potentially serious problems.
When Referral Are Necessary: A referral is necessary anytime another
health care professional is already treating the client for the same condition.
This applies (but is not limited to ) medical- doctors. nurse practitioners,
physicians' assistants, osteopaths, naturopaths, psychiatrists, psychologists,
licensed mental health workers, and social workers. A referral is necessary
anytime a client comes to you for help with a condition and is uncertain of
the exact diagnosis. A referral is in order anytime you question the mental
stability of the client. A referral is necessary anytime a client comes to you
for help who is receiving any type of medication from a medical doctor or
mental health professional that might be impacted by the type of hypnosis
session you wish to perform. A referral is' necessary anytime a client has been
prescribed a medication by his physician that might negatively impact the
success of your hypnosis session.
Headaches and Other Pain Producing Maladies: A client comes to you
wanting help to deal with the discomfort that her frequent migraine
headaches create. You can see she is suffering and you want to help her to
become more comfortable as soon as possible. She is new to town and doesn't
even have a physician yet. Should you teach her hypnoanesthesia to diminish
the discomfort without getting a referral? Absolutely not--until such time as
her condition is f~ly evaluated and diagnosed--and even then, only after you
have secured a medical referral.
Even if the client has been previously diagnosed with migraines, you
should never, use hypnotism to negate physical pain without a medical
referral that includes a diagnosis. Since you have no way to verify if a
headache is caused by a migraine. brain tumor, or aneurysmY4or some other
potentially life-threatening condition--you must instruct the client to obtain
a current, valid referral.
Since any type of pain can actually be a warning sign of an underlying
condition, a physician must properly diagnose it before you conduct a session
with the client that is designed to diminish pain.
In Summary: To be certain that any hypnotism and medical
interventions do not contradict or negatively impact each other, it is essential
that both the physician and the hypnotist are aware of the type of
therapeutic interventions each has put in place. Collaboration between the
physician and hypnotist allow each party to work together to produce the
best outcome for the client. If you are working without a referral, you may
have no way to confer with the physician to see if the hypnosis that you have
employer is producing meaningful benefits for the client. For example, if you
are treating a client for hypertension, you might not be able to definitively
know that your sessions are helping unless the client's blood pressure is
regularly checked by his physician. The same is true for many medical
conditions diagnostic tests need to be performed to know if your sessions are
benefitting the client. Since hypnotists cannot perform diagnostic tests, it is
necessary that you are kept "in the loop" and made aware of the tests
results.
By consistently insisting on signed, medical referrals when performing
medical hypnotism, you safeguard the health of the client. Certainly, that is
the most important reason for obtaining a medical referral. Beyond that, by
working in conjunction with the medical community, you automatically work
to improve the medical community's perception of hypnotists. You are also
likely to receive a lot of medical referrals when you consistently demonstrate
your professionalism.
To further demonstrate your professionalism, it is advised that you
consistently send follow-up notes to any referring physician. The follow-up
note should include details of the type of hypnotherapy you facilitated, how
the client responded to hypnosis, any other details that the physician needs
to be aware of, and any future plans you have for additional sessions with
the client. The follow-up note also provides you the opportunity to thank
the physician for his cooperation and to let the physician know that you are
open to receive referrals.

44. MEDICAL HYPNOSIS: DR DAN ZELLING

In 1958 hypnosis was recognized by the American Medical Association
as a legitimate, safe approach to medical and psychological problems. Today
more people recognize that the mind and body interact. Mind and body are
integrated parts of a whole being; a change in one part affects the other.
Hypnosis is a normal state of consciousness. Hypnosis can be defined as
concentrated and directed daydreaming. A person in hypnosis does not lose
control. Whereas the word sleep is sometimes used to describe the trance
state, the patient is far from being asleep. A person in hypnosis is aware of
his surroundings in a detached sort of way and is more receptive to
acceptable suggestions.
There are many misconceptions about hypnosis. Hypnosis is a natural
state that we have all experienced. An example of this is whenever it is really
important for you to get up at an unusual time and you wake up ten
minutes before the alarm goes off you are responding to a post-hypnotic
suggestion. A mother who sleeps through a thunderstorm but awakens when
her sick child moans, again, responds to a post-hypnotic suggestion. Actually,
all hypnosis is self-hypnosis. Anyone who wants to be hypnotized can be
hypnotized. A hypnotized person will not accept any idea or suggestion that
is against his/her religion, upbringing, morality, or against 'his grain." The
patient achieves his/her own hypnotic state. The medical hypnotherapist is
the guide.
Hypnoanalysis: Hypnoanalysis is a search of the subconscious mind
through the use of hypnosis. This helps to identify the origin of the problem
and redirect the emotional energy that sustains the problem toward a
solution. Hypnosis opens the door to the subconscious; analysis helps you to
understand the root cause of the problem. Hence the term, hypnoanalysis.
Patients are treated individually with hypnoanalysis for concerns such as
migraine or tension headache, anxiety, depression, pain modification,
impotence, anorgasmia, low self-esteem, irrational fears, dependency, stress,
and compulsive behavior. All treatment is strictly confidential. Not everyone
who comes to the Ohio Institute of Medical Hypnosis requires hypnoanalysis.
Hypnotherapy is used for self-improvement, visualization and mental
imagery for sports, memory training, and business success. Hypnotherapy
and visualization air also used as adjunctive therapy for cancer patients.
Touching Every Facet of Our Lives: As we learn more about the power
of the subconscious mind, we can see just how hypnoanalysis can improve the
quality of our lives both physically and emotionally. Some of the areas that
can be successfully treated by Medical
Hypnosis and subconscious analysis include:
* Anxiety, Depression, Low Self-esteem
* Smoking Cessation
* Migraine and Tension Headaches,
* Phobias, such as fear of flying, agoraphobia
* Fear of public speaking
* Stress Management
* Eating Disorders
* Sleep Disorders
* Pain Modification
* Alcoholism and Drug Abuse
* Impotence and Anorgasmia
* Visualization and Mental Imagery
Initial Consultation: What can you expect when you begin therapy at
The Ohio Institute of Medical Hypnosis? The consultation is the first step. Dr.
Zelling will take a complete and confidential medical, psychological, family,
social, and personal history. These individual factors are vital to treatment
success. Therefore, a careful evaluation is extended to each patient. The initial
consultation allows you and the doctor to get acquainted, establish rapport,
and provide necessary information to treat your specific problem Dr. Zelling
will discuss with you whether your problem can be treated with medical
hypnosis and, if so, estimate how many sessions of hypnotherapy will be
required to help you resolve your problem.
What Happens In Therapy? At the Ohio Institute of Medical Hypnosis,
Inc., you can be assured that you will be guided by professional, reputable,
dedicated people who will pot you at ease, offering personal care every step
of the way.
You remain aware and in control during all hypnotic sessions. The
doctor guides you into a state of deep relaxation and helps you, where
needed, to find the root cause of your problem by means of a specifically
designed word association exercise, dream analysis and age regressions. As a
result, you and the doctor have greater access to the subconscious attitudes
and feelings that shape behavior.
Once the underlying reason of the problem has been defined, gentle
suggestions are used, helping you to untie the subconscious knot and free you
to live a healthier, more productive life. The old negative thought patterns
are replaced using positive suggestions, which, in turn, can lead to a well,
emotionally balanced, mature individual.
The 5 "R"s of Hypnoanalytic Treatment:
* Relaxation: By learning to relax and letting go, you can concentrate your
mind better and become receptive to new and helpful suggestions.
* Realization: By realizing that some of your difficulties stem from negative
thinking and feeling, you can learn to restructure those negative attitudes
and create a more positive outlook and frame of mind.
* Repetition: In order to implant positive suggestions in the soil of your
subconscious mind, repetition is necessary. The more you repeat something,
the more it becomes permanently implanted in your mind.
* Rehabilitation: You are able to use new information, new suggestions, and
have time to rehabilitate your own thinking and incorporate it in your daily
life.
* Reinforcement: Through hypnosis and mental concentration, you apply the
positive suggestions you receive. All patients are taught self-hypnosis to
further enhance their self-control.

45. MEDICAL HYPNOTHERAPY: LEIGH PERRY

For a number of years, I was vice president of human resources for a
large, national medical company. During that time, I had the opportunity to
counsel and coach hundreds of employees – focusing on how they could
achieve their goals, both personal and professional. I also had my own
consulting business and worked, again, with a variety of clients to help them
solve their problems. These experiences have helped me to be an active
listener, a successful coach, and, now, an empathic facilitator of healing.
I work intuitively, with compassion and integrity, to help people
experience the truth of who they are. Since the environment I create is very
nurturing and non-threatening, clients feel safe while they are doing deep
trance work to go to places in their psyches where they are stuck, wounded,
or where secrets are kept that are blocking them from being all that they
can be. By receiving Healing Touch/Reiki (when appropriate) and
hypnotherapy together, my clients experience increased well-being and gain
relief from anxiety as well as physical pain. My work in no way takes the
place of medical intervention or psychotherapy, but is a complement to these
modalities, offering another and unique approach to healing.
I have a B.A. degree in psychology from Boston University. I am
certified as a medical hypnotherapist by the International Medical and Dental
Hypnotherapy Association and the Association of Hypnosis Examiners. I am a
member of both of those organizations as well as the National League of
Medical Hypnotherapists and the Colorado Association of Psychotherapists. In
addition, I received training in Healing Touch from the Colorado Center for
Healing Touch, Inc. I have also completed a professional training course in
Past Life Regression Therapy from the Weiss Institute taught by Brian Weiss,
M.D. Finally, I have completed a training program (which meets the criteria
for continuing education credits for psychologists, nurses and social workers)
sponsored by the National Institute for the Clinical Application of Behavioral
Medicine. The focus of this program was on enhancing the powers of the
healer's intuition. This was an intense, three-part program taught by
Christine Page, M.D. and included six months of one-on-one mentoring with
her.
Medical hypnotherapy is a complementary treatment to traditional
medicine. It has the capacity to support a wide range of physical, emotional,
and psychological concerns. Hypnosis can help reduce or eliminate pain,
stress, and inflammation, alleviate fear around medical procedures, generally
improve health, and increase the speed of healing. When traditional medical
interventions are not effective, I work with you in conjunction with your
physicians to help alleviate chronic pain and symptoms of disease. When
appropriate, you and I may also work to identify your unconscious resistance
to healing and remove blocks that stand in the way of your ability to create
the life you want. Integration of hypnotherapy, coaching techniques, Reiki,
and Healing Touch (when appropriate) encourages you to be an active, rather
than passive, participant in your own healing and growth.
More and more, hypnotherapy is perceived as a complementary
treatment to traditional medicine with the capacity to support a wide range
of physical, emotional, and psychological concerns by teaching techniques that
a client can use throughout the rest of his life. Hypnosis can help reduce or
eliminate pain, stress, and inflammation, alleviate fear around a medical
procedure, generally improve health and, increase the speed of healing. In
medical hypnotherapy, hypnotic suggestions are specific to the health concern
of the individual such as decreasing blood pressure, minimizing pain,
managing symptoms with less medication, or reducing
anxiety prior to a procedure.
Even though we often disregard our health, our bodies routinely
fight off illness. We heal and repair in spite of ourselves. With hypnotherapy,
we are able to enhance our natural ability to return to improved health. We
can manage symptoms with less medication; control our comfort and
relaxation and use creative imagery to look forward in time, envisioning
positive resolution. What our mind perceives our body achieves.
For success in hypnotherapy, the client must be willing to accept
suggestions, must believe that they will be effective and, must want them to
work. Some Applications of Hypnotherapy In a Medical Setting Clients in a
hospital setting can benefit with deeper more quality rest, speeding up their
recovery process. Cardiac clients are better able to balance their blood
pressure, regulate their breathing and heart rate. Secretions, bleeding and
tolerating procedures can be managed more effectively with hypnotherapy.
It helps oncology clients to reduce stress and anxiety, altering
sensory perception to minimize pain, relieve nausea, vomiting, respiratory
distress, and even prevent hair loss. In addition, it can offer increased
confidence and self-image and the ability to more easily accept the
restrictions of a chronic condition, or to even help manage end-of-life
transition.
Pre-surgical clients are able to reduce anxiety and stress.
Hypnotherapy can reduce bleeding, promote rapid healing with an improved
immune response, and help manage post-op pain and nausea requiring less
medication and the side effects that go with it. It can give the surgical client
control during a time of vulnerability.
Hypnotherapy helps internal medicine clients by improving
immune response, diminishing inflammation, relieving tension and migraine
headaches. It is also helpful for weight loss, arthritis, Fibromyalgia,
gastrointestinal disorders such as Irritable Bowel Syndrome, as well as stress
related issues. Hypnotherapy helps dentistry clients alleviate pain, fear and
tension around a dental procedure. Relaxation is the goal of hypnodontics.
With relaxation comes a feeling of self-confidence, self-control, security and,
well being.
Today, 50% of our population spends money on alternative or
complementary medical treatments. By pursuing health from the inside out,
science and nature are blended with dramatically increase
positive results.
Hypnosis is NOT a “new age” phenomenon but has been used for
centuries. Primitive peoples in Africa and Australia used chanting, drums,
and the fixation of their eyes to achieve the state we now know as hypnosis.
They were able to effortlessly perform amazing physical feats and easily
endure situations that would ordinarily cause excruciating physical pain.
The word hypnosis is from the Greek word for sleep. People who
are hypnotized, however, are not asleep. In fact, they are in a very alert but
relaxed state (much like a meditative state). Many people are familiar with
stage hypnosis where people are “hypnotized” to do things that make an
audience laugh. These subjects are already pre-disposed to do what they are
told to do since they have volunteered to be a part of the act. If, however,
they were told to do something that they didn’t want to or was against their
belief system, they would immediately come out of their hypnotic trance.
Hypnosis is not sleep, but a natural, normal, relaxed, and focused state of
attention characterized by:
* Feelings of well-being
* Increased muscle relaxation
* Increased pain threshold
* Predominating alpha brain waves
* Diminished ability to vocalize
* Flashback access of stressful memories
* Literal, childlike understanding of ideas
* Ability to accept new ideas if they are emotionalized and not in conflict
with values.
Hypnosis is interactive, guided imagery or applied meditation toward a
specific goal while in various levels of a trance state. In a hypnotherapy
session, used for transformational and therapeutic purposes, the client is in
control and cannot be made to do or say anything that he would not
normally. He is conscious, can hear and speak and can even open his eyes
without coming out of trance. The state of hypnosis is a very relaxing state
much like the last few moments before falling asleep at night. Some people
compare it to being in a meditative state. Meditation, however, is the
opening of the subconscious mind in a passive way. Hypnosis is an active
process focusing on specific goals. Most of us are in a hypnotic state a number
of times a day. At night, in the morning just before becoming fully awake,
and during the day while concentrating on something. Have you ever noticed
that you were driving and didn’t remember how you got to where you were
going? That state is a hypnotic state. While you were in “trance,” the
subconscious took over and got you to your destination. TV is also a powerful
trance inducer and advertisers know it. Have you ever been watching a show,
seen an ad for food and gone to the kitchen to get something to eat?
If so, you were in a trance. “Zoning out" and daydreaming are also
examples of being in a trance state. The mental attitude you hold when you
hear a suggestion determines whether it goes into your subconscious in order
for change to begin, or whether it’s rejected for no change.
* Positive mental attitude. If you really want change to happen, believe that
it will and like the suggestions you hear, your subconscious mind will allow
the suggestion through and change will happen.
* Negative mental attitude. If you do not like the suggestion made to you,
you will reject it and there will be no change.
* Neutral mental attitude. If you are willing to “try” something new but
don’t really care whether or not you do it, you have a neutral attitude. You
cannot “try” – you can only do something or not. If you hope something
happens, you also have a neutral attitude since hoping means that you believe
that there is a chance that it will not work. Your mind will reject the
suggestion.

46. CALL THE MEDICAL HYPNOTIST: APPLIED BEHAVIORAL HEALTH

CARE
Pain. We all suffer it at one time or another. Migraine headaches. Back
pain. Chronic pain from illness or injury. Birthing pains. Pain from surgery or
other medical procedures. Whenever we're in pain we want relief - fast. So
we call the doctor and he prescribes medication. We take it and most of the
time it helps. But other times it doesn't help... enough... or for long enough.
And sometimes we just don't want to take medication. Is there an
alternative? Is there a safe way to get pain relief without medication? Today
more and more people are asking this question. A two hundred year old
technique - hypnosis - is gaining in strength as a modality of choice for pain
relief in treatment of a variety of medical conditions from migraine
headaches to chronic back pain to cancer symptoms.
Hypnotherapy Soothes Recurrent Indigestion: Hypnosis appears to
calm a stomach plagued by a widespread digestive disorder better than an
equivalent amount of supportive therapy or drug treatment, as reported By
Alison McCook in (Reuters Health). Dr. Peter James Whorwell of
Wythenshawe Hospital in Manchester, UK, and his colleagues tested the
usefulness of 16 weeks of hypnotherapy in patients with functional dyspepsia
(FD), a form of chronic indigestion that affects up to 25% of the population.
Patients' symptoms include bloating, nausea, vomiting and feelings of fullness.
Compared to patients given a stomach acid-suppressor or a placebo
plus supportive therapy--during which patients spoke to and were counseled
by a clinician--those who received hypnotherapy experienced a superior
development in their symptoms and quality of life more than a year
afterward. Hypnotherapy patients, on average, scheduled fewer doctors' visits
throughout the 40 weeks following treatment than those given other
treatments.
In addition, Whorwell and his group report that not any of the
patients given hypnotherapy required medications throughout the follow-up
phase following treatment. In contrast, the majority of those who received
supportive therapy or medication for the duration of the study took a
mixture of drugs, together with antacids and antidepressants. These results
imply that hypnotherapy can be an efficient and inexpensive way to calm
indigestion in people with FD. "Hypnotherapy is highly effective in the
long-term management of FD," Whorwell and his team write. "Furthermore,
the dramatic reduction in medication use and consultation rate provide
major economic advantages."
This is not the first study to reveal the benefits of hypnotherapy for an
assortment of conditions, as well as those that involve digestion. For example,
the authors recently showed that hypnotherapy can ease symptoms of a
common intestinal disorder known as irritable bowel syndrome.
Other researchers reported that the method can benefit people with
asthma and mothers in labor. During the present study, reported in the
December issue of Gastroenterology, Whorwell and his group asked a
collection of 126 patients with FD to experience hypnotherapy, supportive
therapy or drug treatment for 16 weeks, then followed them for an extra
40 weeks recording their evolution. Patients who received hypnotherapy and
supportive therapy spent the same amount of time with health
professionals--twelve 30-minute visits--while those given the
acid-suppressor ranitidine (Zantac) attended only four visits.
Whorwell and colleagues found that, while receiving the diverse
treatments, hypnotherapy patients reported added improvements in
symptoms than did those given drugs or supportive therapy. 73% of
hypnotherapy patients said their symptoms had improved, relative to 34% of
those given supportive therapy and 43% of those given drugs. Nine out of 10
patients given medication required other drugs during the follow-up, as did
82% who received supportive therapy. No patient given hypnotherapy
required added medication during the 40 weeks following treatment.
Dr. William E. Whitehead of the University of North Carolina in Chapel
Hill, wrote an accompanying editorial, said he believed the present findings
are "fairly dramatic," and recommended that "it would benefit physicians to
incorporate hypnosis much more frequently than it is now." However, he
noted that major obstacles must be conquered before FD patients and others
have effortless access to hypnotherapy. Few patients are at this time offered
hypnosis for their pain, Whitehead said, many get no reimbursement for the
service from their insurers. Furthermore, relatively few health professionals
are trained to administer hypnotherapy, he and his colleague, Dr. Olafur S.
Palsson write. Nevertheless Whitehead noted that he believed patients with
other types of gastrointestinal problems might benefit from
hypnotherapy,--such as people suffering from rectal pain, milder forms of
indigestion, and nausea or vomiting. "We think it can help people with milder
forms of functional dyspepsia," he said.
SOURCE: Gastroenterology 2002;123:1778-1785, 2132-2147.
Hypnosis in addition to regular medical treatment has several advantages in
pain management. First, it requires no drugs. In fact, studies show that
patients with chronic diseases who practice hypnosis (as taught by a
hypnotherapist trained in pain management) required fewer analgesics to
maintain pain relief. They also suffered less anxiety about their pain and
greater comfort during medical procedures. In a study at Case Western
Reserve University hypnotherapy was found useful as a pain management
tool following such surgical procedures as hysterectomy, coronary by-pass,
hemorrhoid surgery and abdominal surgery.
The test patients also had shorter hospital stays less nausea and more
rapid healing. Twelve studies have proven hypnotherapy to be the preferred
treatment for reducing migraine headache attacks. With such impressive
results, why do we reach for the aspirin bottle instead of the natural,
relaxing, healing capacities within our own minds? The answer is obvious.
Most of us don't know how to practice self-hypnosis. Many of us are not
aware of its proven successfulness.
Still others of us hold outdated, fearful notions that hypnosis involves
"mind control" or loss of our own conscious will to another person. That's
unfortunate because hypnosis - or hypnotherapy as it is often termed today
to indicate the growing acceptance of its therapeutic value - is a resource
that should be explored by all who suffer pain. It provides an ongoing method
of pain management that, once established, can be monitored and adjusted
by the patient him or herself. It returns asense of control back to the patient
and it has no side effects - except an overall increased relaxation.
 Managing Pain: Most hypnotherapists work with pain problem
primarily in conjunction with appropriate healing arts professionals. This is
because pain often is a symptom of a problem rather than the problem itself.
A headache might be migraine; it also might be a brain tumor. A medical
diagnosis is important. However, properly used hypnosis can reduce pain,
alleviate anxiety, remove fears of dentistry or surgery, eliminate or reduce
the need for injections or other applications of chemical anesthesia, promote
comfort and healing and expedite recovery. It is becoming more common in
dentistry, obstetrics, burn treatment and emergency room trauma. In
accomplishing the above it is evident that hypnotherapy can prove
dramatically effective in dealing with medically-related stress situations.
Hypnosis can be helpful for many dental and health issues.

47. HIGHMARK BLUE CROSS BLUE SHIELD SUPPORTING “WHOLE

PERSON” CANCER CARE
PITTSBURGH, Pa, (September 23, 1998) -- Highmark Blue Cross
Blue Shield today announced that it is supporting a pilot program based on
the integration of "whole person" cancer care through the world-renowned
Simonton Cancer Program. Originally documented in " Getting Well Again ,"
a best-selling book co-authored by Dr. O. Carl Simonton , the program
focuses on the integration of effective coping skills, stress reduction techniques
and motivation to take an active role in a person's healing process as effective
supportive strategies to traditional cancer care. It is based on Dr. Simonton's
pioneering research in the late 1970's, which reported a doubling of survival
time for program participants. Refined over the years as week-long retreats
conducted in the United States, Europe and Japan, it is being offered for the
first time as a month-long course in the conventional medical setting at the
Mind-Body Wellness Center in Meadville, Pa.
Highmark Blue Cross Blue Shield has agreed to underwrite the costs for
pilot program participants who are insured through one of Highmark's
traditional or managed care health plans. The insurer's decision was based on
an extensive survey of the medical literature, supportive findings and
outcome-based research at Stanford University School of Medicine and UCLA
School of Medicine.
Highmark also considered recent research published in the "Journal of
the National Cancer Institute" demonstrating that stress impairs the body's
ability to produce Natural Killer Cells (specialized white blood cells that seek
out and destroy cancer cells). These findings have been supported by research
from Italy that presented an animal model in which stress was shown to
reverse the effects of chemotherapy. "The war against cancer must be fought
on many levels," said Dr. Kenneth R. Melani, executive vice president, Health
Services, Highmark Blue Cross Blue Shield. "As one of the country's leading
health insurers, we are convinced it is our role to work with cutting edge
health care providers to observe and validate approaches that have the
potential to make a difference - not only in survival, but in quality of life for
those who are living with cancer. Our pilot program also will explore the cost
effectiveness of this form of comprehensive cancer care for our members."The
Simonton Cancer Program consists of 12, two-hour group sessions and three
one-hour private sessions for each participant. Topics include developing
positive belief systems and creating meaningful support networks. What's
more, relaxation techniques such as guided imagery, meditation and humor
are offered to participants. "The program is not a substitute for standard
medical care", Dr. Simonton said. "It is offered to help individuals develop
positive perspectives for living life to its fullest, while maximizing their healing
potential. By focusing on discovering our strengths rather than our
weaknesses, our program explores a series of possibilities that enable
individuals to choose what they personally need to continue their healing
journey."
 Dr. Barry Bittman , director of Meadville Medical Center's Mind-Body
Wellness Center and co-developer of the Simonton model in the conventional
medical setting, is taking the program to the community level by offering it
at the center. "The management at Highmark Blue Cross Blue Shield
recognized that patients facing the diagnosis of cancer should have the
opportunity of learning to appropriately face and better deal with what may
very well be the greatest challenge of their lives," Dr. Bittman said. "It's clear
that the science of mind-body medicine justifies this program as the fourth
bona fide approach in our armamentarium against cancer, along with
surgery, chemotherapy and radiation therapy. This pilot program is intended
to set a new standard for comprehensive cancer care throughout our
country."
Highmark Blue Cross Blue Shield's Dr. Melani said, "Our role as an
insurer is to place the well-being of our members first by identifying and
offering programs that show considerable promise for advancing medical
science and health treatments. While there is substantial focus on many
high-tech cancer therapies, we must not forget the personal needs and
feelings of those we serve." With $7.4 billion in revenues and nearly 18
million customers nationwide, Highmark Inc. ranks among the country's top
health insurers. Highmark was created in 1996 through the consolidation of
Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield. Highmark's
product portfolio includes traditional health insurance coverage, managed
care health plans, life insurance, and dental and vision programs. In Western
Pennsylvania, the company does business as Highmark Blue Cross Blue Shield.

48. COST ANALYSIS OF ADJUNCT HYPNOSIS WITH SEDATION DURING

OUTPATIENT INTERVENTIONAL RADIOLOGIC PROCEDURES: LANG &
ROSEN: DEC 2001
Procedures1: [Elvira V. Lang, MD and Max P. Rosen, MD, MPH]
1 From the Department of Radiology, Beth Israel Deaconess Medical Center,
Harvard Medical School, 330 Brookline Ave, West Campus 308 CC, Boston,
MA 02215. From the 1999 RSNA scientific assembly. Received February
28, 2001; revision requested April 13; revision received June 25; accepted
August 15. E.V.L. supported by grant RO1 AT00002-04 from the National
Center for Complementary and Alternative Medicine.
PURPOSE: To compare the cost of standard intravenous conscious sedation
with that of sedation with adjunct self-hypnotic relaxation during
outpatient interventional radiologic procedures.
MATERIALS AND METHODS: Data were reviewed from a prospective
randomized study in which patients undergoing vascular and renal
interventional procedures underwent either standard sedation (n = 79) or
sedation with adjunct hypnosis (n = 82). These data were used to construct
a decision analysis model to compare the cost of standard sedation with the
cost of sedation with adjunct hypnosis. Multiple sensitivity analyses were
performed to assess the applicability of these results to other institutions
with different cost structures with respect to the following variables: cost of
the hypnosis provider, cost of room time for interventional radiologic
procedure, hours of observation after the procedure, and frequency and cost
of complications associated with over- or undersedation.
RESULTS: According to data from this experience, the cost associated with
standard sedation during a procedure was $638, compared with $300 for
sedation with adjunct hypnosis, which resulted in a savings of $338 per case
with hypnosis. Although hypnosis was known to reduce room time, hypnosis
remained more cost-effective even if it added an additional 58.2 minutes to
the room time.
CONCLUSION: Use of adjunct hypnosis with sedation reduces cost during
interventional radiologic procedures. Index terms: Anesthesia ·
Cost-effectiveness · Hypnosis · Interventional procedures
INTRODUCTION: Hypnotic and behavioral interventions have been shown to
be effective in reducing pain and anxiety associated with invasive medical
procedures (1–8). Although authors of several reports (5,9,10) allude to the
cost-effectiveness of these interventions, it is difficult to find supportive
numeric data that would favor generalized introduction into clinical practice.
Results of a recent prospective randomized study (6) showed that adjunct
self-hypnotic relaxation provided to patients during interventional radiologic
procedures was associated with greater patient comfort, fewer adverse side
effects, and shorter room times than when patients underwent only
intravenous conscious sedation. The purpose of our study was to compare the
cost of standard intravenous conscious sedation with that of sedation with
adjunct self-hypnotic relaxation during outpatient interventional radiologic
procedures.
MATERIALS AND METHODS:
Patients: Input data originated from a prospective randomized study (6) in
which the authors assessed the effect of adjunct self-hypnotic relaxation on
patient comfort during percutaneous vascular and renal procedures. The
patient pool included consecutive consenting patients referred to the Section
of Vascular and Interventional Radiology at the University of Iowa Hospital
and Clinics, Iowa City, in 1997 and 1998. The study was approved by the
investigational review board for human use and the hospital’s nursing
committee, and all patients signed an informed consent form prior to
enrollment.
Patients were enrolled in the study if they had been referred for any of
the following interventional radiologic procedures: diagnostic arteriography,
diagnostic venography, thrombolysis, angioplasty, vascular stent placement,
placement of vena cava filters, transjugular hepatic biopsy, nephrostomy or
nephroureterostomy. Exclusion criteria were severe chronic obstructive
pulmonary disease, psychosis, intolerance of midazolam or fentanyl,
pregnancy, or inability to hear or understand English. Patients underwent
screening with the Mini-Mental State Examination (11). If they passed with
a score of at least 24 of a maximum of 30 points, they were randomly
assigned to one of three groups. Levels of anxiety or hypnotizability were
neither inclusion nor exclusion criteria.
Seventy-nine patients (36 men, 43 women; age range, 18–92 years;
median age, 57 years) were randomly assigned to a group undergoing
standard intravenous conscious sedation; 82 patients (38 men, 44 women;
age range, 19–82 years; median age, 54 years) were randomly assigned to
a hypnosis group having additional self-hypnotic relaxation. The physical
status classification, according to the American Society of Anesthesiologists,
of the patients ranged from 1 to 4, with a mean of 2.23, defined as
follows: 1, healthy patient; 2, mild systemic disease; 3, severe systemic
disease; 4, acute life-threatening condition. There were no significant
differences in group composition with regard to age, weight, sex, disease
category, type and complexity of procedure, number of prior procedures,
and baseline pain and anxiety levels. Standard Intravenous Conscious
Sedation
All patients were attended by a special procedures nurse and had
access to patient-controlled anesthesia with delivery of 0.5 mg of
midazolam and 25 μg of fentanyl per request for as many as four requests,
with lockout times (when the patient could not access medication) of 5
minutes, followed by a lockout time of 15 minutes. Patients indicated the
desire for medication with activation of a bell that signaled the attending
nurse to deliver the drugs. Medication was withheld when the systolic
pressure was less than 89 mm Hg, oxygen saturation was less than 89%, or
patients developed slurred speech or became difficult to arouse.
The patient-controlled analgesia model was chosen to reduce the
possibility of unblinded experimenter bias toward using more drugs in
control patients and to ensure that all patients had the same access to
drugs. Patient-controlled anesthesia is well suited for acute pain
management during and after medical procedures and is thought to
enhance comfort while providing patients with a means of control (12,13).
In a pilot trial (Lang EV, unpublished observation, 1995) prior to this study,
use of a patient-controlled anesthesia pump was tested but was found to be
potentially hazardous. Since drug-induced cardiorespiratory emergencies are
treated differently from those induced by other causes, rapid knowledge of
the drug history becomes important, and entering the recording mechanism
of a patient-controlled anesthesia pump could cause undue delay. Therefore,
patients were given a reusable attention bell (cost, $3.50 at office supply
stores) that signaled the attending nurse, rather than a machine, to deliver
drugs through an indwelling intravenous access route.
To ensure that patients who would hesitate to use the bell would not
undergo undue distress, rules for overriding patient-determined analgesia
were defined and agreed on by the study and procedure personnel prior to
the study. Overriding criteria included de novo increase in systolic blood
pressure beyond 180 mm Hg, spontaneous complaints, verbal request for
drugs, or significant perceived distress. In addition, all patients received 1%
lidocaine for local anesthesia for all access sites—typically 10 mL for vascular
access and 30–40 mL for percutaneous renal access.
Self-hypnotic Relaxation: The self-hypnotic relaxation intervention was
structured in the procedure room by one of four providers (one nurse, one
psychology graduate student, two medical students) and has been described
in detail previously (14). It included the following standardized behaviors:
matching the patient’s verbal and nonverbal communication pattern (ie,
preference for modes of expression, sitting next to rather than towering
over a supine patient); attentive listening; provision of control; swift
response to patient requests; encouragement; use of emotionally neutral
descriptors ("What are you experiencing?"); avoidance of negative descriptors
("How bad is your pain?"); and reading of a hypnotic induction script, with a
provision for management of anxiety and pain, if needed. In summary,
patients were instructed to roll their eyes upward, close their eyes, breathe
deeply, concentrate on a sensation of floating, and immerse themselves in a
safe and comfortable place (for full text, see reference 14). The completion
time of the hypnotic induction script was 5–10 minutes, and hypnosis was
performed while the patient was prepared for the procedure. Since all
hypnotic inductions were performed in the procedure suite, the time involved
was included in the overall procedure time and, thus, in the cost analysis. All
patient-provider interactions were videotaped, and 60 (25%) of 240 were
randomly selected to check for adherence to the protocol. Fidelity of
treatment administration was invariably high among the providers, and
thus not significantly different.
Analysis of variance showed that there was no difference among
providers with respect to room time; analysis was performed by using the
logarithmic transformation of the procedure times because of skewness of
distribution of the raw time data. To assess for theoretic differences among
future providers, the reader can refer to two sensitivity analyses (described
later) that would reflect the skill of the provider structuring the hypnosis: a
sensitivity analysis performed for the effect of room time with hypnosis and
another sensitivity analysis for the effect of undersedation with hypnosis.
Decision Analysis Model: The cost of the hypnosis treatment, compared with
that of standard treatment, was assessed with a decision analysis model by
using commercial software (DATA; TreeAge, Williamstown, Mass). For both
treatments, with the decision analysis model the following possible outcomes
were used for outpatient interventional radiologic procedures: (a)
uncomplicated sedation, (b) oversedation, or (c) undersedation.
Uncomplicated sedation was assumed to be associated with no
additional cost. Oversedation or undersedation could result in (a) no
additional cost, (b) cost associated with additional intense observation, (c)
cost associated with sustained observation, or (d) cost associated with
hospital admission. Probabilities of occurrence and associated cost for each of
these scenarios were derived from our prior experience with the 161
patients. Costs of materials administered during treatment of oversedation
or undersedation were omitted because of their negligible contribution—for
example, costs for oxygen tubing, emesis basins, and drugs such as nifedipine
or atropine were all less than $1. The analysis was conducted from the
perspective of the hospital. Basic Decision Tree
Since the goal of this study was to provide a generalizable cost assessment for
outpatient interventional radiologic procedures, input data for cost were
derived from year 2000 costs at Beth Israel Deaconess Medical Center,
Boston, Mass, and are listed in Table 1; sensitivity analyses were included to
allow for extrapolation to cost structures at other institutions. For the basic
decision analysis tree, the assumption was made that all patients would
leave the hospital after a 4-hour recovery period unless extended
observation or admission were required.
Room time encompassed the period from the patients’ entry into the
procedure suite until their transfer to the recovery unit. Average procedure
time was 78 minutes in the standard group and 61 minutes in the hypnosis
group. Costs for room time included equipment amortization and personnel
cost based on local salaries and fringe benefits for one physician, one nurse,
one technologist, and one optional additional provider structuring the
hypnotic intervention (Table 1).
The basic decision tree assumptions were that the nurse already
present structured the hypnosis intervention and, thus, the cost for an
optional additional hypnosis provider would be $0. To allow for the
possibility of an additional hypnosis provider in a subsequent sensitivity
analysis (Materials and Methods, last section), the cost of one additional
health care provider, a psychologist, was included in the room time. In
either event, the cost of nursing time was included for the duration of the
entire procedure. Recovery cost included four possible components: (a)
immediate postprocedure time (eg, sheath removal, groin compression); (b)
basic recovery time (eg, monitoring vital signs); (c) additional intense
recovery time, when required; and (d) sustained observation time, when
required. We assumed that one physician and one nurse were required for
the immediate postprocedure care and that one nurse was able to monitor
up to four patients during the basic recovery time. All patients required
immediate postprocedure time and basic recovery time.
If over- or undersedation occurred, we assumed that patients would
require additional intense recovery time and that this would have to be
monitored by a nurse and physician. The following times were assumed for
additional intense recovery time for complications of sedation with hypnosis:
oversedation leading to sustained observation or admission, 15 or 30
minutes, respectively; undersedation leading to sustained observation or
admission, 30 or 60 minutes, respectively. The following times were
assumed for additional intense recovery time for complications of sedation
with standard care: oversedation leading to sustained observation or
admission, 30 or 60 minutes, respectively; undersedation leading to
sustained observation or admission, 45 or 60 minutes, respectively.
If after the intense recovery time the patients still exhibited the effects
of over- or undersedation, we allowed for an additional 30–60 minutes of
sustained observation time monitored by a nurse. After the time in the
interventional radiologic recovery area, all patients either were sent to the
day care unit for an additional 4 hours of "outpatient" observation or, if
complications necessitated, were admitted to the hospital.
To calculate admission cost for undersedation, we used the average cost
weights of diagnosis-related group (DRG) 130, peripheral vascular disorders
with complications (cost weight, 0.9427) and DRG 131, peripheral vascular
disorders without complications (cost weight, 0.6067). The average cost
weight for undersedation was 0.7747. To calculate admission cost caused by
oversedation, we used the average cost weight of DRG 99, respiratory signs
and symptoms with complications (cost weight, 0.6738) and DRG 100,
respiratory signs and symptoms without complications (cost weight,
0.5150). The average cost weight for oversedation was 0.5944. In both
instances, the Medicare blended rate paid to Beth Israel Deaconess Medical
Center, Boston, in 1999 ($4,273) was assumed. The blended rate included
technical but not professional fees. The cost weight is the severity factor
assigned to each DRG by the Health Care Financing Administration, or
HCFA. It is multiplied by the blended rate—the standardized rate that each
hospital is paid— to calculate the exact reimbursement for a specific DRG.
For example, if a DRG has a cost weight of 2 and a blended rate of $5,000,
the hospital would be paid $10,000 for that DRG. An average of two cost
weights was used in the basic decision tree to account for institutional
variations in DRG coding. Subsequently (Materials and Methods, last section),
sensitivity analyses were performed to assess the effect that specific DRG
coding of complications may have on our conclusions. The two cost weights
for each complication defined the range of the sensitivity analyses.
Oversedation
Oversedation included all events associated with depression of
cardiorespiratory or mental status. Oxygen desaturation was included only
when a decrease to less than 89% persisted longer than 2 minutes and
required placement of a nasal oxygen cannula.
Standard group.—Sixteen (20%) of 79 patients showed signs of oversedation.
Six patients with oxygen desaturation incurred no additional cost, except for
the nasal oxygen cannula, which was considered a no-cost item. Six patients
required intense observation because of prolonged hypoxemia with or
without associated cardiovascular depression (n = 5) and slow resolution of
slurred speech (n = 1). Four patients qualified for admission—three because
of drowsiness and/or unresponsiveness and one because of continued
bradycardia, hypotension, and recurrent bleeding from the puncture site.
Hypnosis group.—Oversedation affected nine (11%) of 82 patients and
required no treatment in five patients, except for a nasal cannula. Four
patients needed intense observation—one for prolonged hypoxemia with
distracting behavior during the procedure, one for transient hypoxemia in
recovery, one for being poorly arousable in recovery, and one for
bradycardia.
Undersedation: Undersedation included all events associated with incidents
requiring staff attention, such as discomfort in recovery, persistent new
hypertension, and distracting, attention-seeking patient behavior.
Standard group.—Undersedation was observed in 24 (30%) of 79 patients.
One patient did not need further treatment for transient tachycardia.
Twenty-one patients required intense observation for distracting behavior (n
= 10), discomfort (n = 6), hypertension (n = 3), or recurrent bleeding from
the puncture site (n = 2). Two patients qualified for admission because of
recurrent bleeding.
Hypnosis group.—Undersedation was encountered in eight (10%) of 82
patients because of discomfort (n = 4), hypertension (n = 1), and distracting
behavior (n = 3). All incidents required intense observation.
Sensitivity Analyses: Sensitivity analyses were performed to address how
changes in individual input parameters would affect overall outcome and to
extrapolate the applicability of these results to those of other institutions
with different cost structures. Outcome was considered not sensitive to a
parameter if change in the value of this parameter over a given range did
not affect overall cost superiority of a treatment (ie, standard or hypnosis
treatment). If outcome was sensitive to a parameter, a threshold analysis
was performed to determine at what value one strategy became preferable
to the other.
Sensitivity analyses were performed for the following parameters
(Table 2): (a) cost of an additional hypnosis provider of $0–$10/min; (b)
room time for use of hypnosis of 25–200 minutes; (c) hours of additional
observation after the procedure for complications related to over- or
undersedation of 0–5 hours; (d) probability of oversedation with standard
treatment with P values between .00 and .50; (e) probability of
undersedation with hypnosis treatment with P values between .00 and .50;
(f) cost for admission caused by undersedation of $0–$10,000; (g) cost
weight for admission caused by undersedation of 0.6067–0.9427; (h) cost
for admission due to oversedation of $0–$10,000; (i) cost weight for
admission due to oversedation of 0.5150–0.6738; (j) a blended rate of
$2,500–$10,000; and (k) hourly cost of the procedure room of $2.50–
$10/min.
RESULTS:
Basic Decision Tree: illustrates the decision analysis tree with the associated
probabilities of each outcome (derived from reference 6). Average sedation
cost for standard treatment was $638 and for hypnosis treatment was
$300, which resulted in an average savings of $338 per case with hypnosis.
Sensitivity Analyses: Data used in the sensitivity analyses are presented in
Table 2. The sensitivity analysis allowed us to calculate the effect that
changing one variable would have on the total costs associated with hypnosis
or standard therapy. The lower and upper boundaries correspond to the
lowest and highest values assumed for each variable tested. These boundaries
were chosen to reflect a reasonable range of variation that may be
encountered in different clinical practices. In most cases, the range was
chosen so that the baseline value was near the center of the range.
Effect of an additional hypnosis provider.—When an additional provider is
included to structure the hypnosis treatment, savings realized by using
hypnosis decrease to a threshold of a salary of $5.50/min; when the salary
is greater than this amount, standard treatment is more cost-effective (Fig
3). The threshold of $5.50/min corresponds to $330/h, or $633,600/y
plus 30% fringe benefits. When the basic decision tree is recalculated for a
scenario that includes a staff psychologist at an annual salary of $70,000
plus fringe benefits, the sedation cost with hypnosis is $348. This still leaves
a cost superiority of $290 ($638 minus $348) per case. Graph shows the
effect of adding a health care provider structuring hypnosis during the
procedure. Savings with adjunct hypnosis decrease with increasing
reimbursement, in dollars per minute, to this additional provider up to a
threshold of $5.50/min, or $330/h (dashed line), beyond which it is more
costly to provide adjunct hypnosis. The expected value is the cost in dollars
for standard therapy () versus that for hypnosis ().
Effect of room time and postprocedure observation time.—When
sensitivity analysis was performed with room time of 25–200 minutes
while keeping all other variables constant, a threshold value of 136.2
minutes resulted for adjunct hypnosis (Fig 4). Thus, as long as average room
time with hypnosis does not exceed 136.2 minutes, for a case that would
take 78 minutes with standard conditions, hypnosis remains less costly on
average. Hypnosis was always more cost-effective over a range of
postprocedure observation times of 0–5 hours because of complications of
over- or undersedation.
Graph shows the effect of room time in minutes required for an
interventional radiologic procedure by using hypnosis divided by the expected
value, which is the cost in dollars for standard therapy () versus that for
hypnosis (). The cost of standard therapy is constant at an average procedure
duration of 78 minutes. According to conditions of the basic decision tree, a
procedure with hypnosis lasts, on average, 61 minutes. The threshold value
(dashed line) is the room time at which the cost of hypnosis is equal to the
cost of standard therapy. As long as interventional radiologic procedures
performed with hypnosis require fewer than 136.2 minutes, it is more
cost-effective to perform hypnosis than to perform standard therapy.
Effect of the probability of oversedation during standard treatment.—
Standard treatment was always more expensive than hypnosis treatment
over a range of probability between 0% and 50% of oversedation from
standard therapy. When the probability of oversedation from standard
therapy is 0%, standard therapy costs $189 more than hypnosis. When the
probability of oversedation from standard therapy is 50%, the cost of
standard therapy is $558 more than the cost of hypnosis.
Effect of the probability of undersedation with hypnosis treatment.—
Standard treatment was always more expensive than hypnosis treatment
over a range of probability of 0%–50% of undersedation from hypnosis
therapy. When the probability of undersedation from hypnosis therapy is
0%, standard therapy costs $352 more than hypnosis. When the probability
of undersedation from hypnosis therapy is 50%, the cost of standard
therapy is $290 more than the cost of hypnosis.
Effect of blended rates and cost weights.—The savings with hypnosis
increase with an increase in the blended rate, ranging from $250 ($550 for
standard therapy minus $300 for hypnosis) at a blended rate of $2,500
and reaching $623 ($923 minus $300) at a blended rate of $10,000. We
then tested whether the use of the specific DRG used to estimate the cost of
complications associated with oversedation or undersedation had an effect
on our results. If the cost weight for the DRG used for complications from
oversedation increases from 0.5150 (DRG 100) to 0.6738 (DRG 99), the
savings from the use of hypnosis increase from $321 to $356. If the cost
weight for the DRG used for complications associated with undersedation
increases from 0.6067 (DRG 131) to 0.9427 (DRG 130), the savings from
the use of hypnosis increase from $320 to $357. Thus, as the costs of
complications increase, the net savings associated with the use of hypnosis,
compared with those associated with standard therapy, increase. Effect of
the hourly procedure room cost.—Our base case assumption was that each
minute in the procedure room cost $4.50. As the cost of procedure room
time varied between $2.50 and $10 per minute, the savings realized by
using hypnosis increased from $304 per case to $431 per case.
DISCUSSION: With use of adjunct hypnosis, the savings, on average, was
$338 per case in conditions of the basic decision tree. The savings depended
strongly on the Medicare blended rate of the institution, which ranged from
$250 per case at a blended rate of $2,500 to $623 per case at a blended
rate of $10,000. Thus, high-cost academic centers with high Medicare
blended rates are expected to gain most from use of the hypnotic
intervention.
The basic decision tree assumption was that hypnosis was provided by
an interventional team member, such as a specially trained nurse or
technologist. Members of surgical teams can be highly effective in structuring
hypnosis during invasive medical procedures (3,15–18) and may be
superior to outside personnel (5). If an additional person were to be added
to structure hypnosis, cost savings would be less, but still remain substantial
at $290 per case. This latter number was derived from a decision tree by
using the equivalent of a staff psychologist’s salary of $70,000/y plus 30%
fringe benefits. Sensitivity analysis showed that adjunct hypnosis is less costly
than standard sedation unless the additional person were to demand more
than $330/h. This rate of reimbursement surpasses by far that of most
nonphysician specialists and interventionalists, making even their
participation in hypnosis worth their time.
If procedure personnel structure hypnosis, the cost of training and
continued support should be accounted for. Typically, 24 hours of classroom
instruction, supervised clinical instruction, and a second 8-hour workshop
suffice for medical personnel to achieve sufficient skills in the methods
(6,18). Continued supervision through a psychologist or a physician
experienced in hypnosis on a biweekly basis is highly desirable.
Whether using procedure personnel is more resource-sensitive than
adding a psychologist, who does not need additional training and
supervision, depends on personnel turnover and recurrent training cost. The
up-front costs of establishing a procedure team–based hypnosis program
depend on the level of participation rate of the personnel desired. The
cheapest alternative may be to have individual procedure personnel trained
at a hypnosis course administered by one of the hypnosis societies (eg,
Society for Clinical and Experimental Hypnosis, American Society of Clinical
Hypnosis, New England Society of Hypnosis) or other accredited continuing
medical education programs. Training an entire team for the procedure has
the advantage of creating a supportive climate and providing team members
enhanced communication skills that can also be used in nonpatient
interactions.
On the basis of which model is chosen and how many persons are
selected for training or whether outside trainers are invited, up-front costs
are an estimated $3,000–$15,000 (estimated on the basis of the prior
training cost incurred). From a hospital perspective, these costs are
recuperated after using self-hypnotic relaxation in 10–50 patients.
When offered hypnosis training, personnel commonly voice concerns
that inducing and maintaining hypnosis in the procedure suite is performed
may prolong room time. In the case of adjunct hypnosis, as was used in this
study, room time actually decreased from 78 to 61 minutes despite the
fact that hypnosis was induced in the procedure suite (6). However, even if
hypnosis were to add time to the procedure, it would still be less costly than
standard sedation. Specifically, hypnosis could add up to an additional 58.2
minutes to the procedure time and still have a cost superiority, compared
with the cost of standard treatment (Fig 4). These results should dispel
concerns that introduction of the self-hypnotic intervention would reduce
efficiency or be too costly.
Costs of standard conscious sedation are heavily influenced by the
probability of oversedation with intravenously administered sedatives and
narcotics. The average amount of sedatives and narcotics administered in
standard sedation in patients in this study (1.9 drug units; with one drug
unit equaling 1 mg of midazolam or 50 μg of fentanyl) is well within the
range of doses commonly used for similar procedures (19) and within the
customary range of drugs used in the institution of this study for these types
of procedures. Higher doses risk higher probabilities of oversedation; lower
doses may result in a less cooperative patient. Hypnotic adjuncts are
clinically helpful in that they can provide comfort with less need for
intravenous drugs (0.9 units in this study) and thus less risk of oversedation.
On the other hand, individuals who are not responsive to the hypnotic
intervention may either demand more drugs, and thus be exposed to the
risk of oversedation, or remain undersedated. Undersedation with hypnosis
also affects cost. Sensitivity analysis shows that even if the probability of
undersedation were to reach 80%, hypnosis would still be less costly than
standard therapy, with a savings of $86.
One potential limitation is the use of DRGs to estimate the cost of
complications related to over- and undersedation. Although the DRG may
not directly correspond to the actual cost of care provided by the hospital,
we believe that it is a reasonable proxy. In addition, the use of DRGs
incorporates the blended rate paid to each hospital. The blended rate takes
into account the hospital’s patient population and regional variations in cost.
Thus, by varying the severity of the blended rate, our analysis can be easily
generalized to other institutions.
The superior clinical effect of hypnosis has already been described in the
original article (6) from which the cost data of this study are derived. Thus,
this current analysis does not aim at demonstrating the effect of hypnosis on
clinical well-being (ie, its effectiveness) but merely on the effect of hypnosis
on cost. Several of these events labeled as oversedation or undersedation do
not qualify as complications in the sense of morbidity reporting but rather
represent a highly self-critical reporting of any event in deviation of an ideal
equilibrium among comfort level, dose of medication, and side effects of
medication.
A second limitation is that the cost of room time for the procedure
varies among institutions. However, the sensitivity analysis performed on the
cost of the procedure room demonstrates that the cost superiority of
hypnosis persisted at all values tested from $2.50 to $10 per minute (base
case, $4.50/min). We have previously shown that adjunct hypnosis with
intravenous conscious sedation during interventional radiologic procedures is
effective in reducing pain, anxiety, and procedure time. Findings of this cost
analysis show substantial cost savings when adjunct hypnosis is used.
Therefore, the choice between greater patient comfort and lower cost need
not be made. Medical benefits of hypnosis for the patient notwithstanding,
adjunct hypnosis during procedures is a clinically feasible and cost-saving
practice.
FOOTNOTES:
Abbreviation: DRG = diagnosis-related group
Author contributions: Guarantors of integrity of entire study, E.V.L., M.P.R.;
study concepts and design, M.P.R., E.V.L.; literature research, E.V.L., M.P.R.;
clinical studies, E.V.L.; data acquisition, E.V.L.; data
analysis/interpretation, M.P.R., E.V.L.; statistical analysis, M.P.R.; manuscript
preparation, definition of intellectual content, editing, revision/review, and
final version approval, E.V.L., M.P.R.

49. PAIN MANAGEMENT AND IMPROVING QUALITY OF LIFE IN

TERMINABLY ILL: ALBERT GRAZIA
One morning, the mother of a terminally ill cancer patient called my
office. Her son had renal cell carcinoma (kidney cancer), which had spread
to his liver and lungs. He was recently discharged from the hospital and was
given a very poor prognosis (two to three weeks to live). Since conventional
medical treatment failed to control his disease, he was advised to seek
hospice care. She realized it was a hopeless situation, but still wanted to
know if it was too late to do anything to help her son. I reassured her that
it's only too late if you never start. When I entered the home, I observed a
young man, who was very pale and suffering from cachexia, the wasting
syndrome commonly associated with advanced cancers. (In fact, it is
estimated that 40 percent of all cancer patients actually die of
malnutrition.) He was nauseous and kept a bucket nearby because he was
constantly vomiting. His appetite was almost nonexistent. I noticed his
abdomen was swollen, often caused by a buildup of fluid called ascites. This is
generally regarded as a sign of liver failure from protein malnutrition and
correlated on blood tests with a low serum albumin level. In addition, his
bowels had almost ceased to function. However, the most distressing
symptom of his disease was the intense pain that even morphine taken
every four hours could not alleviate.
As a naturopath, I am often called to help terminally ill cancer
patients. At this point, my focus is directed toward improving the quality of
remaining life. This is where natural healing can provide dramatic results.
Most would agree that few diseases cause such excruciating pain as that
experienced by many terminally ill cancer patients. This added suffering
contributes to increased stress to both the patient as well as family
members. Sometimes death is almost welcomed as the final relief to such an
unimaginable degree of suffering. Family and friends console themselves
with thoughts that their loved one is finally at peace. Unfortunately, those
suffering from advanced cancers find that not only has conventional
medicine failed to cure them, but it also offers them few options other than
to spend their last days in agonizing pain only partly relieved by strong and
toxic drugs.
Introduction Case History of Mr. X: Hypnosis Practice and Repetition
Summary: Now, more than ever, concerned physicians are beginning to ask
about and understand the role of non-drug therapies to assist patients with
headache. These therapies, alone or in combination with medications, can
significantly impact headache treatment. This pleases me. As a family
physician and clinical hypnotist with 30 years experience in the field, I
applaud this trend. Certainly, a capable and compassionate physician will
struggle to assist his or her patient to find headache relief by whatever
methods; complimentary, traditional, or both. Much can be gained if we
look at hypnosis as a helpful tool in the battle for headache relief.
Training your brain: As our understanding of how the brain works and
which compounds (or neurotransmitters) control our pain response
expands, we begin to suspect that relaxation therapies, including hypnosis,
may alter in a positive and fundamental way our brain chemistry such that
pain relief is more likely. An interesting study was performed with patients
who learned relaxation skills. The researchers checked the subjects’
monoamine oxidase levels—since monoamine oxidase is what metabolizes
serotonin, a pain relief chemical, and found changes in those levels consistent
with what you would expect with preventive drug therapy. The study
suggests that it is not just a matter of feeling relaxed that’s important, but
actually learning via these relaxation therapies to turn on and off certain
pain pathways in the nervous system by changing monoamine oxidase levels
and, consequently, serotonin levels. In this article, I would like to introduce
you to hypnosis and self-hypnosis as a modality of pain relief for patients
who suffer from headache. Hypnosis is fun, effective, relaxing, and has no
side effects.
What is this thing they call hypnosis? No, Virginia, it is NOT clucking
like a chicken, barking like a dog or being “put under,” helpless and at the
control of the master. Rather, for most people most of the time, it is a
focused state of attention or harmony. It is easily achieved by visiting a
professional skilled in hypnosis. This pleasant state has two fascinating and
useful properties: 1) It is profoundly relaxing. In our stressful lives what
person would not enjoy a few minutes of deep relaxation in the middle of
the day from hell! 2) The mind becomes open to positive and therapeutic
suggestions. Only suggestions given with your permission and for your own
benefit are accepted. No one can be forced or coerced into doing something
they do not wish to do. Hence, when I help patients use hypnosis for
headache and stress, I offer them headache-specific suggestions as well as
relaxation and stress reduction instructions. I find this process fun and
creative. I get to know my patient not just as Mr. Jones with a headache,
but also as a real person in a stressful situation. This stressor in combination
with his or her biological predisposition to headache is creating more pain.
Case History of Mr. X: Let’s take a look at a case history and see how
it all fits together. Mr. X, a hard-driving chief financial officer of a
high-tech company is known as the “firing man,” and is responsible for
downsizing a company whose expenses exceed its revenues, and whose
market share is declining. His neurologist has referred him to me for help
with his chronic daily headache that has not responded well to numerous
medications. His executive decisions in the short run will result in layoffs
and suffering for many. However, with his expertise, talent, intelligence, and
hard work, he may “turn the company around” and in the long run, his
efforts will benefit far more people than those who will suffer in the short
term. He is not well liked by his coworkers and worries a lot about his health
and finances. He is a pleasant man, but rather intense and self confident to
the point of arrogance. At this time, he is willing to consider non-drug
therapies to diminish the pain and discomfort of his daily headaches.
Motivation: As I got to know him, I developed for him the three
elements essential to our success. First, in order to benefit from the therapy
he must be motivated. He must be motivated to want to use hypnosis for his
purposes, not mine, and motivated to put aside ten minutes each day to
develop via hypnosis relaxation sufficient to impact on the pain chemicals in
his brain. Rapport Second, I established with him a positive and supportive
rapport. Trust is an essential element of the hypnotic process. For this
gentleman who is used to firing people and always being in control in a “one
up, one down” situation, I must simply be his assistant. Without this
rapport, hypnosis will not be effective. Hypnotizability Third, I made sure
he had sufficient hypnotizability. Most of us can experience hypnosis without
difficulty. Maybe only about ten percent of us will not be able to enjoy the
hypnotic process. I have little to worry about with this patient. Most
high-functioning individuals in our society have good hypnotic skills, as
hypnotizability is associated with creativity, intelligence, and imagination.
Hypnosis: After a brief explanation of hypnosis and after gaining his
permission, Mr. X was hypnotized to enjoy some deep relaxation. Of course,
like many patients he had expected to be “put under” as he had seen on the
stage. Prior to his hypnosis, he was informed that this would not happen
and that he could maintain whatever level of awareness that he desired.
Regardless of the depth of his experience, his relaxation and his ability to
accept therapeutic suggestions would please him.
With this mixture of motivation, trust, and hypnotizability, I was not
at all surprised that Mr. X achieved some initial success at relaxation using
hypnosis and self-hypnosis. Contrary to what some might expect, I do not
use a gold watch or have my patients stare at a fixed point or command
people to relax. Rather, I use my voice and music to develop a relaxation
situation that guides a patient via a series of permissive and open-ended
suggestions into a hypnotic state. Mr. X was pleased and agreed to return
for further sessions. Not surprisingly, he canceled most of them because he
was too busy at work! Nonetheless, he was very positive about the hypnosis
that we did. He reported that the relaxation lessened the pain from his
headaches.
Practice and Repetition: It is a principal of hypnosis that all
suggestions require reinforcement. Additionally, practice and repetition are
required to develop these skills so they can produce both a biologically
medicated pain relief (via altered brain chemicals) and a psychological
harmony that helps the patient deal more easily with daily stress. As with
most of my patients, I asked Mr. X to set aside ten minutes daily (preferably
at work and without interruption) to listen to a CD that I created for him to
recapture the relaxed feeling and increased suggestibility that he experienced
in my office. With some practice on his part, I was confident that these
daily and pleasant practice sessions would reinforce positive suggestions
relating to his particular headache and attitude toward work. Results have
been very satisfactory so far. Mr. X has not returned for further work. When
last I inquired, he reported an improvement in the severity of his daily
headache. Once again, he said he had little time for therapy, but he was
enjoying the ten minute practice sessions via his personalized CD. This
particular case history illustrates the value of using non-drug therapies to
assist in pain control. Human beings are complex creatures who may have
many different triggers for headache. Some of these triggers are stress and
psychologically mediated. By dealing effectively with these triggers we may
assist in pain control with fewer or no drugs.
Summary: Hypnosis is effective and fun and provides a powerful
complimentary or stand-alone therapy to those who suffer from headache.
Stress reduction and relaxation techniques have an important role to play in
the treatment in one of the more vexing problems physicians face in practice,
the patient with headache. A recent paper titled “New Treatment Options
in Migraine” by neurologists Drs. Brandes, Edvinson, Marcus, and Rapoport
rates relaxation therapies as “effective” as a non-drug therapy for migraine

50. GOING UNDER: SELF HYPNOSIS FOR PAIN RELIEF: CHRISTINE HAREN
In the movies, hypnosis usually involves someone falling under the
magical spell of a villainous character. The hypnotized person then goes into
a trace and carries out the hypnotizer's nefarious plans. In a medical setting,
however, self-hypnosis—in which people induce a hypnotic state by
themselves—is a tool that people can use to achieve a sense of control,
rather than lose it. In fact, studies show self-hypnosis can help people
manage pain, anxiety, addiction and phobias, among other problems.
"There is nothing mystical or magical about hypnosis," explains David
Spiegel, MD, a professor at the Stanford University School of Medicine in
California. "It's just a state of altered and highly focused attention." Dr.
Spiegel, the past president of the Society for Clinical and Experimental
Hypnosis, says that by learning how to attain a hypnotic state on their own,
people can gain control over what's happening in their bodies. Below, he
discusses the role of self-hypnosis in pain management.
* What is self-hypnosis? All hypnosis is really self-hypnosis. The person
inducing hypnosis doesn't do anything to a person or control them in any
way. Medical professionals are just teaching people how to narrow their
focus of attention, turn inward and put outside of conscious their awareness
of some things that would ordinarily be in consciousness. The only time I
formally hypnotize a patient is the first time when I am assessing their
hypnotizability. After that, I teach people how to enter the state for
themselves. Since hypnosis is not sleep, but rather highly focused attention,
it's a state you can enter into very quickly if you've got the ability. You can
monitor what you're doing while you're in it, and you can choose to end it
when you want to.
* How do you determine someone's receptiveness to hypnosis? I do a
five-minute test called the hypnotic induction profile. I give people a series of
standard instructions for hypnotic experience. I'm basically seeing whether
they have the capacity to experience these hypnotically instructed
alterations in perception, sensation and motor control. To evaluate their
sensory alternation, for example, I ask them to imagine that their hand is
light and floating up in the air. If they pull it down, it will float right back
up. It turns out that hypnotizability in adult life is an extremely stable trait.
It's as stable as IQ. The peak period of hypnotizability in the human life cycle
is children between the ages of 5 and 10. Most 8-year-olds are in trances
most of the time. You know, you call them in for dinner and they don't
hear you. So it's actually quite easy for most children to go into hypnotic
state. Some people have it as adults, some don't, and it's easy to measure.
It's not affiliated with a lot of personality characteristics, but people who are
more hypnotizable tend to rate themselves as more trusting of others. They
are more likely to get absorbed in movies or novels or plays. They are people
who have had early life experiences of imaginative involvement with parents.
But people who have experienced physical punishment are more likely to be
hypnotizable as well.
* What are some of the techniques you use to teach self-hypnosis? Typically
we ask people to look up and close their eyes. There is something about
disengaging from the usual scanning visual awareness that seems to help
people cut off their usual anxious preoccupation with the world outside, and
turn inward. So we recommend that they close their eyes, take a deep
breath, let their bodies float and then imagine they are floating or looking
at an imaginary screen or hearing sounds that they may not ordinarily
hear.
* How can hypnosis be used to alter someone's perception of pain?
There are three main strategies.
* One is physical relaxation. When people are in pain, they are also often
tense. Muscle tension tends to exacerbate the pain by pulling on the area
that hurts. So rather than fighting the pain, if one can focus on an image
that conveys relaxation, like floating, the pain can be reduced.
* The second strategy is sensory alteration. You can actually change your
perception of pain. For example, you can imagine that your hand that hurts
is in a pool of cold ice water in an icy mountain stream. If you focus on the
cool tingly numbness instead of the pain, you learn to filter the hurt out. *
Another technique is distraction. You can focus on sensations in some other
part of your body, and therefore reduce the attention you're paying to the
pain.
* How often do you have to self-hypnotize to maintain pain relief? I
encourage my patients to do it for two to three minutes every one to three
hours if they've got pain, and then anytime the pain starts to get worse. So
it is a technique you can carry with you anywhere and use when you need
it. * Has the effect of hypnosis on pain been studied? There is really solid
evidence that self-hypnosis is helpful. We did a trial some years ago for
women with metastatic breast cancer that showed that teaching
self-hypnosis resulted in a significant reduction in pain compared to patients
who were not taught self-hypnosis. Elvira Lang, MD, at Harvard Medical
School, did a trial involving 240 people who were having a painful invasive
interventional radiology procedure that involved having little cameras
inserted through the arteries. All participants were offered pain medication.
One group was also offered training in self-hypnosis. Another group had a
nurse assigned to them, but no training in self-hypnosis, and the third
group had routine care. The study showed that the patients who received
the hypnosis training had far less pain and virtually no anxiety, whereas
anxiety was going through the roof for the other patients. The hypnosis
patients had fewer complications with the procedure. They used far less
medication, and it took 17 minutes on average less time to get through the
procedures. So they were more comfortable, less anxious, had fewer
problems and got out sooner.
* What kind of studies still need to be done?
* We need more studies evaluating outcome in different contexts, as we
would with any other medical treatment. We need to look at pain in children
undergoing medical procedures; pain control during surgery; pain for
different sorts of problems, from gastrointestinal to arthritis to other serious
chronic pain problems.
* Secondly, we need more studies about how hypnosis affects people's
perception of pain. We're learning that there are specific parts of the brain
that are affected by hypnosis for pain relief. One of them is the anterior
singular gyrus, a part of the brain that helps us focus attention. That seems
to be actively involved in hypnotic analgesia. Parts of the brain that actually
process physical sensation also appear to be involved.
* Thirdly, I think we need some studies of the effect of hypnotic
interventions on the practice and cost of healthcare. In Dr. Lane's hypnosis
study, for example, she found that each procedure cost, on average, $338
less if you taught the patient self-hypnosis. So there are tremendous
economic implications, which also need to be studied more.
* Do you think that self-hypnosis should be taught more regularly?
Absolutely. It's a safe, effective procedure with virtually no side effects. A lot
of people get scared about the idea of hypnosis or think they are being
controlled. It's really a way of enhancing your control over your body. I
think it ought to be part of any pain treatment program. I also think it
should be more a part of medical education. I do think as we do more
studies on hypnosis, medicine will become more accepting of the idea that
this isn't mumbo jumbo. This is science. It's a way in which we can use our
own brains to help ourselves feel better.

51. HEALTH PROFESSIONALS CONCERNING HYPNOSIS: LINDA

THOMSON: JULY 2003
American Journal of Clinical Hypnosis: Hypnosis is a beneficial
therapeutic adjunct that is frequently misunderstood, poorly accepted, and
greatly underutilized. Most health care professionals have little accurate
information about hypnosis, and their attitudes and beliefs are often based
on misinformation. Consequently, many health care providers have probably
not used hypnosis, referred patients for hypnosis, or even considered that
hypnosis has a place in mainstream medicine. It was the purpose of this
study to determine whether an educational presentation on hypnosis could
change the attitudes, practices and beliefs of medical health care
professionals about hypnosis.
There is very little research on the possibility that receiving educational
information on hypnosis or attending an informative and accurate lecture on
hypnosis might have a potential for positive effects in those receiving it. When
Hawkins and Bartsch (2000) studied the effects of an educational lecture on
hypnosis, they found that the lecture-exposed subjects had more positive
attitudes towards hypnosis and fewer stereotypic negative beliefs. It is
noteworthy that health providers frequently have little experience with the
therapeutic benefits of hypnosis and its therapeutic applications. Not unlike
the general public they have widespread misperceptions of hypnosis (Pratt,
Wood & Alman, 1988; Crasilneck, 1985; Marcuse, 1964; Kroeger, 1963;
Wallace 1979). Attitudes concerning hypnosis are often shaped by the media
and stage hypnotists (Pratt et al.1988; Wallace, 1979; Marcuse, 1964).
Studies have shown that subjects who viewed a stage hypnosis performance
or had seen one on television had not been given any accurate information
about hypnosis and were left with negative attitudes toward hypnosis
(Echterling & Emmerling, 1987; Meeker & Barber, 1971; Large & James,
1991).
On the other hand, research has shown that subjects will be less likely
to subscribe to the "myths" surrounding hypnosis when they have been given
accurate information about hypnosis and will have a corresponding
willingness to respond to hypnotic suggestions (Echterling & Whalen, 1995;
Saavedra & Miller, 1983). In a study by Lage and James (1991), subjects
who had expressed negative attitudes toward hypnosis felt more positive
about hypnosis after receiving accurate information and were more
receptive to the possibility of trying hypnosis for pain relief.
Johnson and Hauck (1999) looked at the beliefs and opinions of the lay
public concerning hypnosis and the sources of their beliefs. The group that
had the greatest willingness to experience hypnosis, had beliefs and opinions
which were most influenced by medical/psychological clinicians rather than
the media or stage hypnotists. However, when Sohn and Loveland-Cook
(2002) examined clinicians who recommended hypnosis and other
complementary and alternative therapies, they determined their knowledge
of these modalities was minimal and their primary source of information on
the subject was through personal experience and the lay literature. Of the
nurse practitioners surveyed 11.2% had previously referred patients for
hypnosis. When asked to rate their knowledge concerning hypnotherapy on
a Likert scale (Lowry, 2000) with one representing no knowledge and five,
extensive knowledge, the mean score was 2.2. In this study 5.1 % indicated
that the source of their knowledge was from their graduate nurse
practitioner education; 7.4% indicated that it was outside their nurse
practitioner education. The percent of nurse practitioners surveyed who
expressed interest in further education in hypnosis was 14.5%. In a study
done by Hall and Giles-Corti (2000) which explored the knowledge, attitudes
and referral patterns of general practitioners in Australia concerning
complementary and alternative therapies including hypnosis, 90% had been
approached by patients for advice on complementary therapies; 75% had
referred patients for complementary therapies which included hypnosis
among the most common. Less than half of those physicians surveyed had
ever studied about even one complementary therapy and 60% wished further
training. Pirotta et al. (2000) found that general practitioners
underestimate their patients' use of complementary therapies. Although 80%
had referred patients for acupuncture, hypnosis and meditation, only 20%
had any training in hypnosis. Another study in Australia (Newell &
Sanson-Fisher, 2000) assessed radiation and medical oncologists' attitudes
and knowledge about complementary therapies. This group considered
meditation, hypnosis and acupuncture to be the most likely to be helpful and
reported self-identified gaps in knowledge about non-traditional therapies.
Borkan, Neher, Anson and Smoker (1994) looked at the referral
patterns of allopathic physicians for complementary-alternative therapies.
They found no relationship between the rate of referral and physicians'
knowledge, beliefs and familiarity with the effects of alternative therapies. In
a study of American pediatricians, Sikard and Laken (1998) determined
that 13.8% had referred patients for hypnosis. More than half, 54.1 %,
were interested in continuing medical education courses in complementary
and alternative therapies. Elkins and Wall (1996) assessed the attitudes,
experience, training levels, and interest in future education regarding the
use of hypnosis among physicians and residents. They found that 79% of
physicians and 67% of residents were interested in pursuing training
regarding hypnosis.
The present state of hypnosis training and the attitudes of program
chairs toward including hypnosis training in doctoral programs was
examined by Walling, Baker and Dott (1998). Forty-four out of 170
programs surveyed reported that they offered course work in hypnosis. Of
the nurse practitioner programs investigated by Rauckhorst (1997), 37%
included forma education in complementary and alternative therapies in
their curricula. Professional standards dictate that treatment and referrals
must be grounded in a knowledge base of past experience and practice with
solid roots in scientific knowledge. When professionals attempt to fill the void
in their education and provide guidance to patients about hypnosis based on
personal experience and lay literature, they risk losing credibility and may
jeopardize patient care by referring patients to unlicensed, uncertified or
inadequately trained providers. According to Sohn and Loveland-Cook
(2002), nine out of 10 providers recommended complementary and
alternative therapies, yet their source of information was not derived from
professional education. Given the high rate of referrals and the absence of
any apparent internal logic or solid base of knowledge for such
recommendations, guidelines and expanded educational opportunities are
advisable. Integrated medicine that combines alternative and traditional
treatment approaches is the future of health care. As the public demand for
and use of complementary and alternative therapies including hypnosis
increases, the content of complementary and alternative modalities in formal
academic programs, professional conferences and in-service educational
opportunities must increase. The purpose of this study was to determine if
providing medical health care professionals with accurate information about
hypnosis in the form of a lecture would change their attitudes, practices and
beliefs concerning hypnosis and hypnotherapy.
Method: The research methodology utilized was experimental in nature
and descriptive by design. It involved the collection and analysis of new data
from study subjects before and after an educational intervention about
hypnosis.
Participants: The presentation on hypnosis was given to approximately
300 health care professionals in seven separate venues. These continuing
educationalofferings were given at national nurse practitioner conferences,
grand rounds at a hospital, and a medical center, as well as over interactive
television to nurse practitioner students at a university graduate program in
nursing. Seventy percent of the study sample are nurse practitioners. Nurse
practitioners are advanced practice registered nurses who are Master's degree
prepared and nationally certified. The remainder of the participants are
nurses, physicians, nurse practitioner students, and their faculty. Completing
the questionnaire was not an attendance equirement at the continuing
education offering. There were 196 participants who completed the
pre-test. Several participants arrived several minutes late and filled in the
post-test without having done the pre-test. There were 202 post-tests in
the study. A remarkable 64% or 126 returned the follow-up questionnaire
three months following the intervention. Participation in the study was
completely voluntary. Study subjects received no remuneration for their
participation.
Measures: Data collection in this study was accomplished with the use
of three questionnaires: pre-intervention, post-intervention and a
three-month follow up questionnaire. Each questionnaire consisted of six
questions concerned with the attitudes, practices or beliefs of the subjects
regarding hypnosis and its place in mainstream medicine, hypnotherapeutic
techniques, relaxation, self-regulatory strategies and interest in pursuing
training in hypnosis. A Likert type scale (Lowrey, 2000) was used for
questions 1 through 5 since beliefs, attitudes and practices vary along a
continuum and can be measured by a scale that employs summated ratings
based upon weighting the multiple response categories in a predetermined
direction. A copy of each questionnaire is in the Appendix.
 Procedure: The study subjects attended a 90 to 180 minute
educational offering presented by the author. The lecture included a historical
perspective of the evolution of hypnosis, and a discussion of the myths and
misconceptions concerning hypnosis and characteristics of hypnotizability. The
presentation provided an overview of how hypnosis works therapeutically.
This included a discussion of the relaxation response, distraction, the power
of positive thinking, and the placebo response. The powerful therapeutic uses
of language, post-hypnotic suggestions, and metaphors were presented along
with the components of hypnosis and hypnotic phenomenon.
Psychoneuroimmunology and cyberphysiology were also introduced. Criteria
for success were discussed as well. One of the objectives of the educational
intervention was that the participants develop an appreciation and
understanding of the various uses of hypnosis in clinical practice and learn
how to integrate hypnotherapeutic techniques and self-regulatory strategies
into traditional practice. Information was also given concerning how to
receive training in hypnosis.
The educational intervention included a didactic lecture supplemented
by slides, videotapes, and handouts and was followed by a question and
answer period. There was a variety of videotapes used during the
educational intervention. One of the tapes shown demonstrated how
hypnotherapeutic techniques could be used to engage a child's cooperation
during a physical examination, injections, and blood draws. Other videos
showed a teenage girl having a gynecological procedure done while in a
hypnotic trance; in another a patient gave a first-person account of how she
had utilized hypnosis to help her help herself with enuresis. Following the
lecture those participants who so chose could participate in a hypnotic trance
for the purpose of relaxation.
The data was collected by indirect means utilizing paper and pencil
techniques. The study subjects completed questionnaires before and
immediately after the educational intervention. The follow-up questionnaires
were mailed to the study subjects three months after the workshop along
with a stamped, addressed return envelope.
The raw data collected in this study was converted to an orderly body
of knowledge through statistical computation and analysis. The Friedman
Test (Lowry, 2000) a non-parametric test of one-sample repeated
measures was performed to determine significant differences between the
variables.
Results: The data was collated from each of the three questionnaires:
pre-test, post-- test, and follow-up. The Likert type scale (Lowry, 2000)
used on the questionnaires for questions 1 through 5 was analyzed using a
weighted scoring program. Numerical weights from 1 to 5 were
pre-assigned to each question. A response of 1 or 2 to any question on the
questionnaires indicated an unfavorable or negative attitude toward hypnosis
or a behavior that would never or was very unlikely to ever occur. A response
of 4 or 5 to any question indicated strong agreement or a behavior which
would definitely or very probably take place. A response of 3 represented
uncertainty. Responses to the questions on the pre-test were compared with
the responses on the post-test and followu questionnaires.
Mean scores were tabulated and the Friedman test (Lowry, 2000) was
utilized to determine if a significant difference existed between the subjects'
responses on the pretest and those on the post-test which followed the
educational intervention for each individual question. Likewise, the Friedman
test (Lowry, 2000) was used to compare the responses on the pre-test with
those on the follow-up questionnaire to determine if changes held up over
time (Table 1). There was a highly significant difference between the beliefs
of health care professionals concerning the place hypnosis has in traditional
mainstream medicine before and following an educational intervention both
immediately (p = 0.000) and three months later (p = 0.012). Before the
educational intervention, 77% believed hypnosis has a place in traditional
mainstream medicine as compared with 96% immediately following the
lecture and 91% three months later. There was a significant difference
between the health care professionals' current use of hypnotherapeutic
techniques and their plans for using them in the future (p = 0.00). Their
actual use of hypnotherapeutic techniques in the three months following the
educational session increased; this was statistically significant at the 95%
confidence interval (p = 0.050).
There was a highly significant difference between the health care
professionals' practice of suggesting relaxation techniques to patients before
the educational intervention and their plans for suggesting relaxation
techniques in the future (p = 0.000). Seventy percent of health care
professionals were already suggesting relaxation techniques to their patients
before the educational intervention. Immediately following the educational
intervention there was a highly statistically significant increase in the number
of study subjects who planned to suggest relaxation to their patients.
However, at the three-month follow-up the responses were virtually
identical to those on the pre-- test with 70% recommending relaxation. The
educational intervention had made no change in the behavior of health care
professionals concerning their use of relaxation strategies with patients (p =
0.492). The majority had already been using these techniques and were
continuing to use them.
There was a highly significant difference between health care professionals'
practice of suggesting self-regulatory strategies to patients before the
educational intervention and their plans for suggesting self-regulatory
strategies in the future (p = 0.000). Their actual practice of suggesting
self-regulatory strategies during the 3 month period following the
educational program was not significantly different than before the
intervention (p = 0.075).
 There is a highly significant difference between health care
professionals' practice of suggesting hypnosis with a trained practitioner to
patients before the educational intervention and their plans for suggesting
hypnosis to their patients in the future (p = 0.000). There was also a highly
statistically significant change in the practice of suggesting hypnosis as a
valuable therapeutic adjunct to patients between the pre-test and the
three-month follow-up (p = 0.00).
During the educational intervention it was emphasized that hypnosis is
a skill that could be added to professionals' armamentaria. However, like any
clinical skill it requires education, training, and practice. Information was
given to the participants as to where they could receive training in hypnosis.
Before the lecture 30% had no interest in pursuing training in hypnosis;
following the lecture that percentage dropped to 4%. After the intervention
a large majority of the respondents (78%) were interested in pursuing
training in hypnosis. There was a highly statistically significant difference in
the respondents' interest in pursuing training in hypnosis before and after
the educational intervention (p = 0.000). The three-month follow-up
questionnaire revealed that 83% planned to pursue training in hypnosis.
Twenty-four percent had already done something to further their
knowledge of hypnosis after attending the lecture. Due to a flaw in the
testing instrument, the statistical significance of this could not be assessed in
the same manner as the other questions.
Discussion: On the basis of this study it is possible to conclude that
there was a significant difference between the attitudes of health care
professionals concerning hypnosis and hypnotherapy before and immediately
following their attendance at an educational intervention and this difference
persists over time. The change in the attitudes of the study subjects
concerning hypnosis directly following the educational intervention would
support the results obtained by Large and James (1991) which showed that
after subjects were given accurate information about hypnosis, subjects were
more positive about hypnosis in general and the possibility of trying hypnosis
in the future. Many health care professionals, not unlike the population as a
whole, view hypnosis skeptically and would not consider it a part of
traditional allopathic medicine. Providing the subjects with factual,
scientifically based research that showed the effectiveness of hypnosis was
pivotal in changing their beliefs concerning the place hypnosis should have in
traditional mainstream medicine. Learning about the possibilities of
integrating hypnotherapeutic techniques into traditional clinical practice
may also have contributed to change their perception of hypnosis.
The health care providers learned from the educational intervention
that many of the successful techniques they currently used with patients
were hypnotherapeutic, such as guided imagery, distraction, diaphragmatic
breathing, reframing, leading, and pacing. The recognition of that fact and
their enthusiasm after viewing videotaped examples (such as a child blowing
away the pain of an injection by blowing a pinwheel) were reflected in their
answers on the post-test. The number of study participants who by
self-report continued to incorporate hypnotherapeutic techniques into their
clinical practice following the lecture on hypnosis increased, and was
statistically significant at the 5% significance level. These practitioners had
not received formal training in hypnosis, but rather had learned about
hypnosis and the effectiveness of techniques that are hypnotic in nature but
do not require a formal induction and trance state.
I found a large majority of health care professionals currently use and
will continue to use relaxation techniques with their patients. These
percentages were not affected by the lecture. The term self-regulatory
strategies was intentionally not defined to the participants in the study. The
educational intervention elucidated varying self-- regulatory strategies. For
some participants, the recognition that they were already utilizing some
self-regulatory strategies with patients may be reflected in the large
statistically significant increase in the participants who indicated on the
post-test that they planned on suggesting self-regulatory strategies to
patients in the future. This change, however, was not statistically significant
at the three-month follow-up. Most health care professionals rely on
pharmacology, technology, and surgery to heal their patients. Hopefully, the
lecture broadened their awareness and acceptance of other healing
modalities. Techniques related to hypnosis that involve the careful use of
therapeutic language such as suggestion, reframing, distraction, leading,
pacing, and imagery, can be integrated into a clinical practice by a skilled
clinician without extensive training in hypnosis. Hypnosis, however, should
only be used by trained health care or mental health professionals. Before
the educational intervention most of the study subjects had never considered
suggesting hypnosis to a patient. The presentation was very successful in
raising the consciousness of the attendees to a powerful healing modality.
The post-test revealed that 83% of the health care professionals planned to
suggest hypnosis to their patients in the future as compared to 29% before
the intervention, and only 1% said they did not plan to suggest hypnosis to
patients. By the time of the follow-up (three months after attending the
lecture) 56% had already suggested hypnosis with a qualified provider as a
possible therapeutic option to patients. The analysis of the responses of the
study subjects to this question clearly illustrates the value of a presentation
on hypnosis to health care professionals to dispel myths and misconceptions
and to educate them to the wide range of medical uses of hypnosis,
substantiated by research.
As part of the educational intervention in this study, subjects were
given an experiential opportunity. Those who wished could experience a
hypnotic trance led by the author for the purpose of relaxation. At all venues
the participants (with the exception of only one or two individuals)
remained for the experiential portion. Previous research has shown that
subjects who have previously experienced hypnosis are not as fearful and
have a more accurat concept of hypnosis (Hawkins & Bartsch, 2000). When
subjects are provided accurate information and have the opportunity to
experience a hypnotic trance, positive attitudes and more realistic beliefs
about hypnosis result. The generalizability of this study is limited by the fact
that the attendees at the educational intervention chose to attend because
the subject was of interest to them. In addition, participation in the study
was completely voluntary and only two-thirds of the attendees chose to
participate. Therefore, only those who were motivated or interested enough
completed the questionnaires. This limitation is particularly relevant in
analyzing the follow-up data. The 64% of the study group who contributed
follow-up data may not have been representative of the entire group. The
36% who did not complete the follow-up questionnaire may have been much
less enthusiastic about the topic.
The findings from thisstudy provide evidence for the position that when
subjects have accurate information on hypnosis that is supported by scientific
research, they will be more likely to incorporate hypnotherapeutic techniques
into their clinical practices and suggest hypnosis with qualified providers to
their patients. Their use of self-regulatory strategies and relaxation
techniques with patients may also increase. This project found that when
health care providers are educated about hypnosis, learn the therapeutic
benefits for a variety of conditions and obtain more information about how
to integrate hypnotherapeutic techniques into their clinical practices, they are
more likely to have an interest in pursuing training in hypnosis. The findings
of this research also showed that health care professionals who are not
knowledgeable about hypnosis or convinced of its validity could be educated
and informed by attending a presentation on hypnosis.
Conclusions: Myths and misconceptions concerning the legitimacy of
hypnotherapy abound, not only among the lay public, but also among health
care professionals as well. Its recognized legitimacy and use among medical
health care professionals lags far behind its potential effectiveness. An
educational presentation, which confronts the myths about hypnosis, can be
very effective in dispelling misconceptions. Offering a historical perspective
and discussing how hypnosis can be integrated into clinical practice can
stimulate interest in healthcare professionals. Substantiating the therapeutic
usefulness of hypnosis with solid research can alter opinions.
The study subjects in this research project viewed videotapes of patient
encounters, and also heard case vignettes and taped first-person accounts
from patients who had utilized hypnosis to help themselves with physical or
psychological problems. Having the participants experience a hypnotic trance
for the purpose of relaxation at the end of the intervention was very
powerful. There is no substitute for experience. It is evident from the analysis
of the data that the educational intervention made a positive impact on the
attitudes, beliefs and practices of health care professionals concerning
hypnosis and hypnotherapy.

52. BLUE CROSS STARTS HYPNOTHERAPY REFERRAL NETWORK: HMI

Blue Cross of California, one of the states largest health care providers,
breaks new ground this month with the launch of their new Hypnotherapy
Network. The goal of the program is to introduce Blue Cross customers to the
idea of using hypnotherapy to prevent illness by reducing stress, and to lead
more productive and rewarding lives.
Blue Cross Senior Contract Manager Kathleen Brozee explains this
latest move to stay one step ahead of the competition; "We at Blue Cross
want to do more than just help our customers when they are sick. We also
want to help them stay well by helping them to live well."
Hypnotherapy involves the use of hypnosis to access the subconscious
part of our mind, considered by many as the root or source of many of our
behaviors, emotions, attitudes and motivations. A Hypnotherapist is not a
psychologist or medical doctor, but rather a professional who has completed
a one year specialized training to use the power of hypnosis to help people
achieve their personal self-improvement goals. Blue Cross has created a
referral network of Hypnotherapists who have graduated from an accredited
college of hypnotherapy and offer special discounts to Blue Cross customers.
The official introduction of the Blue Cross Hypnotherapy Network,
expected to reach customers in May, marks a big step towards mainstream
acceptance for hypnotherapists and foretells a huge windfall of interest in
this unique treatment. "Helping people to sleep better, to stop smoking, to be
motivated to exercise and to learn to release the tension of their job, those
are just some of the ways we see Hypnotherapists helping Blue Cross
customers develop healthier lifestyles," says Brozee.
"There is no doubt that this landmark move by Blue Cross will have
profound impact on the acceptance of hypnotherapy into mainstream health
care," states George Kappas, M.A., M.F.C.C., Director of the Hypnosis
Motivation Institute (HMI) in Tarzana. HMI, a nationally accredited college of
hypnotherapy that transforms, natural people helpers into Certified
Hypnotherapists. "With Blue Cross paving a path for customers to experience
the potential life improving benefits of hypnotherapy, we expect the demand
for those services to skyrocket." HMI's college has geared up for the surge of
demand for training by offering evening classes so that students can continue
to work full time in their traditional careers, while preparing for the future
with a new career helping others. HMI also offers Federal Financial Aid to
qualified applicants, making it possible for literally anyone to afford the
training required to transition into this rapidly evolving new health care
profession. "With over four million Blue Cross customers in California, and less
than 400 qualified Hypnotherapists state wide," adds Kappas, "hypnotherapy
represents a ground floor opportunity for anyone interested in a career
helping others." Thinking about a career change? If so, maybe it's time for
you to get motivated and start motivating others with a new career as a
Certified Hypnotherapist! AHA-HMI Enrolled Students-Hypnosis
Articles-HMI Home Page

53. MEDICAL HYPNOTHERAPY OUTLINE: PAUL DURBIN AND MELISSA ROTH

OUTPATIENT/PRIVATE PRACTICE
- focus on PAIN control
- chronic illness
- anxiety
HOW TO CONNECT WITH THE MEDICAL COMMUNITY
Introduction:
- keep in mind: they (doctors) will refer you if you can do for them what they
need done! That means: talk about the symptoms you treat that the majority of
their patients suffer from
PAIN: number 1 complaint
High Blood Pressure (more medical visits for high bp than any other
problem)
Fibromyalgia
Irritable Bowel Syndrome (IBS)
Migraines
Arthritis
- talk to physicians about their common “problems” with patients
- Stress and anxiety
Doctors are giving anti-depressant medication for anxiety/depression
Tricyclic anti-depressants sedates: often worked better for people w/ pain
SSRI (prozac) in clinical trials: 16 clinical trials 300 person sample
size, 14 of the trials showed NO CHANGE 2 showed patients felt slightly
better. PAXIL (another SSRI) utilized marketing2% of clinical trial sample
showed improvement of anxietynow Paxil has largest marketing share.
HYPNOSIS WORKS FOR ANXIETY
I. FIRST STEP
A. Utilize phone book/hospital based directories/University Health
centers/Corporate Health Centers/Teaching hospitals and make a list of the
physicians
B. Have a notepad (letter or legal size) and allow 1 page for each
physician you obtain from step A (don’t write down EVERY name, ie no
radiologistsmostly private practice docs)
C. At top of each page write the Doctors name, address, phone number.
II. SECOND STEP
A. have stack of papers (with doctors names and info) and call receptionist
for info (the following info goes on the designated sheet of paper for each
doctor)
B. Say: I AM A new “DETAIL Representative” in the area
Detail representative is a pharmaceutical rephowever, it is normal
and appropriate practice for physical therapists, massage therapists,
hypnotherapists etc to call themselves this and utilize this to meet with the
doctor and make a connection.
C. Verify address, get FAX, EMAIL (if possible)
D. Get name of NURSE and his/her extension
E. find out when the best day, time is to come by try to make an
appointment right then)
F. Find out when doctor’s day off is (don’t come in b/c he or she is not
there!)
G. “Does your doctor refer to complementary therapists?” (Recent AMA
study showed
that 58% of docs are interested in referring to complementary
practitioners)
“Does your doctor refer to pain clinics?”
Even if they do not refer, still make a page for that doctor.
H. Sort pages (doctors) by geography (medical buildings etc).
III. THIRD STEP
A. After sorting by geography and by who refers to complementary
practitioners. YOU PRACTICE A 2 MINUTE SPEECH to give the doctor:
how hypnosis can help that doctors’ patients.
B. You go to the office for your appointment
- dress professionally, have handouts/brochures/business cards
- have a specific brochure for a specific symptom(s) and on back of
brochure
mention what other things hypnosis is useful for.
- when you arrive, introduce yourself to the receptionist “hello I
am Kathleen Brannan, I am a new detail rep, I am here to see Dr. X, WHERE DO I
STAND”.
C. You catch the doctor in between patients
- “Hello, I am KB, CCH, do you see patients with x, y or z?”
(represent what they need and want)
- tell doctor how many clients you have seen for x, y and z, how many
sessions their patient (s) would need and what your % success rate is if you
are new, say “this therapy has __% (86% for M. Roth) success rate for these
symptoms” (utilize success rate of one of your teachers, just do not lie and
say that it is your success rate)
- anticipate questions and practice overcoming objections
- show how to fill out hypnotherapy Rx
 D. Leave Rx blanks, brochures and refridge magnets
E. Road Blocks
- if doctor asks about past life regression (be careful, this topic
can scare people off) say that it is curious to you, but you honor the model
of the world of the patient, and if past life comes up in therapy, this may be
what needs to be addressed for their issue.
IV. Follow up
A. if patient is referred, send a f/u letter on patients (if patient
signs waiver to okay this) to the referring doctor
- at beginning of therapy
- at middle (state progress)
- at end (State % of improvement)
B. Follow up with MD office every 3 months (for adamant “NO” doctors,
send them a letter or brochure every 3-6 months).
C MEDICAL MODEL
Utilize this when sending a follow up letter
- 1st letter: Example:
Describe pt. & condition they have “37 yo female with chronic low back
pain”
Symptoms upon arrival/presentation (utilize 0/10 scale) “8/10 sharp pain x
4 weeks, nonradiating, worsens with prolonged sitting and with bending over”
Level of trance “client went into trance easily and deepened into moderate
trance state”
(remember if pt did not sign release, you cannot send this to Doctor)
- 2nd letter (middle of therapy)
How symptoms have or have not improved
- 3rd letter
Status of patient symptoms (0/10 rating)
Intention of follow up.
Random Comment
Topic: smoking cessation
- wellbutrin/nicoderm/nicorette etc
Works for 17% of people trying to quit (Nicoderm is only 14%)
- NICOTINE IS NOT a PHYSICAL ADDICTION
- cigarettes are 18% SUGAR!!! Blood sugar drops, body will crave sugar and
cigs.
PAIN: PAUL DURBIN
Many different types of pain
Acute, Chronic
Spiritual, Emotional, Physical
Waking Hypnosis
- example of someone with high BP (in the Hospital on a monitor), sit with
them, establish rapport
- copy their breathing and then normalize yours until they are normalized
- while maintaining eye contact start having them imagine that their BP is
dropping
Prayer Hypnosis
- Religion specific
- start describing the pain (using some of the words they used to describe)
and intensify it, say “pain” a little more emphatically. I.e “your PAIN in
your neck is causing you great misery, you are lacking sleep, cannot exercise
etc”
- then have them close their eyes (it is okay if they are already closed) and
imagine Jesus is standing next to him/her, (describe how they might see Jesus,
he could be dressed in ancient clothes or in modern clothes, light skinned or
dark skinned etc) then have them imagine Jesus is touching their neck (where
the pain is) and they have a great feeling of warmth at that area (intensify
this)
- the pain is being drawn into Jesus’ hand and the warmth increases and as
the pain is pulled away, the endorphins from the nervous system (that decrease
pain) and other enzymes and hormones that promote healing and decrease
inflammation are flooding the area of the neck (at this point, no longer use
the word pain).
- Jesus pulls away his hand, and you close with a prayer.
Secondary Gains of Pain
- attention, love, sympathy
- “how would your life be different if you did not have this pain?”
- story to use:
A man came to Buddha and said, help me, save me from this suffering (you can
be specific with the suffering, ex. Back pain, depression, smoking etc) Buddha
tells him that he can help him, takes him out to a lake and shoves the man
underwater and holds him there. The man starts to struggle and finally is
able to burst out of the water and gasp for air. Buddha says, when your
desire to let go of the struggling becomes as strong as your desire for breath
right now, then you will be able to get rid of your suffering.
- ideo-motor finger raising is very useful to use when wanting to get direct
answers
If the finger raises up smoothly and drops smoothly---it is probably the
conscious mind answering, if the finger kind of jerks up and especially if it
stays up, it is subconscious mind
More on Ideo-motor (good questions to ask)
- is there any emotional reason why you have this pain
- any past experiences that you have experienced that causes this pain
- is there any punishing of self or others
- is there a reason for someone else’s past why you have this pain
- are there any sexual reasons?
- is it okay with the subconscious mind to allow your body to heal, let go?
Don’t say, “I will cure you or I will heal you”.
Power of words
- false statement: Sticks and Stones may break my bones, by names/words will
never hurt me.
- when I doctor says “well, you will have to learn to live with this pain”
what does that mean to the subconx. “to get rid of the pain, you would have
to die.”
- if someone has had a procedure or surgery and they are very sick
afterwards
Regress back to the surgery and find out what was said that may have altered
the patients healing.
- listen to what patients say/describe things
i.e. someone who is losing their hearingupon interviewing they may say
something like “I don’t want to hear anything about that!”
- woman who lost weight with hypnosis, however she gained wt in her
hipskept growing in her hipsthe suggestion in hypnosis was “see your wt
going down to 120, down to 120” (her weight went literally DOWN to her hips)
Random Comment r/t pain
- someone who is focusing on the pain in one part of their body (ie their
knee), it is kind of like watching a football game at a stadium and you are
using binoculars and all you see is the quarterback but you cannot see any of
the other players so you cannot really watch the game. If you put down the
binoculars you can see everythinguse that analogy with the body (you are no
longer focused on the pain).
Suggestibility
- our ability to be suggestible comes from our mother or primary caregiver
- children have to figure out what they mean (the way something is said makes
a big difference)
- if your mom says what she means and means what she says, you as the child
will be more inclined to take or hear things directly (exactly what it means)
If not, then more indirect
Random comment related to analytical people
- have them sit down and tell them that they can close their eyes if they want
to, but they do not have toand as you continue to bore them into trance you
can say if you want to close your eyes you can.
Visual/Auditory/Kinesthetic: Melissa Roth
- watch the clients eyes
- ask open-ended questions
- if they bring their eyes up and to their left = VISUAL
- eyes up and to their right= VISUAL, but they are lying
- eyes side to side = AUDITORY
- eyes down and to their left = kinesthetic
- eyes down and to their right = kinesthetic and they are lying
Melissa on being direct
Melissa does not do “being direct“her equivalent of being direct is “GET
OVER IT!”
She does mostly metaphors
Hierarchy of Client information processing
If patient is more visual, less kinesthetic, and even less auditory (determine
this when watching their eyes)---use that order with imagery/metaphors and
suggestions.
Conscious Vs Subconscious (consx vs. subconsx) and METAPHORS
- consx mind is logical and thinks and communicates through language
- subconsx or unconsx thinks and communicates through imagination and pretend,
the more you can pretend the more your subconsx mind is alive and
communicative
USE METAPHORS:
The use of metaphors bypasses consx and subconsx resistance
Metaphors can set up a chain of events
Empower the subconsx with metaphors
- examples
IBS: GI tract is like Honda auto factory (conveyor belt)
* include whole system even though just the gut is affected by
symptoms
Start with mouth (where raw material is received)
Stomach is processing
Small Intestine where useful products are sorted and distributed
Large Intestine where water levels are balanced and waste products
are packaged
Rectum where waste products are disposed
Anus drop off of disposal
The unconsx mind RECOGNIZES and understands the metaphor
Hypertension: canals/rivers
When water is calm, the people living on the water edge
can function
When water is flooded, it is dangerous
*more elaborate than this
Relaxation (prior to metaphor)
-indicate that they are going to be relaxed from head to toe (progressive
relaxation)
- suggest that they can go as deep as the need to go for the success of the
session.
Symptom necessity
- symptom or pain is a signal that something needs attention
- once you find what needs attention or let the client know that it is not
essential to have symptoms, then the symptoms can go away.
Secondary Gain: Paul Durbin
- prolongs illness
- sometimes the illness is the only way for that person to take a day off or
to get love, attention, someone to clean the house etc.
Imagery
- kinesthetic, visual, auditory
- 8 types of imagery
1. Spontaneous Imagery (comes to you out of the blue) 2. Induced Imagery
(go into trance and have client talk with deceased father)
3. Concrete Imagery (see a certain number on a scale)
4. Abstract Imagery (see a bowl of ice cream with a slash through it)
5. General Imagery (see yourself enjoying life and having a good time)
6. Specific Imagery (see high blood pressure number dropping -- similar to
concrete)
7. End Result Imagery (when you see what you want to have happen, already
happen--great with sports)
8. Process Imagery (imagining going through steps to get something done)
? Guided Imagery
Hypnosis Example:
Client with ringing in ears (tinnitus)
Rapport, explaining hypnosis, give expectation “you will probably have a
decrease of ringing, maybe even a complete disappearance of ringingetc”
- lemon test
- imagery/metaphor
Walking down a beautiful country road (elaborate scene utilizing hierarchy
of info processing-- visual, auditory, kinesth.)
Everything is perfect on this walk down the road except there is a VERY
HEAVY back pack on your back. Nothing in the back pack serves you for this
walk, in fact the only purpose of the contents of the backpack is to support
and serve the ringing in your ears. One of the fingers on your hand, when
lifted will pull a release on the back pack that will cause the back pack to
eject safely off your back, taking away all the things that support and serve
your tinnitus (elaborate). (finger released)
Now you see a volume knob that you can easily turn and see yourself turning
the volume of ringing in your ears all the way down until all you hear is the
normal and regular sounds outside your head (elaborate).
Remember a time when you have accomplished something, access that memory and
feel how wonderful that feels to remember that feeling and bring your index
finger and thumb together and rub them and you feel content and peaceful from
the top of your head to the tips of your toes.
If any ringing occurs, touch the thumb and index finger together and rub
together to anchor the feeling of peace and accomplishment and the volume of
ringing goes down down down and fades away
INSOMNIA: MELISSA ROTH
- problems getting to sleep and staying asleep
- if chief complaint is insomnia without any other complaints---make sure they
do not have PAIN (it can be a hidden cause of insomnia) inquire about prior
injuries or other possible problems with pain
**back in the 1970s study down on post-op patients who had insomnia and
unrecognized mild pain (giving a non-narcotic medication helped with insomnia
by decreasing pain)
- progressive relaxation with mis-direction of attention to relaxation of all
muscles in body
Misdirection of Attention:
“stay awake for 1 hour and think of nothing but the color blue” or
“don’t think about a pink elephant”
- allow the physical body to relax and help get the consx mind out of the way.
- if you are a worrier and go to bed thinking of all the things you need to
dohave a pen and pad at bedside, write down stuff you think of and then let
it go (metaphor--computer, downloading, printing out, turn off computer, turn
back on the next day and download again or more)
FIBROMYALGIA INSOMNIA: Melissa Roth
- not always caused by fibromyalgia: falling asleep, waking up and not falling
back to sleep.
- no restorative sleep, don’t stay in REM long
- ask subconx to extend each REM period to allow restorative sleep and to
awake at an appropriate time for them.
Tapes to give to patient (for insomnia)
M Roth gives taped session to client, when she is doing the termination, she
will say
“if you want to sleep tonight, you can pass the count up and you will drift
deeply into a restorative sleep, waking up when you desire or if someone else
wakes you up, other wise, 1-slowly, calmly gently returning to your full
awareness once again”
Insomnia: Paul Durbin
- have person imagine a chalkboard and have him see the word “sleep then
erase it, then have him see himself write “to sleep”, then erase, then write
“fall to sleep” (usually by then they fall asleep)
- count backwards??? 100-sleep, 99-sleep etc.
- other medical problems r/t insomnia
* pain, sleep apnea, reactive hypoglycemia, menopausal
- post-hypnotic suggestion (for all or any symptoms)
“when water hits the back of your throat (while drinking water) you’ll
feel _______”
Smoking Cessation: Melissa Roth
86% success rate
3 sessions (hypnx best when re-enforced) 1x a week x 3 weeks
- smoking is multi-component process---it is a choice
- 18% sugar, sugar is addictive in cigs
- 4 full days for nicotine to flush out of body
- nicotine absorbs Calcium, B vitamins (supplement with TUMS, and B vitamins)
- if quitting...must eat breakfast to keep blood sugar from dropping (promote
high protein, complex carbs)
- sometimes just having a small glass of orange juice (Dixie cup portion)
will kick the craving and keep blood sugar stable (o.j. does not sub breakfast
this is in addition to breakfast)
1. Build an INCONVENIENCE for them to be a smoker, take away visual triggers,
ash trays, lighter, cigarettes and have them get their car detailed (to get
rid of smell)
2. Fill the VOID that is now missing (what is missing? Opening cigarette
package, lighting , puffing etc.)
- use metaphor of weight lifting: for 30 years you went to gym and did bicep
curls all day every day; you suddenly stop! You will need something to
replace that.
- CELEBRATE! When you realize that you are missing that, CELBRATE that you are
now recognizing and noticing it.
- keep lots of things for your hands to do.
- while in trance, ask what kinds of things they like to do with their hands
- new strategies for boredom and stress
Give them a laundry list, options of new strategiesthe subconsx LOVES this
First Session for smoking cessation:
Metaphor
Use metaphor of dirty old castle (compare to lungs being dirty) be descriptive
and elaborate and have them clean the castle (elaborate)
Parts therapy:
Ask the part in the subconsx that is responsible for smoking; reason why it
allows you to smoke, what the highest intention is of that part etc. THANK
THAT PART and educate it that its highest intention is in contradiction
because the smoking is damaging you etc
Talk to creative part and have that part come up with alternatives to smoking
that would fill the highest intention of the part that allows you to smoke
(give laundry list: give a stranger a complement, exercise etc).
Have all the parts integrate and talk to each other, they are responsible for
their own survival
FUTURE PACE: key times that they smoke
Close metaphor of Castle
Post-hypnotic Suggestion
**anytime you have an urge to smoke you have an urge to drink water instead***
- if the person comes back the following week and they cavedit is not a
failure, it can be fixed.
If the person is craving a cigarettethey HAVE TO HAVE A CIGARETTE. They
can put their shoes on, get in their car, drive to the store, buy a pack,
smoke 1 (only 1) cig and then give the pack away.
Second Session:
Support their successes
Use Metaphor about obsession: DREAM HOUSE (be elaborate) describe the perfect
room where that person would smoke and then tell them that it is unfortunate
but they cannot afford that houselet the subconscx let go.
Cravings/Urges/Habits
- Triggered by time of day/routine
- are time limited, after 20 minutessubconx gets bored!
* tell the client that the subconx gets bored after 2 minutes
* each time they decline that urge, the urge gets weaker and weaker and
easier to ignore
Third Session:
If still smoking, we have not disconnected from positive intents (part
therapy) OR secondary gains is an issue
Metaphor: WALL (wall represents why they keep smoking)
Have them walk up to a wall, see it, feel it, sense its width, height. When
they get close to the wall the get the same feeling they get when they do not
succeed. Have them take a step back from the wall and observe it again (height
width etc), dissociate from it then get close to it again and see if there a
words written on the wall or get close to the wall and let it tell you what
this is all about. Look through a peep-hole on wall and see through to the
other side and see what is there waiting for them (give laundry list of what
is on the other side for them)
If you can get through to that wallwhat resources would you need to break it
down and get through? (give them the resources to get through/tear down
wall---sometimes they need a bulldozer, sometimes they just go kick it down)
BANISH WALL FROM LIFE! Future Pace them to beyond the wall: how it feels, what
it looks like, tastes like etc. when fully associated, have them float above
and look at the scene of them beyond that wall and associate again. Then
associate back into body, out of metaphor and Future Pace AGAIN!
OVERCOMING: PAUL DURBIN
Smoking Cessation
90-95% success rate---if they REALLY want to quit
70% “ ---if they do it for someone else
5% “ ---if they do not want to quit
First Session: (see P. Durbin’s website for script)
Country Road/Heavy Backpack anology
Trigger/anchor (index and thumb rubbing)
Future Pace (1 year ahead) decrease cough, increase taste buds, increase
health, increase energy, elimination of smokers breath.
FIND THE TRIGGER: the desire controls you or you control the desire
Weight Loss:
--This section was done sooooo fast, I could not really get it all down--
- 3 sessions
- get desired weight
- how long has it been since they have been that weight (anything emotional
that happened when they gained wt?)
- Metaphor/Story
* country road/back pack and anchor with index and thumb
- at night before going to sleep, see yourself looking in mirror and your
reflection is your desired image and then see yourself standing on scale and
the number is your desired weight
- “I am in the process of becoming slimmer and slimmer”
Demonstration: Right shoulder pain
- test for suggestibility (lemon)
- induction, deepening (some Dave Elman) also: “breathe in peace, exhale
tension”, breathe in calm and relaxation, exhale stress and worries” etc.
- client told to go to/imagine a very relaxing place to go (see, hear, feel,
etc) give suggestions, client to nod when there.
- while in relaxing place, fractional deepening (head to toe)
- “as deep as you need to go for the success of this session”
- tell client to focus on the shoes on his feet and the ring on his finger,
before the shoes and ring mentioned, he did not feel the pressure of the shoes
or ring, but now he does, he has awareness of them
- imagine yardstick, at the top is #36 and at the bottom is #1. Red indicator
arrow at the #36, as it moves down the arrow changes color and when the arrow
gets as low as it needs to go and stops, the color of the arrow will be your
favorite color. The descent of the arrow determines how deep into hypnosis
you are going or that you are in:
36-24 is light, 23-13 is medium and 12-1 is deep. Have client tell you when
arrow stops. (if above 24, deepen them more)
Take left hand of client and stroke the top of it (just using your index
finger, making a line) while stroking his hand, say that his left hand is
getting number and number. Also go to right hand and tap it and say it is
getting more sensitive. Repeat a few times then test the left hand for
anesthesia by pinching it. (you can also transfer the numbness into the other
hand by placing the numb hand on the sensitive hand and describe the numbness
sinking through to the sensitive hand). Then place the numb hand on the area
of the pain in the shoulder, tap the numb hand on the shoulder and say that
the numbness is transferring into the painful shoulder, taking away the pain
and as the numbness transfers, the sensation returns to the left hand.
When doing glove anesthesia, be sure to un-numb the hand or part that does not
need to stay numb.
Metaphor/story: Country Road/heavy back pack (see page 2 of Hypnosis
Example). Back Pack releases all causes (spiritual, emotional, psychological
reasons why you have the pain)
Termination.
ACUTE PAIN: MELISSA ROTH
Migraines:
Progressive relaxation and glove anesthesia DOES NOT WORK!!!! People with
migraines are in such excruciating pain, they cannot relax. In the body the
nerves flow along blood vessels inbetween muscles, if a patient has an injury
the muscles clump and tighten down and presses on the nerves which causes
pain. With migraines, the blood vessels are engorged, plasma leaks out of the
arteries and veins and it causes pressure in head with extreme pain (like a
vice), Aim for migraine relief is to drain the excess fluid.
1. Give them a scale from 1-100 to rate their pain (1-10 is not adequate)
- usually they will respond with 150 or 200 or even higher.
- if they are above 100 do the following
MENTAL DISTRACTION
A. ask them to give you 3 words to describe their PAIN (emphasize
paininstall it!):
“hurts”, “strong”, “pressure” (actual case in this class, her
pain is a 165 out of 100)
B. now give me 3 OTHER words to describe your DISCOMFORT (do not say
pain):
“discomfort”, “pain”, “dying” (by this point her headache was
gone)
C. tell me what level your discomfort is at? If above 100, continue:
Give me 3 OTHER words to describe your SENSATION:
2. Once their pain level is below 100 do progressive relaxation
3. After progressive, have them imagine that their feet and hands are in
pools of warm water, or in buckets of warm sand, or heated wool gloves and
socksthis helps pull their fluid to their extremities (away from the brain)
* You do not have to be in trance to do this
* In fact, you can imagine the extremities warming when you first get a notion
that you are getting a migraine.
* the mental distraction technique can be used on all types of pain (not just
migraines)
* Pain is a behavior when we make the pain bigger (step A in mental
distraction), the subconx recognizes it as a behaviorit is a behavior that
can be changed
IMPORTANT:
2 instances where the pain cannot be eliminated
1. MEANINGFUL PAIN
Pathology that has not be diagnosed
2. Person thinks it is Meaningful Pain
Example: A person is diagnosed with fibromyalgia by an MD, but they
think there is something else going on, they will hold onto that pain for DEAR
LIFE.
Example: if working on a patient with this technique, tell the subconx
if there is another meaning of the painthe pain will double. This happened
with a patient of Mrs whose pain doubled which forced her to see a doctor who
discovered a bone spur on her spine that was pressing on nerves. Once she
found out what the cause was, her pain went away (even before a surgical
procedure)
SECONDARY GAIN
- always a positive intent for the person. Maybe Granny is lonely (she now
gets visits from her sons b/c she is sick)
THREE TECHNIQUES
I. FIRST technique
- do not try to kill off or drop the Secondary Gainit will not work
- you have to BEFRIEND the secondary gain!
A. Place in trance
B. Progressive relaxation
C. Create anesthesia (glove) in one part of body
D. Very gently and kindly, tell the patient you would like to tell them about
secondary gain (in a Columbo kind of waylike you are just suggesting
something non-chalantly)
“I’d like to tell you about secondary gain, where someone receives an
emotional benefit from their illness or symptoms, they do not have to go to
work, they get lots of love and attention (can elaborate)now, I am not
saying that your pain has a secondary gain, (pause) BUT, if it did (Pause), I
think you deserve it! (agree with subconsx.) IN FACT! I am going to help you
get even more of it and in a way that is HEALTHY and POSITIVE and BENEFICIAL
to you (both the patient and the subconx)
“Now, I do not know if this applies to youbut let’s give it a shot”
*give laundry list for the subconx..
-give yourself a day of comfort---go to spa, have nails done etc
-pay extra attention to your nutrition
- telephone a friend
- give a stranger a compliment
- find a TV show that you really like and take the time to watch it weekly
After laundry listcontinue
“In fact, tonight, when you are dreaming, I want your subconx mind to come up
with new behaviors that support the intention of taking care of you. Tomorrow
night too. By the end of the week, you will have 9 new behaviors that are
healthy, positive and beneficial to you, your family and friends.
- we are not killing off Secondary Gain, we are supporting it
- this technique works 65% of the time, if it does not work, then we need to
explore what the problem is.
II. SECOND Technique
- use symptom WALL
Metaphor: WALL (wall represents why they have illness)
Have them walk up to a wall, see it, feel it, sense its width, height. When
they get close to the wall the can get a glimpse past the wall as to what life
has to offer them. Have them take a step back from the wall and observe it
again (height width etc), dissociate from it then get close to it again and
see if there a words written on the wall or get close to the wall and let it
tell you what this is all about, what the cause is of their illness/symptoms.
Usually they say “FEAR” --explore that. Give them resources they need to
break it down and get through? (give them the resources to get through/tear
down wall---sometimes they need a bulldozer, sometimes they just go kick it
down) BANISH WALL FROM LIFE! Future Pace them to beyond the wall: how it
feels, what it looks like, tastes like etc. when fully associated, have them
float above and look at the scene of them beyond that wall and associate
again. Then associate back into body, out of metaphor to the present! -works
90% of the time.
III. THIRD TECHNIQUE
CORE TRANSFORMATION (Connirae Andreas) Get the book:
Core Transformation: Reaching the Wellspring Within by Connirae Andreas,
Tamara Andreas
CHALLENGES
Patients on DISABILITY!
PRE-Operative POST-Operative
Pre-Op
- the goal is to help the subconx think and believe that the cutting of the
body they are going to experience is BENEFICIAL, healing and positive (the
subconx views any invasion to the body as an assault)
- educate the subconx mind that the surgery is going to benefit them, it will
HELP the body
- educate the subconx mind to minimize bleeding/blood loss, expedite healing,
minimize risk of infection, and that any negative feelings or words that are
mentioned during the surgical process will be ignored and not accepted by the
subconsx
- use trance and guided imagery
Post-Op
- re-enforce same healing imagery, encourage the person to get out of the way
of the body because it knows how to heal.
- imagery for decreased scarring
- use metaphor of Tree in Africa that is covered in ANTS. Special Ant-tree
where the tree is completely covered in ants. Each ant spends its entire life
on the tree; nesting, eating, living etc on the tree. The tree provides
everything for the ant. In return the ant protects the tree (like macrophages
of the immune system). The ants have special mechanisms that protect the
treebalanced relationship. The subconx mind knows exactly where in the body
something is off or needs attention. Macrophages are alerted when needed and
they know exactly where to go. Macrophages are like street sweepers they
clean up foreign invaders, die off of infection, toxins and decomposition from
dead cells.
- the result of post-op hypnosis is expedited healing and decrease pain
MORE ON PAIN
- #1 reason why people go to doctor
- Congress passed a low that pain must be treated as if it is any other
disease
- pain is totally subjective
- pain clinics opening up all over
- pain clinics help 10-25% of the people that go there (usually 10%)
PAUL DURBIN:
Cancer Protocol
- attitude of patient plays large role in outcome--change attitude and expect
healthier and better quality of life
- 1st session: Relaxation
*Homework for patient
Write down any stressful events that occurred 6-18 months prior to dx
(majority have stressful event---stress suppresses the immune system)
- 2nd session:
*Imagery to reduce nausea (for chemo or whatever) elaborate after deepening
that their discomfort is evaporating like steam (elaborate elaborate
elaborate)
*Have them imagine that they can see inside their stomach and they see it
hot red and angry and the color starts to change from red to pink until clear
(ELABORATE)
*Separate the mind from the body through hypnosis (put the mind across the
room)
*Homework
Write down any gain/what they get from having cancer, what they are
getting out of it. Talk about how to meet those needs without having to
support the cancer
- 3rd session
*SET GOALS
Give something to look forward to
*Allow anger to come out (if anger is harbored you cannot heal)
*if person is dying talk about who they want there with them ? (this may only
be appropriate for clergy)
*GIVE HOPE (false hope is better than no hope)
THE SUBCONSX cannot tell the difference between a wish and a fear!
Imagery for Cancer patients:
Have them imagine an increase of White Blood Cells, see them increasing and
attacking the cancer cells, always destroying cancer cells
(someone who is getting chemo and/or radiation) have them imagine that
chemo/radiation is the bodies ally, our body defenses are increasing, our
natural T killer cells are increasing.
For radiation, use metaphor of machine gun/artillery.
Have them visualize that what they want to have happen, has already happened
CHRONIC DISEASE: MELISSA ROTH:
- industrialized world has eliminated many of the infectious diseases that
plagued us in the early-mid 1900s along with advancement in trauma medicine.
Now we have put blinders on and chronic diseases have exacerbated!
IRRITABLE BOWEL SYNDROME (IBS)
- dysautonomia (autonomic nervous system (ANS) is dysfunctioning)
- 20% of population with IBS (1:5 general and 1:3 female)
- not life threatening, either chronic or recurring
- person withdraws into self emotionally and physically
- gut pain, spasm, bloating, gas, diarrhea and/or constipation
-conventional treatment: increase fiber and water, decrease stress and take
anti-spasmotics and anti-depressants
IBS-diarrhea dominant (15%)
* PANIC ATTACK OF THE BOWELS explosive diarrhea (limits your life)
IBS- constipation dominant (5%)
Market share for IBS medication that treats the constipation IBS, was 1
billion in first year and 1.9 billion at 2nd year!!!
- Melissa Roth started working on IBS clients in 1995 has seen > 400:
86% SYMPTOM FREE
94% has 50% decrease in symptoms
- as mentioned earlier, do system approach/metaphors (car factory) 6 sessions
needed
- ulcerative colitis is similar to IBS but also do suggestion about healing
the intestinal lining
FIBROMYALGIA
- also dysautonomia
- 12 sessions system-specific suggestions (nerves, muscles, gastro-
intestinal) use metaphors
- chronic pain in all 4 quadrants of body lasting greater than 4 months
- fatigue is PROFOUND; sleep disturbance, no restorative sleep, fall asleep
but then wake up and cannot fall back to sleep
- mental fog and short term memory loss
- on multiple medications; considered arthritis of the muscles
- symptoms worsen until disabled
- 25% become disabled
- bankrupt socially
- doing regression to cause, parts therapy, reframing---NOT EFFECTIVE
- important to let the client know and understand that when we come into the
world, we do not know as a physical body, how to functionour subconx mind
programs all of the systems. Because of this, the client can understand that
the subconx mind can be retrained (as well as the body)
- METAPHOR- POTHOLE
* when a car hit’s a pothole, the axle is jarred or displaced which
eventually causes the tires to wear unevenly, which then effects the brakes
and so on and so forth. Changing the tires or the brakes remedies the problem
but only temporarily. The axle needs to be adjusted. In the body with
fibromyalgia or IBS, the symptoms of the disease is like the uneven wearing of
the tires. The pothole is equivalent to a stressful event in the life of the
client that caused a shift of the axle which is equivalent of knocking the ANS
out of alignment (causing dysautonomia). Use this metaphor (elaborate and
make it more interesting)
- the longer IBS persists, the more likely the person will acquire
fibromyalgia
- design metaphor and suggest to re-educate and help the ANS realize that
they do not have to regress to the POTHOLE event (the POTHOLE was initially
the catalyst to the problem, but that is now in the past), the person does not
need to know exactly what the POTHOLE event wasthey just have to realign the
ANS and the subconx has to okay to fix it.
HYPERTENSION (HTN)
- 90% of all people 50 years and older have a lifetime risk of having HTN
- more MD visits for HTN than any other disease
- important to decrease stress, watch diet and increase exercise
- >70% of people on HTN medication have blood pressures that are out of
control (even on 2 or 3 different HTN medications)
- 86% usually quit taking medications on their own because of side effects
(decrease libido)
- IBS and HTN are very non-compliant with medications because of side effects
DIABETES MELLITUS
- increasing in all industrialized nations: because of increase access to fast
food, REFINED FOODS, alcohol, cigs etc
- of course person needs to clean up diet (no refined foods or simple sugar,
need adequate protein and complex carbohydrates) increase exercise, check
blood sugar regularly and take meds as prescribed
- pain control with neuropathy
- system specific: moderating and modulating the systems associated pancreas,
kidneys, adrenals, insulin receptor sites on every cell)
- METAPHOR for diabetes (Melissa, I made this one upI hope it is okay!)
At a grocery store, the courtesy clerks are always monitoring the grocery
carts, making sure they do not get overloaded in the parking lot. They run
out to the lot, collect them and place them in their designated corrals. If
too many carts collect in the lot, the cars can get damaged by carts rolling
into them and the corrals are lacking carts for the customers to pick up and
use for shopping. Also the traffic in the lot is congested and the cars can
not move in and out smoothly. The cars sit there longer dripping oil on the
ground of the lot and letting out a load of exhaust.
In the body, the courtesy clerks are like insulin and the grocery carts are
the glucose molecules. The cart corrals are the cells of our body. The
parking lot is our vascular system. Just like the carts congesting the lot so
does sugar in the veins and arteries of our body. That congestion causes
damage to the kidneys, eyes and nerves and the congestion also causes a
slowing of traffic which damages the walls of the vascular system resulting in
neuropathy. The empty corrals (or cells) are starving and they cannot do their
job (customers picking up a cart and going shopping).
ASTHMA
- true designer disease, everybody’s asthma is different, different triggers,
something throws them off and the muscle in lings are in a frenzy-like spasm:
different types
1. Can’t get air in
2. Can’t get air out
3. Muscle spasm (in and out quickly so no air or little air in and out)
4. Sometimes with secretion/mucus or without
5. VOCAL CHORD DYSFUNCTION (VCD)
- something triggers the vocal chord to close down, sign/symptom is
spasmatic cough (cough to open chords) NOW WHEEZING, albuterol and steroids
NOT effective!!
- to treat:
Have the person visualize that they are breathing through a very large
straw (few breaths)
Then have the person visualize that they are breathing through a very
small coffee stirrer
- then teach them (and all asthmatics) how to RELAX!
- for mucus/sputum producers, use metophor of a desert (to dry them up)
ALLERGIES: PAUL DURBIN
- regression can help (example, girl with allergies who regressed to memory
for grandfather dying and not being allowed to grieve because she was too
young, regressed further to time when her mother was upset because husband
away at war, daughter not allowed to cry then, event when older occurred where
client could not cry in high school, allergies started thennow with
allergies, main symptoms being watery eyes)
- can use metaphor of leaky faucet
SENSITIZING EVENTS
- Initial Sensitizing Event (ISE)
* event usually not remembered, associated with problem (example above,
girl with allergies)
- Symptom Producing Event (SPE)
 * event that occurs that begins to cause symptoms (may not be aware of
symptoms)
- Symptom Intensifying Event (SIE)
* event that causes the problem that makes you seek out treatment.
DEATH AND DYING
- we, as hypnotherapist have to come to terms with our own view of death and
dying
- ALWAYS be honest with the patient, do not give a time table
- 5 stages of death (Kubler-ROSS)
1. SHOCK and DENIAL
2. ANGER (mostly towards family and God)
3. BARGAINING
4. DEPRESSION
5. ACCEPTANCE
- as hypnotherapist we have to allow person to go through the steps (do not
take anything personally)
WORKING IN A HOSPITAL OR MEDICAL CENTER: MELISSA ROTH AND PAUL DURBIN
- review Hospital for accreditation of JCAHO
- they (JCAHO) say the hypnotherapist must have a masters degree in a helping
profession (MD, RN, NP, PHARM, CLERGY) to do hypnosis UNSUPERVISED
- if no masters, you can do hypnosis IF supervised by MD who will take
responsibility
- How to work in Hospital
1. Work a proposal
A. Why you want to work at a hospital as a hypnotherapist
B. How it will benefit you and the them (CEO cares about the financial
bottom line)
- a well run Hospital will turn a profit of 3-5 % turnover profit
- show how you would make and/or save money for hospital
- for you: increase professionalism, exposure and income
C. For medical director and nursing director show how quality of care
would improve for patients with hypnosis
2. State what terms you want to work there (in Proposal)
A. supervised or unsupervised
B. scope of activities/where expertise lies
C. employee or independent contractor
D. hours you want to work
E. what type of patients you will see
F. provide research to support your case
G. how you will get paid
3. Send proposal to CEO, MED. Director and VP of nursing or CNO (chief
nursing officer)
4. Send by courier (someone has to sign)
5. Call and tell them that you are sending a proposal
 6. Call CEO to make an appt.
A. iterate benefits to hospital and to patients
7. Bring resume to appt.
8. Bring stack of articles (ones that show expedited healing
- important: if patient can get out of hospital sooner, the hospital saves
money (insurance company will reimburse for set amount of days according to
diagnosis or surgical process, example: for appendectomy, maybe the insurance
covers for 2 days, if the patient has severe pain or needs more healing before
discharge, if they go beyond 2 days, the hospital is not reimbursed for that.)
- another example: if a patient needs an MRI and they are too anxious which
delays the MRI, the MRI could be delayed for use and is not generating money.
3. SERIES of INTERVIEWS
A. see the loss prevention officer (they will ask about malpractice
insurance)
B. negotiate a “hold harmless agreement” (the hospital cannot be sued--we
hold all responsibility
4. Being staff vs. independent contractor
- make more money as independent contractor, but no benefits etc.
HYPNOTIC CHILDBIRTH PREPARATION: PAUL DURBIN
- low on timefor lecture
- see website for protocol (Durbinhypnosis.com)
Warts
- have patient visualize that the blood supply to warts is completely shot
offand the warts just die off and whither away
Bleeding
- have patient imagine or visualize that the blood around an area where there
is a cut is diverted.
For Paul Durbin by Kathy Brannan
CORTISOL STEAL (what happens to our body when we are stressed!)
- The Autonomic Nervous System (ANS) maintains the proper functioning of all
cells of the body. Divided into the sympathetic and parasympathetic nervous
system. Sympathetic nervous system is associated with the term fight or
flight. It excites an organ while the parasympathetic inhibits that organ.
Sometimes both systems work independently of each other. For the most part,
the sympathetic nervous system is involved with stimulating the
organs/hormones glands etc. when there is stress or perceived stress.
Parasympathetic is, for the most part, associated with stimulating healing,
digestion, hormone regulation, immunological functions etc.
When the sympathetic nervous system is activated on a FIGHT OR FLIGHT
levelthe priority (survival mode) is protection of the individual: heart
rate goes up, blood is shunted away from the central body to the extremities.
Most hormonal activity is abandoned (immune system, thyroid, sex hormones etc)
and all attention goes to the adrenals where cortisol is flooded out of the
adrenals to the body so that we have that “superman” ability (heard of
women lifting cars to save trapped child). The cortisol hormone is key to
making us “superman-like” (eyes dilate to see more/better, hearing improves,
body has less inflammation response so we do not have pain, have increased
strength etc.)
HERE IS THE PROBLEM: Cortisol steals the building block hormones that the rest
of the body requires (pregnenalone). The other systems of the body suffer,
weaken, and eventually end up causing disease (whether it is low thyroid, sex
hormone imbalances, immune dysfunction etc.)
HERE IS ANOTHER PROBLEM:
The ANS does not know the difference between real or perceived danger.
Sothe body response to burning dinner or getting in a minor car accident is
the same is if the body was truly in danger (being chased by a mugger/tiger,
running out of burning building). When someone repeatedly goes into a fight
or flightthe adrenals fatigue, cortisol is no longer accessible so that when
you are really needing to fight or flight, you cannot. If someone is to the
point that they have fatigued their adrenals, the ability of the other systems
of the body to utilize pregnenalone is exhausted so there is system-wide
exhaustion.
Another important note. When we are sick (even a cold) we have to force
ourselves to stay in parasympathetic mode (healing)people who go to work
when they are even mildly sick are setting themselves up for a decrease in the
hormones needed to support the immune system.
MORAL OF THE STORY: Don’t stress out!
54. MEDICAL APPLICATIONS: BERYLE SILVERMEN
I. Pain control and anesthesia: A medical referral is needed for all clients who wish help in these
areas. Pain is a symptom, not a problem. It announces that a problem exists. If you remove the
pain, you do not remove the problem, you merely hide it. And this could prove extremely
harmful - in some cases, fatal - to your client. even a headache, for which we Americans down
tons of aspirin every year, is a signal of something wrong. Aspirin wears off in a few hours and
the pain returns - and too much aspirin can cause side effects. In other words, the sufferer usually
must seek medical attention if the pain is severe and persistent. But a good hypnotist can teach a
good subject to keep that pain at bay for an extended period of time. And if that pain is caused
by a brain tumor, for example, medical treatment could be delayed past the point of no return.
The area of the pain determines the licensed medical practitioner from wham referral must
be sought. Usually, the client is asked to see his internist or general practitioner, who may then
refer him further - to a cardiologist, for example, or a neurologist. But it is that licensed member
of the healing arts in whose care the patient finally ends up, who must make the official referral -
if he feels that hypnosis will be of help in his patient's problem. Anesthesiology requires the
concurrence both of the patient's primary physician and the surgeon, if the two are
different...except in the case of anesthesia for dental procedures, where the dentist's referral is
sufficient.
2. Obstetrics and gynecology: Obstetrical use of hypnosis is not limited to hypnotic anesthesia.
Also involved is the client's attitude, the alleviation of morning sickness and other discomforts,
the preparation - especially of new mothers - for the procedures in the labor and delivery rooms,
pain control not only during labor and delivery but for postpartum discomfort as well. Naturally,
the referring physician must be the client's obstetrician. In gynecology, some applications include
alleviation of menstrual discomfort, tolerance of birth control appliances, and some research has
been done in the area of regulation of the menstrual flow itself. Referring physician is the client's
gynecologist.
3. Dermatology and allergies: It has long been suspected that there is a connection between the
emotions and the appearance of certain skin disorders and other allergic reactions. In asthma, for
example, attacks can be shortened and in some cases avoided, through the use of proper hypnotic
techniques. Hives are amenable to hypnotic relaxation and - believe it or not -- certain viral warts
obligingly disappear upon the application of hypnotic suggestion. The dermatologist or the
allergist must be the ones to refer clients for these problems and for other problems in their areas
of specialization.
4. Dentistry: This is a rich field for the use of hypnosis and not only for the control of pain. The
alleviation of fear and anxiety is of as much aid to the client as any anesthetic procedure. Also,
excessive salivation and bleeding can he controlled hypnotically and the gagging reflex can be
subdued. The client's ability to tolerate dental appliances can he increased and healing can be
facilitated, Naturally, the dentist, oral surgeon or orthodontist should refer.
5. Enuresis: Hypnosis has been shown to he extremely effective in such cases. Referring
physician would be either the internist or urologist, whoever is the primary physician in the case.
6. Hyperactivity and blood pressure control: These cannot be considered simply as problems in
relaxation. They must be referred by the attending physician and explicit instructions given for
hypnotic procedures.
7. Psychoanalysis and psychotherapy: Hypnosis lends itself extremely well to use in these
fields. Certain hypnotic uncovering techniques allow the therapist to discover causes for the
patient's problems of which the patient may not be aware - and also enable the patient to continue
to he unaware until the therapist feels he is able to handle the information so elicited. No
uncovering techniques should be handled without the specific prescription of the psychoanalyst or
psychotherapist involved and most should only he handled in their actual presence. Also in this
area are behavior modification techniques, such as conditioning and desensitization procedures.
The latter have proved especially effective in the alleviation of neurotic symptoms and, in the
neuroses, referral is usually sufficient. However, no one untrained or unsupervised should
attempt the treatment of the psychotic. Much experimentation and research has shown that
progress can he made in this area, but it should he done by or in the presence of licensed medical
personnel.
9. Optometrics: Acclimatization to contact lenses is the leading application in this field. Also,
anesthesia for eye surgery and relief for those individuals who are unable to accept eyedrops.
The ophthalmologist or optometrist is the proper party to give the referral.
9 Weight control: Some students may he surprised to find weight control listed with medical
applications of hypnosis. The proliferation of various weight control organizations, spas, groups,
clubs, etc., throughout the country in the past twenty-five years would seem to indicate that this is
a problem that is strictly in the personal area. After all, anyone can decide to diet without going
to the doctor. That's true. And those weight control groups do not require physician's referral.
And they are often cheaper, as well. So you may lose clients for weight control because you
insist that they visit their doctor for a referral. Not true. There are more than enough overweight
people in the world to go around! And you are a hypnotist and therefore more vulnerable. The
weight control groups groups employ no "odd" techniques or "powers" to "force" their clients to
lose weight. The weight control centers do not "invade the mind" of their clients. And if they
provide a diet... well, you can make up your own too. There's no law against it. But there is a
law against the hypnotist dispensing a diet on his own - it's called the medical practice act and it
is alive and functioning in every state of the union. And if your client hasn't come with a
physician's referral (either her general practitioners or internist, NOT her gynecologist! and if the
physical has not approved the diet, either explicitly or implicitly, then that medical practice act
can he used to prosecute you for practicing medicine without a license. You may go along
unmolested for years, making money hand over fist, but the day may come when one complaint
turns the attention of authority your way and all that money you made will have to go for your
defense. Is it really worth it? Because you will have sufficient (in fact, more than sufficient)
clients who will bring you the referral. And as your reputation for success grows, you will have
more and more physicians initiating those referrals - actually sending you their patients
without the patient having first to convince them that hypnosis will work for them. It takes time,
but it's a solid foundation on which to build.

55. APPLICATIONS IN INTERNAL MEDICINE: BERYLE SILVERMEN

The following are only a few of the specific areas in medical practice where hypnosis has
proved to be of value. In general, various hypnotic procedures can be used as facilitators in
almost all areas of medicine. The relaxation technique in particular can be used to relieve patient
anxiety regarding examinations and simple office procedures as well as surgical preparation.
Moderate algesia can be instilled for more painful procedures, such as injections and blood test.
Patient who are taught to carry out both preventive and corrective measures in hypnosis will
usually be much more diligent about he practice of those measures than patients who have simply
been handed an instruction sheet.
More and more physicians are becoming aware of the part that state of mind and attitude
play in the healing process. Here, too, hypnosis can achieve a higher degree of success than the
old fashioned "pep talk".
The acceptance of hypnosis by the medical community has increased greatly over the
past few decades. Hopefully, as more and better-trained hypnotists enter practice and as more
factual information on the benefits of hypnotic procedures is disseminated, this acceptance will
accelerate.
ENURESIS: The first thing that must be established (and this will probably have been
done long before the hypnotist is called in) is to rule out any physiological causes. If a case does
come to you without this having been done, it is up to you to insist that the subject be examined
by a urologist. You must have proper referral for cases of enuresis. Often, psychotherapy is
required and you will be required to obtain a referral from the psychotherapist as well.
This disorder is most often encountered in children. However a significant number of
young adults also suffer from the inconvenience and embarrassment of bedwetting. Statistics
also show it to be more prevalent in males. Emotional factors will often be found to play a
significant part and therapy for this disorder may need to be extended to the parents and siblings a
well.
Many devices and instruments purporting to correct this problem have been developed
and marketed. Some have proved occasionally effective, others are strictly in the realm of
quackery. They range from bells and alarms through drug therapy and electric shock. Even
when such devices are effective, they are usually considered merely placebos to be used - if at all
- as an adjunct to proper therapy. Hypnosis can greatly facilitate that therapy through behavior
control tactics.
Before attempting to deal with a case of enuresis, you should become familiar with some
of the possible emotional factors that cause or perpetuate it. Infants wet their beds - and the
immediate response is attention. The baby is picked up, handled, changed, cuddled and
generally comforted, perhaps fed. The child who feels a need for attention may regress to
bedwetting in order to get it. The birth of a baby may cause this problem to occur in an older
child - usually the next youngest sibling, If the child's need for attention is subsequently
satisfied, the problem disappears on its own as the child matures. But, in some cases, the
behavior is continued. Punishment and ridicule make it worse, especially if the child has reached
the age of five or six with no significant improvement additional factors may be hostility or a
feeling of powerlessness that leads to the child attempting to manipulate his parents by forcing
them to deal with his wet bed. Conflicts within the family also complicate the matter.
Hypnosis is used in conjunction with therapy to facilitate bladder control, to increase
motivation and to change as much as possible the family's attitude and behavior to support and
maintain the correction of the problem.
The hypnotist, as well as the therapist, must gain the child' s trust. Permissive
techniques are usually the techniques of choice, especially if the family attitude has been one of
angry response or punishment. In addition, the hypnotist must make it clear to the child that he is
on the child's side and will support him in every way. That includes, incidentally, giving him
permission to wet his bed whenever he wants. naturally, the suggestion are also given the he can
have a dry bed whenever he wants, too. In fact, the entire course of treatment is geared toward
convincing the child that he is in control. Suggestions that turn the child's attention to the dry
part of the bed, rather than allowing him to focus on the wetness, will have a significant effect.
The parent should also be instructed to praise him for the amount of dryness - "That's wonderful,
Joey, Your bed is almost half dry." would be an example.
Of course, before any improvement can occur, you must have the child's agreement that
he wants to stop wetting his bed. In the prehypnosis period or while the child is in hypnosis,
remarks such as, "How many of your friends still wet their beds," may bring home to him that he
has a problem that most of his friends don't have and helps to establish the necessary motivation
for change. "Would you like me to show you how to stop wetting your bed?" tells him that there's
someone who will help him, that the problem can be solved and, most important in this
relationship between hypnotist and subject, he is not being made to feel guilty about it. It' s just a
little problem and he can learn how to fix it.
Some therapists will require that muscle control exercises be taught in hypnosis in order
to improve bladder capacity and control. Suggestions that the child attempt to hold his urine
during the day for longer and longer times will increase capacity. He may also be given
suggestions that draw his attention to the feeling of a full bladder and he is told that he will be
able to feel it even when he is asleep, so that he will be able to awaken in time to go to the
bathroom and complete the process of urination there. Training can also be given in stopping
and starting urination. This increases not only the actual muscle control but the child's feeling of
control and will greatly facilitate the change.
Imagery techniques that allow the child to see himself (and feel himself) awakening when
his bladder is full and going to the toilet will also prove productive. Naturally, all of the
techniques and imageries that you use must be tailored to the child and his particular needs, as
well as taking into account the work of the primary therapist.
The problem is a bit different with adults. The behavior is of much longer standing and
the unresolved conflicts that led to it and perpetuate it are usually much more completely hidden.
However, the adult can usually be brought to see the relationship between cause and effect on the
intellectual level and this can easily be translated, through suggestion, to methods and
motivations for correction. Also, the adult has come for help willingly, while the child has
simply been brought to you, so the motivational work will be somewhat less complex for the
adult.
Remember, too, that what you will be called upon to do will depend upon the orientation
and techniques of choice of the therapist. Analytically oriented therapy may require other
procedures than a strictly behavioral discipline. Generally, however, you will find a combined
approach tailored to the needs of the subject to be the most effective.
POST OPERATIVE URINE RETENTION: This is a temporary condition, usually
caused by a combination of general anxiety, fear of possible pain during urination, and the trauma
of surgery - often complicated by the insertion of a catheter. Simple suggestions as to the
subject's awareness of bladder fullness and the growing feeling of pressure will lead to unassisted
urination in a very short time. Imagery that allows the subject to "experience" normal elimination
is also helpful. Post-operative constipation can be handled in a similar way. Suggestions should
stress relaxation and normal, comfortable elimination.
PSYCHOSOMATIC GASTROINTESTINAL DISORDERS: It has long has been
accepted that tension, anxiety, aggravation and other stressors can react negatively on the entire
gastrointestinal system. Even when physiological causes are predominant, emotional factors can
work to intensify the symptoms and delay alleviation. Treatment, to be maximally effective,
should be three-fold-medical intervention, certainly; psychotherapy; and hypnosis for relaxation
training. Stress control techniques should also be employed and systematic desensitization
procedures for the relief of anxiety have proved effective. In addition, hypnosis can be used to
implement and maintain the strict dietary programs that are often indicated as part of the medical
treatment.
Some of the more common disorders that respond well to this interdisciplinary program
are peptic ulcer, colitis, constipation, emotional diarrhea, gal bladder dysfunction, chronic
indigestion. bowel spasms and gastritis.
ESSENTIAL HYPERTENSION: The stress factor in essential hypertension has long
been recognized. Therefore, simple relaxation techniques must be augmented with an aggressive
stress control program if long-term results are to be achieved. We all know that, in hypnosis, one
can control heart beat and blood pressure. But it is simply not feasible to expect someone to
remain constantly in hypnosis just to keep his blood pressure down!
A complete examination of the factors that increase the blood pressure must be
undertaken and the hypnotist will find a hierarchy approach extremely effective. Desensitization
to anxiety-producing stimuli will enable the subject to bring his blood pressure under much more
complete control. In some cases, desensitization and stress control, coupled with relaxation
training can obviate the necessity for medication. (Naturally, the referring physician must make
that decision.)
In the case of hypertension, it is sometimes helpful if a simple biofeedback instrument,
such as the GSR, is used to illustrate to the subject that his mind and imagination really can affect
his pulse and heart rate. Some more complex machinery will also register blood pressure
readings so that the subject has even more "proof" that what he is doing is effective. Initially,
the subject may respond negatively, with his vital signs showing increased anxiety rather than
relaxation. Do not mistake this for resistance. The hypertensive patient often responds in this
fashion to the taking of his blood pressure. In fact, it is not unknown for a patient's blood
pressure to go up 10 points just by noticing a frown on the doctor's face. Remember that any
anxiety producing situation has the potential for increasing his pressure -- and the introduction of
a GSR may be equated with the pressure cuff. Reassurance and familiarity will soon reverse the
negative response.
CARDIAC DISORDERS: Whether we are dealing with coronary disease or the
psychogenic cardiac disorders, one of the prime techniques is again hypnotic relaxation training.
Coupled with an effective stress reduction program, it may be all that is required. As you have
already learned in Chapter Eight, stress can be a causative factor in coronary disease.
Certainly prevention is the ideal but it is never too late to teach effective stress control. It could
conceivably increase the odds for a coronary patient.
In the psychogenic disorders, such as arrhythmias, palpitations and effort syndrome, it
may also become necessary to show the subject that he can control his own symptoms by
producing and then removing them in hypnosis. This should, however, only be done under
strict medical supervision. You do not take it upon yourself to bring on arrhythmias, palpitations
or chest pains unmonitored.
In some instances, anesthesia training for control of pain is as effective as medication - the
placebo effect of which for cardiac disorders has long been recognized. In some cases,
medication can be eliminated entirely. In others, hypnoanesthesia can result in reduced dosages
and a correspondent reduction in side-effects.
Hypnosis can also be effective in relieving the fear and anxiety of patients suffering from
what is known as postcoronary syndrome. They can also be taught, through hypnosis, effective
methods of living within the limitations of their disease. This includes assistance for special
diets, recognition of limitations on exercise or exertion, and methods for both mental and
physical relaxation. Their outlook for the future can be enhanced through suggestions that focus
on positive aspects and realistic expectations.
INSOMNIA: Everyone has had the experience at some time or another of tossing and
turning for hours, re-adjusting pillows, sheets and blankets, downing hot milk or brandy, or
picking up the dullest book around in the hopes that it will put you to sleep. Many things can
cause insomnia - worry, excitement over a forthcoming event, the reliving of an aggravating day -
and its seems that the more one tries to sleep, the wider awake one becomes
For the chronic sufferer, these problems ar magnified many times over. Sleeplessness for
them has become the rule, not the exception. Their worry over not sleeping only compounds the
problem. After determining that physiological factors (such as pain) and medications have no
bearing on the problem, the first thing that must be done with the insomniac is to relieve his
major worry - lack of sleep will rarely cause any permanent damage. The next step is to acquire
a complete picture of his actual sleep/awake cycle. Some people consider themselves to be
insomniacs if they sleep less than eight hours a night. Even though they have no trouble
functioning actively and effectively all day, they consider that the four or five hours they usually
sleep are insufficient. Re-education is the only "treatment" needed here. Human individuality is
extremely visible in the variation in sleep patterns. Where you may require a full eight hours,
your neighbor may function just as well on only four - or three -- or six. And the woman down
the street finds herself totally exhausted unless she has had twelve.
Another common fallacy is that all your sleeping should be done at one time - at night.
Not true. There are many people who find they are much more effective during the hours of
night and so - when they can - they prefer to sleep during the day. Others find that two or more
short periods of one to three hours each enable them to function maximally. The problem often
arises from the belief that we must sleep eight hours every night. You should remember
that this belief arose, originally, from necessity. Before artificial lighting, everything stopped
when the sun set. Moonlight was deceptive. You could walk right over a predator and not even
see him. Even later, after the discovery of fire, the limitations still existed except for those few
activities that could be accomplished by the dim illumination of fire or torchlight in the relative
safety of the cave or castle. Until the invention of gaslight and later electricity, the hours of night
largely belonged only to nocturnal animals (often predatory) and those humans who required the
darkness to hide their activities (usually nefarious). And the period before gaslight lasted a lot
longer than the short hundred years or so since. No wonder we're so thoroughly conditioned.
Of course, the demands of a job or family may play havoc with our optimum schedule and
compromise is often necessary. Sometimes it is actually this compromise that causes the problem.
Many cases of true insomnia can be found among people who work "graveyard" shifts or swing
shifts. The latter especially, causing as it does periodic alterations in sleeping schedules, can be
particularly troublesome.
There is no single effective treatment for insomnia, except for the milder cases, where
training in self-hypnotic relaxation often proves completely effective when coupled with
suggestions for falling asleep upon entering the state. Ordinarily we hope our subjects won't fall
asleep when they practice self-hypnosis. In this case, however, we must encourage them to do so.
The chronic insomniac's requirements, though, are much more complex and the exact
techniques and suggestions you will use will depend upon the specific circumstances. First, of
course, is the alleviation of his worry about not sleeping. Then it is often necessary to find out
just what else he is worrying about and determine if suggestion or deconditioning or
desensitization can relieve it. Often stress is a factor and stress control training called for.
One excellent technique is to utilize the "law of reversed effect". ( Kroger, William S.
and Fezler, William D. HYPNOSIS AND BEHAVIOR MODIFICATION. 3. B. Lippincott
Company, Philadelphia, Pa., 1976.) Suggestions are directed toward the necessity of remaining
awake. Naturally, the harder the subject tries to stay awake, the more likely it is that he will fall
asleep.
Another technique is to use imagery to facilitate relaxation. The imagery should be
interesting enough to hold his attention so that his mind doesn't wander back to the things he
usually worries about, but should contain powerful suggestions for relaxation and sleep.
Coupled with strong posthypnotic suggestions, this works well.
Milton Erickson devised a method utilizing the concept of a "contract". He entered into an
agreement with the subject that, every time the subject found herself awake during the night, she
would get up, get out of bed and scrub the kitchen floor. After only a few nights of scrubbing,
she announced that she was sleeping through the night!
Associations should also be taken into account. The bed should be associated only
with sleep. If the subject must take a nap during the day, it should be in the bed. If he awakens
during the night and doesn't fall back to sleep immediately, he should get out of the bed and walk
around, or sit in another room. No eating, reading or watching TV should be done in the bed. Of
course, one night's sleep does not indicate a complete solution, although it certainly prepares the
way and increases the subject's belief that his problem will be solved. The subject's normal
patterns must then be made permanent through conditioning and reinforcement.
The most important thing to remember -- in insomnia or any problem -- is that the best
effects will only be achieved if the treatment "fits" the subject. Tailoring is an art -- in hypnosis
as well as the garment industry.

56. OTHER MEDICAL APPLICATIONS: BERYLE SILVERMEN

BURNS: It should first be understood that a burn is progressive. In other words, the
outer layer of skin is affected immediately, and then succeeding layers become involved over the
next few hours. Naturally, the fewer layers of skin that become involved, the better the chances
of full healing, without the necessity for skin grafts, without scarring and without infection. The
depth of a normal burn, of course, is affected by the degree of heat and the length of exposure.
Applications of ice, which is now the standard emergency treatment in burn cases, slows down
this progressive involvement.
However, experiments (Chapman, L.F., Goodell, i-I., & Wolff, H.G. "Changes in tissue
vulnerability induced during hypnotic suggestion." Journal of_Psychosomatic Research, 1959b, 4,
pp.99-105. and case studies (Ewin, Dabney M. "Clinical Use of Hypnosis for Attenuation of
Burn Depth." Seventh International Congress of Hypnosis and Psychosomatic Medicine July,
1976.) have shown that hypnotic suggestion, initiated as soon as possible after the trauma has a
significant effect on limiting the depth of involvement of tissues an enhancing healing without
scarring or infection. The use of hypnosis, too, results in a decrease in the necessary dosages of
medication for pain, even in severe cases. Icing the burns allows time for a hypnotist to be called
in. The suggestions found to be most effective were, first, for a feeling of coolness in all areas of
the burn, feelings of comfort and healing and suggestions for anesthesia. The subject should
be helped to develop an optimistic and positive attitude and negative and harmful thoughts
are to be avoided. He can be told that the area of the burn will remain comfortable throughout
the healing process, that it will heal quickly and readily, without any infection. Ewin (76) warns
that the word "normal" should be avoided, since, he contends, these victims do have a "normal"
burn.
WARTS: One of the more baffling effects of hypnosis is its success in the removal of
warts. However, when one considers that recent experiments seem to indicate that hypnosis
affects the immune system in various ways (H. R. Hall, 1983) " perhaps it's not so baffling, after
all. Dealing with warts is relatively simple. Direct suggestion has proven extremely effective.
The subject is told that their are "dissolving, becoming smaller and will son disappear entirely."
Self-hypnosis techniques should be used to reinforce these suggestions and imagery such as a
picturing the affected area without the warts or remembering it as it looked before the warts
appeared, can greatly enhance the results. The most important factor here, of course, is the
subject's belief in the effectiveness of the treatment.
HIVES: Considered an allergic reaction, characterized by raised welts, redness and
itching, hives have long been known to be, at least partly, of psychogenic origin. Tension, stress,
anxiety can all combine to produce or aggravate this uncomfortable problem. The usual course of
treatment begins with identification of the allergin. This could be food, something inhaled,
or something encountered topically. Antihistamines and cortisone derivatives prove extremely
effective. In very severe or chronic cases, epinephrine has been used to good effect, and one
might assume from this that it could be possible, through hypnosis, to increase the production of
the body's own epinephrine (adrenaline) to deal with-the problem. Unfortunately, there seems to
have been little or no research in that area. In cases where a particular allergin cannot be
identified, relaxation and stress management techniques can bring swift relief. In addition, the
discomfort can be eased through analgesia production and suggestions of "comfort" in the
affected areas. Some extremely severe and persistent cases may require psychological
intervention.
ASTHMA: Hypnosis has long been used as a method of reducing the severity and
frequency of asthma attacks. Here, again, is a disorder with definite psychogenic
overtones. Anxiety, stress, lack of confidence are factors in asthma, as well as sensitivity to
certain allergens which seem to cause or aggravate symptoms. Allergens and underlying
emotional disturbances must, of course, be dealt with. However, it has been found that hypnotic
treatment helps to raise the subject's sensitivity threshold even without medicinal intervention.
Alleviation of emotional factors should be handled by the appropriate professional.
Desensitized ion procedures utilizing hypnosis have been found extremely effective, in
conjunction with traditional psychotherapy. Hypnosis treatment consists of first stressing the
interrelation between emotions and the autonomic nervous system. The subject..in hypnosis, is
taught proper deep breathing techniques, usually beginning by instructing him to breath in unison
with the hypnotist, who then takes several long, deep breaths, guiding the subject to follow his
example. Suggestions are given that the chest is relaxing, that the bronchial tubes are opening
and that - as the subject learns to breathe properly - his levels of tension and anxiety are lessened
and he feels more and more confidence in himself and in his ability to control his breathing,
whatever the circumstances. It must also be realized that the asthma sufferer, in the threes
of an attack, has a fear of choking, or of smothering due to lack of oxygen. These fears must be
dealt with and the subject assured that he can, himself, control his breathing effectively and
easily.
Imagery is extremely helpful. Construct your image to allow the subject to see or experience
himself in a protected, calm environment -- preferably outdoors, where further imagery of
breathing deeply of the clean, fresh, clear air will enhance the overall effect. Ego strengthening
suggestions are essential, since the asthmatic usually has a deep feeling of vulnerability and
powerlessness. When dealing with children, you may instruct parents in techniques of
re-establishing hypnosis at the onset of asthmatic episodes in order to substantially reduce
the severity and duration of the attack. All subjects for asthma control should be trained in
self-hypnosis reinforcement techniques, and these techniques must be continued for a: long
period of time to avoid any possibility of relapse.
All of the above suggestions, of course, must be coordinated with the primary therapist and
periodic and thorough reports must be issued (as with any medically related problem). Managed
properly, hypnosis can be a`valuable modality for the relief of this frightening and troublesome
disorder. HYPNODONTICS: Hypnodontics incorporates many of the procedures and
techniques you have already learned. The primary use of hypnosis in dentistry is not, as one
might believe, the relief of pain. Chemical analgesics are quick, effective and those used in
dentistry are relatively safe. Of course, for subjects who suffer reactions from the usual
dental anesthetics or who have respiratory problems that preclude their use, hypnotic pain control
is a satisfying alternative.
However, the chief value of hypnosis in other areas - primarily/ the relief, of the anxiety
many patients feel upon setting down in the dentist's chair. It is the expectation or
remembrance of pain more than actual present pain that appears to be the problem. Also, one
must consider that there exists the factor of the violation of the body's integrity. Someone is
forcing instruments into your mouth, causing you discomfort and pain and, to make matters
worse, you are supposed to lie there and take it -- without defending yourself from this violation
-- because he's doing it "for your own good". (A similar emotional reaction can be observed
in gynecologic and obstetric patients undergoing internal examinations.) What makes that
response even more difficult to deal with is the patient's realization that it is an irrational
reaction and I~is subsequent repression of it. Unfortunately, this only serves to intensify
his feelings of powerlessness and anxiety.
Suggestion and imagery, in combination, work very well to deal with this problem.
Suggestion are given to the effect that, since they are now going to be able to control any
discomfort, they will find that the period spent in the dentist's chair is actually a relaxing one.
Glove anesthesia and a method to transfer it to whatever area is necessary is taught and the
subject given a self-hypnosis renewal exercise to practice. He is also taught that, through a
particular signal to himself, he can achieve the hypnotic state whenever he sits down in the dentist
chair. Additional suggestions and imagery should incorporate the situation and sounds of the
dental office. For example, the imagery of riding in a train could be used for the sound of the
drill. Suggestions should include those for being able to keep the mouth open comfortably for
whatever period of tin~e is necessary and also the suggestion that the subject will find the
experience so comfortable and relaxing that he will look forward to his next appointment.
And keep in mind that the subject who tells you that they never feel anxious or fearful
until after the novocain has been administered, may very well have no more serious problem than
a sensitivity to the epinephrine that dentists combine with the novocain to enhance its effect. (See
Chapter Six,) If, once the subject is informed of this chemical cause for their anxiety, he still
finds that the feeling is too troublesome, he can certainly ask the dentist to to administer the
undiluted form of the anesthetic. He should understand, however, that he will have to receive a
larger dose (perhaps additional injections) in order to achieve the same effect as from the
combined form.
Other areas in hypnodontics include elimination of an oversensitive gag reflex. Work in
the area ranges from fairly simple direct suggestion for procedures such as X-ray and
impressions, to a more complected de-sensitization and conditioning technique when gag reflects
interferes wit the patient's ability to adapt to prosthetics. In the later case, the best procedure is
to start working with the subject before the dentures have been inserted. Begin with suggestions
that he will look forward to his new teeth and find it very simple to adapt to wearing them
comfortably and effectively. In most cases, that may be all that is necessary. However, if the
dentures have already proven to be a problem, it is best to see the subject over several sessions,
with suggestions to increase the time that he can keep the dentures in without gagging. If he can
only keep them in for 20 minutes, suggest that he will be able to keep them in for 30. He is to put
them in for that length of time several times a day. At the next session, increase the interval to 45
minutes, and so on. In addition, suggestions and imagery should be directed toward making the
wearing of the dentures a positive, rather than a negative experience. If the person has had a long
history of dental problems, you can use the suggestion that now that he has his dentures, he will
no longer have to endure discomfort in the mouth area and he will look better, feel better and be
able to chew better.
Keep alert, however, for any lack of progress. Sometimes, the loss of the teeth can be a
rather traumatic event and you may be dealing with more complicated emotional problems that
will require proper therapy. Lack of progress - given that you have proceeded competently -- is
usually your first clue.
Finally, you can use hypnosis to control bleeding and to control or completely
eliminate salivation during dental procedures. The latter leads to a much more comfortable
process for the patient and the dentist both, since there is usually no need for the suction device to
be kept in the mouth or for the dentist to constantly have to Stop to dry the area.
Naturally, you will need the proper referral from the subject's dentist and you should keep
the dentist informed regarding the procedures you are using and the results you have obtained.
Another area where hypnosis can prove extremely useful is in the treatment of
bruxism. This is descriptive of excessive clenching and grinding of the teeth, usually during
sleep. In severe cases, it causes gum irritation and can lead to loosening and loss of teeth. In
addition, the sound of teeth grinding can be extraneously annoying to any sleeping partner.
The most effective treatment begins with relaxation training. The subject is taught to relax
the jaw "on cue". Conditioning proceeds to initiate this relaxed state just before sleep and to
maintain it through the night. Sometimes it is necessary to use a p.h. to enable the subject to
awaken should the jaw become tense and then, after initiating the relaxation response once more,
to fall asleep again easily. Many subjects do not even remember the awakening.
What they do notice, however, is that their jaws are no longer sore and tender in the mourning
and the gum irritation disappears. Finally, hypnosis has proved to be a great help in
establishing and reinforcing good oral hygiene habits.
OPTOMETRICS CS: The applications of hypnosis in optometric is often thought to be
confined simply to facilitating habituation to contact lenses. Although this is certainly one of the
major areas, it is by no means the only one.
In fact, before the invention of contact lenses, success was being achieved in reducing the
degree to myopia through hypnosis. The methods used were pure suggestion and, in some cases,
regression to periods of perfect vision. Both approaches were found to elicit a high degree of
success. However, suggestion coupled with imagery seems to be able to do the job just as well as
more radical techniques. The imageries should be carefully constructed to depict sights which
the subject finds interesting and beautiful. For example, he is told, in hypnosis, that he is
standing directly in front of a beautiful painting (one of his favorites or one he is particularly
familiar with). You might also use a photograph of a child, friend or parent but only in the
absence of negative feelings for the object of the photo. The reason for this is understandable in
light of the theory that much of myopia is psychosomatic. The subject is then guided to
examine the picture, and suggestions are given that he sees every detail perfectly. He is then
instructed to stand a little further away (within the imagery) "in order to see it more clearly".
(Remember the truism in the field of art -- you have to stand back from a painting to really see it
properly.) As soon as he reports that he can see all the details, he is again moved back. This
proceeds until he can stand at a distance of about 20 feet and still report seeing the picture with
clarity. Suggestions are given throughout the imagery that this heightened visual acuity will
remain with him even after the trance is terminated; that hypnosis enables him to readjust the
focussing ability of the eye so that he will be able to see much better when he emerges. In most
cases, there will be a significant improvement (barring the presence of astigmatism) and there
have been cases reported where vision is 20/20 in one or both eyes after hypnosis treatment.
The victims of glaucoma can also be helped through hypnosis. Hypnotic intervention has
been known to significantly reduce intra-ocular pressure and pain. Suggestion, coupled with
analgesia training, is extremely effective in such cases.
Excessive tearing, tics and squints also respond well to a combination of direct suggestion
and imagery and improvement is usually observed within tow or three sessions.
There has been some work in correcting amblyopia, the condition commonly known as
"lazy eye", as well as in training strabismic patients to achieve binocular correspondence without
surgery. In the latter condition, the subject focuses one eye on a stationery object, while they are
instructed to follow the movement of a finger or pencil with the other eye. The object is then
slowly moved toward the stationery eye until both eyes are focussing on it. This is repeated as
many times as necessary, in hypnosis. A good degree of depth is necessary in order to maintain
hypnosis with the eyes open, although in some cases so-called "waking hypnosis" has proved just
as effective, Suggestions are given that it is easier and easier to focus both eyes on a single object,
that the muscle of the "wandering" eye is strengthening more and more each day.
Some people find it impossible to maintain an open-eye position for the insertion of eye
drops. While opthamologists have certain techniques which work very well with patients in their
offices, the patient who needs drops at home will find it extremely difficult - if not impossible -
to insert the drops themselves or allow anyone else to do it. Training in lid relaxation, coupled
with suggestions that the drops will feel comfortable, wonderful, soothing, etc., is often effective
in only one or two sessions. The subject is usually instructed to open his eyes hold them open
for a certain period and then close them. He can be told that he will see nothing but a blur while
his eyes are open and will remain deeply hypnotized, or a particular scene can be suggested for
him to focus on so that he is unaware of the sight of something coming toward his eye. Then, the
subject is taught self-hypnosis or a simple reinduction technique. He is told that, when it is time
to take his eyedrops, he will lean his head back, enter hypnosis and see - in his imagination - a
beautiful rainbow in the sky above him. He will then be able to open his eyes wide "in order to
see the rainbow more clearly" and will continue to watch the beautiful sight until the drops have
been applied. He will then blink once or twice and emerge from hypnosis feeling wonderful and
relaxed and his eyes will feel much more comfortable. The combination of muscle
conditioning and imagery training seems to work very quickly in ridding these subjects of their
problem. Even subjects who must administer the drops themselves can be taught a simple
dissociation technique whereby the hand that is administering the drops seems to belong to
someone else and, although they will have no difficulty inserting the drops, they will remain
detached from their hand and unaware of the sight of the evedropper.
Hypnosis can also enable patients to more quickly adjust to bifocals or even regular
glasses. A series of simple suggestions, together with appropriate imageries, can help these
people in a very short time, usually completely eliminating the dizziness and headaches that often
accompany the problem. But, of course, it is for contact lens fitting that hypnosis seems to be best
known. And it can be extremely effective, especially if the hypnosis is begun prior to the initial
fitting. Treatment is begun by enhancing the subject's motivation for the wearing of lenses.
Here is where your initial interview will pay big dividends. Through hypnosis, the subject is
brought to the point where he eagerly anticipates his first fitting. The instruction for inserting
and removing the lenses is done in hypnosis and the subject then "practices" in imagery.
Suggestions are given that he will be able to easily insert and remove the lenses in the "waking"
state as well and that, every time he does so, he will get better and better at it and it will become
easier and easier. A self-hypnosis reinforcement technique should be taught so that the subject
can reinforce the image of himself inserting and removing the lenses a number of times before he
actually begins to practice with them. He should perform the reinforcement exercise daily.
It must also be remembered that you will be changing what is actually a normal
reflex. The eye normally will blink closed when something approaches it. You must convince
the subject that there will by no discomfort at all and that it will be easy for him to hold his eye
open as wide as necessary and to easily perform both insertion and removal. Some subjects
will also need motivation in the proper care and cleaning of the lenses. Quite often, the
necessity for daily care can become so much of a chore that the lenses are eventually abandoned.
Of course, with extended wear lenses now on the market and constantly being improved, this is
less of a factor.
Acclimatization to the lenses can also be facilitated through hypnosis. The subject is told
that he will feel perfectly comfortable for the entire period during which he is to wear them and
he will be aware when it is time to remove them, as he has been instructed by the optometrist or
opthamologist. Suggestions are given that each day, as the time of wearing is extended, he will
continue to be completely comfortable all the time he is wearing the lenses. It is very important,
however, that you refrain from any kind of suggestions for anesthesia in the eye. The subject
must be able to feel the 'presence of any foreign bodies, dust etc., beneath the lenses or lid so that
he can remove them and proceed with proper cleaning. Neglect can lead to serious problems,
including extremely painful conjunctivitis.
AREAS FOR FURTHER STUDY: No single volume could possibly contain in any
detail all of the medical applications for hypnosis. It is suggested that the student investigate
other areas than those covered here, through other books, journals and seminars. In particular,
the areas of hypnosis in chiropody and chiropractic are fairly well documented.
The use of hypnosis in psychology is a particularly rich field for study but you must
remember that the techniques of psychology are only to be applied by a psychologist or
psychiatrist and your function, as a professional hypnotist, is simply to assist him and to carry out
the specific instructions of the referring specialist.
The techniques that you will have learned by the conclusion of this course should enable
you to create effective management plans for almost any problem that might appear in your
office, but continued study and the expansion of your hypnosis horizons is an absolute must if
you are to continue in a successful and creative practice.
(Ha11, H.R "Hypnosis and the immune system: A review with implications for cancer and the
psychology of healing." American Journal of Clinical Hypnosis, 25, pp.92-103.)

57. WHY ARE MEDICAL PROFESSIONALS SEEKING ADVICE ABOUT HYPNOSIS:

PRUDENT PRESS AGENCY: JUNE 2005
Find out why more and more doctors, dentists, nurses, nurse practioners, allied healthcare
professionals are turning to hypnosis as a non-invasive tool for treatment. Medical professionals
are exploring deeper connections of mind-body interactions. They look to hypnotic techniques as
tools to engage their patient’s mind in alleviating their own discomfort, pain, anxiety, and
overcoming their unhealthy habits. It can be used in the emergency room to set a fracture or
suture a wound painlessly. It can be used in the dental office to decrease anticipatory anxiety and
have pain-free dental work. It has been used by emergency services in helping to stabilize
accident victims.
These physicians, dentists, nurses, nurse practitioners, physician assistants, and allied
health care professionals are attending “Medical Hypnosis, A Practicum in Rapid Hypnotic
Applications”, a cutting edge continuing education workshop by a leading Medical Doctor, and a
leading board certified hypnotherapist. This course is being offered on July 22-24th, 2005, and
again on September 23-25th, 2005 in conjunction with the Office of Continuing Medical
Education of the University of Nevada School of Medicine in Las Vegas, Nevada. Read more
visit the web site: www.unr.edu/cme/calendar.html
This course will provide the skills necessary for the rapid application of hypnotic
suggestion, induction in any health care situation. It works very effectively, in any busy practice
or setting, for adults and children. This focused medical hypnosis course teaches techniques and
approaches that will take (with skill and preparation learned) less than a few minutes to apply to
the daily array of problems normally encountered in practice. The emphasis is on participants
learning, and demonstrating their new skills. Participants also receive approved continuing
medical education credits (15.5 CME credits for physicians, dentists and dental hygienists under
NAC 631.173 3E, 18.6 hours NCE for nurses).
Hypnosis is becoming more popular as people learn of its benefits, and for the medical
community as there is more and more evidenced based support. Patients have reported better
outcomes (positive responses), less dependency on or the use of sedative narcotic medications and
appreciate more of the personal attention they have received.
The American Medical Association (AMA) since 1958 has recognized hypnosis as a safe,
legitimate approach to medical and psychological problems. This recognition is mirrored by the
British Medical Association (BMA) in their statement that hypnosis is a viable therapeutic tool.

58. HYPNOSIS IN CONTEMPORARY MEDICINE REVIEW: JAMES H. STEWART, MD:

MAYO CLINIC PROCEDURES: APRIL 2005: [From the Department of Internal Medicine and
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Jacksonville, Fla.
Individual reprints of this article are not available. Address correspondence to James H. Stewart,
MD, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 4500 San Pablo Rd,
Jacksonville, FL 32224 (e-mail: stewart.james@mayo.edu). © 2005 Mayo Foundation for
Medical Education and Research Hypnosis in Contemporary Medicine. JAMES H. STEWART,
MD]
Hypnosis became popular as a treatment for medical conditions in the late 1700s when
effective pharmaceutical and surgical treatment options were limited. To determine whether
hypnosis has a role in contemporary medicine, relevant trials and a few case reports are
reviewed. Despite substantial variation in techniques among the numerous reports, patients
treated with hypnosis experienced substantial benefits for many different medical conditions. An
expanded role for hypnosis and a larger study of techniques appear to be indicated. Mayo Clin
Proc. 2005;80(4):511-524 [AMA = American Medical Association; IBS = irritable bowel
syndrome; PET = positron emission tomography]
As alternative treatments for medical conditions become popular, contemporary medicine
is being challenged to take a more integrative approach. The National Institutes of Health is
supporting clinical trials of complementary and alternative medicine, which includes hypnosis.
To determine whether hypnosis has a role in present day medicine, this review evaluates relevant
clinical trials involving hypnosis. Some important case reports and reviews are included to give
insight into the current and past practice of hypnosis in medicine by professionals. This review
pertains to the use of hypnosis for conditions not believed to be primarily psychological (eg,
depression, anxiety, attention deficit disorders, and phobias), although the potential for a
psychological basis exists for many of these conditions. The intent of this review is to stimulate
greater interest in and understanding of the art and science of hypnosis.
The studies reviewed herein were identified by searching the MEDLINE database for
articles published between 1966 and 2004; the key words hypnosis, hypnotism, and hypnotherapy
were used, as were the specific conditions studied. All studies relevant and applicable to the
treatment of the conditions evaluated were reviewed critically and were subsequently included if
their conclusions were supported by the data given. Results of controlled trials, review articles,
and case reports are presented. In this review, P<.05 was considered statistically significant
unless otherwise indicated.
WHAT IS HYPNOSIS? Although no consensus definition of hypnosis exists, the studies
reviewed indicate that hypnosis involves the induction of a state of mind in which a person’s
normal critical or skeptical nature is bypassed, allowing for acceptance of suggestions
Characteristics of Hypnosis and a Hypnosis Session: Hypnosis is a state of mind that
occurs naturally or is established by compliance with instructions and is characterized by
* Focused attention
* Heightened receptivity for suggestions
* A bypass of the normal critical nature of the mind
* Delivery of acceptable suggestions
* A hypnosis session consists of
* An explanation of the process and consent
* Induction of the trance state
* Deepening of the trance
* Assessment for adequacy of the trance
* Hypnoanalysis—an investigative step (if necessary)
* Delivery of acceptable suggestions
* Emergence from the trance state ]
This state of heightened receptivity for suggestions (induction) is developed with the
cooperation of the patient and is followed by the delivery of positive suggestions.1,2 Hypnosis is
also described as an “attentive, receptive focal concentration,” with the trance state being a
“normal activity of a normal mind,” which occurs regularly, as when reading an absorbing book,
watching an engrossing movie, daydreaming, or performing monotonous activity.3 A common
assumption is that, during hypnosis, the subconscious mind is in a suggestible state while the
conscious mind is distracted or guided to become dormant.
Hypnosis may be compared with meditation, which generally is considered to involve a
quieting of the mind. Meditation may be self-directed. If suggestions are given to achieve a
desired effect, meditation may qualify as hypnosis depending on the state achieved, particularly
because hypnosis can occur naturally (ie, without formal induction).
No attempt is made herein to explain the mechanism of hypnosis for causing the intended
changes as a result of the suggestions given. If positive suggestions for change are accepted by
the mind, any physiological changes that follow defy explanation by contemporary medicine,
although complex explanations have been proposed.4
 IS HYPNOSIS REAL? Various methods have been used to determine whether hypnosis
is a separate state, distinct from sleep, or if the patient is simply complying with the practitioner’s
instructions. 3 Volunteers in whom hypnosis was induced were evaluated by positron emission
tomography (PET). When subjects were given the suggestion to see color, the color perception
areas of their cerebral hemispheres were activated whether they were looking at color or
black-and-white patterns. When subjects were given the suggestion to see black and white, the
color perception areas of the brain showed decreased activity regardless of what the subjects
were viewing. This implies that hypnosis is not a process of simply following instructions but
actually involves a change in the brain’s perception.5
Studies have used other methods, such as electrodermal skin conductance, to evaluate
whether patients in whom hypnosis was induced were “lying” or simply complying with
instructions.6,7 Unpleasant sensations were noted on PET to cause activity in the anterior
cingulate cortex. Hypnosis induced before painful stimuli caused a decrease in the subjective and
objective perception of the pain as noted on the scans.8 Another study using PET in hypnotized
persons showed activation of a region in the right anterior cingulate cortex (Brodmann area 32),
an area activated when sound is heard or when sound is suggested in hypnosis but not when
sound is simply imagined. This implies that the mind registered the hypnotic hallucination as if it
were real.9 Other studies using PET support the occurrence of distinct changes in the brain with
hypnosis.10By using electroencephalography, changes were seen during hypnosis that could not
be evoked by waking imagination.11
Hypnosis does not act as a placebo (administering a pharmacologically inert substance).12
Studies using hypnosis for anesthesia indicate that pain relief from hypnosis is different from a
placebo effect with evidence that the pain is not perceived rather than simply experienced with
greater tolerance.13-15
Hypnosis is not a state of sleep.16 Relaxation generally is believed to be a part of
hypnosis, but it need not be. Volunteers underwent hypnotic induction with use of either the
traditional method involving eye closure, relaxation, and drowsiness encouraged by suggestion or
an active, alert method involving riding a stationary bicycle while receiving suggestions for
alertness and activity. Equally receptive trance states were achieved by the relaxation and alert
methods, and examples were presented of other active, alert trance states.17 Of note, hypnotized
patients may experience considerable anxiety and other emotions while reliving an event with age
regression without coming out of the trance state.18
Age regression, inducing a person through hypnosis to relive events that occurred earlier
in life, is believed to differ from enhancement of memory, but scientific evidence for this
assertion is limited. Age regression may be helpful to treat conditions in which an adverse
behavior is believed to be based on a past event; however, its validity is controversial. The
process of regression may generate strong emotions and can possibly alter a memory or create a
false memory. Studies about the use of age regression have reported the development of infantile
neurologic reflexes on regression to infancy, age specific handwriting and vocabularies on
regression to childhood, and knowledge of the appropriate day of the week of events in the period
to which the person was regressed.19,20
A BRIEF HISTORY OF MODERN HYPNOSIS: The era of modern hypnotism began
with the Austrian physician Franz Anton Mesmer, who is said to have brought animal magnetism
(the term for hypnosis at that time) to France in 1778. Because many people were seeking
treatment from Mesmer and his colleagues, King Louis XVI of France commissioned Benjamin
Franklin and others to investigate the practice. After extensive testing, the commission
discredited Mesmer, indicating in their report that any medical benefit was not from magnetism,
as publicized, and that mesmerism involved only “imagination, imitation, and touch.” One
account indicates that Thomas Jefferson obtained copies of the report to help prevent the spread
of mesmerism to America.21,22
This setback for hypnosis led to a deeper, more covert evaluation of the process. James
Braid, using eye fixation techniques, was able to produce a trance state and later discovered the
importance of adding suggestions. He is credited with introducing the term hypnotism, although
he favored monoideism because he realized that the state differs from sleep.3 In the 19th century,
the English surgeon John Elliotson and the Scottish surgeon James Esdaile performed hundreds
of surgical procedures with use of hypnosis for anesthesia and with extremely low morbidity rates
for the times.22 Almost simultaneously with the reports of success with hypnosis, ether and
chloroform became popular and displaced the use of hypnosis for anesthesia in surgery.23,24
Twentieth-century hypnosis was influenced by the contrasting techniques of indirect suggestion
intermixed with psychoanalysis promoted by Milton H. Erickson and of direct suggestion and
induction of a deep trance state for age regression espoused by others.1,2,22
ACCEPTANCE OF HYPNOSIS IN MEDICINE: Acceptance of hypnosis in medicine
has evolved slowly. In 1847, the Roman Catholic Church indicated acceptance of hypnosis,
noting that hypnosis was not morally forbidden, and in 1956, Pope Pius XII noted its use for
childbirth and indicated the need for proper precautions as for other forms of medical treatment.
Other religions (with exceptions) have shown acceptance, with ministers of different faiths
trained in and using hypnosis in their practices.25
In 1958, the American Medical Association (AMA) published and approved a report from
a 2-year study by the Council on Mental Health. The report indicated that there can be “definite
and proper uses of hypnosis in medical and dental practice” and recommended the establishment
of “necessary training facilities” in the United States.26 The British Medical Association had
issued its report on hypnosis in the British Medical Journal in 1955, with which the AMA’s
Council on Mental Health indicated “essential agreement.”3,26 The American Psychiatric
Association, in a position statement approved by the Council of the Association in 1961,
indicated that “hypnosis has definite application in the various fields of medicine” and that
physicians would be seeking psychiatrists for training in hypnosis.27 A National Institutes of
Health panel issued a statement published by the AMA in 1996 indicating that there was “strong
evidence for the use of hypnosis in alleviating pain associated with cancer.”28
RISKS OF HYPNOSIS: A review of the literature in the late 1980s documented a few
cases of patients who displayed “unanticipated” adverse behavior after hypnosis.18 Adverse
reactions or hypnotic complications consisted of “unexpected, unwanted thoughts, feelings or
behaviors during or after hypnosis which are inconsistent with agreed goals and interfere with the
hypnotic process by impairing optimal mental function.” The most common suspected adverse
reactions included drowsiness, dizziness, stiffness, headaches, anxiety, and, occasionally, more
serious reactions such as symptom substitution and masking of organic disorders. These adverse
reactions were attributed to deficiencies in the hypnotist’s techniques, such as not realizing that
suggestions in hypnosis are accepted literally, bringing the patient too rapidly out of trance, using
age regression inappropriately, not dispelling preconceived expectations of negative
consequences of hypnosis before initiating the session, or not prescreening for certain
psychopathology.18 A more recent review indicated that hypnosis is associated with a risk of
adverse effects, including headache, dizziness, nausea, anxiety, or panic, at levels that might
occur in other test or experimental settings without hypnosis. A prehypnosis discussion session
with the patient was advocated.29 It has been argued that informed consent is not needed before
casual or brief techniques involving helpful semantics since the use of careless and harmful
comments from health care workers has no such prerequisite.30 Hypnosis generally is considered
a “benign process” with “few contraindications”; however, pseudomemories can be created if
leading questions are asked during the investigative phase of hypnosis.16
EVALUATION OF THE CLINICAL TRIALS: Evaluation of clinical trials of
hypnosis is complicated by the nature of hypnosis. The gold standard of a randomized,
double-blind, controlled trial is virtually impossible because cooperation and rapport between
patient and therapist are needed to achieve a receptive trance state. The few hypnosis trials that
were blinded involved suggestions delivered by audiotape during surgery while patients were
under general anesthesia (assumed to be a hypnotic like state). Evaluation of these trials is limited
by the lack of standardized techniques for hypnotic induction, evaluation of the level of trance,
delivery of suggestions, or number and length of sessions. Although the state of hypnosis
involves increased receptivity to acceptable suggestions, the methods of delivering the
suggestions vary substantially. In some trials, researchers gave suggestions only for relaxation or
no suggestions at all. In other trials, researchers indirectly suggested that patients allow a feeling
or imagination rather than directing them to have a certain feeling, which relied on patients
understanding the intention. In some studies, researchers gave suggestions only to distract the
mind during an otherwise uncomfortable procedure or condition. Thus, it is reasonable to
consider the appropriateness of judging hypnosis by the best or worst results, with use of
averaging, or by meta-analyses.31-34 Indeed, although better methods would be expected to
achieve better results, many trials gave too few details about technique to allow comparison. If
the most efficacious hypnosis techniques were known, a more representative review of the state
of the art may include only trials using such techniques.
A deficiency of the trials reviewed is the lack of randomization of patient and practitioner
variables that may affect outcome. Patient characteristics such as fear, attentiveness, interest,
expectation, suggestibility, motivation, desire, and belief in hypnosis may alter outcomes.
According to the literature, vital practitioner characteristics include training and experience and
the ability to induce trance, to properly word suggestions, and to establish the necessary states of
expectancy, rapport, and motivation (if not already present).1,24,35 Furthermore, results from
clinical trials may not accurately estimate the effectiveness achievable in an office setting with
willing, expectant patients. In clinical trials, many patients are likely to be unwilling,
unmotivated, or skeptical about hypnosis. Hypnosis appears to be “particularly useful and yields
better results when it is specifically requested by the patient.”16 Consequently, clinical trials may
underestimate the benefits of hypnosis compared with those obtainable by a proficient,
experienced hypnotist.
CLINICAL TRIALS OF HYPNOSIS OF VARIOUS ILLNESSES:
ALLERGY: Allergic or hypersensitivity reactions usually are not believed to be
psychosomatic and thus are generally considered as unable to be influenced by suggestion. These
highly complex reactions involve IgE antibodies, activation of mast cells and basophils, and
release of chemical mediators of inflammatory and immune responses. Some early literature
suggested that many allergies might have an emotional basis and thus be treatable by hypnosis.2
Subsequent studies have shown that hypnosis may alter the body’s physiological response to
various stimuli. In a study of 18 volunteers selected for their hypnotizability, immediate-type
hypersensitivity reactions were suppressed in 8 of the 12 patients given brief direct suggestions in
hypnosis.36 In another trial, hypnotic suggestions for relaxation reduced helper/inducer cell
percentages, helper/suppressor cell ratios, and natural killer cell activity compared with
prehypnosis baseline values.37 Other researchers have shown the positive effects of social
support on natural killer cell activity and cortisol levels and the adverse effects of stress in
patients with cancer, which has implications for cancer progression.38
Skin prick testing for type I (immediate) hypersensitivity and testing with purified protein
derivative (in persons vaccinated previously for tuberculosis) for type IV hypersensitivity were
performed before and after hypnosis.39 Patients in the hypnosis group (but not the control group)
who were given suggestions for increasing or decreasing skin reactions were able to increase the
flare and wheal reactions on 1 arm and decrease the flare reaction on the other, with a significant
difference between the 2 arms. The same authors later studied volunteers selected for their high
hypnotizability and evaluated their reactions to histamine pin pricks and laser-induced burn
pain.13 Hypnosis was associated with a significant reduction in both pain and flare reactions.
ANESTHESIA FOR PAIN RELIEF: Numerous studies have shown benefits of
hypnosis for pain relief (Table 240-46). In a study with experimental pain stimulation by pin
prick and laser heat, direct suggestions in hypnosis resulted in a significant decrease in pain,
measured subjectively and objectively by means of pain-related brain potentials.13 In another
study, highly hypnotizable (based on susceptibility testing) volunteers given painful electrical
stimulation were able to increase or decrease their perception of pain as noted on event-related
somatosensory potentials.14
The mechanism of analgesia from hypnosis appears to differ significantly from a placebo
effect and from induced endorphin production (endogenous opiates).15 The morphine
antagonist naloxone does not block the pain relief afforded by hypnosis. In a small study, pain
was produced in highly hypnotizable volunteers by inflating a blood pressure cuff on the upper
arm to 250 mm Hg followed by exercise and leaving the cuff on for 10 minutes.40 All patients
reported a pain level of 8 or more (on a scale of 0 to 10, with 10 being the most intense) before
hypnosis.
With hypnosis, all reported a pain level of 0, and this relief was not altered substantially
by administration of naloxone. Hypnosis for pain relief in the clinical setting appears to have
similar benefit. In a randomized, double-blind (for the use of naloxone) crossover study, patients
with neuropathic pain were taught self-hypnosis.41 Considerable relief from pain was achieved
by hypnosis, and this relief was not reversed by administration of naloxone. In patients with low
hypnotizability, hypnosis was equal to placebo for pain relief, whereas highly hypnotizable
people benefitted more from hypnosis than from placebo.12 This finding indicates that hypnosis
involves at least 2 effects: a placebo-type effect and one in which suggestion distorts perception.
Pain relief afforded by hypnosis differs from that induced by acupuncture.15 Twenty
volunteers were evaluated for the level of pain caused by 2 different experimentally induced
methods and were treated subsequently with hypnosis, acupuncture, medication, or placebo.42
Hypnosis with direct suggestions for pain relief produced significant pain relief compared with
placebo (P<.001) and gave the best results of all the treatments. The most favorable results with
hypnosis tended to be in those who were highly hypnotizable, whereas the results with
acupuncture were not related to hypnotizability. Patients with head and neck pain studied in a
single crossover trial served as their own controls before and after treatment with hypnosis or
acupuncture. 43 Both treatments were effective in relieving pain, although patients believed to
have psychogenic pain fared better with hypnosis, and those who were apprehensive about
hypnosis had less benefit.
Many trials have evaluated hypnosis for pain relief for burn injuries. A review of the use
of hypnosis for severely burned children encouraged its use for pain and prevention of regressive
behavior and included case reports.47 Clinical trials have shown significant pain relief with
hypnosis in patients with burns, many of whom were taught self-hypnosis for pain control.44,45
In one trial, patients were treated with a single session of hypnosis. Those with severe pain (but
not those with less pain) noted significant pain relief compared with controls.48 As in some other
studies, younger patients tended to have better results.44 Adult patients with recalcitrant
temporomandibular joint pain treated with hypnosis with suggestions for jaw relaxation noted
significant pain reduction, which persisted at the 6- month follow-up.46
A meta-analysis published in 2000 evaluated the use of hypnosis for pain relief in the
preceding 20 years.31 That review of 18 studies indicated that hypnosis offered a moderate to
large analgesic effect for many types of pain, which met “the criteria for well established
treatment.” Because hypnosis was noted to benefit most patients, a broader application of its use
was advocated. A 2003 comprehensive review of hypnosis for pain relief found it superior to
placebo for acute pain and at times superior to pain relief achieved by other means.15 Hypnosis
for chronic pain was concluded to be a viable option, with the understanding that pain therapy
requires “multidimensional assessment and treatment.”
ANESTHESIA FOR SURGERY: Hypnosis has been used as the sole agent of
anesthesia for both major and minor surgical procedures. In the 19th century, John Elliotson and
James Esdaile reported their successful use of mesmerism for anesthesia in hundreds of
operations, with decreased mortality compared with other methods. Nonetheless, they were
censored by the medical community at the time for unacceptable techniques. Instead, chloroform,
nitrous oxide, and ether won acceptance for general anesthesia.49
The use of hypnosis as the sole agent for anesthesia has been virtually abandoned because
of the availability and dependability of pharmacological agents; nevertheless, a few such cases
have been described in contemporary medical literature. Hypnoanalgesia was described for repair
of atrial septal defects in 3 patients and for mitral commissurotomy in 4 patients, with hypnosis
as the sole method of anesthesia for 1 of the patients.50 The patients were able to open and close
their eyes on command during surgery and to extubate themselves postoperatively. An oral
surgeon documented his own cholecystectomy performed with use of only self-hypnosis for
anesthesia.51 He walked back to his room after surgery and returned to work on the 10th
postoperative day.
A 1999 review of more than 1650 surgical cases using hypnosis combined with other
methods for conscious sedation promoted the safety and patient comfort afforded by hypnosis.49
This form of anesthesia was used instead of general anesthesia for a broad range of surgical
procedures, including thyroidectomy, cervicotomy for hyperparathyroidism, breast augmentation,
neck lift, correction of mammary ptosis, nasal septorhinoplasty, débridement with skin grafting,
maxillofacial reconstruction, and tubal ligation. The authors concluded that hypnosis prevents
pharmacological unconsciousness, allows patient participation, and may allow a faster recovery
and a shorter hospital stay but requires some changes in the atmosphere of the operating room
because of the conscious state of the patient. Other studies support the multiple benefits of
hypnosis as an adjunct to conscious sedation for many types of surgery49,52 (Table 352-56).
 Brief hypnosis has been documented to be beneficial for anesthesia before excisional
breast biopsies53 and invasive radiological procedures.54 Similar benefit was afforded to patients
taught self-hypnosis, which was used during radiological procedures.55 In a randomized trial,
patients hypnotized before and during coronary artery angioplasty required less pain medication
and had a mild increase in tolerance to balloon-induced ischemia56 (Table 3). Benefit was
observed, presumably from the relaxed state and from distraction, without specific suggestions
given for not feeling discomfort.
DERMATOLOGY: Many trials have evaluated hypnosis for eliminating warts (Table
457-60); however, evaluation is complicated by spontaneous remission rates of 20% to 45% and
by accounts of warts being produced by suggestion.61,62 Fourteen patients with bilateral warts
for at least 6 months were given direct suggestions for only unilateral clearing of the warts.57 Of
the 10 patients who were able to reach at least a moderate depth of hypnosis (defined in the
study), 9 (64% of the total group) achieved complete or near-complete resolution of the warts at
3-month follow-up. The warts on the contralateral side were not affected except in 1 highly
hypnotizable person whose contralateral warts resolved 6 weeks later. Hypnosis was advocated to
avoid pain and scarring, reactions to anesthetics, and the need for wound care and special
equipment. The technique may be particularly applicable for warts in sensitive or inaccessible
areas.
In a case report of 41 consecutive patients with predominantly refractory warts, direct
suggestions in hypnosis, followed by age-regression techniques for any nonresponders, resulted in
a cure rate of 80% with no recurrences.58 In volunteers with warts on the hand, a significant
difference was seen in the rate of remission in those treated with hypnosis (50%) compared with
that in the control group (12%).59 Hypnotizability was not found to be related to successful
remission, whereas low expectation for wart regression had a negative association. Volunteers
assigned to receive hypnosis had significantly fewer warts at the 6- week follow-up evaluation
than did groups treated with either placebo or salicylic acid.60
Hypnosis has been used successfully for other dermatologic conditions. Patients with
atopic dermatitis noted decreased pruritus, scratching, sleep disturbance, and tension after
treatment with hypnosis.63 In many patients, improvements persisted at follow-up evaluations up
to 18 months later. A review of the use of hypnosis in dermatology supports its value for many
skin conditions not believed to be under conscious control.64
GASTROENTEROLOGY: Hypnosis for irritable bowel syndrome (IBS) has been
studied extensively. A 1984 study in England showed significant benefits from hypnosis.65
Thirty patients with refractory IBS and severe symptoms were randomly assigned to 7 individual
sessions of hypnotherapy or psychotherapy plus placebo pills. Although the psychotherapy group
showed a small but significant improvement in some characteristics, all patients in the hypnosis
group had significant improvements (P<.0001) in well-being, bowel habits, distention symptoms,
and pain, with no relapses at 3-month follow-up. A subsequent report added 35 more patients to
the hypnosis group of 15 from the earlier study; those with classic symptoms and no
psychological problems fared best with hypnosis, as did patients younger than 50 years.66 Direct,
specific suggestions for symptom relief were most successful. At 18-month followup, the 15
patients in the earlier hypnosis group remained in remission.
The positive results with hypnosis for IBS have been confirmed in several other
trials.67-70 It was concluded that “in addition to relieving the symptoms of irritable bowel
syndrome, hypnotherapy profoundly improves the patients’ quality of life and reduces
absenteeism from work.”69 Use of audiotapes for self-hypnosis at home, used in many IBS
studies, was considered important for success.70-73 Other studies and reviews have shown
similar results for IBS.72-74
Patients with peptic ulcer disease have benefitted from hypnosis. Thirty patients with
recurrent peptic ulcer disease were treated with ranitidine and were assigned randomly to receive
hypnosis or ranitidine alone, initiated after healing was documented by
esophagogastroduodenoscopy. 75 During 12 months of monitoring, significantly fewer patients in
the hypnosis group (53%) experienced relapse compared with 100% of patients in the
ranitidine-only group. The benefit may be from suppression of the secretion of gastric acid, as
shown by a study of 32 volunteers who were able to significantly and appropriately increase and
decrease gastric acid secretion (compared with their baseline values) from suggestive imagery in
hypnosis.76 In a study of 126 patients with functional dyspepsia, those treated with hypnosis
noted improvement in quality of life and long-term symptoms, fewer physician visits, and less
health care spending compared with the group treated with medication.77
Postoperative gastrointestinal motility has been affected positively by hypnosis. Patients
scheduled to undergo abdominal surgery were assigned randomly to either a treatment group read
suggestions for an early return of bowel function and appetite or a control group given only
general preoperative instructions for an equal period.78 With their surgeons unaware of the
study, patients who were read a 5- minute script before surgery had a significantly earlier return
of bowel function (P<.05). They also had a shorter mean duration of hospital stay (6.6 vs 8.1
days) and a cost savings of $1200 per patient. Patients in the perioperative state, as well as
patients treated in the emergency department, are alleged to be in a highly receptive or
hypnoticlike state not requiring formal hypnotic induction.30,79,80 The use of positive assertions
during a situation in which the patient is reliant on and receptive to the health care practitioner,
but not in a formal trance state, has been termed waking hypnosis.2
Hypnosis has been used alone or in combination as anesthesia for liver biopsy,
esophagogastroduodenoscopy, and colonoscopy. A gastroenterologist reported the use of only an
anesthetic throat spray and hypnosis for 200 upper gastrointestinal tract endoscopy procedures
with a reduced overall duration of the procedure.81 No complications were noted, and patients
were able to leave immediately afterward. In another report, patients with either anxiety or
allergy to local anesthetics safely underwent liver biopsies with use of hypnosis.82 Half the
patients in a pilot trial reached a moderate or deep level of hypnosis before colonoscopic
evaluations,83 with more than 80% noting only mild or no discomfort.
HEALING FROM SURGERY OR INJURY: Two trials evaluated the potential for
hypnotic suggestions to facilitate faster wound healing after injuries or surgery. A pilot trial of
hypnosis for patients with nondisplaced ankle fractures showed marginally faster healing,
diminished pain, and increased mobility and functionality.84 Eighteen presurgical patients were
assigned randomly to a hypnosis group that received positive suggestions for healing, a control
group that received supportive attention to the patients’ concerns, or a standard care group.
Surgeons were unaware of their treatment group.85 Patients in the hypnosis group showed
significantly improved healing at 1 and 7 weeks postoperatively compared with the other groups
(P<.02).
HEMATOLOGY: One medical center reported favorable results with the addition of
hypnosis for patients with hemophilia.86 Patients who were assigned to receive hypnosis had a
significantly decreased need for transfusions compared with controls (P=.01). A review of this
program described the methods and various benefits of teaching self-hypnosis to these patients.
HYPERTENSION: Few studies have evaluated the use of hypnosis for hypertension. In
1 study of 44 patients, the hypnosis group had a significant decrease in blood pressure compared
with the control group. At 6 months, the hypnosis group had mean decreases of 13.3 mm Hg
systolic and 8.5 mm Hg diastolic below their baseline blood pressures.87,88 .
NEUROLOGY: Hypnosis has been used successfully for treatment of headaches.
Patients with chronic (=6 months) tension headaches were assigned randomly to hypnosis or a
control group.89 The hypnosis group had a significant reduction in the number, duration, and
intensity of headaches. Instruction in self-hypnosis produced significant benefit for tension
headaches in other studies including a group of less hypnotizable patients.90,91 Hypnosis was
compared with propranolol use for children with migraine headaches in a prospective,
randomized, controlled, crossover trial. 92 Patients taught self-hypnosis had a decreased
frequency of headaches. In another trial, university students with chronic headaches were
studied. Hypnosis using imagery for relaxation and serenity was compared with an active placebo
that consisted of watching slides falsely claimed to contain potent subliminal messages for pain
relief.93 Both groups achieved significant (P<.05) and equal decreases in headache pain
compared with controls. Hypnosis did not outperform the placebo; however, the hypnosis group
received no specific suggestions for pain relief, whereas the placebo group was given suggestions
to expect such benefit (waking hypnosis).
OBESITY: Studies of hypnosis as a single treatment for obesity show variable and
limited success. A critical review of hypnosis for obesity in studies from 1958 through 1978
concluded that hypnosis may be of benefit but that standardization of methods was needed.94 In a
subsequent trial with 156 participants, results from participants who received 9 weekly individual
hypnosis sessions plus behavior-modification treatments were compared with results from those
who received behavior-modification treatment alone.95 On average, the hypnosis group had lost
7 kg of weight more than the control group at the 2-year follow-up. A meta-analysis of trials in
the 1980s showed significantly greater weight loss for those treated with hypnosis and behavior
therapy compared with those who received behavior therapy alone, and this effect persisted or
increased with time (P<.05).96,97 In another trial, 60 obese patients with sleep apnea were
assigned randomly to treatment with diet alone or diet and hypnosis.98 Patients assigned to
hypnosis (two 30-minute hypnosis sessions and a home audiotape) achieved significant weight
loss at 18 months (P<.02); however, the sleep apnea was not eliminated. Rather than a sole
treatment for obesity, hypnosis may be more helpful as part of a program that includes arousing
motivation, dietary counseling, and peer support.1
OBSTETRICS: Hypnosis as anesthesia for childbirth has a long, successful history
supported by several trials. A large trial compared a self-hypnosis group with a control group to
study the effects of hypnosis on labor.99 The hypnosis group reported less discomfort and
shortened labor. The women’s volunteer status and the skill of the hypnotist were factors deemed
important for success. Pregnant adolescents were assigned randomly to individual sessions of
hypnosis or to supportive counseling with the medical staff blinded to their group
assignments.100 At delivery, the hypnosis group had a significant decrease in complications,
fewer surgical interventions, and a shorter hospital stay. Additional positive findings not
statistically significant were a decreased need for anesthesia, postpartum analgesia, and infant
admissions to the intensive care unit. In another trial, the use of a single session of hypnosis (and
encouraging home use of an audiotape) did not induce delivery in postterm women.101 Patients
with hyperemesis gravidarum have benefitted from hypnotic intervention, according to 2 reviews
with case reports.102,103.
ONCOLOGY: Chemotherapy often is associated with nausea and vomiting. Hypnosis
has been studied for reducing these and other adverse effects. Children receiving chemotherapy
who were assigned randomly to hypnosis had less anticipatory nausea and vomiting and less
vomiting with chemotherapy compared with a control group.104 A later prospective randomized
trial examined the effects of hypnosis for the adverse effects of chemotherapy in children with a
resultant significant decrease in anticipatory nausea and the need for antisemitic medications.105
Children who learned self-hypnosis techniques were believed to have gained feelings of control
over their situations.
Hypnosis has been used successfully in other areas of oncology. Patients undergoing bone
marrow transplantation treated with hypnosis experienced significantly less oral pain than control
patients.106 Patients with metastatic breast cancer benefitted from self-hypnosis and from
participation in group support. Despite a lack of specific suggestions, the women benefitted with
significantly less pain and an increased duration of survival.107,108 An untapped potential for
hypnosis for cancer treatment is the reported ability to alter regional blood flow, which offers the
prospect of increasing the delivery of chemotherapy to a tumor or reducing blood flow to it.61
OTORHINOLARYNGOLOGY: Patients with chronic tinnitus treated with hypnosis improved
significantly in 7 of 10 disturbing symptoms compared with a group treated with masking
techniques or supportive measures (P<.05).109 These results support the findings from other
trials. PULMONARY MEDICINE: Several trials have evaluated hypnosis for asthma. A study
of 55 patients with asthma noted that patients assigned randomly to the hypnosis group used
bronchodilators less frequently and experienced less wheezing than controls.110 Those
responding best were younger, more compliant with practicing self-hypnosis techniques, and
more easily hypnotized, and they developed a deeper level of trance. Males responded as well as
females, a finding not consistent in hypnosis trials. A large multicenter trial of patients with
asthma reported a significant decrease in the number of treatment failures and a larger number of
patients deemed “much improved” by independent assessment in the group taught
self-hypnosis.111 Females in the hypnosis group also had lower wheezing scores and less use of
bronchodilators. A retrospective study of asthmatic patients reported similar benefit, with 54% of
patients treated with hypnosis having an “excellent” result and 21% becoming symptom free and
discontinuing medication.112
Decreased rates of hospital admissions, length of stay, and use of corticosteroids were
attained with hypnotherapy during the year of study in patients with refractory asthma who
served as their own controls.113 Highly hypnotizable patients assigned randomly to hypnosis for
asthma treatment improved significantly in measurements of pulmonary function and noted
improved symptoms and less use of bronchodilators compared with a control group.114
A few cases have been reported of success with hypnosis in weaning dependent patients
from ventilators.115 The report indicates a potential benefit of hypnosis when other techniques
have failed. Numerous studies have reported various techniques and outcomes in the use of
hypnosis for smoking cessation, many with beneficial results.1 A 1970 study used a single
12-hour group session for volunteer smokers who had unsuccessfully tried other methods of
smoking cessation.116 The program achieved an 88% 1-year abstention rate. In a large trial
involving 615 persons unable to quit smoking published the same year, participants were taught
self-hypnosis in a single, individual, 45-minute session.117 A 20% abstention rate was noted by
questionnaire at 6 months, counting nonresponders as failures (45% abstention rate in the
responders). Further studies patterned after this trial showed 31% to 40% abstention rates at 6
months.118,119
In a 1992 meta-analysis of 633 smoking-cessation studies involving almost 72,000
participants, hypnosis was the most successful cessation method, with a 12% to 60% success rate
(mean, 36%), 3.5 times that achieved by selfcare methods.33 More aggressive but less acceptable
techniques that combined hypnosis with aversion methods (rapid smoking with negative imagery
and electrical shocks) for smoking cessation resulted in a 3-month abstention rate of 86% in male
volunteers and 87% in female volunteers.120 Another study that combined hypnosis with
aversion methods reported a 90% abstention rate (39 of 43 consecutive referral patients) at 6 to
36 months.121
A 2000 review of 59 studies using various techniques for smoking cessation indicated
that, although some trials failed to achieve significant benefit, several showed a greater than 50%
success rate, with 3 studies (200 participants total) documenting 12-month abstention rates of
63% to 88%.122 Nevertheless, on the basis of the collective results, the reviewers concluded that
hypnosis was only “possibly efficacious.” Less benefit was noted in a group of 2810 persons
unable to quit smoking (who had previously attempted smoking cessation an average of 7 times)
treated with a single 60-minute hypnosis session and encouraged to use a home audiotape.123 An
abstention rate of 22% was found for the previous month in a random sample of participants
questioned several months later. In another report, an experienced practitioner of hypnosis
reviewed his experience and techniques with 4355 patients, citing an 81% success rate for
smoking cessation.124
Two studies examined the effect of suggestions for smoking cessation delivered during
elective surgery. In a double-blind trial, 122 patients listened to audiotapes during general
anesthesia containing either simple, direct suggestions to stop smoking or simple counting
without suggestions.125 After 1 month, significantly more patients in the suggestion group (8
patients) had stopped smoking compared with no patients in the control group (P<.005). No
patient could actively recall the message on the tape. This study is one of several supporting the
assertion that postoperative behavior can be influenced by suggestions given during general
anesthesia without conscious recall of the suggestions. In contrast, another trial using a longer,
complex message showed no difference in the smoking cessation rate between the treatment and
control groups postoperatively.126
RHEUMATOLOGY: Patients with refractory fibromyalgia (mean duration, 8.5 years)
who were randomly assigned to receive hypnosis obtained significant improvement compared
with those assigned randomly to physical therapy alone.127 Benefits included improvements in
morning fatigue (P=.003), sleep (P<.001), muscle pain (P=.004), overall assessment (P=.04), and
use of pain medications, with results persisting for at least 6 months.
SURGERY: A report from the 1960s indicated that surgical patients should be
considered in a state of hypnosis and suggested that patients were able to comprehend much of
the conversation around them, even while under anesthesia.128 In the perioperative state, the
patient is fixated on the forthcoming process and is in a receptive, compliant state of mind,
comparable to the state formally induced with hypnosis. The article further cautioned that patients
in this receptive state may interpret comments made within an audible range as having negative
implications for them if these comments are not made correctly.128 More recently, it has been
emphasized again that health care personnel should be aware that patients under anesthesia have
unconscious auditory perception and tend to interpret comments negatively.129 The report also
stressed that, along with the potential deleterious effects of this awareness, came the opportunity
for using “semantics of positive suggestion” (emphasizing comfort, safety, and success) that
should be “an integral part” of surgical and obstetrical care. It appears appropriate to consider the
use of suggestions for patients in the perioperative period as a part of the practice of hypnosis.
The subject of awareness under anesthesia is controversial. Much of the medical literature
asserts that awareness under general anesthesia occurs only in rare cases, is indicative of an
inadequate level of anesthesia, and can cause psychological trauma, presumably from fear
induced during the awareness.130,131 A prospective study examined the possibility of patient
awareness of events or comments occurring during anesthesia that may not be recalled
consciously. 132 Patients undergoing coronary artery bypass grafting surgery were assigned
randomly to listen to either a personalized audiotape with specific instructions to be recalled
postoperatively or no tape (control) during surgery. Postoperative hypnosis demonstrated
significant (P=.01 compared with the control group) recall of material from the audiotape (as well
as events during surgery) that was not recalled consciously. Numerous studies support the
contention that patients have awareness under anesthesia that can affect their postoperative
course.132
Because it may be harmful to make comments within the audible range of surgical
patients that may be perceived negatively by the patient, promoting good health by
making comments of a clearly positive nature appears warranted.23,24 The “opportunity
for positive semantics” was investigated in a randomized, double-blind study in which
patients undergoing hysterectomy listened either to an audiotape with positive suggestions
or to a blank tape while under general anesthesia.133 The treatment group had
significantly fewer bowel problems (P<.03), shorter recovery time (P<.002), shorter
hospital stay (P<.002), less fever (P<.005), and a better recovery (by nursing assessment)
(P<.002) than the control patients. Other studies cited in the report indicated not only that
“inappropriate or misinterpreted operating theater comments may have a harmful effect
upon recovery,” but also that this perioperative awareness “may instead be employed to
the benefit of the patient.”133 Compared with matched controls, patients listening to
positive suggestions before and during surgery had less blood loss and a shorter
recovery.134 Recommendations for positive semantics for preoperative patients are
similar to those applicable to emergency department patients. Persons in both situations
appear to be in a hypnotic-like state (receptive, focused, willing to comply)
and thus are particularly susceptible to remarks by health care workers.30,79,80
Preoperative hypnosis is less controversial than the idea of awareness during anesthesia,
with benefit noted in many trials. Significant benefits include less anxiety and decreased blood
pressure,135 reduced blood loss,135,136 enhanced postoperative well-being,137 improved
intestinal motility,78 shorter hospital stay,138 reduced postoperative nausea and vomiting,139
and reduced need for analgesics. 139,140 Substantial but not statistically significant decreases in
cost and length of hospital stay were observed in another study.78
A 1991 review of clinical trials using hypnosis, suggestion, or relaxation in the care of
surgical patients found that 89% of the trials showed that these techniques produced a positive
outcome in facilitating physical or psychological recovery from surgery.24 The use of live
therapists (rather than suggestions from audiotapes) and positive and appropriate semantics
(avoiding words that bring to mind undesired outcomes) at the most receptive times were
advocated to foster shorter hospital stays, earlier recovery, and improved patient well-being. A
meta-analysis published in 2002 evaluated hypnosis for surgical patients for its overall effect and
benefits for specific clinical outcomes. Hypnosis as an adjunct to surgery was believed to be
“successful for the majority of individuals,” with benefits such as decreased pain, anxiety, nausea,
and recovery time.32
UROLOGY: The medical literature from the 1960s indicated a strong potential for the
use of hypnosis for impotence,2 and support for this assertion has come from recent clinical
trials. A review of the personal experience and techniques of an experienced practitioner cited an
88% success rate using hypnosis for impotence in almost 3000 patients.124 The hypnosis
techniques used in this trial were studied in 2 randomized controlled trials of men with
nonorganic impotence. One trial that compared hypnosis with placebo showed an 80%
improvement in sexual function with hypnosis compared with 36% with placebo.141 The second
trial compared hypnosis with acupuncture and injected or oral placebo. The success rate
(moderate improvement or “cure”) was 75% for hypnosis.142 A review of developments in
hypnosis reported its efficacy in augmenting other treatment methods for sexual dysfunction and
its potential for exploring contributing psychological conflicts.1
In a trial of hypnosis for chronic (mean, 7 years) urinary incontinence, 50 women served
as their own controls.143 At 1 month, 58% were symptom-free and another 28% were improved,
with cystometric testing at 3 months objectively confirming the benefits.
CONCLUSION: The acceptance of hypnosis as a mode of treatment in medicine is
increasing as a result of “careful, methodical, empirical work of many research pioneers.”35
Many important trials reviewed here have helped to establish the role of hypnosis in
contemporary medicine. These trials have established the utility and efficacy of hypnosis for
several medical conditions, either alone or as part of the treatment regimen. Nonetheless,
skepticism may prevail and hypnosis may remain underused because of the tendency to doubt or
fear the unknown. According to a recent study, health care providers changed their attitudes
significantly and positively when presented with information about the use of hypnosis in
medicine.144 Through greater awareness and acceptance of hypnosis, additional training and
research can be inspired in pursuit of improved techniques and new areas of potential benefit.
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