Professional Documents
Culture Documents
Applications of Clinical Hypnosis in Mind-Body Medicine: Name ASCH-Status
Applications of Clinical Hypnosis in Mind-Body Medicine: Name ASCH-Status
Applications of Clinical Hypnosis in Mind-Body Medicine: Name ASCH-Status
Hypnosis in Mind-Body
Medicine
Name
ASCH-Status
• Dissociation, distortion
• Control
• Privacy
• Amnesia
• Sleep / Loss of consciousness
• Awareness of surroundings
• A priori weak-mindedness
• Having "mind weakened"
ASCH SOT, 2010
MEMORY
Long term Memory
• Declarative/explicit: develops late in
childhood and is dependent on a complex
brain system (hippocampi and medial
temporal-lobe structures)
Semantic: facts independent of context
Episodic: information specific to a context
-depends on perception of particular and
unique events and one’s memory of such
events
-requires conscious recall
ASCH SOT, 2010
Long term Memory
• Procedural or implicit: more primitive parts
of the brain (subcortical structures like the
basal ganglia and cerebellum)
-depends on repetition, is literal, exact and
reproducible
-fixed action pattern (such as, early motor
patterns)
• Use caution
• Do not lead patient
• Do not suggest outcome
• Remain neutral
• And remember only outside corroborating
evidence is confirmatory
• I. Induction
• II. Deepening/ Trance Ratification
• III. Suggestion/Exploration/
Treatment
• IV. Alerting
• V. Debriefing
• 25% no capacity
• LETHARGY
• RELAXATION
• EYE CATALEPSY
• ARM CATALEPSY
Zastrow, 2010
fMRI Neurostructure theory
Rainville and his associates showed that strategically worded suggestions can
dissociate the two components of pain, selectively altering one but not the other.
(Rainville, Duncan, Price, Carrier, & Bushnell, 1997).
The two components of pain have different biological substrates: sensory pain in the
primary somatosensory cortex, and suffering in the anterior cingulate cortex.
Zastrow, 2010
fMRI Neurostructure theory
Zastrow, 2010
fMRI Neurostructure theory
Zastrow, 2010
Zastrow, 2010
fMRI Neurostructure theory
Zastrow, 2010
The anterior cingulate cortex contains distinct areas dissociating
external from self-administered painful stimulation: a parametric
fMRI study.
The anterior cingulate cortex (ACC) has a pivotal role in human pain
processing by integrating sensory, executive, attentional, emotional, and
motivational components of pain.
Zastrow, 2010
Cognitive modulation of pain-related ACC activation has been shown by hypnosis, illusion and
anticipation. The expectation of a potentially noxious stimulus may not only differ as to when but also how
the stimulus is applied. These combined properties led to our hypothesis that ACC is capable of
distinguishing external from self-administered noxious tactile stimulation. Thermal contact stimuli with
noxious and non-noxious temperatures were self-administered or externally applied at the resting right
hand in a randomized order. Two additional conditions without any stimulus-eliciting movements served
as control conditions to account for the certainty and uncertainty of the impending stimulus. Calculating
the differences in the activation pattern between self-administered and externally generated stimuli
revealed three distinct areas of activation that graded with perceived stimulus intensity: (i) in the posterior
ACC with a linear increase during external but hardly any modulation for the self-administered stimulation,
(ii) in the midcingulate cortex with activation patterns independent of the mode of application and (iii) in
the perigenual ACC with increasing activation during self-administered but decreasing activation during
externally applied stimulation.
These data support the functional segregation of the human ACC: the
posterior ACC may be involved in the prediction of the sensory
consequences of pain-related action, the midcingulate cortex in pain
intensity coding and the perigenual ACC is related to the onset uncertainty
of the impending stimuli.
Zastrow, 2010
pain intensity coding
Zastrow, 2010
Amir Raz Phd
Hypnotic suggestion reduces conflict in the human brain
Amir Raz†, Jin Fan‡, and Michael I. Posner
Sackler Institute for Developmental Psychobiology, Weill Medical
College of Cornell University, New York, NY 10021
Contributed by Michael I. Posner, April 13, 2005
Zastrow, 2010
Stroop
In the Stroop task, experienced readers are asked to name the ink color of a
colored word. In responding to the ink color of an incompatible color word (eg,
the word BLUE displayed in red ink), subjects are usually much slower and less
accurate than in identifying the ink color of a control item (eg, XXXX or SHIP
printed in red). This is called the Stroop Interference Effect (SIE), and it is one of
the most robust and well-studied phenomena in attention research.
Zastrow, 2010
Stroop
A simple strategy-free posthypnotic suggestion to circumvent reading within
a classical Stroop design using 32 proficient readers of English naive to the
Stroop task, recruited from a medical students at Cornell University.
Sixteen hypnosis subjects scoring in the highly suggestible range and 16
control subjects scoring in the less-suggestible range on the SHSS-C were
recruited.
Zastrow, 2010
Stroop
Suggestion
Very soon you will be playing the computer game. When I clap my hands,
meaningless symbols will appear in the middle of the screen. They will feel
like characters of a foreign language that you do not know, and you will not
attempt to attribute any meaning to them. This gibberish will be printed in
one of 4 ink colors: red, blue, green or yellow. Although you will only be able
to attend to the symbols' ink color, you will look straight at the scrambled
signs and crisply see all of them. Your job is to quickly and accurately
depress the key that corresponds to the ink color shown. You will find that
you can play this game easily and effortlessly.
Zastrow, 2010
Stroop
Zastrow, 2010
pain intensity coding
Zastrow, 2010
Amir Raz, Ph.D.
Zastrow, 2010
SELF-HYPNOSIS
“All Hypnosis Is Self-Hypnosis”
Milton Erickson, 1948
• Authenticity
• Developing a repertoire
• Sensitivity while “doing hypnosis”
• to our own states of awareness
• to patient/client’s states of
awareness
• Help ourselves cope!
ASCH SOT, 2010
Helping Ourselves
Separate
learning hypnosis
from the presenting problem.
• Be permissive
• Collaborate on suggestions
Murray-Jobsis, 1993
• Continuing education
• Informed consent
• Relaxation/stress • Obesity
reduction • Smoking Cessation
• Anxiety • Addictions
• Depression • Habit disorders
• Pain management • Phobias
surgery, chronic • Psychosomatic
conditions, oncology illness
• Gynecological • Dissociative
• Dermatological disorders
Linden & Draeger-Muenke, 2010
Hypnosis can
• Be utilized with any theoretical approach
• Augment and facilitate treatment
• Strengthen ego-functioning
• Facilitate pain management
• Be used adjunctively for acute or chronic
illness
• Psychodynamic:
Hypnosis used to augment transference clarification and
resolution.
Helps in identifying and resolving unresolved childhood
trauma.
• Client Centered:
Hypnosis used to support reality testing.
Suggestion used to reinforce, support and assist in cognitive
restructuring.
Linden & Draeger-Muenke, 2010
Hypnotic Applications In
Psychotherapy
• Interpersonal Psychotherapy
Hypnosis used to improve interpersonal skills.
Suggestion used to clarify feeling states, improve
interpersonal communication.
• Cognitive Therapy
Hypnosis used in identifying and altering cognitive
distortions that maintain symptoms.
• Systems Approaches
Hypnosis used to address boundary and hierarchical
difficulties.
Typically used to increase flexibility and problem solving
within the system.
Modifies maladaptive behaviors that have contributed to
system breakdown.
• Behavior Therapy
Hypnosis used as part of relaxation training and
augmenting improved social and assertiveness skills.
Can be used for graded exposure, flooding, modeling and
positive reinforcement.
Linden & Draeger-Muenke, 2010
Applications:
Medical & Psychological
Applications:
Medical & Psychological
Hypnosis for Pain Management
Applications of Hypnosis
for Pain Management
Patterson, 2010
Quick Induction for Acute Pain
David R. Patterson, Ph.D.
Patterson, 2010
Quick Induction for Acute Pain (con’d)
Patterson, 2010
Rapid Induction Analgesia
Barber, 1977
• Cooperation
• Seeding/Priming
• Deepening (stairs, counting, indirect suggestions,
relaxation)
• Confusion
• Post-hypnotic suggestions/anchoring
• Alerting
Patterson, 2010
Hypnotic Anesthesia
• Difficult to achieve
• Can be accomplished indirectly by building
psychological and emotional situations that
are contradictory to the experience of pain
Patterson, 2010
Hypnotic Analgesia
Patterson, 2010
Amnesia
Patterson, 2010
Direct suggestions for Total Abolition
of Pain
Patterson, 2010
Displacement of Pain
Patterson, 2010
Hypnotic Time Distortion
Patterson, 2010
Reinterpretation of Pain Experience
Patterson, 2010
Hypnotic Dissociation
Patterson, 2010
Pacing Induction
• Pace (truism)
• Pace (truism)
• Pace (truism)
• Leading statement
Patterson, 2010
Giving Suggestions
• Option A
• Option B
• Option C
• Forced Choice
Patterson, 2010
Applications:
Medical & Psychological
Hypnosis for Headaches
Migraines
There are two forms of migraine: Classical (with aura)
and Common (without aura).
Eighty percent of migraine patients do not have aura,
the remaining twenty percent have aura.
Migraine affects twenty-two percent of the population
in the north central United States and women suffer
from the disease three times more than men. 64%
were age 20 or younger when they first experienced
headaches/migraine attacks.
The average age of migraine onset is 20 and migraine
diagnosis was 25.
Zastrow, 2010
Migraines Prevalence
Zastrow, 2010
Diagnosis
The diagnosis of migraine is a clinical diagnosis based on criteria established
by the International Headache Society (IHS).
Some patients describe a prodromal phase as early as 48 hours before the
headache. This phase includes irritability, depression, frequent yawning, or
hyperexcitability.
The headache itself is usually described as throbbing or pulsatile. It is usually
unilateral, but the side affected in each episode may be different. The headache
usually lasts 6-24 hours. During a headache, patients prefer to lie quietly in a
dark room. Nausea, vomiting, photophobia, phonophobia, irritability, and malaise
are common.
A history of certain triggers can be elicited. Common triggers include certain
foods (eg, chocolate, cheese, oranges, tomatoes, onions, monosodium
glutamate [MSG], aspartame, red wine, alcohol), hormonal changes (eg,
menstruation, ovulation, oral contraceptives, hormone replacement), head
trauma, physical exertion, fatigue, medications (eg, nitroglycerine, histamine,
reserpine, hydralazine, ranitidine, estrogen), and stress.
Migraine with aura (ie, classic migraine) includes several premonitory visual
symptoms that occur as early as 60 minutes before the headache phase. These
symptoms include flashes of light (photopsia) and wavy linear patterns on the
visual fields (fortification spectra), migrating scotoma, or blurred vision. Other
nonvisual prodromata have been described as well. Zastrow, 2010
Diagnosis
Zastrow, 2010
Impact of Migraine
Those surveyed reported their life was disrupted for an average of 19 hours
during an attack and they missed an average of six days of activities over
the past three months due to migraine.
62% of all respondents reported that migraine greatly affects their ability to
participate in exercise or sports activities, and 52% said their
social/recreational activities are limited.
Nearly half reported migraine greatly affects their ability to drive a car (45%),
travel (43%), interact with family and friends (42%) and make/keep plans
(42%).
Employed respondents reported one day of missed work every three months
because of migraine.
Zastrow, 2010
Impact
A migraine attack can last anywhere from four hours to three days and can occur
multiple times a month. They can strike with no warning and often force people to
postpone or cancel plans.
In fact, almost 60 percent of people with migraine miss family or social activities due
to an attack and 67 percent report a 50 percent decrease in their ability to complete
household chores.
Approximately 53 percent of attacks require bed rest; overall, migraine attacks are
associated with an estimated 112 million bedridden days per year.
Migraine attacks cost $13 billion in missed workdays and reduced productivity and
$1 billion in direct medical costs.
Zastrow, 2010
Abortive Medication Stratification by
Severity
Zastrow, 2010
Major Prophylactic Medications
Zastrow, 2010
Cluster Migraines
Rare, affecting approximately 0.1% of the population
Excruciatingly severe pain on one side of the head, usually
centered around the eye.
The pain is often described as boring or stabbing and is often
likened to someone plunging a red hot poker into the eye.
The pain can spread into the temple, jaw and neck area.
The pain escalates very rapidly going from zero to debilitating in 5
to 10 minutes and stops as quickly as it starts with attacks last
between 15 minutes and 3 hours.
One or more of several physical reactions accompany the pain,
always on the same side as the pain. These include watery eye,
runny and/or stopped up nose, red/bloodshot eye, a drooping
eyelid, forehead and facial sweating and irritability.
Zastrow, 2010
Cluster Migraines
Attacks can occur from once every other day to eight
times per day, usually at the same times each day.
An attack will wake a sufferer from a sound sleep.
Unlike with a migraine, a sufferer cannot lay down during
an attack. Instead, he or she will usually pace the floor, sit
rocking back and forth, bang their head on the floor or
wall, curse, scream and cry from the pain. Also, unlike
migraine, light and sound usually have no effect on the
attack, though there are exceptions to every rule.
Zastrow, 2010
Cluster Migraines
Zastrow, 2010
Cluster Migraines Treatments
Tryptans
High Flow Oxygen
Beta Blockers
DHE
Lithium
Tricyclics
Verapamil
Zastrow, 2010
Daily Tension Headaches
Usually Daily.
Worsen as the day progresses.
Starts typically in the shoulders and neck and will go up over the top of
the head to the cranium and usually are diffuse.
Seem better on less stressful days or on vacation.
Better with anti-anxiety medicine or muscle relaxer.
Responds to behavior modification.
Zastrow, 2010
Rebound headaches
A certain group of migraine patients have persistent daily headache of mild
to moderate severity which they are unable to break.
Zastrow, 2010
Trigeminal Neuralgia
Zastrow, 2010
Zastrow, 2010
Trigeminal Neuralgia
It is often caused by an injury to the end of the Trigeminal nerve by some
type of trauma, most often a dental procedure, a blow to the face or
after.
The pain is usually constant, but can fluctuate in intensity. The pain is
usually described as burning, aching or tightness.
Many times numbness is present.
Zastrow, 2010
Trigeminal Neuralgia
Zastrow, 2010
Other Headaches
• temporal arteritis
• space-occupying intracranial lesions
• meningeal irritation
• meningitis,
• lumbar puncture headache
• muscular tension referred pain from cranium, neck,
eyes, or ears
• pseudotumor cerebri (benign intracranial
hypertension)
• psychiatric conditions
Zastrow, 2010
Headache Research
Cognitive and behavioral treatment recommendations.
– • Relaxation training, thermal biofeedback combined with relaxation training,
electromyographic biofeedback, and cognitive-behavioral therapy may be
considered as treatment options for prevention of migraine (Grade A). Specific
recommendations regarding which of these to use for specific patients cannot
be made.
– • Behavioral therapy may be combined with preventive drug therapy to
achieve additional clinical improvement for migraine relief (Grade B).
– • Evidence-based treatment recommendations regarding the use of hypnosis,
acupuncture, transcutaneous electrical nerve stimulation, chiropractic or
osteopathic cervical manipulation, occlusal adjustment, and hyperbaric
oxygen as preventive or acute therapy for migraine are not yet possible.
Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review)
Report of the Quality Standards Subcommittee of the American Academy of Neurology
Stephen D. Silberstein, MD, FACP, for the US Headache Consortium* From the American Academy of Neurology, St. Paul, MN.
Zastrow, 2010
Hypnosis Research
• Headache: The Journal of Head and Face Pain
Volume 31 Page 686 - November 1991
doi:10.1111/j.1526-4610.1991.hed3110686.xVolume 31 Issue 10
Zastrow, 2010
Headache Research
Zastrow, 2010
Headache Research
Zastrow, 2010
Headache Research
• Headache: The Journal of Head and Face Pain
Volume 39 Page 101 - February 1999
doi:10.1046/j.1526-4610.1999.3902101.xVolume 39
Issue 2
Zastrow, 2010
Migraine may affect as many as 9% of all schoolchildren and often presents with
abdominal symptoms of pain, nausea, and vomiting. Even though the
pathophysiology of migraine remains unknown, self-regulation techniques
appear to be more effective in prevention of childhood migraine than
conventional pharmacotherapy which is often associated with adverse effects.
Mast cells have been implicated in the pathogenesis of migraine in adults, but
have not been previously studied in children with migraine.Mast cells are found
close to the vessels and nerves in the meninges where they can release
multiple vasoactive, neurosensitizing, and pro-inflammatory mediators.
Therefore, we investigated whether children with migraine may have increased
urinary levels of mast cell mediators and whether practicing relaxation imagery
exercises has an effect on the frequency of headache, as well as on mast cell
activation.Urine was collected for 24 hours from children with and without
migraine after a 5-day amine-restricted diet. Children with migraine also
collected urine during migraine episodes. The mean levels of urinary histamine,
its main metabolite, methylhistamine, and the mast cell enzyme, tryptase, were
higher in children than generally found in adults, but they did not differ
statistically in any of the categories studied. However, in 8 of 10 children who
practiced relaxation imagery techniques and successfully reduced the
number of migraines, the urine tryptase levels were also significantly
lower. There was no relationship between successful practice and sex or age of
the child. These results suggest that stress may activate mast cells which could
be involved in the pathophysiology of migraine. Zastrow, 2010
Applications:
Medical & Psychological
Hypnosis for Irritable Bowel Syndrome
Hypnosis and Irritable Bowel Syndrome
Hypnosis Research In IBS
• Does hypnosis work for IBS?
Zastrow, 2010
Whorwell
Whorwell PJ; Prior A; Faragher EB.
Controlled trial of hypnotherapy in the treatment of severe refractory irritable-
bowel syndrome.
The Lancet 1984, 2: 1232-4.
placebo-controlled
Thirty patients with severe symptoms unresponsive to other treatment were
randomly chosen to receive 7 sessions of hypnotherapy (15 patients) or 7
sessions of psychotherapy plus placebo pills (15 patients).
The psychotherapy group showed a small but significant improvement in
abdominal pain and distension, and in general well-being but not bowel activity
pattern.
The hypnotherapy patients showed a dramatic improvement in all central
symptom. The hypnotherapy group showed no relapses during the 3-month
follow-up period.
Zastrow, 2010
Zastrow, 2010
Whorwell
Whorwell PJ; Prior A; Colgan SM.
Hypnotherapy in severe irritable bowel syndrome: further experience. Gut,
1987 Apr, 28:4, 423-5.
Zastrow, 2010
Harvey
Harvey RF; Hinton RA; Gunary RM; Barry RE.
Individual and group hypnotherapy in treatment of refractory irritable bowel
syndrome.
This study employed a shorter hypnosis treatment course than other studies
for IBS.
Twenty out of 33 patients with refractory irritable bowel syndrome treated
with four sessions of hypnotherapy in this study improved.
Success rate was lower demonstrating that a larger number of sessions is
necessary for optimal benefit.
Groups of up to 8 patients seems as effective as individual therapy.
Zastrow, 2010
Prior
Prior A, Colgan SM, Whorwell PJ.
Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel
syndrome.
Gut 1990;31:896.
IBS patients to be less sensitive to pain and other sensations induced via
balloon inflation in their gut while they were under hypnosis.
Sensitivity to some balloon-induced gut sensations (although not pain
sensitivity) was reduced following a course of hypnosis treatment.
Zastrow, 2010
Houghton
Houghton LA; Heyman DJ; Whorwell PJ.
Symptomatology, quality of life and economic features of irritable bowel
syndrome--the effect of hypnotherapy.
Aliment Pharmacol Ther, 1996 Feb, 10:1, 91-5.
Zastrow, 2010
Houghton
Houghton LA, Larder S, Lee R, Gonsalcorale WM, Whelan V, Randles J,
Cooper P, Cruikshanks P, Miller V, Whorwell PJ.
Gut focused hypnotherapy normalises rectal hypersensitivity in patients with
irritable bowel syndrome (IBS).
Gastroenterology 1999; 116: A1009.
Zastrow, 2010
Whorwell PJ. Hypnotherapy for irritable bowel syndrome: the response of colonic
and noncolonic symptoms.
Whorwell, Peter J
Journal of Psychosomatic Research. 64(6):621-3, 2008 Jun.
Zastrow, 2010
Koutsomanis
Koutsomanis D.
Hypnoanalgesia in the irritable bowel syndrome.
Gastroenterology 1997, 112, A764.
Zastrow, 2010
Vidakovic
Vidakovic Vukic M.
Hypnotherapy in the treatment of irritable bowel syndrome: methods and results
in Amsterdam.
Scand J Gastroenterol Suppl, 1999, 230:49-51.
Zastrow, 2010
Galovski
Galovski TE; Blanchard EB.
Appl Psychophysiol Biofeedback, 1998 Dec, 23:4, 219-32.
Zastrow, 2010
Hypnotherapy for irritable bowel syndrome in Saudi Arabian patients.
Al Sughayir MA.
Eastern Mediterranean Health Journal. 13(2):301-8, 2007 Mar-Apr.
Zastrow, 2010
Does this therapy hold up over time?
Zastrow, 2010
Gonsalkorale
Gonsalkorale WM, Houghton LA, Whorwell PJ.
Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical
service with examination of factors influencing responsiveness.
Am J Gastroenterol 2002 Apr;97(4):954-61.
Zastrow, 2010
Fifty-three pediatric patients, age 8-18 years, with FAP (n = 31) or IBS (n = 22),
were randomized to either HT or SMT. Hypnotherapy consisted of 6 sessions
over a 3-month period. Patients in the SMT group received standard medical
care and 6 sessions of supportive therapy.
Pain intensity, pain frequency, and associated symptoms were scored in weekly
standardized abdominal pain diaries at baseline, during therapy, and 6 and 12
months after therapy.
Zastrow, 2010
Pain scores decreased significantly in both groups: from baseline to 1 year
follow-up, pain intensity scores decreased in the HT group from 13.5 to 1.3 and
in the SMT group from 14.1 to 8.0.
Pain frequency scores decreased from 13.5 to 1.1 in the HT group and from
14.4 to 9.3 in the SMT group.
Hypnotherapy was highly superior, with a significantly greater reduction in pain
scores compared with SMT (P < .001). At 1 year follow-up, successful
treatment was accomplished in 85% of the HT group and 25% of the SMT
group (P < .001).
Zastrow, 2010
Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary
care-based randomised controlled trial.
Roberts, Lesley. Wilson, Sue. Singh, Sukhdev. Roalfe, Andrea. Greenfield, Sheila.
British Journal of General Practice. 56(523):115-21, 2006 Feb.
Department of Primary Care and General Practice, Division of Primary Care, Public and Occupational
Health, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Multicenter Study. Randomized Controlled Trial. Research Support, Non-U.S. Gov't.
Zastrow, 2010
Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary care-based randomised controlled trial.
Roberts, Lesley. Wilson, Sue. Singh, Sukhdev. Roalfe, Andrea. Greenfield, Sheila.
British Journal of General Practice. 56(523):115-21, 2006 Feb.
Department of Primary Care and General Practice, Division of Primary Care, Public and Occupational Health, University of Birmingham, Edgbaston,
Birmingham B15 2TT, UK. robertslz@adf.bham.ac.uk Zastrow, 2010
Zastrow, 2010
Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary care-based randomised controlled trial.
Roberts, Lesley. Wilson, Sue. Singh, Sukhdev. Roalfe, Andrea. Greenfield, Sheila.
British Journal of General Practice. 56(523):115-21, 2006 Feb.
Department of Primary Care and General Practice, Division of Primary Care, Public and Occupational Health, University of Birmingham, Edgbaston,
Birmingham B15 2TT, UK. robertslz@adf.bham.ac.uk
Zastrow, 2010
Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary care-based randomised controlled trial.
Roberts, Lesley. Wilson, Sue. Singh, Sukhdev. Roalfe, Andrea. Greenfield, Sheila.
British Journal of General Practice. 56(523):115-21, 2006 Feb.
Department of Primary Care and General Practice, Division of Primary Care, Public and Occupational Health, University of Birmingham, Edgbaston,
Birmingham B15 2TT, UK. robertslz@adf.bham.ac.uk
Zastrow, 2010
Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary
care-based randomised controlled trial.
Roberts, Lesley. Wilson, Sue. Singh, Sukhdev. Roalfe, Andrea. Greenfield, Sheila.
British Journal of General Practice. 56(523):115-21, 2006 Feb.
Department of Primary Care and General Practice, Division of Primary Care, Public and Occupational
Health, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. robertslz@adf.bham.ac.uk
Multicenter Study. Randomized Controlled Trial. Research Support, Non-U.S. Gov't.
Zastrow, 2010
Olafur Palsson Ph.D.
http://www.ibshypnosis.com/
http://www.med.unc.edu/medicine/fgidc/
Zastrow, 2010
Palsson
Palsson OS, Turner MJ, Johnson DA, Burnett CK, Whitehead WE.
Hypnosis treatment for severe irritable bowel syndrome: investigation of
mechanism and effects on symptoms.
Dig Dis Sci 2002 Nov;47(11):2605-14.
Patients with severe IBS 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).
Zastrow, 2010
Palsson
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.
17 of 18 patients in study 1 and 21 of 24 patients in study 2 were judged
substantially improved Improvement was well-maintained at 10-12 month
follow up in study 2.
Zastrow, 2010
Lea
Lea R, Houghton LA, Calvert EL, Larder S, Gonsalkorale WM, Whelan V,
Randles J, Cooper P, Cruickshanks P, Miller V, Whorwell PJ.
Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients
with irritable bowel syndrome.
Alimentary Pharmacology& Therapeutics 2003 Mar 1;17(5):635-42.
Zastrow, 2010
Is it all in the head?
Zastrow, 2010
Gonsalkorale
Gonsalkorale WM, Toner BB, Whorwell PJ.
Cognitive change in patients undergoing hypnotherapy for irritable bowel
syndrome.
J Psychosom Res. 2004 Mar;56(3):271-8.
Zastrow, 2010
Palsson
Palsson OS, Turner MJ, Whitehead WE.
Hypnosis home treatment for irritable bowel syndrome: a pilot study.
Int J Clin Exp Hypn. 2006 Jan;54(1):85-99.
Zastrow, 2010
Scripts or no scripts?
Zastrow, 2010
Barabasz
Barabasz A, Barabasz M.
Effects of tailored and manualized hypnotic inductions for complicated irritable
bowel syndrome patients.
Int J Clin Exp Hypn. 2006 Jan;54(1):100-12.
Zastrow, 2010
Conclusions: Acupuncture in IBS is primarily a placebo response.
Zastrow, 2010
American College of Gastroenterology Functional Gastrointestinal
Disorders Task Force
1992
Behavioral therapy is more effective
than placebo at relieving individual IBS
symptoms (Grade B Recommendation)
Level I Evidence: Randomized controlled trials with p values
0.05, adequate sample sizes, and appropriate
methodology
Level II Evidence: Randomized controlled trials with p
values 0.05 and/or inadequate sample sizes and/or
inappropriate methodology
Level III Evidence: Nonrandomized trials with
contemporaneous controls
Level IV Evidence: Nonrandomized trials with historical
controls
Level V Evidence: Case studies
Grade A Recommendations: Recommendations supported
by Level I evidence
Grade B Recommendations: Recommendations supported
by Level II evidence
Grade C Recommendations: Recommendations supported
by Level III–IV evidence
Zastrow, 2010
Evidence Based Grade B
• The American College of gastroenterologist rated
behavioral therapy as class B but did not break out
hypnosis by itself.
• This equates to Level II Evidence: Randomized controlled
trials with p values 0.05 and/or inadequate sample sizes
and/or inappropriate methodology
Zastrow, 2010
Review article Irritable Bowel Syndrome Howard R. Mertz, M.D.
N Engl J Med 2003;349:2136-46.
Zastrow, 2010
Systematic review: the effectiveness of hypnotherapy in the
management of irritable bowel syndrome.
Wilson, S; Maddison, T; Roberts, L; Greenfield, S; Singh, S; Birmingham IBS
Research Group.
Aliment Pharmacol Ther. 24(5):769-80, 2006 Sep 1.
Zastrow, 2010
Systematic review: the effectiveness of hypnotherapy in the
management of irritable bowel syndrome.
Wilson, S; Maddison, T; Roberts, L; Greenfield, S; Singh, S; Birmingham IBS
Research Group.
Aliment Pharmacol Ther. 24(5):769-80, 2006 Sep 1.
Zastrow, 2010
Cochrane Database of Systematic Reviews.
Hypnotherapy for treatment of irritable bowel syndrome, 2007.
Webb, A N. Kukuruzovic, R H. Catto-Smith, A G. Sawyer, S M.
Royal Children's Hospital Melbourne, Gastroenterology, Flemington Road, Parkville Victoria 3052,
Melbourne, Australia. annette.webb@rch.org.au
MAIN RESULTS: Four studies including a total of 147 patients met the inclusion
criteria. Only one study compared hypnotherapy to an alternative therapy
(psychotherapy and placebo pill), two studies compared hypnotherapy with waiting-
list controls and the final study compared hypnotherapy to usual medical
management. Data were not pooled for meta-analysis due to differences in outcome
measures and study design.
The therapeutic effect of hypnotherapy was found to be superior to that of a waiting
list control or usual medical management, for abdominal pain and composite
primary IBS symptoms, in the short term in patients who fail standard medical
therapy.
Harmful side-effects were not reported in any of the trials.
However, the results of these studies should be interpreted with caution due to poor
methodological quality and small size.
AUTHORS' CONCLUSIONS: The quality of the included trials was inadequate to
allow any conclusion about the efficacy of hypnotherapy for irritable bowel
syndrome. More research with high quality trials is needed.
Zastrow, 2010
Zastrow, 2010
A Wolfe in Regulator's Clothing:
Drug Industry Critic Joins the
FDA
JANUARY 9, 2009
A Wolfe in Regulator's Clothing: Drug Industry Critic Joins the FDA
Over three decades, Dr. Wolfe, head of the health group at advocacy organization
Public Citizen that Ralph Nader founded, has helped push 16 drugs off the market
and slap restrictions on several multibillion-dollar products.
He has been so hostile to the FDA under President George W. Bush that he
decried its 100th-anniversary celebration in 2006 as a "propaganda campaign" to
hide its "unprecedented assault on the American public."
Zastrow, 2010
Testimony of Sidney M. Wolfe M.D.
Director, Public Citizen’s Health Research Group
Before FDA Gastrointestinal Drugs and Drug Safety Advisory Committee Hearing
Concerning Alosetron
April 23, 2002
Benefits of Alosetron: Serious Problem with Irritable Bowel Syndrome Studies
Because of Very High Placebo Response Rate
Zastrow, 2010
That this problem of a large placebo response is applicable to
alosetron can be seen in a reanalysis by Public Citizen’s Health
Research Group of Glaxo data that was published in the
Lancet, shown below. The mean pain and discomfort scores
over a three-month period were quite similar in the alosetron
and placebo groups even though there was a statistically
significant difference between the groups as analyzed by Glaxo
and the FDA.
Zastrow, 2010
It is inherently hard to use a placebo blind in hypnosis studies. To date
there are no studies of hypnosis in IBS where one group is given just
an induction and alerted while and another receives active suggestion.
Previous studies on hypnosis and pain control have shown that
Hypnosis, itself has a placebo component.
Given the scientific evidence at hand, should future drug studies in IBS
be done against a hypnotic active group as well as a control group to
more clearly locate how much the drug separates from placebo?
Zastrow, 2010
Conclusions
Often a specific therapy pre-dates the basic science, basic IBS hypnosis research
is catching up to the clinical findings.
High quality trials with standardization are needed.
The therapeutic effect of hypnotherapy was found to be superior to that of a
waiting list control or usual medical management, for abdominal pain and
composite primary IBS symptoms but to what extent is still in question.
The downside risk is minimal to none. This therapy is safe and appears to be long
lasting.
Hypnosis seems to work through the reduction in the perception of pain and
probably has something to do the ACC.
We need to have an fMRI study for IBS hypnosis before and after with a control
group.
Zastrow, 2010
Conclusions
Lotrenox studies given the high placebo improvement are in question and
ischemic colitis is a serious side-effect. We need an IBS drug studies to run
against an active hypnosis arm.
Hypnosis is not a Svengali movie and the patients do not cluck like chickens!
Zastrow, 2010
Applications:
Medical & Psychological
Hypnosis for Anxiety Disorders
Anxiety Disorders
Alladin, 2010
Definition of Anxiety
• Anxiety has to do with future
– Anticipatory anxiety
– Fear of harm, discomfort, embarrassment, loss
of control, and going crazy
• Carl Sagan (astrophysicist – Cosmos)
– Human beings most successful specie
– Ability to think, communicate and plan
– Ability to anticipate
– Catastrophic anticipation
– Origin of neurosis
Alladin, 2010
Treatment of Anxiety Disorders
Alladin, 2010
The Power of Hypnosis
Hypnosis Adds Leverage to Treatment
Alladin, 2010
Rationale for Combining Hypnosis with CBT
Alladin, 2010
First Goal for Utilizing Hypnosis with Anxiety
Disorders:
Reducing Physiological Reactivity
Alladin, 2010
Hypnosis for Reducing Physiological Reactivity
Alladin, 2010
Hypnosis for Reducing Physiological
Reactivity
• Hypnotic Induced Relaxation
• Ability to “let go”
• Floating away to a tranquil setting (Spiegel & Spiegel, and
Stanton, in Hammond, 1990, p.157-159)
• Feeling distant from tension-producing sensation
(Finkelstein; Stickney, in Hammond, 1990, p.158-160)
• Age regression to peaceful scenes and times (Field, in
Hammond, 1990, 170-172)
• Can control feelings and sensations
• Ability to control, “mind over body”
• PHS
• Self-hypnosis tape
Alladin, 2010
Catalepsy to Demonstrate Power of Mind
over Body
Alladin, 2010
Hypnosis for Reducing Physiological
Reactivity
• Anchoring Technique
– For generalizing learning to real situations
– Provides situational or positive self-hypnosis
• Anchoring established following amplification of
relaxation and sense of control
• Relaxation and sense of control conditioned to
clenched fist
• Consolidated by PHS
• Utilize as “see-saw” method or “until you tame
the demon”; second nature
Alladin, 2010
Hypnosis for Reducing Physiological
Reactivity
• Self-Hypnosis
– Homework
– Listen to CD
– Counter NSH
Alladin, 2010
Second Goal of Using Hypnosis with
Anxiety Disorders:
Reducing Emotional Reactivity
Alladin, 2010
Hypnosis for Reducing Emotional Reactivity
Alladin, 2010
Hypnosis for Reducing Emotional
Reactivity
• Cognitive Restructuring
• Two steps
– Self-monitoring of negative cognitions
– Replacement of these cognitions with constructive rational
ones
• Explained in terms of NSH
• Positive self-hypnosis
• Rational therapeutic suggestions formulated through
use of two-column method
Alladin, 2010
Hypnosis for Reducing Emotional Reactivity
Cognitive Restructuring
Sample of Two-Column Method
• Automatic Negative Thoughts •Rational Thoughts
• I will die •I may feel anxious, but I will
not die.
•Anxiety is uncomfortable, but
it does not kill.
•I can use self-hypnosis to
control my anxiety.
•Or I can use the Anchoring
Technique.
Alladin, 2010
Hypnosis for Reducing Emotional Reactivity
Alladin, 2010
Hypnosis for Reducing Emotional Reactivity
• Split-Screen Technique
– Hypnotic induction
– Deepening
– Intensify positive feeling
– Intensify “adult ego” state
– Imagine sitting in front of a large split screen (left and
right)
– Project adult ego state to right side of screen
– Project anxious part to left side of screen
– Imagine ego from right side helping left side
– Integrate the 2 parts
Alladin, 2010
Hypnosis for Reducing Emotional Reactivity
Alladin, 2010
Hypnosis for Reducing Emotional
Reactivity
• Hypnotic Regression Suggestions
• “And, as you already know, you are able to
remember things when you are in a trance that
you have repressed…memories, events, feelings,
that are related to your problem…And you can
tell me about them now…as you remember
them.”
• Golden et al. 1987, cited in Golden, 1994, p.272
Alladin, 2010
Hypnosis for Reducing Emotional Reactivity
• Unconscious Restructuring: Reframing Procedure
– Case of Janet: Situational Panic Attacks
– Married, 32 year-old, with 2 children
– History of anxiety and panic attacks over 10 years
– Referred for psychological treatment by GP
– CBT and SD negligible effect on panic attacks
– Hypnotic age regression
– Fear of trapped and burnt
– “Black Magic” acted as trigger
– Reframed to safety and still being alive
Alladin, 2010
Hypnosis for Reducing Emotional Reactivity
• Unconscious Restructuring: Rewriting Experience
– Case of Betty: Fear of Ward Round
– 30 yr-old Resident had public speaking anxiety
– Had such anxiety for many years, became a serious
problem since residency
– On anxiolytics for 3 years, little effect
– Self-referred for hypnotherapy
– Had CBT and relaxation training, little effect
– Age regression – “derobed” by father when 13
– Rewrote experience
Alladin, 2010
Third Goal of Using Hypnosis with
Anxiety Disorders:
Decreasing Avoidance and Increasing Self-Efficacy
Alladin, 2010
Hypnosis for Decreasing Avoidance and
Increasing Self-Efficacy
• Hypnotic Systematic Desensitization (SD)
– In SD, client confronts fear, or phobia, in a gradual one
step-at-a-time manner
– A Hierarchy is constructed where the phobia is broken
down into steps
– Steps rank-ordered from least to most anxiety-
producing
– Each item of the hierarchy rated on a Subjective Units
of Distress Scale (SUDS)
– From 1-100, where 100 is most anxiety-producing
Alladin, 2010
Hypnosis for Decreasing Avoidance and Increasing
Self-Efficacy
John’s Anxiety (flying phobia) Hierarchy with SUDS
• Situation SUDS
• 1. Looking at travel brochure 30
• 2. Visiting travel agency 35
• 3. Driving to airport 40
• 4. Booking flight 45
• 5. Visiting a plane 60
• 6. Checking in 70
• 7. Boarding 80
• 8. Take off 90
• 9. Turbulence 100
__________________________________
Alladin, 2010
Hypnosis for Decreasing Avoidance and
Increasing Self-Efficacy
• Hypnotic SD Continued…
– Prior to confronting these steps in reality, client receive imaginal
desensitization
– While in a relaxed state, client imagines confronting each step of
the hierarchy
– Therapist proceeds from one item to next, ensuring client feels
relaxed before going to the next step
– If client reports anxiety while imagining an item, therapist helps
to reduce anxiety through use of therapeutic suggestions and
relaxation instructions
Alladin, 2010
Hypnosis for Decreasing Avoidance and
Increasing Self-Efficacy
• Hypnotic SD Continued…
– Number of steps dealt with during each session
depends on client
– Important to proceed at a pace comfortable to client
– For homework, client encouraged to confront
situations in reality
– In vivo desensitization can be gradual
Alladin, 2010
Hypnosis for Decreasing Avoidance and Increasing
Self-Efficacy
• Flooding Technique
– Anxiety-producing situation or image confronted until
situation no longer elicits anxiety
– Similar to SD, flooding can be broken down into steps
– Hypnotic flooding useful when not enough time to do
SD procedure
– Repeat until client report significant reduction in
anxiety
Alladin, 2010
Hypnosis for Decreasing Avoidance and Increasing
Self-Efficacy
• Flooding Technique Script
– “Imagine that you’re now on the plane and the
seatbelt sign goes on. You take some slow deep
breaths, just as you can do right now to reduce some
of the anxiety. You don’t have to reduce it all. Just
enough to feel more in control. The turbulence begins.
It’s uncontrollable but it’s safe. It’s just a normal part
of airplane travel. You’ll be all right. You take long slow
deep breaths, just as you can now.”
– Golden, 1994, p.271
Alladin, 2010
Fourth Goal for Utilizing Hypnosis with
Anxiety Disorders:
Integration of experience
Alladin, 2010
Hypnosis for Integration of Experiences
Alladin, 2010
Hypnosis for Harmonizing Heart-Mind
(1) Education
• Desynchrony of Experience
• Desynchrony among components of anxiety
• Desynchrony interferes with healing
• We use feeling to validate reality
• Reduces credibility of treatment
• Multimodal therapy addresses components but
don’t integrate
• Models of integration or harmonizing lacking
• Hypnosis provides a model
Alladin, 2010
Hypnosis for Harmonizing Heart-Mind
(1) Education Cont/d…
• Models of Mind
• Western model of mind
– Brain is the seat of existence
– Splitting of intellect and feeling
– Don’t know how to integrate
– Confusion – validate reality by the way we feel
• Eastern/Non-Western model of mind
– Heart is the seat of existence
– Feeling at heart validate reality
– Peace at heart provides peace of mind
Alladin, 2010
Hypnosis for Harmonizing Heart-Mind
(2) Hypnotherapy
• Deep trance – mind and body totally relaxed
• Breathing with heart
• Focus on the centre of your heart
• Breathe in and out with your heart
• Slow breathing to 5 sec cycle
• Focus on something that you appreciate
• Notice the good feeling in your heart
• Notice the harmony in your mind and heart
Alladin, 2010
Applications:
Dentistry
Hypnotic Phenomena and
Dental Applications
Phenomena Dental Applications
• Ideomotor phenomena:
- hands moving • Induction methods and
together
training patients
- arm lowering physiological control
-eye closure
-ideomotor signals
- passive arm
catalepsy
- levitation
Filo, 2010
Hypnotic Phenomena and
Dental Applications
Phenomena Dental Applications
- inhibition of voluntary • Trance ratification
control
1. automatic movements
2. finger lock
3. eye catalepsy
4. limb rigidity /
immobilization
Filo, 2010
Hypnotic Phenomena and
Dental Applications
Phenomena Dental Applications
• Ideosensory • Trance ratification
activities • Sensory reframes
Filo, 2010
Hypnotic Phenomena and
Dental Applications
Phenomena Dental Applications
• Analgesia • Minimize chemical
Anesthesia analgesia /
anesthesia
• Substitute for
chemical analgesia /
anesthesia
Filo, 2010
Hypnotic Phenomena and
Dental Applications
Phenomena Dental Applications
• Hypnotic dreams • Procedure rehearsal
• Tx interventions
• Post hypnotic • Behaviour
suggestion modification
• Reinduction cue
Filo, 2010
Hypnotic Phenomena and
Dental Applications
Phenomena Dental Applications
• Hypermnesia & age • Reframing past
regression (partial experiences
and revivification)
• Amnesia
• Amnesia for the
dental experience
Filo, 2010
Hypnotic Phenomena and
Dental Applications
Phenomena Dental Applications
• Time distortion • Modify perception of
treatment duration
• Hidden Observer or • Bruxism / habit
Ego state awareness &
management
Filo, 2010
Hypnotic Phenomena and
Dental Applications
Phenomena Dental Applications
• Hallucinations: • Modification of
negative and treatment experience
positive by changing sensory
- V,A,K,O,G perceptions
Filo, 2010
Hypnotic Phenomena and
Dental Applications
Phenomena Dental Applications
• Classic suggestion • Trance ratification
effect: experiencing
phenomena as
involuntary
Filo, 2010
Dental Fear Categories
Filo, 2010
Phobias & Fears
Filo, 2010
Pain Management:
acute and chronic
A patient in acute pain, especially of traumatic
etiology, likely is in trance; the object is to
enhance and modify the trance state for
patient’s benefit.
Filo, 2010
Pain Management
:
acute and chronic
Victor Rausch DDS *
• acute distress authoritarian
• no distress permissive
• ” I realize you are in extreme discomfort and I can help
you. For me to do that you must help. Listen very
carefully to what I say and follow my instructions. Do you
understand? “
• use finger pressure to induce anesthesia, using pressure
as focus
Filo, 2010
Denture Adaptation
• full and partial dentures may lead to
problems for patients, both mechanical
and emotional in nature.
• mechanical issues once addressed and
resolved may still not alleviate
psychological concerns.
Filo, 2010
Denture Adaptation
Physical manifestations of psychic problems during
fabrication and post insertion include:
• gagging
• lip and circumoral muscle tensing
• defensive (offensive- depending on your perspective)
tongue
• hyperventilation
• excessive salivation
• lacrimation
• coughing
• sweating
• vomiting
Filo, 2010
Denture Adaptation
Hypnosis may help by:
Filo, 2010
Denture Adaptation
Techniques: desensitization
• for the gagger spoon,
plastic disc on floss
once tolerance increased,
impression tray to wear at
home
trial acrylic bases
• all of the preceding worn at home with
incrementally increasing time
Filo, 2010
Denture Adaptation
Techniques: ego strengthening
• visual imagery
• reframing
• split screen
Filo, 2010
Treatment of Syncope
Thomas W. Frost LDS
Filo, 2010
Treatment of Syncope
Ilana Eli and Moris Kleinhauz
Filo, 2010
Habit Management
Irving I Schecter DDS MA *
Tongue Thrusting
- imagine negative theater scene
- imagine positive theater scene
- associate tongue thrust with
negative scene and feelings
- correct position with positive feelings
Filo, 2010
Habit Management
Garland H. Fross DDS
Thumb sucking
• suggest that by sucking thumb he is
showing favoritism to thumb
• to be fair, should give all the fingers equal
time – easiest all at once
• difficulty in compliance with this leads to
dropping of habit
Filo, 2010
Patient Management
Rapport between patient and dentist crucial to
patient satisfaction
Patients change dentists more for interpersonal
reasons cf to technical competence
• decreases stress for patient and dentist
• improves job satisfaction
• can expedite and facilitate treatment
• confers valuable life skill to patient
Filo, 2010
Patient Management
Lawrence M Staples DMD *
• The Let’s pretend game imaginary TV
Filo, 2010
TMD / TMJ
Multifactorial multietiological:
1. functional (bruxing);
2. structural (occlusion);
3. psychological (anxiety, tension, aggression, stress)
Bruxers personalities include:
• interpersonally and expressively aloof
• inhibited
• hard driving
• dissatisfied with their lives
• apprehensively worried and guilt ridden
Filo, 2010
TMD / TMJ
Hypnodynamic assessment (refer Eli & Somer in
Hypnosis in Dentistry) to gather information that
reveals unconscious meaning and motivation.
Techniques:
theater or television
cloud
hypnotic dreams
automatic writing
revivification and age regression
affect bridge
The preceding require training or the employ of a
psychologist in a multidisciplinary treatment model.
Filo, 2010
TMD / TMJ
Harold Golan DMD *
• secret weapon laugh at world
• explanation of stress/parafunction
• ‘method for retaining just enough nervous
energy to do task and spill off rest’
• at night say ‘nothing is important enough in life
to eat myself up’
• during the night abnormal tooth contact will
awaken you, smile, realizing subconscious is
protecting you, roll over go back to sleep
• ratify with glove anesthesia
• control your body, rather than it controlling you
Filo, 2010
TMD / TMJ
Ellis J. Neiburger DDS *
– suggestions to place tongue between
teeth upon becoming aware of clenching
– the longer this is done the more relaxed the
– muscles will become
Filo, 2010
TMD / TMJ
Milton H. Erickson MD *
- ‘when you put your head down’ instantly fall asleep
- suggest that the possibility of bruxing may occur
- describe it as unpleasant
- also suggest awakening on bruxing
- develop a good hand grip and arm muscles instead
- replace bruxing with nocturnal gum chewing habit –
not likely to persevere at it
Filo, 2010
TMD / TMJ
Dov Glazer DDS *
TMD & Tension headache
- tension – press hands fingers together
with hands at face level
- experience tension throughout face
- relax - top to bottom
- enjoy calmness, tranquility, serenity
- massage same mm groups after
mental relaxation
Filo, 2010
TMD / TMJ
Filo, 2010
TMD / TMJ
Milton H Erickson MD *
Bruxism in Children
When the child is old enough, discuss the bruxism
movements
Earnestly hope that he doesn’t awaken
Suggest hearing the bruxing and awakening
Filo, 2010
Motivation: Oral Hygiene
- increase relaxation,
- improve concentration improve
reception and retention of health
promotion information
- efficacy needs research
Filo, 2010
Hygiene
Motivation: Oral
Promotion of Flossing
Maureen A. Kelly DDS, Harlo R. McKinty, Richard Carr *
- suggestions for oral health
- suggestions for improved personal appearance
via attractive, healthy mouth
- improved social acceptability
Filo, 2010
Gagging: control of excessive ‘reflex’
• gag reflex activated to protect the airway
and remove noxious stimuli from GI tract
• somatogenic and psychogenic factors
involved
• hypnosis alone or in combination with
systematic desensitization
• gagging as an avoidance reaction after
previous traumatic experience
• gagging as a defense mechanism
Filo, 2010
Gagging: control of excessive ‘reflex’
Hal Golan *
- denture wear relaxation, suggestions about body as
prize possession
- control of body and not the reverse
- explanation of gagging causes
- glove anesthesia with ratification needle
eyes open trance, remove needle,
keep anesthesia in oral cavity, ratify by having all
surfaces of oral cavity touched
- with kids, substitute arm catalepsy cf needle
alert, proceed to dentistry with reinforcing prn
Filo, 2010
Gagging: control of excessive ‘reflex’
J.Henry Clarke DMD, Stephen J. Persichetti *
Imagery breathing through the neck
(cricothyroid region)
Rationale: they focus on pharynx well, have them
focus lower on breathing
bypassing pharynx – relates to concern with
breathing
practice denture, impression trays at home
with audio tape
Filo, 2010
Gagging: control of excessive ‘reflex’
Filo, 2010
excessive ‘reflex’
Gagging: control of
Louis L. Dubin DDS, PhD *
Gag reflex
- spiel about impossibility of gagging while
holding breath if belong to
- membership in human race
demonstrate
or, temporal tapping
Filo, 2010
Reduction in Chemical Anesthetics, Analgesics,
and Sedation – compliment to N20
Filo, 2010
Reduction in Chemical Anesthetics, Analgesics,
and Sedation – compliment to N20
Filo, 2010
Reduction in Chemical Anesthetics, Analgesics,
and Sedation – compliment to N20
Intravenous Sedation
Hypnosis is used prior to drug injection to permit
lower drug dosage, and to minimize paradoxical
drug effects.
Filo, 2010
Reduction in Chemical Anesthetics, Analgesics,
and Sedation – compliment to N20
General Anesthesia
Hypnosis establishes advantageous
communication with patient;
decreases post operation pain, analgesia usage;
and length of hospital stay.
Filo, 2010
Reduction in Chemical Anesthetics, Analgesics,
and Sedation – compliment to N20
Irving I.Schecter DDS *
- teach hypno-anesthesia
- any stimulus will henceforth
cause anesthesia
Filo, 2010
Reduction in Chemical Anesthetics, Analgesics,
and Sedation – compliment to N20
William T. Heron PhD *
- suggest that need for x-rays, etc. needed
to determine way to proceed
- discuss pleasure when eating food
touching gag triggers
- suggest pt. recall same pleasant
sensations during procedure
Filo, 2010
Reduction in Chemical Anesthetics, Analgesics,
and Sedation – compliment to N20
Louis L. Dubin DDS, PhD *
Paresthesia from induced anesthesia or nerve
damage from manipulation:
- go back to the time when there was full
sensation and function
- overlay this feeling on the present one –
ideomotor confirmation
- when healing takes place or local
dissipates the normal feeling will prevail
Filo, 2010
Reduction in Chemical Anesthetics, Analgesics,
and Sedation – compliment to N20
Louis L. Dubin DDS, PhD *
Anesthesia and alteration of pain awareness:
1. dissociation
2. increased tolerance
3. role-playing
4. recall
Filo, 2010
Reduction in Chemical Anesthetics, Analgesics,
and Sedation – compliment to N20
William S. Kroger MD *
- luxate tooth with finger and suggest
numbness
- demonstrate anesthesia by explorer
bilaterally highlighting difference
Filo, 2010
Control of Hemorrhage
and Salivary Flow
Salivation
Irving I. Schecter DDS *
- saliva increases when there is food
as start of digestion
- since no food no need for saliva
- imagine turning off water faucet
- swallow, note dryness
- turn on faucet only to moisten mouth
Filo, 2010
Control of Hemorrhage and Salivary
Flow
Selig Finkelstein DDS *
Tooth extraction
- progressive muscle relaxation
- ‘applying topical anesthetic to tooth and gums’
squeezing it into gums to get complete anesthesia
- exert even more pressure around the tooth
pushing
material down around the root
- so proud will not feel tooth being removed
Filo, 2010
and Salivary
Control of Hemorrhage
Flow
Vascular control,clotting, and normal healing
- tooth is out
- let socket fill with blood normally
- surprise at minimal discomfort, swelling, etc.
- rapidly heals
Filo, 2010
Professional Organizations
• ASCH The American Society of Clinical Hypnosis
www.asch.net
• SCEH Society for Clinical and Experimental Hypnosis
www.sceh.us
• ISH International Society of Hypnosis www.ish-web.org
• The Milton Erickson Foundation
www.erickson-foundation.org
• The American Psychological Association
www.apa.org (Division 30 Psychological Hypnosis)
• Component Sections of ASCH, i.e. www.gpsch.org
References
• Alladin, A. (2010) Hypnotherapy for Anxiety Disorders.
• American Society of Clinical Hypnosis (2010) Standards
of Training in Clinical Hypnosis, Introductory Workshop.
American Society of Clinical Hypnosis annual meeting.
• Filo, G. (2010) Hypnodontics – Interventions.
• Patterson, D. (2010). Hypnosis and Pain Management.
• Zastrow, J. (2010) Hypnosis and Irritable Bowel
Syndrome.
• Zastrow, J. (2010) Hypnosis and Headaches.