Clinical Hypnosis

Caroyl Gilbert, RN, MSN, CPNP-PCBaylor College of MedicineDepartment of Pediatrics

Gastroenterology, Hepatology, and Nutrition

Acknowledgements

This presentation was adapted with permission from:

Melanie A. Gold, D.O.

Clinical Associate Professor of Pediatrics

University of Pittsburgh School of Medicine

University of Pittsburgh Student Health Service

Objectives

Define clinical hypnosis Define typical hypnotic phenomena Identify the appropriate application of

hypnosis in the clinical setting Know how to introduce hypnosis to

patients and their families Know how to obtain training and

certification in clinical hypnosis Have participated in/observed clinical

hypnosis

Definition

Derived from the term "neuro-hypnotism" (nervous sleep) coined by Dr. James Braid, 1841. (Wikipedia)

Hypnosis

An altered state of consciousness Usually, but not always, involving

relaxation (which may or may not be evident)

A heightened concentration on a particular idea or image

Purpose of altering a symptom

Misconceptions About Hypnosis

Misconceptions

Patient is under control of hypnotherapist

Patient is asleep Only a few people can be hypnotized Only the weak-willed or minded can

be hypnotized Hypnosis masks symptoms All the patient’s psychiatric defense

mechanisms are abolished in trance

All hypnosis is self hypnosis

3 Laws of Hypnosis

Subject must have a clear image of what the result would feel and be like

When will and imagination (or belief) are in conflict, imagination wins out

A suggestion is more likely to be accepted when tied to a positive emotion or affect with which the subject can identify

Hypnotic Phenomena

Cognitive Characteristics

Relaxation Concentration Increased suggestibility Hypermnesia/Amnesia Increased control of

physiologic responses Perception of different

states Concrete thinking

Physical Characteristics

Muscle relaxation Twitching Lacrimation Fluttering eyelids Eye closure Eye movements beneath lids Changes in respiratory

rate/depth Changes in pulse Jaw relaxation (drooling) Catalepsy (suspended

animation) Decreased postural tone

Hypnotic phenomena

Rapport Catalepsy Ideo-motor

activity (not reflex)

Ideo-sensory activity

Memory modification

Ambulation in trance

Time distortion Hypnotic

dreaming Age regression Post-hypnotic

suggestion

Associated and Adverse Effects

Associated Effects Relaxation Headache Dizziness Nausea Anxiety Tearing or crying

Adverse Effects Precipitate

psychotic or panic reaction

Precipitate suicidal behavior

Symptom substitution

Problems that Respond to Hypnosis

Acute and chronic pain Anxiety associated with

procedures or illness Asthma Attention deficit disorder Cerebral palsy Conditioned nausea and vomiting

Problems that Respond to Hypnosis

Diabetes mellitus Dysfluency Encopresis Enuresis Facial tics Habit coughs Insomnia

Problems that Respond to Hypnosis

Migraine syndromes Nail biting Nightmares Performance anxiety Pruritis Psychogenic seizures

Problems that Respond to Hypnosis

Thumb sucking Tongue thrusting Tourette syndrome Trichotillomania Warts

Changes in pain intensity scores during and after treatment

Vlieger, A.M., Menko-Frankenhuis, C., Solfkamp, S.C.S., Tromp, E. & Benninga, M.A. (2007). Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: A randomized controlled trial.

Gastroenterology, 133, 1430-1436.

Hypnosis Reduces Distress and Duration of an Invasive MedicalProcedure for Children

Lisa D. Butler, PhD; Barbara K. Symons, BA; Shelly L. Henderson, MA; Linda D. Shortliffe, MD; and David Spiegel, MD

PEDIATRICS Vol. 115 No. 1 January 2005

TABLE 1. Number, Means, and SDs by Study Condition of Additional Variables Assessed orUsed to Create Summary Scores n Hypnosis n Routine CareChild report Fear before procedure 21 1.81 (1.40) 19 2.42 (1.50) Fear during the procedure 21 2.48 (1.21) 21 2.95 (1.12) Pain during the procedure 21 2.71 (0.96) 21 2.90 (0.94) Crying during the procedure 21 4.24 (1.30) 22 4.68 (1.09)Parent report Fear before procedure 21 3.43 (0.93) 23 3.52 (1.08) Fear during the procedure 21 3.67 (1.11) 23 3.96 (0.82) Pain during the procedure 21 3.05 (0.92) 23 3.13 (0.81) Crying during the procedure 21 2.62 (1.28) 23 3.26 (1.25) How traumatic was VCUG overall? 21 3.10 (1.09) 23 3.39 (0.94)Observational rating Lowest distress level 15 1.83 (0.64) 22 2.39 (0.75) Highest distress level 13 3.68 (1.30) 17 4.53 (1.07)Medical staff rating Difficulty of overall procedure: radiologist 19 3.00 (1.92) 23 4.04 (1.60) Difficulty of overall procedure: technician 19 2.58 (1.78) 23 3.43 (1.62) Difficulty of catheterization: radiologist 12 2.83 (1.64) 14 4.36 (1.98) Difficulty of catheterization: technician 12 2.08 (0.79) 14 3.86 (1.70)

A randomized clinical trial of a brief hypnosis intervention to controlvenepuncture-related pain of paediatric cancer patients

Christina Liossi, Paul White, Popi HatiraPAIN 142 (2009) 255–263

Table 2 Pain and anxiety outcomes for children across time.

Mean Standard deviation T1 T2 T3 T1 T2 T3Anticipated anxiety EMLA 5.28 5.31 5.31 0.79 0.74 0.75 EMLA + Hypnosis 2.43 2.36 2.37 0.45 0.45 0.44 EMLA + Attention 4.36 4.38 4.39 0.33 0.33 0.32Observed distress EMLA 7.26 7.03 7.35 0.83 0.79 0.84 EMLA + Hypnosis 5.07 4.67 4.80 0.59 0.72 1.01 EMLA + Attention 6.30 6.14 6.22 0.91 1.12 1.06Self-reported pain EMLA 4.79 5.09 5.09 0.69 0.84 0.84 EMLA + Hypnosis 2.74 2.89 2.89 0.83 0.79 0.77 EMLA + Attention 4.17 4.91 4.89 0.44 0.51 0.50Self-reported anxiety EMLA 5.12 5.16 5.17 0.72 0.72 0.73 EMLA + Hypnosis 2.35 2.42 2.38 0.52 0.48 0.53 EMLA + Attention 4.17 4.33 4.39 0.38 0.38 0.39

Note. EMLA, eutectic mixture of local anaesthetics; T1, T2, and T3, Times 1, 2, and 3, respectively.

Appropriate Use of Hypnosis

Hypnosis is indicated when: One is responsive to hypnotic

suggestion A problem is treatable with hypnosis Good rapport exists between the

patient and the therapist Patient is motivated to remedy the

problem No iatrogenic harm is anticipated by

use

Inappropriate Use of Hypnosis

Hypnosis is contraindicated when: It would lead to physical

endangerment It may aggravate existing problems or

create new ones It is used for “fun” or entertainment The problem is more effectively and

appropriately treated with a different treatment modality (e.g. medication or family therapy)

Rules for Using Hypnosis

Never treat a condition you are not qualified to treat without hypnosis

Never use authoritarian symptom removal

Do not use for entertainment

Factors Affecting Efficacy

Patient Age Intellectual ability Context of

symptom Acceptability of

hypnosis Hypnotizability (?)

Provider Attitude towards

hypnosis Belief in hypnosis Skill in developing

rapport Skill in encouraging

trance capacity

Factors Affecting Efficacy

Milieu Attitude of family towards

symptoms and hypnosis Societal or cultural attitudes

toward symptom and hypnosis Attitude of staff towards symptom

and hypnosis

Introducing Hypnosis

Learn about the patient Learn about the problem Explain “hypnosis”.. Or not Elicit patient and family beliefs Demystify Use resources Consider the context

Introducing Hypnosis

Using your mind, Pretending about, Imagery, Imagining, Imaging, Using Imagery, Biofeedback, Personal biofeedback, Mind-body interactions, Inside thinking, Inside talking with your [stomach, head, breathing tubes, muscles, bladder..], Relaxing and imagining, Daydreaming, Daydreaming on purpose, Thinking to help yourself, Meditation on your…, Learning how you work the controls in your mind, Learning about what you didn’t know that you knew, Finding out what breathing can do

Goals of Clinical Hypnosis

Develop skills in psychophysiological self-regulation

Balance allopathic therapy (medical treatment) with self-efficacy

Develop integrity in therapeutic relationships

Steps in Clinical Hypnosis

Induction Intensification Therapy in Trance Usual Awareness Ratification/Reflection Follow-up

Clinical Hypnosis

Useful therapeutic tool – not a cure all An adjunct to medical or psychiatric therapy,

usually not the primary treatment Requires self-motivation Not effective when there is a significant

secondary gain maintaining symptom Essentially no adverse effects Gives patient a sense of mastery and control

of symptoms

Training

American Society of Clinical Hypnosis (www.asch.net)

Society for Developmental and Behavioral Pediatrics (www.sdbp.org)

American College of Hypnotherapy(www.aihcp.org)

Society for Clinical and Experimental Hypnosis (www.sceh.us)

The Tad James Company (www.nlpcoaching.com) “neuro-linguistic programming”

Certification

Available through the American Society for Clinical Hypnosis (see website)

Certification indicates that the practitioner: Has undergone advanced training in his/her profession to

obtain a legitimate advanced degree from an accredited institution of higher education;

Is licensed or certified to practice in his/her state/province; Has had his/her education and training in clinical hypnosis

reviewed by qualified peers and approved consultants and such training has met the minimum requirements established by a Standards of Training Committee of qualified peers;

Has been determined to have received at least the minimum educational training that ASCH, the largest such interdisciplinary organization in North America, considers as necessary for utilizing hypnosis.

Referral Resources

Institute for Family Psychology (www.mhehouston.com)

American Society for Clinical Hypnosis (www.asch.net)

Society for Developmental and Behavioral Pediatrics (www.sdbp.org)

Demonstration

Questions & Answers

Contact Information

Caroyl Gilbert, RN, MSN, CPNP-PC

Phone: 832-822-1096

Fax: 832-825-3633

cmgilber@bcm.edu