Medical Hypnosis Primer

Clinical and Research Evidence

Arreed Franz Barabasz, Karen Olness, Robert Boland, Stephen Kahn, Arreed Franz Barabasz, Karen Olness, Robert Boland, Stephen Kahn

• Publisher: Routledge
• Year: 2011
• ISBN:
  9781136915703
• Edition: 1
• Topic: Psicología
• Subtopic: Hipnotismo

This brief Primer, assembled by top recognized hypnosis authorities, briefly presents the basic concepts of modern medical hypnosis and encourages mental health care practitioners to learn how to use hypnosis as an adjunct to standard medical care. It also lays the groundwork for the teaching and practice of hypnosis as part of the required syllabus for every medical and nursing school as well as graduate programs in clinical and counseling psychology. Medical Hypnosis Primer goes far in advancing the medical and factual aspects of this still greatly misunderstood field, and is of great value to practitioners, teachers, and students.

Chapter 1
Hypnosis concepts

Arreed Barabasz and Ciara Christensen

1.1 OVERVIEW

Hypnosis is a set of procedures used by health professionals to treat a range of physical and emotional problems. One can enter this altered state of awareness spontaneously. However, for health care purposes it is attained by an induction procedure appropriate to the patient and the disorder.

Most hypnotic inductions engage patients’ imaginative capacities and include hypnotic suggestions for focused attention, relaxation, and calmness. Inductions used for medical or psychological emergencies or children may use eyes-open protocols (alert hypnosis) and often use hypnotic suggestions for alertness (Olness & Kohen, 1996).

Patients respond to hypnosis in different ways. Some describe their experiences as a state of deepened awareness, others as a calm state of focused attention. Patients usually enjoy the experience and view it as very pleasant. The practitioner serves as the therapeutic agent/facilitator to guide the patient to achieve this pleasant state with hypnotic suggestions to alter perception, thought, and action.

If the responses to hypnotic suggestions satisfy a criterion, it is inferred that the procedure produces a hypnotic state. “Hypnotic responses are those responses and experiences characteristic of the hypnotic state” (Killeen & Nash, 2003, p. 208; Nash, 2005). The best results are obtained in the context of a constructive interpersonal practitioner–patient relationship (Kahn & Fromm, 2001, p. xiv), but hypnosis can also be induced in less than a minute of time to meet emergency medical demands (Barabasz & Watkins, 2005, pp. 54, 131–132).

Most people in the general population respond to hypnosis. Those who respond well to hypnosis are usually not gullible; neither are they more responsive to placebos, social pressures, or authority figures than those who do not respond well to hypnosis. The hypnotic state can be entered without a formal induction. This is a common response to a trauma-inducing event (Spiegel & Spiegel, 2004; Watkins & Barabasz, 2008; van der Kolk, 1994; van der Kolk, McFarlane, & Alexander, 1996; van der Kolk, Pelcovitz, et al., 1996).

1.2 COMMON EVIDENCE-BASED USES OF HYPNOSIS

The references following each common use of hypnosis cited in the following list summarize the most recent evidence-based and clinical efficacy data available in addition to the present brief volume. The majority of study abstracts are available online at no charge via the International Journal of Clinical and Experimental Hypnosis (IJCEH), Web page (http://www.ijceh.com). There are many other legitimate uses of hypnosis supported by the scientific literature. The following list cites only the most common uses of the modality. To review the enormous number of studies and clinical data on hypnosis and psychotherapy is beyond the scope of this brief volume. Some of the most common evidence-based uses are

1. Acute and chronic pain, including medical procedures and pre- and postoperative surgeries (Elkins, Jensen, & Patterson, 2007; Flory, Martinez-Salazar, & Lang, 2007)

2. Posttraumatic stress disorder, PTSD (Lynn & Cardena, 2007; Watkins & Barabasz, 2008)

3. Childhood and adolescent problems (Olness & Kohen, 1996; this volume, chap. 5)

4. Childbirth pain and trauma (Barabasz & Watkins, 2005; Brown & Hammond, 2007; this volume, Chapter 8)

5. Insomnia (Graci & Hardie, 2007; Yapko, 2006)

6. Depression (Alladin & Alibhai, 2007; Yapko, 2006; also IJCEH Special Issue on Hypnosis for Depression, in press, early 2010)

7. Weight control/healthy eating/exercise (M. Barabasz, 2007; Kirsch, 1996)

8. Psychosomatic disorders (Flammer & Alladin, 2007)

9. Habit control (Barabasz & Watkins, 2005; Spiegel & Spiegel, 2004)

10. Irritable bowel syndrome, IBS (Irritable bowel syndrome, Paulson, 2006; Golden, 2007; IJCEH Special Issue on Hypnosis for IBS, 2010)

11. Headaches and migraines (Hammond, 2007)

12. Cancer patient care (Neron & Stephenson, 2007)

13. Human papillomavirus, HPV (currently under study as a possible treatment of choice versus standard medical care but not yet fully evidence based; Barabasz, Higley, Christensen, & Barabasz, 2009; Gruzelier et al., 2002).

1.3 HYPNOSIS DEFINED

A short definition of hypnosis is an “attentive perception and concentration, which leads to controlled imagination” (Spiegel, 1998, p. 2). The hypnotic experience might be best explained to new patients as being very much like the experience one may have when absorbed in a good book, a movie, or even watching cloud shapes change in the sky (Barabasz, 1984; Tellegen & Atkinson, 1974). Most published researchers recognize hypnosis as “primarily an identifiable state” (Christensen, 2005).

Hypnosis operates from one’s latent cognitive ability (hypnotizability), which influenes the extent of the responses. Contrary to common belief, social influenes such as “expectancy” have only a modest influnce on genuine hypnotic responsiveness (Barabasz & Perez, 2007; Benham, Woody, Wilson, & Nash, 2006).

The initial suggestion can constitute the hypnotic induction (Nash, 2005), but medical hypnotic inductions usually involve progressive phases of facilitation on the part of the health care practitioner. This is usually done to help the patient attain a state of hypnosis with a depth suitable for a medical or psychotherapeutic purpose.

The hypnotic state is characterized by the patient’s ability to sustain a state of attention, receptive, and intense focal concentration with diminished peripheral awareness. The hypnotic state occurs in an alert patient who has the capacity for intense involvement with a single point in space and time. Thus, the hypnotic state involves a contraction of awareness of involvement with other points in space and time. The intense focal attention necessitates the patient’s elimination of distracting or irrelevant stimuli, thereby creating dialectic between focal and peripheral awareness (Spiegel & Spiegel, 2004). The physiological hypnotic state can occur spontaneously (Barabasz, 2005–2006; Spiegel & Spiegel, 2004). However, for medical procedures, the hypnotic state is induced under the guidance of the practitioner. It is best understood as both an altered state of consciousness and an interpersonal relationship of trust. Relaxation effects, although not required, are often a by-product of hypnosis. Individuals with the ability to enter hypnosis attend only to a given task while simultaneously freeing themselves from distractions (Barabasz & Watkins, 2005).

1.4 HYPNOTIZABILITY

Hypnosis is not a “special process” with a one-dimensional electroencephalogram (EEG) brain signature where, when experiencing a hypnotic state, a light bulb of sorts fashes on the patient’s forehead. Rather than a simple matter of “either–or,” research shows that reliable physiological correlates refect the various subjective states perceived by the patient, as shown by EEG, event-related potential (ERP), and positron emission tomography (PET; Barabasz, 2000, 2005–2006; Barabasz & Barabasz, 2008; Barabasz et al., 1999; Fingelkurts, Fingelkurts, Kallio, & Revonsuo, 2007; Killeen & Nash, 2003; Kosslyn, Thompson, Constantine-Ferrando, Alpert, & Spiegel, 2000; Spiegel & Spiegel, 2004).

Hypnosis is also a matter of degree. Some individuals may enter a deep state and exhibit behaviors such as regression, time distortion, and hallucinations, all of which can be elicited by various hypnotic inductions. Others, however, may reach a plateau, where they are able to experience only simple suggestions but not ones involving varying degrees of distortions of perception, such as might be required for surgical pain control.

There is a latent cognitive ability, best termed hypnotizability (Christensen, 2005) that strongly influenes hypnotic responsiveness, which operates alongside the much more modest influene of situation and attitude (Benham et al., 2006).

The practitioner is concerned with the degree of “depth” to which a patient can be expected to respond. Some hypnotherapeutic techniques and experimental research responses require deep states (e.g., surgery). Others can be effectively employed with the patient only lightly hypnotized (e.g., minor medical procedures, IBS [Barabasz & Barabasz, 2006], HPV [Barabasz et al., 2009], and many forms of psychotherapy).

Researchers and clinicians alike generally first assess the level of hypnotizability and then the level of depth capability. It is a common mistake to assume that because a patient has shown a high score on a reputable standardized scale of hypnotizability they are somehow automatically able to achieve adequate depth once hypnosis is induced. Such is not the case. It is no surprise to see that the scales of hypnotizability, useful as they are, only predict responses to hypnosis about 50% of the time (Hilgard, 1979).

Efforts should be made to assure adequate depth, which will vary throughout the period of hypnosis, depending on the receptivity of the patient to the induction and deepening procedures. Depth may also vary for dynamic reasons according to the demands placed upon the patient by specific suggestions. When depth is an issue, such as might be required to achieve a pain relief response during a medical procedure, it should be monitored by patient report (see Hilgard & Tart, 1966; McConkey, Wende, & Barnier, 1999).

Prior to using hypnosis, it is advisable to familiarize the patient with “hypnotic-like” experiences to reinforce debunking of myths about hypnosis and to ameliorate potential underlying fears about the modality. This will also help build rapport and trust. These brief informal clinical tests are very useful in evaluating patients for possible hypnotherapy. They not only serve to screen and evaluate, but their very administration can establish a positive psychological set and make later inductions of hypnosis easier (see Barabasz & Watkins, 2005, for protocols). (Standardized clinical testing of hypnotizability is explained in Chapter 2.)

1.5 LEARNING HOW TO USE HYPNOSIS FOR YOUR PATIENTS

Healthcare practitioners should take workshops taught by doctors of psychology (PhD, EdD, PsyD) or medicine (MD, MB ChB) who are known to be workshop leaders from the major hypnosis societies (such as the Society for Clinical and Experimental Hypnosis [SCEH], International Society of Hypnosis [ISH], and Milton H. Erickso...