Hypnotherapy

1
Hypnotherapy

• Applications in Pain Management
• Frank McDonald
• Consultation-Liaison Psychologist
• The Townsville Hospital
• www.fmcdonald.com

2
Introduction

• Most popular application in medical settings is
  for anxiety (e.g. distress during medical
  procedures like needles, chemotherapy, adrenal
  vein sampling) pain control (focus of this
  session)
• Session briefly describes recent pain cases in
  general hospital setting, after outlining nature
  of hypnotherapy, its contra/indications steps
  involved

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Overview

• Video clip of hypno-analgesia followed by
  hypno-anaesthesia
• Nature of hypnosis What is it? How does it
  work? Common ideas/misconceptions vs. evidence
• Whos more less likely to benefit from
  hypnotherapy?
• Contraindications
• Procedural stages
• Pain mx cases chronic cervico-genic headaches,
  pain of burns-bath rx, chronic hyperemesis
  (severe nausea, stomach pain vomiting)
• Resources

4
Video clip

• Dr. Graham Wicks demonstrates hypno- analgesia
  followed by surgery under hypnosis without
  anaesthetic
• Pre-view video at http//www.abc.net.au/catalyst/s
  tories/s1440855.htm Dr. Wicks starts around 19
  minute mark
• Presenter discusses neural mechanisms of pain
  control as suggested by recent fMRI studies

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Nature of HypnosisWhat is it how does it
work?

• Hypnosis - oldest (cognitive) psychological
  strategy predates written history Egyptian
  records go back 4 000 years. Aboriginal
  Australians Africans amongst earliest users
• A phenomenon of attention in which brain suspends
  authentication of raw sensory input. (Focus is on
  internal representation of input. Working with
  that to change pts experience.)
• Results in heightened suggestibility (a cognitive
  flexibility resulting in reduced critical
  analysis), or at least allows suggestibility to
  come to the fore

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Nature of HypnosisWhat is it how does it work?

• In turn, allows access to therapeutically-useful
  psychological physical abilities e.g.
• dissociation
• anaesthesia/analgesia
• involuntary movement
• time distortion
• involuntary nervous system functions (blood flow,
  coagulation time, blood pressure, peristalsis of
  digestive tract, heart rate etc )

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Nature of HypnosisWhat is it how does it
work?

• Hypnosis a form of highly focused attention -
  like meditation. In meditation you concentrate on
  nothing in particular (e.g. the space between
  thoughts) in hypnosis on something (usually
  therapeutic suggestions)
• Hypnotherapy refers to use of strategies
  harnessing hypnotic phenomena (e.g. narrowed
  attention, heightened suggestibilty) in the
  service of therapeutic goals
• Hypnosis is regarded as an adjunct to therapy
  not a therapy in its own right. A state of
  resting arousal, unlike sleep or relaxation

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Nature of HypnosisWhat is it how does it work?

• How it works is not clear absence of a
  scientific explanation has limited its
  acceptance. Age-old debates e.g. Charcot (below)
  vs. Bernheim the current special state v.
  role-play have made it controversial

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Nature of HypnosisWhat is it how does it work?

• How? point of departure/division into two
  academic camps ( theres heterogeneity within
  those)
• Some say hypnotic behaviour reflects changes in
  brain function
• Others say social-psychological ordinary
  cognitive-behavioural factors, like placebo
  (albeit hypnosis more effective than sham pills)
• Whilst polarising, debate helps us appreciate its
  dual nature

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Nature of HypnosisWhat is it how does it work?

• Assuaging an effect of controversies somewhat,
  PET scan fMRI studies showing modulations of
  activity in specific relevant areas are
  starting to allay prejudices to its application
  in certain fields, such as pain mx
• The images differ from those of well-instructed,
  well-motivated role-players

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Nature of HypnosisWhat is it how does it work?

• So, not just imagination, faking,
  play-acting, stage-show gimmickery. For high
  moderate hypnotisables (roughly 2 in 3 people),
  hypnosis can bring benefits beyond those of
  imagination or willing

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Nature of HypnosisWhat is it how does it work?

• Even sceptics (who dont believe in trances)
  believe it can relieve conditions like insomnia,
  obesity, hypertension improve behaviour
  therapies, counselling coping strategies
• Whilst accepting imaging studies, they believe
  though that hypnosis is not tapping into anything
  beyond a continuum of everyday abilities that are
  distributed across the population in a pattern
  detected by hypnotisability scales
• They say its just that hypnosis is one of the
  best ways to tap into these commonplace
  capacities

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Nature of HypnosisCommon ideas vs evidence
What do you know about hypnosis? (Nash,2001)
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Who benefits more?

• 1. People who score high (26) and moderately
  (36) on scales of hypnotisability. 29 are
  mildly hypnotisable. (9 unhypnotisable)
  (Hilgard, 1961)
• 2. Children (peaks age 9 - 12)
• 3. People who ask for hypnotherapy/who are
  motivated
• 4. People who have an imaginative ability e.g.
  artistic
• types
• 5. People who have a capacity for emotional
  involvement
• 6. People who can take things on faith or trust
  as opposed to sceptical, analytical types
• 7. People from certain cultures e.g. Latinos vs.
  Germans
• 8. Rights handers vs. left handers

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Who benefits less?

• 1. People with abnormally low IQ's (attention
  and response-time factors)
• 2. Dementia patients (these patients cannot be
  hypnotised due to problems in prefrontal areas
  necessary to process induction signals)
• 3. People who score low (9) on scales of
  hypnotisability
• 4. People for whom condition brings secondary
  gains (conscious or unconscious pay-offs)
• 5. People in psychotic states. (Can uncover too
  much material and therapist can be drawn in
  to any delusional beliefs)
• 6. People in hypermanic states

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Contraindications

• There are few absolute contraindications to the
  use of hypnosis. It is usually a very safe
  procedure. But there are number of situations in
  which you should be cautious
• Hypnosis is usually contraindicated if you are
  dealing with
• 1. Any condition which would be better treated
  another way
• 2. Any condition outside your specialty and area
  of expertise
• 3. Depression with a risk of suicide. Be on the
  qui-vive for "masked depression" e.g. depression
  masked by low back pain or a habit disorder. The
  tranquillising effects of hypnosis may energise a
  lethargic depressive sufficiently to allow
  suicide
• 4. Thought disorders such as Schizophrenia and
  Delusional Disorder except if you have experience
  with these. While hypnosis cannot precipitate a
  psychosis, you may be incorporated into the
  person's thought disorder more readily

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Phenomena strategies facilitated intensified
by hypnosis

• Phenomena
• Increased temporary and post-hypnotic
  suggestibilty less critical, evaluative
  thinking
• Reduced awareness that improves classical
  conditioning. Easier to establish more
  difficult to extinguish
• Hallucinations that are more real and absorbing
  than ordinary imagination
• Regression and revivification
• Time distortion e.g. time contraction in medical
  procedures
• Analgesia and anaesthesia
• Dissociation (split self off from current
  reality)
• A.N.S. control e.g. changing blood flow
• Arousal modulation (within limits) for the
  demoralised or the distressed to focus therapy
  attention

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Phenomena strategies facilitated intensified
by hypnosis

• Strategies
• Imaginal conditioning
• Revivification and (cognitive) restructuring
• Exposure therapy/ extinction/ abreaction
• Imaginal rehearsal
• Relaxation / arousal reduction
• Suggestion e.g. for ego-strengthening and
  altering pain sensation, enhancing performance
• Simple encouragement and support

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Areas of application

• Medical
• Asthma
• Burns
• Enuresis
• Hypertension
• Childbirth
• Migraine

• Minor Surgical Procedures
• Obesity
• Pain Control
• Gastro-intestinal Disorders
• Warts

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Areas of application

• Psychological Practice Psychiatry
• Anxieties
• Apathy and lack of Motivation
• Confidence Problems
• Eating Disorders
• Depression
• Nail-biting
• Fears and Phobias

• Psychosomatic Syndromes
• Panic Attacks
• Sleep Disorders
• Sexual Dysfunction
• Thumb-sucking
• Stuttering

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Areas of application

• Dentistry
• Anaesthesia
• Anxiety / Apprehension
• Bleeding Control
• Bruxism
• Dental Phobia
• Denture Problems

• Gagging
• Nausea
• Pain-control
• Restlessness
• Salivation-control
• Tempro-mandibular Joint Dysfunction

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Areas of application

• Education
• Concentration and Attention problems
• Exam Fears/Phobias
• Motivation training
• Memory Training
• Study habit problems

• Sports
• Attitude Change
• Confidence Building
• Co-ordinate Mind Body
• Fear of Success
• Fear of Failure
• Maximise Potential
• Improve Concentration
• Performance Anxiety
• Motivation Training control

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Procedural Stages of Hypnotherapy

• 1. Preparation (e.g. removing misconceptions,
  assess interests that may be incorporated in
  procedure)
• 2. Assessment of hypnotisability (capacity for
  concentration and imagery, suggestibility)
• 3. Induction procedure
• 4. Deepening stage
• 5. Trance ratification
• 6. Utilisation of trance for therapeutic
  purposes
• 7. Post-hypnotic suggestions including self-
• hypnosis instructions
• 8. Termination of the trance
• 9. Discussion of the experience. Problems?

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Pain-related Case Discussions

• Cervico-genic headaches in 37 yr old female from
  m.v.a. at age 17
• Mx of pain of burns bath treatment in 10 yr old
  male
• Mx of chronic (2yrs ) hyperemesis in 33 yr old
  female

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Resources Pre-/post- session reading

• http//www.abc.net.au/catalyst/stories/s1440855.ht
  m Vision and transcript. Hypnosis for pain at 19
  minute mark
• Australian Society of Hypnosis
• http//www.ozhypnosis.com.au/Default.htm
• Hypnosis.com the FAQ section is excellent
  http//hypnosis.com/faq/
• This presentation www.fmcdonald.com
• Extra reading presented via JCU network