Hypnosis as an empirically supported clinical intervention: the state of the evidence and a look to the future

Hypnotizability in the Clinic, Viewed from the Laboratory

A recent international survey discovered that clinicians who use hypnosis in their practice rarely assess the hypnotizability of their patients or clients. This contrasts sharply with the practice in laboratory research. One reason offered for this discrepancy is that hypnotizability does not strongly predict clinical outcome. But a comparison of this relationship with similar correlations in other domains shows that this criticism is misleading-especially when the treatment capitalizes on the alterations in perception, memory, and voluntary control that characterize the domain of hypnosis. Routine assessment of hypnotizability improves clinical practice by enabling clinicians to select patients for whom hypnosis is appropriate; and it improves clinical research by providing important information about the mechanisms underlying hypnotic effects.

Applications of Hypnosis as an Adjuvant in Oncological Settings: A Systematic Review

Previous research has shown promising results in using hypnosis to treat various symptoms and side effects of medical treatments. The objective was to identify studies that use hypnosis as an adjuvant to evidence-based treatments to evaluate its benefits in patients with cancer. The search identified 873 articles published between 2000 and February 2021, of which 22 were selected using the principles of the PRISMA. Apart from 1 study, all studies showed that interventions improved the measured variables compared to a control group. Most studies showed that hypnosis has positive effects on reducing anxiety, pain, nausea, fatigue, drug use, and length of hospital stays. Hypnosis also improves depressive symptoms, insomnia, hot flashes, well-being, and quality of life, and helps increase adherence to treatment. When used by qualified professionals as an adjuvant to well-established treatments, hypnosis improves symptoms caused by oncological interventions and the disease itself. In addition, hypnosis has no side effects.

Hypnosis reduces food impulsivity in patients with obesity and high levels of disinhibition: HYPNODIET randomized controlled clinical trial

BACKGROUND

The obesogenic environment of Western countries raises questions about its current management. Some clinical studies have explored hypnosis, although the current state of knowledge does not lead to definitive conclusions about its efficacy.

OBJECTIVES

We assessed the impact of Ericksonian hypnosis and self-hypnosis on disinhibition of eating in adults with obesity and high food impulsivity levels, compared with standard nutritional education.

METHODS

From September 2014 to July 2015, adults with BMI (in kg/m2) of 30-40 and a high disinhibition score [>8 on the Three Factor Eating Questionnaire (TFEQ-51)] were included in a randomized controlled trial. The control and hypnosis groups received the same standard nutrition education in 8 workshops. In the hypnosis group, subjects had 8 sessions of hypnosis combined with training in self-hypnosis. Disinhibition (primary outcome) and other scores from the TFEQ-51 as well as anthropometric, food intake, cardiometabolic, and physical activity variables were collected at inclusion and at 8 mo.

RESULTS

Of 82 randomly assigned adults, 70 participated in all sessions; 80 participated in ≥1 session and were included in the main analysis (hypnosis group, n = 41; control group, n = 39). After 8 mo of follow-up, disinhibition scores adjusted for baseline values were lower in the hypnosis group, with a mean between-group difference of 4.2 (95% CI: 2.8, 5.5; P < 0.001); 67.7% of adults in the hypnosis group had normalized their disinhibition (compared with 11.1% in control; P < 0.0001). Differences for weight (1.8 kg; 95% CI: -0.1, 3.7 kg; P = 0.052), BMI (0.8; 95% CI: 0.1, 1.4; P = 0.028), susceptibility to hunger score (2.2; 95% CI: 1.0, 3.3; P < 0.001), and its 2 subscales also favored the hypnosis group.

CONCLUSIONS

In the management of adults with obesity and a high disinhibition score, hypnosis and self-hypnosis can significantly improve the deep mechanisms of eating behaviors and seem to have a beneficial effect on weight loss.This trial was registered at clinicaltrials.gov as NCT02292108.

Hypnosis for the Management of COPD-related anxiety and dyspnea in Pulmonary Rehabilitation - rationale and design for a cluster-randomised, active-control trial [HYPNOBPCO_2]

Complementary psychological care is recommended for COPD, as it significantly reduces anxiety and boosts the pulmonary rehabilitation efficacy. In a precedent trial (HYPNOBPCO_1, ISRCTN10029862), administering a single hypnosis session was linked to reduced anxiety and improved breathing mechanics in intermediate and advanced COPD patients. However, whether hypnosis could improve self-management of anxiety and dyspnoea in COPD during pulmonary rehabilitation is yet to be investigated.

This is the protocol for HYPNOBPCO_2, a 2-arm, cluster-randomised, statistician-blinded superiority monocentre trial (NCT04868357). Its aim is to assess the efficacy of hypnosis as a tool to manage anxiety and dyspnoea during a pulmonary rehabilitation programme (PRP). Clusters of COPD patients eligible for the conventional hospital-based PRP at the Centre Hospitalier de Bligny (CHB) will be randomised and evenly allocated into two parallel arms: “Hypnosis” (treatment) and “Relaxation” (active control). “Hypnosis” will consist of the CHB's conventional 4-week group PRP, supplemented by two educational sessions for teaching self-hypnosis. “Relaxation” will be identical, except standard relaxation exercises will be taught instead. Primary end-point will consist of assessing weekly changes in anxiety throughout the PRP, additional to total anxiety change after treatment completion. Anxiety will be determined by the six-item version of the State-Trait Anxiety Inventory (STAI-6). Secondary outcomes will include change in the 6-min walk test and the COPD assessment test (CAT). Further follow-up outcomes will include CAT and STAI-6 retests, re-hospitalisation rate, action plan use and persistence in self-hypnosis use, throughout the 12 weeks ensuing PRP completion.

Rationale for HYPNOBPCO_2 (NCT04868357), a trial investigating whether self-hypnosis (fast, low-cost, effortless) reliably improves breathlessness-related anxiety and breathing mechanics, during and after pulmonary rehabilitation in COPDhttps://bit.ly/3JF2vCW

The Effect of Hypnosis on the Intensity of Pain and Anxiety in Cancer Patients: A Systematic Review of Controlled Experimental Trials

BACKGROUND

Pain is a common symptom in cancer patients. Hypnosis is considered one of the most recognized non-pharmacological techniques in pain management. In oncology, this technique can be used as a complementary treatment to reduce the level of pain and anxiety. The objective of this study is to systematically review and evaluate controlled clinical trials (CCTs) examining the effect of hypnosis on the intensity of pain, and anxiety in cancer patients.

METHODS

A systematic review was conducted according to the recommendations of the "Preferred reporting items for systematic reviews and meta-analyses" (PRISMA). The Cochrane systematic review database, the abstract databases, Scopus, PubMed, Google Scholar, and Cochrane Library have been systematically reviewed from 2005 to 2018.

RESULTS

Eleven CCT with a total of 1182 participants met the inclusion criteria and were included in this review. The participants were mainly women (n = 968). Their average age alternates between 48 and 58 years. Perceived pain was measured primarily by visual analog scale (VAS)/numerical pain rating scale (NPRS), which showed that anxiety was measured by Hospital Anxiety and Depression scale (HADS). Hypnosis-related anxiety and pain decreased significantly with respect to usual treatment.

CONCLUSIONS

Evidence suggests promising results of hypnosis on the management of pain, and anxiety levels in the vast majority of cancer patients. Therefore, because of the exploratory design and high risk of bias, the effectiveness of hypnosis or hypnotherapy in reducing pain and anxiety levels remains unclear. There is a need for more rigorous randomized controlled trials (RCTs).

Effectiveness of hypnosis for pain management and promotion of health-related quality-of-life among people with haemophilia: a randomised controlled pilot trial

Joint deterioration and associated chronic pain are common among people with haemophilia (PWH), having an impact on quality-of-life. Though non-pharmacological strategies are recommended, psychological interventions to promote pain control and quality-of-life have scarcely been tested in haemophilia. This randomised controlled pilot trial aimed to assess feasibility, acceptability and effectiveness of hypnosis for pain management and promotion of health-related quality-of-life (HRQoL) among PWH. Twenty adults were randomised either to four weekly hypnosis sessions plus treatment-as-usual (experimental group; EG) or treatment-as-usual only (control group; CG). Participants completed sociodemographic and clinical assessment, measures of pain, HRQoL and emotional distress before (T1) and after (T2) intervention. Changes were analysed by calculating the differences between T1 and T2, and the groups were compared through independent-sample t tests (or chi-squared). Retention rates (90%) and analysis of patient satisfaction showed good acceptability and feasibility of the intervention. The EG (n = 8) had a higher reduction on pain interference than the CG (n = 10) (d = −0.267). A higher improvement on HRQoL (EQ-5D index: d = 0.334; EQ-5D VAS: d = 1.437) and a tendency towards better haemophilia-related quality-of-life (A36-Hemofilia QoL) were also evident in the EG. This is the first study showing the effectiveness of hypnosis to reduce pain interference and promote HRQoL among PWH.

What's in a word? How instructions, suggestions, and social information change pain and emotion

Instructions, suggestions, and other types of social information can have powerful effects on pain and emotion. Prominent examples include observational learning, social influence, placebo, and hypnosis. These different phenomena and their underlying brain mechanisms have been studied in partially separate literatures, which we discuss, compare, and integrate in this review. Converging findings from these literatures suggest that (1) instructions and social information affect brain systems associated with the generation of pain and emotion, and with reinforcement learning, and that (2) these changes are mediated by alterations in prefrontal systems responsible for top-down control and the generation of affective meaning. We argue that changes in expectation and appraisal, a process of assessing personal meaning and implications for wellbeing, are two potential key mediators of the effects of instructions and social information on affective experience. Finally, we propose a tentative model of how prefrontal regions, especially dorsolateral and ventromedial prefrontal cortex may regulate affective processing based on instructions and socially transmitted expectations more broadly.

Cognitive Behavioral Therapy, Mindfulness, and Hypnosis as Treatment Methods for Generalized Anxiety Disorder

Individuals suffering from generalized anxiety disorder (GAD) experience a broad range of physical, emotional, and cognitive distress. A hallmark of GAD is anxiety around making decisions. Many clinicians notice improvements in patients through specific modalities, such as mindfulness, hypnosis, and cognitive behavioral therapy (CBT); however, these individual methods sometimes fall short. Clinicians and researchers alike note that it can be more effective to combine these three methods into an integrative treatment protocol. This article demonstrates the efficacy of an integrative model through the case study of a client who suffers from GAD and acute fear of decision making. Competent use of mindfulness, hypnosis, and CBT helps the client build the skills necessary to self-soothe, diminish worry, access resources, and enhance hope for the future. Through the article, clinicians interested in integrated treatment models will gain insight into how to apply these methods.

A Pragmatic Guide to the Setting up of Integrated Hypnotherapy Services in Primary Care and Clinical Settings

Despite the continued debate and lack of a clear consensus about the true nature of the hypnotic phenomenon, hypnosis is increasingly being utilized successfully in many medical, health, and psychological spheres as a research method, motivational tool, and therapeutic modality. Significantly, however, although hypnotherapy is widely advertised, advocated, and employed in the private medical arena for the management and treatment of many physical and emotional disorders, too little appears to be being done to integrate hypnosis into primary care and national health medical services. This article discusses some of the reasons for the apparent reluctance of medical and scientific health professionals to consider incorporating hypnosis into their medical practice, including the practical problems inherent in using hypnosis in a medical context and some possible solutions.

Effects of Hypnosis on Regression to Primary-Process Thinking

The authors tested the hypothesis that hypnotic age regression produces a shift from secondary- to primary-thought processing in hypnotizable participants. Thirty participants were tested for hypnotizability using the Elkins Scale of Hypnotizability (EHS). Participants were exposed to a tailored hypnotic arm-levitation induction and a hypnotic suggestion to age regress to 5 years of age and to have a dream. Primary-process thinking was assessed using the Primary-Process Thinking Scale. An independent t test with 2 levels of hypnotizability (middle and high) showed high hypnotizables demonstrated higher ratings of primary thought processing than those in the middle group.

Does Hypnosis Make in Vitro, in Vivo?

This case illustrates the use of hypnosis as an adjunct to therapy in phobia treatment. Interventions conducted in an hypnotic context included cue-controlled relaxation and covert desensitization, in which the client reframed her fears and transformed fear-related images into benign stimuli. These interventions were experienced by the client as having an “as real” quality and were successful in reducing her long-standing fear of the wind to a normal level within three sessions. This improvement was maintained at 18 months follow-up. This outcome is discussed in relation to virtual reality approaches to phobia treatments and ways in which hypnosis may facilitate cognitive behavioral techniques.

Current issues in the treatment of specific phobia: recommendations for innovative applications of hypnosis

Specific phobia is the most common and treatable of the anxiety disorders. Exposure-based therapies are the treatment of choice and empirically validated protocols are available that promise rapid and effective results. In many cases, however, patients are reluctant to comply with demanding schedules of exposure, increasing the risk of treatment failure. Furthermore, in clinical practice, patients often present with multiple phobias and other Axis I and Axis II disorders that can further complicate therapy. This article covers four important issues that have been addressed in the literature: (a) managing resistance to treatment, (b) reducing length of treatment, (c) clarifying the optimal application of relaxation training, and (d) applying advances in cognitive neuroscience. These issues are reviewed and recommendations proposed for ways in which to modify current treatments. Specific suggestions are provided for implementing these recommendations including examples of innovative applications of standard hypnotic techniques.

Hypnotherapeutic treatment for anxiety-related relational discord: a short-term hypnotherapeutic protocol

Hypnotherapeutic interventions are currently used to treat both anxiety disorders and relational discord between couples, yet few hypnotherapeutic interventions specifically address anxiety disorders within the context of a romantic partnership. This article explores a short-term hypnotherapeutic treatment protocol designed for couples' therapy in which the relational dynamic has been impacted by one partner's anxiety disorder. Anxiety not only causes suffering for the anxious patient, but can negatively impact intimate relationships as well. The hypnotherapeutic treatment protocol advanced in this article is specifically designed to address relational discord which is fueled by the presence of one partner's anxiety, and complements more standard individual treatment for anxiety disorders. Strategies to assess for the presence of relational discord with individual patients presenting with an anxiety disorder are included, as well as implications for longer-term couples' treatment.

Unconscious agendas in the etiology of refractory obesity and the role of hypnosis in their identification and resolution: a new paradigm for weight-management programs or a paradigm revisited?

Hypnosis has long been recognized as an effective tool for producing behavioral change in the eating disorders anorexia and bulimia. Despite many studies from the latter half of the last century suggesting that hypnosis might also be of value in managing obesity situations, the efficacy of hypnotherapy for weight reduction has received surprisingly little formal research attention since 2000. This review presents a brief history of early clinical studies using hypnosis for weight reduction and describes a hypnotherapeutic approach within which a combination of instructional/pedagogic and exploratory therapeutic sessions can work together synergistically to maximize the potential for sustained weight loss. Hypnotic modulation of appetite- and satiation-associated peptides and hormone levels may yield additional physiological benefits in Type 1 and Type 2 diabetes.

Group hypnosis vs. relaxation for smoking cessation in adults: a cluster-randomised controlled trial

Background

Despite the popularity of hypnotherapy for smoking cessation, the efficacy of this method is unclear. We aimed to investigate the efficacy of a single-session of group hypnotherapy for smoking cessation compared to relaxation in Swiss adult smokers.

Methods

This was a cluster-randomised, parallel-group, controlled trial. A single session of hypnosis or relaxation for smoking cessation was delivered to groups of smokers (median size = 11). Participants were 223 smokers consuming ≥ 5 cigarettes per day, willing to quit and not using cessation aids (47.1% females, M = 37.5 years [SD = 11.8], 86.1% Swiss). Nicotine withdrawal, smoking abstinence self-efficacy, and adverse reactions were assessed at a 2-week follow-up. The main outcome, self-reported 30-day point prevalence of smoking abstinence, was assessed at a 6-month follow up. Abstinence was validated through salivary analysis. Secondary outcomes included number of cigarettes smoked per day, smoking abstinence self-efficacy, and nicotine withdrawal.

Results

At the 6-month follow up, 14.7% in the hypnosis group and 17.8% in the relaxation group were abstinent. The intervention had no effect on smoking status (p = .73) or on the number of cigarettes smoked per day (p = .56). Smoking abstinence self-efficacy did not differ between the interventions (p = .14) at the 2-week follow-up, but non-smokers in the hypnosis group experienced reduced withdrawal (p = .02). Both interventions produced few adverse reactions (p = .81).

Conclusions

A single session of group hypnotherapy does not appear to be more effective for smoking cessation than a group relaxation session.

Trial registration

Current Controlled Trials ISRCTN72839675.

Positive suggestion techniques in somatic medicine: A review of the empirical studies

INTRODUCTION

THERE IS AN EVER REOCCURRING QUESTION IN MEDICAL PRACTICE: Does the positive attitude and communication of the medical staff make any difference?

AIM

Our aim is to present a comprehensive overview of the medically relevant effects of positive suggestions by reviewing the recent literature.

METHODS

We will review the studies measuring the effects of suggestive communication of the past 20 years. In cases of studies presented in more details we quote from the suggestion scripts used in the study, too.

RESULTS

Some of the reviewed papers report that positive suggestions lead to decreased pain and use of pain medication and positively affect physiological factors like bowel motility, blood pressure and bleeding during surgery as well. However, the literature also contains studies in which only partial or no positive effects were found.

CONCLUSIONS

We emphasize further, more detailed investigation of positive suggestion techniques and its integration into the education of medical professionals.

Nocturnal bruxism and hypnotherapy: a case study

This article describes a case study of a hypnotherapeutic treatment of nocturnal bruxism. The author saw the client for a total of 7 sessions. Hypnotherapy was interspersed with an exploration of tacit and initially denied hostility in the client's life as well as aspects of a somewhat difficult childhood. At the end, the bruxism had disappeared. Follow-up 1 year later indicated that the bruxism had not returned, and the client had become more assertive in her relations with others and had more exploratory activities in her life directions. The latter had not been dealt with in therapy. Thus, there appeared to be a "ripple effect" of successful therapy from one part of her life into its other aspects.

Cognitive hypnotherapy with bulimia

Research on the efficacy of hypnosis in the treatment of bulimia nervosa has produced mixed findings. This is due in part to the interplay between the characteristics of people with bulimia and the wide variety of hypnosis interventions that have been employed. Several authors have noted that methodological limitations in hypnosis research often make evaluation of treatment efficacy difficult. Many of the studies extant provide insufficient information regarding the specifics of participants' hypnotizability, the hypnotic induction, or the hypnotic suggestion(s) employed. Such limitations preclude replication and clinical implementation. This article reviews the literature with replicable methodologies and discusses the implications for evaluating treatment efficacy.

Cognitive hypnotherapy: a new vision and strategy for research and practice

This article describes cognitive hypnotherapy (CH), a visionary model of adjunctive hypnotherapy that advances the role of clinical hypnosis to a recognized integrative model of psychotherapy. As hypnosis lacks a coherent theory of psychotherapy and behavior change, hypnotherapy has embodied a mixed bag of techniques and thus hindered from transfiguring into a mainstream school of psychotherapy. One way of promoting the therapeutic standing of hypnotherapy as an adjunctive therapy is to systematically integrate it with a well-established psychotherapy. By blending hypnotherapy with cognitive behavior therapy, CH offers a unified version of clinical practice that fits the assimilative model of integrated psychotherapy, which represents the best integrative psychotherapy approach for merging both theory and empirical findings.

Cognitive hypnotherapy for anxiety disorders

Cognitive hypnotherapy, also known as cognitive-behavioral hypnotherapy (CBH), is applied to the treatment of anxiety disorders. Specific techniques are described and illustrated. The research on CBH is discussed. CBH seems to be at least as effective as behavior therapy (BT) and cognitive-behavior therapy (CBT) treatments that employ imagery and relaxation techniques for anxiety disorders. However, more research is needed because of the lack of adequate studies comparing CBH with BT and CBT. Clinical implications and suggestions for future research are offered.

Multicomponent cognitive-behavioral group therapy with hypnosis for the treatment of fibromyalgia: long-term outcome

This study compared the efficacy of 2 psychological treatments for fibromyalgia with each other and with standard care. Ninety-three patients with fibromyalgia (FM) were randomly assigned to 1 of the 3 experimental conditions: 1) multicomponent cognitive-behavioral therapy (CBT); 2) multicomponent CBT with hypnosis; and 3) pharmacological treatment (standard care control group). The outcome measures of pain intensity, catastrophizing, psychological distress, functionality, and sleep disturbances were assessed before treatment, immediately after treatment, and at 3- and 6-month follow-up visits. CBT and CBT with hypnosis participants received the standard pharmacological management plus 14 weekly, 120-minute-long sessions of psychological treatment. All but 1 session followed a group format; the remaining session was individual. The analyses indicated that: 1) patients with FM who received multicomponent CBT alone or multicomponent CBT with hypnosis showed greater improvements than patients who received only standard care; and 2) adding hypnosis enhanced the effectiveness of multicomponent CBT. This study presents new evidence about the efficacy of multicomponent CBT for FM and about the additional effects of hypnosis as a complement to CBT. The relevance and implications of the obtained results are discussed.

PERSPECTIVE

This article highlights the beneficial effects of adding hypnosis in a multicomponent cognitive-behavioral group treatment of fibromyalgia patients. Also, this research showed that by adding hypnosis the length of treatment did not increase.

Hypnosis for the management of chronic and cancer procedure-related pain in children

The aim of this study was to review published controlled trials of hypnotic treatments for chronic and cancer procedure-related pain in children. Trials were included if participants were 18 years of age or below, were randomized and had populations with chronic pain or cancer procedure-related pain. After the studies were assessed, 12 were selected for review. Although the evidence is limited, the findings indicate that hypnosis is an effective pain-control technique when used with children suffering from cancer procedure-related pain or chronic pain. Further research into the use of hypnosis to manage chronic pain in children should be a priority so that empirically based conclusions can be drawn about the effects of hypnosis on children.

[Positive suggestion techniques in somatic medicine]

There is a re-occurring question in medical practice: do positive attitude and communication of the medical staff make any difference?

AIM

Our aim is to present a comprehensive image of the medically relevant effects of positive suggestions by reviewing the recent literature.

METHODS

We review the studies measuring the effects of suggestive communication of the past 20 years. In cases of studies presented in more details we quote from the suggestion scripts used in the study, too.

RESULTS

Most of the reviewed papers affirm that positive suggestions lead to decreased pain and use of pain medication. But physiological factors like bowel motility, blood pressure and bleeding during surgery can be positively affected, too.

CONCLUSIONS

Suggestive communication - a yet poorly utilized tool - used appropriately can significantly affect healing and recovery of a patient. Thus we emphasize further, more detailed study of this technique and its integration into the education of medical professionals.

Hypnosis in the treatment of depression: considerations in research design and methods

Depressive disorders constitute a serious problem in the United States and around the world. The appearance of practice guidelines and lists of evidenced-based therapies suggests that adequate treatments for depression exist. However, a careful consideration of what is known and not known about the treatment of depression leaves plenty of room for improved approaches to addressing this condition. Although there has been a dearth of research on the treatment of depression using hypnosis, there are several compelling arguments for the inclusion of hypnotic approaches in the array of current strategies for dealing with depression. However, traditional "gold-standard" research methods, namely randomized controlled trials, have many shortcomings for identifying the potential impact of hypnosis on depression. Other strategies, notably single-case design and benchmarking approaches, may offer a more practical solution to the problem of determining "what works for depression."

Hypnosis: exploring the benefits for the role of the hospital social worker

This article will provide an examination of Erickson's model of hypnosis and the impact hypnosis has made on the psychosocial well being of the medically ill patient. The intrinsic three stage process of a hypnotic intervention, as well as its value, practice assumptions, and its relevance to alleviating pain, distress, and anxiety with oncology patients will be discussed. We have found this approach to be particularly effective with adult oncology patients at alleviating the side effects of the arduous treatment that is often endured. Case vignettes will demonstrate the benefits of utilizing this intervention with adult patients in the hospital setting as well as provide specific insight into the creative methods in which we have woven hypnosis into our clinical work. Finally, we will explore the use and rationale of hypnosis in medical settings and the impact of using this intervention on the role of the hospital social worker.

Confirmatory factor analysis of the Valencia Scale on Attitudes and Beliefs toward Hypnosis, Therapist version

Health professionals' beliefs and attitudes toward hypnosis may make them reluctant to use it or even to foster misapplications and iatrogenic uses of hypnosis. The Valencia Scale on Attitudes and Beliefs toward Hypnosis-Therapist version (VSABH-T) is a specific instrument to evaluate therapists' attitudes and beliefs. The aims of this study are to evaluate the 8-factor structure of the VSABH-T proposed from a confirmatory perspective. The sample comprised 1,661 licensed psychologists who are members of the Spanish Psychological Association for the initial test and 787 for the retest. Results confirmed the 8-factor structure obtained in a previous exploratory study, namely: Fear, Memory, Help, Control, Collaboration, Interest, Magic, and Marginal. The scale also showed adequate psychometric properties, including good internal consistency and test-retest reliability.

Reduced prepulse inhibition is associated with increased hypnotizability

Hypnosis involves the manipulation of conscious attentional discrimination. The prepulse inhibition (PPI) paradigm assesses primary unconscious information processing. We investigated the correlation between hypnotizability and PPI of the startle reflex. Forty-eight healthy subjects were evaluated with the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) and acoustic PPI. Subjects were divided into low, medium, and high hypnotizable groups. The low-hypnotizable group showed a significantly higher inhibition of the startle response, at lead intervals 60 ms and 120 ms, than did the medium- and high-hypnotizable groups. We conclude that hypnotizability and PPI may be negatively correlated. These findings lend further support for the role of dopaminergic neurotransmission mechanisms in the determination of hypnotizability levels.

Hypnotic induction and therapeutic suggestions in first-trimester pregnancy termination

Several papers of interest for researchers and clinicians have recently appeared in scientific medical literature evaluating hypnosis' efficacy in managing patients' distress and pain during surgical procedures. In this article, following a pilot study, the authors describe the context and standardized induction procedures that they are using in an ongoing clinical trial evaluating the effect of hypnosis on acute pain and anxiety during termination of pregnancy.

Hypnosis for childbirth: a retrospective comparative analysis of outcomes in one obstetrician's practice

This exploratory, descriptive study, done retrospectively from perinatal medical records, compared childbirth outcomes in one obstetrician's caseload between 50 women who elected antepartal hypnosis preparation (usually a 5-class series) and 51 who did not. The groups were demographically similar. To achieve similar numbers to the hypnosis group, the control group was randomly selected from the women in the caseload who opted not to take hypnosis preparation, based on characteristics of parity and delivery mode. Prenatal hypnosis preparation resulted in significantly less use of sedatives, analgesia, and regional anesthesia during labor and in higher 1-minute neonatal Apgar scores. Other physiologic and outcome measures did not reveal statistical significance, although some trends were of clinical interest. Well-controlled studies are warranted for clinicians to offer hypnosis more frequently as a pain relief option for childbirth. Additional information provided includes pragmatic, clinical, and cost information about incorporating hypnosis into a physician's practice.

Efficacy of hypnotherapy in the treatment of eating disorders

Research on the efficacy of hypnosis in the treatment of eating disorders has produced mixed findings. This is due in part to the interplay between the characteristics of people with eating disorders and the phenomena of hypnosis. In addition, several authors have noted that methodological limitations in hypnosis research often make evaluation of treatment efficacy difficult. Many of the studies extant provide insufficient information regarding the specifics of the hypnotic intervention(s) to facilitate replication and clinical implementation. Therefore, this paper only reviews literature with replicable methodological descriptions. It focuses on the three primary disorders of interest to clinicians: bulimia nervosa, anorexia nervosa, and obesity. The implications for evaluating treatment efficacy are discussed.

Effectiveness of hypnotherapy with cancer patients' trajectory: emesis, acute pain, and analgesia and anxiolysis in procedures

Clinical hypnosis in cancer settings provides symptom reduction (pain and anxiety) and empowers patients to take an active role in their treatments and procedures. The goal of this paper is to systematically and critically review evidence on the effectiveness of hypnotherapy for emesis, analgesia, and anxiolysis in acute pain, specifically in procedures with an emphasis on the period from 1999 to 2006. Further, it aims to provide a theoretical rationale for the use of hypnosis with cancer populations in the whole spectrum of illness/treatment trajectory in several clinical contexts. Finally, a treatment protocol for management of overt anxiety and phobic reactions in the radiotherapy suite is presented, with the intent of having such a protocol empirically validated in the future.

Classes of Multichannel EEG Microstates in Light and Deep Hypnotic Conditions

The study assessed the brain electric mechanisms of light and deep hypnotic conditions in the framework of EEG temporal microstates. Multichannel EEG of healthy volunteers during initial resting, light hypnosis, deep hypnosis, and eventual recovery was analyzed into temporal EEG microstates of four classes. Microstates are defined by the spatial configuration of their potential distribution maps ([Symbol: see text]potential landscapes') on the head surface. Because different potential landscapes must have been generated by different active neural assemblies, it is reasonable to assume that they also incorporate different brain functions. The observed four microstate classes were very similar to the four standard microstate classes A, B, C, D [Koenig, T. et al. Neuroimage, 2002;16: 41-8] and were labeled correspondingly. We expected a progression of microstate characteristics from initial resting to light to deep hypnosis. But, all three microstate parameters (duration, occurrence/second and %time coverage) yielded values for initial resting and final recovery that were between those of the two hypnotic conditions of light and deep hypnosis. Microstates of the classes B and D showed decreased duration, occurrence/second and %time coverage in deep hypnosis compared to light hypnosis; this was contrary to microstates of classes A and C which showed increased values of all three parameters. Reviewing the available information about microstates in other conditions, the changes from resting to light hypnosis in certain respects are reminiscent of changes to meditation states, and changes to deep hypnosis of those in schizophrenic states.

What should we mean by empirical validation in hypnotherapy: evidence-based practice in clinical hypnosis

This paper briefly surveys the trend of and controversy surrounding empirical validation in psychotherapy. Empirical validation of hypnotherapy has paralleled the practice of validation in psychotherapy and the professionalization of clinical psychology, in general. This evolution in determining what counts as evidence for bona fide clinical practice has gone from theory-driven clinical approaches in the 1960s and 1970s through critical attempts at categorization of empirically supported therapies in the 1990s on to the concept of evidence-based practice in 2006. Implications of this progression in professional psychology are discussed in the light of hypnosis's current quest for validation and empirical accreditation.

The special effects of hypnosis and hypnotherapy: A contribution to an ecological model of therapeutic change

There is ample evidence that hypnosis enhances the effectiveness of psychotherapy and produces some astounding effects of its own. In this paper, the effective components and principles of hypnosis and hypnotherapy are analyzed. The "special" hypnotic and hypnotherapeutic effects are linked to the fact that the ecological requirements of therapeutic change are taken into account implicitly and/or explicitly when working with hypnotic trances in a therapeutic setting. The hypnotic situation is described--theoretically and in case examples--as a therapeutic modality that gratifies and aligns the basic emotional needs to feel autonomous, related, competent, and oriented. It is shown how the hypnotic relationship can help promote a sound ecological balance between these needs--a balance that is deemed to be a necessary prerequisite for salutogenesis. Practical implications for planning hypnotherapeutic interventions are discussed.

Habit reversal treatment of tic disorders: a methodological critique of the literature

One of the most commonly reported and successful behavioral interventions for tic disorders is habit reversal (HR). Several narrative literature reviews have adequately summarized the outcomes of these studies. The purpose of this article was to review studies that used HR to treat tics in terms of their methodological characteristics and rigor. Guidelines developed by the Task Force on Promotion and Dissemination of Psychological Procedures were used to evaluate the state of the literature. From an initial database that included 29 studies, 12 were included in the final analysis. Results indicate that although research has been conducted in this area for almost three decades, the majority of studies contain considerable methodological shortcomings. Based on the Task Force guidelines, the existing literature on the use of HR to treat tics can currently be classified as probably efficacious, and it almost meets the criteria for the well-established classification. Directions for future research are discussed.

Hypnosis decouples cognitive control from conflict monitoring processes of the frontal lobe

Hypnosis can profoundly alter sensory awareness and cognitive processing. While the cognitive and behavioral phenomena associated with hypnosis have long been thought to relate to attentional processes, the neural mechanisms underlying susceptibility to hypnotic induction and the hypnotic condition are poorly understood. Here, we tested the proposal that highly hypnotizable individuals are particularly adept at focusing attention at baseline, but that their attentional control is compromised following hypnosis due to a decoupling between conflict monitoring and cognitive control processes of the frontal lobe. Employing event-related fMRI and EEG coherence measures, we compared conflict-related neural activity in the anterior cingulate cortex (ACC) and control-related activity in the lateral frontal cortex (LFC) during Stroop task performance between participants of low and high hypnotic susceptibility, at baseline and after hypnotic induction. The fMRI data revealed that conflict-related ACC activity interacted with hypnosis and hypnotic susceptibility, in that highly susceptible participants displayed increased conflict-related neural activity in the hypnosis condition compared to baseline, as well as with respect to subjects with low susceptibility. Cognitive-control-related LFC activity, on the other hand, did not differ between groups and conditions. These data were complemented by a decrease in functional connectivity (EEG gamma band coherence) between frontal midline and left lateral scalp sites in highly susceptible subjects after hypnosis. These results suggest that individual differences in hypnotic susceptibility are linked with the efficiency of the frontal attention system, and that the hypnotized condition is characterized by a functional dissociation of conflict monitoring and cognitive control processes.

Self-hypnosis for anxiety associated with severe asthma: a case report

BACKGROUND

Management of asthma can be complicated by both medical and psychiatric conditions, such as gastroesophageal reflux, chronic sinusitis, and anxiety. When symptoms of asthma are interpreted without regard to such conditions treatment may yield a suboptimal outcome. For example, anxiety-associated dyspnea, tachypnea, and chest tightness can be mistakenly interpreted as resulting from an exacerbation of asthma. Medical treatment directed only for asthma may thus lead to overuse of asthma medications and increased hospitalizations.

CASE PRESENTATION

The described case illustrates how a systemic steroid-dependent patient with asthma benefited from receiving care from a pediatric pulmonologist who also was well versed in the diagnosis and treatment of anxiety. By using self-hypnosis, the patient was able to reduce her dependence on bronchodilators. Following modification of her medical therapy under supervision of the pulmonologist, and regular use of hypnosis, the patient ultimately was weaned off her systemic steroid therapy.

CONCLUSIONS

This report emphasizes that anxiety must be considered as a comorbid condition in the treatment of asthma. Self-hypnosis can be a useful skill in the treatment of a patient with anxiety and asthma.

Efficacy vs. effectiveness research in psychotherapy: implications for clinical hypnosis

Empirically supported therapy (EST) has become a major focus and trend for mental health practice. When hypnosis is involved, this may mean satisfying a standard that is entirely too narrow in its emphasis. In this article "efficacy"-based research in clinical practice is contrasted with "effectiveness" -focused research, and they are discussed from the perspective of hypnosis. When clinicians can consider trans-theoretical factors as well as those that are treatment-enhancing, possibilities for improved treatment outcome increase. The "effectiveness" perspective also serves as a counter point for hypnosis in contrast with the dubious efficacy-based gold standard currently proposed for therapy in general, and hypnosis in particular.

Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial

Although medical hypnosis has a long history of myriad functional applications (pain reduction, procedural preparation etc.), it has been little tested for site-specific effects on physical healing per se. In this randomized controlled trial, we compared the relative efficacy of an adjunctive hypnotic intervention, supportive attention, and usual care only on early post-surgical wound healing. Eighteen healthy women presenting consecutively for medically recommended reduction mammaplasty at an ambulatory surgery practice underwent the same surgical protocol and postoperative care following preoperative randomization (n = 6 each) to one of the three treatment conditions: usual care, 8 adjunctive supportive attention sessions, or 8 adjunctive hypnosis sessions targeting accelerated wound healing. The primary outcome data of interest were objective, observational measures of incision healing made at 1,7 weeks postoperatively by medical staff blind to the participants' group assignments. Data included clinical exams and digitized photographs that were scored using a wound assessment inventory (WAI). Secondary outcome measures included the participants' subjectively rated pain, perceived incision healing (VAS Scales), and baseline and post-surgical functional health status (SF-36). Analysis of variance showed the hypnosis group's objectively observed wound healing to be significantly greater than the other two groups', p < .001, through 7 postoperative weeks; standard care controls showed the smallest degree of healing. In addition, at both the 1 and 7 week post-surgical observation intervals, one-way analyses showed the hypnosis group to be significantly more healed than the usual care controls, p < 0.02. The mean scores of the subjective assessments of postoperative pain, incision healing and functional recovery trended similarly. Results of this preliminary trial indicate that use of a targeted hypnotic intervention can accelerate postoperative wound healing and suggest that further tests of using hypnosis to augment physical healing are warranted.

Hypnotic responsivity from a developmental perspective: insights from young children

Evidence indicates that hypnotic responsivity in children younger than 8 years of age differs significantly from that of older children and adults. The sudden increase in responsiveness around age 8, differing patterns of item difficulty for young children, specific problems with hypnotic dream and age regression items, and the lack of conceptual distinction between volition and nonvolition argue for a fundamental discontinuity between young children and adults regarding responsivity. These differences result from underlying developmental processes that characterize young childhood, including limitations in executive cognitive functioning, more overt forms of involvement, and reliance on authoritative others for direction, regulation, and support. The unique features of young children's hypnotic responsivity offer the opportunity to reconsider hypnosis within a developmental context.