The placebo effect: how the subconscious fits in

The placebo effect is very well known, being replicated in many scientific studies. At the same time, its exact mechanisms still remain unknown. Quite a few hypothetical explanations for the placebo effect have been suggested, including faith, belief, hope, classical conditioning, conscious/subconscious expectation, endorphins, and the meaning response. This article argues that all these explanations may boil down to autosuggestion, in the sense of "communication with the subconscious." An important implication of this is that the placebo effect can in principle be used effectively without the placebo itself, through a direct use of autosuggestion. The benefits of such a strategy are clear: fewer side effects from medications, huge cost savings, no deception of patients, relief of burden on the physician's time, and healing in domains where medication or other therapies are problematic.

[Possibilities of hypnosis and hypnosuggestive methods in oncology]

Fear of death, pain, or the recurrence of the illness of tumor patients can narrow their attention to a point where a spontaneous altered state of consciousness occurs. In these cases hypnosis either in formal psychotherapy or embedded into the everyday communication with the physician can effectively complement other already known medical and psychological techniques. Although numerous studies have reported the beneficial physical and mental changes induced by hypnosis, for a long time there were not enough research to affect evidence-based medicine. New studies meeting the most rigorous methodological standards, new reviews and the characteristics of hypnosis shown by neuroimaging techniques support the acceptance of this method. Hypnosis is used and studied with adult and child tumor patients alike mostly in the areas of anxiety, pain, nausea, vomiting, quality of life, mood amelioration, immune system and hot flushes. Most of the assays describe hypnosis as an empirically validated treatment technique that in most cases surpass attention diversion, coping trainings, cognitive behavior and relaxation techniques and other regular treatments. In this paper we review these observations.

[Psychotherapy and pain]

In "Integrated psychotherapy" we indicate necessity of combining psychotherapy with all other psychotherapeutic and medical methods (drugs, physiotherapy, etc.) in order to obtain best result. We distinguish between "professional" and "basic" psychotherapy. The latter also has effect on mood and by it on health for patients. Furthermore it is an important facilitating means for a special psychotherapy. We emphasize to teach this in systematic professional education as well for doctors as for all social professions.

Cajal's brief experimentation with hypnotic suggestion

Spanish histologist Santiago Ramón y Cajal, one of the most notable figures in Neuroscience, and winner, along with Camillo Golgi, of the 1906 Nobel Prize in Physiology or Medicine for his discoveries on the structure of the nervous system, did not escape experimenting with some of the psychiatric techniques available at the time, mainly hypnotic suggestion, albeit briefly. While a physician in his thirties, Cajal published a short article under the title, "Pains of labour considerably attenuated by hypnotic suggestion" in Gaceta Médica Catalana. That study may be Cajal's only documented case in the field of experimental psychology. We here provide an English translation of the original Spanish text, placing it historically within Cajal's involvement with some of the key scientific and philosophical issues at the time.

[Babinski and hysteria]

Babinski made important contributions to both psychiatry and neurology. He disagreed with Charcot's theatrical interpretation of hysteria and made a subtle distinction between Suggestion and Persuasion, thereby differentiating Hysteria from Pithiatism. This paper examines Charcot's concepts and the way in which Babinski refined and honed his master's theories.

Recovered memory and the Daubert criteria: recovered memory as professionally tested, peer reviewed, and accepted in the relevant scientific community

Research during the past two decades has firmly established the reliability of the phenomenon of recovered memory. This review first highlights the strongest evidence for the phenomenon itself and discusses the survey, experimental, and biological evidence for the varying mechanisms that may underlie the phenomenon. Routes to traumatic amnesia from dissociative detachment (loss of emotional content leading to loss of factual content) and from dissociative compartmentalization (failure in integration) are discussed. Next, an argument is made that false memory is a largely orthogonal concept to recovered memory; the possibility of one phenomena is largely irrelevant to the potential for the other. Furthermore, some aspects of the false memory research offer supportive data for the recovered memory researcher. Finally, the issue of error rates in making the Daubert case is explored. It is concluded that the weight of the evidence should allow the recovered memory victim to come before the court.

The Blind Protocol and Its Place in Consciousness Research

This paper describes the development of the blind protocol, and its place in this history of consciousness research. It was first devised by Croesus, King of the Lydians (BCE 560-547) and reported by Herodotus ( approximately BCE 484 - approximately 424), and was created to protect against fraud in assessing an Anomalous Perception (AP) event; a Remote Viewing (RV) experiment little different from those conducted today. Its next use in the 17th century was to study a peasant farmer, Jacques Aymar, who solved crimes with Anomalous Perception, using dowsing. Not only was a blind protocol employed, but the rudiments of controls were introduced to assess Aymar. The next documented use of a blind protocol in consciousness research occurred in 1784, when it was explicitly employed in the interest of science, and its history as a research technique can be said to have formally begun. King Louis the XVIth created a commission to evaluate Franz Anton Mesmer's claims concerning healing through "animal magnetism," administered while people were in a trance, and asked Benjamin Franklin to be the commission's head. The paper proposes that Franklin be considered the first parapsychologist. He created the blind protocol to answer the king's question as to whether "animal magnetism" was real, and he not only introduced demographic variables and controls, but literally blindfolded people, which is why today we call it the blind protocol. Franklin's observations also present the first recorded Western description of psychosomatic illness. An unintended consequence of Franklin's Mesmer study was the loss of the idea of psychophysical self-regulation (PPSR) as a research vector, although the English surgeon John Eliotson (1791-1868) apparently saw through the failure of Mesmer's explanatory model to the deeper insight in the form of hypnosis that was Mesmer's real discovery. He seems to have avoided all attempts at explaining how it worked but conducted a considerable number of surgeries using hypnosis as the anesthetic, anticipating its usage in this capacity a century later. So great was the disapproval of Mesmer, however, that no one seems to have gotten Eliotson's point. Franklin's protocol, though, rapidly became the gold standard of science. Rupert Sheldrake, however, carried out a survey of the leading scientific journals and discovered that the main use of the blind protocol is not in medicine per se, but parapsychology and consciousness research, in which it is used for the same purposes it was originally conceived: to winnow out fraud in anomalous consciousness events and to avoid introducing experimenter effects. Ultimately, though, the protocol may be based on a false assumption, because increasingly research in areas such as therapeutic intent/healing and remote viewing suggest that all consciousness from single-celled organisms to human beings may be interlinked through a nonlocal aspect of awareness they all share.

[The berserks--what was wrong with them?]

The terms berserk and going berserk reflect the violent and ferocious warriors and ruthless murderers of Scandinavia and Northern Europe, active from before the Viking age until the advent of Christianity. The main source on the phenomenon is the Old Norse literature, mainly the Icelandic sagas with their sober descriptive accounts of the berserks and their behaviour. The berserks are frequently depicted as having had antisocial character traits; often as bullies who evince, by way of autosuggestion, an enormous and uncontrollable rage, slaughtering and killing. They felt no pain and hardly took in the environment they lived in. The fits were followed by exhaustion or sleep. Although the phenomenon waned completely by the advent of Christianity, it can hardly be discarded as just myth or folklore. Most likely it could be explained as a kind of dissociative reaction. The widespread idea of toadstool as causative agent is at best debatable. The conceptions of pre-Christian heathenism about the human mind are of importance to the understanding of suggestibility and capacity for trance reaction. The condition is considered a culture-bound syndrome. Comparisons are drawn to lycanthropy (werewolf madness), frequently considered an identical phenomenon. Clinically (i.e. historically) it was mainly something different, namely psychotic conditions.

Perioperativer Einsatz von medizinischer Hypnose

BACKGROUND

Surgical treatment of patients under local anaesthesia is quite commonly restricted by limited compliance from the patient. An alternative to treatment under pharmacological sedation or general anaesthesia could be the application of medical hypnosis. With this method, both suggestive and autosuggestive procedures are used for anxiolysis, relaxation, sedation and analgesia of the patient.

PATIENTS AND METHODS

During a 1-year period of first clinical application, a total of 207 surgical procedures on a non-selected collective of 174 patients were carried out under combined local anaesthesia and medical hypnosis.

RESULTS

Medical hypnosis proved to be a standardisable and reliable method by which remarkable improvements in treatment conditions for both patient and surgeons were achievable.

CONCLUSION

Medical hypnosis is not considered to be a substitute for conscious sedation or general anaesthesia but a therapeutic option equally interesting for anaesthesists and surgeons.

The management of blood phobia and a hypersensitive gag reflex by hypnotherapy: a case report

Coping with a hypersensitive gag reflex can be a cause for concern for both the patient and the operator. This report describes a case of blood phobia directed solely towards the oral cavity, linked with the inability to tolerate dentures due to a hypersensitive gag reflex. Management by hypnotherapy using a systematic desensitization technique allowed for extraction of teeth and permanent elimination of the gagging problem.

Seeing is believing? The form and substance of French medical debates over Lourdes

Recent works on Lourdes have tended to emphasize the positive personal, social, and spiritual aspects of a pilgrimage, while downplaying the role of religious politics in (over)determining discussions around the events taking place there over the course of the Third Republic. This paper seeks to reassert the extent to which the medical community remained divided, along religious lines, over the existence and nature of the cures taking place at Lourdes well into the twentieth century, while analyzing how Catholic physicians were able to create an aura of therapeutic credibility around the cures.

Hypnosis principles and applications: an adjunct to health care

Hypnosis has existed since the beginning of humankind, and is a part of everyday life. It is a valuable addition to the methods and techniques available to all health care-providers, as well as a safe and uncomplicated method used to enhance patient health care. It is simply a state of complete physical and mental relaxation which produces an altered state of consciousness acceptable to suggestions. It is characterized by an increased ability to produce desirable changes in habit patterns, motivation, self-image, lifestyle, and personal health.

Treatment outcome expectancies and hypnotic susceptibility as moderators of pain reduction in patients with chronic tension-type headache

The aim of this study was to determine whether hypnotic susceptibility (a) predicts pain reduction posttreatment and at follow-up independent of generic expectations of treatment outcome and mode of treatment and (b) predicts persistence of pain reduction during the follow-up period. In 169 patients with chronic tension-type headaches randomly allocated to either self-hypnosis or autogenic training, pain reduction posttreatment and at follow-up was significantly associated with hypnotic susceptibility independent of generic expectations of treatment outcome and treatment condition. Moreover, it was found that early responders obtained significantly higher hypnotic susceptibility scores than nonresponders, although there were no significant differences in hypnotic susceptibility between late responders in comparison to early and nonresponders. However, almost one fourth of those who were nonresponders posttreatment did respond at follow-up.

Using mind-body techniques in dentistry

Mind-body medicine is a win-win proposition for dentists and their patients. Patients experience less anxiety and less discomfort during procedures. However, it's important to know the advantages and disadvantages if you are considering offering mind-body services in your practice.

Autogenous training--an anxiolytic and a factor contributing to the improvement of the quality of life

Autogenous training in its narrow sense of meaning belongs to the group of supportive psychotherapeutic techniques. In fact, it is an autosuggestive relaxation. Autogenous training has been for decades successfully used as prevention to anxious reactions. Since anxiety is an etiological factor of numerous psychic and psychosomatic disturbances, positive implications of autogenous training have been considerably broadened. Life without anxiety belongs to a more qualitative form of life. Autogenous training directs the trainee towards introspection and self-analysis. Self-respect (self-esteem) is the consequence of our own work on ourselves.

[The therapy of bronchial asthma]

Asthma (Greek word that means "breathlessness" or "open-mouth breath") is a chronic inflammatory disorder of the airways, with extensive infiltration of the airway lumen and wall with eosinophils, mast cells, activated T-lymphocytes. Airway inflammation is associated with airway hyperresponsiveness, recurrent episodes of reversible airflow limitation and respiratory symptoms such as wheezing, chest tightness, breathlessness and cough with mucus production. Curiously, asthma worsens particularly at night and in the early hours of the morning. The current consensus on asthma therapy suggests that pharmacological control of asthma can be achieved with antiinflammatory "controller" medications such as inhaled glucocorticoids and cromones. Short-acting bronchodilators act as "reliever" medications and rapidly reverse acute manifestations of asthma. Asthmatic exacerbations require the repetitive administration of inhaled short-acting beta-2-agonist and the early introduction of oral glucocorticoids. Rarely the severity of exacerbation requires the administration of oxygen (that, if available, is not contraindicated), intravenous bronchodilators, glucocorticoids and epinephryne and mechanical ventilation.

[Free from stress by autogenic therapy. Relaxation technique yielding peace of mind and self-insight]

The utilisation of self-regulatory capacity is one of the purposes of autogenic therapy, a method consisting of exercises focused on the limbs, lungs, heart, diaphragm and head. The physiological response is muscle relaxation, increased peripheral blood flow, lower heart rate and blood pressure, slower and deeper breathing, and reduced oxygen consumption. Autogenic training is applicable in most pathological conditions associated with stress, and can be used preventively or as a complement to conventional treatment.

[Effect of self-hypnosis in patients with pollinosis]

The aim of this study in hypnosis was the exemplary verification of a regulatory intervention in patients with pollinosis. Hypnosis and self-hypnosis are established methods in medicine. 52 patients with pollinosis participated in this clinical study. It lasted over two pollen seasons. Self-hypnosis was learned quite easily. It resulted in a clear yet statistically weak beneficial effect on the subjective assessment of the pollinosis symptoms, on the consumption of drugs and on other objective findings. From a methodological point of view this study might suggest that the classical comparison of experimental groups in clinical research could hide some larger therapeutic effects in individual patients. Therefore, it would be desirable to consider also individual data analysis in all future studies dealing with psychological or psychosomatic mechanisms and in all studies which capture parameters interactive at different levels. The beneficial effect of hypnosis on the swelling of the nasal mucous membrane in a provocation test initiated a subsequent small project on the possible mode of action of hypnosis in this pollinosis study. However, the results were inconclusive.

[Hypnosis and self-hypnosis administered and taught by nurses for relief of chronic pain: a controlled clinical trial]

In this controlled clinical trial hypnosis and self-hypnosis were evaluated when used as an adjuvant treatment to instrumental and pharmacological management of chronic pain. The study took place in a hospital specialized in the treatment of outpatients suffering from chronic pain. Hypnosis and self-hypnosis were administered and taught by nurses who had been trained just recently for this very purpose. Under the conditions of the study it was not possible to measure an effect of hypnosis on pain despite some subjective feeling of usefulness. However, it should be taken into account that this form of adjuvant therapy was used for the first time in that hospital for the purpose of the study and, therefore, took place in an artificial setting. It could well be that the same therapy administered in the proper therapeutic environment of a specialized institution could show beneficial effects on pain.

[Clinical hypnotherapy/self-hypnosis for unspecified, chronic and episodic headache without migraine and other defined headaches in children and adolescents]

Chronic and episodic headaches in children and adolescents are a common problem. Therefore, the growing resistance against frequent use of drugs is quite justified. This study was initiated in search for other helpful therapeutic approaches. The aim was to compare the effect of 5 sessions of hypnosis/ self-hypnosis given at weekly intervals and lasting half an hour each with two psychological treatments requiring the same amount of time, namely behavior therapy and talks to the doctor. Despite the small number of patients, both types of treatments were effective. However, the hypnosis/self-hypnosis seems to be superior not only in terms of frequency and intensity of the headaches but also concerning the patients' ability to keep their headaches and their well-being under control.

Complement to "ratio of male and female characters in a dream series"

This note relates recent research on dream content to other findings on imaginal experiences which suggest that state or situational factors frequently define the content of experiences related to altered states of consciousness. As with hallucinatory, dissociative, and autohypnotic phenomena, dream content reflects a continuity between waking and imaginal experience.

[Clinical study on shortening the birth process using psychological suggestion therapy]

To investigate the effect of psychological suggestion therapy on the birth process, a specially designed, prospective study of psychological suggestion ("insubstantial comfort") was undertaken in 120 healthy, full-term primipara with singleton pregnancy and cephalic presentation. All cases were randomly divided into 2 groups, the birth processes and final modes of delivery were analyzed in 60 cases interfered with the psychological suggestion therapy and 60 cases with spontaneous birth processes as control group. The results showed that a significant shorter time of the first and second stages of labor in the study group than that in the control group (P < 0.01). Based on this study, it is suggested that the conversation concerning about the evaluation of individual birth process between the mother-to-be and nurse should be controlled carefully for the purpose of advancing of birth process. The nurse should apply the psychological suggestion therapy during the birth process, specially when answering the question raised by mother-to-be about the quantity of the cervical dilataion. It is also suggested that the purpose of the rectal examination taking during the first stage of labor should be given some kind of meaning of psychotherapy.

Hypnobehavioral approaches for school-age children with dysphagia and food aversion: a case series

The purpose of this article is to describe hypnobehavioral treatment of five school-age children with maladaptive eating behaviors, including functional dysphagia, food aversion, globus hystericus, and conditioned fear of eating (phagophobia). The unique treatment approach described emphasizes the successful use of self-management techniques, particularly hypnosis, by all five children. Common etiological factors, treatment strategies, and proposed mechanisms of change are discussed. To the authors' knowledge, this is the first such case series in the mainstream pediatric literature describing the use of a hypnobehavioral approach for children with these maladaptive eating problems.

Cognitive therapy of dissociative symptoms associated with trauma

The presentation of dissociative symptoms is not uncommon in clinical settings, particularly when the client has suffered trauma. The phenomenon of dissociation ranges from benign incidents, such as daydreaming, to potentially life-threatening experiences when it precipitates self-harm. Its presentation may be subtle, belying the distress which it can provoke. Cognitive therapists are well equipped to help clients formulate a working conceptualization of the dissociative episode and to develop a range of coping skills to manage and overcome the experience. This paper discusses practical ways in which the cognitive therapist can use standard and schema-focused cognitive therapy to help clients to better deal with the distressing aspects of dissociation.

Hypnotizability and traumatic experience: a diathesis-stress model of dissociative symptomatology

OBJECTIVE

The authors propose a diathesis-stress model to describe how pathological dissociation may arise from an interaction between innate hypnotizability and traumatic experience.

METHOD

To support the proposition that pathological dissociation may reflect autohypnotic process, the authors highlight clinical and research data indicating parallels between controlled hypnotic dissociative states and uncontrolled pathological dissociative symptoms and summarize evidence of hypnotizability in persons with psychiatric disorders that manifest these symptoms. The authors present this evidence by examining dissociative symptomatology in four psychological domains: perception, behavior and will, affect, and memory and identity. In addition, modern cognitive and neuropsychological models of dissociation are briefly reviewed.

RESULTS

Several lines of evidence converge in support of the role of autohypnosis in pathological dissociation. There is considerable evidence that controlled formal hypnosis can produce a variety of dissociations of awareness and control that resemble many of the symptoms in uncontrolled pathological dissociative conditions; and it is possible to discern in dissociative pathology the features of absorption, dissociation, and suggestibility/automaticity that characterize formal hypnotic states. There is also accumulating evidence of high levels of hypnotic capacity in all groups with dissociative symptomatology that have been systematically assessed. In addition, the widespread and successful therapeutic use of hypnosis in the treatment of many dissociative symptoms and conditions (and the potential for hypnosis to induce dissociative symptomatology) also supports the assumption that hypnosis and pathological dissociation share an underlying process.

CONCLUSIONS

High hypnotizability may be a diathesis for pathological dissociative states, particularly under conditions of acute traumatic stress.

Autosuggestibility in memory development

Autosuggestibility is a potentially common source of false memories in children. We studied a form of autosuggestibility in which children's answers to memory tests were shifted in the direction of their illogical solutions to reasoning problems. In Experiments 1 and 2, illogic-consistent shifts were identified in children's memories of the numerical inputs on class-inclusion problems. The magnitudes of the shifts declined with age, and they appeared to be due to the intrusion of inappropriate gist on memory probes rather than retroactive interference from illogical reasoning. A model of how gist intrusion causes autosuggestibility was investigated in Experiments 3-5. The model assumes that children retrieve and process inappropriate gist when memory tests supply cues that are inadequate to permit access to verbatim memories.

Acupuncture inhibits vagal gastric acid secretion stimulated by sham feeding in healthy subjects

In a prospective randomised study, the effect of acupuncture on sham feeding stimulated gastric acid secretion was investigated. In eight healthy volunteers (five men, three women, mean (SEM) age 26.3 (4.7) years) various methods of acupuncture were performed. Apart from the sham procedure, the acupuncture was performed at the classic acupuncture points. Electroacupuncture reduced gastric acid secretion expressed as median (range) significantly during the first 30 minute period to 1.6 (0-5.2) mmol compared with 3.8 (2.3-14.5) mmol (p < 0.05) during control period (sham feeding without acupuncture). Inhibition of gastric acid secretion by electroacupuncture was also significant during the second 30 minute period (0.2 (0-5.6) v 3.6 (0.3-9.1) mmol; p < 0.05) and for peak acid output (0.8 (0.2-5.1) v 7.6 (3.4-12.1) mmol; p < 0.05). Transcutaneous electrical nerve stimulation also resulted in significant reduction of gastric acid secretion during the first 30 minute period (1.0 (0-3.6) mmol v 3.8 (2.3-14.5) mmol; p < 0.05), and peak acid output (3.6 (1.2-12.0) v 7.6 (3.4-12.1) mmol; p < 0.05). The classic needle acupuncture, laser acupuncture, and sham acupuncture had no significant effect on gastric acid secretion. This study shows firstly that in healthy volunteers, only the versions of acupuncture using more pronounced stimulation (electroacupuncture, transcutaneous electrical nerve stimulation), but not those with only mild stimulation of the nerves (classic needle acupuncture, laser acupuncture), and secondly only acupuncture performed at defined points lead to significant reduction in gastric acid secretion.

The first use of self-hypnosis: Mesmer mesmerizes Mesmer

Self-hypnosis is an important modern therapeutic method. This article traces its initial use in either 1778 or 1779 by Franz Anton Mesmer, the founder of animal magnetism, which, in turn, led to the present modality of hypnosis. According to a contemporary account written by a colleague, Mesmer successfully treated himself for a condition described as a blockage in the lower part of his body. He may have also taught the method of self-magnetization to others in his clinic.

Standardized mood induction with happy and sad facial expressions

The feasibility of applying ecologically valid and socially relevant emotional stimuli in a standardized fashion to obtain reliable mood changes in healthy subjects was examined. The stimuli consisted of happy and sad facial expressions varying in intensity. Two mood-induction procedures (happy and sad, each consisting of 40 slides) were administered to 24 young healthy subjects, who were instructed to look at each slide (self-paced) and try to feel the happy or sad mood expressed by the person in the picture. On an emotional self-rating scale, subjects rated themselves as relatively happier during the happy mood-induction condition and as relatively sadder during the sad mood-induction condition. Conversely, they reported that they were less happy during the sad mood-induction condition and less sad during the happy mood-induction condition. The effects were generalized to positive and negative affect as measured by the Positive and Negative Affect Scale. The intraindividual variability in the effect was very small. In a retest study after 1 month, the mood-induction effects showed good stability over time. The results encourage the use of this mood-induction procedure as a neurobehavioral probe in physiologic neuroimaging studies for investigating the neural substrates of emotional experience.

Hypnosis and self-hypnosis in the management of nocturnal enuresis: a comparative study with imipramine therapy

Various therapeutic modalities have been used for treating enuresis due to the lack of a single identifiable cause. We carried out a comparative study of imipramine and direct hypnotic suggestions with imagery used for the management of functional nocturnal enuresis. Enuretic children, ranging in age from 5 to 16 years, underwent 3 months of therapy with imipramine (N = 25) or hypnosis (N = 25). After termination of the active treatment, the hypnosis group continued practicing self-hypnosis daily during the follow-up period of another 6 months. Of the patients treated with imipramine, 76% had a positive response (all dry beds); for patients treated with hypnotic strategies, 72% responded positively. At the 9-month follow-up, 68% of patients in the hypnosis group maintained a positive response, whereas only 24% of the imipramine group did. Hypnosis and self-hypnosis strategies were found to be less effective in younger children (5-7 years old) compared to imipramine treatment. The treatment response was not related to the hypnotic responsivity of the patient in either group.

The use of music as a hypnotic suggestion

We have known of the interaction between music and mood for many years. In this paper, I present a series of case vignettes to illustrate a method using music to affect mood. In hypnosis, I suggested that subjects imagine hearing a piece of music appropriate to a desired emotion, rather like a sound track for a movie. I suggested that the patients vividly recall this music and the accompanying feelings outside of trance when it would be desirable to help them to change their behavior by influencing their emotional state. In this way, music can be used to shape emotion.

Somatization of dissociated traumatic memories in a case of reflex sympathetic dystrophy

In this single case report, I examine the treatment of reflex sympathetic dystrophy (RSD) with hypnosis and ego-state therapy in a subject with a dissociative disorder. RSD is an unusual, debilitating, chronic pain syndrome with a usually poor outcome. The subject achieved temporary symptomatic relief using hypnosis and auto-hypnotic pain-management techniques. Eventually, she achieved permanent relief of RSD symptoms that continued over a two-year follow-up period. She achieved this permanent relief through a process of psychologically integrating physical functions that she experienced as specific to several dissociated ego states. This case illustrates the role of metaphor and imaginative symbolism in constituting a physical condition. It also illustrates how imaginative transformation of the symbolic imagery can induce psychological and physical change.

Predictors of smoking abstinence following a single-session restructuring intervention with self-hypnosis

OBJECTIVE

This study examined the relation of smoking and medical history, social support, and hypnotizability to outcome of a smoking cessation program.

METHOD

A consecutive series of 226 smokers referred for the smoking cessation program were treated with a single-session habit restructuring intervention involving self-hypnosis. They were then followed up for 2 years. Total abstinence from smoking after the intervention was the criterion for successful outcome.

RESULTS

Fifty-two percent of the study group achieved complete smoking abstinence 1 week after the intervention; 23% maintained their abstinence for 2 years. Hypnotizability and having been previously able to quit smoking for at least a month significantly predicted the initiation of abstinence. Hypnotizability and living with a significant other person predicted 2-year maintenance of treatment response.

CONCLUSIONS

These results, while modest, are superior to those of spontaneous efforts to stop smoking. Furthermore, they suggest that it is possible to predict which patients are most likely and which are least likely to respond to such brief smoking cessation interventions.

Influence of self-induced hypnosis on thermal responses during immersion in 25 degrees C water

The efficacy of self-induced post-hypnotic suggestion to improve thermogenic responses to head-out immersion in 25 degrees C water was evaluated in 12 males. An on-line computerized system permitted the change in body heat storage to be used as the independent variable and immersion time as the dependent variable. Test-retest reliability was good, exhibiting a coefficient of variation of less than 5% for exposure time. Immersion profiles consisted of the following: rest until 200 kJ of heat were lost, leg exercise at VO2 approximately 1.5 L.min-1 to regain 200 kJ, rest until 100 kJ were lost, and repeat the exercise to regain 100 kJ. A control immersion was done prior to two 1-h hypnotic training sessions. A second immersion (hypnotic) occurred within 24 h after training. There were no differences in rates of heat production, heat loss, mean skin temperature, or rectal temperature between control and hypnotic immersions. Individual hypnotic susceptibility scores did not correlate with changes in thermal status. Ratings of perceived exertion during exercise were similar for both immersions, but perceived sensation of cold was lower during the second rest period of the hypnotic immersion. Three subjects used images of warm environments during their hypnotic immersion and lost heat at a faster rate than during control immersions. These results indicate that brief hypnotic training did not enhance the thermogenic response to cool water immersion.

Hypnosis for postpolio syndrome & Type-A behavior

Many of the hundreds of thousands of survivors of polio are now developing postpolio syndrome. Symptoms include progressive muscle weakness, fatigue, decreased endurance, joint and muscle pain, weight gain, respiratory difficulties, and sleep disturbance, often precipitated or exacerbated by a Type-A Personality pattern. A postpolio patient with Type-A Personality was taught self-hypnosis as a vital component of treatment. Pre-post testing included the Profile of Mood States, the State-Trait Anxiety Inventory, the State-Trait Anger Inventory, and the Personal Orientation Inventory; the patient's spouse was interviewed during the follow-up. At the 6-month follow-up, improvements were documented in pain level, depression, self-regard, self-acceptance, capacity for intimate contact, time competence (living in the present), confusion, anxiety, insomnia, and in trait and state anger. Only a mild improvement occurred in fatigue, and no improvement was found in weight control. Follow-up at 12 months confirmed the maintenance of improvements. Self-hypnosis training may prove extremely helpful for postpolio patients and may prove helpful in modifying central characteristics of Type-A Personality.

Using hypnosis with children for pain management

Although nurses are in a strategic position to use hypnosis to manage a child's cancer pain, many lack the knowledge, the skill, or the exposure to the clinical effectiveness of hypnosis. Hypnosis has been a potent analgesic and anesthetic agent for more than 100 years; it reduces a child's cancer pain and the pain associated with painful procedures. Nurses can use hypnosis to help children diminish pain and cope with lumbar punctures (LPs), bone marrow aspirations (BMAs), and nausea or vomiting from chemotherapy. This article's purpose is to discuss myths, contraindications, research, processes, and effectiveness of hypnosis as a strategy for managing the cancer pain of school-age children. Vignettes from the author's clinical practice illustrate concepts and procedures.

Self-injurious behavior as a habit and its treatment

The definition of self-injurious behavior applies to persons who hurt or harm themselves without the motive of suicide or of sexual deviation. The different aspects of self-injurious behavior and the theories explaining them are reviewed. For 5 years a young, intelligent woman had inflicted injuries upon herself with sharp instruments while ostensibly caring for her face and legs. The short-term hypnobehavioral treatment included keeping daily reports of her self-inflicted injuries and of her thoughts while executing them, finding alternative activities to replace her habit, and practicing self-hypnosis once a day. Increasing the level of understanding of her inner conflict and accenting ways of breaking the habit by means of positive autosuggestion proved very effective. The treatment was successful after 13 sessions.

Evaluation of a child's perceived self-competence during treatment for cancer

The purpose of this study was to evaluate the effect of self-hypnosis on the perceived self-competence of children undergoing treatment for cancer and to determine longitudinal differences in perception of self-competence over time. Twenty-two children were randomized into an experimental group (taught self-hypnosis) and a control group (given standard care). Data were collected using the Harter Perceived Self-Competence Profile (HPSCP) during four courses of chemotherapy. A decrease in mean scores for the control group was found compared with the hypnosis group, which showed an increase in mean scores in five of six domains. Both groups showed a statistically significant increase in the scholastic cognitive domain and social acceptance domain from the time of diagnosis compared with the second test period. Ten children had a visible physical disability. These children were found to have significant decreases in the domains of athletic competence, social acceptance, and global self-worth. Decreases remained significant throughout all test periods in the athletic competence domain for the children with a visible physical disability. This study is unique in that the researchers evaluated children's perception of self-competence over time. These findings support previous studies and identify the need for nurses to become actively involved in helping children develop effective coping skills during chemotherapy for cancer.

Relaxation techniques for children and young people

The relaxation response, relaxation with mental imagery/self-hypnosis, and centering are techniques that can be used by the nurse practitioner in a variety of clinical situations to help children and young people manage stress. These approaches also can be used to treat certain common pediatric problems, such as headaches, enuresis, acute and chronic pain, and habit disorders. The techniques and their appropriate use are described.

Perspectives on the hallucinatory process

Hallucinations are common psychiatric symptoms and the hallucinating patient presents a number of nursing problems. Although psychiatric nurses have written fairly extensively about hallucinations as a clinical problem, little nursing research has tested commonly recommended nursing interventions. This paper presents a review of interdisciplinary research on hallucinations and synthesizes findings with clinical observations to suggest a number of areas needing greater stress in nursing practice and research. Aspects of a model proposed by Peplau (1963), Rector (1982), and Field (1985) are questioned. Improved assessments of hallucinating patients are recommended, with exploration of subtleties in the hallucinatory experience; and factors needing assessment are identified. Major emphasis is placed on the need to explore patient efforts at controlling hallucinations as a foundation for promoting patient self-monitoring and self-regulation of hallucinatory experience.