Clinical Hypnosis
Caroyl Gilbert, RN, MSN, CPNP-PCBaylor College of MedicineDepartment of Pediatrics
Gastroenterology, Hepatology, and Nutrition
Acknowledgements
This presentation was adapted with permission from:
Melanie A. Gold, D.O.
Clinical Associate Professor of Pediatrics
University of Pittsburgh School of Medicine
University of Pittsburgh Student Health Service
Objectives
Define clinical hypnosis Define typical hypnotic phenomena Identify the appropriate application of
hypnosis in the clinical setting Know how to introduce hypnosis to
patients and their families Know how to obtain training and
certification in clinical hypnosis Have participated in/observed clinical
hypnosis
Definition
Derived from the term "neuro-hypnotism" (nervous sleep) coined by Dr. James Braid, 1841. (Wikipedia)
Hypnosis
An altered state of consciousness Usually, but not always, involving
relaxation (which may or may not be evident)
A heightened concentration on a particular idea or image
Purpose of altering a symptom
Misconceptions About Hypnosis
Misconceptions
Patient is under control of hypnotherapist
Patient is asleep Only a few people can be hypnotized Only the weak-willed or minded can
be hypnotized Hypnosis masks symptoms All the patient’s psychiatric defense
mechanisms are abolished in trance
All hypnosis is self hypnosis
3 Laws of Hypnosis
Subject must have a clear image of what the result would feel and be like
When will and imagination (or belief) are in conflict, imagination wins out
A suggestion is more likely to be accepted when tied to a positive emotion or affect with which the subject can identify
Hypnotic Phenomena
Cognitive Characteristics
Relaxation Concentration Increased suggestibility Hypermnesia/Amnesia Increased control of
physiologic responses Perception of different
states Concrete thinking
Physical Characteristics
Muscle relaxation Twitching Lacrimation Fluttering eyelids Eye closure Eye movements beneath lids Changes in respiratory
rate/depth Changes in pulse Jaw relaxation (drooling) Catalepsy (suspended
animation) Decreased postural tone
Hypnotic phenomena
Rapport Catalepsy Ideo-motor
activity (not reflex)
Ideo-sensory activity
Memory modification
Ambulation in trance
Time distortion Hypnotic
dreaming Age regression Post-hypnotic
suggestion
Associated and Adverse Effects
Associated Effects Relaxation Headache Dizziness Nausea Anxiety Tearing or crying
Adverse Effects Precipitate
psychotic or panic reaction
Precipitate suicidal behavior
Symptom substitution
Problems that Respond to Hypnosis
Acute and chronic pain Anxiety associated with
procedures or illness Asthma Attention deficit disorder Cerebral palsy Conditioned nausea and vomiting
Problems that Respond to Hypnosis
Diabetes mellitus Dysfluency Encopresis Enuresis Facial tics Habit coughs Insomnia
Problems that Respond to Hypnosis
Migraine syndromes Nail biting Nightmares Performance anxiety Pruritis Psychogenic seizures
Problems that Respond to Hypnosis
Thumb sucking Tongue thrusting Tourette syndrome Trichotillomania Warts
Changes in pain intensity scores during and after treatment
Vlieger, A.M., Menko-Frankenhuis, C., Solfkamp, S.C.S., Tromp, E. & Benninga, M.A. (2007). Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: A randomized controlled trial.
Gastroenterology, 133, 1430-1436.
Hypnosis Reduces Distress and Duration of an Invasive MedicalProcedure for Children
Lisa D. Butler, PhD; Barbara K. Symons, BA; Shelly L. Henderson, MA; Linda D. Shortliffe, MD; and David Spiegel, MD
PEDIATRICS Vol. 115 No. 1 January 2005
TABLE 1. Number, Means, and SDs by Study Condition of Additional Variables Assessed orUsed to Create Summary Scores n Hypnosis n Routine CareChild report Fear before procedure 21 1.81 (1.40) 19 2.42 (1.50) Fear during the procedure 21 2.48 (1.21) 21 2.95 (1.12) Pain during the procedure 21 2.71 (0.96) 21 2.90 (0.94) Crying during the procedure 21 4.24 (1.30) 22 4.68 (1.09)Parent report Fear before procedure 21 3.43 (0.93) 23 3.52 (1.08) Fear during the procedure 21 3.67 (1.11) 23 3.96 (0.82) Pain during the procedure 21 3.05 (0.92) 23 3.13 (0.81) Crying during the procedure 21 2.62 (1.28) 23 3.26 (1.25) How traumatic was VCUG overall? 21 3.10 (1.09) 23 3.39 (0.94)Observational rating Lowest distress level 15 1.83 (0.64) 22 2.39 (0.75) Highest distress level 13 3.68 (1.30) 17 4.53 (1.07)Medical staff rating Difficulty of overall procedure: radiologist 19 3.00 (1.92) 23 4.04 (1.60) Difficulty of overall procedure: technician 19 2.58 (1.78) 23 3.43 (1.62) Difficulty of catheterization: radiologist 12 2.83 (1.64) 14 4.36 (1.98) Difficulty of catheterization: technician 12 2.08 (0.79) 14 3.86 (1.70)
A randomized clinical trial of a brief hypnosis intervention to controlvenepuncture-related pain of paediatric cancer patients
Christina Liossi, Paul White, Popi HatiraPAIN 142 (2009) 255–263
Table 2 Pain and anxiety outcomes for children across time.
Mean Standard deviation T1 T2 T3 T1 T2 T3Anticipated anxiety EMLA 5.28 5.31 5.31 0.79 0.74 0.75 EMLA + Hypnosis 2.43 2.36 2.37 0.45 0.45 0.44 EMLA + Attention 4.36 4.38 4.39 0.33 0.33 0.32Observed distress EMLA 7.26 7.03 7.35 0.83 0.79 0.84 EMLA + Hypnosis 5.07 4.67 4.80 0.59 0.72 1.01 EMLA + Attention 6.30 6.14 6.22 0.91 1.12 1.06Self-reported pain EMLA 4.79 5.09 5.09 0.69 0.84 0.84 EMLA + Hypnosis 2.74 2.89 2.89 0.83 0.79 0.77 EMLA + Attention 4.17 4.91 4.89 0.44 0.51 0.50Self-reported anxiety EMLA 5.12 5.16 5.17 0.72 0.72 0.73 EMLA + Hypnosis 2.35 2.42 2.38 0.52 0.48 0.53 EMLA + Attention 4.17 4.33 4.39 0.38 0.38 0.39
Note. EMLA, eutectic mixture of local anaesthetics; T1, T2, and T3, Times 1, 2, and 3, respectively.
Appropriate Use of Hypnosis
Hypnosis is indicated when: One is responsive to hypnotic
suggestion A problem is treatable with hypnosis Good rapport exists between the
patient and the therapist Patient is motivated to remedy the
problem No iatrogenic harm is anticipated by
use
Inappropriate Use of Hypnosis
Hypnosis is contraindicated when: It would lead to physical
endangerment It may aggravate existing problems or
create new ones It is used for “fun” or entertainment The problem is more effectively and
appropriately treated with a different treatment modality (e.g. medication or family therapy)
Rules for Using Hypnosis
Never treat a condition you are not qualified to treat without hypnosis
Never use authoritarian symptom removal
Do not use for entertainment
Factors Affecting Efficacy
Patient Age Intellectual ability Context of
symptom Acceptability of
hypnosis Hypnotizability (?)
Provider Attitude towards
hypnosis Belief in hypnosis Skill in developing
rapport Skill in encouraging
trance capacity
Factors Affecting Efficacy
Milieu Attitude of family towards
symptoms and hypnosis Societal or cultural attitudes
toward symptom and hypnosis Attitude of staff towards symptom
and hypnosis
Introducing Hypnosis
Learn about the patient Learn about the problem Explain “hypnosis”.. Or not Elicit patient and family beliefs Demystify Use resources Consider the context
Introducing Hypnosis
Using your mind, Pretending about, Imagery, Imagining, Imaging, Using Imagery, Biofeedback, Personal biofeedback, Mind-body interactions, Inside thinking, Inside talking with your [stomach, head, breathing tubes, muscles, bladder..], Relaxing and imagining, Daydreaming, Daydreaming on purpose, Thinking to help yourself, Meditation on your…, Learning how you work the controls in your mind, Learning about what you didn’t know that you knew, Finding out what breathing can do
Goals of Clinical Hypnosis
Develop skills in psychophysiological self-regulation
Balance allopathic therapy (medical treatment) with self-efficacy
Develop integrity in therapeutic relationships
Steps in Clinical Hypnosis
Induction Intensification Therapy in Trance Usual Awareness Ratification/Reflection Follow-up
Clinical Hypnosis
Useful therapeutic tool – not a cure all An adjunct to medical or psychiatric therapy,
usually not the primary treatment Requires self-motivation Not effective when there is a significant
secondary gain maintaining symptom Essentially no adverse effects Gives patient a sense of mastery and control
of symptoms
Training
American Society of Clinical Hypnosis (www.asch.net)
Society for Developmental and Behavioral Pediatrics (www.sdbp.org)
American College of Hypnotherapy(www.aihcp.org)
Society for Clinical and Experimental Hypnosis (www.sceh.us)
The Tad James Company (www.nlpcoaching.com) “neuro-linguistic programming”
Certification
Available through the American Society for Clinical Hypnosis (see website)
Certification indicates that the practitioner: Has undergone advanced training in his/her profession to
obtain a legitimate advanced degree from an accredited institution of higher education;
Is licensed or certified to practice in his/her state/province; Has had his/her education and training in clinical hypnosis
reviewed by qualified peers and approved consultants and such training has met the minimum requirements established by a Standards of Training Committee of qualified peers;
Has been determined to have received at least the minimum educational training that ASCH, the largest such interdisciplinary organization in North America, considers as necessary for utilizing hypnosis.
Referral Resources
Institute for Family Psychology (www.mhehouston.com)
American Society for Clinical Hypnosis (www.asch.net)
Society for Developmental and Behavioral Pediatrics (www.sdbp.org)
Demonstration
Questions & Answers
Contact Information
Caroyl Gilbert, RN, MSN, CPNP-PC
Phone: 832-822-1096
Fax: 832-825-3633
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