Symposium on Complementary & Alternative Medicine (CAM)

Symposium Chair: Aaron Michelfelder, M.D., Wednesday, October 10, 2007

Medical Hypnosis

presented by Thomas J. Rostafinski, Ph.D.

Licensed Clinical Psychologist

Clinical Associate Professor Department of Psychiatry and Behavioral Neurosciences Loyola University Medical Center What Is Hypnosis and What Is It Good For? Hypnosis is controversial and always has been. Yet hypnosis is also an approved mode of medical as well as psychological treatment; as such it is not exactly “alternative.” Hypnosis is best regarded as a body of treatment approaches and techniques, not all of which have always used the name. The Long History of Hypnosis Historically: Mesmerism and animal magnetism, Shamanism and possibly exorcism still earlier Currently: Hypnosis in the narrow sense, Relaxation training Visualization Imagery work, and Some aspects of meditation. Defining Hypnosis Hypnosis has been difficult to define unambiguously and its modes of action remain less than fully clear. One clinically useful definition: “Hypnosis is a process that allows us to experience thoughts and images as real.”

David A. Soskis, M.D., Teaching Self Hypnosis: An Introductory Guide for Clinicians. New York: Norton, 1986. p. 8. See also: definition by the Society of Psychological Hypnosis (Division 30 of the American Psychological Association), now in a second version. Defining Hypnosis Hypnosis is best regarded as a tradition of psychological treatment for medical as well as mental disorders. The treatment is psychological because it involves communication, usually verbal but not exclusively so, sometimes entirely nonverbal. Hypnosis can also be invoked by persons on their own once they have learned it. Learning it has to have been a process of communication, though not necessarily involving direct contact with a hypnotic operator. Hypnotic induction makes use of social influences including suggestion, as well as imagery and imagination, to create a state of receptivity to suggestions. Individuals differ in their ability to enter or benefit from such a state. DEMONSTRATION: Hypnotic Ideomotor Phenomena Medical Hypnosis Thomas J. Rostafinski, Ph.D., 10 October 2007, page 2

Hypnotic ideomotor phenomena usefully highlight the mind-body connection The experience of involuntariness; Allowing the body to respond to external or, eventually, internal symbolic communication; Extending the benefits of traditional or alternative medical procedures: Trigger point injections Massage Acupuncture (which is often reported to produce a trance-like state) Hypnotic techniques consist of several phases Patient / subject selection (hypnotizability) Patient preparation (role induction, correction of misconceptions) Induction (focusing of attention) Deepening, “trance ratification” Suggestions, for modification of experience and toward clinical goals Post-hypnotic suggestions, ego strengthening Realerting and post-assessment Hypnotic Ability Varies Not all persons are equally receptive or responsive to hypnotic techniques Hypnotic responsiveness when measured in the laboratory is normally distributed. High responsiveness, or deep trance, is not required for most clinical applications, although effectiveness with pain management seems to be correlated with hypnotizability. Patients’ misconceptions about hypnosis may adversely affect response to hypnotic techniques.

Myths & Misconceptions About Hypnosis Hypnosis is sleep Hypnosis is magical The hypnotist takes over the subject’s life by force of will Hypnosis can bring back any forgotten memory Hypnosis creates false memories Hypnosis is dangerous Hypnosis can make a person do whatever the hypnotist suggests to them Hypnosis can make a person stop smoking or overeating Applications of Hypnosis Emotional and mental disorders including anxiety and dissociative disorders Management of acute and chronic pain including burn treatment Preparation for surgery, anesthesia, preparation for childbirth Medical conditions including gastrointestinal and dermatologic Habit control including smoking cessation, weight control, eating disorders Stress management, self-improvement, inner practice How Does Hypnosis Work? There is controversy: whether hypnosis is/produces truly an altered state of consciousness, or whether social psychological mechanisms are sufficient to explain the phenomena of hypnosis. While hypnosis is experienced as an altered state of consciousness, it is not clear that it represents a special state psychobiologically. Awareness of the social psychology of hypnotic treatment is necessary for maximizing patient benefit from hypnotherapy. Suggestion With and Without Hypnosis Suggestion can be used in various settings besides hypnosis Waking suggestion may not require any induction or other specific ceremony or alteration of state. Persons entering a hospital, in shock, or under anesthesia may be especially receptive to suggestions. The Psychological Management of Stress Medical Hypnosis Thomas J. Rostafinski, Ph.D., 10 October 2007, page 3

While acute stress serves to mobilize the organism, chronic stress tends to deplete physical and psychological resources. Stress is part of life; life is inherently stressful. Change causes stress. The lack of change can also cause stress.

The Psychological Management of Stress The psychological management of stress begins with the realization that stress has effects on the organism that can be deleterious. The next step is to determine what can be done, not to eliminate the stress, but to counter its effects on the organism. Self-Hypnosis Training for Stress Self-hypnosis can be helpful in decreasing excessive arousal and other effects of stress: Relaxation Visualization, imagery The training of focused attention as an antidote to rumination and runaway thinking Adjunct to cognitive-behavioral psychotherapy DEMONSTRATION: Self-Hypnotic Relaxation Training

References: Books and Articles

Alman, B. M., & Lambrou, P. T. (1992). Self-hypnosis: The complete manual for health and self-change (2nd ed.). New York: Brunner/Mazel.

Barber, J. (1991). The locksmith model: accessing hypnotic responsiveness. In S. J. Lynn & J. W. Rhue (Eds.), Theories of hypnosis: Current models and perspective, pp. 241-274. New York: Guilford.

Barber, J. (1996). Hypnosis and suggestion in the treatment of pain: A clinical guide. New York: Norton.

Brown, D. P., & Fromm, E. (1987). Hypnosis and behavioral medicine. Hillsdale, NJ: Erlbaum.

Crasilneck, H. B., & Hall, J. A. (1985). Clinical hypnosis: Principles and applications (2nd Ed.). Orlando, FL: Grune & Stratton.

Eimer, B. N. (2002). Hypnotize Yourself Out of Pain Now!: A Powerful, User Friendly Program for Anyone Searching for Immediate Pain Relief. Oakland, CA: New Harbinger Publications.

Fromm, E., & Kahn, S. (1990). Self-hypnosis: The Chicago paradigm. New York: Guilford.

Hoorwitz, A. N. (1989). Hypnotic methods in nonhypnotic therapies. New York: Irvington.

Lynn, S. J., & Rhue, J. W. (1991). Theories of hypnosis: Current models and perspectives. New York: Guilford.

Sanders, S. (1990). Clinical self-hypnosis. New York: Guilford.

Soskis, D. A. (1986). Teaching self-hypnosis: An introductory guide for clinicians. New York: Norton.

Spiegel, H., & Spiegel, D. (1978). Trance and treatment: Clinical uses of hypnosis. New York: Basic Books.

Wachtel, P. L. (1993). Therapeutic communication. New York: Guilford. ch. 9: Attribution and Suggestion, pp. 157-184 Medical Hypnosis Thomas J. Rostafinski, Ph.D., 10 October 2007, page 4

References: Journals

American Journal of Clinical Hypnosis International Journal of Clinical and Experimental Hypnosis Contemporary Hypnosis (British journal) Australian Journal of Clinical and Experimental Hypnosis American Journal of Psychiatry Journal of Abnormal Psychology

The International Journal of Clinical and Experimental Hypnosis Special Issues: Evidence-Based Practice in Clinical Hypnosis: Volume 55, Number 2 - April 2007 Volume 55, Number 3 - July 2007 References: Professional Societies

Society for Clinical and Experimental Hypnosis http://www.sceh.us/ http://www.ijceh.com/

American Society of Clinical Hypnosis http://www.asch.net/ http://www.hypnosis-research.org/

Chicago Society of Clinical Hypnosis (CSCH) www.chisoclinhyp.org

American Psychological Association Society of Psychological Hypnosis - Division 30 http://www.apa.org/divisions/div30/