Hypnosis: Teaching Children Self Regulation

1
Hypnosis Teaching Children Self Regulation
2
Case Study 1

• Karie is an 8 year old girl who has end stage
  renal disease from obstructive uropathy, she
  developed hypertensive crises, and PICU
  management. She emerged from the process feeling
  frightened vulnerable.

3
Her erythropoietin injections became the weekly
focus of this fear anxiety. It took 20 min of
discussion negotiation to give the injection.
Her pediatrician recommended hypnosis to diminish
her procedure associated fear anxiety.
4
She was given an introductory pamphlet on
hypnosis to read and share with her parents.
After two visits using hypnosis, she used her
relaxation for all her injections. Her mother now
injects Karie's GH erythropoietin at home.
5
Case Study 2

• Seven-year old Sarah came to the office with a
  facial laceration requiring sutures. Her anxiety
  was controlled effectively when she was taught to
  focus her attention on breathing and change her
  perception of discomfort. Upon leaving the
  office, she told her mother, "This is the best
  day of my life!"

6
HYPNOSIS is a term coined in the mid 1800 by the
English surgeon James Braid from the Greek,
hypnos, for sleep. Braid reviewed, as a complete
skeptic, the controversial work on "animal
magnetism" of the Frenchman Antonie Mesmer, some
60 yrs before him.
7
Although Braid refuted Mesmer's theory that
induced magnetic fields were the medium of
behavioral change in his subjects, he reasoned
that some innate ability involving imagination
was the core of hypnotic phenomena.
8
Hypnotic capacity is the ability to focus
narrowly intensify one's concentration
perception while reciprocally diminishing
awareness of all other stimuli.
9
Children are particularly endowed with the
ability to use hypnosis to modify their behavior
psychology. This is not surprising their lack
of experience allows them to blur the boundaries
between our rational world their inner world of
imagination.
10
Too often our medical therapeutics devalues the
child's inner world. The attitude belief
systems we present to youngsters can do affect
their behavior, including their responses to
therapeutic interventions. Hypnosis builds a
bridge between the child's inner world real
therapeutic change.
11
Children adolescents benefit from learning self
regulation by assuming a more central role in
their therapy. The confidence ability they
achieve enhances self-esteem.
12
What is Hypnosis?

• We all enter hypnotic trance states frequently
  intentionally, as in deep thought or prayer. Fear
  anger can trigger spontaneous trance states.
  With children, often in medical settings, we call
  these tantrums.

13
The person in hypnosis is more willful than in
usual, less intense states of awareness. He or
she is mentally active rather than passive. Young
children are likely to their eyes open remain
physically active in hypnosis.
14
There are no unique physical or physiologic
manifestations of hypnotic trances.
15
Although the theoretical bases of what
constitutes the psycho-socio-cultural aspects of
hypnosis are debated, hypnotic phenomena are not
in dispute.
16
Hypnosis is not a placebo effect. Studies of
transduction of neurologic impulses at the
thalamus to affect endocrine, immune, autonomic
activity their links to state dependent
learning are well described.
17
The emerging fields of psychoneuroimmunology
neuroendocrinology have clinical roots leaves
in the evolution of modern clinical hypnosis.
18
Although hypnosis uses imagination, relaxation,
imagery, it is more than these exercises. Thus,
many prefer to use the historically accurate
more general term Hypnosis".
19
What is Achievable with Hypnosis?

• It is used for managing pain, irritating
  medication side effects. As children can alter
  their responses to painful stimuli, airway
  reactivity, salivary IG A, brainstem evokes
  responses, peripheral blood flow, electro-dermal
  activity even neutrophil adhesiveness via
  hypnosis in structured lab settings.

20
Hypnosis has been shown to reduce childhood
migraine more effectively than propranolol or
placebo. It also helps to reduce emesis in
patients with ALL. It is also successful in ER,
diminishing anxiety during immunization.SEE
TABLE 1.
21
(No Transcript)
22
Methodology

• Can be divided into 4 steps Fig 1 but these
  steps represent a continuum of interaction with
  the child, throughout the practitioner's
  language is important.

23
(No Transcript)
24
Language

• The tone, pace, semantics all must suggest
  confidence in the child's ability, creating a
  sense of positive expectancy. Words as try,
  perhaps, maybe, can, might are less effective
  than will is.

25
Rapport

• The 1st step establishes therapeutic rapport by
  assessing joining in the young person's
  motivation goals. Take a good history use the
  opportunity to teach about the pathogenesis of
  the symptoms the methods of treatment,
  including hypnosis.

26
Trance Initiation (Induction)

• There are innumerable methods for helping
  children narrow their focus of concentration
  absorb their imagination.
• Possible methods by age group are presented in
  Fig 2.

27
(No Transcript)
28
Therapy in Trance

• This often follows from the trance initiation
  technique as in, "Now that you're enjoying
  swimming in your magic swimming pool, you'll
  begin to notice that relaxed numbness in your
  back. Can you? See how your back does not mind
  the needle touching you? Isn't that interesting?"

29
Kohen, September 1994, university of Minnesota,
Division of Behavioral Pediatrics, personal
communication, has complied ten "hypnotic
methodologies" for reducing pain suffering
among children. Table 3.
30
(No Transcript)
31
Ratification Reflection

• After the child is asked to return to "usual
  awareness" or to "finish imaging for now," the
  experience is reviewed. This helps the youngster
  confirm understand the experience.

32
The child knows that he or she has shifted away
from being entranced by pain anxiety. A simple
statement of the truth- "Well, now you know how
to do it!"- may be enough. Excessive praise is
stigmatizing detrimental.
33
This is the time to ask for feedback from the
child. For example, "Did I say or do anything
that made you uncomfortable or that you did not
like?"
34
Practical Applications

• A common misconception is that the practice of
  clinical hypnosis requires a large amount of time
  beyond that of the normal patient care. This is
  understandable but incorrect. This time required
  varies with the context, rapport, experience of
  the practitioner.

35
For example using hypnosis in the process of
giving injection to the child when the injection
is over the child realizes his or her success
at self control, the practitioner can say, "Now
you know how to make painful things bother you
less." This adds no time to the visit may
reduce the time required with that child at
future visits.
36
Hypnosis can be taught during consultations for
specific problems. This takes the young person
out of the often fearful setting of an office
visit. An audiotape of the hypnosis session can
be given to the child to use at home.
Consultations often take less than 30 minutes at
the beginning or end of the daily schedule. These
can be the most rewarding of clinical encounters
for the child the practitioner.
37
Parents' Roles

• The role of parents in hypnotherapy is pivotal
  because they
• 1- So often transmit their anxiety to the child.
• 2- Have great insight into their child's
  experiences
• 3- Have preconceptions about hypnosis that may
  either interfere with or aid their child's
  therapy.

38
Educational pamphlets on hypnosis, videotapes,
teaching parents about hypnosis all are useful
methods to gain their understanding support in
the process. Methods of hypnosis can be a natural
addition to parenting.
39
In general, there is a positive correlation
between the young's person needs for autonomy
the degree of parental involvement. Issues of
dependency, which often "cloud" chronic diseases
psycho -physiologic symptoms, may impair the
therapeutic rapport motivation of the child who
is in hypnotherapy.
40
Family therapy may be indicated before parents
can allow children to develop mastery over their
discomfort or behavior.
41
Training

• As with other therapeutic skills, training
  ongoing evaluation are crucial. The practitioner
  learning about hypnotherapy should enroll in a
  basic workshop sponsored by the Society for
  Behavioral Pediatrics, the Society for Clinical
  Experimental Hypnosis, the American Society of
  Clinical Hypnosis, or at the University school of
  medicine or a department of psychology. There's a
  3 part examination which include written, oral,
  practical clinical demonstration sections.

42
(No Transcript)