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Hypnotherapy

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Hypnotherapy Applications in Pain Management Frank McDonald Consultation-Liaison Psychologist The Townsville Hospital www.fmcdonald.com Introduction Most popular ... – PowerPoint PPT presentation

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Title: Hypnotherapy


1
Hypnotherapy
  • Applications in Pain Management
  • Frank McDonald
  • Consultation-Liaison Psychologist
  • The Townsville Hospital
  • www.fmcdonald.com

2
Introduction
  • Most popular application in medical settings is
    for anxiety (e.g. distress during medical
    procedures like needles, chemotherapy, adrenal
    vein sampling) pain control (focus of this
    session)
  • Session briefly describes recent pain cases in
    general hospital setting, after outlining nature
    of hypnotherapy, its contra/indications steps
    involved

3
Overview
  • Video clip of hypno-analgesia followed by
    hypno-anaesthesia
  • Nature of hypnosis What is it? How does it
    work? Common ideas/misconceptions vs. evidence
  • Whos more less likely to benefit from
    hypnotherapy?
  • Contraindications
  • Procedural stages
  • Pain mx cases chronic cervico-genic headaches,
    pain of burns-bath rx, chronic hyperemesis
    (severe nausea, stomach pain vomiting)
  • Resources

4
Video clip
  • Dr. Graham Wicks demonstrates hypno- analgesia
    followed by surgery under hypnosis without
    anaesthetic
  • Pre-view video at http//www.abc.net.au/catalyst/s
    tories/s1440855.htm Dr. Wicks starts around 19
    minute mark
  • Presenter discusses neural mechanisms of pain
    control as suggested by recent fMRI studies

5
Nature of HypnosisWhat is it how does it
work?
  • Hypnosis - oldest (cognitive) psychological
    strategy predates written history Egyptian
    records go back 4 000 years. Aboriginal
    Australians Africans amongst earliest users
  • A phenomenon of attention in which brain suspends
    authentication of raw sensory input. (Focus is on
    internal representation of input. Working with
    that to change pts experience.)
  • Results in heightened suggestibility (a cognitive
    flexibility resulting in reduced critical
    analysis), or at least allows suggestibility to
    come to the fore

6
Nature of HypnosisWhat is it how does it work?
  • In turn, allows access to therapeutically-useful
    psychological physical abilities e.g.
  • dissociation
  • anaesthesia/analgesia
  • involuntary movement
  • time distortion
  • involuntary nervous system functions (blood flow,
    coagulation time, blood pressure, peristalsis of
    digestive tract, heart rate etc )

7
Nature of HypnosisWhat is it how does it
work?
  • Hypnosis a form of highly focused attention -
    like meditation. In meditation you concentrate on
    nothing in particular (e.g. the space between
    thoughts) in hypnosis on something (usually
    therapeutic suggestions)
  • Hypnotherapy refers to use of strategies
    harnessing hypnotic phenomena (e.g. narrowed
    attention, heightened suggestibilty) in the
    service of therapeutic goals
  • Hypnosis is regarded as an adjunct to therapy
    not a therapy in its own right. A state of
    resting arousal, unlike sleep or relaxation

8
Nature of HypnosisWhat is it how does it work?
  • How it works is not clear absence of a
    scientific explanation has limited its
    acceptance. Age-old debates e.g. Charcot (below)
    vs. Bernheim the current special state v.
    role-play have made it controversial

9
Nature of HypnosisWhat is it how does it work?
  • How? point of departure/division into two
    academic camps ( theres heterogeneity within
    those)
  • Some say hypnotic behaviour reflects changes in
    brain function
  • Others say social-psychological ordinary
    cognitive-behavioural factors, like placebo
    (albeit hypnosis more effective than sham pills)
  • Whilst polarising, debate helps us appreciate its
    dual nature

10
Nature of HypnosisWhat is it how does it work?
  • Assuaging an effect of controversies somewhat,
    PET scan fMRI studies showing modulations of
    activity in specific relevant areas are
    starting to allay prejudices to its application
    in certain fields, such as pain mx
  • The images differ from those of well-instructed,
    well-motivated role-players

11
Nature of HypnosisWhat is it how does it work?
  • So, not just imagination, faking,
    play-acting, stage-show gimmickery. For high
    moderate hypnotisables (roughly 2 in 3 people),
    hypnosis can bring benefits beyond those of
    imagination or willing

12
Nature of HypnosisWhat is it how does it work?
  • Even sceptics (who dont believe in trances)
    believe it can relieve conditions like insomnia,
    obesity, hypertension improve behaviour
    therapies, counselling coping strategies
  • Whilst accepting imaging studies, they believe
    though that hypnosis is not tapping into anything
    beyond a continuum of everyday abilities that are
    distributed across the population in a pattern
    detected by hypnotisability scales
  • They say its just that hypnosis is one of the
    best ways to tap into these commonplace
    capacities

13
Nature of HypnosisCommon ideas vs evidence
What do you know about hypnosis? (Nash,2001)
14
Who benefits more?
  • 1. People who score high (26) and moderately
    (36) on scales of hypnotisability. 29 are
    mildly hypnotisable. (9 unhypnotisable)
    (Hilgard, 1961)
  • 2. Children (peaks age 9 - 12)
  • 3. People who ask for hypnotherapy/who are
    motivated
  • 4. People who have an imaginative ability e.g.
    artistic
  • types
  • 5. People who have a capacity for emotional
    involvement
  • 6. People who can take things on faith or trust
    as opposed to sceptical, analytical types
  • 7. People from certain cultures e.g. Latinos vs.
    Germans
  • 8. Rights handers vs. left handers

15
Who benefits less?
  • 1. People with abnormally low IQ's (attention
    and response-time factors)
  • 2. Dementia patients (these patients cannot be
    hypnotised due to problems in prefrontal areas
    necessary to process induction signals)
  • 3. People who score low (9) on scales of
    hypnotisability
  • 4. People for whom condition brings secondary
    gains (conscious or unconscious pay-offs)
  • 5. People in psychotic states. (Can uncover too
    much material and therapist can be drawn in
    to any delusional beliefs)
  • 6. People in hypermanic states

16
Contraindications
  • There are few absolute contraindications to the
    use of hypnosis. It is usually a very safe
    procedure. But there are number of situations in
    which you should be cautious
  • Hypnosis is usually contraindicated if you are
    dealing with
  • 1. Any condition which would be better treated
    another way
  • 2. Any condition outside your specialty and area
    of expertise
  • 3. Depression with a risk of suicide. Be on the
    qui-vive for "masked depression" e.g. depression
    masked by low back pain or a habit disorder. The
    tranquillising effects of hypnosis may energise a
    lethargic depressive sufficiently to allow
    suicide
  • 4. Thought disorders such as Schizophrenia and
    Delusional Disorder except if you have experience
    with these. While hypnosis cannot precipitate a
    psychosis, you may be incorporated into the
    person's thought disorder more readily

17
Phenomena strategies facilitated intensified
by hypnosis
  • Phenomena
  • Increased temporary and post-hypnotic
    suggestibilty less critical, evaluative
    thinking
  • Reduced awareness that improves classical
    conditioning. Easier to establish more
    difficult to extinguish
  • Hallucinations that are more real and absorbing
    than ordinary imagination
  • Regression and revivification
  • Time distortion e.g. time contraction in medical
    procedures
  • Analgesia and anaesthesia
  • Dissociation (split self off from current
    reality)
  • A.N.S. control e.g. changing blood flow
  • Arousal modulation (within limits) for the
    demoralised or the distressed to focus therapy
    attention

18
Phenomena strategies facilitated intensified
by hypnosis
  • Strategies
  • Imaginal conditioning
  • Revivification and (cognitive) restructuring
  • Exposure therapy/ extinction/ abreaction
  • Imaginal rehearsal
  • Relaxation / arousal reduction
  • Suggestion e.g. for ego-strengthening and
    altering pain sensation, enhancing performance
  • Simple encouragement and support

19
Areas of application
  • Medical
  • Asthma
  • Burns
  • Enuresis
  • Hypertension
  • Childbirth
  • Migraine
  • Minor Surgical Procedures
  • Obesity
  • Pain Control
  • Gastro-intestinal Disorders
  • Warts

20
Areas of application
  • Psychological Practice Psychiatry
  • Anxieties
  • Apathy and lack of Motivation
  • Confidence Problems
  • Eating Disorders
  • Depression
  • Nail-biting
  • Fears and Phobias
  • Psychosomatic Syndromes
  • Panic Attacks
  • Sleep Disorders
  • Sexual Dysfunction
  • Thumb-sucking
  • Stuttering

21
Areas of application
  • Dentistry
  • Anaesthesia
  • Anxiety / Apprehension
  • Bleeding Control
  • Bruxism
  • Dental Phobia
  • Denture Problems
  • Gagging
  • Nausea
  • Pain-control
  • Restlessness
  • Salivation-control
  • Tempro-mandibular Joint Dysfunction

22
Areas of application
  • Education
  • Concentration and Attention problems
  • Exam Fears/Phobias
  • Motivation training
  • Memory Training
  • Study habit problems
  • Sports
  • Attitude Change
  • Confidence Building
  • Co-ordinate Mind Body
  • Fear of Success
  • Fear of Failure
  • Maximise Potential
  • Improve Concentration
  • Performance Anxiety
  • Motivation Training control

23
Procedural Stages of Hypnotherapy
  • 1. Preparation (e.g. removing misconceptions,
    assess interests that may be incorporated in
    procedure)
  • 2. Assessment of hypnotisability (capacity for
    concentration and imagery, suggestibility)
  • 3. Induction procedure
  • 4. Deepening stage
  • 5. Trance ratification
  • 6. Utilisation of trance for therapeutic
    purposes
  • 7. Post-hypnotic suggestions including self-
  • hypnosis instructions
  • 8. Termination of the trance
  • 9. Discussion of the experience. Problems?

24
Pain-related Case Discussions
  • Cervico-genic headaches in 37 yr old female from
    m.v.a. at age 17
  • Mx of pain of burns bath treatment in 10 yr old
    male
  • Mx of chronic (2yrs ) hyperemesis in 33 yr old
    female

25
Resources Pre-/post- session reading
  • http//www.abc.net.au/catalyst/stories/s1440855.ht
    m Vision and transcript. Hypnosis for pain at 19
    minute mark
  • Australian Society of Hypnosis
  • http//www.ozhypnosis.com.au/Default.htm
  • Hypnosis.com the FAQ section is excellent
    http//hypnosis.com/faq/
  • This presentation www.fmcdonald.com
  • Extra reading presented via JCU network
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