Title: Hypnotherapy
1Hypnotherapy
- Applications in Pain Management
- Frank McDonald
- Consultation-Liaison Psychologist
- The Townsville Hospital
- www.fmcdonald.com
2Introduction
- 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
3Overview
- 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
4Video 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
5Nature 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
6Nature 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 )
7Nature 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
8Nature 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
9Nature 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
10Nature 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
11Nature 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
12Nature 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
13Nature of HypnosisCommon ideas vs evidence
What do you know about hypnosis? (Nash,2001)
14Who 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
15Who 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
16Contraindications
- 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
17Phenomena 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
18Phenomena 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
19Areas of application
- Medical
- Asthma
- Burns
- Enuresis
- Hypertension
- Childbirth
- Migraine
- Minor Surgical Procedures
- Obesity
- Pain Control
- Gastro-intestinal Disorders
- Warts
20Areas 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
21Areas of application
- Dentistry
- Anaesthesia
- Anxiety / Apprehension
- Bleeding Control
- Bruxism
- Dental Phobia
- Denture Problems
- Gagging
- Nausea
- Pain-control
- Restlessness
- Salivation-control
- Tempro-mandibular Joint Dysfunction
22Areas 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
23Procedural 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?
24Pain-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
25Resources 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