an overview of clinical hypnosis

An Overview of Clinical An Overview of Clinical HypnosisHypnosis

Connie Lemmond, LCSWConnie Lemmond, LCSW&&

Jay Yeomans, MDJay Yeomans, MD

Grand RoundsGrand RoundsBehavioral Health Center, Behavioral Health Center,

CMC-RandolphCMC-Randolph

March 21March 21stst 2009 2009

An Overview of Clinical HypnosisAn Overview of Clinical HypnosisDefinitionDefinition

State of inner absorption, concentration & focused attentionState of inner absorption, concentration & focused attention‘‘using a magnifying glass to focus the rays of the sun’ … ultimate using a magnifying glass to focus the rays of the sun’ … ultimate

act of self-controlact of self-controlPractitioners use clinical hypnosis in three ways.Practitioners use clinical hypnosis in three ways. FirstFirst, they encourage the use of , they encourage the use of imaginationimagination.. Mental imagery is very Mental imagery is very

powerful, esp. in a focused state of attention. The mind seems capable of powerful, esp. in a focused state of attention. The mind seems capable of using imagery, even if it is only symbolic, to assist us in bringing about the using imagery, even if it is only symbolic, to assist us in bringing about the things we are imagining. For example, a patient w/UC may be asked to things we are imagining. For example, a patient w/UC may be asked to imagine what his/her distressed colon looks like. If she imagines it as being imagine what his/her distressed colon looks like. If she imagines it as being like a tunnel, with very red, inflamed walls that are rough in texture, the like a tunnel, with very red, inflamed walls that are rough in texture, the patient may be encouraged in hypnosis (& self hypnosis) to imagine this patient may be encouraged in hypnosis (& self hypnosis) to imagine this image changing to a healthy one.image changing to a healthy one.

Second Second basic hypnotic method is to present ideas or basic hypnotic method is to present ideas or suggestions suggestions that are that are compatible with what the patient wants.compatible with what the patient wants.

ThirdlyThirdly, hypnosis may be used for , hypnosis may be used for unconscious explorationunconscious exploration, to better , to better understand underlying motivations or identify whether past events or understand underlying motivations or identify whether past events or experiences are associated with a problem, avoiding the critical censor of experiences are associated with a problem, avoiding the critical censor of the conscious mind.the conscious mind.

An Overview of Clinical HypnosisAn Overview of Clinical HypnosisFranz Anton Mesmer (1734-1815)Franz Anton Mesmer (1734-1815)

Viennese physicianViennese physician‘‘Mesmerism’Mesmerism’Magnetic fluid in our body Magnetic fluid in our body determines our healthdetermines our healthover the affected organs with magnets, over the affected organs with magnets, Sick could be cured by passing Sick could be cured by passing contact with magnetized water or the contact with magnetized water or the magnetically gifted hands of the Mastermagnetically gifted hands of the MasterPatients would go into “a grand crisis” Patients would go into “a grand crisis” (resembled an epileptic seizure) (resembled an epileptic seizure) ParisParis … … 1780s1780s ‘marvel of the age’ ‘marvel of the age’Large oaken tubs containing a layer of Large oaken tubs containing a layer of supposedly magnetized water covering supposedly magnetized water covering a layer of iron filings & powdered broken a layer of iron filings & powdered broken glass bottles floated on top,glass bottles floated on top,iron & glass rods projected from the lid –iron & glass rods projected from the lid –sufferersgrasped the rods & held hands … sufferersgrasped the rods & held hands … emanations from the rodsemanations from the rodswere supposed to stimulate the circulation were supposed to stimulate the circulation of the of the ‘magnetic fluid’ ‘magnetic fluid’ in the patients in the patients’’

An Overview of Clinical HypnosisAn Overview of Clinical HypnosisFranz Anton MesmerFranz Anton Mesmer

An Overview of Clinical HypnosisAn Overview of Clinical Hypnosis

““Mesmerism”Mesmerism” persisted in various incarnations into the mid 19 persisted in various incarnations into the mid 19thth century - it’s creator faded into disrepute when a royal century - it’s creator faded into disrepute when a royal

commission which included commission which included Benjamin FranklinBenjamin Franklin & the chemist & the chemist AntoineAntoine LavoisierLavoisier decreed that there was nothing to Mesmer’s decreed that there was nothing to Mesmer’s

magnetism except “excitement of the imagination”magnetism except “excitement of the imagination”

Hindu-Portuguese priest, Hindu-Portuguese priest, AbbeAbbe׳׳FariaFaria wrote in 1819 that the wrote in 1819 that the stimulus for ‘lucid sleep’ of mesmerism was not magnetism but stimulus for ‘lucid sleep’ of mesmerism was not magnetism but concentration – clients relax, lean back, empty their minds & concentration – clients relax, lean back, empty their minds &

concentrate on falling asleepconcentrate on falling asleep


““Mesmerism”Mesmerism”

James BraidJames Braid: (British surgeon - 1795-1860) via experimentation : (British surgeon - 1795-1860) via experimentation that “nervous sleep” was a condition brought about by a that “nervous sleep” was a condition brought about by a

suggestion … coined the terms “hypnosis” and “hypnotism” suggestion … coined the terms “hypnosis” and “hypnotism” (Greek (Greek hypnos hypnos = sleep) – misnomer = sleep) – misnomer

used it frequently in his medical practice in the 1840s & 1850sused it frequently in his medical practice in the 1840s & 1850s

James EsdaileJames Esdaile: (British surgeon) performed > 300 major : (British surgeon) performed > 300 major operations in India the 1840s using “mesmerism” as anesthesiaoperations in India the 1840s using “mesmerism” as anesthesia


““Mesmerism”Mesmerism”QuestQuest was to understand what happens in was to understand what happens in hypnosis - what mechanisms are at work, are hypnosis - what mechanisms are at work, are

they physical, psychological or both? they physical, psychological or both?

Late 19Late 19thth century - bitter rivalry between two century - bitter rivalry between two French neurologist French neurologist

Jean Martin CharcotJean Martin Charcot (1825-1893) (1825-1893) & &

Hippolyte Hippolyte Bernheim Bernheim (1840-1919)(1840-1919)

An Overview of Clinical HypnosisAn Overview of Clinical Hypnosis““Mesmerism”Mesmerism”

CharcotCharcot:: susceptibility to hypnosis was a pathological state – susceptibility to hypnosis was a pathological state – ““Morbid condition”Morbid condition” of hypnosis was closely related to of hypnosis was closely related to hysteriahysteria

BernheimBernheim: susceptibility to hypnosis came through suggestions from : susceptibility to hypnosis came through suggestions from either the hypnotist or the subject himself – either the hypnotist or the subject himself –

phenomenon is driven by the force of ‘phenomenon is driven by the force of ‘suggestion’suggestion’, defined as , defined as ““the amplitude to transform an idea into an act”the amplitude to transform an idea into an act”

Charcot attributed hysteria to organic disease Charcot attributed hysteria to organic disease Bernheim explained hysteria & hypnosis entirely on psychological Bernheim explained hysteria & hypnosis entirely on psychological

groundsgrounds

Freud:Freud: studied under both Charcot & Bernheim - used hypnosis early studied under both Charcot & Bernheim - used hypnosis early in his career but eventually abandoned it, however, in favor of free in his career but eventually abandoned it, however, in favor of free

association and the interpretation of dreams, which became the association and the interpretation of dreams, which became the basis of psychoanalysis. basis of psychoanalysis.

An Overview of Clinical HypnosisAn Overview of Clinical Hypnosis Charles DickensCharles Dickens practiced it often & practiced it often &

contemplated a career as a contemplated a career as a mesmeristmesmerist

Edgar Allen Poe’sEdgar Allen Poe’s, “The Facts in the , “The Facts in the Case of M. Valdemar” - man Case of M. Valdemar” - man

suspended in a mesmeric trance suspended in a mesmeric trance between life & deathbetween life & death

H.G. WellsH.G. Wells & & Sir Arthur ConanSir Arthur Conan DoyleDoyle wrote stories built around hypnosiswrote stories built around hypnosis

*Hypno-novel *Hypno-novel Trilby Trilby ((George DuGeorge Du MaurierMaurier - 1894) – diabolical - 1894) – diabolical

Svengali exerts total domination Svengali exerts total domination over the winsome & helpless Trilby over the winsome & helpless Trilby

- publication led to demands to outlaw - publication led to demands to outlaw hypnosishypnosis

Svengali (1931) - John Barrymore1931) - John Barrymore


““Traveling mesmerizers’Traveling mesmerizers’Stage hypnosis Stage hypnosis

““human plank” trickhuman plank” trickDanish hypnotist Carl Hanson & Danish hypnotist Carl Hanson &

“The Amazing Kreskin”“The Amazing Kreskin”

5-10% of the population that was 5-10% of the population that was characterized as “fantasy-prone”characterized as “fantasy-prone”

Some people, by nature, are highly Some people, by nature, are highly susceptible & can experience the susceptible & can experience the

effects of suggestion whether effects of suggestion whether they have been hypnotized or notthey have been hypnotized or not

AmjPsych ’92: dissociative disorder AmjPsych ’92: dissociative disorder patients had higher patients had higher

hypnotizability scoreshypnotizability scores

DSM-IV: Histrionic Personality DSM-IV: Histrionic Personality (criteria 7/8: highly suggestible)(criteria 7/8: highly suggestible)

An Overview of Clinical HypnosisAn Overview of Clinical HypnosisStanford Hypnotic Susceptibility Scale (’50s)Stanford Hypnotic Susceptibility Scale (’50s)

12 activities: Score range from 0 – 1212 activities: Score range from 0 – 120=id who do not respond to any of the hypnotic suggestions 0=id who do not respond to any of the hypnotic suggestions

(most people score 5-7)(most people score 5-7)Ability to respond is remarkably stable during adulthoodAbility to respond is remarkably stable during adulthood

New Science:New Science: Mass Gen Hosp … Mass Gen Hosp … increased blood flow in increased blood flow in susceptible parts of the brain of hypnotized subjectssusceptible parts of the brain of hypnotized subjects

1969 – Thomas H. McGlashan 1969 – Thomas H. McGlashan (U of Penn)(U of Penn)……for poorly hypnotizable for poorly hypnotizable people, hypnosis was as effective in reducing pain as a sugar pill that people, hypnosis was as effective in reducing pain as a sugar pill that

the subjects had been told was a powerful painkiller. But highly the subjects had been told was a powerful painkiller. But highly hypnotizable subjects benefited three times more from hypnosis than hypnotizable subjects benefited three times more from hypnosis than

placeboplacebo

An Overview of Clinical HypnosisAn Overview of Clinical HypnosisHypnosis & MemoryHypnosis & Memory

””recovered” (‘false’) memory …recovered” (‘false’) memory …Actual or imagined eventsActual or imagined events

cuecue that humans use in making the distinction between reality & that humans use in making the distinction between reality & imagination is the experience of imagination is the experience of effort effort … at the time of encoding a … at the time of encoding a

memory, a “tag” cues us as to the amount of effort we expend … if the memory, a “tag” cues us as to the amount of effort we expend … if the event is tagged as having involved a good deal of mental effort, we event is tagged as having involved a good deal of mental effort, we interpret it as something we interpret it as something we imaginedimagined – if it’s tagged as having little – if it’s tagged as having little

mental effort then we interpret as something that actually mental effort then we interpret as something that actually happened happened

Calling card of hypnosis is the feeling of effortlessness – can see why Calling card of hypnosis is the feeling of effortlessness – can see why hypnotized people can easily mistake an imagined past event for hypnotized people can easily mistake an imagined past event for

something that actually happened long agosomething that actually happened long agoespecially in highly hypnotizable subjectsespecially in highly hypnotizable subjects

1950s LAPD – ‘Svengali Squad’ - hypnotically induced statements1950s LAPD – ‘Svengali Squad’ - hypnotically induced statements

An Overview of Clinical HypnosisAn Overview of Clinical HypnosisHypnosis & PainHypnosis & Pain

1969 - NIH panel judged hypnosis to be an effective 1969 - NIH panel judged hypnosis to be an effective intervention for alleviating pain from cancer & other intervention for alleviating pain from cancer & other chronic conditions - chronic conditions -

e.g. reduced acute pain experienced by patients e.g. reduced acute pain experienced by patients undergoing burn-wound debridement, children enduring undergoing burn-wound debridement, children enduring bone marrow aspirations & women in laborbone marrow aspirations & women in labor

Meta-analysis Meta-analysis (International Journal of Clinical & Experimental Hypnosis)(International Journal of Clinical & Experimental Hypnosis)

… … hypnotic suggestion relieved pain in 75% of 933 subjects hypnotic suggestion relieved pain in 75% of 933 subjects participating in 27 different studies …pain relief was participating in 27 different studies …pain relief was substantial & in some cases matched or exceeded substantial & in some cases matched or exceeded morphinemorphine

An overview of clinical hypnosisAn overview of clinical hypnosis

Hypnosis & PainHypnosis & PainAlleviates pain by decreasing the Alleviates pain by decreasing the

activity of brain areas involved in activity of brain areas involved in the experience of suffering – PET the experience of suffering – PET

scan – while hands of a scan – while hands of a hypnotized subject where dunked hypnotized subject where dunked into painfully hot water – act of the into painfully hot water – act of the

somatosensory cortexsomatosensory cortex (processes physical stimuli) did (processes physical stimuli) did

not differ whether the subject was not differ whether the subject was given hypnotic suggestion that the given hypnotic suggestion that the sensation would be sensation would be painfully hotpainfully hot (L)(L) or that it would be or that it would be minimally minimally unpleasant (R)unpleasant (R) … in contrast, … in contrast, anterior cingulate cortexanterior cingulate cortex

(involved in mediating pain) was (involved in mediating pain) was much less active when subjects much less active when subjects were told that the pain would be were told that the pain would be

minimally unpleasantminimally unpleasant

An Overview of Clinical HypnosisAn Overview of Clinical HypnosisUses of Hypnosis in MedicineUses of Hypnosis in Medicine

Gastrointestional Disorders Gastrointestional Disorders (PUD, (PUD, IBSIBS, Crohn’s), Crohn’s)Dermatological DisordersDermatological Disorders (Eczema, Herpes, Neurodermatitis, etc.)(Eczema, Herpes, Neurodermatitis, etc.)

Surgery / AnesthesiologySurgery / AnesthesiologyAcute & Chronic PainAcute & Chronic Pain

BurnsBurnsNauseaNausea & Vomiting, esp. assoc. w/chemo & Vomiting, esp. assoc. w/chemo

ChildbirthChildbirthHemophiliaHemophilia

Allergies / Allergies / Asthma Asthma High Blood Pressure High Blood Pressure Raynaud’s DiseaseRaynaud’s Disease

An Overview of Clinical HypnosisAn Overview of Clinical HypnosisUses of Hypnosis in DentistryUses of Hypnosis in Dentistry

Behavior ModificationBehavior ModificationRelaxation / Anxiety ControlRelaxation / Anxiety Control

Fear EliminationFear EliminationQuelling Undesirable Habits (Bruxism, Clenching)Quelling Undesirable Habits (Bruxism, Clenching)

AmnesiaAmnesiaAnalgesia / Anesthesia / Pain ControlAnalgesia / Anesthesia / Pain Control

Prevention of Gagging & NauseaPrevention of Gagging & NauseaControl of Saliva & BleedingControl of Saliva & Bleeding

Creative visualization for healingCreative visualization for healingRestorative Appliance Tolerance / Pretx DesensitizationRestorative Appliance Tolerance / Pretx Desensitization

Self-image / Self-esteem and ConfidenceSelf-image / Self-esteem and Confidence

An Overview of Clinical HypnosisAn Overview of Clinical HypnosisHypnosis & PsychotherapyHypnosis & Psychotherapy

Meta-analysis Meta-analysis (International Journal of Clinical & Experimental Hypnosis)(International Journal of Clinical & Experimental Hypnosis)

… … examined the outcome of subjects in 18 studies & found examined the outcome of subjects in 18 studies & found that patients that received CBT plus hypnosis for obesity, that patients that received CBT plus hypnosis for obesity, insomnia, anxiety and HTN showed greater improvement insomnia, anxiety and HTN showed greater improvement than 70% of patients who received psychotherapy alone.than 70% of patients who received psychotherapy alone.

APA task force validated hypnosis as a adjunct procedure APA task force validated hypnosis as a adjunct procedure for the treatment of obesity.for the treatment of obesity.

Drug addiction & EtOHism do not respond well.Drug addiction & EtOHism do not respond well.

Smoking cessation results are equivocal.Smoking cessation results are equivocal.

An Overview of Clinical HypnosisAn Overview of Clinical HypnosisUses of Hypnosis in Psychotherapy & Behavioral HealthUses of Hypnosis in Psychotherapy & Behavioral Health

Trauma (physical & emotional abuse, etc.)Trauma (physical & emotional abuse, etc.)Anxiety & stress management (phobias)Anxiety & stress management (phobias)

DepressionDepressionEnuresisEnuresis

Sports & Athletic PerformanceSports & Athletic PerformanceSmoking CessationSmoking Cessation

Obesity & weight control Obesity & weight control Sexual dysfunctionSexual dysfunction

Sleep disordersSleep disordersConcentration difficulties / test anxiety, etc.Concentration difficulties / test anxiety, etc.


Selecting a qualified HypnotherapistSelecting a qualified HypnotherapistHypnosis & Hypnotherapy are not regulated in most Hypnosis & Hypnotherapy are not regulated in most

statesstates

Lay hypnosis training programs vary widely in their Lay hypnosis training programs vary widely in their depth & length – some lay hypnotherapist may depth & length – some lay hypnotherapist may

have only attended a brief W/E workshop with little have only attended a brief W/E workshop with little to no supervised learningto no supervised learning

Major Distinction between the two is that Major Distinction between the two is that professionalsprofessionals have received specific training in have received specific training in medicine, psychology, dentistry, social work or medicine, psychology, dentistry, social work or

counselingcounseling

An Overview of Clinical HypnosisAn Overview of Clinical HypnosisSelecting a qualified HypnotherapistSelecting a qualified Hypnotherapist

Recommend: Recommend: professionally-trained practitionerprofessionally-trained practitionerQuestions to ask

Licensed?Licensed? (not certified) (not certified)

Degree?Degree? (hypnosis or hypnotherapy – lay hypnotist) (hypnosis or hypnotherapy – lay hypnotist)

Membership?Membership? American Society of Clinical Hypnosis American Society of Clinical Hypnosis

Society for Clinical and Experimental HypnosisSociety for Clinical and Experimental Hypnosis (only nationally recognized organizations for licensed health care professionals using hypnosis)(only nationally recognized organizations for licensed health care professionals using hypnosis)

AMA,APA,NASW,ANAAMA,APA,NASW,ANA

An Overview of Clinical HypnosisAn Overview of Clinical Hypnosis“you are getting sleepy”“you are getting sleepy”

-Demonstration--Demonstration-

Quiet PleaseQuiet Please

an overview of clinical hypnosis

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