Mind-Body Research

Hypnosis and Mind Body Interventions

Joel Marcus PsyD

Mind-Body Cancer Research Program

Scott and White Clinic and Hospital

Texas A&M University System HSC College of Medicine

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Learning Objectives

• Identify specific clinical disorders that may be amenable to a Hypnotic Mind-Body Intervention

• Identify specific Hypnotic Mind-Body interventions that may be viable for clinical disorders

• Be able to describe a Hypnotic Mind-Body Stress reduction technique so that it would be acceptable for a pediatric or adolescent population.

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Any Concept of Health and Healing Which Does Not

Acknowledge the Power of Intangibles Such As Love,

Empathy, Caring, Compassion, Hope, Prayer and the Power of the Mind and the Strength of the Human Spirit, Is Sorely

Lacking.

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“Cogito, ergo sum”

Rene DescartesI think therefore I exist

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What is hypnosis?

• Relaxation

• Mental Imagery

• Suggestion

• Hypnotic Phenomena

• Post-Hypnotic Suggestion

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Clinical Hypnosis

An altered state of consciousness characterized by increased receptivity and involuntary

experienced response to which is multiply determined by relationship,

expectancy and trance factors.

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Hypnosis is a multiple determined experience

• Relationship variables– Transference

• Motivation and Expectancy– Set a positive expectancy– Determine Motivation

• Trance variables– Dissociation– Involuntary Responses

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What is Hypnosis?

• Purposeful altered state of consciousness

• Increased concentration and acceptance of suggestion which results in alteration of sensory and/or motor capabilities

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What is Hypnosis?

• Mental imagery is utilized

• Response is experienced in an involuntary manner – Ex: arm levitation

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Examples of hypnosis most people have experienced

• Everyday type trance– Driving on a freeway and caught yourself

briefly unaware of what you were doing– So engrossed in watching a movie that you are

unaware of surroundings and other people speaking

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Depth of Hypnosis

5% Refractory

45% Light Trance

55% Medium Trance

20% Deep Trance (Somnambulism)

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Individual Factors in Hypnosis

• Chronological Age

• Intelligence

• Imagery Ability

• Motivation

• Psychopathology

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High hypnotizables in the hypnotic analgesia conditions did not adopt deliberate strategies for coping with cold-pressor pain, but they nonetheless managed to reduce the pain to a very considerable degree.

High Hypnotizables

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Low Hypnotizables

• Low hypnotizables subjects in this condition also did not employ deliberate strategies of pain control, but unlike their high hypnotizable counterparts, they showed no attenuation of the cold-pressor pain.

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Hypnotic analgesia

Hypnotic analgesia is quite dependent on hypnotic ability rather than on the deliberate use of cognitive strategies.

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Uses of Hypnosis• Indications that Hypnosis might be useful in

treatment….– Stress management

• Chronic Stress– headaches– insomnia

• Periodic stress– exams, etc

– Trauma therapy/post-traumatic stress• Sudden death of a friend or loved one.

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Uses of Hypnosis

• Examples of indications for hypnotherapy– Habit control

• Tics– Tourette

• Weight loss / management– Insomnia– Irritable Bowel Syndrome

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Uses of Hypnosis

• Indications that Hypnosis might be useful in treatment….– Reduction of anxiety and fears

• Improve Coping Ability• Able to think and concentrate better

– Treatment of phobias• Fears of flying, elevators, etc

– Dental work• Receive care with less stress and strain

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Hypnosis today

• With the increased interest in complementary therapies, more patients are using mental imagery/relaxation– The list of uses keeps growing…...

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Indications for Hypnosis with Children

• Pain Management• Dealing with Anxiety• Tension and Migraine

Headaches• Coping with Painful

Medical Procedures• Insomnia

• Bedwetting• Habit Control• Irritable Bowel

Syndrome• Post-Traumatic Stress• Habits• Psychosomatic

Distress

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Hypnotherapy for Management of Symptoms

Assess the patient’s symptoms Introduce hypnosis as a mind-body

intervention Empower the patient Set specific goals and expectancy Assess hypnotizability as a part of the

process

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Hypnotherapy for Management of Symptoms

Match suggestions and Imagery to the patients symptoms and personal preferences

Teach Self-Hypnosis Provide adequate follow-up Involve the family and other medical

staff as needed

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Process of a Hypnotic Induction & Intervention

• Focus of attention– Stare at a spot….

• Suggestions for eye closure– Your eyes can feel heavy as they stare at the

spot...

• Relaxation– The Wave of Relaxation

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Process of a Hypnotic Induction & Intervention

• With hypnosis, we quiet the mind and relax the body, then add mental imagery - the conscious creation of vivid, meaningful pictures in the mind is a powerful way to help bring about what one wants to achieve

• Any imagery is appropriate– Use imagery that the patient finds enjoyable

• Its VERY hard to feel tense when you are in your favorite place...

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Trance

• Deepening Trance – Deepening the trance state often involves

metaphors to do with progression and often descent. e.g counting up or down, descending stairs, visualizing each of the chakras in turn, following a path leading somewhere tranquil.

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Process of a Hypnotic Induction & Intervention

• Positive suggestions for goal achievement– All the things that the patient wants to

accomplish

• Ego strengthening – “you're doing a great job…”

• Alerting

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"Principles of Suggestion"

• Law of Concentrated Attention - whenever attention is concentrated on an idea over and over again, the idea tends to spontaneously realize itself.

• .

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"Principles of Suggestion"

• Law of Reversed Effect- the harder you try to will yourself to do something, the less chance you have to succeed.

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"Principles of Suggestion"

• Law of Dominant Effect - a strong emotion tends to replace a weaker one. Attaching a strong emotion to a suggestion tends to make the suggestion more effective

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Focusing Attention

• During the trance state there is a heightened concentration for the specific purpose of maximizing potential or changing understanding and experience. Relaxation and imagery is used to obtain a fixed, narrowed attention with a high degree of concentration.

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Fading

• Fading -also called distraction, or redirection of attention, used with pacing and leading provides the conscious the opportunity to take hold and be accepted when they are not being subjected to conscious and critical analysis.

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Pacing

• Pacing: The process of gaining rapport through feeding back some or all of a client's observable verbal or nonverbal behavior. Pacing can be fully direct, partially direct, or indirect. Successful pacing builds sufficient rapport that will allow the therapist to make more direct, leading statements. Unsuccessful hypnosis, or insufficient trance depth are almost always the result of insufficient

pacing.

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Leading

• Leading: Providing the client with information in the form of instructions that relate to furthering the trance experience or implementing a therapeutic goal. Leading can be direct or indirect. Direct leading can be implemented in deeper trances with more profound levels of dissociation. Indirect leading is called for when clients are in less profound states of dissociation or lighter trances. Leading will fail without sufficient pacing.

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Variation in voice

• Typically, a light trance state is evidenced by a general relaxing of muscle tone and posture, a visible change in facial tension, a slower rate of breathing, fluttering of the eyelids, a decrease in the tempo of speech and voice volume, and a shift in language use which might include metaphorical or body-based descriptions of internal states (Gilligan, 1987 p. 125).

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Trance phenonomen

• The trance state is natural and often experienced, both clinically and in everyday life. The use of formal induction, directed suggestions which typically include the words "deeper" and "relax," are not necessary to induce deep trance states. Instead, the use of language patterns, muscular relaxation, and the focusing of concentration can be used in a naturalistic manner to induce trance

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Personal Imagery and Experience• Visualization and imagination are closely related to the

unconscious mind. Imagery has been described as the language of the unconscious. The key to successful use of imagery is to be as creative and imaginative as one can.

• Use personal memories and experiences and fill ones images with colors, sounds, aromas, textures and tastes to be as real and as absorbing as they can be. Keep visualizations positive and personally appealing to be a powerful tool in hypnosis.

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Dissociation

• "... A process whereby specific mental contents (memories, ideas, feelings, perceptions) are lost to conscious awareness and become unavailable to voluntary recall..." (16th ed. Merck Manual)

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Setting the overall goal

• Hypnosis can be used as a tool for patients to achieve goals such as smoking cessation, weight control, stress management, self esteem, pain management and goal setting

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Reinforcement of Response

• While suggestions remain with some individuals indefinitely, others may need reinforcement

• Reinforcement occurs whenever drive is reduced, leading to learning of whatever response solves the client's problem. Thus the reduction in need serves as reinforcement and produces reinforcement of the response that leads to it.

• http://www.sonoma.edu/users/d/daniels/hullspence.htm

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Hypnotic Induction by Age

• Age 4-6– Favorite Place– Flower Garden– Mighty Oak Tree– Story Telling

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Hypnotic Induction by Age

• Age 7-11– Action Imagery– Coin Drop Induction– Arm Lowering– Flying Blanket– Science Fiction Imagery

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Hypnotic Induction by Age

• Age 12-18– Sports Activity– Deep Breathing– Hand Levitation– Adult Oriented Induction

– INDIVIDUALIZATION

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All Hypnosis Is Self-hypnosis

Response to hypnosis is largely determined by the

persons talent or ability to use the mind-body connection. The goal of hypnosis is to

empower the patient.

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Pain Control and Child Hypnosis

• Anxiety Reduction

• Relaxation

• Suggestion

• Perceptual Alteration

• Dissociation and Imagery

• Self-Hypnosis

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Research and Child Hypnosis

• Pain Management

• Psycho physiological Processes

• General Medical Problems

• Chemotherapy Distress

• Acute Pain

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Evidence for Pain Reduction

Integration of behavioral and relaxation approached into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. JAMA, 1996, Jul 24-31, 276(4): 313-8.

Syrjala, KL, et al. Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatments: a controlled clinical trial. Pain, 1995; 63: 189-198.

DePalma, MT. Psychological influences on pain perception and non-pharmacologic approaches to the treatment of pain. Journal of Hand Therapy, 1997; 10(2):183-191.

Urba, SG. Nonpharmacologic pain management in terminal care. Clinics in Geriatric Medicine, 1996, May, 12(2) 301-11.

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Learning Objectives

• Identify specific clinical disorders that may be amenable to a Hypnotic Mind-Body Intervention – Pain– Phobia– Tic or Tourette’s– Insomnia

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Learning Objectives

• Identify specific Hypnotic Mind-Body interventions that may be viable for clinical disorders – Distraction– Going to a “favorite place”– Seeing a “Movie in your Mind”– Reframing the sensation

• Pain to pressure

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Learning Objectives

• Be able to describe a Hypnotic Mind-Body Stress reduction technique so that it would be acceptable for a pediatric or adolescent population. – The general “every day” trance experiences

• Getting ready to and falling asleep

• Watching a movie and ignoring everything else

• daydreaming

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The End

Proceed to the Post Test1. Down load the post test2. Complete the post test3. Send the post test to Dr. Sandra Oliver

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Post test

1. Which of the following are considered hypnosis:

A. Relaxation and mental imagery

B. Suggestion

C. Mental

1. A and B

2. B and C

3. A and C

4 All of the above

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Post test

2. Hypnosis is dependent on which of the following:

A. Motivation

B. Negative Expectancy

C. Association

D. Voluntary Responses

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Post Test

3. Hypnosis is least utilized in

A. Stress management

B. Pain management

C. Employee management

D. Weight loss management

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Post test

4. With hypnosis, to bring about what you want to achieve you:

A. Excite the mind

B. Relax the body

C. Create obscure mind pictures

D. Take control of the patient

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Post test

5. Hypnotic induction of a 7-11 year old includes which of the following:

A. Sports Activity

B. Deep Breathing

C. Science Fiction Imagery

D. Adult Oriented Induction

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Post test

5. The general “every day” trance experiences includes all except

A. Getting ready to and falling asleep

B. Deep sleep

C. Watching a movie and ignoring everything else

D. Daydreaming