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Basic Hypnosis for the Family Physician


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Title: Basic Hypnosis for the Family Physician

Basic Hypnosis for the Family Physician
Youre fired
  • I love you
  • Im sorry
  • Youre right
  • Its Over
  • Its cancer
  • Im pregnant
  • Im sorry

Two or Three words can have a profound change in
ones life. Our words have a profound
effect. What and How we say our words will
impact our ability to heal.
This shot is gonna hurt, hang on!
I think you will be pleasantly surprised how
little discomfort there will be..
This 3-hour workshop will introduce the use of
clinical hypnosis in family practice. Basic
hypnosis techniques will be demonstrated. Discuss
how hypnosis can be used in a busy family
practice. Review techniques and give some pearls
for use in common medical settings. Participants
will experience trance and practice trance
Upon completion of this session participants
should be able to Give examples of medical
issues amenable to medical hypnosis. Explain
several components of a successful
hypnotherapeutic interaction. Utilize a
hypnosis relaxation technique for self and
others. Find resources for further training in
What is Hypnosis?
It is a tool to add to your practice.
Hypnosis is a social interaction in which one
person responds to suggestions given by another
person (the hypnotist) for imaginative
experiences involving changes in perception,
memory, and the voluntary control of action using
The term "hypnosis" is a Greek word for "sleep"
coined by scientist James Braid in 1843.
What is Trance?
This is hard to define and is often thought
synonymous with hypnosis.
Trance is a natural aspect of absorption. One of
the most common altered states of
consciousness. Trance is sometimes characterized
by extreme disassociation often to the point of
appearing unconscious but the brain is very
Trance is not
  • A magical incantation
  • Missing voluntary action
  • Sleep
  • Possession
  • Rapture

Trance can be deliberately induced using a
variety of techniques, including prayer,
religious rituals, meditation, breathing
exercises, physical exercise, sex, music,
dancing, sweating (sweat lodge), fasting,
thirsting, and the consumption of psychotropic
Asklepios Temple of Epidaurus
A seeker of healing would make pilgrimage to the
Temple of Epidaurus, a Greek asclepieion temple A
priest would welcome and bless them and promote
dreams in the seeker which promoted healing and
the solutions to problems aided by the oracles.
This temple is traditionally regarded as the
birthplace of Asclepios. Zeus, fearing that
Asklepios might make men immortal, killed him
with a thunderbolt. Asklepios was generally
depicted as a bearded man wearing a robe that
leaves his breast uncovered.
Asklepian dream healing temples were located on
or near springs and in an otherwise very dry
area we have several springs.. In some version of
the myth, Asklepios' wife was named Hygieia and
was said to heal with her hands.
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The more recent history of hypnosis begins with
Franz Anton Mesmer who theorized that disease was
caused by imbalances of a physical force, called
animal magnetism. Mesmer also believed that
cures could be achieved by redistributing this
magnetic fluid -- a procedure that typically
resulted in pseudoepileptic seizures known as
Marquis de Puysegur
Mesmer's was discredited in 1794 by a French
council directed by Ben Franklin. His practices
lived on when the Marquis de Puysegur
magnetised a young shepherd. The shepard fell
into a somnambulistic (sleeplike) state in which
he was responsive to instructions, and from which
he awoke with an amnesia for what he had done.
Later in the 19th century, John Elliotson and
James Esdaile reported the successful use of
mesmeric somnambulism as an anesthetic for
surgery. Ether and chloroform soon proved to be
more reliably effective.
James Braid
James Braid, a British physician, speculated that
somnambulism was caused by the paralysis of nerve
centers induced by fixation of the eyes on an
object. Braid renamed the state "neurhypnotism"
(nervous sleep) a term later shortened to
hypnosis. Later, he concluded that hypnosis was
due to the subject's concentration on a single
thought (monoideism) rather than physiological
Milton Erickson
He is generally acknowledged to be the world's
leading practitioner of medical hypnosis. His
writings on hypnosis are the authoritative word
on techniques of inducing trance, experimental
work exploring the possibilities and limits of
the hypnotic experience, and investigations of
the nature of the relationship between hypnotist
and subject.
After World War II, interest in hypnosis rose
rapidly. Ernest Hilgard, together with Josephine
Hilgard and Andre Weitzenhoffer, founded a
laboratory for hypnosis research at Stanford
University. Hilgard's status as one of the
world's most distinguished psychologists helped
establish hypnosis as a legitimate subject of
scientific inquiry.
Can Anyone be Hypnotized?
There are large individual differences in
response to hypnosis. Hypnosis has little to do
with the hypnotist's technique, and very much to
do with the individual's capacity, or talent, for
experiencing hypnosis.
How is Hypnotizability Measured?
Hypnotizability is measured by standardized
psychological tests such as the Stanford Hypnotic
Susceptibility Scale or the Harvard Group Scale
of Hypnotic Susceptibility.
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The Ability to be Hypnotized Varies with Age
Very young children relatively unresponsive to
hypnosis. School age children have a universally
good ability. Peaks at the onset of
adolescence. Scores drop off among middle-aged
and elderly individuals. Hypnotizability assessed
in college students remains about as stable as IQ
over a period of 25 years.
Self Hypnosis
All hypnosis is self-hypnosis. The hypnotist
does not hypnotize the individual. The hypnotist
serves as a coach or tutor whose job is to help
the person become hypnotized. Hypnotist's
rapport and the individuals hypnotizability are
the most important factors.
The Ability to be Hypnotized Relates to
Hypnotizability is not related to intelligence,
conformity, persuasibility, or response to other
forms of social influence. Hypnotizability is
related to an individuals disposition to have
hypnosis-like experiences outside of formal
hypnotic settings. Hypnotizable individuals tend
to display a high level of imaginative
involvement in domains such as reading and
drama. Absorption is the most reliable
personality correlate of hypnotizability.
What Happens During Hypnosis?
A typical hypnosis session begins with an
induction procedure in which the person is asked
to focus his or her eyes on a fixation point,
relax, and concentrate on the voice of the
hypnotist. Although suggestions for relaxation
are generally part of the hypnotic induction
procedure, people can respond positively to
hypnotic suggestions while engaged in vigorous
physical activity. The hypnotist then gives
suggestions for further relaxation, or a
deepening, with focused attention, and often eye
closure. After the persons eyes are closed,
further suggestions for various imaginative
experiences are given. Posthypnotic suggestions
may also be given for responses to occur after
hypnosis has been terminated. The patient ends
the session with a re-alerting.
Induction Deepening Suggestion Post Hypnotic
suggestion Re-Alerting
What Happens to the Brain during Hypnosis?
Brain activity in hypnosis more closely resembles
that of a person who is awake. The discovery of
hemispheric specialization, led to the
speculation that hypnotic response is somehow
influenced by right-hemisphere activity. Studies
employing both behavioral and electrophysiological
mechanisms have been interpreted as indicating
increased activation of the right hemisphere of
the brain among highly hypnotizable individuals,
but positive results have proved difficult to
replicate and interpretation of these findings
remains controversial.
Alpha- and Theta-state theories
Four major brain-wave patterns. Beta state
(alert/working) is defined as 1432 cycles per
second (CPS) Alpha state (relaxed/reflecting) as
the 714 CPS Theta state (drowsy) as 47
CPS Delta state (sleeping/dreaming/deep sleep) as
approximately 35 CPS. One theory defines
hypnosis states with the EEG level necessary to
perform the task of clinical hypnosis. Smoking
cessation, weight management, reduction of
phobias, sports improvement, etc., is the alpha
state. (The alpha state is commonly associated
with closing one's eyes, relaxation, and
daydreaming) The theta state is required for
therapeutic change. The theta state is associated
with hypnosis for surgery, hypnoanesthesia (the
use of hypnosis to numb sensation of pain), and
hypnoanalgesia (the use of hypnosis to decrease
sensitivity to pain), which occur more readily in
the theta and delta states. Anesthetics,
sedatives and hypnotics disrupt neuronal
synchrony, thought to underly theta waves.
Hypnosis as a conditioned process leading to
sleep Ivan Pavlov believed that hypnosis was a
"partial sleep". He observed that the various
degrees of hypnosis did not significantly differ
physiologically from the waking state and
hypnosis depended on insignificant changes of
environmental stimuli. Pavlov also suggested that
lower brain stem mechanisms were involved in
hypnotic conditioning
Hypersuggestibility theory Currently a more
popular theory, it states the subject focuses
attention by responding to the suggestion of the
hypnotist. As attention is focused and magnified,
the hypnotist's words are gradually accepted
without the subject carrying any conscious
censorship of what is being said. This is not
unlike the athlete listening to the last pieces
of advice from a coach minutes before an
important sport event Concentration filters out
anything that is unimportant and magnifies what
is said about what really matters for the
Informational theory This theory applies the
concept of the brain-as-computer model. In
electronic systems, a system adjusts its feedback
networks to increase the signal-to-noise ratio
for optimum functioning, called a "steady state".
Increasing the receptability of a receptor
enables messages to be more clearly received from
a transmitter primarily by trying to reduce the
interference (noise) as much as possible. Thus,
the object of the hypnotist is to use techniques
to reduce the interference and increase the
receptability of specific messages (suggestions).
Systems theory This theory may be regarded as an
extension of James Braid original
conceptualization of hypnosis as involving a
process of greatly enhancing or depressing the
activity of the nervous system. It takes as
established the necessary organization of the
nervous system into interacting subsystems. On
that basis it develops a picture of hypnotic
phenomena as involving not only increasing or
decreasing of the activity of particular
subsystems, but on their interaction. As a result
it brings into center stage the phenomenon of
feed-back loops, familiar in systems theory, and
thereby throws light on a mechanism for creating
the more extreme of hypnotic phenomena.
Structural Theory
  • Pet scan
  • fMRI

Hypnotic influence is exerted through the
executive control system to co-ordinate how
information to the level of awareness is handled.
It is an evolutionary, hierarchical description
of a more sophisticated level of information
processing in humans than in mammals than in
reptilian brains with an advancing subjective
experience into a more meaningful perspective.
Neural Mechanisms Of Antinociceptive Effects Of
Hypnosis Marie Elisabeth Faymonville MD Phd et al
Anesthesiology 2000 92 1257-67 p 1257
PET Scan of 11 volunteers. Two scans each of
state (hypnotic, resting and Mental imagery)
and stimulation (warm and hot noxious stimuli
to right thenar eminence). Hypnosis decreased
both pain sensation and the unpleasantness of
noxious stimuli. Noxious stimuli caused an
increase in regional blood flow in thalamic
nuclei and anterior cingulate and insular
cortices. The hypnotic state induced a
significant activation of a right sided
extrastriate area and the anterior cingulate
cortex. Activity in the anterior mid cingulate
cortex was related to pain perception and
unpleasantness differently in the hypnotic state
than control.
Functional magnetic resonance images (fMRI)
elicited by thermal pain in hypnotized subjects.
Schulz-Stubner S, Krings T, Meister IG, Rex S,
Thron A, Rossaint R.Department of Anesthesia,
University of Iowa Hospitals and Clinics
Less activation in the primary sensory cortex,
the middle cingulate gyrus, precuneus, and the
visual cortex was found with hypnosis. An
increased activation was seen in the anterior
basal ganglia and the left anterior cingulate
Structure of the cingulate cortex. The anterior
region of the mid cingulate cortex (MCC, shown in
green) is a subregion called the anterior mid
cingulate cortex of the ACC (aMCC) it has a
variety of other names including the caudal ACC,
the dorsal ACC (dACC), or cognitive division of
theACC (ACC-CD). pACC, anterior perigenual ACC
rACC, rostral ACC.
Hypnotic suggestion reduces conflict in the human
brain Amir Raz , Jin Fan , and Michael I.
Posner  Sackler Institute for Developmental
Psychobiology Weill Medical College of Cornell
University, New York, NY PNAS (Proceedings of the
National Academy of Sciences) July 12, 2005, vol.
102, no. 28p. 9978-9983
Functional MRI data revealed that under
posthypnotic suggestion, both ACC and visual
areas presented reduced activity in highly
hypnotizable persons compared with either
no-suggestion or less-hypnotizable controls.
Fig. 1. Stroop conflict (incongruent minus
congruent) fMRI data. (A) Interaction between
group (highly hypnotizable, less-hypnotizable)
and suggestion (absent, present). Compared with
the less-hypnotizable controls, conflict
reduction (i.e., activation decrease) was
significant in the highly hypnotizable
individuals (Tables 13). (B and C)
Interpretation of highly suggestible fMRI absent
posthypnotic suggestion (B) and under
posthypnotic suggestion (C) to construe the
stimuli as nonsense strings proposes that no
difference was detected between incongruent and
congruent trials. Whereas prefrontal activations
(e.g., crosshair at the ACC) probably correlated
with cognitive control, posterior activations
might relate to early occipital modulation or
aspects of visual word recognition.
Raz's neuroimaging findings show that a specific
brain area which regulates automatic processes,
the anterior cingulate cortex (ACC), "lights up"
when individuals perform the Stroop task without
suggestion. However, the ACC tends to turn off
when highly hypnotizable individuals perform the
task under the suggestion that these English
words should be perceived as gibberish.
Amir Raz Phd.
"At least for highly suggestible people, words
framed as part of a carefully-crafted suggestion
can change focal brain activity in a way no drug
we have can do"
pain intensity coding
Hypnosis works here
prediction of the sensory consequences of
pain-related action
the onset uncertainty of the impending stimuli
Clinical Hypnosis Modulates Functional Magnetic
Resonance Imaging Signal Intensities and Pain
Perception in a Thermal Stimulation Paradigm
Sebastian Schulz-Stiibner. M.D., Ph.D., Timo
Krings, M.D. Ingo G. Meister, M.D., Stefen Rex,
M.D., Armin Thron, M.D., Ph.D., and Rolf
Rossaint, M.D., Ph.D. Regional Anesthesia and
Pain Medicine, Vol 29, No 6 (November-December,
2004 pp 549-556 fMRI scans were performed
during repeated painful heat stimuli. Activation
of brain regions in response to thermal pain
during hypnosis was compared with responses
without hypnosis. With hypnosis, less
activation in the primary sensory cortex, the
middle cingulate gyrus, precuneus, and the visual
cortex was found. An increased activation was
seen in the anterior basal ganglia and the left
anterior cingulate cortex. There was no
difference in activation within the right
anterior cingulate gyrus in our fMRI studies. No
activation was seen within the brainstem and
thalamus under either condition. Conclusion
Clinical hypnosis may prevent nociceptive inputs
from reaching the higher conical structures
responsible for pain perception. Whether the
effects of hypnosis can be explained by increased
activation of the left anterior cingulate cortex
and the basal ganglia as part of a possible
inhibitory pathway on pain perception remains
speculative given the limitations of our study
Family Practice Uses for Clinical Hypnosis
Pain modification Phobias (needle, procedure,
traumatic stress) Anxiety Irritable Bowel
Syndrome Habit control (smoking, nail biting,
bedwetting weight reduction) Dermatological
(warts, burns, pruritus, trichotillomania,
hyperhydrosis) Cancer treatment (nausea, therapy
augmentation, pain) Migraine Asthma
Pain Control
Beyond Placebo
  • Hypnosis is not placebo
  • Hypnosis itself has its own placebo effects
  • Hard to control for placebo in hypnosis studies

Pain Control
  • Endoscopy
  • Surgical
  • Cancer
  • Orthopedic
  • Emergencies
  • Childbirth

Katherines Colon
The patient was in for a routine sigmoidoscopy.
She had voiced fear of the procedure and concern
for pain. A simple eye fixation was induced
while I set up the equipment. I asked her to
breathe deeply and to relax with each breathe. I
asked her to tighten and then release muscles. I
included the anal sphincter and abdominal
muscles. She was asked to go to a nice place and
then redirected to a rose garden during which
time the procedure was done. Encouraging
statements were made during the procedure such
as one was moving down the path freely, seeing
the curve of a hill and easily sliding down it,
Hypnosis Vs Midazolam Sedation for Colonoscopy A
Preliminary Report Gianluca Bersani, Francesca
Baiardi, Angelo Rossi, Giorgio Ricci, Giovanni De
Fabritiis, Riccardo Arone Di Bertolino, Vittorio
Alvisi Sixty-eight patients were enrolled in
this preliminary case control study sedation
with Midazolam was administred in 29 pts and
Hypnosis (trance, visualization and relaxation)
in 38 patients. One hour after the colonoscopy,
each patients completed a questionaire regarding
satisfaction of the examination and measured the
level of pain felt during the colonoscopy by a
Visual Analogue Scale (VAS). Patients
undergoing colonscopy with Hypnosis reported less
pain than patients sedated with midazolam (VAS
2.97 vs VAS 5.48, p lt 0.05). 63 of patients
with Hypnosis were satisfied of the examination
vs 24 of the patients sedated (p lt 0.05).
During the colonoscopy a 17 rise of HR was
observed in patients with Hypnosis vs 9 HR rise
in patients sedated (p. N.S.).
Pauls Paronychia
A 45 year old black male with kidney disease,
hypertension and history of a stroke presented
with a 3 day history of worsening pain, swelling
and pus in his middle finger. I asked him if he
would like to remain in pain. He said no. I had
him stare at his finger and did a rapid induction
eye fixation technique. I explained to him that
I needed to have his help to control the amount
of blood flow into the finger. I asked him to
make it as cold as possible and gave suggestions
that it be like a popsicle. His finger may feel
warm now, but it can be as if you have been
outside on a cold day or even placed it in a snow
bank. I then injected the finger, and drained
the pus. He reported no pain on injection and was
surprised I was finished.
Group Therapy and Hypnosis Reduce Metastatic
Breast Carcinoma Pain DAVID SPIEGEL, MD AND
JOAN R. BLOOM, PH.D Psychosomatic Medicine Vol.
45, No. 4 (August 1983)
The pain and mood disturbance of 54 women with
metastatic carcinoma of the breast were studied
over the course of one year. A random sample was
offered weekly group therapy during the year,
with or without self-hypnosis training directed
toward enhancing their competence at mastering
pain and stress related to cancer. Both treatment
groups demonstrated significantly less self-rated
pain sensation (t 2.5p lt 0.02) and suffering (t
2.17, p lt 0.03) than the control sample. Those
who were offered the self-hypnosis training as
well as group therapy fared best in controlling
the pain sensation (F 3.1, p lt 0.05). Pain
frequency and duration were not affected. Changes
in pain measures were significantly correlated
with changes in self-rated total mood disturbance
on the Profile of Mood States and with its
anxiety, depression, and fatigue subscales.
Possible mechanisms for the effectiveness of
these interventions are discussed.
Spiegel and Bloom
Visual analog scale of 0-10
Darlenes Ribs
58 year old women with a history of colon cancer
s/p empyema drainage with rib fracture and
intractable pain despite oxycontin. Reported a
10/10 pain. Laid on her side with an eye
fixation, stair deepening technique. Found a duck
pond and used same controller unit. Pain
decreased but this freaked her out and it
re-intensified. She was given a magic glove to
touch the area. The glove also sent a message to
the area that the warnings were received well and
that the ribs and the nerves did a great job in
warning her. Now that we knew all about this
problem they could be quiet now.
Carries Fracture
7-year-old female fell from a swing with sudden
onset of pain and apparent broken arm. She was
asked if she would like to have the pain reduced.
She was asked if she would like to watch a movie.
She agreed and stated she would like to watch
Harry Potter. She was asked to close her eyes and
concentrate on the inside of her eyelids. A calm
voice with a repetitive statement to see the
movie more and more clearly allowed for a rapid
induction. She was encouraged that as the movie
continued she would be more and more relaxed with
the pain reducing. The 45-minute drive to the
hospital was uneventful aside from one railroad
track bump. She was given simply encouraged to
see the movie begin again.  In the noisy ER a
suggestion that as the noise increased so would
the relaxation seemed to keep her calm. In
addition using Harry Potter imagery, Madame
Pomfrey as a healer was evoked. Fortunately, the
idea of magic cures was easy to evoke. The break
was imagined and the shrinking of the break
allowed for more relief of pain. A nurse came
along and said so are you the little girl with
that big break? Trance ratification was
provided by the girls reply no I have a small
break.  She was taken to the operating room for
a reduction of the fracture. She was given a
suggestion that as soon as she had a mask placed
on her face she would easily go to sleep. The
orthopedic surgeon stated she received very
little anesthesia and indeed was quickly awake
upon arriving to the recovery room. She was given
a post hypnotic suggestion for pain control
anchored by a touch to her shoulder.  She
required very little pain medicine and weeks
later when she was itching from the cast she was
given a suggestion that the itching would be felt
more like a tickle.
(No Transcript)
Fears and phobias
  • Procedures
  • Needle phobias
  • PTSD
  • Specific Phobias Flying, heights, spiders etc
  • Generalized Anxiety

Premedication in children hypnosis versus
midazolam. Paediatric Anaesthesia. 15(4)275-81,
2005 Apr. Calipel, Severine. Lucas-Polomeni,
Marie-Madeleine. Wodey, Eric. Ecoffey,
Claude. Department of Anesthesiology and Surgical
Intensive Care 2, Hopital Pontchaillou,
Universite de Rennes 1, Rennes, France. The main
objectives of premedication in children are to
facilitate the separation from the parents, to
reduce preoperative anxiety, to smooth the
induction of anesthesia and to lower the risk of
postoperative behavioral disorders. Fifty
children from 2 to 11 years of age were
randomized into two groups group H received
hypnosis as premedication group M were given 0.5
mg x kg(-1) midazolam orally, 30 min before
surgery. R The number of anxious children was
less during induction of anesthesia in the
hypnosis group ( 39 vs 68) (P lt 0.05).
Postoperatively, hypnosis reduced the frequency
of behavior disorders approximately by half on
day 1 (30 vs 62) and day 7 (26 vs 59).
Adjunctive self-hypnotic relaxation for
outpatient medical procedures A prospective
randomized trial with women undergoing large core
breast biopsy.
Elvira V. Lang Pain 126 (2006) 155164
Carls Flight
C.S. is a 46 year old mechanic for Ford. He won a
cruise as a business reward for his mechanic
skills. It required a flight to Miami. He had
flown once as a boy scout for 10 minutes in a
small aircraft. The flight made him queasy. He
was nervous flying in a 757, which he thought was
used in the September 11th attacks. He does have
some nervousness with heights, can go up tall
elevators and was in the Washington monument. He
did not have other common fears. He has been
working with a therapist for depression who
suggested he might take some medicine for. He was
looking forward to the vacation. He identified
some stress running for town commissioner as it
was election day. He requested a few pills to
take for the flight on the upcoming Friday. I
discussed hypnosis with him and scheduled time
later at lunch.
After informed consent, I used a Chaisson
technique with a balloon and pail deepening
technique and asked him to visualize something
pleasant. He saw red orchids. I reminded him that
orchids were in Hawaii and it would take a flight
to get there. I asked him to visualize a
controller box similar to the diagnostic boxes in
cars. I asked him what his anxiety and depression
scales were at. He had one for anxiety that was
set on 8 and he turned it to 2, depression was at
7 and he turned it down to 2 the rest were
adequately controlled. I asked him to regress
back to a younger age. He was present w/ his dad
at an Easter parade. Had him move forward to a
confident time, he chose his wedding. After this,
I then moved him forward to a time when he was
flying and noticed how confident he was. He went
into in great detail about the flights both to
and from Miami. Prior to a short lunch break, I
then had him see an internal advisor who appeared
as a trusted co-worker who explained to him how
safe flying was. I asked him to examine the
aircraft. I showed him how strong and well built
the aircraft was. I had him anchor w/ a
posthypnotic suggestion of touching the aircraft
and seeing how strong it is prior to him going
into the aircraft. He would get very calm and
free of any anxiety. He was provided with xanax,
which he reportedly did not use.
Needle Phobia A Neglected Diagnosis Hamilton,
James G. Journal of Family Practice 08/1995 v41
n2 p169(7)
Needle phobia is a recently defined medical
condition that affects at least 10 of the
Belonephobiafear of needlesAichmophobiafear of
pointed objectsAlgophobiafear of
painTrypanophobiafear of injections
Marys I.V.
AdvisorAge Regression ReframingDirect
ControllerGeneral Anxiety SuggestionsPost
Hypnotic SuggestionsCD prior to anesthetic
Lynns IBS
Whorwell PJ Prior A Faragher EB. Controlled
trial of hypnotherapy in the treatment of severe
refractory irritable-bowel syndrome.The Lancet
1984, 2 1232-4.
This study is the earliest and perhaps the best
study in this research area to date, as it was
thoroughly placebo-controlled and showed dramatic
contrast in response to hypnosis treatment above
the placebo group. Thirty patients with severe
symptoms unresponsive to other treatment were
randomly chosen to receive 7 sessions of
hypnotherapy (15 patients) or 7 sessions of
psychotherapy plus placebo pills (15 patients).
The psychotherapy group showed a small but
significant improvement in abdominal pain and
distension, and in general well-being but not
bowel activity pattern. The hypnotherapy
patients showed a dramatic improvement in all
central symptom. The hypnotherapy group showed no
relapses during the 3-month follow-up period.
(No Transcript)
IBS Pathophysiology
  • The cause of irritable bowel syndrome is unknown

IBS Pathophysiology
  • Associated pathophysiology includes altered
    gastrointestinal motility and increased gut

(No Transcript)
  • Increased small-bowel and colonic contractions
    temporally associated with abdominal pain
  • Heightened sensitivity to visceral distention,
    particularly that which is perceived as noxious
  • Interplay between motor and sensory dysfunction
    appears to explain the symptoms of irritable
    bowel syndrome.

Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ.
Long term benefits of hypnotherapy for irritable
bowel syndrome. Gut. 2003 Nov52(11)1623-9. In
this study, 204 IBS patients treated with a
course of hypnotherapy completed questionnaires
scoring symptoms, quality of life, anxiety, and
depression before, immediately after, and up to
six years following treatment. 71 of patients
showed improvement in response to treatment
initially, and of those, 81 were still improved
years later, while most of the other 19 only
reported slight worsening of symptoms. Quality of
life and anxiety or depression scores were also
still significantly improved at follow-up but
showed some deterioration. Patients also reported
fewer doctor visits rates and less medication use
long-term after hypnosis treatment. These results
indicate that for most patients the benefits from
hypnotherapy last at least five years.
Gonsalkorale et al. Journal of Psychosomatic
Research 56 (2004) 271-278
Habit Control
Larrys Cigarettes
  • Larry is a 58 year old man with a 2 pack a day
    habit. His wife wanted him to quit smoking. He
    had tried patches, and is currently taking Zyban.

Zyban, Welbutrin, Bupropion
CLINICAL TRIALS The efficacy of ZYBAN as an aid
to smoking cessation was demonstrated in 3
placebo-controlled, double-blind trials in
nondepressed chronic cigarette smokers (n
1,940, 15 cigarettes per day). In these studies,
ZYBAN was used in conjunction with individual
smoking cessation counseling. The first study was
a dose-response trial conducted at 3 clinical
centers. Patients in this study were treated for
7 weeks with 1 of 3 doses of ZYBAN (100, 150, or
300 mg/day) or placebo quitting was defined as
total abstinence during the last 4 weeks of
treatment (weeks 4 through 7). Abstinence was
determined by patient daily diaries and verified
by carbon monoxide levels in expired air. Results
of this dose-response trial with ZYBAN
demonstrated a dose-dependent increase in the
percentage of patients able to achieve 4-week
abstinence (weeks 4 through 7). Treatment with
ZYBAN at both 150 and 300 mg/day was
significantly more effective than placebo in this
The continuous abstinence rate was 30 (95 CI
24-35) in the ZYBAN treated patients, at 26 weeks
compared with 13 (95 CI 7-18) in the placebo
group in women. At 52 weeks, the continuous
abstinence rate was 23 (95 CI 18-28) in the
ZYBAN treated patients, 8 (95 CI 3-12) in the
placebo group. The men had no statistical
significant differences between placebo and
active drug group.
Shewchuk LA Dubren R Burton D Forman M Clark
RR Jaffin ARPreliminary observations on an
intervention program for heavy smokersInt J
Addict 1977 Apr12(2-3)323-36 (ISSN 0020-773X)
Each of 571 smokers selected one of three
methods of smoking cessation group therapy,
individual counseling, and hypnosis. One-year
results suggest little difference between the
three methods in producing ex-smokers. All
methods produced an average success rate of
approximately 20. It should be noted, however,
that with all types of verbal or verbally related
therapy it is not known precisely how these
techniques work or whether the outcomes are
really a function of what is put into the therapy
by the treatment agent and/or the recipient. It
was generally found that younger, more educated
smokers chose hypnosis older, more educated
smokers chose group therapy and older,
less-formally educated smokers chose individual
counseling while the youngest and generally less
educated smokers chose to become nonattenders and
not take part in therapy. These results have
important implications for designing optimal
treatment programs which will be acceptable and
effective for the greatest number of smokers.
Cochrane Report Hypnosis in Smoking Cessation
  • A substantive amendment to this systematic review
    was last made on 18 February 1998. Cochrane
    reviews are regularly checked and updated if
  • Background Hypnotherapy is widely promoted as a
    method for aiding smoking cessation. It is
    proposed to act on underlying impulses to weaken
    the desire to smoke or strengthen the will to
  • Objectives The objective of this review was to
    evaluate the effects of hypnotherapy for smoking
  • Search strategy We searched the Cochrane Tobacco
    Addiction Group Specialized Register and the
    databases MEDLINE, EMBASE, AMED, SCI, SSCI and
    CISCOM using the terms smoking cessation and
    hypnotherapy or hypnosis in February 2005.
  • Selection criteria We considered randomized
    trials of hypnotherapy which reported smoking
    cessation rates at least six months after the
    beginning of treatment.
  • Data collection and analysis Two authors
    extracted data on the type of subjects, the type
    and duration of the hypnotherapy, the nature of
    the control group,the outcome measures, method of
    randomization, and completeness of follow up.The
    main outcome measure was abstinence from smoking
    after at least six months follow up in patients
    smoking at baseline. We used the most rigorous
    definition of abstinence in each trial, and
    biochemically validated rates where available.
    Those lost to follow up were counted as smokers.
    Where possible, we performed meta-analysis using
    a fixed-effect model.

Cochrane Report Hypnosis in Smoking Cessation
  • Main results Nine studies compared hypnotherapy
    with 14 different control interventions.There was
    significant heterogeneity between the results of
    the individual studies, with conflicting results
    for the effectiveness of hypnotherapy compared to
    no treatment or to advice. We therefore did not
    attempt to calculate pooled odds ratios for the
    overall effect of hypnotherapy. There was no
    evidence of an effect of hypnotherapy compared to
    rapid smoking or psychological treatment.
  • Authors' conclusions We have not shown that
    hypnotherapy has a greater effect on six month
    quit rates than other interventions or no
    treatment.The effects of hypnotherapy on smoking
    cessation claimed by uncontrolled studies were
    not confirmed by analysis of randomized
    controlled trials.

  • There seems to be three main reasons why people
    are unable to quit smoking.
  • Psychological crutch Wellbutrin
  • Nicotine withdrawal Nicotine Patches and
  • Plain Habit Hypnosis Hypnosis

45 of subjects receiving CHANTIX 1 mg per day
(0.5 mg BID) and 51 subjects receiving 2 mg per
day (1 mg BID) had CO-confirmed continuous
abstinence during weeks 9 through 12 compared to
12 subjects in the placebo group.
Combined therapies? A clinical trial should be
done to see how these three items fare.
Vickis Pepsi Habit
Vicki is a 39 year old mother of three who had a
solitary parathyroid adenoma requiring surgery.
Vicki noted that she could not stop drinking
Diet Pepsi and needed some help to deal with this
She was told that an advisor approaches, then
told your body works with your mind. It may have
developed habits. Habits can make our life more
pleasant and efficient. When routines are broken
it can reset the system. When we wish to change
some things we have been doing often we have to
have all parts of us in agreement. Do you wish to
make a change? Bring a leader (liter) forward in
your mind to take control of the fluid condition
and make it as you wish. A wish to drink
non-caffienated products."
Talking Warts Off(The dermatological use of
hypnosis for verroucous lesions)
(the most effective treatment for removing or
fetching a wart is that prescribed by Samuel
Clemens involving stump water and a dead cat at
midnight. See. TOM SAWYER )
First reported case
The treatment of warts by suggestion. Sulzberger
MB, Wolf J Med Rec 1934 140 552-556.
Am J Clin Hypn. 1992 Jul35(1)1-10. Hypnotherapy
for warts (verruca vulgaris) 41 consecutive
cases with 33 cures.Ewin DM.Tulane Medical
School, New Orleans, LA.Published, controlled
studies of the use of hypnosis to cure warts are
confined to using direct suggestion in hypnosis
(DSIH), with cure rates of 27 to 55.
Prepubertal children respond to DSIH almost
without exception, but adults often do not.
Clinically, many adults who fail to respond to
DSIH will heal with individual hypnoanalytic
techniques that cannot be tested against
controls. By using hypnoanalysis on those who
failed to respond to DSIH, 33 of 41 (80)
consecutive patients were cured, two were lost to
follow-up, and six did not respond to treatment.
Self-hypnosis was not used. Several illustrative
cases are presented.
Psychosom Med. 1990 Jan-Feb52(1)109-14. Effect
s of hypnotic, placebo, and salicylic acid
treatments on wart regression.Spanos NP,
Williams V, Gwynn MI.Department of Psychology,
Carleton University, Ottawa, Canada.Subjects
with warts on their hands and/or feet were
randomly assigned to a hypnotic suggestion,
topical salicylic acid, placebo, or no treatment
control condition. Subjects in the three treated
groups developed equivalent expectations of
treatment success. Nevertheless, at the six-week
follow-up interval only the hypnotic subjects had
lost significantly more warts than the no
treatment controls. Theoretical implications are
Wart research
Condylomata acuminata results of treatment using
hypnosisJ Am Acad Dermatol 1983 Sep9(3)434-6
(ISSN 0190-9622)Straatmeyer AJ Rhodes NRWe
report a 48-year-old woman with venereal warts
hypnosis was used to treat her condition. After
four weekly treatment sessions, her warts were
Verrucae vulgares in children successful
simulated X-ray treatment (a suggestion-based
therapy)Dermatology. 2002204(4)287-9Meineke
V, Reichrath J, Reinhold U, Tilgen WDepartment
of Dermatology, University of the Saarland,
Homburg/Saar, Germany
  • BACKGROUND Treatment of verrucae vulgares is
    sometimes difficult. Invasive methods should not
    be used for young children.
  • METHODS Nine children with warts on the hands
    and/or feet and in the face were treated with a
    simulated X-ray treatment.
  • RESULTS Five children showed a complete
    remission of warts, 3 children a partial
    remission. For 1 child, there was no response. On
    average, 3 treatment sessions were needed for
    children showing a complete remission.
  • CONCLUSION This therapy offers an
    easy-to-perform, alternative treatment option. It
    is noninvasive and does not depend on special
    psychological techniques for which training is

Psychodermatologic Disorders Acne
disorders Alopecia areata Atopic
dermatitis Psoriasis Psychogenic purpura Rosacea
Seborrheic dermatitis Urticaria (hives)
Delusions of parasitosis Neurotic excoriations
Trichotillomania Hemangiomas Ichthyosis
Kaposi's sarcoma Psoriasis Vitiligo
Adapted from ASCH Lecture Handout from Philip D
Shenefelt MD MS
Hypnotherapeutic management of alopecia
areata Ria Willemsen, MD,a Johan Vanderlinden,
PhD,b Arlette Deconinck, MD,a and Diane Roseeuw,
MD, PhDa Brussels and Leuven, Belgium Published
online March 21, 2006. 2006 by the American
Academy of Dermatology, Inc. Hypnosis was used in
28 patients with extensive AA who were refractory
to previous conventional treatments. It was added
as a complementary treatment or used as the only
treatment. 21 patients, 9 with alopecia totalis
or alopecia universalis and 12 with extensive AA,
were analyzed during a 5-year period. After
treatment, all patients had a significantly lower
score for anxiety and depression. Scalp hair
growth of 75 to 100 was seen in 12 patients
after 3 to 8 sessions of hypnotherapy. Total
growth occurred in 9 of these 12 patients,
including 4 patients with alopecia universalis
and 2 with ophiasis. In 5 patients, a significant
relapse occurred.
Tigers Hyperhydrosis
T.C. is a 17-year-old high school golfer
who ranked in the top 5 amateurs in the state. He
has a promising career in golf or at least a
scholarship to college. He would sweat
excessively to the point of going through 5-6
gloves during a round of golf. He has missed
shots because of the loss of grip. The
hyperhydrosis was also quite embarrassing in
addition to costly. He noted it had an acute
onset sometime in the 9th grade. No precipitating
event. There was no family history. He failed all
OTC medicines and aluminum chlorhexahydrate
topical. He denied fears or phobias. He has
above average grades and a family that appears to
be caring and loving. He appears to be well
balanced and did not appear anxious. He had an
eye fixation induction and a progressive muscle
deepening. He then was asked to grab some sand
from the sand trap and note how dry it was. It
was suggested that his hands could stay this dry
if he wanted them to be. He was also asked to
image a control panel and on it he would find
many controllers. Here he could control the
moisture content. He also noted one for anxiety
was up very high and this was adjusted to a lower
more comfortable level. He was given a relaxation
CD and on it suggestions for appropriate amount
of sweat was suggested. He returned stating he
was improved, as he was able to play a round
without changing a glove, but it was not gone.
Paxil was added for social anxiety and the
hyperhydrosis resolved. His mother was seen a
year later and reported he did not get a
scholarship, but he has a job at a local golf
course and things are going well for him and the
hyperhydrosis is resolved.
Zen Master Phil Jackson insists that the
Chicago Bulls practiced daily self-hypnosis when
he coached Michael Jordan and the Bulls to their
6 NBA Championships. Several years ago, after his
winning three-point shot propelled his team into
the NBA Finals, Jordan was asked how he prepared
in the huddle with three seconds left with his
team down by two. "I've been put in that
situation enough times to just let things
instinctively happen. My thought process is about
successful opportunities like this in the past.
You feed the mind with positive things and then
just go out and let it flow," he responded.
Woods grew up with his Green Beret father
administering toughness drills adapted from
military interrogation, and family friend Dr. Jay
Brunza introduced subliminal tapes and hypnosis.
"All Jay and I did was build a base and establish
the importance," says Earl Woods. "Tiger took it
from there."From Psyched to win (Sport
psychologists convince pros like Ernie Els that
the key to beating Tiger is mostly mental)By
Jaime DiazGolf DigestOctober 2002
Akram Esfandani and Fereshteh Shakibaei Department
of Psychiatry, Isfahan Medical University,
Iran Contemporary Hypnosis (2004)Vol. 21, No. 1,
2004, pp. 2834
The mean ages of the intervention and control
groups were 30.5 12.1 and 36.6 16.6 years,
respectively (P 0.26). The total body surface
area that was burned (TBSA) was 30.2 11.3 in
the control group and 27.1 9.3 in the
intervention group (P 0.33). Twenty-nine
patients had second and third degree burns (66).
Hypnosis for pain relief in labour and
childbirth a systematic review AM. Cyna, GL.
McAuliffe and MI. Andrew British Journal of
Anaesthesia 93 (4) 50511 (2004)
The evidence presented suggests that hypnosis,
alone or in combination with other anaesthetic
techniques, may offer advantages over
conventional analgesia alone.
Adapted from Improved Obstetric Outcomes Using
Hypnotic Analgesia and Skill Mastery Combined
With Childbirth Education Harmon, Hynan and
Tyre Journal of Consulting and Clinical
Psychology 1990, Vol. 58, No. 5, 525-530
Adapted from Improved Obstetric Outcomes Using
Hypnotic Analgesia and Skill Mastery Combined
With Childbirth Education Harmon, Hynan and
Tyre Journal of Consulting and Clinical
Psychology 1990, Vol. 58, No. 5, 525-530
Breast Cancer
Spiegel D, Bloom JR, Kraemer HC and Gottheil E
(1989) Effect of psychosocial treatment of
survival of patients with metastatic breast
cancer. Lancet. 1989 Oct 142(8668)888-91.
Effect of psychosocial treatment on survival of
patients with metastatic breast cancer. Spiegel
D Bloom JR Kraemer HC Gottheil E Lancet, 1989
Oct 14, 2(8668)888-91.
The effect of psychosocial intervention on time
of survival of 86 patients with metastatic (stage
4) breast cancer was studied prospectively. The
1-year intervention consisted of weekly
supportive group therapy with self-hypnosis for
pain. Both the treatment (n 50) and control
groups (n 36) had routine oncological care. At
10-year follow-up, only 3 of the patients were
alive, and death records were obtained for the
other 83. Survival from time of randomisation and
onset of intervention was a mean 36.6 (SD 37.6)
months in the intervention group compared with
18.9 (10.8) months in the control group, a
significant difference. Survival plots indicated
that divergence in survival began at 20 months
after entry, or 8 months after intervention ended.
Bonnies Breast Cancer
A 47 year old white nurse who previously
underwent radiation treatment and had a new
cancer on the opposite breast develop. She had a
guided imagry cd for radiation the first time and
had hypnosis prior to the surgery.
Created a CD for her of a guided imagery for
radiation treatments. Asked permission of her
skin to allow the beams to pass through without
damage to the skin. Asked the cells surrounding
the cancer to help the beams find their way to
the cancer cells. Asked the white cells that
regulate the bodys immune response to find the
invading cancer cells and take them away to be
Chemo Side Effects
A randomized, controlled study of behavioral
intervention for chemotherapy distress in
children with cancer. Zeltzer LK, Dolgin MJ,
LeBaron S, LeBaron C. Pediatrics. 19918834-42.
Zeltzer LK, Dolgin MJ, LeBaron S, LeBaron C.
Pediatrics. 19918834-42.
Zeltzer LK, Dolgin MJ, LeBaron S, LeBaron C.
Pediatrics. 19918834-42.
Zeltzer LK, Dolgin MJ, LeBaron S, LeBaron C.
Pediatrics. 19918834-42.
Zeltzer LK, Dolgin MJ, LeBaron S, LeBaron C.
Pediatrics. 19918834-42.
Zeltzer LK, Dolgin MJ, LeBaron S, LeBaron C.
Pediatrics. 19918834-42.
Linda is a 46 year old dental hygienist who has
suffered migraines for as long as I can
remember. She gets some adequate relief but not
total relief from Imitrex. She typically has to
lay down or leave work. Her employer referred her
to me. I used a standard eye fixation and a
basic whole body relaxation deepening technique.
She was asked to visualize dials that she could
control. She had an anchor gesture placed to
abort the migraines and direct suggestions that
when she did take her medicine it would help her
to the maximum possible.
Headache Research
Hypnotherapy for migraine has been used since the
mid-19th century (Bernheim 1887, Braid 1843,
Esdaile 1850) Case studies remain the commonest
form of justification for its use (Daniels 1976,
Peter 1992). A few trials of hypnotherapy with
other treatment types have been reported
(Andreychuk and Skriever 1975, Stambaugh and
House 1977) or with drug treatment (Anderson et
al 1975). There are very few reported cases of a
systematic approach to the testing of such a
process involving significant numbers (Drummond
Hypnosis Research
Treatment of Chronic Tension-type Headache With
Hypnotherapy A Single-blind Time Controlled
Study Patricia M.L. Melis , M.S. , Wilma Rooimans
, M.S. , Egilius L.H. Spierings , M.D.,Ph.D. and
Cornelis A.L. Hoogduin , M.D., Ph.D. Headache
The Journal of Head and Face PainVolume 31 Page
686  - November 1991Volume 31 Issue 10   Chronic
tension-type headache studied. A waiting list
control group was used to control for the changes
in headache activity due to the passage of time.
The results showed significant reductions in the
number of headache days (plt0.05), the number of
headache hours (plt0.05) and headache intensity
(plt0.05). The improvement was confirmed by the
subjective evaluation data gathered with the use
of a questionnaire and by a significant reduction
in anxiety scores (plt 0.01). 
Headache Research
Matthews M, Flatt S (1999) The efficacy of
hypnotherapy in the treatment of
migraine. Nursing Standard. 14, 7, 33-36. Date of
acceptance September 24 1999.
Comparison of Self-Hypnosis and Propranolol in
the Treatment of Juvenile Classic Migraine Karen
Olness, John T. MacDonald and Donald L.
Uden Pediatrics 198779593-597
Mast Cell Activation in Children With Migraine
Before and After Training in Self-regulation Karen
Olness, MD Howard Hall, PhD Jacek J.
Rozniecki, PhD, MD Wendy Schmidt, OTR/L, MPA
T.C. Theoharides, PhD, MD
Migraine may affect as many as 9 of all
schoolchildren and often presents with abdominal
symptoms of pain, nausea, and vomiting. The
pathophysiology of migraine remains unknown,
self-regulation techniques appear to be more
effective in prevention of childhood migraine
than conventional pharmacotherapy which is often
associated with adverse effects. Mast cells have
been implicated in the pathogenesis of migraine
in adults. Investigated whether children with
migraine may have increased urinary levels of
mast cell mediators and whether practicing
relaxation imagery exercises has an effect on the
frequency of headache, as well as on mast cell
activation via 24 hours urine samples. The mean
levels of urinary histamine, its main metabolite,
methylhistamine, and the mast cell enzyme,
tryptase, were higher in children than generally
found in adults, but they did not differ
statistically in any of the categories studied.
However, in 8 of 10 children who practiced
relaxation imagery techniques and successfully
reduced the number of migraines, the urine
tryptase levels were also significantly lower.
There was no relationship between successful
practice and sex or age of the child. These
results suggest that stress may activate mast
cells which could be involved in the
pathophysiology of migraine.
Hardly any random controlled placebo trials have
tested the effectiveness of hypnosis for asthma.
A1962 British trial of 55 patients with asthma
noted that patients assigned randomly to the
hypnosis group used bronchodilators
less frequently and experienced less wheezing
than controls. Nonetheless, the balance of the
case reports suggest the evidence seems positive.
A recent case report from Denver suggests that
repairing the maternal-fetal bond through
hypnosis with the mother can positively affect
the childs symptoms. Much more work in this
area needs to be done.
Controlled trial of hypnosis in the symptomatic
treatment of asthma. Mason AA, MacDonald N, Fry
L. Br Med J. 19622371-376. Helping Children
with Asthma by Repairing Maternal-infant Bonding
Problems Antonio Madrid American Society of
Clinical Hypnosis 482-3, October 2005/January
Medical Education
In 1955, the British Medical Association, in 1958
the American Medical Association and in 1960, the
American Psychological Association had approved
the medical uses of hypnosis. Even though they
recognized the validity of hypnosis, medical
schools and universities largely ignored the
subject. So the private sector became the
provider of hypnosis training. So there was no
authentic degree or diploma in hypnosis issued in
either Great Britain, USA nor in any other
country in the world. There was no such thing as
a qualified hypnotherapist. There were only some
training courses for qualified doctors, dentists
and clinical psychologists. There is a profession
wide program of trying to secure National
Qualifications Framework for hypnotherapy. This
has created an interesting problem of lay
hypnotists that is individuals who hold no
medical degree who practice hypnotherapy for a
broad range of medical, dental and psychological
problems. I believe that this is a tool which
helps you practice family medicine and not a
therapy unto itself and is practicing medicine
without a license.
Description Code 90880 is described as
hypnotherapy. Hypnosis is an artificially
induced alteration of consciousness in which the
patient is in a state of increased
suggestibility. Documentation Claims must be
submitted with a covered diagnosis. Comments
Hypnosis may be used for diagnostic or
therapeutic purposes. When used therapeutically
to enhance psychotherapy or provided in
conjunction with psychotherapy in the same
session, only code 90880 should be
reported. Medicare will cover hypnotherapy for
the following diagnoses 300.11 Conversion
disorders 300.12 Psychogenic amnesia 300.13
Psychogenic fugue 300.14 Multiple
personality 300.15 Dissociative disorder or
reaction 300.20-300.29Phobic disorders 307.80
Psychogenic pain 308.0-309.9 Stress disorders
Lay Hypnotists
Founded in 1951, the National Guild of
Hypnotists is the oldest and largest hypnosis
organization of its kind.  Professional
membership in the NGH signifies that an
individual possesses specific qualifications,
agrees to abide by a strict code of ethics, and
will pursue continuing education studies for
annual re-certification.
 The services I render are held out to the
public as non-therapeutic hypnotism, defined as
the use of hypnosis to inculcate positive
thinking and the capacity for self-hypnosis. I do
not represent my services as any form of medical,
behavioral or mental health care, and despite
research to the contrary, by law I may make no
health benefit claims for my services.
ASCHAmerican Society of Clinical Hypnosis
ASCH is unique among organizations for doctoral
and master's prepared professionals using
clinical hypnosis. Our members are psychologists,
psychiatrists, clinical social workers, marriage
and family therapists, mental health counselors,
medical doctors, master's level nurses, dentists
and chiropractors. As an interdisciplinary
organization, ASCH provides an opportunity to
learn from and interact with colleagues in other
health and mental health care disciplines. This
allows for a cross fertilization of ideas and
applications that meshes neatly with current
trends, such as mind-body health and integrative
Do not use hypnosis to treat diseases you
normally would not treat without hypnosis.
Keep the use of hypnosis within your usual
scope of practice.
Cocaine that can be abused or used for
Hypnosis can be abused for fun, frolics and
profits or it can be a useful tool to help