Transcript PEDIATRIC HYPNOSIS Helping Children Help Themselves Linda

Hypno-Potamize
Pediatric Hypnosis
Helping Children Help Themselves
Hypnovations III - Intermediate Workshop
Burlington, VT
April 2010
Lnda Thomson, APRN, ABMH
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Objectives

Describe how developmental age is more
important than chronological age when
using hypnosis with children

Demonstrate two hypnotic techniques that
are effective with children
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With hypnosis the art of
interacting with children in
pediatrics is taken to a higher
level.
Sugarman
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Introducing Hypnosis to
Children and Families

Learn about the patient
 Learn about the problem
 Learn why the child wants to change
– How would life be better without the problem

Explain about the mind body connection
 Discuss the power of imagination
 Explain and demystify hypnosis
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RAPPORT
 Relationship,
especially one of mutual
trust or emotional affinity.
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Learn about the Problem
(while developing rapport
and obtaining history)
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Medical history
Experiences with the symptom or problem
Imaginative description of symptoms
Worries and dreams
Cognitive re-framing
Roles of parents, other relationship
• Kohen
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Integrate the child and the
problem
“How will life be better when it is
gone?”
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Hypnosis is about learning what you
never knew you knew and controlling
what you never knew you could. .
Using your mind. . .
Daydreaming on purpose. . .
Thinking to help yourself. . .
Learning how to work to control your
mind. . .
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Studies show that children

Have greater hypnotic capacity
– Most hypnotizable 11 years (8 – 12)

Their ability to alter behavior/physiology
with hypnosis related to depth/creativity of
imagery
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Hypnosis uses imagination to change:
symptomatology
physiology
and
behavior
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Developmental Stage
Age 0 - 2

Piaget – Sensorimotor
– Preverbal
– Reflex activity - - - - -purposeful activity
– Rudimentary thought

Erikson – Trust vs Mistrust
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Hypnosis with young children
 Absorbing Attention:
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Tactile: patting, rubbing, massage
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Kinesthetic: rocking, motion
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Auditory: singing, rhyming, white noise
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Visual: peek-a-boo, puppets, mobiles,
dolls
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Hypnosis with young children
 Pertinent
characteristics:

Enter their world
 Fantasy is spontaneous
 Ease of Fractionation
 Importance of parents
 Importance of transistional objects
 Activity in hypnosis
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Developmental Stage
Age 2 - 6

Piaget – Preoperational & Prelogical
– Initial reasoning
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Erikson – Autonomy vs Shame
– 11/2 – 31/2 yrs
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Iniative vs Guilt
– 31/2 – 6yrs
– Skills broaden thru play and imagination
– Guilt restricts development of play skills and
imagination
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Hypnosis with Pre-school
Children

Playful, flexible, do the unexpected
 Shifts easily in/out of trance
 Trance created when child focuses attention on
something external or in inner world
 Eye closure and relaxation rare

Mastery, initiative, autonomy important
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Hypnotic inductions with
Pre-school Children
Let’s Pretend
 Story telling or favorite place
 Puppets and other props
 Songs, rhyming
 Blowing bubbles, pinwheels
 Stereoscopic viewer, pop-up books
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Developmental Stage
Age 6 - 12

Piaget - Concrete operational
– Logical
– Problem solving restricted to real objects
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Erikson – Industry vs Inferiority
– Competence, mastery
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Hypnosis with School-age
Children

Concrete thinkers
 Active use of fantasy and identification
with real and imagined characters
 Increasing self-awareness, rules, fairness
 Increasing control over new feelings/desires
 Mastery
and achievement
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Hypnotic Inductions and
Techniques with School-age
Children

Favorite place imagery, adventure imagery,
Harry Potter, Magic Carpet
 Yoyo or belly breathing, Helium balloon,
bucket of sand, magnetic forces, coming
down a mountain
 Controls, wires and switches
 Videogames, television imagery
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Developmental Stage
Age 12 +

Piaget
– Comprehension of purely abstract or symbolic content
– Development of advance logical functions (eg.
Complex analogy, deduction)
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Erikson – Identity vs Identity Diffusion
– Self-certainty vs self-doubt
– Trying on various roles
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Abstract Reasoning

This begins to come into thought
processing at an average age of 16
years. The range may be 12 to 20
years.
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Hypnosis with Adolescents

Period of tremendous change, great
variability
 Ego-centricity of adolescence - imaginative
audience
 Illusion of immortality
 Autonomy,
independence and mastery
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Changes in Hypnotic
Techniques with Advanced
Development
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Simple language
“Let’s pretend”
Imitative
 Repetitive themes
 Familiar key roles and
events
 More flexible with sex
and age roles
 Fewer preconceived
notions
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More complex language
 “Perhaps you’d like to
learn
 Creative
 True inventiveness
 Adventurous, more daring
 More rigid with sex and
age rolls
 More hypnosis stereotypes
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Hypnotic Inductions and
Techniques with Adolescents
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Eye fixation, coin watching
Safe Place imagery, Sports activity
Diaphragmatic breathing, progressive relaxation
Arm levitation and reverse levitation
Playing or listening to music, dancing
Driving a car, snowmobile, dirt bike
Video or computer games, television
Maturity and mastery imagery
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Induction
 Simply
as much as the patient needs.

Narrowing focus of attention
 Intensifying self-awareness
 Permission to imagine
 Creating positive self-expectancy
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Let patients notice that they
are in control
“Relaxing at the speed that is right for you.
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There is no correct or right
way to experience hypnosis
Allow patient to feel good and
okay about whatever they do
experience
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Office Procedures
Physical Exams – use of transistional
objects, humor, play, magic
 Throat Cultures
 Immunizations: Pinwheels, Bubbles,
Viewfinders
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– Attenders or avoiders
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Other procedures – belly breathing, yoyo
breathing, diaphragmatic breathing,
distraction – game boy, story telling
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Hypnosis in a Primary Care
Practice
Sugarman J Dev Behav Ped, 1996

Problems

– Enuresis
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– Headaches
– Abdominal Pain
– Anxiety
– Asthma
– Chronic Disease
– Habit Disorder
– Tics
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14 females, 25 males
Age 5 – 18 (10)
Visits 1 – 7 (2)
20-75 minutes (45)
59% >50% improved
80% of those attribute
change to hypnosis
– ADD
– Encopresis
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Hypnosis in Behavioral
Encounters
Kohen, J Dev Behav Peds,1984
Hypnotherapeutic interventions in 505 children
followed for up to 2 years with:

Enuresis
 Pain
 Habit disorders
 Asthma

Obesity
 Encopresis
 Anxiety
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Hypnosis in Behavioral
Encounters
Kohen, J Dev Behav Peds,1984 (continued)
Response of 505 Pediatric Patients to Relaxation Mental Imagery
________(Self-Hypnosis): Number of Visits_________
Response
# of Pts
# of Visits
to RMI*
1
2
3
4
>5
0
37
7
6
7
7
10
1
46
1
7
10
5
23
2
163
30
23
23
26
21
3
259
90
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58
31
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0 – no change; 1- demonstrated initial improvement, but did not
practice exercises; 2- more than 50% reduction in symptoms;
3- complete resolution of problem
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Hypnosis in Behavioral
Encounters
Kohen, J Dev Behav Peds,1984 (continued)

Conclusions

Long or frequent office visits not required
 Effectiveness of hypnosis
 Parental reminders negate success / mastery
 Spillover of therapeutic efficacy
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Usefulness of hypnosis in
managing anxiety
Stimulates the relaxation response –
physiologic changes that occur with
physical/muscular relaxation
 Children don’t like to feel anxious
 Children are interested in self-mastery and
how their mind and body works together
 Hypnosis cultivates imagination
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The first hypnotic intervention
for pain came when a mother
first kissed her child’s booboo
and told him it would be all
better,
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Childhood Pain
Ross & Ross, Pain, 1984
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Interviewed 994 elementary children
 384 had a painful procedure with MD or
DDS
 Only 21% used any sort of coping strategy
 Only 13 children reported having been
taught pain coping techniques
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Blowing away pain
French, Pediatrics

149 4-7 year olds divided into control and
test group

Test group taught to blow away pain of
immunizations
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Test group had significantly fewer pain
behaviors p <.04
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Hypnosis with Pediatric Surgical
Patients
Lambert, JDBP, 1996
26 Pts in
each group
Hypnosis
Control
P value
Length of
5.0 days
hospital stay
5.8 days
P <.05
Pain Scale
3.9
4.4
P<.01
Post-op
Anxiety
-1.00
+2.04
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Hypnosis and Headaches
2 year F/U on 126 children taught selfhypnosis for recurrent headaches
DP Kohen, ISH, 2004

87.7% had a decrease in frequency
 86.9% had a decrease in intensity
 88.6% had a decrease in duration
 25.7% were completely headache free
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Functional Abdominal Pain
Anbar, Clinical Pediatrics, 2001
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Most common recurrent physical symptom
attributable to psychological factors among
children and adolescents
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4 out of 5 improved after one hypnosis
session
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Hypnotherapy for Children
with FAP or IBS
Vlieger, et al 2007
After Treatment
1 year F/U
Control
Hypnosis Control
Hypnosis
No Effect
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15
46
4
Improved
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26
29
11
Cured
12
59
25
85
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Psychoneuroimmunology:
Self-Regulation of Salivary
IgA
Olness, et al Pediatrics, 1989
Hewson-Bowers,
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3 groups: hypnosis, relaxation and control
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Hypnosis was able to statistically reduce
the frequency and duration of respiratory
infections by increasing salivary IgA
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Hypnosis for Childhood
Asthma
Kohen, Hypnos, 1995
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N= 28 7-12 yr.olds RCT
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As compared to control hypnosis
significantly reduced (p<0.05 – 0.001)
– Symptom severity
– School absence
– Emergency visits
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Asthma and Anxiety

767 children 11-17yrs with asthma
 9% met DSM-IV criteria for anxiety disorder
 Children with both asthma and anxiety had
significantly more asthma symptom days
 Children with both asthma and anxiety more
likely to be taking more medication
• Richardson, Pediatrics, 2006
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Hypnosis with Children with
CF

Improved attitude about health
 Sense of independence
 Decreased anxiety
 Increased control over pain, taste and
nausea
• Anbar, Pediatrics, 2000
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Adolescents with IDDM

No changes in management other than the
addition of hypnosis
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Reduced HgbA1C from 13.2% to 9.7%
 Reduced avg FBS from 426 to 149
• Ratner, et al AJCH 1990
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Hypnosis and Enuresis
Banerjee, et al, AJCH, 1993
50 children divided into 2 groups
Tofranil

After 3 months
– 76% dry
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After treatment
discontinued
– 24% dry
Hypnosis
 After 3 months
– 72% dry
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After treatment
discontinued
– 72% dry
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Patients do the changing:
they have the ability and get
the credit
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Ego Strengthen whenever
possible
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Breathe in self-confidence, breathe out
self-doubt
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Breathe in self-esteem
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That’s right, you’re doing great
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You are doing this very well
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Ego Strengthen whenever
possible
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As you do this more and more for yourself,
you will probably be very proud of what
you are learning and accomplishing.
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It is good to know that you are doing this
exactly right, and the more you do it, the
better you get.
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Ego Strengthening
Suggestions

Mastery
 Positive Coping
 Control
 Self-esteem
 Self-appreciation
 Confidence and ability
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Hypnosis is indicated when. . .

One is responsive to hypnotic suggestion
 A problem is treatable with hypnosis
 Good rapport exists between the patient and
the therapist
 Patient is motivated to remedy the problem
 No iatrogenic harm is anticipated by use
• Sugarman
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Hypnosis is contraindicated
when. . .

It may lead to physical endangerment
 It may aggravate existing problems or cause new
ones
 It is used for “fun” or entertainment
 A problem is more effectively or appropriately
treated with a different modality
• Sugarman
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Summary
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Useful therapeutic tool, not a cure all
An adjunct to medical or psychiatric therapy,
usually not the primary treatment
Requires self-motivation, not effective if there is
significant secondary gain
Essentially no adverse effects
Gives the patient a sense of mastery and control
over symptoms
Never use authoritarian symptom removal
Do not use for entertainment
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Factors necessary for
Success

R - RAPPORT, relationship
 A - accurate assessment, aptitude
 H - history

T - trust
 E - expectation
 A - active participation
 M - motivation
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Blessed are they that use
hypnosis to help children
help themselves for they
shall dwell in the land of the
good guys forever.
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LINDA THOMSON
131 Thomson Drive
Ludlow, Vermont 05149
[email protected]
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