Transcript Hypnotherapy

Hypnotherapy
Applications in Pain Management
Frank McDonald
Consultation-Liaison Psychologist
The Townsville Hospital
www.fmcdonald.com
Introduction
Most popular application in medical settings
is for anxiety (e.g. distress during medical
procedures like needles, chemotherapy,
adrenal vein sampling) & pain control
(focus of this session)
 Session briefly describes recent pain cases in
general hospital setting, after outlining
nature of hypnotherapy, its contra/indications
& steps involved
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Overview
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Video clip of hypno-analgesia followed by hypnoanaesthesia
Nature of hypnosis – What is it? How does it work?
Common ideas/misconceptions vs. evidence
Who’s more & less likely to benefit from hypnotherapy?
Contraindications
Procedural stages
Pain mx cases – chronic cervico-genic headaches, pain
of burns-bath rx, chronic hyperemesis (severe nausea,
stomach pain & vomiting)
Resources
Video clip
Dr. Graham Wicks demonstrates hypnoanalgesia followed by surgery under hypnosis
without anaesthetic
 Pre-view video at
http://www.abc.net.au/catalyst/stories/s144085
5.htm Dr. Wicks starts around 19 minute mark
 Presenter discusses neural mechanisms of pain
control as suggested by recent fMRI studies
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Nature of Hypnosis:
What is it & how does it work?
Hypnosis - oldest (cognitive) psychological
strategy – predates written history – Egyptian
records go back 4 000 years. Aboriginal
Australians & Africans amongst earliest users
 A phenomenon of attention in which brain
suspends authentication of raw sensory input.
(Focus is on internal representation of input.
Working with that to change pt’s experience.)
 Results in heightened suggestibility (a cognitive
flexibility resulting in reduced critical analysis), or
at least allows suggestibility to come to the fore
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Nature of Hypnosis:
What is it & how does it work?
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In turn, allows access to therapeutically-useful
psychological & physical abilities e.g.
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dissociation
anaesthesia/analgesia
involuntary movement
time distortion
involuntary nervous system functions (blood flow,
coagulation time, blood pressure, peristalsis of
digestive tract, heart rate etc )
Nature of Hypnosis:
What is it & how does it work?
‘Hypnosis’ a form of highly focused attention like meditation. In meditation you concentrate
on nothing in particular (e.g. “the space
between thoughts”); in hypnosis on something
(usually therapeutic suggestions)
 ‘Hypnotherapy’ refers to use of strategies &
harnessing hypnotic phenomena (e.g. narrowed
attention, heightened suggestibilty) in the
service of therapeutic goals
 Hypnosis is regarded as an adjunct to therapy –
not a therapy in its own right. A state of “resting
arousal”, unlike sleep or relaxation
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Nature of Hypnosis:
What is it & how does it work?
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How it works is not clear – absence of a
scientific explanation has limited its acceptance.
Age-old debates e.g. Charcot (below) vs.
Bernheim & the current ‘special state’ v. ‘roleplay’ have made it controversial
Nature of Hypnosis:
What is it & how does it work?
How? = point of departure/division into two
academic camps (& there’s heterogeneity within
those)
 Some say hypnotic behaviour reflects changes in
brain function
 Others say social-psychological & ordinary
cognitive-behavioural factors, like placebo (albeit
hypnosis more effective than sham pills)
 Whilst polarising, debate helps us appreciate its
dual nature
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Nature of Hypnosis:
What is it & how does it work?
Assuaging an effect of controversies
somewhat, PET scan & fMRI studies
showing modulations of activity in specific
& relevant areas are starting to allay
prejudices to its application in certain
fields, such as pain mx
 The images differ from those of wellinstructed, well-motivated role-players
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Nature of Hypnosis:
What is it & how does it work?
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So, not just “imagination”, “faking”, “playacting”, “stage-show gimmickery”. For high
& moderate hypnotisables (roughly 2 in 3
people), hypnosis can bring benefits
beyond those of imagination or willing
Nature of Hypnosis:
What is it & how does it work?
Even sceptics (who don’t believe in ‘trances’)
believe it can relieve conditions like insomnia,
obesity, hypertension & improve behaviour
therapies, counselling & coping strategies
 Whilst accepting imaging studies, they believe
though that hypnosis is not tapping into anything
beyond a continuum of everyday abilities that are
distributed across the population in a pattern
detected by hypnotisability scales
 They say it’s just that hypnosis is one of the best
ways to tap into these commonplace capacities
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Nature of Hypnosis:
Common ideas vs evidence
What do you know about hypnosis? (Nash,2001)
Who benefits more?
1. People who score high (26%) and moderately (36%) on
scales of hypnotisability. 29% are mildly hypnotisable.
(9% unhypnotisable) (Hilgard, 1961)
2. Children (peaks age 9 - 12)
3. People who ask for hypnotherapy/who are motivated
4. People who have an imaginative ability e.g. artistic
types
5. People who have a capacity for emotional involvement
6. People who can take things on faith or trust as opposed
to sceptical, analytical types
7. People from certain cultures e.g. Latinos vs. Germans
8. Rights handers vs. left handers
Who benefits less?
1. People with abnormally low IQ's (attention and responsetime factors)
2. Dementia patients (these patients cannot be hypnotised
due to problems in prefrontal areas necessary to process
induction signals)
3. People who score low (9%) on scales of hypnotisability
4. People for whom condition brings secondary gains
(conscious or unconscious pay-offs)
5. People in psychotic states. (Can uncover too much
material and therapist can be drawn in to any delusional
beliefs)
6. People in hypermanic states
Contraindications
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There are few absolute contraindications to the use of hypnosis. It is
usually a very safe procedure. But there are number of situations in
which you should be cautious
Hypnosis is usually contraindicated if you are dealing with:
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1. Any condition which would be better treated another way
2. Any condition outside your specialty and area of expertise
3. Depression with a risk of suicide. Be on the qui-vive for "masked
depression" e.g. depression masked by low back pain or a habit
disorder. The tranquillising effects of hypnosis may energise a
lethargic depressive sufficiently to allow suicide
4. Thought disorders such as Schizophrenia and Delusional Disorder
except if you have experience with these. While hypnosis cannot
precipitate a psychosis, you may be incorporated into the person's
thought disorder more readily
Phenomena & strategies
facilitated & intensified by hypnosis
Phenomena
Increased temporary and post-hypnotic suggestibilty =
less critical, evaluative thinking
 Reduced awareness that improves classical conditioning.
Easier to establish & more difficult to extinguish
 Hallucinations that are more real and absorbing than
ordinary imagination
 Regression and revivification
 Time distortion e.g. time contraction in medical
procedures
 Analgesia and anaesthesia
 Dissociation (split self off from current reality)
 A.N.S. control e.g. changing blood flow
 Arousal modulation (within limits) for the demoralised or
the distressed to focus therapy attention
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Phenomena & strategies
facilitated & intensified by hypnosis
Strategies
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Imaginal conditioning
Revivification and (cognitive) restructuring
Exposure therapy/ extinction/ abreaction
Imaginal rehearsal
Relaxation / arousal reduction
Suggestion: e.g. for ego-strengthening and
altering pain sensation, enhancing performance
Simple encouragement and support
Areas of application
Medical
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Asthma
Burns
Enuresis
Hypertension
Childbirth
Migraine
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Minor Surgical Procedures
Obesity
Pain Control
Gastro-intestinal Disorders
Warts
Areas of application
Psychological Practice
& Psychiatry
Anxieties
Apathy and lack of
Motivation
 Confidence Problems
 Eating Disorders
 Depression
 Nail-biting
 Fears and Phobias
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Psychosomatic
Syndromes
Panic Attacks
Sleep Disorders
Sexual Dysfunction
Thumb-sucking
Stuttering
Areas of application
Dentistry
Anaesthesia
 Anxiety / Apprehension
 Bleeding Control
 Bruxism
 Dental Phobia
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Denture Problems
Gagging
 Nausea
 Pain-control
 Restlessness
 Salivation-control
 Tempro-mandibular Joint
Dysfunction
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Areas of application
Education
Sports
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Concentration and
Attention problems
Exam Fears/Phobias
Motivation training
Memory Training
Study habit problems
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Attitude Change
Confidence Building
Co-ordinate Mind & Body
Fear of Success
Fear of Failure
Maximise Potential
Improve Concentration
Performance Anxiety
Motivation Training
control
Procedural Stages of Hypnotherapy
1. Preparation (e.g. removing misconceptions, assess
interests that may be incorporated in procedure)
2. Assessment of hypnotisability (capacity for
concentration and imagery, suggestibility)
3. Induction procedure
4. Deepening stage
5. Trance ratification
6. Utilisation of trance for therapeutic purposes
7. Post-hypnotic suggestions including selfhypnosis instructions
8. Termination of the trance
9. Discussion of the experience. Problems?
Pain-related Case Discussions
Cervico-genic headaches in 37 yr old
female from m.v.a. at age 17
 Mx of pain of burns bath treatment in 10
yr old male
 Mx of chronic (2yrs +) hyperemesis in 33
yr old female
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Resources + Pre-/post- session
reading
http://www.abc.net.au/catalyst/stories/s1440855.htm
Vision and transcript. Hypnosis for pain at 19 minute
mark
 Australian Society of Hypnosis
http://www.ozhypnosis.com.au/Default.htm
 Hypnosis.com – the FAQ section is excellent
http://hypnosis.com/faq/
 This presentation www.fmcdonald.com
 Extra reading presented via JCU network
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