A randomized controlled trial of hypnosis for burn wound care.

Purpose/Objective: There have been few randomized controlled studies on the effectiveness of clinical hypnotic analgesia. The authors' goal was to improve on previous methodologies and gain a better understanding of the effects of hypnosis on different components of pain in a clinical setting. Research Method/Design: This study used a randomized controlled design in which the nurses and data collectors were unaware of treatment condition to compare hypnotic analgesia with an attention-only placebo for burn pain during wound debridements. Data were analyzed on a total of 46 adult participants. Results: The authors found that the group receiving hypnosis had a significant drop in pain compared with the control group when measured by the McGill Pain Questionnaire but not when measured by other pain rating scales. Conclusion: The McGill Pain Questionnaire total score reflects multiple pain components, such as its affective component and various qualitative components, and is not merely a measure of pain intensity. Thus, the findings suggest that hypnosis affects multiple pain domains and that measures that assess these multiple domains may be more sensitive to the effects of hypnotic analgesia treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnosis treatment of clinical pain: understanding why hypnosis is useful

Clinical and experimental research literature indicates hypnosis is very useful for severe and persistent pain, yet reviews suggest hypnosis is not widely used. To encourage more widespread clinical application, the author reviews recent controlled clinical studies in which hypnosis compares favorably with other interventions; links advances in understanding endogenous pain modulation to a neurophysiologic view of hypnosis and hypnoanalgesia; relates the neurophysiology of hypnoanalgesia to management of chronic pain; challenges the view that hypnotic pain control is only for the highly hypnotizable patient; and raises issues about how people learn to control pain with hypnosis. Training in hypnotic analgesia may usefully enhance nervous system inhibitory processes that attenuate pain.     

The clinical use of hypnosis.

Reviews recent experimental evidence on the hypnotic treatment of obesity, cigarette smoking, alcoholism, clinical pain, warts, and asthma. It is concluded that although hypnosis may be effective with addictive behavior, the therapeutic success is attributable to nonhypnotic factors. In contrast, hypnosis appears to be of unique value in the treatment of clinical pain, warts, and asthma. Differential effectiveness may be attributable to the nature of the disorders or to the manner in which hypnosis is used in treating them. The relevance of hypnotizability to treatment is discussed, as is the need to distinguish between genuine and placebo-based hypnotic effects. It is concluded that future research must be more attentive to the (a) nature of the disorders and patient populations, (b) adequate implementation of therapeutic techniques, (c) context in which treatment is delivered, and (d) influence of hypnotic susceptibility and other S factors on outcome. (4? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In Response to "Hypnotic Enhancement of Cognitive-Behavioral Interventions for Pain: An Analogue Treatment Study".

Comments that the article by Milling, Levine, and Meunier (2003; see record 2003-05896-014) regarding hypnotic analgesia overlooked important relevant research, including at least one study that challenges their conclusions. Milling and colleagues stated that they know of only three studies that compared the pain-reducing effects of cognitivebehavioral interventions with those that added the element of hypnosis. They further pointed out that they must examine whether their findings, "based on the analogue treatment of experimental pain, apply to the treatment of clinical pain" (Milling et al., 2003, p. 412). However, other researchers (Faymonville et al., 1995) have already compared the analgesic effects of a hypnotic and a nonhypnotic relaxation intervention in patients undergoing plastic surgery. The present author further asserts that the work of Faymonville et al., may actually be superior to the work of Milling and colleagues. It is also commented that there have also been other clinical studies in the medical literature and their omission from the article's literature review was "disappointing." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic analgesia and stress inoculation in the reduction of pain.

Investigated the influence of hypnotic ability on 3 methods of reducing cold-pressor pain. Following a baseline immersion, 30 high- and 30 low-hypnotizable undergraduates were randomly assigned to 1 of 3 treatment groups: stress inoculation training, stress inoculation training defined as hypnosis, or hypnotic analgesia. Analysis of pain reports indicated a significant hypnotic ability?×?treatment interaction. Among Ss receiving hypnotic analgesia, high-hypnotizables reported significantly less intense pain than lows. There was no differential response for high- and low-hypnotizable Ss receiving stress inoculation training, whether or not it was defined as hypnotic. Moreover, Ss in the stress inoculation condition (whether or not defined as hypnosis) reported using cognitive strategies to reduce pain, whereas this was not the case for Ss in the hypnotic analgesia condition. The present findings seem inconsistent with the social psychological account of hypnosis and are discussed from a dissociation perspective, which views hypnosis as involving changes in the way information is processed. (56 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: Response expectancies and emotional distress.

Objective: The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). Method: Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years; 63% White, 15% Hispanic, 13% African American, and 9% other) were randomized to a hypnosis or to an attention control group. Prior to surgery, patients completed assessments of hypothesized mediators (response expectancies and emotional distress), and following surgery, patients completed assessments of outcome variables (pain, nausea, and fatigue). Results: Structural equation modeling revealed the following: (a) Hypnotic effects on postsurgical pain were partially mediated by pain expectancy (p p = .12); (b) hypnotic effects on postsurgical nausea were partially mediated by presurgical distress (p = .02) but not by nausea expectancy (p = .10); and (c) hypnotic effects on postsurgical fatigue were partially mediated by both fatigue expectancy (p = .0001) and presurgical distress (p = .02). Conclusions: The results demonstrate the mediational roles of response expectancies and emotional distress in clinical benefits associated with a hypnotic intervention for breast cancer surgical patients. More broadly, the results improve understanding of the underlying mechanisms responsible for hypnotic phenomena and suggest that future hypnotic interventions target patient expectancies and distress to improve postsurgical recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic enhancement of cognitive-behavioral interventions for pain: An analogue treatment study.

Recent meta-analyses have shown that adding hypnosis enhances the effectiveness of cognitive behavioral psychotherapy. This hypnotic enhancement effect was evaluated in the analogue treatment of pain. Individuals scoring in the high (n=135) and low (n=150) ranges of hypnotic suggestibility were randomly assigned to 1 of 6 conditions: Stress Inoculation Training, the same treatment provided hypnotically, nonhypnotic analgesia suggestions, hypnotic analgesia suggestions, a hypnotic induction treatment, or a control condition. The 5 analogue treatments reduced experimental pain more than the control condition, but were not different from one another. Under circumstances optimized to detect an enhancement effect, neither Stress Inoculation Training nor analgesia suggestions produced more relief when delivered in a hypnotic context than identical treatments provided nonhypnotically. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analgesic effects of posthypnotic suggestions and virtual reality distraction on thermal pain.

The individual and combined effects of posthypnotic suggestion (PHS) and virtual reality distraction (VRD) on experimentally induced thermal pain were examined using a 2 × 2, between-groups design. After receiving baseline thermal pain, each participant received hypnosis or no hypnosis, followed by VRD or no VRD during another pain stimulus. Consistent with the hypothesis that hypnosis and VRD work via different mechanisms, results show that posthypnotic analgesia was moderated by hypnotizability but VRD analgesia was not. The impact of PHSs for analgesia was specific to high hypnotizables, whereas VRD was effective independent of hypnotizability. Results also show a nonsignificant but predicted pattern for high hypnotizables: Audio hypnosis combined with VRD reduced worst pain 22% more and pain unpleasantness 25% more than did VRD alone. Theoretical and clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnosis, surgery, and mind–body interaction: An historical evaluation.

Maintains that hypnosis is one of the many means for understanding mind–body interactions. Hypnosis has been shown to be effective in the treatment of asthma, dermatological conditions, burns, clinical pain, and perhaps some forms of cancer. The less researched area of surgical pain is the focus of the present study, with particular emphasis on surgeries performed in the 19th century, both before and after safe and effective chemical anesthetics were developed. Some of the modern scepticism toward such reports, which attempt to dismiss them in terms of social-psychological variables is discussed, as are the mechanisms underlying hypnotic responsivity as indicated by both current theorizing and research. It is concluded that the mechanisms underlying high hypnotic responsivity involve imagination in which a person becomes deeply involved to the extent that critical judgment is superseded. While these observations may have profound implications for the understanding of some of the processes underlying health and illness, the mechanisms by which semantic messages are converted to somatic ones are still not at all understood. (French abstract) (45 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Instructional set and the relative efficacy of hypnotic and waking analgesia.

Tested the hypothesis that hypnotic analgesia is intrinsically more effective than waking analgesia by administering both treatments while varying expectations concerning treatment efficacy. 23 male and 37 female undergraduates were assigned to hypnosis/hypnosis, hypnosis/explicit instruction, hypnosis/ambiguous instruction, and control groups. Ss given equivocal information about the efficacy of the 2 treatments exhibited larger pain tolerance in hypnotic analgesia. Ss explicitly informed that waking analgesia was more effective exhibited equivalent pain tolerance in the 2 treatments. Although these Ss rated themselves as deeply hypnotized on their hypnotic analgesia trial, they rated themselves as much less hypnotized on their waking analgesia trial. Findings did not support the hypothesis. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical hypnosis: Differential impact on volitional and nonvolitional disorders.

Presents a conceptualization of hypnosis that differentiates the effects of the hypnotic experience from the effects of the hypnotic context. Within this framework, the clinical impact of hypnotic techniques on disorders that are usually not under volitional control (e.g., pain and asthma) as well as on those that are essentially problems of self-control (e.g., smoking and obesity) is examined. Findings generally indicate that whereas the hypnotic experience is responsible for therapeutic gain in the former type of disorder, it is the hypnotic context that affords such gain in the latter type. (French abstract) (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic analgesia: Dissociated experience or dissociated control?

18 high-hypnotizable Ss were superior to 18 low-hypnotizable Ss in the extent of pain reduction produced by hypnotic analgesia and by a stress-inoculation procedure. However, stress inoculation but not hypnotic analgesia impaired performance on a cognitively demanding task that competed with pain reduction for cognitive resources. This outcome implies that hypnotic analgesia occurs with little or no cognitive effort to reduce pain and challenges the social psychological model of hypnosis. The findings are also inconsistent with the notion of dissociated experience, which proposes that pain and the cognitive efforts to reduce it are cut off from consciousness by an amnesialike barrier. However, the results do support the notion of dissociated control, which proposes that suggestions for hypnotic analgesia directly activate pain reduction and thereby avert the need for cognitive strategies to reduce pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnosis and psychopathology: Retrospect and prospect.

As an editorial introduction to a special issue on hypnosis and psychopathology, this article discusses several links between the 2 fields. Historically, observation of the parallels between hypnosis and hysteria played an important role in the discovery of unconscious mental processes, the development of psychogenic theories of psychopathology and the rise of psychotherapy. It is proposed that hypnotic anesthesia and analgesia, amnesia, and posthypnotic suggestion may serve as laboratory models of dissociative phenomena seen in the clinic. Furthermore, hypnosis may be useful in the exploration of processes involved in emotional response and the formation of hallucinations and delusions. With respect to personality and behavior change, hypnosis has commonly been employed in the treatment of pain and habit disorders by means of direct suggestion, but its use is not limited to suggestive therapeutics. Hypnotic relaxation, images and dreams, suggested amnesia, hypermnesia, and age regression may be useful in both psychodynamic and cognitive-behavioral therapies. Possible lines for further research on the relation between hypnosis and both experimental and clinical psychopathology are discussed. (82 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moderating effects of contextual variables on the relationship between hypnotic susceptibility and suggested analgesia.

Assessed 75 undergraduates high, medium, or low on hypnotic susceptibility (the Carleton University Responsiveness to Suggestion Scale) on the cold pressor task before and after 1 of 3 instructional treatments. The treatments were (a) brief instructions to try to reduce pain, (b) the same analgesia instructions preceded by a hypnotic induction procedure, and (c) no hypnotic induction or instructions. In the hypnotic treatment, susceptibility correlated significantly with reductions in reported pain, and high-susceptible Ss reported significantly larger pain reductions than did control Ss. In the instruction-alone treatment, there was no significant relationship between susceptibility and pain reduction, and Ss at all 3 susceptibility levels reduced reported pain significantly more than did controls and as much as did high-susceptible hypnotic Ss. Findings suggest that the correlation between hypnotic susceptibility and hypnotic analgesia is moderated by Ss' attitudes and expectancies concerning their own performance in situations defined as related to hypnosis. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediation and moderation of psychological pain treatments: Response expectancies and hypnotic suggestibility.

The mediator role of response expectancies and the moderator role of hypnotic suggestibility were evaluated in the analogue treatment of pain. Approximately 1,000 participants were assessed for hypnotic suggestibility. Later, as part of a seemingly unrelated experiment, 188 of these individuals were randomly assigned to distraction, cognitive-behavioral package, hypnotic cognitive-behavioral package, hypnotic analgesia suggestion, placebo control, or no-treatment control conditions. Response expectancies partially mediated the effects of treatment on pain. Hypnotic suggestibility moderated treatment and was associated with the relief produced only by the hypnotic interventions. The results suggest that response expectancies are an important mechanism of hypnotic and cognitive-behavioral pain treatments and that hypnotic suggestibility is a trait variable that predicts hypnotic responding across situations, including hypnosis-based pain interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modification of hypnotizability: A review.

Discusses the domain of hypnotic behavior and presents the controversy between clinical and experimental hypnotists concerning the modification of the ability to be hypnotized. 4 sections deal with the evidence demonstrating that responsiveness to hypnosis can be meaningfully altered. Modification studies are discussed in relation to sensory alterations, hypnotic set and environmental setting situational variations, training experiences in nonhypnotic behavior, and training in hypnotic behavior. Persistent hypnotic performance alterations are differentiated from transitory changes. An attempt is made to synthesize the findings, and possible approaches in future investigation are discussed. (51/2 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relevance of hypnotic susceptibility in the clinical context.

Comments that despite experimental evidence that hypnotic susceptibility is a relatively stable characteristic of the individual, and one that is difficult to modify, clinical investigators tend to see susceptibility as irrelevant to therapeutic outcome. Such investigators view motivational and interpersonal variables as more essential to the therapeutic change. The evidence for the clinical relevance of hypnotizability is sparse and contradictory. Most studies stem from medical hypnosis and indicate that susceptibility plays an important role in the successful treatment of such conditions as clinical pain, warts, and asthma. Two studies are reported that pursue a contrary finding reported by C. Perry and G. Mullen (see record 1976-30394-001), who found that susceptibility was unrelated to the successful treatment of a socially learned behavior (cigarette smoking). Both studies confirmed the earlier finding of a lack of relation. In Study 1, however, stepwise multiple regression analysis located 3 inventory items concerning the motivation of cigarette smokers. The combination of items was found to predict outcome for 67.39% of 46 clients treated either by hypnosis or by rapid smoking. The finding was replicated in Study 2, which utilized a combined hypnosis/rapid smoking technique and employed a different therapist. The outcome for 9 of the 13 quitters and 37 of the 62 nonquitters across the 2 studies could be predicted by the 3 motivational questionnaire variables. (59 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy for clinical pain control: a 15-year update and its relationship to hypnosis

Since Tan's (1982) review of cognitive and cognitive-behavioral methods for pain control was published 15 years ago, significant advances have been made in cognitive-behavioral therapy for pain. The scientific evidence for its efficacy for clinical pain attenuation is now much more substantial and is briefly reviewed. In particular, cognitive-behavioral therapy for chronic pain was recently listed as one of 25 empirically validated or supported psychological treatments available for various disorders. A number of emerging issues are further discussed in light of recent developments and research findings. The relationship of cognitive-behavioral therapy to hypnosis for pain control is briefly addressed, with suggestions for integrating hypnotic and cognitive-behavioral techniques.     

The theory of the mind of the autistic child]

It has been suggested that hypnosis techniques may have the potential to enhance eyewitness memory in forensic investigations. However, laboratory research shows that increases in recall with hypnosis techniques are often associated with decreases in accuracy, false confidence in incorrect information, and increased suggestibility to leading questions and misleading post-event information. These problems limit the usefulness of hypnosis as an interviewing procedure. However, in practical investigations, many factors associated with hypnosis, apart from the hypnotic induction itself, might lead to memory enhancement compared with standard police interviews. For example, hypnotic interviewers, because of their psychological, clinical, and interpersonal skills, may be better interviewers than police officers. They may use effective interviewing strategies such as those associated with the "cognitive interview"; a procedure which has the potential to enhance recall by approximately 35% without the problems of memory distortion associated with hypnosis. It is concluded, therefore, that a cognitive interview procedure should be used in preference to hypnosis.