HYPNOTHERAPY

Applications in Pain Management

Lecture by: M.K. Sastry

 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
 Overview
1. Video clip of hypno-analgesia followed by hypno-
anaesthesia
2. Nature of hypnosis – What is it? How does it work?
Common ideas/misconceptions vs. evidence
3. Who’s more & less likely to benefit from hypnotherapy?
4. Contraindications
5. Procedural stages
6. Pain mx cases – chronic cervico-genic headaches, pain
of burns-bath rx, chronic hyperemesis (severe nausea,
stomach pain & vomiting)
7. Resources
 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
 Nature of Hypnosis:
What is it & how does it work?
 In turn, allows access to therapeutically-useful
psychological & physical abilities e.g.
 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
 Nature of Hypnosis:
What is it & how does it work?
 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. ‘role-play’ 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
 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 well-instructed,

well-motivated role-players
 Nature of Hypnosis:
What is it & how does it work?
 So, not just “imagination”, “faking”, “play-acting”,
“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
 Nature of Hypnosis:
What is it & how does it work?
 They say it’s just that hypnosis is one of the best
ways to tap into these commonplace capacities
 NATURE OF
HYPNOSIS:
Common ideas
vs evidence
What do you
know about
hypnosis?
 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 response-
time 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
 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:

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
 Contraindications
 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:

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
 Phenomena & strategies
facilitated & intensified by hypnosis
Phenomena
 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
 Phenomena & strategies
facilitated & intensified by hypnosis
Strategies
 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
 Asthma  Minor Surgical Procedures
 Burns  Obesity
 Enuresis  Pain Control
 Hypertension  Gastro-intestinal Disorders
 Childbirth  Warts
 Migraine
 Areas of application
Psychological Practice & Psychiatry
 Anxieties  Psychosomatic Syndromes
 Apathy and lack of  Panic Attacks
Motivation  Sleep Disorders
 Confidence Problems  Sexual Dysfunction
 Eating Disorders  Thumb-sucking
 Depression  Stuttering
 Nail-biting
 Fears and Phobias
 Areas of application
Dentistry
 Anaesthesia  Gagging
 Anxiety / Apprehension  Nausea
 Bleeding Control  Pain-control
 Bruxism  Restlessness
 Dental Phobia  Salivation-control
 Denture Problems  Tempro-mandibular Joint
Dysfunction
 Areas of application
Education Sports
 Concentration and  Attitude Change
Attention problems
 Confidence Building
 Exam Fears/Phobias
 Co-ordinate Mind & Body
 Motivation training
 Memory Training  Fear of Success
 Study habit problems  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 self- hypnosis 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
Thank You