# HT and CBT lots of information very impressive



## eric (Jul 8, 1999)

FYIWith permission from the UNC Cognitive-behavioral therapy, hypnosis can help soothe irritable bowel syndrome Back to Good Medicine By DR. OLAFUR S. PALSSON UNC Health Care Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that is characterized by abdominal pain associated with disturbed bowel functioning such as constipation, diarrhea or both. It affects 10-15 percent of the U.S. population, and is at least twice as common in women as in men. The causes of IBS are poorly understood in spite of much research, and medical treatments have proven relatively ineffective for that reason. Our research team found in a study of more than 1,600 patients that only 51 percent of them were at least somewhat better six months after seeing a doctor for IBS. Until recently, there were no medications available specifically for IBS, but doctors used more general medications to treat individual symptoms of the disorder. In the past few years, two prescription medications for IBS have been in use -- one for IBS where constipation is predominant and another for patients who have mostly diarrhea. However, these medications only help at best about half of patients. The limited success of standard medical treatment has led researchers to seek different treatment alternatives for IBS. So far, the most promising of these have been psychological treatments. Although it may at first seem far-fetched to treat bowel problems by talking to people, there are, in fact, a couple of good reasons for using psychological treatments for IBS. One is that studies have indicated that stress and other psychological symptoms substantially affect the bowel symptoms of many IBS sufferers. The other reason is that there is increasing evidence that a "dysfunction" in the brain's normal regulation of the sensations and activity of the bowels plays a role in causing IBS, and this problem might be correctible with psychological methods. Many types of psychological treatment have been tested for IBS. The two that have been most consistently successful are cognitive-behavioral therapy and hypnosis. The majority of studies on both of these therapies have shown that they substantially improve all the central symptoms of IBS in up to 70-80 percent of treated patients and that the benefit often lasts for years after treatment. Both hypnosis and cognitive-behavioral therapy typically require about 8-12 visits to a therapist. In cognitive-behavioral therapy, the therapists work to help patients to overcome distorted and negative thinking patterns that adversely affect life functioning and amplify symptoms, and help them to adopt more effective ways to handle life situations that aggravate the bowel problems. Hypnosis uses a special altered mental state of heightened focus to produce its beneficial effects. Mental imagery and hypnotic suggestions are used to bring about overall relaxation of the bowels and the whole body, lessened sensitivity to gut discomfort, and increased mental control over bowel symptoms. These psychological treatments have proven to have several important advantages that make it likely that they will be increasingly important in the care of IBS in the coming years. They often work well for patients who have not improved from regular medical treatment, they have no uncomfortable side effects and they produce long-term improvement in symptoms. Finally, they often enhance psychological well-being and quality of life in addition to improving gastrointestinal symptoms. At the present time, the main limitations to widespread use of psychological treatments for IBS are the costs of treatment and the lack of therapists who are experienced in these specialized applications of hypnosis and cognitive-behavioral therapy. However, most communities have therapists who use these methods to treat IBS, and the costs may seem reasonable considering the probability of good improvement. IBS sufferers who do not gain satisfactory symptom relief from standard medical treatment may therefore want to discuss these psychological treatment options with their doctor. Olafur S. Palsson, Psy.D., is an associate professor of medicine in the Division of Gastroenterology and Hepatology at the University of North Carolina at Chapel Hill. This column was released for publication in July 2004. ------------- Comment In reference to the above article: [QUOTE: "At the present time, the main limitations to widespread use of psychological treatments for IBS are the costs of treatment and the lack of therapists who are experienced in these specialized applications of hypnosis and cognitive-behavioral therapy. However, most communities have therapists who use these methods to treat IBS, and the costs may seem reasonable considering the probability of good improvement."] Although there are communities who do have clincical hypnotherapists who MAY treat IBS, it is important for the reader to note that there are several IBS treatment hypnotherapy protocols - some are whatever that particular therapist does in practice, and may or may not be geared for IBS, and then there are therapists who use the UNC protocol of gut-directed therapy - and this can be determined by asking a therapist if they have this protocol. There are only a few per state that are actually listed who do this, but it is always best to ask. But the third, most cost effective and certainly the easiest way to treat IBS with hypnotherapy may be by using the treatment method many BB members as well as myself have used successfully, which is the IBS Audio Program 100 - the advantage being that you can do it in your own home - this overrides the objections above to finding a therapist - and comprises a clinically proven method costing less than one - in person therapist visit. You can find out more info for in-person IBS therapy from the UNC site, and you can find out more info for the IBS Audio Program 100 at www.ibsaudioprogram.com ------------------------- HOW AND WHY HYPNOSIS WORKS Thomas Yarnell, Ph.D. Licensed Clinical Psychologist Hypnosis Specialist Modern hypnosis has been used for hundreds of years to build self-confidence, change habits, lose weight with weight loss programs, stop smoking, improve memory, end behavior problems in children and eliminate anxiety, fear and phobias. The question is, WHAT IS HYPNOSIS? Hypnosis is a state of mind characterized by relaxed brain waves and a state of hyper-suggestibility. Hypnosis and hypnotic suggestions have played a major role in healing for thousands of years. According to the World Health Organization, 90% of the general population can be hypnotized. Hypnosis is a perfectly normal state that just about everyone has experienced. What we call "highway hypnosis" is a natural hypnotic state. You drive somewhere and don't remember driving or even remember seeing the usual landmarks. You are on automatic pilot. The natural hypnotic state also exists when you become so involved in a book, TV show or some other activity that everything else is blocked out. Someone can talk to you and you don't even see or hear them. Whenever you concentrate that strongly, you automatically slip into the natural hypnotic state. The hypnotic state, by itself, is only useful for the relaxation it produces. The real importance of hypnosis to the healing and emotional change process is that while you are in the hypnotic state, your mind is open and receptive to suggestions. Positive and healing suggestions are able to sink deeply into your mind much more quickly and strongly than when you are in a normal, awake state of mind. I say positive suggestions because all research has demonstrated that while in the hypnotic state, you cannot be made to do anything against your moral values. All of our habitual and behavior controlling thoughts reside in what is called our subconscious mind. It's called that because it is deeper than our conscious mind. It's below our level of consciousness. We are unaware of the thoughts and feelings that reside there. Did you ever forget you had a dental appointment or some other appointment that you really didn't want to keep? Your subconscious mind is where that thought or memory that you had to go to the dentist at 2 PM went when you forgot you had the appointment. Once it was too late to go, your conscious mind relaxed and the memory came back. Imagine that there is a trap door between your conscious mind and your subconscious mind. Normally, the trap door is closed until your brain waves slow down to a relaxed, alpha brain wave level. This happens when you are asleep. The door opens for short periods of time and ideas, images and thoughts come out of your subconscious mind. We call what comes out in your sleep, "dreams". When you are in a state of hypnosis, the door also opens so helpful suggestions can be directed into your subconscious mind or forgotten memories can be retrieved. The hypnotic induction that hypnotists use is simply a way to focus your attention and concentration so you will go into that natural, normal hypnotic state. Once in the state of hypnosis, the trap door opens and suggestions to help you can be given. The list of ways hypnosis has been used to help children, adolescents and adults is practically endless but does include: weight loss, stopping smoking, building self-confidence and self-esteem, improving academic performance at every age level, improving test taking ability from children through high school, college, medical and law school as well as the National Teacher Certification Exam, pain management, eliminating anxiety, fear and phobias, stress management, insomnia and other sleep problems and helping to heal physical problems. 2. To really work well, suggestions must be reinforced by repetition. Most of the habits, feelings and emotions we want to change are deeply implanted in our subconscious mind and will not just "go away" with one set of suggestions. Most of the time, the hypnotic suggestions need to be repeated on a regular basis until you notice a change. This is one reason that most specialists in hypnosis give clients cassette tapes of their sessions so they can listen to them every day. It's also the reason why hypnosis tapes you buy can work so well. You get to listen to them every day or often enough that the suggestions become permanently a part of you. There is no way to predict how long it will take to see change. It will depend partly on your motivation and commitment. The Three Keys to the successful use of hypnosis for self improvement and personal growth are self motivation, repetition and believable suggestions. 1. The motivation to change must come from within you. If you are trying to change because someone else wants you to "lose weight" or "stop smoking", the chances are greately reduced that the hypnosis will work. For example, I've worked with many people for weight loss or to quit smoking who came to me because their physician or spouse wanted them to change. These people do not respond as well to the hypnosis as those who really want to change. Those who came because they wanted to quit smoking or lose weight responded quickly and easily. Before you start to use hypnosis for your self improvement, you should get it clear in your own mind why you want to change. This clear intention to change will help the hypnotic suggestions to take hold and manifest themselves in your everyday life. 3. The third key to the successful use of hypnosis for personal change is believable suggestions. If you are to accept a suggestion, your mind must first accept it as a real possibility. Telling a chocoholic that chocolate will be disgusting to them and will make them sick is too big a stretch for the imagination. If a suggestion like this even took hold, it would only last a short time because it would be so unbelievable to a real chocolate lover. In cases like this, one of the successful weight loss suggestions I use is that the next time the individual eats chocolate, it will not taste quite as good as the time before. This is far more acceptable and believable to most people. Then, with enough repetition over a period of time, chocolate loses much of it's positive taste and control over that person. One final note is that HYPNOSIS IS NOT DANGEROUS. There are almost no risks when used by trained professionals. You cannot be made to do anything that is against your moral values. An amateur or stage hypnotist might give you suggestions that might embarrass you, might not work or that might make you feel uncomfortable or self-conscious at the time. To avoid this, stick with professionally trained hypnosis specialists. The one risk I know about involves falling asleep. If you are tired or if you become too relaxed, you may move from the state of hypnosis to the normal sleep state. This is fine if you were going to go to sleep right after the trance but if you have other plans after listening to a hypnosis tape, you may want to set an alarm clock just in case you fall asleep. I've even had students fall asleep because they became too relaxed. In relation to this, never listen to a hypnosis tape while driving. It is very dangerous for you and everyone else on the road. Don't even listen to it if you are a passenger as the relaxation suggestions could make the driver fall asleep. Over the years, self improvement and personal growth using hypnosis has helped millions of people change their lives permanently because it is a safe and powerful tool for changing your thoughts, feelings and habits. Copyright C 2001 by Thomas D. Yarnell, Ph.D., Clinical Psychologist. All rights reserved. This material may be copied for educational purposes as long as full credit is given to Dr. Yarnell. ---------------------------------------- Medical Abstract General practitioners believe that hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care. BMC Fam Pract, October 13, 2004; 5(1): 22. Stephen Cox, Simon de Lusignan, and Tom Chan BACKGROUND: Irritable bowel syndrome is a common condition in general practice. It occurs in 10 to 20% of the population, but less than half seek medical assistance with the complaint. METHODS: A questionnaire was sent to the 406 GPs listed on the West Sussex Health Authority Medical List to investigate their views of this condition and whether they felt hypnotherapy had a place in its management RESULTS: 38% of general practitioners responded. The achieved sample shared the characteristics of target sample. Nearly half thought that irritable bowel syndrome (IBS) was a "nervous complaint" and used a combination of "the placebo effect of personal care," therapeutic, and dietary advice. There is considerable divergence in the perceived effectiveness of current approaches. Over 70% thought that hypnotherapy may have a role in the management of patients with IBS; though the majority (68%) felt that this should not be offered by general practitioners. 84% felt that this should be offered by qualified hypnotherapist, with 40% feeling that this should be offered outside the health service. CONCLUSIONS: General practitioners vary in their perceptions of what constitutes effective therapy in IBS. They are willing to consider referral to a qualified hypnotherapist. PMID: 15482597 http://highwire.stanford.edu/cgi/medline/pmid;15482597 -------------------------------------------- December 7, 2004 The New York Times THE CONSUMER New Remedies for a Frustrating Illness. But Do They Work? By MARY DUENWALD he women in the television commercial pull up their shirts to display the words "abdominal pain," "bloating" or "constipation" scrawled in black marker on their abdomens. Some viewers probably respond by reaching for the remote control. But others may be prompted to ask their doctors whether Zelnorm, the Novartis drug in the advertisement, can actually ease the symptoms of irritable bowel syndrome. The answer, experts say, is, "It depends." Zelnorm is one of two drugs - the other is Lotronex from GlaxoSmithKline - approved by the Food and Drug Administration for the treatment of irritable bowel syndrome, or I.B.S., a disorder that is estimated to affect about 45 million Americans. Twice as many women as men suffer from it. Their search for relief is often frustrating, because it has no single cause and no cure, and doctors are sometimes dismissive of patients' complaints. The symptoms vary. About a third of sufferers have constipation, another third have diarrhea and the rest alternate between the two. Bloating after meals and lower abdominal pain are also common, as are severe fatigue, sleep difficulties, low interest in !!!!!!!!!, hopelessness and tension, a recent study in The Archives of Internal Medicine says. Zelnorm, the trade name for tegaserod, has been shown to be effective in treating the syndrome in large clinical trials. It works just for people who suffer constipation. A chief side effect is diarrhea. "Because I.B.S. is so heterogeneous, an agent that may treat one symptom can potentially exacerbate another one," said Dr. Robert S. Fisher of the Temple School of Medicine in Philadelphia. Zelnorm is specifically approved for women, but also prescribed for men. Most studies of its safety and effectiveness have been conducted mainly on women. Doctors say that people with irritable bowel syndrome typically require both medications and changes in their routines, the exact regimen depending on a patient's symptoms and their severity. The syndrome was once thought to be simply a visceral response to stress, because doctors could find no biological explanation. As a result, many patients felt that their doctors gave their problem short shrift or, worse, implied it was all in their heads. "People with I.B.S. are sensitized to doctors' thinking they're crazy," Dr. Fisher said. Recent studies indicate that the syndrome may arise from problems in the working of the colon and in the connection between the brain and the colon. "The brain and bowels are wired with a series of nerves," Dr. Brennan M. R. Spiegel, a gastroenterologist at the University of California, Los Angeles, said. "If you have I.B.S., you're wired up in a slightly different way, and that can cause diarrhea, constipation or pain." Studies have shown that people with the syndrome are more sensitive to colon pain and that their brains process the pain abnormally. Stress and anxiety can lead to symptoms or worsen them, but those factors do not cause the disorder, experts say. Abnormal functioning of serotonin in the colon also appears to promote irritable bowel syndrome. In the brain, serotonin is thought to influence mood. But in the colon, where 95 percent of the body's serotonin is found, it helps produce the normal contractions of peristalsis. Zelnorm stimulates serotonin receptors, enhancing peristalsis and relieving constipation. Alosetron, sold as Lotronex, works in an opposite manner, blocking serotonin receptors and slowing peristalsis. Lotronex is for patients whose primary symptom is diarrhea. But the F.D.A. restricts its use because in some patients it has caused extreme diarrhea or restricted blood supply to the colon, problems that have in some cases been fatal. Patients given alosetron have to sign releases stating that they understand its risks. Bacteria may also play a role. Dr. Henry C. Lin of the University of Southern California and others have found that in many patients bacteria that normally reside just in the large intestine move into the small intestine, where they interfere with digestion and generate excess gas, producing symptoms. Because bloating and pain often occur after meals, patients are advised to cut back on foods that seem to set off the worst symptoms, including caffeine, alcohol, fats and milk. For mild cases of the syndrome with constipation, doctors recommend fiber laxatives like Metamucil or FiberCon. Loperamide - Imodium or Kaopectate, for example - can relieve diarrhea. Low doses of old-fashioned antidepressants like amitriptyline and desipramine have been shown to relieve abdominal pain. Newer antidepressants like Prozac do not seem to be as effective. More helpful, studies suggest, are techniques like cognitive therapy and hypnosis, which Dr. Spiegel says may help patients "get some control over their own symptoms." -------------------------------------- Hypnotherapy in the treatment of irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2005 Jan;17(1):15-20. Related Articles, Links Hypnotherapy in the treatment of irritable bowel syndrome. Gonsalkorale WM, Whorwell PJ. Department of Medicine, University Hospital of South Manchester, UK. There is accumulating and compelling evidence that hypnotherapy is an effective treatment for irritable bowel syndrome. Recently, studies have shown that hypnotherapy has beneficial effects that are long lasting, with most patients maintaining improvement, and with decreased consultation and medication needs in the long term. The particular gut directed approach used, which is aimed at normalizing and controlling gut function, is also described. While the mechanisms of how hypnotherapy brings about its therapeutic effect are not fully known, changes in colonic motility and rectal sensitivity have been demonstrated, although changes in central processing and psychological effects may also play a role. PMID: 15647634 ----------------------------------------- Eur J Gastroenterol Hepatol. 2005 Jan;17(1):11-4. Related Articles, Links Cognitive behaviour therapy for irritable bowel syndrome. Hutton J. Department of Psychological Medicine, King's College Hospital, London, UK. The UK Department of Health states that there is suggestive, although not conclusive, evidence for the efficacy of cognitive behavioural therapy (CBT) in irritable bowel syndrome (IBS) and that CBT should be considered as a treatment option for the syndrome. This paper provides a general introduction to CBT, the principles which underlie it and how they can be applied to IBS. The components of CBT for IBS are described in some detail. Guidelines for gastroenterologists are provided on how these principles can be used to inform their practice and the existing outcome data are reviewed. PMID: 15647633 -------------------------------------------- MOTILITY AND VISCERAL SENSATION Visceral sensation and emotion: a study using hypnosis L A Houghton, E L Calvert, N A Jackson, P Cooper and P J Whorwell Department of Medicine, University Hospital of South Manchester, Manchester M20 2LR, UK http://gut.bmjjournals.com/cgi/content/full/51/5/701 ------------------------------------ Harvard Health "Hypnosis: Theory and Application Part I Although it has been familiar for more than 200 years as a means of entertainment, self-help, and psychotherapy, hypnosis is still a misunderstood practice and the hypnotic experience an elusive state of mind. Most of us think we know what it is to be hypnotizedâ€"until we are asked. But by now enough research has been conducted and enough knowledge accumulated to make it clear that hypnosis is neither a parlor trick nor an occult phenomenon. The Experience The term â€œhypnosis,â€ invented in the 19th century, is derived from the Greek word for sleep, but the derivation is misleading. Subjects are often physically relaxed, and they may be told to close their eyes to enter a hypnotic state, but all the while they are fully awake and alert. The best descriptions point to three related features of hypnosis: absorption or selective attention, suggestibility, and dissociation. Selective attention is a tendency to focus narrowly, noting certain aspects of experience while becoming oblivious to others. Suggestibility is high responsiveness to social and other environmental cues, including the instructions of a hypnotist. Dissociation is an apparent loss of the unity and continuity of consciousnessâ€"a seemingly divided awareness or the capacity to shut out certain perceptions and memories. Vivid and unusual phenomena may occur under hypnosisâ€"automatic writing, negative hallucinations (not seeing something that is clearly there), and reliving the distant past as though it were present. During hypnotic age regression, subjects may talk and act like small children while responding like adults to a command to move forward and backward through time. Their physical reactions may indicate pain while they say they donâ€™t feel it. They sometimes have apparent amnesia for the experience or respond to posthypnotic suggestionâ€"instructions given during the hypnotic state to be obeyed afterward on the snap of a finger or other cue. Inducing the state generally takes 10â€"20 minutes (sometimes only seconds), and there are many ways to do it. Perhaps the best known is to have the subject stare at a target like a swinging pocket watch or a dot on a blank sheet of paper. Or the subject may be helped to relax and then repeatedly told in a rhythmic and monotonous voice something like, â€œYour eyelids are getting heavy.â€ Sometimes it is enough just to repeat, â€œRelax, focus, float.â€ Visual imagery may be used to deepen the trance: â€œImagine riding down a long escalator.â€ There are also many indirect ways of diverting and fixing attention. Some practitioners even claim to be able to induce hypnosis over the telephone. To end a session, the hypnotist simply tells the subject to come out of it. Hypnosis is not mind control. People in a hypnotic trance may feel as though their actions are compelled, and they usually respond to instructions and requests from the hypnotist. But hypnotists have no special powers, and they are not necessarily charismatic or flamboyant. Stage magicians, as everyone knows, can get volunteers to do entertainingly ridiculous things. But people cannot be hypnotized against their will or obliged to do or say anything that conflicts with their moral standards or seriously offends their sense of decorum. And they can usually bring themselves out of the hypnotic state whenever they want. In fact, hypnosis does not require a hypnotist. Some people become hypnotized spontaneously as they lose themselves in daydreams or drifting thoughts or become deeply absorbed in work or play. Most can also learn to hypnotize themselves deliberately. The hypnotist is just an instructor or guide. In an important sense, hypnosis is always self-hypnosis. Hypnotizability Researchers have devised tests of hypnotic susceptibility and scales to measure it, mostly involving the ability to hallucinate, alter physical sensations, forget and remember in unusual ways, and produce seemingly involuntary movements or paralysis. Some common tests are the ability to roll the eyes far upward, the willingness to fall backward on command, the capacity to produce a feeling that an arm or leg is paralyzed or levitating, the capacity to conjure up a sweet taste in the mouth, and the capacity to show no signs of pain when pricked with a pin. Subjects may be told they have no sense of smell and then watched as a bottle of ammonia is waved in front of their noses. There is some dispute about whether these tests are definitive and even whether hypnotic susceptibility can be measured on a single scale. Still, researchers generally agree that individual differences in the capacity to respond to hypnosis exist and are remarkably stable over a lifetime. The capacity peaks at ages 5â€"10 and then slowly declines until it levels off in the early 20s. Studies comparing identical and fraternal twins indicate that hypnotizability is highly heritable. It is estimated that, by standard scales, about 90% of us can achieve at least a light hypnotic state, while 10%â€"20% are highly (or deeply) hypnotizable, and 10%â€"15% are not susceptible at all. It is less clear what kinds of people are most easily hypnotized. It is often said, and seems intuitively plausible, that the best subjects are imaginative, trustful, and emotionally unguarded rather than literal-minded, skeptical, and cautious. But personality tests do not consistently indicate these characteristics, so the issue remains in doubt. Theories of Hypnosis A related doubt concerns the nature of hypnosisâ€"whether it is a distinct state of consciousness and how it differs from other experiences of relaxation, suggestion, and imaginative absorption. The most influential theories of hypnosis emphasize dissociation, which is said to explain the amnesia of hypnotic subjects and the fact that they often say their actions are not willed but happening spontaneously. Further evidence for dissociation comes from experiments indicating a so-called â€œhidden observer.â€ For example, the hypnotist instructs a subject that he or she is deaf and then says, â€œAlthough you are deaf, perhaps part of you can hear. If so, raise your finger.â€ The finger rises. When asked later, the subject says he heard nothing but suddenly felt his finger rise. The experiment suggests that two distinct systems of consciousness are operating, separated by a partial or total barrier of amnesia. A different understanding is reflected in the social-cognitive theory of hypnosis, which emphasizes suggestibility rather than dissociation. Social-cognitive theorists interpret the hypnotic trance not as an altered state of consciousness but as one striking effect of the human susceptibility to social influence. Their idea is that the hypnotist and the subject have entered into an implicit agreement that certain things will be allowed to happen and the subject will describe or confirm certain experiences. The subject responds to these â€œdemand characteristicsâ€ of the situation, doing and saying what is expected to win the hypnotistâ€™s approval. The hypnotic trance is a performanceâ€"not mere playac ting but the sincere adoption of a role. If this view is correct, hypnotic susceptibility is a result of willingness to comply with suggestions, sensitivity to nuances in personal communication, and a high capacity for sincere make-believe and self-dramatization. Social-cognitive theorists say that they can increase or decrease a personâ€™s apparent hypnotic susceptibility simply by changing the instructions and therefore the subjectâ€™s expectations. For evidence, they rely heavily on experiments with people who, according to standard tests, are not easily hypnotized. When these simulators pretend to be hypnotized and act accordingly, they are said to respond just like a person in a â€œgenuineâ€ trance. Social-cognitive theorists add that the hidden observer of dissociation theory is not real but a product of suggestion that can also be manipulated by changes in the instructions. Apparent individual differences in hypnotic susceptibility are explained by differences in suggestibility and in the expectations brought to the situation. In response, advocates of the dissociation theory argue that people who are pretending to be hypnotized respond to suggestions only when they are being observed, unlike people who are truly hypnotized. Also, some people who are told to pretend may actually go into a trance, and susceptibility to social influence may itself sometimes be a hypnotic effect. Some believe the dispute between the theories cannot be resolved, because in the end there is no difference between entering a special state of consciousness and immersing oneself in a performance so deeply that it is no longer experienced as playacting. In either case there are likely to be signs of imaginative absorption, divided attention, and selective recall. Resources A therapeutic hypnotist should be a licensed practitioner in one of the mental health professionsâ€"psychology, psychiatry, social work, or psychiatric nursing. The following organizations train and license therapists who use hypnosis and provide referrals for hypnotic therapy. American Society of Clinical Hypnosis, 130 East Elm Court, Suite 201, Roselle , IL 60172-2000 . Telephone: 630-980-4740 . On the Web: http://www.asch.net. Society for Clinical and Experimental Hypnosis, Washington State University, P. O. Box 642114, Pullman , Washington 99164-2114 . Telephone: 509-332-7555 . On the Web: http://www.hypnosis-research.org Hypnosis: Theory and Application Part II In Part I we described the hypnotic experience and discussed theories about its nature. This month we cover the results of brain imaging studies and the therapeutic uses of hypnosis. Research has shown that brain activity often changes during the hypnotic state. The brainâ€™s response to pain is reduced, and many hypnotic subjects have high electrical activity of the type that indicates a relaxed state in the left frontal region of the cerebral cortex, which controls planning and decision-making. In one experiment, hypnotized volunteers were instructed to put their hands in hot water and told how intensely to experience the pain. Positron emission tomography (PET) scans showed that changes in pain perception were correlated with changes in blood flow to the anterior cingulate gyrus, a region involved in the control of attention and the relationship of emotions to perceptions. Activity in that area increased in response to a suggestion that the pain was becoming worse and decreased in response to a suggestion that it was milder. Seeing Hypnosis Another experiment using PET scans shows a different correlation between the hypnotic state and brain activity. Volunteers chosen for high hypnotic susceptibility were shown a grid of colored squares, then told they were colorblind and able to see only shades of gray. They performed the experiment both while hypnotized and while not under hypnosis. When they were not hypnotized, blood flow and energy consumption were reduced in color vision areas of the brain, but only in the right hemisphere of the cerebral cortex. Under hypnosis, color vision areas lost blood flow in both hemispheres. If the subjects were not told they were colorblind but simply asked to visualize the images as gray, only the right hemisphere was affected. All the same effects occurred in reverse when subjects were presented with a black-and-white grid and instructed to see it in color. If this result is confirmed, it will be evidence that the hypnotic experience and the exercise of visual imagination correspond to different states of the brain. These experiments do not resolve the dispute about the nature of hypnosis, because other forms of absorption and concentration might produce similar effects. But the brain imaging research at least suggests that hypnotism has a real neurophysiological correlate. Hypnotic Therapy Despite their limited understanding of the nature of hypnosis, physicians and psychotherapists recommend it to manage stress, change physical sensations, and heighten emotional sensitivity. Altered states of consciousness that might now be called hypnotic have been a part of religious and healing rituals for thousands of years. Meditative techniques like the yogic mantra rely on similar procedures. In the late 19th century, Pierre Janet used hypnotic suggestion to reproduce the forms of mind-created anesthesia and paralysis that occur in patients with conversion disorders (at that time called hysteria). He introduced the term â€œdissociation of consciousnessâ€ to describe the condition. Freud was influenced by Janetâ€™s work, and although he eventually abandoned the practice of hypnosis, it left a mark on his idea of the dynamic unconscious. Today, the popularity of therapeutic hypnosis is sustained by the increasing interest in mind-body connections and alternative medicine. Hypnotic therapy attempts to take advantage of hypnotic subjectsâ€™ high sensitivity both to their own sensations and feelings and to everything the hypnotist says and does. One approach is simply to suggest that symptoms will go away. The results are rarely lasting, although even temporary relief can be important in some situationsâ€"acute illness or surgery, for example. Today, hypnosis is also applied in subtler ways, to help patients not by controlling them but by helping them take control. Therapists teach patients self-hypnosis and encourage them to make up their own suggestions. Hypnotic techniques are almost always used not alone but as an aid to psychotherapy or medical treatment. Despite Freudâ€™s rejection of hypnosis, some psychodynamic therapists have hypnotized patients to generate emotional reactions for examination, liberate fantasies and associations, retrieve memories, and accelerate the establishment and resolution of the transference (the relationship between patient and therapist that recapitulates earlier emotional ties). However, there is little evidence that these methods are effective, and they pose some danger of evoking unmanageable emotional reactions. In behavior therapy and cognitive therapy, hypnosis is used to enhance relaxation, generate imagery, heighten the expectation of success, and alter self-defeating thoughts. It can facilitate covert reinforcement, in which a patient imagines a reward after imagining the desired actions; and desensitization, in which relaxation and imagery are used to relieve anxiety and eliminate phobias. Therapeutic Uses One of the best confirmed therapeutic uses of hypnosis is the control of pain. Under hypnosis, patients can learn to alter their experience of pain by concentrating on the other parts of the body or making the painful area feel numb, warm, or cold instead. Images can be invokedâ€"a switch turning off the pain, an ice cube cooling an aching head, a vision of teeth being removed from the mouth before a dentist goes to work. Hypnosis can reduce the discomfort of medical procedures and, at least partially, control the pain of chronic backache, migraine, childbirth, and cancer. Hypnotic techniques have also been used with varying success to treat other physical symptoms, including bedwetting, sexual problems, asthma, warts, gastrointestinal disorders, and side effects of chemotherapy. Hypnosis has not proved effective for alcohol and drug addictions, although some practitioners believe it can help smokers quit. In the treatment of anxiety and phobias, hypnosis may serve to dissociate physical discomfort from mental anxiety and prevent a spiral of physical and emotional distress. Many people with phobias can use self-hypnosis to help master their fears. Hypnotic methods are also used to treat physical symptoms complicated by anxiety; for example, people with asthma can be taught to control their reactions to breathing difficulties. Hypnosis has been used in the treatment of post-traumatic stress disorder (PTSD) since World War I, when it was introduced as a therapy for shell-shocked soldiers. Experiences like combat, rape, assault, and child abuse often cause pervasive demoralization. Victims feel helpless, emotionally numb, and compelled to avoid reminders of the traumatic event. The experience returns in the shape of nightmares, flashbacks, and involuntary memories. Therapists who advocate hypnotic treatment describe it as a safe, comfortable, and voluntary form of dissociation that can help people suffering from post-traumatic symptoms to interrupt and control intrusive reliving experiencesâ€"and eventually, in some cases, to confront the past and free themselves from it. Dissociative identity disorder (formerly known as multiple personality disorder) is a controversial diagnosis given to people who, apparently because of severe child abuse, have lost access to various aspects of identity, memory, and consciousness. They may describe themselves as possessed, or abruptly enter altered states of consciousness in which they seem to adopt new personalities. These patients are highly hypnotizable, and hypnosis or self-hypnosis has been used to help them integrate disparate personalities by breaking the barriers of amnesia. Hypnosis and Memory Critics are concerned that a focus on recovering memories and reliving experiences will divert attention from the need to change present behavior, improve general functioning, and reduce symptoms in patients with PTSD or dissociative identity disorder. The hypnotic treatment of people suffering from the after effects of child abuse is particularly controversial because of fears that the recovered memories will be fictions resulting from suggestion acting on an all too lively imagination. There is some evidence that hypnotically induced memoriesâ€"often vivid, emotionally intense, and produced effortlesslyâ€"inspire greater confidence than they deserve. Studies show that hypnosis tends to cause people both to remember and to imagine more, thereby increasing both true and false memories. Responsible psychotherapists warn that autobiographical memories, whether evoked under hypnosis or not, should never be accepted without corroboration as historical truth. Controlled research has found hypnosis helpful in a variety of ways: One study evaluated the effectiveness of self-hypnosis for relieving pain and anxiety in people undergoing local anesthesia for angioplasty and other medical procedures. Compared with a control group, patients trained in self-hypnosis required half the amount of painkilling drugs on average and were less likely to have troublesome variations in blood pressure and heart rate. On average, hypnosis reduced the cost of intravenous sedation by more than $100 per patient and the time needed for the procedure by a third. Another study shows that self-hypnosis can be useful in preparing for childbirth and reducing labor pains. In this study, 66 pregnant adolescents were divided into three groups and assigned to hypnosis preparation, counseling, or standard care beginning in the sixth month of pregnancy. The first group was taught to use labor contractions as a signal to go into a mild hypnotic state. Compared with women in the other two groups, they needed less anesthesia during delivery, took less pain medication afterward, and left the hospital sooner. In a meta-analysis of 18 controlled studies, hypnosis was found to have provided significant pain relief for more than 75% of 900 patients. Another meta-analysis of 18 studies indicated that patients who received cognitive-behavioral therapy along with hypnosis for such problems as pain, obesity, insomnia, anxiety, and high blood pressure showed, on average, greater improvement than 70% of patients who received cognitive-behavioral therapy alone. Therapeutic research and psychological experiments have brought hypnosis out of the realm of magic. The hypnotic experience is not a fraud, not a placebo, not a panacea, but one striking and potentially illuminating effect of a common human capacity to experience changes in consciousness. As brain imaging and other new techniques improve our understanding of hypnosis, we will come to know better when and how it should be used in research and therapy." http://www.health.harvard.edu --------------------------------------------- http://www.twincities.com/mld/pioneerpress/6974868.htm Pioneer Press Posted on Sun, Oct. 12, 2003 HEALTH: Hypnosis gaining respectability among doctors, patients BY MICHAEL WALDHOLZ Wall Street Journal Hypnosis, often misunderstood and almost always controversial, is increasingly being employed in mainstream medicine. Numerous scientific studies have emerged in recent years showing that the hypnotized mind can exert a real and powerful effect on the body. The new findings are leading major hospitals to try hypnosis to help relieve pain and speed recovery in a variety of illnesses. At the University of North Carolina, hypnosis is transforming the treatment of irritable bowel syndrome, an often-intractable gastro-intestinal disorder, by helping patients to use their mind to quiet an unruly gut. Doctors at the University of Washington's regional burn center in Seattle regularly use it to help patients alleviate excruciating pain. Several hospitals affiliated with Harvard Medical School are employing hypnosis to speed up postsurgical recovery time. In one of the most persuasive studies yet, a Harvard researcher reports that hypnosis quickened the typical healing time of bone fractures by several weeks. "Hypnosis may sound like magic, but we are now producing evidence showing it can be significantly therapeutic," says David Spiegel, a Stanford University psychologist. "We know it works, but we don't exactly know how, though there is some science beginning to figure that out, too." Hypnosis can't help everyone, many practitioners say, and some physicians reject it entirely. Even those who are convinced of its effect say some people are more hypnotizable than others, perhaps based on an individual's willingness to suspend logic or to simply be open to the potential effectiveness of the process. GOING MAINSTREAM These days, legitimate hypnosis is often performed by psychiatrists and psychologists though people in other medical specialties are becoming licensed in it, too. It can involve just one session, but often it takes several â€" or listening to a tape in which a therapist guides an individual into a trancelike state. Whatever the form, it is increasingly being used to help women give birth without drugs, for muting dental pain, treating phobias and severe anxieties, for helping people lose weight, stop smoking or even perform better in thletics or academic tests. Many health-insurance plans, even some HMOs, now will pay for hypnosis when part of an accepted medical treatment. Until the past decade, many traditional science journals regularly declined to publish hypnosis studies, and research funding was scarce. That's changing. Spiegel, for instance, is co-author of a widely referenced randomized trial involving 241 patients at several prestigious medical centers. Published several years ago in the Lancet, a respected medical journal, it found that patients hypnotized before surgery required less pain medication, sustained fewer complications and left the hospital faster than a similar group not given hypnosis. Using new imaging and brain-wave measuring tools, Helen Crawford, an experimental psychologist at Virginia Polytechnic Institute in Blacksburg, Va., has shown that hypnosis alters brain function, activating specific regions that control a person's ability to focus attention. "The biological impact is very real and it can be quantified," Crawford says. STAYING LEGITIMATE Still, proponents say they typically spend a great deal of time dispelling commonly held myths and answering skeptics. Hypnosis, they say, cannot make people do or say something against their will. Credible hypnotists don't wave a watch in front of their clients, as portrayed in many old movies. People who enter into a so-called hypnotic trance are not, generally, put to sleep. On the contrary, practitioners say, they refocus their concentration to gain greater control. Even so, the field continues to be hurt by quacks, says Marc Oster, president of the American Society of Clinical Hypnosis. His group, along with the Society for Clinical and Experimental Hypnosis, publishes research studies, conducts educational seminars for health providers and certifies those who complete course work and meet other standards. Oster suggests that people interested in hypnosis see a health provider licensed in a medical discipline who is also certified by one of the hypnosis societies â€" someone who "uses hypnosis as an adjunct" to a principal medical practice. Researchers say that most people unwittingly enter into hypnosislike trances on their own in everyday life. When reading a riveting novel or watching a film or TV, many people are experiencing a trancelike state when they are so focused they become only vaguely aware of nearby noise, conversation or activity. In a dream, when someone imagines falling off a cliff and is startled awake by the sensation of falling, they are triggering the same mental machinery that in hypnosis allows the mind to influence the body, says Dabney Ewin, a psychiatrist at Tulane University Medical School. Katie Miley used self-hypnosis, taught to her by a Chicago-area psychologist, to help her give birth "without being so anxious and without pain medication." For weeks preceding the delivery, M


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