Research Database -
International Updates

Hypnosis / Relaxation

Issue 68

GILLANI and SMITH, Roosevelt University Stress Institute, Chicago, IL 60605, USA, attempted to rigorously map the psychological effects of Zen meditation among experienced practitioners.
Methods: 59 Zen meditators with at least 6 years experience practised 1 hour of traditional Zazen seated meditation. A control group of 24 college students silently read popular magazines for 1 hour. All subjects were assessed before meditation/relaxation using the Smith Relaxation States Inventory (SRSI), the Smith Relaxation Dispositions/ Motivations Inventory (SRD/MI) and the Smith Relaxation Beliefs Inventory (SRBI). After meditation/relaxation, subjects were assessed again on the SRSI.
Results: Assessments taken prior to practice revealed that meditators were less likely than control subjects to believe in God and more likely to believe in ‘Inner Wisdom’; and meditators were more likely to display the relaxation dispositions ‘Mental Quiet’, ‘Mental Relaxation’ and ‘Timeless/Boundless/Infinite’. Following practice of meditation/ relaxation, meditators showed greater increases than control subjects in the relaxation states ‘Mental Quiet’, ‘Love and Thankfulness’ and ‘Prayerfulness’. Meditators also showed reductions in ‘Worry’.
Discussion: The investigators concluded that the results supported Smith’s ABC Relaxation Theory.
Gillani NB, Smith JC. Zen meditation and ABC relaxation theory: an exploration of relaxation states, beliefs, dispositions, and motivations. Journal of Clinical Psychology 57 (6): 839-46. Jun 2001.

Comments: A most reassuring result!

Issue 65

TRAVIS and PEARSON, Psychology Department, Maharishi University of Management, Fairfield, IA 52557, USA explored subjective reports and physiological correlates of the experience of ‘consciousness itself’ – self awareness isolated from the processes and objects of experience – during Transcendental Meditation practice.
Discussion: Subjectively, the state of ‘consciousness itself’ is characterized by the absence of time, space and body sense and the qualities of inner and outer perception that define waking experiences. Physiologically this state involves apneustic breathing, autonomic orienting at the outset of breath changes, and increased frequency of peak EEG power. The authors present the ‘junction point model’, which integrates pure
consciousness with waking, dreaming or sleeping. This model may be
useful for testing the full range of consciousness, so enabling us to fully understand what it means to be human.
Travis F, Pearson C. Pure consciousness: distinct phenomenological and physiological correlates of ‘consciousness itself. The International Journal of Neuroscience 100 (1-4): 77-89. 2000.

BRAFFMAN and KIRSCH, Department of Psychology, University of Connecticut, Storrs 06269-1020, USA investigated hypnotic and nonhypnotic suggestibility in two experiments.
Results: In experiment 1, nonhypnotic suggestibility was suppressed when measured after hypnotic suggestibility, whereas hypnotic suggestibility was not affected by the order of assessment. Experiment 2 confirmed a small but significant effect of hypnosis on suggestibility when nonhypnotic suggestibility was measured first. Nonhypnotic suggestibility was correlated with absorption, fantasy proneness, motivation and response expectancy. However, only expectancy predicted suggestibility when other variables were controlled for. Behavioural response to hypnosis was predicted by nonhypnotic suggestibility, motivation and expectancy in a model accounting for 53% of the variance. The experimental response to hypnotic suggestibility was predicted only by nonhypnotic suggestibility. Unexpectedly, hypnosis decreased suggestibility in a substantial minority of participants.
Braffman W, Kirsch I. Imaginative suggestibility and hypnotizability: an empirical analysis. Journal of Personality and Social Psychology 77 (3): 578-87. Sep 1999.

VIDAKOVIC VUKIC, Sint Lucas Ziekenhuis, Department of Internal Medicine, Amsterdam, The Netherlands investigated hypnotherapy in the treatment of patients with irritable bowel syndrome (IBS).
Background: IBS is relatively common, but its cause and pathogenesis are still unknown. However, individual perceptions clearly play an important part in the pathogenesis of the hypersensitive/hyperreactive gut. There is no easy medical treatment for IBS. In recent years, however, hypnotherapy has been found to be a successful treatment.
Methods: The author reports recently starting treating IBS patients with hypnotherapy. All the patients had remained symptomatic despite medical therapy. The gut-targeted method of hypnotherapy was applied, with the view that therapy should be tailored to the individual in accordance with each person’s unique representative style.
Results: At the time of this report, 27 patients had been treated as described. The author describes the results as ‘good’, ‘comparable with results elsewhere’. 2 of the 27 patients stopped the therapy prematurely and 1 remained symptomatic. All the other 24 patients experienced clear improvement: pain and flatulence were reduced or eliminated, and bowel habits were normalized.
Conclusion: Based on data from the published literature and the author’s own findings, the author concludes that hypnotherapy is a valuable addition to conventional treatment of IBS. Further research is needed to: 1) improve knowledge of sensitivity to hypnotherapy; 2) recognize cases with greater hypersensitivity; and 3) recognize cases dominated by hypervigilance. More generally, there is a need for a theoretical model of hypnotherapy as applied to treating physiological disorders.
Vidakovic Vukic M. Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam. Scandinavian Journal of Gastroenterology (Supplement) 230: 49-51. 1999.

Comment: That hypnotherapy can be a valuable addition in the treatment programme for IBS is good news. See also Anne McIntyre’s column this issue on page 18.

Issue 63

KOSSLYN and colleagues, Department of Psychology, Harvard University, Cambridge, MA 02138, USA, smk@wjh.harvard.edu investigated whether hypnosis can modulate (modify) colour perception.
Background: If hypnosis can modify colour perception, this may provide insight into the nature and underlying mechanisms of hypnosis.
Methods: The researchers asked 8 highly hypnotisable individuals (under hypnosis) to see a) a colour pattern in colour, b) a similar grey-scale pattern in colour, c) the colour pattern as grey scale, or d) the grey-scale pattern as grey scale, while their brain activity was being monitored by positron emission tomography (PET) scanning using ((15)O)CO2. (The classic colour perception area in the fusiform or lingual region of the brain was identified from the results obtained when subjects were asked to perceive colour as colour versus when they were asked to perceive grey as grey.)
Results: During hypnosis, when subjects were asked to perceive colour, the colour perception areas of the left and right cerebral hemispheres were activated, whether or not they were actually shown the colour or grey-scale patterns. When subjects were asked to perceive grey scale, activity in these areas of the brain decreased, whether or not they were actually shown the colour or grey-scale patterns. The changes in the left hemisphere occurred only when the subjects were under hypnosis; whereas blood flow changes in the right hemisphere reflected instructions to perceive colour versus grey scale, whether or not the subjects were under hypnosis.
Conclusion: Changes in subjective experience achieved during hypnosis were reflected by changes in brain function that resembled those that occur in the actual process of perception. The results support the view that hypnosis is a psychological state with distinct neurological correlates rather than the result of simply adopting a role.
Kosslyn SM et al. Hypnotic visual illusion alters color processing in the brain. The American Journal of Psychiatry 157 (8): 1279-84. Aug 2000.

KALT, (No information re. affiliation/institution) reviewed (40 references) a number of key experiments and case studies relating to psychoneuroimmunology.
Discussion: Most techniques to influence or direct the immune system via the mind fall into the following theoretical categories: passive, active and targeted effects. A number of important conclusions are drawn from examining the results of experiments and case studies in the light of these categories, which are used to explain differences in experimental results, describe variables that seem to be central to obtaining (positive) results, and describe what future studies need to concentrate on to further knowledge of psychoneuroimmunology.
Kalt HW. Psychoneuroimmunology: an interpretation of experimental and case study evidence towards a paradigm for predictable results. The American Journal of Clinical Hypnosis (43 (1): 41-52. Jul 2000.

EIMER, Alternative Behavior Associates, Philadelphia, PA 19115, USA, brucecbt@philly.infi.net reviews (77 references) four specific applications of hypnosis that can enhance psychotherapy for pain management.
Discussion: Hypnosis can be used clinically in the following ways to make psychotherapy for pain management briefer, more goal oriented and more efficient: 1) to assess hypnotizability; 2) to induce hypnotic pain relief and develop individualised pain coping strategies; 3) use of direct suggestion, cognitive reframing, hypnotic metaphors and pain relief imagery; and 4) for brief psychodynamic reprocessing during the trace state of emotional factors in the patient’s experience of chronic pain. The author presents important theoretical and clinical issues regarding hypnotisability and the induction of hypnotic pain relief, describes possible ways of individualising pain treatment strategies, and presents ways of integrating various hypnotic methods to resolve unconscious sources of treatment resistance and reducing the emotional overlay associated with chronic pain.
Eimer BN. Clinical applications of hypnosis for brief and efficient pain management psychotherapy. The American Journal of Clinical Hypnosis 43 (1): 17-40. Jul 2000.
Comments: This research publication will be of extreme use to any patients in pain or hypnotherapists wanting to expand their repertoire of techniques to help patients cope with pain.

SIMON and LEWIS, Department of Psychology, Multi-Disciplinary Pain Clinic, Tripler Regional Medical Center, University of Hawaii, Hawaii, USA, EricSimon@yahoo.com examined the effectiveness of medical hypnosis in reducing the pain symptoms of temporomandibular disorders (TMD).
Methods: In this open-label (uncontrolled) study, 28 patients with TMD underwent medical hypnosis for TMD treatment and were assessed for their pain symptoms a) during wait list, b) before treatment, c) after treatment and d) at a 6-month follow-up. Pre- and post-treatment use of medical treatment was also examined.
Results: Patients reported significant decreases in pain frequency, pain duration and pain intensity and an increase in daily functioning. Analysis of the results suggested that the patients’ symptoms did not improve spontaneously, and that their benefits were maintained for 6 months after hypnosis treatment. In addition, after hypnosis, patients’ use of medical treatment was significantly reduced.
Conclusion: Medical hypnosis appears to be an effective treatment modality for TMD in terms of reducing both symptoms and medical (treatment) use.
Simon EP and Lewis DM. Medical hypnosis for temporomandibular disorders: treatment efficacy and medical utilization outcome. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 90 (1): 54-63. Jul 2000.

TOOLEY and colleagues, School of Psychology, La Trobe University, Victoria, Bundoora, Australia, investigated whether a period of meditation could influence plasma melatonin levels.
Methods: Two groups of meditators were tested, in a repeated measures design study, for plasma melatonin levels at midnight.
Results: Experienced meditators practising either TM-Sidhi or another internationally well known form of yoga had significantly higher plasma melatonin levels in the period immediately following meditation compared with the same period at the same time on a control night.
Discussion: It remains to be determined whether the changes in plasma melatonin levels induced by meditation are achieved through decreased hepatic metabolism of the hormone or via a direct effect on the pineal gland.
Conclusion: Meditation, at least in the forms studied here, can affect plasma melatonin levels. Facilitation of higher physiological melatonin levels at appropriate times of day may be one route via which the acclaimed health benefits of meditation occur.
Tooley GA et al. Acute increases in night-time plasma melatonin levels following a period of meditation. Biological Psychiatry 53 (1): 69-78. May 2000.

Rayman, Centre for Nutrition and Food Safety, School of Biological Sciences, University of Surrey, Guildford, UK. discussed the importance of selenium to human health.
Discussion: The essential trace mineral, selenium, is of fundamental importance to human health. Selenium has structural and enzymic roles, in the latter context being best known as an antioxidant and catalyst for the production of active thyroid hormone. Selenium is needed for the proper functioning of the immune system, and appears to be a key nutrient in counteracting virulence and inhibiting HIV progression to AIDS. It is required for sperm motility and may reduce the risk of miscarriage. Deficiency has been linked to adverse mood states. Findings have been equivocal in linking selenium to cardiovascular disease risk although other conditions involving oxidative stress and inflammation have shown benefits of a higher selenium status. An elevated selenium intake may be associated with reduced cancer risk. Large clinical trials are now planned to investigate this hypothesis. In the context of these health effects, low or diminishing selenium status in some parts of the world, notably in some European countries, is giving cause for concern.
Rayman MP. The importance of selenium to human health. Lancet 356 (9225): 233-41. Jul 2000.

Issue 57

GREEN and LYNN, Ohio State University, Lima 45804, USA have reviewed (96 references) the evidence for hypnosis and suggestion-based approaches to smoking cessation.
Discussion: This article reviews 59 studies of hypnosis and smoking cessation as to whether the research empirically supports hypnosis as a treatment. Whereas hypnotic procedures generally yield higher rates of abstinence relative to wait-list and no-treatment conditions, hypnotic interventions are generally comparable to a variety of non-hypnotic treatments. The evidence for whether hypnosis yields outcomes superior to placebos is mixed. In short, hypnosis cannot be considered a specific and efficacious treatment for smoking cessation. Furthermore, in many cases, it is impossible to rule out cognitive/behavioural and educational interventions as the source of positive treatment gains associated with hypnotic treatments. Hypnosis cannot, as yet, be regarded as a well-established treatment for smoking cessation. Nevertheless, it seems justified to classify hypnosis as a "possibly efficacious" treatment for smoking cessation.
Green JP and Lynn SJ. Hypnosis and suggestion-based approaches to smoking cessation: an examination of the evidence. International Journal of Clinical and Experimental Hypnosis 48(2): 195-224. Apr 2000.

LYNN and colleagues, Psychology Department, State University of New York at Binghamton 13902, USA, have reviewed the evidence for hypnosis as an empirically supported clinical intervention.
Discussion: This article summarizes the evidence for the effectiveness of hypnosis as an empirically supported clinical intervention. Generally, the clinical research to date generally substantiates the claim that hypnotic procedures can ameliorate some psychological and medical conditions, as judged against the Chambless and Hollon methodological guidelines. In many cases, these clinical procedures can also be quite cost-effective. It is probable that with some key empirical refinement a number of other hypnosis treatment protocols will have sufficient empirical documentation to be considered well established. However, it is noted that the Chambless and Hollon guidelines are not particularly well suited for assessing hypnosis' impact when used adjunctly with other interventions. The authors concluded with recommendations regarding the efficacy questions that need to be more fully addressed empirically and offers methodological guidelines for researchers and practitioners.
Lynn SJ et al. Hypnosis as an empirically supported clinical intervention: the state of the evidence and a look to the future. International Journal of Clinical and Experimental Hypnosis 48(2): 239-59. Apr 2000.

MONTGOMERY, DUHAMEL and REDD, Cancer Prevention and Control Program, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. guy.montgomery@mssm.edu investigated the effectiveness of hypnotically induced analgesia.
Background: Over the past two decades, hypnoanalgesia has been widely studied. However, no systematic attempts have been made to determine the average size of hypnoanalgesic effects or establish the generalizability of these effects from the laboratory to the clinic. This study examines the effectiveness of hypnosis in pain management, comparing studies that evaluated hypnotic pain reduction in healthy volunteers versus those using patient samples, compares hypnoanalgesic effects and participants' hypnotic suggestibility, and determines the effectiveness of hypnotic suggestion for pain relief relative to other non-hypnotic psychological interventions.
Results: Meta-analysis of 18 studies revealed a moderate to large hypnoanalgesic effect, supporting the efficacy of hypnotic techniques for pain management. The results also indicated that hypnotic suggestion was equally effective in reducing both clinical and experimental pain. The overall results suggest broader application of hypnoanalgesic techniques with pain patients.
Montgomery GH et al. A meta-analysis of hypnotically induced analgesia: how effective is hypnosis? International Journal of Clinical and Experimental Hypnosis 48(2): 138-53. Apr 2000.

Comment: The effectiveness of hypnosis for pain management is an exciting issue as its application is widespread throughout medicine. In addition, it is a relatively cheap treatment and side effects are minimal.

PINNELL and COVINO, Arizona School of Professional Psychology, USA have reviewed the use of hypnosis in medicine.
Discussion: Recent changes in health care have been characterized by an increased demand for empirically supported treatments in medicine. Presently, there is moderate support for the integration of hypnotic techniques in the treatment of a number of medical problems. The authors have critically reviewed the research literature focusing on the empirical research on the effectiveness of hypnotic treatments as adjuncts to medical care for anxiety related to medical and dental procedures, asthma, dermatological diseases, gastrointestinal diseases, haemorrhagic disorders, nausea and emesis in oncology, and obstetrics/ gynaecology. Wider acceptance of hypnosis as an intervention to assist with medical care will require further research.
Pinnell CM and Covino NA. Empirical findings on the use of hypnosis in medicine: a critical review. International Journal of Clinical and Experimental Hypnosis 48(2): 170-94. Apr 2000.

Issue 54

SHENEFELT, Department of Internal Medicine, College of Medicine, University of South Florida, Tampa 33612 USA. pshenefe@hsc.usf.edu writes that hypnosis has been used since ancient times to treat medical and dermatological (skin) problems. The authors review (87 references) the literature regarding the uses for hypnosis as a treatment in skin practice.
Methods: The author conducted a MEDLINE search between January 1966 through December 1998 using key words related to hypnosis and skin disorders.
Results: Hypnosis, used as an alternative or complementary therapy can improve or cure a wide range of skin disorders including acne excoriee, alopecia areata, atopic dermatitis, congenital icthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris and vitiligo.
Conclusions: Clinicians trained appropriately may successfully treat patients with many skin disorders using hypnosis.
Shenefelt PD. Hypnosis in dermatology. Archives of Dermatology 136(3): 393-9. Mar 2000.

LYNN and SHERMAN, Psychology Department, State University of New York at Binghamton 13902 USA reviews (90 references) and documents the contributions and clinical relevance of influential sociocognitive models of hypnosis.
Discussion: The authors argue that an appreciation of the influence and interplay of sociocognitive constructs, combined with a knowledge of basic research findings, can contribute to sound clinical practice. This review extends previous statements of response set theory by further elucidating the social and cognitive underpinnings of how response sets are established, maintained, and strengthened, by providing a scientific rationale for Milton Erickson's most prominent strategic interventions.
Lynn SJ and Sherman SJ. The clinical importance of sociocognitive models of hypnosis: response set theory and Milton Erickson's strategic interventions. The American Journal of Clinical Hypnosis 42(3-4): 294-315. Jan-Apr 2000.

Comments: For an interesting example of Milton Erickson's techniques see also Hypnotherapy for Health: Modelling Erickson by Steve Nichols, page 14).

BARBER, Research Institute, Ashland MA 01721 USA reviews (165 references) the literature regarding clinical hypnosis.
Background: The author writes that numerous research projects converge on the conclusion that there are three major types of very good or highly responsive hypnotic subjects: a) fantasy-prone individuals who have secretly spent much of their time since childhood fantasizing vividly and realistically; b) amnesia-prone individuals who have developed special abilities for mentally repressing or compartmentalizing undesired memories, thoughts and emotions; and c) positively-set individuals who are maximally ready to cooperate, think-with, and imagine what is suggested to the best of their ability while letting go of contrary thoughts.
Discussion: The major principle which provides a deep understanding of hypnosis and hypnotic phenomena is that all hypnotic subjects are affected, albeit in different ways for different types of subjects, by four powerful behaviour-determining factors which can be maximized in hypnotic situations: a) social factors which obligate the socialized subject to cooperate and try to actualize or realize the hypnotists's expectations and explicit suggestions; b) the hypnotist's unique skills and personal characteristics (including creative ideas, communicative ability, and interpersonal efficacy) and the nature of the hypnotist-subject interpersonal relationship; c) the effectiveness of the induction procedure in guiding the subject to think-with the suggestions; and d) the depth of meaning, creativity, and 'force' or 'power' of the suggested ideas.
Barber TX. A deeper understanding of hypnosis: its secrets, its nature, its essence. The American Journal of Clinical Hypnosis 42(3-4): 208-72. Jan-Apr 2000.

ANTONI and colleagues, Department of Psychology, University of Miami, Coral Gables, Florida 33124 USA. mantoni@umiami.ir.miami.edu studied the effects of a multimodal cognitive-behavioural stress management (CBSM) intervention upon mood, stress, and immune parameters in symptomatic HIV+ gay men.
Methods: The authors recruited 73 men to this study, who were randomized to either a group-based CBSM intervention (n = 47) or to a waiting list control (WLC) group (n = 26). Outcome measures included anxious mood, perceived stress, 24-hour urinary catecholamine levels and changes in T-lymphocyte subpopulations over time.
Results: Compared with the waiting list controls, men in the CBSM group showed significantly lower posttreatment levels of self-reported anxiety, anger, total mood disturbance and perceived stress and less norephinephrine (NE) output. At the individual level anxiety decreases paralleled NE reductions. There were significantly greater numbers of T-cytotoxic/suppressor (CD3+CD8+) lymphocytes found 6-12 months later in the CBSM group. Additionally, greater decreases in NE output and a greater frequency of relaxation home practice during the 10-week CBSM intervention predicted higher CD3+CD8+ cell counts at follow-up.
Antoni MH et al. Cognitive-behavioral stress management intervention effects on anxiety, 24-hr urinary norephinephrine output, and T-cytotoxic/suppressor cells over time among symptomatic HIV-infected gay men. Journal of Consulting and Clinical Psychology 68(1): 31-45. Feb 2000.

Comments: A highly significant result, which hopefully can be integrated into clinical practice for HIV+ gay men.

Issue 43

POTTS and colleagues, University Department of Psychiatry, Royal Edinburgh Hospital UK used a psychological treatment regime to treat patients with chest pain despite normal cardiac measures.
Methods: 60 patients with continuing chest pain and who had normal angiography had a psychological treatment package, consisting of education, relaxation, breathing training, graded exposure to activity and exercise and challenging automatic thoughts about heart disease. The treatment was delivered in 6 sessions over 8 weeks for groups of up to 6 patients. Patients maintained daily records of chest pain episode frequency and nitrate use. Questionnaires assessed anxiety, depression and disability. Exercise tolerance was assessed using treadmill electrocardiography, and assessment of hyperventilation was carried out capnographically. The results of these patients were compared to waiting-list controls.
Results: The psychological treatment regimes significantly reduced chest pain episodes from a median 6.5 to 2.5 per week. There were significant improvements in anxiety and depression scores, disability rating and exercise tolerance, which were maintained at 6-month follow-up. The treatment reduced hyperventilation prevalence from 54% to 34%, but not the prevalence of ECG-positive exercise tests. Those patients who continued to attribute their pain to heart disease had poorer outcomes.
Conclusions: Group psychological treatment for non-cardiac chest pain is feasible, reduces pain, psychological morbidity, disability and improves exercise tolerance.
Potts SG et al. Group psychological treatment for chest pain with normal coronary arteries. Qjm 92(2): 81-6 Feb 1999.

GYSIN, (No affiliation provided) writes that chronic and episodic headaches in children and adolescents are a common problem, and that the growing resistance against the frequent use of drugs is quite justified. The author conducted a study in order to search for other helpful therapeutic approaches.
Methods: The author compared the effect of 5 sessions of hypnosis/ self-hypnosis given at weekly intervals for 30 minutes with two other psychological treatments each requiring the same amount of time, behaviour therapy and talking to the doctor.
Results: Despite the small number of patients, both types of treatments were effective. The hypnosis/self-hypnosis appeared to be superior not only in terms of frequency and intensity of headaches, but also regarding the patients’ ability to keep their headaches and well-being under control.
Gysin T. Clinical hypnotherapy/self-hypnosis for unspecified, chronic and episodic headache without migraine and other defined headaches in children and adolescents. Forschende Komplementarmedizin 6(1): 44-6. Feb 1999.

BUCHSER, (No affiliation provided) conducted a controlled clinical trial to evaluate hypnosis and self-hypnosis as an adjuvant treatment for the instrumental and pharmacological management of chronic pain.
Methods: The study was conducted at a hospital specialising in the treatment of outpatients suffering from chronic pain. Hypnosis and self-hypnosis were administered and taught by nurses who had been trained recently for this very purpose.
Results: Under the conditions of the study, it was not possible to measure an effect of hypnosis upon pain, despite subjective feeling of usefulness. However, it needs to be taken into account that this form of adjuvant therapy was used for the first time in that hospital for the purpose of the study, and therefore, occurred within an artificial setting. It is, therefore possible that the same therapy administered in the proper therapeutic environment of a specialised institution could demonstrate effects upon pain.
Buchser E. Hypnosis and self-hypnosis administered and taught by nurses for relief of chronic pain: a controlled clinical trial. Forschende Komplementarmedizin 6(1): 41-3. Feb 1999.

Issue 42

ROBINSON and colleagues, Catholic Health Partners, Chicago, IL USA write that psychoneuroimmunology (PNI) is the study of the interrelationships among behaviour, neural and endocrine function and the immune system, and studies the relationships among stress, physiological dysregulation and health outcomes.
Background: Published research has documented the theory that emotional distress and the resulting neuroendocrine activation may induce suppression of the immune system, with significant implications for disease susceptibility and progression.
Results: The authors explore the literature regarding HIV disease and its extensive immunological consequences within the framework of PNI. Within the context of HIV disease, potential physiological pathways which may mediate stress-induced dysregulation are identified, and key HIV-related PNI research are reviewed (56 references) and critically analysed. The authors also discuss implications for nursing practice and research.
Robinson FP et al. Stress and HIV disease progression: psychoneuroimmunological framework. J Assoc Nurses Aids Care 10(1): 21-31. Jan-Feb 1999.

LEAHY and colleagues, Department of Gastroenterology, Royal Free Hospital London studied the effectiveness of a computer biofeedback game designed to teach deep relaxation for patients with irritable bowel syndrome.
Methods: The authors conducted an open, prospective single centre study at the Royal free Hospital, London with 40 patients with irritable bowel syndrome refractory to conventional treatment. The main outcome measures were the development of a computer aided biofeedback apparatus directed at the gut for teaching relaxation to patients with irritable bowel syndrome, and the patients’ ability to complete a computer game involving biofeedback relating changes in stress to animated computer graphics. The degree to which deep relaxation was achieved was measured numerically by a progressive reduction in sensitivity level of the biofeedback loop. The success of relaxation was measured with daily diaries in which global and weighted bowel symptom scores were entered.
Results: A computer biofeedback game based on animated gut imagery was successfully developed. Most patients learned to achieve progressively deeper levels of relaxation after four 30-minute biofeedback sessions. The use of ‘dosed’ relaxation when bowel symptoms were troublesome helped in 50% of patients, reducing the global symptoms score (mean difference 0.5) and the bowel symptoms score (mean difference 0.8). At long-term follow-up, 64% of patients who had been helped by dosed relaxation, continued to use the technique, even though they had no further contact with the hospital.
Conclusions: The computer biofeedback game taught deep relaxation rapidly and effectively. 50% of the patients with refractory irritable bowel syndrome found the technique helpful on most occasions on which it was used. Therefore, computer biofeedback games may offer a simple, inexpensive strategy for managing other stress related medical conditions.
Leahy A et al. Computerised biofeedback games: a new method for teaching stress management and its use in irritable bowel syndrome. J R Coll Physicians Lond 32(6): 552-6 Nov-Dec 1998.

Issue 24

MEURISSE and colleagues, Service de Chirurgie des Glandes Endocrines et Transplantation, Centre Hospitalier Universitaire de Liege, Belgium performed 108 thyroidectomies (97 partial or unilateral and 11 bilateral) and 13 cervical explorations for hyperparathyroidism under hypnosedation (HS) technique, which combines hypnosis and light conscious sedation. METHODS: Informed consent was obtained from each patient; none of these patients underwent preoperatively standard susceptibility test score or preparatory hypnotic session. Despite this, no patient required conversion to general anaesthesia. Operative data and postoperative courses were compared to a well-matched population (n = 70) of patients operated on for thyroid diseases using general anaesthesia (GA). RESULTS: with HS, mortality was zero and surgical management complicated only by unilateral definitive recurrent laryngeal nerve paralysis in one case and the need for neck reexploration for severe haematoma following parthyroidectomy in another case. In all cases hyperparathyroidism was cured. Surgeons all reported superior operating conditions for cervicotomy using HS, which is probably related to reduced bleeding within the operative field. All patients reported a very pleasant experience and enjoyed having their surgery performed under HS. Patients having HS had less postoperative pain, analgaesic consumption was significantly reduced in the HS group compared with the GA group, and hospital stay was significantly lower, resulting in a substantial reduction in medical care costs. Postoperative fatigue syndrome and surgical convalescence were significantly improved following HS; full return to social or professional activity was usually achieved after 10.3 days in the HS group compared to 36 days in the GA group. CONCLUSIONS: HS is a very effective technique for providing relief of intra- and postoperative pain in endocrine surgery. The technique results in high patient satisfaction and improved surgical convalescence. The technique can be used in most motivated patients and reduces the socioeconomic impact of hospitalisation.
Meurisse M et al. Endocrine surgery by hypnosis. From fiction to daily clinical application. Ann Endocrinol (Paris) 57(6): 494-501. 1996.

ASHTON and colleagues, Department of Surgery, College of Physicians & Surgeons, Columbia University, New York NY USA conducted a study to evaluate the effects of self-hypnosis and its role in coronary artery bypass surgery. The authors hypothesised that self-hypnosis relaxation techniques would have a positive effects upon the patient’s mental and physical condition following coronary artery bypass surgery. METHODS: In the prospective, randomised trial at Columbia Presbyterian Medical Center, patients were followed, commencing one day prior to surgery until time of hospital discharge. All patients undergoing first-time elective coronary artery bypass surgery were eligible and the 32 patients who were recruited to the trial were randomised into two groups. The study group was taught self-hypnosis relaxation techniques preoperatively; the control group received no therapy. Outcome variables included anaesthetic requirements, operative parameters, postoperative pain medication requirements, quality of life, hospital stay, major morbidity and mortality. RESULTS: Compared to the control group, the patients who had been taught self-hypnosis relaxation techniques were significantly more relaxed postoperatively. Those patients who practised the self-hypnosis relaxation techniques required significantly less pain medication than those who did not. There were no differences seen in intraoperative parameters, morbidity or mortality. CONCLUSIONS: The research demonstrates the beneficial effects of self-hypnosis relaxation techniques on patients undergoing coronary artery bypass surgery and also provides a framework in which to study complementary techniques and the limitations encountered.
Ashton C Jr et al. Self-hypnosis reduces anxiety following coronary artery bypass surgery. A prospective, randomised trial. J Cardiovasc Surg (Torino) 38(1): 69-75. Feb 1997.

COMMENTS: It is encouraging to read of the application of hypnosis techniques to surgical protocol, with its resultant improved prognosis and reduction in pain medication.

SCHREIBER, Rowan College of New Jersey USA studied whether group hypnosis would improve college students’ examination grades. METHODS: The examination grades of a midterm and final test of 30 educational psychology students who had been hypnotised were compared with those of 2 control groups of 35 and 32 students. RESULTS: Compared with the control groups, the hypnotised group had a significantly higher mean score on the final examination, although midterm exam differences were not significant. Further research suggestions are outlined.
Schreiber EH. Use of group hypnosis to improve college students’ achievement. Psychol Rep 80(2): 636-8. Apr 1997.

Issue 20

YUNG and KELTNER, Department of Health Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong compared the efficacy of muscle versus cognitive relaxation procedures to reduce blood pressure. METHODS: 30 borderline hypertensive patients were assigned to muscle tense release, muscle stretch release and cognitive relaxation procedures, placebo attention and test only control conditions. The groups were matched for pre-treatment systolic blood pressure, sex and age. The relaxation procedures were designed so as to be distinctive for each condition so that cognitive and muscle procedures were not confounded. RESULTS: Both cognitive and muscle relaxation techniques were superior in reducing blood pressure compared to controls. The muscle tense release procedure was the most effective procedure. CONCLUSIONS: These results dispute the common assumption that an amalgam of these two components (muscle tense and cognitive) is most effective and support previous results that muscularly oriented relaxation methods seem to be more effective in the treatment of somatic problems. The practical and theoretical significance of emphasising a muscle relaxation approach in clinical practice and in further studies is discussed.
Yung PM and Keltner AA. A controlled comparison on the effect of muscle and cognitive relaxation procedures on blood pressure: implications for the behavioural treatment of borderline hypertensives. Behav Res Ther 34(10): 821—6. Oct 1996.

SCHULZ-STUBNER, Klinik fur Anasthesiologie und Intensivmedizin des Kreiskrankenhauses Grevenbroich Germany write that hypnosis can be an alternative to cerebral sedatives, especially in high-risk and fearful patients, with no side effects for sedation during regional anaesthesia. METHODS: Patients experienced with techniques such as Jakobson's progressive muscle relaxation are very good hypnosis candidates, but hypnosis is contraindicated in patients with psychotic disorders, major depression and hallucinogenic drug abuse. The authors describe his personal method of hypnosis used in 10 cases, based upon fixation and suggestive techniques including muscle relaxation, temperature sensation and the creation of emotional pictures. RESULTS: Hypnosis was successful in 6 out of 10 cases, not completely successful in 2 cases where hypnosis was interrupted after 30 minutes and was unsuccessful in 2 individuals. Vegetative stress symptoms such as tachycardia and shivering ceased immediately following induction. Described are 4 individuals where hypnosis was used during spinal anaesthesia for knee and hip surgery or brachial plexus block for open fixation of Colles' fracture. CONCLUSIONS: Because hypnosis requires more time – 15—45 minutes – to inform and test patients, and special organisational conditions, it may not become a routine procedure, but yet hypnosis offers a good alternative in selected cases.
Schulz-Stubner S. Hypnosis – a side effect-free alternative to medical sedation in regional anaesthesia. Anaesthesist 45(10): 965—9. Oct 1996.

SOMMERS-FLANAGAN and SOMMERS-FLANAGAN, University of Montana, School of Education, Missoula USA describe a general approach called Wizard of Oz hypnotherapy. METHODS: This approach is designed for use with 8—13 year-old children who are often difficult to treat due to their inattention, impulsive and oppositional characteristics. The authors use this approach as an adjunct to cognitive-behavioural therapy individually and within small groups. The Wizard of Oz metaphor is integrated into a hypnotherapy approach which is designed to help problem-solving, improve self-regulation skills and enhance self-esteem and efficacy. RESULTS: Used as an adjunct to cognitive-behavioural therapy, this procedure improves the therapeutic relationship, raises young client's interest in therapy methods and improves overall treatment cooperation. Described and discussed are the therapeutic and hypnotic characteristics contributing to this technique's effectiveness.
Sommers-Flanagan J and Sommers-Flanagan R. The Wizard of Oz metaphor in hypnosis with treatment-resistant children. Am J Clin Hypn. 39(2): 105—14. Oct 1996.

MOORE and WIESNER, Kaiser Permanente, Oakland California USA studied the effectiveness of behaviourally-induced vasodilation – hypnosis incorporating biofeedback and autogenics – for the treatment of upper extremity repetitive strain injuries (RSI). METHODS: 30 patients suffering from recent onset of upper extremity RSI symptoms were randomly assigned to either hypnotically-induced vasodilation or a waiting-list control. Treatments were performed individually, once per week for 6 weeks. RESULTS: Compared to the controls, patients in the hypnosis group showed highly significant increases in hand temperature between pre- and post-treatment and highly significant reductions in pain.
Moore LE and Wiesner SL. Hypnotically-induced vasodilation in the treatment of repetitive strain injuries. Am J Clin Hypn 39(2): 97—104. Oct 1996.

JOHNSON and KARKUT write that studies of hypnotic, covert and overt aversive techniques have yielded equivocal results regarding effect upon weight loss and examined the use of combinations of techniques. METHODS: The authors studied the effects of 2 programmes of hypnosis, imagery, diet, tape, behaviour management and support which differed in the overt use of aversion – electric shock, disgusting tastes and smells. Of 172 overweight adult women, 86 women were treated in a hypnosis only and 86 women in an overt aversion and hypnosis regimen. RESULTS: Significant weight losses were achieved with both programmes. Compared with the women treated only with hypnosis, the women receiving overt aversion achieved somewhat more desired goals and lost more weight, but the differences between the groups were not significant.
Johnson DL and Karkut RT. Participation in multicomponent hypnosis treatment programs for women's weight loss with and without overt aversion. Psychol Rep 79(2): 659—68. Oct 1996.

FIELD and colleagues, Touch Research Institute, University of Miami School of Medicine, Florida USA studied the use of massage for anxiety and alertness. METHODS: 26 adults were given a chair massage; 24 control adults simply relaxed in the massage chair for 15 minutes, twice per week for 5 weeks. EEG was monitored on the first and last study days, prior to, during and following the sessions. Also before and after the sessions the people performed math computations, complete the POMS Depression and State Anxiety Scales and gave a saliva sample to be evaluated for cortisol. Prior to the beginning of the sessions they completed Life Events, Job Stress and Chronic POMS Depression Scales. RESULTS: 1) Frontal delta power increased in both groups, which suggested relaxation; 2) The group which was massaged showed decreased frontal alpha and beta power, suggesting enhanced alertness, while the controls showed increased alpha and beta power; 3) The massage group showed increased speed and accuracy on math computations, whereas there was no change in the control group; 4) Anxiety levels decreased following the massage, but not the control sessions, although mood state was less depressed following both the massage and control sessions; 5) Levels of salivary cortisol were lower following massage, only on the first day, but not at all following the control sessions; 6) Depression scores were lower for both groups at the end of 5 weeks and job stress scores were lower only in the massage group. CONCLUSIONS: Massage therapy reduced anxiety and enhanced alertness.
Field T et al. Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations. Int J Neurosci 86(3—4): 197—205. Sep 1996.

STENSTROM and colleagues, Department of Rheumatology, Malarsjukhuset, Eskilstuna, Sweden compared dynamic training versus muscle relaxation for patients with inflammatory rheumatic diseases. METHODS: 54 patients, mean age of 54 years, mean symptom duration 14 years were randomised to either a dynamic training programme or a muscle relaxation training programme for home use. Following personal instructions, each patient exercised at home for 30 minutes, 5 days per week for 3 months. Prior to and following the interventions, all patients were assessed for health-related quality of life, joint tenderness and physical capacities. RESULTS: The dynamic training group improved in perceived exertion at the walking test and the relaxation training group had improved their total Nottingham Health Profile, its subscale for lack of energy, Ritchie's articular index, muscle function of lower extremities and arm endurance. There was a significant difference between the groups in favour of the relaxation training group regarding changes in muscle function of the lower extremities. CONCLUSIONS: These results indicate that progressive relaxation training may improve health-related quality of life, reduce joint tenderness and be superior to dynamic muscle training to improve muscle function of the lower extremities in patients with inflammatory rheumatic diseases. Because the clinical effects were small, the results must be interpreted with caution.
Stenstrom CH et al. Dynamic training versus relaxation training as home exercise for patients with inflammatory rheumatic diseases. A randomized controlled study. Scan J Rheumatol 25(1): 28—33. 1996.

COMMENTS: It is incredibly heartening to read of the wide ranging array of research to which relaxation and hypnosis is being applied.