Ipa november pediatric hypnosis no video

Franz Baumann
The first pediatrician elected President of the
American Society of Clinical Hypnosis (1950-1970)

Learning Objectives
Objective #1: What is pediatric hypnosis?
Developmental and Experiential Component
Objective #2: Pediatric hypnosis – efficacy &
applications?
Objective #3: Training & integrating into your practice

Thesis
Clinical pediatric hypnosis is a tool to
facilitate the evolution and refinement of
self-regulation skills and capacities.

Ego Integrity
vs. Despair
Working Toward Mastery
Intimacy vs.
Isolation
Trust vs.
Mistrust
Identity vs.
Role
Confusion
Autonomy
vs. Shame
& Doubt
Initiative
vs. Guilt
Industry
vs.
Inferiority
Generativity
vs.
Stagnation
Erik Erikson’s 8 Psycho-Social Stages of Development
Pendergrast and Lombard, March 22, 2014

Definitions of hypnosis
Hypnosis: a state of consciousness involving focused
attention and reduced peripheral awareness
characterized by an enhanced capacity for response to
suggestion.
Hypnotizability: an individual’s ability to experience
suggested alterations in physiology, sensations,
emotions, thoughts, or behavior during hypnosis.
Hypnotherapy: The use of hypnosis in the treatment of
a medical or psychological disorder or concern.
www.lisalombardphd.com
The American Psychological Association Division 30, 2014

Hypnosis is a state of inner absorption, concentration and
focused attention. It is like using a magnifying glass to focus
the rays of the sun and make them more powerful. Similarly,
when our minds are concentrated and focused, we are able to
use our minds more powerfully. Because hypnosis allows
people to use more of their potential, learning self-hypnosis is
the ultimate act of self-control.... Recent research supports the
view that hypnotic communication and suggestions effectively
changes aspects of the persons physiological and neurological
functions.
American Society of Clinical
Hypnosis Website

A spontaneously occurring or induced alternative
state of awareness (with or without relaxation,
which may or may not be evident) in which an
individual develops a focused concentration on
some idea or image with the expressed purpose
of maximizing potential, creating a CHANGE,
and/or reducing or resolving some problem (Kohen
and Olness, 2011).

Hypnotizability
Essential traits needed to be
hypnotized include:
 being able to focus one’s attention
 being highly responsive to
suggestion.
(Brown & Fromm, 1986)

Hypnosis myths
Bad hypnosis cartoons
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What limits hypnotizability and
effectiveness?
 Misconceptions about hypnosis.
 May see hypnosis as “magic”
 May refuse because of secondary gain of symptoms.
 Attitudes of significant adults
 Parents

Pediatric Hypnosis
A tool to strengthen children‘s existing or
under-developed skills in self-regulation,
i.e., capacities to shift attention, maintain
focused attention, inhibit and control
reflexive actions, delay gratification, use
problem solving strategies, and self-monitor
and modulate thinking, emotion, behavior,
and psycho-physiological reactivity.
Kaiser, P. Chlldhood Anxiety, Worry, and Fear: Individualizing Hypnosis Goals and
Suggestions for Self-Regulation. Am. J. Clin. Hypn. 2011, 54, 16–31

Daily and Random
Hypnotic Experiences
 TV/video games
 Sports trance…in the zone
 Daydreaming
 Booboo and runs to parent
 At the hospital, doctor’s office

 http://youtu.be/XhLrlhFzAjA
Notice how Disney Introduction uses many of
the same elements:
absorption, narrowed focus, multi-sensory
input, novelty, curiosity about what comes next,
etc.

Pediatric Clinical Hypnosis –
Many Shapes
Formal
Conversational
Spontaneous
Self-hypnosis
Books
Drawings
Materials
(monotonous)
Metaphors

Imaginative involvement
 Process where the child is absorbed in a "here and now" fantasy
experience
 Present reality is suspended in the interests of the current experience
 Used with younger children
 Used instead of classic hypnosis
 Must pay attention to the (changing) behavioral responses of young
children
 Different from Classic Hypnosis which may involve:
 dissociated ego state
 profoundly relaxed physiological state
 distinct altered state of consciousness

Developmental differences in
hypnotic processes
Younger children
 less structured
more action-oriented
 present-centered
Children 7 years and older
 Ability to close eyes during hypnosis
 Use creative imagination
More structured
Hypnotic process in adults
 Structured
 Ability to close eyes
More relaxation

Clinical Hypnosis across development:
Infants and toddlers
Infants and toddlers understand the world through sensory
experiences
Hypnosis in infants and toddlers:
 Sensory or motor based techniques
 Auditory
 Playing soothing music, singing songs- lullabies, telling a story
 Kinesthetic
 Rocking- example would be rocking at a pace that approximates maternal heart beat
 Soothing
 Repetition, familiarity, predictability
 Minimally verbal, direct, simple
 Integration of play and hypnotic suggestion

Across Development: Preschool
Years
Preschoolers
 Language
Simple and clear; Cognitively concrete and literal in their communication and
comprehension
 Flexibility
Follow child in and out of trance in a sensitive manner; Unaccustomed to physical
relaxation; Move fluidly between fantasy and reality; Move around with eyes open
during hypnosis without effecting trance
 Attention
Absorb child's attention in an informal manner; Short attention spans
 Avoid lengthy inductions

School Age Children
C Cognitive functioning
 Longer attention spans
 Better cooperation
 Ability to use imagination
 More willing to close eyes
 Can relax their bodies
 Breathing is more regular
 Metaphors and suggestions
 Focused facial expressions
 Tell child that hypnosis is a
talent that can be used
anywhere
 Use child's personal
experiences to make hypnosis
relevant

Induction and Deepening
Techniques with Children
 Eyes open story
 Mighty oak tree
 Raggedy Ann doll
 Progressive muscle
relaxation (e.g.,
imagery such as
melting snowman)
 Favorite place, song,
activity…
 T.V., movie, computer
game
 Bouncing ball
adventure
 Boat ride, magic
carpet ride, ride in
clouds
 Fill sand pail
 Eye fixation
 Distraction
 Ideomotor techniques

Using Hypnosis in Child
Therapy

Thinking
(Cognition)
Feeling (Affect)
Treatmen
t Goals
Doing (Behavior)
Sensing
(Physiological/Sensory)

Manage
Symptoms
Interrupt Old
Patterns/
Create New
Patterns
Improve Self-
Regulation
Build Positive
Expectancies
Develop
Discrimination
Skills
Enhance
Resources
Model based on Pamela Kaiser’s
work

Elements of Hypnotherapy
 Rapport
 Induction and Intensification
 Suggestions/Metaphors/Themes
 Check-in with patient
 Contextualization/PHS
 Closure, Alert, and Orient
 Debrief

Only describe what you
notice
Rather than,
“you are feeling relaxed now…”
invite the patient to notice differences or
change…
??????
“Let me know please when you are
beginning to notice the relaxation…”

When people are curious they listen carefully
Convey Positive Expectations:
“ I won’t be surprised WHEN…”
“ Won’t it be great WHEN…? ”

Therapeutic Uses of Language
(When…not IF)
“IF you can feel your muscles relax…”
When you feel relaxed, then you’ll be very proud of
yourself & comfortable…
“TRY to ….”
You may wish to…
“I want you to move your arm down.”
You might be curious to notice how it feels to move your arm…
What’s not good about these phrases? How can you improve them?

Because
Why is this word important in suggestions?
 Because people need a reason to do the suggestion.
 Motivating (based on history and treatment plan).
 “Allow yourself to relax down to your feet…because ???
 You may wish to imagine a beautiful magic carpet
because???

Ego Strengthening
Offer reinforcing suggestions or statements
 “You are doing this very well.”
 “ As you do this more and more for yourself you will
probably be very proud of what you are learning and
accomplishing…”
 “It’s good to know that you are doing this exactly
right.”
Emphasize words like: confidence, competence, comfort,
pride, joy, satisfaction, peace, serenity, comfortable
easily, effortlessly, relaxed, slowly

Developing Cues for PHS
Touch
Five
Senses
Sight
Taste
Smell Sound

Range of applications
 Anxiety, including PTSD
 Phobias (simple/complex)
 Learning Disabilities,
Asperger’s Disorder
 Hypnoanalgesia
 Medical Problems
 Invasive Medical
Procedures
 Pediatric Medical Problems
 Habit Disorders
 Trichotillomania
 Nail biting
 Thumb sucking
 Enuresis
 Sleep Disturbances

Specific Pediatric Medical
Problems
 Asthma
 Hives
 Allergies
 Itching, scratching, picking
 Hyperhidrosis
 Warts
 Diabetes
 Neurologically mediated intractable reflexes
 Cerebral palsy
 Reflex sympathetic dystrophy
 Rehabilitation following central nervous system
injury
 Pulmonary symptoms related to psychological
problems, discomfort because of medication, or
fear related to procedures
 Dentistry
Cancer
Hemophilia
Gastrointestinal disorders
Juvenile rheumatoid
arthritis
Malignancies
Headaches
Seizures
Urine retention
Cyclic vomiting
Sports medicine
Burns

Summary: Pediatric hypnosis promotes self regulation in
functioning
• Thinking
• Doing
• Feeling
• Sensing
• Noticing

Self Regulation - Thoughts
Foster locus of control
• More realistic risk-appraisal
• Cognitive restructuring: catastrophic thinking
• Expand self-efficacy: draw on past mastery experiences
• Compartmentalize
• Create + expectations

Self Regulation - Emotions
• Emotional literacy
• Manage extreme or strong feelings; Compartmentalize anxiety and fear
• Feelings change in degree and over time; Let go of old fear/anxiety
• Label feeling within body; Embodied thinking
• Sense of internal safety and empowerment
• Increase comfort and calmness
• Foster optimism
• Strengthen confidence to manage situation
• Separate-individuate from parental external soothing and reassurance (LOC)

Modulate emotional reactivity
Compartmentalize fear/anxiety/worries
 box- balloons

Anxiety/Worry/Fear Reactivity:
 Tantrums & meltdowns
 Nightmares
 Specific fears
 Panic
 Limited self-soothing
 Anxious attachment
 Seek
reassurance/proximity/contac
t
 Bite/pick (nails, lips, clothes)
 Hypervigilance
 Gaze aversion
 Cry/tantrum
 School avoidance/resistance
 Avoid-escape-freeze

Brain with dimmer switch in it; emotions go from
sad to happy
Pendergrast and Lombard, March 22, 2014

Self Regulation - Behaviors
• Down-regulate or Up-regulate
• Cause and effect
• Healthy choices
• Adjustment to chronic illness and conditions

MindUp Curriculum: Mindfulness in
Preschool through 3rd Grade

Self Regulation - Attention
• Alert and activate
• Discrimination: essential from non-essential details
• High Interest vs. Low Interest Activities
• Magnification

Self Regulation - Sensing
Modulate Psychophysiological Reactivity:
 Dampen initial response - numbing
 Relaxation training - belly breathing
 Raise sensory threshold
 Calm a specific internal organ (e.g., stomach)
 Reframe panic episodes - somatization reduction

Modulate PSYCHOPHYSIOLOGICAL REACTIVITY with
hypnotic suggestions
 Dampen initial and sustained reactivity
 0-10 scales
 Control panel (be the “boss”)
 Calm and self sooth

Review of Self Regulation
Learned ability to control inner states or responses
related to:
 Thoughts - Cognition
 Emotions - Feeling
 Behavior - Doing
 Attention - Noticing
 Physiological Reactivity - Sensing

How Hypnosis addresses pain
 Develops metaphor
 Captures imagination
 Sustains and promotes hope
 Curtails uncertainty and fear
 Plays with possibilities
 Works with paradox
 Envisions optimal outcome
 Distorts time

Pediatric hypnosis has been used with these
Medical Problems
 Asthma
 Hives
 Allergies
 Itching, scratching, picking
 Hyperhidrosis
 Warts
 Diabetes
 Neurologically mediated intractable reflexes
 Cerebral palsy
 Reflex sympathetic dystrophy
 Rehabilitation following central nervous
system injury
 Pulmonary symptoms related to psychological
problems, discomfort because of medication,
or fear related to procedures
 Dentistry
Cancer
Hemophilia
Gastrointestinal disorders
Juvenile rheumatoid
arthritis
Malignancies
Headaches
Seizures
Urine retention
Cyclic vomiting
Sports medicine
Burns

Switch-wire Imagery
• Pair hypnosis with new variations of imagery to help
children cope with phobias & pain
• A dissociation-oriented imagery involving a “switch-wire”
metaphor can help child turn on/off the anxiety
at the sight or experience of the phobic stimulus
• Helps develop mastery and control of fear
• Teaches a child to dissociate his/her body; adds to
heightened experience of hypnotic induction and
suggestion
• A switch metaphor is more tangible and can be more
easily visualized for a younger child
• Children can easily utilize the self-hypnotic protocol
once learned

APPLIED ANALGESIA
Suggestions: These classic suggestions use different parts of
the brain.
 You feel numbness in your body
(Somatosensory).
 The sensations seem far away (Thalamus).
 If you feel anything, it might be a feeling of
pressure or tingling (Prefrontal cortex).

Magic Glove
http://youtu.be/cyApK8Z_SQQ?t=32s
Leora Kuttner, Ph.D.
Clinical Psychologist and Clinical Professor of
Pediatrics Vancouver, BC. Canada
http://lifeafterpain.com/info/expert-interviews/managing-pain-interview-
with-doctor-leora-kuttner/

Applications of Hypnosis in
Chronic Illness
Post-Hypnotic Suggestions: ease of remembering
sensations of comfort, joy, easy breathing, etc.
Amnesia: forgetting prior discomfort, regression to
time before the illness, use of “Affect Bridge” to bring
good feelings back.

Chronic Illness...
Strategies
 Create atmosphere of hope, positive expectations for
change, help child to perceive a difference with re-framing...
 Time Distortion - regression, progression
 Scales of comfort/discomfort e.g. 0-12 (useful for
pain, anxiety, sleep, etc.)
 Dissociation - THAT DISCOMFORT, NOT YOURS

Chronic Illness...
Imagery
 Color, Size of discomfort > change it
= where you’d rather be imagery
 Imagery to turn things down, off...around the body to
make repairs, create changes in organs, healing,
brain’s computer...

Pediatric Surgery
Preoperative
 Suggestions focus on comfort and calm, easy return to normal
body functions, and rapid healing
Hypnotherapy as adjunct to anesthesia
 Allows child to be more active
 Found to reduce anticipatory anxiety and procedure-related
pain, anxiety, distress behavior, duration, and improve the
quality of recovery

Applications of Hypnosis in Chronic Illness...
Split-Screen Technique:
Problem on one side, desired outcome on the other
side.
Watch (or create) the change, as one gets smaller and
the other bigger...

“Go to Resource” to get
started
 Kohen, D.; Kaiser, P. Clinical Hypnosis with Children
and Adolescents—What? Why? How?: Origins,
Applications, and Efficacy. Children 2014, 1(2), 74-98;
doi:10.3390/children1020074.
 http://www.mdpi.com/2227-9067/1/2/74

Select References
 Anbar, R.D. Self-hypnosis for patients with cystic fibrosis. Pediatr. Pulm. 2000, 30, 461–465.
 Anbar, R.D.; Hall, H.R. Childhood habit cough treated with self-hypnosis. J. Pediatr. 2004, 144, 213–217.
 Curtis, S.; Wingert, A.; Ali, S. The Cochrane Library and Procedural Pain in Children: An Overview of Reviews. Evid.-
Based Child Health: A Cochrane Rev. J. 2012, 7, 1363–1399. doi:10.1002/ebch.1864.
 Cyr, L.R.; Culbert, T.; Kaiser, P. Helping children with stress and anxiety: An integrative medicine approach.
Biofeedback 2003, 31, 12–17.
 Gold, J.I.; Kant, A.J.; Belmont, K.A.; Butler, L.D. Practitioner review: Clinical applications of pediatric hypnosis. J.
Child Psychol. Psychiatry 2007, 48, 744–754.
 Golden, W. Cognitive Hypnotherapy for Anxiety Disorders. Am. J. Clin. Hypn. 2012, 54, 263–274
 Gulewitsch, M.; Muller, J.; Hautzinger, M.; Schlarb, A.A. Brief hypnotherapeutic-behavioral intervention for functional
abdominal pain and irritable bowel syndrome in childhood: A randomized controlled trial. Eur. J. Pediatr. 2013, 172,
1043–1051.
 Kohen, D.P.; Olness, K.N. Hypnosis and Hypnotherapy with Children, 4th ed.; Routledge Publications, Taylor &
Francis: New York, NY, USA, 2011.
 Kohen, D.P.; Zajac, R. Self-hypnosis training for headaches in children and adolescents. J. Pediatr. 2007, 150, 635–
639.

Select References
 Kuttner, L. Pain—An integrative approach. In Oxford Textbook of Palliative Care for Children; Goldman, A., Hain, R., Liben, S.,
Eds.; Oxford University Press: New York, NY, USA, 2006; pp. 332–341.
 Kuttner, L. A Child in Pain: How to Help: What Health Professionals Can Do to Help Crown; House Publishing: Bethel, CT, USA,
2010.
 Landier, W.; Tse, A. Use of Complementary and Alternative Medical Interventions for the Managaement of Procedure-Related
Pain, Anxiety, and Distress in Pediatric Oncology: An Integrative Review. J. Pediatr. Nurs. 2010, 25, 566–579.
 McClafferty, H. Complementary, Holistic, and Integrative Medicine: Mind-Body Medicine. Pediatr. Rev. 2011, 32, 201–203.
 Myers, C.D.; Bergman, J.; Zeltzer, L.K. Complementary and alternative medicine use in children with cancer. In Psychosocial
Aspects of Pediatric Oncology; Kreitler, S., Arush, M.B., Eds.; John Wiley and Sons: Hoboken, NJ, USA, 2004; pp. 335–
350Richardson, J.; Smith, J.; McCall, G.; Pilkington, J. Hypnosis for Procedure-Related Pain and Distress in Pediatric Cancer
Patients: A Systematic Review of Effectiveness and Methodology Related to Hypnosis Interventions. J. Pain Symp. Manag.
2006, 31, 70–84.
 Schnur, J.B.; Kafer, I.; Marcus, C.; Montgomery, G.H. Hypnosis to Manage Distress Related To Medical Procedures: A Meta-
Analysis. Contemp Hypn. 2008, 25, 114–128, doi:10.1002/ch.364.
 Uman, L.S.; Birnie, K.A.; Noel, M.; Parker, J.A.; Chambers, C.T.; McGrath, P.J.; Kisely, S.R. Psychological interventions for
needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst. Rev. 2013, 10,
doi:10.1002/14651858.CD005179.pub3.
 Uman, L.S.; Chambers, C.T.; McGrath, P.J.; Kisely, S.A. A systematic review of randomized controlled trials examining
psychological interventions for needle-related procedural pain and distress in children and adolescents: An abbreviated
Cochrane Review. J. Pediatr. Psychol. 2008, 33, 842–854.
 Vlieger, A.M.; Menko-Frankenhuis, C.; Wolfkamp, S.C.S. Hypnotherapy for children with functional abdominal pain or Irritable
Bowel Syndrome: A randomized controlled trial. Gastroenterology 2007, 133, 1430–1436.

Questions??
Please feel free to contact me
lisalombardphd@gmail.com
National Pediatric Hypnosis Training Institute (NPHTI)
www.NPHTI.org
Offices in Oak Park & Streeterville

Ipa november pediatric hypnosis no video

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