Lauralea Cox, MS, LSW, IPR

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  • Pain is the most common symptom aside from fatigue. Hypnosis has been amply documented to be a potent pain modulator (Chaves, 1994; Hilgard and Hilgard, 1994; Holroyd, 1996; Lynch, 1999; Peter, 1996; Schafer, 1996). There is a synergistic relationship between pain and anxiety, and pain and depression.
  • The following case history demonstrates the role of hypnotherapy in modifying symptoms associated with cancer.
    A stockbroker with a diagnosis of colon carcinoma established two years previously was referred by his oncologist for hypnotic treatment of pelvic pain. A recent examination revealed metastatic liver nodules, and a solitary lesion in the pelvic bone. Ambivalent about plans for chemotherapy and radiation, he opted for more time to make a decision about these matters.
    He achieved a hypnotic trance with an arm levitation technique. This technique, like many others, recruits the ability of the mind to experience imagined sensations. He raised his arm in front of him in the image of a piece of wood floating on a lake. Eyes closed he could imagine lightness and buoyancy filling his arm, as would a light gas lifting a balloon. "Let those buoyant feelings move your arm upward and gently toward your face." His hand gently touched his face, then rested on his thigh. In the same way that he was able to imagine lightness, he could conjure feelings of numbness in his hand. "Imagine a cold breeze from a snow-capped mountain coursing through your hand." A pinch of a thenar skinfold was eventually perceived by him as a faraway flicker of touch. "The numbness in your hand can travel into your thigh, as if touching the smooth surface of a pond; you may be able to visualize the concentric rings of numbness spreading within your body in all directions. This ability now becomes your own, and you will be able to use it in self-hypnosis."
    The relief he obtained was incontrovertible. Sometimes he could banish the pain completely and could walk comfortably for an hour or so. At other times, especially when his mood was low, he could gain only partial relief. He felt significantly more relaxed, reported more energy, and clearly enjoyed his heightened capacity for pain-free activity.
    States of mind reached in hypnosis often have the property of ushering a propitious milieu for experiencing insights. "Eyes closed, your body can contact its deepest rhythms and your mind can drift into the endless expanse of relaxation. Opening doors to the vast knowledge within you, you can let your unconscious mind offer you insights about how best to proceed with your medical treatment."
    Through this exercise, he gained clear perception to undertake chemotherapy. He successfully applied self-hypnosis to modulate its side effects. He also recruited self-hypnosis to heighten energizing feelings of optimism and self-esteem, which robustly assisted him in his medical trajectory.
  • Lauralea Cox, MS, LSW, IPR

    1. 1. Medical Benefits of Hypnotherapy for Pain Control April 2009
    2. 2. Lauralea Cox MS LSW IPR Texas Oncology 1300 North 4th Street Longview, TX 75601 903-757-2122 Education – Walden University, Capella University, Texas A & M - Commerce, The Hypnosis Institute of Texas, Ethics in Medical Practice at Harvard Certification – Licensed Independent Practice Social Worker, Certified Hypnotherapist Experience – Clinical Hypnotherapist, Medical Social Worker Specialty – Using hypnotherapy to manage stress, controlling pain, prepare for chemotherapy, and smoking cessation
    3. 3. Fellow Health Care Providers: If you can answer “Yes” to any of these questions, you may want to consider the following information. • Maximize the effects of your healing interventions? • Enhance comfort, healing and overall well-being of your patients? • Encourage their relaxation? • Let them know you care? • Decrease the cost of providing health care? We who live in the United States have access to some of the finest health care services in the world. Yet, the system faces challenges. Health care providers are caring people who strive to give their patients the best care possible. The financial paradigm sometimes does not allow this to be communicated to the patient. Would you consider a Complementary Medical Intervention that would
    4. 4. Hypnosis and Hypnotherapy Harnesses the vast power of the mind Safe, cost effective, naturally occurring state of mind Used for centuries without side effects Can be used by any person of normal intelligence
    5. 5. Hypnosis and Hypnotherapy • Approved by the AMA in 1958 as a valuable healing modality for anesthesia and pain control • “Spontaneous hypnosis” can occur when watching a movie, reading a book, or driving (highway hypnosis) • Years of research have proven the overwhelming success of hypnosis
    6. 6. Theories of Hypnosis • 􀂄 A form of deep relaxation (Edmonston 1981) - builds on Pavlov’s idea - EEG is not the same as sleep. Resembles transitional and waking states (beta/alpha waves) • 􀂄 Epiphenomenon - exists as outcome of other process - Social psychology explains it as role playing - However, in trying to explain it away they give it some credence (e.g. Sociocognitive Theory, Spanos, 1991)
    7. 7. Theories of Hypnosis continued • 􀂄 Neodissociative Theory (Hilgard 1991 -(most popular view of those that believe in Hypnosis) • 􀂄 Most people can separate one part of the mind from another (e.g. driving from point A to B - how did I get here?) • 􀂄 Hidden observer (i.e. part of the conscious mind that looks out for you under hypnosis) • 􀂄 Social-Psychobiological (Eva Banya 1991) - subjective experience of altered consciousness with somatic and behavioral changes that are real also following.
    8. 8. Medical Uses for Hypnosis • Stress management • Pain management • Childbirth and fertility • Preparation for surgery
    9. 9. The Hypnotic State • 􀂄 sleep like state but EEG does not resemble any sleep stage • 􀂄 normal function reduced, person tends to wait for instruction • 􀂄 attention becomes highly selective • 􀂄 role playing is easily accomplished • 􀂄 post-hypnotic suggestion is observed
    10. 10. Stress and Health • Stress is a total body response to a perceived internal or external threat • Stress can save lives in emergencies, but is also responsible for 60 to 90% of all illnesses • Studies indicate wounds in unstressed patients heal more quickly – Janice Kiecolt-Glaser of Ohio State University College of Medicine conducted a study comparing wound healing in stressed vs. unstressed patients. Those who were stressed took 9 days longer to heal. (1)
    11. 11. Pain and Anesthesia • Two components of pain – the affected site – the perception by the brain (example: phantom limb pain) • Stress exacerbates pain • Pain management is expensive • Hypnotherapy remains a powerful, simple, safe method for managing pain.
    12. 12. Hypnosis and Cancer • Hypnosis and self-hypnosis find applications at several levels of cancer care. • It is useful as a means of dealing directly with the symptoms of the condition: pain and symptoms referable to specific organ systems, and nonspecific symptoms such as fatigue, malaise, and insomnia. • Useful in the management of the side effects of cancer treatments. • Hypnosis has been aimed at modifying the course of the disease process itself through the use of imagery. • Hypnosis has been well documented to have therapeutic potential for conditioned anticipatory emesis (Genuis, 1995; Marchioro, 2000).
    13. 13. Surgery • Benefits of pre-surgery hypnosis: – less anxiety – less pain – fewer complications – shorter hospital stays – quicker recovery
    14. 14. Pre-Surgery Hypnosis Examples • Blue Cross of California used guided imagery tapes to prepare 900 hysterectomy patients for surgery. The average total billings for these members was $2,000 less per patient, as compared with those not prepared by guided visualization. • Stanford University Physician David Spiegel found that hypnotized subjects “used less medication, experienced less pain, felt far less anxiety than control groups. Operations on these patients averaged 17 minutes shorter and the cost of a standard radiological procedure fell from $638 to $300.”
    15. 15. Other Proven Applications • Irritable Bowel Syndrome • Asthma • Smoking Cessation • Weight Management • Drug and Alcohol Addictions • Enhancing the Effects of Chemotherapy • Oral Surgery
    16. 16. References 1. Wound Healing Ronald Blumer and Muffie Meyer The New Medicine, companion book to the Public Television Series 2. Turning Breech Baby, Lewis E. Mehl, MD, PhD, University of Vermont College of Medicine, Archives of Family Medicine 1994, 3:881-887 3. IVF Reuters Health quoting Fertility and Health, May 2006 4. Guided Imagery and Surgery Ronald Blumer and Muffie Meyer The New Medicine, companion book to the Public Television Series 5. Surgery, David Spiegel, Hypnosis Works, Discover Magazine Vol. 25, November 2004
    17. 17. Resources & Links “Hypnosis in Contemporary Medicine.” James H. Stewart; from the Department of Internal Medicine and Cardiovascular Diseases, Mayo Clinic College of Medicine, Jacksonville, Florida, abstract from Mayo Clinic Proceedings: Hypnosis became popular as a treatment for medical conditions in the late 1700’s when effective pharmaceutical and surgical treatments were limited. To determine whether hypnosis has a role in contemporary medicine, relevant trials and a few case reports were reviewed. Despite substantial variation in techniques among the numerous reports, patients treated with hypnosis experienced substantial benefits for many medical conditions. An expanded role for hypnosis and a larger study of techniques appear to be indicated. “Hypnosis Works.” “The Power of trance can no longer be disputed, a psychiatrist at Stanford University says. Now we just have to use it.” Discover, Vol 25, no 11, November 2004, Mind and Brain, an article about Elvira Lang, a radiologist, and David Spiegel, a professor of psychiatry at Stanford University School of Medicine who have done extensive studies of hypnosis in the operating room. “You will now feel Better.” Letters, Discover, December 2004: “As a surgeon who has used hypnotic techniques with patients, I heartily support psychiatrist David Spiegel’s findings (“Hypnosis Works,” November). I think that studies of the brain both under anesthesia and under hypnosis would show many similarities. I have been able to correct cardiac arrythmias, bleeding, rapid pulse rates and other physiological problems by talking to anesthetized patients in a therapeutic way during surgical procedures and by using similar techniques preoperatively. Surgeons have also done major abdominal surgery on patients under hypnosis alone. Hypnotic and communication techniques can create positive results. The placebo effect is, in essence, a positive result of communication. I have had children go to sleep as they entered the operating room because I told them they would, and some have resisted hair loss from chemotherapy because we relabeled their vitamins ‘hair growing pills.’ Just as we can heal with a scalpel, we can heal with words.”—Bernie Siegel, Woodbridge, Connecticut
    18. 18. Resources & Links, continued “Altered States.” Newsweek Health: Hypnosis can help with problems from anxiety to pain. How and what it does to the brain. msnbc.msn.com/id/6037903/site/newsweek “The Healing Power of Hypnosis” by Alexis Jetter, Prevention Magazine, March 2006 www.prevention.com “Health For Life MD: Mind Over Matter.” Newsweek Health. Alice D. Domar, Ph. D., Director of the Mind/Body Center for Women’s Health at Boston IVF answers questions about the body mind connection; msnbc.msn.com/id/6037809/site/newsweek The New Medicine. DVD and companion book to the public television series; Ronald H. Blumer and Muffie Meyer; reports of studies and case reports of the importance of the human touch in conjunction with high tech medical interventions. “Stress and Health in Dementia Caregivers.” Jan Kiecolt-Glaser, Ohio State School of Medicine, conducted a study to evaluate the impact of stress on healing. A small, eraser sized wound healed nine days faster in the control group; pni.psychiatry.ohio-state.edu/jkg/ad.html “Stress Weakens the Immune System.” Synopsis of pertinent research about the effects of stress; psychologymatters.org/stressimmune.html “Hypnosis and Orthopedic Hand Surgery.” M. H. Mauer, et al. (1999) Medical hypnosis and orthopedic hand surgery, pain perception, postoperative recovery, and therapeutic comfort; International Journal of Clinical Hypnosis; 47, 144-61: Sixty hand surgery patients had either routine care or routine care plus hypnosis. Subjectively, the hypnosis group experienced less pain intensity and less anxiety. Surgeons reported that the hypnosis patients progressed more rapidly and had fewer complications than the group without hypnosis. Hypnosis was strongly recommended as an adjunct therapy for hand surgery patients.
    19. 19. Resources & Links, continued “Adjunctive non-pharmacological analgesia (including hypnosis) for invasive medical procedures: a randomized trial.” R. V. Lang et al; Lancet, April, 1486–90 (2000): Several doctors from Beth Israel and Deaconess Medical Center/Harvard Medical School studied a group of 241 patients having invasive percutaneous vascular and kidney procedures. The patients were divided into 3 groups. One group received standard care. The second group received structured attention. The third group received self-hypnotic relaxation. During the procedure, it is anticipated that the pain and anxiety would increase. This did happen with the two control groups but pain did not increase in the group using hypnotic relaxation. In all three groups, anxiety then decreased over time, but decreased most in the group using hypnosis. Another remarkable result was that in the standard group, 12 patients experienced instability versus 10 in the attention group versus one in the group using hypnosis. “Presurgery Anxiety? Hypnosis May Help.” WebMD October 25, 2005; Doctors at Yale University’s medical school reported to the American Society of Anesthesiologists’ annual meeting: Halej Saadat, MD, researcher and assistant professor of anesthesiology at Yale, states that anxiety increases the chances of postoperative pain, postoperative analgesic consumption, hospital stay and recovery. “We were hoping that by using behavioral modification like hypnosis programs, preoperatively, we can get rid of the postoperative complications.” 76 outpatient surgical patients were divided into 3 groups. One, received routine preoperative care; the second got caring and attention for 30 minutes. The third got 25 to 30 minutes of hypnosis. Patients were less anxious after hypnosis. Right after hypnosis, anxiety levels were 68% lower than in the waiting room. In the operating room, the hypnosis group’s anxiety was still less than half of what it had originally been. Caring attention helped a little at first, cutting anxiety by 10%. But, anxiety increased in the operating room. The control group fared worst. There anxiety levels increased 17% on the second evaluation and increased 47% in the operating room. American Society of Anesthesiologists’ Annual Meeting, Atlanta, October 22–26, 2005

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