A Pragmatic Guide to the Setting up of Integrated Hypnotherapy Services in Primary Care and Clinical Settings

Despite the continued debate and lack of a clear consensus about the true nature of the hypnotic phenomenon, hypnosis is increasingly being utilized successfully in many medical, health, and psychological spheres as a research method, motivational tool, and therapeutic modality. Significantly, however, although hypnotherapy is widely advertised, advocated, and employed in the private medical arena for the management and treatment of many physical and emotional disorders, too little appears to be being done to integrate hypnosis into primary care and national health medical services. This article discusses some of the reasons for the apparent reluctance of medical and scientific health professionals to consider incorporating hypnosis into their medical practice, including the practical problems inherent in using hypnosis in a medical context and some possible solutions.     

Enhancing witness memory with techniques derived from hypnotic investigative interviewing: focused meditation, eye-closure, and context reinstatement

Due to several well-documented problems, hypnosis as a forensic interviewing tool has been largely replaced by the cognitive interview; however, the latter is problematic in time and complexity. This article builds on previous research showing that some procedures used in traditional hypnotic forensic interviewing might still be useful in developing alternative procedures for use in investigative interviewing. Two experiments are described that include a focused meditation with eye-closure technique with similarities to conventional hypnotic induction but without the label of hypnosis. In the first, focused meditation was comparable to a context reinstatement, or revivification, technique in facilitating memory in children aged 6 to 7 without increasing errors or inflating confidence. In the second, when used in combination with context reinstatement, focused meditation was resistant to the effects of misleading information in adults. Implications are discussed.     

Stents in the femoral artery: aid or problem?

Percutaneous transluminal angioplasty (PTA) is a well-established technique in the treatment of symptomatic femoropopliteal artery stenoses and obstructions. It is a method of treatment with excellent initial technical and clinical results. However, the long-term results of PTA alone must be considered as unsatisfactory as recurrences are frequently observed. In the past, femoropopliteal stenting appeared to be a promising tool to prevent recurrence and to increase patency rates, but it did not produce better results than PTA alone. For this reason, alternative therapeutic strategies such as brachytherapy, drug-eluting pharmastents and gene therapy were developed. Several investigators are beginning to explore their potential use. This article reviews the present possibilities of PTA and stenting in the femoropopliteal region and considers potential future concepts. In this context, the current clinical literature is discussed.     

Undesirable effects of hypnosis: The determinants and management

Various kinds of complications arising from the use of hypnosis are reviewed. The distinction is drawn between the induction of hypnosis when it is perceived as an episodic event, as in a laboratory context, versus the effect when it is perceived as leading to permanent changes, as in a therapeutic context. An attempt is made to draw these and other distinctions in order to understand better the possible sources of difficulties.     

Factors That Contribute to the Willingness to Try “Street Hypnosis”

This study takes a context-specific approach to examine people’s willingness to try hypnosis under various conditions and the factors that contribute to their willingness. It examined 378 participants, who completed a web-based hypnosis survey. The results showed that people’s willingness to try hypnosis varies by context. Specifically, people are more willing to try hypnosis when it is framed as “peak focus” rather than “hypnosis” and when they perceive the environment as being safer. Moreover, factors including participants’ demographics, hypnotists’ demographics (relative to the subjects’), participants’ control bias, and knowledge of hypnosis affect people’s degrees of willingness to try hypnosis, depending on the specific context. The results suggest further analysis of hypnosis occurring in public contexts and the effects it may have on attitudes and therapeutic outcomes.     

Hypnosis for acute distress management during medical procedures

The use of hypnosis during medical procedures has a long-standing tradition but has been struggling for acceptance into the mainstream. In recent years, several randomized-controlled trials with sufficient participant numbers have demonstrated the efficacy of hypnosis in the perioperative domain. With the advancements of minimally invasive high-tech procedures during which the patient remains conscious, hypnotic adjuncts have found many applications. This article describes the procedural environment as well as pharmacologic and nonpharmacologic interventions to reduce distress. Current research findings, controversies in the literature, and safety considerations are reviewed. Implications for clinical practice and training as well as directions for future research are discussed. Obstacles and possible reasons for the slow acceptance of nonpharmacologic interventions, mind-body therapies, and patient-centered approaches are addressed.     

Prolonged hypnosis with individualized therapy

A therapeutic approach is presented which involves the use of prolonged hypnosis for the treatment of diverse medical and/or psychological conditions, including intractable pain. This approach may be indicated either as a complementary tool used in conjunction with other treatment approaches or as the only method of intervention. The technique is based on achieving a prolonged hypnotic response, during which hypno-relaxation serves as the foundation for the delivery of an individualized therapeutic plan which includes self-hypnosis, suggestive procedures, metaphors, and constructive imagery techniques. In debilitated patients, medical supervision and nursing care are essential, and hospitalization is recommended if necessary. Theoretical assumptions underlying this approach are presented, and clinical implications are discussed. The method is illustrated through case presentations.     

A case of gynaecomastia with poly‐substance abuse

Hypnotherapy continues to be a misunderstood and maligned subject Its effectiveness, nevertheless, is perhaps becoming more clearly demonstrated and appreciated. Contemporary views emphasize indirect as well as direct hypnotic suggestion, the use of hypnosis as a context for amplifying other forms of psychotherapy, and the desirability of an individualized approach to cater for clients' unique needs and goals. In the field of addictive behaviours, it is argued with reference to clinical data and empirical research, that hypnotherapy is a valuable tool in assisting individuals to achieve greater control. As applicable to all forms of psychotheapy, however, commitment to desired changes, active participation in the therapeutic process and a good working alliance are prerequisite.     

The use of hypnosis in a primary care setting

An aware clinician using the modality of hypnosis either themselves or induced by a trained practitioner will find many indications on a daily basis. The application can be used for control of symptoms such as nausea or pain or, in the case of some clinical conditions, as a primary or adjunctive therapy. An overview of the commonly occurring opportunities for the use of hypnosis is presented in this article.     

Self-hypnosis: alternative anesthesia for childbirth

The purpose of this article is to inform nurses about the use of self-hypnosis in childbirth. Hypnosis is a focused form of concentration. Self-hypnosis is one form of hypnosis in which a certified practitioner or therapist teaches an individual to induce his or her own state of altered consciousness. When used for childbirth pain, the primary aim of self-hypnosis is to help the woman maintain control by managing anxiety and discomfort though inducing a focused state of relaxation. Before the widespread use of pharmaceuticals for pain, hypnosis was one of the few pain relief methods available for labor. However, as new technologies for pain relief emerged, hypnosis received less attention. Most nurses have little experience with hypnosis, and there is limited information available in the literature. However, because nurses are at laboring women's bedsides, it is important that nurses learn about self-hypnosis to be able to inform pregnant women fully about all pain control options and to maximize the benefits for the woman choosing hypnosis.     

Hypnosis for pediatric fracture reduction

Hypnosis can diminish pain and anxiety for many emergency patients during examinations and procedures. While hypnosis has been used for millennia and was demonstrated to be of use in clinical medicine more than a century ago, modern physicians have been reluctant to adopt this technique in clinical practice. This article describes four children with angulated forearm fractures who had no possible access to other forms of analgesia during reduction, and in whom hypnosis was used successfully. A simple method for hypnotic induction is described.     

Defining Need Amid Exponential Change: Conceptual Challenges in Workforce Planning for Clinical Genetic Services

Rapid growth in the volume of referrals to clinical genetics services in many countries during the past 15 years makes workforce planning a critical policy tool in ensuring that the capacity of the clinical genetics workforce is large enough to meet current and future needs. This article explores the distinctive challenges of workforce planning in clinical genetics and provides recommendations for addressing these challenges using a needs-based planning approach. Specifically, at least 3 features complicate efforts to estimate the need for clinical genetic services: the difficulty in linking many clinical genetic services to concrete health outcomes; the rapidly changing nature of genetic medicine, which creates intrinsic uncertainty about the appropriate level of service; and the heightened relevance of patient preferences in this context. Our recommendations call for needs-based planning studies to include an explicit definition of necessary care, to be flexible in considering nonhealth benefits, to err on the side of including services currently funded by health systems even when evidence about outcomes is limited, and to use scenario analysis and expert input to explore the impact of uncertainty about patients’ preferences and future technologies on estimates of workforce requirements.     

Devices used in cardiac arrest

Even the best conventional manual cardiopulmonary resuscitation (CPR) is highly inefficient, producing only a fraction of normal cardiac output. Over the past several decades, many therapeutic devices have been designed to improve on conventional CPR during cardiac arrest and increase the probability of survival. This article reviews several adjuncts and mechanical alternatives to conventional CPR for use during cardiac arrest. Recent clinical studies comparing conventional resuscitation techniques with the use of devices during cardiac arrest are reviewed, with a focus on clinical implications and directions for future research.     

Trance and the trickster: hypnosis as a liminal phenomenon

This paper makes the case that hypnotic phenomena are liminal in nature and that hypnotic practitioners (such as Milton Erickson) share many traits with traditional societies' "tricksters." The ambiguous nature of hypnosis has been apparent since the days of Mesmer's animal magnetism. Hypnotized people often report hallucinations that confound their ordinary distinctions between reality and illusion, external and internal processes, and many other binary oppositions, including time and space as well as mind and body. In addition, hypnosis can obscure the distinction between fact and fiction in one's memory, as is evident in the "recovered memory" controversy. The role played by imagination is central to both indigenous rituals and hypnosis, and hypnosis is a multifaceted phenomenon requiring explanation at multiple levels. Some investigators and practitioners have missed the importance of the social context in which hypnosis occurs, while others have come close to destroying the most interesting and useful hypnotic phenomena under the guise of objectivity.     

Case study examining the efficacy of a multi-modal psychotherapeutic intervention for hypertension

This study examines the effectiveness of a multimodal psychotherapeutic approach using hypnosis in the treatment of a single case of hypertension. A systematic eclectic conceptualization and treatment approach was implemented using psychodynamic, behavioral, and cognitive-behavioral elements. Hypnosis was used to support each of the treatment modalities. Time-series analysis procedures indicate that the psychological interventions were associated with significantly reduced diastolic blood pressure. Additionally, the effect of the psychological interventions was significant over and above traditional pharmacological interventions. However, psychotherapeutic interventions had no substantial impact on systolic pressure. The flexibility of hypnosis as a therapeutic tool is discussed in terms of potential advantages in treatment.     

Case study examining the efficacy of a multi-modal psychotherapeutic intervention for hypertension

This study examines the effectiveness of a multimodal psychotherapeutic approach using hypnosis in the treatment of a single case of hypertension. A systematic eclectic conceptualization and treatment approach was implemented using psychodynamic, behavioral, and cognitive-behavioral elements. Hypnosis was used to support each of the treatment modalities. Time-series analysis procedures indicate that the psychological interventions were associated with significantly reduced diastolic blood pressure. Additionally, the effect of the psychological interventions was significant over and above traditional pharmacological interventions. However, psychotherapeutic interventions had no substantial impact on systolic pressure. The flexibility of hypnosis as a therapeutic tool is discussed in terms of potential advantages in treatment.     

Contemporary psychoanalysis and hypnosis

The relationship between psychoanalysis and hypnosis is presented in three parts: past, present, and future. First, the parallel developments in psychoanalysis and hypnosis over the past 100 years are summarized. Four major theoretical evolutions in psychoanalysis (drive theory, ego psychology, object relations theory, and self psychology) are described, with their corresponding influences on the practice of psychoanalytically informed hypnosis. Second, four contemporary movements in psychoanalysis are enumerated (postmodernism, spontaneity, pluralism, and integrationism), with commentary on these movements' likely impact on the current and future practice of hypnosis. Finally, the impact of shrinking mental health dollars on the practice of psychoanalysis and psychoanalytically informed treatments is presented. Hypnosis is offered as uniquely positioned, with its history of multitheoretically informed brief interventions, grounded in research and clinical practice, to provide psychoanalysis with a life raft into the next 100 years of practice.     

Using text messaging in the treatment of eating disorders

New technologies for communicating with patients can open up new treatment possibilities. This article describes the use of mobile phone text messaging as a therapeutic intervention in the treatment of eating disorders. In text messaging a person can conceal themselves and--very significantly in the context of eating disorders--the body does not show. The exchange does not have to be instantaneous and is not face to face. This article outlines the use of mobile phone texting, alongside therapy and other nursing interventions, as an effective tool to help clients communicate their thoughts and feelings in a safer and freer way.     

An experimental indirect technique for the induction of hypnosis without awareness

A procedure is described which has been used in an experimental setting as a method of indirectly inducing hypnosis without S's awareness. Ss are not told that hypnosis is involved in the procedure, but are told they will be taught how to relax. The aim of the indirect procedure is to create different expectations and preconceptions from those normally occurring in the special hypnotic relationship. Evidence from 3 studies (samples of 63, 63, 120) indicates that the procedure successfully induces hypnosis comparable in depth to other standard hypnotic procedures. About half of the Ss tested apparently do not recognize the procedure involves hypnosis. Approximately 30% of the 5s who receive the procedure, as well as 30% of the Ss in the control group who did not receive the procedure, but were tested with the same test suggestions, recognized that an attempt had been made to induce hypnosis. The perceptions about whether hypnosis was involved were unrelated to scores on typical hypnotic phenomena. It was concluded that the indirect induction technique successfully induces hypnosis and is a useful technique for manipulating 5-expectations in an experimental context.     

The Opinion of Oncologists on the Practice of Hypnosis among Cancer Patients in Lebanon

IntroductionMedical hypnosis has received an increasing attention during the past decades. Various applications of hypnosis can be incorporated into the oncology field. This study aims to assess the knowledge of Lebanese medical oncologists on the use of hypnosis in the management of cancer patients.Material and methodsAn anonymous questionnaire was sent to all Lebanese medical oncologists to assess their knowledge, opinion and understanding of hypnosis and its use in oncology, as well as the obstacles facing its application in Lebanon.ResultsHundred and three Lebanese medical oncologists responded to the survey, with a response rate of 65%. The findings revealed that most oncologists had little or no knowledge about hypnosis, but recommended it due to the benefits they believed it provided for the patients in improving chronic pain, invasive procedures, chemotherapy-induced nausea and anxiety. Around 40% of participants were interested in receiving a training in hypnosis. Lebanese oncologists also described many obstacles to the practice of hypnosis, mainly the lack of training for this technique and the lack of financial resources.ConclusionDespite all obstacles, the majority of Lebanese oncologists would recommend hypnosis to their patients in order to improve their quality of life.