Clinical Hypnosis — A Perspective

Hypnosis and trance states are as old as man himself. Over the years, many misconceptions concerning this phenomenon have arisen from lack of knowledge and misrepresentations in the literature and on the stage; however, these are being dispelled as more scientific research into the nature of hypnosis is undertaken. When applied in accordance with ethical principles, hypnotherapy has a very wide range of clinical applications, only one of which is psychotherapy. This overview of the current status of medical hypnosis includes a discussion of misconceptions, myths, and dangers, as well as an outline of common uses.     

Hypnosis,Attachment, and Oxytocin:An Integrative Perspective 1

This article considers links between clinical hypnosis, attachment theory, and oxytocin. First, it proposes that commonalities between clinical hypnosis and attachment theory may improve our understanding of the hypnotherapeutic process. Then, it suggests that an integrative model unifying clinical hypnosis and attachment theory may constitute a link between clinical hypnosis and a neurobiological factor such as oxytocin. Finally, it discusses the implications of these hypotheses for clinical practice and future researches.     

Feasibility of Clinical Hypnosis For The Treatment of Parkinson's Disease: A Case Study

Parkinson's disease is a severe neurodegenerative disorder with a prevalence rate of approximately 1.6% in elderly Americans. This case study reports on a 51-year-old male Parkinson's patient who received 3 weekly sessions of a hypnosis intervention, as well as instruction in self-hypnosis. Actigraphy was used to assess rest-tremor severity. Results revealed a 94% reduction in rest tremors following treatment. Self-reported levels of anxiety, depression, sleep quality, pain, stiffness, libido, and quality of life also showed improvements. The patient reported a high level of satisfaction with treatment. These findings suggest clinical hypnosis is potentially feasible and beneficial treatment for some Parkinson's symptoms. Further investigation with diverse samples and an ambulatory monitoring device is warranted.     

Management and Treatment of Temporomandibular Disorders: A Clinical Perspective

A temporomandibular disorder (TMD) is a very common problem affecting up to 33% of individuals within their lifetime. TMD is often viewed as a repetitive motion disorder of the masticatory structures and has many similarities to musculoskeletal disorders of other parts of the body. Treatment often involves similar principles as other regions as well. However, patients with TMD and concurrent cervical pain exhibit a complex symptomatic behavior that is more challenging than isolated TMD symptoms. Although routinely managed by medical and dental practitioners, TMD may be more effectively cared for when physical therapists are involved in the treatment process. Hence, a listing of situations when practitioners should consider referring TMD patients to a physical therapist can be provided to the practitioners in each physical therapist''s region. This paper should assist physical therapists with evaluating, treating, insurance billing, and obtaining referrals for TMD patients.KEYWORDS: Dentistry, Physical Therapy, Temporomandibular Disorders, Temporomandibular JointAtemporomandibular disorder (TMD) is a musculoskeletal disorder within the masticatory system. Many practitioners refer to TMD as a single disorder in spite of the fact that patients have various sub-diagnoses (e.g., myofascial pain, temporomandibular joint (TMJ) inflammation)^1,2. TMD is a prevalent disorder most commonly observed in individuals between the ages of 20 and 40. Approximately 33% of the population has at least one TMD symptom and 3.6% to 7% of the population has TMD with sufficient severity to cause them to seek treatment^1–3.TMD is often viewed as a repetitive motion disorder of the masticatory structures. It has many similarities to musculoskeletal disorders of other parts of the body, and therapeutic approaches for other musculoskeletal disorders generally apply to this disorder as well^1,2,4. Similar to other repetitive motion disorders, TMD self-management instructions routinely encourage patients to rest their masticatory muscles by voluntarily limiting their use, i.e., avoiding hard or chewy foods and restraining from activities that overuse the masticatory muscles (e.g., oral habits, clenching teeth, holding tension in the masticatory muscles, chewing gum, and yawning wide)^1,2,5. The self-management instructions also encourage awareness and elimination of parafunctional habits (e.g., changing teeth clenching habit to lightly resting the tongue on top of the mouth or wherever the tongue is most comfortable) and keeping the teeth apart and masticatory muscles relaxed^1,2,5.As with other musculoskeletal disorders, pain during function and/or at rest is the primary reason patients seek treatment, and reduction in pain is generally the primary goal of therapy^1,2. Less commonly, individuals seek TMD therapy for TMJ catching or locking, masticatory stiffness, limited mandibular range of motion, TMJ dislocation, and unexplained change in their occlusion (anterior or posterior open bite, or shift in their mandibular midline). However, TMJ noises are common among the general population, are generally not a concern for individuals or practitioners, are not commonly treated, and do not generally respond as well to therapy as pain^1,2,6–9. The purpose of this clinical perspective is to describe the examination and treatment of TMD from both a dentist''s and a physical therapist''s perspective.     

Management and Treatment of Temporomandibular Disorders: A Clinical Perspective

Abstract

A temporomandibular disorder (TMD) is a very common problem affecting up to 33% of individuals within their lifetime. TMD is often viewed as a repetitive motion disorder of the masticatory structures and has many similarities to musculoskeletal disorders of other parts of the body. Treatment often involves similar principles as other regions as well. However, patients with TMD and concurrent cervical pain exhibit a complex symptomatic behavior that is more challenging than isolated TMD symptoms. Although routinely managed by medical and dental practitioners, TMD may be more effectively cared for when physical therapists are involved in the treatment process. Hence, a listing of situations when practitioners should consider referring TMD patients to a physical therapist can be provided to the practitioners in each physical therapist's region. This paper should assist physical therapists with evaluating, treating, insurance billing, and obtaining referrals for TMD patients.     

Mindfulness,Acceptance, and Hypnosis: Cognitive and Clinical Perspectives

The authors propose that hypnosis and mindfulness-based approaches can be used in tandem to create adaptive response sets and to deautomatize maladaptive response sets. They summarize recent research on the effectiveness of mindfulness-based approaches in clinical and nonclinical contexts and propose that the cognitive underpinnings of mindfulness approaches can be conceptualized in terms of the metacognitive basis of mindful attention, Toneatto’s elucidation of the Buddhist perspective on cognition, and Kirsch and Lynn’s response-set theory. They also suggest that mindfulness can serve as a template for generating an array of suggestions that provides cognitive strategies to contend with problems in living and to ameliorate stress and negative affect more generally. Many of the ideas the authors advance are speculative and are intended to spur additional research and clinical work.     

Hypnosis in the Treatment of Morgellons Disease: A Case Study

Morgellons Disease is a condition involving painful skin lesions, fibrous growths protruding from the skin, and subcutaneous stinging and burning sensations, along with symptoms of anxiety, depression, fatigue, and memory and attention deficits. The etiological and physiological bases of these symptoms are unclear, making the diagnosis controversial and challenging to treat. There are currently no established treatments for Morgellons Disease. The following case example depicts treatment of a woman with Morgellons Disease using hypnotherapy. Data from this case example suggest that hypnotherapy is a promising intervention for the physical and psychological symptoms associated with Morgellons Disease.     

Storytelling,Hypnosis and the Treatment of Sexually Abused Children

The present article describes an assessment and therapy program for sexually abused children using hypnotherapeutic techniques which center on storytelling. Storytelling presents the therapist with an opportunity to use comforting suggestions, symbolism, and metaphor to provide the emotional distance necessary to deal with the trauma of abuse. Hypnotherapy proceeds in a stepwise fashion from the building of a sense of safety and security; to imaginative sharing; to the introduction of reality events; to the final step of addressing complex emotional issues of loss, trust, love, and guilt brought about by the abuse.     

Clinical Research on the Utility of Hypnosis in the Prevention,Diagnosis, and Treatment of Medical and Psychiatric Disorders

The authors summarize 4 articles of special interest to the hypnosis community in the general scientific and medical literatures. All are empirical studies testing the clinical utility of hypnosis, and together address the role of hypnosis in prevention, diagnosis, and treatment of medical and psychiatric disorders/conditions. The first is a randomized controlled study of smoking cessation treatments comparing a hypnosis-based protocol to an established behavioral counseling protocol. Hypnosis quit rates are superior to those of the accepted behavioral counseling protocol. A second study with pediatric patients finds hypnosis critically helpful in differentiating nonepileptic seizure-like behaviors (pseudoseizures) from epilepsy. The remaining 2 papers are randomized controlled trials testing whether hypnosis is effective in helping patients manage the emotional distress of medical procedures associated with cancer treatment. Among female survivors of breast cancer, hypnosis reduces perceived hot flashes and associated emotional and sleep disruptions. Among pediatric cancer patients, a brief hypnotic intervention helps control venepuncture-related pain.     

A Meta-Analysis of Hypnosis in the Treatment of Depressive Symptoms: A Brief Communication

The efficacy of hypnosis in the treatment of depressive symptoms was subjected to a meta-analysis. Studies were identified using Google Scholar and 6 electronic databases: PubMed, Cochrane Library, PsiTri, PsychLit, Embase, and the Cochrane Depression, Anxiety and Neurosis Review Group (CCDAN). The keywords used were (a) hypnosis, (b) hypnotherapy, (c) mood disorder, (d) depression, and (e) dysthymia. Six studies qualified and were analyzed using the Comprehensive Meta-Analysis software package. The combined effect size of hypnosis for depressive symptoms was 0.57. Hypnosis appeared to significantly improve symptoms of depression (p < .001). Hypnosis appears to be a viable nonpharmacologic intervention for depression. Suggestions for future research are discussed.     

CRISPR-Cas9: A Preclinical and Clinical Perspective for the Treatment of Human Diseases

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Clinical Hypnosis in Postoperative,Adult-Onset Dysphagia: A 2-Year Empirical Case Study

Dysphagia, the perceived impediment to swallowing food, is a common postsurgical symptom that can have debilitating consequences. This study presents the successful treatment of severe esophageal dysphagia with a problem-focused and patient-centered approach to hypnosis, informed by long-term empirical follow-up. The authors describe a case history involving significant and persistent difficulty swallowing for which no medical or surgical treatment could be found. Over the course of 10 sessions, the patient was assessed, treated with imaginal exposure, and instructed in self-hypnosis. Outcomes were measured at treatment conclusion, and 6-, 9-, and 18-month follow-ups. Following hypnosis, the patient exhibited significant and reliable change (RC) in visceral hypersensitivity (RC = ?3.16, p = .002), emotional distress (RC = ?2.21, p= .03), subjective well-being (RC = 4.14, p< .0001), and posttraumatic symptoms (RC = ?3.33, p= .001). Gains were maintained at 18-month follow-up.     

A Meta-Analysis of Hypnosis for Chronic Pain Problems: A Comparison Between Hypnosis,Standard Care,and Other Psychological Interventions

Hypnosis is regarded as an effective treatment for psychological and physical ailments. However, its efficacy as a strategy for managing chronic pain has not been assessed through meta-analytical methods. The objective of the current study was to conduct a meta-analysis to assess the efficacy of hypnosis for managing chronic pain. When compared with standard care, hypnosis provided moderate treatment benefit. Hypnosis also showed a moderate superior effect as compared to other psychological interventions for a nonheadache group. The results suggest that hypnosis is efficacious for managing chronic pain. Given that large heterogeneity among the included studies was identified, the nature of hypnosis treatment is further discussed.     

Virtual Reality Hypnosis in the Treatment of Chronic Neuropathic Pain: A Case Report

This case report evaluates virtual reality hypnosis (VRH) in treating chronic neuropathic pain in a patient with a 5-year history of failed treatments. The patient participated in a 6-month trial of VRH, and her pain ratings of intensity and unpleasantness dropped on average 36% and 33%, respectively, over the course of 33 sessions. In addition, she reported both no pain and a reduction of pain for an average of 3.86 and 12.21 hours, respectively, after treatment sessions throughout the course of the VRH treatment. These reductions and the duration of treatment effects following VRH treatment were superior to those following a trial of standard hypnosis (non-VR) treatment. However, the pain reductions with VRH did not persist over long periods of time. The findings support the potential of VRH treatment for helping individuals with refractory chronic pain conditions.     

Hypnosis,Human Nature,and Complexity: Integrating Neuroscience Approaches into Hypnosis Research

Hypnosis research has contributed much to the understanding of human behavior and experience, both normal and abnormal. This paper considers ways in which neuroscience approaches may be integrated into hypnosis research to continue and enhance that contribution, as well as further reveal the nature of hypnosis itself. The authors review the influences on and advances in hypnosis research over the last century; illustrate the investigative value of hypnosis to selected phenomena across the areas of doing, feeling, believing, and remembering; and specify elements for the successful integration of neuroscience approaches into hypnosis research. The authors believe that hypnosis research offers powerful techniques to isolate psychological processes in ways that allow their neural bases to be mapped. Successful integration will be achieved when researchers add levels of explanation, rather than shift the emphasis from one level or feature to another.     

A Meta-Analysis of Gender,Smoking Cessation,and Hypnosis:A Brief Communication

Results of a meta-analysis showed that males were more likely to report smoking abstinence than female participants following hypnosis-based treatments for smoking. Across 12 studies that used hypnosis in the treatment of smoking and reported outcome statistics by gender, the authors found that the odds of achieving smoking abstinence were 1.37 times greater for male than female participants. The results are consistent with the nonhypnosis literature suggesting that females have a more difficult time achieving smoking abstinence compared to males.     

Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective

Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear‐avoidance, pain catastrophizing, pain self‐efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health‐related quality‐of‐life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered “real” in an individual patient. This information can guide treatment selection when working with an individual with CLBP.     

The Effects of Hypnosis on Anxiety,Depression, Fatigue,and Sleepiness in People Undergoing Hemodialysis: A Clinical Report

This study investigated the effect of hypnosis on anxiety, depression, fatigue, and sleepiness in hemodialysis patients. Twenty-nine patients participated in the 15-day study. A single hypnosis session was performed on Day 8. Anxiety, depression, fatigue, and sleepiness were measured at baseline, on Day 8, and on Day 15 (HADS, MFI, ESS). Daily fatigue was also measured numerically. Anxiety, depression, and sleepiness significantly decreased after hypnosis. Weekly measures of fatigue remained stable; however, daily fatigue decreased.     

Hypnosis and mastery: Clinical contributions and directions for research

This paper explores the concept of mastery in relation to hypnotherapy by pulling together clinical observations and suggesting directions for research. It is suggested that a sense of mastery may enhance the effectiveness of hypnosis, either by facilitating induction, or by strengthening hypnotherapeutic suggestions, or by maintaining hypnotherapeutic gains. Moreover, the question is raised as to whether hypnotherapy, as compared with other psychotherapeutic approaches, better facilitates the development of a sense of mastery.