Hypnotic Conflict: A Brief Report

Two studies investigated management of conflict in hypnosis by subtly increasing the brightness of a visual stimulus during a suggestion for hypnotic blindness to the stimulus. In Study 1, 23 high hypnotizable participants were administered a hypnotic suggestion for blindness to a projected light. For half the participants, the brightness of the light was intensified during the suggestion. Behavioral ratings and online analog-dial measurement indicated that participants reported decreased hypnotic blindness during the increased conflict condition. In Study 2, 20 participants were administered the nonexperimental procedure to investigate the impact of demand characteristics in this paradigm. Parallel findings in Studies 1 and 2 indicated that demand characteristics may explain the response to hypnotic conflict. Limitations in applying the nonexperimental procedure to this paradigm and the need for further investigation are discussed.     

An Hypnotic Suggestion: Review of Hypnosis for Clinical Emergency Care

Background

Hypnosis has been used in medicine for nearly 250 years. Yet, emergency clinicians rarely use it in emergency departments or prehospital settings.

Objective

This review describes hypnosis, its historical use in medicine, several neurophysiologic studies of the procedure, its uses and potential uses in emergency care, and a simple technique for inducing hypnosis. It also discusses reasons why the technique has not been widely adopted, and suggests methods of increasing its use in emergency care, including some potential research areas.

Discussion

A limited number of clinical studies and case reports suggest that hypnosis may be effective in a wide variety of conditions applicable to emergency medical care. These include providing analgesia for existing pain (e.g., fractures, burns, and lacerations), providing analgesia and sedation for painful procedures (e.g., needle sticks, laceration repair, and fracture and joint reductions), reducing acute anxiety, increasing children's cooperation for procedures, facilitating the diagnosis and treatment of acute psychiatric conditions, and providing analgesia and anxiolysis for obstetric/gynecologic problems.

Conclusions

Although it is safe, fast, and cost-effective, emergency clinicians rarely use hypnosis. This is due, in part, to the myths surrounding hypnosis and its association with alternative-complementary medicine. Genuine barriers to its increased clinical use include a lack of assured effectiveness and a lack of training and training requirements. Based on the results of further research, hypnosis could become a powerful and safe nonpharmacologic addition to the emergency clinician's armamentarium, with the potential to enhance patient care in emergency medicine, prehospital care, and remote medical settings.     

Mechanisms of Hypnosis: Toward the Development of a Biopsychosocial Model

Evidence supports the efficacy of hypnotic treatments, but there remain many unresolved questions regarding how hypnosis produces its beneficial effects. Most theoretical models focus more or less on biological, psychological, and social factors. This scoping review summarizes the empirical findings regarding the associations between specific factors in each of these domains and response to hypnosis. The findings indicate that (a) no single factor appears primary, (b) different factors may contribute more or less to outcomes in different subsets of individuals or for different conditions, and (c) comprehensive models of hypnosis that incorporate factors from all 3 domains may ultimately prove to be more useful than more restrictive models that focus on just 1 or a very few factors.     

Motor Imagery in Hypnosis: Accuracy and Duration of Motor Imagery in Waking and Hypnotic States

This study assessed response times and accuracy of motor imagery in waking and hypnotic states and to related responses to hypnotic experiences. The Vividness of Motor Imagery Questionnaire (VMIQ) was administered to 47 participants. A mental walking task was then performed in the waking state. In hypnosis, the same task was included within an imaginary journey after a hypnotic induction. An interaction effect showed for condition (waking vs. hypnotic) and distances. The further the participants had to walk in imagination, the longer they took. For all combinations, participants took significantly longer in hypnosis (p < .001) and were significantly less accurate in hypnosis in reproducing the difference between the different distances (p < .001). Results appear to show a relationship between motor imagery and hypnotic responding and support a state-trait conception of imagery.     

Hypnotic Susceptibility,Hypnosis, and EMG Biofeedback in the Reduction of Frontalis Muscle Tension

In the course of validating with 100 Ss the concept of a “classical suggestion-effect,” i.e., the existence of a class of non-voluntary behaviors elicited by communications intended to serve as traditional “suggestions,” evidence has been incidentally obtained which clearly shows that many so-called “instructions” given to presumably hypnotized Ss also function like “suggestions.” The data show that in these circumstances it is not possible to state a priori that a verbal communication will function as an “instruction” in contrast to being a “suggestion.” Such a statement can be made with certainty only a posteriori, on the basis of the nature of the resulting behavior. This finding has implications both for research and for the clinical uses of hypno-suggestive phenomena.     

Neurophysiological Attributes of the Hypnotic State and the Utility of Hypnosis in Pediatric Medicine and Burn Care

Three articles of special interest to the hypnosis community recently appeared in the general scientific and medical literatures. The first paper is a thoughtful review of the clinical applications of hypnosis in pediatric settings. The second article reports the findings of a randomized, controlled trial of hypnosis for burn-wound care, carried out at the University of Washington Medical School. The third article describes an innovative EEG laboratory case study tracking the cortex functional connectivity of a highly hypnotizable subject across various baseline and experimental conditions. These three articles are sturdy examples of how hypnosis illuminates (and is illuminated by) medical and psychological science.     

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.     

Resolving Conflict: A Primer for Nurse Practitioners on Alternatives to Litigation

Nurses share the concern of all health care professionals for legal liability and litigation in the United States today. Understanding the alternative strategies and procedures for dealing with risks equips NPs to take an active and informed role, from risk management and avoidance to consultation with legal counsel.     

Confirmatory factor analysis of the Valencia Scale on Attitudes and Beliefs Toward Hypnosis: an international study

Cognitions held about hypnosis have an important impact on areas such as initial rapport and hypnotic-treatment compliance. The Valencia Scale on Attitudes and Beliefs toward Hypnosis may be the first instrument specifically geared to the Spanish-speaking population. Besides measuring these cognitions, the scale can also help evaluate the effect of clinical and experimental manipulations on people's attitudes and beliefs toward hypnosis. The article presents a confirmatory factor analysis using a sample from 5 different countries (N=2,402). Test-retest analyses were also carried out. The authors found statistical confirmation for an 8-factor model solution: automatism, help, personal control, interest, magical solution, collaboration, memory, and marginal.     

Confirmatory Factor Analysis of the Valencia Scale on Attitudes and Beliefs Toward Hypnosis: An International Study

Cognitions held about hypnosis have an important impact on areas such as initial rapport and hypnotic-treatment compliance. The Valencia Scale on Attitudes and Beliefs toward Hypnosis may be the first instrument specifically geared to the Spanish-speaking population. Besides measuring these cognitions, the scale can also help evaluate the effect of clinical and experimental manipulations on people's attitudes and beliefs toward hypnosis. The article presents a confirmatory factor analysis using a sample from 5 different countries (N=2,402). Test-retest analyses were also carried out. The authors found statistical confirmation for an 8-factor model solution: automatism, help, personal control, interest, magical solution, collaboration, memory, and marginal.     

Fostering Cognitive Change in Cognitive Therapy of Depression: An Investigation of Therapeutic Strategies

There is little evidence regarding which therapist strategies promote cognitive change in cognitive therapy (CT) of depression. Drawing from a sample of CT patients, we selected two consecutive sessions for which patients reported markedly different amounts of cognitive change (CC; i.e., a low and high cognitive change session). We then investigated whether four observer-rated psychotherapy process variables differentiated high and low CC sessions. Our analyses focused on 62 patients with large session-to-session differences in self-reported CC. Results from single predictor models showed the therapeutic alliance and therapists’ use of cognitive methods predicted high versus low CC session type. In a model including multiple predictors, only cognitive methods remained significant. These findings are consistent with the view that cognitive methods promote CC in CT.

     

Specificity of Hopelessness about Resolving Life Problems: Another Test of the Cognitive Model of Depression

Although empirical evidence suggests that global hopelessness differentiates depression from anxiety, the degree to which depressed and anxious patients endorse hopelessness about specific life events has yet to be investigated. In the present study, outpatients with major depression (n = 64), outpatients with generalized anxiety disorder (n = 29), and outpatients with other psychiatric disorders (n = 56) completed the Imagined Outcome Test, in which they described the personal problem that was most distressing to them, imagined the worst and best possible outcomes, and rated the likelihood that these outcomes would actually occur. Depressed outpatients rated worst outcomes as being more likely and best outcomes as being less likely than outpatients in the other two groups. Results support the hypothesis that hopelessness about the resolution of life problems is unique to depression.     

Assessing Cognitive and Behavioral Coping Strategies in Children

The objective was to examine the psychometric qualities of a Dutch version of the Coping Strategies Checklist for Children (CCSC-R1) in the Netherlands and to replicate the 4-factor coping model that was established in an American population. Confirmatory factor analyses were used to investigate the factorial structure underlying the 13 subscales. A 5-factor model in which Positive Cognitive Restructuring was a separate coping dimension proved superior to a 4-factor model in which Positive Cognitive Restructuring was part of Direct Problem Solving. The 5-factor model proved invariant across age, and 10 subscales proved invariant across gender. Significant gender differences were found for the subscales “support for feelings,” “distracting actions” and “wishful thinking,” with girls scoring higher than boys. Pro-social behavior correlated positively with all five coping dimensions; the strongest correlations were with the coping dimensions Direct Problem Solving and Positive Cognitive Restructuring. Socially inadequate behavior was only significantly correlated with Avoidance Coping. The significance of coping assessment for cognitive and behavioral interventions for children with mental health problems was discussed.

Hypnosis in the emergency department

Five cases are presented wherein hypnosis was used by the emergency physician either as the primary mode of treatment or as an adjuvant to standard medical care. Common hypnotic phenomena (eg, anesthesia, analgesia), as well as novel effects, are reported. The technique used for trance induction and utilization is briefly outlined, and criteria are set forth for the bedside recognition of hypnotic trance.     

Salient Findings: Hypnosis in Medical Settings

Five papers of special interest to medical researchers and clinicians have recently appeared in the general scientific and medical literatures. Three of these papers are original clinical research studies evaluating whether hypnosis can be useful in treating acute stress disorder, allergic rhinitis, and distress associated with an invasive medical procedure for children. The remaining two articles critically review the empirical literature on whether and how hypnosis might be useful in a number of medical specialties.