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From the Magazine
"Science." Reprinted in "Time Magazine."
Mind over Medicine. Hypnosis as an alternative to sedation. is making a comeback in the operating room.
Here's how it works. By SORA SONG
Shelley Thomas, 53, was wheeled
into an anteroom at London's Middlesex Hospital in preparation for pelvic surgery. A patient going into that operation is
usually given a mix of painkilling narcotics and nerve-quelling tranquilizers. But not Thomas. Instead she rested on a gurney,
alert and calm, taking deep breaths at her hypno-therapist's instruction. Thomas counted aloud, "One hundred, deep sleep;
99, deeper sleep; 98 ..." "By the time I got to 95, the words and numbers had all gone," says Thomas. "It's
quite peculiar. They all go."
Minutes later, thoroughly hypnotized, Thomas was rolled into the operating room. There she underwent a 30-min. procedure
with no anesthetics and no discernible pain. Her hypno-therapist stayed by her side throughout, monitoring her trance state
and refocusing her mind when it drifted.
Thomas' story is not as extraordinary as you might think. Since the early 1990s, thousands of patients
have opted for hypnosis--either as a substitute for or (more typically) as a complement to anesthesia--in a wide variety of
surgical procedures, from repairing hernias to removing tumors. At the University Hospital of Liège in Belgium, a team
of doctors led by Dr. Marie-Elisabeth Faymonville has logged more than 5,100 surgeries by hypno-sedation, a technique Faymonville
developed that replaces general anesthesia with hypnosis, local anesthesia and a mild sedative. "Patients tell us that
it is a very special experience," says Faymonville. "We now have people coming from all over the world."
Hypnosis
was first used as a surgical anesthetic in India in 1845 but was quickly abandoned with the introduction of ether the following
year. The practice languished for decades, becoming, at least in the public eye, little more than a parlor trick. In 1958
it was sanctioned by the American Medical Association for use in medicine and dentistry. Since then, doctors have hypnotized
patients to help ease such ills as migraines, depression, anxiety and chronic cancer pain.
But it is in Europe that surgical
applications of hypnosis have flourished. The new interest stems in part from studies showing that hypno-sedated patients
suffer fewer side effects than fully sedated ones do. According to Faymonville, hypnotized patients can get by on less than
1% of the standard medications required for general anesthesia, thus avoiding such aftereffects as nausea, fatigue, lack of
coordination and cognitive impairment. In a 1999 study of thyroid patients, Faymonville found that the typical hypno-sedated
patient returned to work 15 days after surgery, compared with 28 days for a fully anesthetized patient.
Meanwhile, studies using advanced
scanning technology have shed new light on how hypnosis works to block pain. In a report published two years ago in the journal
Regional Anesthesia and Pain Medicine, Dr. Sebastian Schulz-Stübner of the University of Iowa reported using heat-producing
thermodes to measure the pain thresholds of 12 healthy volunteers ("painful" stimuli earning a rating of 8 or higher
on a 10-point scale). When the participants were hypnotized and re-exposed to the thermodes, all 12 reported feeling significantly
reduced pain (with ratings of 3 or lower) or no pain at all.
The differences in the subjects' brain scans were
equally striking. The typical pain signal follows a well-worn path from the brain stem through the midbrain and into the cortex,
where conscious feelings of pain arise. In Schulz-Stübner's study, the hypnotized group showed sub-cortical brain activity
similar to that of non-hypnotized volunteers, but the primary sensory cortex stayed quiet. The "ouch" message wasn't
making it past the midbrain and into consciousness. The new findings have fostered interest in the U.S., where doctors are using hypnosis for procedures
in which sedation is inappropriate or for patients who are allergic to anesthetics. Dr. David Spiegel, associate chair of
the department of psychiatry and behavioral sciences at Stanford University, hypnotizes Parkinson's sufferers during the implantation
of deep-brain electrodes--a process that requires tremulous patients to remain conscious and calm. He has also coaxed children
into imagining that a balloon tied to their wrist will fly them to their favorite places, a hypnotic technique that has lessened
anxiety in pediatric patients undergoing bladder catheterizations. In Iowa, Schulz-Stübner hypnotizes patients to reduce
pain and anxiety while they receive pre-surgery nerve blocks, such as epidurals. He finds that the calming effects of hypnosis
often last through the entire operation. Yet even the most enthusiastic proponents of hypno-sedation don't suggest that it replace anesthesia
entirely. For one thing, not everybody can be hypnotized. Some 60% of patients are hypnotizable to some degree, Spiegel says;
an additional 15%, highly so. The rest seem to be unresponsive. Moreover, many patients are fully sedated before surgery not
because the surgeon requires it but because they choose to be. "People don't want to feel or hear anything. They want
to be out," says Schulz-Stübner. "That's what you hear most of the time." From “Using Hypnosis to Gain
More Control Over Your Illness.” By LESLEY ALDERMAN Published: April 15, 2011 – The New York Times.
KIRSTEN RITCHIE, 44, is no stranger to surgery - nearly 20 years ago, doctors removed four tumors from her brain.
She remembers the operation and its aftermath as “horrific.” So the news that she needed brain surgery again
was hardly welcome. Determined to make her second operation a better - or at least less traumatic – experience.
Ms. Ritchie, an insurance marketing representative in Cleveland, turned to an unusual treatment. At the Cleveland
Clinic’s Center for Integrative Medicine, she had four hypnosis sessions in the month before her procedure, during which
she addressed her fear of the coming surgery. She also practiced self-hypnosis every day. Eventually, she said, “I got
to a place where I felt a sense of trust instead of fear.”
In February, doctors removed a plum-sized tumor from her brain. But there the similarity to her previous experience
ended. Ms. Ritchie woke up from the procedure, she said, feeling “alert and awesome.” She ate a full dinner that
night and went home in two days. “My neurosurgeon was stunned at how little medication I required before and after
surgery, and how quickly I bounced back,” she said. Ms. Ritchie attributes her speedy recovery and calm state
to her hypnosis sessions.
Used for more than two centuries to treat a host of medical problems, particularly pain management and anxiety, hypnosis
is now available to patients at some of the most respected medical institutions in the country, including Stanford Hospital,
the Cleveland Clinic, Mount Sinai Medical Center and Beth Israel Medical Center in New York.
Some critics find the research into mind-body therapies unconvincing, but their skepticism has not deterred patients
like Ms. Ritchie. And there are researchers who say they believe that by helping patients feel in better control of their
symptoms, hypnosis can reduce the need for medication and lower costs.
Some critics find the research into mind-body therapies unconvincing, but their skepticism has not deterred patients
like Ms. Ritchie. And there are researchers who say they believe that by helping patients feel in better control of their
symptoms, hypnosis can reduce the need for medication and lower costs. “It is an effective and inexpensive way to manage
medical care,” said Dr. David Spiegel, director of the Center on Stress and Health at Stanford University School of
Medicine and a leading authority on hypnosis.
A study by radiologists at Harvard Medical School, published in 2000, found that patients who received hypnosis during
surgery required less medication, had fewer complications and shorter procedures than patients who did not have hypnosis.
In a follow-up study in 2002, the radiologists concluded that if every patient undergoing catheterization were to receive
hypnosis, the cost savings would amount to $338 per patient.
http://www.nytimes.com/2011/04/16/health/16patient.html?_r=2&emc=eta1
MANCHESTER,
England, April 20 - Hypnotherapy helped relieve non-cardiac, angina-like chest pain, an extremely debilitating and difficult-to-treat
condition, according to a small study here. - Reassure patients with non-cardiac,
angina-like chest pain that heart disease is not the source of their ailment.
- Explain to
interested patients that those in this small study were helped by hypnotherapy, a treatment already effective for patients
with irritable bowel syndrome.
There is good evidence that patients with this condition and normal coronary arteries have an excellent
prognosis in terms of life expectancy and that the risk of developing coronary artery disease at a later date is remarkably
low, researchers wrote in a study reported online by Gut. Nevertheless, these patients
remain difficult to reassure, and consequently they continue to take anti-anginal medication and seek medical advice even
more often than individuals with proven coronary artery disease, said Peter Whorwell, M.D., and colleagues, of Wythenshawe
Hospital here. In
the study, 28 patients with normal coronary angiography and no contributory esophageal reflux were randomized to 12 sessions
of hypnotherapy over a 17 week period or "supportive therapy" plus placebo medication. Hypnotherapy was administered
by a non-physician therapist, the researchers wrote. Patients were started with a tutorial about their condition and the factors
that might be involved, such as disturbances in motility and visceral sensation along with stress. Hypnosis was induced by
eye closure, followed by progressive muscular relaxation and standard deepening techniques. After the first two sessions,
"chest focused" suggestions were introduced centered on normalizing esophageal motility and sensitivity, using both
imagery and conditioning techniques. More direct suggestions about pain reduction and health improvement were added. Patients
were also given an audio tape or CD of each session and were encouraged to practice at home. The mean age of the 15 hypnotherapy patients,
including 10 women, was 60, while the mean age of the 13 controls, including eight women, was 54. Twelve (80%) of 15 hypnotherapy
patients experienced a global improvement in pain compared with only three of 13 (23%) controls (P=0.008).
This was associated with a significantly greater reduction in pain intensity (P=0.046), although not frequency,
the researchers reported. Hypnotherapy also produced a significantly greater improvement in global assessment of overall well
being for 73% of the hypnotherapy patients compared with 23% of the controls (P=0.008). In addition, the hypnotherapy patients were able
to reduce their use of medications, whereas the controls increased usage, creating a significant difference in favor of hypnotherapy
(P=0.017), the investigators said. A laundry list of drugs taken by both groups
included beta-blockers, calcium-channel blockers, potassium-channel activators, nitrates, aspirin, and statins. Only statins
were more common in the hypno-treated patients. However, anxiety and depression scores were similar in both groups and remained
unchanged, according to the study. Supportive therapy was provided by a research assistant equal in status to the hypnotherapist. Patients
were encouraged to discuss their physical symptoms and emotional issues and were also given placebo medication to boost the
effects of the control supportive treatment and improve expectations, the researchers explained. A variety of factors have
been implicated in the pathogenesis of this disorder, Dr. Whorwell wrote, including esophageal reflux or motor dysfunction,
visceral hypersensitivity, musculoskeletal problems, and psychological factors. The researchers had previously shown that in patients with irritable
bowel syndrome, hypnotherapy helped normalize visceral sensations in the gut, reduced the contractile activity of the distal
colon, and decreased gastric acid secretion, thereby cutting down on medication use and visits to the doctor. The therapy
also has good pain-relieving qualities, they said, suggested by brain scans showing the treatment's effect on a brain region
that processes the emotional content of painful stimuli. A limitation of the study was that it could not be double-blinded, the investigators
noted. Thus the study was single-blinded with all outcomes assessed by an independent investigator blinded to the treatment
allocation. However,
a major drawback of hypnotherapy, Dr. Whorwell's team wrote, is that it is labor intensive for both patient and therapist
and comparatively expensive. In spite of this, they said, if the beneficial effects are sustained, substantial savings are
likely because of the high cost of continued medical consultations, medications, and repetitive clinical studies. Further
research is probably justified with somewhat different standards for inclusion, the researchers said. New studies, for example,
could alter the requirements for inclusion, such as the need for coronary angiography, which meant that participants in the
current study were likely to be older, whereas many actual patients are likely to be young and female, they said. If hypnotherapy
is successful, "It may avoid the necessity for coronary angiography, which is sometimes undertaken largely for the purpose
of reassurance," Dr. Whorwell concluded.
Taken
from, “The Possibilities in Hypnosis, Where the Patient Has the Power.” By
JANE E. BRODY. htt p://www.nytimes.com/2008/11/04
My husband, Richard, smoked cigarettes for 50 years, having failed several attempts to quit on his own. When
a friend told him in August 1994 that hypnosis had enabled her to quit, he decided to give it a try. “It didn’t
work; I wasn’t hypnotized,” he declared after his one and only session. But it did work; since that day,
he has not taken one puff of a cigarette.
Gloria Kanter of Boynton Beach, Fla., thought her attempt in 1985 to use hypnosis to overcome her
fear of flying had failed. “When the therapist brought me out, I said it didn’t work,” she recalled
in an interview. “I told her, “I heard everything you said.” Nonetheless, the next time she and her husband headed for the
airport, she was not drenched in sweat and paralyzed with fear. “I was just fine,” she said, “and
I’ve been fine ever since.”
Like many others whose knowledge of hypnotism comes from movies and stage shows, my husband and Mrs. Kanter
misunderstood what hypnosis is all about. While in a hypnotic trance, you are neither unconscious nor asleep, but rather in
a deeply relaxed state that renders the mind highly focused and ready to accept suggestions to help you accomplish your goals.
Hypnosis has been mired in controversy for two centuries, and its benefits are
often overstated. It does not help everyone who wants to quit smoking, for example; then again, neither do other kinds of
treatments. And the patient’s attitude is critical. In the words of Brian Alman, a psychologist who practices hypnosis
in San Diego, “The power of hypnosis actually resides in the patient and not in the Doctor.”
Roberta Temes, a clinical hypnotist in Scotch Plains, N.J., insists that hypnosis cannot
make people do anything they don’t want to do. Hypnosis can succeed only in helping people make changes they desire,
she said in an interview. In her book, “The Complete Idiot’s Guide to Hypnosis.”
Dr. Temes points out that success in achieving your goal is the best proof that you were really hypnotized.
She also suggests a second or third session if you didn’t quite reach your goal after the first try.
What Hypnosis Can Do.
In effect, hypnosis is the epitome of mind-body medicine. It can enable the mind to
tell the body how to react, and modify the messages that the body sends to the mind. It has been used to counter the nausea
of pregnancy and chemotherapy; dental and test-taking anxiety; pain associated with surgery, root canal treatment and childbirth;
fear of flying and public speaking; compulsive hair-pulling; and intractable hiccups, among many other troublesome health
problems.
Writing in The Permanente Journal in 2001, Dr. Alman said that “Useful
potential” for benefiting from hypnosis “exists within each patient.” “The goal
of modern medical hypnosis,” he said, “is to help patients use this unconscious potential.”
Dr. Alman described a 65-year-old concentration camp survivor who repeatedly choked
when she tried to swallow, though examinations of her esophagus revealed no obstruction. After three hypnotherapy sessions,
her problem was solved. “I was liberated from my esophagus,” the patient said. You may not even have
to be face to face with a hypnotist to benefit medically. Dr. Temes said hypnosis could be helpful even if done with a cassette
tape or CD, or by telephone, which she offers as part of her practice.
Ellen Fineman, a physical therapist in Portland, Ore., had had five surgeries to repair a retina
that kept detaching. Hoping that a sixth attempt would hold, she used a hypnosis tape prepared by Dr. Temes for patients undergoing
surgery. The hypnosis tape “was very calming and reassuring,” Ms. Fineman said in
an interview. “It told me that I would be in the hands of professionals who would take good care of me and that
I’d have minimal swelling,” she said. “This time the surgery went superbly - no inflammation, no
swelling and no more detachment. The surgeon was amazed and asked what I had done differently this time.”
While not everyone is easily hypnotized, nearly everyone can slip into a therapeutic
trance, Dr. Temes maintains. Another of her patients, Dr. Susan Clarvit, a New York psychiatrist, thought she could not be
hypnotized - she was too scientific, too rational a person, she said. “But I was desperate,” Dr. Clarvit
said in an interview. “I was pregnant with my second child and too nauseated to be alive. Dr. Temes asked me what
I held most often, and I said a pen. She hypnotized me so that when I held a pen I had an overall feeling of wellness. I held
a pen all the time, even while driving, and didn’t feel nauseated.”
Under hypnosis, Dr. Clarvit was given a posthypnotic suggestion that linked holding
a pen to feeling well. Such suggestions enable people to practice a new, desired behavior after being brought out of the trance.
Someone trying to overcome snacking on sweets might be told, “When you are hungry, you will eat vegetables.”
The suggestion to a smoker might be “You will drink water when you want a cigarette.” and someone terrified
of public speaking might be told, “You will do deep breathing when you feel scared.”
Many patients are also taught to practice self-hypnosis to reinforce the new behavior.
Dr. Karen N. Olness, a professor of pediatrics at Case Western Reserve University who is the president of the International
Society of Hypnosis, said that “Self-hypnosis training in children is an effective and practical strategy to prevent
migraine episodes.”
Indirect Benefits.
Sometimes patients with well-established illnesses can benefit indirectly from hypnosis.
Dr. Alman told of a woman with multiple sclerosis who was treated with hypnosis for depression that had failed to improve
with antidepressants. Almost immediately, he reported, not only did the woman’s depression ease, but her gait and speech
improved markedly.
He explained
that for many patients the medical problem is so complex that specific directions and commands may be ineffective. The benefit
from hypnosis may rely more on unleashing unconscious processes within the patient. He suggested that there exists, “A
wealth of material in the patient’s unconscious that can be used in healing,” but lamented the fact that
although medical hypnosis can often produce rapid change even in difficult cases, it is, “underutilized as a therapeutic
tool.” New
Study: 5/25/2010: Using Guided Imagery
(Hypnosis) for Prenatal Stress. Researchers
from University Hospital Basel in Switzerland compared the immediate effects of brief guided imagery and relaxation exercises
- two active and one passive 10-min relaxation technique - on prenatal stress in a randomized, controlled trial with 39 healthy
pregnant women. Subjects were assigned to one of two active relaxation techniques, progressive muscle relaxation
(PMR) or guided imagery (GI), or a passive relaxation control condition.
Measures were self-reported relaxation on a visual analogue scale (VAS); the State Anxiety Inventory (STAI-S); scores
on the hypothalamic-pituitary-adrenal (HPA) axis (cortisol and ACTH); and sympathetic-adrenal-medullary (SAM) system activity
(nor-epinephrine and epinephrine). Additionally, measures were taken of cardiovascular responses, such as heart rate, systolic
and diastolic blood pressure. Scores were measured at four points before and after the relaxation exercise.
Progressive Muscle Relaxation and the control conditions were not as effective as
Guided Imagery, which was significantly more effective in enhancing levels of relaxation. Together with PMR, GI was associated
with a significant decrease in heart rate.
Within the groups, passive as well as active relaxation procedures were associated with a decline in endocrine measures
except epinephrine.
Data indicates that guided imagery was especially effective in increasing self-reported relaxation in pregnant women
and reducing heart rate.
Citation:
Urech C, Fink NS, Hoesli I, Wilhelm FH, Bitzer J, Alder J. Effects of relaxation on psychobiological wellbeing during pregnancy:
A randomized controlled trial. Psychoneuroendocrinology. 2010 Apr 21. [Epub ahead of print]
Taken from:
Seth-Deborah Roth - Hypnosis and Health: YOUR BODY AND MIND IS ONE
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