There are many studies and articles regarding hypnosis / self-hypnosis available from medical journal searches. There are also many different hypnosis techniques in use. I am collecting abstracts from studies most applicable to the techniques I use.

Alcohol and Drugs

Am J Clin Hypn. 2004 Apr;46(4):281-97

Self-hypnosis relapse prevention training with chronic drug/alcohol users: effects on self-esteem, affect, and relapse.

Pekala RJ, Maurer R, Kumar VK, Elliott NC, Masten E, Moon E, Salinger M.

hBiofeedback Clinic (116B), Coatesville VA Medical Center, Coatesville, PA 19320-2096, USA. Ronald.Pekala@med.va.gov

This study evaluated the effectiveness of a self-hypnosis protocol with chronic drug and alcohol patients in increasing self-esteem, improving affect, and preventing relapse against a control, a transtheoretical cognitive-behavioral (TCB), and a stress management (attention-placebo) group. Participants were 261 veterans admitted to Substance Abuse Residential Rehabilitation Treatment Programs (SARRTPs). Participants were assessed pre- and post intervention, and at 7-week follow-up. Relapse rates did not significantly differ across the 4 groups at follow-up; 87% of those contacted reported abstinence. At follow-up, the participants in the 3 treatment conditions were asked how often they practiced the intervention materials provided them. Practicing and minimal-practicing participants were compared against the control group for each of the 3 interventions via MANOVAs/ANOVAs. Results revealed a significant Time by Groups interaction for the hypnosis intervention, with individuals who played the self-hypnosis audiotapes "at least 3 to 5 times a week" at 7-week follow-up reporting the highest levels of self-esteem and serenity, and the least anger/impulsivity, in comparison to the minimal-practice and control groups. No significant effects were found for the transtheoretical or stress management interventions. Regression analyses predicted almost two-thirds of the variance of who relapsed and who did not in the hypnosis intervention group. Hypnotic susceptibility predicted who practiced the self-hypnosis audiotapes. The results suggest that hypnosis can be a useful adjunct in helping chronic substance abuse individuals with their reported self-esteem, serenity, and anger/impulsivity.

Breast Augmentation

Peter H.C. Mutke, M.D. (UCLA) performed the first study. He presented his results as a research paper to the Department of Neuropsychiatry, University of California, Los Angeles, February 28, 1971. As of 1994, Dr Mutke was still with UCLA and has been active in the American Council of Hypnotist Examiners.
2. Williams, J.E., Stimulation of breast growth by hypnosis. "Journal of Sex Research," 1974, 10:316-326. His thirteen volunteers averaged 2.11 inch increase in the circumference of their breasts (2 cup sizes).
3. Staib, A.R., and Logan, D.R., Hypnotic Stimulation of Breast Growth. "The American Journal of Clinical Hypnosis," 1977, 4:201-208. They repeated Dr. Williams' results with similar results. They also found women's waist size decreased by 1.4 inches. Their follow up study showed that 81 % of the breast enlargement was retained several months after the women stopped their visual imagery.
4. Willard, R. D., Breast enlargement through visual imagery and hypnosis. "The American Journal of Clinical Hypnosis," 1977, 4:195-200. Dr Willard used a different technique than Dr. Williams (who used age regression and age progression) and achieved an average 1.44 inch increase in breast size for his 22 volunteers. Every woman had an increase in their breast circumference.

Beran, Roy (a neurologist at Adelaide Children's Hospital, England) presented the results of his study to the February 1979 National Convention of Hypnotherapists in Adelaide. Dr. Beran showed that the breast volume (he measured the breast's cubic displacement of water) more than doubled during the three month hypnosis program.

Excerpt of the RESULTS section of the Willard study:
At the end of 12 weeks, 28% had reached the goal they had set at the beginning of the program and desired no further enlargement. There were 85% who could tell a significant enlargement in their breasts had been accomplished, and 46% found it necessary to buy a larger brassiere. Forty-two percent had a loss in weight of greater than 4 pounds and still had enlargement of their breasts. The average increase in circumference was 1.37 inches; the average increase in the vertical measurement was 0.67 inches and the average increase in horizontal measurement was 1.01 inches.... [note: the study was continued past 12 weeks to let those who hadn't reach their goals to do so.]
In this study, 63% of the subjects had had children and complained of pendulous breasts. These subjects expressed a desire to reclaim the fullness and contour of the breasts which they had before the pregnancies. All of these subjects reported they were very pleased with the increase in fullness and firmness of their breasts at the end of the study....
The only two subjects who subjectively felt there had been no significant increase, did have a measurable increase in size. Both subjects had difficulty obtaining the visualizations. All of the subjects reported an increase in firmness of their breasts. All of the subjects who began the study with one breast smaller than the other found them to be equal in size at the end of the twelve weeks.

Childbirth

Contraception  2007 Jan;75(1):52-8.

The use of hypnosis to improve pain management during voluntary interruption of pregnancy: an open randomized preliminary study.

Marc I, Rainville P, Verreault R, Vaillancourt L, Masse B, Dodin S.

Chaire Lucie et André Chagnon pour l'Avancement d'Une approche intégrée en santé, Hôpital St-François d'Assise, CHUQ, Université Laval, Quebec City, PQ, Canada.

OBJECTIVE: This report describes an open randomized study that aims to determine whether a brief hypnotic intervention during first-trimester surgical abortion reduces requests for pain medication. METHODS: Thirty women undergoing first-trimester surgical abortion at the family planning clinics of a large hospital in Quebec City were randomized into a control group that received standard care and a hypnosis group that received, in addition to standard care, an intervention of hypnosis, including analgesia suggestions 20 min before and throughout the surgical procedure. Patients in both groups were given the option to control their pain with nitrous oxide (N(2)O) sedation administered through a nose mask as often and for as long as they wanted during the procedure. N(2)O sedation as the primary outcome was assessed at each step of the procedure. The patient's self-reported anxiety and pain were also assessed during the procedure as secondary outcomes. RESULTS: Thirty-six percent of patients in the hypnosis group requested N(2)O sedation during the procedure versus 87% in the control group (p<.01). No differences between the groups were found in reports of pain and anxiety during the procedure. CONCLUSION: These results suggest that hypnosis can be integrated into standard care and reduces the need for N(2)O in patients undergoing first-trimester surgical abortion. This reduction in N(2)O consumption did not lead to significant changes in pain or anxiety, and a larger sample size is required to assess the possible effects of hypnosis on those variables.

PMID: 17161125 [PubMed - indexed for MEDLINE]

MCN Am J Matern Child Nurs. 2002 Nov-Dec;27(6):335-40; quiz 341.

Self-hypnosis: alternative anesthesia for childbirth.

Ketterhagen D, VandeVusse L, Berner MA.

Women's Health Center, Waukesha Memorial Hospital, Waukesha, WI 53188, USA. debra.ketterhagen@phci.org

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. 

Br J Anaesth. 2004 Oct;93(4):505-11. Epub 2004 Jul 26.

Hypnosis for pain relief in labour and childbirth: a systematic review.

Cyna AM, McAuliffe GL, Andrew MI.

Department of Women's Anaesthesia, Women's and Children's Hospital, Adelaide, South Australia 5006, Australia. cynaa@wch.sa.gov.au

BACKGROUND: In view of widespread claims of efficacy, we examined the evidence regarding the effects of hypnosis for pain relief during childbirth. METHODS: Medline, Embase, Pubmed, and the Cochrane library 2004.1 were searched for clinical trials where hypnosis during pregnancy and childbirth was compared with a non-hypnosis intervention, no treatment or placebo. Reference lists from retrieved papers and hypnotherapy texts were also examined. There were no language restrictions. Our primary outcome measures were labour analgesia requirements (no analgesia, opiate, or epidural use), and pain scores in labour. Suitable comparative studies were included for further assessment according to predefined criteria. Meta-analyses were performed of the included randomized controlled trials (RCTs), assessed as being of "good" or "adequate" quality by a predefined score. RESULTS: Five RCTs and 14 non-randomized comparisons (NRCs) studying 8395 women were identified where hypnosis was used for labour analgesia. Four RCTs including 224 patients examined the primary outcomes of interest. One RCT rated poor on quality assessment. Meta-analyses of the three remaining RCTs showed that, compared with controls, fewer parturients having hypnosis required analgesia, relative risk=0.51 (95% confidence interval 0.28, 0.95). Of the two included NRCs, one showed that women using hypnosis rated their labour pain less severe than controls (P<0.01). The other showed that hypnosis reduced opioid (meperidine) requirements (P<0.001), and increased the incidence of not requiring pharmacological analgesia in labour (P<0.001). CONCLUSION: The risk/benefit profile of hypnosis demonstrates a need for well-designed trials to confirm the effects of hypnosis in childbirth.

Fertil Steril. 2006 Mar 25;

Impact of hypnosis during embryo transfer on the outcome of in vitro fertilization-embryo transfer: a case-control study.

Levitas E, Parmet A, Lunenfeld E, Bentov Y, Burstein E, Friger M, Potashnik G.

Fertility and IVF Unit; Department of Obstetrics and Gynecology, Soroka University Medical Center.

OBJECTIVE: To investigate whether hypnosis during ET contributes to successful IVF/ET outcome. DESIGN: Case-control clinical study. SETTING: Academic Fertility and IVF Unit, Soroka Medical Center, Beer-Sheva, Israel. PATIENT(S): Infertile couples undergoing IVF. INTERVENTION(S): Ninety-eight IVF/ET cycles with hypnosis during the ET procedure were matched with 96 regular IVF/ET cycles. MAIN OUTCOME MEASURES: Comparison of clinical pregnancy and implantation rates between the two groups. RESULT(S): We obtained 52 clinical pregnancies out of 98 cycles (53.1%) with an implantation rate of 28% among hypnosis IVF/ET cycles, and 29 out of 96 (30.2%) clinical pregnancies and an implantation rate of 14.4% in the control cycles. Our overall IVF program pregnancy rate for the same period was 32.1%. Logistic regression analysis was performed emphasizing the positive contribution of hypnosis to the IVF/ET conception rates. CONCLUSION(S): This study suggests that the use of hypnosis during ET may significantly improve the IVF/ET cycle outcome in terms of increased implantation and clinical pregnancy rates. Furthermore, it seems that the patients' attitude to the treatment was more favorable.

Dental Hypnosis

Fogorv Sz. 2002 Oct;95(5):199-203

[Psychic aspects of the overactive gag reflex (gagging) in connection with a clinical case]

Gaspar J, Fejerdy L, Fabian TK.
Semmelweis Egyetem, Fogorvostudomanyi Kar, Fogpotlastani Klinika, Budapest.

The overactive gag reflex is one of the etiologic categories of psychosomatic symptoms, which most often arise from environmental stressors. If organic disturbances, anatomic anomalies, or biomechanical inadequacies of existing prostheses are not key causes, the services of trained specialists are needed to help with behavioural management of the problem. Hypnosis can provide the clinician with a set of techniques, which may be used to augment or facilitate a particular course of treatment. In the case report, the patient's history and her overactive gag reflex suggested to use hypnosis therapy. The responsibility of a dentist can be found in his possible recognition of eventually necessary psychotherapy when consulting a patient.

Rev Belge Med Dent. 2003;58(2):99-104

[Hypnosis techniques used to diminish anxiety and fear: review of the literature]

Willemsen R.

Service de dermatologie, AZ Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Jette. riawil@pi.be

Hypnosis can be a valuable technique in the management of patients who fear medical treatment. Hypnosis leads to a stronger concentration and a more focussed attention, and thus to a better acceptance and greater effectiveness of suggestions. Literature indicates that hypnotherapy can reduce pain and fear in case of dental or medical phobia. After a short review of the existing literature on the topic, the practical aspects of the hypnotic approach are explained.

ASDC J Dent Child. 2000 Jul-Aug;67(4):263-7, 231

The use of imagery suggestions during administration of local anesthetic in pediatric dental patients.

Peretz B, Bimstein E.

Department of Pediatric Dentistry, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel.

The aim of this study was to evaluate the effects of suggestion before and during the administration of local anesthesia to children. These effects were then observed and correlated with social, behavioral and dentally related variables. Eighty children between the ages of three and sixteen years and who required at least one injection of local anesthesia were monitored. Retrospective examinations of their dental records provided the information regarding the behavior and dental treatment histories of the patients. All other data were provided through observation during the dental treatment phase. During the first treatment session, before the injection, each child was asked to select a favorite, pleasant memory or image. Where children had difficulty in identifying an image, one was proposed by the dentist. After an image had been chosen, the patients were asked to concentrate on the image and to visualize it during the procedure. The majority of children had chosen their own images, and significantly visualized the same images throughout the injection procedures. Image selection and visualization had no association with gender, age, the parent's assessment of the child's behavior, previous dental experience, behavior (both past and present) or, management techniques (both past and present). We conclude that imaging techniques may be successfully utilized in the administration of local anesthesia to young children (from three years of age) in an effort to mitigate untoward, pain-related stress.

Eur J Oral Sci. 2002 Aug;110(4):287-95.

A 3-year comparison of dental anxiety treatment outcomes: hypnosis, group therapy and individual desensitization vs. no specialist treatment.

Moore R, Brodsgaard I, Abrahamsen R.

Department of Oral Epidemiology and Pediatric Dentistry, Dental Phobia Research and Treatment Center, Royal Dental College, Aarhus University, Denmark. roding@post8.tele.dk

Outcomes of hypnotherapy (HT), group therapy (GT) and individual systematic desensitization (SD) on extreme dental anxiety in adults aged 19-65 yr were compared by regular attendance behaviors, changes in dental anxiety and changes in beliefs about dentists and treatment after 3 yr. Treatment groups were comparable with a static reference control group of 65 anxious patients (Dental Anxiety Scale > or = 15) who were followed for a mean of nearly 6 yr. After 3 yr, 54.5% of HT patients, 69.6% of GT patients and 65.5% of SD patients were maintaining regular dental care habits. This was better than the 46.1% of the reference group, who reported going regularly to the dentist again within the cohort follow-up period, and 38.9% of a control subgroup with observation for 3 yr. Women were better regular attenders than men at 3 yr. Specialist-treated regular attenders were significantly less anxious and had more positive beliefs than regular attenders from reference groups. There were few differences between HT, GT and SD after 3 yr. It was concluded that many patients can, on their own, successfully start and maintain regular dental treatment habits with dentists despite years of avoidance associated with phobic or extreme anxiety. However, it also appears that these patients had less success in reducing dental anxiety and improving beliefs about dentists long-term than did patients who were treated at the specialist clinic with psychological strategies.

J Orofac Pain. 1994 Fall;8(4):397-401.

A cognitive-behavioral approach to temporomandibular dysfunction treatment failures: a controlled comparison.

Oakley ME, McCreary CP, Clark GT, Holston S, Glover D, Kashima K.

Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles 90024-1762, USA.

The effects of cognitive-behavioral treatment for patients with temporomandibular disorders were studied by comparing active treatment to a wait-list control condition. Patients were predominantly women and had been referred to the study after having poor response to dental/physical medicine care. Patients' conditions were evaluated pretreatment and posttreatment based on self-report measures of pain, distress, and jaw function problems. They were examined by a dentist who assessed pain-free opening, muscle palpation pain, and tenderness of the temporomandibular joints. The 5-week cognitive-behavioral treatment included relaxation training, self-monitoring of stressors, and cognitive coping strategies. Treatment had its greatest impact on improving mood, especially anxiety; however, there were some effects on the patients' experiences of pain. 

Dent Clin North Am. 1986 Oct;30(4 Suppl):S93-105.

Relaxation skills for the patient, dentist, and auxiliaries.

Schutt NL, Bernstein DA.

The aforementioned stress reduction techniques can be useful for some people, but not all individuals will benefit to the same degree with a similar technique. Those who manifest severe stress symptoms, such as ulcers, hypertension, and migraine headaches, are advised to seek a medical evaluation before attempting relaxation or any other type of stress reduction method. The relaxation skill most beneficial for an individual's own needs might be best sought through a qualified therapist. Those who desire reduction in general tension, or who wish a rejuvenation during the workday, may well benefit from less controlled stress reduction techniques, such as taped instructions, breathing, and imagery methods. A trained therapist can provide the most appropriate relaxation method for an individual's needs. We, as health care providers, can enlighten our patients about methods which can aid them in dealing with anxiety and stress and thus gain better control over the pace of their lives and ours.

Dent Clin North Am. 1988 Oct;32(4):745-61.

Hypnosis in the treatment of dental fear and phobia.

Forgione AG.

Gelb Craniomandibular Pain Center, Tufts University School of Dental Medicine, Boston, Massachusetts.

The term hypnosis is currently used to define an area of research and treatment that employs suggestion. Within this area, suggestion refers to the induction of expectancies by implicit or explicit means, usually involving concentration and the expectancy that the suggested results are possible. This use of suggestion differs from the common use of the term suggestion, which is a logical offering for a change in behavior or thought. The long history of hypnosis is testimony to its effectiveness, although there has been controversy as to why it works. Patient selection is important. Further, fear must be distinguished from phobia. Combined with other treatment techniques, such as systematic desensitization, it is a powerful behavior modification method. To prevent accidental delivery of suggestions that may be counterproductive to treatment, the study of hypnosis is important even to those health care professionals who have no intention of employing it in their practice.

Am J Clin Hypn. 1991 Apr;33(4):235-40.

Treatment of tongue thrust with hypnosis: two case histories.

Golan HP.

Boston City Hospital, MA.

Tongue thrust is a relatively infrequent habit which can result in disruptive, permanent oral malocclusion, bone changes, and facial disharmony. The use of hypnotic phenomena can augment myofunctional therapy. Temperature control, glove anesthesia, relaxation, and imagery enhance demonstration of the proper way to swallow. The cornerstone of having the patient actually feel the contraction at the insertion of the masseter muscles provides an inner biofeedback which provides a very positive signal that the improper habit is being corrected. Hypnosis can then be used in the manner described to achieve a good clinical result.

Depression

Int J Clin Exp Hypn. 2007 Apr;55(2):147-66

Cognitive hypnotherapy for depression: an empirical investigation.   [Article in English, French, German]

Alladin A,

Alibhai A.

University of Calgary. Calgary, Alberta. Canada.

To investigate the effectiveness of cognitive hypnotherapy (CH), hypnosis combined with cognitive-behavioral therapy (CBT), on depression, 84 depressives were randomly assigned to 16 weeks of treatment of either CH or CBT alone. At the end of treatment, patients from both groups significantly improved compared to baseline scores. However, the CH group produced significantly larger changes in Beck Depression Inventory, Beck Anxiety Inventory, and Beck Hopelessness Scale. Effect size calculations showed that the CH group produced 6%, 5%, and 8% greater reduction in depression, anxiety, and hopelessness, respectively, over and above the CBT group. The effect size was maintained at 6-month and 12-month follow-ups. This study represents the first controlled comparison of hypnotherapy with a well-established psychotherapy for depression, meeting the APA criteria for a "probably efficacious" treatment for depression

Dermatology

Dermatology. 2002;204(4):287-9

Verrucae vulgares in children: successful simulated X-ray treatment (a suggestion-based therapy).

Meineke V, Reichrath J, Reinhold U, Tilgen W.

Department of Dermatology, University of the Saarland, Homburg/Saar, Germany. Viktor.Meineke@t-online.de

BACKGROUND: Treatment of verrucae vulgares is sometimes difficult. Invasive methods should not be used for young children. OBJECTIVE: Evaluation of a special suggestion therapy for treatment of verrucae vulgares in children. METHODS: Nine children with warts on the hands and/or feet and in the face were treated with a simulated X-ray treatment. RESULTS: Five children showed a complete remission of warts, 3 children a partial remission. For 1 child, there was no response. On average, 3 treatment sessions were needed for children showing a complete remission. CONCLUSION: This therapy offers an easy-to-perform, alternative treatment option. It is noninvasive and does not depend on special psychological techniques for which training is required. Copyright 2002 S. Karger AG, Basel

Am J Clin Hypn. 1992 Jul;35(1):1-10.

Hypnotherapy for warts (verruca vulgaris): 41 consecutive cases with 33 cures.

Ewin DM.

Tulane Medical School, New Orleans, LA.

Published, controlled studies of the use of hypnosis to cure warts are confined to using direct suggestion in hypnosis (DSIH), with cure rates of 27% to 55%. Prepubertal children respond to DSIH almost without exception, but adults often do not. Clinically, many adults who fail to respond to DSIH will heal with individual hypnoanalytic techniques that cannot be tested against controls. By using hypnoanalysis on those who failed to respond to DSIH, 33 of 41 (80%) consecutive patients were cured, two were lost to follow-up, and six did not respond to treatment. Self-hypnosis was not used. Several illustrative cases are presented.

Psychosom Med. 1990 Jan-Feb;52(1):109-14.

Effects of hypnotic, placebo, and salicylic acid treatments on wart regression.

Spanos NP, Williams V, Gwynn MI.

Department of Psychology, Carleton University, Ottawa, Canada.

Subjects with warts on their hands and/or feet were randomly assigned to a hypnotic suggestion, topical salicylic acid, placebo, or no treatment control condition. Subjects in the three treated groups developed equivalent expectations of treatment success. Nevertheless, at the six-week follow-up interval only the hypnotic subjects had lost significantly more warts than the no treatment controls. Theoretical implications are discussed.

Arch Dermatol. 2000 Mar;136(3):393-9

Hypnosis in dermatology.

Shenefelt PD.

Department of Internal Medicine, College of Medicine, University of South Florida, Tampa 33612, USA. pshenefe@hsc.usf.edu

BACKGROUND: Hypnosis is an alternative or complementary therapy that has been used since ancient times to treat medical and dermatologic problems. OBJECTIVE: To describe the various uses for hypnosis as an alternative or complementary therapy in dermatologic practice. METHODS: A MEDLINE search was conducted from January 1966 through December 1998 on key words related to hypnosis and skin disorders. RESULTS: A wide spectrum of dermatologic disorders may be improved or cured using hypnosis as an alternative or complementary therapy, including acne excoriee, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. CONCLUSION: Appropriately trained clinicians may successfully use hypnosis in selected patients as alternative or complementary therapy for many dermatologic disorders. 

Dermatol Clin. 2005 Oct;23(4):723-34.

Complementary psychocutaneous therapies in dermatology.

Shenefelt PD.

Division of Dermatology and Cutaneous Surgery, College of Medicine, University of South Florida, 12901 Bruce B. Downs Boulevard, Tampa, FL 33612, USA. pshenefe@hsc.usf.edu

The skin and the nervous system develop side by side in the fetus and remain intimately interconnected and interactive throughout life. Because of the skin-nervous system interactions, there is a significant psychosomatic or behavioral component to many dermatologic conditions. This permits complementary nonpharmacologic psychotherapeutic interventions, such as acupuncture, aromatherapy, biofeedback, cognitive-behavioral therapy, hypnosis, placebo, and suggestion, to have positive impacts on many dermatologic diseases. Complementary pharmacologic psychotherapeutic interventions, such as herbs and supplements, also may help improve some dermatologic disorders.

Dermatol Ther. 2003;16(2):114-22.

Biofeedback, cognitive-behavioral methods, and hypnosis in dermatology: is it all in your mind?

Shenefelt PD.

Division of Dermatology and Cutaneous Surgery, Department of Internal Medicine, College of Medicine, University of South Florida, Tampa, Florida 33612, USA. pshenefe@hsc.usf.edu

Biofeedback can improve cutaneous problems that have an autonomic nervous system component. Examples include biofeedback of galvanic skin resistance (GSR) for hyperhidrosis and biofeedback of skin temperature for Raynaud's disease. Hypnosis may enhance the effects obtained by biofeedback. Cognitive-behavioral methods may resolve dysfunctional thought patterns (cognitive) or actions (behavioral) that damage the skin or interfere with dermatologic therapy. Responsive diseases include acne excoriee, atopic dermatitis, factitious cheilitis, hyperhidrosis, lichen simplex chronicus, needle phobia, neurodermatitis, onychotillomania, prurigo nodularis, trichotillomania, and urticaria. Hypnosis can facilitate aversive therapy and enhance desensitization and other cognitive-behavioral methods. Hypnosis may improve or resolve numerous dermatoses. Examples include acne excoriee, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. Hypnosis can also reduce the anxiety and pain associated with dermatologic procedures.

Dyspepsia

Gastroenterology. 2002 Dec;123(6):1778-85.

Gastroenterology. 2002 Dec;123(6):2132-5.

      Gastroenterology. 2003 Aug;125(2):636; author reply 637.

      Rev Gastroenterol Disord. 2003 Summer;3(3):182-4.

Long-term improvement in functional dyspepsia using hypnotherapy.

Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ.

Department of Medicine, Wythenshawe Hospital, Southmoor Road, Manchester, United Kingdom.

BACKGROUND & AIMS: We have shown hypnotherapy (HT) to be effective in irritable bowel syndrome, with long-term improvements in symptomatology and quality of life (QOL). This study aimed to assess the efficacy of HT in functional dyspepsia (FD). METHODS: A total of 126 FD patients were randomized to HT, supportive therapy plus placebo medication, or medical treatment for 16 weeks. Percentage change in symptomatology from baseline was assessed after the 16-week treatment phase (short-term) and after 56 weeks (long-term) with 26 HT, 24 supportive therapy, and 29 medical treatment patients completing all phases of the study. QOL was measured as a secondary outcome. RESULTS: Short-term symptom scores improved more in the HT group (median, 59%) than in the supportive (41%; P = 0.01) or medical treatment (33%; P = 0.057) groups. HT also benefited QOL (42%) compared with either supportive therapy (10% [P < 0.001]) or medical treatment (11% [P < 0.001]). Long-term, HT significantly improved symptoms (73%) compared with supportive therapy (34% [P < 0.02]) or medical treatment (43% [P < 0.01]). QOL improved significantly more with HT (44%) than with medical treatment (20% [P < 0.001]). QOL did improve in the supportive therapy (43%) group, but 5 of these patients commenced taking antidepressants during follow-up. A total of 90% of the patients in the medical treatment group and 82% of the patients in the supportive therapy group commenced medication during follow-up, whereas none in the HT group did so (P < 0.001). Those in the HT group visited their general practitioner or gastroenterologist significantly less (median, 1) than did those in the supportive therapy (median, 4) and medical treatment (median, 4) groups during follow-up (P < 0.001). CONCLUSIONS: HT is highly effective in the long-term management of FD. Furthermore, the dramatic reduction in medication use and consultation rate provide major economic advantages.

Curr Treat Options Gastroenterol. 2003 Aug;6(4):289-297

Treatment of Functional Dyspepsia.

Feinle-Bisset C, Andrews JM.

Department of Medicine, University of Adelaide, Level 6, Eleanor Harrald Building, Frome Road, Adelaide, SA 5000, Australia. christine.feinle@adelaide.edu.au

Because there is currently no universally effective treatment for functional dyspepsia, a stepwise approach is useful. The initial steps should include 1) making a firm clinical diagnosis and providing the patient with appropriate information and reassurance; 2) ascertaining the reason for referral/consultation, as this determines what the patient will regard as a satisfactory outcome; 3) informing the patient that there is no universally effective drug treatment; and 4) giving dietary and general lifestyle advice, such as ingestion of smaller, more frequent meals, a low-fat diet, avoidance of certain foods that may exacerbate symptoms, limiting coffee and alcohol intake, smoking cessation, and stress management techniques. If the initial approach does not provide a satisfactory outcome, the following approaches may be helpful. Psychologic treatment approaches, such as hypnotherapy and/or antidepressants, have shown very encouraging results in recent studies and deserve active consideration. In patients with uninvestigated dyspepsia, the "test and treat" strategy for Helicobacter pylori is a cost-effective approach. Prokinetics are of possible benefit in subjects with delayed gastric emptying; however, the relationship between improvement of gastric emptying and symptom alleviation is weak. Furthermore, it needs to be recognized that treatments directed at acid suppression are generally of little sustained benefit, and that there is ongoing controversy as to whether H. pylori eradication is of direct benefit.

Aliment Pharmacol Ther. 2006 Apr 15;23(8):1241-9.

Prokinetic effect of gut-oriented hypnosis on gastric emptying.

Chiarioni G, Vantini I, DE Iorio F, Benini L.

Department of Gastroenterology, Rehabilitation Hospital of Valeggio s/M, University of Verona, Verona, Italy.

Summary Background No data are available on the effect of hypnosis on gastric emptying. Aim To determine the effect of a hypnosis session on gastric emptying and dyspeptic symptoms. Methods We studied emptying by ultrasonography and epigastric sensations in 11 healthy subjects and in 15 patients affected by functional dyspepsia under three conditions according to a fixed schedule: (a) basal, (b) after cisapride and (c) during a 90 min hypnotic trance. Eight healthy subjects repeated an emptying study listening to relaxing music. Statistical analysis was performed using the Friedman test or RM-anova. Results In dyspeptics, the postprandial increase in the antral area was significantly smaller during the hypnosis trance than under the basal and the cisapride conditions. For the patients gastric emptying was significantly shortened by cisapride, and even more by hypnosis (basal 274 +/- 16.8 min; cisapride 227 +/- 13.2; hypnosis 150 +/- 9.7) whereas for healthy subjects it was shortened only by hypnosis. The repeated study in healthy subjects listening to relaxing music showed no significant difference compared with the basal. Epigastric sensations were improved in dyspeptics by hypnosis, but not by cisapride. Conclusions Gut-oriented hypnosis is effective in shortening gastric emptying both in dyspeptic and in healthy subjects.

Habits

Addiction. 2002 Jan;97(1):87-93.

The urge to smoke depends on the expectation of smoking.

Dols M, van den Hout M, Kindt M, Willems B.

Department of Medical, Clinical and Experimental Psychology, Maastricht University, The Netherlands. M.Dols@dep.unimaas.nl

AIMS: An earlier study (Dols et al. 2000) suggested that cue-induced urge to smoke depends on the expectation of smoking. The present study tried to replicate the findings under stringently controlled conditions. DESIGN: A 2 (context) x 2 (cues) x 6 (trial) within-subject design. Each smoker entered two different contexts; one context predicted the future occurrence of smoking (i.e. one puff of a cigarette) and one context predicted the non-occurrence of smoking. In each context smokers were exposed to smoking cues (i.e. cigarettes and lighter) or not. SETTING: Laboratory at Maastricht University. PARTICIPANTS: Thirty-two daily smokers, smoking at least five cigarettes a day for at least 2 years. MEASUREMENTS: Participants reported their urge to smoke in each context in the presence and absence of smoking cues using a computerized visual analogue scale (VAS). FINDINGS: The results revealed that the urge to smoke was higher in a context in which smoking was expected relative to a context in which it was not expected. As in the previous study the urge-inducing effect of smoking cues was larger in the smoking context than in the non-smoking context. Moreover, smoking cues did not have a significant effect in the non-smoking context. CONCLUSIONS: It was shown that smoking cues elicit craving due mainly to a generated expectation of the occurrence of smoking and less due to salience or long history of associative learning. Theoretical and practical implications of the results are discussed.

PMID: 11895274 [PubMed - indexed for MEDLINE]

J Pediatr. 2004 Feb;144(2):213-7.

Childhood habit cough treated with self-hypnosis.

Anbar RD, Hall HR.

Department of Pediatrics, University Hospital, State University of New York Upstate Medical University, Syracuse, New York 13210, USA. Anbar@mail.upstate.edu

OBJECTIVES: To better understand factors associated with the development and persistence of habit cough and to report use of self-hypnosis for this condition. STUDY DESIGN: A retrospective chart review was performed for 56 children and adolescents with habit cough. Interested patients were instructed in self-hypnosis for relaxation and to help ignore the cough-triggering sensation. RESULTS: The patients' mean age was 10.7 years. The cough was triggered by upper respiratory infections in 59%, asthma in 13%, exercise in 5%, and eating in 4%. Onset of the cough occurred as early as 2 years, and its average duration was 13 months (range, 2 weeks to 7 years). There was a high incidence of abdominal pain and irritable bowel syndrome in the 50% of the patients who missed more than 1 week of school because of their cough. Among the 51 patients who used hypnosis, the cough resolved during or immediately after the initial hypnosis instruction session in 78% and within 1 month in an additional 12%. CONCLUSIONS: Habit cough is triggered by various physiologic conditions, related frequently to other diagnoses, and it is associated with significant school absence. Self-hypnosis offers a safe efficient treatment.

J Dev Behav Pediatr. 1996 Oct;17(5):328-34.

Hypnotherapeutic management of pediatric and adolescent trichotillomania.

Kohen DP.

Department of Pediatrics, University of Minnesota, Minneapolis 55454, USA.

Trichotillomania in children is regularly described as analogous to a habit disorder. As such, it is thought at times to be benign in a manner analogous to habits such as thumb sucking and nail biting. It is also considered by some to be an obsessive-compulsive disorder, to be more recalcitrant to intervention, and to be more socially disabling than simple habits, particularly when persistence and intensity eventuate in obvious alopecia. This report presents five cases of trichotillomania in which self-monitoring, dissociative hypnotic techniques, and self-hypnosis (relaxation/mental imagery) practice were used in teaching children successful management of this vexing problem. Specific emphasis is placed on the nature and importance of modifying the described techniques for the personal and specific developmental needs of individual patients.

Ann Allergy. 1991 Dec;67(6):579-82.

Outcome of habit cough in children treated with a brief session of suggestion therapy.

Lokshin B, Lindgren S, Weinberger M, Koviach J.

Pediatric Allergy & Pulmonary Division, University of Missouri Hospital, Columbia.

Nine patients with habit cough, initially misdiagnosed as asthma, were treated during a period of sustained repetitive symptoms with a brief session of suggestion therapy. Symptoms had previously been present for up to 2 years (median = 2 months). Five had been hospitalized for the cough. Evaluation revealed no physiologic or radiologic abnormality. All patients became symptom free during a 15-minute session of suggestion therapy. During the subsequent week, one remained completely asymptomatic and 8 had transient minor relapses that were readily self-controlled. Seven of the 9 could be contacted for determination of long-term outcome at periods up to 9 years (median 2.2 years) after the session. Six were totally asymptomatic; one had occasional minor self-controlled symptoms. A standardized questionnaire assessing psychologic symptoms at the time of follow-up revealed no somatization nor emotional distress. In contrast to this apparent cure, others have reported extended periods of continued symptoms in the absence of a uniform treatment plan for suggestion therapy even though the correct diagnosis was made. We conclude that the classical habit cough syndrome is amenable to immediate relief and long-term cure in most cases with a single session of appropriate suggestion therapy.

Arch Dis Child. 1990 Jun;65(6):626-7.

Self hypnotherapeutic treatment of habitual reflex vomiting.

Sokel BS, Devane SP, Bentovim A, Milla PJ.

Department of Psychological Medicine, Hospital for Sick Children, London.

A 9 year old boy with intractable postprandial reflex vomiting was taught a self hypnotherapy technique incorporating relaxation exercises, mental imagery, and suggestions of symptom relief. The sequence was recorded on a personal stereo cassette tape. Vomiting was completely eliminated within four weeks. At 12 month review vomiting had not recurred.

Am J Clin Hypn. 1989 Oct;32(2):84-9.

Self-injurious behavior as a habit and its treatment.

Orian C.

The definition of self-injurious behavior applies to persons who hurt or harm themselves without the motive of suicide or of sexual deviation. The different aspects of self-injurious behavior and the theories explaining them are reviewed. For 5 years a young, intelligent woman had inflicted injuries upon herself with sharp instruments while ostensibly caring for her face and legs. The short-term hypnobehavioral treatment included keeping daily reports of her self-inflicted injuries and of her thoughts while executing them, finding alternative activities to replace her habit, and practicing self-hypnosis once a day. Increasing the level of understanding of her inner conflict and accenting ways of breaking the habit by means of positive autosuggestion proved very effective. The treatment was successful after 13 sessions.

Impotence

Scand J Urol Nephrol. 1997 Jun;31(3):271-4.

Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction.

Aydin S, Ercan M, Caskurlu T, Tasci AI, Karaman I, Odabas O, Yilmaz Y, Agargun MY, Kara H, Sevin G.

Department of Urology, Medical School of Yuzuncu Yil University, Istanbul, Turkey.

We have examined the effects of acupuncture and hypnotic suggestions, and compared them with placebo in the treatment of male sexual dysfunction with no detectable organic cause. The study comprised 15 men (mean age 36.7 +/- 10.43 years) who received acupuncture treatment, 16 men (mean age 38.4 +/- 10.75 years) who underwent hypnosis (mean age 35.3 +/- 11.52 years) and 29 men (mean age 36.2 +/- 11.38 years) who served as controls. They were interviewed periodically; the patients' reports were verified by interviewing their partners. Men who received placebo had a 43-47% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of acupuncture and hypnotic suggestions were 60% and 75% respectively. Although the improvement was not statistically significant, treatment with acupuncture could be used as an adjuvant therapy in non-organic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study. 

Br J Urol. 1996 Feb;77(2):256-60.

Efficacy of testosterone, trazodone and hypnotic suggestion in the treatment of non-organic male sexual dysfunction.

Aydin S, Odabas O, Ercan M, Kara H, Agargun MY.

Department of Urology, Medical School of Yuzuncu Yil University, Van, Turkey.

OBJECTIVE: To examine the effects of hypnotic suggestions or the administration of testosterone or trazodone to impotent men with no detectable organic cause for the impotence. PATIENTS AND METHODS: The study comprised 79 men in whom clinical and laboratory examinations revealed no organic cause for their impotence: 20 men (mean age 38.7 +/- 11.47 years) received testosterone, 21 men (mean age 39.5 +/- 10.73 years) received trazodone, 20 men (mean age 34.2 +/- 11.69 years) underwent hypnosis and 18 men (mean age 39.1 +/- 11.46 years) served as controls. They were assessed by interview 4, 6 and 8 weeks after starting treatment: the patient's reports were verified by interviewing their partners. RESULTS: Men who received a placebo had a 39% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of testosterone and trazodone treatment and hypnotic suggestions were 60%, 67% and 80%, respectively. CONCLUSION: Although the improvement was not statistically significant, treatment with testosterone and trazodone could be used as an adjuvant therapy in nonorganic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.

Va Med. 1977 Jun;104(6):389-92.

The hypnotherapeutic treatment of impotence.

Ward WO.

Fifty cases of primary and secondary impotency are presented. A breakdown of the patients as to age shows that the problem is wide-spread from youth to middle-age; in this study there was a mean age of 29.40 years. All patients who remained in therapy were able to perform sexually at the time of their discharge. In followup of 66% of the patients, all stated they were doing well except for two. Hypnosis used as an uncovering modality is shown to be markedly effective. This, incorporated with ego-strengthening and new self-image suggestions, seems to be the treatment of choice for psychogenic impotence.

Pain Management

Niger Postgrad Med J. 2007 Sep;14(3):238-41.

Hypnosis and its place in modern pain management - review article.

Amadasun FE.

Department of Anaesthesiology, University of Benin Teaching Hospital, Benin City, Nigeria.

This is an evidence-based review of the efficacy of hypnosis in pain management. Hypnosis is as old as mankind. It is reported in the Ebers Papyrus in ancient Egyptian cures. It went into decline in the Middle Ages with the rise of Christianity, being erroneously associated with witchcraft. There was resurgence of interest in the 19th century. In the early 1950s, the British Medical Association endorsed the teaching of hypnosis in all medical schools. The literature is replete with anecdotal and controlled studies of the efficacy of hypnotherapy in pain management. Not much is found of the effectiveness in acute pain conditions. Nevertheless, in spite of some methodological flaws in many reports, there seems to be sufficient clinical evidence of sufficient quality, to conclude that hypnosis has demonstrable efficacy in the treatment of chronic pain.

PMID: 17767210 [PubMed - indexed for MEDLINE]

Pain. 2007 Aug 3

Hypnosis in the management of persistent idiopathic orofacial pain - Clinical and psychosocial findings.

Abrahamsen R, Baad-Hansen L, Svensson P.

Department of Clinical Oral Physiology, School of Dentistry, University of Aarhus, Vennelyst Boulevard 9, DK-8000 Aarhus, Denmark.

This controlled and patient blinded study tested the effect of hypnosis on persistent idiopathic orofacial pain (PIOP) in terms of clinical and psychosocial findings. Forty-one PIOP were randomized to active hypnotic intervention or simple relaxation as control for five individual 1-h sessions. Primary outcome was average pain intensity scored three times daily in a pain diary using visual analogue scale (VAS). Secondary outcome measures were pain quality assessed by McGill pain questionnaire (MPQ), psychological symptoms assessed by symptom check list (SCL), quality of life assessed by SF36, sleep quality, and consumption of analgesic. Data were compared between groups before and after treatment using ANOVA models and paired t-tests. The change in VAS pain scores from baseline to the last treatment (t4) was (33.1+/-7.4%) in the hypnosis group and (3.2+/-5.4%) in the control group (P<0.03). In the hypnosis group, highly hypnotic susceptible patients had greater decreases in VAS pain scores (55.0+/-12.3%) when compared to less susceptible patients (17.9+/-6.7%) (P<0.02). After the last treatment there were also statistically significant differences between groups in perceived pain area (MPQ) and the use of weak analgesics (P<0.03). There were no statistically significant changes in SCL or SF36 scores from baseline to t4. In conclusion, hypnosis seems to offer clinically relevant pain relief in PIOP, particularly in highly susceptible patients. However, stress coping skills and unresolved psychological problems need to be included in a comprehensive management plan in order also to address psychological symptoms and quality of life.

PMID: 17689192 [PubMed - as supplied by publisher]

Palliat Support Care. 2007 Jun;5(2):147-52.

An exploration of the utility of hypnosis in pain management among rural pain patients.

Thornberry T, Schaeffer J, Wright PD, Haley MC, Kirsh KL.

The Pain Treatment Center of the Bluegrass, Lexington, Kentucky, USA.

OBJECTIVE: Hypnosis is an adjunctive, noninvasive treatment with few side effects that can be useful in the management of chronic pain. However, it has fallen into disfavor in recent years and is often perceived by physicians as simple charlatanism. We evaluated the efficacy of this treatment as used clinically in a large, mostly rural, pain management center. METHODS: We conducted a chart review of 300 pain patients from the Pain Treatment Center of the Bluegrass who had undergone hypnosis for their pain concerns. A chart audit tool was developed consisting of basic demographics, pre- and posthypnosis pain ratings, a rating of relaxation achieved posthypnosis, and scores on the Beck Depression Inventory, Perceived Disability Scale, and the Pain Anxiety Symptom Scale. RESULTS: The sample consisted of 79 men (26.3%) and 221 women (73.7%) with a mean age of 46.3 years (SD = 9.9, range = 19-78). Pain levels recorded pre- and posthypnosis revealed significant improvement as a result of the intervention (mean difference = 2.5, t (1,298) = 25.9, p < .001). Patients reported an average of 49.8% improvement in relaxation level posthypnosis (SD = 24.2%) and had a mean score of 19.0 on the Beck Depression Inventory (SD = 9.9), indicating moderate levels of depression. Also, patients saw themselves as severely disabled regarding their ability to engage in physical (8.3/10) or job-related (7.7/10) activities. Attempts to identify predictors of hypnosis success were not fruitful with one exception. "Poor" responders to hypnosis reported greater levels of perceived dysfunction in their sexual functioning compared to the "good" responders, F(1,187) = 7.2, p < .01. SIGNIFICANCE OF RESULTS: Hypnosis appears to be a viable adjunct for pain management patients, including those from rural and relatively disadvantaged backgrounds. Prospective trials are needed to examine the utility of this modality in end-of-life and palliative care patients.

PMID: 17578065 [PubMed - indexed for MEDLINE]

Psychosom Med. 2007 Mar-Apr;69(2):191-9. Epub 2007 Feb 8.

Effects of age on responsiveness to adjunct hypnotic analgesia during invasive medical procedures.

Lutgendorf SK, Lang EV, Berbaum KS, Russell D, Berbaum ML, Logan H, Benotsch EG, Schulz-Stubner S, Turesky D, Spiegel D.

Department of Psychology, University of Iowa, Iowa City, IA 52242, USA. susan-lutgendorf@uiowa.edu

OBJECTIVES: To assess the effects of age on responsiveness to self-hypnotic relaxation as an analgesic adjunct in patients undergoing invasive medical procedures. MATERIAL AND METHODS: Secondary data analysis from a prospective trial with 241 patients randomized to receive hypnosis, attention, and standard care treatment during interventional radiological procedures. Growth curve analyses, hierarchical linear regressions, and logistic regressions using orthogonal contrasts were used for analysis. Outcome measures were Hypnotic Induction Profile scores, self-reported pain and anxiety, medication use, oxygen desaturation < or =89%, and procedure time. RESULTS: Hypnotizability did not vary with age (p = .19). Patients receiving attention and hypnosis had greater pain reduction during the procedure (p = .02), with trends toward lower pain with hypnosis (p = .07); this did not differ by age. As age increased, patients experienced more rapid pain control with hypnosis (p = .03). There was more rapid anxiety reduction with attention and hypnosis (p = .03). Trends toward lower final anxiety were also observed with attention and hypnosis versus standard care (p = .08), and with hypnosis versus attention (p = .059); these relationships did not differ by age. Patients requested and received less medication and had less oxygen desaturation < or =89% with attention and hypnosis (p < .001); this did not differ by age. However, as age increased, oxygen desaturation was greater in standard care (p = .03). Procedure time was reduced in the attention and hypnosis groups (p = .007); this did not vary by age. CONCLUSIONS: Older patients are hypnotizable and increasing age does not appear to mitigate the usefulness of hypnotic analgesia during invasive medical procedures.

PMID: 17289823 [PubMed - indexed for MEDLINE]

Pain. 1990 Aug;42(2):243-51

Quantitative evaluation of hypnotically suggested hyperaesthesia and analgesia by painful laser stimulation.

Arendt-Nielsen L, Zachariae R, Bjerring P.

Department of Medical Informatics, University of Aalborg, Denmark.

The ability to reduce both clinically and experimentally induced pain by hypnotic suggestion of analgesia is well known. However, the nature of hypnotic analgesia still remains uncertain. Attempts to demonstrate and identify specific psycho physiological mechanisms have, so far, been unsatisfactory. Methodological problems in inducing pain and monitoring physiological responses may be the reason for this lack of success. In the present study, we have attempted to eliminate some of these methodological problems. The sensory and pain thresholds to laser stimulation were determined, and the laser-evoked brain potentials were measured for 8 highly hypnotically susceptible subjects in 3 conditions: (1) waking state, (2) suggestion of hyperesthesia, (3) suggestion of analgesia.

J Behav Med. 2006 Jan 11;:1-30

Hypnotic Treatment of Chronic Pain.

Jensen M, Patterson DR.

Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA.

This article reviews controlled trials of hypnotic treatment for chronic pain in terms of: (1) analyses comparing the effects of hypnotic treatment to six types of control conditions; (2) component analyses; and (3) predictor analyses. The findings indicate that hypnotic analgesia produces significantly greater decreases in pain relative to no-treatment and to some non-hypnotic interventions such as medication management, physical therapy, and education/advice. However, the effects of self-hypnosis training on chronic pain tend to be similar, on average, to progressive muscle relaxation and autogenic training, both of which often include hypnotic-like suggestions. None of the published studies have compared hypnosis to an equally credible placebo or minimally effective pain treatment, therefore conclusions cannot yet be made about whether hypnotic analgesia treatment is specifically effective over and above its effects on patient expectancy. Component analyses indicate that labeling versus not labeling hypnosis treatment as hypnosis, or including versus not including hand-warming suggestions, have relatively little short-term impact on outcome, although the hypnosis label may have a long-term benefit. Predictor analyses suggest that global hypnotic responsivity and ability to experience vivid images are associated with treatment outcome in hypnosis, progressive relaxation, and autogenic training treatments. The paper concludes with a discussion of the implications of the findings for future hypnosis research and for the clinical applications of hypnotic analgesia.

J Vasc Interv Radiol. 2005 Dec;16(12):1585-92

Pain and anxiety during interventional radiologic procedures: effect of patients' state anxiety at baseline and modulation by nonpharmacologic analgesia adjuncts.

Schupp CJ, Berbaum K, Berbaum M, Lang EV.

Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, WCC 308, Boston, Massachusetts 02215, USA.

PURPOSE: To assess how patients' underlying anxiety affects their experience of distress, use of resources, and responsiveness toward nonpharmacologic analgesia adjunct therapies during invasive procedures. MATERIALS AND METHODS: Two hundred thirty-six patients undergoing vascular and renal interventions, who had been randomized to receive during standard care treatment, structured empathic attention, or self-hypnotic relaxation, were divided into two groups: those with low state anxiety scores on the State-Trait Anxiety Inventory (STAI, scores < 43; n = 116) and those with high state anxiety scores (> or = 43; n = 120). All had access to patient-controlled analgesia with fentanyl and midazolam. Every 15 minutes during the procedure, patients rated their anxiety and pain on a scale of 0-10 (0, no pain/anxiety at all; 10, worst possible pain/anxiety). Effects were assessed by analysis of variance and repeated-measures analysis. RESULTS: Patients with high state anxiety levels required significantly greater procedure time and medication. Empathic attention as well as hypnosis treatment reduced procedure time and medication use for all patients. These nonpharmacologic analgesia adjunct treatments also provided significantly better pain control than standard care for patients with low anxiety levels. Anxiety decreased over the time of the procedure; patients with high state anxiety levels experienced the most significant decreases in anxiety with nonpharmacologic adjuncts whereas patients with low state anxiety levels coped relatively well under all conditions. CONCLUSION: Patients' state anxiety level is a predictor of trends in procedural pain and anxiety, need for medication, and procedure duration. Low and high state anxiety groups profit from the use of nonpharmacologic analgesia adjuncts but those with high state anxiety levels have the most to gain.

Pain Manag Nurs. 2005 Sep;6(3):105-11

Hypnosis for pain management in the older adult.

Cuellar NG.

University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania 19002, USA. ncuellar@nursing.upenn.edu

Pain is a physical, emotional and psychologic phenomenon that is often ignored in older adults causing depression and poor quality of life. Older adults report the use of complementary and alternative medicine in some form with 80% of these users reporting improvement in their health conditions. Although physical pain in the older adult is usually managed with pharmacologic interventions, methods that may reduce the use of prescription drugs may decrease adverse effects that can compromise the physiologic state of the older adult. Hypnosis has continued to gain acceptance within mainstream medicine as an appropriate treatment and can be integrated safely with conventional medicine as an effective treatment for a variety of conditions in the older adult. It is an intervention that can be used for relaxation and pain control, especially when conventional pharmacologic regimens have failed. The purpose of this article is to review the concepts related to pain in older adults; the use of complementary and alternative medicine in the older adult; hypnosis and the older adult (i.e., background, definition, benefits, research, mechanism of action, hypnotizability, and the process); and the implications of using hypnosis for pain management in the older adult.

J Rheumatol. 1991 Jan;18(1):72-5

Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia.
 
Haanen HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP, Hekster GB.

Department of Rheumatology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands.

In a controlled study, 40 patients with refractory fibromyalgia were randomly allocated to treatment with either hypnotherapy or physical therapy for 12 weeks with followup at 24 weeks. Compared with the patients in the physical therapy group, the patients in the hypnotherapy group showed a significantly better outcome with respect to their pain experience, fatigue on awakening, sleep pattern and global assessment at 12 and 24 weeks, but this was not reflected in an improvement of the total myalgic score measured by a dolorimeter. At baseline most patients in both groups had strong feelings of somatic and psychic discomfort as measured by the Hopkins Symptom Checklist. These feelings showed a significant decrease in patients treated by hypnotherapy compared with physical therapy, but they remained abnormally strong in many cases. We conclude hypnotherapy may be useful in relieving symptoms in patients with refractory fibromyalgia.

Psychol Bull. 2003 Jul;129(4):495-521

Hypnosis and clinical pain.

Patterson DR, Jensen MP.

Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle 98104, USA. davepatt@u.washington.edu

Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute procedural pain and chronic pain conditions. Methodological issues of this body of research are discussed, as are methods to better integrate hypnosis into comprehensive pain treatment.

Proc Natl Acad Sci U S A. 2005 Sep 6;102(36):12950-5

The subjective experience of pain: where expectations become reality.

Koyama T, McHaffie JG, Laurienti PJ, Coghill RC.

Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1010, USA.

Our subjective sensory experiences are thought to be heavily shaped by interactions between expectations and incoming sensory information. However, the neural mechanisms supporting these interactions remain poorly understood. By using combined psychophysical