Transcript Types of Evidence Validation Questions - Marc Oster

Marc I. Oster, Psy.D., ABPH
American School of Professional Psychology
at Argosy University Schaumburg Campus
999 Plaza Drive, Suite 111
Schaumburg, IL 60173
(847) 969-4944
[email protected]
The Use of Hypnosis in the Treatment of
Digestion and Elimination Problems
Loyola University Medical Center
Maywood, IL
April 24, 2009
1. To describe a model for the
development of psychophysical
disorders.
2. To describe how the term “success” can
be used to minimize failure experiences
in treatment.
3
Types of Evidence
Validation Questions
________________________________________________________________________________
 Experimental evidence
Is the practice efficacious when
examined experimentally?
 Clinical (practice) evidence
Is the practice effective when applied
clinically?
 Safety evidence
Is the practice safe?
 Comparative evidence
Is it the best practice for the problem?
 Summary evidence
Is the practice known and evaluated?
 Rational evidence
Is the practice rational, progressing, and
contributing to medical and scientific
understanding?
 Demand evidence
Do consumers and practitioners want the
practice?
 Satisfaction evidence
Is it meeting the expectations of patients
and practitioners?
 Cost evidence
Is the practice inexpensive to operate and
cost-effective? Is it provided by
payers?
 Meaning evidence
Is the practice the right one for the
individual?
4
1. Hypnotic ability: both high and low
2. Habitual Catastrophic Thinking
3. Habitual Neuroticism - Sympathetic Reactivity/Negative Affectivity
4. Major Life Changes and/or Daily Hassles
5. Social Support Systems and Coping Skills
Wickram divides the five factors as follows:
Predisposers (1-3)
Hypnotic Ability
Catastrophizing
Sympathetic Reactivity
Triggers (4)
Major Life Events
Daily Hassles
Buffers (5)______
Support Systems
Coping Skills

Wickramasekera, I. (1987). Risk factors leading to chronic stress-related symptoms. Advances. Institute for the Advancement of Health, 4(1), 9-35.

Wickramasekera, I. (1998). Secrets kept from the mind but not the body or behavior: the unsolved problems of identifying and treating somatization and
psychophysical disease. Advances in Mind-Body Medicine, 14, 81-132.
5
Symptom reduction or management
 Habit alteration/change
 Increase awareness
 Enhance treatment compliance
 Improve medication utilization
 Exploration
 Ego strengthening
* From Weisberg & Clavel (2008) ASCH.


Language
Meaning is in the ear of the beholder
93% message is in something other than words

38%
Inflection

55%
Gestures

7%
Words
Phil & Norma Barretta
Patient-centered
 Ego-strengthening
 Positive
 Empathetic
 Suggests change

AVOID
 Burning
 Stinging
 Painful
 Hurts
 Bad
 Awful
USE
Warm
Tingly
Sore
 Scratchy
Soft
Gently
Easily
Quickly
Nicely
Understanding and Treating
Irritable Bowel Syndrome
And Encopresis

Irritable Bowel Syndrome or IBS is a
functional gastrointestinal disorder
characterized by abdominal pain, bowel
function abnormalities in frequency and
consistency, and sometimes bloating or
abdominal distention.
12

IBS affects 9-20% of the population.

IBS is twice as common in women,
representing about 75-80% of all IBS seen
in practice.

IBS accounts for 3 million doctors visits a
year.

IBS represents 25-50% of all visits to
gastroenterologists.
13
IBS prevalence as high as 20%
 Diabetes about 3%
 Asthma about 4%
 Heart disease about 8%
 Hypertension about 11%

14

At lease 3 months of continuous or recurrent symptoms, and:

Abdominal pain relieved by defecation or accompanied by
a change in stool frequency (<3 x week or >3 x day) or
consistency, and

Disturbed defecation at least 25% of the time, consisting of
two or more of the following:
altered frequency of bowel movements
altered consistency of stool
altered stool passage
passage of mucus
abdominal distention





15

Many patients with IBS who consult
physicians also have depression or anxiety,
perfectionism, obsessive-compulsiveness,
elevated scores on tests of social
desirability, and other physical complaints.

However, IBS is not a psychological
disorder. It is a physical disorder that is
strongly affected by one's emotional state,
as well as stress and tension.
16

The lifetime prevalence of IBS is about 20%. Although not a
very serious disorder when compared to something like
schizophrenia, it is a major healthcare concern.

Like many other conditions, but maybe more dramatically so,
IBS suffers can be divided into two groups, those who seek
treatment and those who do not seek treatment.

Studies found that of those IBS patients who do not consult a
physician, 70-80% of all IBS patients, were psychologically
healthy and similar to normal controls on psychological
testing.

Those IBS suffers who seek medical treatment tended to also
be more psychologically distressed on psychological tests.
17
One's "suffering" is what determines their
consultation with a physician.
 In one study, 85% of a sample reported
changes in their bowel habits secondary
to psychological stress. Other studies
found that figure to be closer to 10%.
 Some studies report childhood trauma
being linked to the development of IBS
symptoms. Of those with functional GI
disorders, 53% were sexually abused
during childhood as compared to 37% of
those with organic diseases.

18
19
20

IBS patients have been found to be
twice as likely to report sexual abuse
history as healthy subjects.
21
IBS patients consistently report more stressful
life events than control subjects.
 More than half of IBS patients report that
stressful psychological events exacerbate
their symptoms or precede symptom onset.
The stressful life events IBS patients report
are typically commonplace events, but;
loss of a parent and sexual abuse seem
particularly common in the stressor history of
IBS patients.

22

Do not treat unless you're sure that a diagnosis of IBS has
been made by a physician,

“Maintain good contact with their primary care physician”
and encourage patients to continue to consult their
physician on any changes in physical symptoms,

Use brief and time limited treatment of the kinds that have
been demonstrated to be effective in research,

Make clear to the patient that progress is going to be
gradual,

Use improvement in abdominal pain, bowel dysfunction, and
social and work functioning as the chief criteria for
improvement with emotional well being as secondary criteria.
23
24

Brief cognitive therapy

Brief dynamic therapy

Brief hypnosis treatment

Highest success rates reported for cognitive
therapy, 80% and hypnosis treatment 80-95%*;
these are the only treatments with replicated
highly successful outcomes in controlled
studies. Improvement is maintained at 14year
follow-up.
* VOL 57, NO 1 / JANUARY 2008 THE JOURNAL OF FAMILY PRACTICE
25

When comparing various treatment models, treatment
duration is usually short, ranging from 7-10 sessions over 8-13
weeks.

Common forms of therapy included relaxation training,
cognitive, dynamic and supportive therapy as well as
hypnosis. Treatment effects are generally well maintained at
one-year follow-up.

When comparing insight-oriented therapy, hypnotherapy,
cognitive-behavioral therapy, and biofeedback, all produce
notable improvements in some symptoms with the best
objective reports being with hypnotherapy showing 85%
improvement in patients under age 50 at one-year follow-up,
followed by cognitive-behavioral therapy alone.
26
Whorwell (classic approach) vs UNC/Palsson’s Model:
1. 10 - 20-30min sessions maximum; improvement usually noted in 4-8 sessions;
2. hypnosis is directive, "gut-directed" and not exploratory;
3. standard eye-fixation induction and suggestions for imagery (to assess
imagery capacity);
4. place hand on abdomen and feel warmth, repeat several times;
5. suggest to relate warmth to the reduction of spasm and the ability to
alleviate pain and distension, bowel habits will normalize as their control
gradually improves;
6. if they can visualize, they are asked to see a meandering river, then note the
effect of an obstruction to the flow, such as a lock or gate. Observe the
effect of the opening and closing of the gate;
7. the river is like their guts and the gate is the smooth muscle and they adjust
them to a comfortable setting;
8. around the 3rd session, work on self-hypnosis, ego-strengthening and
confidence –building;
9. explain that this method help them to control nor cure their problem, thus
requiring regular practice.
27
age
classic IBS
atypical IBS
------------------------------------------------------------------ <50 yrs
93%
33%
 >50 yrs
50%
50%
------------------------------------------------------------------Total
86%
38%
28
This might be complete relief of symptoms, or it may
be slight or temporary relief, or partial relief.
 Sometimes, a symptom might even get a little worse.
Even that is good because any change in symptoms
implies movement and where there's movement,
greater change can occur.
 Finally, there may be minimal or no change, but you
notice a sense of impending change or feel hopeful
that change is coming.

29

Beth’s IBS

Mike the pooper, or not
30

Blanchard, E.B. (1993). Irritable Bowel Syndrome. In
R.J. Gatchel & E.B. Blanchard (Eds.)
Psychophysiological Disorders: Research and Clinical
Applications. Washington, DC: APA.

Palsson, O.S. (Editor) (2006). Special Issue: Irritable
Bowel Syndrome. IJCEH, 54:1.

Palsson, O.S. (1997). Hypnosis treatment for Irritable
Bowel Syndrome. Gastroenterology, 112, A803.

Whorwell, P.J. (1987). Hypnotherapy in the irritable
bowel syndrome. Stress Medicine, 3, 5-7.
31

Whorwell, P.J.; Prior, A. & Faragher, E.B. (December
1, 1984). Controlled trial of hypnotherapy in the
treatment of severe refractory irritable bowel
syndrome. The Lancet, 1232-1233.

Wickramasekera, I. (1987). Risk factors leading to
chronic stress-related symptoms. Advances,
Institute for the Advancement of Health, 4(1), 9-35.
32

Mailing Address:
1954 First Street, #103
Highland Park, IL 60035-3104

Private Practice / Office Address:
Center for Psychological Services, LLC
465 Central Ave., Suite 201
Northfield, IL 60093

(847) 604-1593 voicemail
(847) 962-4086 cell phone



[email protected]
www.marcoster.homestead.com
33