Transcript Powerpoint - CRE Learning Home

MEDICAL HYPNOSIS PRIMER
CLINICAL AND RESEARCH EVIDENCE
TRAINING SUPPORT PROGRAM
Powerpoint designed by: Angela Carabali
BASED UPON THE TEXTBOOK
MEDICAL HYPNOSIS PRIMER - CLINICAL AND RESEARCH EVIDENCE
Developed by SCEH and ISH
DRAFT VERSION 13 TO MOTIVATE TESTING
POWERPOINT PRESENTATION
(supporting the printed WORKPACK, GUIDE and DIARY)
2-3 day full time course or 10-12 two hour sessions
ALL IDEAS WELCOME
Version 14 – January 20, 2010
Copyright RGAB/1 Freely available on request
TRAINING SUPPORT PROGRAM
SPECIFIC OBJECTIVES
•
This brief cost effective program provides course members with the opportunity
to both understand and practice modern medical hypnosis.
•
It is training support for the new 2009 textbook - Medical Hypnosis Primer Clinical and Research Evidence and supporting DVD’s published with SCEH
(Society of Clinical and Experimental Hypnosis) and ISH (International Society of
Hypnosis)
•
Training for medical and nursing students can be covered in 10-12 two hour
regular course sessions. The program can also be a 2-3 day full time training
course for doctors, nurses and primary health care workers.
TRAINING SUPPORT PROGRAM
The specific learning objectives of the program are to:
1. Briefly present the basic concepts of modern medical hypnosis.
2. Encourage health practitioners to use hypnosis as an adjunct and reinforcement
to medical care.
3. Support the teaching and practice of hypnosis as a part of the requires syllabus of
medical schools, nursing schools and primary health care training units.
4. Develop confidence in using basic cost effective brief hypnosis techniques with
patients.
5. Motivate further study in the future with the courses run by the professionally
recognized national and international hypnosis societies.
TRAINING SUPPORT PROGRAM
SPECIAL NOTE ON THE LEARNING
•
UP TO 2009:
•
With so many new health care developments and publications to absorb each year,
how will and doctors and nurses be motivated to read the Primer on Medical
Hypnosis?
•
So many doctors and nurses are skeptical about the validity of medical hypnosis.
Many patients are frightened by the word hypnosis.
•
Getting medical hypnosis into the required regular syllabus of medical and nursing
schools in 2010 is a severe challenge.
•
The medical school syllabus is already over-flowing with new EBM scientific evidence
for hypnosis, and yet medical hypnosis is not widely accepted.
•
Doctors and nurses are concerned about patient anxiety but they simply do not have
the time for 30 minutes of psychological care, which belongs more to psychiatrists.
TRAINING SUPPORT PROGRAM
BUT:
• Medical hypnosis can often reinforce medical care in only five
minutes.
• Self hypnosis can help the patient to help himself, to feel in
control of mind and body, and thus to feel like part of the health
care team.
• Medical hypnosis can be highly cost effective with no side effects.
• Self hypnosis can benefit not only the anxious patient but also the
stressed doctor, nurse and other members of the health care
team.
TRAINING SUPPORT PROGRAM
FROM 2010:
• A rigorous trial of medical hypnosis is justified.
• A new approach to is needed which can motivate doctors
• and nurses to learn and begin to practice.
•
•
•
•
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The program presents a new way to learn and practice basic
medical hypnosis, in a flexible 2-3 day course for doctors,
nurses and primary health care workers, or in 10-12 two
hour sessions for medical and nursing students, with special
support.
TRAINING SUPPORT PROGRAM
The program is based upon the concept that
experienced health care professionals will read and
accept the new Primer on Medical Hypnosis, when
it is supported by a challenging interactive learning
experience, with professional demonstrations,
practical hypnosis exercises and some brief extracts
from recognized professional hypnosis practice
videos.
TRAINING SUPPORT PROGRAM
• Based on the book, a standard Medical Hypnosis
training course, must be developed and validated with
rigorous testing of relevance, efficiency and
effectiveness.
• The training course can be highly cost effective when it
requires only one professional hypnosis instructor as
course organizer with key resources.
• Critical choice of lecture notes, videos and exercises
needs to be finalized with rigorous testing.
TRAINING SUPPORT PROGRAM
•
The initial brief (12-15 minute) extracts from classic professional hypnosis
videos are:
•
Sugarman – “Therapeutic Hypnosis with Children and Adolescents” (Crown
House) by Professor William Wester & Dr Laurence Sugarman
•
Rossi - “Hypnosis Techniques” – Professor Ernest Rossi (published by
Erickson)
•
Kuttner (1) - "No Tears, No Fears" (Fanlight Productions) by Dr. Leora Kuttner
•
Kuttner (2) - Follow up videotape of the reactions of same children, ten years
later.
•
With alternatives as decided by the Organizer.
TRAINING SUPPORT PROGRAM
Flexible Course Outline
1. Hypnosis Concepts
2. Hypnotic Testing
3. Acute pain
4. Chronic Pain
5. Childhood Problems
6. PTSD
7. Surgery
8. Childbirth
9. Sleep
10. Depression
11. Stress & anxiety & Procedural
Hypnosis
12. Summary & Review Session
TRAINING SUPPORT PROGRAM
FLEXIBLE COURSE OUTLINE
REQUIRED PRE-COURSE STUDY:
REVIEW - MEDICAL HYPNOSIS PRIMER - CLINICAL AND RESEARCH EVIDENCE.
TEST - SUPPORTING DVD - HYPNOTIC INDUCTION DEMONSTRATIONS (BARABASZ &
CHRISTENSEN)
DAY 1:
• 08.00 - 10.00 Unit 1 Introduction & Concepts
(SG – small group)
• 10.00 - 10.15 Break
• 10.15 - 12.15 Unit 2 Hypnotizability
(CSG – combined small group)
• 12.15 - 01.15 Lunch
• 01.15 - 03.15 Unit 3 Acute Pain (new SG)
• 03.15 - 03.30 Break
• 03.30 - 05.30 Unit 4 Chronic pain (CSG)
• 05.30 - 06.00 Discussion & Homework (MG – main group)
TRAINING SUPPORT PROGRAM
DAY 2
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•
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•
•
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•
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08.00 10.00 10.15 12.15 01.15 03.15 03.30 05.30 -
10.00
10.15
12.15
01.15
03.15
03.30
05.30
06.00
Unit 5 Childhood Problems (new SG)
Break
Unit 6 PTSD (CSG)
Lunch
Unit 7 Surgery (new SG)
Break
Unit 8 Childbirth (CSG)
Discussion & homework (MG)
TRAINING SUPPORT PROGRAM
DAY 3
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•
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08.00 10.00 10.15 12.15 01.15 -
10.00
10.15
12.15
01.15
03.15
Unit 9 Sleep (new SG)
Break
Unit 10 Depression (CSG)
Lunch
Unit 11 Stress, Anxiety & Procedural
Hypnosis (new SG)
• 03.15 - 03.30 Break
• 03.30 - 05.30 Unit 12 Summary and Review (CSG)
• 05.30 - 06.00 Discussion & Post course Study (MG)
TRAINING SUPPORT PROGRAM
NOTE
THE BASIC THREE DAY COURSE OUTLINE INCLUDES ALL TWELVE UNITS. BUT
SOME UNITS MAY NOT BE OF IMMEDIATE INTEREST TO SPECIFIC LEARNERS
AND THE COURSE TIME MAY BE TOO INTENSE.
ALTERNATIVE COURSE OUTLINES:
•
THREE DAYS WITH TEN UNITS AND TWO UNIT TIMES AS PRACTICE WITH MINICASES
•
OR THREE DAYS WITH ONLY NINE UNITS AND SHORTER HOURS
•
OR TWO DAYS WITH ONLY EIGHT UNITS.
•
ANY UNITS NOT SELECTED CAN BE USED FOR POST-COURSE OR HOMEWORK STUDY.
Unit 1 Introduction & Concepts
TIME SCHEDULE
ACTIVITY
Objectives
MINUTES
10
AGL
5
Quiz
40
Review of primer
10
Narrated Lecture
15
Video
15
Demo/practice Exercise
15
Summary
10
120
NOTE
ALL INSTRUCTIONS ARE GIVEN IN MG FOLLOWED BY DISCUSSION AND
INTERACTION. BREAKS AS NEEDED.
Unit 1 Introduction & Concepts
1.1 OBJECTIVES OF THE PROGRAM (10 minutes)
• To stimulate the learner knowledge, skills and attitudes for efficient and
effective basic medical hypnosis practice and to motivate further study
and practice in the future.
• Based on the Medical Hypnosis Primer the key pre-learning textbook for
the course, to get medical hypnosis training into the required syllabus of
every medical/nursing school and PHC training facility in 2010.
• To use the AGL (Autonomous Group Learning) system to create 24 hours
of highly interactive training, in 2 hour units, which can be organized
and provided by one qualified hypnosis instructor. Each unit can be
adapted to local culture,
• To give in each unit an inspiring learning mixture of: narrated lecture,
group discussion, Primer study, video, practical exercise and quiz
Unit 1 Introduction & Concepts
• To create a website with training materials (with controlled access by
code) to encourage free access and translation of the textbook and
training materials, into local languages. To use this web site as a resource
for post training help, feedback and support of further study.
• To promote and support the Olness Training program and for primary
health care workers in developing counties. See Appendix.
• To use a rigorous alternative choice quiz (80 questions) in the first and
last units of the training, to measure and reward the learning achieved.
• To provide allow alternative scheduling as a 2-3 day course for Doctors,
nurses and primary health care workers, or In 10-12 two hour sessions
for medical and nursing students, with individual support as needed.
Unit 1 Introduction & Concepts
1.2 AGL (AUTONOMOUS GROUP LEARNING) SYSTEM (5 minutes)
a.
AGL was designed as an intensive highly interactive learning experience
with a variety of 2 hour units which may be selected. Some parts may
be less challenging for the experienced health worker with many years
of experience.
b. AGL creates a very special group learning environment that is new to
the group members. It is a highly effective but rather challenging
learning experience. Members should therefore try to keep an open
mind on their reactions until the second day of the program.
c.
Members can and do solve ALL the problems and answer ALL the
questions, from the special materials (Workpack, Guide, Diary and DVD)
provided and the experience of other members of the group.
Unit 1 Introduction & Concepts
d. The Organizer can respond directly to technical questions, but the
learning is better when members help each other. The critical skill of
the Organizer is to HELP the participants to WORK TOGETHER to resolve
successfully, all questions arising. Thus by the end of the program
EVERY QUESTION is resolved!
e.
In AGL the learning will be done:
IND
SG
CSG
MG
Individually, or
Small Group (four members or partners which change), or
Combined Small Group (two small groups together), or
Main Group (short lectures, demos and with visual aids).
Unit 1 Introduction & Concepts
f.
We hope you too will find the program stimulating, efficient and
effective for you in every unit!
g. The specific objectives Unit 1 are to present and practice:
•
•
•
•
•
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Basic hypnosis concepts
Common evidence-based uses of hypnosis
Definitions of hypnosis
Hypnotizability
Using self hypnosis yourself
Examples of a hypnotic-like experiences.
NOW IN SG START THE REGISTRATION FORM IN THE DIARY.
COMPLETE IT AS HOMEWORK TONIGHT.
Unit 1 Introduction & Concepts
1.3 QUIZ (40 minutes)
• Instructions SG::
a. Individually complete on the answer sheet provided in the Diary,
the 80 question alternative choice quiz which is in the GUIDE.
Choose questions only for the selected units included in the
course.
b. Hand your answer sheet to the Organizer who will give you a
score of hypnosis learning at the start of the course.
c. The same quiz will be completed in the last learning unit, to give
you feedback on your achievement.
Unit 1 Introduction & Concepts
1.4 REVIEW OF PRIMER (10 minutes)
• Instructions SG:
• Briefly review the Primer – Introduction & Ch. 1.
• Discuss following questions:
What are your reactions?
How will your patients react
Unit 1 Introduction & Concepts
1.5 NARRATED LECTURE (15 minutes)
A. OVERVIEW
•
Hypnosis is a set of procedures used by health professionals to treat a range
of emotional and physical problems. Hypnosis is an altered state of
awareness one can enter spontaneously. However, for health care purposes
it is attained by an induction procedure.
•
Most hypnotic inductions engage patients’ imaginative capacities and
include suggestions of focused attention, relaxation, and calmness.
•
Patients respond to hypnosis in different ways. Some describe their
experiences as a state of deepened awareness, others as calm state of
focused attention.
•
Prior to using hypnosis, always familiarize the patient with “hypnotic-like”
experiences, to reinforce debunking of myths about hypnosis. Self-hypnosis
is the key to hypnosis efficiency and effectiveness.
Unit 1 Introduction & Concepts
B. HYPNOSIS DEFINED
•
•
•
A short definition of hypnosis is ‘attentive perception and concentration, which
leads to controlled imagination’. Hypnosis operates from one’s latent cognitive
ability (hypnotizability).
•
•
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Social influences such as ‘expectancy’ have only a modest influence on
responsiveness. It is altered state of consciousness and an interpersonal
relationship of trust.
•
The initial suggestion can constitute the hypnotic induction.
•
•
Clinical hypnotic inductions usually involve progressive phases to reach a depth
for a medical or psychotherapeutic purpose.
•
•
•
The hypnotic state is characterized by the patient’s ability to sustain a state of
attention, receptive, intense focal concentration with diminished peripheral
awareness.
Unit 1 Introduction & Concepts
C. COMMON EVIDENCE BASED USES OF HYPNOSIS
Clinical hypnosis has proven useful reinforcement in health care of:
1. Acute and chronic pain (including medical procedures; surgeries, pre-post op)
2. Post Traumatic Stress Disorder (PTSD) with EMDR.
3. Childhood and adolescent problems.
4. Childbirth pain and Trauma
5. Insomnia.
6. Depression
7. Weight control/healthy eating and exercise
8. Psychosomatic Disorders
9. Habit control
10. Irritable Bowel Syndrome.
11. Headaches and Migraines
12. Cancer patient care etc.
Unit 1 Introduction & Concepts
D. HYPNOTIZABILITY
•
Hypnosis is a matter of degree.
•
Some individuals may enter a deep state and exhibit behaviors such as
regression, time distortion, and hallucinations.
•
Others, however, may reach a plateau, where they are able to experience only
simple suggestions..
•
Some hypnotherapeutic techniques and experimental research responses require
deep states (e.g. surgery).
Unit 1 Introduction & Concepts
•
Others can be effectively employed with the patient only lightly hypnotized (e.g.
minor medical procedures, irritable bowel syndrome [IBS], many forms of
psychotherapy).
•
Researchers and clinicians alike may first assess the level of hypnotizability and
then the level of depth capability.
•
The scales of hypnotizability, useful as they are, only predict responses to
hypnosis about 50% of the time.
•
Standardized Tests of Hypnotizability are discussed in UNIT 2.
Unit 1 Introduction & Concepts
E. CONCLUSIONS
•
•
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Hypnosis is an essentially culturally free adjunctive treatment modality that
has been shown to be effective in a wide range of medical and psychological
disorders.
•
•
It is especially cost effective in contrast to standard medical care, well
accepted by patients and adaptable to multi-cultural settings.
•
•
•
But is most often used to reinforce standard medical and psychological
interventions to improve patient tolerance of initial and long-term
treatment outcomes.
•
•
•
Hypnosis is an altered state of awareness involving attentive perception,
concentration and controlled imagination. In most cases, an induction
procedure is employed.
•
•
•
The ability patient to use hypnosis (hypnotizability) is a stable trait easily
measured by standardized procedures. Measurement affords a fit between
a specific procedure and the patients responsiveness
Unit 1 Introduction & Concepts
1.6 VIDEO (15 minutes)
• Instructions:
• MG – Play the video extract - Sugarman 1 of 3
• SG – Discuss the following questions:
What are your reactions to the video?
How will your patients react?
Unit 1 Introduction & Concepts
1.7 DEMO/EXERCISE (20 minutes)
Instructions: Self hypnosis is an important part of medical hypnosis. Study the
Organizer demo and then role play the experience with a partner, as clinician and
client. Partner provides instructions using this brief SH - self hypnosis script, to his
client:
a. Now tell yourself that you are going to achieve self hypnosis.
b. Make yourself comfortable. Gently grip the LEFT THUMB into the left fist. This is
your “anchor sign” for instant SH. Begin to breathe very deeply.
c. Focus your attention on a spot high up on the wall. As you concentrate feel more
relaxed. Concentrate intently so that other things begin to fade into the
background. As this occurs, notice a relaxed heavy feeling and allow your eyes to
close. Then pretend that you cannot open them for two minutes. Nod you’re
head when you have done it.
Unit 1 Introduction & Concepts
d. Relax your whole body, by visualizing and smiling at each part carefully ... from
the top of your head to the tips of your toes.
e. Begin slowly and mentally, to count down from 10 to 0 … saying … deeper…
deeper …
f. Imagine a beautiful white light ... coming from above your head ... cleaning
every part of you ... as it passes through your whole mind and body ... and out of
your toes.
g. Imagine a beautiful soothing golden fluid ... coming in from your toes ... soothing
and healing every part of your mind and body ... right up to the top of your head.
h. Then RELAX , as you make one or two POSITIVE suggestions to yourself ... to find
new strengths within yourself that help YOU to learn and achieve … in YOUR
OWN WAY …
Unit 1 Introduction & Concepts
i.
And then REPEAT your suggestions two or three times. Think deeply and
gently talk with yourself about these things … for a few moments … and
then … in your own time … when YOU are ready.
j.
TO COME BACK FROM SH, tell yourself that when you come back …
counting from 1 to 5 and as you say 4 …eyes will open and you will feel very
well … calm, contented and very CONFIDENT and MOTIVATED … to achieve
what you need.
k.
Slowly release the thumb from the left fist ( anchor sign). Slowly count up
from 1 to 5 and open your eyes.
l.
Stretch the arms and neck. Relax. Feel calm, confident and pleased with
yourself. Over!
Unit 1 Introduction & Concepts
•
•
•
•
•
•
•
Questions for brief discussion:
1.
2.
3.
4.
5.
What do you notice when you focus attention on the wall?
What did you notice from the effect of the white light?
What did you notice on your body reaction to the golden fluid?
What did you notice when you came out of hypnosis
Do you feel that you are completely out?
Unit 1 Introduction & Concepts
1.8 SUMMARY (10 minutes)
•
Instructions: MG – Questions, answers and discussion
TEST OF UNIT 1
1. Which of the following is not true?
•
a. Hypnosis is a set of procedures used by health professionals to treat a range of
emotional and physical problems.
•
b. Hypnosis is an altered state of awareness one can enter spontaneously.
However, for health care purposes it is attained by an induction procedure
•
c. Hypnotic induction controls the patient’s imaginative capacity.
•
d. Patients respond to hypnosis in different ways. Some describe deepened
awareness and others focused attention.
TEST OF UNIT 1
2. Prior to using hypnosismake a special effort to:
a. Familiarize the patient with “hypnotic-like” experiences.
b. Reinforce debunking of myths about hypnosis.
c. Recognize self-hypnosis as the key to hypnosis efficiency and effectiveness.
d. All of the above.
3. A short definition of hypnosis is:
a.
b.
c.
d.
Attentive perception and concentration with controlled imagination
Latent cognitive ability.
Uncontrolled Imagination.
Meditation
TEST OF UNIT 1
4. Which of the following is true:
a. Altered state of consciousness leads to fear.
b. Social influences such as ‘expectancy’ have only a modest influence on
responsiveness.
c. Interpersonal relationship results in mistrust.
d. Initial suggestion cannot constitute the hypnotic induction
5. Hypnosis is characterized by the patient’s ability to sustain a state of:
a.
b.
c.
d.
Attention
Diminished peripheral awareness
All of the these.
Receptive intense focal concentration
TEST OF UNIT 1
6. The hypnotic state involves reduced awareness of other points in space and time.
a.
b.
c.
d.
Always true
False
Sometimes true
Irrelevant
7. Clinical hypnosis is a proven reinforcement in health care of all of these except:
a.
b.
c.
d.
Acute pain (including medical procedures, surgery etc.)
Post Traumatic Stress Disorder (PTSD) .
HIV
Childhood and adolescent problems.
TEST OF UNIT 1
8. All of the following are true, EXCEPT:
a.
b.
c.
d.
d.
Clinical inductions involve progressive stages to reach a medical purpose.
Most individuals may enter a deep state.
Some individuals may exhibit behaviors such regression time distortion and
hallucinations.
Others, however, may reach a plateau, where they are able to experience only
simple suggestions.
9. Which of the following is not true:
a. Some hypnotherapeutic techniques require deep states (e.g. surgery).
b. Others can be effectively employed with the patient only lightly hypnotized.
c. Researchers and clinicians may first assess the level of hypnotizability and
then the level of depth capability.
d. The scales of hypnotizability predict responses to hypnosis about 90% of the
time.
TEST OF UNIT 1
10. Which of the following is true:
•
a. Hypnosis is not an altered state of awareness.
• b. Hypnosis can always be cost effective in contrast to standard medical
care, well accepted by patients and adaptable to multi-cultural settings.
• c. Hypnosis can always replace standard medical and psychological
interventions for long-term treatment outcomes.
• d. Hypnosis is an essentially culture dependent adjunctive treatment
modality that has been shown to be effective in a wide range of medical
and psychological disorders.
•
cda bbc cbd a
Unit 2 Hypnotizability
TIME SCHEDULE
ACTIVITY
Objectives
Study of primer
MINUTES
10
20
Narrated Lecture
Video
30
20
Demo/Practice
Exercise
30
Sumary
10
120
Unit 2 Hypnotizability
2.1 OBJECTIVES (10 MINUTES)
To learn and practice:
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Hypnotizability
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Measurements
•
Clinical test of Hypnotizability
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Other clinical scales
•
Stability of Hypnotizability
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Setting the context for treatment
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A method of self-hypnosis
Unit 2 Hypnotizability
2.2 STUDY OF PRIMER (20 minutes)
•
Instructions:
•
Individually study on the Primer – Ch. 2.
•
In SG – discuss the answers to the following questions:
What are your reactions?
How will your patients react?
Unit 2 Hypnotizability
2.3 NARRATED LECTURE (30)
A. INTRODUCTION
•
•
•
Many hypnotic induction techniques are used to gett trance, ranging from eye fixation
on fixed or moving targets, through eye closure, body sway, touch by the hypnotist,
evoking numbness, paresthesias or paralysis, counting up and down stairs, etc.
•
•
Trance phenomema may occur spontaneously, or in response to a variety of induction
techniques.
•
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Variability in the hypnotic response depends more on the hypnotic capacity of the
individual being hypnotized than the induction or the skill of the clinician.
•
•
Clinical measurement of hypnotizability is part of the medical and psychiatric and
psychological examination.
•
•
The setting is appropriate for both the patient and the therapist, for transformation
into trance to occur quickly and to the person’s optimal capacity.
Unit 2 Hypnotizability
B. MEASUREMENTS
•
Hypnotizability is a stable and measurable trait.
•
•
Several well-standardized scales of hypnotizability, hypnotic capacity, or
hypnotic susceptibility have been developed.
•
•
•
With Harvard Group Scales patients themselves score them in twenty
minutres. They correlate with the Stanford Hypnotic Susceptibility Scale,
which requires one hour.
•
•
Tests standardized on college student populations often reflect concern with
only a limited sample of age and education, not the wide range
characteristics of a patient population.
•
•
•
Since hypnosis is an expression of integrated concentration. Factors which
impair concentration such as drugs, psychopathology, and neurological
deficits should be taken into account
Unit 2 Hypnotizability
C. CLINICAL TESTS OF HYPNOTIZABILITY
• The Hypnotic Induction Profile (HIP) takes five to ten minutes to
administer. It is both a procedure for trance induction and a disciplined
measure of of hypnotizability standardized on a patient population in a
clinical setting.
• In HIP the hypnotist is the measuring instrument. It is brief and clinically
appropriate. Once a hypnotizability score is determined, the time for the
shift into trance is a few seconds.
• The HIP is moderately and positively correlated with the Stanford Scales.
Unit 2 Hypnotizability
D.
OTHER CLINICAL SCALES
•
The need is for briefer clinical measures of hypnotizability that
are practical and appropriate to the pressures of clinical work,
and yet reliable and valid.
•
The Hilgards introduced two briefer scales, one the Stanford
Hypnotic Clinical Scale, which takes about 20 minutes and the
Stanford Hypnotic Arm Levitation Induction Test which takes 5
minutes.
Unit 2 Hypnotizability
E. STABILITY OF HYPNOTIZABILITY
• Hypnotizability is stable trait, like IQ.
• A patient’s baseline hypnotizability score is the same 25
years later.
Unit 2 Hypnotizability
F. SETTING THE CONTEXT FOR TREATMENT
• Patients fear that hypnosis represents a loss of control. In fact, it is an
opportunity to enhance their control over both mental and physical
states.
• Hypnotizability can demonstrate to the patient how easily he can
enhance and expand his own sense of control of himself and his body,
utilizing intensely focused imagination.
• Hypnotizability testing can be used to decide whether or not it to employ
hypnosis.
• The degree of intact hypnotizability is a useful clue to the style of
interaction with the patient.
Unit 2 Hypnotizability
• Highly hypnotizable individuals often what to know ‘what’ to do,
while low hypnotizables want to know ‘why.’ The former want
direction, the latter explanation.
• Low hypnotizables often prefer various introspective, analytically
oriented psychotherapies.
• Those who are mid-range in hypnotizability group and respond
better to consolation and confrontation from the therapist.
• Highly hypnotizable individuals benefit most from firm guidelines
to enhance their capacity to generate their own decisions and
directions.
Unit 2 Hypnotizability
G.
SUMMARY
•
Low-hypnotizable patients do best with a therapeutic strategy
that employs reason to free and mobilize affect.
•
High-hypnotizable patients do best with a therapy which
employs affective relatedness to the therapist in the service of
enhancing rational control.
•
Those in the mid-range respond to an approach which employs a
balance of rational and affective factors in helping the patient
confront and put in perspective his own tendency to oscillate
between periods of activity and despair.
Unit 2 Hypnotizability
2.4 VIDEO (20)
•
Instructions:
•
MG – Play video extract – Sugarman 2of 3 or alternative.
•
In SG – Discuss the following questions:
What are your reactions?
How will your patients react?
Unit 2 Hypnotizability
2.5 DEMO/PRACTICE EXERCISE (30)
•
•
Instructions: First EXERCISE 1. - another self hypnosis method. Then
EXERCISE 2. - brief test of your hypnotizability. Study the Organizer demo and
then role play the experience with a partner.
•
EXERCISE 1 - Self Hypnosis
•
This is how it is done:
•
•
•
I am going to count to three. Follow this sequence again. One, look up
toward your eyebrows, all the way up; two, close your eyelids, take a
deep breath; three, exhale, let your eyes relax, and let your body float.
Unit 2 Hypnotizability
•
As you feel yourself floating, you concentrate on the sensation of floating and at
the same time you permit one hand or the other to feel like a buoyant balloon
and allow it to float upward. As it does, your elbow bends and your forearm
floats into an upright position. Sometimes you may get a feeling of magnetic pull
on the back of your hand as it goes up.
•
When your hand reaches this upright position, it becomes a signal for you to
enter a state of meditation. As you concentrate, you may make it more vivid by
imagining you are an astronaut in space or a ballet dancer.
•
NOTE: In this atmosphere of floating, you focus on whatever strategy is relevant
for the patient’s goal Formulate the approach in a self-renewing manner which
the patient is able to fit into his everyday life style.
Unit 2 Hypnotizability
•
Then bring yourself out of this state of concentration called self-hypnosis by
counting backwards this way … Three, get ready. Two, with your eyelids
closed, roll up your eyes (and do it now). And, one, let your eyelids open
slowly.
•
Then, when your eyes are back in focus, slowly make a fist with the hand
that is up and, as you open your fist slowly, your usual sensation and control
returns. Let your hand float downward.
•
That is the end of the exercise. But you will retain a general feeling of
floating.
•
Do this exercise as often as ten different times a day. At first the exercise
takes about a minute; but as you become more expert at it, much less time.
Unit 2 Hypnotizability
EXERCISE 2 - Hypnotizability - Arm-Drop Test
•
The patient is told:
•
"I would like to test your reflexes. Would you please sit up straight in your
chair or hospital bed (or stand) and extend both arms straight out in front of
you, palms down”.
•
The patient then imagines that more and more water is being placed into
the left hand bucket, one litrer at a time. Slowly on and on.
Unit 2 Hypnotizability
• Hypnotizability is indicated by the following movements:
• 1. The patient’s perception of the experience is the key factor, out
weighing the objective distance the arm drops
• 2. The hand gradually lowers shows either compliance or veridical
hypnotic response.
• 3. If the hand lowers somewhat, the patient is responsive to hypnosis,
but may either be resistant, a slow responder, or capable of reaching
only a light or medium trance.
• 4. The response for lack of hypnotizability is no movement at all.
NOTE
The Arm-Drop test is a valuable test that it can be applied in a very short
period of time.
Unit 2 Hypnotizability
•
The word "hypnosis” need not be mentioned to the patient. It is an easily
administered rapid indicator of a patient’s response. positive response, indicated
by both the patient’s behavior and perception of the experience on this test
typically means that he or she is likely capable of responding favorably to a
hypnotic induction.
•
The Arm-Drop test can be turned into an induction.
•
When the practitioner is uncertain of their chances for success in inducing
hypnosis are minimal. Patient confidence in the practitioner is critical.
•
When the test is favorable, the practitioner, begins induction procedures with
confidence, transmitted to the patient..
•
Never qualify or disqualify a patient for hypnosis on a single test item.
Unit 2 Hypnotizability
QUESTIONS FOR DISCUSSION
•
Did your arm go down because it felt heavier and heavier as the water was
poured into the bucket or did you just lower it because you that was the goal of
the exercise?
•
Why? How can you adapt the exercise to your cultural environment
Unit 2 Hypnotizability
2.6 SUMMARY (10)
•
Instructions: MG – Questions, answers and discussion
TEST OF UNIT 2
1. Trance may occur spontaneously, or in response to a variety of induction
ceremonies, as long as the subject has hypnotic capacity and is not
culturally offended by the ceremony.
•
•
•
•
a.
b.
c.
d.
Sometimes true
False
True
Irrelevant
2. Variability in the hypnotic response has far less to do with the hypnotic
capacity öf the patient being hypnotized that the induction or the skill of the
clinician inducing hypnosis.
•
•
•
•
a.
b.
c.
d.
True
False
Sometimes true
Irrelevant
TEST OF UNIT 2
3. If the setting is appropriate for clinician and patient trance always occurs
slowly to the patient full capacity
•
• a. True
• b. False
• c. Sometimes true
• d. Irrelevant
4. In the HIP Induction Scale, if subject reports that the arm used in the
preparatory levitation task feels “less a part” of the body than the other
arm,” this refers to:
•
• a. Dissociation
• b. Float
• c. Cut-off
• d. Signalled levitation
TEST OF UNIT 2
5. Highly hypnotizable individuals benefit from firm guidelines to enhance
their capacity to generate their own decisions and directions.
•
• a. True
• b. False
• c. Sometimes true
• d. Irrelevant
6. Poorly hypnotizable individuals do benefit from firm guidelines to
enhance their capacity to generate their own decisions and directions.
•
• a. True
• b. Sometimes true
• c. False
• d. Irrelevant
TEST OF UNIT 2
7. All are true EXCEPT:
• a.HIP teaches the subject to use his own cuing system for entering and
exiting trance.in order to initiate and use it independently.
• b. The Spiegel Hypnotic Induction Profile (HIP) takes 30 minutes to
administer
• c.If the setting is appropriate for both the patient and the therapist, the
transformation into trance may occur to the person’s full capacity
• d There is strong evidence that hypnotizability is not a very stable trait.
ca bd acd
UNIT 3 – ACUTE PAIN
ACTIVITY
MINUTES
Objectives
10
Study of primer
20
Narrated Lecture
30
Video
20
Demo/Practice Exercise
30
Sumary
10
120
UNIT 3 - ACUTE PAIN
3.1 OBJECTIVES (10 minutes)
To learn and practice:
•
•
•
•
Evaluating the patient
Development and negotiation of the treatment plan.
Acute pain crises.
Procedures that help acute pain
UNIT 3 - ACUTE PAIN
3.2 STUDY OF PRIMER (10)
• Instructions:
•
Individually study again the Primer – Ch. 3.
•
In SG – discuss the following questions:
What do you feel about pain control?
What applications may be most useful in your health care work?
How will your patients react?
UNIT 3 - ACUTE PAIN
3.3 NARRATED LECTURE (20)
A. OVERVIEW
•
•
Pain control is the area of clinical hypnosis that has the most empirical
support.
•
Acute pain is usually related to suffering and anxiety...
•
•
•
Patients experiencing acute pain will frequently be in a medical crisis
with tissue damage or inflammation, trauma (e.g., cuts, blunt force
injury, amputations) or acute illness (e.g., sickle cell anemia, cancer).
•
•
•
A second common cause of acute pain is from medical procedures.
where pain can be predicted, which gives the patient and clinician the
ability to prepare for it e.g. childbirth.
•
•
Acute pain substantially interacts with psychological factors, particularly
anxiety.
•
•
The conditioned anxiety from acute pain can become as significant a
problem as the pain itself.
UNIT 3 - ACUTE PAIN
B. EVALUATING THE PATIENT WITH ACUTE PAIN
•
Evaluation of patients with acute pain is less complex than for chronic pain.
•
Acute pain that is not associated with a medical procedure is often a warning
sign, and the first step of an evaluation is typically a thorough medical workup.
•
Medically, it is appropriate to treat patients aggressively with opioid analgesics as
well as anesthetic agents. Opioid analgesics (i.e., morphine and its derivatives)
used to treat acute pain, is seldom addicting.
•
Also relevant are: useful procedures such as epidural delivery of agents, patient
controlled analgesia, blocks and anesthetic agents.
UNIT 3 - ACUTE PAIN
•
Medical evaluation of patients should include assessment of previous history of
acute pain and trauma, as well as their potential response and side effects to
interventions.
•
Clinicians should assess history of previous mental health disorders and anxiety
disorders, frequently the key acute pain complication.
•
Patients with histories of problems with medical procedures may develop phobic
reactions to future ones.
•
Determine how patients cope with medical procedures, as “repressors”
(avoiders) r “sensitizers” (exquisite attention).
UNIT 3 - ACUTE PAIN
C. DEVELOPMENT AND NEGOTIATION OF THE TREATMENT PLAN
•
Once the medical reasons for an acute pain episode are determined, the goal of
treatment becomes quite simply to reduce suffering as quickly as possible.
•
With procedural pain, clinicians can work with patients well in advance and apply
cognitive behavioral interventions over several treatment sessions to cope with a
procedure long before it occurs.
•
Pre-surgical evaluations address pain control and investigate factors that are
likely to make the patient show better health outcome.
•
Reducing recovery time and time back to work, improving sleep, and facilitating
health-promoting behaviors are potential treatment plans from hypnosis.
UNIT 3 - ACUTE PAIN
D. HYPNOSIS FOR ACUTE PAIN CRISES
•
Patients in acute pain find it extremely difficult to focus their attention on this
approach.
•
Patients with anxiety may have , shallow breathing and dissociation. Induction
must capture the patient’s attention, to achieve deep level of relaxation in a
short amount of time.
•
Relative to other applications, hypnosis with acute pain crises may become
much more direct and authoritarian with suggestions.
UNIT 3 - ACUTE PAIN
•
Clinician needs to recognize the patient’s vulnerability and dependence and take
control in a respectful manner.
•
A patient in intense pain will show high trust and cooperation and will proceed
with an induction. If the patient is hesitant, then more education about hypnosis
or even abandon hypnosis.
•
Once the patient has reached a level of relaxation, any number of suggestions
can be made for comfort, relaxation, well-being and rapid healing. Generally,
finger signals are extremely useful for quick inductions.
UNIT 3 - ACUTE PAIN
E. HYPNOSIS FOR PROCEDURES THAT CAUSE ACUTE PAIN
•
Medical procedures can cause substantial pain and anxiety.
•
•
However, the clinician can work with the patient before the procedure, several
times, and ideally in calm, pain-free circumstances, even in one hour.
•
The steps for using hypnosis for anticipated procedures include:
1. Establishing rapport.
2. Identifying stimuli with procedure and a “safe place” for the Patient.
3. Performing the induction4. Providing post-hypnotic suggestions linked to cues with the procedure
5. Providing additional suggestions that benefit.
•
•
•
Before returning the patient to a waking state, the clinician gives post-hypnotic
suggestions based on individual needs, for improved sleep, healing time or
responses to other procedures.
UNIT 3 - ACUTE PAIN
NOTE
The patient can use self hypnosis for temporary pain relief with powerful
imagination potential including:
•
•
•
•
•
•
•
•
Floating in the air
Going to another happy place
Changing position
Changing location
Asking pain to stop in two minutes or you will have to get up and do
an necessary but very unpleasant job
Ice water in the pain area
Numbing
Transfer of pain to another body area etc.
UNIT 3 - ACUTE PAIN
F. CONCLUSIONS
•
Controlled studies demonstrate that hypnosis is superior not only to control
groups but to alternative interventions.
•
Hypnosis reduces pain and anxiety with procedures and reduces use of costs of
anesthetics, the operating room rime and hospitalization.
UNIT 3 - ACUTE PAIN
3.4 VIDEO (20)
• Instructions:
MG – Play video extract: Rossi 1 of 3 or alternative
•
SG – Discuss following questions:
What reactions to the video?
How will your patients react?
UNIT 3 - ACUTE PAIN
3.5 DEMO/PRACTICE EXERCISE (30)
•
Instructions: Study the Organizer demo and then role play with a partner:
•
I am going to ask you to stare at this coin that I am holding in my hand and you
do so, pay no attention to any other sounds or noises. You are aware that you
are- breathing more rapidly and also that as you stare intensively at this coin,
your eyelids are beginning to blink and to feel heavy.
•
As you feel them-getting heavy and drowsy, just let them close . . . that's it. . .
they are fluttering … closing and closed . . . closing and closed … and as I
continue talking you will enter a very very deep level of hypnosis . . for in so a
very deep and sound level ..for in doing so you are going to get well … a very
deep and sound level
UNIT 3 - ACUTE PAIN
•
As you are aware of a heavy feeling in your extremities, your arms and legs ... as
you are aware of this . . . nod your head … Good a deeper and a sounder state .
. Now the finger that I touch will lose all feeling … Now that finger is and feels
numb . . . nod your head, yes …
•
Good. Now open your eyes. You will note that I am stimulating that finger very
hard with the point of my nail file, but you have absolutely no sensation of pain.
Pressure, but no pain. Now normal sensations return to your finger.
•
As you feel the file just barely stimulating your finger, pull it away. . .. Good, . . .
Relax . . now you can realize the power of the mind over the body and if you can
block pain . . . real pain . . . then, you can allow your body to respond to other
suggestions equally well.
UNIT 3 - ACUTE PAIN
•
You are now in a very deep state of relaxation. . . . You are going to hear some
soft music that is pleasurable to you . . . and as this occurs nod your head, yes.
Good now in a now a very deep and relaxed state of mind and body.
•
Because of the power of your mind over your body you are going to be able to
feel pressure but no pain. Think about it deeply.
•
Now as I slowly count from ten to one you will awaken …relaxed, well, at ease
and ready to heal yourself in so many ways.
•
QUESTIONS FOR DISCUSSION:
What are your reactions?
How will your patients react?
UNIT 3 - ACUTE PAIN
3.6 SUMMARY (10)
• Instructions: MG – Questions, answers and discussion
TEST ON UNIT 3
1. Acute pain is defined as all of the following EXCEPT:
a.
b.
c.
d.
High intensity
A duration of over six months
A relationship with tissue damage
A good response to opioid analgesics
2. The psychological reaction that most commonly accompanies acute pain
is:
a.
b.
c.
d.
Withdrawal
Psychosis
Depression
Anxiety when cause is known
TEST ON UNIT 3
3. Acute pain differs from chronic pain in that:
a. It is often related to current tissue damage
b. It lasts longer than three months
c. It responds poorly to medical interventions
d. Treatment should be combined with psychotherapy
4. Evaluation of a patient with acute pain should consider which of the following:
a. Medical explanations for the acute pain
b. Previous reactions to pain medication and anesthesia
c. Patient’s history of previous medical procedures and hisr reactions to
them
d. All of the above
TEST ON UNIT 3
5. The most important part of hypnosis for acute pain is:
a. The type of induction used
b. The therapeutic relationship
c. Being brief
d. Awareness of medications the patient is on
6. Imagery used in a hypnotic induction should:
a. Be based on interests coming from the patient
b. Always include auditory components
c. Involve elements of age regression
d. Be done early in the induction
TEST ON UNIT 3
7. If a patient is a “sensitizor” to acute pain, the best psychological approach will
include:
a. Dissociation
b. Distraction
c. Focusing on the intervention and reinterpreting it
d. Deep relaxation
8. To capture an anxious patient's attention the clinician should:
a. Model calmness
b. Pace with the patient
c. Match the patient's affect
d. All of the above
•
bca dba cd
UNIT 4 - CHRONIC PAIN
TIME SCHEDULE
ACTIVITY
MINUTES
Objectives
10
Study of- primer
20
Narrated Lecture
30
Video
20
Demo/Practice Exercise
30
Sumary
10
120
UNIT 4 - CHRONIC PAIN
4.1 OBJECTIVES (10 minutes)
To learn and practice:
•
•
•
•
•
•
Evaluating the patient
Development and negotiation of the treatment plan.
Chronic pain management.
Induction
Suggestions for enhanced outcome
Analgesia and comfort.
UNIT 4 - CHRONIC PAIN
4.2 STUDY OF PRIMER (20)
• Instructions:
• Individually study again the Primer – Ch. 4.
• In SG – discuss the following questions:
What are your reactions?
How will your patients react?
UNIT 4 - CHRONIC PAIN
4.2 NARRATED LECTURE (30)
A. OVERVIEW
• Chronic pain persists beyond the normal healing time after an injury,
or as pain that is the result of an ongoing disease process (such as
cancer or arthritis).
• Self hypnosis strategies can both (a) reduce background daily pain,
and (b) provide patients with specific skills to reduce the suffering
and impact of pain.
UNIT 4 - CHRONIC PAIN
Chronic pain has many inter-related factors, including:
(a) Ongoing physical damage and resulting nociceptive input from nerves
that transmit pain information to the central nervous system (which is
responsible for nociceptive or non-neuropathic pain);
(b) Previously damaged peripheral (outside of the spinal cord) or central
(within the brain or spinal cord) nervous system neurons (which is
responsible for neuropathic pain);
(c) Inactivity that results in weakened muscles and tendons, which then
makes the patients more susceptible to injury.
UNIT 4 - CHRONIC PAIN
(d) Discomfort from even normal activity;
(e) Overuse of medications
(f) Learning history (that is, the presence of a history of reinforcement for
pain and illness behavior); mood and distress; beliefs about the meaning
of pain; and coping strategies (maladaptive strategies, such as paincontingent rest or guarding) used to manage pain.
UNIT 4 - CHRONIC PAIN
B. EVALUATION THE PATIENT WITH CHRONIC PAIN
• No treatment for chronic pain until medical and psychological
• evaluation, to determine changes in medication regimens.
• Medical evaluation to determine how inactivity and guarding may be
• contributing to weakened muscles and tendons, with chronic pain.
• Physical therapy or graded reactivation programs may be indicated.
• Patients may be so “pain focused” and unable to focus on any other
• aspect of life
• Initial evaluation includes medical and psychological factors contributing
• to the pain problem, and the development of treatment goals that
• address all of these factors.
UNIT 4 - CHRONIC PAIN
C. DEVELOPMENT AND NEGOTIATION OF THE TREATMENT PLAN
• Treatment goals will be identified and more easily achieved if hypnotic
interventions are utilized:
•
•
(a) Increased activity, mobility and strength;
(b) Decreased use of analgesics or sedatives agreed with the evaluation
physician;
(c) Decreased overall (baseline) pain and increased ability to reduce ]=
pain using self-hypnosis skills;
(d) Improved sleep;
(e) Decreased anxiety/depression and increased well-being.
UNIT 4 - CHRONIC PAIN
(f) Decreased pain focus (increased ability to ignore pain); and
(g) Decreased catastrophizing, and other components of a negative
cognitive set.
(h) Self hypnosis training for pain reduction, decreased pain focus,
and improved sleep.
Effective treatments include:
graded activity and quota-based exercise programs, non pain
contingent medication tapers, sleep hygiene education (with
cognitive-behavioral therapy), cognitive restructuring,
contingency management and self-hypnosis training
UNIT 4 - CHRONIC PAIN
D. PAIN MANAGEMENT -
INDUCTIONS
•
All hypnosis inductions begins with the same cue. Post-hypnosis suggestions rhe
cue and subsequent hypnosis. This makes it easier for the patient to begin selfhypnosis with the cue.
•
Start relaxation induction with suggestions that the patient will experience each
body part or muscle group as becoming increasingly relaxed and comfortable),
because:
(a) Individuals respond with changes subjective experience of relaxation, with
positive outcome expectancies and self-efficacy;
(b) Perceived relaxation is inconsistent with suffering, so the induction brings
increased comfort;
(c) SH is easy to learn and use at home.
Experiment with a other inductions as treatment progresses, to find what
works best with any particular patient.
UNIT 4 - CHRONIC PAIN
E. PAIN MANAGEMENT - ENHANCE OUTCOME
• Do not apply self-hypnosis training only for chronic pain. Seek multiple
goals: improved sleep, increased activity, reduced analgesic or sedative
medication, physical therapy, and decreased catastrophizing, anxiety
control etc. .
• Suggestions should build confidence (self-efficacy), effortlessness, with a
neutral or positive mood of relaxation or even excitement).
UNIT 4 - CHRONIC PAIN
• F. PAIN MANAGEMENT - ANALGESIA AND COMFORT
• Use what the patient gives you to develop two types of
• outcome for hypnotic treatment of chronic pain:
(a) A substantial and relatively permanent reduction in
daily baseline pain, and
(b) An increase in the patient’s ability to reduce or ignore
pain for a period hours or longer with post-hypnotic
suggestions.
UNIT 4 - CHRONIC PAIN
NOTE:
The patient can use self hypnosis for temporary pain relief with powerful
imagination potential including:
•
Floating in the air, going to another happy place
•
Changing position, changing location
•
•
Asking pain to stop in two minutes or you will have to get up and do
an necessary unpleasant job
•
Ice water in the pain area
•
Numbing
•
Transfer of pain to another body area etc
UNIT 4 - CHRONIC PAIN
G. CONCLUSIONS
• Each patient responds to different suggestions in unique ways. Use what
the patient gives you and his imagination, to provide a wide variety of
possible suggestions for benefit from, and gradually eliminating those
not liked or with poor response..
• Types of suggestions to consider include those that:
(a) Reduce pain experience directly;
(b) Reduce the affective component of pain (how much any pain bothers
the patient);
(c) Increase the patient’s ability to ignore pain;
(d) Alter the meaning of pain from a signal of harm or danger to a signal
that has little meaning;
UNIT 4 - CHRONIC PAIN
(e) Shift pain from a location that is more bothersome (e.g., low
back) to an area that is less bothersome (e.g., the little finger);
(f) Alter the quality of the sensation from one of “pain” to one of
“pressure” or other not unpleasant sensation; and
(g) Alter the patient’s sense of time around any flare-ups (that they
are perceived as lasting for very short periods of time).
(h) Audio tapes may enhance outcomes, for some patients and can
even be used to reinforce a patient’s ability to use hypnosis
without the recording.
UNIT 4 - CHRONIC PAIN
4.4 VIDEO (20)
• Instructions:
• MG – Play the video extract: Rossi 2 of 3 or alternative.
• SG – Discuss the following questions:
What are your reactions?.
How will your patients react?
UNIT 4 - CHRONIC PAIN
4.5 DEMO/PRACTICE EXERCISE (30)
• Instructions: Study the Organizer demo and then role play with a
• partner, these two EXERCISES of suggestions.
•
EXERCISE 1 - Suggestions for pain reduction
With every breath you take, breathing comfort in and tension or
• discomfort out, you can wonder how it is that you may be feeling more
• and more comfortable, right here and now.
• You may be pleased, of course, but you may also be surprised that it’s so
• much easier now to simply not notice uncomfortable feelings, to simply
• not pay attention to anything other than your comfort.
• So much easier to enjoy the relaxing, peaceful comfort of each breath.
• So simple, so natural, to attend to your breathing.
UNIT 4 - CHRONIC PAIN
• As we continue, you can enjoy discovering that the uncomfortable
feelings just seem somehow to change. With every breath you take, you
can notice how those feelings seem to become less and less clear, less
and less strong… as if they are becoming farther and farther away…or
smaller and smaller, taking up less and less space in your awareness.
• You can trust that your unconscious mind will notice any feelings that
you need to pay attention to. If your health requires that you notice any
uncomfortable feelings, you will do so. It’s so nice, though, that any old,
chronic discomforts can fade away, come less and less strong.
• You can picture putting these feelings in a box, and then putting this box
in another box, and then putting this box in yet another box, and placing
that box in a room down a long hallway.
•
So that even if you are aware of these sensations at some level, it is
almost as if they are buried…far away… so easy to ignore.
UNIT 4 - CHRONIC PAIN
• It’s so easy to feel the comfort of every breath. So easy to let yourself
daydream about a pleasant place, maybe to remember a happy time in
your life or maybe to imagine a happy time you’d like to have in your life.
• Letting yourself feel free, right now, to just let your mind wander… to
wander over pleasant memories or to wander over a pleasing image of
something you’d like in your life right now.
UNIT 4 - CHRONIC PAIN
• With every breath you take, breathing comfort in and tension or
discomfort out, let yourself notice greater and greater comfort. Let every
breath you take contribute to your sense of peaceful comfort and wellbeing.
• As you breathe, and as you notice the sensations of each breath, notice,
too, that any remaining uncomfortable feelings are less and less clear,
less and less strong… as if they are becoming farther and farther
away…or smaller and smaller, taking up less and less space in your
awareness.
• I wonder if you’ll be pleased or surprised…or perhaps both…as you
become more and more aware of feeling more and more comfortable.
UNIT 4 - CHRONIC PAIN
EXERCISE 2 - Post Hypnotic Suggestions
• All right, it is now time to extend any comfort and skills you have gained
in this session into your daily life.
• Begin by closing your eyes, and taking a deep, comfortable, relaxing
breath and hold it….hold it for a moment… and then let it slowly out.
• That’s right. Really feel the sensations of each breath.
UNIT 4 - CHRONIC PAIN
• Notice that breathing in feels different than breathing out. Now, I’d like
you to imagine something with me. Imagine that you are breathing
comfort in each time you breathe in… actual comfort, each time you
breathe in… and imagine you are breathing tension or discomfort out
each time you breath out.
•
As you do so, maybe you already notice that you can feel relaxation and
comfort washing over you, like warm water in a bath. As you allow
yourself to relax more and more…
• Breathe comfort in and tension out, with each breath you take. Really
focus your mind on each breath, and let each breath contribute to your
comfort. When you do this, your mind will automatically select one or
more of the skills you are learning, and you will be able to experience
the benefits of these again.
UNIT 4 - CHRONIC PAIN
• Remember, any time you want to feel more comfortable, just rest back
and take a very deep, very satisfying breath, and hold it … and then, as
you let it all the way out, let your eyelids close and focus on your
breathing.
• Breathe comfort in, and tension out with each breath you take. Really
focus your mind on each breath. Let each breath contribute to your
comfort.
• Your mind will automatically use and practice the skills you are learning
so that you will feel more comfortable and any remaining sensations will
bother you less, and less. And the benefits will stay with you.
UNIT 4 - CHRONIC PAIN
• You may choose to practice for a minute or two every hour, or for several
minutes just a few times a day.
• I don’t know how you will choose to do it, but the more you practice, the
better you will feel.
•
And the more your mind will be able to use these skills, automatically,
throughout the day, so that you can feel more and more comfortable.
UNIT 4 - CHRONIC PAIN
• As you are practicing, when you need to end the experience, you’ll find
that you’re sitting up automatically, your eyes are open, your mind is
clear and alert…yet the comfort remains with you.
• No matter how clear and alert your mind remains, this inner comfort,
this inner sense of ease, can remain with you and grow. Because this is
your experience. And you can have it whenever you need.
• The more you practice this, the easier it will be to keep the comfort with
you.
•
In a moment I am going to count from ten back to one, and as I do, come
back up with me, feeling more and more aware and alert.
UNIT 4 - CHRONIC PAIN
• When I reach the number “one” you will be fully alert, but still
comfortable. The feelings of comfort, relaxation, and calmness you have
been feeling, these feelings will stay and linger. And the more your
practice, the better you will be at allowing yourself to feel comfortable,
until this becomes automatic.
QUESTIONS FOR DISCUSSION
1. How might the suggestions be altered to address different types of pain
problems?
2. How might the suggestions be altered to adapt to your cultural
environment?
3. What other suggestions or types of suggestions do you think individuals
with chronic pain might benefit from?
4. Other issues?
UNIT 4 - CHRONIC PAIN
4.6 SUMMARY (10)
• Instructions: MG – Questions, answers and discussion
TEST ON UNIT 4
1.
Pain that persists beyond the normal healing time after an injury, or the
result of an ongoing disease process (such as cancer or arthritis). May be
defined as:
a.
b.
c.
d.
Acute pain
Unnecessary pain.
Chronic pain
Useful pain
2. Training a patient with chronic pain to use self hypnosis strategies can result
in:
a.
b.
c.
d.
Reducing background daily pain
All of the these.
Improving patient morale.
Providing patient with skills to reduce the severity and impact of pain when
needed.
TEST ON UNIT 4
3. The key advantage of self-hypnosis training for chronic pain is:
a. Reduction in the experience of pain.
b. No “side effects”
c. Improved sleep
d. Improved well-being and sense of control.
4. Neuropathic pain conditions may respond positively to some
anticonvulsants (gabapentin or pregabolin) and so patients diagnosed with
neuropathic pain who might respond to such treatments should be offered
them.
a. True
b. False
c. Sometimes true
d. Irrelevant
TEST ON UNIT 4
5. Suggestions that might benefit a patient who is unsure about but willing
to participate in a medication reduction might include such words as:
“…and you can feel good, knowing that you are more and more able to
manage your discomfort on your own, knowing that your body has all of
the resources it needs to deal with any and all symptoms… feeling
stronger and stronger… independent… knowing what is right and health
for your body…”
a.
b.
c.
d.
True.
False
Sometimes true
Irrelevant
TEST ON UNIT 4
6. Outcomes for hypnotic treatment of chronic pain include all of the
following EXCEPT: :
a.
b.
c.
d.
Substantial and relatively permanent reduction in daily baseline pain
An increase in the patient’s ability to reduce pain.
An increase in the patient’s ability to ignore pain for a period of time.
A permanent reduction in the level of pain for ever.
7. A recording with post-hypnotic suggestions can reinforce a patients ability
to use hypnosis without the recording.
a.
b.
c.
d.
True.
False
Sometimes true
Irrelevant
TEST ON UNIT 4
8. A state of perceived relaxation is inconsistent with a state of suffering, so
the induction itself contributes to increased comfort.
a.
b.
c.
d.
Sometimes true.
False
True
Irrelevant
cbd bad ac
UNIT 5 - CHILDHOOD PROBLEMS
TIME SCHEDULE
ACTIVITY
MINUTES
Objectives
10
Study of- primer
20
Narrated Lecture
30
Video
20
Demo/Practice Exercise
30
Sumary
10
120
UNIT 5 - CHILDHOOD PROBLEMS
5.1 OBJECTIVES (10 minutes)
•
•
•
•
•
•
To learn and practice:
Preparing to teach children self-hypnosis
Research in hypnosis with children
Assessment of the child
Approaches to teaching children
Self-hypnosis and pain management.
UNIT 5 - CHILDHOOD PROBLEMS
5.2 STUDY OF PRIMER (20)
• Instructions:
• IND - Individually study again the Primer – Ch. 5.
• In SG – discuss the following questions:
Why are children good at hypnosis?
How will your patients react?
UNIT 5 - CHILDHOOD PROBLEMS
4.3 NARRATED LECTURE (30 minutes)
A. OVERVIEW
•
Hypnosis can help children in stress and pain.
•
Children learn self hypnosis easily, with a sense of personal participation in
treatment that enhances his/her sense of mastery and competency.
•
Hypnosis is primary or adjunct therapy for:
o
o
o
o
o
Habit problems such as nail biting, hair pulling, or thumb sucking.
Chronic conditions, including: migraine, asthma, hemophilia, diabetes, or
cancer.
Performance anxiety including sports, music, speaking in class, or test
performance.
Enuresis
Warts
UNIT 5 - CHILDHOOD PROBLEMS
• Hypnosis is primary or adjunct therapy for (continued) :
o
o
o
o
Conditioned fears or anxiety
Sleep problems: Falling asleep, night-waking, nightmares, night
terrors
Pain with procedures such as dental work, lumbar punctures, or
venipunctures.
Chronic pain
All of the above are EBM !!!
UNIT 5 - CHILDHOOD PROBLEMS
• Children reduce anxiety associated with pain by practicing
self hypnosis, and reducing the sensory component of
pain.
• The teaching and application of self hypnosis may be
enhanced by providing a biofeedback opportunity to the
child.
UNIT 5 - CHILDHOOD PROBLEMS
B. PREPARING TO TEACH CHILDREN SELF HYPNOSIS
• The professional must practice self hypnosis himself. Learning self
hypnosis is a valuable lifelong skill that provides many benefits.
• Professionals should take more advanced hypnosis workshops of
at least 20-24 hours and include at least six hours of supervised
practice.
• After basic training the professional should seek a mentor who, by
phone or email, can provide guidance and support, and attend
follow up workshops etc. .
UNIT 5 - CHILDHOOD PROBLEMS
C. RESEARCH IN HYPNOSIS WITH CHILDREN
•
Clinical research documents the efficacy of hypnosis with children in areas such
as pain management, habit problems, wart reduction, and performance anxiety.
•
Learning disabilities, such as auditory processing handicaps, interfere with the
ability of children to learn self hypnosis training.
•
Interventions may called “relaxation imagery”, “imagery”, “visual imagery”, or
“progressive relaxation” each lead to a hypnotic state.
•
A hand warming biofeedback group received four sessions of cognitive
behavioral stress management training, thermal biofeedback, progressive muscle
relaxation, imagery training of warm places, and deep breathing techniques.
These children were clearly also being taught self hypnosis without calling it
such.
UNIT 5 - CHILDHOOD PROBLEMS
D. ASSESSMENT OF THE CHILD
•
Know the child well before teaching him/her self-hypnosis.
•
Is the problem more significant to parents or caretakers than to the child?
•
Is the child motivated and interested in learning how he/she can help him/herself?
•
What are his/her likes/ interests, dislikes and/or fears?
•
How does he/she learn best?
•
•
Does the child have learning disabilities? What is the preferred mental imagery of a
child? This may be visual, auditory, kinesthetic, and/or olfactory/taste.
•
•
If a child has the presenting problem of enuresis, has a careful evaluation ruled out
causes, such as a urinary tract infection, that would not respond to self hypnosis?
UNIT 5 - CHILDHOOD PROBLEMS
E. APPROACH TO TEACHING CHILDREN
•
Emphasize that the child is in control and can decide when and where to use self
hypnosis.
•
Self hypnosis belongs to the child, that he needs to practice to become more
skilled just as he must practice to learn soccer.
•
Parents should understand that self-hypnosis is a skill to be developed and
refined and that only the child can do so, hopefully with their support and
encouragement.
•
Strategies for teaching self hypnosis varies depending on the child’s age and
developmental stage. As children mature their cognitive abilities change.
•
Pre school children are very concrete in their thinking and, for this reason, the
therapist must choose words very carefully.
UNIT 5 - CHILDHOOD PROBLEMS
• Children between ages two and five years spend much time in various
types of behavior based on imagination and fantasy.
• They enjoy stories and may enter a hypnotic state as the parent or
teacher reads a story to them. Unlike adults they often prefer to do self
hypnosis practice with their eyes open.
• Although adolescents may enjoy learning self-hypnosis methods that are
similar to those preferred by adults, immature adolescents may prefer to
use methods which also appeal to younger children.
• Children with cognitive impairment can learn self hypnosis if the
therapist selects a teaching approach appropriate for their actual
developmental stage.
UNIT 5 - CHILDHOOD PROBLEMS
F.
SELF HYPNOSIS AND PAIN MANAGEMENT
•
Practicing self hypnosis reduces the anxiety components of pain. It is of special
benefit to children with chronic pain illnesses such as sickle cell disease, hemophilia,
cancer, or migraine.
•
General principles for teaching hypnotic pain control include the following:
a) Assess personal experience about pain The clinician who had negative
experiences with painful procedures when he was a child may unconsciously
project his fears and negative expectations onto his patient.
b) Assess parental perceptions and expectations about pain. Children are
sensitive to their parents’ fears and anxieties. It may be beneficial for parents
also to learn self hypnosis.
UNIT 5 - CHILDHOOD PROBLEMS
c)
Consider the impact of the pediatric treatment team The attitudes and
expectations of adults on the treatment team are also understood by the child.
Changes in the voice, movement, or demeanor of adults may increase anxiety in
a child even before a procedure beginsd.
d)
Consider the age and development of the child For a toddler, a distraction
approach, such as blowing bubbles may be most appropriate.
e)
Consider a child’s interests, likes and dislikes. It is easier to learn self hypnosis
by focus on something he enjoys.
f) Emphasize the child’s control and mastery
g) Select a pain assessment tool appropriate to the child and understood by the
child. This might be a ruler if the child understands numbers. “number 10 is a
lot of discomfort and number 1 is a tiny bit of discomfort, and 0, of course, is NO
discomfort”.
h) Explain what you plan to do and what the child may
UNIT 5 - CHILDHOOD PROBLEMS
Avoid prescribing the child’s images or pain perceptions:
• It is incorrect to say that something will not hurt.
• It is also incorrect to say that something will hurt.
• The doctor or nurse can say:
“Some children say this feels like cold ice, some say it feels like a
thorn from a bush, and some say it feels like a cat scratching.
I wonder what it will feel like for you.”
UNIT 5 - CHILDHOOD PROBLEMS
G. APPLICATIONS
•
There are many hypnotic techniques to teach children, depending on their age
and preference.
•
One approach is to offer the child a pretend “magical glove” to make your hand
numb. The doctor or nurse then slowly puts on the pretend glove, finger by
finger, encouraging the child to notice the numb feeling.
•
A prior careful history will allow the doctor or nurse to know if, for example, the
child had a previous ‘numbing’ experience like another cut or a dental
extraction, in which the memory of the absence of discomfort can be recalled
and helpful in using the magic glove.
•
Another favorite approach is to explain about nerves going from all parts of the
body to the brain. It helps to make a drawing of nerves from the legs, the
tummy, and arms and the head.
UNIT 5 - CHILDHOOD PROBLEMS
•
One can explain to a school age child that it is impossible to pay attention to
more than one or two body sensations at the same time, and that we are
continually turning off our awareness to many of our nerves.
•
Thus, the child can learn to voluntarily turn off body suggestions. The doctor or
nurse can also ask the child to think about what might be a favorite type of
switch e.g. flips switch, dimmer switch, pull switch, push button switch.
•
The child can then practice turning off the switches that connect his brain to
various areas of the body. This method is easily understood by most children and
very effective.
•
Sometimes children like the analogy of one part of the body communicating with
the brain by “imaginary cell phones” which allow, for example, a “sore part” to
talk to the brain and ask for the switch to be turned off, or for the bladder to call
the brain and tell the brain when it is full.
UNIT 5 - CHILDHOOD PROBLEMS
5.4 VIDEO (20)
• Instructions:
• MG – Play video extract: Sugarman 3 of 3 or alternative.
•
In SG – Discuss the following questions:
What are your reactions?.
How will your patients react?
UNIT 5 - CHILDHOOD PROBLEMS
5.5 DEMO/PRACTICE EXERCISE (30)
• Instructions: Study the Organizer demo and then role play the two
EXERCISES with a partner.
• One person plays the role of the clinician and the other plays the role of
the patient who shares the experience.
UNIT 5 - CHILDHOOD PROBLEMS
EXERCISE 1 - Ann, age 5 years, was brought into the emergency room by
her mother because she had a big cut on her left leg. She had been
playing with an old tricycle and fell on its sharp edges.
• The doctor who greeted them noted Ann’s tears and said, “Hello, Ann,
Wow!. You have very healthy red blood and you have beautiful tears.
And your body is washing the germs away with that blood. How did you
know just how to do that?”
• Ann stopped crying and paid attention. The doctor explained to her that
he knew some of the things in the emergency room might look strange
but everything was there to help her. He asked her to sit on a gurney
while he looked at the cut.
UNIT 5 - CHILDHOOD PROBLEMS
• We can fix that,” he said. “We just have to close the cut with a few
stitches and your strong body will do the rest for you.” “I will put
some medicine around the cut so it will be numb when I do the
sewing.” “And when you go home, what is the first thing you want
to do?”
• Ann said she wanted to play when she got home.
• “Good idea,” said the doctor. “Just pretend you are at home now
and playing, and I will fix the cut. Some people say it feels like a
feather touching and some say it feels like a mosquito bite when I
put the numbing medicine in. I wonder what it will feel like for
you.”
UNIT 5 - CHILDHOOD PROBLEMS
• “Tell me what game you are playing,” said the nurse who was assisting.
• “I’m playing hide and seek,” said Ann. Her mother added, “She loves to
play hide and seek.”
• In a few minutes the suturing was completed and the wound was
bandaged.
• “You did very well using your imagination,” said the doctor, “and now
you can go home with a bandage on your cut. When you see your
friends, you can tell them all about it.”
UNIT 5 - CHILDHOOD PROBLEMS
NOTE
This approach may seem very simple. When children and adults are anxious
in a strange situation, they are receptive to either positive or negative
suggestions
• This vignette represents important points related to communication and
suggestions with young children. Bleeding is scary to most children.
• The doctor made a positive about the bleeding, telling her that she has
strong, red blood. His statement was very meaningful to a concrete
thinking five year old girl.
• He did not say, “Everything will be all right. Stop crying.” He said her
tears were beautiful.
• The average child is afraid when he or she enters an emergency room.
The doctor acknowledged that things might look strange to her.
UNIT 5 - CHILDHOOD PROBLEMS
• The doctor reassured her that he would make the wound area numb.
And then he implied that she would be going home by asking what she
would like to do when she got home.
• This type of indirect suggestion was undoubtedly reassuring to her. He
incorporated her answer into the hypnotic induction. She could imagine
something which she liked. It was helpful that both the nurse and the
mother reinforced Ann’s imagery.
• When the procedure was over the doctor gave her more positive
reinforcement, increasing the likelihood that this child would have less
anxiety the next time that circumstances might bring her to a hospital.
• Unfortunately, there are many adults who are still struggling with
unresolved fears related to inappropriate treatment in a hospital or in a
dental office when they were children.
UNIT 5 - CHILDHOOD PROBLEMS
EXERCISE 2 - Role play with a partner. One person plays the role of the clinician
and the other plays the role of the patient who shares the experience.
•
Jason, age 9 years, came to the doctor because he was having trouble falling
asleep every night. He would cry, want his parents to sit with him for an hours,
and, after they said goodnight, he would come into their room to sleep with
them.
•
He said he was afraid of monsters and “can’t turn off my brain which keeps
thinking about everything at school.”
•
Jason’s favorite activity was to play soccer. He was eager to learn self hypnosis
and followed well as he was taught a “simple, fun breathing game called 3 and 6.
•
Breathe in through your nose while you count to 3 slowly and then breathe out
slowly through your mouth while you count to 3 slowly and then breathe out
slowly through your mouth while you count to 6….that’s right!
•
Now notice how automatically your shoulders go down and get soft and relaxed
when you breathe out … Great!
UNIT 5 - CHILDHOOD PROBLEMS
•
•
Now let that feeling keep moving down from your shoulders down to your arms,
and hands and chest…and tummy.
•
•
•
And while your body is doing that…. notice in your mind you can be having a
wonderful soccer game, running, doing headers, scoring goals.. and it’s so FUNNY
that while you are active in your mind your body is soon relaxed here…
•
•
•
And every time you score a goal in your mind, your body gets more relaxed.. and I don’t
know if you’ll be all asleep before the second half starts or if your muscles will get all
relaxed before you win the game….Good night!”
•
•
•
After Jason practiced this self hypnosis technique for just a few nights, his parents reported
that he was now falling asleep quickly and easily. Furthermore, he was very proud of what
he had accomplished himself.
•
QUESTIONS FOR DISCUSSION
What are your reactions?
How will your patients react?
UNIT 5 - CHILDHOOD PROBLEMS
5.4 SUMMARY
•
Instructions: MG – Questions, answers and discussion
TEST ON UNIT 5
1. Hypnosis is now primary or adjunct EBM therapy for:
a.
b.
c.
d.
Habit problems such as nail biting, hair pulling, or thumb sucking.
All of these
Performance anxiety including sports, music, speaking in class, or test .
Chronic conditions, including migraine, asthma, hemophilia, diabetes, or cancer
2. All are true EXCEPT:
a. Hypnosis can help every child in stress and pain.
b. Children can reduce anxiety associated with pain by practicing self hypnosis, and thus
reducing the sensory component of pain.
c. The teaching and application of self hypnosis may be enhanced by providing a
biofeedback opportunity to the child.
d. None of the above
TEST ON UNIT 5
3. For self hypnosis to be increasingly effective with a patient the clinician should
practice:
a.
b.
c.
d.
Self hypnosis himself.
Advanced hypnosis
Only with a mentor present
All of the above.
4. Clinical research documents the effectiveness of hypnosis with children in all
EXCEPT:
a.
b.
c.
d.
Pain management
Habit problems
Performance anxiety
Complete character change
TEST ON UNIT 5
5. Hypnosis interventions may sometimes be named as:
a.
b.
c.
d.
All of these
Meditation
Progressive relaxation
Acu- puncture or placebo effects
6. Know the child well before teaching her self-hypnosis includes all EXCEPT:
a. Is the problem more significant to parents than to the child?
b. Is the child motivated and interested in learning how she can help
him/herself?
c. How can she be required to learn self hypnosis.
d. What are her likes/ interests, dislikes and fears?
TEST ON UNIT 5
7. All are true EXCEPT:
a. The clinician is in control and decides when the child uses self hypnosis.
b. Self hypnosis belongs to the child, that he needs to practice to become more
skilled just as he must practice to learn soccer.
c. As children mature their cognitive abilities change
d. Strategies for teaching self hypnosis varies depending on the child’s age and
developmental stage. .
8. Children that are very concrete in their thinking and, the therapist must choose
words very carefully, are especially for children :
a.
b.
c.
d.
Pre-school 2-5 years
7-10 years
11-13 years
Adolescents.
TEST ON UNIT 5
9. General principles for teaching a child hypnotic pain control, include all of the
following EXCEPT:
a.
b.
c.
d.
Assess child s personal experience about pain
Confirm parental expectations
Control impact of the pediatric treatment team
Assess age and development of the child
10. There are many hypnotic techniques to teach children, depending on their age and
preference. Including all EXCEPT :
a.
b.
c.
d.
Magic glove
Nerves going from all parts of the body to the brain.
Specific order to turn off body pain swirch.
Imaginary cell phones
•
bdc dac acb c
UNIT 6 - PTSD - POST TRAUMATIC STRESS
DISORDERS
TIME SCHEDULE
ACTIVITY
MINUTES
Objectives
10
Study of- primer
20
Narrated Lecture
30
Video
20
Demo/Practice
Exercise
30
Sumary
10
120
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
6.1 OBJECTIVES (10 minutes)
To learn and practice:
•
Overview of posttraumatic stress disorder (PTSD)
•
Diagnostic categories
•
Assessment
•
Treatment
•
PTSD and hypnosis
•
Psychological treatment of PTSD using hypnosis
•
Hypnosis for release of unbound affect.
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
6.2 STUDY OF PRIMER (20)
• Instructions:
• IND - Individually study again the Primer – Ch. 6.
• In SG – discuss the following questions:
What are your reactions to PTSD?
How will your patients react?
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
6.3 NARRATED LECTURE (30 minutes)
A. OVERVIEW OF PTSD
•
Human violence, including rape, robberies, assault, natural disaster, and accidents can
leave the individual with intense terror, fear, and paralyzing helplessness.
•
About 60% of men and 50% of women have experienced psychological trauma (defined as
threat to life of self or significant other) at some time in their lives. PTSD is increasingly
recognized as being present in diverse cultures.
•
PTSD is defined as: A mental disorder characterized by a preoccupation with traumatic
events beyond normal human experience; events such as rape or personal assault, combat,
violence against civilians, natural disasters, accidents or torture precipitate this mental
disorder,
•
Patients suffer from recurring flashbacks of the trauma and often feel emotionally numb,
are overly alert, have difficulty remembering, sleeping or concentrating, and may feel
guilty for surviving.
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
B.
DIAGNOSTIC CATEGORIES
•
Symptoms of PTSD are divided into three categories: a) Re-experiencing of the
event, b) Avoidance of stimuli, and c) Persistent symptoms of increased
arousal. The symptoms must lead to social and functional impairments in order
to meet diagnostic threshold.
•
Symptoms of PTSD generally become evident within the first months following
the trauma; sometimes acute stress disorder (ASD) develops into PTSD.
•
ASD is a rather similar disorder compared with PTSD that may occur
immediately after traumatic stress exposure and may last from 2 days to
4 weeks and includes symptoms of dissociation, such as de-realization and
depersonalization.
•
There may also be profound feelings of guilt and blaming themselves for
surviving when others did not, keeping the guilt inside. This conflict, in its most
acute presentation, typically resembles an agitated depression and is described
as being associated with frequent dreams of friends dying (e.g., in battle) and
avoidance of intimacy due to fear other party may abandon or die.
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
•
PTSD can result from a single type trauma, sometimes referred to as type I
trauma (rape, assault) or from repetitive, chronic trauma exposure, referred to
as type II trauma (child abuse, war.
•
Can have its onset early in life or later as adult. This has important consequences
for therapy. In early life trauma therapy the psychopathology is usually complex
and requires longer treatment.
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
C.
ASSESSMENT
•
Trauma measures vary widely ranging from self-report checklists
assessing the presence or absence of a limited range of potentially
traumatic events to comprehensive protocols assessing a wide range
of stressors through both self-report and interview.
•
The caveat for the diagnosis of PTSD is non-disclosure (not talking
about the trauma out of reasons of shame, guilt, fear for
prosecution).
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
D. TREATMENT
•
Control, rapport, and history are key elements in the treatment of
patients with PTSD. Patients have no difficulty in remembering and
over-engaging in the traumatic scene; they need to be able to
resolve the underlying issues through hypnotic abreactive or
adjunctive alternative hypnotic interventions.
•
Such resolution restructures the patient’s personality to function
more adaptively.
•
Antidepressant medications are the mainstay of treatment and are
the best studied in controlled clinical trials.
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
E. PTSD AND HYPNOSIS
• PTSD patients as a group are moderately high in hypnotizability
• Traumatic experiences can mobilize hypnotic responses that resemble
the ‘hypnotic state’ during which intense absorption in the hypnotic focal
experience can be achieved by means of a dissociation of experience.
• Subsequent reactivation of traumatic memories can also have trance-like
features:
• There are a number of emotional states that characterize PTSD in
addition to exaggerated fear responses to threat.
• As reviewed earlier, these include symptoms of dissociation, loss of selfagency, feeling worse with traumatic reminders, amnesia, and flashbacks
upon visual imagery of the traumatic event that plays back like a movie.
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
F. PSYCHOLOGICAL TREATMENT OF PTSD USING HYPNOSIS
• Hypnotic treatment allows modifying ownership and agency of
traumatic memories. Hypnosis in treatment of PTSD is often embedded
in a phase-oriented approach in which three elements need to be timed
sequentially:
• (a) symptom stabilization - relaxation based, anxiety management, w/o
medication
• (b) exposure - ‘working through’ the trauma, abreaction and
alternatives to abreaction
• (c) closure - usually with ritual, providing a perspective treatment of
stress response syndromes.
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
G. HYPNOSIS FOR RELEASE OF UNBOUND AFFECT
• Ego State Therapy targets PTSD by allowing the fullest expression by the
traumatized ego state while providing the needed recourse to respond to
the threatening agent. Once resolved in this brief therapy the
symptoms of PTSD disappear because they are no longer driven by an
underlying state that carried the unresolved trauma.
• The patient has overcome the fear and can quickly return normal range
functioning, at ease, and empowered.
• Thus, hypnosis is a powerful contribution to the treatment of PTSD,
which makes it the treatment of choice for experienced clinicians
treatment of posttraumatic conditions: an evidence-based approach.
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
• Hypnosis can facilitate the revivification of emotionally disturbing
experiences that happened to the individual and can release the affect
that has been connected to that experience.
• The first line procedure for skilled clinicians is the use of hypnotically
facilitated abreaction.
• A variation of the technique also developed by the Spiegel’s, asks the
patient to divide the screen, the patient can project a left sinister side,
that is the trauma side, and then the right side a picture of how they
could protect themselves and stand up to the perpetrator or
perpetrators or otherwise adaptively handle the abuser or the incident.
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
H. CONCLUSIONS
•
The role of hypnosis in traumatic recall helps patients with trauma related disorders.
•
•
•
•
•
Patients with trauma related psychopathology like PTSD or other trauma-related
disorders can alternate between states of consciousness in which they
experience their trauma over and over again as if it were happening on the spot,
with the same vividness and psycho-physiologic changes, and episodes in which
they are apparently unaware of it..
•
•
High hypnotizable and can use their hypnotic capacity to block pain and traumatic
recall.
•
The challenge for a patient is to learn to control.
•
•
Combining biological, psychological, and psychosocial treatment may well yield best
results.
•
•
Rehabilitative goals should replace curative techniques in those patients with chronic
PTSD.
•
•
Similar to the importance of pharmaco-education, the importance of psychoeducation should not be underestimated.
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
6.4 VIDEO (20)
• MG – Play the video extract: Rossi 3 of 3 or alternative.
• In SG – Discuss the following questions:
How will you recognize PTSD?
How will your patients react?
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
6.5 DEMO/PRACTICE EXERCISE (30)
•
Instructions: Study the Organizer demo and then role play with a partner.
•
Learned Helplessness, using a description of the laboratory experiments in
which animals were exposed to aversive uncontrollable events, can be a useful
therapeutic metaphor to deliver to the client in trance:
•
And there's an experiment I'd like to tell you about that you about that you may
learn a lot from . . . and I wonder just how many different possibilities will occur
to you about your own experience changing as you consider some laboratory
dogs that were divided into two groups.
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
•
One group was harnessed dangling in mid-air unable to be mobile…the others
were unharnessed , free to run.
•
The harnessed dogs were given painful shocks, but could not escape them . . .
the others were also given shock, but could run away ... a sensible reaction to
pain . . .
•
And when the harnesses: dogs were unharnessed and were again shocked,
though they could now escape but they did not even try to …their previous
experience led them to conclude they could do nothing . . . even though ±hey
really could do something . . .
•
Because now isn't then . . . and was true then may no longer be true now . . . and
you won't know until you try . . . and I wonder if you realize that depression
clouds our ability to discover the harness is gone … and there's more for you to
do than you've realized . . . and you can discover your ability to develop effective
ways to manage your life …one day at a time …
UNIT 6 - PTSD - POST TRAUMATIC
STRESS DISORDERS
6.6 SUMMARY (10)
•
Instructions: MG – Questions, answers and discussion
TEST ON UNIT 6
1. All are true about PTSD EXCEPT:
a. a single type trauma, sometimes referred to as type I trauma (rape, assault)
b. repetitive, chronic trauma exposure
c. consequences for therapy
d. onset early in life or later as adult
2. Measuring trauma may relate to :
a. widely ranging from self-report checklists assessing the presence or absence of a
limited range of potential traumas
b. comprehensive protocols assessing a wide range of stressors
c. self-report and interview
d. all of the above.
TEST ON UNIT 6
3. Patients with trauma related psychopathology like PTSD:
a. All of these
b. Experience their trauma over and over again as if it were happening on the spot
c. Have the same vividness and psycho-physiologic changes, and episodes in which
they are apparently unaware of it.
d. Can alternate between states of consciousness
4. Which of the following is true about PTSD:
a. Patients with high hypnotizability and can learn to use their hypnotic capacity to block
pain and traumatic recall.
b. The challenge for the clinician is to take complete control.of the patient.
c. Combining biological, psychological, and psychosocial treatment may well yield best
results.
d. Rehabilitative goals should gradually replace curative techniques
TEST ON UNIT 6
5. The key element in the treatment of a patient with PTSD are:
a.
b.
c.
d.
control
rapport
history
All of the above
•
cda bd
UNIT 7 - SURGERY
TIME SCHEDULE
ACTIVITY
MINUTES
Objectives
10
Study of- primer
20
Narrated Lecture
30
Video
20
Demo/Practice
Exercise
30
Sumary
10
120
UNIT 7 - SURGERY
7.1 OBJECTIVES (10)
•
•
•
•
To learn and practice:
Using hypnosis before surgery
What the research has shown
Obtaining the history
Trancework
UNIT 7 - SURGERY
7.2 STUDY OF PRIMER (20)
•
Instructions:
•
IND - Individually study again the Primer – Ch. 7.
•
In SG – discuss the following questions:
What is your reaction?
How will your patients react
UNIT 7 - SURGERY
7.3 NARRATED LECTURE (30)
A. INTRODUCTION – HYPNOSIS BEFORE SURGERY
•
Preparing patients hypnotically for their surgery can have an
enormous positive impact on both their surgical course and their
recovery.
•
Hypnosis can be very effective in enhancing the patient’s coping
skills, managing stress, anxiety, reducing pain and increasing a sense
of self-mastery in the patient having surgery.
UNIT 7 - SURGERY
B. WHAT THE RESEARCH HAS SHOWN
• Hypnosis can be used as a sole anesthetic for patients with above
average hypnotizability but most often hypnosis is used to potentiate the
effects of analgesics and anesthetics, facilitate postoperative healing,
and to help maintain stability of vital signs.
• Patients in the hypnosis groups had better outcomes than 89% of the
patients in control groups.
• With hypnosis there is less pain and infection, faster recovery, less
nausea and vomiting etc. as used.
• A randomized, controlled study showed faster wound healing and
improved functional recovery in women following breast surgery.
UNIT 7 - SURGERY
C.
OBTAINING THE HISTORY
•
•
Hypnosis can be used pre-operatively, intra-operatively and postoperatively.
•
•
A careful history should be obtained by the clinician while building rapport
with the patient.
•
•
•
Previous experience with hospitalizations, surgery and hypnosis should be
established and the patient’s particular thoughts, wishes, worries and
fears.
•
•
Determine how their life will be better after the surgery so that this can be
reflected back in trance.
•
•
Spiritual belief system is important. Patient may request scripture, prayer
or a poem with special meaning be included in the trance work.
•
•
•
The building of the therapeutic alliance between patient and clinician can
reduce anxiety and increase the patient’s positive expectation for a
successful surgical outcome.
UNIT 7 - SURGERY
D. TRANCEWORK – LANGUAGE
•
The careful use of language is essential when working hypnotically with a surgical
patient. Feelings of helplessness and dependency create fear and frustration.
The individual often feels that they have lost control of the situation.
•
Patients with a negative expectancy are more likely to have a negative outcome.
Through the careful use of language, hypnosis can control for the nocebo
response. Hypnosis uses language to create a new paradigm.
•
Surgery is a traumatic injury that stimulates the stress response. Stress delays
healing and surgical recovery. Hypnosis can mitigate that response
UNIT 7 - SURGERY
E. TRANCEWORK – STRESS
•
To establish a low stress, low anxiety environment, create a safe place of comfort
needs to be created.
•
This would be a safe place that the patient can return to in his imagination
whenever he wants or needs to.
UNIT 7 - SURGERY
•
Offer a technique for getting rid of unwanted thoughts or worries such as floating
them off on a cloud. As the patient awaits his surgery in the operating room and
pre-operative area, there will be many interruptions that can be utilized for
fractionation to take the patient deeper into trance.
• A suggestion might be:
• You will be interested to note that as you are asked to answer
questions or are asked to do anything, that it does not disrupt
your level of comfort. In fact anytime during your journey that
you open your eyes or are asked to move from one place to
another, you will notice when you close your eyes again, you will
feel yourself going even more deeply relaxed.
UNIT 7 - SURGERY
•
With children eyes open alert hypnosis can be used as children enter the
hypnotic state best by active engagement and are typically reluctant to close
their eyes during medical intervention.
•
Not everything the patient hears in the operating room and pre-operatively will
be therapeutic or even pertains to the patient. The hypnotic suggestion may be
given:
• Pay attention only to the voice that is speaking directly to you. All
other sounds will seem pleasantly far away. And if anyone says
anything to you that is less than helpful, it will be as if they are
speaking in a foreign language that you do not understand.
UNIT 7 - SURGERY
•
Since operating rooms are kept cool, suggestions for warmth or a healing light
are useful.
•
The high tech equipment in hospitals and operating rooms can be quite
frightening. The patient may be given the suggestion:
•
The equipment is all there to help your surgery go well and perhaps you will
notice how safe it makes you feel
UNIT 7 - SURGERY
F.
TRANCEWORK - MEDICAL STABILITY AND HEALING
•
Hemodynamic stability can be enhanced with a hypnotic suggestion that as the
operative area is being washed with the antiseptic solution, it will be a signal to
constrict the blood vessels to that area diverting blood flow to all other areas.
UNIT 7 - SURGERY
• Suggestions concerning homeostasis are given.
• Your inner mind knows how to regulate your blood flow, blood
pressure and blood glucose at the level that is perfect for you.
• The patient will find it especially reassuring to hear in hypnosis:
• Your doctor and nurses will take good care of you, but know also
that you can do anything you need to do to increase your level of
comfort. When your procedure is over, the healing can begin
immediately.
UNIT 7 - SURGERY
• To enhance post-operative pain control the hypnotic suggestion can be
given:
• The sensations that you feel will be those of healing and mending and
need not bother you.
• Earlier return of GI function and decreased postoperative vomiting can
be accomplished with the following suggestions:
• Note with pleasure how soon all of your bodily functions return to
normal. You will swallow to clear your throat and that will be the signal
to your digestive track – one way going down, only going down.
UNIT 7 - SURGERY
• Hypnotic suggestions to enhance healing might include:
• You can look forward to feeling better, getting better so you can
enjoy life fully. As your body heals different changes occur and
you can cooperate with the work of your body by remaining as
calm as you are now.
• Your only responsibility is for healing. Everything else is being
taken care of.
• There are no demands on you and no expectations. At any time
during your recovery period you can go right back to this place of
comfort and relaxation.
UNIT 7 - SURGERY
• The patient may be offered amnesia for the uncomfortable portions
of the procedure and ego strengthening for their hypnotic success.
• You may choose to remember to forget or forget to remember as
much or as little of this experience as you want or need to. You may
remember to remember that you were able to give yourself an
amazing amount of comfort.
UNIT 7 - SURGERY
7.5 SUMMARY
•
The clinician skilled in hypnosis has the wonderful opportunity to use this
powerful modality with patients who are facing surgery.
•
The patients will be significantly more relaxed, experience greater comfort, and
have faster healing than those who are not hypnotically prepared.
•
With hypnotic interventions the patient is empowered to take charge of his or
her recovery.
•
Surgery with hypnosis can be cost effective and management effective with the
relaxed environment for patient and staff.
UNIT 7 - SURGERY
7.4 VIDEO (20)
• Instructions:
•
MG – Play the video extract: Kuttner (1) 1 of 3 or alternative.
• In SG – Discuss and record on the SG flip-chart,
• the answers to the follow the following questions:
What are your reactions?
How will your patients react?
UNIT 7 - SURGERY
7.5 DEMO/PRACTICE EXERCISE (30)
Instructions: Study the Organizer demo and then role play with a
partner.
• One person plays the role of the clinician and the other plays the
role of the patient, who is anticipating surgery.
• Use the phrases in the chapter.
• Develop a list of questions to ask the patient to elicit his history
and find out about his upcoming surgery
UNIT 7 - SURGERY
Plan the session
1. Align goals with the patient
2. Anxiety reduction
3. Positive expectancy
Hypnotic suggestions for post-operative period:
Self hypnosis
Increase comfort
Pain Management
Nausea and vomiting reduction
Expedite mobility and function
Hasten healing
REVERSE ROLES AND REPEAT THE EXERCISE
UNIT 7 - SURGERY
QUESTIONS FOR DISCUSSION:
• 1, How effective was the exercise?
• 2. Why?
• 3. How can you adapt the exercise to your cultural environment?
• 4. Other reactions?
UNIT 7 - SURGERY
7.6 SUMMARY (10)
•
Instructions:
•
MG – Questions, answers and discussion
TEST ON UNIT 7
1. When a surgical patient is experiencing stress, anxiety or pain all of the following
apply EXCEPT:
a.
b.
c.
d.
Patient becomes exquisitely susceptible to suggestion
Become could become chronically depressed
Statements by persons in authority are not particularly powerful
When hearing something ambiguous they are more likely to interpret it
negatively.
2. All of the following are true EXCEPT:
a.
b.
c.
d.
Casual conversation or comments may function as powerful suggestions
Non-verbal communication can be as effective as words
Words with positive connotations can result in beneficial effects
Suggestibility can not be used therapeutically to the patient’s benefit
TEST ON UNIT 7
3. All of the following may be used to decrease pain EXCEPT:
a.
b.
c.
d.
Distraction
Reducing anxiety
Decreasing the patient’s sense of mastery over the pain
Changing the cognitive focus
4. Patient perception of pain is mainly influenced by all of the following EXCEPT:
a.
b.
c.
d.
Age
Previous experience with pain
Context or emotional significance
High cost of the treatment.
TEST ON UNIT 7
5. Pain is either physical or psychological. It is never both.
a.
b.
c.
d.
True
False
Sometimes true
Irrelevant
6. Research has shown that hypnosis can be effectively used with surgical patients to
achieve all of the following EXCEPT:
a.
b.
c.
d
Increase bleeding time
Decrease post-operative pain perception
Decrease post-operative nausea and vomiting
Facilitate post-operative healing
•
bdc aba
UNIT 8 – CHILDBIRTH
TIME SCHEDULE
ACTIVITY
MINUTES
Objectives
10
Study of primer
20
Narrated Lecture
30
Video
20
Demo/Practice
Exercise
30
Sumary
10
120
UNIT 8 – CHILDBIRTH
8.1 OBJECTIVES (10 minutes)
To learn and practice:
•
Self-hypnosis for childbirth
•
Childbirth as an adventure
•
The childbirth partner
•
Pain management
•
Variations in sensory preferences
•
Hypnosis for operative childbirth
•
Working with varying cultures and religious beliefs.
UNIT 8 – CHILDBIRTH
8.2 STUDY OF PRIMER (20)
• Instructions:
• IND - Individually study again the Primer – Ch. 8.
• In SG – discuss the following questions:
What is your reaction?
How will your patients react
UNIT 8 – CHILDBIRTH
8.3 LECTURE (30)
A. INTRODUCTION – SELF HYPNOSIS FOR CHILDBIRTH
•
Often during childbirth, a woman engages a “fight or flight” response which
increases her perception of pain intensity and decreases internal blood flow.
•
With the ability to use self hypnotic techniques women and their partners can
effectively enter the childbirth experience with calm and focus.
•
When internal blood flow is optimal, there is also increased uterine blood flow
and increased oxygen perfusion through the placenta.
•
Hypnotizability testing is unnecessary prior to working with a woman or couple.
Motivation seems to be the greatest predictor of success during childbirth.
UNIT 8 – CHILDBIRTH
•
The specific skills needed for childbirth include self induction for the woman,
resting techniques, pain management, using several sensory options for focus,
techniques to deal with external distractions, development of birthing
metaphors, and helping skills for her partner.
•
Some women interviewed immediately after giving birth, reported that hypnotic
techniques totally eliminated their perception of contraction pain.
•
The majority testified, however, that the success of hypnosis was related rather
to decreased anxiety; their perception that they were engaged in a birthing
adventure; the continual presence of a partner or care giver who provided
comfort, safety, and focus; and their ability to rest and calm themselves.
UNIT 8 – CHILDBIRTH
B. CHILDBIRTH AS AN ADVENTURE
•
Childbirth can be approached as a painful obstacle to be overcome or as a journey
to be traveled and experienced, using all the skills and options available.
•
The movement of contractions can become the peaks and troughs of waves, hills, or
gusts of wind. The laboring woman may find herself working intensely through her
contractions, or moving away from the physical sensations to a distant image, a
sound, or a tactile sensation.
•
Because contractions come and go as do waves, hills, and gusts of wind, these often
provide the most useful metaphors for childbirth.
•
The most important skill she must develop for this journey is, however, the ability
to rest deeply between the contractions. This should become an automatic
response to moving over the peak of a contraction, as the intensity decreases and
she can rest.
•
This experience is more successful if she is accompanied by a partner or care giver
who provides companionship, comfort, and safety.
UNIT 8 – CHILDBIRTH
C.
THE CHILDBIRTH PARTNER
•
This partner can be a spouse, friend, family member, or medical care giver.
•
The partner’s role is to protect, mediate, calm, sooth, and provide focus;
allowing the laboring woman to do her important internal work without fear of
journeying alone or of a sudden intrusion from outside.
•
If possible the partner is taught self hypnosis techniques for their own use and
to better understand the needs of the laboring woman.
UNIT 8 – CHILDBIRTH
D. PAIN MANAGEMENT
•
In most cases the pain of labor contractions is not a constant pain.
•
Anxiety and fear of pain and loss of control can, however, cause the perception
that the contraction pain never subsides.
•
Self hypnosis practice with pain simulation should be provided in the same
manner that contractions occur. Contractions occur for approximately 1 minute
with resting between contractions for 2 to 3 minutes.
•
To simulate contractions, the partner can apply ice to both of the woman’s wrists
or pinch the area of her hand between her forefinger and thumb for one minute
followed by 2 to 3 minutes of rest.
•
While using self hypnosis, images, sounds, and feelings of working through the
sensations or moving away can be suggested, followed by hypnotic suggestions
of deep rest and soothing when the stimulus is removed.
•
Ice and pinching work well because these can be easily practiced away from
training sessions.
UNIT 8 – CHILDBIRTH
E. VARIATIONS IN SENSORY PREFERENCES
•
The partner should be sensitive to the sensory language that will be most helpful
to her. All of the following can be woven into her hypnosis training and practice.
•
Recordings of waves, rivers or streams, storms and rain can be used to induce
and deepen her trance during practice sessions and childbirth. Marbles or
stones, cloth textures, clay or play dough work well as options for tactile focus.
Visual imagery, candles, and pictures are options for visual focus. During
childbirth most women are very sensitive to olfactory stimuli.
•
Providing aroma therapy with elements such as lavender, mint, or many others
depending on the woman’s preferences may help calm or energize, while
masking other odors that can interfere with her focus.
•
If a woman is birthing away from home she should also be encouraged to bring
soothing items from home, such as her pillow, pictures, cloth pieces, etc.
UNIT 8 – CHILDBIRTH
F. HYPNOSIS FOR OPERATIVE CHILDBIRTH
• The use of hypnosis during the cesarean can provide a focus distant
from the operative environment and help her to feel safe and calm.
• Once again the goal is to teach a skill set that will enable the woman
to comfort and soothe herself while providing increased blood flow
internally to her uterus and oxygen to her baby.
• This way she decreases her sympathetic response to this experience.
UNIT 8 – CHILDBIRTH
G. WORKING WITH VARYING CULTURES AND RELIGIOUS BELIEFS
•
Working with individuals of other backgrounds rather than women and
couples of European descent, it seems that prayer and deep spiritual beliefs
can often play an important role.
•
In these individuals there seems to be a much more open response to the
physical environment, and the emotional changes that accompany trance
experience
UNIT 8 – CHILDBIRTH
H. SUGGESTED TRAINING CURRICULUM
Session 1. Discuss hypnosis, benefits and limitations.
Session 2. Hypnotic experience for woman and partner using tactile focus (marble,
stone) and pain stimuli (pinching) for one minute followed by suggestions for
resting for two to three minutes.
Session 3. Discuss options for woman to communicate needs during labor
Session 4. Discuss hypnotic experience for couple using labor metaphors, resting, time
distortion.
Session 5. Hypnotic rehearsal through each phase of childbirth for couples with possible
metaphors, images, sounds, feelings, interventions.
UNIT 8 – CHILDBIRTH
I.
CONCLUSIONS
•
The success of hypnosis in childbirth is related to decreased anxiety; and a
positive perception of the birthing adventure, with the continual presence of a
partner, to provide comfort, safety, and to focus on the ability to retain control.
UNIT 8 – CHILDBIRTH
8.4 VIDEO (20)
• Instructions:
•
MG – Play the video extract: Kuttner (1) 2 of 3 or alternative.
•
In SG – Discuss the following questions:
What are your reactions?.
How will your patients react?
UNIT 8 – CHILDBIRTH
8.5 DEMO/PRACTICE EXERCISE (30)
Instructions:
Study the Organizer demo and then role play with a partner.
•
The woman is directed to enter a trance state either with the suggestions from
the practitioner or through self induction (as taught from previous training).
•
She is then asked to indicate nonverbally when she is ready to begin the
exercise.
•
Her partner is then directed to either pinch the area of her hand between her
forefinger and thumb, or place ice cubes on the palm side of both wrists.
UNIT 8 – CHILDBIRTH
•
She is then given hypnotic suggestions by the practitioner to change the
sensation in some way, move away from the sensation, or use her own
imagination to move over or through the sensation she is experiencing.
•
She is reminded that she is safe and her partner is close by helping to prepare for
the childbirth adventure they will share.
•
She is also given hypnotic suggestions to look ahead to the resting that will take
place when the sensation is gone.
UNIT 8 – CHILDBIRTH
•
After approximately one minute the pinching is stopped or the ice is removed.
Her partner then soothes the area of her hand or wrists that was affected by the
stimuli.
•
The practitioner gives suggestions for deep rest and allowing the memory of the
sensation to disappear into the past.
•
Her partner is directed to give the same suggestions following the lead of the
clinician.
•
This resting and soothing period lasts from two to three minutes. This is similar
to the rest period that occurs between contractions during labor.
UNIT 8 – CHILDBIRTH
•
The sequence is then repeated five to six times using the same suggestions. Her
partner is encouraged to provide more of the hypnotic suggestions with each
practice while the practitioner speaks less.
•
The woman is encouraged to rest more deeply and experience the confidence,
calm, and safety that increases as she works closely with her partner preparing
for their adventure.
•
After she reorients from her hypnotic experience she and her partner are
encouraged to discuss the experience with each other.
•
The practitioner should allow five minutes for this to occur without interruption
before asking for feedback from the partners.
•
The woman should also be encouraged to experience the sensation without the
use of self hypnosis and to be aware of any differences in her experience.
UNIT 8 – CHILDBIRTH
8.6 SUMMARY (10)
•
Instructions: MG – Questions, answers and discussion
TEST ON UNIT 8
1. When a woman engages her sympathetic “ fight or flight” response during
childbirth:
a.
b.
c.
d.
Pain perception increases and there is increased blood flow to her uterus.
Pain perception decreases and there is decreased blood flow to her uterus.
Pain perception increases and there is decreased blood flow to her uterus.
Pain perception decreases and there is increased blood flow to her uterus.
2. Which of the following is NOT usually necessary for success in using self hypnosis
during childbirth?
a.
b.
c.
d.
Motivation of the woman and her partner.
Techniques to deal with distractions and pain management.
Hypnotizability testing
Developing childbirth metaphors.
TEST ON UNIT 8
3. Metaphors for a childbirth adventure can be best be developed in which one of the following
ways?
a. Providing a specific script for the partner to read during all parts of childbirth.
b. Suggesting that if the woman is successful she will feel no contraction pain.
c. Suggesting that contractions can be imagined and experienced as wind,
waves, hills, or anything that comes and goes.
d. Suggesting that an adventure means that the couple should know exactly what
is going to happen at all times.
4. Childbirth pain management can be safely taught in all the following ways EXCEPT:
a. Pinching the woman’s hand between her forefinger and thumb.
b. Pinching her hand with a hemostat to prove how much pain she can tolerate in
trance.
c. Placing ice on the palm side of her wrists.
d. Suggestions that the contraction pain lasts only a short time and is followed by
long periods of rest
TEST ON UNIT 8
5. Self hypnosis during a cesarean delivery can help in all the following EXCEPT:
a.
b.
c.
d.
Stabilize her blood pressure and pulse.
Decrease blood flow to her uterus and oxygen to her baby.
Decrease fear and anxiety regarding the surgical procedure.
Causes spinal or epidural anesthesia to be less effective.
6. Which of the following is NOT important to a woman’s perception of successful
use of self hypnosis during childbirth?
a.
b.
c.
d.
The ability to rest and calm oneself.
Decreased anxiety and fear.
The comfort and safety provided by a partner or caregiver.
The total elimination of her perception of contraction pain.
TEST ON UNIT 8
7. The childbirth partner should be all of the following EXCEPT?
a.
b.
c.
d.
Always a woman.
Invested in provided calm and protection for the laboring woman.
Willing to learn hypnotic language to help sooth and focus the laboring woman.
Someone whom the woman trusts.
•
bcc bbd a
UNIT 9 – SLEEPING
TIME SCHEDULE
ACTIVITY
MINUTES
Objectives
10
Study of primer
20
Narrated Lecture
30
Video
20
Demo/Practice
Exercise
30
Sumary
10
120
UNIT 9 – SLEEPING
9.1 OBJECTIVES (10 minutes)
•
To learn and practice:
•
Insomnia as a risk factor for depression
•
Treatment options for depression-related insomnia
•
Hypnosis and psychotherapy for insomnia
•
Targeting rumination, and enhancing sleep
•
Hypnotic approaches
•
Indications and contraindications.
UNIT 9 – SLEEPING
9.2 STUDY OF PRIMER (20)
• Instructions:
•
IND - Individually study again the Primer – Ch. 9.
• In SG – discuss the answers to the following questions:
•
What are your reactions?
Reactions of your patients?.
How will your patients react?
UNIT 9 – SLEEPING
9.3 NARRATED LECTURE (30)
A.
INTRODUCTION – HYPNOSIS & SLEEP
•
The relationship between secondary insomnia and major depression.
•
Depression is the most common mood disorder in the world, and, according to
the World Health Organization (WHO), is a leading cause of human suffering and
disability that is still increasing in prevalence.
•
Insomnia is the most common sleep disorder related to depression. Insomnia is
defined as:
“A complaint of difficulty initiating sleep, maintaining sleep, and/or
non-restorative sleep that causes clinically significant distress or
impairment in social, occupational, or other important areas of functioning.”
•
Thus, an individual may complain of having difficulty initially falling asleep or
staying asleep, the latter condition manifesting as either middle of the night or
early morning awakenings.
UNIT 9 – SLEEPING
•
The negative consequences of chronic insomnia are substantial.
•
Occupationally, these include a higher rate of absenteeism from work, greater
use of health services, a higher number of accidents, and decreased productivity.
•
On a personal level, chronic insomnia sufferers report a decreased quality of life,
loss of memory functions, feeling fatigued, unable to concentrate well, and
diminished interest in socializing or engaging in pleasurable activities, further
increasing depressive symptoms.
•
A sleep disturbance can increase the risk for alcohol-related problems. Survey
respondents who reported sleep disturbances, more than 12 years later, had
twice as high a rate of alcohol-related problems.
UNIT 9 – SLEEPING
B. INSOMNIA AS A RISK FACTOR FOR DEPRESSION
•
Because insomnia and depression are so often found together, it is logical to
wonder whether insomnia causes depression, depression causes insomnia, or
whether they cause each other.
•
The onset of insomnia may serve as an “early warning signal” for an impending
depressive episode.
•
Thus, an early diagnosis of insomnia may prevent depression’s onset if it is
recognized and treated appropriately.
•
Only about 33% of those suffering insomnia report it to their physicians, and only
about 5 percent of those with insomnia actively seek treatment for it.
UNIT 9 – SLEEPING
C. TREATMENT OPTIONS FOR DEPRESSION-RELATED INSOMNIA
•
Interventions fall into two general categories: medications and
psychotherapy. Self-help strategies, including hypnosis, however, are a
viable option.
•
The use of self-help techniques for enhancing sleep offers several key
advantages:
•
Self-help will not lead to either addiction or dependence, it can be applied
under all conditions, and it will not lead to potentially harmful interactions
with other interventions
UNIT 9 – SLEEPING
D. HYPNOSIS AND PSYCHOTHERAPY FOR INSOMNIA
•
Hypnosis may be of greatest benefit to a patient with insomnia. He can learn
skills including: relaxation, good sleep hygiene and another target for a well
crafted hypnotic intervention called “rumination” (repetitive thinking).
•
Rumination is the cognitive process of spinning around the same thoughts over
and over as stress leading to depression.
•
Rumination can be thought of as a pattern of avoidance that actually increases
anxiety and agitation.
UNIT 9 – SLEEPING
•
Ruminative responses include repeatedly expressing to others how badly one
feels, thinking to excess why one feels bad, and catastrophizing the negative
effects of feeling bad. By ruminating, the person avoids having to take decisive
and timely action, further compounding a personal sense of inadequacy.
•
Rumination leads to more negative interpretations of life events, greater recall of
negative autobiographical memories and events, impaired problem-solving, and
a reduced willingness to participate in pleasant activities.
•
Rumination generates both somatic and cognitive arousal, both of which can
increase insomnia, but the evidence suggests cognitive arousal is the greater
problem. Minimal cognitive processing and special effort towards sleep are key
treatment goals
UNIT 9 – SLEEPING
E. HYPNOSIS, TARGETING RUMINATION AND ENHANCING SLEEP
•
Hypnosis can teach the ability to direct one’s own thoughts rather than merely
react to them.
•
Reducing the stressful wanderings of an agitated mind and also relaxing the
body while simultaneously helping people create and follow a line of pleasant
thoughts and images that can soothe and calm the person.
UNIT 9 – SLEEPING
To achieve these aims, important components to include in treatment
include:
1) How to efficiently distinguish between useful analysis and useless
ruminations.
2) Time-organization. - separate bed-time from problem-solving time
3) Establishing better coping skills.
4) Effective strategies for choosing among a range of alternatives.
5) Addressing attitudes and issues of sleep hygiene.
6) Teaching “mind-clearing” or “mind-focusing” strategies.
UNIT 9 – SLEEPING
F. HYPNOTIC APPROACHES
•
Hypnosis teaching gives the client effective ways to make distinctions between
useful analysis and useless ruminations, time-organization (compartmentalize)
various aspects of experience, develop better coping skills, develop more
effective decision-making strategies, and develop good behavioral and thought
habits regarding sleep.
•
Such hypnosis sessions are quite different in their structure than is a session
designed specifically for the purpose of enhancing to actually to fall and stay
asleep.
•
In standard therapy sessions involving hypnosis, the opposite is true: The
clinician takes active steps to prevent the client from falling asleep during the
session. It has been well established that hypnosis isn’t a sleep state, and that
sleep learning is a myth.
UNIT 9 – SLEEPING
G. INDICATIONS AND CONTRA-INDICATIONS
•
There are no known contraindications to teaching clients to focus and relax.
However, it is important that the client understand that hypnosis is a valuable
tool for relaxing and reducing ruminations.
•
The rest of the larger treatment plan involves learning time-organization skills
(compartmentalization), that will support the use of hypnosis in order to make a
more enduring contribution to enhancing sleep.
•
The client needs to be able to place the hypnosis in the context of the larger
therapy.
UNIT 9 – SLEEPING
9.4 VIDEO (20)
• MG – Play the video extract: Kuttner (1) 3 of 3 or alternative.
• In SG – Discuss the following questions:
Reactions?
How will your patients react?
UNIT 9 – SLEEPING
9.5 DEMO/PRACTICE EXERCISE (30)
Instructions: Study the Organizer demo and then role play with a partner.
•
When you are laying down, ready to sleep, make a point of saying slowly
(either out loud in a quiet voice or silently in your thoughts in a soothing
voice) positive statements about favorable environmental conditions.
•
Examples might be: “The room temperature is really comfortable…my pillow
is so soft…the night sounds are so comforting…there’s nothing else I need to
do or think about right now besides how good it feels to fall asleep…”
•
If and when you have an intrusive or unwanted thought, simply say calmly
“I’ll pay attention to that some other time” and resume your descriptions of
favorable conditions until you fall asleep. Train your mind to focus on
immediate comfort of sleep.
UNIT 9 – SLEEPING
9.6 SUMMARY
•
Instructions: MG – Questions, answers and discussion
TEST ON UNIT 9
1. The most common mood disorder in the world, and, according to the World Health
Organization (WHO), is a leading cause of human suffering and disability, still
increasing in prevalence is:
a.
b.
c.
d.
Insomnia
HIV
Malaria
Depression
2. A complaint of difficulty initiating sleep, maintaining sleep, and/or non-restorative
sleep that causes clinically significant distress or impairment in social, occupational, or
other important areas of functioning, is:
a. Depression
b. HIV
c. Malaria
d. Insomnia
TEST ON UNIT 9
3. The consequences of chronic insomnia, occupationally include all EXCEPT:
a.
b.
c.
d.
Higher rate of absenteeism from work, greater use of health services
Higher number of accidents
Less interest in health services
Decreased productivity
4. Rumination (repetitive thinking) leads to all of the following EXCEPT::
a.
b.
c.
d.
More negative interpretations of life events
Greater recall of negative autobiographical memories and events
Improved problem-solving
Reduced willingness to participate in pleasant activities.
TEST ON UNIT 9
5. Hypnosis can be used as a vehicle for teaching the client effective ways to all of
these EXCEPT:
a.
b.
c.
d.
Making distinctions between useful analysis and ruminations.
Make ruminations useful.
More effective time-organization (compartmentalize).
Better thought habits regarding sleep.
6. Rumination (repetitive thinking) includes all of the following EXCEPT:
a. A cognitive process of spinning around the same thoughts over and over
again.
b. An enduring style of coping with ongoing problems and stress unsuccessfully.
c. Relaxation to reduce depression.
d. A pattern of avoidance that actually increases anxiety and agitation
TEST ON UNIT 9
7. By ruminating, the person avoids having to take decisive and timely action, further
compounding a personal sense of inadequacy, with responses which include:
a.
b.
c.
d.
Repeatedly expressing to others how badly one feels.
Thinking to excess why one feels bad.
Catastrophizing the negative effects of feeling bad
All of the above.
•
aac cbc d
UNIT 10 – DEPRESSION
TIME SCHEDULE
ACTIVITY
MINUTES
Objectives
10
Study of primer
20
Narrated Lecture
30
Video
20
Demo/Practice
Exercise
30
Sumary
10
120
UNIT 10 – DEPRESSION
10.1 OBJECTIVES (10)
To learn and practice:
1. Hypnosis for major depression
2. Major depressive disorder (MDD)
3. Stages of cognitive hypnotherapy for depression
4. Clinical assessment & First aid for depression - protocol
5. Hypnotic cognitive behavior therapy
6.. Cognitive restructuring using hypnosis
7.. Attention switching and positive mood induction
8. Interactive training & social skills training
9. Ideal goals/reality training
10. Booster and follow-up sessions
UNIT 10 – DEPRESSION
10.2 STUDY OF PRIMER (20)
• Instructions:
•
IND - Individually study again the Primer – Ch. 10.
• In SG – discuss the following questions:
What are your reactions?
How will your patients react?
UNIT 10 – DEPRESSION
10.3 NARRATED LECTURE (30)
A. INTRODUCTION – HYPNOSIS FOR DEPRESSION
•
Hypnotherapy for major depressive disorder (MDD).
•
MDD is among one of the most common psychiatric disorders.
•
Can be treated successfully with antidepressant medication and psychotherapy,
but a significant number of depressives do not respond to these approaches.
•
Cognitive Hypnotherapy (CH), a multimodal treatment approach to depression
that may be applicable to a wide range of people with depression.
UNIT 10 – DEPRESSION
B. DESCRIPTION OF MAJOR DEPRESSIVE DISORDER (MDD)
•
MDD (used interchangeably with depression in this chapter) is characterized by
feelings of sadness, lack of interest in formerly enjoyable pursuits, sleep and
appetite disturbance, sense of worthlessness, and thoughts of death and dying.
•
Depression is on the increase (World Health Organization,1998). Estimated that
out of every 100 people, approximately 13 men and 21 women are likely to
develop MDD some point in life. About one-third of the population may suffer
from mild depression..
•
By 2020 clinical depression will become the second (chronic heart disease)
international health disease burden cause of death, disability, incapacity to work.
•
Approximately 60% of people who has a major depressive episode will have a
second episode. Among those who have experienced two episodes, 70% will
have a third, and among those who have had 3 episodes, 90% will have a
fourth.
UNIT 10 – DEPRESSION
C. COGNITIVE HYPNOTHERAPY (CH) FOR DEPRESSION SESSIONS 1-2
•
CH generally consists of 16 weekly sessions.
A. CLINICAL ASSESSMENT
UNIT 10 – DEPRESSION
B. FIRST AID FOR DEPRESSION – PROTOCOL
•
Encourage patient to talk;
•
Plausible biological explanation
•
Hypnotic induction to alter depressive posture
•
Encourage smile by imagining looking in a mirror
•
Imagine a "funny face"
•
Play a happy mental tape"
•
Condition to a positive cue-word:
•
“From now on, whenever you feel down or depressed, and don’t want to feel
this way, all you have to do is to repeat the word BUBBLES and soon the bad
feeling will ease away, replaced by good feeling.”
UNIT 10 – DEPRESSION
C. COGNITIVE HYPNOTHERAPY (CH) FOR DEPRESSION SESSIONS 3-6
•
COGNITIVE BEHAVIOUR THERAPY (CBT)
•
Coach on access
•
Restructuring deeper self-schemas.
•
Advise to constantly monitor and restructure negative cognitions until it
becomes a habit.
UNIT 10 – DEPRESSION
D. HYPNOTHERAPY (CH) FOR DEPRESSION SESSIONS 7-8
•
HYPNOSIS
•
•
•
•
•
Focus two hypnotic sessions on relaxation
Somatosensory changes
Power of the mind
Ego-strengthening
Increasing confidence in the ability to utilize self-hypnosis.
•
Post-hypnotic suggestions (PHS) offered to counter negative self-hypnosis (NSH),
with self-hypnosis to induce relaxation, positive mental set, and egostrengthening..
UNIT 10 – DEPRESSION
E. HYPNOTHERAPY (CH) FOR DEPRESSION SESSIONS 9-12
•
COGNITIVE RESTRUCTURING USING HYPNOSIS
•
Guide to focus attention on a specific area of concern
•
Once the negative cognitions are identified, encouraged patient to restructure
the maladaptive cognitions and then to attend to the resulting (desirable)
responses.
•
Positive Mood Induction technique in of five steps:
•
•
•
•
•
(1) education,
(2) making a list of positive experiences,
(3) positive mood induction,
(4) posthypnotic suggestions, and
(5) home practice.
UNIT 10 – DEPRESSION
F. HYPNOTHERAPY (CH) FOR DEPRESSION SESSIONS 13-14
•
ACTIVE INTERACTIVE TRAINING
•
•
•
Break "dissociative” habits and
Encourage "association" with the pertinent environment.
Prevent reflexive dissociation.
•
Patient (1) must become aware of the automatic occurrence of such a process,
(2) actively attempt to inhibit it by switching attention away from "bad anchors",
and (3) actively attend to pertinent cues or conceptual reality.
•
SOCIAL SKILLS TRAINING
UNIT 10 – DEPRESSION
G. HYPNOTHERAPY (CH) FOR DEPRESSION SESSIONS 15-16
• IDEAL GOALS/REALITY TRAINING
• Under hypnosis image ideal but realistic goals
• Then imagine planning appropriate strategies
• Take necessary actions for achieving.
• BOOSTER AND FOLLOW-UP SESSIONS
• Some depressed patients may, however, require fewer or more sessions.
• Further booster follow-up sessions provided as required.
UNIT 10 – DEPRESSION
H. CONCLUSIONS
•
MDD is one of the most common psychiatric disorders treated by psychiatrists
and psychotherapists.
•
Although MDD can sometimes be treated successfully with antidepressant
medication and psychotherapy, a significant number of depressives do not
respond to these approaches
•
Cognitive Hypnotherapy (CH), a multimodal treatment, may now become
available to a wide range of people with MD, with validated benefits.
•
Further research is needed.
UNIT 10 – DEPRESSION
10.4 VIDEO (20)
• Instructions:
• MG – Play video extract: Kuttner (2) 1 of 3 or alternative.
• SG – Discuss the following questions:
Does the video help patients? .
How will your patients react?
UNIT 10 – DEPRESSION
10.5 DEMO/PRACTICE EXERCISE
Instructions: Study the Organizer demo and then role play 3 EXERCISES with a
partner.
EXERCISE 1 Practice: FIRST AID FOR DEPRESSION
Encourage patient to talk. plausible biological explanation; hypnotic induction
to alter depressive posture; encourage smile by imagining looking in a mirror; i
imagine a "funny face";"play a happy mental tape"; condition to a positive cueword:
“From now on, whenever you feel down or depressed, and don’t want to feel
this way, all you have to do is to repeat the word BUBBLES and soon the bad
feeling will ease away, replaced by good feeling.”
UNIT 10 – DEPRESSION
EXERCISE 2 Practice - Use of a CD
•
Practice: Day by day, as you listen to your self-hypnosis CD, you will become
more relaxed, less anxious, and less depressed.
•
As a result of this treatment and as a result of you listening to your self-hypnosis
CD every day, you will begin to feel more confident and you will begin to cope
better with the changes and challenges of life every day.
•
You will begin to focus more and more on your achievements and successes than
on your failures and shortcomings.
UNIT 10 – DEPRESSION
EXERCISE 3 Practice - Rumination
Depressives tend to constantly ruminate with negative thoughts, feelings and
images (a form of NSH); especially following a stressful experience: (e.g. “I
will not be able to cope.”).
•
Practice:
•
While you are in an upsetting situation, you will become more aware of how to
deal with it rather than focusing on your depressed feeling.
•
When you plan and take action to improve your future, you will feel more
optimistic about the future.
•
As you get involved in doing things, you will be motivated to do more things.
UNIT 10 – DEPRESSION
10.6 SUMMARY
•
Instructions: MG – Questions, answers and discussion
TEST ON UNIT 10
1. It is important to find new approaches to the treatment of depression, because:
a.
b.
c.
d.
Current treatments are outdated.
Common treatments can have very serious side-effects.
Currents treatments do not work.
So many depressed patients do not respond to current traditional treatments.
2. Cognitive hypnotherapy is a multimodal approach for treating depression, mainly
consisting of
a.
b.
c.
d.
Behavior therapy and light therapy .
Medication and cognitive behavior therapy.
Hypnosis and cognitive behavior therapy.
Hypnosis and electroconvulsive therapy.
TEST ON UNIT 10
3. What percentage of depressives with three episodes of depression are likely to
have a fourth episode?
a.
b.
c.
d.
90%.
60%
40%
20%
4. Hypnosis provides a powerful technique for getting access to and for restructuring
unconscious negative attitudes..
a.
b.
c.
d.
Not true.
True.
Not sure.
Used to, but not now.
TEST ON UNIT 10
5. What is the ultimate goal of any form of depression therapy?
a.
b.
c.
d.
To help the person feel better.
To establish a new identity.
To help the patient become independent.
All of the above.
d.
aca ac
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
TIME SCHEDULE
ACTIVITY
Objectives
MINUTES
10
Study of primer
Narrated Lecture
Video
20
30
20
Demo/Practice
Exercise
30
Sumary
10
120
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
11.1 OBJECTIVES
To learn and practice:
•
•
•
•
•
•
Anxiety research
Assessment
Stages of anxiety treatment
Development of procedural hypnosis
Evidence of efficacy
Application considerations
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
11.3 NARRATED LECTURE (30)
A. INTRODUCTION – HYPNOSIS FOR STRESS & ANXIETY
•
The most common disorders of anxiety are phobias, including agoraphobia, and
generalized anxiety disorder.
•
More serious anxiety disorders such as Post-Traumatic Stress Disorder or
Obsessive Compulsive Disorder involve more complicated treatments.
B. RESEARCH
•
Research on the on the efficacy of hypnosis with anxiety is clearly evidenced in
many published treatment protocol.
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
C. ASSESSMENT
•
First Session. Assessment includes: history, changes in the symptoms over time,
symptom coping strategies, associated stresses and impact on lifestyle, patient’s
strengths, including both cognitive and emotional resources, self-soothing and
relaxation.
•
Homework self-monitoring of the symptoms on an hourly basis including what
influences their appearance and disappearance and any associated stresses.
•
Many patients with generalized anxiety disorder ascertain triggers they did not
realize were affecting them.
•
High-risk times and/or situations can be utilized as factors that decrease anxiety
become clearer. Self-monitoring decreases anxiety.
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
D. FOUR STAGES OF TREATMENT OF ANXIETY - VISCERAL
•
The specific treatment of anxiety involves four stages with each resting on the earlier
stage.
•
Visceral Control - Hypnosis and self-hypnosis to teach the patient to relax in nonstressful circumstances. Post-hypnotic suggestions achieve easier relaxation can be
given.
•
If the patient can achieve a reasonable depth of trance and relaxation, then a
recording (cassette or CD) can allow practice at home, twice a day, whjen patient is
relaxed and removed from internal or external distractions.
•
For a patient unable to achieve a relaxed state, the therapist can discuss resistance or
even use paradox or other indirect methods like Erickson to get the patient to relax
and allow self-hypnosis.
•
Patient’s achieves ability to go to a deep level of relaxation in just a few minutes daily.
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
E. FOUR STAGES OF TREATMENT OF ANXIETY - DESENSITIZATION
•
Patient creates a hierarchy of feared situations or objects.
•
Graded exposure (starting with the least-feared circumstance) in hypnosis allows
the patient to experientially process his reactions and learn to modulate them by
inducing the relaxation response in the imagined presence of anxiety-producing
situations
•
A television screen can give more distance and put the control (remote control) in
the patient’s hands, where the patient can shift from the anxiety situation to
“the relaxation channel”.
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
F. FOUR STAGES OF TREATMENT OF ANXIETY - COGNITIVE
•
Cognitive - Cognitions, particularly catastrophizing and generalization can be
rewritten since the anxiety can be countered with the thought “I have mastered
my fear and feel confident I can manage my anxiety which is under control.
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
G. FOUR STAGES OF TREATMENT OF ANXIETY - REHEARSAL
•
Rehearsal - is the final stage utilizing his new coping strategies to relieve his
stress and anxiety.
•
Once this has been mastered in imagination, i.e. little or no anxiety throughout
the whole stressful situation, the patient is ready for controlled rehearsal in vivo.
•
Patient with flying phobia, can simulate his trip to the airport, approaching the
gate and even waiting in line to board, before he actually attempts the flight.
•
Preventive intervention for a patient who will undergo surgery or any invasive
medical procedure.
•
Can be a used alone or as reinforcement to anesthesia etc.
•
Effective and powerful for most stress and anxiety, including panic disorder,
phobias and social anxiety which could cause distress.
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
H. CONCLUSIONS
•
Both curative and preventive hypnosis is an effective and powerful intervention
for most types of phobias and for generalized anxiety.
•
With more severe situations, such as OCD and PTSD, intervention is much more
complex and varied.
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
11.4 VIDEO (20)
• Instructions:
• MG – Play the video extract: Rossi 3 of 3 (again) or alternative.
• In SG – Discuss the following questions:
What are your reactions?
How will your patients react?
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
11.5 DEMO/PRACTICE EXERCISE (30)
Instructions: Study the Organizer demo and then role play with a partner.
1. Picture the day that is coming up when you will have your medical procedure (e.g.,
childbirth, dental care, surgery etc). Picture the building where this will occur.
Imagine the door you might walk in. Think about the room where it will take place.
Who will be there? What sort of preparations will they take immediately before the
procedure? Establish a clear image of this series of scenarios in your mind.
2. Use all of your talents to put yourself in the deepest state of relaxation possible. Start
by concentrating on your breathing, and slow it down. Then start with one part of
your body (your head, toes or fingers) and progressively relax each part until you have
covered all areas. Repeat to yourself: "My fingers are warm, my finger are relaxed,
my fingers and becoming very heavy." Repeat for all parts of the body.
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
3. After achieving a deep state of relaxation, begin to picture the cues on the day of
your procedure. Walk yourself through the event, beginning with entering the
building. Watch yourself calmly and painlessly going through all of the events.
4. Now picture yourself at some point in the future, well after the procedure is over.
See yourself as healthy, relaxed, and at peace.
UNIT 11 – STRESS & ANXIETY &
PROCEDURAL HYPNOSIS
11.6 SUMMARY (10)
•
Instructions: MG – Questions, answers and discussion
TEST ON UNIT 11
1. The most common disorders of anxiety are:
a.
b.
c.
d.
Phobias, including agoraphobia, and generalized anxiety disorder.
Post-Traumatic Stress Disorder
Obsessive Compulsive Disorder
All of the above.
2. Assessment of anxiety includes:
a.
b.
c.
d.
History
All of the these
Symptom coping strategies & associated stresses
Changes in the symptoms over time
TEST ON UNIT 11
3. All are true EXCEPT:
a. Self-monitoring increases anxiety.
b. Many patients with generalized anxiety disorder find triggers they did not realize
were affecting them.
c. High-risk times and/or situations can be utilized as factors that decrease anxiety
become clearer.
d. Homework self-monitoring of the symptoms on an hourly basis includes what
influences their appearance and disappearance, and any associated stress.
4 . In the four stages of treatment with hypnosis and self-hypnosis to teach the
patient to relax in non-stressful circumstances is:
a.
b.
c.
d.
Visceral control
Dessentisation
Cognitive
Rehearsal
TEST ON UNIT 11
5. In the four stages of treatment, when patient creates a hierarchy of fears m it is
a.
b.
c.
d.
Visceral control
Dessentisation
Cognitive
Rehearsal
6. In the four stages of treatment, catastrophizing and generalization an the thought
“I have mastered my fear and feel confident I can manage my anxiety which is
under control. Is:
a.
b.
c.
d.
Visceral control
Dessentisation
Cognitive
All of the above
TEST ON UNIT 11
7. In the four stages of treatment, utilizing his new coping strategies to
relieve his stress and anxiety is:
a.
b.
c.
d.
Visceral control
Dessentisation
Cognitive
Rehearsal
•
dba abc d
UNIT 12 – SUMMARY & REVIEW
SESSION
TIME SCHEDULE
ACTIVITY
MINUTES
Objectives
10
Study of Primer
10
Video
20
Quiz
30
Summary Lecture
20
Feedback Report (Diary)
20
Post Course Support
10
120
UNIT 12 – SUMMARY & REVIEW
SESSION
12.1 OBJECTIVES (10 minutes)
A. The whole program was designed to achieve learning and practice basic medical
hypnosis with confidence.
B. The specific learning objectives of the program are to:
1. Briefly present the basic concepts of modern medical hypnosis.
2.
Encourage health practitioners to use hypnosis as an adjunct and reinforcement to medical
care.
3. Support the teaching and practice of hypnosis as a part of the requires syllabus of medical
schools, nursing schools and primary health care training units.
4. Develop confidence in using basic cost effective brief hypnosis techniques with patients.
5.
Motivate further study in the future with the courses run by the professionally recognized
national and international hypnosis societies.
UNIT 12 – SUMMARY & REVIEW
SESSION
C.
To create a website training materials (with controlled access by code) to
encourage free access and translation of the text book and training materials,
into local languages.
D.
To use this website as a resource for post training help, feedback and support of
further study. To promote and support the Olness Training program for primary
health care workers in developing countries. See Appendix.
E.
To use a rigorous alternative choice quiz (80 questions) in the first and last units
of the training, to measure and reward the learning achieved.
F.
To provide allow alternative scheduling as a 2-3 day course for Doctors, nurses
and primary health care workers, or in 10-12 two hour sessions for medical and
nursing students, with individual support as needed.
UNIT 12 – SUMMARY & REVIEW
SESSION
12.2 STUDY OF PRIMER (10)
•
Instructions:
•
IND – Review the Primer.
•
In SG – discuss the following questions:
What are your reactions?
How will your patients react?
UNIT 12 – SUMMARY & REVIEW
SESSION
12.3 VIDEO (20)
• Instructions:
• MG – Play again video extract: Sugarman 3 of 3.
• In SG – Discuss and record on the SG flip-chart,
• the answers to the follow the following questions:
What are your reactions now?
How will your patients react?
UNIT 12 – SUMMARY & REVIEW
SESSION
12.4 SUMMARY LECTURE (20 minutes)
1. Some guidelines for clinical practice:
2. Clinician must have confidence and create empathy rapidly with the patient.
3. Recognize that medical hypnosis is based upon self hypnosis and upon powerful imagination.
4. Clinician must be skilled in self-hypnosis.
5. Patient must understand hypnosis, believe in it and expect it to work.
6.Use what the patient gives you, in both verbal an body language, to plan a therapy which
directly relates to the patient’s values, culture and expectations, and meets his needs.
7. Practice simply and gently with a skilled Mentor available as needed.
8. Work with a professional hypnosis society for further study.
9. Give confidence to the patient to feel an essential part of the health care team. etc …
10- 20 to be included
UNIT 12 – SUMMARY & REVIEW
SESSION
12.5 QUIZ (40)
• IND Instructions:
•
Complete on the answer sheet provided, for the 80 question alternative choice
quiz which is in the GUIDE. Choose only the questions for units you have covered
inn the course.
•
Hand your answer sheet to the Organizer who will give you a score of hypnosis
learning at the start of the course.
•
This is the same quiz you completed in Unit 1 to give you feedback and reward
your achievement.
UNIT 12 – SUMMARY & REVIEW
SESSION
12.6 FEEDBACK REPORT (20)
•
Instructions:
– IND – Complete the first feedback report in the DIARY for the Organizer.
– After one month of practice, please send us the final feedback report.
UNIT 12 – SUMMARY & REVIEW
SESSION
12.7 POST COURSE SUPPORT (10)
•
A web site can be available to give help, advice and response to questions.
•
International and national societies of hypnosis are available (see Primer) with
current published journals and more advanced training courses.
•
•
Vlaamse Wetenschappelijke Hypnose Vereniging 517 3070 Kortenberg Belgium
E-mail: [email protected] Web site: http://www.vhyp.be
•
Video ans DVD are available. Barabasz A., & Christensen, C. (2009). Hypnosis
induction demonstrations: Techniques, metaphors, and scripts. DVD. So many
books are available.
•
Barabasz A., & Watkins, J. G. (2005). Hypnotherapeutic techniques. New York:
Brunner-Routledge.
•
Michael D. Yapko Trancework – An Introduction to the Practice of Clinical
Hypnosis (Taylor & Francis)
UNIT 12 – SUMMARY & REVIEW
SESSION
•
Jensen, M. P., & Patterson, D. R. (2006). Hypnotic treatment of chronic pain, journal of Behavioral
Medicine, 29, 95-124.
•
McCarthy, P. (2001). Hypnosis in obstetrics and gynecology. In L. E. Fredericks (Ed.), The use of
hypnosis in surgery and anesthesiology (pp. 163-211). Springfield, IL: Charles C. Thomas.
•
Olness, K., & Kohn, D. (1996). Hypnosis and hypnotherapy with children (3rd ed.). New York:
Guilford.
•
Paterson, D. R. Clinical hypnosis in pain control and management (unpublished manuscript).
Washington, DC: American Psychological Association.
•
Spiegel, H., & Spiegel, D. (2004). Trance and treatment: Clinical uses of hypnosis. Washington, DC:
American Psychiatric Association Publishing.
•
Thomson, L. (2005). Hypnotic intervention therapy with surgical patients. Hypnos, 32(2), 88-96.
•
Watkins, J. G., & Barabasz, A. F. (2008). Advanced hynotherapy: Hypno-dynamic techniques. New
York: Routledge.
UNIT 12 – SUMMARY & REVIEW
SESSION
12.8 FINAL CONCLUSIONS
1. FOR THE HEALTH CARE PROFESSIONAL, SUCCESS IN CLINICAL MEDICAL
HYPNOSIS, COMES WITH COMPETENCE IN SELF-HYPNOSIS AND THE
CONFIDENCE, TO USE WHAT THE PATIENT GIVES YOU, TO ALLOW MEDICAL
HYPNOSIS TO REINFORCE YOUR HEALTH CARE WITH NEW SKILLS AND
ATTITUDES.
2. FOR THE PATIENT, SUCCESS IN CLINICAL MEDICAL HYPNOSIS, COMES FROM
THE CONVICTION AND CONFIDENCE TO USE SELF- HYPNOSIS TO MOBILIZE
INNER RESOURCES FOR HEALING, AND THUS WITH CONFIDENCE, TO
BECOME AN ACTIVE MEMBER OF THE HEALTH CARE TEAM.
3. GOOD LUCK FOR THE FUTURE … ON WE GO TOGETHER …
APPENDIX (See Workpack)
Olness Team Hypnosis Training Program for Developing Countries
• This proven pediatric workshop training program for developing
countries is offered at three levels (introductory, intermediate,
advanced) depending on previous experience in hypnosis.
• It provides training in the use of hypnosis and its applications in
clinical pediatric settings.
• Emphasis is placed on supervised practice of hypnotic techniques.
• See Workpack for full details.