Transcript Hypnosis - Society for Adolescent Health and Medicine

Cora Collette Breuner, MD, MPH, FAAP
Professor of Pediatrics and
Adolescent Medicine
Seattle Childrens Hospital/ University of Washington
Anju Sawni, MD, FAAP
Assistant Professor of Pediatrics
Hurley Children’s Hospital/Hurley Medical Center/MSU/CHM
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Faculty Disclosure Information
In the past 12 months, I have not had a significant
financial interest or other relationship with the
manufacturer(s) of the product(s) or provider(s)
of the service(s) that will be discussed in my
presentation.
This presentation will not include discussion of
pharmaceuticals that have not been approved by
the FDA
Case Study
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A 9 year old boy diagnosed with headaches is
brought into your clinic by his mother. They are
frustrated because despite multiple medications,
he continues to complain of headaches several
times each month and has missed a lot of school.
Mom wants to discuss other options for her son.
How could you advise her?
Case Study
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A 9 year old boy diagnosed with headaches is
brought into your clinic by his mother. They are
frustrated because despite multiple medications
and dietary modifications, he continues to
complain of abdominal pain several times each
month and has missed a lot of school.
When asked mom states that he has missed over 25
days this year
Treatment recommendations on behavioral and
physical treatments for migraine from US Headache
Consortium evidence-based guidelines
Relaxation training, thermal biofeedback combined with
relaxation training, electromyographic biofeedback, and
cognitive-behavioral therapy may be considered as treatment
options for prevention of migraine (Grade A evidence*)
Behavioral therapy (ie, biofeedback, relaxation) may be
combined with preventive drug therapy to achieve additional
clinical improvement for migraine relief (Grade B evidence*)
Evidence-based recommendations are not yet possible on the
use of hypnosis, acupuncture, transcutaneous electrical nerve
stimulation, cervical manipulation, occlusal adjustments, or
hyperbaric oxygen as preventive or acute therapy for migraine
(Grade C evidence*)
Grade A: Multiple well-designed randomized controlled trials (RCTs) revealing
a consistent pattern of positive fi ndings.
Grade B: Some supportive evidence
from RCTs, but not optimal support (often because RCTs were few or fi ndings
were judged to be inconsistent).
Grade C: Consensus on the recommendation
achieved among consortium members in the absence of acceptable RCTs.
Patient characteristics for which behavioral treatments
for migraine may be particularly well suited
1. Preference for a nondrug approach
2. Intolerance of, or medical contraindication to, drug treatment
3. Absent or minimal response to drug treatment
4. Pregnancy, plans to become pregnant, or current nursing status
5. History of long-term, frequent, or excessive use of analgesic or
other acute medications that aggravate headache symptoms or
are reducing medication effectiveness
6. Presence of significant life stress or lack of adequate stress
coping skills
US Headache Consortium evidence-based guidelines
Biofeedback History
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40 years ago, biofeedback was heralded as a major breakthrough for
the effective treatment of a number of medical conditions – from
headaches to anxiety to Attention-Deficit Hyperactivity Disorder .
After a period of significant scientific scrutiny, a number of earlier
claims were unfounded.
Current researchers have shown that there are indeed several useful
clinical applications for biofeedback, including headache, Raynaud's
disease, and bowel and bladder incontinence.
Evidence is also mixed, albeit promising, for the use of biofeedback to
treat recurrent abdominal pain, ADHD, anxiety, and hypertension.
What is biofeedback?
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Biofeedback is a technique intended to teach
patients self- regulation of certain physiologic
processes not normally considered to be under
regulatory control.
Patients are taught modify physiologic functions by
being connected through electrical sensors to a
computer .
A typical program consists of 5- 20 training sessions
of 30 – 60 minutes each. Through learning specific
techniques patients learn to control their heart rate,
breathing , muscle tension, galvanic skin response
and skin temperature.
BIOFEEDBACK MODALITIES
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EMG
Skin Temperature
GSR
Respiratory rate
Cardiac rate
Heart Rate Variability
Neurofeedback
Blume HK, Brockman LN, Breuner CC. Biofeedback therapy for
pediatric headache: factors associated with response. Headache. 2012
Oct;52(9):1377-86.
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132 children who attended ≥2 biofeedback sessions.
Median headache frequency dropped from 3.5 to 2
headache days/week between the first and last visits.
Response-58% overall; 48% for chronic headaches
and 73% episodic headaches.
In multivariate analysis, ability to raise hand
temperature by >3°F at the last visit and use of
selective serotonin reuptake inhibitors (SSRIs) were
associated with a positive response, and preventive
medication use was associated with nonresponse.
Anxiety, depression, and somatization were not
significantly associated with response
Nestoriuc Y, Martin A. Efficacy of biofeedback
for migraine: a meta -analysis. Pain. 2007;
128(1-2):111-27.
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86 outcome studies. 55 studies, including randomized
controlled trials as well as pre-post trials, met our inclusion
criteria and were integrated.
BFB was more effective than control conditions. Frequency of
migraine attacks and perceived self-efficacy demonstrated the
strongest improvements.
Blood-volume-pulse feedback yielded higher effect sizes than
peripheral skin temperature feedback and electromyography
feedback.
BFB in combination with home training to be more effective
than therapies without home training.
Treatment effects remained stable, even when drop-outs were
considered as nonresponders.
Nestoriuc, Y, Rief, W, Martin, A. Meta-analysis of
biofeedback for tension-type headache: Efficacy, specificity,
and treatment moderators. Journal of Consulting and
Clinical Psychology. 2008 : 76(3): 379-96.
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74 outcome studies, of which 53 were selected according to predefined
inclusion criteria.
Meta-analytic integration resulted in a significant medium-to-large effect size
(d = 0.73; 95% confidence interval = 0.61, 0.84) that proved stable over an
average follow-up phase of 15 months. Biofeedback was more effective than
headache monitoring, placebo, and relaxation therapies.
The strongest improvements resulted for frequency of headache episodes.
Further significant effects were observed for muscle tension, self-efficacy,
symptoms of anxiety, depression, and analgesic medication.
Moderator analyses revealed biofeedback in combination with relaxation to
be the most effective treatment modality; effects were particularly large in
children and adolescents.
It is concluded that biofeedback constitutes an evidence-based treatment
option for tension-type headache
Case Study
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A 14 year old girl diagnosed with functional
abdominal pain is brought into your clinic by her
mother. They are frustrated because despite
multiple medications and dietary modifications, she
continues to complain of abdominal pain several
times each month and has missed a lot of school.
Mom wants to discuss other options for her
daughter. How could you advise her?
Biofeedback Efficacy?
IBS
Behavioral treatment of IBS: a 1-year followup study.
Schwartz SP. Biofeedback & Self Regulation. 1986; 11:189-98
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16 Ss received 1 yr. of:
 progressive muscle relaxation
 thermal biofeedback
 cognitive therapy
 & IBS education
57% had ≥ 50% reduction in major
symptom scores & 15/16 felt
subjectively improved.
Bowel Sound Biofeedback for IBS.
Radnitz CL. Biofeedback & Self Regulation. 1988; 13:169-79.
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Using an electronic stethoscope, 5 IBS
Ss received bowel sound biofeedback
Ss alternately and  bowel sounds.
3/5 Ss  daily ratings of diarrhea 
50%.
@ 1-yr f/u 2/3 Ss maintained clinical
improvement.
Dobbin A. Randomised controlled trial of brief intervention with
biofeedback and hypnotherapy in patients with refractory irritable bowel
syndrome. J R Coll Physicians Edinb. 2013;43(1):15-23.
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97 patients randomized into the study, 21 failed to
attend the therapy session; 15 of 76 patients who
attended for therapy dropped out before week 12
post-therapy.
128 IBS patients suitable for the study declined to
consider nonpharmacological therapy; 29 patients
did not attend beyond the first session.
Biofeedback group had greater decrease in
symptom severity scores p=0.029.
61 patients with refractory IBS, biofeedback and
hypnotherapy were equally effective at improving
IBS symptom severity scores, total nongastrointestinal symptom scores and anxiety and
depression ratings during 24 weeks follow-up.
Biofeedback Efficacy?
Movement Disorders
Reduction of spasticity in CP using feedback of
tonic stretch reflex.
O’Dwyer N. Dev Med Child Neurology 1994;
36:770-786.
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8 CP Ss received EMG feedback of the
gain of tonic stretch reflex of triceps
muscle.
Average stretch reflex gain reduced by
~50% in all Ss.
No significant change in no Rx controls.
Modification of gait in real-time using surface
EMG.
Bolek JE. Applied Physiology & Biofeedback
2003; 28:129-138.
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2 children with CP were taught
recruitment of anterior tibialis at the
correct time in the gait cycle.
The children learned to walk with the
new gait pattern and reproduce the old
one at will.
Physiotherapy approaches for recovery of postural
control and lower limb function after stroke.
Pollock A. Cochrane Database of Systematic
Reviews 2003; 2:CD001920
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11 randomized or quasi-randomized
trials comparing a neurophysiological
approach with a motor learning or
orthopedic approach.
Insufficient evidence found to conclude
that any physiotherapy approach is more
effective in promoting recovery.
Summary:
Movement Disorders
Studies have a small N or are anecdotal.
 Feedback appears to be labor intensive.
 Difficult to separate contribution of Rx
components.
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Biofeedback Efficacy?
Syncope
Adolescent with Headache & Syncope.
Smith MS. Glass ST. J Adolecent Health Care 1989;
10:54-56.
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14 yr. girl with multiple syncopal
episodes followed by occipital headache.
Dx: basilar aa. migraine
No improvement with anticonvulsants,
anticholinergic or B-blocker Rx.
Sx resolved during a course of skin
temperature biofeedback training.
Biofeedback-assisted Relaxation Rx for
Neurocardiogenic Syncope.
McGrady AV. ApplPhysiol & Biofeedback 2003; 28:183-191.
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22 Ss randomized to
 EMG & Temp. Biofeedback
+ Autogenic / Relaxation
vs.
 Waiting List control
Rx group > Wait List for  headache
activity, loss of consciousness, state
anxiety & depression. (p <.05)
Summary: Syncope
Small case series & anecdotal reports.
 No evidence for specificity of
biofeedback.
 Continuous BP biofeedback expensive.
 ANS “stability” may be enhanced with
Temperature or HRV biofeedback ?
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Biofeedback Efficacy?
Raynaud’s Phenomenon
Nifedipine vs. Temp. Biofeedback for 1° Raynaud Phenomenon
Raynaud's Treatment Study (RTS)
Arch Intern Med 2000; 160:1101-1108
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N= 313 with 1° Raynaud’s
phenomenon.
Randomized Trial With 1yr. F/u.
 Nifedipine vs. placebo
 Temperature Biofeedback vs. EMG
attention placebo
Nifedipine vs. Temp. Biofeedback for 1° Raynaud Phenomenon
Raynaud's Treatment Study (RTS)
Arch Intern Med 2000; 160:1101-1108
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Nifedipine had  66% in attacks compared
when with placebo (p<.001).
T biofeedback had  32% compared with
EMG Attention Placebo (p=.37)
Conclusions: Temperature biofeedback is
not better than control Rx and is inferior to
sustained-release nifedipine.
RTS: Biofeedback Protocols Acquisition of Temp Skills.
Middaugh SJ. Applied Psychophysiology & Biofeedback 2001; 26:251-278.
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RTS Ss had substantial problems with
acquisition of self-regulation skills.
Successful learning to criterion:
 34% temperature biofeedback group
 55% EMG biofeedback group
 67% normal controls
RTS: Biofeedback Protocols Acquisition of Temp Skills.
Middaugh SJ. Applied Psychophysiology & Biofeedback 2001; 26:251-278.
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Multivariate analysis predictors of
acquisition of hand-warming skills:
 coping strategies
 gender
 clinic site
 but not severity of Raynaud’s
Summary:
Raynaud’s Phenomenon
Extensive anecdotal and small N
literature suggesting efficacy.
 The large RTS study did not show
efficacy, but most of the Ss did not train
to criterion.
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Other References
Kang, Eun-Ho. Park, Joo-Eon. Chung,
Chin-Sang. Yu, Bum-Hee. (2009). Effect of
biofeedback-assisted autogenic training on
headache activity and mood states in
Korean female migraine patients. Journal
of Korean Medical Science. 24(5):936-40.
Cognitive Behavioral Therapy
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Huertas-Ceballos A. Psychosocial interventions for
recurrent abdominal pain (RAP) and irritable bowel
syndrome (IBS) in childhood. Cochrane Database
Syst Rev. 2008;1:CD003014
Walker LS. Parent attention versus distraction:
impact on symptom complaints by children with
and without chronic functional abdominal pain.
Pain. 2006;122(1–2):43–52.
Levy RL. Cognitive behavioral therapy for children
with functional abdominal pain and their parents
decreases pain and other symptoms. Am J Gastro.
2010;105:946-956.
CBT, Relaxation Training & Routine Clinical Care for IBS.
Boyce PM. American Journal of Gastroenterology. 2003; 98:2209-18.
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105 Ss - 8 wk. randomized controlled trial
with three arms:
 Standard care
 Std. care + CBT
 Relaxation.
Blinded outcome assessments @ yr of f/u.
Clinical Hypnosis in
Adolescents
Anju Sawni M.D. FAAP
Assistant Professor of Pediatrics
Hurley Children’s Hospital/Hurley
Medical Center/MSU/CHM
Mind - Body Therapies
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incorporating aspects of the mind and body in
the prevention and treatment of disease
based on known links between the mind,
neuroendocrine system and immune system
(psychoneuroimmunology PNI)
encompass: -behavior management/counseling
-meditation/relaxation tech
-hypnosis/biofeedback
-support groups
Psychoneuroimmunology
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Looks at neuropeptides &
neurotransmitters & supports the
connection between the mind, body&
spirit
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Reasonable evidence that thoughts,
feelings, emotions, & perceptions alter
immunity
(Ref: Ader R, On the Development of Psychoneuroimmunology. Eur
J Pharmacol 2000;405
Solomon GF, Amkraut AA. Psychoneuroendocrinology Effects
on the Immune Response. Annu Rev Micorbiol 1981;35
Benson H. The Relaxation Response. New York. Avon Books)
Psychoneuroimmunology
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The neuroendocrine and immune
systems operate in a bi-directional
communication system
Psychoneuroimmunology
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The brain influences the immune system via the
hypothalamus & pituitary, the neuroendocrine system,
the autonomic nervous system & the release of cytokines
Bi-directionally, the immune system influences brain
activity by the immune peptides, such as interleukins,
corticotropin, and endorphins
(Ref: Blalock JE, Harbout -McMenamin D, et al. Peptide hormones shared by
the neuroendocrine and immunological systems. J Immunology 1985;135
Pert CB, Ruff MR, et al. Neuropeptids and their receptors: a psychosomatic
network. J Immunol 1985;35
Pert CB. Molecules of emotions. New York. Scribner, 1997)
Mind - Body Therapies
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Activate the parasympathetic branch of
the autonomic nervous system
Induce the opposite physiological
response to stress
Experientially Focused
MIND-BODY THERAPIES
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By using mind-body techniques such
as self hypnosis/relaxation/mediation,
we can teach children & adolescents
how to manage anxiety, stress, pain &
physical sx that have an emotional
bases by creating a sense of relaxation
and thus increaseing the capacity to
focus, as well improve self-esteem.
History of Hypnosis in Medicine
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Milton Erickson and Ernest Hilgard were among the first investigators
in the United States to undertake a modern, systematic approach to
hypnosis, and the American Medical Association acknowledged
hypnosis as a valuable tool in medical treatment in 1958
 Council on Mental Health. Medical use of hypnosis.
JAMA.1958:186– 189
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National Institutes of Health Technology Assessment Panel report in
1996 judged hypnosis to be a viable and effective intervention for
alleviating pain with cancer and other chronic pain.
 NIH Technology Assessment Panel on Integration of Behavioral
and Relaxation Approaches Into the Treatment of Chronic Pain
and Insomnia. JAMA.1996;276 :313– 318
Hypnosis
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hypnosis can be useful in treating pain (assoc with
chronic ds e.g.. malignancy, sickle cell,or with
acute prob ,LP, suturing, & injuries)
behavioral problems (tics, habit problems,
enuresis, encopresis, smoking , wgt control,
nightmares)
anxiety assoc with procedures, or illness,
performance anxiety (test, athletes) nausea/vomit
Hypnosis
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“altered state of consciousness or awareness”
different from normal waking or sleep state
resembles various meditative states. Imagery is
often used in hypnosis to be in this altered state
A heightened concentration on a particular idea
or image
In hypnosis, guided imagery is the technique
most often used where, specific images, sounds
& smells are suggested to the pt for the purpose
of altering some symptom.
ALL HYPNOSIS IS SELF
HYPNOSIS
Self Hypnosis
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Spontaneous self hypnosis may happen
while driving a car, reading, listening to
music, watching TV, dancing, walking in
the woods, playing a musical instrument, or
doing yoga, Tai Chi
Misconceptions about Hypnosis
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Patient is under the control of the hypnotherapist
Patient is a sleep
Patient is unaware of surroundings & activities
around him/her
Patient’s defenses are impaired
Symptoms are masked
Only “weak-minded people” are “hypnotizable”,
only a few people can be hypnotized
Hypnosis is indicated when…..
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One is responsive to hypnotic suggestions
A problem is treatable with hypnosis
Good rapport exists between the teen & the
therapist
Teen is motivated to remedy the problem
No iatrogenic harm is anticipated by use
Hypnosis
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Emphasize that the teen is in control
Offer to be the teacher or coach
Offer choices and options
Say the teen can use the skill (self-hypnosis) when
he/she chooses.
Applications of Hypnosis
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Acute pain management
Chronic pain management
Anxiety associated with chronic illness
Recurrent abdominal pain
Headaches, tension/migraine
Tic disorders
Performance anxiety
Asthma
Enuresis
Sleep problems
Tourette syndrome
Dysfluencies
Warts
Conditioned fears
Characteristics of hypnotic trance
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Relaxation
Concentration
Increased suggestibility
Hypermnesia/Amnesia
Trance Logic
Increased control of physiologic
response
Perception of different states
Concrete thinking
Methods of Hypnosis
Rap-port
Rap-prot
Rap-prot
Relationship especially one of mutual
trust or emotional affinity.
Methods of Hypnosis
Steps in Clinical Hypnosis
Induction
– Intensification
– Therapy in Trance
– Usual Awareness
– Ratification/Reflection
– Follow-up
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Methods of Hypnosis
What’s Induction
Intensifying Attention
– Permission to Imagine
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Methods of Hypnosis
What’s Induction
-Progressive relaxation
-Progressive activity
-Eye-closure
-Conversing
-Increase somatic
perception
-Eye-opening
-Being quiet
-Decreased somatic
perception
Steps in Clinical Hypnosis
1. Induction
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Narrowing focus of attention
Intensifying self-awareness
Creating positive expectancy
Examples:
-favorite place
-progressive relaxation
-hypnotic phenomena
-biofeedback
Steps in Clinical Hypnosis
2. Intensification
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Progressive increase in induction effects
Facilitating patient ownership
Methods:
-more induction
-adding another method
-facilitating awareness of a single
experiential aspect
Steps in Clinical Hypnosis
3. Therapy in Trance
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Metaphors for symptom control
Utilize information from the
introductory interview
Awareness of the trance experience
Ego-strengthening suggestions about “
doing it right”
Post-hypnotic suggestions
Steps in Clinical Hypnosis
4. Usual Awareness
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Review of experience in trance
Ego-strengthening congratulations
Permissive return to “usual” awareness
Steps in Clinical Hypnosis
5. Ratification & Reflection
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Establish state of awareness
Review experience
Ratify effectiveness
-the needle did not hurt
-time distortion
-activate post-hypnotic suggestions
Ask for feedback
Steps in Clinical Hypnosis
6. Follow-up
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Help plan self-hypnosis “practice”
Timing of the next visit
Self-monitoring
Provide an audiotape
Communication between visits
Think about the patient
Hypnosis
(scientific support)
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In 49 child & adolescents with cancer,
hypnosis proved more effective than
nonhypnotic behavioral tech(deep breathing,
distraction) in reduce pain assoc spinal taps
and BM
(Zelter L, Behavioral Ped 1982;101:1032)
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Hypnosis can be effective as an adjunct tx for
procedural pain as a well as for postoperative
pain & anxiety & for chronic headaches.
(Rogovik, A.L. Goldman, R.D. “ hypnosis for treatment of pain in
children. “ Can Fam Physician. 2007. 53 (5): 823)
Hypnosis
(scientific support)
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Hypnosis in the prevention of chemo-rel’t N/V
(Jacknow DS, J Dev Behav Ped 1994;15:258)
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Hypnosis is effective as an adjuvant treatment
for children with inflammatory bowel ds.
(Shaoul, R. Sukhotnik I. et.al. J Dev Behav Pediatr 2009, 30)
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Use of self-hypnosis in the manage of 505 ped
behav encounters
(Kohen DP, J Dev Behav Ped 1984;1:21)
Hypnosis
(scientific support)
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A comprehensive review of studies looking at the effectiveness of
hypnosis for reducing procedure-related pain in children &
adolescents (younger than 19yrs) in which hypnosis was compared
with a control condition or an alternative intervention in reducing the
procedure-related pain.
Results: Hypnosis was consistently found to be more effective than
control conditions in alleviating discomfort associated with bone
marrow aspirations, lumbar punctures, voiding cysto-urethograms, the
Nuss procedure, and post-surgical pain
“The
effectiveness of hypnosis for reducing procedure-related pain in children
and adolescents: a comprehensive methodological review”. Accardi MC, Milling
LS. J Behav Med. 2009 Aug;32(4):328-39. doi: 10.1007/s10865-009-9207-6. Epub
2009 Mar 3.
Hypnosis
(scientific support)
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Self-hypnosis for headaches:
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Retrospective review of 144 youth referred to a behavioral
pediatric program for recurrent headaches
Reported reduction in frequency of headaches, intensity &
duration of headaches.
Conclusion: training in self-hypnosis was assoc with significant
improvement of chronic recurrent headaches in children &
adolescents
(Kohen, D.P. Zajac, R. “Self-hypnosis training for headaches in children and
adolescents. “ J Pediat 2007, 150 (6): 635)
Hypnosis
(scientific support)
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Self hypnosis for respiratory complaints:
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108, 12–18 years old were seen at a pediatric pulmonary center for
respiratory c/o thought to be psychologically based- anxiety, habit
cough, chest pain, dyspnea, or vocal cord dysfunction.
Hypnotherapy was offered and majority of them had
improvement of their sx.
“Identification of children who may benefit from self-hypnosis at a pediatric
pulmonary center”. Anbar RD & Geisler SC. BMC Pediatr. 2005 Apr 25;5(1):6.
Hypnosis
(scientific support)
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Hypnosis for functional abd pain:
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53 children/adolesc randomized to hypnosis or standard medical therapy
(SMT)
Learned hypnosis, 6 sessions over 3 mths
Pain intensity, freq and assoc sx were recorded as baseline, during
therapy, and 6 & 12 mths later.
Results: hypnosis was highly superior with significant reduction in a pain
compared to SMT even up to 1 yr f/u
Conclusion: gut-directed hypnosis is highly effective in the tx of FAP or
IBS
-Vlieger, A.M. Menko-Frankenhuis, C. “ Hypnotherapy for children with
functional abdominal pain or irritable bowel syndrome: a randomized
controlled trial.” Gastroenterology. 2007. 133 (5): 1430)
-Gottsegen D. Hypnosis for functional abdominal pain. Am Clin Hypnosis.
2011;54(1):56-69.
Hypnosis
(scientific support)
Hypnosis for functional abd pain
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3 RCT comparing HT to a control treatment were included with
sample sizes ranging from 22 to 52 children.
2 studies examined HT performed by a therapist, one examined HT
through self-exercises on audio CD.
All showed statistically significantly greater improvement in
abdominal pain scores among children receiving HT.
1 trial reported beneficial effects sustained after 1 year of followup.
1 trial reported statistically significant improvement in quality of
life in the HT group.
2 trials reported significant reductions in school absenteeism after
HT.
Rutten J. Gut-directed hypnotherapy for functional abdominal
pain or irritable bowel syndrome in children: a systematic
review. Arch Dis Child. 2013; 98(4):252-7
Hypnosis
(scientific support)
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Hypnosis for treatment of insomnia:
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a retrospective chart review of 84 children & adolescents with
insomnia were offered self-hypnosis for treatment of insomnia, and
for other somatic c/o; (chest pain, dyspnea, functional abdominal
pain, habit cough, headaches, and vocal cord dysfunction)
Results: self- hypnosis helped majority of the patients deal with
insomnia as well as other somatic c/o.
Hypnosis for treatment of insomnia in school-age children: a retrospective chart
review. Anbar RD, Slothower MP. BMC Pediatr. 2006 Aug 16;6:23.
Case presentation: Hypnosis
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15 yr male with primary enuresis, (6/7 wet nights/week)
has away hockey games embarrassed about wetting the bed,
motivated to stop.
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FH: + for enuresis in dad, all else noncontributory
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SH: 10th grd, hockey player, late ngt hockey practices & drinks
fluids after game. Hard time unwinding & falling asleep. Deep
sleeper.
denied drugs, ETOH, tob. Doing well emotionally in school.
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Taught him self-hypnosis, mind- body connection “brain and
bladder talking to each other . Discussed bladder hygiene – no
fluids 1hr before bed, bladder stretching exercises during the day
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Did 2 sessions self-hypnosis with him, 2mth f/u, enuresis resolved
completely. 2yr f/u enuresis resolved. Doing well.
Case presentation: Hypnosis
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14 yr male refer by PMD for self-hypnosis for “shot
phobia”
Refuses any shots or blood draws includ finger poke.
Becomes anxious “hysterical”
Behind on immunizations & hasn’t had lab work, CBC,
chol testing for years.
PMH: ADD on Concerta doing well. Is a “worrier” an
No evidence of thought disorder or any other Psych
disorder.
Motivated to learn self-hypnosis.
Taught him self-hypnosis, distraction techniques.
One session and he got his shots.
Case presentation: Hypnosis
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10½ yr old with chronic stress headaches
Missing school, parents divorced, dad remarried,
new baby brother
Headaches at school & home, creating inc conflict
at home, school grades dec
Meds: Tylenol, Motrin or missing school
CAM modality: taught pt self-hypnosis, kept
calendar of headaches
Within after 1 mth headaches dec, after 3 mths
headaches resolved, school better, less stress
Hypnosis
(resourses)
Good review article on the benefits of
hypnosis in children and adolescents
“Hypnosis as a Therapeutic Tool in Pediatrics”. Saadat, H;
Kain Zeev. Pediatrics Vol. 120 No. 1 July 1, 2007. pp. 179 -181
Text Book:
Olness K, Kohen DP. Hypnosis and Hypnotherapy With
Children. 3rd ed. New York, NY: Guilford Press; 1996
Training in Hypnosis
Society for Developmental & Behavioral
Pediatrics: http://www.sdbp.org
703-556-9222
 Society for Clinical & Experimental
Hypnosis: http://www.sceh.us
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617-469-1981
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American Society for Clinical Hypnosis:
www.asch.net
Increase
hope
Bolster
expectations
Reduce
symptoms Enhance wellbeing
Mini Break
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This is a 30-second way to “chill out” and
relax during or after a stressful situation. You
can
use it any time you feel tension, anxiety,
headache or any other pain as a result of
stress.
You can also prevent pain or anxiety from
happening by doing this regularly.
1. Take a deep breath and exhale slowly.
2. Scan your forehead, jaw, neck, shoulders
and
other areas of your body to find the tense
spots. Try to relax and breathe into these
areas as you exhale.
3. Smile with your mouth open, and remind
yourself that you can choose how you want to
react to things, no matter what is going on.
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4. If it feels good to you, briefly tighten the
area that is tense, and then let it go.
5. Take 2 or 3 slow, deep breaths. As you
exhale, imagine breathing away all of your
tension, stress or pain. Let the feeling of
relaxation flow down through your body to
your toes.
6. As you inhale, tell yourself, “I’m breathing
in
peace, relaxation and calmness.” As you
exhale, tell yourself, “I’m letting go of
tension” or “I feel calm and relaxed” or “I
can
let go of this.” These thoughts to yourself
become the cues to your body that it is time to
relax.
TO LEARN