Evidence-Based Reviews

Hypnosis: Brief interventions offer key to managing pain and anxiety

Current Psychiatry. 2004 April;3(4):48-59

References

1. Spiegel D, Jasiukaitis P. Hypnosis: Brain basis. In: Smith BH (ed). Elsevier’s encyclopedia of neuroscience. The Netherlands: Elsevier Science, 1999.

2. Rainville P, Hofbauer RK, Bushnell MC, et al. Hypnosis modulates activity in brain structures involved in the regulation of consciousness. J Cogn Neurosci 2002;14:887-901.

3. Rainville P, Duncan GH, Price DD, et al. Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science 1997;277:968-71.

4. Kosslyn SM, Thompson WL, Costantini-Ferrando MF, et al. Hypnotic visual illusion alters color processing in the brain. Am J Psychiatry 2000;157:1279-84.

5. Spiegel D. Negative and positive visual hypnotic hallucinations: attending inside and out. Int J Clin Exp Hypn 2003;51:130-46.

6. Spiegel D, King R. Hypnotizability and CSF HVA levels among psychiatric patients. Biol Psychiatry 1992;31:95-8.

7. Piccione C, Hilgard ER, Zimbardo PG. On the degree of stability of measured hypnotizability over a 25-year period. J Pers Soc Psychol 1989;56:289-95.

8. Spiegel H, Spiegel D. Trance and treatment: Clinical uses of hypnosis. Washington, DC: American Psychiatric Press, 2004.

9. Wertz JM, Sayette MA. Effects of smoking opportunity on attentional bias in smokers. Psychol Addict Behav 2001;15:268-71.

10. Nishith P, Barabasz A, Barabasz M, Warner D. Brief hypnosis substitutes for alprazolam use in college students: transient experiences and quantitative EEG responses. Am J Clin Hypn 1999;41:262-8.

11. Lang EV, Benotsch EG, Fick LJ, et al. Adjunctive nonpharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 2000;355:1486-90.

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Self-blame. Many trauma victims would rather feel guilty than helpless. They blame themselves inappropriately for events over which they had no control, rather than accept their helplessness. They misuse hindsight about the trauma to assume the events were predictable and therefore avoidable. They imagine they can replay the events and change the outcome.

Such an approach to trauma can be profoundly demoralizing, leaving victims burdened by needless guilt and shame. Helping them face and bear the feelings associated with traumatic events can free them from efforts to “undo” or take responsibility for the trauma and accept what happened.

Split-screen technique. Using hypnosis with a “split-screen” technique can help patients restructure the memory of trauma. The left screen symbolizes the trauma in condensed form. The right screen helps patients focus on how they tried to master the situation. This grief work allows patients to acknowledge, bear, and put into perspective the humiliation of the experience and their loss of invulnerability, health, or loved ones (Box 3).¹⁸

Dissociation. Dissociating during a threatening situation may enable a person to put aside some awareness of the danger and take self-protective action. Persistent dissociation, however, may make it too easy to avoid working through the traumatic experiences later on.^22-24

Dissociation makes subsequent exposure to reminders of the trauma more similar to a reexperiencing rather than a controlled remembering of it. This can trigger physiologic stress reactions and lead to or worsen PTSD.^25-27

Dissociative disorders can be understood as chronic and severe PTSDs.²⁸ Many individuals with dissociative disorders have histories of sexual and physical abuse.^29-31 Clearly, traumatic experiences sensitize survivors to subsequent trauma through conditioned activation of fear circuitry involving the amygdala, hippocampus, and frontal lobes.³²

Hypnosis can be especially helpful—both for diagnosis and therapy.³³ It can assist the controlled recovery of memories, while allowing some images to remain dissociated from cognition until the patient is ready to deal with them. The patient can turn memories on and off by entering and exiting the hypnotic state and thereby recover and reprocess memories at a tolerable pace.

Related resources

Society for Clinical and Experimental Hypnosis. http://ijceh.educ.wsu.edu
American Society of Clinical Hypnosis. www.asch.net
American Psychological Association, Division 30. Society of Psychological Hypnosis. http://www.apa.org/about/division/div30.html