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Salient findings summaries ofkey findings in the researchliteraturePublished online: 31 Jan 2008.

To cite this article: (2000) Salient findings summaries of key findings in the researchliterature, International Journal of Clinical and Experimental Hypnosis, 48:4, 438-444,DOI: 10.1080/00207140008410373

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SALIENT FINDINGS Summaries of Key Findings in the Research Literature

JOURNAL: Cognitive Neuropsychiaty

Oakley, D. A. (1999). Hypnosis and conversion hysteria: A unifying model. Cognitive Neuropsychiat y, 4,243-265.

This paper presents a model of consciousness and self-awareness as a means of understanding the similarities between hypnotic phenomena and symptoms of conversion hysteria. Both experiences present para- doxically: behaviors are subjectively felt as real and involuntary while objectively appearing to be role-congruent enactments responsive to the manipulation of motivational factors, expectancy, and social influence. This paradox can be understood, in part, by reviewing neurophysiologi- cal and brain-imaging studies of hypnotically produced effects and con- version symptoms that implicate frontal cortical structures in moderat- ing changes elsewhere in the brain, particularly the cingulate cortex. The presented model develops the idea of a central executive structure acting outside of awareness but at a late stage of information processing. This supervisory attentional system is thought to be directly influenced by both internal and external sources to produce both conversion symp- toms and hypnotic phenomena. With both hypnosis and conversion dis- order, the contents of self-awareness are manipulated in a manner that allows either external (hypnotist) or internal (dynamics and motiva- tions) influences to alter the individual’s consciousness system so that motivated behavior is experienced as involuntary. A further extension of this model leads to the proposal that symptoms of hysteria can be classi- fied as either positive or negative symptoms of an auto-suggestive disor- der. Thus, conversion disorder, dissociative disorders, and pain disorder could be reclassified under one heading, auto-suggestive disorder, which recognizes the common mechanism underlying these diverse problems (Moene, Hooguin, & Van Dyke, 1998).

REFERENCE Moene, F. C., Hooguin, K.A.L., &Van Dyke, R. (1998). The inpatient treatment of patients

suffering from (motor) conversion symptoms: A description of eight cases. International Journal of Clinical and Experimental Hypnosis, 46, 171-190.

The Infernational Iournal ofClinical and Experimental Hypnosis, Vol. 48, No. 4, October 2000 438-444 0 2000 The International \oournnl of Clinicnl and Elyerimenla1 Hypnosis

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SALIENT FINDINGS 439

JOURNAL: Applied Psychophysiology and Biofeedback

Galovski, T. E., & Blanchard, E. B. (1998). The treatment of irritable bowel syndrome with hypnotherapy. Applied Psychophysiology and Biofeed-

This research examines the efficacy of hypnosis as a treatment for irri- table bowel syndrome (IBS). Twelve individuals with IBS were divided into matched pairs based upon age, gender, presence of Axis I diagnosis, and Stanford Hypnotic Susceptibility Scale scores. These six matched pairs were then randomly assigned to either a treatment (hypnosis) or a control (symptom-monitoring wait list) condition. The one member of each pair that was assigned to the control condition was crossed over to the treatment condition after 6 weeks of monitoring. The treatment con- dition consisted of 12 weekly individual treatment sessions. The initial two sessions involved guided imagery and ego-strengthening meta- phors, which then progressed to more gut-directed imagery for the sub- sequent sessions. Comparison of an overall Composite Primary Symp- tom Reduction Score indicated that the hypnotherapy group improved more than the wait-list group. Eighty percent of the treatment group showed some improvement, whereas 0% of the control group improved until crossed over into treatment, at which point 67% showed significant improvement. Overall, 82% of the treated patients improved, with 11% being symptom-free. Follow-up at 2 months suggests that these improve- ments are relatively enduring, with hgh levels of improvement in overall symptoms and change in pain. Psychopathology was related to effec- tiveness of treatment at posttest but not at follow-up. Hypnotic suggest- ibility was unrelated to improvement. Hypnosis was readily accepted as a form of treatment by all patients, and anecdotal reports suggest some beneficial effects beyond gut-related symptom change.

back, 23,219-232.

JOURNAL: Journal of Asthma

Hackman, R. M., Stem, J. S., & Gershwin, M. E. (2000). Hypnosis and asthma: A critical review. journal of Asthma, 37,l-15.

Asthma is one of the most common chronic diseases in the Western world and significantly affects quality of life for child and adult patients. Asthma symptoms can be triggered by both environmental and emo- tional factors, and this creates some problems for treatment. In addition, medical treatments often have negative side effects over the long term, which may account for increases in morbidity and mortality rates. Thus, finding alternative treatment modalities is of much importance. The authors provide a review of research examining hypnosis as a form of

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treatment for asthma and conclude that, although hypnosis may be an effective treatment, further randomized controlled studies are necessary before unequivocal conclusions can be drawn. There is consistent evi- dence that hypnosis does have an effect on asthma symptoms, but it remains unclear what consistent alterations can be produced. Several conclusions can be drawn regarding hypnotic interventions for asthma. Efficacy is improved when patients are hypnotically responsive and the clinician is experienced with hypnosis. Furthermore, multiple treatment sessions appear to provide greater efficacy, as does the use of self-hypno- sis. More controlled studies are necessary to provide clear evidence that hypnosis is an efficacious treatment for asthma. Although medications are effective, there are some compelling reasons to continue to research and develop alternative methods of treating asthma. Future research examining the efficacy of hypnosis for treating asthma should consider costs and benefits as well as effectiveness and mechanisms.

JOURNAL: Lancet

Halligan, P. W., Athwal, B. S., Oakley, D. A., & Frackowiak, R. S . J. (2000). Imaging hypnotic paralysis: Implications for conversion hysteria. Lancet, 355,986-987.

The researchers revisited the classic and venerable notion in psychia- try that motor conversion disorders and hypnotically induced paralyses are in some way related, perhaps physiologically. The authors replicated a positron emission tomography (PET) protocol originally carried out with a patient who had longstanding conversion hysteria (leg paralysis). That original protocol found that the patient had two distinct areas of prefrontal cortex activated. The current investigators posited that the brain regions activated when lower limb paralysis was hypnotically suggested in a normal high hypnotizable subject would be similar to those activated in hysterical paralysis. This is a notion that had been pre- viously forwarded by the third author of this study, David Oakley. The protocol used with the 25-year-old right-handed male involved hypno- sis and suggestions for paralysis of the left leg. This was followed by a complex but carefully orchestrated series of attempted movements dur- ing hypnosis-attempted movements of both the left leg and the unaf- fected right leg. There was a control condition involving no attempted movement at all.

Moving the right leg activated the usual motor and premotor areas (left hemisphere), but when the subject attempted to move the left leg (but failed to do so), right orbito-frontal (Brodman area BA 10/11) and anterior cingulate (Brodman area BA32) cortex were selectively

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activated without similar activity in the motor cortex. Although these areas differ slightly from those areas involved with the original hysteric patient, they are located within the same cytoarchitectural regions. It would seem that either the anterior cingulate and orbito-frontal cortex are implicated in the inhibition of the subject's voluntary attempt to move his leg, or that these activations reflect the mental conflict involved with the attempt to move a limb that is experienced as paralyzed. The authors conclude that their findings are consistent with the notion that "psychological mechanisms that underlie hypnotic phenomena provide a versatile and testable model for understanding and treating conver- sion hysteria symptoms" (p. 987).

JOURNAL: Lancet

Lang, E. V., Benotsch, E. G., Fick, L. J., Lutgendorf, S., Berbaum, M. L., Berbaum, K. S . , Logan, H., & Spiegel, D. (2000). Adjunctive nonpharmacological analgesia for invasive medical procedures: A randomised trial. Lancet, 355,1486-1490.

This article reports on a prospective, randomized, single-center study testing whether a hypnotic intervention might be useful as a nonpharmacological behavioral adjunct with patients undergoing two types of percutaneous medical procedures (i.e., percutaneous vascular and renal procedures). These are procedures in which tissue damage is minimal, thus rarely requiring general anesthesia. These procedures, however, do typically involve enough pain, anxiety, and discomfort to require intravenous conscious sedation with narcotics and sedatives. Of course, use of these drugs does carry some risk for oversedation, some- times with quite serious complications. Hence, the authors sought to test whether hypnosis might lead to less patient suffering, with lower usage of medications. Patients were randomly assigned to one of three groups: (a) intravenous conscious sedation alone; (b) intravenous conscious seda- tion with the adjunctive use of self-hypnosis relaxation; and (c) intrave- nous conscious sedation with the adjunctive use of structured attention. Pain, anxiety, amount of patient-controlled intravenous medication used, and time-in-procedure were assessed. Pain increased with time for all but the hypnosis group. Patients in the intravenous sedation-only group self-administered twice as much medication during the procedure as did patients in the structured attention and hypnosisgroups. Just one hypno- sis patient became hemodynamically unstable, compared with 10 struc- tured-attention patients and 12 intravenous sedation-only patients. Fur- thermore, the time-in-procedure was sigruficantly shorter in the hypnosis group (61 minutes) compared to the intravenous-only and structured- attention groups (78 and 67 minutes, respectively). What makes this

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article particularly important is that it documents the benefit of adjunctive nonpharmacological interventions across a number of dimensions: reduc- tion of pain and anxiety, dramatic reduction of medication used, minimization of side effects, and reduced time-in-procedure (i.e., greater staff efficiency). Some similar work with children was reported by Liossi and Hatira (1999).

REFERENCE Liossi, C., & Hatira, P. (1999). Clinical hypnosis versus cognitive behavioral training for

pain management with pediatric cancer patients undergoing bone marrow aspirations. International journal of Clinical and Experimental Hypnosis, 47,104-116.

JOURNALS: British Journal of Audiology, Epilepsia, Best Practice & Research in Clinical Pneumatology,Jounzal ofAlternativeand Complementa y Medi- cine, lnternational Journal of STD &AIDS , Anesthesia and Analgesia, Best Practice 6 Research in Clinical Gastroenterology, Birth: Issues in Perina tal Care.

Anderson, G., & Lyttkens, L. (2000). A meta-analytic review of psycho- logical treatments for tinnitus. British Journal ofAudiology, 33,201-210.

Barry, J. J., Atzman, O., & Morrell, M. J. (1999). Discriminating between epileptic and nonepileptic events: The utility of hypnotic seizure in- duction. Epilepsia, 41,81-84.

Berman, B. M., & Swyers, J. P. (1999). Complementary medicine treat- ments for fibromyalgia syndrome. Best Practice & Research in Clinical Pheumatology, 13,487-492.

Defechereux, T., Meurisse, M., Hamoir, E., Gollogly, L., Joris, J., & Faymonville, M. E. (1999). Hypnoanesthesia for endocrine cervical surgery: A statement of practice. Journal ofAlternative and Cornplernen- ta y Medicine, 5,509-520.

Fox, P. A., Henderson, D. C., Barton, S . E., Champion, A. J., Rollin,M. S. H., Catalan, J., McCormack, S. M. G., & Gruzelier, J. (1999). Immunologi- cal markers of frequently recurrent genital herpes simplex virus and their response to hypnotherapy: A pilot study. International Journal of

Ghoneim, M. M., Block, R., Sarasin, D. S., Davis, C. S., & Marchman, J. N. (2000). Tape-recorded hypnosis instructions as adjuvant in the care of patients scheduled for third molar surgery. Anesthesia and Analgesia,

S T D & AIDS, 7 0,730-734.

90,64-68.

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Read, N. W. (1999). Harnessing the patient’s powers of recovery: The role of the psychotherapies in the irritable bowel syndrome. Best Practice & Research in Clinical Gastroenterology, 13,473-487.

Simon, E. P., & Schwartz, J. (1999). Medical hypnosis for hyperemesis gravidarum. Birth: lssues in Perinatal Care, 26,248-254.

Eight interesting reviews and clinical reports mentioning hypnosis have appeared in the general medical literature over the past year. The clinical applications addressed were: hyperemesis gravidarum in preg- nancy, tinnitus, fibromyalgia, hypnoanesthesia for endocrine cervical surgery, irritable bowel syndrome, discrimination of epileptic and nonepileptic episodes, genital herpes simplex virus, and third molar surgery.

Four of these eight papers were essentially reviews of the clinical and research literatures. In a meta-analysis of psychological treatments for tinnitus, Anderson and Lyttkens (2000) found that psychosocial inter- ventions seem to impact annoyance, but loudness ratings (especially at follow-up) seem resistant tochange. The authors found only two empiri- cal studies that employed hypnosis. A descriptive review of psychologi- cal interventions for irritable bowel syndrome (Read, 1999) outlined the treatment rationales for various types of interventions including hypno- sis. There was little attention to research findings on the matter. Berman and Swyers (1999) emphasized clinical research on complementary medicine treatments for fibromyalgia but found only one study specifi- cally addressing hypnosis. They conclude that biofeedback, hypnosis, and cognitive-behavioral approaches show promise. Finally, Simon and Schwartz (1999) describe the rationale and typical clinical protocol used with women suffering from excessive nausea and vomiting during preg- nancy (hyperemesis gravidarum). They illustrate the approach with two clinical case examples.

The four remaining papers report on original clinical research. Using nonrandom assignment, Defechereux et al. (1999) compared 21 cases of cervical explorations for hyperparathyroidism, in which hypno- anes- thesia was used, to 119 cases where it was not used. They found less pain reported and shorter hospital stays in the former group. In a random assignment study, Ghoneim et al. (2000) found that 24 third molar sur- gery patients experienced less pain but more vomiting than 22 subjects in a control group. Barry et al. (2000) reported some success in discrimi- nating epileptic (EE) from nonepileptic events (NEE) using a hypnotizability scale and suggestions for a seizure. Only one of 22 EE patients produced seizure behavior upon suggestion, compared to 37 of the nonepileptic patients. Finally, in a study (Fox et al., 1999) of immuno- logical markers of recurrent genital herpes simplex virus among 20

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patients treated with hypnosis, there was a significant reduction in the number of symptom episodes accompanied by an increase in the num- bers of CD3 and CD8 lymphocytes. In general, the findings of these stud- ies are compatible with those of other recent work (e.g., Mauer, Bumett, Ouellette, Ironson, & Dandes, 1999).

REFERENCE Mauer, M. H., Burnett, K. F., Ouellette, E. A., Ironson, G. H., &Dandes, H. M. (1999). Medi-

cal hypnosis and orthopedic hand surgery: Pain perception, postoperative recovery, and therapeutic comfort. Intonational Iournal of Clinical and Experimental Hypnosis, 47, 144-161.

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