International Handbook of Clinical - part 1 potx

Other Wiley Editorial Of®ces John Wiley & Sons, Inc., 605 Third Avenue, New York, NY 10158-0012, USA WILEY-VCH Verlag GmbH, Pappelallee 3, D-69469 Weinheim, Germany John Wiley & Sons Aus

Handbook of

Clinical Hypnosis

Edited by

Graham D Burrows AO, KSJ

The University of Melbourne, Australia

Robb O Stanley

The University of Melbourne, Australia

Peter B Bloom

The University of Pennsylvania, USA

JOHN WILEY & SONS, LTD

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Library of Congress Cataloging-in-Publication Data

International handbook of clinical hypnosis [edited by] / Graham D Burrows, Robb O Stanley, Peter B Bloom

A catalogue record for this book is available from the British Library

ISBN 0-471-97009-3

Typeset in 10/12pt Times from the author's disks by Keytec

Printed and bound in Great Britain by Antony Rowe Ltd, Chippenham

This book is printed on acid-free paper responsibly manufactured from sustainable forestry,

in which at least two trees are planted for each one used for paper production.

List of Contributors ixPreface xiPART I THE NATURE OF HYPNOSIS

1 Introduction to Clinical Hypnosis and the Hypnotic Phenomena 3Graham D Burrows and Robb O Stanley

2 Training in Hypnosis 1 9Peter B Bloom

PART II GENERAL CLINICAL CONSIDERATIONS

3 Patient Selection: Assessment and Preparation,Indications and

Contraindications 35Julie H Linden

4 Memory and HypnosisÐGeneral Considerations 49Peter W Sheehan

5 Neuropsychophysiology of Hypnosis: Towards an Understanding

of How Hypnotic Interventions Work 61Helen J Crawford

PART III THE PSYCHOTHERAPIES

6 Injunctive Communication and Relational Dynamics:

An Interactional Perspective 85Jeffrey K Zeig

PART IV SPECIFIC DISORDERS AND APPLICATIONS

7 Hypnosis and Recovered Memory: Evidence-Based Practice 97Kevin M McConkey

8 Hypnosis in the Management of Stress and Anxiety Disorders 1 1 3Robb O Stanley, Trevor R Norman and Graham D Burrows

9 Hypnosis and Depression 1 29Graham D Burrows and Sandra G Boughton

10 Hypnosis,Dissociation and Trauma 1 43David Spiegel

11 Conversion Disorders 1 59

C A L Hoogduin and Karin Roelofs

12 Personality and Psychotic Disorders 1 71Joan Murray-Jobsis

13 Dissociative Disorders 1 87Richard P Kluft

14 Eating DisordersÐAnorexia and Bulimia 205Moshe S Torem

15 Hypnotherapy in Obesity 221Johan Vanderlinden

16 Hypnotic Interventions in the Treatment of Sexual Dysfunctions 233Robb O Stanley and Graham D Burrows

17 Hypnosis in Chronic Pain Management 247Frederick J Evans

18 Hypnosis and Pain 261Leonard Rose

19 The Use of Hypnosis in the Treatment of Burn Patients 273Dabney M Ewin

20 Hypnosis in Dentistry 285Dov Glazer

21 Dental Anxiety Disorders,Phobias and Hypnotizability 299Jack A Gerschman

22 Applications of Clinical Hypnosis with Children 309Daniel P Kohen

23 The Negative Consequences of Hypnosis Inappropriately

or Ineptly Applied 327Robb O Stanley and Graham D Burrows

Index 335

Peter B Bloom,MD Department of Psychiatry, University of Pennsylvania, School of Medicine, c/o

416 Riverview Avenue, Swarthmore, PA 19081-1221, USA.

Sandra G Boughton,DipClinPsych Department of Psychiatry and Behavioural Science, University

of Western Australia, Perth, Western Australia 6009, Australia.

Graham D Burrows,AO KSJ MD Department of Psychiatry, University of Melbourne, Austin and Repatriation Medical Centre, Heidelberg, Victoria 3084, Australia.

Helen J Crawford,PhD Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061-0436, USA.

Frederick J Evans,PhD Path®nders: Consultants in Human Behavior, 736 Lawrence Road, renceville, NJ 08648-0412, USA.

Law-Dabney M Ewin,MD Departments of Surgery and Psychiatry, Tulane University, c/o 318 Baronne Street, New Orleans, LA 70112-1606, USA.

Jack A Gerschman,BDSc,PhD School of Dental Science, University of Melbourne, c/o Suite 5, 3rd Floor, 517 St Kilda Road, Melbourne, Victoria, 3004, Australia.

Dov Glazer,DDS Lousiana State University School of Dentistry, 3525 Prytania Street, Suite #312, New Orleans, LA 70115-3566, USA.

C.A.L Hoogduin,MD,PhD Department of Psychology and Personality, University of Nijmegen, PO Box 9104, NL-6500 HE Nijmegen, The Netherlands.

Richard P Kluft,MD Department of Psychiatry, Temple University, c/o 111 Presidential Boulevard, Suite 231, Bala Cynwyd, PA 19004-1004, USA.

Daniel P Kohen,MD Behavioral Pediatrics Program, Department of Pediatrics ± University of Minnesota, Gateway Center ± Suite 160, 200 Oak Street SE, Minneapolis, MN 55455-2002, USA Julie H Linden,PhD Private Practice, 227 East Gowen Avenue, Philadelphia, PA 19119-1021, USA Kevin M McConkey,PhD School of Psychology, University of New South Wales, Sydney, New South Wales 2052, Australia.

Joan Murray-Jobsis,PhD Human Resource Consultants, 100 Europa Center, Suite 260, Chapel Hill,

NC 27514-2357, USA.

Trevor R Norman,PhD Department of Psychiatry, University of Melbourne, Austin and Repatriation Medical Centre, Heidelberg, Victoria 3084, Australia.

Karin Roelofs,MA Department of Psychology and Personality, University of Nijmegen, PO Box

9104, NL-6500 HE Nijmegen, The Netherlands.

Leonard Rose,MBBS Melbourne Pain Management Clinic, 96 Grattan Street, Suite 14, Carlton, Victoria 3053, Australia.

Peter W Sheehan,PhD,AO Vice-Chancellor, Australian Catholic University, PO Box 968, North Sydney, New South Wales 2059, Australia.

David Spiegel,MD Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401Quarry Road, Of®ce 2325, Stanford, CA 94305-5718, USA.

Robb O Stanley,DClinPsych Department of Psychiatry, University of Melbourne, Austin and Repatriation Medical Centre, Heidelberg, Victoria 3084, Australia.

Moshe S Torem,MD Center for Mind-Body Medicine, Northeastern Ohio Universities, College of Medicine, 4125 Medina Road, Suite 209, Akron, OH 44333-4514, USA.

Johan Vanderlinden,PhD Department of Behavior Therapy, University Centre St-Josef, B-3070 Kortenberg, Belgium.

Jeffrey K Zeig,PhD The Milton H Erickson Foundation, 3606 North 24th Street, Phoenix, AZ 85016-6500, USA.

The editors of this volume, the International Handbook of Clinical Hypnosis, ®rstmet to discuss the idea for it during the 13th International Congress of Hypnosisheld in Melbourne, Australia, in 1994 During the Congress, sponsored on behalf

of the International Society of Hypnosis by the Australian Society of Hypnosis andthe Department of Psychiatry of the University of Melbourne, the presidency of theInternational Society of Hypnosis was passed from Graham D Burrows AO toPeter B Bloom, while Robb O Stanley continued as secretary treasurer

From that vantage point and following the publication of Contemporary tional Hypnosis, the proceedings of the 13th Congress, we realized the need for ahandbook authored by senior clinicians and researchers, who could present topics

Interna-in greater length and depth that would substantially contribute to the ®eld ofhypnosis and its applications

We hope that interested readers from many and varied disciplines who seek morede®nitive knowledge on how clinical hypnosis is used in a variety of medical,dental and psychological conditions will bene®t from reading this volume We alsohope that health care professionals from many disciplines, whether they areexperienced or inexperienced with the principles of clinical hypnosis, will ®ndways to better serve their patients or clients in the future

The editors wish to thank our colleagues for their contributions to this handbook.Our contributors are experts in their ®elds and come with broad experience inmedicine, dentistry, and psychology Most are professors at major universities,some are chairman of their departments, and all are members of the leadinghypnosis societies in their own countries These societies, of which most of ourauthors have served as president, promote clinical training and research in theunderstanding of this immensely useful modality in the healing arts

We sincerely thank Mrs Gertrude Rubinstein for her excellent editorial tance; and we are grateful to our publisher, John Wiley & Sons, who hasconsistently helped us to shape these endeavors to the bene®t of us all

assis-Graham D Burrows, AO KSJ MD, AustraliaRobb O Stanley, DClinPsych, Australia

Peter B Bloom, MD, USA

Introduction to Clinical

Hypnosis and the Hypnotic

Phenomena

GRAHAM D BURROWS and ROBB O STANLEY

University of Melbourne, Australia

This volume presents a collection of brief monographs by specialists in variousapplications of hypnosis to the alleviation of chronic debilitating conditions.Hypnosis has an established role as an adjunct to the healing professions The manysocieties and associations of hypnosis practitioners worldwide provide standards oftraining that enhance the learning, accreditation, and public trust in practitioners ofhypnotic interventions in individuals seeking responsible health care

The chapters range from general issues of training and choice of clients, throughtheoretical considerations of memory, the neurophysiology of hypnosis, and thepsychotherapies A generous admixture of clinical case histories is given The morespeci®c directions for applications of hypnosis techniques include cautions againstproblems encountered over years of clinical practice

At a basic level, researchers are taking advantage of developments over the lastdecades in imaging the brain to gain a better understanding of the neurophysio-logical basis of hypnotic phenomena

At the clinical level, the current open attitudes of society to problems thatpreviously were brushed under the carpet, while solving some problems havesometimes raised as many new ones There has been much heated controversyabout repressed memories, but in the long term we gain from such controversies inwisdom as well as knowledge about the complexities of the human mind

International Handbook of Clinical Hypnosis Edited by G D Burrows, R O Stanley and P B Bloom

# 2001 John Wiley & Sons, Ltd

International Handbook of Clinical Hypnosis Edited by G D Burrows, R O Stanley, P B Bloom Copyright # 2001 John Wiley & Sons Ltd

ISBNs: 0-471-97009-3 (Hardback); 0-470-84640-2 (Electronic)

judgment and reality testing, a suspension of forward planning, increased ibility, heightened imagery or involvement in fantasy, and hypnotic role behaviour.While there are many de®nitions of hypnosis, the most widely accepted is thatproposed by the British Medical Association as a result of their investigation intothe use of hypnosis in medicine in 1955 (BMA, 1955, 1982):

suggest-Hypnosis is a temporary condition of altered perception in the subject which may beinduced by another person and in which a variety of phenomena may appear sponta-neously or in response to verbal or other stimuli These phenomena include alterations

in consciousness and memory, increased susceptibility to suggestion, and the tion in the subject of responses and ideas unfamiliar to him in his normal state ofmind Further phenomena such as anaesthesia, paralysis and the rigidity of muscles,and vasomotor changes can be produced and removed in the hypnotic state

produc-HISTORICAL USE IN THE TREATMENT OF CLINICAL PROBLEMSThe use of hypnosis, under other names, for the treatment of clinical problems has

a long history, being recorded in ancient scripts describing ritual and religiousceremonies The phenomena of hypnosis have been used to account for miraculouscures that in the middle ages were attributed to sacred statues, healing springs andthe `laying on of hands' by those of high status or religious power The moremodern use of hypnosis began with the work of the Viennese physician FranzMesmer, who achieved many spectacular cures which he attributed to the appro-priate redistribution of invisible `magnetic ¯uid' within the body In 1784, acommission of Louis XVI could ®nd no evidence of animal magnetism, andattributed Mesmer's successes to suggestion

Despite Mesmer's fall from popularity following the Royal Commission, interest

in the clinical application of hypnosis developed rapidly throughout the nineteenthcentury The term hypnosis was coined in 1841 by James Braid, a Manchestersurgeon, who believed that a psychological state similar to sleep accounted for thephenomena observed The use of hypnosis by the French neurologist Charcot, and

by Breuer and Freud in the 1880s, extended its use to the treatment of neuroticdisorders broadly referred to as `hysterical.' Freud subsequently abandoned the use

of hypnosis in favour of psychoanalytic techniques (Sulloway, 1979)

The development of behavioural approaches in psychology in the early twentiethcentury saw a temporary lessening of interest in internal psychological processessuch as hypnosis Despite this, the use of hypnosis to induce relaxation inbehavioural therapies for anxiety was frequently described (Beck & Emery, 1985;Clarke & Jackson, 1983; Marks, Gelder & Edwards, 1968; Rubin, 1972; Rossi,1986) Hypnotic phenomena were also used to induce behavioural change (Hussain,1964; Wolpe, 1958, 1973; Kroger & Fezler, 1976) but the nature of the hypnoticcomponent was not always discussed The more recent development of cognitivetherapies which focus on altering the patient's perceptions and cognitions (Brewin,

4 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS

1988) have all but ignored the use of hypnosis, in spite of the cognitive phenomenawhich have been demonstrated to accompany the hypnotic state.

PHENOMENA OF HYPNOSIS

A variety of phenomena accompany the hypnotic state, which may be induced onthe instruction of a therapist or self-induced by the subject The extent that thephenomena are experienced and observed depends upon the depth of the hypnoticstate, which is a characteristic of the subject and commonly referred to ashypnotizability or hypnotic susceptibility

During the hypnotic process the focus of attention is narrowed and shiftedtowards an internal cognitive focus This leads to a reduction in awareness of thesensory input requiring a response There is a relative reduction in arousal ofsensory and response systems of the central nervous system, in contrast to themobile shifting of attention which occurs as the anxious patient scans the environ-ment for potential of imagined danger or threat

REDUCTION IN CRITICAL THINKING, REALITY TESTING AND

TOLERANCE OF REALITY DISTORTION

Shor (1969) described the operation processes which characterize normal tion processing The `generalized reality orientation' brings into play the frame ofreference whereby the individual interprets and gives meaning to experience In thehypnotic state this orientation is to a considerable degree suspended, resulting inconcrete uncritical thought processes Clarke and Jackson (1983) noted in theirsubjects, that `ability to rouse oppositional self statements/beliefs is low [duringhypnosis]' (p 242)

informa-Persuasive communications are a part of effective therapy interventions Studies

of hypnosis and hypnotizability are observed to produce a similar reduction incritical thinking Malott, Bourg & Crawford (1989) demonstrated experimentallythat hypnotized subjects generated fewer counter-arguments to persuasive com-munications, and that highly hypnotizable subjects experience more favourablethoughts and a positive attitude towards messages, whether hypnotized or not.Accompanying the suspension of critical thinking and the `generalized realityorientation' is the readiness to accept as reality changes in perception and cognitionthat are suggested by the therapist

In the hypnotic state, subjects, through their narrowed focus of attention,suspended thoughts of future actions or events The contemporary focus of thehypnotic state encouraged this process

HEIGHTENED IMAGERY VIVIDNESS OR REALITY

The heightening of imagery or fantasy generation has been suggested to be aneffect of the hypnotic procedure and a characteristic of hypnosis and hypnotiz-ability (Sheehan, 1979; Lynn & Rhue, 1987), and yet the correlations betweenimagery vividness and hypnotizability are moderate With the internal/cognitivefocus of attention and the suspension in critical judgment referred to earlier, it islikely that imagery experienced will be accepted and responded to as if it hasgreater reality rather than greater sensory vividness

VOLITIONAL CHANGES AND ALTERATIONS IN VOLUNTARY

MUSCLE ACTIVITY

Subjects undergoing hypnotic induction procedures frequently report a sense oftheir behaviour as being under their normal control Weitzenhoffer (1978) dis-cussed this as a feature of the `classic suggestion effect' that is a characteristic ofhypnosis This suggestion effect has two component criteria: (a) that there must be

a response to a suggestion; (b) that the response must be experienced as avolitional.Relaxation, paralysis, automatic movements and rigid catalepsy may all beexperienced as avolitional changes in response to hypnotic suggestion Enhancedmuscle performance may also be reported, but this may be due to reducedperception of muscle fatigue, rather than to actual improved performance

ALTERATIONS IN INVOLUNTARY MUSCLES, ORGANS AND

ALTERATIONS IN PERCEPTIONS

While many phenomena associated with hypnosis are subtle and few are sively related to the hypnotic state, the alterations in sensation, particularly pain,have not been demonstrated to the same extent in nonhypnotic states when suitablesubjects and techniques of hypnosis are used Many descriptions have been given

exclu-of major and minor surgery carried out with hypnotic anesthesia alone While thisapproach is not suggested as the intervention of choice, given the ready availability

6 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS

of chemical anesthesia, the procedures described con®rm the effect of the hypnoticstate.

HEIGHTENING OF EXPECTATIONS AND MOTIVATIONS

Given the generally held public beliefs and expectations of the `magic' of hypnosis,the clinician may appropriately use these expectations to maintain patient motiva-tions at the highest possible level and to diminish therapeutic resistance Theexperience of the involuntary nature of responses to hypnotic suggestions furtherenhances motivation promoting success in its application to clinical problems.INCREASED REALITY ACCEPTANCE OF FANTASY EXPERIENCESMany psychotherapies utilize imagery and fantasy to facilitate the process ofchange Certain patients in hypnotically assisted therapies may more readilyrespond to imagery and fantasy as reality, since the hypnotic process provides apowerful way of enhancing imagery For the most effective and responsible use ofthis potent tool, members of the healing professions seek training in hypnosis toprovide an adjunct to their own particular disciplines

TRAINING IN HYPNOSIS

Training programs in using hypnosis differ from each other around the world Eachprogram strives for standards of training that enhance the learning, accreditation,and public trust in practitioners of hypnotic interventions in individuals seekingresponsible health care While many clinicians want to learn hypnosis in order totreat the more dif®cult cases which they encounter, true pro®ciency occurs overtime and requires advanced workshops in subsequent months or years Moreover,

an important principle is that no one should treat those patients with hypnosis thatone is not trained and comfortable treating without hypnosis A ®nal part oftraining is devoted to ethical principles, professional conduct, and certi®cation.Joining national and international organizations ensures future personal and profes-sional development

Current controversies in hypnosis research and their applications to clinicalpractice raise major issues Dr Bloom stresses the danger of accepting as literallytrue uncorroborated claims of perinatal and prenatal memories and recollectionsfrom past lives The problems of accepting recovered memories of early childhoodsexual abuse are of universal concern While such abuse certainly does occur, there

is the possibility that these memories may be due more to an artifact of thehypnosis than an indication that the abuse occurred There are guidelines to aid theclinician in using hypnosis in uncovering memories of sexual abuse (Bloom, 1994),but in the ®nal analysis, it is the clinician's own judgment with a particular case onhow to proceed

Dr Linden's chapter outlines a four-step process for establishing the hypnoticrelationship with a client: evaluation, education of client, assessment of hypno-tizability, and the teaching of self-hypnosis phase, during which time positiveexpectancies about hypnosis and motivation of the client are enhanced As theauthor points out, the public is more open to and more educated abouthypnosis than in the past Moreover, the criteria for patient selection havealtered with increased understanding of the interactive nature of the treatmentprocess and its relation to the doctor±patient partnership Case histories revealthat often the client wants help not with the presenting problem but with anentirely different concern Therefore diagnostic skills are no less important thanhypnotic skills

Several important but widely differing issues for concern may be mentionedhere Before initiating hypnotic intervention, the nonmedical clinician is advised toinquire of clients as to whether any medical evaluation of their condition has beenperformed Many common presentations to the hypnotherapist may have organicetiologies which require surgical or pharmaceutical treatment In obtaining thetrauma history the clinician must be capable of dealing with abreactive materialwhich may surface as normal psychological defenses are evaded And when inquiryinto childhood physical and/or sexual abuse is being made, it is crucial to avoidsuggestive or leading questions which may compromise the validity of activatedmemories

Some clinical presentations which are poorly suited to hypnotic intervention arelisted Forensic subjects also can pose a particular challenge to clinicians Finally,when a client's presenting problem is outside the clinician's ®eld of expertise theclient should be referred elsewhere

Chapter 4, on memory in hypnosis, is especially important in view of sies about repressed memories The author attempts to give unbiased consideration

controver-to the complexity of memory itself, as well as complications introduced by theinteraction between client and therapist The use of hypnosis provides no guarantee

to assessing veracity; a degree of con®dence (both in hypnosis and in the wakingstate) should in no way be taken as a reliable indicator of accurate memory Thischapter examines the association between hypnosis and memory by ®rst exploringbrie¯y the nature of both hypnosis and memory, and then looking speci®cally at

8 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS