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International Updates

Hypnosis / Relaxation

Issue 89

CROFT and co-workers, Department of Cognitive Neuroscience and Behaviour, Imperial College London, Medical Faculty, St Dunstan’s Road, London W6 8RF, UK, write about pain perception, hypnosis and 40 Hz oscillations.
Background: A number of regions of the brain are associated with the subjective experience of pain. This study considers the relations between cortical oscillations in response to pain, with and without hypnosis and hypnotic analgesia, and the experience of pain.
Methods: 33 subjects’ neural responses (EEG) were measured in the 40-540 msec period following electrical stimulation to the right hand, under control and hypnosis conditions. Resultant FFT amplitudes for frequencies ranging from 8 to 100 Hz were computed. These were grouped into 7 scalp topographies, and for each frequency, relations between these topographies and pain ratings, performance and stimulus intensity measures were assessed.
Results: Gamma activity (32-100 Hz) over prefrontal scalp sites predicted subject pain ratings in the control condition (p = 0.004), and no other frequency/topography combination did. This relation was present both in high and low hypnotizable subjects and was independent of performance and stimulus intensity. This relation was unchanged by hypnosis in low hypnotizable subjects but was not present in high hypnotizable subjects during hypnosis, suggesting that hypnosis interferes with this pain/gamma relation.
Conclusions: This study provides evidence for the role of gamma oscillations in the subjective experience of pain. Further it also supports the view that hypnosis involves the dissociation of the prefrontal cortex from other neural functions.
Croft RJ, Williams JD, Haenschel C, Gruzelier JH. Pain perception, hypnosis and 40 Hz oscillations. International Journal of Psychophysiology 46 (2): 101-108, Nov 2002.

Issue 87

CALVERT and colleagues, Department of Medicine, Wythenshawe Hospital, Southmoor Road, Manchester, U.K., show long-term improvement of functional dyspepsia using hypnotherapy.
Background: Hypnotherapy has been shown to be effective in IBS. This study aimed to assess the usefulness of hypnotherapy in functional dyspepsia.
Methods: In this randomized controlled trial, 126 patients with functional dyspepsia were randomized to hypnotherapy, supportive therapy plus placebo medication, or medication for 16 weeks. Percentage change in symptoms from baseline was measured immediately post treatment and 56 weeks post treatment. Quality of life was measured as a secondary outcome.
Results: 26 hypnotherapy patients, 24 supportive therapy patients, and 29 medical treatment patients completed all phases of the trial. Short-term symptom scores improved more in the hypnotherapy group (59%) than in the supportive therapy group (41%; p = 0.01) or the medical treatment group (33%; p = 0.057). Hypnotherapy also led to improvements in the quality of life compared to supportive therapy or medication (42% as compared to 10% and 11%; p = 0.01). After one year, hypnotherapy had significantly improved symptoms compared with supportive therapy and medication (73% compared with 34% and 43%; p = 0.02). Quality of life improved significantly more with hypnotherapy than with medical treatment (44% and 20%; p = 0.001). A total of 82% of patients in the supportive therapy group and 90% of patients in the medication group started on antidepressant medication during the follow-up period, whereas none of the hypnotherapy patients did. Patients in the hypnotherapy group visited their GP or gastroenterologist less in the follow-up period than patients in either of the other groups (median, 1 visit compared to 4).
Conclusions: Hypnotherapy is highly effective in the long-term management of functional dyspepsia. Moreover, as the reduction in medication consumption and medical consultations show, it is also cost-effective.
Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ. Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterology 123 (6): 1778-1785, Dec 2002

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KETTERHAGEN et al., Women’s Health Center, Waukesha Memorial Hospital, Waukesha, WI 53188, USA, debra.ketterhagen@phci.org, propose self-hypnosis as an alternative anaesthesia for childbirth.
Background: The purpose of this review (28 references) is to inform nurses about the use of self-hypnosis in childbirth. Hypnosis is a focussed form of concentration. Self-hypnosis is one form of hypnosis in which a therapist teaches an individual to induce his or her own altered state of consciousness. When used for labour pain, the primary aim of self-hypnosis is to help the woman manage her anxiety and discomfort through maintaining a focussed state of relaxation. Most nurses have little experience with hypnosis, and there is limited information available in the literature.
Conclusions: Because nurses are at labouring women’s bedsides, they need to learn about self-hypnosis in order to be able to fully inform pregnant women about all options for labour pain control, and maximize the benefits for women who do choose self-hypnosis as a pain control tool.
Ketterhagen D, VandVusse L, Berner MA, et al. Self-hypnosis: alternative anesthesia for childbirth. The American Journal of Maternal Child Nursing 17(6): 33-340, Nov-Dec 2002.

PALSSON and co-workers, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA, investigated the mechanism of action of hypnotherapy in the treatment of IBS and its effects on symptoms.
Background: Hypnosis improves Irritable Bowels Syndrome (IBS) but the mechanism of action is unknown. In two studies, possible physiological and psychological mechanisms were investigated.
Methods: Patients with severe IBS were given seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study 1), and changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study 2). Somatization, anxiety, and depression were measured.
Results: All IBS symptoms improved substantially in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning remained unchanged in the study. However somatization and psychological distress showed large decreases.
Conclusions: The study suggests that hypnosis improves IBS by reducing psychological distress. The improvements were found to be unrelated to changes in the physiological parameters measured.
Palsson OS, Turner MJ, Johnson DA, Burnelt CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Digestive Diseases and Sciences 47 (11): 2605-2614, Nov 2002.

Issue 86

HOUGHTON et al., Department of Medicine, University Hospital of South Manchester, Manchester M20 2LR, UK, lahoughton@man.ac.uk, studied visceral sensation and emotion using hypnosis.

Background: The authors have previously shown that both anger and excitement, when hypnotically induced, increased colonic motility, while happiness reduced it. This study investigates the effect of hypnotically induced emotions on rectal sensitivity in patients with irritable bowels syndrome (IBS).

Methods: Sensory responses to balloon distension of the rectum were assessed in 20 patients with IBS. Patients were studied on 4 occasions either awake or in hypnosis, during which anger, happiness, or relaxation (neutral emotion) were induced.

Results: Hypnotic relaxation increased the distension volume required to produce discomfort while anger reduced it. Happiness did not further alter sensitivity from that observed during relaxation.

Conclusions: The study emphasizes how awareness of the emotional state of a patient is important when either measuring visceral sensitivity or treating IBS.

Houghton LA, Calvert EL, Jackson NA, Cooper P, Whorwell PJ, et al. Visceral sensation and emotion: a study using hypnosis. Gut 51 (5): 701-704, Nov 2002.

Issue 83

SOLOMON and JOHNSON, Office of Behavioral and Social Science Research, National Institute of Health, Bethesda, MD 20892, USA, reviewed (17 references) outcome research of psychosocial treatment of posttraumatic stress disorder.

Results: A review of treatment research indicates that several forms of therapy appear to be useful reducing the symptoms of posttraumatic stress disorder (PTSD). Treatments combining cognitive and behavioural techniques are strongly supported. Hypnosis, psychodynamic, anxiety management and group therapies may also produce short-term symptom reduction. Imaginal exposure to trauma memories and hypnosis are most likely to affect the intrusive symptoms of PTSD, while cognitive and psychodynamic approaches may address better the numbing and avoidance symptoms. It is still unclear whether any of the approaches tested produces lasting effects.

Conclusions: Treatment should be tailored to severity and type of presenting PTSD symptoms, to type of trauma experience, and to the many likely comorbid diagnoses and adjustment problems.

Background: The aim of the study was to examine the effects of hypnotic susceptibility and hypnotic suggestions upon electrocortical and self-report measures of painful stimuli.

Methods: A dense array EEG procedure was used to measure the effects of hypnotic susceptibility and hypnotic suggestions on electrocortical activity of painful stimuli. Self-report measures of painful stimuli were also used. Six high- and six low-hypnotic susceptible individuals were examined during an initial baseline investigation and following a standard hypnotic induction under suggestions to either increase or decrease painful stimulation.

Results: The subjects showed few self-report or psychophysiological differences in response to pain stimuli. They reported differential pain experiences depending on hypnotic suggestions, and displayed differential psychophysiological indicators following a hypnotic induction with a suggestion of hypoalgesia.

Conclusions: The findings suggest that hypnotic suggestions with highly susceptible individuals modulate the later components of the evoked potential in a global manner. The importance of using both high and low hypnotically susceptible individuals preceding and following a hypnotic induction is pointed out.

Issue 74

KIECOLT-GLASER and colleagues, Department of Psychiatry, Ohio State University College of Medicine, Columbus 43210, USA, kiecolt-glaser.1@osu.edu, analysed the effects of hypnotic-relaxation training on cellular immune function during a stressful event.
Methods: Subjects were 33 medical and dental students, selected according to their hypnotic susceptibility. Blood samples were taken during a ‘lower stress’ period and again 3 days before their first major exam of the term. Half of subjects were randomly assigned to receive hypnotic-relaxation training in the period between blood sampling.
Results: Control subjects showed stress-related decreases in immune cell proliferative responses to two mitogens and percentages of CD3+ and CD4+ T-lymphocytes and interleukin-1 production by peripheral blood leukocytes. Subjects who underwent hypnosis-relaxation were, on average, protected from these immunological changes. More frequent hypnotic-relaxation practice resulted in higher percentages of CD3+ and CD4+ T-lymphocytes.
Conclusion: The results provide encouraging evidence that hypnosis- relaxation can reduce detrimental immune function changes associated with acute stress.
Kiecolt-Glaser JK et al. Hypnosis as a modulator of cellular immune dysregulation during acute stress. Journal of Consulting and Clinical Psychology 69 (4): 674-82. Aug 2001.

MUEHLBERGER and colleagues, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Germany, evaluated the effects of repeated exposure to virtual reality (VR) flights on subjects with flight phobia.
Methods: 30 subjects who suffered from flight phobia were randomly assigned to one of two groups: 1) one VR test flight followed by four VR exposure flights in one lengthy session (VR group, n=15); or 2) one VR test flight followed by a lengthy relaxation training session (relaxation group, n=15). All subjects completed a second VR test flight at the end of their respective sessions. Outcome measures included fear reports and physiological fear reactions (heart rate, skin conductance level) during VR exposures. Psychometric assessments of fear of flying were made from 3 weeks before to 3 months after exposure.
Results: Flight phobics showed subjective and physiological fear responses during exposure to VR flights. These responses diminished within and across VR flights. Repeated VR exposure resulted in greater reduction in fear parameters than did relaxation training. Psychometric scores of fear of flying improved in both groups, but several outcome measures indicated greater effects in the VR group.
Conclusion: Exposure to VR may offer a new and promising approach to treating fear of flying.
Muehlberger A et al. Repeated exposure of flight phobics to flights in virtual reality. Behaviour Research and Therapy 39 (9): 1033-50. Sep 2001.

Issue 71

GRUZELIER and colleagues, Department of Cognitive Neuroscience and Behaviour, Imperial College Medical School, St. Dunstan’s Road, London W6 8RF, UK, j.gruzelier@ic.ac.uk, evaluated the effects of self-hypnosis training on immune function and mood in medical students at exam time.
Methods: Hypnosis involved relaxation and imagery directed at improved immune function and increased energy, alertness and concentration. Hypotheses were made about activated and withdrawn personality differences. Eight high and eight low hypnotically susceptible participants were given 10 sessions of hypnosis, one live and nine tape-recorded, and were compared with control subjects (n=12). CD3, CD4, CD8, CD19 and CD 56 natural killer (NK) cells and blood cortisol were assayed. Lifestyle, activated versus withdrawn temperament, arousal and anxiety questionnaires were administered.
Results: Self-hypnosis buffered the decline found in controls in NK (p<0.002) and CD8 cells (p<0.007) and CD8/CD4% (p<0.06) (35-45% order of magnitude differences), while there was an increase in cortisol (p<0.05). The change in NK cell counts correlated positively with changes in both CD8 cells and cortisol. Results were independent of changes in lifestyle. Energy ratings were higher after hypnosis (p<0.01), and increased calmness with hypnosis correlated with an increase in CD4 counts (p<0.01). The activated temperament, notably the cognitive subscale (speaking and thinking quickly), was predictive of exam levels of T and B lymphocytes and reached r=0.72 (p<0.001) in the non-intervention control group.
Conclusion: The sizeable influences on cell-mediated immunity achieved by a relatively brief, low-cost psychological intervention in the face of a compelling, but routine, stress in young healthy adults have implications for illness prevention and for patients with compromised immunity.
Gruzelier J et al. Cellular and humoral immunity, mood and exam stress: the influences of self-hypnosis and personality predictors. International Journal of Psychophysiology 42 (1): 55-71. Aug 2001.

TRAVIS, Psychology Department, Maharishi University of Management, Fairfield, IA 52557, USA, compared electroencephalogram (EEG) and autonomic patterns during transcending to ‘other’ experiences during Transcendental Meditation (TM) practice.
Methods: To correlate specific meditation experiences with physiological measures, the investigator rang a bell three times during the TM session and subjects categorized their experiences around each bell ring.
Results: Transcending, compared with ‘other’ experiences during TM practice, was marked by: 1) significantly lower breathing rates, 2) higher respiratory sinus arrhythmia amplitudes, 3) higher EEG alpha amplitude, and 4) higher alpha coherence. Skin conductance responses to the bell rings were larger during transcending.
Conclusion: According to the author, the findings suggest that monitoring patterns of physiological variables may index dynamically changing inner experiences during meditation practice. This could allow a more precise investigation into the nature of meditation experiences and a more accurate comparison of meditation states with other eye-closed conditions.
Travis F. Autonomic and EEG patterns distinguish transcending from other experiences during Transcendental Meditation practice. International Journal of Psychophysiology 42 (1): 1-9. Aug 2001.

Issue 70

HEWSON-BOWER and DRUMMOND, Murdoch University, Murdoch, Western Australia 6150, Australia, bhewsonb@central.murdoch.edu.au, investigated the effects of stress management and relaxation with guided imagery on upper respiratory tract infections (URTIs) in children.
Methods: Subjects were 45 children with a history of 10 or more infections in the past year. Secretory immunoglobulin A (sIgA), an indicator of mucosal immunity, was measured before and during psychological treatment.
Results: The number of symptomatic episodes during 13 weeks of monitoring was similar in treatment and waitlist conditions; however, episodes were shorter in stress management and guided imagery conditions than in the waitlist condition. Levels of sIgA increased towards the end of treatment. These findings were confirmed in a replication study. Symptom reduction and improvements in psychological state persisted at 1-year follow-up.
Conclusion: Psychological treatment appears to interrupt a chronic illness cycle in children with symptoms of recurrent URTI.
Hewson-Bower B, Drummond PD. Psychological treatment of recurrent symptoms of colds and flu in children. Journal of Psychosomatic Research 51 (1): 369-77. Jul 2001.

WILLIAMS and GRUZELIER, Imperial College of Science Technology and Medicine, London, UK and Psychology Group, School of Health and Social Sciences, Coventry University, Coventry, CV1 5FB, UK, john.williams@coventry.ac.uk, investigated the associations of alpha and theta brain activity with relaxation, hypnosis and hypnotic susceptibility in subjects of high and low hypnotic susceptibility.
Methods: The researchers measured narrow-band theta and alpha activity over anterior and posterior [brain] sites before, during and after hypnosis in 16 adult subjects who had previously been identified as having either high or low hypnotic susceptibility. Experimental measures included electroencephalography (EEG), electrooculography and questionnaires.
Results: ‘High susceptibles’ had greater theta activity post-hypnosis; otherwise, there were no differences in theta activity between ‘high’ and ‘low susceptibles’. The results from ‘highs’ and ‘lows’ suggested that theta activity is an index of relaxation that continues after hypnosis in ‘highs’. In ‘high susceptibles’, alpha activity in posterior sites increased from pre-hypnosis to hypnosis conditions and decreased post-hypnosis. Exactly the converse effects were seen in ‘low susceptibles’. ‘High susceptibles’ showed greater alpha activity than ‘low susceptibles’ during both pre-hypnosis and hypnosis conditions, indicating an association of alpha activity with hypnotic susceptibility.
Conclusion: The authors state that these results indicate that theta activity indexes relaxation, whereas alpha activity indexes the hypnotic experience and susceptibility.
Williams JD, Gruzelier JH. Differentiation of hypnosis and relaxation by analysis of narrow band theta and alpha frequencies. The International Journal of Clinical and Experimental Hypnosis 49 (3): 185-206. Jul 2001.

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