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Hypnosis is an alternative or complementary therapy that has been used since ancient times to treat medical and dermatologic problems. To describe the various uses for hypnosis as an alternative or complementary therapy in dermatologic practice. A MEDLINE search was conducted from January 1966 through December 1998 on key words related to hypnosis and skin disorders. A wide spectrum of dermatologic disorders may be improved or cured using hypnosis as an alternative or complementary therapy, including acne excoriée, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. Appropriately trained clinicians may successfully use hypnosis in selected patients as alternative or complementary therapy for many dermatologic disorders.
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Hypnosis in Dermatology
Philip D. Shenefelt, MD, MS
Background: Hypnosis is an alternative or complemen-
tary therapy that has been used since ancient times to treat
medical and dermatologic problems.
Objective: To describe the various uses for hypnosis
as an alternative or complementary therapy in dermato-
logic practice.
Methods: A MEDLINE search was conducted from Janu-
ary 1966 through December 1998 on key words related
to hypnosis and skin disorders.
Results: A wide spectrum of dermatologic disorders
may be improved or cured using hypnosis as an alter-
native or complementary therapy, including acne
excorie´e, alopecia areata, atopic dermatitis, congenital
ichthyosiform erythroderma, dyshidrotic dermatitis,
erythromelalgia, furuncles, glossodynia, herpes sim-
plex, hyperhidrosis, ichthyosis vulgaris, lichen planus,
neurodermatitis, nummular dermatitis, postherpetic
neuralgia, pruritus, psoriasis, rosacea, trichotilloma-
nia, urticaria, verruca vulgaris, and vitiligo.
Conclusion: Appropriatelytrained clinicians may success-
fully use hypnosis in selected patients as alternative or
complementary therapy for many dermatologic disorders.
Arch Dermatol. 2000;136:393-399
T
HE HYPNOTIC phenom-
enon has been used since
ancient times in the form of
trance induction to assist
healing. Each of us goes
into spontaneous mild trances daily while
engrossed in watching television or a
movie, reading a book or magazine, or oth-
erwise being absorbed in some activity or
meditation. With proper training, an in-
dividual can intensify this trance state in
himself or herself or in another indi-
vidual, and use this heightened focus to
induce mind-body interactions that help
alleviate suffering or promote healing. The
state of altered consciousness known as a
“trance state” may be induced using guided
imagery, relaxation, deep breathing, medi-
tation techniques, self-hypnosis, or hyp-
nosis-induction techniques. Some indi-
viduals are more highly hypnotizable than
others, but most can obtain some benefit
from hypnosis. In dermatologic practice,
hypnosis may help reduce skin pain and
pruritus, ameliorate psychosomatic as-
pects of skin diseases, and hasten the reso-
lution of some skin diseases, including ver-
ruca vulgaris. Even suggestion, without
formal trance induction, can be effective
in some patients. Early articles on the use
of suggestion to treat verrucae include
those by Bloch
1
and Sulzberger and Wolf.
2
The precise definition of hypnosis has
proven to be slippery. Marmer
3
defined hyp-
nosis as a psychophysiological tetrad of al-
tered consciousness consisting of nar-
rowed awareness, restricted and focused
attentiveness, selective wakefulness, and
heightened suggestibility. For more de-
tailed discussion of the definitions of hyp-
nosis, see Crasilneck and Hall
4
or Wat-
kins.
5
Many myths exist regarding
hypnosis—too numerous to enumerate and
refute here—that overrate, underrate, and
distort the true capabilities of hypnosis.
PSYCHOPHYSIOLOGIC
EFFECTS OF HYPNOSIS
To what degree hypnosis can affect physi-
ological factors such as blood flow and re-
lease of chemical mediators, as opposed
to a purely psychological response, is of-
ten difficult to measure reliably. Nonethe-
less, many patients note subjective im-
provement of symptoms and, in some
cases, objective reductions in the size,
number, or intensity of skin lesions. The
exact psychophysiologic mechanisms by
which hypnosis induces improvement are
REVIEW
From the Division of
Dermatology and Cutaneous
Surgery, Department of
Internal Medicine, College of
Medicine, University of South
Florida, Tampa.
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not fully elucidated. Hypnosis is known to be able to regu-
late blood flow and other autonomic functions not usu-
ally under conscious control. The relaxation response that
occurs with hypnosis also affects the neurohormonal sys-
tems that in turn, regulate many body functions (see the
discussion and references in the remainder of this sec-
tion).
Results of studies
6-8
of the effect of hypnosis on im-
mediate immune responses show the ability of hypno-
tized volunteers to significantly decrease the flare reac-
tion to the histamine prick test (P,.02). The effect of
hypnotic suggestion on delayed cellular immune re-
sponses was significant on erythema size (P,.02) and
palpable induration (P,.01) in one study,
6
but not in oth-
ers.
9,10
However, even simple suggestion has been shown
11
to induce contact dermatitis in an area not touched by
lacquer tree allergen but believed by sensitized individu-
als to have been so touched; the same individuals did not
react when actually touched by lacquer tree allergen but
believed that they had not been so touched (P,.01). Simi-
larly, using hypnosis, volunteers in a double-masked pro-
tocol
12
who were told to increase their sensitization to 1
of 2 experimental allergens—dinitrochlorobenzene and
diphenylcyclopropenone—while decreasing it to the other
showed a significant difference in reactions between al-
lergens they were told under hypnosis to enhance and
those they were told to diminish (P,.01).
Results of a study
13
of persons with multiple per-
sonality disorder (now called dissociative identity dis-
order) and different allergic responses; dermatologic re-
actions; and effects on seizure disorders, pain control, and
healing in the same individual, depending on the per-
sonality present, show how much influence the mind can
have on physiological reactions and disease processes.
This study cited similar related differences in physiologi-
cal responses and disease conditions for some individu-
als under hypnosis vs in their normal waking state.
Treatment strategies that include hypnosis may
be used to improve healthful behaviors, diminish situ-
ational stress, alleviate phobias (eg, to needles or
bugs), control harmful habits such as scratching, pro-
vide immediate and long-term analgesia, reduce symp-
toms related to disease such as pruritus, improve
recovery from surgery, and facilitate the mind-body
connection to promote healing. Hypnosis can be an
especially useful tool for treating skin diseases that
have a psychosomatic aspect. Griesemer
14
and Griese-
mer and Nadelson
15
recorded the incidence of emo-
tional triggering of dermatoses in 4576 patients during
1 year (
Table 1).
Good reference sources for skin disease response to
hypnosis are found in the somewhat outdated book by
Scott,
16
and in a chapter on the use of hypnosis in der-
matologic problems in the book by Crasilneck and Hall.
4
Koblenzer
17
also mentions the use of hypnosis in com-
mon dermatologic problems. An excellent book for pa-
tients by Grossbart and Sherman
18
discusses mind-body
interactions in skin diseases, and includes hypnosis as
recommended therapy for a variety of skin conditions.
Some dermatoses that have responded to hypnotherapy
are discussed in the following subsections.
METHODS OF MEDICAL HYPNOTHERAPY
Hypnosis is a tool, analogous to a scalpel, that is used to
cut through psychological and behavioral roadblocks to
MATERIALS AND METHODS
A MEDLINE search was conducted from January 1966
through December 1998 on key words related to hyp-
nosis and skin disorders. Hypnosis was searched as
a MeSH category, and “hypnosis” and “hypnotic” as
title and abstract words. Names of specific skin dis-
eases were searched as MeSH categories, and as title
and abstract words. Boolean “and” combinations of
hypnosis and hypnotic with names of specific skin
diseases produced relevant references. References ear-
lier than 1966 and book references were obtained from
the reference lists that were included in articles. Pref-
erence was given to articles based on controlled tri-
als when available. Case reports were included to cover
the use of hypnosis in treating skin diseases when con-
trolled trials had not yet been reported.
Table 1. Emotional Triggering of Dermatoses
in 4576 Patients*
Diagnosis
Diagnoses
Emotionally
Triggered, %
Time Interval
Between Stress
Occurrence and
Clinical Change
Hyperhidrosis 100.0 Seconds
Neurotic excoriations 97.5 Seconds
Lichen simplex chronicus 98.4 Days to 2 wk
Alopecia areata 96.4 2 wk
Warts, multiple and spreading 94.9 Days
Rosacea 94.1 2 d
Pruritus 85.7 Seconds
Lichen planus 81.8 Days to 2 wk
Dyshidrotic hand dermatitis 75.8 2 d for vesicles
Atopic dermatitis 70.2 Seconds for itching
Factitial dermatosis 69.2 Seconds
Urticaria 68.1 Minutes
Psoriasis 62.3 Days to 2 wk
Traumatic dermatitis 55.6 Seconds
Dermatitis not otherwise specified 55.6 Days
Acne vulgaris 55.3 2 d for papules
Telogen effluvium 54.7 2-3 wk
Nummular dermatitis 51.8 Days
Seborrheic dermatitis 40.6 Days to 2 wk
Herpes simplex and zoster 35.7 Days
Vitiligo 33.3 2-3 wk
Nail dystrophy 28.5 2-3 wk
Pyoderma and bacterial infections 29.1 Days
Cysts 27.0 2-3 wk
Warts, single and multiple 17.4 Days
Contact dermatitis 15.3 2 d
Fungal infections 8.7 Days to 2 wk
Basal cell carcinoma 0 . . .
Keratoses 0 . . .
Nevi 0 . . .
*
Modified from Griesemer.
14
Ellipses indicate no relationship.
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healing. It is not a therapy in and of itself. The therapies
that can be facilitated by hypnosis include supportive (ego
strengthening), direct suggestion, symptom substitu-
tion, and hypnoanalysis.
16,19-21
Induction of the hypnotic state in adults can be
achieved by a variety of methods that focus attention,
soothe, or produce monotony or confusion.
4,5
In chil-
dren, the hypnotic state is often induced by having the
child pretend that he or she is watching television, a movie,
or a play, or by using some other distractive process that
uses the imagination.
22
Supportive (ego-strengthening) therapies during a
hypnotic state include positive suggestions for self-
worth and effectiveness. Posthypnotic suggestion is
often used, and further strengthening of the effect can
often be obtained by making an audiocassette tape that
the patient can use repeatedly for self-hypnosis. The
strengthened ego is then better able to repress or con-
front discordant elements that block healing.
Direct suggestion while in the hypnotic state is the
most commonly used method of decreasing discomfort
from pain, pruritus, burning sensations, anxiety, and in-
somnia. Posthypnotic suggestion and repeated use by the
patient of an audiocassette tape for self-hypnosis helps
reinforce the effectiveness of direct suggestion. For deeply
hypnotizable individuals, direct suggestion may pro-
duce a sufficiently deep anesthesia to permit cutaneous
surgery. Direct suggestion can also be used to reduce com-
pulsive acts such as skin scratching or picking, nail bit-
ing or manipulating, and hair pulling or twisting.
16
Psy-
chophysiologic responses such as hyperhidrosis, blushing,
and some forms of urticaria can also be controlled by di-
rect suggestion. Some types of skin lesions can even be
induced to resolve themselves by using direct sugges-
tion, the classic example being verrucae (see the “Ver-
ruca Vulgaris” subsection).
Symptom substitution is a method of retraining the
subconscious through hypnosis to replace a destructive
habit pattern with a more constructive one.
13,16
For ex-
ample, scratching can be replaced by some other physi-
cal activity, such as grabbing onto something and hold-
ing it so tightly for half a minute so that it almost hurts.
Other outlets for stress that can substitute for scratch-
ing include athletic activities, artwork, verbal expres-
sion of feelings, and meditation.
Hypnoanalysis may prove useful in patients with
chronic psychosomatic dermatoses that are nonrespon-
sive to other, simpler approaches. Results may occur more
quickly than with standard psychoanalysis.
16
USES OF MEDICAL HYPNOTHERAPY FOR
SPECIFIC DERMATOLOGIC CONDITIONS
Many older studies of the effectiveness of hypnosis on
specific dermatologic conditions are based on 1 or a few
uncontrolled cases. Although these findings are in-
cluded in the following subsections, they await further
confirmation. The word may is used to qualify recom-
mendations that are based on skimpy evidence. This weak-
ness should be kept in mind when evaluating the infor-
mation and recommendations presented. In recent years,
the trend toward more controlled trials has produced more
reliable information.
23
However, randomized con-
trolled trial results are still not available for most dis-
ease categories. Although this list of dermatologic con-
ditions is not all-inclusive, it includes most of the
dermatologic conditions for which hypnosis has been
found to be reasonably helpful in reducing symptoms or
improving aspects of the condition (
Table 2).
Acne Excorie´e
Hollander
24
reported success in controlling acne excorie´e
in 2 patients by using posthypnotic suggestion. Under hyp-
nosis, the patient was instructed to remember the word
scar whenever she wanted to pick her face and to refrain
from picking by saying scar instead. The excoriations re-
solved, whereas the underlying acne did not. Therefore,
hypnosis may be an appropriate primary alternative treat-
ment for the excoriation aspect of acne excorie´e, with stan-
dard acne treatments for the acneiform aspects.
Alopecia Areata
Gupta et al
25
found a strong correlation between high stress
reactivity and depression in patients with alopecia ar-
eata (P,.001). Hypnosis can be used to teach patients
to control high stress reactivity. Although there are an-
ecdotal reports of hypnotherapy improving alopecia ar-
eata, results of a small clinical trial
26
of medical hypno-
therapy with 5 patients who had extensive alopecia areata
showed a significant increase in hair growth in only 1
Table 2. Literature Summary for Hypnosis
in Skin Disorders*
Disease
Type of
Therapy
Study
RCT NRCT CS MCR SCR
Acne excorie´e C 24
Alopecia areata C 26
Atopic dermatitis C 28
Congenital ichthyosiform
erythroderma
C30
Dyshidrotic dermatitis C 33
Erythromelalgia A 34
Furuncles C 35
Glossodynia C 36
Herpes simplex C 38
Hyperhidrosis C 39
Ichthyosis vulgaris C 40
Lichen planus C 33
Neurodermatitis C 42
Nummular dermatitis C 33
Postherpetic neuralgia C 38
Pruritus C 45
Psoriasis C 52 50
Rosacea C
Trichotillomania C 53
Urticaria C 59
Verruca vulgaris ACP 80 81 71
Vitiligo C 33
*
RCT indicates randomized control trial; NRCT, nonrandomized control
trial; CS, case series; MCR, multiple case reports; SCR, single case report;
C, complementary; A, alternative; and P, primary. Numbers in the body of the
table are reference numbers.
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patient; 3 had a slight increase in hair growth, and 1 had
no change. Hypnosis improved psychological variables
in these 5 patients.
26
It seems that hypnosis may be more
appropriate as a complementary therapy than as a pri-
mary alternative treatment for alopecia areata.
Atopic Dermatitis
There are numerous anecdotal articles
27
in the literature
of improved atopic dermatitis in children and adults as a
result of hypnotherapy. In a clinical trial, Stewart and
Thomas
28
treated 18 adults with extensive atopic derma-
titis who had been resistant to conventional treatment with
hypnotherapy. They used relaxation, stress management,
direct suggestion for nonscratching behavior, direct sug-
gestion for skin comfort and coolness, ego strengthening,
posthypnotic suggestions, and instruction in self-
hypnosis. Their results were statistically significant (P,.01)
for reduction in itch, scratching, sleep disturbance, and ten-
sion. Reported topical corticosteroid use decreased by 40%
at 4 weeks, 50% at 8 weeks, and 60% at 16 weeks. For milder
cases of atopic dermatitis, hypnosis along with moistur-
ization can suffice as a primary alternative treatment. For
more extensive or resistant atopic dermatitis, hypnosis can
be a useful complementary therapy that reduces the amounts
required of other conventional treatments.
Congenital Ichthyosiform Erythroderma
Mason
29
described remarkable resolution of congenital
ichthyosiform erythroderma of Brocq in a 16-year-old boy
after direct suggestion for resolution under hypnosis. Simi-
lar yet less spectacular results were confirmed by Wink
30
in 2 sisters aged 8 and 6 years, by Schneck
31
in a 20-year-
old woman, and by Kidd
32
in a 34-year-old father and his
4-year-old son. In light of these case reports, hypnosis
may be potentially useful as a complementary therapy
to emollients.
Dyshidrotic Dermatitis
Reduction in severity of dyshidrotic dermatitis has been
reported with the use of hypnosis as a complementary
treatment.
33
Data from Griesemer
14
(Table 1) indicate a
significant psychosomatic component for dyshidrosis, so
hypnosis may be useful as a complementary therapy.
Erythromelalgia
In one case report
34
of successful treatment of erythro-
melalgia in an 18-year-old woman using hypnosis alone
followed by self-hypnosis, permanent resolution oc-
curred.
Furuncles
Jabush
35
described a 33-year-old man with recurrent mul-
tiple Staphylococcus aureus–containing furuncles since age
17 years that were unresponsive to multiple treatment
modalities. He had a negative self-image. Hypnosis and
self-hypnosis with imagined sensations of warmth, cold,
tingling, and heaviness brought about dramatic improve-
ment in 5 weeks, with full resolution of the recurrent fu-
runcles. The patient also improved substantially from a
mental standpoint. Presumably, the hypnosis helped nor-
malize his immune response to the bacteria. Conven-
tional antibiotic therapy is the first line of treatment for
furuncles, but in unusually resistant cases with signifi-
cant psychosomatic overlay, complementary use of hyp-
nosis may help end the long-term susceptibility to re-
current infection.
Glossodynia
When oral pain has a psychogenic component, hypnosis
may be effective as a primary treatment.
36
Even with or-
ganic disease, hypnosis may give temporary relief from pain.
Herpes Simplex
Onset of herpes labialis was intentionally triggered by hyp-
notic suggestion in a patient.
37
Ameliorization of discom-
fort from herpes simplex eruptions is similar to that for
postherpetic neuralgia (see the “Postherapeutic Neural-
gia” subsection). Reduction in the frequency of recur-
rences of herpes simplex after hypnosis has also been re-
ported.
38
In cases with an apparent emotional trigger factor,
hypnotic suggestion may be useful as a complementary
therapy for reducing the frequency of recurrence.
Hyperhidrosis
Hypnosis or autogenic training may be useful as adjunc-
tive therapies for hyperhidrosis.
39
Ichthyosis Vulgaris
A 33-year-old man with lifelong ichthyosis vulgaris that
was better in summer and worse in winter began hyp-
notic suggestion therapy in the summer and was able to
maintain the summer improvement throughout the fall,
winter, and spring.
40
Hypnosis may thus be useful as a
complementary therapy for ichthyosis.
Lichen Planus
Pruritus and the accompanying lesions may be reduced
in selected patients using hypnosis as a complementary
therapy for lichen planus.
16,33
Neurodermatitis
Several cases of neurodermatitis have resolved using hyp-
nosis as an alternative therapy,
41-44
and stayed resolved
for up to 4 years of follow-up. Hypnosis may be useful
as a complementary or even alternative therapy for neu-
rodermatitis.
Nummular Dermatitis
Reduction of pruritus and resolution of lesions has been
reported,
16,33
with use of hypnotic suggestion as a comple-
mentary therapy for nummular dermatitis.
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Postherpetic Neuralgia
The pain of acute herpes zoster and of postherpetic neu-
ralgia can be reduced by hypnosis.
16,38
Hypnosis may have
a place as a complementary therapy for postherpetic neu-
ralgia.
Pruritus
The intensity of pruritus may be modified and im-
proved by hypnosis.
16
An example
45
is that of a man with
chronic myelogenous leukemia whose intractable pru-
ritus was much improved with hypnotic suggestion. Hyp-
nosis may be used as a complementary therapy for in-
tractable pruritus.
Psoriasis
Stress plays an important role in the onset, exacerba-
tion, and prolongation of psoriasis. Hypnosis and sug-
gestion have been shown to have a positive effect on
psoriasis.
46-48
In a typical case report,
49
75% resolution
of psoriasis was reported using a hypnotic sensory-
imagery technique. Another case
50
of extensive severe
psoriasis of 20 years’ duration showed marked improve-
ment using sensory-imagery to replicate feelings in the
patient’s skin that he had experienced during sunbath-
ing. Yet another case
51
of severe psoriasis of 20 years’
duration resolved fully with use of a hypnoanalytic
technique. Tausk and Whitmore
52
performed a small,
randomized double-masked controlled trial using hyp-
nosis as adjunctive therapy in psoriasis, with significant
improvement in highly hypnotizable patients. Hypnosis
can be useful as a complementary therapy for resistant
psoriasis, especially if there is a significant emotional
factor in its triggering.
Rosacea
Improvement of rosacea, especially the vascular blush
component, has been described in selected cases of re-
sistant rosacea in which hypnosis has been added as
complementary therapy.
16,33
Trichotillomania
Several cases of successful adjunctive treatment of tricho-
tillomania have been described.
53-55
It seems that hypno-
sis may be a useful complementary therapy for tricho-
tillomania.
Urticaria
Inhibition of immediate-type hypersensitivity response
by direct suggestion under hypnosis was described for 8
of 12 patients.
56
In another study,
57
flare but not wheal
sizes were significantly reduced after hypnosis com-
pared with sessions without hypnosis. Two patients with
urticaria that responded to hypnotic suggestion were de-
scribed in another study,
58
including an 11-year-old boy
whose urticarial reaction to chocolate could be blocked
by hypnotic suggestion, so that hives appeared on one
side of his face but not the other in response to that hyp-
notic suggestion. In a study
59
of hypnosis with relax-
ation therapy on 15 patients with chronic urticaria of 7.8
years’ average duration, within 14 months, 6 patients had
resolved and another 8 improved, with decreased medi-
cation requirements reported by 80% of patients. In se-
lected individuals, it seems that hypnosis may be useful
as complementary or even alternative therapy for chronic
urticaria.
Verruca Vulgaris
Results of the early studies by Bloch
1
and Sulzberger and
Wolf
2
on the efficacy of suggestion in treating warts have
since been confirmed numerous times to a greater or lesser
degree,
60-63
as well as not confirmed in a few studies.
64,65
A recent study
66
with negative results was criticized for
using a negative suggestion about not feeding warts rather
than a positive suggestion about having the warts re-
solve. Numerous studies
67-82
attest to the efficacy of hyp-
nosis in treating warts, but this was not confirmed in a
study
83
that tried to replicate the success reported by Sin-
clair-Gieben and Chalmers
84
of using hypnotic sugges-
tion to cause warts to disappear from one hand but not
the other in persons with bilateral hand warts. In a well-
conducted study
85
that serves as a typical example, 53%
of the experimental group had improvement of their warts
3 months after the first of 5 hypnotherapy sessions,
whereas none of the control group had improvement. In
summary, it seems that hypnosis can be helpful as comple-
mentary or alternative therapy for warts.
Vitiligo
Hautmann and Panconesi
86
described in detail the psy-
choneuroendocrinimmunologic aspects and mecha-
nisms of vitiligo. Occasionally, patients with vitiligo have
improved using hypnotic suggestion as complementary
therapy.
16,33
APPROPRIATE USE OF MEDICAL
HYPNOTHERAPY IN DERMATOLOGIC PRACTICE
Hypnosis currently is underused as an alternative or
complementary therapy in dermatologic practice. For
selected skin diseases in appropriately selected patients,
it can decrease or eliminate symptoms and, in some
cases, induce lasting remissions or cures. Discussing
this option with patients will allow the dermatologist to
gauge the patient’s receptiveness to this treatment
modality. Time requirements for screening patients,
educating them about realistic expectations for results
from hypnosis, and actually performing the hypno-
therapy are generally no greater than for screening, pre-
paring, and educating patients about cutaneous surgery
and then actually performing it. Just as many derma-
tologists choose to refer patients with complex cutane-
ous surgical problems to competent specialists in der-
matologic surgery, many dermatologists would choose
to refer patients with complex psychosomatic dermato-
logic problems to competent specialists in hypnosis-
assisted therapy. Dermatologists who prefer to refer
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patients to hypnotherapists or who desire further infor-
mation about training in hypnotherapy can obtain
referrals and information from the American Society of
Clinical Hypnosis or similar professional organizations.
Advantages of medical hypnotherapy for skin dis-
eases include nontoxicity, cost-effectiveness, ability to
obtain a response when other treatment modalities fail,
ability to reduce relapses, and ability of patients to self-
treat and gain a sense of control when taught self-
hypnosis reinforced by using audiocassette tapes. Add-
ing this treatment capability can result in pleased and
grateful patients.
Disadvantages of medical hypnotherapy in derma-
tologic practice include the extensive practitioner train-
ing required, the low hypnotizability of some patients,
the negative social attitudes still prevalent about hypno-
sis, and the lower reimbursement rates for cognitive thera-
pies such as hypnosis compared with procedural thera-
pies such as cutaneous surgery. The training requirements
for hypnosis are no more extensive than those required
for cutaneous surgery. Social attitudes and reimburse-
ment policies can be changed with time. The low hyp-
notizability of some individuals is, to a large extent, “hard-
wired” into their brains and tends to be consistent over
time, as measured by the Hypnotic Induction Profile.
87
Patient selection is an important aspect of success-
ful medical hypnotherapy in dermatologic practice. Part
of the art of being a dermatologist is being able to choose
appropriate therapeutic modalities for specific patients.
Hypnosis-assisted therapy works best in moderately to
highly hypnotizable patients who are appropriately mo-
tivated, and who have dermatoses with a large psycho-
somatic component or that are otherwise known to be
responsive to intervention with hypnosis. As with any
therapy, it is best to start with simple cases, referring the
more complex cases to those more experienced. As the
practitioner gains experience, more difficult cases may
be added.
Hypnosis, like any other tool, can be effective and
gratifying in many cases, when appropriately applied. Like
any other tool, hypnosis is not a panacea. It seems to work
miracles for some and yet, to fail completely for others;
most results lie somewhere in between. The specific type
of therapy chosen to be assisted by hypnosis is also a key
factor in producing positive results. With proper selec-
tion of disease process, patient, and provider, hypnosis
can decrease suffering and morbidity from skin disor-
ders with minimal adverse effects.
Accepted for publication June 24, 1999.
Reprints: Philip D. Shenefelt, MD, MS, Division of Der-
matology and Cutaneous Surgery, Department of Internal
Medicine, Mailstop MDC 019, College of Medicine, Uni-
versity of South Florida, 12901 Bruce B Downs Blvd, Tampa,
FL 33612 (e-mail: pshenefe@hsc.usf.edu).
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... The benefits of a healthy lifestyle in AD patients have been investigated in the fields of conventional medicine and complementary medicine (CM). To date, positive effects of exercise [14][15][16], relaxation hypnotherapy [17][18][19][20][21] and dietary or nutritional adjustments, such as time-restricted eating and the application of a low-calorie vegetarian/vegan diet [22][23][24][25], have been reported in case reports and mostly explorative studies. However, few data are available about self-application of lifestyle behaviors in Germany. ...
... Vieira et al. [49] conducted a literature review and found limited evidence that hypnosis and perhaps other stressrelieving techniques play at least an adjunctive role in the management of AD. It was reported that hypnosis may improve wellbeing and skin conditions by activating a relaxation response, regulating autonomic functions, regulating immunological mechanisms, reducing scratching behaviors, altering dysfunctional habits, promoting skin healing and improving skin comfort [19,21]. In our population, most respondents who applied at least one relaxation technique found it to be helpful. ...
Article
Background: The severity of atopic dermatitis (AD) is associated with lifestyle behaviors such as exercise, relaxation techniques, and dietary or nutritional adjustments. Objective: To investigate the frequency of self-initiated exercise, relaxation techniques, and dietary or nutritional adjustments and their perceived benefits in patients with AD. Methods: An exploratory cross-sectional study was performed in May 2019 with 115 AD patients who participated in a three-armed randomized controlled trial (the CAMATOP study). Data on lifestyle behaviors in the three domains of exercise, relaxation techniques, and dietary or nutritional adjustments and their perceived benefits were collected anonymously by a questionnaire and exploratively evaluated. Results: A total of 58 (50.4%) patients responded and were included in the analyses. Within the previous four months, 54 (93.1%) respondents had performed exercise, and 24 (41.4%) respondents had used a relaxation technique. A total of 44 (75.9%) respondents had adjusted their diet or nutrition intake due to AD. Exercise, relaxation techniques, and dietary or nutritional adjustments were rated as helpful by most respondents (57.4%, 87.0%, and 95.1%, respectively). Overall, 54 (93.1%) respondents adopted at least one lifestyle factor, and 13 (22.4%) adopted a lifestyle factor in all three domains. Conclusion: In our sample, AD patients often adopted lifestyle behaviors such as exercise, relaxation techniques, diet and nutrition; and perceived relaxation techniques and nutritional adjustments as helpful. Further high-quality cohort studies and prospective clinical trials should evaluate the benefits and possible risks of potentially healthy lifestyle behaviors in AD patients.
... Hypnosis is interesting as it has already shown its efficiency on both physical and psychological symptoms in several clinical domains (e.g., [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58]). Moreover, it works on dysfunctional thoughts or negative beliefs with more unconscious material, which does not mobilize language capacities and in which implicit learning is allowed, even in the event of memory deficits [59]. ...
... However, positive expectations, professional endorsement, and the feasibility of using hypnosis for medical purposes are three factors that perhaps counterbalance the negative representations of hypnosis. In recent years, studies showing the use and effectiveness of clinical hypnosis in different fields of health have given a more reassuring image of the practice [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58]. Most of the couples in our study were reassured and took the study seriously, as it was proposed by a professional they trusted. ...
Article
Background: Dementia has a negative impact on the quality of life of the person with dementia and their spouse caregivers, as well as on the couple's relationship, which can lead to high levels of distress for both partners. Hypnosis has been shown to be effective in managing distress and increasing the quality of the relationship. Objective: The aim was to develop a standardized hypnosis intervention for couples confronted with Alzheimer's disease and evaluate its feasibility, acceptability, and helpfulness in managing the distress of both partners and increasing the quality of the relationship. Methods: In a single-arm study, sixteen couples received the 8-week intervention. Qualitative and quantitative assessments were conducted pre- and post-intervention as well as three months after. Results: 88.9% of couples (n = 16) of the final sample (n = 18) completed the intervention. Despite the negative representations of hypnosis, several factors led couples to accept to participate in this study: positive expectations, professional endorsement, medical application, non-drug approach, home-based, free, flexible, and couple-based intervention. The results showed a significant decrease in distress for both partners. These effects were maintained three months after the intervention. Couples felt more relaxed, had fewer negative emotions, accepted difficulties more easily, were more patient, and reported better communication and more affection in the relationship. Conclusion: Overall, this pilot study shows the feasibility and acceptability of hypnosis with couples confronted with Alzheimer's disease. Although measures of the preliminary pre- and post-intervention effects are encouraging, confirmatory testing with a randomized controlled trial is needed.
... It is believed that through accessing the subconscious mind, an individual's emotions, behaviors, and physiological responses can be influenced. While it may represent a useful adjunct therapy, it requires access to trained practitioners as well as careful subject selection, as some subjects exhibit greater hypnotic susceptibility than others [40]. ...
... Hypnosis has been employed in dermatology to reduce pain and pruritus from skin disorders, to reduce procedure-related anxiety, to reduce harmful behaviors, and as an aid for healing skin disease [40,41]. ...
Article
Full-text available
Stress has multiple and wide-ranging physiologic and clinical impacts on skin disease. This has led to an interest in mind body therapies as potential adjunct treatments for skin disease. The stress response results in the activation of the endocrine, neurologic, and immune systems, with a resulting cascade of impacts, that are both systemic and cutaneous. The 2 main arms of the stress response are the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. The resultant release of cortisol, catecholamines, and neuropeptides has multiple effects. Clinically, these have been shown to increase skin inflammation, increase itching, impair skin barrier function, impair wound healing, and suppress immunity. Mind body therapies are those that focus on the interaction between the mind and the body, with the goal to influence physical function and impact health. These have been shown to ameliorate some of the harmful physiologic changes attributed to stress or to reduce harmful behaviors. In some cases, such as with biofeedback, they may also result in beneficial physiologic changes. Treatments such as meditation, biofeedback, hypnosis, guided imagery, and others have been evaluated in the treatment of skin disease and have shown some benefits. Although randomized controlled trials are limited, these interventions have shown beneficial effects on itching, psychosocial outcomes, and even skin severity. These interventions have been evaluated in diseases such as atopic dermatitis, psoriasis, trichotillomania, and others. Given the potential benefits, improvements in psychosocial outcomes, and a low risk profile, referral to qualified practitioners or multidisciplinary clinics should be considered for some patients.
... Hypnosis is a method of treatment that is considered effective on physical and psychological symptoms in the following settings: emergency care (Iserson, 2014), depression (Shih et al., 2009;Yapko, 2001;Yapko, 2013), anxiety (Hammond, 2010), sleep disorders (Becker, 2015;Cordi et al., 2015), chronic pain (Morone & Greco, 2007), obesity (Cherniack, 2008), cancer (Cramer et al., 2015;Liossi & White, 2001;Richardson et al., 2007), as an adjunct during colonoscopy (Elkins et al., 2006), substance abuse disorders (Green & Lynn, 2000;Potter, 2004), dermatology (Shenefelt, 2000) and sexual dysfunctions (Stanley & Burrows, 2001). This method consists in "a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion" (Elkins et al., 2015). ...
... Hypnosis may help in improving the physical and psychological symptoms of patients with dementia. These results are consistent with the effects obtained in other health domains (Becker, 2015;Cherniack, 2008;Cordi et al., 2015;Cramer et al., 2015;Green & Lynn, 2000;Hammond, 2010;Iserson, 2014;Liossi & White, 2001;Morone & Greco, 2007;Potter, 2004;Richardson et al., 2007;Shenefelt, 2000;Shih et al., 2009;Stanley & Burrows, 2001;Yapko, 2001;Yapko, 2013). Moreover, the Duff and Nightingale study (2007) showed improved performance on concentration, immediate memory and memory of significant life events, even after the hypnosis sessions had ended. ...
Article
Background Dementia has negative implications for the quality of life of person and lead to situations of distress. Hypnosis is effective in several health domains but its use in people with dementia is debated. Objective The aim was to scope the research activity on the use of hypnosis with persons with dementia to manage their distress, symptoms or daily life. Method We used five international databases: PubMed/Medline, the Cochrane Library, ScienceDirect, PsycINFO, and Google Scholar. Results Only seven articles were listed and three articles described the same longitudinal pilot study. Hypnosis was used either in one or several sessions, alone or as an adjunct and reinforced with daily self-hypnosis with or without audio tapes in people with dementia. The results show that they experienced moderate-to-high hypnotizability, but some adaptations were needed given their attention disabilities. They showed benefit on symptoms. Nevertheless, some methodological weaknesses such as small heterogeneous samples, the use of non-validated tools for hypnotizability or outcomes, or the insufficient definition of the content of sessions limit the scope of the results. Conclusion Hypnosis seems feasible and acceptable for people with dementia and could provide interesting clinical benefits, but a randomized controlled trial with a large homogeneous sample would be highly informative.
... For example, a recent study failed to establish any conclusive relation between urticaria and some microelement levels including vitamins B12 and D(4). Fourth effectiveness of hypnotherapy in the treatment of different allergic skin disorders is also noted by different authors (7,1). ...
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Chronic urticaria (CU) is a condition characterized by the development of wheals, angioedema, or both, lasting longer than six weeks. The wheals vary in size and appear and fade repeatedly as the reaction runs its course. CU carries a substantial burden on the patients and the healthcare system. The relation of CU to psychological factors and stressors seems to be obvious. Life stressors and impairment of psychological well-being can play a role of sensitizing trigger consequently launching the whole chain of mastcell reactions. This is the reason why psychological interventions can be considered as alternative treatment options especially when the conventional treatment modalities previously tried, failed in the achievement of satisfactory results.
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The mind–skin interaction has been progressively clarified by recent research that has focussed on psychoneuroimmunology. This article focusses on brain–cell communication by means of chemical messengers and the changes in the skin they provoke under stress, providing an origin to dermatoses linked to the mind, called psychodermatoses. The author refers to three types of psychodermatoses: those caused by prior psychiatric disturbances, those that cause psychologic disturbances by their aspect, and those that are influenced by emotional states. This article highlights the four simple and natural mind–body anti-stress techniques of posture, diaphragmatic breathing, muscle relaxation, and meditation that every doctor can teach to patients, which will enable them to face stressful situations and therefore protect themselves against the negative psychological effects of stress. Several therapeutic behaviours in the doctor–patient relationship are recommended to build a patient’s trust in their doctor and to encourage the patient to play an important part in their treatment process. It is emphasised that the treatment of psychodermatoses needs to be co-operative, integrating specialists in dermatology, psychiatry, and psychology. Dermatologists take care of the skin alterations, while psychiatrists are involved with the associated mental disturbances and are able to prescribe a large range of psychopharmaceuticals to treat anxiety, depression, post-traumatic stress disorder, and compulsive states. Psychotherapists try to correct erroneous behaviours and false feelings, employing cognitive-behavioural therapy, analytic and reprogramming techniques, and also hypnosis, in order to rid patients of psycho-emotional perturbations and facilitate successful outcomes in the skin.
Article
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The psychological aspect of dis-ease, which is indeed a lack of 'ease' is generally overlooked in the management of myriad maladies that affect the human body. The concept of mindfulness meditation, which is an interesting hybrid born from the meditative discipline of the east and the intellectual discipline of the west is gaining attention in the past two decades for its benefits in the holistic development of individuals. When individuals with ailments are trained under therapists supervised by the clinicians, significant results can be seen in alleviating symptoms like pain, stress, anxiety and an improvement in the quality of life is observed. This review article focuses on the structure and basics of mindful meditation and the mechanisms of mindfulness and its positive effects on various diseases like lichen planus, urticaria, psoriasis, eczema, myofacial pain dysfunction syndrome, to name a few. There are various arenas within the discipline of oral and maxillofacial medicine where mindfulness-based techniques can be explored for its effectiveness in combating psychosomatic conditions. The article highlights the importance of holistic approach in treating diseases in which mindfulness meditation techniques play an important role.
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Psychological factors might be involved in some oral mucosal diseases, such as recurrent aphthous stomatitis (RAS) and oral lichen planus (OLP). However, there is little information about the psychosomatic approaches to manage these oral mucosal diseases. This review summarizes the reports on the psychological statuses of patients with oral mucosal diseases, including RAS and OLP and others, and discusses the appropriate psychosomatic approaches for the management of these diseases. The psychosomatic background is probably involved in onset and course of inflammatory oral mucosal diseases, and can be called as “psychosomatic diseases”. The field of psychosomatic medicine for oral mucosal diseases may be termed “psychostomatology”.
Chapter
In an age that demands empirically sound methodology, yet seeks new and innovative methods for treatment, the latest blend of cognitive-behavioural therapy and hypnosis can just be the creative solution practitioners have been looking for. The integration of the much older hypnosis and relatively younger cognitive-behavioural therapy paired with various relaxation techniques are important tools in the armamentarium of any inspiring psychodermatologist.
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Die Hyperhidrosis ist eine funktionelle Störung der ekkrinen Drüsen; auch bei extremer Achselnässe sind die apokrinen Drüsen nicht ursächlich beteiligt. Diese liefern lediglich das Substrat zur Bildung des typischen apokrinen Körpergeruchs. Erst die bakterielle Zersetzung geringster Mengen apokrinen Schweißes läßt dann geruchsaktive Substanzen entstehen [14].
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This study was designed to test the hypothesis that warts are treatable by hypnotherapy. Seventeen experimental patients with bilateral common or flat warts were hypnotized weekly for five sessions and were told that the warts would disappear on one side only. They were reexamined three months from the time of the first hypnotic session. Seven patients who were untreated were also reexamined at the end of three months. Fifty-three percent of the experimental group improved. No improvement was observed among untreated controls. These findings support the hypothesis that warts respond to hypnotherapy. Whereas specific lesions could not be influenced selectively, the findings suggest that hypnosis has a general effect on host response to the causative virus.
Article
Objective. —To determine whether individuals selected for good general health, high hypnotizability, and the ability to alter skin temperature under hypnotic suggestion can influence the delayed-type hypersensitivity (DTH) response to varicella-zoster (VZ) antigen under hypnotic suggestion.Design. —A blinded clinical trial using a repeated measures design with subjects serving as their own controls. Subjects were randomly assigned to undergo a predetermined sequence of four different experimental conditions, occurring at weekly intervals, with each condition including VZ skin testing: (1) hypnosis with suggestions to enhance the DTH response to VZ antigen; (2) hypnosis with suggestions to suppress the DTH response; (3) hypnosis with suggestions for relaxation only; and (4) skin testing without hypnosis.Setting. —A National Institutes of Health—supported clinical research center in a teaching hospital.Subjects. —A stratified sample of 24 ambulatory, healthy, highly hypnotizable, volunteer college students selected for their above-average ability to alter skin temperature after hypnotic suggestions and their positive baseline responses to VZ antigen. There were 11 males and 13 females with a mean±SD age of 22±6 years. The mean±SD hypnotizability score (Harvard Group Scale of Hypnotic Susceptibility) was 11±1.Interventions. —Intradermal skin testing with VZ antigen (Mantoux method) and hypnotic suggestion.Main Outcome Measures. —Areas of induration of the DTH response measured at 24 and 48 hours after injection of antigen.Results. —The area of the DTH response was not affected by the experimental interventions. The area of erythema was likewise unaffected.Conclusions. —Our subjects were unable to alter their DTH responses using hypnotic suggestion.(JAMA. 1994;272:47-52)
Article
Relaxation mental imagery (RMI), standard topical treatment (TopTx), and equal time-control interventions were compared on measures of wart regression in sixty one, 6–12-year-old children. Subjects chose one common (“index”) wart and attended 4 visits over 8 weeks. At each visit, total and “index” extremity wart number were counted and a photo was taken of the “index wart” for later measurement. On average, total wart number decreased by 10% and “index wart” area decreased by 20% with no significant group differences during the first eight weeks. Phone follow was conducted 6 to 18 months from study entry. At phone follow up, there was a trend for more RMI and TopTx subjects to report complete wart resolution (p = 0.07) with a majority of RMI children reporting use of RMI or no specific treatment pursuit. We conclude there was no significant short-term benefit for RMI in this randomized controlled trial of wart regression in children. However, longer term benefits for RMI and TopTx groups are suggested.
Article
This study used hypnosis to treat seven consecutively referred patients with warts that had been refractory to numerous treatments with conventional therapies. The hypnotic techniques used with these cases focused on the patient as the active agent in collaboration with the therapist, working in tandem to obtain the desired outcomes. All of the patients had warts that were causing social problems. Nearly all patients (86%) were completely cured of their warts within 3 months of the onset of therapy. Results are discussed in terms of needed research examining the psychologic and physiologic mechanisms connected with the involution of warts and possible mind-body connections that could be scrutinized using the treatment of warts as a paradigm. J Dev Behav Pediatr 15:170-173, 1994. Index terms: hypnosis, warts, psychosomatics, psychoneuroimmunology.