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A New Hypnotic Technique for Treating Combat-Related Posttraumatic
Stress Disorder:
A Prospective Open Study
Eitan G. Abramowitza; Pesach Lichtenbergb
a Mental Health Division, Israel Defense Forces, Israel b Herzog Hospital and the Hadassah Medical
School of the Hebrew University of Jerusalem, Israel
Online publication date: 25 May 2010
To cite this Article Abramowitz, Eitan G. and Lichtenberg, Pesach(2010) 'A New Hypnotic Technique for Treating
Combat-Related Posttraumatic Stress Disorder:
A Prospective Open Study
', International Journal of Clinical and
Experimental Hypnosis, 58: 3, 316 — 328
To link to this Article: DOI: 10.1080/00207141003760926
Full terms and conditions of use:
This article may be used for research, teaching and private study purposes. Any substantial or
systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or
distribution in any form to anyone is expressly forbidden.
The publisher does not give any warranty express or implied or make any representation that the contents
will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses
should be independently verified with primary sources. The publisher shall not be liable for any loss,
actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly
or indirectly in connection with or arising out of the use of this material.
Intl. Journal of Clinical and Experimental Hypnosis, 58(3): 316–328, 2010
Copyright © International Journal of Clinical and Experimental Hypnosis
ISSN: 0020-7144 print / 1744-5183 online
DOI: 10.1080/00207141003760926
A Prospective Open Study1
Eitan G. Abramowitz2
Mental Health Division, Israel Defense Forces, Israel
Pesach Lichtenberg
Herzog Hospital and the Hadassah Medical School of the Hebrew University of Jerusalem, Israel
Abstract: Many combat veterans with posttraumatic stress disorder
(PTSD) have an olfactory component to their traumatic memories that
might be utilized by a technique called hypnotherapeutic olfactory
conditioning (HOC). Thirty-six outpatients with chronic PTSD, fea-
turing resistant olfactory-induced flashbacks, were treated with six
1.5-hour sessions using hypnosis. The authors used the revised Impact
of Events Scale (IES–R), Beck Depression Inventory, and Dissociative
Experiences Scale as outcome measures. Significant reductions in
symptomatology were recorded by the end of the 6-week treatment
period for the IES–R, as well as for the Beck Depression Inventory
and the Dissociative Experiences Scale; 21 (58%) of the subjects
responded to treatment by a reduction of 50% or more on the IES–R.
Improvement was maintained at 6-month and 1-year follow-ups. Use
of medication was curtailed. HOC shows potential for providing ben-
efit to individuals suffering from PTSD with olfactory components.
Chronic posttraumatic stress disorder (PTSD) can be a particularly
prevalent problem among members of armed forces exposed to combat
(Sareen et al., 2007; Stimpson, Thomas, Weightman, Dunstan, & Lewis,
2003) and may be difficult to treat effectively. While multiple treatment
approaches are used for PTSD, including cognitive-behavioral therapy
Manuscript submitted July 27, 2009; final revision accepted November 24, 2009.
1This work was supported by a research grant from the IDF Medical Corp. and Israeli
MOD as well as by a gift to Herzog Memorial Hospital from the Maury and Florence
Rosenblatt Fund, Toronto, Canada. We wish to thank Lisa Deutsch, PhD, for the statistical
2Address correspondence to Eitan G. Abramowitz, MD, 91/3 Emek Haelah St.,
Modiin, 71700, Israel. E-mail:
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(CBT; Harvey, Bryant, & Tarrier, 2003), exposure therapy (Rothbaum
& Schwartz, 2002), and pharmacotherapy (Zhang & Davidson, 2007),
significant distress often remains, so that any therapeutic intervention
that may offer additional benefit ought to be explored.
Hypnosis for the treatment of trauma victims has a long pedi-
gree (Breuer & Freud, 1895/1982; Janet, 1889) and continues to be
employed in the treatment of PTSD. Several studies have suggested a
place for hypnosis in the treatment of PTSD (Cardeña, 2000; Cardeña,
Maldonado, Hart, & Spiegel, 2000; Lynn & Cardeña, 2007). Hypnosis
has several advantages when working with PTSD sufferers. First of all,
hypnosis may work by producing a dissociative state in the patient
(H. Spiegel & Spiegel, 1987). Persistent dissociation in the aftermath
of a trauma (Hagenaars, van Minnen, & Hoogduin, 2007), though not
necessarily at the time of the trauma (Van der Velden & Wittmann,
2008), may predict the subsequent development of PTSD. Continuing
dissociative phenomena are a serious cause of suffering and disabil-
ity in PTSD (Van der Velden & Wittmann; Hagenaars et al.). Hypnosis,
then, may be a treatment modality tailored to the nature of the symp-
tom, which can further be used to reframe dissociative phenomena for
therapeutic purposes (Cardeña et al.).
A second potential advantage of a hypnotic intervention is that hyp-
nosis is a flexible form of treatment that can target nondissociative
symptoms as well, such as anxiety and emotional withdrawal. Third,
hypnosis can easily be integrated as an adjunct therapy employed
with other treatment approaches. Fourth, evidence suggests that peo-
ple with PTSD tend to be more highly hypnotizable than the general
population (Bryant, Guthrie, Moulds, Nixon, & Felmingham, 2003;
D. Spiegel, Hunt, & Dondershine, 1988) and may therefore be well
suited to respond to the careful administration of hypnosis.
Hypnotherapeutic olfactory conditioning (HOC; E. G. Abramowitz,
Israel Society of Hypnosis, Tel Aviv, Israel, 2003) is a technique that
helps the patient develop new olfactory associations to overcome anx-
ieties and dissociative states. While the specifics of each application of
the technique will of course vary in accordance with the details of the
distress and the factors that caused and maintained the pathological
situation, unique to HOC is the development, under hypnotic con-
ditions, of a positive olfactory association (sometimes referred to by
neuro-psycholinguists as an “anchor”; Bandler & Grinder, 1973), which
allows the patient to regain control of his or her symptoms, especially
when they are triggered by olfactory stimuli.
The sense of smell can be powerfully evocative of memories (Herz
& Reich, 1995; Maylor, Carter, & Hallett, 2002). The olfactory bulb, the
only part of the brain in direct contact with the physical environment,
sends output fibers to limbic and neocortical areas involved in storing
memories and processing emotions. The amygdala, in particular, plays
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a role in the long-term, unconscious storage of memories of fear, as well
as in the emotional processing of olfactory stimuli (Otto, Cousens, &
Herzog, 2000; Zald & Pardo, 1997). These neuroanatomical connections
are the substrate for the observed relationship between emotion and
olfaction (Herz & Cupchik, 1995; Herz & Reich).
The ability of olfactory stimuli to evoke vivid flashbacks of trauma
scenes in individuals suffering from combat-related PTSD has been
noted (Kline & Rausch, 1985; Vermetten & Bremner, 2003). A recent
positron tomographic emission study of combat veterans with PTSD
revealed an activation in the amygdala, insula, medial prefrontal,
and anterior cingulate cortical areas upon reexposure to olfactory ele-
ments of the traumatic memories (Vermetten, Schmahl, Southwick, &
Bremner, 2007).
The suggestion has been made that the intense emotional response
to olfactory stimuli might be exploited for therapeutic purposes
(Vermetten & Bremner, 2003). We have reported the use of HOC to treat
a case of combat-related PTSD (Abramowitz & Lichtenberg, 2009).
HOC incorporates elements of CBT, which is the most thoroughly
studied and evidence-based psychotherapeutic intervention for PTSD
(Harvey et al., 2003). As we describe in the “Method” section in greater
detail, in HOC the patient develops mastery over anxiety symptoms
by being conditioned to associate a pleasant odor with a state of calm.
Using olfactory cues, the patient then learns how to cultivate a “safe
place” where one can learn to manage one’s anxiety and to gain a sense
of mastery over fear and stress. In the next phase, the patient is finally
able to withstand imaginal exposure to the traumatic memory itself.
Finally, the patient, who has learned the role of scent in producing
one’s symptoms, is able to replace the traumatic olfactory cues with
pleasant ones.
In an important controlled study, Brom, Kleber, and Defares (1989)
were able to show benefit with hypnosis for PTSD. However, they
treated a less chronic population with trauma unrelated to com-
bat. Other treatment studies working with combat-related PTSD have
demonstrated the difficulty of obtaining good therapeutic results with
this population. A careful study, conducted with Israeli soldiers with
chronic PTSD, failed to show improvement following the careful appli-
cation of individualized and group CBT approaches (Solomon, Bleich,
Shoham, Nardi, & Kotler, 1992). We thought that exposure produced in
the manner of HOC might lead to more salutary results. Our therapeu-
tic interventions also allow for more individualized approaches than in
the earlier study.
We therefore decided to undertake an open study of patients suf-
fering from chronic combat-related PTSD whose condition had not
improved with other treatment modalities and who were then treated
with HOC.
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Participants were drawn from the Posttraumatic Stress Disorder
Treatment Unit of the Mental Health Services of the Israel Defense
Forces. The PTSD Unit provides multidisciplinary ambulatory care for
former and current soldiers who in the course of duty were exposed to
combat trauma and developed symptoms of PTSD. The staff includes
a psychiatrist, clinical psychologists, and social workers. The PTSD
Unit routinely has its clients complete self-assessment scales, includ-
ing those described below, during two 1.5-hour intake interviews.
Most clients receive treatment for up to a year. Inclusion criteria were
a diagnosis of chronic combat-related PTSD according to Diagnostic
and Statistical Manual of Mental Disorders (4th ed.) criteria (DSM-IV;
American Psychiatric Association, 1994), as determined by a semistruc-
tured psychiatric interview conducted by a psychiatrist with over 10
years of experience treating PTSD; flashbacks and/or panic attacks
triggered by olfactory stimuli; continuing troubling symptoms despite
prior attempts at treatment; and, finally, competence and agreement to
sign an informed consent. Exclusion criteria included evidence of psy-
chosis, severe traumatic brain injury or postconcussion syndrome, and
uncontrolled substance abuse.
All 84 patients receiving treatment and follow-up at the clinic and
fulfilling the inclusion criteria were offered a course of psychotherapy
with hypnosis, which they were told might help to ameliorate their
symptoms and to improve their quality of life. Thirty-seven provided
written consent. Participants continued to receive standard treatment
at the PTSD Unit for at least 1 year following the HOC. The treatment
was conducted between January 2005 and November 2007.
A retrospective assessment of the clinical scales in HOC interven-
tion was approved by the Ethical Committee for Experimentation in
Human Subjects of the Israel Defense Forces and by the Israel Ministry
of Health.
The HOC technique has been described elsewhere (Abramowitz &
Lichtenberg, 2009). Briefly, treatment included six weekly 1.5-hour ses-
sions. In the first session, after a detailed discussion of the nature of
hypnosis, the therapist takes a sort of olfactory history from the patient,
including a description of any scents that might trigger flashbacks,
panic attacks, and other unpleasant reactions. The patient then chooses
from a selection of three simple aromatic oils (vanilla, red mandarin,
and basil) a vial with a subjectively pleasing odor and, while retrieving
pleasant memories and experiences, is taught to associate the scent with
a sense of control and calm.
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In the second session, the patient, following a hypnotic induction,
reexperiences past episodes of successful functioning under stress, for
purposes of applying these emotional resources in the “here and now,”
and receives posthypnotic suggestions for dealing successfully with the
ordeal of frequent flashbacks to the traumatic event.
In the third session, the therapist and patient together choose a care-
fully detailed safe place, drawn from the memories evoked during
the previous session. While hypnotized, the patient practices “enter-
ing” the safe place while inhaling the scent chosen in the first session,
thereby strengthening the association between the hypnotically con-
jured safe place and the actual scent.
During the fourth and fifth sessions, the patient, while hypnotized
and smelling the pleasant scent, is encouraged to remember the trau-
matic event, in particular its olfactory characteristics. The therapist
reframes the traumatic memory, replacing its olfactory content with the
pleasant scent in the hope of moderating the patient’s reactions to the
memories. This may be practiced more than a dozen times in the course
of these two sessions.
In the final session, the patient practices what he or she has learned
and is further taught to use the vial of pleasant-smelling oil to reenter
the safe place in situations that trigger anxiety or panic attacks. It is
understood that the patient will continue to carry this vial with him
or her, as a tool for combating anxiety and hopefully as a substitute
for benzodiazepines, which one may have been consuming in stressful
Concurrent pharmacotherapy was not discontinued during the
6 weeks of HOC therapy. Subsequently, the medication and dosages
were changed as deemed necessary by the treating psychiatrist, who
also performed the hypnotic intervention.
Before the first session, basic demographic and clinical data were col-
lected. In addition, at baseline, all subjects underwent testing with the
Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C; Weitzenhoffer
& Hilgard, 1962). In accordance with Israeli law, all hypnosis was per-
formed by a hypnotist with accreditation from the Ministry of Health
(Aviv, Dalia, Gaby, & Kobi, 2008). We used the Hebrew version of the
SHSS:C, which showed a total scale correlation of .69 (Lichtenberg,
Shapira, Kalish, & Abramowitz, 2009).
The following clinical assessments, administered in Hebrew, were
conducted for each participant at baseline, 6 weeks (i.e., the completion
of the six therapy sessions), 6 months, and 1 year:
1. Impact of Events Scale-Revised (IES–R; Weiss & Marmar, 1997). The IES–
R, which served as the primary outcome measure in this study, is a
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22-item questionnaire assessing symptoms of intrusion, avoidance, and
hyperarousal resulting from exposure to a traumatic event. The subjects,
relating to the 7-day period prior to completing the questionnaire, rate
answers on a scale of 0 (not at all)to5(extremely). Though we did not
find in the research literature criteria for categorizing score changes, we
decided that we would rate a 50% reduction in total score as a response
to treatment.
2. Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, &
Erbaugh, 1961). The BDI is a widely used, 21-item self-completed ques-
tionnaire evaluating depressive feelings, attitudes, and symptoms. Item
ratings of 0 to 3, in increasing severity, yield a score in the range of
0 to 63. Scores in the range of 10 to 18 suggest a mild-to-moderate depres-
sion, 19 to 29 a moderate-to-severe depression, and 30 or above a severe
3. Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986). The
potential importance of dissociative phenomena in the development and
subsequent symptomatology of PTSD has been alluded to. The DES is
a 28-item scale that measures dissociation in both healthy and clinical
subjects by requiring the subject to estimate the percentage of time (0 to
100) one experiences a variety of dissociative symptoms. The final score
is the mean of the results for all the test items. The DES has produced
test–retest reliability scores of .84 and internal reliability scores of .90
(Bernstein & Putnam). A review of the use of the scale in over 100 stud-
ies showed mean reliability and convergent validity scores of .93 and .67,
respectively (Ijzendoorn & Schuengel, 1996).
All hypnotic assessments were conducted by a single investigator
(EGA). The scales used for clinical assessment—the IES–R, BDI, and
DES—were all completed by the participants, overseen by staff not
involved in the hypnotic treatment and assessment.
Analysis of Data
All statistical tests were two-sided except for the test of the null
hypothesis, which was one sided. Categorical variables were presented
as a count and percentage with an exact 95% confidence interval when
relevant. Continuous variables were summarized by a mean, median,
and standard deviation and compared with a ttest or analysis of vari-
ance methodology. The change from baseline over time in the three
clinical scales scores (IES–R, BDI, and DES) was modeled by means of
repeated measures analysis of variance methods using PROC MIXED
in SAS v9.1 (SAS Institute, Cary, NC). In order to test for differences
in the slope of change from baseline, time (6 weeks, 6 months, and 12
months) was entered into the model as a continuous variable with base-
line value entered as a covariate. To test if the change from baseline was
significant per time point, time was entered as a categorical variable
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and the least-squares means were evaluated for a significant difference
from 0. We tested for effect of the other variables (years after the battle,
age, period before HOC, and baseline SHSS:C) by modeling them in the
same manner.
Only 1 participant dropped out of the study, after the first session,
and was not included in the subsequent analysis. All remaining 36
participants were male, with mean age 41.2 (SD =12.2, range 24–64).
The trauma had occurred an average of 16.5 years earlier (SD =
14.3, range 1–37). Prior to their enrollment in the HOC treatment
protocol, the participants had been in treatment an average of 2.44
years (SD =1.3, range 1–6), including a mean of 1.9 years of antide-
pressant pharmacotherapy. All patients were receiving treatment with
selective serotonin reuptake inhibitors. In addition, 18 (50%) were
receiving benzodiazepines and 9 (25%) were taking major tranquilizers
(antipsychotics) for help in controlling their symptoms. Baseline clin-
ical assessment showed significant psychopathology, with mean IES–R
scores of 77.1 (SD =17.4), mean BDI scores of 30.3 (SD =13.1), and
mean DES scores of 47.3 (SD =19.9). The mean score on the SHSS:C
assessing hypnotic susceptibility at baseline was 6.31 (SD =1.97).
The results of the three clinical scales are presented in Figure 1. The
pattern is similar for all three scales: A clinically and statistically sig-
nificant reduction in scores was obtained by 6 weeks (the end of the
HOC intervention). Mean IES–R at this point was 48.0 (SD =25.0),
mean BDI was 18.5 (SD =13.9), and mean DES was 33.7 (SD =22.6).
This improvement was maintained at 6 months, mean IES was 46.5
(SD =26.1), mean BDI was 16.7 (SD =13.3), and mean DES was 34.2
(SD =24.3); and at 1 year, mean IES was 43.8 (SD =26.1), mean BDI
was 17.5 (SD =14.9), and mean DES was 33.4 (SD =23.07). Of the 36
subjects, 21 (58%) showed a response to treatment, as evidenced by a
reduction of 50% or more on IES total score.
Baseline SHSS:C score was shown to have a significant effect on the
reductions in clinical scores; a higher baseline SHSS:C correlated with
a more pronounced reduction in the scores: for IES–R, F(1, 31) =7.14,
p=.0119; for BDI, F(1, 31) =10.06, p=.0034; and for DES, F(1, 31) =
3.74, p=.0623. For the least hypnotically susceptible subjects (defined
as SHSS:C score 4; n=7), only the IES–R showed a reduction in scores
(13.6, SE =4.63; p=.0065).
We also found a reduction in use of medication, shown in Table 1:
31% [95% exact binomial CI:(16.3%, 48.1% )] had reduced or discontin-
ued their selective-serotonin reuptake inhibitor medication, 55% [95%
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0Baseline 6 Weeks 6 Months 12 Months
Change From Baseline (Is mean ± SE)
Figure 1. Clinical condition at baseline, end of treatment, and follow-up.
Table 1
Medication Usage at One-Year Follow-Up Compared With Baseline
SSRIs 36 6 (17) 19 (61) 6 (17) 5 (14)
Benzodiazepines 18 0 (0) 0 (0) 8 (44) 10 (56)
Neuroleptics 9 1 (11) 3 (33) 3 (33) 2 (22)
exact binomial CI:(21.2%, 86.3% )] their antipsychotics, and all 100%
[95% exact binomial CI:(81.5%,100%)] their benzodiazepines.
Age at time of trauma, the period from the trauma to the HOC
treatment, and the period of prior treatment, did not affect treatment
A significant reduction in all three scales was found after 6 weeks:
IES–R, t=15.1, p<.0001; BDI, t=11.24, p<.0001; and DES, t=10.51,
p<.0001. At 12 months, the decline continued in the IES–R scale,
F(1, 30) =14.54, p=.0006, and remained stable in the BDI, F(1, 30) =
0.19, p=.0843, and DES scales, F(1, 30) =0.11, p=.7372.
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We have presented here the findings of an uncontrolled open study
of a new form of hypnotic intervention for chronic, combat-related
PTSD with olfactory components. We found that at the end of six
weekly sessions, 36 active and discharged soldiers, who had suf-
fered for years from symptoms of their disorder and had remained
symptomatic after undergoing other treatments, responded to the
therapy with significant reductions in their psychopathology, as deter-
mined by measures of posttraumatic, depressive, and dissociative
We used a population screened for PTSD who suffered from disso-
ciative or anxiety reactions following olfactory stimuli. This is common
in soldiers with combat-related PTSD, where the smells, produced
for example by explosions and burning flesh, can be elements of the
traumatic event and may play an important role in triggering flash-
backs, dissociative states, and panic attacks. The degree to which this
form of therapy may be usefully applied to PTSD following traumatic
events without olfactory components, or to anxiety disorders in gen-
eral, needs to be investigated separately. We have reported elsewhere
the successful application of HOC in the treatment of a simple phobia
and panic disorder, neither of which was related to olfactory stimuli
(Abramowitz & Lichtenberg, 2009).
While olfactory stimuli have been used in the context of aversive
behavioral therapy to alter patterns of deviant sexuality (Laws, 2001)
and of overeating (Cole & Bond, 1983), this is to our knowledge the
first attempt to exploit olfactory stimuli in working with combat-related
Beyond the elements of CBT, HOC attempts to harness through hyp-
nosis the potent psychological and neurophysiological link between
olfaction, emotion, and memory by reframing the traumatic mem-
ory and replacing the elements that formerly provoked flashbacks
and dissociative states with scents that usher the patient into a calm,
secure, and safe place. The improvement in symptomatology and the
marked reduction in use of psychotropic medication suggest that this
intervention was effective.
This was an open and uncontrolled trial, which obviously limits the
certainty with which we can draw conclusions about the efficacy of
HOC. Moreover, the therapist administering the HOC intervention was
also the treating psychiatrist determining medications and dosages.
Nevertheless, our findings are highly suggestive that HOC can be of
value in the treatment of chronic combat-related PTSD. First of all, the
treatment population had been unresponsive to a variety of treatment
modalities provided for significant periods of time. Any treatment
capable of producing this degree of improvement for chronic PTSD,
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a disorder often refractory to treatment, deserves further investigation.
Second, our follow-up lasted for 1 year, far longer than most treatment
intervention studies in PTSD. This allowed us to see that the improve-
ment was maintained for a year, suggesting strongly that the clinical
gains accruing to PTSD sufferers treated with HOC are longstand-
ing. Finally, the positive correlation between baseline hypnotizability
scores and improvement in clinical assessment scores suggests that
the hypnotic intervention was indeed related to the favorable clinical
HOC was found effective regardless of age of patient and duration
of disorder. This is encouraging; though the technique’s effectiveness
needs to be assessed in a still wider range of ages and of course in
women as well.
PTSD sufferers may be more highly hypnotizable than the general
population (Bryant et al., 2003; D. Spiegel, Hunt, & Dondershire, 1988).
The average hypnotizability score on the SHSS:C in this study of indi-
viduals with PTSD (M=6.31) appears to be higher than that reported
for the general Israeli population (M=5.62; Solomon et al., 1992).
Higher hypnotizability predicted a better response to treatment with
HOC, though low hypnotizables also showed evidence of improve-
ment in their posttraumatic psychopathology. An initial assessment of
hypnotizability may be useful for anticipating the benefit to be gained
from this treatment.
Our findings are strongly suggestive that HOC is of therapeutic
value in treating chronic sufferers of combat-related PTSD. Subsequent
studies should incorporate a randomized control group of PTSD
patients. The control group may receive a proven intervention, such
as CBT. Alternatively, both groups might receive CBT, while one group
receives HOC adjuvant therapy as well.
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Eine neue Hypnosetechnik für die Behandlung gefechtsbezogener
Posttraumatischer Belastungsstörung
Eitan G. Abramowitz und Pesach Lichtenberg
Zusammenfassung: Viele Kriegsveteranen mit Posttraumatischer
Belastungsstörung haben eine olfaktorische Komponente in ihrem
Traumagedächtnis. Diese könnte durch die Technik des hypnothera-
peutischen olfaktorischen Konditionierens (HOC) nutzbar gemacht werden.
36 Patienten mit chronischer PTSD (wiederkehrend olfaktorisch induzierten
Flashbacks) wurden mit 61.5-Stunden Hypnosesitzungen behandelt. Als
abhängige Variablen wurden die revised Impact of Events Scale, das Beck
Depression Inventory und die Dissociative Experiences Scale verwen-
det. Signifikante Reduktionen der Symptomatologie wurden am Ende
der 6-wöchigen Behandlung sowohl für die IES-R als auch für das Beck
Depression Inventory und die Dissociative Experiences Scale beobachtet; 21
(58%) der Teilnehmer reagierten auf die Behandlung mit einer Reduktion
von 50% oder mehr auf der IES-R. Die Verbesserung konnte bei den 6- und
12-Monat Nachfolgeuntersuchungen aufrechterhalten werden. HOC hat
das Potenzial zur Behandlung von PTSD mit olfaktorischen Komponenten
Ralf Schmaelzle
University of Konstanz, Germany
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Une nouvelle technique hypnotique pour le traitement du de syndrome de
stress post-traumatique lié au combat: Une étude ouverte prospective
Eitan G. Abramowitz et Pesach Lichtenberg
Résumé: Les souvenirs traumatisants de nombreux vétérans souffrant du
syndrome de stress post-traumatique (SSPT) comportent une composante
olfactive pouvant être utilisée selon une technique appelée condition-
nement olfactif hypnothérapeutique (COH). Trente-six patients externes
souffrant d’un SSPT chronique, avec flashbacks résistants provoqués par
stimulation olfactive, ont été traités à l’aide de six séances d’hypnose de une
heure et demie chacune. Pour mesurer leurs résultats, les auteurs ont utilisé
l’Échelle (révisée) des répercussions d’un événement (ERE-R), l’Inventaire
de dépression de Beck et l’Échelle d’expériences dissociatives. Une réduc-
tion significative des symptômes a été enregistrée à la fin de la période de
traitement de six semaines avec l’ERE-R ainsi qu’avec l’Inventaire de dépres-
sion de Beck et l’Échelle d’expérience dissociative. Vingt-et-un sujets (58%)
ont répondu au traitement par une réduction d’au moins la moitié de leurs
symptômes sur l’ERE-R. Cette amélioration s’était maintenue aux suivis de 6
mois et de 12 mois. L’usage de médicaments a été réduite. Le COH montre un
effet positif potentiel dans le soulagement des personnes souffrant de SSPT
avec composante olfactive.
Johanne Reynault
C. Tr. (STIBC)
Una nueva técnica de hipnosis para tratar el trastorno por estrés
postraumático relacionado con el combate: Un estudio prospectivo y abierto
Eitan G. Abramowitz y Pesach Lichtenberg
Resumen: Muchos de los veteranos de guerra con TEPT tienen un compo-
nente olfativo a sus recuerdos traumáticos que puede ser utilizado por una
técnica hipnoterapéutica de condicionamiento olfativo (HCO). Tratamos a 36
pacientes ambulatorios con TEPT crónico con flashbacks resistentes induci-
dos olfativamente con 6 sesiones de 1.5 horas usando hipnosis. Utilizamos la
Escala de Impacto del Evento Revisada (IES-R), el Inventario de Depresión
de Beck, y la Escala de Experiencias Disociativas como medidas de resul-
tado. Observamos reducciones significativas de la sintomatología al finalizar
el período de 6 semanas de tratamiento en el IES-R, así como en el Inventario
de Depresión de Beck y la Escala de Experiencias Disociativas; 21 (58%) de
los participantes respondieron al tratamiento con una reducción del 50% o
más en el IES-R. La mejoría se mantuvo en seguimientos a los 6 meses y 1
año. El uso de medicamentos se redujo. El HCO muestra el potencial de pro-
porcionar beneficios a las personas que sufren de TEPT con componentes
Etzel Cardeña
Lund University, Sweden
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... In accordance with these results, our study also showed that blood-injection-injury phobia was significantly correlated with generalized anxiety, which was measured by the Beck`s anxiety scale (14). Taking into consideration these findings some authors suggested certain types of psychological treatments of patients with needle phobia to achieve a decrease in the anxiety level, and therefore to extenuate needle phobia in these patients (6,12,22,27,28). Some other authors even recommended oral premedication with benzodiazepines, or some other anti-anxiety agents to avoid the development of needle phobia in stressful situations, involving blood, injections of injuries (7,27). ...
... It was pointed out previously that specific smell of the room was closely related to the needle phobia (19,29), and our study came to the same conclusion. Specific smell of the room as a provoking factor of needle phobia can be explained by the ability of scents to arouse potent emotional reactions (28). Our study confirmed some additional findings from this study that watching and hearing sounds when medical staff prepare syringes can cause needle phobia (19). ...
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Fear of needles can significantly limit professional and social functioning of a person, and is highly prevalent in general population (4%). The aim of our study was to reveal risk factors that are associated with fear of needles among healthy university students of medicine and pharmacy. The study was of a cross-sectional type. In total, 301 students of medicine or pharmacy (82% female and 18% male) attending from 1st to 5th year of study were surveyed at the Faculty of Medical Sciences, University of Kragujevac, Serbia. The students were surveyed using a questionnaires (scales) for assessing the fear of needless, a visual analog scale for self-assessment intensity of the fear of needless, and a general questionnaire with questions about socio-demographic characteristics of the participants. Using a score on the scales as out-come variables, multiple regressions were employed to reveal factors that may influence the fear of needles. Average values of Blood/Injection Fear Scale, Injection Phobia Scale-Anxiety and Medical Avoidance Survey scores were 7.89 ± 9.48, 4.46 ± 5.18 and 89.95 ± 12.73, respectively. The following factors affected significantly the score of the scales: course of study, chronic disease in the family, fear of a dentist, smell of the room phobia, sound phobia, score on the Beck’s anxiety scale and fear of a situation when medical staff give an injection. The presence of chronic disease in the family was a protective factor, while the other six factors were contributing to the fear of needles. Fear of needles is more prevalent among the students of pharmacy than among the students of medicine. It is less frequent among students with chronic disease in their family, while fear of dentist, smell of the room phobia, sound phobia, general anxiety and fear from the situation when medical staff give an injection are all factors that predispose students of medicine or pharmacy to develop fear of needles.
... Furthermore, the observed increased reactivity to odors in PD might be useful for therapeutic purposes. Although this area is still evolving, Abramowitz and Lichtenberg (2009) showed a case report of a PD patient who was successfully treated with hypnotherapeutic olfactory conditioning. During a state of hypnosis, this patient associated a scent with a feeling of security and self-control which afterwards enabled him to cope with panic attacks. ...
Previous research showed a high sensitivity in sensorial modalities in panic disorder (PD). This disorder has been consistently associated to the joint hypermobility syndrome (JHS). In non-clinical samples, this collagen alteration has been also related to an enhanced sensitivity in some sensorial modalities. The main aim of this study is to explore the olfactory functioning in PD in relation to JHS. Sixty patients with PD and sixty healthy controls performed the Sniffin' Sticks Test (SST) (threshold subtest), and completed the Affective Impact of Odors scale (AIO), the Relational Scale of Olfaction (EROL), and the Odor Awareness Scale (OAS). Clinical symptom rating scales and JHS assessment were also obtained. PD patients showed enhanced odor acuity, greater reactivity to smells and also increased odor awareness compared to the healthy controls. Within the patients group, those suffering from JHS displayed higher functioning in all olfactory domains compared to the non-JHS ones. The JHS and anxiety measures emerged as predictor variables of the olfactory function. The present findings highlight the importance of the olfactory function in PD and underline that both, JHS and anxiety, determine the olfactory characteristics in this disorder.
Background: Although some studies have shown decreases in the olfactory bulb (OB) volume and olfactory function in depressive disorder, there are no studies investigating OB volume in patients with panic disorder. Aim: The aim of this study was to investigate whether there was a change in OB volume and olfactory sulcus (OS) depth in patients with panic and depressive disorder when compared with the control group, and which group was more affected by comparing the two disease groups. Methods: Data of 51 patients with panic disorder and 56 patients with depressive disorder were obtained by scanning the database of the hospital retrospectively. The control group consisted of 56 subjects without panic and depressive disorder. OB volume and OS depth measurements were performed on cranial magnetic resonance imaging (MRI). Results: Bilateral OB volume of the panic and depressive disorder groups were significantly lower than those of the control group. The lowest volume was found in depressive patients. There was no significant difference between the groups with respect to OS measurements. When OB volume and OS depth differences between the genders were evaluated, a statistically significant difference was not determined. Conclusion: Reduced OB volume was determined in both panic and depressive disorder patients, and clarification of these preliminary findings may contribute to the pathophysiology of panic and depressive disorders.
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Olfaction is the most ancient sense and is directly connected with emotional areas in the brain. It gives rise to perception linked to emotion both in everyday life and in memory-recall activities. Despite its emotional primacy in perception and its role in sampling the real physical world, olfaction is rarely used in clinical psychological settings because it relies on stimuli that are difficult to deliver. However, recent developments in virtual-reality tools are creating novel possibilities for the engagement of the sense of smell in this field. In this article, we present the relevant features of olfaction for relaxation purposes and then discuss possible future applications of involving olfaction in virtual-reality interventions for relaxation. We also discuss clinical applications, the potential of new tools, and current obstacles and limitations.
Zusammenfassung Klinische Studien zur Wirksamkeit von Aromatherapie attestieren ätherischen Ölen ein großes Potenzial für die Behandlung von affektiven Beschwerden und kognitiven Defiziten. Nach Jellinek basiert die psychogene Wirksamkeit von ätherischen Ölen und Duftstoffen jedoch nicht nur auf pharmakologischen, sondern auch auf psychologischen Wirkmechanismen, sodass die resultierenden Effekte durch verschiedene, intrapersonelle Faktoren beeinflusst werden können. In diesem Beitrag werden die einzelnen Mechanismen vorgestellt und anhand von Beispielen aus der Emotions- und Kognitionsforschung diskutiert. Der Zusammenhang zwischen Anwendungsart und Wirksamkeit von ätherischen Ölen wird ebenso beleuchtet wie ihre möglichen unerwünschten Wirkungen. Die Kenntnis der verschiedenen Wirkmechanismen ermöglicht einen gezielten Einsatz von ätherischen Ölen und kann die Aromatherapie zu einer noch effizienteren phytotherapeutischen Behandlungsform machen.SchlüsselwörterAromatherapie, Kognition, Emotion, olfaktorische Stimuli,hedonische Valenz
Si les phénomènes de transe sont connus depuis l'Antiquité, le débat sur la nature de l'hypnose entre étatistes et non-étatistes, vieux de plusieurs siècles, est aujourd'hui clos notamment grâce aux progrès apportés par la neuro-imagerie fonctionnelle. En effet, celle-ci permet d'objectiver l'existence d'un fonctionnement neurologique propre en hypnose, corroborant donc l'hypothèse de l'existence d'un état hypnotique, différent de l'état vigil. Cela vient appuyer les thèses psychodynamiques d'Hilgard et Janet, expliquant l'hypnose par un état de conscience modifié et une dissociation dans les fonctions du Moi. Un certain nombre de caractéristiques propres à l'hypnothérapie en font un traitement de choix du psychotraumatisme, qui reste un enjeu majeur de santé publique du fait notamment de sa forte prévalence et de l'importance de ses conséquences sur la santé psychique des sujets. Or, si les études réalisées à ce jour sont encourageantes, elles sont encore trop peu nombreuses pour valider l'hypnothérapie comme traitement de première intention des états de stress post-traumatiques. Certains obstacles propres à l'évaluation d'une thérapie qui se plie difficilement aux protocoles de la recherche en médecine constituent un élément de réponse quant à cette carence d'études sur le sujet. Il reste donc nécessaire d'approfondir la recherche en ce domaine, l'hypnose étant en mesure de constituer un atout thérapeutique majeur dans la prise en charge du psychotraumatisme.
Sleep disturbance is quite common in patients with post-traumatic stress disorder (PTSD), as a symptom of the underlying disorder; as a part of comorbid anxiety, depression, or chronic pain disorder; or as an independent sleep disorder diagnosis. Chronic sleep disturbance from any cause is associated with poorer daytime functioning as well as medical comorbidities and thus critical to address. Insomnia, the most common sleep symptom, is a state of hyperarousal linked to central changes in metabolism and electroencephalographic activity and peripheral mechanisms such as autonomic activation. This physiological state when combined with inadvertent behavioral conditioning (e.g., checking the bedside clock) can become a chronic condition. In patients with PTSD, insomnia can be even more severely chronic given how the associated heightened hypervigilance and nightmares further disrupt sleep. Abnormalities in the brain’s default mode network (DMN) have been implicated in both PTSD, combat trauma (even without PTSD), childhood trauma, and insomnia. The DMN is a network of interconnected brain regions which is most active during low-demand tasks such as daydreaming and self-absorbed thinking and when not attending to outside stimuli. One of the under-recognized treatment modalities for insomnia in patients with PTSD is hypnosis. This chapter will review the empirical evidence on the effectiveness of hypnosis for insomnia and PTSD and summarize the neurobiological substrates underlying the hypnotic state, including changes in the DMN.
A hypnosis protocol for treating panic disorder is provided. The implementation of this protocol is demonstrated through a case example involving the successful treatment of a 28-year-old firefighter presenting with a 4-month history of near-daily panic attacks. Core principles associated with this protocol include: (1) Elementary education about the physiology of panic; (2) A review of primary factors contributing to the evolution and manifestation of panic; (3) Encouragement of physical activity; (4) Utilization of hypnosis applications; and (5) Monitoring and measuring progress evidenced by a reduction in the frequency and intensity of panic attacks. Six years after his last hypnosis session, “Jason,” the once panicked firefighter returned to my office for concerns unrelated to panic, and reported that he remained panic-free, retained his job, and was twice promoted.
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Part 6 focuses on the use of hypnosis in the treatment of the following subtypes within the specific phobia category-natural environmental type, blood-injection-injury type, and other types. The author reviews a range of treatment strategies which have been shown to have been effective in clinical practice. The report examines the efficacy of hypnosis in the treatment of conditions such as wind phobia, heat phobia, balloon phobia and aquaphobia, while attention is given to the blood-injection-injury type which includes needle phobia, a problem which affects a large proportion of the population. Detailed accounts of each treatment strategy are given so that practitioners may incorporate these techniques both in a hospital setting and in private practice.
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A large-scale study of the effectiveness of psychotherapeutic methods for the treatment of posttraumatic stress disorders was conducted. The sample consisted of 112 persons suffering from serious disorders resulting from traumatic events (bereavement, acts of violence, and traffic accidents) that had taken place not more than 5 years before. Trauma desensitization, hypnotherapy, and psychodynamic therapy were tested for their effectiveness in comparison with a waiting-list control group. The results indicated that treated cases were significantly lower in trauma-related symptoms than the control group. (C) 1989 by the American Psychological Association
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The Koach project was designed and implemented by the Mental Health Department of the IDF (Israel Defense Forces) Medical Corps as a treatment program for chronic PTSD veterans, aimed at reducing the prevalence and severity of PTSD and accompanying psychiatric symptomatology and improving functioning in the military, the family, and the community. It was comprised of a 1-month residential phase on an army base, followed by mutual self-help groups in the veterans'' communities. The project combined behavioral, cognitive, and group approaches into an integrated therapeutic program. This article presents the rationale behind the project and describes the treatment approaches that were utilized.
As its title implies, the focus of the work is on what one does in practicing hypnotism, but I also feel that any professional who works with hypnotism ought to know what is fact and what is fiction about hypnosis, one needs to have a thorough knowledge of the phenomena that can be produced and how they are brought about, irrespective of particular applications. . . . For this reason, I have not limited myself to mere description of methods and techniques but have presented them within a framework of what has been scientifically established about hypnotism, delving at some length into the phenomenology of hypnotism. Volume 1 follows closely the original plan of G.T. [General Techniques of Hypnotism] describing in detail context-free techniques, that is, that area of general applicability. Much of Volume 2 describes the traditional, and especially the semi-traditional, approach to clinical hypnotism. This work will probably have a varied readership. It is addressed to a professionally trained audience that I have assumed will have a certain amount of technical knowledge. Last, as with G.T., this work has been written to be used for self-study and training. It should also serve well as a textbook to supplement courses and workshops in hypnotism. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Dissociative Experiences Scale (DES) has now been used in over 100 studies on dissociation. This article reports on a series of meta-analyses to test some of the theoretical assumptions underlying the DES and to examine the instrument's reliability and validity. Studies with the DES were identified through Psychlit, Medline, Social Sciences Citation Index, and Current Contents. Across studies in similar domains (e.g., studies on multiple personality disorders) combined effect sizes were computed using the Rosenthal-Mullen approach. The DES showed excellent convergent validity with other dissociative experiences questionnaires and interview schedules (combined effect size: d = 1.82; N = 5,916). The DES also showed impressive predictive validity, in particular concerning dissociative disorders (Multiple Personality Disorder: combined effect size d = 1.05; N = 1,705) and traumatic experiences (post-traumatic stress disorder: combined effect size d = 0.75; N = 1,099; and abuse: combined effect size d = 0.52; N = 2,108). However, the discriminant validity was less well established. The DES is sensitive to response and experimenter biases. It is recommended to average DES-scores over more points in time and over more judges. The DES seems to measure the current view on past dissociative experiences. The model of dissociation as a form of autohypnosis failed to receive support from the data. A developmental model to interpret dissociation is proposed.