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Hypnosis and physiotherapy

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Abstract

Hypnotherapy is now a validated evidence-based science, demonstrated on brain imaging, especially thanks to modern techniques of medical imaging. Imaging studies further enabled the hypnotic state to be described as a specific state of consciousness, differentiating it from other states of consciousness. This state of consciousness is primarily characterized by a state of mental permeability or suggestibility, showing an increased ability to produce desirable changes in motivation, habits, lifestyle, health, perception and behavior as well as modifying physical sensation. Its usefulness is interesting for physiotherapists since hypnosis has higher levels of evidence than many other conventional tools used in physiotherapy. The basic techniques of hypnosis are: the interview which seeks to put the patient at ease, eliminating all preconceived misconceptions about hypnosis and creating treatment expectations that are as positive as possible; suggestion which is the most powerful technique in hypnosis: direct suggestion, indirect suggestion, post-hypnotic suggestion, and self-suggestion; induction which is the process of transition from the usual waking state to the hypnotic state; visualization which consists in a virtual experience of a specific event proposed by the therapist. It is often used by physiotherapists in traumatologic, rheumatologic and neurologic rehabilitation, where efficacy is improved by hypnosis. Hypnosis affects the subconscious, which is the center of emotions, habits and automatisms. The subconscious transmits commands to the unconscious mind, which in return translates these emotions into somatic feelings and reactions. In parallel, the neurophysiology of hypnotic suggestion is currently well-defined, as is the brain permeability associated with increased regional cerebral blood flow in the attentional system of the brain. Furthermore, positive expectation and labeling of “hypnosis” seem to have remarkable effects on the efficacy of the procedure. Clinical randomized controlled studies have shown efficacy on pain in general, tension headache and migraine, temporomandibular pain, chronic low back pain, osteoarthritis and bone and joint pain, fibromyalgia, regional pain syndrome, phantom limb pain, sports rehabilitation, irritable bowl syndrome, stress and anxiety, and many other pathologies. Hypnosis is a powerful and very useful tool in everyday physiotherapy. Level of evidence NA.

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... Hypnosis exists since the beginning of humanity and is an integral part of our daily life. Hypnosis affects the subconscious, which is the center of emotions, habits and automatisms [4]. Hypnotherapy is a procedure by virtue of which the professional proposes to patients suggestions resulting in changes at both physical and psychical levels. ...
... Most hypnotherapy sessions include enjoyable and desirable situations such as light and floating feelings and deep physical and mental relaxation that result in therapeutic effects of hypnosis. With the help of hypnosis, patient learn that they have more control over their body than they thought (Wehbe & Safar, 2015) Previous studies have revealed that hypnotherapy can be effective in treatment of anxiety, pain, and sleep disorders as well as in enhancing self-esteem (Lam et al., 2015; Shenefelt, 2013; Stafrace & Evans, 2004; Steel, Frawley, Sibbritt, Broom, & Adams, 2016) Since hypnosis is a useful technique that can lead to ego strengthening (Hartland, 1971) and valuable cognitive changes (Van Dyck & Spinhoven, 1994), further research is necessary in this regard. Accordingly, the effect of hypnotherapy on ego strengthening and self-talk modification in female-headed households will be pursued in this paper. ...
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Purpose: Females who are heads of households, due to considerable life difficulties, are a vulnerable population that needs more support, including psychological treatment and empowerment programs. The current paper aims at ego strengthening and decreasing negative self-talk as useful strategies to achieve this goal. Methods: This paper was a quasi-experimental study that aimed to strengthen the ego and reduce the negative selftalk through hypnotherapy in female-headed households. In this study, a sample of 30 Iranian women were selected by purposive Sampling from all female-headed households who had been referred for treatment was randomly divided into two groups (experimental and control), and eight 45-minute sessions of hypnotherapy were performed for them. The ego strength and self-talk of the subjects were measured using Psychosocial Inventory of Ego Strengths and Self-Talk Inventory. Results: Multiple Analysis of Covariance indicated there was a significant difference between the control and the experimental group in terms of ego strength Wilks' Lambda = 0.29,F = 25.6,p < .001, and negative self-talk scores, Wilks' Lambda = 0.49,F = 10.6,p = .001, on the posttest. And ego strength. In other words, after controlling the effect of pretest or a covariate, ego strength was higher in the experimental group than in the control group, and the experimental group had less negative self-talk after treatment. Conclusions: The result of this study indicates that ego-strengthening-based hypnotherapy can be effective in reducing negative self-talk.
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Article
Visualizations under hypnosis enabled nationally ranked Stanford male gymnasts to execute for the first time several complex tricks that they had been working on for over a year. The gymnasts were able to eliminate timing errors in the tricks, to increase flexibility, and, possibly, to concentrate strength. The rationale for the effectiveness of trance visualizations, the induction and deepening strategies used, and the effects are described. Also included is an example of the use of a translator for the induction of a subject with a minimal fluency in English. Implications for further use of hypnosis with athletes are suggested.
Article
The purposes of this study were to quantify the effects of severe irritable bowel syndrome on quality of life and economic functioning, and to assess the impact of hypnotherapy on these features. A validated quality of life questionnaire including questions on symptoms, employment and health seeking behaviour was administered to 25 patients treated with hypnotherapy (aged 25-55 years; four male) and to 25 control irritable bowel syndrome patients of comparable severity (aged 21-58 years; two male). Visual analogue scales were used and scores derived to assess the patients' symptoms and satisfaction with each aspect of life. Patients treated with hypnotherapy reported less severe abdominal pain (P < 0.0001), bloating (P < 0.02), bowel habit (P < 0.0001), nausea (P < 0.05), flatulence (P < 0.05), urinary symptoms (P < 0.01), lethargy (P < 0.01), backache (P = 0.05) and dyspareunia (P = 0.05) compared with control patients. Quality of life, such as psychic well being (P < 0.0001), mood (P < 0.001), locus of control (P < 0.05), physical well being (P < 0.001) and work attitude (P < 0.001) were also favourably influenced by hypnotherapy. For those patients in employment, more of the controls were likely to take time off work (79% vs. 32%; p = 0.02) and visit their general practitioner ( 58% vs. 21%; P = 0.056) than those treated with hypnotherapy. Three of four hypnotherapy patients out of work prior to treatment resumed employment compared with none of the six in the control group. This study has shown that in addition to relieving the symptoms of irritable bowel syndrome, hypnotherapy profoundly improves the patients' quality of life and reduces absenteeism from work. It therefore appears that, despite being relatively expensive to provide, it could well be a good long-term investment.
Article
Sixty-one patients hospitalized for severe burns were randomly assigned to conditions in which they received either hypnosis or a control condition in which they received attention, information, and brief relaxation instructions from a psychologist. The posttreatment pain scores of the 2 groups did not differ significantly when all patients were considered. However, when a subset of patients who reported high levels of baseline pain were examined, it was found that patients in the hypnosis group reported less posttreatment pain than did patients in the control group. The findings are used to replicate earlier studies of burn pain hypnoanalgesia, explain discrepancies in the literature, and highlight the potential importance of motivation with this population.
Article
The study of hypnosis has been plagued by conflict. Although a more recent trend has been the search for convergence among disparate points of view, two highly salient issues remain contentious: the question of whether hypnosis involves alterations in consciousness, and the nature and correlates of individual differences in hypnotic response. Theoretical convergence is a laudable goal, but not at the expense of obscuring the complexity of hypnosis as a state of altered consciousness, a cognitive skill, and a social interaction. Perhaps the best prescription for convergence in hypnosis is the cautious conviction advocated by Kenneth S. Bowers and so clearly exemplified in his own research.
Article
We present a new theory of hypnotic involuntariness based on an integration and extension of recent social and cognitive theories on the automaticity of mundane, intentional behavior. According to this model, experiences of volition and involuntariness-in and out of hypnosis-are constructions or interpretations made possible by the high degree of automaticity that is a characteristic of all complex behavior, including novel behavior. Suggested nonvolitional behaviors are intentional acts that are triggered automatically by situational cues (suggestions) and cue-related sensations. The triggering of both the behaviors and the sensations are enabled by the formation of a generalized response expectancy, which is a cognitive set to respond appropriately to suggestions. Response expectancies are functionally equivalent to implementation intentions taking the form, "emit response x when situation y is encountered." The classification of a response set as either an expectancy or an intention and the experience of the response as volitional or nonvolitional depend on interpretations derived from instructional cues and prior beliefs.
Article
An auditory hallucination shares with imaginal hearing the property of being self-generated and with real hearing the experience of the stimulus being an external one. To investigate where in the brain an auditory event is "tagged" as originating from the external world, we used positron emission tomography to identify neural sites activated by both real hearing and hallucinations but not by imaginal hearing. Regional cerebral blood flow was measured during hearing, imagining, and hallucinating in eight healthy, highly hypnotizable male subjects prescreened for their ability to hallucinate under hypnosis (hallucinators). Control subjects were six highly hypnotizable male volunteers who lacked the ability to hallucinate under hypnosis (nonhallucinators). A region in the right anterior cingulate (Brodmann area 32) was activated in the group of hallucinators when they heard an auditory stimulus and when they hallucinated hearing it but not when they merely imagined hearing it. The same experimental conditions did not yield this activation in the group of nonhallucinators. Inappropriate activation of the right anterior cingulate may lead self-generated thoughts to be experienced as external, producing spontaneous auditory hallucinations.
Hypnosis has been used in numerous medical applications for functional and psychological improvement, but has been inadequately tested for anatomical healing. To determine whether a hypnotic intervention accelerates bodily tissue healing using bone fracture healing as a site-specific test. Randomized controlled pilot study. Massachusetts General Hospital, Boston, Mass, and McLean Hospital, Belmont, Mass. Twelve healthy adult subjects with the study fracture were recruited from an orthopedic emergency department and randomized to either a treatment (n = 6) or a control group (n = 6). One subject, randomized to the treatment group, withdrew prior to the intervention. All 11 subjects received standard orthopedic care including serial radiographs and clinical assessments through 12 weeks following injury. The treatment group received a hypnotic intervention (individual sessions, audiotapes) designed to augment fracture healing. Radiological and orthopedic assessments of fracture healing 12 weeks following injury and hypnotic subjects' final questionnaires and test scores on the Hypnotic Induction Scale. Results showed trends toward faster healing for the hypnosis group through week 9 following injury. Objective radiographic outcome data revealed a notable difference in fracture edge healing at 6 weeks. Orthopedic assessments showing trends toward better healing for hypnosis subjects through week 9 included improved ankle mobility; greater functional ability to descend stairs; lower use of analgesics in weeks 1, 3, and 9; and trends toward lower self-reported pain through 6 weeks. Despite a small sample size and limited statistical power, these data suggest that hypnosis may be capable of enhancing both anatomical and functional fracture healing, and that further investigation of hypnosis to accelerate healing is warranted.
Article
The response set theory of hypnosis (Kirsch & Lynn, 1997) is an extension of response expectancy theory (Kirsch, 1985), which is rooted in social cognitive approach to understanding human experience and behavior. Although the idea of a uniquely hypnotic altered state of consciousness is rejected, so too are compliance-based explanations of hypnotic behavior. Suggestions, in or out of the social context of hypnosis, can produce profound alterations in experience, including dissociative experiences, and these can be verified through corresponding changes in brain physiology. Response expectancies play a major, but not exclusive, role in the production of subjective experience in general (Kinsbourne, 1998) and therefore of these suggested experiences as well. Because of widespread cultural beliefs about hypnosis, the hypnotic context intensifies the effects of suggestion for most people, and this is the primary source of its therapeutic effects.
Article
The neural mechanisms underlying the modulation of pain perception by hypnosis remain obscure. In this study, we used positron emission tomography in 11 healthy volunteers to identify the brain areas in which hypnosis modulates cerebral responses to a noxious stimulus. The protocol used a factorial design with two factors: state (hypnotic state, resting state, mental imagery) and stimulation (warm non-noxious vs. hot noxious stimuli applied to right thenar eminence). Two cerebral blood flow scans were obtained with the 15O-water technique during each condition. After each scan, the subject was asked to rate pain sensation and unpleasantness. Statistical parametric mapping was used to determine the main effects of noxious stimulation and hypnotic state as well as state-by-stimulation interactions (i.e., brain areas that would be more or less activated in hypnosis than in control conditions, under noxious stimulation). Hypnosis decreased both pain sensation and the unpleasantness of noxious stimuli. Noxious stimulation caused an increase in regional cerebral blood flow in the thalamic nuclei and anterior cingulate and insular cortices. The hypnotic state induced a significant activation of a right-sided extrastriate area and the anterior cingulate cortex. The interaction analysis showed that the activity in the anterior (mid-)cingulate cortex was related to pain perception and unpleasantness differently in the hypnotic state than in control situations. Both intensity and unpleasantness of the noxious stimuli are reduced during the hypnotic state. In addition, hypnotic modulation of pain is mediated by the anterior cingulate cortex.
Article
This value of imagery in sports is widely acknowledged. The contribution of hypnosis to enhancing athletes' performance is also recognized, but the value of hypnosis in enhancing imagery has little recognition. The reason for this neglect is explored. The study used Martens' Sport Imagery Questionnaire, which asked the participants to image 4 different situations in their own sport--practicing alone, practicing in front of others, watching a teammate, and competing. Participants reported their subjective impression of vividness on four dimensions--visual, auditory, kinesthetic, and affective. The 14 athletes participating imaged each situation in and out of hypnosis--half of the time the imagery in hypnosis came first and half after. The participants reported that the imagery under hypnosis was more intense for each dimension and more intense for each situation. Whether the imagery was done under hypnosis first or after was not significant. The findings suggest that hypnosis substantially enhances imagery intensity and effectiveness.
Article
Hypnosis has existed since the beginning of humankind, and is a part of everyday life. It is a valuable addition to the methods and techniques available to all health care-providers, as well as a safe and uncomplicated method used to enhance patient health care. It is simply a state of complete physical and mental relaxation which produces an altered state of consciousness acceptable to suggestions. It is characterized by an increased ability to produce desirable changes in habit patterns, motivation, self-image, lifestyle, and personal health.
Article
Hypnorelaxation has a potentially beneficial effect in the treatment of masticatory myofascial pain disorders (MPD). However, there are no data regarding the efficacy of hypnorelaxation in the treatment of MPD compared with other accepted modes of treatment (such as occlusal appliance) or with the mere effect of time. The purpose of the present study was to evaluate the effectiveness of hypnorelaxation in the treatment of MPD compared with the use of occlusal appliance and/or to minimal treatment. The study population consisted of 40 female patients with myofascial pain who were allocated to 1 of 3 possible treatment groups: (1) hypnorelaxation (n = 15), (2) occlusal appliance (n = 15), and (3) minimal treatment group (n = 10). Both active treatment modes (hypnorelaxation and occlusal appliance) were more effective than minimal treatment regarding alleviating muscular sensitivity to palpation. However, only hypnorelaxation (but not occlusal appliance) was significantly more effective than minimal treatment with regard to the patient's subjective report of pain on the Visual Analog Scale. Hypnorelaxation is an effective mode of treatment in MPD, especially with regard to some of the subjective pain parameters.
Article
Hypnosis is associated with profound changes in conscious experience and is increasingly used as a cognitive tool to explore neuropsychological processes. Studies of this sort typically employ suggestions following a hypnotic induction to produce changes in perceptual experience and motor control. It is not clear, however, to what extent the induction procedure serves to facilitate suggested phenomena. This study investigated the effect on suggestibility of (a) a hypnotic induction and (b) labelling that procedure 'hypnosis.' Suggestibility of participants was tested before and after an adapted hypnotic procedure, which was either labelled as 'hypnosis' or as 'relaxation.' The hypnotic procedure produced a modest increase in suggestibility when it was called 'relaxation,' but a very significant increase if it was labelled 'hypnosis.' The results are important for both clinical and experimental applications and indicate that labelling an induction procedure 'hypnosis' is an important determinant of subsequent responses to suggestion.
Article
Hypnosis is a procedure during which a mental health professional suggests that a patient experience changes in sensations, perceptions, thoughts, or behavior. The purpose of this article is to briefly describe the use of various methods of relaxation, hypnosis, and imagery techniques available to enhance athletic performance. The characteristics that these techniques have in common include relaxation, suggestibility, concentration, imaginative ability, reality testing, brain function, autonomic control, and placebo effect. Case studies are provided for illustration.
Article
Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause. Despite its prevalence, there remains a significant lack of efficient medical treatment for IBS to date. However, according to some previous research studies, hypnosis has been shown to be effective in the treatment of IBS. To determine the definite efficacy of hypnosis in the treatment of irritable bowel syndrome. A systematic review of the literature on hypnosis in the treatment of IBS from 1970 to 2005 was performed using MEDLINE. Full studies published in English were identified and selected for inclusion. We excluded case studies and those studies in which IBS symptoms were not in the list of outcome measures. All studies were reviewed on the basis of the Rome Working Team recommendations for design of IBS trials. From a total of 22 studies, seven were excluded. The results of the reviewed studies showed improved status of all major symptoms of IBS, extracolonic symptoms, quality of life, anxiety, and depression. Furthermore these improvements lasted 2-5 years. Although there are some methodologic inadequacies, all studies show that hypnotherapy is highly effective for patients with refractory IBS, but definite efficacy of hypnosis in the treatment of IBS remains unclear due to lack of controlled trials supporting this finding.