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American Journal of Clinical Hypnosis
47:4, April 2005 Copyright 2005 by the American Society of Clinical Hypnosis
Successful Repeated Hypnotic Treatment of
Warts in the Same Individual:
A Case Report
Robert H. Goldstein
University of Rochester School of Medicine and Dentistry
259
Address correspondence and reprint requests to:
Robert H. Goldstein, Ph.D.
2000 Winton Rd. South
Building 4, Suite 303
Rochester, NY 14618
We report on a case of a female patient who was successfully treated
with hypnosis for warts on 2 occasions separated by an interval of 7
years. Of note is the fact that she had low expectations regarding the
benefit to be derived from hypnosis and did not at first appear to be
highly hypnotizable.
Keywords: Hypnosis, treatment, warts.
The use of hypnotic methods in the treatment of warts has been
reported and utilized for at least 70 years (Scott,1960). Numerous case studies
have appeared in the literature, usually with small numbers of patients
(Obermayer & Greenson, 1949; McDowell, 1949; Yalom, 1964; French, 1977;
Clawson & Swade, 1975; Tasini & Hackett, 1977; Dreaper, 1978; Morris, 1985;
Noll, 1988; Reid, 1989; O’Laughlan, 1995), although larger case series have
also been reported (Bloch, 1927; Vollmer, 1946; Ewin, 1995). Research into the
hypnotic treatment of warts has dealt, in large measure, with the efficacy of the
process, the extent to which hypnotic treatment yields results that exceed
those expected as a result of spontaneous remission, and comparisons of
hypnotic treatments with other modalities (DuBreuil & Spanos, 1993).
Some investigations have also focused on the role of placebo effects
(Clarke, 1965; Stankler, 1967; Spanos, 1988) as well as on the impact of differing
levels of hypnotizability (Asher, 1956; Ulman & Dudek, 1960; Chandrasena,
1982), and on variations in subjects’ cognitive processes and expectations as
these relate to the procedure employed (Kirsch, 1985; Spanos, 1988; Spanos,
1990).
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Goldstein
Individual case reports have generally been considered to be a potential source
of clinical hypotheses but have not been viewed as proof of the role of hypnosis
because of the large number of coexistent factors that cannot be adequately controlled
in the individual case (Mott, 1986). Therefore, the case that will be reported here is not
presented as definitive evidence of hypnotic efficacy. However, there do not appear to
be any case reports that are currently available in which a single individual was
successfully treated with hypnosis on two separate occasions separated by a
considerable time period and, therefore, it was thought that this case may be of interest
to readers of this Journal.
History
When seen on the first occasion, the patient presented as a pleasant articulate
16-year-old Caucasian female who was referred to the author at the suggestion of the
dermatologist who had been treating her for bilateral plantar warts for somewhat over a
year. The warts had, in fact, been present since the patient was 9 years old. Medical
therapy had included the application of liquid nitrogen and other topical agents. The
patient reported that these had been somewhat helpful since the warts had “come and
gone” (i.e., increased and diminished) several times. She reported that at one point they
had “almost gone,” but rapidly reappeared when treatment was discontinued. On the
most recent dermatological consultation, the patient was offered the options of laser
therapy, extensive surgery, and hypnosis. When she learned that neither of the first
two would assure that the warts might not recur, she agreed to referral for hypnosis.
The patient described her belief that the warts had been contracted “in the
pool” where, as an active competitive swimmer, she spent considerable time. She added
that they had seemed to become more troublesome during the swim season. The warts
were not described as being particularly painful, but their location, on both heels, was
noted to be “annoying.” She described herself as being “sick of them” and as wanting
them “to go away.” She stated that she had been led to believe that with the medical
treatment that had been carried out thus far, “the average person would have gotten rid
of them by now.”
The patient reported no prior history of mental health contacts and had no
prior experience with hypnosis, but did mention that her mother had known people who
had hypnosis for childbirth and that “it had worked.”
Treatment
Hypnosis was explained to her as being a process in which she could learn to
focus her attention and that she would be in full control of the experience. An initial eye
roll test (Spiegel & Spiegel, 1978) resulted in a response rated as a 2 out of 4 and hence
could be interpreted as indicating a modest capacity for hypnotic responding. Initial
induction was accomplished by eye fixation with upward gaze, eye closure, and
deepening by backward counting from ten to one together with imagery of descending
a staircase. Imagery of a relaxing pleasurable scene was suggested based on her
description of her favorite situations; that is, stretched out on a blanket on the grass
with her cat or relaxing in a tub of warm water. After approximately 15 minutes devoted
to a gradual induction and deepening, communication via finger signals was established
and an inquiry was conducted during which the patient indicated that she was
comfortable with the idea of ridding herself of the warts and that she had no need to
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Repeated Hypnotic Treatment of Warts
retain them.
Direct suggestions were then given to the effect that she would give her body
permission to do all that was necessary to restore the skin in the affected areas to its
normal healthy condition. She was also requested to visualize the way she would like
the skin of her heels to appear.
Following preparation for re-induction on subsequent meetings, trance was
terminated by having the patient count from one to five. She emerged rapidly from
trance, reporting having felt “very relaxed” and estimating the duration of the experience
as having been approximately 15 minutes, with the actual elapsed time having been 35
minutes. The patient’s mother had been present during the entire procedure
On the second treatment session, one week later, the patient reported no major
changes in the warts, but noted that they had not gotten worse, as had often been the
case during a period of active swimming practice and competition such as the one in
which she was currently engaged.
A similar induction procedure was conducted but with the addition of a
successful right-hand levitation. Right-arm rigidity was suggested and trance was tested
by challenging the patient to bend her arm, which she was unable to do until given
permission to do so.
Similar suggestions were given; that is, that her body would do all that was
necessary to cause the warts to clear up and disappear. Suggestions were also given
that she would feel some cooling of the affected areas as she visualized her heels with
“clear, natural, pink healthy skin.”
At the third treatment session, two weeks later, the patient reported that the
warts had completely disappeared from her right heel and that her left heel was clear,
but with a slight amount of tissue still being “raised up.” She described her heels as
being “clean and real nice” and stated that since the initial onset of the warts years ago
her heels “had never been as good as this.” Her parents confirmed this. She stated that
the disappearance of the warts was “weird” and that it “seemed like it just happened
overnight.”
A further hypnotic induction was carried out essentially replicating the prior
session. In addition, suggestions were given that she would be able to induce a self-
hypnotic state by the means she had learned and that further visualization could be
carried out in order to “continue the effect.” She subsequently reported that during the
trance she had noticed a slight temperature change characterized by a “line drawn
across my ankle, above which the skin would not cool, but instead got warm.” A brief
telephone contact several weeks later indicated that her condition remained quite
satisfactory.
Seven years later, the patient contacted the writer to request assistance with
another group of warts, this time on her right index and middle fingers. When seen, she
presented now as an attractive young woman who reported that there had been no
recurrence of the plantar warts in the 7 years since the initial hypnotic treatment. She
did, however, note that the warts on her fingers had been present for approximately 6
years, and that she had sought dermatologic consultation only when they had begun
to enlarge and spread during the previous 10 months.
Medical therapy had again involved liquid nitrogen and Duofilm. She felt that
there had been some improvement in her condition, but that the consultation with
several other dermatologists had been unsatisfactory because each had informed her
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Goldstein
that the warts “had gone” even though she did not feel that this was the case. (The
warts were, in fact, plainly evident to the writer at the time of this second contact, and
the observations of the dermatologists she had consulted remained inexplicable.) The
most recent dermatologist had, in addition to medical treatment, suggested that she
think of the warts as responding to her placing her hands in warm water while thinking
of the warts as “being gone” and her hands as “being perfect.” She had also been
instructed to visualize water running under the skin of her hands and there being
“nothing there to interfere with it.” She had attempted this repeatedly, but reported
that she had been unable to picture her hands without the warts. Nevertheless, she felt
that some progress had been made.
The patient reported having been quite busy for some time preparing for her
upcoming marriage. Indeed, it was the fact of her impending marriage, some two weeks
hence, that had led her to request hypnotic treatment now. She anticipated having to
shake hands frequently with guests and family members on her wedding day and both
she and her fiancé wanted her to be rid of the warts for that occasion
On interview, she described herself as “not sold on hypnosis” but as being
more accepting of the value of “positive thinking.” She indicated, however, that she did
feel that hypnosis had “made a difference” in her prior therapy. She described her
father as having recommended that she again consult with the writer for hypnotic
treatment and added that “Since he’s willing to pay for it, I’ll do it.”
The hypnotic intervention on this second occasion consisted of a single
session, using an induction essentially identical to that employed previously. Finger
signals were again used to determine that she had no need to retain the warts.
Suggestions again involved her using “all the resources of mind and body to do whatever
is needed to eliminate the warts.” Specific suggestions at this time emphasized that
these bodily resources would “identify, destroy, and dispose of the viral invader of
your fingers.” It was also suggested that she would sense a throbbing or tingling
feeling in her fingers as this occurred. Finally, imagery of her fingers having “clean,
clear, smooth, healthy, pink, natural skin” was suggested.
An appointment was made for a second session 12 days later, but 5 days after
the first session the patient called and left a message canceling this second appointment,
stating that “the warts are all gone.” In a brief phone conversation on the day of the
canceled appointment, she reported that she had seen her dermatologist since the
hypnotic session and that he had confirmed that the warts had fully regressed. The
patient described having used “positive thinking” while holding her hands in warm
water and that she had become able to do this even without the aid of warm water
immersion. A follow-up phone conversation several months later confirmed the
continuing absence of the warts.
Discussion
Several factors are of interest in this case. First, it is noteworthy that the
patient was able to achieve rapid regression and disappearance of two separate
outbreaks of warts, each of which had been present for at least 6 years. The possibility
of spontaneous regression after this extended a course would appear to be quite low
since spontaneous regression is generally reported to occur over a shorter period of
time (Lynch, 1982). The patient had, in each instance, been receiving conventional
medical treatment; in the first instance, for a period of 1 year and, in the second, for 10
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Repeated Hypnotic Treatment of Warts
months prior to the hypnotic intervention. While the rapid response occurred
immediately following the hypnotic intervention, one cannot rule out the possibility of
1) a delayed response to the medical treatment or 2) an interaction between the hypnotic
procedure and the medical treatment, which allowed the medical treatment to become
more efficacious.
Secondly, on both occasions, the patient appeared to have a low level of belief
in the efficacy of the hypnotic intervention. Thus, the hypothesis that “believed in
efficacy” plays a central role in hypnotic treatment of warts (Johnson & Barber, 1978) is
not supported by this case. It has been reported that high expectancy of successful
hypnotic treatment of warts is not necessarily predictive of a positive treatment outcome,
but that low expectancy is associated with a negative outcome (Spanos, 1988). In the
present case, the patient felt that cognitive factors (i.e., “positive thinking”) could be
expected to produce beneficial results, but she did not specifically attribute these
results to the hypnotic procedure. It is, of course, possible that her belief in the use of
“positive thinking” may have played a significant role in the positive results achieved.
Third, although no extensive formal assessment of the patient’s level of
hypnotic capacity was undertaken, the clinical impression was certainly that, despite
her skeptical attitude and her low eye-roll score, she was able to experience an adequate
level of trance depth. The reports available on the relationship between hypnotizability
and successful treatments yield mixed results. Studies that used nonstandard measures
of hypnotizability have found a relationship between hypnotizability and wart loss
(Asher, 1956; Sinclair-Gieben & Chalmers, 1959; Ullman & Dudek, 1960 ), while those
that have assessed hypnotizability by more rigorous means have not found any such
relationship. (Spanos et al., 1988; Surman et al., 1973).
All the limitations of single case reports are also obviously present in this
case, but it could be argued that somewhat greater significance could be attributed to
this case because of the unique opportunity to conduct a second and apparently equally
successful trial of the hypnotic procedure in the same subject following an interval of
7 years. In that sense, one might consider this to have been an instance of a within-
subject repeat measures model of single subject research.
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