The role of hypnotizability assessment in treatment

Redefining hypnosis: A narrative review of theories to move towards an integrative model

Hypnosis is an ancient mind-body intervention that has regained interest with the surge of research in the last decade documenting its clinical validity. Yet, theoretical controversies and misconceptions prevail among theorists, clinicians, and the general public, impeding the understanding, acceptance, replication, and use of hypnosis. Providing adequate information, which dispels misconceptions and promotes more balanced views, is warranted to facilitate the implementation and adoption of hypnosis in clinical and research settings. This review re-examines the conceptualisation of hypnosis throughout history and the theoretical controversies surrounding it while highlighting their meeting points and clinical implications. Despite dichotomies, a broad agreement appears across theoretical approaches regarding hypnotic analgesia effects, key components, and vocabulary. Further, theories highlight key factors of hypnotic responding. For instance, social theories highlight social and contextual variables, whereas state theories highlight biopsychosocial mechanisms and individual factors. Based on theories, the terms hypnotherapy or clinical hypnosis are recommended to refer to the therapeutic use of hypnosis in psychotherapeutic and medical contexts, respectively. This review concludes with a model that integrates various theories and evidence and presents hypnosis as a complex multifaceted intervention encompassing multiple procedures, phenomena, and influencing factors. This review intends to deepen our understanding of hypnosis, and promote its more rapid adoption and adequate implementation in research and clinical contexts, in addition to steering research towards evidence-based hypnotic practice. The review can have important research and clinical implications by contributing to advancing knowledge regarding hypnotic procedures, phenomena, and influencing factors.

Real-time assessment of hypnotic depth, using an EEG-based brain-computer interface: a preliminary study

OBJECTIVE

Hypnosis can be an effective treatment for many conditions, and there have been attempts to develop instrumental approaches to continuously monitor hypnotic state level ("depth"). However, there is no method that addresses the individual variability of electrophysiological hypnotic correlates. We explore the possibility of using an EEG-based passive brain-computer interface (pBCI) for real-time, individualised estimation of the hypnosis deepening process.

RESULTS

The wakefulness and deep hypnosis intervals were manually defined and labelled in 27 electroencephalographic (EEG) recordings obtained from eight outpatients after hypnosis sessions. Spectral analysis showed that EEG correlates of deep hypnosis were relatively stable in each patient throughout the treatment but varied between patients. Data from each first session was used to train classification models to continuously assess deep hypnosis probability in subsequent sessions. Models trained using four frequency bands (1.5-45, 1.5-8, 1.5-14, and 4-15 Hz) showed accuracy mostly exceeding 85% in a 10-fold cross-validation. Real-time classification accuracy was also acceptable, so at least one of the four bands yielded results exceeding 74% in any session. The best results averaged across all sessions were obtained using 1.5-14 and 4-15 Hz, with an accuracy of 82%. The revealed issues are also discussed.

Hypnotizability in the Clinic, Viewed from the Laboratory

A recent international survey discovered that clinicians who use hypnosis in their practice rarely assess the hypnotizability of their patients or clients. This contrasts sharply with the practice in laboratory research. One reason offered for this discrepancy is that hypnotizability does not strongly predict clinical outcome. But a comparison of this relationship with similar correlations in other domains shows that this criticism is misleading-especially when the treatment capitalizes on the alterations in perception, memory, and voluntary control that characterize the domain of hypnosis. Routine assessment of hypnotizability improves clinical practice by enabling clinicians to select patients for whom hypnosis is appropriate; and it improves clinical research by providing important information about the mechanisms underlying hypnotic effects.

Clinical Hypnosis for Pediatric Gastrointestinal Disorders: A Practical Guide for Clinicians

Functional abdominal pain disorders (FAPDs) are common in the pediatric population and are associated with a significant reduction in quality of life. Bidirectional communication of the brain-gut axis plays an important role in pain generation and perception in FAPDs. There is a paucity of data on the best approach to treat this group of disorders, with no Food and Drug Administration (FDA)-approved drugs and scarce research to substantiate the use of most medications. Use of hypnosis in pediatric FAPDs is supported by evidence and has long-term benefits of up to at least 5 years beyond completion of treatment, highlighting the importance of incorporating this therapy into the care of these patients. The mechanisms by which clinical hypnosis is beneficial in the treatment of FAPDs is not completely understood, but there is growing evidence that it impacts functioning of the brain-gut axis, potentially through influence on central pain processing, visceral sensitivity, and motility. The lack of side effects or potential for significant harm and low cost makes it an attractive option compared to pharmacologic therapies. This review addresses current barriers to clinical hypnosis including misconceptions among patients and families, lack of trained clinicians, and questions around insurance reimbursement. The recent use of telemedicine and delivery of hypnosis via audio-visual modalities allow more patients to benefit from this treatment. As the evidence base for hypnosis grows, acceptance and training will likely increase as well. Further research is needed to understand how hypnosis works and to develop tools that predict who is most likely to respond to hypnosis. Studies on cost-effectiveness in comparing hypnosis to other therapies for FAPDs will increase evidence for appropriate healthcare utilization. Because hypnosis has applications beyond pain and is child-friendly with minimal to no risk, hypnosis could be an important therapeutic tool in the wider pediatric gastrointestinal population.

Hypnotherapy for procedural pain, itch, and state anxiety in children with acute burns: a feasibility and acceptability study protocol

Background

Burns and related procedures are painful and distressing for children, exposing them to acute and chronic sequelae that can negatively affect their physiological, psychological, and social functions. Non-pharmacological interventions such as distraction techniques are beneficial adjuncts to pharmacological agents for procedural pain, state anxiety, and itch in children with burns but have limitations (e.g. lack of research on burn-related itch, tailoring, and consensus on optimal treatment). Hypnotherapy is a non-pharmacological intervention that can be tailored for varied settings and populations with evidence of benefit for itch and superior effectiveness in comparison to other non-pharmacological interventions for children’s procedural pain and state anxiety. Thus, children with burns can benefit from hypnotherapy as an adjunct to pharmacological agents. Yet, in paediatric burns, rigorous studies of effectiveness are limited and no studies have been identified that screen for hypnotic suggestibility, an important predictor of hypnotherapy outcomes. Considering potential barriers to the delivery of hypnotherapy in paediatric burns, the proposed study will examine the feasibility and acceptability of hypnotic suggestibility screening followed by hypnotherapy for procedural pain, state anxiety, and itch in children with acute burns.

Methods

An observational mixed-methods feasibility and acceptability study will be conducted over 15 weeks. Eligible children (N = 30) aged 4 to 16 years presenting to a paediatric burns outpatient centre in a metropolitan children’s hospital in Australia with acute burns requiring dressing changes will be included. Eligible parents of children (N = up to 30) and clinicians who perform dressing changes (N = up to 20) will also be included. Child participants screened as having medium to high suggestibility as assessed by behavioural measures will receive hypnotherapy during dressing changes. A process evaluation will target feasibility and acceptability as primary outcomes and implementation (i.e. fidelity in delivery), reach, potential effectiveness, and adoption of evaluation procedures and intervention as secondary outcomes.

Discussion

Ethical approval was obtained from the Queensland Children’s Hospital and Health Service ethics committee. Results will be published in peer-reviewed publications and conference proceedings.

The findings will guide the design of future trials on the effectiveness of hypnotherapy and inform the development of child-centred hypnotic interventions in children with burns.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12620000988954

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01017-z.

Association of Thought Impact Scale Scores with Hypnosis Treatment Responses and Hypnotherapy-Seeking: A Confirmation Study

Previous research has indicated that high Thought Impact Scale (TIS) scores are associated with greater therapeutic response to hypnosis treatment and greater tendency to seek such treatment. This study aimed to confirm those findings in a new population-based subject sample and also evaluate hypothesized associations of TIS scores with several hypnotic phenomena. An internet survey of 1,500 U.S. adults identified 80 individuals who had undergone hypnosis treatment. As previously found, high TIS scorers were much more likely than low scorers (median-split) to have undergone hypnosis treatment (7.2% vs. 3.2%, p < .0001), but, in contrast with prior findings, high TIS scorers did not report a significantly higher rate of moderate or greater improvement from hypnosis treatment (58.6% vs. 40.9%, p = .12). TIS scores were positively correlated with greater imagery vividness, sense of automaticity, and altered body perception during hypnosis.

UNITED KINGDOM NORMS FOR THE HARVARD GROUP SCALE OF HYPNOTIC SUSCEPTIBILITY, FORM A

The Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A), is widely used as a measure of suggestibility to screen participants for research purposes. To date, there have been a number of normative studies of the HGSHS:A, the majority of which originate from Western countries. The outcomes of these Western studies are summarized, and variations in methodologies are described and discussed. Also reported are the psychometric properties of the HGSHS:A in a large contemporary United Kingdom (UK) sample. Overall, these UK results are consistent with the earlier Western norms studies in terms of response distribution and item difficulty, with only minor differences. The continued use of HGSHS:A as a screening procedure is supported, particularly if corrected for response subjectivity/involuntariness and with revised amnesia scoring. The HGSHS:A is also important as a potential measure of the broader trait of direct verbal suggestibility.

A Pragmatic Guide to the Setting up of Integrated Hypnotherapy Services in Primary Care and Clinical Settings

Despite the continued debate and lack of a clear consensus about the true nature of the hypnotic phenomenon, hypnosis is increasingly being utilized successfully in many medical, health, and psychological spheres as a research method, motivational tool, and therapeutic modality. Significantly, however, although hypnotherapy is widely advertised, advocated, and employed in the private medical arena for the management and treatment of many physical and emotional disorders, too little appears to be being done to integrate hypnosis into primary care and national health medical services. This article discusses some of the reasons for the apparent reluctance of medical and scientific health professionals to consider incorporating hypnosis into their medical practice, including the practical problems inherent in using hypnosis in a medical context and some possible solutions.

Hypnosis for burn-related pain: Case studies and a review of the literature

Burn injuries create severe pain and psychological distress that are highly variable between patients. Distinct types of pain during various stages of injury and recovery make treatment complex. Standard pharmacological treatment of pain can have adverse effects and is not effective in treating anxiety and other psychological issues. Researchers have proposed that integrating clinical hypnosis as a complementary therapy can be highly beneficial to burn patients and their healthcare providers. The existing literature is reviewed and specific hypnosis techniques are discussed. Evidence exists indicating that adjunctive hypnosis is effective at reducing pain and procedural anxiety. Implementing a multidisciplinary burn care team that includes clinical hypnosis and focuses on the patients’ psychological health as well as pain reduction is likely to result in faster healing and reduced distress for patients and caregivers alike.

Cognitive hypnotherapy for anxiety disorders

Cognitive hypnotherapy, also known as cognitive-behavioral hypnotherapy (CBH), is applied to the treatment of anxiety disorders. Specific techniques are described and illustrated. The research on CBH is discussed. CBH seems to be at least as effective as behavior therapy (BT) and cognitive-behavior therapy (CBT) treatments that employ imagery and relaxation techniques for anxiety disorders. However, more research is needed because of the lack of adequate studies comparing CBH with BT and CBT. Clinical implications and suggestions for future research are offered.

An investigation of Taiwanese norms for the Stanford Hypnotic Susceptibility Scale: Form C (Mandarin Chinese Translation)

This study establishes normative data for the Mandarin Chinese Translation of the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C-MCT). Fourteen administrators gave the SHSS:C-MCT as well as demographic and meditation questionnaires to 322 participants of Taiwanese nationality. Score distributions, normality, internal consistency, item difficulty, and comparisons with other SHSS:C samples are presented. Scores on the SHSS:C-MCT were compared to both demographic and meditation practice data. The psychometric properties of the SHSS:C-MCT were found to be similar to those of other samples, and the Taiwanese mean score was found to be higher than most other samples, providing support for continued and expanded use of hypnosis in relative treatment applications in Taiwan.

The efficacy of hypnosis as an intervention for labor and delivery pain: a comprehensive methodological review

This paper presents a comprehensive methodological review of research on the efficacy of hypnosis for reducing labor and delivery pain. To be included, studies were required to use a between-subjects or mixed model design in which hypnosis was compared with a control condition or alternative intervention in reducing labor pain. An exhaustive search of the PsycINFO and PubMed databases produced 13 studies satisfying these criteria. Hetero-hypnosis and self-hypnosis were consistently shown to be more effective than standard medical care, supportive counseling, and childbirth education classes in reducing pain. Other benefits included better infant Apgar scores and shorter Stage 1 labor. Common methodological limitations of the literature include a failure to use random assignment, to specify the demographic characteristics of samples, and to use a treatment manual.

The effectiveness of hypnosis for reducing procedure-related pain in children and adolescents: a comprehensive methodological review

A comprehensive, methodologically informed review of studies of the effectiveness of hypnosis for reducing procedure-related pain in children and adolescents is provided. To be included in the review, studies were required to use a between-subjects or mixed model design in which hypnosis was compared with a control condition or an alternative intervention in reducing the procedure-related pain of patients younger than age 19. An exhaustive search identified 13 studies satisfying these criteria. Hypnosis was consistently found to be more effective than control conditions in alleviating discomfort associated with bone marrow aspirations, lumbar punctures, voiding cystourethograms, the Nuss procedure, and post-surgical pain. Furthermore, hypnosis was as at least as effective as distraction. Three hypnotic interventions met criteria as a possibly efficacious empirically supported therapy for reducing post-surgical or lumbar puncture pain. Several other hypnotic interventions would have achieved the status of a possibly efficacious therapy had studies used a treatment manual.

Hypnotherapy in child psychiatry: the state of the art

Children are more easily hypnotized than adults, and hypnotherapy as a method responds to the general developmental needs of children by addressing their ability for fantasy and imagination. Hypnotherapy and self-hypnosis are tools with which to assess and develop protective factors, and enhance positive adjustment. Meta-analyses and overviews have demonstrated the effect of hypnotherapy in paediatric disorders like asthma, chronic and acute pain, and in procedure-related distress in cancer patients. We wanted to examine the use and benefits of hypnotherapy when applied to child psychiatric disorders. A review of a literature search from PubMed, PsychINFO and the Cochrane databases revealed 60 publications, mostly case reports based on 2-60 cases, addressing the use of hypnotherapy in various child psychiatric conditions. Findings indicate that hypnotherapy may be useful for a wide range of disorders and problems, and may be particularly valuable in the treatment of anxiety disorders and trauma-related conditions. In conclusion, knowledge of hypnosis is useful in clinical practice and hypnotherapy may play an important role as an adjunctive therapy in cognitive-behavioural treatment and family therapy. Additional qualitative and quantitative studies are needed to assess the place for hypnosis/hypnotherapy in child psychiatry.

A spanish version of the barber suggestibility scale for the puerto rican population

Currently in Puerto Rico, there are no reliable and valid instruments to assess hypnotic responsiveness. The most widely utilized scales have not been scientifically translated and adapted with Puerto Ricans. In the present study, the Barber Suggestibility Scale (BSS) was translated and adapted using back-translation and decentralization. The translated BSS (the ESB) was individually administered to Puerto Rican college students (N = 85). No significant differences were found among the mean scores for the current sample on the ESB and the 1965 sample on the BSS. Both samples had similar score distributions. The internal consistency of the ESB was adequate, and there were significant correlations among scale items and total scores. The authors conclude that the ESB is an adequate instrument to measure hypnotic response within the Puerto Rican population.