Applications in General Medicine
Because hypnosis can be used to produce a state of relaxation and to reduce anxiety, it has proved to be valuable as an adju-vant to medical procedures. Once patients have been trained in the use of self-hypnosis, they can use it both in preparation for a hospital visit and while in the clinic or hospital. Once in that state, they can imagine themselves being somewhere they enjoy and feel safe, thereby dissociating their mental experience from the physical (and possibly painful or unpleasant) aspects of the procedure. It can also be used as a way of mastering the anxi-ety associated with potentially threatening procedures, such as computed tomography, bone marrow aspirations, phlebotomy, needle biopsy, lumbar punctures, or therapeutic interventions, such as chemotherapy, external beam radiation therapy and dental procedures.
Pain is always a psychosomatic phenomenon, combining somatic with subjective distress. It never exists in a vacuum and always represents a combination of tissue injury and the emotional reac-tion to it. Despite the organic factors causing pain, it is clear that psychological factors are major variables in the intensity of the pain experience. Beecher (1956) demonstrated that the intensity of pain was directly associated with its meaning. For example, to the extent that pain represented threat and the possibility of future disability, it was more intense than it was among a group of combat soldiers to whom the pain of injury meant that they were likely to get out of combat alive.
Hypnosis can facilitate an alteration in the subjective ex-perience of pain (Brose and Spiegel, 1992). Several techniques can be used to achieve this goal. Most techniques involve the production of physical relaxation coupled with visual or somatic imagery that provides a substitute focus of attention for the pain-ful sensation.
Even though the precise mechanism for hypnotic analgesia is not known, it is suspected to have components of two comple-mentary mechanisms: physical relaxation and attention control. Patients in pain tend to splint the painful area instinctively, which in turn increases muscle tension around the painful area, often resulting in increased pain. Therefore, creating a state of hypnoti-cally induced relaxation may easily decrease their experience or perception of pain.
Studies have also shown the superiority of hypnotic an-algesia to the level of analgesia provided by either placebo (McGlashan et al., 1969) or acupuncture (Knox and Shum, 1977). Katz and colleagues (1974) have shown a correlation between hypnotizability and responsiveness to acupuncture, proving that hypnotic mechanisms of pain control may be mobilized by other treatment techniques. Nevertheless, the explicit use of hypnosis with hypnotizable patients has proved to be the most powerful means of controlling pain. Hilgard and Hilgard (1975) estimated a 0.5 correlation between hypnotizability and treatment respon-siveness for pain control.
Hypnosis is useful in both the diagnosis and the treatment of psy-chosomatic illness. By using hypnosis with these patients, the therapist may assist in diagnosing the symptoms as psychoso-matic. Under hypnosis, many of the symptoms may improve or be completely reversed. It is important not to “force a cure” in any patient, but rather to allow patients to improve at a pace that feels comfortable, or to give up the symptom when ready. This allows patients not only to feel in control of the treatment and recovery process but also slowly to get back their sense of control over their body. Some patients obtain insight into what is happening to their bodies owing to the ability to explore the meaning and cause of the symptoms hypnotically.
In most instances, it is better if hypnosis is used as an adjuvant to any other medical treatment, including physical re-habilitation or any other treatment modality typically used in the treatment of the “real illness”. Most such problems involve a combination of somatic and psychological symptoms. Using a rehabilitation model avoids the trap of humiliating the patient who improves with the inference that the problem was “all in the mind”.
Hypnosis can be invaluable in the treatment of a number of psychosomatic conditions. In particular, disorders affecting the gastrointestinal system are among those conditions in which studies demonstrated a dramatic response. In cases of ulcerative colitis and regional enteritis, peptic ulcer disease and side effects of chemotherapy, hypnosis can produce a sense of control over a symptom that causes the patient to feel especially helpless, thereby diminishing the cycle of reactive anxiety.