Volume 5, double-issue 1+2, October 2010, 304 Pages

of the journal Hypnose - Zeitschrift für Hypnose und Hypnotherapie (Hypnose-ZHH)

Table of Contents

  • Thomas Weiss and Wolfgang H. R. Miltner
    Cortical mechanisms of hypnotc analgesia
  • Ulrike Halsband and Thilo Hinterberger
    Changes in brain plasticity under hypnosis
  • Ernil Hansen
    Hypnotic communication – an improvement in the contact to patients
  • Albrecht Schmierer
    Hypnosis in dentistry: history, organization, methods, practice
  • Dirk Hermes
    Clinical hypnosis in oncological, plastic and reconstructive facial surgery
  • Marie-Elisabeth Faymonville
    Hypnosis in anaesthesia
  • Walter Tschugguel and Sabine Tschugguel
    Hypnosis in Patients with Gynecologic Symptoms
  • Wolfgang Schulze
    Hypnosis in palliative care
  • Burkhard Peter
    Construction of “symptom-gestalt” and “symptom-bearer”: Two hypnotherapeutic approaches for the treatment of chronic pain patients
  • Katharina Tigges-Limmer and Jan Gummert
    Hypnotherapeutic interventions in heart transplantation
  • Hansjörg Ebell
    Hypnosis and self-hypnosis as key-elements of therpeutic communication with the cronically ill
  • Jochen Hefner
    Hypnosis in contemporary medicine – proof of effectiveness and efficacy
  • Winfried Häuser
    Is hypnosis a well-establised treatment of internal medicine?
  • Walter Tschugguel and Sabine Tschugguel
    The Problem of producing evidence of effectiveness and efficacy of hypnotherapy in clinical trials – A stimulation article
  • Susanne Merl
    Hypnosis in an obstetric emergency – a case report
  • Hansjörg Ebell
    The Heidelberg Hypnosis Trial 1936. A woman under hypnotic influence for seven years. A case of ruthless exploitation being discovered? Part 1

Abstracts & Download (German Originals)

Thomas Weiss and Wolfgang H. R. Miltner, Universität Jena

Cortical mechanisms of hypnotc analgesia
Hypnose-ZHH, 2010, 5(1+2), 9-31

Major theme: While there is general agreement that hypnotic analgesia significantly reduces pain, a generally accepted theory on the cognitive processes and brain structures responsible for hypnotic analgesia is still lacking. This paper reviews actual hypotheses and own studies on the neural basis of hypnotic analgesia.

Development of the theme: Some authors suggested that hypnotic analgesia is based on mechanisms of distraction. However, results of studies on event-related potentials (ERP) and pain ratings in response to experimental painful stimuli applied under hypnotic analgesia as compared to a non-hypnotic control condition have suggested that hypnotic analgesia and distraction represent two different states of pain control. While ERP-components were shown being significantly reduced when subjects ́ attention is distracted from noxious stimulation, no change of ERP-amplitudes to equivalently strong and painful stimuli was observed when subjects were under hypnotic analgesia. It was presumed that hypnotic analgesia and distraction of attention are based on different mechanisms of pain control and on different brain processes. Additionally, the degree of subjects’ suggestibility plays a differential role for the effectiveness of pain control by hypnotic analgesia and distraction. Distraction was shown to be equally potent in reducing pain in response to experimental painful stimuli in high and low suggestible subjects; however, only highly susceptible subjects significantly profit from suggestions of hypnotic analgesia.

Implications: Based on these and other observations it was hypothesized that hypnotic analgesia is generated by a state of “neural dissociation”, i.e., by a breakdown of neural communication between different areas of the brain whose synchronized cell activities are vital for the subjective experience of pain. While the activity within parts of these pain-processing brain structures was shown to be unaffected by hypnotic analgesia, the disturbed communication between these brain structures does not allow the organization of perception of pain.

Keywords: hypnosis, hypnotic analgesia, attention, event-related potentials, ERP, coherence, EEG, MEG, fMRI

Ulrike Halsband, Universität Freiburg, and Thilo Hinterberger, Universitätsklinikum Freiburg

Changes in brain plasticity under hypnosis
Hypnose-ZHH
, 2010, 5(1+2), 33-50

Background and aims of the study: The search for the neural correlates that characterize hypnosis is a topic of great interest in neurosciences. As a main aim of the present investigations we tried to investigate whether suggestions of a subjective experience induced by hypnosis are in fact accompanied by corresponding neuronal changes in the brain.

Methods: We analysed brain activity in hypnosis using functional magnetic resonance imaging (fMRI), positron emission tomography (PET) and electroencephalography (EEG).

Results: The brain reacts to suggestions under hypnosis differently compared to instructions without hypnosis. Using fMRI, functional changes in effective connectivity were observed in a visual illusion condition. When a grey chart was presented in hypnosis and subjects were asked to perceive it in colours, both the right fusiform gyrus and the ACC were found to receive bilateral input from intraparietal sulcus. Learning of high-imagery words in hypnosis was associated with (i) more pronounced bilateral activation in the occipital cortex and prefrontal areas (PET) and (ii) an improved memory performance. In an EEG study the neurophysiological correlates of a motor suggestion in hypnosis were systematically analysed. During arm levitation, significant changes in EEG activity were observed which were most pronounced in sensory motor areas. The suggested movement was perceived as being external. Different activity patterns occurred in deep hypnosis as compared to light hypnosis. Findings were specific to hypnosis and differed from the neuronal correlates of a meditative trance.

Conclusions: Hypnotic suggestions and illusions increase the experience of reality and correlate with specific brain activation patterns. Visual and motor illusions resulted in an enhanced neuronal response in brain areas that play a crucial role in perception and/or motor processing.

Keywords: hypnosis, brain plasticity, fMRI, PET, EEG

Ernil Hansen, Universität Regensburg

Hypnotic communication – an improvement in the contact to patients
Hypnose-ZHH
, 2010, 5(1+2), 51-67

Major theme: The medical environment inadvertently is full of negative suggestions. Patients are especially susceptible as they often experience the situation as extreme and go into a natural trance state with increased suggestibility. This instead might be utilized to place positive suggestions and to use techniques of hypotherapy even without a formal hypnotic induction.

Logical development of the theme: Signs of trance can be observed in patients, negative suggestions can be identified and avoided, and suggestions prove effective without hypnosis. Indirect suggestions, utilization, reframing, dissociation in location or in time to a safe place, metaphors, and nonverbal communication including body contact can be used to mediate accompaniment and safety. Thereby, pain and fears are reduced, stress and wearing noises are compensated, and patients are animated to activate their own coping strategies.

Examples: Without additional time anxieties can be avoided or reduced during induction of anesthesia leaving a patient with a smile on his face. Using scalp blocks, accompaniment and hypnotic communication tumor surgery at eloquent areas of the brain are performed under really awake conditions, allowing for intraoperative testing without pharmacological interference.

Implications: Recognition and avoidance of negative suggestions and the use of hypnotic principles and techniques can be applied – in contrast to hypnosis - to all patients. For the reduction of pain and anxiety and for a better activation of the patient`s own resources this should become part of medical education.

Keywords: communication, suggestions, awake hypnosis, anesthesia, awake craniotomy

Albrecht Schmierer, Stuttgart

Hypnosis in dentistry: history, organization, methods, practice
Hypnose-ZHH
, 2010,5(1+2),69-93

Major theme: Development of dental hypnosis during the last 20 years.

Development of the theme: Dental hypnosis has matured from a speciality of only a few to a normal tool in dental practice in Germany.

Author's point of view: We differentiate between dental hypnosis and hypnotherapy. The average hypnodontist has only 3 to 15 Minutes time before he starts with his dental work. He is using hypnosis as an adjunct to his chemical anaesthesia, because with hypnosis he needs less with longer effect. Only dentists with a training in hypnotherapy and therapeutic experience care about the psychosomatic associated problems, like chronic pain, psychosomatic intolerance of prostheses or extreme gagging.

Conclusions: A few practitioners used hypnosis just after their own experience, but after some years of development the DGZH (German Society of Dental Hypnosis) was founded. One of the goals of DGZH is supporting research in the field of dental hypnosis. Therefore dental hypnosis has been subject of scientific research in the last years. It will establish as every-day tool in dental practice.

Keywords: hypnosis, dentistry, induction techniques, dental fear, hypnotic anaesthesia

Dirk Hermes, Universität Lübeck

Clinical hypnosis in oncological, plastic and reconstructive facial surgery
Hypnose-ZHH
, 2010, 5(1+2), 95-109

Major theme: Oncological, plastic and reconstructive procedures in the facial area are predominantly multi-step procedures, can mostly be performed under local anesthesia and cause considerable intraoperative stress for patients. Patients are mostly elder and can present with severe somatic diseases. Especially in those patients, clinical hypnosis can be used as a non-pharmacological procedure for intraoperative anxiolysis, dissociation and relaxation free of side-effects.

Logical development of the theme: Since 2002, the author uses intraoperative hypnosis on a regular basis. All aspects of hypnotherapy (e.g. information, seeding, induction, utilisation, maintenance of trance, dehypnosis) can be integrated in the surgical treatment path without significant technical/organisational effort. Treatment circumstances are considerably improved for both patients and surgical team. Positive effects of the procedure can be proved by valid surgical studies.

Authors point of view: Hypnosis has proven to be a very efficient therapeutic option with high acceptance of patients in facial surgery under local anesthesia.

Conclusions: Hypnosis does not replace pharmacological procedures but adds a valuable alternative. Not only satisfied patients but results of further clinical studies could help to increase acceptance of the procedure in surgeons.

Keywords: Hypnosis, local anesthesia, facial surgery, plastic surgery, anxiolysis

Marie-Elisabeth Faymonville, Université de Liège, Belgien

Hypnosis in anaesthesia
Hypnose-ZHH
, 2010, 5(1+2), 111-120

Major theme: Hypnosis is a valuable and effective tool for surgical interventions.

Logical development of the theme: While originally the main technique to help patients to tolerate surgery, hypnosis was relayed with the discovery of chemo-anaesthesia, to see now increasing use as an adjunct to local, regional, or general anaesthesia. This is based on scientific data and evidence, as well as on its positive effects on pain, anxiety and autonomic functions. A number of publications describe efficient application of suggestions and hypnosis in varying surgical situations.

Author ́s point of view: Hypnosis as an adjunct to conscious intravenous sedation was used in more than 7500 surgical interventions as a new anaesthetic technique. Surgery was done under local anaesthesia. This technique called „hypnosedation“ has been used since 1992 at the University Hospital of Liège for the great satisfaction of the patients and the surgical team.

Conclusions: It permits the patient to be conscious but distracted by hypnosis during surgery. This technique avoids pharmacological coma (general anaesthesia) and gives better pain control, lesser fatigue. We propose that active participation in surgery may hasten recovery by giving the patient a sense of control.

Keywords: Hypnosis, hypnosedation, surgery, local anaesthesia

Walter Tschugguel, Medizinische Univeristät Wien, and Sabine Tschugguel, Universität Wien

Hypnosis in Patients with Gynecologic Symptoms
Hypnose-ZHH
, 2010, 5(1+2), 121-144

Scope of the review: 23 papers are systematically overviewed concerning potential therapeutic effects of hypnosis on patients suffering from gynecologic symptoms.

Publication time span: 1950-2009

Publication origin: Pubmed, EMBASE, CINAHL, Cochrane, Google, CD-ROM „Milton H. Erickson: Complete Works“, the books „Cheek, D.B. (1994). Hypnosis: The application of ideomotor techniques” and “Rossi, E.L. & Cheek, D.B. (1988). Mind-body therapy: Methods of ideodynamic healing in hypnosis”.

Types of documents reviewed: Original papers, reviews, secundary literature, CD-ROM, books.

Results and discussion: Case series and case reports confirm the efficacy of hypnosis in patients with gynecologic symptoms. The only available randomized controlled trial suffers from inadequate methodology.

Conclusions about the research trends: Naturalistic effectiveness trials are required to gaining general acceptance of using hypnosis for treatment of patients with gynecologic symptoms. Such a naturalistic research setting should be carefully selected regarding hypnosis as a process between persons but not between a person and symptoms.

Keywords: Hypnosis, hypnotherapy, gynecology, medicine, psychotherapy

Wolfgang Schulze, Klinikum Bayreuth

Hypnosis in palliative care
Hypnose-ZHH
, 2010, 5(1+2), 145-162

Theme: Hypnosis/Hypnotherapy is an excellent tool in the management of various situations in palliative care. It should be used much more in palliative care (especially in Germany).

Development: In the past, modern hypnotherapy and modern palliative care developed mostly juxtaposed, especially in Germany, nearly without interconnection, but with many parallels, which will be discussed, and which directly ask for the use of hypnotherapy in palliative care.

Author's point of view: The potentials of hypnotherapy can be transferred into the context of palliative care. Own experiences and reports in clinical literature show the good effectiveness of hypnosis in the treatment of the typical symptoms in palliative care like pain, dyspnea, vomiting etc. Furthermore hypnotherapy is useful for the psychological, existential and spiritual support in the last life stage, is helpful for the acceptance of lethal diseases, the abandonment of life options and to take leave of relatives. It shows a (psycho-)therapeutic potential in respect of the very limited time resources of this patients. The excellent potentials of hypnotherapy for palliative care are unfortunately barely realized in Germany.

Conclusion: Physicians in palliative care should know and use the eminent possibilities of clinical hypnosis for the holistic care of patients in their last phase. Hypnotherapists should utilize their possibilities for the treatment of patients in palliative care. Further investigations are necessary by both groups.

Keywords: Palliative care, hypnosis, hypnotherapy, symptom control, pain, dyspnoea, radiation therapy, spirituality

Burkhard Peter, München

Construction of “symptom-gestalt” and “symptom-bearer”: Two hypnotherapeutic approaches for the treatment of chronic pain patients
Hypnose-ZHH
, 2010, 5(1+2), 163-178

Theme: Hypnotherapy of chronic pain patients is more than just teaching them self-hypnosis.

Development and author ́s point of view: Ideally, they should be thought to modify processes within their brain responsible for pain reception. Because there is no explicit language and/or detailed instruction manual such teaching has to be done in a metaphoric and ritualistic way. Different strategies and approaches serve this purpose.

Implications for therapeutic practice: One possible and efficient strategy for a symptom oriented approach is the construction of a “symptom gestalt”, i.e. the transformation of pain reception into other sensory modalities which are much easier to modify. If a problem oriented treatment is necessary the externalisation onto a “symptom-bearer” as well as its counterpart, an “anti-symptom-bearer”, is helpful to work on a conflict behind without evoking resistance. Hypnotic trance is helpful for these strategies; some imaginary abiliy is necessary.

Keywords: chronic pain patients, hypnosis, hypnotherapy, “pain-gestalt”, “symptombearer”

Katharina Tigges-Limmer and Jan Gummert, Ruhr Universität Bochum

Hypnotherapeutic interventions in heart transplantation
Hypnose-ZHH
, 2010, 5(1+2), 179-197

Major theme: Heart transplantation in its various phases means for the patient a massive challenge for both body and mind. Especially in the acute phase of the transplant process, which is characterized by severe physical disabilities, emotional stress and affective crises, hypnotherapeutic interventions with its future and resource orientation can be extremely helpful partially beyond verbal communication.

Examples: In the various phases of heart transplantation (diagnosis, preterminal, transplant and follow-up phase), different psychological stress can be treated with different hypnotherapeutic interventions. Formal hypnotic inductions (eg biopsy, catheter implementation) and indirect inductions (eg decision making, management of the waiting period, dealing with ICD-action, donor organ integration, management of donor fantasies) can be used.

Implications: The possibility and necessity of psychological co-treatment of heart transplant patients is embodied in the German Transplantation Law. In clinical practice it is very helpful to use hypnotherapeutic interventions in the transplant process to facilitate an improved disease management.

Keywords: heart transplantation, hypnosis, hypnotherapeutic interventions

Hansjörg Ebell, München

Hypnosis and self-hypnosis as key-elements of therpeutic communication with the cronically ill
Hypnose-ZHH
, 2010, 5(1+2), 199-216

Major theme: Utilizing hypnosis techniques, hypnotic phenomena, and self hypnosis for treatment of the chronically ill requires an intensive subjective exchange over a period of time. Patient and therapist embark as traveling companions on a journey together through uncharted territory.

Development of the theme: This journey of mutual experience and learning cannot be substituted by mere suggestion. Therapeutic communication focuses on the promotion of change, self-efficacy and coping strategies by drawing on the intrinsic resources of the patient.

Author’s point of view: Within this treatment context the patients are enrolled as coplanners and decision makers. Their active participation in determining treatment steps is of the utmost necessity, simply because all the information necessary is carried within the patients themselves. Even though it cannot be foreseen whether the ensuing changes in the patient's experience will be decisive or not, there are indeed reasons to proceed with optimism (case examples).

Conclusions: Hypnosis and self hypnosis are invaluable tools for dealing with symptoms of chronic illness (e.g. pain), as well as diverse psychological issues (e.g. helplessness) - furthermore (in the frame of psychotherapeutic approaches) to access the individual code of life experiences and conflicts. The patient alone has the capacity to decipher his or her own code, reformulate it or create a new one.

Keywords: Hypnosis, Self hypnosis, chronical illness, coping, therapeutic communication

Jochen Hefner, Universitätsklinik Tübingen

Hypnosis in contemporary medicine – proof of effectiveness and efficacy
Hypnose-ZHH
, 2010, 5(1+2), 217-235

Scope of the review: The following article reviews data on the use of hypnosis – an ancient method of treatment in principal – in contemporary medicine.

Publication time span: In substance, this paper covers publications of the recent 20 years.

Publication origin and types of documents: German and English original articles, specialist books, electronic data sources and publications of scientific societies in the field of psychosomatic medicine, somatic medicine and addiction therapy serve as basis of this paper.

Results: Results clearly demonstrate a beneficial effect of hypnosis when administered as sole treatment of certain illnesses. Furthermore, hypnosis complements and cheapens state of the art medical treatments such as invasive diagnostic procedures, surgical procedures, stem-cell transplantations or in-vitro fertilizations.

Author’s opinion: Numerous supporting documents about the effectiveness and efficacy of hypnosis in high-end medicine can be found in the literature. But even the recognition as a scientific method did not lead to a broad approval among physicians or a widespread application of hypnosis in medicine.

Conclusions: Future trials have to be designed to meet present scientific criteria in order to ameliorate the recognition of hypnosis in medicine. An increasing number of basic researchers, which apply hypnosis in their experiments, could support this endeavor.

Keywords: Hypnosis in modern medicine, proof of effectiveness, hypnosis as a scientific method, efficient use in hospital and medical practice

Winfried Häuser, Klinikum Saarbrücken

Is hypnosis a well-establised treatment of internal medicine?
Hypnose-ZHH
, 2010, 5(1+2), 237-252

Scope of the review: It is assessed by a systematic review whether hypnotherapy is a wellestablised treatment for diseases or diagnostic or therapeutic procedures of internal medicine.

Methods (Publication time span, publication origin): Medline was searched the 11th of july 2009 by the strategy „Hypnosis“ [Mesh] AND „Review“ [Publication type]. If systematic reviews of hypnotherapy in internal diseases or diagnostic or therapeutic procedures in internal medicine were found, Medline was searched for metaanalyses for these topics. Moreover the database of the German Association of Medical Scientific Societies was searched if German S3 guidelines recommend hypnotherapy for these indications.

Results: The search of literature yielded 751 hits. Systematic reviews of hypnotherapy in irritable bowel syndrome, functional dyspepsia, fibromyalgia syndrome, asthma bronchiale, diabetes mellitus, chronic pain syndromes, side effects of chemotherapy, palliative care and endoscopy were found. Metaanalyses were available for irritable bowel syndrome and chemotherapy induced nausea and vomiting. A recommendation for the use of hypnotherapy was only found in the guideline on irritable bowel and fibromyalgia syndrome.

Conclusions: Hypnotherapy can become a well-establised treatment of irritable bowel and fibromyalgia syndrome. Further high quality randomised controlled trials with hypnotherapy in these disorders and an engagement of hypnotherapists in the development of medical guidelines are necessary to achieve this goal.

Keywords: Hypnosis, internal medicine, irritable bowel, syndrome, fibromyalgia syndrome, systematic review, guideline

Walter Tschugguel, Medizinische Universität Wien, and  Sabine Tschugguel, Universität Wien

The Problem of producing evidence of effectiveness and efficacy of hypnotherapy in clinical trials – A stimulation article
Hypnose-ZHH
, 2010, 5(1+2), 253-269

Major theme: The randomized controlled trial research methodology, originally developed for pharmaceutical research, does not commensurate with clinical hypnosis research.

Logical development of the theme: Hypnosis is a therapeutic method essentially based upon relationship between persons, personal development and context. By contrast, scientific justification of hypnosis is reasoned and publicized through means of studies the methods of which ideally correspond with methods of well controlled pharmaceutical trials.

Authors` point of view: Hypnosis research, by investigating hypnosis relevant criteria such as relationship, personal development and context cannot neglect its essential criteria by restricting to measure effect sizes.

Inferences: Hypnosis research should use adequate methods not only comprising natural science but also phenomenology and hermeneutics (understanding). Such methods are already part of modern psychotherapeutic research.

Keywords: hypnosis, hypnotherapy, efficacy, effectiveness, RCT, research paradigm, psychotherapeutic research

Susanne Merl, Goldbergklinik Kehlheim

Hypnosis in an obstetric emergency – a case report
Hypnose-ZHH
, 2010, 5(1+2), 271-277

A pregnant woman (44 years old, 30th week of gestation) was sent to the hospital by her general practitioner because of high blood pressure: suspected preeclampsia. After a vicious cycle of anxiety and helplessness got started, compounded by the stress reactions of the surrounding people, the author (a specialist in gynecology and obstetrics) utilizes the securing and soothing potential of therapeutic communication by interacting supportively and giving clear suggestions. To minimize the risk for the unborn infant the author decides to accompany the patient on her one hour ride in the emergency ambulance to a specialized hospital. In hypnosis, induced by the offered suggestions, the “real” dramatic transportation ride turns into a vacation experience (including horse back riding), based on her memories of a stay on the island of Forteventura some years ago. On arrival, after reorientation from hypnosis, she reports to feel “relaxed and calm, like after a short vacation trip”. Her blood pressure is still not back to normal, but considerably improved: an optimal result, compared to the conditions in the beginning. Some reflexions about the integration of therapeutic communication in the delivery room (“Your contractions are like waves, coming and going, carrying your baby into the world”) are added to the case report, followed by remarks about the influence of her experiences of this kind on her medical practice and professional self awareness.

With a postscript of Hansjörg Ebell

Keywords: case report, hypnosis, obstetrics, preeclampsia

The Heidelberg Hypnosis Trial 1936

A woman under hypnotic influence for seven years. A case of ruthless exploitation being discovered? Part 2

Hypnose-ZHH, 2010, 5(1+2) 299-303

Part 1 (including abstract) was published Hypnose-ZHH, 2009, 4(1+2), 237-251. To be continued.

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