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EN Volume 19 (2024) – State of Art and Science 1984 - 2024
Issue 1+2, October 2024, 240 pages
of the journal Hypnose – Zeitschrift für Hypnose und Hypnotherapie (Hypnose-ZHH)
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Table of Contents and Abstracts
Burkhard Peter
„State of Art and Science“: 1784 – 1984 – 2024 (Editorial)
H y p n o s e Z H H 2024, 19(1+2), 5-10
Burkhard Peter
"Back then we still had dreams." Hypnotherapy in cancer – a personal review after 40 years
H y p n o s e Z H H 2024, 19(1+2), 11-34
The background to the main topic "Hypnotherapy in cancer" for the introductory issue of the journal HYPNOSE UND KOGNITION 40 years ago is first described, including the author's personal motives. This is followed by a brief historical overview of psycho-oncology, a description of the discussions about the "cancer personality" in the 1980s and the efforts to prolong life through psychotherapy and hypnotherapy. It also describes the great disillusionment that followed when rigorously conducted studies and meta-analyses dashed these hopes. Today, however, methods of imagination, relaxation and hypnosis are part of the standard treatment of many psycho-oncological and palliative institutions as a matter of course.
Keywords: hypnosis, hypnotherapy, psychotherapy, oncology, cancer personality
Dr. Burkhard Peter, Dipl.-Psych
Konradstr. 16
80801 München
Michael E. Harrer
Hypnosis in psychooncology?
Hypnose-ZHH 2024,19(1+2), 35-59
This review of 40 years of hypnosis in psycho-oncology shows the still current and valuable possibilities of hypnosis in oncology. The aim of using hypnosis to influence the course of the disease has changed in the direction of improving quality of life. The taboo of addressing death and dying has also diminished. The possibilities of hypnosis to contribute to symptom control and quality of life through relaxation and imagination have been introduced in the relevant guidelines. The article refers in particular to the importance of the therapeutic relationship, aspects of working with ego-states, self-hypnosis and the combination of hypnosis and mindfulness. Finally, Milton Erickson's contribution in this area is also acknowledged using some of his case studies.
Keywords: Cancer, oncology, hypnosis, psychooncology, self-hypnosis, relaxation, palliative care, Milton Erickson
Dr. Michael E. Harrer
Mühlbachgasse 6/1
A-5020 Salzburg
Hansjörg Ebell
Avoidance goals and goals of approach in pain therapy. What instead – core element of therapeutic communication, hypnosis, and self hypnosis
Hypnose-ZHH 2024,19(1+2), 61-78
Erickson ingeniously proposed, that the experience of suffering pain be understood as a complex three prong construct consisting of actual present experience, associative recourse to the past (memory, implicit memory), and corresponding prediction of a probable future. This precept lays the groundwork for a variety of (hypno-) therapeutic options. Interpersonal communication based on a hypnosystemic approach stimulates a search for what should be "instead". This inquiry generates the core element of cooperation between the practitioner and the patient. Each of them has a specific perspective on the issue of pain: For the one it is an explanation of illness. For the other it is the experience of being ill. In this article conceptual maps are outlined that serve as orientation in the complex and diverse terrain of the treatment of acute and chronic pain. Pathogenetically oriented thought regarding intervention and salutogenetically oriented thinking about interrelation are both necessary and compatible. In the case of chronic pain combat strategies that focus exclusively on avoidance goals (“less of ...”) do not offer an exit from the experience of pain, powerlessness, and helplessness, usually they lead even deeper into it. It is consequently of central importance to ascertain individual goals of approach (“more of ...”) that enable success to be perceived step by step in smaller or even greater improvements. Such "what instead" experiences are encouraging for all involved, for they offer those affected the potential of self-competence. This is crucial if pertinent problems, including pain itself, continue to present major challenges that yet need to be met. This aspect is typical of the psycho-oncological context. Models of neuronal networks in the central nervous system and the activation of a behavioral inhibition system (BIS) and a behavioral activation system (BAS) respectively offer the scientific basis for the important distinction between avoidance goals and approach goals. A "what instead"-communication rooted in the BIS/BAS model and Erickson's "rule of thirds" foster the sustainable experience of personal self-efficacy to mitigate or overcome suffering from pain (especially, if successfully using self-hypnosis). Within the overall framework of an appropriate pain therapy concept, hypnosis and self-hypnosis serve as an individually tailored complementary offer of often astonishing effectiveness.
Keywords: Milton Erickson, pain, pain therapy, avoidance goals, Behavioral Inhibition System (BIS), approach goals, Behavioral Activation System (BAS), therapeutic communication, hypnosis, self hypnosis.
Dr. med. Hansjörg Ebell
Breisacher Straße 4 – Rückgebäude
81667 München
Sabine Fruth
Dying in peace, and hypnosis. Accompanying a young lymphoma patient in the last weeks of life with the help of "Imaginary Body Journeys". Case report
Hypnose-ZHH 2024,19(1+2), 79-94
The following case study treats the six-week therapeutic support of a 19-year-old lymphoma patient in the last phase of life. He had already begun to work on his own using „Imaginary Body Journeys” by Sabine Fruth, a method of hypnosis. In the course of the eight ‘intensive body journeys’ together that followed, we were gradually to experience improvement and success, realization and acceptance, as well as release, and his ability to say goodbye in peace with himself in his inner well-being space. My most important insight as his travelling companion is, in hindsight, the humility I felt in face of his deeply personal realizations and their ultimate outcome. It is of particular importance in so difficult a case, to provide a procedural structure of support as a framework that still allows patients enough freedom to arrive at their own incisive individual decisions on an unconscious level. At our closure, he was able to experience the entire process as coherent.
Sabine Fruth
Institut Fruth
Nicolaistraße 15
35287 Amöneburg
Mark P. Jensen
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
Reflections on the state-of-science of hypnosis
Hypnose-ZHH 2024,19(1+2), 99-122
This paper summarizes the author's thoughts regarding advancements made in our understanding of the efficacy and mechanisms of clinical hypnosis in the 40 years since the first M.E.G. congress, held in October of 1984. Progress has occurred in three key areas: (1) our understanding of the beneficial effects of hypnosis (addressing the question: Is hypnosis effective?), (2) our understanding of the mediators of hypnosis (addressing the question: How does hypnosis work?), and (3) our understanding of the moderators of hypnosis (addressing the question: For whom is hypnosis effective?). At the time of the first M.E.G. congress, there were very few published randomized clinical trials testing the efficacy of hypnosis. Since then, there has been a steady increase in both the number and scientific rigor of clinical trials. We have the strongest evidence regarding the efficacy of hypnosis for managing irritable bowel syndrome, for depression, and for both acute and chronic pain. Moreover, advances in technology for brain imaging have allowed for better understanding of neurophysiological processes that underlie the effects of hypnosis. Finally, most recently ‒ and in order to better understand the significant between-person variability observed in treatment outcome ‒ scientists have begun to examine the factors that predict who is more, and who is less likely to benefit from hypnosis treatment. Research in all three of these areas will likely continue. As our scientific understanding of the effects and mechanisms of clinical hypnosis increases, so, too, will an interest in hypnosis from individuals seeking treatment, from clinicians who provide health care, and from sponsors who pay for this treatment.
Keywords: hypnosis, effectivity, mechanisms, mediators, moderators
Prof. Dr. Mark P. Jensen
Department of Rehabilitation Medicine University of Washington
Box 359612
Harborview Medical Center
325 Ninth Avenue
Seattle, WA 98104 USA
Jenny Rosendahl und Antonia Haddenhorst
Universitätsklinikum Jena, Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie
Effects and side effects of clinical hypnosis
Hypnose-ZHH 2024,19(1+2), 123-138
For an appropriate assessment of whether an intervention can be helpful for patients, a balanced evaluation of both the positive and negative effects is necessary. The aim of this article is to summarize the current state of research on the effects and side effects of clinical hypnosis. A large number of randomized controlled trials are available on the efficacy of hypnosis for various mental and physical health problems. The vast majority of results point to positive effects of hypnosis. The greatest effects were found in the use of hypnosis in children and adolescents, in the treatment of pain and in support patients during medical procedures. In clinical practice, hypnosis is considered to be particularly effective in reducing stress and anxiety, increasing well-being and self-esteem, preparation for surgery, promoting mindfulness and during labor and birth. Adverse events or side effects of hypnosis are rarely examined in randomized studies. In clinical practice, more than half of hypnotherapists report negative effects caused by hypnosis, although serious side effects are apparently quite rare.
Keywords: Clinical hypnosis, Hypnotherapy, Efficacy, Side effects, Treatment guidelines
Prof. Dr. Jenny Rosendahl
Universitätsklinikum Jena, Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie
Stoystr. 3
07743 Jena
Winfried Häuser
Medizinisches Versorgungszentrum für Schmerzmedizin und seelische Gesundheit Saarbrücken sowie Klinik für Psychosomatische Medizin und Psychotherapie der Technischen Universität München
Gut-directed hypnosis – a guideline-recommended therapy for irritable bowel syndrome
Hypnose-ZHH 2024,19(1+2), 139-155
Irritable bowel syndrome (IBS) is a frequent health condition which can be associated with functional disability and reduced helath-related quality of life. IBS is classified as a disorder of the brain-gut axis. IBS is a very heterogenous condition with regards to the underlying pathophysiological mechanisms, the clinical picture and the amount of functional impairment. Within a biopsychosocial model of IBS psychosocial factors can play a role in the predisposition, triggering and development of chronicity. Somatic or psychosocial or a mixture of both factors might predominate in an individual patient.
Gut-directed hypnosis is a special type of medical hypnosis combining standardised gutdirected suggestions (hypnosis) with suggestions tailored to the psychological characteristics of the patient (hypnotherapy). Of brain-gut therapies, cognitive based interventions and gutdirected hypnosis have the largest evidence for both short-term and long-term efficacy in controlled trials for IBS and are recommended by current European and North American gastroenterology guidelines as second line treatment options. Standardised gut-directed hypnosis is available and can be part of a multicomponent self-management approach by digital health applications. It can be used – based on the patient‘s preferences – as first line therapy for mild forms of IBS. Severe forms of IBS require face-to-face interdisciplinary management. Standardized gut-directed hypnosis and hypnotherapy tailored to the individual patient can be part of this approach.
Keywords: Irritable bowel syndrome; gut-directed hypnosis; efficacy; gastroenterology; guidelines; digital health applications
Winfried Häuser, Prof. Dr. med.
Medizinisches Versorgungszentrum für Schmerzmedizin und seelische Gesundheit Saarbrücken
Großherzog-Friedrich-Straßen 44
66111 Saarbrücken
Maria Hagl
Efficacy and effectiveness research in the field of clinical hypnosis in 2023
Hypnose-ZHH 2024,19(1+2), 157-180
Each year, the Milton Erickson Society of Clinical Hypnosis in Germany commissions an overview of newly published randomized controlled trials (RCTs) and meta-analyses regarding the efficacy and effectiveness of clinical hypnosis and hypnotherapy. The systematic literature search (on MEDLINE, APA PsycINFO, and PSYNDEX) for studies in English and German language in peer-reviewed journals in 2023 resulted in eleven studies that evaluated hypnotherapeutic interventions in a randomized controlled design that allowed for conclusions on the efficacy of hypnosis. In one case, the treatment of a mental disorder was evaluated (i.e., Agoraphobia according to DSM-5). In this and three other RCTs addressing the treatment of chronic conditions, a trained hypnotherapist delivered the treatment, in one case conducted via videocall. All four of these studies were small feasibility RCTs that could serve as a first starting point for larger-scale RCTs addressing the respective disorders. In three other RCTs targeting chronic conditions, hypnosis was delivered per mobile app or as audio recording. Also, in two of four RCTs that evaluated hypnosis during medical procedures, hypnosis was delivered via virtual reality (VR) headsets. What’s more, VR headsets were used in several of those newly published RCTs where the specific effect of hypnosis was not controlled for, e.g., when comparing hypnosis per VR headsets vs hypnotic communication during a medical procedure; and VR hypnosis will continue to be evaluated quite frequently in the future, as a search for newly registered RCTs showed. All in all, eHealth is trending in the field of hypnosis. The discussion addresses how more research is needed to evaluate the long-term benefits of digital health applications using hypnosis and whether remotely delivered hypnotherapy is as effective as face-to-face therapy.
Keywords: Hypnosis, hypnotherapy, efficacy, effectiveness, randomized controlled trials, RCT, meta-analysis, review.
Dr. Maria Hagl
Augsburgerstr. 12
80337 München
Sarah Becker, Ann-Christine Ehlis, David Rosenbaum, Betti Schopp, Ramona Täglich, Dirk Revenstorf
Universität Tübingen, Psychologisches Institut
Effect of hypnosis and exposure to virtual reality on subjective trance depth and brain physiological correlates in acrophobia. A pilot study
Hypnose-ZHH 2024,19(1+2), 181-194
In recent years, hypnosis has been increasingly studied in the context of virtual reality (VR) for the treatment of mental disorders. However, little attention has been paid to the physiological changes in the brain. The present pilot study investigates the efficacy of audio trance induction compared to audiovisual VR trance induction in high and low hypnotizable individuals with vertigo. Participants used a VR headset and underwent trance induction followed by altitude exposure in a virtual environment. The subjective trance depth as well as the functional connectivities (FC) with fNIRS and the change in dizziness were investigated. The functional connectivities served as brain physiological correlates of trance depth. In principle, it was assumed that highly suggestible people go deeper into trance and that audiovisual VR leads to a deeper trance than audio trance induction without visual input. A deeper subjective trance was indeed found in high-suggestibles. It was also hypothesized that low-suggestibles would benefit from audio-visual trance induction to a greater extent than high-suggestibles, which would lead to a deeper trance in the former than if they only heard an auditory trance. This should not be the case for highly suggestible people, as they are distracted from their own inner images by the VR imagery. The different influence of auditory and audiovisual presentations was confirmed here. It was also assumed that the transition from trance induction to altitude exposure causes an increase in FC, as the resulting anxiety could reduce the trance. This was not confirmed. There were also no differences in FC during altitude exposure with regard to suggestibility and induction form. Furthermore, it was assumed that lower FC are related to a greater reduction in anxiety as a result of the exposure. A corresponding significant correlation was found between the reduction of state anxiety (STAI) and lower FC between the left DLPFC and the precuneus. In contrast, a reduction in fear of heights (HIQ) was associated with a lower FC between the right DLPFC and the precuneus. The implications of the results, the brain areas investigated and the generalization of the results are discussed.
Keywords: hypnosis, virtuell reality, acrophobia, fNIRS, DLPC, precuneus
Dirk Revenstorf, Prof. Dr.
Milton Erickson Akademie
Biesingerstr. 14
72070 Tübingen
Wolfgang H. R. Miltner
Institut für Psychologie, Friedrich-Schiller-Universität Jena
Controlling pain with hypnosis: a journey into the depths of the brain
Hypnose-ZHH 2024,19(1+2), 195-225
The following article summarises psychophysiological and neuroscientific studies and reflections on what happens in the human brain when people are hypnotised and suggested to feel no pain or less pain in response to noxious (painful) stimuli. These observations of so-called hypnotically induced analgesia are contrasted with some conditions in which people are asked to distract themselves from the stimuli or to process these stimuli without a specific task. This raises the question of whether the brain processes and exchanges between different frontal and sensory brain areas differ in these conditions. It is shown that hypnotized subjects do not simply imagine such perceptual changes and only pretend that the proposed stimulus events are no longer perceived but represent real experiences. This is followed by a summary of which areas of the brain are involved in the processing of noxious stimuli, which neural mechanisms are responsible for the development of pain, and which methods can be used to study them. It then discusses several studies that have used neural correlates derived from the electroencephalogram to analyse early attentional processes and the processing of somatosensory and emotional aspects, as well as the intensity of noxious stimuli, and to investigate the effect of medical and psychotherapeutic methods. The results of these studies are discussed in the light of some theories of hypnosis. Finally, it is postulated that hypnosis works by altering the activity of precisely those brain functions and network activities that are indispensable for the constitution of pain.
Keywords: hypnosis, distraction, simulation, pain, brain areas, EEG, ECP
Prof. Dr. Wolfgang H. R. Miltner
Institut für Psychologie Friedrich-Schiller-Universität Jena
Am Steiger 3/1
07749 Jena