Search

Booth, S. (2020). Hypnosis in a specialist palliative care setting – enhancing personalized care for difficult symptoms and situations. Palliative Care & Social Practice, 14, 1-11, doi.org/10.1177/...

Dzogchen meditation has been practiced by Bonpo and Buddhist yogis for at least 1,200 years. Dzogchen utilizes methods of meditation and yogic exercises that are said to help one fully awaken from ...

This study examined if clinical contact with clients within one week of discharge from an inpatient psychiatric facility had an influence on their readmission. One of the factors explored in this study was whether the impact of clinical contact could reduce readmission rates after discharge used to develop intervention strategies to reduce readmission. The study found that those individuals who had a case management appointment set within the first seven days of discharge from an inpatient psychiatric facility was approximately eight times more likely than non-clinical referrals, 32 % vs. 4 %, to be not readmitted to an inpatient psychiatric facility. When this was examined even more closely, it was determined that case management appointments attended within the first day following discharge from an inpatient psychiatric facility was significantly associated with attendance following discharge. The number of individuals who attended case management appointments dropped approximately 50% within 24 hours of discharge, as compared with the number of individuals who attended appointments following two days after discharge (18 % to 8 %). This trend continued as time progressed for the first two to seven days following discharge from an inpatient psychiatric facility, where the attendance of a clinical appointment dropped to 4% within seven days following discharge. These findings have implications on what type of clinical contact should be pursued following discharge from an inpatient facility, and how soon that appointment should be accomplished in order to decrease readmissions.

This study examined the levels of empathy and absorption of individuals who regularly play fantasy and science fiction role-playing games. A hypothesis was developed that higher levels of empathy would be found in individuals who fantasy role-play based upon previous research in hypnosis such as J. R. Hilgard's (1970) imaginative involvement hypothesis, research into the "fantasy prone" personality type (Wilson & Barber, 1981), and the empathic involvement hypothesis (Wickramasekera II & Szlyk, 2003). The participants in the current study were 127 fantasy role-players who volunteered and completed the Davis Interpersonal Reactivity Index (empathy) and the Tellegen Absorption Scale (absorption). The results demonstrated that those who play fantasy role-playing games scored significantly higher than the comparison group on the IRI scale of empathy, confirming the hypothesis that fantasy role-players report experiencing higher levels of empathic involvement with others. Correlational analysis between the measures demonstrated a significant positive correlation between empathy and absorption (r = .43, p

This article reviews a growing body of research and theory in hypnosis and neuroscience that supports the empathic involvement theory (EIT) of hypnosis (Wickramasekera II, 2001; Wickramasekera IISzlyk, 2003; Wickramasekera II, 2007c). The EIT is a unified transpersonal theory of hypnosis and the self, which weaves together empathic elements of Dzogchen, neodissociative, neuroscience, psychoanalytic, sociocognitive, and other theories by proposing that hypnotic phenomena are inherently characterized by their deep involvement with processes of empathy and the self. The EIT proposes that the experience of hypnosis is embodied in a system of neural networks in the brain that utilizes empathy-related processes, adaptive resonance between perceptual input and top-down expectancies, and connectionist learning algorithms to (a) empathically enact the affect, cognition, body language, response expectancies, social roles, sensations, etc. that are presented to them during hypnosis in accordance with socio-cognitive theories of hypnosis; (b) engage in a convergent psychophysiological relationship with another person in accordance with psychoanalytic, Ericksonian, and polyvagal/social engagement system theories; (c) alter the empathic self/other (theory of mind) coding of phenomenological experiences during hypnosis in accordance with aspects of the neo-dissociative and socio-cognitive traditions; and (d) develop an experiential understanding of the illusion of self that may lead, in some people, to its transcendence in accordance with Bon-Buddhist, Dzogchen, and transpersonal scholars. A unified definition of hypnosis is proposed based on findings in the empathic neuroscience of hypnosis as well as a working model of the neuromatrix of the self.

By Judith Sherven, PhD, and Jim Sniechowski, PhD JayEss Publishing, 2012. Available from http://MagnifyYourExcellence.com. Reviewed by Ian E. Wickramasekera II, PsyD

I am grateful to Stephen Lankton, the Editor-in-Chief of the American Journal of Clinical Hypnosis, for the opportunity to guest-edit this special issue on empathy and hypnosis. I have been engaged...

The hypnosis community has struggled for over 200 years to craft a universally agreed upon definition of hypnosis that it can share with the public and utilize in guiding scientific research and cl...

The author presents an analysis of the similarities and differences between the role of a kalyanamitra (spiritual friend) in Vajrayana Tibetan Buddhism and the role of a psychotherapist in client-centered psychotherapy. The common ground between both traditions is explored by elucidating Buddhist perspectives on the three necessary and sufficient conditions of client-centered psychotherapy (congruence, positive regard, and empathic understanding). The differences are also discussed in terms of the directive nature of the mind/body techniques that are taught within the teacher-student relationship in Vajrayana. The author concludes with an integration of the general points of agreement concerning topics such as empathy, self-actualization, and self-deception.

A total of 224 chronic pain somatoform disorder patients without obvious pathophysiology or psychopathology were found to have colder hands than nonpatients. A paradoxical temperature increase (PTI) in response to a cognitive stressor (mental arithmetic) was noted in a subset of these chronic pain patients. Patients were defined as “PTI” responders if, during cognitive stress, an increase in digital temperature occurred over a prior eyes closed resting condition. It was found that 49.4% of males and 42.6% of females in a total sample of 224 patients demonstrated PTI. The PTI patients had significantly colder hands than non-PTI patients prior to stress. A concurrent SCL measure of sympathetic activation found no difference between the PTI and non-PTI groups either at baseline or during cognitive stress. It appears from this data that PTI is specific to the peripheral vascular system of these patients and may be a marker of psychophysiological dissociation or trauma blocked from consciousness.

Eighty-three consecutive patients with chronic somatic complaints seen prior to therapy were tested on the eight factors of the High Risk Model of Threat Perception. Thirty-two percent were high and 28% were low on hypnotic ability, which is more highs and lows than would be expected in a normal population. In the high and low hypnotic ability somatizers, the distribution of somatic and psychological symptoms is significantly different from the moderate group. Counterintuitively, hypnotic ability and major life change were orthogonal to all of the other risk factors. These findings are consistent with eight of nine predictions from the High Risk Model of Threat Perception.

A study was undertaken to examine whether empathy could be related to absorption and incongruence (repressive coping). The participants were 71 graduate students who completed measures of empathy, absorption, and incongruence (repressive coping). The results confirmed a previous finding that empathy appears positively related to absorption (r = .42, p < .001). The results also suggest that affective components of empathy are inversely related to repressive coping (r = -.29, p < .05) while cognitive components are positively related to the social desirability aspects of incongruence (r = .31, p < .01). The findings are collectively discussed in terms of the Empathic Involvement Hypothesis of Hypnosis (Wickramasekera II, 2001), the Four-factor theory of Repressive Coping (Eysenck, 1997), Incongruence (Rogers, 1957), and the High Risk Model of Threat Perception (I. E. Wickramasekera I, 1998).

This study examined whether trait empathy is related to hypnotic ability and absorption. Sixty-four graduate students and mental health professionals completed the Harvard Group Scale of Hypnotic Susceptibility, Form A; the Davis Interpersonal Reactivity Index; and the Tellegen Absorption Scale as measures of hypnotic ability, empathy, and absorption. Correlation analysis determined that statistically significant relationships exist between empathy and hypnotic ability (r = .41); empathy and absorption (r = .43); and absorption and hypnotic ability (r = .31). The results also indicate that empathy and absorption are both predictors of hypnotic ability, although absorption does not appear to contribute a statistically significant amount of the explained variance in hypnotizability that is independent of empathy. It may be that the conceptual ground shared by both empathy and absorption is what predicts hypnotic ability.

The electrodermal response to cognitive threat of unhypnotized female patients with somatic symptoms and high on both hypnotic ability and neuroticism (H-H) was found to be significantly higher (p

Medical high technology and superior medical skills cannot substitute for individual responsibility for health care today. One of the primary causes of chronic disease today is our psychological and psychophysiological reactions to psychosocial stress and our maladaptive (smoking, obesity, drug abuse) ways of coping with psychosocial stress. These psychological A part of this paper was first read as an invited presentation to the American Association for the Advancement of Tension Control, Chicago 1977, and a summary of it without reference to self-hypnosis was printed in the proceedings of the American Association for the Advancement of Tension Control. This paper was also read at the American Psychological Association Convention in Toronto, 1978, at the annual convention of the Illinois Psychological Association in 1978, and at the annual convention of the American Association for the Advancement of Science, Houston, Texas, 1979. and psychophysiological reactions are consequences of fixed perceptions of threat and fixed perceptions of the ways of coping with threat. Hence, giving patients tools and the responsibility to use these tools to alter their own perception of threat is a major step toward restoring individual responsibility for health care. Self-hypnosis may be a useful prototype of such a tool to alter fixed perceptions of threat arousal and resolution.

Patients may be referred to a behavioral medicine practitioner for a variety of reasons. Generally, the bulk of these referrals come from physicians with patients who present chronic physical complaints in the absence, on repeated investigations, of physical findings. Alternatively, they are patients whose somatic complaints have been unresponsive to multiple, conventional chemical and/or surgical interventions. Often the referrals are poorly made. Without rapid and effective patient reorientation by the behavioral medicine practitioner, these patients are unlikely to make or keep an appointment, or if they come in, to return after the first visit.

Sir William Osler is reported to have said that “sometimes it is more important to know what kind of patient has a disease than what kind of disease the patient has”. One implication of this statement is that certain types of personality features can potentiate or attenuate either the symptoms or the etiology of a disease, or both. The first goal of this paper is to start to specify a promising set of personality features and also a set of situational events under which people who are either biologically prone to a disease or exposed to the relevant pathogens will become symptomatic. The second goal of this paper is to tentatively suggest some procedures to quantify these personality dimensions and these situational conditions. The third goal is to present evidence from my clinical practice and the research literature to support this model of the patient at high risk to develop chronic stress related illness. The present model (Wickramasekera, 1979, 1980a;1980b) is based on clinical observations made, and case study data collected, over the last 15 years in an increasingly specialized clinical practice.

Until the twentieth century, physicians had not much more than the placebo effect to offer their patients (Benson & Epstein, 1975). In spite of this situation and the fact that they subjected their patients to purging, leeching, puncturing, cutting, heating, and freezing, physicians generally occupied respected social positions. This paradox is accounted for by the potency of the placebo effect in the history of medicine. The disapproval of the placebo effect developed mainly with the start of controlled drug studies in the 1950s.

There is a growing awareness that the parameters of acute and chronic pain vary widely. Acute pain is easy to localize and recognize, and may, in fact, be mediated through different pathways from chronic pain (Sweet, 1981). These pathways include the (a) dorsal-column post synaptic system (DCPS), (b) spinocervical tract (SCT) and (c) neospinothalamic tract (NSTT), which are all rapidly conducting systems suited to convey phasic information (Melzack & Dennis, 1978). Acute pain is marked by an increase in mytonia, heart rate, blood pressure, skin conductance, and peripheral vasoconstriction together with other indicators of sympathetic activation. From a psychological or behavioral viewpoint we are seeing the same signs that indicate fear or anxiety. Chronic pain has been defined as any pain that has persisted for over 6 months and has not responded to standard medical management, including drugs, physical therapy, and surgery (Sternbach, 1974). Bonica, a pioneer in the study and therapy of chronic pain, defines it as “pain which persists beyond the usual course of an acute disease or a reasonable time for an injury to heal, or it recurs at intervals of months or years (Bonica, 1980). Studies by Johnson (1978) and Barton, Haight, Marsland, and Temple (1976) reveal that 75% of patients who complain of recent onset back pain experience spontaneous remission within 3 months.

Profound changes have been occurring in health care, particularly in terms of the types of diseases presented to physicians today, and the recognition of the inadequacies of conventional medical treatments for these disorders. Acute infectious diseases, like pneumonia and tuberculosis, no longer kill or cripple citizens of the United States so frequently as they did in 1900. Instead, chronic stress-related multifactorial conditions, like cardiovascular disease, cancer, and auto accidents, are today’s major killers and cripplers. These diseases cannot be traced to a single pathogen, but behavioral and environmental factors can increase vulnerability to the disease (Califano, 1979). Eighty percent of the problems presented to physicians today are chronic diseases, such as colitis, arthritis, asthma, diabetes, and cardiovascular disease. These are diseases of choice, not chance, because life-style and behavioral factors, such as diet, smoking, and exercise, are major risk factors for the prevention of these disorders. With the chronicity of disease, behavioral factors become even more crucial to prognosis and to effective therapy (compliance with medication, depression, etc.). In 1979 the Surgeon General’s Report attributed 50% of all deaths to unhealthy behaviors. The profile of illness today is marked by chronic-stress-related multifactorial diseases in which behavioral and psychological variables and issues of choice are crucial to prevention, therapy, and prognosis. It is worth noting that even for a new infectious disease, AIDS, behavior is a major risk factor and in fact a specific type of behavior, sexual behavior. (See Figure 5.)

There are five types of questions the therapist should ask about each patient profile. First, for this patient, what is the most distressing chronic symptom or symptoms (e.g., back pain on walking, headache, angina) and what is the frequency (times per day or hour), intensity (patient’s subjective rating, absent 0–5 severe), duration (length of symptomatic episode), the antecedents (psychological mood and situational) and the consequences (onset or offset of aversive events, attention, sympathy, etc.) of this distressing symptom or symptoms. Investigating these questions involves finding out why an acute problem became chronic in this case. Second, what factor or factors does the patient believe have caused or is presently maintaining the distressing symptom or symptoms. Third, what conceptual or procedural links can be made between the patient’s beliefs about the etiology or present condition of the disorder and the five components of the high-risk profile. Fourth, what elevations or deficits discovered through the patient’s performance on the high-risk profile (Wickramasekera, 1979) can account for parts or all of the patients presenting problems. In other words, what predisposes, triggers, and buffers are operating in this case at this point in time. Fifth, what maladaptive, unattended, or unconscious and overlearned beliefs and behavioral responses block this patient’s assimilation of major life changes (e.g., rape, physical impairment, death, loss of job, loss of lover, loss of child, etc.) in intimate relationships (commitment, sex, affection, confiding) and work (commitment, production, challenge, control) relationships. In intimate relationships it is crucial to be able to feel committed; and to be sexually, affectionally, and verbally uninhibited with at least one person. In the work situation too, it is important to feel committed to what one is doing and to feel some degree of control over the products of one’s work and to be challenged by them. Impairments of adaptation in areas of work and love are destructive to normality. Unconscious (unattended) and overlearned belief filters or schemata the patient holds may block the assimilation of and adaptation to a traumatic incident or major life change. For example, the premature death or betrayal of a loved one may be incongruent with one’s unconscious, unattended, or over-learned belief in a just world. This unconscious cognitive incongruence may obstruct the assimilation and adaptation to this irreversible life change. Repeated episodes of unstable angina or a myocardial infarction in a young adult may not fit the overlearned belief “I am intact and invulnerable.” A discrepancy between unattended and overlearned unconscious beliefs and everyday empirical experiences can generate feelings of incoherence, disorientation, and hopelessness. A serious breach of personal or professional standards may be incongruent with the deep unattended belief “I do not do bad things.” This guilt may torture the person. A series of incomprehensible personal and/or professional losses or failures may be incongruent with the unconscious belief that “my world has meaning and I am in control of my life.” Deep unconscious or overlearned beliefs like I am “unworthy” or “incompetent” can be threatened by life events like the prospect of promotion, marriage, or love. These threats to unattended and overlearned or unconscious deep schemata can unwittingly trigger intrusive ruminative episodes, attack, or escape behaviors that block or impede functional adaptation to major life changes that have, in fact, occurred. For example, symptoms like chronic anxiety, depression, dissociative acting-out episodes, guilt, insomnia, rheumatoid arthritis, torticollis, chronic pain, or an ulcer can occur in response to the loss of a loved one or a major personal or professional failure.

Sir William Osier had to rely on intuition to identify subject features that could potentiate or attenuate either the symptoms or the etiology, or both, of a disease. The first goal of the present chapter is to specify a promising set of empirically identifiable individual differences and also a set of situational events that increase the risk of developing stress-related physical symptoms. The second goal is to present evidence from my clinical practice and the research literature to support this model of the patient at high risk to develop chronic stress-related illness. The third goal of this chapter is tentatively to suggest some procedures to quantify these subject dimensions and these situational conditions. The present model (Wickramasekera, 1979, 1980b,d, 1983) is based on clinical observations in an increasingly specialized clinical practice, theoretical speculations, and empirical data from several disparate lines of controlled research.

In 1950, health care costs accounted for 4.6% of the gross national product. In 1985, health care costs accounted for 10.8% of the gross national product (Cohen, 1985). Sophisticated biomedical technology and expensive medical tests have contributed to this cost escalation (Culliton, 1978). This massive increase in health care costs appears to have occurred without a comparable increase in health status (DeLeon & VandenBos, 1983) of United States citizens as measured by morbidity, mortality, longevity, and so on.

It is absolutely essential immediately to move the patient presenting physical complaints without physical findings toward a psycho-physiological model and away from a biomedical model (mind—body dichotomy model) of one’s presenting complaints. The psycho-physiological model is implemented through a role induction which should be administered within the first three sessions of patient contact, before the window of hope and opportunity, temporarily opened by a new therapy context, closes in the patient’s head. The psycho-physiological role induction is an effort to challenge and change the patient’s perception of the possible origins of one’s somatic complaint. This is done by challenging the patient’s prior beliefs about the extent to which one’s thoughts can influence or do in fact inaccurately reflect one’s biological functions. This is accomplished through a psycho-physiological role induction, which uses what I call a Trojan Horse Procedure. This procedure has at least four components, which start on the outside with somatic symptoms and work their way upward into the patient’s head. (See Table 7.)

Background: Headaches account for a high percentage of office visits to primary care physicians, with migraine and tension-type headaches the most common. This article provides a summary of psychophysiologic therapies for migraine and tension-type headache and considers psychosocial factors relevant to headache. Psychophysiologic therapy of headache consists primarily of relaxation and biofeedback. Method: Representative controlled studies, meta-analysis, and reviews are utilized to assess the efficacy of biofeedback and relaxation for migraine and tension-type headache. Results: Psychophysiologic therapy comprising biofeedback and relaxation can be provided in standard or limited therapist contact formulas to patients as sole therapy or concurrently with medical therapy. Effectiveness has been demonstrated for thermal biofeedback–and electromyograph biofeedback–assisted relaxation with minimal or no side effects. A typical treatment protocol is offered to exemplify the integration of psychophysiologic therapy into primary care practice. Conclusion: Psychophysiologic therapy represents an important adjunctive treatment for chronic benign headache that can be incorporated into primary care.