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The selection of a variety of imagery from the patient's abundant garden of experience and fantasy can aid in controlling physiological processes. Analgesia or pain control may be obtained through a reduction of individual components of pain—i.e., experiential, anticipatory or actual pain stimuli. Local anesthesia obtained by hypnosis becomes useful for venipuncture, spinal taps, bone marrow aspiration or biopsy, injections, etc. An ability to maintain body rigidity is required for wound care and therapeutic or diagnostic radiology; body flaccidity may be required for examinations or diagnostic tests. The surgical patient often is aided by stimulation/suppression of appetite, gag reflex, salivation, bowel movement, urinary bladder function, etc. In addition, hemorrhage control may be crucial. Nausea and vomiting from cancer chemotherapy is often uncontrollable with medication. Hypnotic imagery for control of these physiological processes is used with consistent success. . . . The goals of ego-strengthening, faith enhancement, and reduction of secondary gain result in increased patient autonomy and cooperation. Experiencing a decreased sense of fear and anxiety, the patient reacts with less antagonism and resistance to the necessary, optimal therapy.
[The following suggestions, excerpted from an individual case report, illustrate types of verbalizations that may be used. Induction and deepening had already occurred. It should be kept in mind that these suggestions were tailored to the individual patient, whose interests included snowmobiling, bowling, being outdoors in winter and at the beach in the summer. (Ed.)]
pain control for mouth, throat and stomach.
Now picture the following: A winter scene at dawn in a safe, secure home or cabin in the woods. Have a relaxed, easy breakfast in front of a fireplace. A warm drink and nourishing food to remove the night's chill. So good to feel comfortable. Being warmly dressed, step outside feeling tip-top, into the invigorating air. Look around you. See each of the objects before you. Let them take on shape, dimension, texture. See each of their colors. Feel the warmth of the clothing—the refreshing coolness of the air. Hear the sounds of the woods — if only to allow the room noises of the nurses working or the intercom announcements to drift off—Perhaps all you can hear is the sound of quiet or even a dog's bark in the distance. Try to smell the fragrances of the woods in winter—a little more and a little bit more. Note how good it feels.
If you were to take off your glove, in your mind's eye, your hand might get numb. If you went on a warmed-up, well-tuned snowmobile through the woods, your cheek might feel a cool numbness with the wind and light snow flurries going refreshingly by. When they put in the central venous line this afternoon, and when they do the bone marrow tap, it will be interesting to think about that cool, comfortable numbness right in the area they're working. Wouldn't be surprised if you could make it numb even before they put the anesthesia in. George, you'll surprise yourself. I'm sure of it, George! Make it numb before they begin, if you want.
time distortion. [Time distortion was introduced as part of an undirected, open-ended use of the image used thus far.] I enjoy thinking about a snowmobile ride, down a new trail. One that can become a very familiar one. While you think about that snowmobile trail, I'd like to talk to you. You can control the speed and where you wish to go. Could even go in slow motion, like the old-time movies, or speed it up or go in reverse. As you take that ride, you can still listen to the things I'll say.
motivation and ego-strengthening. Body and health are our most prized possessions. You're now working toward restoration of complete health. By mastering this technique, which you're so good with, George, you are regaining self-control. Just as you control how fast you snowmobile, you control your anxiety with relaxation.
There is no longer a need to worry about procedures. You can put it out of your mind if you like, until it's time. You'll be able to relax over it. Able to control the sting of needles, to take the hurt right out of it—pressure, but nothing more. No longer need to wait for pain pills or nausea meds. Once you've told the nurses or doctors, and only if it's appropriate, you can bring relaxation into that part of your body. You've become part of the treatment team. No need to be patient, or tolerate anything unpleasant. Not fighting the nurses or doctors anymore. Not delaying taking meds because now you're learning to handle each situation. Now unified to fight the disease and wipe out the bad cells.
instructions for self-hypnosis. Now I've been talking a lot. You probably weren't paying complete attention but you heard everything. Now you're paying attention! You'll remember what we did so you can practice it four or five times a day. You're just an excellent patient and I know you will be able to master this thing so you can turn it on quickly, at a moment's notice. Remember to assume a comfortable position with arms and legs uncrossed. Take three slow, deep breaths. Hold. Feel the tension. Say "relax" and let the tension flow with each breath. Think about some safe, secure, comfortable place—might be the winter scene we talked about or any other scene. Perhaps the beach. See the objects—their shapes, texture, colors. Feel the warmth or coolness, moisture or dryness. Hear the sounds. Smell the fragrances.
posthypnotic suggestions. George, you will remember everything you need to. You will practice it four or five times a day and be able to achieve deeper relaxation each time more easily and quickly. You will feel better about yourself—a sense of accomplishment and mastery. Now you're able to control feeling instead of them controlling you. Feel just tip-top! Allow the day to take on a rosy glow. Feel the benefits of deep relaxation. As if having had a good night's rest. You will be able to go through the day more relaxed, more comfortable and secure in one's feelings. Look forward to the next session and think about reorienting to the room in a few moments.
posthypnotic phase. [After the patient was reoriented, he was encouraged to talk by saying:] Any questions? [After any needed clarification, reassurance and "waking" hypnotic suggestions were given.] George, you're such an excellent person for this. You did so well! I know you will practice what we've done and you'll benefit greatly from applying this when it is appropriate. I'll see you tomorrow. We can do another session, if you want. May not even need it.
Images do not intrinsically evoke specific effects; the practitioner's verbalization must include imbedded therapeutic suggestions. While there are no restrictions as to which images to use for a given desired result, the prehypnotic interview will often disclose which experiences of the patient might be revivified or what situations might be fantasized. Patients' likes and dislikes, as well as what things make them feel "good" or what they would really like to be doing, are important clues. Specific treatment goals should be elicited by asking the reason(s) hypnosis is desired. The winter woods scene used with this patient was carefully interwoven with both direct and indirect suggestions of "safe, secure; relaxed, easy breakfast; so good to feel comfortable; refreshing coolness; cool, comfortable numbness; regain self-control; control anxiety with relaxation; not fighting nurses or doctors; fight disease (pronounced ambiguously: disease); wipe out bad cells; rosy glow; etc."
specific images. Relaxation and anxiety control can be evoked with almost any trance induction or deepening imagery. The broad, green leaf detaching from the tree top, gently drifting on a breeze, as if in slow motion, and finally settling so easily it doesn't bend a single leaf of grass beneath the tree (per Albert Forgione, Ph.D.) can be modified to a colorful fall leaf, a winter snowflake, a speck of dust on a drop of water in a rainbow or the mist of a waterfall. Expansion to full vivification involving sight, sound, smell, taste and touch hallucination can easily introduce suggestions of time distortion (patient controls speed as in slow motion), dissociation (patient separates from the restraints of time, body, ideation, rumination or obsession), and selective amnesia (patient experiences the imagery instead of something perceived as painful or unpleasant). Other scenes of seashores, mountains, underwater or outer space are equally valid and widely used. Karen Olness' flying blanket . . . deserves special mention for use with children. This author often utilizes the imagery of a mare and its colt (or other animal/offspring pair). This image is readily accepted by children and serves the purpose of a strong metaphor (as the colt engages in its activity, the mother is near to make sure that all is well).
Analgesia and pain control involve reduction of the components of experiential (remembered or previously imagined), anticipatory or real (physically stimulated) pain. The first two of these are generally approached through relaxation, dissociation or behavioral desensitiza-tion. The actual pain may be reduced by removing the "hurt" from the "unbearable" through reinterpretation or suggestions of direct reduc tion, space and time contraction, transfer of analgesia/anesthesia to the area or transfer of the pain to another locus. Imagery of a cool, comfortable fog or light rain touching the cheeks, being breathed in and pleasantly numbing the tongue, mouth, throat, stomach, etc. has been particularly helpful and is expanded to a "fog of anesthesia" (as proposed by Andrew St. Amand, M.D.). This image can be adapted to induce local anesthesia, body rigidity or flac-cidity, nausea and emesis control, stimulation or suppression of appetite, salivation, or bowel movement, urinary bladder release or retention, and even healing enhancement and tumor shrinkage/destruction.
The psychological goals of ego strengthening, motivation to recover, and reduction of secondary gain are obtained by including suggestions within the imagery. Visualizations of increased self-control, mastery of physiological control and autonomy are encouraged. Within the image the patient is in control of the sailboat, snowmobile, magic carpet, etc., or gains mastery of mountain climbing, swimming, running, etc., and this is linked with any control gained over the patient's physiological complaint.
Revivification of past accomplishments such as success with school, job, family, community or recreation shows previous ability to succeed. Abreaction may occur if the patient perceives this image as confirming the loss of some ability that was important to him. However, this can be a valuable therapeutic event to get the patient beyond the mourning stages of denial, anger and depression to acceptance and continuation of life. Imagery of value with this task involves regression back to early grade school when promotion to a new classroom meant chairs and tables seemed larger than life. The idea of looking through adult eyes at the same scene (with all of the accomplishments since grade school) is introduced. Thus the patient gains the perspective that, viewed from today, the obstacles of the past have been overcome, although they seemed insurmountable then. Childhood experiences of playgrounds, trips to relatives, vacations, etc., are variations on this theme (suggested by Harold Golan, D.M.D.).
Perhaps the most useful aspect of the imagery technique involves giving permission to experience all of the images that will allow the patients themselves to resolve any issues they need to, at the point in their "therapy" when they are ready. Within the image, patients interact with some "significant other" and are told what they need to hear to resolve their inner conflict. A related approach involves spiritual "awakening" or contact from which the patient gets the feeling of strength to survive and carry on.
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