Medical Issues and Hypno-psychotherapy
For today’s blog, I would like to offer you a very important piece of work created for theÂ National College of Hypnosis and Psychotherapy by its Chief Medical Officer, Dr Geoff Ibbotson. I believe this to be of extreme interest to those practising hypno-psychotherapy/hypnotherapy and those who are seeking out these services.
There is much confusion as to the inter-relationship between hypnosis and âmedical conditionsâ with many feeling that hypnosis is contraindicated in many circumstances.
Whilst I was initially trained in the medical model and worked as a GP for many years using this mind-set I now realise that this can be too tight a frame that should not be applied in too wide a set of circumstances. We must remember that illnesses have been present since time immemorial and the advent of the medical diagnostic criteria does not mean that the medical profession are the only ones who have a valid opinion concerning treatment.
Hippocrates appears to understand the holistic approach with such statements as
The mind and body cannot be divided
Natural forces are the true healers of disease
However has medicine perhaps taken its off the ball a little since then?
Many may think of hypnosis the new kid on the block that was born when Paul McKenna started his activities. However the concepts of Hippocrates were incorporated in the Sleep Temples in around 380 BC. Here patients were placed in a trance-like state. They were encouraged to use meditation.
Perhaps the first use of hypnosis was around 10,000 BC when it was used in Shamanism. The shamans entered into an altered state of consciousness and treated ailments by mending the soul. In this way the body was restored to balance and wholeness.
There has been much controversy around who should be trained in hypnosis. One end of the spectrum would state that the only ones who should be trained in the use of hypnosis are those who are health professionals. Whereas there are many who would say that hypnosis is a valid and valuable tool for psychotherapists.
The words of Hippocrates could be helpful in considering this dialectic.
The chief virtue that language can have is clearness,
and nothing detracts from it so much as the use of unfamiliar words
The phrase health professional generally is taken to mean such professionals as doctors, dentists and nurses. A list of health professionals was available from the Health Professional Council (HPC). Psychologists were recently added to its remit. This list included a wide range of professions but there were some (such as doctors and dentists) missing from the list and some categories that most would not initially think of as health professionals. The HPC has now changed its remit and name to the Health and Care Professions Council, also incorporating such professionals as social workers.
Lars-Eric Unesthl, Ph.D. is a clinical psychologist, Professor in Applied Psychology and Mental Training and President for Scandinavian International University. He recently spoke at a symposium organised by the British Society of Medical & Dental Hypnosis (Scotland) and said Hetero-hypnosis should only be taught to experts who already know the treatment modelsâ and also said The Therapeutic Alliance is needed for treatmentâ
(Unesthl, Lars-Eric, 2013).
Perhaps a helpful way of resolving the dialectic would be propose that there were two elements that were necessary for safe effective therapy. These are the understanding of medical models and also understanding of the principles of psychotherapy. Hence a doctor should only use hypnosis if they have training in psychotherapy. In a similar way, some medical conditions could be treated by psychotherapists who have training in the medical treatment models for that condition.
Some practitioners of hypnosis talk of a very extensive list of contraindications to hypnosis. These include epilepsy, serious or current heart conditions, blood pressure problems (too high or too low), depression, the elderly or frail, persistent alcohol or drug abuse, psychosis, pregnancy, those taking medication and diabetes. Such a list includes a very large proportion of the human race and some individuals fall into several of these categories.
Psychosis is normally regarded as an absolute contraindication to the use of hypnosis. The reasoning behind this is that such individuals have problems in being in touch with reality and hence the use of fantasy and dissociation may worsen their condition. However sometimes those who have great experience in the treatment of psychosis may occasionally use hypnosis (Santiago & Khan, 2007; Hart and Spiegel, 1993). This decision of the advisability of the use of hypnosis in psychosis is further complicated if one considers whether a one time definition of psychosis is a lifetime ban to subsequent use of hypnosis at a later time when the client is stable and symptom free. Any practitioner who has reason to believe that their client may be psychotic should consult their supervisor in the first instance, and probably then consult the clientâs GP and/or psychiatrist.
Antisocial and similar personality disorders should be regarded as an absolute contraindication to hypnosis. This is because the use of hypnosis would possibly disinhibit the individual and lead to the risk of violent activity that would endanger the therapist, the client and even members of the public. Such conditions should only be treated by those specially trained and experienced in the conditions and also the treatment should be in a team setting with good supervision.
Post-Traumatic Stress Disorder (PTSD) responds very well to treatment using imagery and hypnosis. There is evidence that such treatment is faster than approaches using cognitive behavioural therapy (CBT). There is evidence that treatment using trauma-focussed hypnosis is quicker than CBT (Ibbotson & Williamson, 2010). Before embarking on treatment of PTSD the therapist should have specific training.
Hypnosis is a safe technique that can be used in pregnancy. Hypnosis can be used to treat infertility (Mackett and Maden, 1989). Hyperemesis Gravidarum is a condition in pregnancy where there is nausea, extreme vomiting and dehydration. This can be treated using hypnosis (Fuchs, 1983). Hypnosis has been used to treat premature labour (Omar, 1986). Hypnosis has been used extensively in order to facilitate labour (Harmon, 1990; Jenkins, 1993).
Neither hypertension nor hypotension are contraindications to the use of hypnosis. In fact hypnosis may be effective in the treatment of hypertension (Friedman, 1977).
Hypnosis is not contraindicated in the treatment of depression, however care needs to be taken with clients who have suicidal ideation. Such clients should only be treated by therapists who are experienced in treating such clients without hypnosis. It used to be thought that ego-strengthening was contraindicated in depressed clients as they might âget their act togetherâ and commit suicide. Dr Michael Yapko Ph D, a world authority on the treatment of depression, states that this is not the case (Yapko, 1997). However we do not recommend that our graduates work with other than mild, reactive depression until completion of the diploma, and then only with severe depression when having completed specialist training such as that offered as an Advanced Hypno-psychotherapy Module by David Collingwood Bell.
A quote on epilepsy is attributed to Hippocrates. (Stated by Carl Sagan in Cosmos, 1985).
Men think epilepsy divine, merely because they do not understand it.
But if they called everything divine which they do not understand, why,
there would be no end of divine things
Epilepsy is a symptom rather than a discrete medical condition. Humans have a seizure (a fit) if they are provoked by a wide variety of factors including low blood sugar, high temperature and dehydration. Some have repeated fits and these may be idiopathic or a consequence of physical factors in the brain. In such circumstances there is a typical electrical activity in the brain and the fits respond to anticonvulsant medication. These individuals are said to suffer from epilepsy.
There are seizures that look like an epileptic fit but do not have the characteristic electrical brain activity of an epileptic fit. Such events are called epileptiform seizures. Epileptiform seizures are reported in ten to twenty three percent of referral centres. Some patients have both epileptic and epileptiform seizures (Nash, 2008).
Hypnosis has been used in research to differentiate between epileptic and epileptiform seizures (Peterson et al, 1950). Hypnosis can be used to reduce or eliminate seizures (Miller, 1983; Betts, 2003).
In around 4% of epileptic subjects epileptic seizures can be provoked if the client looks at flashing lights such as a television or a video game. It is important that such individuals avoid exposure to flashing lights (Frucht, 2000). It is for this reason that television broadcasters say âwe would like to warn you that the following material contains flashing imagesâ. If a client suffers from photogenic epilepsy they should avoid flashing lights. There are some that say that the provocation of fits can be prevented by covering one eye whilst watching the flashing light. This also applies to those who have migraines triggered by strobe lighting, so if you use any light-based therapy, always check.
There are references to a case where a client died of a seizure during hypnotic treatment. It is for this reason that some regard epilepsy as a contraindication to hypnosis. However no information is available of the medical circumstances. Was this a fit in a known epileptic or was it the clientâs first seizure induced by, for instance, a catastrophic medical problem. The use of hypnosis in research and the treatment of epilepsy is reassuring that epilepsy is not a contraindication to the use of hypnosis. It is, of course, prudent that care should be exercised with an epileptic with frequent fits. We recommend that all practitioners ask about epilepsy as a matter of course and ensure that their epilepsy is controlled by medication before continuing treatment.
A previous stroke is not a contraindication to hypnosis. Hypnosis can be used to help in the rehabilitation of those who have suffered a previous stroke (Diamond, 2006).
Diabetes is not a contraindication to hypnosis. However, always make sure that a diabetic client is balanced before inducing hypnosis. This, of course, implies that you always find out whether your client is diabetic or not.
Asthma is not a contraindication to hypnosis. However, always make sure that a asthmatic client has their inhaler (if they use one) handy before inducing hypnosis. This, of course, implies that you always find out whether your client is asthmatic or not.
Hypnosis is not contraindicated with elderly or frail clients. There is no upper age limit to the use of hypnosis. Clearly care should be taken to avoid extreme distress in trance. This might have occurred during regression and abreaction for trauma. However it is the opinion of the author that past trauma should now be treated by dissociated imagery (which reduces emotional trauma during the therapy).
Hypnosis can be used as part of a package in the management of dementia (Duff & Nightingale, 2007).
The author found a bizarre response from an elderly client who was using imagery of a beach as part of her self hypnosis technique. The client used a beach that she had last visited around twenty years previously. At the next session they reported that they could only see the left side of the beach. The author asked them to go into trance and visualise the beach. Again the client said they were unable to see the right hand side of the beach. When asked to turn their head to the right they reported that they were able to see the right side of the beach. On questioning the client reported that they had suffered from a cataract in the right eye when they last visited the beach, but had now had successful cataract surgery.
Heart conditions are not a contraindication to the use of hypnosis. However if angina is easily provoked then care should be taken in the choice of hypnotic techniques.
Alcohol or drug abuse are not contraindications to hypnosis but clients should not be seen at that time if they present for treatment whilst inebriated. Hypnosis can be useful as part of the package of approaches used in the treatment of addictions (Katz, 1980; Potter, 2004).
Clearly medication is not a contraindication to hypnosis. However if this causes extreme drowsiness or other symptoms that may interfere with the cognitive processing and retention necessary for therapy, caution should be exercised. Such individuals will find the extreme drowsiness interferes with their day to day living and it is advisable that they seek medical advice with a view to modification of their therapy.
First aid training teaches appropriate treatment of accidents and medical emergencies. There is an attempt to widen the knowledge of first aid. If a therapist is treating clients with medical conditions it is, perhaps, desirable that they are trained in first aid.
It might be thought that hetero-hypnosis would have a greater effect on a clientâs physiology than self-hypnosis. A PhD student wrote her thesis on the subject and found that they both had similar effects (Luna, 2009).
Following the philosophy of Lars-Eric Unestahl psychotherapists could treat certain medical conditions following appropriate training. The National College of Hypnosis and Psychotherapy (NCHP) runs CPD training on PTSD, fertility, hypnosis for childbirth, depression, healthy weight coaching and tinnitus.
Most advice on hypnosis for medical conditions suggests seeking advice from a doctor as to who is suitable for treatment by hypnosis. The problem is that many doctors do not know anything about hypnosis and may simply follow urban myths. Perhaps this document could assist them in giving an informed opinion.
Betts, T. (2003) Use of aromatherapy (with or without hypnosis) in the treatment of intractable epilepsy – a two-year follow-up study. Seizure, 12, 534-538.
Diamond, S. et al. (2006) Hypnosis for rehabilitation for stroke: six case studies. Contemporary Hypnosis, 23, 173-180.
Duff, S. & Nightingale, D. (2007) Alternative approaches to supporting individuals with dementia: enhancing quality of life through hypnosis. Alzheimerâs care today, 8, 321-331.
Friedman, H. & Taub, H. (1977) The use of hypnosis and biofeedback procedures for essential hypertension. International Journal of Clinical & Experimental Hypnosis, 25, 335-347.
Frucht, M. et al. (2000) Distribution of Seizure precipitants Among Epilepsy Syndromes. Epilepsia, 41, 1534-1539.
Fuchs, K. (1983) Treatment of hyperemesis gravidarum by hypnosis. Third European Congress of European Society of Hypnosis in Psychotherapy and Psychosomatic Medicine, Haifa, Israel.
Harmon, T., Hynam, M. & Tyre, T. (1990) Improved obstetric outcomes using hypnotic analgesia and skill mastery compared with childbirth education. Journal of Consulting & Clinical Psychology, 58,5, 525-530.
Hart, O. & Spiegel, D. (1993) Hypnotic assessment and treatment of trauma-induced psychosis: the early psychotherapy of H Breukink and modern views. International Journal of Clinical & Experimental Hypnosis, 41 (3), 191-209.
Ibbotson, G. & Williamson, A. (2010) Treatment of Post-traumatic Stress Disorder Using Trauma-Focussed Hypnosis. Contemporary Hypnosis, 27, 257-267.
Jenkins, M. & Pritchard, M. (1993) Hypnosis: practical applications and theoretical considerations in normal labour. British Journal of Obstetrics and Gynaecology, 100, 3, 221-226.
Katz, N. (1980) Hypnosis and the addictions: A critical review. Addictive behaviours, 5, 41-47.
Luna, K. (2009) Physiological differences between self-hypnosis and hetero-hypnosis. PhD thesis, Indiana University of Pensylvania.
Mackett, J. & Maden, W. (1989) Simple hypnotherapy for infertility. Hypnosis: The fourth European Conference at Oxford, 201-205.
Miller, H. (1983) Psychogenic seizures treated by hypnosis. American Journal of Clinical Hypnosis, 25, 4, 248-252.
Nash, M. & Barnier, A. (2008) The Oxford Handbook of Hypnosis Theory, Research and Practice. Oxford University Press, Oxford.
Omer, H., Friedlander, D. & Palti, Z. (1986) Hypnotic relaxation in the treatment of premature labour. Psychosomatic Medicine, 48, 351-361.
Peterson, D., Sumner, J. & Jones, G. (1950) Role of hypnosis in differentiation of epileptic from convulsive-like seizures. American Journal of Psychiatry, 107, 428-433.
Potter, G. (2004) Intensive therapy: utilizing hypnosis in the treatment of substance abuse disorders. American Journal of Clinical Hypnosis, 23,1, 21-28.
Santiago, A. & Khan, M. (2007) Hypnosis for schizophrenia. Cochrane database of systematic reviews., CD004160.
Unestahl, Lars-Eric (2013) Hypnosis and Mental Training for Clinical Use and for Personal and Health Development. BSMDH (Scotland) spring symposium, Glasgow.
Yapko, M. (1997) Breaking the pattern of depression. Broadway books, New York.