Current Trends in Hypnosis Therapy - Essay Example

Current Trends in Hypnosis Therapy Hypnosis is difficult to define, but relentless researches on the theoretical basis of hypnosis and its practical applications have led to a consensus that although abstract in nature, it has a structural basis. There are debates among hypnotists as to its exact nature, and in the midst of this continuing debate, new theories have been proposed, and this has opened the arena of its application in the clinical practice, where hypnoanalytic approaches are increasingly being assumed to analyze the client, and depending on those, a combination of approaches in hypnotherapy is increasingly being used depending on the patients' conditions. Current trends are showing an application of integrative approaches in management of different medical conditions where conventional management alone fails to satisfy the patient needs in a varying array of complicated scenario or difficult pathophysiology. Current theories of hypnotherapy attempts to find out the neurological connections and alterations associated with it, and once the neurocognitive significance of such diseases would be elucidated, hypnotherapy, as expected, would perhaps get the status of treatment from its current status of adjunct to treatment. Current research calls for more extensive studies to develop specific criteria for development of management guidelines. Introduction: It is difficult to define very precisely what hypnosis is, and on the face of very many different definitions, it can be defined as a temporary condition of altered perception in the subject which may be induced by another person and in which a variety of phenomena may appear spontaneously or in response to verbal or other stimuli. These include alterations in the consciousness of the subject and in his memory, may involve increased susceptibility to suggestion, and these may lead to production in the subject of responses or ideas that are familiar to him in the usual state of mind. Hypnosis is all about the manipulation of the unconscious mind. The unconscious mind of any individual not only holds information that is outside his consciousness, but it also manages sensations and body functions. Thus, not only does information from the mind affect the body, but there is now scientific evidence that any mental processes, mental states, and mental behaviors affect all the cells and all the organs in the body all the time. Hypnosis, in one form or another, has been used in different parts of the world to treat various medical and psychological disorders since ancient times. As yet no universal definition or explanation of hypnosis has been postulated. Many theories, loosely classified under state and nonstate theories, have been advanced to explain hypnosis, but none of the theories has satisfactorily explained all the phenomena associated with. State theorists conceptualize hypnosis as a trance or altered state of consciousness, influenced by subjective traits and the states of the hypnotized person. According to Alladin in 2006, the nonstate theorists purport a social, psychological explanation and maintain that there is nothing unique about hypnosis; they argue that most hypnotic phenomena can occur without a hypnotic induction (Alladin, A., 2006). These theorists focus on the social or relational aspects of the hypnotic interaction, and they emphasize the role of a variety of interactional forces, such as expectations and situational demands, in the production of hypnotic phenomena. These different formulations of hypnosis have broadened our understanding of the subject. Academics and experimentalists have generally endorsed nonstate, interpersonal, or multifactorial views of hypnosis, whereas clinicians have tended to adopt state, intrapersonal, or single views of hypnosis. There is another theory; the neodissociation theory of hypnosis is a new approach that has been accepted by the clinicians. Proponents of both camps, however, agree that hypnotic suggestions can produce altered states, determined by some subject variables that can influence the hypnotic performance. Barber in 1999 suggested that the important subject variables include cooperation, expectations, motivation, and level of involvement in suggestion-related thoughts and images. Some theorists emphasize that both state and nonstate theorists agree that hypnotic suggestions can produce altered states such as amnesia, analgesia, involuntariness, and others, although there is disagreement about whether these altered experiences depend on the prior induction of a trance state. To clinicians the goal is to reduce a patient's distress, and they do not bother much on the theory or the dispute and the debate whether trance exists or does not exist, or whether trance-induction is necessary or not necessary (Barber, T.X., 1999). What is important in the clinical context is the skilful negotiation of variables to maximize therapeutic gains. Basic hypnotherapy involves primarily, although not exclusively, the amelioration of symptoms by direct hypnotic intervention via the establishment of the hypnotic state and the use of appropriate suggestions coupled in some cases with self-hypnotic techniques. Information is carried within the body in the form of electrical impulses that pass through nerve cells, or neurons. Between any two neurons, there is a gap, or synapse. In order for impulses to travel along a continuous path of nerve cells, something has to carry the impulses across the gaps. This essential task is performed by neurotransmitters, which are chemicals that conduct electrical impulses across the synapses between nerve cells. During the hypnotic process, that can be induced on the instruction of a therapist or self-induced by the subject, the extent that phenomena is experienced and observed depends upon the depth of the hypnotic state and is commonly referred to as hypnotic susceptibility. Although controversial, Hilgard's neodissociation conceptualization of hypnosis is one of the most influential theories of hypnosis, both from an experimental and clinical standpoint. Hilgard describes hypnosis and other related phenomena such as fugues, possession states, multiple personality, and the like in terms of dissociation or divided consciousness. The new cognitive neurosciences edited by Gazzaniga in 2000 states that dissociation is defined as a psychological process in which information, incoming, stored, or outgoing, is actively deflected from integration with its usual or expected associations. This produces alterations in thoughts, feelings, or actions so that, for a period, certain information is not associated or integrated with other information in the usual or logical way. Some have also put forward the view that systems of ideas can become split off from the main personality and exist as an unconscious subordinated personality, capable of becoming conscious through hypnosis. Hilgard, by deriving ideas and concepts from information processing, selective attention, brain functioning, and the cognitive model of consciousness, reformulated the theory in contemporary terms and called it neodissociation theory where dissociation is seen as an extension of normal cognitive functioning. It has been suggested that during ordinary consciousness, information is processed on a number of levels by a hierarchy of cognitive operations and controls. Ordinarily, these operations are integrated, but during hypnosis or dissociation, the integration decreases, and certain aspects of experiences may not be available to the conscious mind (Gazzaniga, M. (Ed.), 2000). Mesulam in his book, Principles of behavioral and cognitive neurology discusses Hilgard's theory. According to him, Hilgard's theory proposed that an individual possesses a number of cognitive systems, hierarchically arranged, with a central control structure or executive ego and multiple superordinate and subordinate structures, each with its own input and output connections with the world. Although the executive ego is normally in control, the other structures can take over as a result of hypnotic-type suggestions or other similar procedures or situations. In other words, hypnosis or other similar procedures has the effect of dissociating these systems from one another, and some of these systems can be taken out of awareness or consciousness. A hypnotized individual may thus report feeling no pain, but the cognitive system that is aware of what is going on may report feelings of pain (Mesulam, M.M. (Ed.), 2000). The neodissociation theory proposes that, when a subject is hypnotized, only some of the cognitive systems are involved, while others remain unaffected. Thus a person who experiences only a vague feeling of relaxation has only a very few low level cognitive systems affected. Dissociation can be externally induced, self-induced, or it can occur spontaneously. Linking hypnosis with consciousness seems intuitive and logical. With the recent upturn of interest in consciousness as an area of scientific study in affective and cognitive neuroscience the relationship between consciousness and hypnosis is likely to be further clarified. Some striking parallels have already been observed in the mental processes involved in dreaming and hypnosis. It has been observed by Vaitl et al in 2005 that dissociations between the specific and nonspecific thalamocortical systems underpinning dreaming, implying that a state of hyperattentiveness to intrinsic activity can occur without registering sensory input. In dreaming, it has been observed that there is a dissociation between context and sensory input and the cognitive features of dreaming including altered sense of time, absence of temporality, lack of guiding reality and critical judgment, anchoring in personal experience, and affective coloring. These findings have led researchers to draw parallels between hypnosis and altered state of consciousness (Vaitl, D. et al., 2005). It can be argued that neodissociation theory of hypnosis is incomplete. Although it has proposed cognitive structures, there is little information about what happens inside them. It is also unclear how many cognitive systems a person possesses, and how many of these are engaged in hypnosis. Moreover, the neodissociation theory has been criticized for ignoring the role of social compliance factors. However, some followers of Hilgard have addressed the role of social compliance in hypnosis. Within this debate, it might be wise to contemplate that only confining to the social context of the hypnotic experiments would be wrong, and logically, if mind has a neural structure, then experiences arising out of it would have a specific pattern, if it results from its stimulation. Referring to Gruzelier in 2005, many observers have performed brain mapping studies, and these demonstrated that while highly hypnotizable subjects claimed to be experiencing hallucinations, the observed brain activity was extremely like that resulting from true sensory stimulation. Others have demonstrated that hypnotized individuals cortically responded to suggested experiences such as colors rather than to the actual stimuli in measurable ways. In fact, abundant neurophysiological and neurocognitive evidence supports the hypothesis that the anterior cingulated cortex and the left dorsolateral prefrontal cortex are involved in hypnotic analgesia (Gruzelier, J., 2005). An examination of the clinical research on hypnotherapy makes it clear that there has been a tendency of the researchers to integrate the domains of behavioral medicine and hypnotherapy, and consequently, there has been greatly increased application of hypnosis in the field of behavioral medicine. Lynn and Kirsch suggested in 2006 that current literature document efficacy of hypnosis as an adjunctive therapy of many psychophysiological and medical illnesses. There is enormous amount of data accumulating that might enable the psychologists to use hypnosis as effective therapeutic adjuncts for management of pain, headache, asthma, many gastrointestinal disorders, skin disorders, immune mediated illnesses, and insomnia. Since this therapy can modify subjective affects and can facilitate adjustment to painful medical procedures and chronic incurable debilitating conditions, it is worthwhile to use this method that can lead to positive experiences of the patients (Lynn, S.J., & Kirsch, I., 2006). Yapko in 2003, proposed that the main contribution of hypnosis to clinical outcome is positive subjective effects translated into decreased distress and increased sense of well-being. Going deeper, repeated hypnosis is known to cause behavioral changes in terms of symptom reduction. It has other secondary benefits, such as, decreased use of medications and decreased frequency of medical visits. However, it has been argued that since this is a purely subjective phenomenon, it would not be able to alter or modify the underlying pathophysiology of the psychophysiological disorders in chronic illnesses, but current research has a trend to demonstrate that it indeed can induce structural changes in asthma, hemiparesis, premature labor, and metastatic carcinoma of the breast (Yapko, M.D., 2003).. Many researchers have concluded that the field of hypnosis can be unified through active collaboration between scientists with neurophysiological and social orientations. If hypnotic state can be referred to as an altered state of consciousness, it is an altered state according to subjective experience and altered psychological functioning where hypnosis generates an alteration in sensory input, physiological changes, and motor activity, and these together can produce an altered state in which one's perception of an interaction with the external environment is different than the internal experience. Hypnosis as an altered state of consciousness has been described both theoretically and experientially along the dimensions of alterations in perception, cognition, awareness of one's surroundings, and absorption in an unusual experience. Kallio and Revonsuo's in their recent research in 2003 have reviewed the psychological and neurobiological investigations of consciousness and concluded that different states of consciousness are influenced by compromised brain structure, transient changes in brain dynamics such as disconnectivity, and changes in neurochemical and metabolic processes. In relation to hypnosis, this review suggests that hypnosis affects integrative functions of the brain and induces an alteration or even breakdown between subunits within brain responsible for the formation of conscious experience (Kallio, S., & Revonsuo, A., 2003). Despite many limitations and debates on distinctive points, the trend is a shift toward integrative hypnotherapy. Some authors have presented consistent theoretical explanations of the psychodynamic theories that underlie the approaches to hypnotherapy and hypnoanalysis. Hypnoanalytic treatment of the severely disturbed psychiatric patients would involve essentially application of structural and developmental psychoanalytic theories in these areas. The current trend, therefore, is based on the current knowledge that hypnosis is a complex subject involving mind/brain/body phenomenon and, therefore, it will be impossible for a single theory to explain the broad range of human responses to it. Similarly, it is unlikely that a single physiological signature of hypnosis will be found. Because hypnosis involves a variety of phenomenological experience, various physiological underpinnings are bound to exist. Referring to Kirsch, 2002, it can be stated that although intense debate exists about the nature of hypnosis between the state and nonstate theorists, there is agreement that hypnotic suggestions can produce altered states such as amnesia, analgesia, involuntariness, and the like. To clinicians, who are mainly concerned with reducing a patient's distress, the debate whether trance exist or does not exist, or whether trance-induction is necessary or not necessary is not at all considered paramount. What is important in the clinical context is the skilful negotiation of the patient's and technique's variables to maximize therapeutic gains. As suggested by this trend, it is important for the clinician to be flexible enough to move across diverse theoretical perspectives to select the theory and related approach in treatment or may even be ready to assume a combination strategy that would best match the need of the patient (Kirsch, I., 2005). Conclusion: When the data in the individual cases are used to guide the selection of a treatment strategy in hypnosis out of diverse possibilities, a careful and well planned selection process that is systematic and integrative would be necessary based on the understanding which treatment would be best suitable for which condition. As indicated by this trend, more studies are being undertaken where hypnocognitive therapies are being matched with specific patient populations whose diseases have a high cognitive load. Further researches are indicated that would develop criteria to guide clinical treatment planning. Reference List Alladin, A. (2006). Cognitive hypnotherapy for treating depression. In R. Chapman (Ed.), The clinical use of hypnosis in cognitive behavior therapy: A practitioner's casebook (pp. 139-187). New York: Springer Publishing Company. Barber, T.X. (1999). A comprehensive three-dimensional theory of hypnosis. In I. Kirsch, A. Capafons, E. Cardena-Buelna, & S. Amigo (Eds.), Clinical hypnosis and self-regulation: Cognitive-behavioral perspective (pp. 21-48). Washington, DC: American Psychological Association. Gazzaniga, M. (Ed.) (2000). The new cognitive neurosciences. Cambridge: MIT Press. Gruzelier, J. (2005). Altered states of consciousness and hypnosis in the twenty-first century. Contemporary Hypnosis, 22, 1-7. Kallio, S., & Revonsuo, A. (2003). Hypnotic phenomena and altered states of consciousness: A multilevel framework of description and explanation. Contemporary Hypnosis, 20, 111-164. Kirsch, I. (2005). Empirical resolution of the altered state debate. Contemporary Hypnosis, 22, 18- 23. Lynn, S.J., & Kirsch, I. (2006). Essentials of clinical hypnosis: An evidence-based approach. Washington, DC: American Psychological Association. Mesulam, M.M. (Ed.) (2000). Principles of behavioral and cognitive neurology. Oxford: Oxford University Press. Vaitl, D., Birbaumer, N., Gruzelier, J., Jamieson, G., Kotchoubey, B., Kubler, A., et al. (2005). Psychobiology of altered states of consciousness. Psychology Bulletin, 131, 98-127. Yapko, M.D. (2003). Trancework: An introduction to the practice of clinical hypnosis (3rd ed.) New York: Brunner-Routledge. Read More