Hypnotherapy Of Pain In Children With Cancer

Josephine R. Hilgard, Samuel LeBaron

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781317840855
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Presents findings on the effects of hypnosis in reducing anxiety and pain in children with cancer and suggests that hypnotherapy offers real promise of pain relief without drugs.First published in 1991. Routledge is an imprint of Taylor & Francis, an informa company.

1 Hypnosis, Cancer, and Pain

In 1794, a 9-year-old boy was operated upon for the removal of a tumor. Long before the use of chemical anesthetics, the boy was distracted during the procedure by being told a story so interesting that he later insisted he had felt no pain whatsoever. Eighteen years later the story “Snow White” was submitted to a publisher by Jacob Grimm, that same boy who would become one of the world’s most famous authors of fairy tales (Hypnos, 1982, May/June, p. 1).

Many years ago the Swiss psychologist Karl Groos described the phenomenon at work for the young Grimm:

The child who listens absorbedly to a fairy story, the boy for whom the entire external world sinks and vanishes while he is lost in a tale of adventure, or the adult who follows with breathless attention the development of a captivating romance; all allow the authors’ creations to get possession of their consciousness to the exclusion of reality, and yet not as an actual substitute for it… . It may often be observed that the child’s eyes lose their convergence as their interest is absorbed—a means of detachment from surrounding reality. Even in half-grown children the power of detachment is much greater than in adults (Groos, 1901, p. 134).

If the reality that Groos speaks of is physical and mental distress, then stories such as those told to little Jacob Grimm are capable of excluding distress from consciousness and temporarily substituting for it. Many patients have found relief from anxiety and pain through experiences not too different from that of Jacob Grimm, whose mother told fairy tales to him almost two centuries ago. Some patients like fairy tales, some prefer stories of adventure, such as Groos describes, and still others pay rapt attention to closely-related, suggested events that take place in hypnotherapy.

Many children and adolescents in treatment for cancer must undergo painful procedures and are desperately in need of relief from the pain. These patients provided an opportunity to explore ways in which hypnotherapy might serve a humane role in relieving some of their distress. After studying methods of hypnotic pain control over a number of years with a college student population, we undertook to apply our knowledge of hypnosis to patients in treatment for cancer on the pediatric oncology units at the Children’s Hospital at Stanford and at the Presbyterian Hospital in San Francisco. We felt that we could offer a genuine service to young patients while at the same time conducting much-needed research. In the ensuing investigation which we shall refer to as the Stanford study, children and adolescents who were required to undergo a repeated and painful diagnostic procedure, namely the bone marrow aspiration, were given the option of electing hypnotherapy as a possible method of obtaining relief from the pain. Both quantitative measures of pain and descriptions of the therapeutic interventions form the substance for clinical data and their interpretation.

That hypnosis can relieve pain associated with burns, dentistry, surgery, and various other trauma—including pain related to cancer and to hemophilia—has been established by clinical studies in adults and to a lesser extent in children. However, many questions remain: Is hypnosis as effective in treating children and adolescents as it is in treating adults? If so, is hypnosis the same for young children as for adolescents and adults? How does hypnosis produce relief from suffering? Can all patients benefit from hypnosis to the same extent? In the course of our work, answers to these questions became clearer as further knowledge about the nature and development of hypnosis during the early years emerged.

In this chapter we shall present an orientation to hypnosis, to distress in cancer particularly as it relates to the bone marrow aspiration, and to the hypnotherapy of pain.

The Nature of Hypnosis

It is not surprising that the public is confused and uneasy about the use of hypnosis as a therapeutic tool when movies, television programs, and occasional nightclub performers continue to present it in a highly dramatized and inaccurate way. Scientific studies of hypnosis during the last quarter of a century have greatly extended our knowledge of hypnosis, and it seems wise, therefore, to begin with a clear explanation and discussion.

Hypnosis has long been identified with suggestion. When the hypnotist says, “Your eyes are closing by themselves,” responsive subjects feel their eyes closing “automatically” despite efforts to keep them open. Usually these suggestions of the hypnotist call for active participation by a subject, such as imagining that the eyelids are heavy. Other hypnotic suggestions seek to activate the imagination even more, by guiding the subject’s regression into childhood. The difference between the fantasies entertained in hypnosis and those associated with ordinary daydreaming is that, in hypnosis, the imagined events are experienced as real: the eyelids do feel heavy, and the person actually does reexperience childhood events. One way of describing this condition is to call it “believed-in-imagination.” The hypnotic experience can easily be terminated by the hypnotist, or, after a little experience and training, by the hypnotized person. Contrary to misconceptions that result from movies and nightclub performances, hypnosis does not involve the casting of a “spell” whereby the hypnotist, through some special power, controls the subject’s mind. Rather, hypnosis requires a mutual agreement between hypnotist and subject, and the quality of the hypnotic experience depends on the subject’s own abilities.

To explain the nature of responses to suggestions, the French investigator, Pierre Janet (1889), introduced the concept of dissociation—that is, a division of consciousness. An example of dissociation is when the subject, whose eyes are about to close, wonders in some part of the mind whether they will, in fact, close. Similarly, when the person is a child again in regression, part of the mind is ready for the suggestion to come back to the present. In other words, dissociation refers to a splitting off from each other of certain parts of the mind that normally interact. The significance of dissociation in hypnosis has been recognized and updated by E. Hilgard (1977). Although dissociation was introduced by Janet in connection with hypnosis, mild dissociations occur in everyday life; accordingly, some distinctions need to be made to account for the more extensive dissociations characteristically achieved through hypnosis.

Dissociation in Everyday Life. Mild dissociations are familiar events of everyday life. They occur whenever we engage in two activities at once. For example, we eat dinner automatically while we pay close attention to a television program. We drive a car and talk politics with our passenger without giving much thought to the mechanics involved in controlling the automobile. A skilled pianist can play a well-rehearsed concerto while carrying on a spirited conversation with a colleague. Experienced typists can continue to produce accurate copy while answering questions addressed to them. In each of these activities, attention to the task recedes as the skill is mastered and becomes essentially automatic. Once it has been automatized, attention is free to be directed elsewhere, to the television screen or to conversation. Of course if trouble develops—a pit is discovered in the cherry pie, the traffic becomes snarled, or the typewriter keys stickattention is redirected immediately. In other words, it is appropriate to describe activities as dissociated when one of them goes on automatically, with little conscious effort, as the other is carried out with attention focused on it.

Nighttime dreams represent another form of dissociation in that dreams arise spontaneously, often to our surprise, despite the fact that we produce our own dreams. The experience is one of dissociation because the planning of the dream has proceeded unconsciously, whereas the dream itself, to the extent that it can be recalled as a “happening,” is a conscious product.

An altered state of consciousness is characterized by a shift in subjective experience or in psychological functioning that one perceives as distinctively different from the usual alert, waking consciousness. It is not possible to draw a fine line between a minor dissociation and an altered state of consciousness because they often shade gradually from one to the other, much like the transition periods of such ambiguous states as dusk and dawn. In reverie, or “wool-gathering,” ideas and images flow automatically as we attend to other things, but normal contact with the environment is easily regained. Other states that provide for transitions are the drowsy states between waking and sleep, or the gradual shifts from a loosening of the tongue to intoxication that may follow the drinking of alcoholic beverages.

Degrees of Dissociation in Hypnosis. A distinctive characteristic of hypnotic dissociations is that they are more readily enhanced and maintained than those occurring in everyday experience. Those who do not confuse imagination with reality under ordinary conditions may, under hypnosis, convert an imagined object to a hallucinated object which, in the extreme, is perceived as if real. With a suggestion from the hypnotist, for example, a hypnotized person may see someone sitting in a chair that is actually vacant. He or she may converse with the hallucination, hear its voice, see it as a person, and accept its remarks as if another person is actually talking.

It is this distortion of normal mental functioning in hypnosis that has led to the concept of hypnosis as a trance or an altered state of consciousness. It would perhaps be simpler to adopt the term “hypnotic state” as many contemporary hypnotic practitioners do to describe hypnotic involvement. Unfortunately, the simplicity of this terminology is misleading because there are many degrees of response to hypnotic suggestion. Therefore, we prefer to speak more precisely of degrees of dissociation produced by hypnotic suggestion. If dissociations are extensive and profound, and the changes are pervasive, we would agree that the hypnotic condition can be described as an altered state of consciousness or trance. For the most part, however, the dissociations produced by hypnotic suggestion leave unaffected major fractions of the person’s cognitive functioning. These partial dissociations are very valuable in hypnotherapy.

There are several ways of characterizing a person’s degree of hypnotic involvement. Because hypnosis was formerly described as analogous to sleep, it became common—and is still prevalent—to use the metaphor of depth of hypnosis corresponding to depth of sleep. Even though hypnosis is no longer considered a form of sleep, the metaphor is familiar and easily understood. A related concept is that of degree of involvement in the experiences suggested by the hypnotist. For example, if a new identity has been suggested, a profoundly involved subject may act and feel as if he or she were indeed the suggested person. This ability is sometimes referred to as role involvement. What these different characterizations have in common is that they all attempt to explain differences in the extent to which the hypnotic suggestions have been effective. The dissociative interpretation of hypnosis points to divisions of consciousness on a continuum between the limited ones and those that are widespread. Some illustrations will clarify how these degrees of dissociation apply.

Suppose the hypnotist tells 8-year-old Roy: “Now please hold your right arm and your fingers straight out.” Compliance with such a request involves no hypnosis, for if Roy is socially cooperative, he will simply comply. But suppose that the hypnotist suggests the use of imagination: “Think of making your arm very stiff and straight, very, very stiff. Think about it as though you are a tree and your arm is a strong branch of a tree, very straight and very strong, like the branch of a tree … so stiff that you can’t bend it … Now see how stiff your arm is … try to bend it. Try.” Roy may now find that he has temporarily lost his normal capacity to control his arm. When he tries to bend it, the muscles tighten and the arm becomes even stiffer. Voluntary control of the arm is said to be dissociated, because his own plan of action does not produce the intended movements. When the hypnotist cancels the suggestion, Roy’s normal voluntary control returns. The disturbance in Roy’s voluntary control represents a limited dissociation.

Such a limited dissociation often proves to be very effective in hypnotic treatment. One of our Children’s Hospital patients, Charlotte, who was about to receive an injection that had previously been quite painful, was able to achieve numbness in the arm that was to receive the injection. After hypnotizing her, the therapist suggested that the arm would be numb and would not feel the injection. Next, following the standard practice of implanting a posthypnotic suggestion, he suggested that the arm would remain numb after she had been aroused from hypnosis. After arousal, when asked how she felt, she said that everything was as it had been before she was hypnotized. Her conversation was normal in every way, with no signs of altered consciousness, although her arm remained as numb as if she had received a local anesthetic. Charlotte talked in a spirited way with the physician during the subsequent injection procedure and showed no signs of discomfort. It is appropriate to say that the conscious awareness of her arm was dissociated; no discernible change occurred in her total consciousness, nor was there any sudden change in her orientation after the feeling in her arm was restored through suggestion. In the midst of the hypnotic session, prior to the posthypnotic suggestion, her dissociation had been extensive. After her arousal from hypnosis, the activated posthypnotic suggestion restricted the dissociation to the numb arm.

Posthypnotic suggestion is also used to increase the rapidity of dissociation. One illustration is the use of a brief signal to reinstate what previously had required a longer induction. Doris, a child of 10, was sitting in a relaxed state with her eyes closed while she was hypnotized. She was told that after awakening and becoming alert, she would go back into hypnosis when she heard the hypnotist’s hands clap together. A few minutes after arousal from hypnosis, the signal was given and the automatic reaction took place promptly. At one moment Doris was talking in an animated fashion but, in the next moment, when she heard the clapping, she suddenly slumped, her eyes closed, and she became limp. For Doris, the dissociation through the posthypnotic suggestion was profound, while for Charlotte it had been limited.

The alterations a person can undergo in a suggested age regression often exhibit the changes associated with a more extensive dissociation. A lawyer who had been referred to one of us for hypnotic treatment of low back pain was tested initially for his responsivity to hypnosis before deciding on the preferred course of treatment. His reaction to age regression illustrates how the reliving of childhood episodes can be dissociated from the adult experience. Following the induction of hypnosis, age regression was induced as follows:

Something very interesting is about to happen. In a little while you are going back to a happy day in elementary school … to the third grade … ONE, you are going back into the past. It is no longer 1980, or 1975, or 1970, but much earlier … Two, you are becoming much younger and smaller … In a moment you will be back in the third grade, on a very nice day. THREE, getting younger and younger, smaller and smaller all the time. Soon you will feel an experience exactly as you did once before on a nice day. FOUR, soon you will be right back there. FIVE, you are a small boy in school.

When asked what was happening, he talked freely about what he was doing and what he saw:

“I’m playing marbles in the schoolyard with my friends. Some older guys are playing baseball over there in the corner of the yard … Recess is about over and my teacher is ready to call us….”

After he was brought out of hypnosis, he said his experience as a 9-year-old boy had been very real to him. He felt as though he had, in fact, been small. This complete change in his awareness of himself was sufficient for it to be classified as an altered state of consciousness. In some instances, the hypnotized person has a double experience during age regression—that of an observing adult and that of an experiencing child—and both experiences are perceived as genuine.

The Process of Hypnosis

With the nature of the hypnotic experience in mind, let us now consider the practices used in inducing hypnosis and in measuring the differences that are found in the degree of hypnotizability from one person to another.

Inducing Hypnosis. In the ongoing experiences of everyday life, we are involved mostly in the realities around us, whereas in hypnosis we set most of these reality demands aside and concentrate on a restricted set of experiences. Induction procedures are designed to provide a gradual transition from our usual generalized reality orientation to the limited orientation characteristic of hypnosis.

Two common procedures for inducing hypnotic dissociation are referred to as eye fixation and arm levitation. Both techniques typically make use of relaxation, a familiar technique used in conventional hypnotic practices. Although relaxation is not essential to an induction (Banyai and E. Hilgard, 1976), it is helpful in enabling subjects to set aside their ties to ordinary activities and problems so that they can devote full attention to the hypnotist’s suggestions. Relaxation is furthered by having the subject sit in a comfortable position in an easy chair before giving specific suggestions to relax the arms, the legs, and other parts of the body, in turn. In eye fixation, the subject is asked to focus attention on a “target,” perhaps a thumbtack on the wall or a thumbnail on the hand. The hypnotist will suggest sensations of drowsiness that become strong enough for the subject’s eyes which were open and staring at the target, to become fatigued and to close “by themselves.” With eye closure, the subject begins to experience the feeling of dissociation that is implicit in the difference between the voluntary effort of keeping the eyes open and their involuntary closing as a consequence of the hypnotist’s suggestions.

In arm levitation, the subject is first asked to pay attention to a hand that is in the lap or on the side of the chair, then is given a suggestion that the hand feels light and is about to rise by itself from its resting position. The suggestion is reinforced with various verbal images, such as “becoming light as a feather,” or “tied to a balloon.” As the subject’s hand rises, suggestions of general relaxation continue. The hypnotist indicates that when the...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• 1. Hypnosis, Cancer, and Pain
• 2. Hypnotherapy as Experienced by Older and Younger Patients
• 3. The Stanford Study: Relief of Pain and Anxiety during Bone Marrow Aspirations
• 4. Differential Responses to Hypnotherapy for Pain
• 5. Adapting Hypnosis to Specific Symptoms of Distress Connected with Cancer
• 6. Distraction Techniques in the Relief of Pain
• 7. Parents, Nurses, and Physicians: How They Help Patients Cope
• 8. Understanding Hypnosis and Hypnotherapy
• 9. The Growth of Hypnotic Ability: A Developmental Approach
• 10. Opportunities for Research
• Appendix A
• Appendix B
• References
• Index