•EEG – measures brain states

•Pain associated with more neurons firing relatively fast (beta frequencies) and less neurons firing at slower (alpha frequencies)

•Hypnotic suggestion for pain relief results in a decrease in beta frequencies with an increase in relative alpha activity 

•PET and fMRI measures locations of brain activation

•Intensity and quality – sensory cortices

•Unpleasantness/bothersomeness – ACC

•Comfort and physical integrity – Insula

•Reduced threat and negative implication – amygdala and prefrontal cortex

•Screen out discomfort – spinothalamic tract

• Jensen & Patterson, 2014, pp. 7-9

 

Clinical Implications:

•“To maximize efficacy, hypnotic treatment should target multiple specific pain domains. Second, clinician should take full advantage of the calming effect of hypnosis on brain activity and processes”

•Jensen and Patterson, 2014, p.9

•Hypnotic induction, like meditation and relaxation techniques, can have in and of itself analgesic effects. 

•Additionally, hypnotic suggestion can target a large range of changes

•Sensory experience

•Thoughts

•Emotions

•Behaviors

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•Hypnosis:  “A focused experience of attentional absorption that invites people to respond experientially on multiple levels to amplify and utilize their personal experiences in a goal directed fashion”

•(Yapko, Trancework, p.7)

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Auditory - focused attention - deeply focusing on a relaxed state.

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Attentional Absorprtion - sensory - somatic - wealth of expereince of life - right at your fingertips - a lifetime of knowledge, skills& resournces to get in touch with;

• The process of knowing by sensory sensation - 

•Focus on hands with fingers lightly touching

•Exhale fully, take in a deep breath and close your eyes to increase your focus on your fingertips

•Begin to move your hands in “whatever rhythm feels right for you”

•Continue to focus on your fingertips as your hands move “in whatever rhythm feels right to you”

•“You’ll begin to notice a phenomenon in which your hands seem to get larger and larger in your mind, as everything else seems to fade away”(focused absorption, dissociation)

•“Increase principle” – “what you focus on increases in awareness while what you are not focused on fades away”

•Yapko: “The first lesson of hypnosis: what you focus on you amplify in your awareness”

•“Your hands will increasingly move on their own in whatever rhythm feels right to you, without you having to think about or make them move” (ideomotor movement)

•“and you have many experiences of your hands moving automatically without you thinking about them”

•Brushing your teeth, writing your name, steering your car

•“Your brain knows what rhythmic pattern of kinesthetic input it wants, what feels best, just like you know what music you are in the mood for”

•Calm/soothing; Upbeat/dance, Inspirational/Spiritual, Oldies

•“In this way, creating a feedback loop that transforms (trance forms) excess nerve energy (generated by anxiety/pain) into a calming, soothing input”

 

resources retrieval - you know so much, do so much - so well...

 

•Sensorimotor learning – hands moving automatically, musical instrument, keyboard

•Enjoyable sensory experiences – feeling your hands in the sand/water

•Competence/Mastery – “handling things easily”, “the feeling of the ball on your fingers, knowing it will go in before it leaves your hand”

•Flow/In the Zone – (“moving effortlessly, confidently, without thinking”)

•“We are focusing on your hands, not only because they are rich in sensory nerves, but you have a wealth of life experience at your fingertips.”

•“You can get in touch with what will be most helpful to you now”

•“Sensing what you need”

•“You can reach within yourself for what will best help you handle things”

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•Positive emotional experiences –  “the feeling of a child’s hand in yours”; “getting in touch with what you feel appreciation/gratitude for”

•Coping – “getting a handle on things”, “getting a grip”, “knowing you can handle this”

•Future Pacing – “seeing your life back in your own hands”

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Post Hypnotic Suggestion - PHS
 

•“The more you practice this, the more strongly you will feel a sense of (calm, comfort, control, confidence) flow through you whenever you put your fingers together and move in whatever rhythm is right for you”

•“With practice you will eventually feel this by simply putting your fingers together and moving your hands, not needing to close your eyes”

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The CORE principle:

 

•Induction

•Utilizing the sensitivity of the finger tips

•Skedung, L., Arvidsson, M., Chung, J. Y.,  Stafford,C.M., Berglund, B. & Rutland, M.W. (2013). Feeling Small: Exploring the Tactile Perception Limits. Nature: Science Reports, 3: 2617.

•Utilizing the high degree of representation of the hands in the somatosensory cortex

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Checking sources & induction 2 - 
 

•Generating counter stimulation

•TENS, Spinal Cord Stimulator

•Longe SE, Wise R, Bantick S, Lloyd D, Johansen-Berg H,McGlone F, Tracey I. (2001). Counter-stimulatory effects on pain perception and processing are significantly altered by attention: an fMRI study. Neuroreport:12(9):2021-5

•Generating a different pattern of stimulation moment to moment, activating the orienting response to novel stimuli

•Lange F, Seer C, Finke M, Dengler R, Kopp B, (2015), Dual routes to cortical orienting responses:  Novelty detection and uncertainty reduction. Biol Psychol. 2015 Feb;105:66-71

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Checking sources & induction 3 - 

•Utilization/Redirection of psychomotor agitation primed by the fight or flight reaction to pain/stress

•Generating and utilizing the relaxing quality of rhythmic sensation

•Self stimulation of infants/developmentally disabled

•Self soothing techniques of dialectical behavior therapy

•Experiential memory – rocking in a rocking chair, swinging on a swing, swaying in a hammock

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ENTRAINMENT​

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•“When coherence is increased in a system that is coupled to other systems, it can pull the other systems into increased synchronization and more efficient function.  For example, frequency pulling and entrainment can easily be seen between the heart, respiratory, and blood-pressure rhythms, as well as between very low-frequency brain rhythms, craniosacral rhythms, and electrical potential measured across the skin.”

• McCraty, R & Childre, D. (2010). Coherence:  Bridging Personal, Social, and Global Health. Alternative Therapies. 16 (4), 10-24.

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COHERANCE

•“As coherence tends to naturally emerge with the activation of heartfelt, positive emotions such as appreciation, compassion, care, and love, it suggests that such feelings increase the coherence and harmony in our energetic systems which are the primary drivers of our physiological systems.  This increased coherence and alignment in turn facilitate the body’s natural regenerative processes”

•McCraty and Childers, 2010

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Utilisation APPLICATION
 

•Sensitivity of the fingers

•Representation of the  hands in the somatosensory cortex

•Fight or Flight Reaction/Psychomotor agitation

•Distracting/analgesic effect of counter stimulation

•Brain’s orienting response to novelty

•Soothing quality of rhythmic movement

•Sense memories associated with the hands

•Positive emotions/skills/competencies associated with the hands (encoded experiential learning and experience)

•Entrainment/Coherence 

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16

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•Pain is a complex subjective experience involving multiple areas of the brain and multiple aspects of prior and current human experience

•There are significant individual differences in sensitivity to and reactivity to pain

•The experience of pain can be influenced by expectations, attention, arousal, affect (emotions), cognitions, and behaviors

•Chronic pain different than acute pain (central sensitization/nociplastic)

•Affective/emotional aspects of pain generally more important than the sensory

•We can influence the affective experience through the language used and the evocation of positive experiential memories (Ericksonian interspersal and utilization)

•The importance of normalizing mind/body techniques

•Hypnotically informed relaxation/breathing technique of therapeutic benefit to most individuals regardless of hypnotic responsiveness

•The relaxation/breathing technique can be used diagnostically to assess  responsiveness (rather than an hypnotic suggestibility scale) and suggest what to utilize to individually tailor further treatment

•Analgesic suggestions may not play a primary role in beneficial outcomes of hypnosis at the beginning of chronic pain management

•Ericksonian utilization can be used on multiple levels for pain management/coping. 

•Pain and hypnosis research and clinical experiences guides us to shift from traditional hypnosis approaches that focus on  anesthesia/ analgesia through direct suggestion to an approach that initially assists a higher percentage of people and subsequently individualizes treatment

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