Advertisement
Mayo Clinic Proceedings Home

Hypnosis in Contemporary Medicine

  • James H. Stewart
    Correspondence
    Individual reprints of this article are not available. Address correspondence to James H. Stewart, MD, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 4500 San Pablo Rd, Jacksonville, FL 32224
    Affiliations
    Department of Internal Medicine and Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Jacksonville, Fla
    Search for articles by this author
      Hypnosis became popular as a treatment for medical conditions in the late 1700s when effective pharmaceutical and surgical treatment options were limited. To determine whether hypnosis has a role in contemporary medicine, relevant trials and a few case reports are reviewed. Despite substantial variation in techniques among the numerous reports, patients treated with hypnosis experienced substantial benefits for many different medical conditions. An expanded role for hypnosis and a larger study of techniques appear to be indicated.
      AMA (American Medical Association), IBS (irritable bowel syndrome), PET (positron emission tomography)
      As alternative treatments for medical conditions become popular, contemporary medicine is being challenged to take a more integrative approach. The National Institutes of Health is supporting clinical trials of complementary and alternative medicine, which includes hypnosis. To determine whether hypnosis has a role in presentday medicine, this review evaluates relevant clinical trials involving hypnosis. Some important case reports and reviews are included to give insight into the current and past practice of hypnosis in medicine by professionals. This review pertains to the use of hypnosis for conditions not believed to be primarily psychological (eg, depression, anxiety, attention deficit disorders, and phobias), although the potential for a psychological basis exists for many of these conditions. The intent of this review is to stimulate greater interest in and understanding of the art and science of hypnosis.
      The studies reviewed herein were identified by searching the MEDLINE database for articles published between 1966 and 2004; the key words hypnosis, hypnotism, and hypnotherapy were used, as were the specific conditions studied. All studies relevant and applicable to the treatment of the conditions evaluated were reviewed critically and were subsequently included if their conclusions were supported by the data given. Results of controlled trials, review articles, and case reports are presented. In this review, P<.05 was considered statistically significant unless otherwise indicated.

      WHAT IS HYPNOSIS?

      Although no consensus definition of hypnosis exists, the studies reviewed indicate that hypnosis involves the induction of a state of mind in which a person's normal critical or skeptical nature is bypassed, allowing for acceptance of suggestions (Table 1). This state of heightened receptivity for suggestions (induction) is developed with the cooperation of the patient and is followed by the delivery of positive suggestions.
      • Fromm E
      Significant developments in clinical hypnosis during the past 25years.
      • Elman D
      Hypnosis is also described as an “attentive, receptive focal concentration,” with the trance state being a “normal activity of a normal mind,” which occurs regularly, as when reading an absorbing book, watching an engrossing movie, daydreaming, or performing monotonous activity.
      • Spiegel H
      • Greenleaf M
      • Spiegel D
      Hypnosis.
      A common assumption is that, during hypnosis, the subconscious mind is in a suggestible state while the conscious mind is distracted or guided to become dormant.
      Table 1Characteristics of Hypnosis and a Hypnosis Session
      • Hypnosis is a state of mind that occurs naturally or is established by compliance with instructions and is characterized by
        • Focused attention
        • Heightened receptivity for suggestions
        • A bypass of the normal critical nature of the mind
        • Delivery of acceptable suggestions
      • A hypnosis session consists of
        • An explanation of the process and consent
        • Induction of the trance state
        • Deepening of the trance
        • Assessment for adequacy of the trance
        • Hypnoanalysis—an investigative step (if necessary)
        • Delivery of acceptable suggestions
        • Emergence from the trance state
      Hypnosis may be compared with meditation, which generally is considered to involve a quieting of the mind. Meditation may be self-directed. If suggestions are given to achieve a desired effect, meditation may qualify as hypnosis depending on the state achieved, particularly because hypnosis can occur naturally (ie, without formal induction).
      No attempt is made herein to explain the mechanism of hypnosis for causing the intended changes as a result of the suggestions given. If positive suggestions for change are accepted by the mind, any physiological changes that follow defy explanation by contemporary medicine, although complex explanations have been proposed.
      • Rossi EL

      IS HYPNOSIS REAL?

      Various methods have been used to determine whether hypnosis is a separate state, distinct from sleep, or if the patient is simply complying with the practitioner's instructions.
      • Spiegel H
      • Greenleaf M
      • Spiegel D
      Hypnosis.
      Volunteers in whom hypnosis was induced were evaluated by positron emission tomography (PET). When subjects were given the suggestion to see color, the color perception areas of their cerebral hemispheres were activated whether they were looking at color or black-and-white patterns. When subjects were given the suggestion to see black and white, the color perception areas of the brain showed decreased activity regardless of what the subjects were viewing. This implies that hypnosis is not a process of simply following instructions but actually involves a change in the brain's perception.
      • Kosslyn SM
      • Thompson WL
      • Costantini-Ferrando MF
      • Alpert NM
      • Spiegel D
      Hypnotic visual illusion alters color processing in the brain.
      Studies have used other methods, such as electrodermal skin conductance, to evaluate whether patients in whom hypnosis was induced were “lying” or simply complying with instructions.
      • Kinnunen T
      • Zamansky HS
      • Block ML
      Is the hypnotized subject lying?.
      • Kinnunen T
      • Zamansky HS
      • Nordstrom BL
      Is the hypnotized subject complying?.
      Unpleasant sensations were noted on PET to cause activity in the anterior cingulate cortex. Hypnosis induced before painful stimuli caused a decrease in the subjective and objective perception of the pain as noted on the scans.
      • Faymonville ME
      • Laureys S
      • Degueldre C
      • et al.
      Neural mechanisms of antinociceptive effects of hypnosis.
      Another study using PET in hypnotized persons showed activation of a region in the right anterior cingulate cortex (Brodmann area 32), an area activated when sound is heard or when sound is suggested in hypnosis but not when sound is simply imagined. This implies that the mind registered the hypnotic hallucination as if it were real.
      • Szechtman H
      • Woody E
      • Bowers KS
      • Nahmias C
      Where the imaginal appears real: a positron emission tomography study of auditory hallucinations.
      Other studies using PET support the occurrence of distinct changes in the brain with hypnosis.
      • Rainville P
      • Hofbauer RK
      • Bushnell MC
      • Duncan GH
      • Price DD
      Hypnosis modulates activity in brain structures involved in the regulation of consciousness.
      By using electroencephalography, changes were seen during hypnosis that could not be evoked by waking imagination.
      • Jensen SM
      • Barabasz A
      • Barabasz M
      • Warner D
      EEG P300 event-related markers of hypnosis.
      Hypnosis does not act as a placebo (administering a pharmacologically inert substance).
      • McGlashan TH
      • Evans FJ
      • Orne MT
      The nature of hypnotic analgesia and placebo response to experimental pain.
      Studies using hypnosis for anesthesia indicate that pain relief from hypnosis is different from a placebo effect with evidence that the pain is not perceived rather than simply experienced with greater tolerance.
      • Zachariae R
      • Bjerring P
      The effect of hypnotically induced analgesia on flare reaction of the cutaneous histamine prick test.
      • Spiegel D
      • Bierre P
      • Rootenberg J
      Hypnotic alteration of somatosensory perception.
      • Patterson DR
      • Jensen MP
      Hypnosis and clinical pain.
      Hypnosis is not a state of sleep.
      • Tasman A
      • Kay J
      • Lieberman JA
      Relaxation generally is believed to be a part of hypnosis, but it need not be. Volunteers underwent hypnotic induction with use of either the traditional method involving eye closure, relaxation, and drowsiness encouraged by suggestion or an active, alert method involving riding a stationary bicycle while receiving suggestions for alertness and activity. Equally receptive trance states were achieved by the relaxation and alert methods, and examples were presented of other active, alert trance states.
      • Banyai EI
      • Hilgard ER
      A comparison of active-alert hypnotic induction with traditional relaxation induction.
      Of note, hypnotized patients may experience considerable anxiety and other emotions while reliving an event with age regression without coming out of the trance state.
      • MacHovec F
      Hypnosis complications, risk factors, and prevention.
      Age regression, inducing a person through hypnosis to relive events that occurred earlier in life, is believed to differ from enhancement of memory, but scientific evidence for this assertion is limited. Age regression may be helpful to treat conditions in which an adverse behavior is believed to be based on a past event; however, its validity is controversial. The process of regression may generate strong emotions and can possibly alter a memory or create a false memory. Studies about the use of age regression have reported the development of infantile neurologic reflexes on regression to infancy, age-specific handwriting and vocabularies on regression to childhood, and knowledge of the appropriate day of the week of events in the period to which the person was regressed.
      • Gidro-Frank L
      • Bowersbuch MK
      A study of the plantar response in hypnotic age regression.
      • LeCron LM
      A study of age regression under hypnosis.

      A BRIEF HISTORY OF MODERN HYPNOSIS

      The era of modern hypnotism began with the Austrian physician Franz Anton Mesmer, who is said to have brought animal magnetism (the term for hypnosis at that time) to France in 1778. Because many people were seeking treatment from Mesmer and his colleagues, King Louis XVI of France commissioned Benjamin Franklin and others to investigate the practice. After extensive testing, the commission discredited Mesmer, indicating in their report that any medical benefit was not from magnetism, as publicized, and that mesmerism involved only “imagination, imitation, and touch.” One account indicates that Thomas Jefferson obtained copies of the report to help prevent the spread of mesmerism to America.
      • McConkey KM
      • Perry C
      Benjamin Franklin and mesmerism, revisited.
      • Forrest DW
      This setback for hypnosis led to a deeper, more covert evaluation of the process. James Braid, using eye fixation techniques, was able to produce a trance state and later discovered the importance of adding suggestions. He is credited with introducing the term hypnotism, although he favored monoideism because he realized that the state differs from sleep.
      • Spiegel H
      • Greenleaf M
      • Spiegel D
      Hypnosis.
      In the 19th century, the English surgeon John Elliotson and the Scottish surgeon James Esdaile performed hundreds of surgical procedures with use of hypnosis for anesthesia and with extremely low morbidity rates for the times.
      • Forrest DW
      Almost simultaneously with the reports of success with hypnosis, ether and chloroform became popular and displaced the use of hypnosis for anesthesia in surgery.
      • Marmer MJ
      Present applications of hypnosis in anesthesiology.
      • Blankfield RP
      Suggestion, relaxation, and hypnosis as adjuncts in the care of surgery patients: a review of the literature.
      Twentieth-century hypnosis was influenced by the contrasting techniques of indirect suggestion intermixed with psychoanalysis promoted by Milton H. Erickson and of direct suggestion and induction of a deep trance state for age regression espoused by others.
      • Fromm E
      Significant developments in clinical hypnosis during the past 25years.
      • Elman D
      • Forrest DW

      ACCEPTANCE OF HYPNOSIS IN MEDICINE

      Acceptance of hypnosis in medicine has evolved slowly. In 1847, the Roman Catholic Church indicated acceptance of hypnosis, noting that hypnosis was not morally forbidden, and in 1956, Pope Pius XII noted its use for childbirth and indicated the need for proper precautions as for other forms of medical treatment. Other religions (with exceptions) have shown acceptance, with ministers of different faiths trained in and using hypnosis in their practices.
      • Durbin PG
      In 1958, the American Medical Association (AMA) published and approved a report from a 2-year study by the Council on Mental Health. The report indicated that there can be “definite and proper uses of hypnosis in medical and dental practice” and recommended the establishment of “necessary training facilities” in the United States.
      • Council on Mental Health
      Medical use of hypnosis.
      The British Medical Association had issued its report on hypnosis in the British Medical Journal in 1955, with which the AMA's Council on Mental Health indicated “essential agreement.”
      • Spiegel H
      • Greenleaf M
      • Spiegel D
      Hypnosis.
      • Council on Mental Health
      Medical use of hypnosis.
      The American Psychiatric Association, in a position statement approved by the Council of the Association in 1961, indicated that “hypnosis has definite application in the various fields of medicine” and that physicians would be seeking psychiatrists for training in hypnosis.
      • American Psychiatric Association
      Regarding Hypnosis Position Statement [approved by the Council February 15, 1961].
      A National Institutes of Health panel issued a statement published by the AMA in 1996 indicating that there was “strong evidence for the use of hypnosis in alleviating pain associated with cancer.”
      • NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia
      Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia.

      RISKS OF HYPNOSIS

      A review of the literature in the late 1980s documented a few cases of patients who displayed “unanticipated” adverse behavior after hypnosis.
      • MacHovec F
      Hypnosis complications, risk factors, and prevention.
      Adverse reactions or hypnotic complications consisted of “unexpected, unwanted thoughts, feelings or behaviors during or after hypnosis which are inconsistent with agreed goals and interfere with the hypnotic process by impairing optimal mental function.” The most common suspected adverse reactions included drowsiness, dizziness, stiffness, headaches, anxiety, and, occasionally, more serious reactions such as symptom substitution and masking of organic disorders. These adverse reactions were attributed to deficiencies in the hypnotist's techniques, such as not realizing that suggestions in hypnosis are accepted literally, bringing the patient too rapidly out of trance, using age regression inappropriately, not dispelling preconceived expectations of negative consequences of hypnosis before initiating the session, or not prescreening for certain psychopathology.
      • MacHovec F
      Hypnosis complications, risk factors, and prevention.
      A more recent review indicated that hypnosis is associated with a risk of adverse effects, including headache, dizziness, nausea, anxiety, or panic, at levels that might occur in other test or experimental settings without hypnosis. A prehypnosis discussion session with the patient was advocated.
      • Lynn SJ
      • Martin DJ
      • Frauman DC
      Does hypnosis pose special risks for negative effects? a master class commentary.
      It has been argued that informed consent is not needed before casual or brief techniques involving helpful semantics since the use of careless and harmful comments from health care workers has no such prerequisite.
      • Bierman SF
      Hypnosis in the emergency department.
      Hypnosis generally is considered a “benign process” with “few contraindications”; however, pseudomemories can be created if leading questions are asked during the investigative phase of hypnosis.
      • Tasman A
      • Kay J
      • Lieberman JA

      EVALUATION OF THE CLINICAL TRIALS

      Evaluation of clinical trials of hypnosis is complicated by the nature of hypnosis. The gold standard of a randomized, double-blind, controlled trial is virtually impossible because cooperation and rapport between patient and therapist are needed to achieve a receptive trance state. The few hypnosis trials that were blinded involved suggestions delivered by audiotape during surgery while patients were under general anesthesia (assumed to be a hypnoticlike state). Evaluation of these trials is limited by the lack of standardized techniques for hypnotic induction, evaluation of the level of trance, delivery of suggestions, or number and length of sessions. Although the state of hypnosis involves increased receptivity to acceptable suggestions, the methods of delivering the suggestions vary substantially. In some trials, researchers gave suggestions only for relaxation or no suggestions at all. In other trials, researchers indirectly suggested that patients allow a feeling or imagination rather than directing them to have a certain feeling, which relied on patients understanding the intention. In some studies, researchers gave suggestions only to distract the mind during an otherwise uncomfortable procedure or condition.
      Thus, it is reasonable to consider the appropriateness of judging hypnosis by the best or worst results, with use of averaging, or by meta-analyses.
      • Montgomery GH
      • DuHamel KN
      • Redd WH
      A meta-analysis of hypnotically induced analgesia: how effective is hypnosis?.
      • Montgomery GH
      • David D
      • Winkel G
      • Silverstein JH
      • Bovbjerg DH
      The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis.
      • Viswesvaran C
      • Schmidt FL
      A meta-analytic comparison of the effectiveness of smoking cessation methods.
      • Bongartz W
      • Flammer E
      • Schwonke R
      Efficiency of hypnosis: a meta-analytic study [in German].
      Indeed, although better methods would be expected to achieve better results, many trials gave too few details about technique to allow comparison. If the most efficacious hypnosis techniques were known, a more representative review of the state of the art may include only trials using such techniques.
      A deficiency of the trials reviewed is the lack of randomization of patient and practitioner variables that may affect outcome. Patient characteristics such as fear, attentiveness, interest, expectation, suggestibility, motivation, desire, and belief in hypnosis may alter outcomes. According to the literature, vital practitioner characteristics include training and experience and the ability to induce trance, to properly word suggestions, and to establish the necessary states of expectancy, rapport, and motivation (if not already present).
      • Fromm E
      Significant developments in clinical hypnosis during the past 25years.
      • Blankfield RP
      Suggestion, relaxation, and hypnosis as adjuncts in the care of surgery patients: a review of the literature.
      • Baker EL
      The state of the art of clinical hypnosis.
      Furthermore, results from clinical trials may not accurately estimate the effectiveness achievable in an office setting with willing, expectant patients. In clinical trials, many patients are likely to be unwilling, unmotivated, or skeptical about hypnosis. Hypnosis appears to be “particularly useful and yields better results when it is specifically requested by the patient.”
      • Tasman A
      • Kay J
      • Lieberman JA
      Consequently, clinical trials may underestimate the benefits of hypnosis compared with those obtainable by a proficient, experienced hypnotist.

      CLINICAL TRIALS OF HYPNOSIS

      Allergy

      Allergic or hypersensitivity reactions usually are not believed to be psychosomatic and thus are generally considered as unable to be influenced by suggestion. These highly complex reactions involve IgE antibodies, activation of mast cells and basophils, and release of chemical mediators of inflammatory and immune responses. Some early literature suggested that many allergies might have an emotional basis and thus be treatable by hypnosis.
      • Elman D
      Subsequent studies have shown that hypnosis may alter the body's physiological response to various stimuli. In a study of 18 volunteers selected for their hypnotizability, immediate-type hypersensitivity reactions were suppressed in 8 of the 12 patients given brief direct suggestions in hypnosis.
      • Black S
      Inhibition of immediate-type hypersensitivity response by direct suggestion under hypnosis.
      In another trial, hypnotic suggestions for relaxation reduced helper/inducer cell percentages, helper/suppressor cell ratios, and natural killer cell activity compared with prehypnosis baseline values.
      • Kiecolt-Glaser JK
      • Glaser R
      • Strain EC
      • et al.
      Modulation of cellular immunity in medical students.
      Other researchers have shown the positive effects of social support on natural killer cell activity and cortisol levels and the adverse effects of stress in patients with cancer, which has implications for cancer progression.
      • Spiegel D
      • Sephton SE
      Psychoneuroimmune and endocrine pathways in cancer: effects of stress and support.
      Skin prick testing for type I (immediate) hypersensitivity and testing with purified protein derivative (in persons vaccinated previously for tuberculosis) for type IV hypersensitivity were performed before and after hypnosis.
      • Zachariae R
      • Bjerring P
      • Arendt-Nielsen L
      Modulation of type I immediate and type IV delayed immunoreactivity using direct suggestion and guided imagery during hypnosis.
      Patients in the hypnosis group (but not the control group) who were given suggestions for increasing or decreasing skin reactions were able to increase the flare and wheal reactions on 1 arm and decrease the flare reaction on the other, with a significant difference between the 2 arms. The same authors later studied volunteers selected for their high hypnotizability and evaluated their reactions to histamine pin pricks and laser-induced burn pain.
      • Zachariae R
      • Bjerring P
      The effect of hypnotically induced analgesia on flare reaction of the cutaneous histamine prick test.
      Hypnosis was associated with a significant reduction in both pain and flare reactions.

      Anesthesia for Pain Relief

      Numerous studies have shown benefits of hypnosis for pain relief (Table 2
      • Goldstein A
      • Hilgard ER
      Failure of the opiate antagonist naloxone to modify hypnotic analgesia.
      • Spiegel D
      • Albert LH
      Naloxone fails to reverse hypnotic alleviation of chronic pain.
      • Stern JA
      • Brown M
      • Ulett GA
      • Sletten I
      A comparison of hypnosis, acupuncture, morphine, valium, aspirin, and placebo in the management of experimentally induced pain.
      • Lu DP
      • Lu GP
      • Kleinman L
      Acupuncture and clinical hypnosis for facial and head and neck pain: a single crossover comparison.
      • Wakeman JR
      • Kaplan JZ
      An experimental study of hypnosis in painful burns.
      • Patterson DR
      • Everett JJ
      • Burns GL
      • Marvin JA
      Hypnosis for the treatment of burn pain.
      • Simon EP
      • Lewis DM
      Medical hypnosis for temporomandibular disorders: treatment efficacy and medical utilization outcome.
      ). In a study with experimental pain stimulation by pin prick and laser heat, direct suggestions in hypnosis resulted in a significant decrease in pain, measured subjectively and objectively by means of pain-related brain potentials.
      • Zachariae R
      • Bjerring P
      The effect of hypnotically induced analgesia on flare reaction of the cutaneous histamine prick test.
      In another study, highly hypnotizable (based on susceptibility testing) volunteers given painful electrical stimulation were able to increase or decrease their perception of pain as noted on event-related somatosensory potentials.
      • Spiegel D
      • Bierre P
      • Rootenberg J
      Hypnotic alteration of somatosensory perception.
      Table 2Comparison of Clinical Trials of Hypnosis for Analgesia
      NA = not applicable; NR = not reported.
      Trial
      ReferenceType of painTesting for hypnotizabilityControlledRandomizedNo. of subjects/patientsRefractory conditionSelf-hypnosis or home tapes?
      Patients encouraged to use either self-hypnosis or audiotapes at home (usually daily).
      TherapyNo. of sessionsFollow-up
      Goldstein & Hilgard,
      • Goldstein A
      • Hilgard ER
      Failure of the opiate antagonist naloxone to modify hypnotic analgesia.
      1975
      Induced by tourniquetYesOwn
      Patients served as their own controls.
      No3NANoIndividual1NA
      Spiegel & Albert,
      • Spiegel D
      • Albert LH
      Naloxone fails to reverse hypnotic alleviation of chronic pain.
      1983
      NeuropathicYesOwn
      Patients served as their own controls.
      Doubleblind, crossover6NoYesNRNRNA
      Stern et al,
      • Stern JA
      • Brown M
      • Ulett GA
      • Sletten I
      A comparison of hypnosis, acupuncture, morphine, valium, aspirin, and placebo in the management of experimentally induced pain.
      1977
      Induced by ice water or tourniquetYesOwn
      Patients served as their own controls.
      No20NANoIndividual1NA
      Lu et al,
      • Lu DP
      • Lu GP
      • Kleinman L
      Acupuncture and clinical hypnosis for facial and head and neck pain: a single crossover comparison.
      2001
      Various: head and neckYesOwn
      Patients served as their own controls.
      Crossover25SomeYesIndividual then audiotapes3None
      Wakeman & Kaplan,
      • Wakeman JR
      • Kaplan JZ
      An experimental study of hypnosis in painful burns.
      1978
      Burn woundsNoYesYes42NoYesIndividual then self-hypnosisVariableNR
      Patterson et al,
      • Patterson DR
      • Everett JJ
      • Burns GL
      • Marvin JA
      Hypnosis for the treatment of burn pain.
      1992
      Burn woundsNoYesYes57NoNoIndividual1None
      Simon & Lewis,
      • Simon EP
      • Lewis DM
      Medical hypnosis for temporomandibular disorders: treatment efficacy and medical utilization outcome.
      2000
      Temporo-mandibular disordersNoOwn
      Patients served as their own controls.
      No23YesYesGroup66 mo
      * NA = not applicable; NR = not reported.
      Patients served as their own controls.
      Patients encouraged to use either self-hypnosis or audiotapes at home (usually daily).
      The mechanism of analgesia from hypnosis appears to differ significantly from a placebo effect and from induced endorphin production (endogenous opiates).
      • Patterson DR
      • Jensen MP
      Hypnosis and clinical pain.
      The morphine antagonist naloxone does not block the pain relief afforded by hypnosis. In a small study, pain was produced in highly hypnotizable volunteers by inflating a blood pressure cuff on the upper arm to 250 mm Hg followed by exercise and leaving the cuff on for 10 minutes.
      • Goldstein A
      • Hilgard ER
      Failure of the opiate antagonist naloxone to modify hypnotic analgesia.
      All patients reported a pain level of 8 or more (on a scale of 0 to 10, with 10 being the most intense) before hypnosis. With hypnosis, all reported a pain level of 0, and this relief was not altered substantially by administration of naloxone.
      Hypnosis for pain relief in the clinical setting appears to have similar benefit. In a randomized, double-blind (for the use of naloxone) crossover study, patients with neuropathic pain were taught self-hypnosis.
      • Spiegel D
      • Albert LH
      Naloxone fails to reverse hypnotic alleviation of chronic pain.
      Considerable relief from pain was achieved by hypnosis, and this relief was not reversed by administration of naloxone. In patients with low hypnotizability, hypnosis was equal to placebo for pain relief, whereas highly hypnotizable people benefited more from hypnosis than from placebo.
      • McGlashan TH
      • Evans FJ
      • Orne MT
      The nature of hypnotic analgesia and placebo response to experimental pain.
      This finding indicates that hypnosis involves at least 2 effects: a placebo-type effect and one in which suggestion distorts perception.
      Pain relief afforded by hypnosis differs from that induced by acupuncture.
      • Patterson DR
      • Jensen MP
      Hypnosis and clinical pain.
      Twenty volunteers were evaluated for the level of pain caused by 2 different experimentally induced methods and were treated subsequently with hypnosis, acupuncture, medication, or placebo.
      • Stern JA
      • Brown M
      • Ulett GA
      • Sletten I
      A comparison of hypnosis, acupuncture, morphine, valium, aspirin, and placebo in the management of experimentally induced pain.
      Hypnosis with direct suggestions for pain relief produced significant pain relief compared with placebo (P<.001) and gave the best results of all the treatments. The most favorable results with hypnosis tended to be in those who were highly hypnotizable, whereas the results with acupuncture were not related to hypnotizability. Patients with head and neck pain studied in a single crossover trial served as their own controls before and after treatment with hypnosis or acupuncture.
      • Lu DP
      • Lu GP
      • Kleinman L
      Acupuncture and clinical hypnosis for facial and head and neck pain: a single crossover comparison.
      Both treatments were effective in relieving pain, although patients believed to have psychogenic pain fared better with hypnosis, and those who were apprehensive about hypnosis had less benefit.
      Many trials have evaluated hypnosis for pain relief for burn injuries. A review of the use of hypnosis for severely burned children encouraged its use for pain and prevention of regressive behavior and included case reports.
      • LaBaw WL
      Adjunctive trance therapy with severely burned children.
      Clinical trials have shown significant pain relief with hypnosis in patients with burns, many of whom were taught self-hypnosis for pain control.
      • Wakeman JR
      • Kaplan JZ
      An experimental study of hypnosis in painful burns.
      • Patterson DR
      • Everett JJ
      • Burns GL
      • Marvin JA
      Hypnosis for the treatment of burn pain.
      In one trial, patients were treated with a single session of hypnosis. Those with severe pain (but not those with less pain) noted significant pain relief compared with controls.
      • Patterson DR
      • Ptacek JT
      Baseline pain as a moderator of hypnotic analgesia for burn injury treatment.
      As in some other studies, younger patients tended to have better results.
      • Wakeman JR
      • Kaplan JZ
      An experimental study of hypnosis in painful burns.
      Adult patients with recalcitrant temporomandibular joint pain treated with hypnosis with suggestions for jaw relaxation noted significant pain reduction, which persisted at the 6-month follow-up.
      • Simon EP
      • Lewis DM
      Medical hypnosis for temporomandibular disorders: treatment efficacy and medical utilization outcome.
      A meta-analysis published in 2000 evaluated the use of hypnosis for pain relief in the preceding 20 years.
      • Montgomery GH
      • DuHamel KN
      • Redd WH
      A meta-analysis of hypnotically induced analgesia: how effective is hypnosis?.
      That review of 18 studies indicated that hypnosis offered a moderate to large analgesic effect for many types of pain, which met “the criteria for well established treatment.” Because hypnosis was noted to benefit most patients, a broader application of its use was advocated. A 2003 comprehensive review of hypnosis for pain relief found it superior to placebo for acute pain and at times superior to pain relief achieved by other means.
      • Patterson DR
      • Jensen MP
      Hypnosis and clinical pain.
      Hypnosis for chronic pain was concluded to be a viable option, with the understanding that pain therapy requires “multidimensional assessment and treatment.”

      Anesthesia for Surgery

      Hypnosis has been used as the sole agent of anesthesia for both major and minor surgical procedures. In the 19th century, John Elliotson and James Esdaile reported their successful use of mesmerism for anesthesia in hundreds of operations, with decreased mortality compared with other methods. Nonetheless, they were censored by the medical community at the time for unacceptable techniques. Instead, chloroform, nitrous oxide, and ether won acceptance for general anesthesia.
      • Faymonville ME
      • Meurisse M
      • Fissette J
      Hypnosedation: a valuable alternative to traditional anaesthetic techniques.
      The use of hypnosis as the sole agent for anesthesia has been virtually abandoned because of the availability and dependability of pharmacological agents; nevertheless, a few such cases have been described in contemporary medical literature. Hypnoanalgesia was described for repair of atrial septal defects in 3 patients and for mitral commissurotomy in 4 patients, with hypnosis as the sole method of anesthesia for 1 of the patients.
      • Marmer MJ
      Hypnoanalgesia and hypnoanesthesia for cardiac surgery.
      The patients were able to open and close their eyes on command during surgery and to extubate themselves postoperatively. An oral surgeon documented his own cholecystectomy performed with use of only self-hypnosis for anesthesia.
      • Rausch V
      Cholecystectomy with self-hypnosis.
      He walked back to his room after surgery and returned to work on the 10th postoperative day.
      A 1999 review of more than 1650 surgical cases using hypnosis combined with other methods for conscious sedation promoted the safety and patient comfort afforded by hypnosis.
      • Faymonville ME
      • Meurisse M
      • Fissette J
      Hypnosedation: a valuable alternative to traditional anaesthetic techniques.
      This form of anesthesia was used instead of general anesthesia for a broad range of surgical procedures, including thyroidectomy, cervicotomy for hyperparathyroidism, breast augmentation, neck lift, correction of mammary ptosis, nasal septorhinoplasty, débridement with skin grafting, maxillofacial reconstruction, and tubal ligation. The authors concluded that hypnosis prevents pharmacological unconsciousness, allows patient participation, and may allow a faster recovery and a shorter hospital stay but requires some changes in the atmosphere of the operating room because of the conscious state of the patient. Other studies support the multiple benefits of hypnosis as an adjunct to conscious sedation for many types of surgery
      • Faymonville ME
      • Meurisse M
      • Fissette J
      Hypnosedation: a valuable alternative to traditional anaesthetic techniques.
      • Faymonville ME
      • Mambourg PH
      • Joris J
      • et al.
      Psychological approaches during conscious sedation: hypnosis versus stress reducing strategies: a prospective randomized study.
      (Table 3
      • Faymonville ME
      • Mambourg PH
      • Joris J
      • et al.
      Psychological approaches during conscious sedation: hypnosis versus stress reducing strategies: a prospective randomized study.
      • Montgomery GH
      • Weltz CR
      • Seltz M
      • Bovbjerg DH
      Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients.
      • Lang EV
      • Benotsch EG
      • Fick LJ
      • et al.
      Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial.
      • Lang EV
      • Joyce JS
      • Spiegel D
      • Hamilton D
      • Lee KK
      Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use.
      • Weinstein EJ
      • Au PK
      Use of hypnosis before and during angioplasty.
      ).
      Table 3Comparison of Clinical Trials of Hypnosis for Anesthesia
      In all these randomized, controlled trials, hypnosis treatment consisted of 1 individual therapy session, and there was no follow-up.
      ReferenceTesting for hypnotizabilityNo. of patientsSelf-hypnosis
      Patients encouraged to use self-hypnosis during the procedure.
      Faymonville et al,
      • Faymonville ME
      • Mambourg PH
      • Joris J
      • et al.
      Psychological approaches during conscious sedation: hypnosis versus stress reducing strategies: a prospective randomized study.
      1997
      No60No
      Montgomery et al,
      • Montgomery GH
      • Weltz CR
      • Seltz M
      • Bovbjerg DH
      Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients.
      2002
      No20No
      Lang et al,
      • Lang EV
      • Benotsch EG
      • Fick LJ
      • et al.
      Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial.
      2000
      No241Yes
      Lang et al,
      • Lang EV
      • Joyce JS
      • Spiegel D
      • Hamilton D
      • Lee KK
      Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use.
      1996
      No30Yes
      Weinstein & Au,
      • Weinstein EJ
      • Au PK
      Use of hypnosis before and during angioplasty.
      1991
      Yes32No
      * In all these randomized, controlled trials, hypnosis treatment consisted of 1 individual therapy session, and there was no follow-up.
      Patients encouraged to use self-hypnosis during the procedure.
      Brief hypnosis has been documented to be beneficial for anesthesia before excisional breast biopsies
      • Montgomery GH
      • Weltz CR
      • Seltz M
      • Bovbjerg DH
      Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients.
      and invasive radiological procedures.
      • Lang EV
      • Benotsch EG
      • Fick LJ
      • et al.
      Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial.
      Similar benefit was afforded to patients taught self-hypnosis, which was used during radiological procedures.
      • Lang EV
      • Joyce JS
      • Spiegel D
      • Hamilton D
      • Lee KK
      Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use.
      In a randomized trial, patients hypnotized before and during coronary artery angioplasty required less pain medication and had a mild increase in tolerance to balloon-induced ischemia
      • Weinstein EJ
      • Au PK
      Use of hypnosis before and during angioplasty.
      (Table 3). Benefit was observed, presumably from the relaxed state and from distraction, without specific suggestions given for not feeling discomfort.

      Dermatology

      Many trials have evaluated hypnosis for eliminating warts (Table 4
      • Sinclair-Gieben AH
      • Chalmers D
      Evaluation of treatment of warts by hypnosis.
      • Ewin DM
      Hypnotherapy for warts (verruca vulgaris): 41 consecutive cases with 33 cures.
      • Spanos NP
      • Stenstrom RJ
      • Johnston JC
      Hypnosis, placebo, and suggestion in the treatment of warts.
      • Spanos NP
      • Williams V
      • Gwynn MI
      Effects of hypnotic, placebo, and salicylic acid treatments on wart regression.
      ); however, evaluation is complicated by spontaneous remission rates of 20% to 45% and by accounts of warts being produced by suggestion.
      • Clawson Jr, TA
      • Swade RH
      The hypnotic control of blood flow and pain: the cure of warts and the potential for the use of hypnosis in the treatment of cancer.
      • Gravitz MA
      The production of warts by suggestion as a cultural phenomenon.
      Fourteen patients with bilateral warts for at least 6 months were given direct suggestions for only unilateral clearing of the warts.
      • Sinclair-Gieben AH
      • Chalmers D
      Evaluation of treatment of warts by hypnosis.
      Of the 10 patients who were able to reach at least a moderate depth of hypnosis (defined in the study), 9 (64% of the total group) achieved complete or near-complete resolution of the warts at 3-month follow-up. The warts on the contralateral side were not affected except in 1 highly hypnotizable person whose contralateral warts resolved 6 weeks later. Hypnosis was advocated to avoid pain and scarring, reactions to anesthetics, and the need for wound care and special equipment. The technique may be particularly applicable for warts in sensitive or inaccessible areas.
      Table 4Comparison of Clinical Trials of Hypnosis for Warts
      In each trial, individual therapy was used.
      Trial
      ReferenceTesting for hypnotizabilityControlledRandomizedNo. of patientsRefractory conditionSelf-hypnosis or home tapes
      Patients encouraged to use either self-hypnosis or audiotapes at home (usually daily).
      No. of sessionsFollow-up
      Sinclair-Gieben & Chalmers,
      • Sinclair-Gieben AH
      • Chalmers D
      Evaluation of treatment of warts by hypnosis.
      1959
      YesOwn
      The contralateral side was the control.
      No14SomeNoNot reported3 mo
      Ewin,
      • Ewin DM
      Hypnotherapy for warts (verruca vulgaris): 41 consecutive cases with 33 cures.
      1992
      NoNoNo41MostNoVariable6 mo to several years
      Spanos et al,
      • Spanos NP
      • Stenstrom RJ
      • Johnston JC
      Hypnosis, placebo, and suggestion in the treatment of warts.
      1988
      YesYesYes63NoYes1 individual, 1 self6 wk
      Spanos et al,
      • Spanos NP
      • Williams V
      • Gwynn MI
      Effects of hypnotic, placebo, and salicylic acid treatments on wart regression.
      1990
      YesYesYes40NoYes1 individual plus self6 wk
      * In each trial, individual therapy was used.
      Patients encouraged to use either self-hypnosis or audiotapes at home (usually daily).
      The contralateral side was the control.
      In a case report of 41 consecutive patients with predominantly refractory warts, direct suggestions in hypnosis, followed by age-regression techniques for any nonresponders, resulted in a cure rate of 80% with no recurrences.
      • Ewin DM
      Hypnotherapy for warts (verruca vulgaris): 41 consecutive cases with 33 cures.
      In volunteers with warts on the hand, a significant difference was seen in the rate of remission in those treated with hypnosis (50%) compared with that in the control group (12%).
      • Spanos NP
      • Stenstrom RJ
      • Johnston JC
      Hypnosis, placebo, and suggestion in the treatment of warts.
      Hypnotizability was not found to be related to successful remission, whereas low expectation for wart regression had a negative association. Volunteers assigned to receive hypnosis had significantly fewer warts at the 6-week follow-up evaluation than did groups treated with either placebo or salicylic acid.
      • Spanos NP
      • Williams V
      • Gwynn MI
      Effects of hypnotic, placebo, and salicylic acid treatments on wart regression.
      Hypnosis has been used successfully for other dermatologic conditions. Patients with atopic dermatitis noted decreased pruritus, scratching, sleep disturbance, and tension after treatment with hypnosis.
      • Stewart AC
      • Thomas SE
      Hypnotherapy as a treatment for atopic dermatitis in adults and children.
      In many patients, improvements persisted at follow-up evaluations up to 18 months later. A review of the use of hypnosis in dermatology supports its value for many skin conditions not believed to be under conscious control.
      • Shenefelt PD
      Hypnosis in dermatology.

      Gastroenterology

      Hypnosis for irritable bowel syndrome (IBS) has been studied extensively (Table 5
      • Whorwell PJ
      • Prior A
      • Faragher EB
      Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome.
      • Whorwell PJ
      • Prior A
      • Colgan SM
      Hypnotherapy in severe irritable bowel syndrome: further experience.
      • Harvey RF
      • Hinton RA
      • Gunary RM
      • Barry RE
      Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome.
      • Prior A
      • Colgan SM
      • Whorwell PJ
      Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome.
      • Houghton LA
      • Heyman DJ
      • Whorwell PJ
      Symptomatology, quality of life and economic features of irritable bowel syndrome: the effect of hypnotherapy.
      • Galovski TE
      • Blanchard EB
      The treatment of irritable bowel syndrome with hypnotherapy.
      • Vidakovic-Vukic M
      Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam.
      • Gonsalkorale WM
      • Houghton LA
      • Whorwell PJ
      Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness.
      ). A 1984 study in England showed significant benefits from hypnosis.
      • Whorwell PJ
      • Prior A
      • Faragher EB
      Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome.
      Thirty patients with refractory IBS and severe symptoms were randomly assigned to 7 individual sessions of hypnotherapy or psychotherapy plus placebo pills. Although the psychotherapy group showed a small but significant improvement in some characteristics, all patients in the hypnosis group had significant improvements (P<.0001) in well-being, bowel habits, distention symptoms, and pain, with no relapses at 3-month follow-up. A subsequent report added 35 more patients to the hypnosis group of 15 from the earlier study; those with classic symptoms and no psychological problems fared best with hypnosis, as did patients younger than 50 years.
      • Whorwell PJ
      • Prior A
      • Colgan SM
      Hypnotherapy in severe irritable bowel syndrome: further experience.
      Direct, specific suggestions for symptom relief were most successful. At 18-month follow-up, the 15 patients in the earlier hypnosis group remained in remission.
      Table 5Comparison of Clinical Trials of Hypnosis for Irritable Bowel Syndrome
      Trial
      ReferenceTesting for hypnotizabilityControlledRandomizedNo. of patientsRefractory conditionSelf-hypnosis or home tapes
      Patients encouraged to use either self-hypnosis or audiotapes at home (usually daily).
      TherapyNo. of sessionsFollow-up
      Whorwell et al,
      • Whorwell PJ
      • Prior A
      • Faragher EB
      Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome.
      1984
      NoYesYes30YesYesIndividual73 mo
      Whorwell et al,
      • Whorwell PJ
      • Prior A
      • Colgan SM
      Hypnotherapy in severe irritable bowel syndrome: further experience.
      1987
      NoNoNo35YesYesIndividual≤10≤18 mo
      Harvey et al,
      • Harvey RF
      • Hinton RA
      • Gunary RM
      • Barry RE
      Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome.
      1989
      NoNoYes33YesYesGroup vs individual45 mo
      Prior et al,
      • Prior A
      • Colgan SM
      • Whorwell PJ
      Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome.
      1990
      NoYesNo30NoNoIndividual103 mo
      Houghton et al,
      • Houghton LA
      • Heyman DJ
      • Whorwell PJ
      Symptomatology, quality of life and economic features of irritable bowel syndrome: the effect of hypnotherapy.
      1996
      NoYesNo50YesYesIndividual12Not reported
      Galovski &
      Blanchard,
      • Galovski TE
      • Blanchard EB
      The treatment of irritable bowel syndrome with hypnotherapy.
      1998
      YesYesYes12SomeYesIndividual125 mo
      Vidakovic-Vukic,
      • Vidakovic-Vukic M
      Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam.
      1999
      NoOwn
      Patients served as their own controls.
      No27YesYesIndividual12Variable
      Gonsalkorale et al,
      • Gonsalkorale WM
      • Houghton LA
      • Whorwell PJ
      Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness.
      2002
      NoOwn
      Patients served as their own controls.
      No250YesYesIndividual123 mo
      * Patients encouraged to use either self-hypnosis or audiotapes at home (usually daily).
      Patients served as their own controls.
      The positive results with hypnosis for IBS have been confirmed in several other trials.
      • Harvey RF
      • Hinton RA
      • Gunary RM
      • Barry RE
      Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome.
      • Prior A
      • Colgan SM
      • Whorwell PJ
      Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome.
      • Houghton LA
      • Heyman DJ
      • Whorwell PJ
      Symptomatology, quality of life and economic features of irritable bowel syndrome: the effect of hypnotherapy.
      • Galovski TE
      • Blanchard EB
      The treatment of irritable bowel syndrome with hypnotherapy.
      It was concluded that “in addition to relieving the symptoms of irritable bowel syndrome, hypnotherapy profoundly improves the patients’ quality of life and reduces absenteeism from work.”
      • Houghton LA
      • Heyman DJ
      • Whorwell PJ
      Symptomatology, quality of life and economic features of irritable bowel syndrome: the effect of hypnotherapy.
      Use of audiotapes for self-hypnosis at home, used in many IBS studies, was considered important for success.
      • Galovski TE
      • Blanchard EB
      The treatment of irritable bowel syndrome with hypnotherapy.
      • Vidakovic-Vukic M
      Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam.
      • Gonsalkorale WM
      • Houghton LA
      • Whorwell PJ
      Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness.
      • Palsson OS
      • Turner MJ
      • Johnson DA
      • Burnett CK
      • Whitehead WE
      Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms.
      Other studies and reviews have shown similar results for IBS.
      • Gonsalkorale WM
      • Houghton LA
      • Whorwell PJ
      Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness.
      • Palsson OS
      • Turner MJ
      • Johnson DA
      • Burnett CK
      • Whitehead WE
      Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms.
      • Spanier JA
      • Howden CW
      • Jones MP
      A systematic review of alternative therapies in the irritable bowel syndrome.
      Patients with peptic ulcer disease have benefited from hypnosis. Thirty patients with recurrent peptic ulcer disease were treated with ranitidine and were assigned randomly to receive hypnosis or ranitidine alone, initiated after healing was documented by esophagogastroduo-denoscopy.
      • Colgan SM
      • Faragher EB
      • Whorwell PJ
      Controlled trial of hypnotherapy in relapse prevention of duodenal ulceration.
      During 12 months of monitoring, significantly fewer patients in the hypnosis group (53%) experienced relapse compared with 100% of patients in the ranitidine-only group. The benefit may be from suppression of the secretion of gastric acid, as shown by a study of 32 volunteers who were able to significantly and appropriately increase and decrease gastric acid secretion (compared with their baseline values) from suggestive imagery in hypnosis.
      • Klein KB
      • Spiegel D
      Modulation of gastric acid secretion by hypnosis.
      In a study of 126 patients with functional dyspepsia, those treated with hypnosis noted improvement in quality of life and long-term symptoms, fewer physician visits, and less health care spending compared with the group treated with medication.
      • Calvert EL
      • Houghton LA
      • Cooper P
      • Morris J
      • Whorwell PJ
      Long-term improvement in functional dyspepsia using hypnotherapy.
      Postoperative gastrointestinal motility has been affected positively by hypnosis. Patients scheduled to undergo abdominal surgery were assigned randomly to either a treatment group read suggestions for an early return of bowel function and appetite or a control group given only general preoperative instructions for an equal period.
      • Disbrow EA
      • Bennett HL
      • Owings JT
      Effect of preoperative suggestion on postoperative gastrointestinal motility.
      With their surgeons unaware of the study, patients who were read a 5-minute script before surgery had a significantly earlier return of bowel function (P<.05). They also had a shorter mean duration of hospital stay (6.6 vs 8.1 days) and a cost savings of $1200 per patient. Patients in the perioperative state, as well as patients treated in the emergency department, are alleged to be in a highly receptive or hypnoticlike state not requiring formal hypnotic induction.
      • Bierman SF
      Hypnosis in the emergency department.
      • Peebles-Kleiger MJ
      The use of hypnosis in emergency medicine.
      • Wain HJ
      • Amen DG
      Emergency room use of hypnosis.
      The use of positive assertions during a situation in which the patient is reliant on and receptive to the health care practitioner, but not in a formal trance state, has been termed waking hypnosis.
      • Elman D
      Hypnosis has been used alone or in combination as anesthesia for liver biopsy, esophagogastroduodenoscopy, and colonoscopy. A gastroenterologist reported the use of only an anesthetic throat spray and hypnosis for 200 upper gastrointestinal tract endoscopy procedures with a reduced overall duration of the procedure.
      • Zimmerman J
      Hypnotic technique for sedation of patients during upper gastrointestinal endoscopy.
      No complications were noted, and patients were able to leave immediately afterward. In another report, patients with either anxiety or allergy to local anesthetics safely underwent liver biopsies with use of hypnosis.
      • Adams PC
      • Stenn PG
      Liver biopsy under hypnosis.
      Half the patients in a pilot trial reached a moderate or deep level of hypnosis before colonoscopic evaluations,
      • Cadranel JF
      • Benhamou Y
      • Zylberberg P
      • et al.
      Hypnotic relaxation: a new sedative tool for colonoscopy?.
      with more than 80% noting only mild or no discomfort.

      Healing From Surgery or Injury

      Two trials evaluated the potential for hypnotic suggestions to facilitate faster wound healing after injuries or surgery. A pilot trial of hypnosis for patients with nondisplaced ankle fractures showed marginally faster healing, diminished pain, and increased mobility and functionality.
      • Ginandes CS
      • Rosenthal DI
      Using hypnosis to accelerate the healing of bone fractures: a randomized controlled pilot study.
      Eighteen presurgical patients were assigned randomly to a hypnosis group that received positive suggestions for healing, a control group that received supportive attention to the patients’ concerns, or a standard care group. Surgeons were unaware of their treatment group.
      • Ginandes C
      • Brooks P
      • Sando W
      • Jones C
      • Aker J
      Can medical hypnosis accelerate post-surgical wound healing? results of a clinical trial.
      Patients in the hypnosis group showed significantly improved healing at 1 and 7 weeks postoperatively compared with the other groups (P<.02).

      Hematology

      One medical center reported favorable results with the addition of hypnosis for patients with hemophilia.
      • LaBaw W
      The use of hypnosis with hemophilia.
      Patients who were assigned to receive hypnosis had a significantly decreased need for transfusions compared with controls (P=.01). A review of this program described the methods and various benefits of teaching self-hypnosis to these patients.

      Hypertension

      Few studies have evaluated the use of hypnosis for hypertension. In 1 study of 44 patients, the hypnosis group had a significant decrease in blood pressure compared with the control group. At 6 months, the hypnosis group had mean decreases of 13.3 mm Hg systolic and 8.5 mm Hg diastolic below their baseline blood pressures.
      • Friedman H
      • Taub HA
      The use of hypnosis and biofeedback procedures for essential hypertension.
      • Friedman H
      • Taub HA
      A six-month follow-up of the use of hypnosis and biofeedback procedures in essential hypertension.

      Neurology

      Hypnosis has been used successfully for treatment of headaches. Patients with chronic (≥6 months) tension headaches were assigned randomly to hypnosis or a control group.
      • Melis PM
      • Rooimans W
      • Spierings EL
      • Hoogduin CA
      Treatment of chronic tension-type headache with hypnotherapy: a single-blind time controlled study.
      The hypnosis group had a significant reduction in the number, duration, and intensity of headaches. Instruction in self-hypnosis produced significant benefit for tension headaches in other studies including a group of less hypnotizable patients.
      • Spinhoven P
      • Linssen AC
      • Van Dyck R
      • Zitman FG
      Autogenic training and self-hypnosis in the control of tension headache.
      • ter Kuile MM
      • Spinhoven P
      • Linssen AC
      • Zitman FG
      • Van Dyck R
      • Rooijmans HG
      Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups.
      Hypnosis was compared with propranolol use for children with migraine headaches in a prospective, randomized, controlled, crossover trial.
      • Olness K
      • MacDonald JT
      • Uden DL
      Comparison of self-hypnosis and propranolol in the treatment of juvenile classic migraine.
      Patients taught self-hypnosis had a decreased frequency of headaches. In another trial, university students with chronic headaches were studied. Hypnosis using imagery for relaxation and serenity was compared with an active placebo that consisted of watching slides falsely claimed to contain potent subliminal messages for pain relief.
      • Spanos NP
      • Liddy SJ
      • Scott H
      • et al.
      Hypnotic suggestion and placebo for the treatment of chronic headache in a university volunteer sample.
      Both groups achieved significant (P<.05) and equal decreases in headache pain compared with controls. Hypnosis did not outperform the placebo; however, the hypnosis group received no specific suggestions for pain relief, whereas the placebo group was given suggestions to expect such benefit (waking hypnosis).

      Obesity

      Studies of hypnosis as a single treatment for obesity show variable and limited success. A critical review of hypnosis for obesity in studies from 1958 through 1978 concluded that hypnosis may be of benefit but that standardization of methods was needed.
      • Mott Jr, T
      • Roberts J
      Obesity and hypnosis: a review of the literature.
      In a subsequent trial with 156 participants, results from participants who received 9 weekly individual hypnosis sessions plus behavior-modification treatments were compared with results from those who received behavior-modification treatment alone.
      • Bolocofsky DN
      • Spinler D
      • Coulthard-Morris L
      Effectiveness of hypnosis as an adjunct to behavioral weight management.
      On average, the hypnosis group had lost 7 kg of weight more than the control group at the 2-year follow-up. A meta-analysis of trials in the 1980s showed significantly greater weight loss for those treated with hypnosis and behavior therapy compared with those who received behavior therapy alone, and this effect persisted or increased with time (P<.05).
      • Kirsch I
      • Montgomery G
      • Sapirstein G
      Hypnosis as an adjunct to cognitive-behavioral psychotherapy: a meta-analysis.
      • Kirsch I
      Hypnotic enhancement of cognitive-behavioral weight loss treatments: another meta-reanalysis.
      In another trial, 60 obese patients with sleep apnea were assigned randomly to treatment with diet alone or diet and hypnosis.
      • Stradling J
      • Roberts D
      • Wilson A
      • Lovelock F
      Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea.
      Patients assigned to hypnosis (two 30-minute hypnosis sessions and a home audiotape) achieved significant weight loss at 18 months (P<.02); however, the sleep apnea was not eliminated. Rather than a sole treatment for obesity, hypnosis may be more helpful as part of a program that includes arousing motivation, dietary counseling, and peer support.
      • Fromm E
      Significant developments in clinical hypnosis during the past 25years.

      Obstetrics

      Hypnosis as anesthesia for childbirth has a long, successful history supported by several trials. A large trial compared a self-hypnosis group with a control group to study the effects of hypnosis on labor.
      • Jenkins MW
      • Pritchard MH
      Hypnosis: practical applications and theoretical considerations in normal labour.
      The hypnosis group reported less discomfort and shortened labor. The women's volunteer status and the skill of the hypnotist were factors deemed important for success. Pregnant adolescents were assigned randomly to individual sessions of hypnosis or to supportive counseling with the medical staff blinded to their group assignments.
      • Martin AA
      • Schauble PG
      • Rai SH
      • Curry Jr, RW
      The effects of hypnosis on the labor processes and birth outcomes of pregnant adolescents [published correction appears in J Fam Pract. 2001;50:749].
      At delivery, the hypnosis group had a significant decrease in complications, fewer surgical interventions, and a shorter hospital stay. Additional positive findings not statistically significant were a decreased need for anesthesia, postpartum analgesia, and infant admissions to the intensive care unit. In another trial, the use of a single session of hypnosis (and encouraging home use of an audiotape) did not induce delivery in postterm women.
      • Omer H
      • Sirkovitz A
      Failure of hypnotic relaxation in the treatment of postterm pregnancies.
      Patients with hyperemesis gravidarum have benefited from hypnotic intervention, according to 2 reviews with case reports.
      • Simon EP
      • Schwartz J
      Medical hypnosis for hyperemesis gravidarum.
      • Torem MS
      Hypnotherapeutic techniques in the treatment of hyperemesis gravidarum.

      Oncology

      Chemotherapy often is associated with nausea and vomiting. Hypnosis has been studied for reducing these and other adverse effects. Children receiving chemotherapy who were assigned randomly to hypnosis had less anticipatory nausea and vomiting and less vomiting with chemotherapy compared with a control group.
      • Zeltzer LK
      • Dolgin MJ
      • LeBaron S
      • LeBaron C
      A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer.
      A later prospective randomized trial examined the effects of hypnosis for the adverse effects of chemotherapy in children with a resultant significant decrease in anticipatory nausea and the need for antiemetic medications.
      • Jacknow DS
      • Tschann JM
      • Link MP
      • Boyce WT
      Hypnosis in the prevention of chemotherapy-related nausea and vomiting in children: a prospective study.
      Children who learned self-hypnosis techniques were believed to have gained feelings of control over their situations.
      Hypnosis has been used successfully in other areas of oncology. Patients undergoing bone marrow transplantation treated with hypnosis experienced significantly less oral pain than control patients.
      • Syrjala KL
      • Cummings C
      • Donaldson GW
      Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial.
      Patients with metastatic breast cancer benefited from self-hypnosis and from participation in group support. Despite a lack of specific suggestions, the women benefited with significantly less pain and an increased duration of survival.
      • Spiegel D
      • Bloom JR
      Group therapy and hypnosis reduce metastatic breast carcinoma pain.
      • Spiegel D
      • Bloom JR
      • Kraemer HC
      • Gottheil E
      Effect of psychosocial treatment on survival of patients with metastatic breast cancer.
      An untapped potential for hypnosis for cancer treatment is the reported ability to alter regional blood flow, which offers the prospect of increasing the delivery of chemotherapy to a tumor or reducing blood flow to it.
      • Clawson Jr, TA
      • Swade RH
      The hypnotic control of blood flow and pain: the cure of warts and the potential for the use of hypnosis in the treatment of cancer.

      Otorhinolaryngology

      Patients with chronic tinnitus treated with hypnosis improved significantly in 7 of 10 disturbing symptoms compared with a group treated with masking techniques or supportive measures (P<.05).
      • Attias J
      • Shemesh Z
      • Sohmer H
      • Gold S
      • Shoham C
      • Faraggi D
      Comparison between self-hypnosis, masking and attentiveness for alleviation of chronic tinnitus.
      These results support the findings from other trials.

      Pulmonary Medicine

      Several trials have evaluated hypnosis for asthma. A study of 55 patients with asthma noted that patients assigned randomly to the hypnosis group used bronchodilators less frequently and experienced less wheezing than controls.
      • Maher-Loughnan GP
      • Mason AA
      • MacDonald N
      • Fry L
      Controlled trial of hypnosis in the symptomatic treatment of asthma.
      Those responding best were younger, more compliant with practicing self-hypnosis techniques, and more easily hypnotized, and they developed a deeper level of trance. Males responded as well as females, a finding not consistent in hypnosis trials. A large multicenter trial of patients with asthma reported a significant decrease in the number of treatment failures and a larger number of patients deemed “much improved” by independent assessment in the group taught self-hypnosis.
      Hypnosis for asthma—a controlled trial: a report to the Research Committee of the British Tuberculosis Association.
      Females in the hypnosis group also had lower wheezing scores and less use of bronchodilators. A retrospective study of asthmatic patients reported similar benefit, with 54% of patients treated with hypnosis having an “excellent” result and 21% becoming symptom free and discontinuing medication.
      • Collison DR
      Which asthmatic patients should be treated by hypnotherapy?.
      Decreased rates of hospital admissions, length of stay, and use of corticosteroids were attained with hypnotherapy during the year of study in patients with refractory asthma who served as their own controls.
      • Morrison JB
      Chronic asthma and improvement with relaxation induced by hypnotherapy.
      Highly hypnotizable patients assigned randomly to hypnosis for asthma treatment improved significantly in measurements of pulmonary function and noted improved symptoms and less use of bronchodilators compared with a control group.
      • Ewer TC
      • Stewart DE
      Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomised controlled trial.
      A few cases have been reported of success with hypnosis in weaning dependent patients from ventilators.
      • Bowen DE
      Ventilator weaning through hypnosis.
      The report indicates a potential benefit of hypnosis when other techniques have failed.
      Numerous studies have reported various techniques and outcomes in the use of hypnosis for smoking cessation, many with beneficial results.
      • Fromm E
      Significant developments in clinical hypnosis during the past 25years.
      A 1970 study used a single 12-hour group session for volunteer smokers who had unsuccessfully tried other methods of smoking cessation.
      • Kline MV
      The use of extended group hypnotherapy sessions in controlling cigarette habituation.
      The program achieved an 88% 1-year abstention rate. In a large trial involving 615 persons unable to quit smoking published the same year, participants were taught self-hypnosis in a single, individual, 45-minute session.
      • Spiegel H
      A single-treatment method to stop smoking using ancillary self-hypnosis.
      A 20% abstention rate was noted by questionnaire at 6 months, counting nonresponders as failures (45% abstention rate in the responders). Further studies patterned after this trial showed 31% to 40% abstention rates at 6 months.
      • Rabkin SW
      • Boyko E
      • Shane F
      • Kaufert J
      A randomized trial comparing smoking cessation programs utilizing behaviour modification, health education or hypnosis.
      • Hyman GJ
      • Stanley RO
      • Burrows GD
      • Horne DJ
      Treatment effectiveness of hypnosis and behaviour therapy in smoking cessation: a methodological refinement.
      In a 1992 meta-analysis of 633 smoking-cessation studies involving almost 72,000 participants, hypnosis was the most successful cessation method, with a 12% to 60% success rate (mean, 36%), 3.5 times that achieved by self-care methods.
      • Viswesvaran C
      • Schmidt FL
      A meta-analytic comparison of the effectiveness of smoking cessation methods.
      More aggressive but less acceptable techniques that combined hypnosis with aversion methods (rapid smoking with negative imagery and electrical shocks) for smoking cessation resulted in a 3-month abstention rate of 86% in male volunteers and 87% in female volunteers.
      • Johnson DL
      • Karkut RT
      Performance by gender in a stop-smoking program combining hypnosis and aversion.
      Another study that combined hypnosis with aversion methods reported a 90% abstention rate (39 of 43 consecutive referral patients) at 6 to 36 months.
      • Barber J
      Freedom from smoking: integrating hypnotic methods and rapid smoking to facilitate smoking cessation.
      A 2000 review of 59 studies using various techniques for smoking cessation indicated that, although some trials failed to achieve significant benefit, several showed a greater than 50% success rate, with 3 studies (200 participants total) documenting 12-month abstention rates of 63% to 88%.
      • Green JP
      • Lynn SJ
      Hypnosis and suggestion-based approaches to smoking cessation: an examination of the evidence.
      Nevertheless, on the basis of the collective results, the reviewers concluded that hypnosis was only “possibly efficacious.” Less benefit was noted in a group of 2810 persons unable to quit smoking (who had previously attempted smoking cessation an average of 7 times) treated with a single 60-minute hypnosis session and encouraged to use a home audiotape.
      • Ahijevych K
      • Yerardi R
      • Nedilsky N
      Descriptive outcomes of the American Lung Association of Ohio hypnotherapy smoking cessation program.
      An abstention rate of 22% was found for the previous month in a random sample of participants questioned several months later. In another report, an experienced practitioner of hypnosis reviewed his experience and techniques with 4355 patients, citing an 81% success rate for smoking cessation.
      • Crasilneck HB
      Hypnotic techniques for smoking control and psychogenic impotence.
      Two studies examined the effect of suggestions for smoking cessation delivered during elective surgery. In a double-blind trial, 122 patients listened to audiotapes during general anesthesia containing either simple, direct suggestions to stop smoking or simple counting without suggestions.
      • Hughes JA
      • Sanders LD
      • Dunne JA
      • Tarpey J
      • Vickers MD
      Reducing smoking: the effect of suggestion during general anaesthesia on postoperative smoking habits.
      After 1 month, significantly more patients in the suggestion group (8 patients) had stopped smoking compared with no patients in the control group (P<.005). No patient could actively recall the message on the tape. This study is one of several supporting the assertion that postoperative behavior can be influenced by suggestions given during general anesthesia without conscious recall of the suggestions. In contrast, another trial using a longer, complex message showed no difference in the smoking cessation rate between the treatment and control groups postoperatively.
      • Myles PS
      • Hendrata M
      • Layher Y
      • et al.
      Double-blind, randomized trial of cessation of smoking after audiotape suggestion during anaesthesia.

      Rheumatology

      Patients with refractory fibromyalgia (mean duration, 8.5 years) who were randomly assigned to receive hypnosis obtained significant improvement compared with those assigned randomly to physical therapy alone.
      • Haanen HC
      • Hoenderdos HT
      • van Romunde LK
      • et al.
      Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia.
      Benefits included improvements in morning fatigue (P=.003), sleep (P<.001), muscle pain (P=.004), overall assessment (P=.04), and use of pain medications, with results persisting for at least 6 months.

      Surgery

      A report from the 1960s indicated that surgical patients should be considered in a state of hypnosis and suggested that patients were able to comprehend much of the conversation around them, even while under anesthesia.
      • Cheek DB
      Importance of recognizing that surgical patients behave as though hypnotized.
      In the perioperative state, the patient is fixated on the forthcoming process and is in a receptive, compliant state of mind, comparable to the state formally induced with hypnosis. The article further cautioned that patients in this receptive state may interpret comments made within an audible range as having negative implications for them if these comments are not made correctly.
      • Cheek DB
      Importance of recognizing that surgical patients behave as though hypnotized.
      More recently, it has been emphasized again that health care personnel should be aware that patients under anesthesia have unconscious auditory perception and tend to interpret comments negatively.
      • Erickson III, JC
      The use of hypnosis in anesthesia: a master class commentary.
      The report also stressed that, along with the potential deleterious effects of this awareness, came the opportunity for using “semantics of positive suggestion” (emphasizing comfort, safety, and success) that should be “an integral part” of surgical and obstetrical care. It appears appropriate to consider the use of suggestions for patients in the perioperative period as a part of the practice of hypnosis.
      The subject of awareness under anesthesia is controversial. Much of the medical literature asserts that awareness under general anesthesia occurs only in rare cases, is indicative of an inadequate level of anesthesia, and can cause psychological trauma, presumably from fear induced during the awareness.
      • Sigalovsky N
      Awareness under general anesthesia.
      • Ranta SO
      • Laurila R
      • Saario J
      • Ali-Melkkila T
      • Hynynen M
      Awareness with recall during general anesthesia: incidence and risk factors.
      A prospective study examined the possibility of patient awareness of events or comments occurring during anesthesia that may not be recalled consciously.
      • Goldmann L
      • Shah MV
      • Hebden MW
      Memory of cardiac anaesthesia: psychological sequelae in cardiac patients of intra-operative suggestion and operating room conversation.
      Patients undergoing coronary artery bypass grafting surgery were assigned randomly to listen to either a personalized audiotape with specific instructions to be recalled postoperatively or no tape (control) during surgery. Postoperative hypnosis demonstrated significant (P=.01 compared with the control group) recall of material from the audiotape (as well as events during surgery) that was not recalled consciously. Numerous studies support the contention that patients have awareness under anesthesia that can affect their postoperative course.
      • Goldmann L
      • Shah MV
      • Hebden MW
      Memory of cardiac anaesthesia: psychological sequelae in cardiac patients of intra-operative suggestion and operating room conversation.
      Because it may be harmful to make comments within the audible range of surgical patients that may be perceived negatively by the patient, promoting good health by making comments of a clearly positive nature appears warranted.
      • Marmer MJ
      Present applications of hypnosis in anesthesiology.
      • Blankfield RP
      Suggestion, relaxation, and hypnosis as adjuncts in the care of surgery patients: a review of the literature.
      The “opportunity for positive semantics” was investigated in a randomized, double-blind study in which patients undergoing hysterectomy listened either to an audiotape with positive suggestions or to a blank tape while under general anesthesia.
      • Evans C
      • Richardson PH
      Improved recovery and reduced postoperative stay after therapeutic suggestions during general anaesthesia.
      The treatment group had significantly fewer bowel problems (P<.03), shorter recovery time (P<.002), shorter hospital stay (P<.002), less fever (P<.005), and a better recovery (by nursing assessment) (P<.002) than the control patients. Other studies cited in the report indicated not only that “inappropriate or misinterpreted operating theatre comments may have a harmful effect upon recovery,” but also that this perioperative awareness “may instead be employed to the benefit of the patient.”
      • Evans C
      • Richardson PH
      Improved recovery and reduced postoperative stay after therapeutic suggestions during general anaesthesia.
      Compared with matched controls, patients listening to positive suggestions before and during surgery had less blood loss and a shorter recovery.
      • Enqvist B
      • von Konow L
      • Bystedt H
      Pre- and perioperative suggestion in maxillofacial surgery: effects on blood loss and recovery.
      Recommendations for positive semantics for preoperative patients are similar to those applicable to emergency department patients. Persons in both situations appear to be in a hypnotic-like state (receptive, focused, willing to comply) and thus are particularly susceptible to remarks by health care workers.
      • Bierman SF
      Hypnosis in the emergency department.
      • Peebles-Kleiger MJ
      The use of hypnosis in emergency medicine.
      • Wain HJ
      • Amen DG
      Emergency room use of hypnosis.
      Preoperative hypnosis is less controversial than the idea of awareness during anesthesia, with benefit noted in many trials. Significant benefits include less anxiety and decreased blood pressure,
      • Hart RR
      The influence of a taped hypnotic induction treatment procedure on the recovery of surgery patients.
      reduced blood loss,
      • Hart RR
      The influence of a taped hypnotic induction treatment procedure on the recovery of surgery patients.
      • Bennett HL
      • Benson DR
      • Kuiken DA
      Preoperative instructions for decreased bleeding during spine surgery [abstract].
      enhanced postoperative well-being,
      • John Jr, ME
      • Parrino JP
      Practical hypnotic suggestion in ophthalmic surgery.
      improved intestinal motility,
      • Disbrow EA
      • Bennett HL
      • Owings JT
      Effect of preoperative suggestion on postoperative gastrointestinal motility.
      shorter hospital stay,
      • Lambert SA
      The effects of hypnosis/guided imagery on the postoperative course of children.
      reduced postoperative nausea and vomiting,
      • Enqvist B
      • Bjorklund C
      • Engman M
      • Jakobsson J
      Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts: a prospective, randomized and blinded study.
      and reduced need for analgesics.
      • Enqvist B
      • Bjorklund C
      • Engman M
      • Jakobsson J
      Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts: a prospective, randomized and blinded study.
      • Ashton Jr, C
      • Whitworth GC
      • Seldomridge JA
      • et al.
      Self-hypnosis reduces anxiety following coronary artery bypass surgery: a prospective, randomized trial.
      Substantial but not statistically significant decreases in cost and length of hospital stay were observed in another study.
      • Disbrow EA
      • Bennett HL
      • Owings JT
      Effect of preoperative suggestion on postoperative gastrointestinal motility.
      A 1991 review of clinical trials using hypnosis, suggestion, or relaxation in the care of surgical patients found that 89% of the trials showed that these techniques produced a positive outcome in facilitating physical or psychological recovery from surgery.
      • Blankfield RP
      Suggestion, relaxation, and hypnosis as adjuncts in the care of surgery patients: a review of the literature.
      The use of live therapists (rather than suggestions from audiotapes) and positive and appropriate semantics (avoiding words that bring to mind undesired outcomes) at the most receptive times were advocated to foster shorter hospital stays, earlier recovery, and improved patient well-being. A meta-analysis published in 2002 evaluated hypnosis for surgical patients for its overall effect and benefits for specific clinical outcomes. Hypnosis as an adjunct to surgery was believed to be “successful for the majority of individuals,” with benefits such as decreased pain, anxiety, nausea, and recovery time.
      • Montgomery GH
      • David D
      • Winkel G
      • Silverstein JH
      • Bovbjerg DH
      The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis.

      Urology

      The medical literature from the 1960s indicated a strong potential for the use of hypnosis for impotence,
      • Elman D
      and support for this assertion has come from recent clinical trials. A review of the personal experience and techniques of an experienced practitioner cited an 88% success rate using hypnosis for impotence in almost 3000 patients.
      • Crasilneck HB
      Hypnotic techniques for smoking control and psychogenic impotence.
      The hypnosis techniques used in this trial were studied in 2 randomized controlled trials of men with nonorganic impotence. One trial that compared hypnosis with placebo showed an 80% improvement in sexual function with hypnosis compared with 36% with placebo.
      • Aydin S
      • Odabas O
      • Ercan M
      • Kara H
      • Agargun MY
      Efficacy of testosterone, trazodone and hypnotic suggestion in the treatment of non-organic male sexual dysfunction.
      The second trial compared hypnosis with acupuncture and injected or oral placebo. The success rate (moderate improvement or “cure”) was 75% for hypnosis.
      • Aydin S
      • Ercan M
      • Caskurlu T
      • et al.
      Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction.
      A review of developments in hypnosis reported its efficacy in augmenting other treatment methods for sexual dysfunction and its potential for exploring contributing psychological conflicts.
      • Fromm E
      Significant developments in clinical hypnosis during the past 25years.
      In a trial of hypnosis for chronic (mean, 7 years) urinary incontinence, 50 women served as their own controls.
      • Freeman RM
      • Baxby K
      Hypnotherapy for incontinence caused by the unstable detrusor.
      At 1 month, 58% were symptom-free and another 28% were improved, with cystometric testing at 3 months objectively confirming the benefits.

      CONCLUSION

      The acceptance of hypnosis as a mode of treatment in medicine is increasing as a result of “careful, methodical, empirical work of many research pioneers.”
      • Baker EL
      The state of the art of clinical hypnosis.
      Many important trials reviewed here have helped to establish the role of hypnosis in contemporary medicine. These trials have established the utility and efficacy of hypnosis for several medical conditions, either alone or as part of the treatment regimen. Nonetheless, skepticism may prevail and hypnosis may remain underused because of the tendency to doubt or fear the unknown. According to a recent study, health care providers changed their attitudes significantly and positively when presented with information about the use of hypnosis in medicine.
      • Thomson L
      A project to change the attitudes, beliefs and practices of health professionals concerning hypnosis.
      Through greater awareness and acceptance of hypnosis, additional training and research can be inspired in pursuit of improved techniques and new areas of potential benefit.

      REFERENCES

        • Fromm E
        Significant developments in clinical hypnosis during the past 25years.
        Int J Clin Exp Hypn. 1987; 35: 215-230
        • Elman D
        Hypnotherapy. Westwood Publishing Co, Glendale, Calif1964
        • Spiegel H
        • Greenleaf M
        • Spiegel D
        Hypnosis.
        in: Sadock BJ Sadock VA 7th ed. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Vol 2. Lippincott Williams & Wilkins, Philadelphia, Pa2000: 2138-2146
        • Rossi EL
        The Psychobiology of Mind-Body Healing: New Concepts of Therapeutic Hypnosis. Rev ed. WW Norton, New York, NY1993
        • Kosslyn SM
        • Thompson WL
        • Costantini-Ferrando MF
        • Alpert NM
        • Spiegel D
        Hypnotic visual illusion alters color processing in the brain.
        Am J Psychiatry. 2000; 157: 1279-1284
        • Kinnunen T
        • Zamansky HS
        • Block ML
        Is the hypnotized subject lying?.
        J Abnorm Psychol. 1994; 103: 184-191
        • Kinnunen T
        • Zamansky HS
        • Nordstrom BL
        Is the hypnotized subject complying?.
        Int J Clin Exp Hypn. 2001; 49: 83-94
        • Faymonville ME
        • Laureys S
        • Degueldre C
        • et al.
        Neural mechanisms of antinociceptive effects of hypnosis.
        Anesthesiology. 2000; 92: 1257-1267
        • Szechtman H
        • Woody E
        • Bowers KS
        • Nahmias C
        Where the imaginal appears real: a positron emission tomography study of auditory hallucinations.
        Proc Natl Acad Sci U S A. 1998; 95: 1956-1960
        • Rainville P
        • Hofbauer RK
        • Bushnell MC
        • Duncan GH
        • Price DD
        Hypnosis modulates activity in brain structures involved in the regulation of consciousness.
        J Cogn Neurosci. 2002; 14: 887-901
        • Jensen SM
        • Barabasz A
        • Barabasz M
        • Warner D
        EEG P300 event-related markers of hypnosis.
        Am J Clin Hypn. 2001; 44: 127-139
        • McGlashan TH
        • Evans FJ
        • Orne MT
        The nature of hypnotic analgesia and placebo response to experimental pain.
        Psychosom Med. 1969; 31: 227-246
        • Zachariae R
        • Bjerring P
        The effect of hypnotically induced analgesia on flare reaction of the cutaneous histamine prick test.
        Arch Dermatol Res. 1990; 282: 539-543
        • Spiegel D
        • Bierre P
        • Rootenberg J
        Hypnotic alteration of somatosensory perception.
        Am J Psychiatry. 1989; 146: 749-754
        • Patterson DR
        • Jensen MP
        Hypnosis and clinical pain.
        Psychol Bull. 2003; 129: 495-521
        • Tasman A
        • Kay J
        • Lieberman JA
        Psychiatry. Vol 2. WB Saunders Co, Philadelphia, Pa1997: 1478-1499
        • Banyai EI
        • Hilgard ER
        A comparison of active-alert hypnotic induction with traditional relaxation induction.
        J Abnorm Psychol. 1976; 85: 218-224
        • MacHovec F
        Hypnosis complications, risk factors, and prevention.
        Am J Clin Hypn. 1988; 31: 40-49
        • Gidro-Frank L
        • Bowersbuch MK
        A study of the plantar response in hypnotic age regression.
        J Nerv Ment Dis. 1948; 107: 443-458
        • LeCron LM
        A study of age regression under hypnosis.
        in: LeCron LM Experimental Hypnosis: A Symposium of Articles on Research by Many of the World's Leading Authorities. Macmillan, New York, NY1952: 155-174
        • McConkey KM
        • Perry C
        Benjamin Franklin and mesmerism, revisited.
        Int J Clin Exp Hypn. 2002; 50: 320-331
        • Forrest DW
        Hypnotism: A History. Penguin, London, England1999
        • Marmer MJ
        Present applications of hypnosis in anesthesiology.
        West J Surg Obstet Gynecol. 1961; 69: 260-263
        • Blankfield RP
        Suggestion, relaxation, and hypnosis as adjuncts in the care of surgery patients: a review of the literature.
        Am J Clin Hypn. 1991; 33: 172-186
        • Durbin PG
        Kissing Frogs: Practical Uses of Hypnotherapy. 2nd ed. Kendall/Hunt Publishing Co, Dubuque, Iowa1998
        • Council on Mental Health
        Medical use of hypnosis.
        JAMA. 1958; 168: 186-189
        • American Psychiatric Association
        Regarding Hypnosis Position Statement [approved by the Council February 15, 1961].
        (Accessibility verified February 9, 2005.)
        • NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia
        Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia.
        JAMA. 1996; 276: 313-318
        • Lynn SJ
        • Martin DJ
        • Frauman DC
        Does hypnosis pose special risks for negative effects? a master class commentary.
        Int J Clin Exp Hypn. 1996; 44: 7-19
        • Bierman SF
        Hypnosis in the emergency department.
        Am J Emerg Med. 1989; 7: 238-242
        • Montgomery GH
        • DuHamel KN
        • Redd WH
        A meta-analysis of hypnotically induced analgesia: how effective is hypnosis?.
        Int J Clin Exp Hypn. 2000; 48: 138-153
        • Montgomery GH
        • David D
        • Winkel G
        • Silverstein JH
        • Bovbjerg DH
        The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis.
        Anesth Analg. 2002; 94: 1639-1645
        • Viswesvaran C
        • Schmidt FL
        A meta-analytic comparison of the effectiveness of smoking cessation methods.
        J Appl Psychol. 1992; 77: 554-561
        • Bongartz W
        • Flammer E
        • Schwonke R
        Efficiency of hypnosis: a meta-analytic study [in German].
        Psychotherapeutics. 2002; 47: 67-76
        • Baker EL
        The state of the art of clinical hypnosis.
        Int J Clin Exp Hypn. 1987; 35: 203-214
        • Black S
        Inhibition of immediate-type hypersensitivity response by direct suggestion under hypnosis.
        Br Med J. 1963; 1: 925-929
        • Kiecolt-Glaser JK
        • Glaser R
        • Strain EC
        • et al.
        Modulation of cellular immunity in medical students.
        J Behav Med. 1986; 9: 5-21
        • Spiegel D
        • Sephton SE
        Psychoneuroimmune and endocrine pathways in cancer: effects of stress and support.
        Semin Clin Neuropsychiatry. 2001; 6: 252-265
        • Zachariae R
        • Bjerring P
        • Arendt-Nielsen L
        Modulation of type I immediate and type IV delayed immunoreactivity using direct suggestion and guided imagery during hypnosis.
        Allergy. 1989; 44: 537-542
        • Goldstein A
        • Hilgard ER
        Failure of the opiate antagonist naloxone to modify hypnotic analgesia.
        Proc Natl Acad Sci U S A. 1975; 72: 2041-2043
        • Spiegel D
        • Albert LH
        Naloxone fails to reverse hypnotic alleviation of chronic pain.
        Psychopharmacology (Berl). 1983; 81: 140-143
        • Stern JA
        • Brown M
        • Ulett GA
        • Sletten I
        A comparison of hypnosis, acupuncture, morphine, valium, aspirin, and placebo in the management of experimentally induced pain.
        Ann N Y Acad Sci. 1977; 296: 175-193
        • Lu DP
        • Lu GP
        • Kleinman L
        Acupuncture and clinical hypnosis for facial and head and neck pain: a single crossover comparison.
        Am J Clin Hypn. 2001; 44: 141-148
        • Wakeman JR
        • Kaplan JZ
        An experimental study of hypnosis in painful burns.
        Am J Clin Hypn. 1978; 21: 3-12
        • Patterson DR
        • Everett JJ
        • Burns GL
        • Marvin JA
        Hypnosis for the treatment of burn pain.
        J Consult Clin Psychol. 1992; 60: 713-717
        • Simon EP
        • Lewis DM
        Medical hypnosis for temporomandibular disorders: treatment efficacy and medical utilization outcome.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90: 54-63
        • LaBaw WL
        Adjunctive trance therapy with severely burned children.
        Int J Child Psychother. 1973; 2: 80-92
        • Patterson DR
        • Ptacek JT
        Baseline pain as a moderator of hypnotic analgesia for burn injury treatment.
        J Consult Clin Psychol. 1997; 65: 60-67
        • Faymonville ME
        • Meurisse M
        • Fissette J
        Hypnosedation: a valuable alternative to traditional anaesthetic techniques.
        Acta Chir Belg. 1999; 99: 141-146
        • Marmer MJ
        Hypnoanalgesia and hypnoanesthesia for cardiac surgery.
        JAMA. 1959; 171: 512-517
        • Rausch V
        Cholecystectomy with self-hypnosis.
        Am J Clin Hypn. 1980; 22: 124-129
        • Faymonville ME
        • Mambourg PH
        • Joris J
        • et al.
        Psychological approaches during conscious sedation: hypnosis versus stress reducing strategies: a prospective randomized study.
        Pain. 1997; 73: 361-367
        • Montgomery GH
        • Weltz CR
        • Seltz M
        • Bovbjerg DH
        Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients.
        Int J Clin Exp Hypn. 2002; 50: 17-32
        • Lang EV
        • Benotsch EG
        • Fick LJ
        • et al.
        Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial.
        Lancet. 2000; 355: 1486-1490
        • Lang EV
        • Joyce JS
        • Spiegel D
        • Hamilton D
        • Lee KK
        Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use.
        Int J Clin Exp Hypn. 1996; 44: 106-119
        • Weinstein EJ
        • Au PK
        Use of hypnosis before and during angioplasty.
        Am J Clin Hypn. 1991; 34: 29-37
        • Sinclair-Gieben AH
        • Chalmers D
        Evaluation of treatment of warts by hypnosis.
        Lancet. 1959; 2: 480-482
        • Ewin DM
        Hypnotherapy for warts (verruca vulgaris): 41 consecutive cases with 33 cures.
        Am J Clin Hypn. 1992; 35: 1-10
        • Spanos NP
        • Stenstrom RJ
        • Johnston JC
        Hypnosis, placebo, and suggestion in the treatment of warts.
        Psychosom Med. 1988; 50: 245-260
        • Spanos NP
        • Williams V
        • Gwynn MI
        Effects of hypnotic, placebo, and salicylic acid treatments on wart regression.
        Psychosom Med. 1990; 52: 109-114
        • Clawson Jr, TA
        • Swade RH
        The hypnotic control of blood flow and pain: the cure of warts and the potential for the use of hypnosis in the treatment of cancer.
        Am J Clin Hypn. 1975; 17: 160-169
        • Gravitz MA
        The production of warts by suggestion as a cultural phenomenon.
        Am J Clin Hypn. 1981; 23: 281-283
        • Stewart AC
        • Thomas SE
        Hypnotherapy as a treatment for atopic dermatitis in adults and children.
        Br J Dermatol. 1995; 132: 778-783
        • Shenefelt PD
        Hypnosis in dermatology.
        Arch Dermatol. 2000; 136: 393-399
        • Whorwell PJ
        • Prior A
        • Faragher EB
        Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome.
        Lancet. 1984; 2: 1232-1234
        • Whorwell PJ
        • Prior A
        • Colgan SM
        Hypnotherapy in severe irritable bowel syndrome: further experience.
        Gut. 1987; 28: 423-425
        • Harvey RF
        • Hinton RA
        • Gunary RM
        • Barry RE
        Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome.
        Lancet. 1989; 1: 424-425
        • Prior A
        • Colgan SM
        • Whorwell PJ
        Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome.
        Gut. 1990; 31: 896-898
        • Houghton LA
        • Heyman DJ
        • Whorwell PJ
        Symptomatology, quality of life and economic features of irritable bowel syndrome: the effect of hypnotherapy.
        Aliment Pharmacol Ther. 1996; 10: 91-95
        • Galovski TE
        • Blanchard EB
        The treatment of irritable bowel syndrome with hypnotherapy.
        Appl Psychophysiol Biofeedback. 1998; 23: 219-232
        • Vidakovic-Vukic M
        Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam.
        Scand J Gastroenterol Suppl. 1999; 230: 49-51
        • Gonsalkorale WM
        • Houghton LA
        • Whorwell PJ
        Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness.
        Am J Gastroenterol. 2002; 97: 954-961
        • Palsson OS
        • Turner MJ
        • Johnson DA
        • Burnett CK
        • Whitehead WE
        Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms.
        Dig Dis Sci. 2002; 47: 2605-2614
        • Spanier JA
        • Howden CW
        • Jones MP
        A systematic review of alternative therapies in the irritable bowel syndrome.
        Arch Intern Med. 2003; 163: 265-274
        • Colgan SM
        • Faragher EB
        • Whorwell PJ
        Controlled trial of hypnotherapy in relapse prevention of duodenal ulceration.
        Lancet. 1988; 1: 1299-1300
        • Klein KB
        • Spiegel D
        Modulation of gastric acid secretion by hypnosis.
        Gastroenterology. 1989; 96: 1383-1387
        • Calvert EL
        • Houghton LA
        • Cooper P
        • Morris J
        • Whorwell PJ
        Long-term improvement in functional dyspepsia using hypnotherapy.
        Gastroenterology. 2002; 123: 1778-1785
        • Disbrow EA
        • Bennett HL
        • Owings JT
        Effect of preoperative suggestion on postoperative gastrointestinal motility.
        West J Med. 1993; 158: 488-492
        • Peebles-Kleiger MJ
        The use of hypnosis in emergency medicine.
        Emerg Med Clin North Am. 2000; 18: 327-338
        • Wain HJ
        • Amen DG
        Emergency room use of hypnosis.
        Gen Hosp Psychiatry. 1986; 8: 19-22
        • Zimmerman J
        Hypnotic technique for sedation of patients during upper gastrointestinal endoscopy.
        Am J Clin Hypn. 1998; 40: 284-287
        • Adams PC
        • Stenn PG
        Liver biopsy under hypnosis.
        J Clin Gastroenterol. 1992; 15: 122-124
        • Cadranel JF
        • Benhamou Y
        • Zylberberg P
        • et al.
        Hypnotic relaxation: a new sedative tool for colonoscopy?.
        J Clin Gastroenterol. 1994; 18: 127-129
        • Ginandes CS
        • Rosenthal DI
        Using hypnosis to accelerate the healing of bone fractures: a randomized controlled pilot study.
        Altern Ther Health Med. 1999; 5: 67-75
        • Ginandes C
        • Brooks P
        • Sando W
        • Jones C
        • Aker J
        Can medical hypnosis accelerate post-surgical wound healing? results of a clinical trial.
        Am J Clin Hypn. 2003; 45: 333-351
        • LaBaw W
        The use of hypnosis with hemophilia.
        Psychiatr Med. 1992; 10: 89-98
        • Friedman H
        • Taub HA
        The use of hypnosis and biofeedback procedures for essential hypertension.
        Int J Clin Exp Hypn. 1977; 25: 335-347
        • Friedman H
        • Taub HA
        A six-month follow-up of the use of hypnosis and biofeedback procedures in essential hypertension.
        Am J Clin Hypn. 1978; 20: 184-188
        • Melis PM
        • Rooimans W
        • Spierings EL
        • Hoogduin CA
        Treatment of chronic tension-type headache with hypnotherapy: a single-blind time controlled study.
        Headache. 1991; 31: 686-689
        • Spinhoven P
        • Linssen AC
        • Van Dyck R
        • Zitman FG
        Autogenic training and self-hypnosis in the control of tension headache.
        Gen Hosp Psychiatry. 1992; 14: 408-415
        • ter Kuile MM
        • Spinhoven P
        • Linssen AC
        • Zitman FG
        • Van Dyck R
        • Rooijmans HG
        Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups.
        Pain. 1994; 58: 331-340
        • Olness K
        • MacDonald JT
        • Uden DL
        Comparison of self-hypnosis and propranolol in the treatment of juvenile classic migraine.
        Pediatrics. 1987; 79: 593-597
        • Spanos NP
        • Liddy SJ
        • Scott H
        • et al.
        Hypnotic suggestion and placebo for the treatment of chronic headache in a university volunteer sample.
        Cognit Ther Res. 1993; 17: 191-205
        • Mott Jr, T
        • Roberts J
        Obesity and hypnosis: a review of the literature.
        Am J Clin Hypn. 1979; 22: 3-7
        • Bolocofsky DN
        • Spinler D
        • Coulthard-Morris L
        Effectiveness of hypnosis as an adjunct to behavioral weight management.
        J Clin Psychol. 1985; 41: 35-41
        • Kirsch I
        • Montgomery G
        • Sapirstein G
        Hypnosis as an adjunct to cognitive-behavioral psychotherapy: a meta-analysis.
        J Consult Clin Psychol. 1995; 63: 214-220
        • Kirsch I
        Hypnotic enhancement of cognitive-behavioral weight loss treatments: another meta-reanalysis.
        J Consult Clin Psychol. 1996; 64: 517-519
        • Stradling J
        • Roberts D
        • Wilson A
        • Lovelock F
        Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea.
        Int J Obes Relat Metab Disord. 1998; 22: 278-281
        • Jenkins MW
        • Pritchard MH
        Hypnosis: practical applications and theoretical considerations in normal labour.
        Br J Obstet Gynaecol. 1993; 100: 221-226
        • Martin AA
        • Schauble PG
        • Rai SH
        • Curry Jr, RW
        The effects of hypnosis on the labor processes and birth outcomes of pregnant adolescents [published correction appears in J Fam Pract. 2001;50:749].
        J Fam Pract. 2001; 50: 441-443
        • Omer H
        • Sirkovitz A
        Failure of hypnotic relaxation in the treatment of postterm pregnancies.
        Psychosom Med. 1987; 49: 606-609
        • Simon EP
        • Schwartz J
        Medical hypnosis for hyperemesis gravidarum.
        Birth. 1999; 26: 248-254
        • Torem MS
        Hypnotherapeutic techniques in the treatment of hyperemesis gravidarum.
        Am J Clin Hypn. 1994; 37: 1-11
        • Zeltzer LK
        • Dolgin MJ
        • LeBaron S
        • LeBaron C
        A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer.
        Pediatrics. 1991; 88: 34-42
        • Jacknow DS
        • Tschann JM
        • Link MP
        • Boyce WT
        Hypnosis in the prevention of chemotherapy-related nausea and vomiting in children: a prospective study.
        J Dev Behav Pediatr. 1994; 15: 258-264
        • Syrjala KL
        • Cummings C
        • Donaldson GW
        Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial.
        Pain. 1992; 48: 137-146
        • Spiegel D
        • Bloom JR
        Group therapy and hypnosis reduce metastatic breast carcinoma pain.
        Psychosom Med. 1983; 45: 333-339
        • Spiegel D
        • Bloom JR
        • Kraemer HC
        • Gottheil E
        Effect of psychosocial treatment on survival of patients with metastatic breast cancer.
        Lancet. 1989; 2: 888-891
        • Attias J
        • Shemesh Z
        • Sohmer H
        • Gold S
        • Shoham C
        • Faraggi D
        Comparison between self-hypnosis, masking and attentiveness for alleviation of chronic tinnitus.
        Audiology. 1993; 32: 205-212
        • Maher-Loughnan GP
        • Mason AA
        • MacDonald N
        • Fry L
        Controlled trial of hypnosis in the symptomatic treatment of asthma.
        Br Med J. 1962; 2: 371-376
      1. Hypnosis for asthma—a controlled trial: a report to the Research Committee of the British Tuberculosis Association.
        Br Med J. 1968; 4: 71-76
        • Collison DR
        Which asthmatic patients should be treated by hypnotherapy?.
        Med J Aust. 1975; 1: 776-781
        • Morrison JB
        Chronic asthma and improvement with relaxation induced by hypnotherapy.
        J R Soc Med. 1988; 81: 701-704
        • Ewer TC
        • Stewart DE
        Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomised controlled trial.
        Br Med J (Clin Res Ed). 1986; 293: 1129-1132
        • Bowen DE
        Ventilator weaning through hypnosis.
        Psychosomatics. 1989; 30: 449-450
        • Kline MV
        The use of extended group hypnotherapy sessions in controlling cigarette habituation.
        Int J Clin Exp Hypn. 1970; 18: 270-282
        • Spiegel H
        A single-treatment method to stop smoking using ancillary self-hypnosis.
        Int J Clin Exp Hypn. 1970; 18: 235-250
        • Rabkin SW
        • Boyko E
        • Shane F
        • Kaufert J
        A randomized trial comparing smoking cessation programs utilizing behaviour modification, health education or hypnosis.
        Addict Behav. 1984; 9: 157-173
        • Hyman GJ
        • Stanley RO
        • Burrows GD
        • Horne DJ
        Treatment effectiveness of hypnosis and behaviour therapy in smoking cessation: a methodological refinement.
        Addict Behav. 1986; 11: 355-365
        • Johnson DL
        • Karkut RT
        Performance by gender in a stop-smoking program combining hypnosis and aversion.
        Psychol Rep. 1994; 75: 851-857
        • Barber J
        Freedom from smoking: integrating hypnotic methods and rapid smoking to facilitate smoking cessation.
        Int J Clin Exp Hypn. 2001; 49: 257-266
        • Green JP
        • Lynn SJ
        Hypnosis and suggestion-based approaches to smoking cessation: an examination of the evidence.
        Int J Clin Exp Hypn. 2000; 48: 195-224
        • Ahijevych K
        • Yerardi R
        • Nedilsky N
        Descriptive outcomes of the American Lung Association of Ohio hypnotherapy smoking cessation program.
        Int J Clin Exp Hypn. 2000; 48: 374-387
        • Crasilneck HB
        Hypnotic techniques for smoking control and psychogenic impotence.
        Am J Clin Hypn. 1990; 32: 147-153
        • Hughes JA
        • Sanders LD
        • Dunne JA
        • Tarpey J
        • Vickers MD
        Reducing smoking: the effect of suggestion during general anaesthesia on postoperative smoking habits.
        Anaesthesia. 1994; 49: 126-128
        • Myles PS
        • Hendrata M
        • Layher Y
        • et al.
        Double-blind, randomized trial of cessation of smoking after audiotape suggestion during anaesthesia.
        Br J Anaesth. 1996; 76: 694-698
        • Haanen HC
        • Hoenderdos HT
        • van Romunde LK
        • et al.
        Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia.
        J Rheumatol. 1991; 18: 72-75
        • Cheek DB
        Importance of recognizing that surgical patients behave as though hypnotized.
        Am J Clin Hypn. 1962; 4: 227-236
        • Erickson III, JC
        The use of hypnosis in anesthesia: a master class commentary.
        Int J Clin Exp Hypn. 1994; 42: 8-12
        • Sigalovsky N
        Awareness under general anesthesia.
        AANA J. 2003; 71: 373-379
        • Ranta SO
        • Laurila R
        • Saario J
        • Ali-Melkkila T
        • Hynynen M
        Awareness with recall during general anesthesia: incidence and risk factors.
        Anesth Analg. 1998; 86: 1084-1089
        • Goldmann L
        • Shah MV
        • Hebden MW
        Memory of cardiac anaesthesia: psychological sequelae in cardiac patients of intra-operative suggestion and operating room conversation.
        Anaesthesia. 1987; 42: 596-603
        • Evans C
        • Richardson PH
        Improved recovery and reduced postoperative stay after therapeutic suggestions during general anaesthesia.
        Lancet. 1988; 2: 491-493
        • Enqvist B
        • von Konow L
        • Bystedt H
        Pre- and perioperative suggestion in maxillofacial surgery: effects on blood loss and recovery.
        Int J Clin Exp Hypn. 1995; 43: 284-294
        • Hart RR
        The influence of a taped hypnotic induction treatment procedure on the recovery of surgery patients.
        Int J Clin Exp Hypn. 1980; 28: 324-332
        • Bennett HL
        • Benson DR
        • Kuiken DA
        Preoperative instructions for decreased bleeding during spine surgery [abstract].
        Anesthesiology. 1986; 65: A245
        • John Jr, ME
        • Parrino JP
        Practical hypnotic suggestion in ophthalmic surgery.
        Am J Ophthalmol. 1983; 96: 540-542
        • Lambert SA
        The effects of hypnosis/guided imagery on the postoperative course of children.
        J Dev Behav Pediatr. 1996; 17: 307-310
        • Enqvist B
        • Bjorklund C
        • Engman M
        • Jakobsson J
        Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts: a prospective, randomized and blinded study.
        Acta Anaesthesiol Scand. 1997; 41: 1028-1032
        • Ashton Jr, C
        • Whitworth GC
        • Seldomridge JA
        • et al.
        Self-hypnosis reduces anxiety following coronary artery bypass surgery: a prospective, randomized trial.
        J Cardiovasc Surg (Torino). 1997; 38: 69-75
        • Aydin S
        • Odabas O
        • Ercan M
        • Kara H
        • Agargun MY
        Efficacy of testosterone, trazodone and hypnotic suggestion in the treatment of non-organic male sexual dysfunction.
        Br J Urol. 1996; 77: 256-260
        • Aydin S
        • Ercan M
        • Caskurlu T
        • et al.
        Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction.
        Scand J Urol Nephrol. 1997; 31: 271-274
        • Freeman RM
        • Baxby K
        Hypnotherapy for incontinence caused by the unstable detrusor.
        Br Med J (Clin Res Ed). 1982; 284: 1831-1834
        • Thomson L
        A project to change the attitudes, beliefs and practices of health professionals concerning hypnosis.
        Am J Clin Hypn. 2003; 46: 31-44