Joseph Barber

Effects of Self-Hypnosis Training and EMG Biofeedback Relaxation Training on Chronic Pain in Persons with Spinal-Cord Injury

Abstract Thirty-seven adults with spinal-cord injury and chronic pain were randomly assigned to receive 10 sessions of self-hypnosis (HYP) or EMG biofeedback relaxation (BIO) training for pain management. Participants in both treatment conditions reported substantial, but similar, decreases in pain intensity from before to after the treatment sessions. However, participants in the HYP condition, but not the BIO condition, reported statistically significant decreases in daily average pain pre- to posttreatment. These pre- to posttreatment decreases in pain reported by the HYP participants were maintained at 3-month follow-up. Participants in the HYP condition, but not the BIO condition, also reported significant pre- to posttreatment increases in perceived control over pain, but this change was not maintained at the 3-month follow-up.

A Comparison of Self-Hypnosis Versus Progressive Muscle Relaxation in Patients With Multiple Sclerosis and Chronic Pain

Abstract Twenty-two patients with multiple sclerosis (MS) and chronic pain we recruited into a quasi-experimental trial comparing the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on pain intensity and pain interference; 8 received HYP and the remaining 14 participants were randomly assigned to receive either HYP or PMR. HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants, and gains were maintained at 3-month follow-up. Most of the participants in both conditions reported that they continued to use the skills they learned in treatment and experienced pain relief when they did so. General hypnotizability was not significantly related to treatment outcome, but treatment-outcome expectancy assessed before and after the first session was. The results support the efficacy of self-hypnosis training for the management of chronic pain in persons with MS.

Satisfaction with, and the beneficial side effects of, hypnotic analgesia

Abstract Case study research suggests that hypnosis treatment may provide benefits that are not necessarily the target of specific suggestions. To better understand satisfaction with and the beneficial “side effects” of hypnosis treatment, questions inquiring about treatment satisfaction and treatment benefits were administered to a group of 30 patients with chronic pain who had participated in a case series of hypnotic analgesia treatment. The results confirmed the authors’ clinical experience and showed that most participants reported satisfaction with hypnosis treatment even when the targeted symptom (in this case, pain intensity) did not decrease substantially. Study participants also reported a variety of both symptom-related and nonsymptom-related benefits from hypnosis treatment, including decreased pain, increased perceived control over pain, increased sense of relaxation and well-being, and decreased perceived stress, although no single benefit was noted by a majority of participants.

Hypnotic analgesia for chronic pain in persons with disabilities: a case series.

Abstract Thirty-three adults with chronic pain and a disability were treated with hypnotic analgesia. Analyses showed significant pre- to posttreatment changes in average pain intensity that was maintained at 3-month follow-up. Significant changes were also found in pain unpleasantness and perceived control over pain but not in pain interference or depressive symptoms. Hypnotizability, concentration of treatment (e.g., daily vs. up to weekly), and initial response to treatment were not significantly associated with treatment outcome. However, treatment-outcome expectancy assessed after the first session showed a moderate association with treatment outcome. The findings support the use of hypnotic analgesia for the treatment of pain in persons with disabilities for some patients but not the use of pretreatment measures of hypnotizability or treatment-outcome expectancy for screening patients for treatment. 1This research was supported by grant number R01 HD42838 from the National Institutes of Health, National Institute of Child and Health, National Center for Medical Rehabilitation Research, grant number H133B031129 from the Department of Education, National Center of Disability and Rehabilitation Research, and the Hughes M. and Katherine G. Blake Endowed Professorship in Health Psychology awarded to MPJ. The authors gratefully acknowledge the assistance of Chiara LaRotonda and Kristin McArthur in data collection and data entry.

Freedom from smoking: integrating hypnotic methods and rapid smoking to facilitate smoking cessation.

Abstract Hypnotic intervention can be integrated with a Rapid Smoking treatment protocol for smoking cessation. Reported here is a demonstration of such an integrated approach, including a detailed description of treatment rationale and procedures for such a short-term intervention. Of 43 consecutive patients undergoing this treatment protocol, 39 reported remaining abstinent at follow-up (6 months to 3 years posttreatment).

Long-Term Outcome of Hypnotic-Analgesia Treatment for Chronic Pain in Persons with Disabilities

Abstract Data from 26 participants in a case series of hypnotic analgesia for chronic pain were examined to determine the long-term effects of hypnosis treatment. Statistically significant decreases in average daily pain intensity, relative to pretreatment values, were observed at posttreatment and at 3- and 9-month follow-up but not at 6- or 12-month follow-up. The percent of participants who reported clinically meaningful decreases in pain were 27%, 19%, 19%, and 23%, at the 3-, 6-, 9-, and 12-month follow-up points, respectively. Moreover, at 12-months posttreatment, 81% of the sample reported that they still used the self-hypnosis skills learned in treatment. Overall, the results indicate that about 20% of the sample obtained substantial and lasting long-term reductions in average daily pain following hypnosis treatment and that many more continue to use self-hypnosis up to 12 months following treatment.

Hypnotic Analgesia for Chronic Pain in Persons with Disabilities: A Case Series Abstract

Abstract Thirty-three adults with chronic pain and a disability were treated with hypnotic analgesia. Analyses showed significant pre- to posttreatment changes in average pain intensity that was maintained at 3-month follow-up. Significant changes were also found in pain unpleasantness and perceived control over pain but not in pain interference or depressive symptoms. Hypnotizability, concentration of treatment (e.g., daily vs. up to weekly), and initial response to treatment were not significantly associated with treatment outcome. However, treatment-outcome expectancy assessed after the first session showed a moderate association with treatment outcome. The findings support the use of hypnotic analgesia for the treatment of pain in persons with disabilities for some patients but not the use of pretreatment measures of hypnotizability or treatment-outcome expectancy for screening patients for treatment. 1This research was supported by grant number R01 HD42838 from the National Institutes of Health, National Institute of Child and Health, National Center for Medical Rehabilitation Research, grant number H133B031129 from the Department of Education, National Center of Disability and Rehabilitation Research, and the Hughes M. and Katherine G. Blake Endowed Professorship in Health Psychology awarded to MPJ. The authors gratefully acknowledge the assistance of Chiara LaRotonda and Kristin McArthur in data collection and data entry.

The mysterious persistence of hypnotic analgesia

Hypnotic treatment of pain has a long history and, among hypnotic phenomena, pain relief is a relatively commonplace focus for intervention, yet we lack a conceptual explanation for this treatment. Hilgards neodissociation theory accounts for the phenomenon of acute hypnotic analgesia, but not of persistent pain relief. Perhaps the enduring effect of hypnotic treatment can be explained at either of two levels: a neurophysiological model or a learning model. This explanation leads to the further question: How does hypnotic treatment of recurring pain achieve enduring relief? Clinical experience suggests a two-component model. First, the clinician communicates specific ideas that strengthen the patients ability to derive therapeutic support and to develop a sense of openness to the unexplored possibilities for pain relief within the security of nurturing therapeutic relationship. Second, the clinician employs posthypnotic suggestions that capitalize on the patients particular pain experiences, which simultaneously ameliorate the pain experience, and which, in small, repetitive increments, tend to maintain persistent pain relief over increasing periods of time.

The effect of hypnotic suggestion on spinal cord injury pain

Chronic pain is a significant concern for many individuals with spinal cord injury (SCI). However, few effective treatments have been found for SCI-related pain. The current study sought to explore whether persons with SCI-related pain would respond to hypnotic suggestion for pain relief, and to examine possible moderators of this response. Twenty-two individuals with SCI-related pain rated their 6-month average and least pain on 0‐10 scales of pain intensity. They also rated their current pain intensity and pain unpleasantness on 0‐10 scales at eight subsequent time points: immediately before a hypnotic induction, immediately after the induction, after each of five hypnotic suggestions, and at the end of the entire session after awakening. Eighty-six percent of the participants reported decreases in pain intensity and pain unpleasantness from pre-induction to post-induction. Significant omnibus analyses of variance followed by pairwise comparisons indicated statistically significant decreases in pain intensity and unpleasantness from pre-to post induction for both pain intensity and pain unpleasantness, and an additional decrease in pain intensity following the analgesia suggestion. In addition, although not specifically suggested, the decrease in pain that subjects experienced during the hypnotic session persisted after they were instructed to awaken. The ability of the subjects to decrease pain intensity to levels lower than the least pain they had experienced during the past six months was associated with hypnotic responsiveness, while the decrease in pain intensity from pre-induction to post-analgesia suggestion was associated with 6-month average pain. These preliminary findings indicate that hypnotic interventions have the potential to benefit many individuals with SCI-related pain, and that controlled trials of hypnotic analgesia with this population are warranted.

Where ericksonian legend meets scientific method: A comment on matthews

Milton Erickson was not particularly well-known and exerted little influence during the greater part of his working life. Late in his life, however, the publication of Haley‘s (1973) Uncommon Therapy gave birth to the Ericksonian legend. Erickson’s fame and influence swiftly grew, as Matthews so aptly describes, and now everyone has an opinion about Erickson. Although most of the Ericksonian literature has been laudatory-beatifying, even-there is a range of opinion about him. He has been variously described as a genius (Zeig, 1985) and as a scoundrel (Gibson, 1984). Perhaps the only profound analysis of Erickson’s work was done by Ernest Hilgard (1984), who expressed respectful interest in Erickson’s clinical skill even as he raised critical questions about Erickson’s ideas. Does ”Ericksonian hypnosis” have something uniquely valuable to offer? Let me first lament the term Ericksonian hypnosis. Unfortunately, hypnosis refers both to a set of techniques as well as a psychological condition, and this dual meaning leads to confusion. Ericksonian hypnosis is a particularly vexing case of this potential misunderstanding of terms, because it leads to the widespread misunderstanding that Ericksonian hypnosis refers to a psychological phenomenon different from that denoted by the mere word hypnosis. I have contended previously (Barber, 1988) that this confusion is heightened by a lack of understanding of hypnotic process among most Ericksonians, the consequence of a misguided emphasis on ”naturalistic” technique. This emphasis has led to a generation of clinicians largely unfamiliar with classical hypnotic phenomena (e.g., analgesia, amnesia, and automatic response to posthypnotic suggestion, to name the most obvious) and who have, instead, focused narrowly upon the elaboration of techruque. Matthews discusses two common examples, indirection and storytelling, and reports that neither of these techniques has any necessary relationship to effective hypnotic treatment. I