Hypnotherapy and guided imagery research references follow on this page. We hope you will find them useful, informative and educational.

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• Stress and Hypnosis

• Pain and Hypnosis Resources

• Surgery and Hypnosis Resources

• Miscellaneous Health Care Information

Stress and Hypnosis

The Possibilities in Hypnosis, Where the Patient Has the Power - (linked article)
    By JANE E. BRODY

“Stress and Health in Dementia Caregivers.”  Jan Kiecolt-Glaser, Ohio State School of Medicine, conducted a study evaluate the impact of stress on healing.  A small, eraser sized wound healed nine days faster on the control group then the stressed caregivers.

“Stress Weakens the Immune System.”  Synopsis of pertinent research about the effects of stress;  psychologymatters.org/stressimmune.html

Gallup Healthways Well-Being Index is the countries largest poll of health and wellbeing.  They found the impact of a negative work environment alone is 12.3 million sick days a month nationwide or about $14 billion a year in wages alone.

The American Psychological Association published an online study reflecting the response of 1,848 adults October 24, 2007.  Some of the findings were 77% experienced physical symptoms during the last month as a result of stress, 74% found work a significant source of stress, 48% of adults lay awake at night because of stress and on average report losing 21 hours of sleep.

“We’re stressed,We’re Struggling and We Like Weekends” Detroit Free Press, April 30, 2008, The data from the countries largest poll on health and happiness done by the Gallup Organization and Healthways Inc.  showed stress, chronic health conditions (Including preventable ones) and negative work environment are having a dramatic impact on workers productivity.  A graph showing Americans happiness rises sharply on the weekends and drops during the week.  Americans overall job happiness increased when employees were given the chance to meet and get to know each other.

“Less Stress, Happy Heart” Loriena Yancura, Ph.D , This study looks at 716 older men and the way they coped with stress.  Those that coped better had higher levels of HDL (good) cholesterol.  Those that lashed out or handles stress poorly had higher levels of LDL (bad) cholesterol.  Hostility was linked to higher levels of LDL.

“What Your Doctor May Not Tell You about Cholesterol” By author Stephen Devries, MD  “ Even if you’re eating well and exercising, you may still be at risk for heart disease because your still not managing your stress,”  he says.  “Stress should be addressed as carefully as problems like high blood pressure”.

“Finding Clues to Aging in the Fraying Tips of Chromosomes” Claudia Dreifus, This article is an interview with Elizabeth H. Blackburn, a cell biologist.  The article explains how scientists have proven psychological stress actually ages cells by wearing down the tips of chromosomes called telomeres.  As we age telomeres naturally wear down.  This has been proven to occur more rapidly in stressed people.  This is scientific proof of the mind –body connection.

“Emotional Stress and Prostate Cancer”  George Kulik, Ph.D,  Hypothesizes that emotional stress activates anti-apoptotic signaling in prostate cancer cells and, as a result, contributes to the progression of prostate cancer and resistance of advanced prostate cancer to therapies.

“Pathophysiological process underlying emotional triggering of acute cardiac events” Philip C. Strike, Kesson Magid, Daisy L. Whitehead, Lena Brydon, Mimi R. Bhattacharyya,  and Andrew Stepoe, Wake Forest University School of Medicine and North Carolina School of Medicine.

“Hypnosis as a modulator of cellular immune dysregulation during acute stress” Kiecolt-Glaser and colleagues, Department of Psychiatry, Ohio State University College of Medicine.   Journal of Consulting and Clinical Psychology 69(4):  674-82 Aug 2001.  Analyzed the effects of hypnotic-relaxation training on the cellular immune function during a stressful event The research showed evidence that hypnosis-relaxation can reduce detrimental immune function changes associated with acute stress.

“Cellular and humeral immunity, mood and exam stress:  the influences of self-hypnosis and personality predictors” Gruzelier and colleagues, Department of Cognitive Neuroscience and Behavior, Imperial College Medical School, London, International Journal of Psychophysiology.  The study found that self-hypnosis, a low cost psychological intervention, had a sizeable influence on cell-mediated immunity brought on by stress.  These findings support the premise that hypnosis is a cost effective modality that can be applied to other populations such as patients with compromised immunity.

Pain and Hypnosis Resources

“Hypnosis Works” Discover Vol.25 No. 11, Nov. 2004 Michael Abrams, A study was done on 241 patients having vascular or kidney surgery.  They were asked every 15 minutes to rate their pain and anxiety level.  They were also hooked up to an IV and given as much pain medicine as they wanted.  The results found the hypnotized subjects used less pain medication, experienced less pain, and felt less anxious.  The operations on the hypnotized subjects averaged 17 minutes shorter and the standard procedure expense went from$638 to $300.

“Pain Management:  Beyond Pharmacology to Acupuncture and Hypnosis” Journal of the American Medical Association, 200; 283:118-119 Jane Loitman, MD Brown University School of Medicine, This article discusses pain and its complications.  It talks about hypnosis assisting patients to reach a deep level of relaxation which leads to more peaceful sleep, increased energy, and diminished pain. 

“Treatment Preferences for CAM in Children with Chronic Pain” Jennie C. I. Tasao, Marcia Meldrum. Su C. Kim, Margaret C. Jacob and Lonnie K. Zeltzer, UCLA, This article discusses a study done on which CAM therapies children prefer.  129 children participated in the study.  Over 60% of the patients elected to try a CAM treatment, bieofeedback, hypnosis and yoga were the most popular.

“Neural Mechanisms of Antinociceptive Effects of Hypnosis” Faymonville ME, Laureys S, Degueldre C, Del Fiore G, Luxen A, Franck G, Lamy M, Maquet P, This study was done on 11 healthy adults to observe the brain area involved in hypnosis and pain perception.  Different levels of painful stimuli were involved and the participant’s brains were scanned.  The study concluded both intensity and unpleasantness of the stimuli were reduced in the hypnotic state, additionally “hypnotic modulation of pain is mediated by the anterior cingulated cortex”.

“Use the Power of Your Mind to Ease Pain and Stress” Arthritis Today, Polly Campbell, Guided imagery or creative visualization can help reduce stress and pain.  3,000 hospitals nationwide use it for chronic pain, cancer, chemotherapy and other debilitating illnesses.  Studies show it can diminish depression as well.  Creative visualization is shown to reduce the level of Cortisol, the stress hormone. 

“Hypnosis Reduces Pain and Costs in Breast Cancer Surgery”, Journal of the National Cancer Institute Liz savage, Andrea Widener, Hypnosis before breast cancer surgery reduced the amount of anesthesia used during the procedure, the level of pain after, the time and the cost of the procedure.  David Spiegel, MD of the Stanford School of Medicine “It has taken us a century and a half to rediscover the fact that the mind has something to do with pain and can be a powerful tool in controlling it…  It is now abundantly clear that we can retrain the brain to reduce pain:  ‘float rather than fight,’” Spiegel writes.

“Integration for behavioral and relaxation approaches into the treatment of chronic pain and insomnia.  NIH technology Assessment Panel of Integration of behavioral and Relaxation Approaches into the treatment of Chronic Pain Insomnia” Journal of American Medical Association, vol.276, No 4 July 24, 1996, The objective of this study was to provide physicians with an assessment of the integration of behavioral and relaxation approaches for the treatment of chronic pain and insomnia.  The panel of experts concluded there was strong evidence for the use of relaxation techniques in reducing chronic pain as well as strong evidence for the use of hypnosis to alleviate pain associated with cancer.

“Hypnosis Eases Pain” The Australian September 18, 2004, Chris Watson, A study involving cancer patients between the ages of 6 and 16 showed children had significantly less pain and discomfort when using hypnotized or using self-hypnosis.  Hypnosis reduce anxiety and the side effects of treatments such as nausea and vomiting. 

Surgery and Hypnosis Resources

“Hypnosis Decreases Presurgical Distress in Excisional Breast Biopsy Patients”  Julie B. Schnur, Ph.D, Dana Bovbjerg, PhD, Daniel David, PhD, Kristin Tatrow, PhD, Alisan B. Goldfarb, MD, Jeffrey H. Silverstein, MD, Christina R.Weltz, MD, and Guy H. Montgomery, PhD.  The study investigated the ability of a brief hypnosis session to reduce presurgical psychological distress.  This psychological distress has negative implications for post surgical side effects and satisfaction with anesthesia.  The study concluded that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical distress in women awaiting diagnostic breast cancer surgery.

“Hypnosis Reduces Preoperative Anxiety in Adult Patients”  Haleh Saadat, MD, Jacqueline Drummond-Lewis, MD  Inna Maranets, MD, Deborah Kaplan, Anusha Saadat, Shu-Ming Wang, MD, and Zeev N. Kain, MD.  In this study the effect of hypnosis on preoperative anxiety was examined. On entrance to the operating room the hypnosis patients reported a 56% decrease in stress.  The control group reported a 47% increase in their anxiety upon entrance to the operating room. The study concluded  hypnosis significantly alleviates preoperative anxiety.

“The Mind Prepared” David Spiegel, MD, Dept of Psychiatry and Behavioral Sciences, Stanford Univ. School of Medicine.  This article talks about a study done on 200 patients who underwent excisional breast biopsy or lumpectomy for breast cancer.  Patients were assigned to either a routine anesthesia plus a nondirective empathic listening or a brief 15-minute pre-surgery hypnosis session.  It concluded this brief hypnosis session significantly reduced the use of propofol and lidocaine.  The hypnosis group also had less pain, less nausea, less fatigue, less discomfort and less emotional upset then the control group.  The study also concluded the hypnosis saved an average of $772.71 per surgery, largely because of shorter time in the operating room.  The article discusses the large body of evidence proving adjunctive hypnosis substantially reduces pain and anxiety during surgical procedures thereby decreasing medication use, procedure time and cost.  The author comments,  “If a drug were to do all that, everyone would by now be using it”. 

“Adjunctive non-pharmacological analgesia for invasive medical procedures:  a randomized trial”  Lang EV, Benotsch EG, Fick LJ, Lutgendorf S, Berbaum ML, Berbaum KS, Logan H, Spiegal D, This study tested the assumption that non-pharmacological behavior adjuncts are a safe and efficient means of reducing discomfort and adverse effects during medical procedure.  This study consisted of 241 patients undergoing percutaneous vascular and renal procedures.  One group received standard care, a second received structured attention and the third received self- hypnotic relaxation.  The study concluded that the procedure time was shorter in the hypnosis group then the standard group and the attention group fell in the middle.  Hypnosis had a more pronounced effect on pain and anxiety and is superior because it also improved hemodynamic stability.

“Adjunctive self-hypnotic relaxation for outpatient medical procedures:  A prospective randomized trial with women undergoing large core breast biopsy” Lang EV, Berbaum KS, Faintuch, Hatsiopoulou O, Halsey N, Li XY, Berbaum ML, Laser E, Baum J, This article discussed the fact that there are limited options of managing pain and anxiety pharmacologically in medical procedures with an outpatient setting.  They performed a study using self-hypnotic relaxation on patients needing a large core needle breast biopsy.  236 women were randomly put in three groups, the first receiving standard care, the second structured empathic attention and the third self-hypnotic relaxation.  The study concluded both structured empathy and hypnosis decrease procedural pain and anxiety, however hypnosis provides more powerful anxiety relief without undue expense and is therefore an attractive option for outpatient pain management.

“Hypnosis and Surgery:  Past, Present and future”, Albrecht H. K. Wobst, MD, This article begins discussing the history of hypnosis.  It was first used in the 18th century. The first use of hypnosis for anesthesia in surgery was documented in the 1830’s and was called hypnoanesthesia.  In the late 1840’s ether and chloroform were introduced in surgical procedures and hypnosis became discredited.  Clinical hypnosis has been used sporadically since WWII.  A recent trend toward conscious sedation in anesthesia has renewed the interest in hypnosis.  Hypnoanalgesia has emerged as a combination of hypnotic techniques and pharmacological anesthesia and sedation. Studies show evidence that the combination of analgesia and hypnosis are superior to conventional pharmacologic anesthesia.

The article concludes that we now have measurable effects of hypnosis on the nervous system.  Imaging and electrophysiologic studies demonstrate changes in spinal and supraspinal pain pathways while a patient is under hypnosis.  When hypnosis is a part of the perioperative management, faster wound healing, less nausea, and earlier postoperative gastrointestinal recovery have all been shown. The author states “If hypnosis and autosuggestions provide clinical benefit, they do so without the need for equipment or drugs.  What other therapeutic measure appears so devoid of increased cost and demonstrable adverse effects?  Personal attention to the patient, emotional support, positive suggestions, and even hypnosis are readily available, safe, inexpensive, and attractive measures that might improve the care of our patients.”

Miscellaneous Health Care Information

“Five Core Principles to Ensure Patients Receive High Value Health Care” America’s Health Insurance Plans, May 29, 2008 

Principle #1 Patients and their doctors must have the information and tools they need to evaluate treatment options and make health care decisions on the basis of safety, quality and cost.

Proposal - Give access to a trusted source for providers and patients that compare the effectiveness and cost of treatment.

Principle #2 Patients and doctors want an efficient, interconnected health care delivery system that reduces medical errors.

Proposal – Encourage widespread use of health information technology, such as electronic health records and e-prescribing.

Principle #3 Doctors and nurses need the freedom to practice medicine without worrying about frivolous lawsuits. 

Proposal – Reform the legal system, replace the current medical liability system with a dispute resolution process to provide quick and fair resolution and promote evidence based medicine.

Principle #4 Health insurance plans are transitioning to a system that more closely aligns payments with the quality of care patients receive. 

Proposal - Build healthcare reform around quality improvement by rewarding safety, value and effectiveness.  Work for broader adoption of value based reimbursement mechanisms and provide consumers with more actionable information about healthcare value.

Principle #5 The nation must move towards a system of care that focuses on keeping people healthy, detects disease at the earliest possible stage and rewards chronic care management.

Proposal - Enhanced disease management, care coordination and prevention programs.  Develop new strategies that emphasize prevention, improve chronic care and tailor healthcare for patients to help them live longer and stay healthier.

“Hospitals Want Involved Patients” Chicago Tribune, June 10, 2008, This article discusses the importance of patients being involved in there care.  Hospitals are starting programs to empower patients and urge them to speak up if they don’t understand or have concerns about what a patient is doing.  Even though patients are being encouraged to speak up they are not comfortable doing it.  One study, of 856 adults showed 91% were willing to ask doctors or nurses to explain something they didn’t understand.  Only 25% were willing to ask providers if they washed there hands before an examination.  In an effort to reduce debilitating hospital-based infections and involve patients in there care, hospitals encourage questions.
“Stress and Diabetes” Jennifer Nelson, WebMD This article discusses the fact that stress, both physical and mental, can impact your blood sugar if you have diabetes. When you’re stressed hormones like epinephrine and cortisol increase blood sugar.  It’s called the fight or flight response.  When blood sugars aren’t regulated in a diabetic you’re at risk for blindness, kidney problems, nerve damage, cardiovascular disease and stroke.  It’s very important to identify when you’re stressed.  One recommendation is to make a note of how you’re feeling (a stress journal) when you test your blood sugar.  It often becomes clear the correlation between your stress and blood sugar level.  Pin point the stressors and take action to control your stress.

“A Lifetime of Danger” Washington Post May 19, 2008, One in three children are obese in this country.  Elementary school children have high blood pressure, high cholesterol, joint problems, increasing incidence of type 2 diabetes and gallstones.  Though it’s not completely understood the damage of being overweight as a child is far more dangerous then putting on weight later in life.  In the 6-19 age group obesity has tripled in the past 25 years.  This could be the countries first generation to have a shorter life span then the previous one.  This epidemic will add billions of dollars to the S.S. healthcare bill.  Its been called “a national catastrophe” by the acting Surgeon General Steven Galson.  It’s a cycle overweight women giving birth to larger babies that become obese and the cycle continues.

“You Name it Exercise Helps it” New York Times April 29, 2008 Exercise can lower the risk for heart attack, stroke, hypertension, diabetes, obesity, depression, dementia, osteoporosis, gallstones, diverticulitis, falls, erectile dysfunction, peripheral vascular disease and 12 kinds of cancer.  People with chronic health problems can benefit from exercise as well.  It increases your ability to battle your disease. 

“Training the Mind Changes the Brain” by Kathryn Britton, Neuroscientists who use brain imaging to study behavior and emotion are finding behavioral interventions have a biological effect.  They can cause more specific brain changes then psychotropic medications.  Patience, calmness, cooperation, and kindness are skills that can be trained.  They are not traits that are in born or set for life.

“More Health Plans Adopt ‘Never –Event’ Policies that don’t reimburse for Treatment Needed to Correct Medical Errors” AIS’s Health Business Daily, February 21, 2008, Insurers like Aetna, Anthem Blue Cross and Pennsylvania Medicaid in an effort to heighten awareness among hospitals of steps that need to be taken to prevent serious medical mistakes, have come up with events that they won’t reimburse hospitals for.  Examples are surgery on the wrong person or body part, infants sent home with the wrong parent and care to stage three or four pressure ulcers that the patient wasn’t admitted with. 

“Doctors Miss Cultural Needs, Study Says” New York Times, June 10, 2008, A study was done on 6,814 patients being treated for diabetes from 2005-2007.  The study showed fewer black patients adequately controlled their blood sugar, cholesterol and blood pressure then the white patients.  It has been theorized in the past that this disparity was caused by access to quality care.  This study has proven that not to be the case in this instance.  The doctors treated the patients the same.  That appears to be the problem.  The doctors didn’t take into consideration their cultural norms and tailor the plans to individual patients.  An example was telling a black or Latino patient to lower their carbohydrate intake by limiting rice, if rice is a family staple food that’s not a realistic strategy.  Also by listing examples of fruits and vegetables that are not a part of a persons culture their not providing the information the patient needs.  Health care providers need to learn more about minority cultures to treat and educate their patients appropriately.