1. Hypnotic Phenomena and Applications _____________________ ASCH Regional Workshop Columbus, OH May 8-11, 2014 _____________________ G. Lane Wagaman, Ed.D. Carolina Rehabilitation and Surgical Associates Cary, NC _________________________________

2. Disclosure I have no financial relationships to disclose.
I will not discuss off-label use(s) and/or investigational use(s) of drugs and/or procedures in my presentation.

3. Hypnotic Phenomena and Applications Objectives
Identify the main principles of formulating suggestions for eliciting hypnotic phenomena.
Identify five different hypnotic phenomena.
Discuss and describe how the concept of trance logic and other hypnotic phenomena can be used therapeutically.

4. The Experience of Hypnosis
Hypnosis is a highly subjective experience; no two individuals experience it in the same way; and within individuals the experience often varies.
Hypnosis is a therapeutic tool (heterohypnotic or autohypnotic) to increase awareness, enhance acceptance, create change.

5. The Experience of Hypnosis
Experiential and selective absorption of attention (Spiegel and Spiegel, 1987).
Effortless expression (Gilligan, 1987).
Experiential, non-conceptual involvement (Erickson, Rossi and Rossi, 1976).

6. The Experience of Hypnosis
Willingness to experiment (Gilligan, 1987).
Flexibility in time/space relations (Erickson, Rossi and Rossi, 1976).
Alterations of perception (Erickson and Rossi, 1987).

7. The Experience of Hypnosis
Fluctuations in degree of involvement (Gilligan, 1987).
Motoric/verbal inhibition (Erickson, Rossi and Rossi, 1987).
Trance logic; reduction in reality testing (Shor, 1959).

8. The Experience of Hypnosis
Symbolic processing (Zeig, 1980).
Time distortion (Erickson, Rossi and Rossi, 1976).
Amnesia (full or partial) (Erickson, Rossi and Rossi, 1976; Rossi, 1993).

9. The Experience of Hypnosis
Physical Characteristics of Hypnotic Trance
Muscle relaxation
Muscle twitching
Lachrymation
Fluttering eyelids, eye closure, REM

10. The Experience of Hypnosis
Physical Characteristics of Hypnotic Trance
Change in breathing rate
Change in pulse rate
Jaw relaxation
Catalepsy

11. The Experience of Hypnosis
Psychological Characteristics of Hypnotic Trance
Selective attention
Personal absorption
Dissociation
Increased acceptance of and responsiveness to suggestion

12. The Experience of Hypnosis
Psychological Characteristics of Hypnotic Trance
Subjective interpretation
“Trance Logic”
Relaxation

13. Hypnotic Phenomena Produced naturally, involuntarily.
Produced via suggestion (visual, auditory, kinesthetic): implied or explicit.
Different from regular perception of reality.
Immediate and/or post-hypnotic.
External behavioral response is only observable outcome of internal phenomena.

14. The Experience of Hypnosis
Hallmarks of Hypnotic Phenomena
Experience of involuntariness, automaticity
Things happen as if by themselves
Inhibition of planning function (Hilgard neo-dissociation theory)
Responses appear independent of any conscious effort or reasoning
Often used as criterion for “real hypnotic” experience (subjective); experiential validation
Mind influences body influences mind
Useful trance

15. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Regression / Progression
Amnesia / Hypermnesia
Analgesia
Anesthesia / Hyperesthesia
Catalepsy
Dissociation

16. The Experience of Hypnosis
The Phenomena of Hypnosis
Hallucination / Sensory alterations
Ideodynamic Responses
Ideomotor
Ideosensory
Ideoaffective

17. The Experience of Hypnosis
The Phenomena of Hypnosis
Time Distortion: expansion; contraction

18. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Regression
Intense experiential utilization of memory.
Provides opportunity to go back in time, recent or distant, in order to recover forgotten or repressed memories of significant events in order to work through old memories in order to reach new conclusions (change what experience means to patient).

19. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Regression
General strategies
(1) Return to negative experience(s) to allow patient to discharge repressed emotion while providing new ways to perceive experience.
(2) Use patient’s abilities demonstrated in past, not currently in use; rediscover dormant personal abilities and apply to current situations.

20. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Regression
Hypermnesia: Recall of / remembering of experience as intensely as possible; patient is in the present while simultaneously recalling vividly the details of the memory.
Revivification: Re-experience as if happening in the present; patient is immersed in the experience, reliving it as the memory was incorporated at the time experience actually happened. Does not represent biological reinstatement of the past but may represent considerable degree of perceptual reinstatement.

21. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Regression
Approaches
Any communication that assists patient to go back in time.
Use of imagination to recover past experience.
Naturalistic approaches to immerse in memory.
Vehicles to transport back in time.
Indirect suggestions to engage in memory (“Isn’t it interesting how clearly you can recall how you felt when …”)

22. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Regression
Approaches
Describe experience(s) of clinician / others (allows patient projection of cognition and affect into situation, imagining how she would / did feel).

23. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Regression
Approaches
Affect bridge (current awareness / affect linked to first or on of first times she had that same awareness or feeling (“.. And as you notice how aware you are of that feeling you have described, you might allow yourself to drift back in time and recall the first time you ever had that same feeling…”)

24. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Regression
Approaches
Time disorientation using confusion (“What happens now and then is that remembering then now reminds you now of then when then is so important and when then becomes now because yesterday led to today and you can remember yesterday as if it were now because now and then remembering then as if it were now can be so important …”)

25. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Regression
Approaches
Orient to the future first by age progression then age regression. From the future, recall of past events can be accomplished from an even greater emotional distance.

26. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Progression
Orientation in time to the future.
Utilization of projection of the future.
Guide patient into future where she might be able to imagine potential consequences of change(s) / experience(s) (covert rehearsal; confidence building), integrate meaning(s)

27. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Progression
Approaches
Direct approach via special vehicle (movie screen, calendar turning, photographs of future).
Indirect approach via metaphor (“ I am reminded of a patient I worked with who would imagine herself three ….. and six ….. and twelve months after our work together ….. doing just what we’re discussing now…”).

28. The Experience of Hypnosis
The Phenomena of Hypnosis
Age Progression
Approaches
Indirect via embedded instruction (“I often like to look around and wonder what will happen in the future when you look back and feel really good about the changes you’ve made…”).
Indirect via presupposition (“I wonder exactly where you will be when you realize you are not worried abut …”).

29. The Experience of Hypnosis
The Phenomena of Hypnosis
Amnesia: Loss, inhibition, disruption of memory that may be either spontaneous or suggested.
Common phenomenon that happens naturally (forgetting name soon after being introduced).
Duration of amnesia unpredictable.
Is not automatic with hypnosis.
Can happen spontaneously in hypnosis.

30. The Experience of Hypnosis
The Phenomena of Hypnosis
Amnesia
Conscious forgetting of suggestions and experiences allows unconscious to develop its own response and freely use hypnotic experience as creatively and individually as desired.

31. The Experience of Hypnosis
The Phenomena of Hypnosis
Amnesia
Approaches
Less likely to be obtained the more directly it is suggested.
Indirect strategies much more acceptable to patients (confusion, attentional shifts, permission to be aware but pay no attention, just let it go).

32. The Experience of Hypnosis
The Phenomena of Hypnosis
Analgesia and Anesthesia
Analgesia: Reduction in sensation of pain, while allowing other/associated sensation(s) (position, temperature, pressure) to remain.
Estimated 70-90% may develop some analgesic relief.
In low hypnotizable patients, hypnosis appears to provide benefit similar to placebo, cognitive-behavioral innoculation training, acupuncture. In less hypnotically responsive patients, hypnosis may reduce affective response to pain sensation (suffering) more than sensory component of pain.

33. The Experience of Hypnosis
The Phenomena of Hypnosis
Analgesia and Anesthesia
Analgesia
Analgesia and anesthesia exist on continuum of diminishing somatic sensation.

34. The Experience of Hypnosis
The Phenomena of Hypnosis
Analgesia and Anesthesia
Anesthesia
Development of total or near total lack of physiological sensation in part or all of the body.
Among highly hypnotizable patients, 10-20% appear capable of developing complete anesthesia, equivalent to morphine.

35. The Experience of Hypnosis
The Phenomena of Hypnosis
Analgesia and Anesthesia
Potential to influence / reduce / eliminate pain is one of the most important applications of clinical hypnosis.
Working with patients in pain relatively easy (often high level of motivation) and exceedingly difficult (impact of pain on all aspects of patients’ lives).

36. The Experience of Hypnosis
The Phenomena of Hypnosis
Analgesia and Anesthesia
Hypnotic strategies address not only psychological dimensions of pain experience but also the varied physiological components of pain experience.

37. The Experience of Hypnosis
The Phenomena of Hypnosis
Analgesia and Anesthesia
Approaches
Analgesia often arises spontaneously in hypnosis as a result of diminished voluntary movement and diminished awareness of body.
Approaches that shift awareness from bodily sensations can produce analgesic effect. Patients can then learn to voluntarily distract, disengage, shift, refocus.

38. The Experience of Hypnosis
The Phenomena of Hypnosis
Analgesia and Anesthesia
Approaches
Direct approaches:
suggestion for reduction or elimination of sensation in affected body part
Sensory alteration (e.g. glove anesthesia)

39. The Experience of Hypnosis
The Phenomena of Hypnosis
Analgesia and Anesthesia
Approaches
Amnesia (forget having had pain … interruption of continuous experience of pain, thus allowing increasing intermittent pain-absent / comfort periods.
Suggestion of gradual diminution: discomfort diminishes over specific period of time.
Age progression to post-recovery time.
Age regression to pre-pain experience time.

40. The Experience of Hypnosis
The Phenomena of Hypnosis
Analgesia and Anesthesia
Approaches
Time distortion: periods of discomfort can be compressed; periods of comfort can be expanded.
Physical dissociation: facilitation of analgesia by suggestion that mind and body contemporaneously exist on different and separate levels of experience. Separation distance allows patient to not notice what her body is experiencing.

41. The Experience of Hypnosis
The Phenomena of Hypnosis
Hyperesthesia
Increased sensitivity to touch / physical sensation.

42. The Experience of Hypnosis
The Phenomena of Hypnosis
Catalepsy
Inhibition of voluntary movement associated with heightened focus on a specific stimulus (or on a new and different reality, thus allowing patient to let go of old reality long enough to create experience of other hypnotic phenomena).
Associated directly or indirectly with almost every other hypnotic phenomenon.

43. The Experience of Hypnosis
The Phenomena of Hypnosis
Catalepsy
Degree of focus is associated with level of experience of catalepsy (slowing of basic physiological processes, general immobility, fixed gaze, inflexibility).
Indicates intense engagement that indicates high degree of receptiveness to suggestion.

44. The Experience of Hypnosis
The Phenomena of Hypnosis
Catalepsy
Degree of focus is associated with level of experience of catalepsy (slowing of basic physiological processes, general immobility, fixed gaze, inflexibility).
Indicates intense engagement that indicates high degree of receptiveness to suggestion.

45. The Experience of Hypnosis
The Phenomena of Hypnosis
Catalepsy
Can be an intended response in and of itself (assist patient who must limit movement to undergo procedure, heal, recover).
Can be used to facilitate further hypnotic experience via patient’s recognition of her (Ucs) ability to respond in different / automatic ways (assist in initiating and maintaining attention or increasing hypnotic involvement [deepening]).

46. The Experience of Hypnosis
The Phenomena of Hypnosis
Catalepsy
Can be used to assess responsiveness to suggestion, trance ratification, induction, deepening, facilitation of anesthesia.

47. The Experience of Hypnosis
The Phenomena of Hypnosis
Catalepsy
Approaches
Almost anything that captures intense attentional focus / interest (interesting stories, surprise, shock, confusion.
Can be achieved directly or indirectly, verbally or nonverbally.
Most common avenue is to offer suggestions for relaxation and immobility.

48. The Experience of Hypnosis
The Phenomena of Hypnosis
Catalepsy
Approaches
Very practical nonverbal suggestion is indirect strategy of modeling (using body as model to demonstrate shift from normal, animated communication to demonstration of potential immobility of hypnotic state).

49. The Experience of Hypnosis
The Phenomena of Hypnosis
Dissociation
Detachment from the immediate environment.
Similar to dream when see oneself doing something outside one’s body.
Ability to segment a global experience into component parts and to enhance awareness for one part while diminishing awareness of others.
Hypnosis necessarily involves dissociation.

50. The Experience of Hypnosis
The Phenomena of Hypnosis
Dissociation
Patient does not have to be attached to immediate experience: can not really be there. Conscious can be in entirely different place, preoccupied with what has attracted attention, while unconscious is free to respond to and in what ways it chooses.
The deeper the hypnotic involvement, the greater the degree of dissociation (and the greater the potential for unconscious responses).

51. The Experience of Hypnosis
The Phenomena of Hypnosis
Dissociation
Approaches
Suggestions that facilitate division of experience
Emphasize patient’s ability to experience and learn effortlessly and automatically (while the conscious focuses on ideas, experiences, the unconscious is allowed, encouraged to respond in other ways and to learn at levels outside conscious awareness

52. The Experience of Hypnosis
The Phenomena of Hypnosis
Dissociation
Approaches
Directly: allow patient to learn that it is possible to have experiences on different levels and that such experiences can occur spontaneously, automatically
Indirectly: when suggestions for particular hypnotic phenomenon are offered. Use of metaphors, confusion, other indirect suggestions may facilitate dissociation

53. The Experience of Hypnosis
The Phenomena of Hypnosis
Hallucination / Sensory Alteration
Hallucination
Sensory experience that does not arise from external stimulation.
Can be positive or negative in structure (positive: experience of something that is not objectively present; negative: not experiencing something sensorily that is objectively present.
By facilitating hallucination, clinician is assisting patient in alteration of awareness for sensory input, thus allowing patient to experience self and world differently.

54. The Experience of Hypnosis
The Phenomena of Hypnosis
Hallucination / Sensory Alteration
Hallucination
All five senses can be hallucinated.
Taste, olfactory, kinesthetic are easiest to obtain (36%-46% research subjects). Visual is most difficult (3%)’ auditory second most difficult (13%-17%).

55. The Experience of Hypnosis
The Phenomena of Hypnosis
Hallucination / Sensory Alteration
Approaches
Often occur spontaneously
Intentional facilitation can be direct or indirect
Direct: offer within positive suggestion structure so patient knows what to experience (not what should not)
Indirect: offer within positive suggestion structure (e.g. suggest that patient be increasingly aware of her hand/arm is indirect suggestion not to notice her foot/leg)

56. The Experience of Hypnosis
The Phenomena of Hypnosis
Ideodynamic Responses
Conversion of an idea to a dynamic
Ideosensory: automatic experience of sensation associated with processing of suggestion
Ideoaffective: automatic emotional response associated with suggestion or thinking about experience(s)

57. The Experience of Hypnosis
The Phenomena of Hypnosis
Ideodynamic Responses
Ideomotor: Involuntary capacity of body to respond instantaneously to thoughts, ideas, emotion. Includes eye closure, arm/hand movement, inability to move, limb rigidity.
Involuntary ideomotor signals may be evidenced in 78% of patients.
Useful to signal clinician that internal processes have been established/completed (e.g. numbness present).

58. The Experience of Hypnosis
The Phenomena of Hypnosis
Ideodynamic Responses
Approaches
Will occur no matter what clinician does; patients not able to prevent unconscious body movement or prevent re-experience of emotion and sensation associated with what is being talked about.
Preoccupation of patient with content of suggestion facilitates ideodynamic process.

59. The Experience of Hypnosis
The Phenomena of Hypnosis
Time Distortion
Subjective alteration in the experience of time (experience of time is purely subjective, depending on focus of attention).
Time Expansion: subjective experience of time passing very slowly.
Time Contraction: subjective experience of time passing very quickly.

60. The Experience of Hypnosis
The Phenomena of Hypnosis
Time Distortion
Occurs naturally, frequently among all people, therefore in hypnotic state, time distortion occurs even without specific suggestions for it. (closed eyes, increased absorption in internal experience [sensation, thought, memory, emotion] results in outside reality becoming background, thus making less important and more difficult realistic assessment of passage of time).

61. The Experience of Hypnosis
The Phenomena of Hypnosis
Time Distortion
Permissive, direct suggestions facilitate time distortion well.
Indirect suggestions gently remind patient that experience of time can be altered (e.g., stories including experiences of time experience alteration).
Useful in sports, pain recovery, migraine, review of past experience, trance ratification.

62. The Experience of Hypnosis
Trance
Naturally occurring state
Intentionally entered state

63. Trance Logic
The alternative thinking process that enables ideas that would be paradoxical to the conscious self to peacefully coexist within the mind while in a state of trance.
Mosby’s Dictionary of Complementary and Alternative Medicine (©) 2005

64. Trance Logic
Patient’s lack of need for her experience to be entirely rational or realistic.
Patient can, at least temporarily, accept the suggested reality, however illogical and objectively impossible it may be, as if it were the only reality.
A voluntary state of acceptance of suggestions by the patient without the critical evaluation occurring that would destroy the validity or meaningfulness of some suggestions.

65. Trance Logic
The opportunity for the patient to respond “as if” something were real can be an avenue to deeper emotions or issues appropriate for therapeutic consideration.
Result of the ego being able to release function of criticality while in hypnotic trance, thus allowing more primary thought process.

66. Trance Logic Tolerance of logical inconsistencies.
Trance logic is significant factor in hypnotic behavior (Blum and Grael, 1971; Sheehan, 1977).
Trance logic is the “essence” of hypnosis (Orne, 1959; 1979) (coined term).

67. Trance Logic
Suggested reality in hypnosis that would not normally be accepted in the awake state.
“The stronger the contractions become, the more relaxed and comfortable you will feel”
Hallucinating a person while the same person is actually present (illogical experience of seeing same person in two places at same time)

68. Trance Logic
Principal distinction between real and simulating hypnosis patients: truly hypnotized patients have higher tolerance for, and acceptance of, logical inconsistencies.

69. Principles for Formulating Suggestions for Eliciting Hypnotic Phenomena
Prepare and educate patient well
Establish rapport and trust
Create positive expectancy
Utilize trance ratification
Recognize value of positive suggestions
Utilize what patient brings to session/treatment
Use behavioral and cognitive modeling
Appropriate timing of introduction to phenomena

70. The Process of Hypnotic Induction
Pt Assessment, Establishment of Rapport
Orientation and Education of Pt
Fixation of Attention and Deepening Involvement
Facilitating Unconscious (Involuntary) Response
Trance Ratification
Removing Suggestions and Re-Alerting Pt

71. Principles of Induction and Suggestion
Preparation of the Pt
Establish Rapport and a Cooperative Relationship
Create Positive Expectancy
Law of Reversed Effect
Law of Dominant Effect
Law of Concentrated Attention
The Carrot Principle

72. Principles of Induction and Suggestion
Principle of Positive Suggestion
Principle of Successive Approximations
Law of Parsimony
Principle of Positive Reinforcement
Principle of Trance Ratification
Erickson’s Principle of Individualization and Utilization

73. Principles of Induction and Suggestion
Principles of Timing
Principle of Interspersing Suggestions