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Hypnosis in Disability Settings Michael Ellner* Robert Aurbach**
Abstract Hypnosis is an excellent intervention tool for the treatment of injured and ill workers with respect to learned helplessness, disability behavior and many of the physical and emotional symptoms experienced by injured workers. Assistance with stress and coping with external stressors, chronic pain, insomnia, depression and fostering a positive mental attitude are all well documented applications of hypnosis. A self-hypnosis training regimen offered by properly trained and certified hypnosis professionals offers an opportunity for a brief and measurable intervention, resulting in a likelihood of positive impact on the injured or ill worker, with none of the risks traditionally associated with psychological intervention in workers’ compensation cases.
* Hypnosis Practitioner and Educator, New York, NY. Email:
[email protected] ** CEO, Uncommon Approach and IAIABC Journal Editor, Albuquerque, NM. Email:
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Introduction Over 10 million Americans are suffering from disabling chronic pain, according to a spokesperson for The American Society of Interventional Pain Physicians (ASIPP)1. A number of studies have recognized the psychosocial aspects of disability both with respect to learned disability behavior and development of chronic pain (Flor, 1988; Strang, 1985; Rugulies, 2004; Bongers, 2002; Feurerstein, 2001). Nonetheless, there has been reluctance on the part of workers’ compensation benefit payers to address these kinds of issues for at least two reasons. First, there is a concern, particularly in the adjusting community, about traditional psychological treatments extending for unlimited duration. Second, there is a concern that there is no proven manner to measure the progress of a person towards avoiding or unlearning disability behaviors. These concerns may apply to some forms of intervention in psychosocial issues, but not to all possible strategies. The strategic use of certified hypnosis professionals2 in assisting people with disabilities has the potential to improve every aspect of living or working with disabilities without falling into either of these traps.
Hypnosis 101 A Brief History References to healing with what is now recognized as hypnotic phenomena can be found in writings from ancient Egypt, Greece, Rome and Asia http://www.bio-medicine.org/medicine-news-1/Rubenstein-Public-Relationsto-Launch-National-Campaign-for-The-American-Society-of-Interventional-PainPhysicians-29270-1/
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For purposes of this article we are using the term “certified hypnosis professional” to refer to an individual who has been trained and tested at least in accordance with the standards of the National Guild of Hypnotists (NGH) or the International Medical and Dental Hypnosis Association (IMDHA). Hypnosis is not, generally, a licensed profession, and the quality of the training, support and oversight provided by the certifying organization does matter.
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Minor. Scientists and physicians as renowned as Sigmund Freud, James Esdaile, Jean Martin Charcot, Ambrose-Auguste Liebault, Ernest Hilgard, and Milton Erickson have studied and used variations of a process that Dr. James Braid misnamed “Hypnosis” to help their patients. It is not the purpose of this introductory article to provide a bibliography or self-study guide on hypnosis, so authority for general propositions about the nature of hypnosis will be captured in a general bibliography of standard references in a special section below.
What is Hypnosis? In spite of its extensive history and well-documented benefits (more of this shortly), there is no universally accepted definition of hypnosis. Hypnosis is associated with certain brain wave states, but has not yet been localized to any specific area or formation of the brain (Oakley, 2009). It is not sleep, yet it is often associated with deep physical and mental relaxation. Suggestions offered in hypnosis are often said to by-pass the critical nature of the conscious mind, yet it is widely believed that suggestions that violate the principles of the hypnotic subject will be rejected. People experience hypnosis differently, but it is clear that it is a naturally occurring state experienced by almost all of us at one time or another. If you’ve ever suspended disbelief in a futuristic or fantasy entertainment, or driven while your conscious attention was elsewhere, you’ve experienced hypnosis. For purposes of our discussion, hypnosis is an enhanced state of focused attention in which people demonstrate significantly greater control over both mental and physical functions. The link between mental states and physical states has been extensively reported and is immediately obvious to us – a person under stress will likely breathe differently, have a different heart rhythm and sweat more – we commonly call it the “fight or flight” response. By providing training in intentional relaxation, hypnosis can significantly reduce unhealthy reactions associated with being sick or injured and in pain. Moreover, current neuroscientific theory (Duffau, 2006; Oakley, 2009) suggests that the brain is “plastic” – that it can adapt in significant ways to
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current conditions, breaking old “habits of thought” and establishing new ones. The neuroscientists sometimes use the phrase “neurons that fire together, wire together” to describe this phenomenon. By use of suggestion, the skilled certified hypnosis professional can help coach the client to break habits of thought that do not serve them and replace them with more adaptive beliefs, attitudes and habits. This is the basis of some of the better-known uses of hypnosis, such as smoking cessation and weight release.3 Critical to all utilization of hypnosis is the coaching of skills in controlling the so-called “fight or flight” response. Again, this is urgent because that response creates a profound biochemical reaction in the body. We know that heart and breathing rates are affected as blood chemistry is altered by the production of adrenaline and cortisol allowing the body to respond effectively to a physical threat. Unfortunately, the body responds the same way to a perceived threat – even one that does not call for a physical response. Pain and fear of pain create this reaction. So does a sense of helplessness and loss of control. The chronic alterations of the body experienced by people who face such stressors over time cause genuine suffering, depression and loss of hope. This pattern of “learned disability” should be familiar to most who have had occasion to deal with people who have experienced serious injuries, chronic and degenerative diseases and other continuing disorders. Financial stressors relating to being unable to work can be especially dangerous, because they often trigger a cascade of fears and doubts and reactions from 3 Hypnosis is widely used for smoking cessation and weight loss “Latest Survey Shows More Hospitals Offering Complementary and Alternative Medicine Services” http://www.aha.org/aha/press-release/2008/080915-pr-cam. html; “Use of and Interest in Alternative Types of Therapy Among Clinicians and Adult Members of the KP Northern California Region: Results of a 1996 Survey” http://xnet.kp.org/permanentejournal/sum99pj/cam.html ; “Hypnosis in Contemporary Medicine — Mayo Clinic proceedings”http://www.mayoclinicproceedings.com/content/80/4/511.abstract)
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others around the issue of being able to provide for one’s family and obligations, which creates more stress and unwanted dependencies.4
What Hypnosis is Not Hypnosis used in the disability management setting is not a stage entertainment. It is not a form of mind control. Rather, the certified hypnosis professional is acting as a self-help coach engaged in the training of the injured worker in the skill set necessary to allow him or her to maintain their rehabilitation practices long after the intervention of the certified hypnosis professional has ended. In this context, hypnosis deals with the circumstances of the subject since the disabling injury or disease onset. It does not require the worker to relive the incident through their memories. It does not require the worker to embrace any external belief system or philosophy. Anyone (with the exception of a very small percentage of the population that lacks the cognitive ability to focus their attention due to injury or developmental disability) can be hypnotized and obtain benefit from the process.5
Stress 101 Some of the confusion about “stress” stems from the way different researchers use the word. It is often meant to apply to outer events (e.g., getting fired, a death in the family, a change in a relationship) and inner events (e.g., heartbeat speeding up, adrenaline pumping, depression of the immune system). Technically speaking though, the word “stress” refers to the internal events and the word “stressor” refers to the external events. Hypnosis, and practicing self-hypnosis, address “stress” - the “inner connections” that govern the inner stress response. It is a way for us to activate and help reorganize the different stressor-negotiating mechanisms and their associated physiology into a more integrated state. 4
Please see general references section, below.
5
Please see general references section, below.
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This is helpful because, after “maximum medical improvement”6 we cannot do much, if anything, about the client’s physical health challenges or certain outside events. But, on the other side of the coin, by practicing selfhypnosis under the guidance of a certified hypnosis professional we can quickly help these people do something about their internal reactions to these events so they can deal with the external events more efficaciously. Instead of feeling pressured, we can sense an excitement. Instead of feeling anxious or afraid, we can sense opportunities for practical action and experience confidence. Once these new habits of thought are in place and operating automatically, we can feel challenged by stressful situations without stressing ourselves.
Self-hypnosis is Effective for Treating the Components of Disability There is substantial research demonstrating the effectiveness of hypnosis and self-hypnosis for controlling and/or ameliorating each of the individual components of the typical cluster of issues confronting the injured worker. What follows is not intended to be an exhaustive review of the research, but rather a mere sampling of this fertile area.
Pain Studies have found hypnosis effective in treating both chronic pain (Tan, 2006; Tan, 2002; Anderson, 2006) and acute pain (Alvarez-Nemegyei, 2007). At least two reviews of multiple studies have been conducted and “Maximum medical improvement” is a standard term of art for the initiated. For the injured worker, hearing the words for the first time from a physician, term takes on an aspect of a life sentence to the physical condition that they are currently experiencing. The medical judgment is intended to denote the point when further treatment is not justified and the body’s natural healing or degenerative processes will take precedence in the progress of the condition. The worker may hear instead the notion that they are as good as they will ever get, with resulting dilatory effects on their expectations of recovery.
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concluded that there is a good evidentiary basis for the use of hypnosis for pain (Kessler, 2003; Smith et al., 2006).
Stress Stress interferes with the ability of the body to heal by putting the body into a fight or flight reaction, engaging the limbic nervous system and impeding appropriate functioning of the immune system (American Psychological Association, 2006). One controlled study of aortal bypass patients showed that patients trained in self-hypnosis experienced significant increases in their stress handling capacity resulting in less post-operative stress and reduced post-operative need for pain medication (Ashton, 1997). Stress also exacerbates catastrophizing behaviors, poor coping skills, comorbid behaviors such as smoking and overeating and attitudes fostering inappropriate secondary gain and dependency (Beaton, 2003). Self-hypnosis has been shown to be an effective modality for the treatment and prevention of stress and its deleterious effects (Whitehouse, 1996; Gruzeller, 2001; Gruzeller, 2002).
Depression The combination of chronic health problems and associated loss of basic functionalities of everyday life often results in depression and/or anger. These conditions decrease compliance with therapeutic efforts, interfere with appropriate return to work, slow healing and severely impact quality of life. Hypnosis is an effective modality for treating depression (Yapko, 2006, 1999, 1992; Kessler, 2001).
Insomnia When a person is sleep deprived all his or her coping mechanisms are reduced in effectiveness, their perception of pain increases and their ten© 2009 IAIABC
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dency toward inappropriate reaction is exacerbated. Unfortunately these same conditions interfere with the achievement of appropriate sleep, resulting in a self-reinforcing cycle of stress related sleep deficiency. Hypnosis is an effective treatment modality for sleep disorders, even though there is a lack of randomized experimental designs in the area (Ng, 2008).
Encouragement of Positive Mental Attitude A positive mental attitude can impact powerfully on a range of appropriate behaviors that should be encouraged in any person facing disability. Moreover, the positive mental attitude itself is beneficial and should be encouraged in its own right. Hypnosis and self-hypnosis can promote health (Spiegel, 1989) the desire to return to work, increase self-reliance and independence and promote forgiveness and emotional healing (Novack, 1987). A 40-year study of 7,000 participants conducted by the Mayo Clinic and published in its July 2009 Mayo Clinic Health Letter notes that persons with a pessimistic mental attitude had increased morbidity as compared with persons from the same cohort with a positive mental attitude.7
Co-morbid Conditions That Often Present With Chronic Pain Two co-morbidities that often contribute to the “disability mindset” are: Smoking cessation. While the evidence for the effectiveness of smoking cessation varies substantially in quality, many studies strongly suggest its effectiveness (Orleans, 1985). Weight management. Hypnosis appears to be most effective when used as motivational and reinforcing modality with conventional weight loss strategies (Cochrane, 1986; Kirsch, 1996).
http://www.bio-medicine.org/medicine-technology-1/July-2009-Mayo-ClinicHealth-Letter-Highlights-a-Positive-Outlook--Bells-Palsy-and-Heart-Valve-Repair-4765-1/
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Scope and Nature of the Intervention As noted above, there is considerable scientific evidence that practicing self-hypnosis can help reduce stress and increase coping skills and abilities. With the well-known potential for adverse effects of opiod analgesics (Stockbridge et al., 2006) and the increasing challenge of medical inflation, a new approach is needed. The certified hypnosis professional offers a relatively modest adjunctive intervention, lasting 6 to 10 sessions, that is sufficient to accomplish the desired results. The intervention is subject to external monitoring for progress toward return to work, reduction on drug dependency or other goals. The self-limiting nature of the treatment is deeply ingrained in the professional sensibilities of hypnosis professionals. In my experience, serving over 12,000 clients, and my experience teaching hundreds of students and interacting with dozens of other trainers at regional, national and international conferences sanctioned by the IMDHA and NGH, the utilization of indefinite ongoing care is regarded as being unprofessional and inappropriate. I have rarely utilized as many as ten sessions to achieve results or determine that I could not successfully work with the client, and hypnosis students are taught that the short term nature of the intervention is a principle distinguishing factor recommending hypnosis over other modalities. Studies showing the effectiveness of hypnosis for Irritable Bowel Syndrome were based on a protocol of 10-12 sessions (Gonsalkorale, 2008). There are several approaches to hypnosis, but teaching self-hypnosis is an efficient and highly successful tool for addressing the complex of issues impacting an injured worker. Self-hypnosis is particularly valuable, because it allows the creation of an environment where the injured or diseased person regains some of the control that they’ve lost as a result of their injury or disease. Self-hypnosis protocols are necessarily predicated on the notion that controlling the beliefs and perceptions experienced by the client is the key to controlling the behavior or sensation that is being addressed. The self-hypnosis subject, because they are responsible for the process that alters that perception or belief, are in control of their own outcome. This is a significant departure from the “passive” nature of traditional medicine, where the patient is told by the physician what to take, and what to do.
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Unlike medications, modalities and medical devices, self-hypnosis is a skill that, once learned, is always available for use by people living with challenges. Plus, there is no risk that one might have a serious adverse “sideeffect,” forget a remedy or medication, have batteries fail, or have a pain flare-up without having resources available. Self-hypnosis skills are easily learned, and there is no continuing dependence on the certified hypnosis professional for maintenance of the program. A self-hypnosis practitioner can choose to abandon the practice and resume the pain or other unwanted behavior or perception. Especially with regard to physical pain, that is a choice that, in my experience, is seldom made.
Components of the Program Of necessity, each program will be individualized to the particular circumstances of the person facing the challenge, and the nature of the challenge that confronts them. There are, however, certain basic components: Creation of New Skill Sets. The subject must experience relaxation (perhaps for the first time since the initiation of the challenge) and develop the ability to recognize the triggers for his or her particular “fight or flight” response. The ability to rapidly enter into a brief self-induced state of ease must be established, so that voluntary control of the “rest and digest” state (the opposite of “fight or flight” this state is where healing is done) is established. Symptom control. Whether the person is faced with chronic discomfort, a disease process or another challenge, it is critical to establish the expectation that the symptoms they experience are subject to modification or selective perception under their voluntary control. This is merely an extension of the well-documented placebo effect (Niemi, 2009). Even very significant permanent injury with chronic serious nervous system stimulation is amenable to this approach. A colleague of mine, Daniel Cleary, suffered from Brachial Plexus Avulsion and a paralyzed right arm in a motorcycle accident almost 30 years ago. This incident resulted in a constant and intense crushing, burning sensation in his arm, inability to sleep, and associated issues. Using these techniques, he has been free of both suf-
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fering and medications for the control of pain for over 20 years (Cleary, 2007). Creation of expectations about the future. When people believe that something will happen, at a minimum they experience an enhanced sense of control over their circumstances, as compared to the belief that their fate is out of their control. It is also an interesting and well-documented (if not thoroughly explained) commentary on the human condition that such beliefs have an uncanny knack of being fulfilled – in normal parlance we refer to this as “self-fulfilling prophecy.” Direct support for specific co-morbid conditions. Insomnia often accompanies discomfort. Excess body weight and smoking often complicate the recovery process and sometimes counter-indicate specific medical treatments. Depression often accompanies the physical symptoms, loss of income, social role, loss of control incident to the disability determination system. All these issues can be addressed through self-hypnotic processes.
It’s all a matter of conditioning Did you ever wonder why two people who are faced with the same stressful situation can react so differently? Why one may fall apart under the stress while the other is spurred on to greater achievement, invigorated rather than incapacitated by the challenge it presents? One explanation for the difference lies in their internal mental connections. Current neuroscientific theory holds that the brain is adaptive to ongoing experience and essentially rewires itself to more easily express current experiences and beliefs (Duffau, 2006; Oakley, 2009). This “Brain plasticity” allows us to make and break habits and change our minds. Self-hypnosis under the guidance of certified hypnosis professional can help these people to learn to make better “connections” internally and experience better outcomes externally - better connections between a potential stressor and the outcome it leads to. Another important benefit is that hypnosis (and practicing self-hypnosis)
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can create the emotional resources necessary for motivating people to return to work. The increased stress handling capacity helps them to cope with residual discomfort while reducing the fears associated with return to work, by increasing the desire to go back to work. Although there have not yet been published studies of the effectiveness of hypnosis and self-hypnosis for workers’ compensation claimants, there is considerable anecdotal evidence of long term effectiveness. This intervention is quite different than the traditional fears concerning psychological treatment. It would be unusual for positive change to require more than 6 to 10 self hypnosis training sessions extending over two months or less, and monitoring for improvement can start as soon as the first session. Interventions of indefinite extension, and a Never Never Land of indefinite delay before results are shown simply are not features of a properly structured treatment plan produced by a certified hypnosis professional. Claims administration personnel can and should insist on a treatment plan and documented progress notes demonstrating meaningful progress. Failure to provide such documentation, or more than occasional requests for extensions of treatment should be considered “red flags” calling for further inquiry. It is entirely appropriate to limit initial approvals for treatment to six to ten sessions.
The Certified Hypnosis Professional The practice of hypnosis is a self-regulated, rather than a state-licensed, profession. Credible hypnosis certification organizations like the National Guild of Hypnotists and the International Medical and Dental Hypnotherapy Association have been training and certifying hypnotists for helping people become more effective since 1985 and 1989, respectively. Like any profession, it is important to critically consider the qualifications and experience of the practitioner when making utilization decisions. Specialty certifications in useful sub-specialties are available from the major certifying organizations. At a minimum, specialty certification in hypnotic approaches to pain and training in a well-developed self-hypnosis protocol IAIABC Journal, Vol. 46 No. 2
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are suggested. The International Medical and Dental Hypnotherapy Association (www.imdha.com) and the National Guild of Hypnotists (www. ngh.net) offer specialty trainings and certifications to their certified members and are amenable to educational outreach to inform the public about the benefits of hypnosis.
Measuring the Outcome There are at least three possible measures for the effectiveness of self-hypnosis programs in a disability setting. The first involves the self-reporting of the worker as to current symptoms and expectations. Although “pain scales” are generally used, they tend to focus the worker’s attention on experiencing pain. A more effective tool focuses on the perceived relief and comfort experienced by the injured or ill worker. They measure the same thing, but how we talk to each other and to ourselves really does influence what we focus upon, and therefore affects our experience. In common parlance we might refer to this as the difference between seeing the glass half empty and seeing it as half full. The second possible approach depends on standard “quality of life” measurement instruments. The assumption is that increases in the perceived quality of life reflect better overall coping skills and perceptions concerning physical condition – exactly what the self-hypnosis training protocol is designed to impact. The final measurement approach requires some medical support. As stress reactions occur, the limbic nervous system releases certain hormones into the blood stream, that remain there unless “burned off” by appropriate activity. Measurement of cortisol levels can reveal these chemical markers for stress. One or all of these measurement approaches can be used to monitor the progress of workers and demonstrate the objective effectiveness of this approach to the avoidance of needless workplace disability.
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Conclusion Utilizing certified hypnosis professionals to teach self-hypnosis to people in the acute states of disability is a cost effective, tool that can quickly provide the increased coping skills and abilities needed during these hard times. Self-hypnosis can help people feel better, heal faster and generally be more effective, when learned and practiced with the guidance of a certified hypnosis professional. Hypnosis and self-hypnosis can be utilized to help people coping with disabilities trigger the moods, mindsets and actions that promote rehabilitation and healing at any stage of disability. David DePaulo calls for reframing the disability mindset to one empowers and motivates instead of one that fosters chronic conditions and dependency in the Spring 2009 issue of the IAIABC Journal (DePaulo, 2009). There is a growing awareness in the hypnosis, disability management and workers’ compensation communities that there is tremendous potential to change the paradigm of treatment of the injured worker from a passive recipient model of health care after work injury or illness to a model of active worker involvement and cooperation. Hypnosis can be an effective and cost efficient mechanism to achieve this result when conducted under the guidance of a properly trained professional. Empirical evidence for the success of this approach in the workers’ compensation population is already being collected in at least one pilot project currently being conducted by a certified hypnosis professional, in cooperation with supervising physicians and a local insurer. Further efforts at collecting such information should be supported whenever possible. Hypnosis is an ideal adjunctive modality because it is able to enhance the benefits of a wide variety of medical interventions. Since hypnosis can be effective for preventing and reducing chronic stress and pain its use should be included in the basic standard of care for people at every stage of disability.
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References Alvarez-Nemegyei, J., Negreros-Castillo, A., Nuño-Gutiérrez, B.L., Alvarez-Berzunza, J., & Alcocer-Martínez, L.M. (2007, Jul-Aug). Ericksonian hypnosis in women with fibromyalgia syndrome. Revista Medica del Instituto Mexicano del Seguro Social 45(4), 395-401. American Psychological Association. (2006, February). Stress Weakens the Immune System. APA Online. Retreived from http://www. psychologymatters.org/stressimmune.html Anderson, R. (2006, October). Low back pain and hypnosis. Townsend Letter for Doctors and Patients. Retrieved from http://www.tldp.com Ashton, C., Jr., et al. (2004). Self Hypnosis Reduces Anxiety Following Coronary By-Pass Surgery. A Prospective Randomized Trial. Journal of Cardiovascular Surgery (Torino). (2), 335-6. Ayan, S. (2009, April – June). Laughing matters. Scientific American Mind, 20,(2), 24-31. Beaton, D. (2003). Effects of Stress and Psychological Disorders on the Immune System, Personality Research.Org. Retrieved from http:// www.personalityresearch.org/papers/beaton.html Bongers, P., et al. (2002). Are psychosocial factors, risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist? American Journal of Industrial Medicine, 41, 315-342. Cleary, D. (2007). Changing pain: Relief is realistic. Retrieved from danclearyhypnosis.com Cochrane, G., & Freisen, J. (1986). Hypnotherapy in weight loss treatment, Journal of Consulting and Clinical Psychology, 54, 489-492.
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DePaulo, D. (2009). The evolution of workers’ compensation: Work injury insurance. IAIABC Journal, 46(1). Duffau, H. (2006, November). Brain plasticity: From pathophysiological mechanisms to therapeutic applications. Journal of Clinical Neuroscience, 13(9), 885-897. Feuerstein, M., et al. (2001, December). Working with low back pain: workplace and individual psychosocial determinants of limited duty and lost time. American Journal of Industrial Medicine, 40(6), 627-638. Flor, H., & Turk, C. (1988, June). Chronic back pain and rheumatoid arthritis: Predicting pain and disability from cognitive variables. Journal of Behavioral Medicine, 11(3). Gonsalkorale, W., et al. (2001). Hypnotherapy in irritable bowel syndrome: A large-scale audit of a clinical service with examination of factors influencing responsiveness. The American Journal of Gastroenterology, 97(4), 954 – 961. doi: 10.1111/j.1572-0241.2002.05615 Gruzeller, J.H., Smith, F., Nagy, A., & Henderson, D. (2001). Cellular and humoral immunity, mood and exam stress: the influence of self-hypnosis and personality predictors. International Journal of Psychophysiology, 42(1), 55-71. doi:10.1016/S0167-8760(01)00136-2 Gruzeller, J.H. (2002, June). A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects immunity and health. Stress, 5(2), 147-163. Kessler, R., et al. (2003, June). Hypnosis and relaxation with pain patients: Evidence for effectiveness. Seminars in Pain Medicine, 1(2), 67-78. Kessler, R., et al. (2001, February). Use of complementary and alternative therapies to treat anxiety and depression in the United States. American Journal of Psychiatry, 158, 289-294.
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Kirsch, I. (1996). Hypnotic enhancement of cognative behavioral weight loss treatments – another meta-reanalysis. Journal of Consulting and Clinical Psychology, 64(3), 517-519. Ng, B.Y., & Lee, T.S. (2008). Hypnotherapy for sleep disorders. Annals of The Academy of Medicine, Singapore, 37(8), 683-688. Niemi, M. (2009, February-March). Cure in the mind. Scientific American Mind, 20(1), 42-49. Novack, D. (1987, September). Therapeutic aspects of clinical encounter. Journal of General Internal Medicine, 2(5), 346-355. Oakley, D., & Halligan, P. (2009). Hypnotic suggestion and cognitive neuroscience. Trends in Cognitive Sciences, 13(6), 264-270. doi: 10.1016/j.tics.2009.03.004 Orleans, T. (1985, February). Understanding and promoting smoking cessation: overview and guidelines for physician intervention. Annual Review of Medicine, 36, 51-61. Rugulies, R.,et al. (2004, May). The psychosocial work environment and musculoskeletal disorders: Design of a comprehensive intervieweradministered questionnaire. American Journal of Industrial Medicine, 45(5), 428-439. Smith, C.A., Collins, C.T., Cyna, A.M., & Crowther, C.A. (2006). Complementary and alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews: Reviews, 4. Spiegel, D., et al. (1989, Movember 18). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 2, 88891. Stockbridge, H., et al. (2006). Review of opioids for non-cancer pain: Parts 3 and 4. IAIABC Journal, 42, 181. .
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Strang, J.P. (1985). In G.M. Aronoff (Ed.), The Chronic Disability Syndrome, Evaluation and Treatment of Chronic Pain, pp. 247-58. Baltimore, Maryland: Urban & Schwarzenberg. Tan, G., et al. (2002). Hypnosis treatment for chronic low back pain. Internal paper, Michael DeBakey VA Medical Center, Department of Anesthesiology, Bayer College of Medicine, Houston, Texas. Tan, G., Alvarez, J., & Jensen, M. (2006). Complementary and alternative medicine approaches to pain management. Journal of Clinical Psychology in Session, 62(11), 1419 – 1431. Whitehouse, W.G., et al. (1996). Psychological and immune effects of self-hypnosis training for stress management throughout the first semester of medical school. Psychosomatic Medicine, 58(3), 249-263. Yapko, M. (2006). Depression. American Psychological Association. Yapko, M. (1999). Breaking the patterns of depression. New York: Broadway Books.. Yapko, M. (1992). Treating depression with hypnosis. Taylor and Francis.
General References Regarding Hypnosis Barber, T.X., Chaves, J., & Spanos, N. (1974, November). Hypnosis, imagination, and human potentialities: peragamon general psychology series. Oxford: Pergamon Press. Elman, D. (1984). Hypnotherapy. Glendale, California: Westwood Publishing. Hammond, D. C. (1990). Handbook of hypnotic suggestions and metaphors. New York: W.W. Norton & Co.
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Hartland, J., & Tinkler, S. (1966). Medical and dental hypnosis and its clinical applications. Oxford: Balliere Tindall. Hughes, John C. (2008, August). The illustrated history of hypnotism. Merrimack, NH: National Guild of Hypnotists, Inc. Rosenfeld, S. (2008, August). A critical history of hypnotism: The unauthorized story. Bloomington, IN: Xlibris Corporation. Tinterow, M., (1970). Foundations of hypnosis: from Mesmer to Freud. Springfield, IL: C.C. Thomas.
© 2009 IAIABC
IAIABC Journal, Vol. 46 No. 2
Distributed with permission of the IAIABC Journal. To go to Journal, visit www.iaiabc.org.
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Michael Ellner is a hypnosis practitioner and educator who teaches Hypnotic Pain Relief theory and techniques to doctors, dentists, nurses and therapists of all persuasions for PAINWeek, a recurring major medical conference. Ellner also certifies Hypnosis practitioners as Self-help Educators in Pain Relief as an adjunct instructor for major hypnosis certifying organizations like the National Guild of Hypnotists and the International and Medical Dental Hypnotherapy Association. Ellner was a member of a NIH Community Research Initiative exploring Alternative Medicine from 1988 to1992 and his Complementary and Alternative Medicine Blog appears on www.therapytimes.com. Robert Aurbach is currently the CEO of Uncommon Approach, Inc., which provides consulting services on a wide range of workers’ compensation and related issues. He has prior experience in private practice and as a state prosecutor and state Prosecutor Coordinator. Bob is also a hypnotherapist, and provides services to injured workers. Bob has served as one of three U.S. delegates to the Working Group on CrossBorder Workers’ Compensation Issues formed by the Commission on Labor Cooperation, North American Agreement on Labor Cooperation. He wrote the administrative rules for the 1991 New Mexico rewrite of their workers’ compensation law. He has also consulted with the Navajo Nation (rewrite of the Tribal workers’ compensation code) and Virgin Islands Department of Labor (drafting of administrative rules for the Workers’ Compensation Division) and the State of Delaware in their efforts at workers’ compensation reform. Bob’s recent research and writing includes: the effects of attorney involvement on workers’ compensation programs, reform of the treatment of workers’ compensation claims in Federal Bankruptcy Court, tribal sovereignty, cross-border coverage issues, large deductible policies and PEO/leasing arrangements. Bob is a 1979 graduate of Cornell Law School and served as General Counsel for the New Mexico Workers’ Compensation Administration from 1990 to 2005.
IAIABC Journal, Vol. 46 No. 2
© 2009 IAIABC
Distributed with permission of the IAIABC Journal. To go to Journal, visit www.iaiabc.org.
