We periodically have discussed on this list the possible role of hypnosis and
self-hypnosis in human performance and managing pain. The following website
gives some useful information on this subject. Some of the clinical
hypnotists on our list may like to add their comments.

Here are some excerpts:

——————-

The Truth and Hype of Hypnosis

< http://www.sciam.com/2001/0701issue/0701nash.html>

Though often denigrated as fakery or wishful thinking, hypnosis has been
shown to be a real phenomenon
with a variety of therapeutic uses — especially in controlling pain

……. is hypnosis a real phenomenon? If so, what is it useful for? Over the
past few years, researchers have found that hypnotized individuals actively
respond to suggestions even though they sometimes perceive the dramatic
changes in thought and behavior they experience as happening “by themselves.”
During hypnosis, it is as though the brain temporarily suspends its attempts
to authenticate incoming sensory information. Some people are more
hypnotizable than others, although scientists still don’t know why.
Nevertheless, hypnosis is finding medical uses in controlling chronic pain,
in countering anxiety and even–in combination with
conventional operating-room procedures–in helping patients to recover more
quickly from outpatient surgery….

What Hypnosis Is

…….. researchers with very different theoretical perspectives now agree
on several fundamental principles of hypnosis. The first is that a person’s
ability to respond to hypnosis is remarkably stable during adulthood…..
Studies have shown that an individual’s Stanford score remains as consistent
over time as his or her IQ score–if not more so. In addition, evidence
indicates that hypnotic responsiveness may have a hereditary component:
identical twins are more likely than same-sex fraternal twins to have similar
Stanford scores.

A person’s responsiveness to hypnosis also remains fairly consistent
regardless of the characteristics of the hypnotist: the practitioner’s
gender, age and experience have little or no effect on a subject’s ability to
be hypnotized. Similarly, the success of hypnosis does not depend on whether
a subject is highly motivated or especially willing. A very responsive
subject will become hypnotized under a variety of experimental conditions and
therapeutic settings, whereas a less susceptible person will not, despite his
or her sincere efforts. (Negative attitudes and expectations can, however,
interfere with hypnosis.)

Several studies have also shown that hypnotizability is unrelated to
personality characteristics such as gullibility, hysteria, psychopathology,
trust, aggressiveness, submissiveness, imagination or social compliance. The
trait has, however, been linked tantalizingly with an individual’s ability to
become absorbed in activities such as reading, listening to music or
daydreaming.

Under hypnosis, subjects do not behave as passive automatons but instead are
active problem solvers who incorporate their moral and cultural ideas into
their behavior while remaining exquisitely responsive to the expectations
expressed by the experimenter. Nevertheless, the subject does not experience
hypnotically suggested behavior as something that is actively achieved. To
the contrary, it is typically deemed as effortless–as something that just
happens. People who have been hypnotized often say things like “My hand
became heavy and moved down by itself” or “Suddenly I found myself feeling no
pain.”

Many researchers now believe that these types of disconnections are at the
heart of hypnosis. In response to suggestion, subjects make movements without
conscious intent, fail to detect exceedingly painful stimulation or
temporarily forget a familiar fact. Of course, these kinds of things also
happen outside hypnosis–occasionally in day-to-day life and more
dramatically in certain psychiatric and neurological disorders.

Using hypnosis, scientists have temporarily created hallucinations,
compulsions, certain types of memory loss, false memories, and delusions in
the laboratory so that these phenomena can be studied in a controlled
environment…

What Hypnosis Isn’t

As scientists discover more about hypnosis, they are also uncovering evidence
that counters some of the skepticism about the technique. One such objection
is that hypnosis is simply a matter of having an especially vivid
imagination. In fact, this does not seem to be the case. Many imaginative
people are not good hypnotic subjects, and no relation between the two
abilities has surfaced….

In 1998 Henry Szechtman of McMaster University in Ontario and his co-workers
used PET to image the brain activity of hypnotized subjects who were invited
to imagine a scenario and who then experienced a hallucination. The
researchers noted that an auditory hallucination and the act of imagining a
sound are both self-generated and that, like real hearing, a hallucination is
experienced as coming from an external source. By monitoring regional blood
flow in areas activated during both hearing and auditory hallucination but
not during simple imagining, the investigators sought to determine where in
the brain a hallucinated sound is mistakenly “tagged” as authentic and
originating in the outside world.

Szechtman and his colleagues imaged the brain activity of eight very
hypnotizable subjects who had been prescreened for their ability to
hallucinate under hypnosis. During the session, the subjects were under
hypnosis and lay in the PET scanner with their eyes covered. Their brain
activity was monitored under four conditions: at rest; while hearing an
audiotape of a voice saying, “The man did not speak often, but when he did,
it was worth hearing what he had to say”; while imagining hearing the voice
again; and during the auditory hallucination they experienced after being
told that the tape was playing once more, although it was not.

The tests showed that a region of the brain called the right anterior
cingulate cortex was just as active while the volunteers were hallucinating
as it was while they were actually hearing the stimulus. In contrast, that
brain area was not active while the subjects were imagining that they heard
the stimulus. Somehow hypnosis had tricked this area of the brain into
registering the hallucinated voice as real.

Another objection raised by critics of hypnosis concerns its ability to blunt
pain. Skeptics have argued that this effect results from either simple
relaxation or a placebo response. But a number of experiments have ruled out
these explanations. In a classic 1969 report, Thomas H. McGlashan and his
colleagues at the University of Pennsylvania found that for poorly
hypnotizable people, hypnosis was as effective in reducing pain as a sugar
pill that the subjects had been told was a powerful painkiller. But highly
hypnotizable subjects benefited three times more from hypnosis than from the
placebo. In another study, in 1976, Hilgard and Stanford colleague Éva I.
Bányai observed that subjects who were vigorously riding stationary bicycles
were just as responsive to hypnotic suggestions as when they were hypnotized
in a relaxing setting.

In 1997 Pierre Rainville of the University of Montreal and his colleagues set
out to determine which brain structures are involved in pain relief during
hypnosis. They attempted to locate the brain structures associated with the
suffering component of pain, as distinct from its sensory aspects. Using PET,
the scientists found that hypnosis reduced the activity of the anterior
cingulate cortex — an area known to be involved in pain — but did not
affect the activity of the somatosensory cortex, where the sensations of pain
are processed.

Despite these findings, however, the mechanisms underlying hypnotic pain
relief are still poorly understood. The model favored by most researchers is
that the analgesic effect of hypnosis occurs in higher brain centers than
those involved in registering the painful sensation. This would account for
the fact that most autonomic responses that routinely accompany pain — such
as increased heart rate — are relatively unaffected by hypnotic suggestions
of analgesia. ….

Hypnosis and Memory

Perhaps nowhere has hypnosis engendered more controversy than over the issue
of “recovered” memory. Cognitive science has established that people are
fairly adept at discerning whether an event actually occurred or whether they
only imagined it. But under some circumstances, we falter. We can come to
believe (or can be led to believe) that something happened to us when, in
fact, it did not. One of the key cues humans appear to use in making the
distinction between reality and imagination is the experience of effort.
Apparently, at the time of encoding a memory, a “tag” cues us as to the
amount of effort we expended: if the event is tagged as having involved a
good deal of mental effort on our part, we tend to interpret it as something
we imagined. If it is tagged as having involved relatively little mental
effort, we tend to interpret it as something that actually happened to us.
Given that the calling card of hypnosis is precisely the feeling of
effortlessness, we can see why hypnotized people can so easily mistake an
imagined past event for something that happened long ago. Hence, something
that is merely imagined can become ingrained as an episode in our life story.

A host of studies verify this effect. Readily hypnotized subjects, for
instance, can routinely be led to produce detailed and dramatic accounts of
their first few months of life even though those events did not in fact occur
and even though adults simply do not have the capacity to remember early
infancy. Similarly, when given suggestions to regress to childhood, highly
hypnotizable subjects behave in a roughly childlike manner, are often quite
emotional and may later insist that they were genuinely reliving childhood.
But research confirms that these responses are in no way authentically
childlike–not in speech, behavior, emotion, perception, vocabulary or
thought patterns. These performances are no more childlike than those of
adults playacting as children. In short, nothing about hypnosis enables a
subject to transcend the fundamental nature and limitations of human memory.
It does not allow someone to exhume memories that are decades old or to
retrace or undo human development.

What It’s Good For

So what are the medical benefits of hypnosis? A 1996 National Institutes of
Health technology assessment panel judged hypnosis to be an effective
intervention for alleviating pain from cancer and other chronic conditions.
Voluminous clinical studies also indicate that hypnosis can reduce the acute
pain experienced by patients undergoing burn-wound debridement, children
enduring bone marrow aspirations and women in labor. A meta-analysis
published in a recent special issue of the International Journal of Clinical
and Experimental Hypnosis, for example, found that hypnotic suggestions
relieved the pain of 75% of 933 subjects participating in 27 different
experiments. The pain-relieving effect of hypnosis is often substantial, and
in a few cases the degree of relief matches or exceeds that provided by
morphine…

Hypnosis can boost the effectiveness of psychotherapy for some conditions.
Another meta-analysis that examined the outcomes of people in 18 separate
studies found that patients who received cognitive behavioral therapy plus
hypnosis for disorders such as obesity, insomnia, anxiety and hypertension
showed greater improvement than 70 percent of the patients who received
psychotherapy alone. After publication of these findings, a task force of the
American Psychological Association validated hypnosis as an adjunct procedure
for the treatment of obesity. But the jury is still out on other disorders
with a behavioral component. Drug addiction and alcoholism do not respond
well to hypnosis, and the evidence for hypnosis as an aid in quitting smoking
is equivocal.

That said, there is strong, but not yet definitive, evidence that hypnosis
can be an effective component in the broader treatment of other conditions.
Listed in rough order of tractability by hypnosis, these include a subgroup
of asthmas; some dermatological disorders, including warts; irritable bowel
syndrome; hemophilia; and nausea associated with chemotherapy. The mechanism
by which hypnosis alleviates these disorders is unknown, and claims that
hypnosis increases immune function in any clinically important way are at
this time unsubstantiated….

————

The following website offers a great deal of information on the history,
applications and theories of hypnosis:

<http://www.institute-shot.com/hypnosis_and_health.htm>

————–

Dr Mel  Siff

It discussed some interesting principles such as desensitisation to stretch
rather the muscle spindle lengthening, which make one think about our
treatments and advices in the past. >>

*** Several of us have been questioning the necessity for the use of
dedicated “stretching” and “warming up” sessions for many years, so it is
good to see a review of this stature examining these issues in depth (see
Siff MC “Facts and Fallacies of Fitness” 2000). I also like to point out
that stretching exercise (which are meant to deform tissues) are not
necessarily the same as flexibility exercises (which are meant to increase
range of movement).

There are several interesting issues in Shrier’s article on stretching facts
and myths (THE PHYSICIAN & SPORTSMEDICINE – Vol 28 – No. 8 – Aug 2000), such
as this one:

< With respect to alleviating the pain associated with stiffness, the weight
of the evidence suggests that the decrease in stiffness is not as important
as the increase in “stretch tolerance”. Briefly, an increase in stretch
tolerance means that patients feel less pain for the same force applied to
the muscle. The result is increased range of motion, even though true
stiffness does not change. This could occur through increased tissue strength
or analgesia; however, increased stretch tolerance that occurs immediately
after stretching must be caused by an analgesic effect because tissue
strength does not increase during 2 minutes of stretching. Unfortunately,
evidence of a possible analgesic effect is recent, and the underlying
mechanism is unknown. After weeks of stretching, increases in stretch
tolerance could theoretically occur because stretch-induced hypertrophy may
increase tissue strength , and/or an analgesia effect may be present. >

***The use of the term “analgesic” may not be entirely appropriate. While
there may be an as yet identified analgesic effect associated with intense
stretching, this may be greatly overshadowed by an accommodation effect which
changes the Rating of Perceived Effort (or pain) with regular imposition of
progressively increased stretching loads. This happens with all lifting -
the load progressively feels lighter and the lifter then can execute more reps
or a heavier 1 rep max.

This is not necessarily the same as the so-called disinhibition effect which
is an objective altering of nervous processes in the body – it is an effect
that is more subjectively psychological in origin (even though it also
obviously involves neural processes).

Despite the very useful and interesting nature of this review, the reference
list was disappointingly small and it made no use of some really relevant
work by Russian scientists such as Iashvili (see Ch 3 of Siff & Verkhoshansky
“Supertraining” 1999).

At least, the high profile given to this article will tend to make the
fitness pros and sports coaches start wondering a lot more about all those
traditional ideas about stretching and warming up.

Dr Mel C Siff

<< In keeping with this discussion I recently found an excellent literature
review-
“Myths and Truths of Stretching” at the following website:
www.physsportsmed.com

It discussed some interesting principles such as desensitisation to stretch
rather the muscle spindle lengthening, which make one think about our
treatments and advices in the past. >>

*** Several of us have been questioning the necessity for the use of
dedicated “stretching” and “warming up” sessions for many years, so it is
good to see a review of this stature examining these issues in depth (see
Siff MC “Facts and Fallacies of Fitness” 2000). I also like to point out
that stretching exercise (which are meant to deform tissues) are not
necessarily the same as flexibility exercises (which are meant to increase
range of movement).

There are several interesting issues in Shrier’s article on stretching facts
and myths (THE PHYSICIAN & SPORTSMEDICINE – Vol 28 – No. 8 – Aug 2000), such
as this one:

< With respect to alleviating the pain associated with stiffness, the weight
of the evidence suggests that the decrease in stiffness is not as important
as the increase in “stretch tolerance”. Briefly, an increase in stretch
tolerance means that patients feel less pain for the same force applied to
the muscle. The result is increased range of motion, even though true
stiffness does not change. This could occur through increased tissue strength
or analgesia; however, increased stretch tolerance that occurs immediately
after stretching must be caused by an analgesic effect because tissue
strength does not increase during 2 minutes of stretching. Unfortunately,
evidence of a possible analgesic effect is recent, and the underlying
mechanism is unknown. After weeks of stretching, increases in stretch
tolerance could theoretically occur because stretch-induced hypertrophy may
increase tissue strength , and/or an analgesia effect may be present. >

***The use of the term “analgesic” may not be entirely appropriate. While
there may be an as yet identified analgesic effect associated with intense
stretching, this may be greatly overshadowed by an accommodation effect which
changes the Rating of Perceived Effort (or pain) with regular imposition of
progressively increased stretching loads. This happens with all lifting -
the load progressively feels lighter and the lifter then can execute more reps
or a heavier 1 rep max.

This is not necessarily the same as the so-called disinhibition effect which
is an objective altering of nervous processes in the body – it is an effect
that is more subjectively psychological in origin (even though it also
obviously involves neural processes).

Despite the very useful and interesting nature of this review, the reference
list was disappointingly small and it made no use of some really relevant
work by Russian scientists such as Iashvili (see Ch 3 of Siff & Verkhoshansky
“Supertraining” 1999).

At least, the high profile given to this article will tend to make the
fitness pros and sports coaches start wondering a lot more about all those
traditional ideas about stretching and warming up.

Dr Mel Siff