Hypnosis Principles and Applications. an Adjunct to Anesthesia - m.r. Eslinger

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HYPNOSIS PRINCIPLES AND APPLICATIONS: AN ADJUNCTHYPNOSIS PRINCIPLES AND APPLICATIONS: AN ADJUNCTTO ANESTHESIATO ANESTHESIA

by Michael R. "Ron" EslingerRN, CRNA, MA, APN, BCH, CICaptain, UnitedStates Navy, RetiredOwner Healthy Visions Wellness CenterOak Ridge,Tennessee

INTRODUCTIONINTRODUCTIONFor all that we know in medicine there are so many things that we do not know.Hypnosis is nothing new, but it is still grossly misunderstood as an adjunct

therapy to the majority of health care providers. However, providers educated inhypnosis and the power of suggestion realize its real value and nature in the

healing arts. Most people go in and out of hypnosis several times a day. Daydreaming is so nearly like hypnosis, some authorities consider them one and thesame. The difference is that thoughts are random in daydreaming where inhypnosis, suggestions are directed.1

The hypnotic state is something a person accomplishes by himself. It is a stateof complete relaxation, physical and mental. It is an alternate state ofconsciousness characterized by profound relaxation. In this state the mind is moresusceptible to suggestions. Hypnosis is accomplished by a combination ofconfidence and suggestion which can have marvelous results. It is not a medicine

nor is it a "cure-all," but rather a "tool" which can benefit one immensely.Today, some twenty thousand physicians, dentists, psychologists, nurses,hypnotherapists in other medical professions, and hypno-technicians are usinghypnosis in their practices. Hypnosis is being taught to members of the healingarts, police officers, lawyers, clergymen, students, salesmen and a host of otherswho have found it beneficial in their endeavors. Some medical schools are nowincluding a course in hypnosis as part of their curriculum.

Hemophilia - a case studyHemophilia - a case study 22

Tommy was fourteen and a victim of hemophilia which is a defective or deficientblood coagulation molecule known as factor VIII.3 Tommy required as many as sixtransfusions of cryoprecipitate weekly, a very expensive and time consumingtreatment. Using hypnosis as an adjunct therapy, Tommy learned how to managehis bleeds drastically decreasing his need for transfusions. This was a significantchange for the family financially and in Tommy's improved mental and physicalhealth.

Hypnosis was used in four ways. First, was ego-strengthening. Tommy wasgiven suggestions that he no longer had to compete with his peer group to be

accepted. Second, He was taught to recognize when he was bleeding into a jointvery early. Early recognition of internal bleeding combined with increased self-esteem allowed him to stop what he was doing without embarrassment,decreasing the amount of injury. Third, Tommy used guided imagery to create

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cold at the site of bleeding to slow down blood flow. He also visualized faucets onhis blood vessels that could be switched on or off. Fourth, He learned auto-hypnosis which enabled him to reinforce the post-hypnotic suggestions given bythe hypnotist.

What is HypnosisWhat is Hypnosis

The word hypnosis is derived from the Greek word "hypnos," meaning sleep.4 Inthe hypnotic state, however, the individual is not asleep, so the word hypnosis ismisleading. Health care practitioners today prefer the term "relaxation." How oftenhave you said to a patient, "Relax, take a deep breath and relax?" Relaxation canbe described, as a particular mental and physical state a person enters whenhe/she accepts suggestions uncritically and acts upon them.5 Hypnosis orrelaxation is a learning process in the therapist - patient relationship. Patients aretreated in hypnosis, not with or by hypnosis.

In the minds of some people the word "hypnosis" has connotations of black

magic, or hocus-pocus. The media, movies and fiction books misrepresent it aswell. Many people believe that the therapist has incredible powers, but nothing isfarther from the truth. No one can be hypnotized without their consent.6 Simplystated, it is an absolute, complete state of relaxation. This is commonly called the"trance state,"7 which is accomplished by suggestions given to a patient while heor she is in a hypnotic state.

Imagination and the Human MindImagination and the Human MindImagination is an extremely important ingredient of hypnosis. The law of "will

power and imagination"8 states: "When the imagination and will power conflict theimagination always wins out." When on a diet one may use will power to say theywill not eat, but as soon as they start imagining how good their favorite desertwould taste the mouth starts watering, gastric juices are secreted, and they haveto have it.

Normal sleep is an unconscious state, or a state of unawareness; hypnosis is aconscious state, or a state of awareness.9 It is said that in hypnosis, one'sawareness is increased by 1,000 percent. Patients in the operating room are mostoften induced into general anesthesia using hypnotic medications. What they hear

in those few moments of hypnotic awareness may leave a lasting imprint thatcould effect their physical and emotional health. Therefore, positive commentssuch as, "you will feel better than you thought you would," or "you will have awarm and comfortable feeling as you wake up," encourage positive results to thehealing process. One patient who was told to have a pleasant thought as she wasinduced into anesthesia later emerged from anesthesia saying, those were themost wonderful roses she had ever smelled.

The human mind is extremely complex and there is still a great deal to belearned about it. However, we do know the mind has two levels; the consciouslevel and the subconscious level. The conscious level may be referred to as ourobjective mind, while the subconscious level may be considered as the subjectiveor autonomic mind.10 In the normal state, ideas or suggestions are presented tothe conscious level; while in the hypnotic state they are presented to the

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subconscious level. The subconscious level accepts suggestions more readily andacts upon them. Since the subconscious level cannot analyze what it is told, itaccepts everything as the truth. In the normal conscious state after hypnosis, allunits of mind power are impregnated with the suggestions or ideas that werepresented during the hypnotic state.11

The mind, stimulated by suggestion, is capable of great things through itsimagination. As a result of various emotional reactions, remarkable physical andmental changes can occur;12 these same changes can be obtained throughhypnosis and imagery conditioning.

History of HypnosisHistory of HypnosisHypnosis is older that medicine itself and has been with us since mankind had

its beginnings. Virtually every culture and race of people has used it. Cavedrawings suggest that man was experimenting with hypnosis thousands of year'sago.13

In Biblical times, people went to "sleep temples"14

to be cured of their illnessesby the Egyptian priests. The ancient Chinese employed hypnotic techniques in theform of prayer and meditation. There is evidence that the Romans used "magicsleep" for various purposes. The Greeks unknowingly used hypnosis, thinking thatcures came from the Gods. Hippocrates wrote about impressing health on the illby inducing trances and making passes over the body some what like the healingtouch techniques used today.15

Throughout the centuries, many great medical men have studied, researched,and experimented with hypnosis. In doing so, they were usually labeledcharlatans, quacks, or impostors. It is impossible to mention all of thoseindividuals who contributed to the development and progression of modernhypnosis, but it seems necessary to mention a few.

Some, two hundred years ago, Dr. Franz Anton Mesmer (1734-1815)formulated his own brilliant theory of "animal magnetism."16 He believed that amagnetic fluid permeated the body and that this fluid could help diagnose, cure,as well as prevent illnesses. Dr. Mesmer never realized that his results wereobtained by the power of suggestion.

Many years later, Dr. James Braid (1785-1860) coined the word "hypnosis,"because he was convinced that the trance-like state that he employed was akin to

sleep.17 Later, he recognized that hypnosis was not sleep; but the term hadalready gained common currency. Braid's Theory or Doctrine of Suggestionearned him the title, "Father of Modern Hypnosis."

In 1884, Dr. Sigmund Freud (1856-1939) started using hypnosis in his practicefor the treatment of hysteria.18 However, in the late 1890's he abandoned the useof hypnosis in favor of the free association method. As a result of his early workwith hypnosis, psychoanalysis was born.

Much of the credit for the development of modern hypnosis is given to ahardworking country doctor from Nancy, France, Dr. A.A. Leibeault (1823-1904).19

His interest was focused mainly on the cure of the patient. He arrivedindependently at the conclusion that hypnotic phenomena were purely subjectivein origin.

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Hypnosis gained a great deal of popularity and acceptance during World Wars Iand II and the Korean conflict because of the positive results from its use intreating war neuroses.20

On April 23, 1955, the British Medical Society, and on September 13, 1958, theAmerican Medical Association, after much research and study, officially acceptedhypnosis as a legitimate treatment method to be used by medicine and dentistry.Both groups strongly recommend that instruction in the use of hypnosis beincluded in the curricula of medical schools. It was mutually agreed upon thatpersons who were properly trained and qualified to use it.21 should only usehypnosis

Migraine Headache, Case StudyMigraine Headache, Case Study 2222

Jan weighed over two hundred and fifty pounds. During her first month ofweekly hypnosis sessions she lost weight as expected. However, there was noadditional weight loss noted at the end of her second month of therapy. When

asked how she felt about no additional weight loss her reply was quite a surprise.She was not concerned because she had not had a migraine headache since shebegan hypnotherapy. When Jan recognized the relationship of relaxation and thedisappearance of her headaches her focus changed from losing weight to relieffrom her migraine headaches.

Future hypnosis sessions included suggestions that she no longer hadmigraines because she was eating properly and sparingly and for the nourishmentof her body only. She was also given suggestions for confidence building.Confidence not only in what she had to do, but also in the things she needed todo; such as continuing to eat properly and exercising on a regular basis. Shereported no headaches over the next four months and at the end of six monthsshe had also lost approximately fifty pounds.

Stages, Signs, and PlanesStages, Signs, and Planes 2323

The different levels of hypnosis vary from person to person and are measurableas light, medium and deep planes. These planes are divided into six stages.Characteristic signs note each stage. Each plane is made up of a pair of stages.Plane one consists of stages one and two and so on.

Approximately 20% of the population can go no deeper than a light plane.Rapport and physical relaxation is the distinguishing characteristics of stages oneand two that make up the light plane of hypnosis. This is very important in therelationship between the patient and the health care staff. The patient receivessuggestions from all hospital staff in some manner. The simplest suggestion, suchas a smile, can make a difference in a patient's response to treatment. In stagetwo complete cooperation and deep concentration are the dominant signs.

Stages three and four make up the medium plane of hypnosis and areidentifiable by olfactory and taste changes, aphasia, partial amnesia andanalgesia. Glove anesthesia can be produced and then transferred to other partsof the body. Approximately sixty percent of the population can learn to reach themedium plane.

Stages five and six are the deepest and produce the most dramatic phenomena4


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such as complete anesthesia, total amnesia, visual and auditory hallucinations.Approximately fifteen percent of the population can reach such a deep level.

LeCron states that approximately twenty percent of the population can go nodeeper into hypnosis than the light stages of rapport and relaxation.24 That meansthat eighty percent of the population are at least adequate candidates for apositive response to hypnotherapy. Therefore, a kind word and a positivecomment from a nurse or physician is beneficial in soliciting a positive patientresponse to medical treatment.

Hypnosis and AnesthesiaHypnosis and AnesthesiaHypnosis has been a part of medicine throughout the centuries.25 It was found to

be an effective method of inducing anesthesia long before the existence ofchemical anesthetics. Anesthesia, as well as medicine in general, is acombination of art and science; equally so is hypnosis. In order to use this methodof anesthesia more effectively, it is important for the anesthetist to understand that

hypnosis is a method or technique, not an anesthetic agent.Toward the end of the nineteenth century, there was no longer any question asto the reality of hypnosis, and its use in producing analgesia and anesthesia.26

Historically, natural or hypno-anesthesia preceded chemical anesthesia byapproximately twenty-one years.27

The first operation using hypno-anesthesia reported in the United States was anasal polypectomy, performed thirteen years before Crawford Long28 started usingether as an anesthetic agent. To date, virtually every body cavity has beenentered and almost every organ has been operated upon using hypno-anesthesia.Only recently, valid reports of operations performed under hypno-anesthesiamade the nightly news.29

Hypno-anesthesia should not be considered a replacement for chemicalanesthesia. Not all patients can be hypnotized as easily as they can beanesthetized.30 Nevertheless, hypnosis is a method which can be very useful tothe anesthesia clinician before, during, and after a surgical procedure.

An ideal anesthetic combines the use of hypnotic techniques with reduceddoses of chemical anesthetic drugs. Propofol, Sodium Thiopental, and Etomidateare classed as hypnotics. These anesthesia induction medications when givenslowly in combination with post-hypnotic suggestions greatly enhance patient

recovery from both the anesthetic and the operative procedure. The combinationof pre surgical hypnosis and chemical hypnosis at the time of anesthesia inductiongreatly reduces depression of the cardiovascular, pulmonary, renal, and hepaticsystems. Medhmet C. Oz, M.D. of Columbia-Presbyterian Medical Centerroutinely offers hypnosis to his open-heart-surgery patients to reduce anxietybefore the procedure.31

In contrast to chemical anesthesia, hypno-anesthesia has the advantage ofbeing completely safe and harmless to the patient. The disadvantage of using thismethod is time. In order to use hypnosis as the sole and total means of

anesthesia or even as the major portion of the anesthetic procedure, more time isgenerally required than just the pre-anesthetic visit or phone call. Though it mayvery well be the method of choice for many patients, it is not often used because

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most patients are not aware of hypnosis as an alternative or adjunct to their care.Also, medical personnel are not trained in alternatives such as hypnosis, andthose trained do not want to spend the time required for conditioning the patientprior to the proposed procedure. The advent of epidural anesthesia for labor anddelivery has also had a great impact on patient motivation toward both Lamazeand hypnosis for child birth. If the patient is disinterested the physician followssuit. In addition, the basic induction of hypnosis can require as long as fifteen tothirty minutes.32

Plastic Surgery, Case StudyPlastic Surgery, Case Study 3333Ann, at forty-three, elected to under go plastic surgery for a brow lift and laser

exoneration of the face. She requested the procedure be done using hypnosis. Inpreparation for surgery, Ann under went weekly hypnosis sessions over a fourweek period. She was also taught self-hypnosis and a relaxation tape was used toreinforce suggestions at home. During the pre surgical hypnosis sessions Ann

proved to be only a moderately suggestible patient. The decision was made to usehypnosis as an adjunct therapy with local anesthesia. This was a major departurefrom the general anesthetic requested by the surgeon.

Post hypnotic suggestions using the technique of glove anesthesia were givenfor localized anesthesia about the face, neck and scalp. Suggestions were alsogiven to incorporate all sounds heard and words said in the operating room toenhance a feeling of comfort and relaxation.

The surgeon and the operating room staff were also prompted on how tointeract with the patient. Simple conditions like keeping the room quiet and sayingencouraging words to the patient was requested. Staff were asked to refrain fromasking Ann unnecessary questions which might effect her ability to remainfocused and in a relaxed hypnotic state during surgery.

Ann was very happy with her experience and the surgeon who normally usedgeneral anesthesia on this type of patient asked if future patients could also usehypnosis with local anesthesia as an alternative to general anesthesia.

ConclusionConclusionHypnosis has been shown to be an effective tool for all specialties of the health

care profession. The following are some of the practical applications of hypnosis.1. To overcome fear, apprehension and anxiety so as to reduce the tensionassociated with anticipated anesthesia and surgery.

2. For sedation, either in conjunction with, or as a substitute for drugmedication.

3. To increase patient cooperation and create peace of mind.4. To produce analgesia and/or anesthesia by reducing the total amount of,

or replacing, chemical anesthetic agents.5. To make for a more pleasant and comfortable post operative period.6. To permit the use of post-hypnotic suggestions:7. reduce incidence of post-operative nausea and vomiting.8. encourage deep breathing and necessary coughing,9. raise the pain threshold thereby reducing the need for narcotics,

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10. encourage earlier fluid intake, and (e) increase urinary output.11. To produce amnesia of the procedure.12. To establish better morale, thus motivating the patient toward a faster

recovery.Hypnosis can be used as the method of anesthesia for any surgical, obstetrical,

or dental procedure for almost any age group. It is useful in emergency rooms forminor surgical and orthopedic procedures, especially when the patient has justeaten a heavy meal. When utilizing hypnosis for major procedures, it proved morebeneficial when used as an adjunct to chemical agents.

How does the anesthetist actually decide when to use hypno-anesthesia? Thedecision is usually made for him; it is resolved by the attitude of the patient andthe attending physician. All available information regarding the patient's mentaland physical condition and the planned procedure must be carefully evaluated.The final determination is made exactly as it would be if chemical anesthesia wereto be used.

From all this, it would appear that hypnosis is an ideal method of anesthesia for

most operations. Why is it not used more widely? The answer is that although thetechnical aspects of inducing hypnosis are easy to learn, successful induction andmaintenance of hypno-anesthesia depends largely upon the interaction of manyfactors in the personalities of the patient and the hypnotherapist. These factorsare little understood at the present time, and many of them are not understood atall. Likewise, Sodium Thiopental has been around for a lot of years and the exactmechanism of action is still not completely understood, however, it is still used.

Hypnosis is a valuable addition to the methods and techniques available to allhealth care providers. It is a safe and uncomplicated method of anesthesia, to be

used only by competent, skillful, and ethical anesthetists within the limitations oftheir specialty and in the best interest of the patients. Ideal anesthesia can beachieved by combining hypnotic techniques with safer, smaller doses of chemicalhypnotic anesthetic agents.

Instruction in the use of hypnosis should be included in all health care trainingprograms. As more people become educated in the subject, it will become morereadily and widely accepted.34

REFERENCESREFERENCES1 Roger A. Straus, Ph. D., Strategic Self-Hypnosis (New Jersey: Prentice-Hall, 1982). P. 23.2 Personal experience of the Author.3 Robert K. Stoelting, M.D. and Stephen F. Dierdorf, M.D., Handbook for Anesthesia and Co-Existing

Disease (New York: Churchill Livingston, 1993), p.255.4 William S. Kroger, M.D. and William D. Fezler, M.D., Hypnosis and Behavior Modification: Imagery

Conditioning (Philadelphia: J. B. Lippincott Company, 1976), p. 8.5 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology,

2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 7.6 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications

(New York: Grune and Stratton, 1975), p. 39-40.7 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology,

2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 7.8 William S. Kroger, M.D. and William D. Fezler, M.D., Hypnosis and Behavior Modification: Imagery

Conditioning (Philadelphia: J. B. Lippincott Company, 1976), p. 28.9 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications

(New York: Grune and Stratton, 1975), p.19.

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10 Joseph Murphy, D.R.S., Ph.D., D.D., L.L.d., The Power of Your Subconscious Mind (New Jersey:Prentice-Hall, 1977), p. 33.

11 S. J. Van Pelt, M.D., Secrets of Hypnotism 10th ed. (North Hollywood: Wilshire, 1958), p. 7.12 Leslie M. LeCron and Jean Bordeaux, Ph. D., Hypnotism Today (North Hollywood: Wilshire, 1947),

p. 150.13 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and

Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 1.14 William S. Kroger, M.D. and William D. Fezler, M.D., Hypnosis and Behavior Modification: Imagery

Conditioning (Philadelphia: J. B. Lippincott Company, 1976), p. 8.15 Dorothea hover-Kramer, Ed. D., RN, Healing Touch A Resource for Health Care Professionals(New York: Delmar Publishers, 1996), p. 98.

16 Lesly Kuhn and Salvatore Russo, Ph.D., Modern Hypnosis, 2nd ed. (North Hollywood: Wilshire,1958), p. 1.

17 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications(New York: Grune and Stratton, 1975), p. 7.



20 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications

(New York: Grune and Stratton, 1975), p. 9.21 Personal experience of the Author.22 Leslie M. LeCron and Jean Bordeaux, Ph. D., Hypnotism Today (North Hollywood: Wilshire, 1947),

p. 62.23 Leslie M. LeCron and Jean Bordeaux, Ph. D., Hypnotism Today (North Hollywood: Wilshire, 1947),

p. 74.24 S. J. Van Pelt, M.D., Secrets of Hypnotism 10th ed. (North Hollywood: Wilshire, 1958), p. 9.25 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and

Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 1.26 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and



Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 2.29 NBC Nightly News, June 1997.30 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and

Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 213.31 Lena Kleiman, "The New American Medicine," SELF, April 1997. Pp. 159-226.32 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and

Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 213.33 Personal experience of the Author.34 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications

(New York: Grune and Stratton, 1975), p. 88.

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Hypnosis Principles and Applications. an Adjunct to Anesthesia - m.r. Eslinger

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