VRsano Explained Part 3 – Clinical Hypnosis

Clinical hypnosis is one of the modules utilized by the patented VRsano method.  It alters the psychosomatic state of the patient and is used to guide the patient into a state that is optimally responsive to medical treatment, faster recovery, symptom alleviation, and general health.

In this series of blog posts we break down each of the three main modules of the VRsano method – VR, neurofeedback, and clinical hypnosis.  We explain how they are each used traditionally, their benefits and limitations, and how VRsano is employing them in a new, maximally efficient way.

Clinical Hypnosis is a proven effective treatment method for various disorders and conditions which has so far been underutilized in its clinical use. Clinical use of hypnosis alters the psychosomatic state of the patient and can be used to guide the patient into a state optimally responsive to treatment. Hypnosis has been consistently proven as an effective method for alleviating pain and anxiety, altering somatic functions and leading to improved outcomes after surgery, radiology and chemotherapy treatments, and other invasive medical procedures and treatments (1, 2, 3, 4, 5). Medical hypnosis has also been shown to reduce intra-operative blood loss, hospital stay, and pain and to accelerate bone and wound healing (6, 7, 8, 9). It has been used as a successful adjunct to numerous invasive treatments including coronary bypass surgery, severe burn treatment, and emergency medicine as well (10, 11, 12, 13).

Benefits

A study on how hypnosis affects children having surgery reported that there were half as many anxious children in the hypnosis group than in the control group preoperatively and half as many with behavior disorders postoperatively (14). Children experiencing the painful and fear-inducing voiding cystourethrography (VCUG) also showed less trauma and distress from the procedure and had significantly easier and shorter procedures (by as much as 14 minutes) than non-hypnosis group children (15). Research has shown that patients in the hypnosis group have hospital stays that are 1.6 to 2 days shorter than patients in the non-hypnosis group (16, 17). There has also been evidence that participants in hypnosis groups exhibit structural differences in healing after surgical procedures. A study by Ginandes et al. (8) showed that after a reduction mammaplasty, women in the hypnosis group showed significantly greater wound healing than the non-hypnosis group, 1 through 7 weeks post-procedure.

A meta-analysis of 18 studies of hypnotically induced analgesia (pain relief) reported that hypnotic analgesia is “a valid and reliable phenomenon” with 75% of the clinical and experimental subjects reporting reduction in both acute and chronic pain (18), a finding supported by Patterson and Jenson (19). Another meta-analyses on hypnosis utility with surgical patients found that patients taking part in hypnosis treatment had better outcomes than 89% of patients in control groups, with beneficial effects observed in measures of negative affect, pain, pain medication, physiological indicators, recovery, and treatment time (20).

Limitations

Although hypnosis has proven to be a powerful treatment method for a broad spectrum of disorders, it is plagued by many shortcomings. Limitations include the therapists’ variables such as ability, training, and consistency, environmental variables, and the usual lack of observable/objective feedback to indicate if and when the patient is ready for the next step in induction. The patient’s variables interfering with the intervention are lower hypnotizability, lack of the cognitive abilities of visualization and concentration, heightened distressed state/distractibility, and general distrust of hypnosis.

VRsano

Since visualization is very important in hypnosis, an inability to visualize well can greatly hinder the ability of the patient to enter a state of hypnosis induction and therefore impedes the success of the session. This is especially true in medical settings where the distraction of pain, distress and a new, intimidating environment can make it particularly difficult for a patient to visualize and ignore their surroundings. VRsano combats this problem by using Virtual Reality.  The immersive HD Virtual Reality of the method distracts the patients from their surroundings thus disengaging their mental resources from the distressing reality. The VR images free the patient from the effort of having to visualize under stress and make it much easier for them to engage with the hypnosis.  In addition, the photorealistic HD images correspond to the patient’s current psychophysiological state and are designed in accordance with the principles of imagery’s effects on brain reactivity and neuro-plasticity (for more on VR, see Blog Post 1).

VRsano also addresses the limitations of traditional hypnosis during which it is a challenge for the clinician to detect when the patient is ready for the next step of the induction.  In VRsano, the output of induction steps is dependent on precise brainwave data received from the neurofeedback component.  When the brainwave pattern of the patient fits the predetermined criteria, the algorithm will launch the next step of the hypnosis induction at the moment when the patient is ready to receive and respond to it.  This will maximize the effectiveness of the session and optimize its benefits.  If the patient’s brainwaves do not reach the required parameters, this will indicate to the algorithm that the patient is not easily hypnotizable and guided learning will be employed instead of hypnosis to achieve similar results. In rare cases when the level of distress is too significant and not conducive to hypnosis and/or learning, the device will resume the basic relaxation and distraction mode until the needed state is achieved for the next steps of induction or it will terminate the session, depending on the neurofeedback received from the patient. The gathered psychophysiological data will be fully auditable, saved and utilized in the following session(s), thus customizing the treatment to the needs of the patient and maximizing its benefits (for more on neurofeedback see Blog Post 2).

References

1. Lang E. V., Berbaum K. S., Faintuch S., Hatsiopoulou O., Halsey N., Li X., Berbaum M. L., Laser E., Baum J. (2006). Adjunctive self-hypnotic relaxation for outpatient medical procedures: a prospective randomized trial with women undergoing large core breast biopsy. Pain. 126(1-3):155-164
2. Lang E. V., Benotsch E. G., Fick L. J., Lutgendorf S., Berbaum M. L., Berbaum K. S., Logan H., Spiegel D. (2000). Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. 355(9214):1486-1490
3. Montgomery G. H., Bovbjerg D. H., Schnur J. B., David D., Goldfarb A., Weltz C. R., Schechter C., Graff-Zivin J., Tatrow K., Price D. D., Silverstein J. H. (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. J Natl Cancer Inst. 99(17):1304-1312
4. Lee J. S., Spiegel D., Kim S. B., Lee J. H., Kim S. I., Yang B. H., Choi J. H., Kho Y. C., Nam J. H. (2007). Fractal analysis of EEG in hypnosis and its relationship with hypnotizability. Int J Clin Exp Hypn. 55(1):14-31
5. Colgan S. M., Faragher E. B., Whorwell P. J. (1988). Controlled trial of hypnotherapy in relapse prevention of duodenal ulceration. Lancet. 1(8598):1299-1300
6. Lynn, S. J., Kirsch I., Barabasz A., Cardeña E., Patterson D. (2000). Hypnosis as an empirically supported clinical intervention: The state of the evidence and a look to the future. International Journal of Clinical and Experimental Hypnosis, 48(2), 239-59.
7. Lang, E. V., Benotsch E. G., Fick L. J., Lutgendorf S., Berbaum M. L., Berbaum K. S., Logan H., Spiegel D. (2000). Adjunctive non-pharmacological analgesia for invasive medical procedures: A randomised trial. Lancet, 355(9214), 1486-1490.
8. Ginandes, C., Brooks P., Sando W., Jones C., Aker J. (2003). Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial. American Journal of Clinical Hypnosis, 45(4), 333-351.
9. Ginandes, C. S. & Rosenthal, D. I. (1999). Using hypnosis to accelerate the healing of bone fractures: A randomized controlled pilot study. Alternative Therapies in Health and Medicine, 5(2), 67-75.
10. Mehmet, C. O. (2000). About self-hypnosis and coronary artery bypass surgery. Journal of Cardiothoracic Surgery (Torino), 41(2), 335-336.
11. Peebles-Kleiger, M. J. (2000). The use of hypnosis in emergency medicine. Emergency Medicine Clinics of North America, 18(2), 327-338.
12. Gallagher, G., Rae, C. P., & Kinsella, J. (2000). Treatment of pain in severe burns. American Journal of Clinical Dermatology, 1(6), 329-335.
13. Spiegel, R. B. (2011). The Integration of Heart-Centered Hypnotherapy and Targeted Medical Hypnosis in the Surgical/Emergency Medicine Milieu. Journal of Heart-Centered Therapies, 14(2), 87-106.
14. Calipel, S., Lucaspolomeni, M., Wodey, E., & Ecoffey, C. (2005). Premedication in children: Hypnosis versus midazolam. Pediatric Anesthesia, 15(4), 275-281.
15. Butler, L. D., Symons, B. K., Henderson, S. L., Shortliffe, L. D., Spiegel, D. (2005). Hypnosis reduces distress and duration of an invasive medical procedure for children. Pediatrics, 115(1), e77-e85
16. Lobe, T. E. (2006). Perioperative hypnosis reduces hospitalization in patients undergoing the Nuss procedure for pectus excavatum. Journal of Laparoendoscopic & Advanced Surgical Techniques, 16(6), 639-642.
17. Cowan, G. S., Jr., et al. (2001). Assessment of the effects of a taped cognitive behavior message on postoperative complications (therapeutic suggestions under anesthesia). Obesity Surgery, 11(5), 589-593
18. Montgomery, G. H., Durham, K. N., & Redd, W. H. (2000). A meta-analysis of hypnotically induced analgesia: How effective is hypnosis? International Journal of Clinical and Experimental Hypnosis, 48, 138-153.
19. Patterson D. R., Jensen M. (2003). Hypnosis and clinical pain. Psychological Bulletin. 129(4):495-521.
20. Montgomery, G. H., David, D., Winkel, G., Silverstein, J. H., Bovbjerg, D. H. (2002). The Effectiveness of Adjunctive Hypnosis with Surgical Patients: A Meta-Analysis. Anesthesia & Analgesia. 94(6), 1639-1645.