Clinical ReviewsAn Hypnotic Suggestion: Review of Hypnosis for Clinical Emergency Care
Introduction
Although hypnosis has been used in medicine for nearly 250 years, emergency clinicians rarely use it in emergency departments (EDs) or prehospital settings. This review describes hypnosis, its historical use in medicine, several neurophysiologic studies of the procedure, its uses and potential uses in emergency care, and a simple technique for inducing hypnosis. It also discusses some reasons why the technique has not been widely adopted and suggests some methods to increase the use of hypnosis in emergency care, including potential areas for emergency medicine−related research.
Section snippets
What Is Hypnosis?
Although its etymology derives from the Greek hypnos, meaning sleep, hypnosis is actually a state of highly focused awareness. Hypnosis, familiar to most people as a staple of stage shows, film noir, and psychiatric practice, often appears under other guises, such as meditation, religious ecstasy, guided imagery, therapeutic imagery, suggestive therapeutics, guided meditation, and biofeedback. Hypnotic trance states can also occur naturally, as when reading an absorbing book, watching an
Brief History of Hypnosis
Medical and religious practitioners have used hypnosis for millennia under various names. Calling it “sacred sleep,” Egyptian priests used hypnosis for religious and medical purposes at least 4000 years ago; the ancient Greeks were treated with hypnosis in “sleep temples of the sick.”
Medical hypnotism's modern era began in 1778, when the Austrian physician Franz Anton Mesmer introduced it in France under the unfortunate name “animal magnetism.” In the 19th century, surgeons John Elliotson and
Is Hypnosis Real?
Neurophysiologic studies demonstrate that hypnosis differs from simple imagination, placebos, and sleep (21). Research using positron emission tomography (PET) shows that hypnosis involves the anterior cingulate cortex and that actual changes occur in the brain's perception that do not occur when a suggestible person simply follows instructions 22, 23. PET also shows that hypnosis, through the midcingulate cortex modulating a large cortical network, actively decreases a person's subjective and
Uses in EM and Emergency Medical Systems
Hypnosis has been sporadically discussed in the emergency medical literature, and is even rarer in the emergency medical systems (EMS)/wilderness medicine literature 15, 37, 38, 39, 40, 41, 42, 43, 44. Hypnosis fulfills nearly all requisites of the ideal EM intervention; it is safe, fast, readily available, cost effective, uses minimal personnel and equipment, and has no risks. In addition, it can be used in any age group, including the elderly, with children aged 7 to 14 years old being
Hypnotic Techniques
Multiple techniques to induce hypnosis have been described, including the arm-drop, arm levitation, association, bionic arm (for children), confusion, two-finger, and direct gaze (60).
Basic hypnotic techniques are easy to learn. Most clinicians have or can learn the interpersonal communication skills and the methods to put people at ease that foster successful hypnosis; many physicians with a “good bedside manner” already use some of these elements, such as calm reassurance, a steady speech
Hypnotizability
The common myth is that only gullible people or those with deficient intellects can be hypnotized. In reality, only those with the power to concentrate can be hypnotized. Hypnotic suggestibility is a sign of psychological health. Those with very low intelligence, schizophrenics, patients inebriated with drugs and alcohol, and those with organic brain syndrome cannot usually be hypnotized, although that varies with the individual subject (47). Boulton and Cole, writing about anesthesia in
Why Don't Emergency Clinicians Use Hypnosis?
Discussing hypnosis in 1989, Bierman wrote, “Direct clinical application of such phenomena to medical emergencies has received only sporadic attention” (39). Although medical hypnosis has been used for millennia, most emergency clinicians hesitate to use this nonpharmacological intervention for a variety of reasons, including its association with alternative-complementary medicine. As Boulton wrote, “It is a pity that hypnosis, admittedly through the fault of some of its practitioners, often
Potential Hypnosis Studies in EM
Investigational studies will be needed to identify how hypnosis can best be used in EM. Hypnosis offers ED and prehospital practitioners numerous investigational opportunities. Study areas can be most easily divided into patients, methods, and outcomes.
Patient-related studies might usefully address what factors make EM patients more hypnotizable, such as age, presenting complaint, chronic or acutely administered medications, level of alcohol/illicit drug use, prior hypnotic experiences, and
Conclusions
Hypnosis holds enormous potential as a safe nonpharmacologic tool for patient care in emergency medicine, prehospital care, and remote medical settings. Advancing its use in EM and prehospital care will require research into the most effective techniques, delineating in which acute care situations, where it is most effective, providing education and training in hypnotic techniques, and, eventually, its endorsement by major professional organizations and inclusion in required curriculums.
Every
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Cited by (32)
Implications on hypnotherapy: Neuroplasticity, epigenetics and pain
2021, Neuroscience and Biobehavioral ReviewsCitation Excerpt :Numerous studies have showed that hypnosis can be an effective and safe approach for the treatment of pain, wound healing, emotional stress, haemorrhage, depression, anxiety, sleeping disorders or stressful events like surgical procedures or tooth extraction. Furthermore, hypnosis has been applied in the context of bone marrow aspiration, colonoscopy and for psychotherapy (Chester et al., 2016; Rogovik and Goldman, 2007; Evans et al., 2008; Iserson, 2014; Schnur et al., 2008; Fuhr et al., 2017; Chiu et al., 2018; Golden, 2012; Milling et al., 2018; Moser et al., 2013; Mackey, 2018; Abdeshahi et al., 2013; Chen et al., 2018; Wobst, 2007). Feeling pain is a stressful and often induces anxiety.
Use of hypnosis in the field of dementia: A scoping review
2021, Archives of Gerontology and GeriatricsCitation Excerpt :Therefore, the management of the distress and symptoms of persons with dementia is gaining increasing importance with a view to improving their quality of life. Hypnosis is a method of treatment that is considered effective on physical and psychological symptoms in the following settings: emergency care (Iserson, 2014), depression (Shih et al., 2009; Yapko, 2001; Yapko, 2013), anxiety (Hammond, 2010), sleep disorders (Becker, 2015; Cordi et al., 2015), chronic pain (Morone & Greco, 2007), obesity (Cherniack, 2008), cancer (Cramer et al., 2015; Liossi & White, 2001; Richardson et al., 2007), as an adjunct during colonoscopy (Elkins et al., 2006), substance abuse disorders (Green & Lynn, 2000; Potter, 2004), dermatology (Shenefelt, 2000) and sexual dysfunctions (Stanley & Burrows, 2001). This method consists in “a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion” (Elkins et al., 2015).
Clinical Practice Guideline: Needle-Related or Minor Procedural Pain in Pediatric Patients
2019, Journal of Emergency NursingCitation Excerpt :Hypnosis has been used for over 250 years in various fields of medicine and has been used at times by emergency clinicians (Iserson, 2014). Hypnosis is beneficial because it can reduce individuals’ subjective and objective perception and an individual’s emotional response to pain (Iserson, 2014). In the emergency setting, hypnosis has been used for pediatric patients undergoing incision and drainage, foreign-body removal, suturing, and reduction of fractures and dislocations (Iserson, 2014).
Hypnoanesthesia in vascular access
2015, JAVA - Journal of the Association for Vascular AccessPain management at the emergency room reception desk
2020, Revue de l'Infirmiere
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