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How hypnosis is clinically utilized to address the spectrum of cancer's physical and psychological dimensions
By Gérard V. Sunnen, M.D.
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Techniques of Pain Relief in Cancer
When used adjunctively with analgesics, hypnosis can serve to reduce their dosage (Pinnell, 2000). The following approaches may be used singly or concomitantly in any patient, depending upon their hypnotic proficiencies (Edwin, 2001).
Hypnotic relaxation. Hypnosis may be described as the most potent non-pharmacological relaxant known to science. An important mechanism of hypnotic pain reduction centers upon its remarkable property for quelling anxiety in any one of its myriad expressions. Anticipatory anxiety — the anxious sensation that pain may ominously appear or worsen — may be so relentless that it creates its own anxiety. Relaxation can significant assist analgesia and enrich quality of life (Levitan, 1999).
Direct suggestions for pain removal. Some patients easily assimilate direct suggestions that the pain will diminish in intensity to the point of becoming unnoticeable. In spite of psychoanalytic assertions that symptom removal necessarily implies symptom substitution, it is often gratifying to observe patients responding unequivocally to such suggestions as: "Your mind has the capacity to let go of the discomforts and the pains you have been experiencing. With each breath, let discomforts give up their intensity to the point where they lose their power, and possibly even vanish."
Hand anesthesia with extension and diffusion. The hand is ideally suited as a starting point for hypnotic anesthesia because it is so richly endowed with sensory innervation and occupies such a prominent place in the cortical homunculus. Once the anesthetic experience is established in the hand, it is a relatively small step to transfer it to other parts of the body.
Altering the configuration of pain. The representation of pain in the mind — the pain's body image — may be reconfigured to occupy a smaller space in the mind's eye, therefore assuming less experiential presence. Neurophysiologically, this corresponds to a shrinking of cortical association networks. Suggestions are made for the pain to decrease in size as the patient is asked to visualize the pain as a progressively dwindling three-dimensional shape in mental space (Hammond, 1990).
Altering the qualitative aspects of pain. As pain fibers project from thalamic nuclei through diffuse thalamic radiations into cortical association networks, they gather complex nuances of experiencing. Pain is a multisensory dimension malleable by cortical influences. Hypnotic intervention, by the medium of recruitment of cortical override, is thus able to change pain's qualitative expressions. Pain may be paired with coolness, warmth, heaviness, or other sensory modality, in order to soften the sharpness of its impact.
Imagery. With some individuals, hypnotic imagery is the most effective pathway to pain control. The type of imagery favored depends upon the patient's eidetic style. The imagery proclivities of the patient are noted in order to match imagery style with appropriate suggestions (Hammond, 1990). "Imagine a garden richly endowed with beautiful vegetation bathed in sunlight. The garden represents the forces in your mind. You notice some plants that do not appear to fit in this space. They represent your discomforts and your difficult symptoms. As you approach this unwanted vegetation you can begin to decide ways you want to deal with them."
Dissociation. Dissociation is an effective mechanism by which the pain may be experienced as moving away from the locus of awareness (Rainville et al., 1999). "The pain is not sticking to you. It begins to disconnect from your body, traveling outward, moving with each breath further and further into the distance; so far that it may even feel that it no longer belongs to you."
Hypnotic Treatment of Chemotherapy Side Effects
Particularly bothersome for some patients are certain side effects of chemotherapy. Sometimes a patient will become so sensitized by treatment after-effects that even the thought of subsequent sessions brings about great autonomic distress. Hypnosis has been well documented to have therapeutic potential for conditioned anticipatory emesis (Genuis, 1995; Marchioro, 2000). The following case illustrates some of the treatment principles in this condition.
A 26 year old graduate student with stage three Hodgkin's disease was receiving combination chemotherapy. Although physically tolerating this regimen, he became increasingly distressed by post-treatment nausea. During the third treatment, his nausea became so bothersome that he inquired about other treatment options. He complained of anticipatory anxiety and described how the mere picturing of the doctor's office had brought him waves of gastric turmoil.
Induction made use of the hypnotic technique of awareness of breath, an ancient discipline central to many practices of meditation. Eyes closed, he was asked to dispatch his feelings into his breathing and open his perception to the sensation of air touching the inside of his lungs. An ideomotor technique signaled degrees of internal discomfort. When nausea was experienced, his index finger moved sideways. When nausea was relieved, he moved it back. To counter nauseous feelings, sensations of hunger were elicited. Did he like the fresh taste of mint? What were his favorite foods and memorable gastronomical experiences? He imagined a typical treatment session gradually pairing treatment scenarios with intestinal comfort. Dissociation strategies were used to repel nausea further and further away in mind space. During the third session, he was able to visualize himself receiving treatment with no distress. In the actual treatment situation, he experienced only mild nausea but no vomiting, and he was able to gracefully finish his entire regimen protocol.
Hypnosis in preparing patients for medical procedures and operations
Cancer patients, in their medical trajectories, are likely to encounter a variety of diagnostic procedures and operative interventions. Confronted by an expanding array of medical tests and complex surgical options, the mind often reacts with perplexity and apprehension.
Hypnotic techniques are used to reduce anticipatory worry and to regulate sleep and other biological rhythms, thus saving the organism's energy reserves (Kessler, 1996; Montgomery, 2002). Post-hypnotic suggestions — affirmations designed to actualize themselves at a future time — can express themselves during the operative procedure so as to stabilize physiological parameters, even while anesthesia is administered (Eger, 1999). Postoperatively, hypnotic intervention aims to accelerate the physical and psychological task of convalescent healing (Holden Lund, 1988) read more›
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