Kaplan + Sadock's Synopsis of Psychiatry, 11e

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28.9 Hypnosis

behavioral compliance and suggestibility. The HIP is a shorter test that uses the eye-roll sign as a biological indicator and mea- sures cognitive flow, which differentiates those with no hypnotic capacity because of mental pathology from those mentally nor- mal patients with any inherent hypnotic capacity (Fig. 28.9-1). Induction Many different induction protocols follow the same basic prin- ciples and pattern, but may be better suited to the patients with different levels of hypnotizability. Doctor: Take a long, deep breath—inhale and exhale; now close your eyes and relax. Pay particular attention to the muscles in and about your eyes—relax them to the point that they just won’t work. Are you trying to do that? Good. If you really have them relaxed, right at this very moment, no matter how hard you try, they just won’t open. Test them. The harder you try, the faster they stick together, just as if they were glued together. That’s fine! Now you can open your eyes; that’s good. When I tell you to and not before, open and close your eyes once more, and, when you close them this time, you will be ten times as relaxed as you are right now. Go ahead, open and close, and feel that surge of relax- ation go through your whole body, from the top of your head to the tip of your toes. Very good! Now once again, open and close your eyes, and this time, when you close them, you will double the relaxation that you now have. Fine. Table 28.9-2 Hypnotic Induction Profile–Derived Method of Self-Hypnosis One, look up toward your eyebrows, all the way up; two, close your eyelids slowly and take a deep breath; count to three, exhale, let your eyes relax, and let your body float. As you feel yourself floating, you permit one hand or the other to feel like a buoyant balloon and allow it to float upward. As it does, your elbow bends, and your forearm floats into an upright position. When your hand reaches this upright position, it becomes a signal for you to enter a state of meditation and to increase your receptivity to new thoughts and feelings. In this state of meditation, you concentrate on this feeling of imaginary floating and, at the same time, concentrate on the following critical points (e.g., the three critical points to stop smoking in the following discussion). Reflect on the implications of these critical points, and then bring yourself out of this state of concentration called self-hypnosis by counting backward in this manner: Three, get ready; two, with your eyelids closed, roll up your eyes (do it now); and, one, let your eyelids open slowly. Then, when your eyes are back in focus, slowly make a fist with the hand that is up; and, as you open your fist slowly, your usual sensation and control returns. Let your hand float down. That is the end of the exercise, but you can retain a general overall feeling of floating. By doing this exercise ten different times each day, you can float into this state of buoyant repose. Give yourself this island of time, 20 seconds, ten times a day, in which to use this extra receptivity to reimprint these critical points. Reflect on them, then float back to your usual state of awareness, and then continue with what you ordinarily do. (Courtesy of Herbert Spiegel, M.D., Marcia Greenleaf, Ph.D., and David Spiegel, M.D.)

Table 28.9-1 Indicators of Trance Development

Autonomous ideation Balanced tonicity (catalepsy) Changed voice quality Comfort, relaxation Economy of movement Eye changes/closure Facial features ironed out Feeling distant

Feeling good after trance Lack of body movement Lack of startle response Literalism Objective and impersonal ideation Pupillary changes

Response attentiveness Retardation of reflexes: Swallowing Blinking Sensory, muscular, and body changes Slowing pulse Slowing and loss of blink reflex Slowing respiration Spontaneous hypnotic phenomena: Amnesia Anesthesia Catalepsy Regression Time distortion Time lag in motor and conceptual behavior

(From Erickson M, Rossi EL, Rossi SI. Hypnotic Realities: The Induction of Clinical Hypnosis and Forms of Indirect Suggestion . New York: Irvington; 1976:98, with permission.)

and noxiousness of pain are believed to be processed by differ- ent regions of the brain, because different areas of reduced blood flow result when each is minimized through hypnosis. The role of the anterior brain regions, such as the frontal lobes, in hypnosis has been shown physiologically by the posi- tive correlation between homovanillic acid concentrations in the cerebrospinal fluid and degree of hypnotizability. The frontal cortex and basal ganglia have a large number of neurons that use dopamine, of which the metabolite is homovanillic acid. This may explain why pharmacological enhancement of hypnotiz- ability, although difficult, is primarily accomplished with dopa- minergic agents, such as amphetamine. The increased activation of the basal ganglia may relate to the increased automaticity of hypnotic motor behavior.

Clinical Assessment of Hypnotic Capacity

Two major procedures exist to clinically evaluate hypnotic capacity: the Stanford Hypnotic Susceptibility Scale and the Hypnotic Induction Profile (HIP) (Table 28.9-2). The Stan- ford Hypnotic Susceptibility Scale is a long laboratory-based test that has been modified for clinical evaluation and requires approximately 20 minutes to perform. It primarily measures