ipa november pediatric hypnosis no video
TRANSCRIPT
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Franz Baumann
The first pediatrician elected President of the
American Society of Clinical Hypnosis (1950-1970)
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Learning Objectives
Objective #1: What is pediatric hypnosis?
Developmental and Experiential Component
Objective #2: Pediatric hypnosis – efficacy &
applications?
Objective #3: Training & integrating into your practice
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Thesis
Clinical pediatric hypnosis is a tool to
facilitate the evolution and refinement of
self-regulation skills and capacities.
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Ego Integrity
vs. Despair
Intimacy vs. Isolation
Trust vs.
Mistrust
Identity vs.
Role
Confusion
Working Toward Mastery
Autonomy
vs. Shame
& Doubt
Initiative
vs. Guilt
Industry
vs.
Inferiority
Generativity
vs.
Stagnation
Erik Erikson’s 8 Psycho-Social Stages of Development
Pendergrast and Lombard, March 22, 2014
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Definitions of hypnosis
www.lisalombardphd.com
Hypnosis: a state of consciousness involving focused
attention and reduced peripheral awareness
characterized by an enhanced capacity for response to
suggestion.
Hypnotizability: an individual’s ability to experience
suggested alterations in physiology, sensations,
emotions, thoughts, or behavior during hypnosis.
Hypnotherapy: The use of hypnosis in the treatment of
a medical or psychological disorder or concern.
The American Psychological Association Division 30, 2014
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Definitions of hypnosis
www.lisalombardphd.com
Hypnosis is a state of inner absorption, concentration and
focused attention. It is like using a magnifying glass to focus
the rays of the sun and make them more powerful. Similarly,
when our minds are concentrated and focused, we are able to
use our minds more powerfully. Because hypnosis allows
people to use more of their potential, learning self-hypnosis is
the ultimate act of self-control.... Recent research supports the
view that hypnotic communication and suggestions effectively
changes aspects of the persons physiological and neurological
functions.
American Society of Clinical
Hypnosis Website
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Definitions of hypnosis
A spontaneously occurring or induced alternative
state of awareness (with or without relaxation,
which may or may not be evident) in which an
individual develops a focused concentration on
some idea or image with the expressed purpose
of maximizing potential, creating a CHANGE,
and/or reducing or resolving some problem (Kohen
and Olness, 2011).
www.lisalombardphd.com
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Hypnotizability
Essential traits needed to be hypnotized include:
being able to focus one’s attention being highly responsive to
suggestion.
(Brown & Fromm, 1986)
www.lisalombardphd.com
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Hypnosis myths
Bad hypnosis cartoons
frame width="420" height="315"
src=”/www.youtube.com/embed/b0flM2Oflvo"
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What limits hypnotizability and
effectiveness?
Misconceptions about hypnosis.
May see hypnosis as “magic”
May refuse because of secondary gain of symptoms.
Attitudes of significant adults
Parents
www.lisalombardphd.com
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Pediatric Hypnosis
A tool to strengthen children‘s existing or
under-developed skills in self-regulation,
i.e., capacities to shift attention, maintain
focused attention, inhibit and control
reflexive actions, delay gratification, use
problem solving strategies, and self-monitor
and modulate thinking, emotion, behavior,
and psycho-physiological reactivity.
Kaiser, P. Chlldhood Anxiety, Worry, and Fear: Individualizing Hypnosis Goals and
Suggestions for Self-Regulation. Am. J. Clin. Hypn. 2011, 54, 16–31
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Daily and Random
Hypnotic Experiences
TV/video games
Sports trance…in the zone
Daydreaming
Booboo and runs to parent
At the hospital, doctor’s office
www.lisalombardphd.com
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http://youtu.be/XhLrlhFzAjA
www.lisalombardphd.com
Notice how Disney Introduction uses many of
the same elements:
absorption, narrowed focus, multi-sensory
input, novelty, curiosity about what comes next,
etc.
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Pediatric Clinical Hypnosis –
Many Shapes
Formal
Conversational
Spontaneous
Self-hypnosis
Books
Drawings
Materials (monotonous)
Metaphors
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www.lisalombardphd.com
Imaginative involvement Process where the child is absorbed in a "here and now" fantasy
experience
Present reality is suspended in the interests of the current experience
Used with younger children
Used instead of classic hypnosis
Must pay attention to the (changing) behavioral responses of young
children
Different from Classic Hypnosis which may involve:
dissociated ego state
profoundly relaxed physiological state
distinct altered state of consciousness
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Developmental Considerations
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Developmental differences in
hypnotic processes
www.lisalombardphd.com
Younger children
less structured
more action-oriented
present-centered
Children 7 years and older
Ability to close eyes during hypnosis
Use creative imagination
More structured
Hypnotic process in adults
Structured
Ability to close eyes
More relaxation
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Clinical Hypnosis across development:
Infants and toddlers
Infants and toddlers understand the world through sensory experiences
Hypnosis in infants and toddlers: Sensory or motor based techniques
Auditory
Playing soothing music, singing songs- lullabies, telling a story
Kinesthetic
Rocking- example would be rocking at a pace that approximates maternal heart beat
Soothing
Repetition, familiarity, predictability
Minimally verbal, direct, simple
Integration of play and hypnotic suggestion
www.lisalombardphd.com
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Across Development: Preschool
YearsPreschoolers
LanguageSimple and clear; Cognitively concrete and literal in their communication and comprehension
FlexibilityFollow child in and out of trance in a sensitive manner; Unaccustomed to physical relaxation; Move fluidly between fantasy and reality; Move around with eyes open during hypnosis without effecting trance
AttentionAbsorb child's attention in an informal manner; Short attention spans
Avoid lengthy inductions
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C Cognitive functioning
Longer attention spans
Better cooperation
Ability to use imagination
More willing to close eyes
Can relax their bodies
Breathing is more regular
Metaphors and suggestions
Focused facial expressions
Tell child that hypnosis is a talent that can be used anywhere
Use child's personal experiences to make hypnosis relevant
School Age Children
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Induction and Deepening
Techniques with Children Eyes open story
Mighty oak tree
Raggedy Ann doll
Progressive muscle relaxation (e.g., imagery such as melting snowman)
Favorite place, song, activity…
T.V., movie, computer game
Bouncing ball adventure
Boat ride, magic carpet ride, ride in clouds
Fill sand pail
Eye fixation
Distraction
Ideomotor techniques
www.lisalombardphd.com
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Using Hypnosis in Child
Therapy
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Thinking(Cognition)
Feeling (Affect)
Doing (Behavior)Sensing
(Physiological/Sensory)
Treatment Goals
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Manage Symptoms
Interrupt Old Patterns/
Create New Patterns
Improve Self-Regulation
Develop Discrimination
Skills
Enhance Resources
Build Positive
Expectancies
Model based on Pamela Kaiser’s
work
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Elements of Hypnotherapy
Rapport
Induction and Intensification
Suggestions/Metaphors/Themes
Check-in with patient
Contextualization/PHS
Closure, Alert, and Orient
Debrief
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Only describe what you
notice
Rather than,
“you are feeling relaxed now…”
invite the patient to notice differences or change…
??????
“Let me know please when you are beginning to notice the relaxation…”
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When people are curious they listen carefully
Convey Positive Expectations:
“ I won’t be surprised WHEN…”
“ Won’t it be great WHEN…? ”
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Therapeutic Uses of Language
(When…not IF)
“IF you can feel your muscles relax…”When you feel relaxed, then you’ll be very proud of
yourself & comfortable…
“TRY to ….”You may wish to…
“I want you to move your arm down.”You might be curious to notice how it feels to move your arm…
What’s not good about these phrases? How can you improve them?
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BecauseWhy is this word important in suggestions?
Because people need a reason to do the suggestion.
Motivating (based on history and treatment plan).
“Allow yourself to relax down to your feet…because ???
You may wish to imagine a beautiful magic carpet
because???
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Ego StrengtheningOffer reinforcing suggestions or statements
“You are doing this very well.”
“ As you do this more and more for yourself you will
probably be very proud of what you are learning and
accomplishing…”
“It’s good to know that you are doing this exactly
right.”
Emphasize words like: confidence, competence, comfort,
pride, joy, satisfaction, peace, serenity, comfortable
easily, effortlessly, relaxed, slowly
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Post-Hypnotic Suggestions
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Five Senses
Touch
Sight
SoundSmell
Taste
Developing Cues for PHS
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Range of applications
Anxiety, including PTSD
Phobias (simple/complex)
Learning Disabilities, Asperger’s Disorder
Hypnoanalgesia
Medical Problems Invasive Medical
Procedures
Pediatric Medical Problems
Habit Disorders
Trichotillomania
Nail biting
Thumb sucking
Enuresis
Sleep Disturbances
www.lisalombardphd.com
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Specific Pediatric Medical
Problems
Asthma
Hives
Allergies
Itching, scratching, picking
Hyperhidrosis
Warts
Diabetes
Neurologically mediated intractable reflexes
Cerebral palsy
Reflex sympathetic dystrophy
Rehabilitation following central nervous system injury
Pulmonary symptoms related to psychological problems, discomfort because of medication, or fear related to procedures
Dentistry
www.lisalombardphd.com
Cancer
Hemophilia
Gastrointestinal disorders
Juvenile rheumatoid arthritis
Malignancies
Headaches
Seizures
Urine retention
Cyclic vomiting
Sports medicine
Burns
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• Thinking
• Doing
• Feeling
Summary: Pediatric hypnosis promotes self regulation in
functioning
• Sensing
• Noticing
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Self Regulation - Thoughts
Foster locus of control
• More realistic risk-appraisal
• Cognitive restructuring: catastrophic thinking
• Expand self-efficacy: draw on past mastery experiences
• Compartmentalize
• Create + expectations
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Self Regulation - Emotions
• Emotional literacy
• Manage extreme or strong feelings; Compartmentalize anxiety and fear
• Feelings change in degree and over time; Let go of old fear/anxiety
• Label feeling within body; Embodied thinking
• Sense of internal safety and empowerment
• Increase comfort and calmness
• Foster optimism
• Strengthen confidence to manage situation
• Separate-individuate from parental external soothing and reassurance (LOC)
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Modulate emotional reactivity
Compartmentalize fear/anxiety/worries
box- balloons
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Anxiety/Worry/Fear Reactivity:
Tantrums & meltdowns
Nightmares
Specific fears
Panic
Limited self-soothing
Anxious attachment
Seek reassurance/proximity/contact
Bite/pick (nails, lips, clothes)
Hypervigilance
Gaze aversion
Cry/tantrum
School avoidance/resistance
Avoid-escape-freeze
www.lisalombardphd.com
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Brain with dimmer switch in it; emotions go from
sad to happy
Pendergrast and Lombard, March 22, 2014
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Self Regulation - Behaviors
• Down-regulate or Up-regulate
• Cause and effect
• Healthy choices
• Adjustment to chronic illness and conditions
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MindUp Curriculum: Mindfulness in
Preschool through 3rd Grade
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www.lisalombardphd.com
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Self Regulation - Attention
• Alert and activate
• Discrimination: essential from non-essential details
• High Interest vs. Low Interest Activities
• Magnification
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Self Regulation - Sensing
Modulate Psychophysiological Reactivity:
Dampen initial response - numbing
Relaxation training - belly breathing
Raise sensory threshold
Calm a specific internal organ (e.g., stomach)
Reframe panic episodes - somatization reduction
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Modulate PSYCHOPHYSIOLOGICAL REACTIVITY with
hypnotic suggestions
Dampen initial and sustained reactivity
0-10 scales
Control panel (be the “boss”)
Calm and self sooth
www.lisalombardphd.com
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Review of Self RegulationLearned ability to control inner states or responses
related to:
Thoughts - Cognition
Emotions - Feeling
Behavior - Doing
Attention - Noticing
Physiological Reactivity - Sensing
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How Hypnosis addresses pain
Develops metaphor
Captures imagination
Sustains and promotes hope
Curtails uncertainty and fear
Plays with possibilities
Works with paradox
Envisions optimal outcome
Distorts time
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www.lisalombardphd.com
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Pediatric hypnosis has been used with these
Medical Problems
Asthma
Hives
Allergies
Itching, scratching, picking
Hyperhidrosis
Warts
Diabetes
Neurologically mediated intractable reflexes
Cerebral palsy
Reflex sympathetic dystrophy
Rehabilitation following central nervous system injury
Pulmonary symptoms related to psychological problems, discomfort because of medication, or fear related to procedures
Dentistry
Cancer
Hemophilia
Gastrointestinal disorders
Juvenile rheumatoid arthritis
Malignancies
Headaches
Seizures
Urine retention
Cyclic vomiting
Sports medicine
Burns
www.lisalombardphd.com
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Switch-wire Imagery• Pair hypnosis with new variations of imagery to help
children cope with phobias & pain
• A dissociation-oriented imagery involving a “switch-wire” metaphor can help child turn on/off the anxiety at the sight or experience of the phobic stimulus
• Helps develop mastery and control of fear
• Teaches a child to dissociate his/her body; adds to heightened experience of hypnotic induction and suggestion
• A switch metaphor is more tangible and can be more easily visualized for a younger child
• Children can easily utilize the self-hypnotic protocol once learned
www.lisalombardphd.com
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APPLIED ANALGESIA
Suggestions: These classic suggestions use different parts of
the brain.
You feel numbness in your body (Somatosensory).
The sensations seem far away (Thalamus).
If you feel anything, it might be a feeling of pressure or tingling (Prefrontal cortex).
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Magic Glove
Leora Kuttner, Ph.D.
Clinical Psychologist and Clinical Professor of
Pediatrics Vancouver, BC. Canada
http://lifeafterpain.com/info/expert-interviews/managing-pain-
interview-with-doctor-leora-kuttner/
http://youtu.be/cyApK8Z_SQQ?t=32s
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Applications of Hypnosis in
Chronic Illness
Post-Hypnotic Suggestions: ease of remembering
sensations of comfort, joy, easy breathing, etc.
Amnesia: forgetting prior discomfort, regression to
time before the illness, use of “Affect Bridge” to bring
good feelings back.
www.lisalombardphd.com
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Applications of Hypnosis in
Chronic Illness...
Strategies
Create atmosphere of hope, positive expectations for
change, help child to perceive a difference with re-
framing...
Time Distortion - regression, progression
Scales of comfort/discomfort e.g. 0-12 (useful for
pain, anxiety, sleep, etc.)
Dissociation - THAT DISCOMFORT, NOT YOURS
www.lisalombardphd.com
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Applications of Hypnosis in
Chronic Illness... Imagery
Color, Size of discomfort > change it
= where you’d rather be imagery
Imagery to turn things down, off...around the body to make repairs, create changes in organs, healing, brain’s computer...
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Pediatric Surgery
Preoperative
Suggestions focus on comfort and calm, easy return to normal body functions, and rapid healing
Hypnotherapy as adjunct to anesthesia
Allows child to be more active
Found to reduce anticipatory anxiety and procedure-related pain, anxiety, distress behavior, duration, and improve the quality of recovery
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Applications of Hypnosis in Chronic Illness...
Split-Screen Technique:
Problem on one side, desired outcome on the other
side.
Watch (or create) the change, as one gets smaller and
the other bigger...
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“Go to Resource” to get
started Kohen, D.; Kaiser, P. Clinical Hypnosis with Children
and Adolescents—What? Why? How?: Origins,
Applications, and Efficacy. Children 2014, 1(2), 74-98;
doi:10.3390/children1020074.
http://www.mdpi.com/2227-9067/1/2/74
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Select References Anbar, R.D. Self-hypnosis for patients with cystic fibrosis. Pediatr. Pulm. 2000, 30, 461–465.
Anbar, R.D.; Hall, H.R. Childhood habit cough treated with self-hypnosis. J. Pediatr. 2004, 144, 213–217.
Curtis, S.; Wingert, A.; Ali, S. The Cochrane Library and Procedural Pain in Children: An Overview of Reviews. Evid.-
Based Child Health: A Cochrane Rev. J. 2012, 7, 1363–1399. doi:10.1002/ebch.1864.
Cyr, L.R.; Culbert, T.; Kaiser, P. Helping children with stress and anxiety: An integrative medicine approach.
Biofeedback 2003, 31, 12–17.
Gold, J.I.; Kant, A.J.; Belmont, K.A.; Butler, L.D. Practitioner review: Clinical applications of pediatric hypnosis. J.
Child Psychol. Psychiatry 2007, 48, 744–754.
Golden, W. Cognitive Hypnotherapy for Anxiety Disorders. Am. J. Clin. Hypn. 2012, 54, 263–274
Gulewitsch, M.; Muller, J.; Hautzinger, M.; Schlarb, A.A. Brief hypnotherapeutic-behavioral intervention for functional
abdominal pain and irritable bowel syndrome in childhood: A randomized controlled trial. Eur. J. Pediatr. 2013, 172,
1043–1051.
Kohen, D.P.; Olness, K.N. Hypnosis and Hypnotherapy with Children, 4th ed.; Routledge Publications, Taylor &
Francis: New York, NY, USA, 2011.
Kohen, D.P.; Zajac, R. Self-hypnosis training for headaches in children and adolescents. J. Pediatr. 2007, 150, 635–
639.
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Select References Kuttner, L. Pain—An integrative approach. In Oxford Textbook of Palliative Care for Children; Goldman, A., Hain, R., Liben, S.,
Eds.; Oxford University Press: New York, NY, USA, 2006; pp. 332–341.
Kuttner, L. A Child in Pain: How to Help: What Health Professionals Can Do to Help Crown; House Publishing: Bethel, CT, USA, 2010.
Landier, W.; Tse, A. Use of Complementary and Alternative Medical Interventions for the Managaement of Procedure-Related Pain, Anxiety, and Distress in Pediatric Oncology: An Integrative Review. J. Pediatr. Nurs. 2010, 25, 566–579.
McClafferty, H. Complementary, Holistic, and Integrative Medicine: Mind-Body Medicine. Pediatr. Rev. 2011, 32, 201–203.
Myers, C.D.; Bergman, J.; Zeltzer, L.K. Complementary and alternative medicine use in children with cancer. In Psychosocial Aspects of Pediatric Oncology; Kreitler, S., Arush, M.B., Eds.; John Wiley and Sons: Hoboken, NJ, USA, 2004; pp. 335–350Richardson, J.; Smith, J.; McCall, G.; Pilkington, J. Hypnosis for Procedure-Related Pain and Distress in Pediatric Cancer Patients: A Systematic Review of Effectiveness and Methodology Related to Hypnosis Interventions. J. Pain Symp. Manag. 2006, 31, 70–84.
Schnur, J.B.; Kafer, I.; Marcus, C.; Montgomery, G.H. Hypnosis to Manage Distress Related To Medical Procedures: A Meta-Analysis. Contemp Hypn. 2008, 25, 114–128, doi:10.1002/ch.364.
Uman, L.S.; Birnie, K.A.; Noel, M.; Parker, J.A.; Chambers, C.T.; McGrath, P.J.; Kisely, S.R. Psychological interventions forneedle-related procedural pain and distress in children and adolescents. Cochrane Database Syst. Rev. 2013, 10, doi:10.1002/14651858.CD005179.pub3.
Uman, L.S.; Chambers, C.T.; McGrath, P.J.; Kisely, S.A. A systematic review of randomized controlled trials examining psychological interventions for needle-related procedural pain and distress in children and adolescents: An abbreviated Cochrane Review. J. Pediatr. Psychol. 2008, 33, 842–854.
Vlieger, A.M.; Menko-Frankenhuis, C.; Wolfkamp, S.C.S. Hypnotherapy for children with functional abdominal pain or Irritable Bowel Syndrome: A randomized controlled trial. Gastroenterology 2007, 133, 1430–1436.
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Questions??Please feel free to contact me
www.lisalombardphd.com
National Pediatric Hypnosis Training Institute (NPHTI) www.NPHTI.org
Offices in Oak Park & Streeterville