Christina Liossi, Lecturer in Health Psychology.
University of the West of England Bristol
Psychological approaches to symptom management are among the oldest and are an intrinsic part of medical practice in every culture. Hypnosis under various names has been used for as long as records have been kept. Suggestive therapy is probably the oldest of all therapeutic methods. Using hypnotic techniques with children also dates back to ancient times. This article gives a brief overview of the contemporary uses of hypnosis in paediatric oncology.
Given the contentiousness of the field, the following definition and description of hypnosis as prepared by the American Psychological Association, Division of Psychological Hypnosis (Division, 30) for the general public is provided:
Hypnosis is a procedure during which a health professional or researcher suggests that a client, patient, or subject experience changes in sensation, perception, thought, or behaviour. The hypnotic context is generally established by an induction procedure. Although there are many different hypnotic inductions, most include suggestions for relaxation, calmness, and well being. Instruction to imagine or think about pleasant experiences are also commonly included in hypnotic inductions.
People respond to hypnosis in different ways. Some describe their experiences as an altered state of consciousness. Others describe hypnosis as a normal state of focused attention, in which they feel very calm and relaxed. Regardless of how and to what degree they respond, most people describe the experience as very pleasant.
Some people are very responsive to hypnotic suggestion and others are less responsive. A persons ability to experience hypnotic suggestion can be inhibited by fears and concerns arising from some common misconceptions.
Contrary to some depictions of hypnosis in books, movies or on television, people who have been hypnotized do not lose control over their behaviour. They typically remain aware of who they are and where they are, and unless amnesia has been specifically suggested, they usually remember what transpired during hypnosis. Hypnosis makes it easier for people to experience suggestions, but it does not force them to have those experiences ... (American Psychological Association, 1994).
THEORIES OF HYPNOSIS
From the observations on the uses to which hypnosis and hypnotic phenomena have been put, various theories concerning the fundamentals of hypnosis have been proposed. In the past, the majority of hypnosis researchers believed that there is an hypnotic state, which fundamentally differs from the waking state. Nowadays, instead of two opposing camps, there is a continuum of positions on the issue. At one end of this continuum are scholars who espouse the concept of hypnotic state in its strongest possible form, as a condition that is fundamentally different from normal waking consciousness and from other altered states such as daydreaming and relaxation.
||At the other end of the continuum are theorists who use the term state to describe hypnotic phenomena but deny that it explains or causes those phenomena in any way and those who explicitly reject the hypnotic state construct as inaccurate and misleading. Most hypnosis researchers agree that the impressive effects of hypnosis stem from social influence and personal abilities, not from a trancelike state of altered consciousness (kirsch & Lynn, 1995).
Similar to the state issue, the trait issue can most accurately be portrayed as a continuum, rather than a dichotomy. Most scholars recognize a role for stable individual differences and a role for contextual variables in determining hypnotic response. Furthermore, most stress the importance of considering the interaction between these variables (Kirsch & Lynn, 1995).
Clinical Hypnosis for Children with Cancer
Hypnosis has established a successful record in the paediatric oncology setting mainly in the management of chemotherapy-related nausea and vomiting (NV) and procedure-related pain.
Initial reports on the use of hypnosis to treat NV were in the form of case studies. Subsequently several controlled studies have assessed and supported the efficacy of hypnotherapy in alleviating chemotherapy-related NV. In the most recent study Hawkins et al (1995) demonstrated the effectiveness of hypnosis for the reduction of anticipatory NV in a randomized controlled-design study that aimed to assess the possible therapeutic gains that may be derived from hypnosis while controlling for gains that may be derived from non-specific therapeutic factors.
Children and adolescents in treatment for cancer undergo also numerous painful procedures including venepunctures, lumbar punctures, bone marrow aspirations and biopsies. A number of controlled studies have shown that hypnosis is effective in treating procedure-related cancer pain.
Hypnosis interventions have been found to be of significant help in reducing pain and anxiety in all of the studies conducted so far. In the most recent one Liossi and Hatira (1999) reported a comparison of hypnosis versus cognitive behavioural (CB) skills training in alleviating the pain and distress of thirty paediatric cancer patients undergoing bone marrow aspirations.
Results indicated that both hypnosis and CB coping skills are effective in preparing patients for BMA with hypnosis being superior in minimizing anxiety and behavioural distress.
The consistency of the findings among the studies contacted so far indicates the usefulness of hypnosis as an effective intervention for helping children and adolescents to control the pain and anxiety associated with medical procedures (Liossi, 1999).
Additionally, there is possibility for hypnosis to be utilized for the management of other cancer-related symptoms such as chronic pain, phantom limb pain, needle phobia, generalized anxiety, dysphagia for pills, insomnia etc.
It is important to remember that at any particular time, the young cancer patient may present a number of symptoms, one of which can be dominant at a single hypnotherapy session, but that does not mean that other symptoms need be ignored.