ESSENTIALS of CLINICAL HYPNOSIS

272 Pages·2008·14.89 MB·English

ESSENTIALS of
CLINICAL HYPNOSIS
Dissociation, Trauma, Memory,
and Hypnosis Book Series
Steven Jay Lynn, Series Editor
Believed'In Imaginings: The Narrative Construction of Reality
Joseph de Rivera and Theodore R. Sarbin, Editors
CZinical Hypnosis and Self'Regulation: Cognitive-Behavioral Perspectives
Irving Kirsch, Antonio Capafons, Etzel Cardena-Buelna,
and Salvador Amigo, Editors
Essentials of Clinical Hypnosis: An Evidence-Based Approach
Steven Jay Lynn and Irving Kirsch, Authors
HeaZing From Within: The Use of Hypnosis in Women's Health Care
Lynne M. Hornyak and Joseph P. Green, Editors
Varieties of Anomalous Experience: Examining the Scientific Evidence
Etzel Cardena, Steven Jay Lynn, and Stanley Krippner, Editors
ESSENTIALS of
CLINICAL HYPNOSIS
AN EVIDENCE-BASED APPROACH
Steven Jay Lynn and Irving Kirsch
American Psychological Association • Washington, DC
Copyright © 2006 by the American Psychological Association. All rights reserved.
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Psychological Association.
Library of Congress Cataloging-in'Publication Data
Lynn, Steven J.
Essentials of clinical hypnosis: an evidence-based approach / Steven Jay Lynn and
Irving Kirsch.— 1st ed.
p. cm.
Includes bibliographical references and index.
ISBN 1-59147-344-6
1. Hypnotism—Therapeutic use. 2. Evidence-based medicine. I. Kirsch, Irving,
1943- II. Title.
RC495.L96 2006
615.8'512—dc22 2005012320
British Library Cataloguing-in-Publication Data
A CIP record is available from the British Library.
Printed in the United States of America
First Edition
CONTENTS
Preface vii
Chapter 1. Introduction: Definitions and Early History 3
Chapter 2. Contemporary Theories and Research 17
Chapter 3. The Basics of Clinical Hypnosis: Getting Started 31
Chapter 4. Hypnotic Inductions and Suggestions 53
Chapter 5. Techniques for Catalyzing Empirically
Supported Treatments 67
Chapter 6. Smoking Cessation 79
Chapter 7. Eating Disorders and Obesity
with Maryellen Crowley and Anna Campion 99
Chapter 8. Depression 121
Chapter 9. Anxiety Disorders 135
Chapter 10. Posttraumatic Stress Disorder 159
Chapter 11. Pain Management, Behavioral Medicine,
and Dentistry
with Danielle G. Koby 175
Chapter 12. Questions and Controversies 197
References 215
Author Index 251
Subject Index 259
About the Authors 271
PREFACE
As in the field of psychology generally, within the area of hypnosis
there is often a gap between the world of the laboratory and the world of
clinical practice. Many clinicians complain that most research in hypnosis
fails to address the issues that they confront daily in their practices. On the
other side of the divide, researchers may feel that their work is ignored by
most clinicians. This book was born out of a desire to bridge the gap between
research and practice.
We are best known as researchers and theorists. Between us, we have
authored well over 300 journal articles, most of them focused on scientific
research. But we are also clinical psychologists. Throughout our careers, we
have had active clinical practices in which we have both practiced and
supervised psychotherapy. We have also supervised and taught classes in
psychotherapy to graduate students in the clinical psychology PhD programs
at our universities. Looking at our publications alone might lead one to
underestimate our professional role as clinicians. In fact, we are scientist
practitioners in the tradition of the Boulder model, which shaped clinical
psychology programs throughout the United States. This work represents
the culmination of our individual thinking about hypnosis as well as the
fruits of a 20-year collaboration.
This book is essentially clinical in nature. But it is a clinical book
with a research base. The clinical strategies and techniques that we present
are ones that we have used in our practice and that we have taught our
graduate students to use. They are procedures with an evidential base. Many
of the specific techniques we describe have been validated in clinical trials
and outcome studies, and our approach to most strategic issues has been
shaped by our understanding of the research literature in hypnosis, psycho-
therapy, and psychopathology. If there is a fundamental difference between
this book and the many other guides that have been published on clinical
applications of hypnosis, it is the degree to which the principles and practices
we describe are evidence-based. Hence, the subtitle of this book.
We aim to bring our enthusiasm for integrating hypnosis with empiri-
cally supported methods to a wide readership and to move hypnosis more
securely into the mainstream of established clinical practice. We help novices
get started by presenting basic inductions and suggestive methods and de-
scribe when to use and when not to use hypnotic procedures. More advanced
and specialized techniques and strategies are described for students of hypno-
sis at all levels. Readers will encounter fundamental information about the
history of hypnosis, surveys of different theoretical perspectives on hypnosis,
up-to-date literature reviews on empirically supported treatments, and dis-
cussions of thorny issues including the use of hypnosis for memory recovery.
Transcripts from sessions, illustrative examples, and step-by-step procedures
for treating an array of commonly encountered disorders and conditions
(e.g., anxiety, depression, posttraumatic stress disorder, pain and medical
conditions, smoking, and eating disorders) serve as road maps for implement-
ing hypnotic methods. We are confident that this volume, combined with
supervised experiences in using hypnotic procedures and accessible through
workshops sponsored by well-established hypnosis societies (e.g., Society for
Clinical and Experimental Hypnosis, American Society of Clinical Hypno-
sis), will provide readers with the knowledge and experience required to
practice hypnosis with confidence.
As with any book, there are many people we have to thank. We
owe a debt of gratitude to Susan Reynolds of the American Psychological
Association for her patience and support; to Joseph Green, Linda McCarter,
Sheri Oz, Fern Pritikin Lynn, Genevieve Gill, and Judith Pintar for their
perceptive comments on the manuscript; to our graduate students, from
whom we have learned as they have learned from us; to David Mellinger
for his contributions to the chapter on anxiety; and to our patients, who,
in the process of their own growth, have helped us grow as clinicians and
as human beings.
viii PREFACE
ESSENTIALS of
CLINICAL HYPNOSIS
1
INTRODUCTION:
DEFINITIONS AND EARLY HISTORY
Shrouded for centuries in mystery and myth, hypnosis has been viewed
by many with suspicion. At the same time, it has attracted the interest of
the most renowned scholars of human behavior. Hypnosis was given serious
consideration by Sigmund Freud, Alfred Binet, William James, Wilhelm
Wundt, Clark Hull, Ernest R. Hilgard, and other luminaries of psychology.
Yet only recently has hypnosis begun to receive the recognition it deserves.
It is a subject of intensive investigation in psychological laboratories around
the world (see Fromm & Nash, 1992; Kirsch & Lynn, 1995; Lynn & Rhue,
1991a) as well as a treatment component of demonstrated efficacy. A special
issue of the International Journal of Clinical and Experimental Hypnosis on
the topic of hypnosis as an empirically supported clinical intervention has
documented the effectiveness or promise of hypnosis in treating a wide
variety of psychological and medical conditions ranging from acute and
chronic pain to obesity (see Lynn, Kirsch, Barabasz, Cardena, & Patterson,
2000). Furthermore, meta-analytic reviews, which synthesize findings over
multiple trials, have shown that hypnosis enhances the effectiveness of both
psychodynamic and cognitive-behavioral psychotherapies (Kirsch, 1990;
Kirsch, Montgomery, & Sapirstein, 1995).
There are a number of reasons for the slow pace of acceptance of
hypnosis. One is the dramatic nature of its effects. During hypnosis, many
people appear to lose control over normally voluntary behavior; some exhibit
temporary, selective amnesia; and they may report seeing and hearing things
that are not present and not seeing or hearing things that are present.
Behavior and reported experiences of this sort seemed so extraordinary that
many investigators assumed they were due to an altered state of conscious'
ness, typically referred to as a trance.
The trance concept is another reason for the widespread—but
diminishing—reluctance to learn and use hypnosis in clinical practice. This
idea can be frightening to both clinicians and their patients. Putting someone
in a trance sounds like serious business. What if the person gets stuck there
and cannot come out? The accumulated data from controlled research should
dispel fears of this sort. The state of consciousness produced by typical
hypnotic inductions does not seem to be any different from that produced
by nonhypnotic relaxation training (Edmonston, 1981; Kirsch, Mobayed,
Council, & Kenny, 1992; E. Meyer & Lynn, 2004). Although most research-
ers have concluded that hypnotic responses are not due to a hypnotic state
or trance (see Kirsch & Lynn, 1995), neither is hypnosis simply relaxation.
Hypnosis can be induced with instructions to relax or feel energized. Hypno-
sis can even be induced while people are exercising vigorously (Banyai,
1991; Banyai & Hilgard, 1976). The issue of whether hypnosis is an altered
state of consciousness or trance is still controversial and is discussed in detail
in the concluding chapter.
WHAT IS HYPNOSIS?
What, then, is hypnosis? Clinicians and researchers of diverse theoreti-
cal orientations (see Kirsch, 1994a) have agreed on the following description
of hypnosis, which has been officially adopted by Division 30 (Society of
Psychological Hypnosis) of the American Psychological Association (APA):
Hypnosis is a procedure during which a health professional or researcher
suggests that a client, patient, or subject experience changes in sensa-
tions, perceptions, thoughts, or behavior. The hypnotic context is gener-
ally established by an induction procedure. Although there are many
different hypnotic inductions, most include suggestions for relaxation,
calmness, and well-being. Instructions to imagine or think about pleas-
ant experiences are also commonly included in hypnotic inductions.
People respond to hypnosis in different ways. Some describe their
experience 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 suggestions and others are less responsive. A
person's ability to experience hypnotic suggestions can be inhibited by
fears and concerns arising from some common misconceptions. Contrary
ESSENTIALS OF CLINICAL HYPNOSIS