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. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, including, but not limited to, the process of scanning or digitization, or stored in a database or retrieval system, without the prior written permission of the publisher. Published by American Psychological Association 750 First Street, NE Washington, DC 20002 www.apa.org To order In the U.K., Europe, Africa, and the Middle APA Order Department East, copies may be ordered from P.O. Box 92984 American Psychological Association Washington, DC 20090-2984 3 Henrietta Street Tel: (800) 374-2721 Covent Garden, London Direct: (202) 336-5510 WC2E 8LU England Fax: (202) 336-5502 TDD/TTY: (202) 336-6123 Online: www.apa.org/books/ E-mail: [email protected] Typeset in Goudy by World Composition Services, Inc., Sterling, VA Printer: United Book Press, Inc., Baltimore, MD Cover Designer: Naylor Design, Washington, DC Technical/Production Editor: Genevieve Gill The opinions and statements published are the responsibility of the authors, and such opinions and statements do not necessarily represent the policies of the American 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