Biobehavioral Disorders

This group of disorders with clearly identified pathophysiologic origins and effects have been traditionally understood to have significant psychoemotional components. Examples include asthma, migraine, encopresis, Tourette's Syndrome, and inflammatory bowel disease, all of which are known to include psychological stress as just one stimulus which may 'trigger' exacerbations or promote difficulties with the disease. Teaching self-hypnosis as an integral component of a comprehensive management approach has the dual goal of promoting an overall sense of self-control and providing a strategy for reduction of symptoms.

In the case of a child with encopresis, for example, self-hypnosis may be one strategy of a multimodal therapeutic plan involving education about gastrointestinal anatomy and physiology, nutritional guidance (toward an anti-constipating diet), behavior modification and self-monitoring for its value in self-regulation (e.g., regular toilet sitting after meals with a sticker-chart reward system).

The effectiveness of hypnosis to regulate functions previously thought to be involuntary has now been well established in research. These include demonstration of self-regulation of peripheral temperature (Dikel & Olness, 1980), brainstem audio-evoked response (Hogan, Olness & MacDonald, 1985), transcutaneous oxygen flux (Olness & Conroy, 1985), salivary immunoglobulin (Olness, Culbert & Uden, 1989), migraine headaches (Olness, MacDonald & Uden, 1987), pulmonary function (Kotses, Harver, Segreto et al., 1991; Kohen, 1995b), and tics and Tourette's Syndrome (Kohen & Botts, 1987; Kohen, 1995a).

Children with asthma easily learn to use self-hypnosis and biofeedback to modulate acute episodes of wheezing (Kohen, 1986; Kotses et al., 1991; Kohen & Wynne, 1997; Kohen, 1995b). Children with asthma who learn self-hypnosis experience fewer Emergency Room visits, fewer missed school days, and a better sense of control (Kohen, 1995b). Young people with juvenile migraine who learn RMI are more effective in reducing the intensity, frequency, and duration of their migraine headaches than control patients or patients taking propranolol (Olness, MacDonald & Uden, 1987).

With all child hypnotherapy, precise hypnotic suggestions depend upon the child's personal imagery (e.g., favourite activities), on their unique understanding of their problem, and the feelings and imagery they report in association with modulation of the problem. An 11-year-old girl with migraine was asked to draw a picture of migraine, and her image of comfort (i.e. no headache). She drew a chaotic mixture of red, black, and blue scribbled lines labelled 'migraine'; and then drew a scene of a beach, complete with blanket, beach umbrella, a book, a 'boom box' tape player, and a drink with a straw. When the time came to select hypnotic imagery 'where nothing bothers you and where you never had a headache', the choice was clear (Kohen & Olness, 1993)

Case History: Barry

Barry is a boy of over 12 years referred by his paediatric neurologist for self-hypnosis for migraine headaches. A bright young man, Barry said 'We came here upon the recommendation of Dr _ who said I could learn how to hypnotize myself for my migraines ... If I could drop the migraines that would great...' Barry detailed his 7-year history of headaches which began in Kindergarten. Acetaminophen had been helping, but then 'stopped working'. Ibuprofen was said to help about half of the headaches, but they preferred to not use any medicine. Typical for migraine, Barry's headaches occurred in the forehead, often beginning unilaterally and 'sometimes ocular'. Sonophobic and photophobic during a headache, he noted triggers to include bright lights like the computer or TV, stress like an upcoming test in school, and of being 'very small and getting shoved and jostled a bit.' Barry described fatigue and loss of appetite in association with his headaches. Most headaches lasted 1-2 hours, though some had lasted an entire day. He reported daily headaches, particularly over the past month with half being 'regular' ones and half being 'migraines'.

The idea of a headache ruler from 0 to 12 was introduced. Barry caught on quickly and said 'usually it's a 3 or 4 ... without Ibuprofen the highest will be 9, highest ever was a 10 or 11 and usually it has to be 6 before I take the medicine. It gets the headache to go 'down to like 2 or 1 or 0'. He says he can be his regular self when it's at 1-2. Barry's goal was to get the headache down 'under 2, maybe to 1.75'.

Barry also had respiratory allergies since age 6, short stature (smallest in his junior high 7th grade), and a history of sleepwalking, having once been discovered trying to leave the house in the middle of the night.

At the second visit Barry's calendar showed headaches most days in the previous 2 weeks, with self-ratings as high as '7'. He and his family watched a video of other children learning self-hypnosis. he was taught a self-hypnosis exercise focusing on favourite place imagery, progressive relaxation, and imagining the headache 'ruler' in his mind, adjusting it whatever way he decided. Stories were told of other children who adjusted their rulers, for example, 'I knew this 7-year-old girl who had tummy aches, and every time she had one she'd picture an elevator in her mind and whatever the tummy ache was on, she'd be on that floor ... so if it was a 4 she'd picture herself on the fourth floor, and she'd reach over and push the elevator button to ride ... down ... to 3 ... the light would go off at 4 and on at 3 ... then off at 3 on at 2 ... that's right. Then 1 and then 0 and when she got off the elevator her tummy ache was gone. There was this 11-year-old boy who had headaches, he pictured himself travelling around his own body, made his way to the main computer called the brain, found the switch for headaches, and turned ... it... down ... I don't know what ways you'll discover, but you will...' He was taught self-hypnosis during this first experience and agreed to practise daily.

At the third visit 2 weeks later, Barry proudly reported daily self-hypnosis practice at bedtime, and only three headaches in the preceding 2 weeks. At the fourth visit 2 weeks later he reported two headaches which 'I got rid of in 5 minutes with my self-hypnosis.' Barry's mother was thrilled to note the startling difference in him, noting not only absence of headaches, but that he was no longer coming home from school exhausted, and overall seemed much happier.

Using Hypnosis To Achieve Mental Mastery

Using Hypnosis To Achieve Mental Mastery

Hypnosis is a capital instrument for relaxation and alleviating stress. It helps calm down both the brain and body, giving a useful rest. All the same it can be rather costly to hire a clinical hypnotherapist, and we might not always want one around when we would like to destress.

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