Open Access Journals

Students and therapists often ask us about where to go to get current research. There are of course the old favourites of PubMed and ScienceDirect. What many people don't realise is that there are a plethora of highly respected peer reviewed journals whose content is available for free on the web. These are known as 'open access journals'. As there are literally thousands of such journals available searching for them can be daunting. The good news is that there are two very good directories that list these journals and provide links to their respective websites.

The first is the Directory of Open Access Journals. This gives a comprehensive list of all scientific and scholarly open access journals available.

The second is BioMed Central. The list here is more focused on science, technology and medicine.

Both have very good search facilities that allow you to search through their entire catalogue of journals looking for relevant articles. Have a look around and enjoy the wealth of knowledge to be found for free on the internet.

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Typical Calories Used in Exercise

Ever wondered how many calories are used up in exercise? Here's a brief guide that you and your patients may find useful:

Typical number of calories used
                                                                                  
Running (calories per hour at 8-minute mile pace)                    913

Swimming (calories per hour for continuous laps)                    730

Uphill walking at a 10% gradient (calories per hour )               694

Rowing (calories per hour at a moderate pace)                        611

Cycling (calories per hour at 12-14mph pace )                         584

Jogging (calories per hour at 12-minute mile pace)                  511

Walking (calories per hour at 15-minute mile pace)                  365

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Fat Burning Exercise Tips to Help Your Patients

As we all know, one of the not-so-secret secrets of effective weight management is to exercise regularly. To that end, here are some exercise tips to help your patients burn off some of that excess fat. Of course, your patient must always check with their doctor that it is safe for them to take up more exercise.

Be intense with your exercise
Don’t be fooled by the so-called fat-burning zone. This is the misguided notion that working at a lower intensity is better for fat burning than working at a higher effort level (say, for example, walking instead of running.) The harder you exercise, the more calories you will burn and it is this that really counts when it comes to losing fat.

Choose your exercise carefully
There is no such thing as the ‘ultimate’ calorie-torching activity. Energy burned is dependent not just on the activity itself, but on how much effort you put in, how skilled you are at it, how long you do it for, and how often. So choose something that you are going to do regularly and consistently. That means an activity that you actually enjoy (unless you want your workouts to involve untold misery and boredom!) and one that is practical and accessible.

Exercising larger muscles
Serious fat-burning activity uses the large muscle groups of the body – the thighs and bottom, chest and back. The greater the overall recruitment of muscle, the higher the calorie expenditure. So in the gym, you are much better off using, say, the rower than one of those arm-cranking machines.

Sustainable exercise development
To fire up the calorie furnace, fat-burning activity has to be sustainable for a reasonable period. So while skipping is great exercise, it’s not much use if you can only do it for three minutes. The American College of Sports Medicine recommends 20-60 minutes per session, three to five times per week. It doesn’t have to be continuous effort, however …

Interval training
Interval training, in which you mix hard efforts with bouts of recovery, is one of the best ways of maximising calorie expenditure, improving aerobic fitness and making use of limited time. To get the most out of an interval session, ensure that you work outside the comfort zone on the efforts and ease right off during the recoveries. Try a 2:2 rest/work ratio to start with.

Carry the exercise load
Activities that are weight bearing, such as walking and running, use more calories than those in which your weight is supported (such as swimming or cycling), simply because you have to shift your own body weight against gravity.

Running on empty?
You may have heard that exercising on an empty stomach in the morning burns more fat. It is true that the body has to rely on fat stores if you don’t break the overnight fast, but then again, the lack of a ready energy supply may mean that you don’t work out for as long, or as hard, as you may have otherwise done.

Go for the afterburn
One of the best things about exercise is that the fat-burning benefits continue long after you’ve got out the shower. This ‘afterburn’ (increased calorie expenditure) is far greater following exercise at 75% of maximum heart rate, or higher – another reason to eschew those low-intensity workouts!

Increase exercise intensity
If you want to keep seeing results in your fat-burning programme, you must keep increasing the intensity. This isn’t the same as increasing your effort, because as you get fitter, your body will be able to cope with increasing demands. If you rest on your laurels, the benefits will begin to tail off.

Keep moving
Maximise your daily fat burning by moving! Researchers at the Mayo Clinic have found that leaner people tend to stand and move more than overweight people in normal daily life. Their ‘non-exercise activity thermogenesis’ (NEAT) was as much as 350 calories higher each day. So don’t just sit there, wiggle your toes, shake a leg, get up regularly and move your body!

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Top Tips For Mental Wellbeing

The Mental Health Foundation in the UK recently released the following tips for improving mental well being. They are worth reading as they can provide a template for that feel good factor not only for ourselves, but for our patients too:

• Eat a balanced diet and drink sensibly: Improving your diet can protect against feelings of anxiety and depression. 

• Maintain friendships: Just listening and talking to friends who are feeling down can make a huge difference. So make sure your devote time to maintaining your friendships both for their sake and your own.

• Maintain close relationships: Close relationships affect how we feel - so nurture them and if there is a problem within a relationship, try and resolve it.

• Take exercise: The effects of exercise on mood are immediate. Whether it is a workout in the gym or a simple walk or bike ride, it can be uplifting. Exercise can also be great fun socially.

• Sleep: Sleep has both physical and mental benefits. Physically it is the time when the body can renew its energy store but sleep also helps us to rebuild our mental energy.

• Laugh: A good laugh does wonders for the mind and soul.

• Cry: It is good to cry. Even though it may feel terrible at the time, a good cry can release pent up feelings, and people often feel better afterwards.

• Ask for help when you need it: The longer you leave a problem, the worse it will get. Don't be scared to ask for help from a family member, friend or professional.

• Make time for you: Do you sometimes feel like you have no time for yourself?

• Make time for your hobbies and interests.

• Remember, work isn't everything: Ninety one million working days a year are lost to mental ill-health in the UK so take it easy.

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Hypnosis and Food Intolerance

Originally written for FoodsMatter.com

In recent years the field of mind body medicine (known as psycho-neuro-immunology or PNI) has been gaining wider recognition. Clinicians are now realising that the Cartesian dualist viewpoint with regard to medicine and healing (that the mind and body are separate entities that do not communicate) is no longer applicable, and that a holistic approach to the treatment of a patient is desirable.

Increasingly the patient’s emotional state, beliefs, etc. are being addressed as part and parcel of their treatment package. This not withstanding, it has been known for a long time that emotional factors play an important role in the course of disorders of the intestinal tract and that to treat conditions such as irritable bowl syndrome, food intolerance and food allergy, psychological stability and well-being needs to be attained.

From this position the realisation that other gastrointestinal disorders (as well as organic disorders in general) will benefit from the alleviation of psychological upset has become widely acknowledged, and that both positive and negative emotional factors can and do influence the functioning of our immune system (the part of our body responsible for maintaining our health). Many clinicians are now recommending that some form of psychological intervention accompany standard treatment approaches and much has been written in the scientific press detailing the efficacy of such interventions. These studies have also shown that the hypnotherapeutic approach is particularly effective in alleviating symptoms, improving quality of life, and reducing absenteeism from work.

What is hypnosis?
The use of hypnosis as a therapeutic tool has a very long history. The earliest recorded examples are found in the sleep temples of ancient Egypt where archaic hieroglyphs detail procedures that in this day and age would be considered hypnotic. (The word ‘hypnosis’ was only invented in the 1800s.) Interest in its use has fluctuated throughout the years and is currently in resurgence perhaps due to the ever expanding scientific literature detailing its efficacy, combined with the general public’s search for a viable alternative/accompaniment to so called conventional medicine.

Hypnosis is, in essence, a very pleasant and natural state of deep mental and physical relaxation that is often referred to as trance into which almost anyone can enter if they so wish. In this state a person is open to accepting beneficial suggestions delivered by a therapist (a process known as hypnotherapy) that can help alleviate a wide range of presenting symptoms.

However, for some the very word hypnosis is steeped in mysticism and many erroneous myths have arisen surrounding the subject. For example, the belief that it is akin to brain washing is far from the truth, and it is important to realise that hypnosis is not mind control. A patient in trance is not ‘under the power’ of the therapist. On the contrary, full control is maintained throughout with the unconscious mind protecting the subject, rejecting unwanted suggestions or any that are alien to a person’s ethical or moral beliefs. Essentially, hypnotherapy is a therapeutic method that allows a person to regain control over an area of their life where they feel control has been lost, thus helping to alleviate both psychological and physical symptoms. 

By Peter Mabbutt

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Thousands are Dodging the Dentist

Hard-up people are putting their health at risk by avoiding trips to the dentist, a new survey shows.

Sixty eight per cent of dentists said their patients were deferring treatment and 59 per cent reported cancelled appointments.

The poll of 251 dentists in England, for the British Dental Association (BDA), found the knock-on effect was a clear rise in the numbers needing emergency treatment.

More than a third (34 per cent) of practitioners questioned in October and November said they had seen increased demand for emergency treatment over the previous 12 months.

Dental check-ups often reveal more serious underlying health problems than simple gum disease.

Some dental diseases are closely linked to many serious health conditions including heart disease, arthritis and diabetes.

‘It’s understandable that, at a time when there is widespread concern about household finances, some patients’ financial anxieties are leading them to defer dental appointments and treatment,’ said Susie Sanderson, of the BDA.

‘Achieving short-term money savings at the expense of longer-term health problems isn’t wise, though.

‘Neglecting your oral health can increase both the complexity of the problems you face and the cost of the treatment you must eventually have.’

Click here to read more.

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Hypnosis and Surgery

From a talk given to the James Braid Society in July 2002:

Hypnosis and Pre and Postoperative Surgery

Peter Mabbutt FBSCH

CEO/Director of Studies

Despite the fact that we live in a health-conscious society cardiovascular disease is still one of the major causes of premature death.

These days we drink too much; we eat too much (of both the wrong and right kinds of food); and smoking is still endemic. Compounding this we are encouraged to lead increasingly sedentary and stressful lifestyles. All this represents bad news for the heart as these activities place it under increasing strain and could result in the development of cardiovascular disease.

If recognised early enough, drugs and a change of lifestyle are all that’s needed to provide an effective route to management and recovery from cardiovascular disease. However, for some the only route to better health will be through surgical intervention.

For anyone facing the prospect of surgical intervention this will be a major event in their life. Despite the fact that the techniques of cardiovascular surgery have advanced immeasurably over recent years, as with all surgical interventions there is a risk of death. It is therefore not surprising that patients faced with surgical intervention go through a whole range of feelings and emotional responses. Research has shown that 60% of patients hospitalised for heart disease experience elevated levels of stress, anxiety and depression. Unfortunately the heart responds unfavourably to these emotional states thus placing extra demands on an already damaged cardiovascular system.

Psychology of surgery

For anyone being told that they need to undergo a surgical procedure this will undoubtedly provoke a stressful response, that may increase when the surgery is considered to be major or life saving. For many this can bring on a bereavement reaction as they will experience a whole range of losses: a loss of health; a perceived loss of control over their life; and a possible loss of independence. Also, they are likely to experience guilt over the harm their life-style may have caused their body. Compounding this may be an increased awareness of their own mortality as they are going into hospital for an operation that will save their life. Fear is another factor that features as many patients may be worried that they will not survive the surgery or, alternatively, that they may be damaged mentally or physically in some way by the surgical procedure.

It must be remembered that psychological disturbance also occurs during the post-surgical period. Even when surgery has been successful many patients will enter a period of post-surgical depression. Many factors may be responsible including a continued perception of lost health due to post-anaesthetic nausea, pain, and worry about the healing process. Patients may also experience a profound loss of control over their life. During the early stages of recovery they may be bed-bound and therefore reliant on others for cleaning, feeding and drinking. Compounding this they will experience a loss of privacy with regard to bodily functions, as urine and faecal output need to be monitored immediately after surgery.

Many patients will experience concerns over what they will and won’t be able to do in the future as a result of their heart condition and surgery. Unfounded concerns that they will be unable to engage in the sexual act can lead to psychogenic sexual dysfunction. The belief that they may damage the heart during coitus can lead to performance anxiety with all its consequences.

Often patients will exhibit concerns that they will be unable to give up activities proscribed by their medical-care team such as excessive alcohol consumption, smoking and eating certain foods.

If left untreated all these psychological factors could provoke a negative mind-set. Many studies have shown that a patient’s outlook toward upcoming surgery as well as to the post-surgical period can greatly affect recovery outcome. Essentially, patients with a poor outlook may have a poor prognosis (it has also been shown that those patients who are socially isolated and come from the lower-income bracket are also at greater risk post-surgically). However, those patients showing an optimistic outlook recover more rapidly and show an increased survival rate.

Studies have shown that those patients undergoing hypnosis as an integral part of the pre- and post-operative procedure demonstrate an increased rate of recovery and decreased levels of post-surgical infection.

Hypnosis and Surgery

As the patient should be set up for success from the beginning, pseudo orientation in time needs to be included on each session, taking the patient to a time in the future when they have successfully recovered from the operation. It goes without saying that the therapist must ensure that the pseudo-orientated future is realistic and achievable. As well as this, ego boosting should also be included on each session to help the patient create a positive mind-set and to enhance inner resources.

Reframing approaches should not be ignored. It is an undeniable fact that the patient’s life-style may have led to the reason they are in hospital at this time. Reframing the situation so that the patient perceives that they are taking control of their future thus ensuring a speedy recovery as well as living a long, healthy and productive life will be of obvious benefit to the therapeutic process.

Induction of Hypnosis

A word needs to be said about the induction process used with cardiovascular patients. Any induction will suffice. However, as part of the therapeutic process it is important to teach the patient how to relax, so progressive relaxation approaches should be the therapist’s primary consideration as this will indirectly provide a format for the patient’s own approach to relaxation.

Dealing with Fear

Many patients will understandably have a fear of the process of surgery and of their stay in hospital. Imagination techniques (a preferable term to visualisation as asking someone to visualise implies that they have to ‘see’ and therefore does not take into account the other modalities of representation) should be used to take them through their hospital experience and beyond: being admitted to hospital; the pre-surgical stay; going to the operating theatre and receiving their pre-medication; undergoing the operation; their time in the recovery room; being taken back to the ward and their post-operative stay; leaving hospital; and making a full recovery. Presented scenarios should show the patient coping calmly, confidently and with appropriate self-control. Again the therapist needs to be realistic with regard to the outcome. Self-hypnosis should be taught and the patient encouraged to practice these imagination techniques.

If the patient has specific fears with regard to their stay in hospital, for example needle phobia, these need to be dealt with as a separate issue.

Life-style Issues

Many patients presenting for cardiovascular surgery will be advised to make life-style changes. These may include reducing their alcohol intake, stopping smoking or reducing their weight. Here hypnosis takes an obvious role and standard approaches are used. For the patient there is the added incentive of the increased health risk should they not change which will provide a strong motivator that can be used during therapy. Care should be taken as some may view these life-style changes as a short-term adaptation and may subsequently revert to old behaviours once they have recovered (a possible indication that they are experiencing denial with regard to the seriousness of their heart condition).

Stress management should be taught, as stress responses will place an added burden on an already damaged heart. The use of self-hypnosis should be included and encouraged, as the trance state will reduce any stress-induced increase in cardiac activity. It is also known that the trance state will reduce blood pressure (high blood pressure, or hypertension, is a major risk-factor in coronary disease).

Post-surgery

In many cases pre-surgical hypnotic intervention will help to prevent post-surgical depression. However, biochemical changes occurring after the use of anaesthetics may result in the patient developing an endogenous depression. This state should be dealt with appropriately.

A positive mental attitude towards the healing process needs to be encouraged. Various approaches can be taken with an emphasis placed on healing the body: asking the patient to imagine the heart healing and becoming more healthy; imagining the wound healing, the tissue and bone knitting together with the minimum of scarification; imagining the body protecting the wound, the immune system guarding the incision and preventing infection.

Pain may be an issue and the full range of pain control techniques should be employed: glove anaesthesia; imagination approaches; control room of the mind; dissociation.

The therapist should also help the patient to maintain recommended life-style changes.

Cardiophobia

Some patients develop cardiophobia: an abnormal awareness of their heart beating. This can provide a focus for neuroticism after any heart event or surgical intervention, as the patient may believe that naturally occurring changes in the beating of the heart herald a catastrophic heart event. Consequently they become over-protective towards their cardiovascular system and this may lead to a sedentary life-style (that in its own right will be damaging to the heart). Desensitisation approaches and reframing should be used.

Regression

A word of warning with regard to the use of regression with patients who have experienced a heart event needs to be given. Do not take them back to the event as they may re-experience it with inevitable consequences. If carrying out a diagnostic approach, regressing the patient year by year, avoid the year in which the event occurred for same reason. If possible regression should be avoided.

Conclusion

Hypnosis can play an important role in cardiovascular surgery by helping to create a positive mental outlook for the surgical patient. This, combined with helping the patient undertake and maintain lifestyle recommendations, can significantly increase the prospects of a full and healthy recovery.

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Eating disorders in Children

Disturbing news is coming from America where a recent report by the American Academy of Pediatrics shows that eating disorders are on the rise in boys, younger children and minority children. In an interview with the online journal Medscape Today the reports lead author, Dr David Rosenberg, says that there is no clear reason for this trend. He hypothesises that this may be in part due to the rush to combat the obesity epidemic resulting in certain vulnerable children being accidentally misdirected by the healthy eating message and ending up with an eating disorder.

Dr Rosenberg recommends that vigilance is important when looking at our children’s dietary habits. It’s no good waiting until medical complications have set in. Prevention is better than cure!

The full report can be downloaded for free from the journal Pediatrics web site.

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Hypno-Desensitisation

This paper examines the danger of clinical hypnotherapists ignoring the patients' stated objectives in order to pursue their own prejudiced assumptions. The author argues there is an orthodoxy which too easily can blind therapists to the most effective means of helping their patients. That there is a tendency to look for a cause which fits the therapist's personal perceptions and ignore the clearly stated views of the client. The paper goes on to express the view that rather than follow 'standard' procedures, hypnotherapists must pay attention first and foremost to what their patients want. This claim is illustrated by an anonymised case history in which the author admits his own early failure and the lasting value of the lesson it provided.

All at sea with Admiral Nelson and a phobic fallacy

By Michael Joseph

Case History

The year was 1977 and I had only recently started my career as a hypnotherapist when Janice - not her real name - whom I had never met, rang asking for an appointment as quickly as possible. She did not explain why - but she sounded desperate and arrangements were made for her to come the following day.

She was punctual, stylishly dressed, in her early-twenties and in every way appearing a picture of health. She came straight to the point. "I have come to you as a last resort. I heard about you from a colleague whom you stopped smoking a few weeks ago. But I don't want you to stop me smoking. I have a terrible problem, a phobia, but before I tell you what it is I want you to promise me something." "What is it?" I asked. Slowly, stressing her words, she replied: "When I tell you about ... the problem ... when I tell you about me ... please promise you won't laugh at me."

I did so without hesitation; in the course of my training, and as a trainee practitioner, I had read about and heard many strange tales, and expected neither shock nor amusement at anything new. Hesitantly Janice continued:

"The sight of a certain thing ... when I think of it ... or just see a picture of it in a newspaper or on television ... I just collapse. I can't stop myself." Janice was becoming tense, sitting forward to the edge of her chair, her cheeks gathering colour. "I feel physically sick and nauseous. I even throw up sometimes. I perspire all over, and shake as if I was running a temperature.

My face flushes and my eyelids seem to swell up over my eyelids as if I am going to be unable to see between them. I can't speak. I have to lie down for a while...It's awful!"

Even as she spoke, she began taking on the aspect of a person entering just such a crisis. She explained her attacks had been occuring for more than two years. Carefully I began to investigate. "You said there is a particular 'thing' that starts off these attacks - something you see, and then ..." This produced another long pause, more tension. Then she said: "Nelson's Column." (Note - Nelson's column is a monument that stands in Trafalgar Square, London)

"Nelson's Column ..." I repeated, in the best matter-of-fact voice I could manage. She watched me, apprehensively. It suggested to me that her phobia, with its all too apparent Freudian connotations, had provoked insensitive mirth on previous occasions.

I began taking a thorough case history, the usual things - her general health, her life until that time. Then I moved on towards her personal relationships - within the family, with people of her own age, of her own and the opposite sex. Suddenly she cut me short. "Look here. You are just asking the same old questions all over again, the same as everyone else I have seen." Then she began to tell her story. Her doctor - quite properly - had sent her for tests.

They produced nothing. She was put on tranquillisers - they didn't help. She was then referred to a psychologist by whom she was asked to fill out a number of questionnaires and her condition was duly diagnosed as a phobia.

After this an appointment with a psychiatrist resulted in her being referred to a psychoanalyst. She visited the psychoanalyst once a week for approximately thirteen months. Eventually she discontinued her analysis because she was "fed up with talking about my childhood week after week while my problem got worse". Choosing her words carefully she continued: "The truth is there was nothing wrong with my childhood. I loved my mother. I loved my father. I get on well with them now. I have a younger brother whom I just adore." "What I mean is ... everybody thinks that my problem has something to do with my sex life. It is simply not true! My sex life has always been what I wanted it to be." "My problem is Nelson's Column. Everybody thinks it's funny - but it's hell. So please do what you like with me. Hypnotise me so that I'll never be frightened again."

I explained to Janice hypnotherapy did not quite work in that way, and before helping her I needed to find out a lot more about her. She told me, somewhat abruptly and in her own words to 'mind my own business' about everything else in her private life and would I please do what she had asked me to do.

She sounded very determined and arguing with her seemed counter productive. I agreed to hypnotise her, with the proviso that only a 'mild' form of hypnosis would be used and she would come back for another session next week. This was readily accepted, since I also promised her that I would do what I could to...'do what she asked me to do'.

In that first session I hypnotised Janice using a simple 'progressive relaxation' technique and with a ten to one countdown as a deepener. The full 'egostrengthening' (Hartland¹) suggestions were then employed and I awakened her with some standard suggestions for well-being. This is an excellent method to conclude a first session of hypnosis when hypnotherapists are unsure of what course of action to follow. The time between the first and second sessions will give them time to think or seek advice and generally consider the patient's problem. The patient also benefits by experiencing the relaxation response, and will certainly be more ready to accept whatever therapy is suggested because of the powerful effects of the full 'egostrengthening' suggestions.

After careful consideration I decided to use age regression in the second session, explaining to Janice that by going to the source of the problem we would have an excellent chance of resolving her difficulty once and for all.

She readily accepted and I hypnotised her in exactly the same way as the previous week. After the deepener I installed an Ideo Motor Response

(I.M.R.) using the right index finger as the signalling mechanism - this, of course, in itself deepens the trance.

I did not at this time believe that hers was a classic phobic response - 'one trial learning' - but suspected an unresolved sexual conflict of some kind.

Therefore, a free-floating regression technique (Blythe²) was chosen that would allow her to explore a myriad of experiences in her past which might have played a crucial part in the development of her problem. Essentially, the suggestion was given that there would be a finger movement each time:

'... when something happened to you ... which not only affected you deeply at the time ... but has continued to affect you...and to play an important part in the problem you have been having ...'

It took only 30 seconds for her finger to lift, followed by a strong physical reaction. Her face blanched. She began to heave, thankfully without actually throwing up. Eventually the heaving subsided and she began to cry, followed by a smile that was to remain throughout the session. When the finger went down I waited approximately ten minutes for the finger to rise again but nothing happened and I concluded that the cause of her problem was probably a 'one trial learning' after all.

I re-orientated Janice to the present time and whilst she remained in the trance I asked her to describe to me what she had been feeling a few moments before. She declined to speak so I awakened her employing a short 'ego-strengthening' method that I was developing at the time (see Conclusion) and with the suggestions that:

'... no part of you remains in the past ... every part of you will be back here with me in the present ...’

When she awoke she could recall the episode clearly, but with a complete sense of detachment. She saw herself on her way to work, travelling on the top deck of a number 159 London bus. Approaching Trafalgar Square – the location of Nelson's Column - she was overwhelmed by what she described as a 'nasty turn'. Indeed, she had temporarily re-experienced the same nauseous feelings while in the trance. However, she claimed to have no (conscious) recollection of this event.

I told her, that, somehow, Nelson's Column had become associated in her mind with the 'nasty turn' and since then the sight of Nelson's Column had inevitably triggered off an action replay of the nausea. Since nobody likes to feel sick, I explained, it was perfectly natural for her to avoid looking even at a picture of the column - a classic phobic response in fact.

Janice was happy with this explanation. She sounded overjoyed, even triumphant, as she told me: "I knew there was nothing wrong with me." When we finished congratulating each other I wished her luck and she was on her way. I never expected to see her again.

At around 6 p.m. that evening however my phone rang, with a hysterical Janice at the other end of the line. On returning home she had turned on her television set. One of the news items was a demonstration around Trafalgar Square and when she saw Nelson's Column she immediately became violently sick again. I asked to see her again and an appointment was fixed for early the next morning.

I decided to turn to the behavioural sciences, hoping systematic desensitisation (Wolpe³) would 'uncouple' the image of Nelson's Column from her feelings of nausea once and for all. A simple Subjective Unit of

Disturbance (SUDS) scale was constructed and as Janice was an excellent hypnotic subject I felt that we could dispense with the preliminary deep muscle relaxation training usually recommended for this method. No formal hypnosis was employed at this time, but each time a low anxiety value scene was presented she was asked to 'remember how relaxed she felt when she was hypnotised'.

The whole process took less than an hour and when she had no adverse reaction to any of the images of Nelson's Column that I could conjure up for her I showed her the morning papers. She looked at the pictures of Trafalgar Square and the statue and in a matter of fact voice told me she was sure that she was free from the awful problem that had made life miserable for her these last two years. Janice was then discharged. A letter from her General Practitioner three weeks later - and subsequent telephone calls to the GP at three monthly intervals for the next 18 months and at six monthly intervals for the following two years - confirmed that she no longer suffered from those 'nasty turns'.

Janice's problem expressed itself in a very physical way. This is an excellent - if rather unusual - example of not only a classic phobic response but also of a psychosomatic disorder. Many people suffer physical symptoms for psychological reasons, but far too few get the treatment they really need.

From the start, Janice didn't disguise the fact that she came to see me only as a last resort. She was, as it were, scraping the bottom of the barrel - fortunately the barrel was not entirely exhausted.

She had seen her doctor, undergone psychological tests, tried psychoanalysis for more than a year, all to no avail. This, though, is not surprising - it is happening everywhere, countless times a day. This is not to argue that the medical practitioner, the psychologist or the psychoanalyst were all wrong - nor is it suggested hypnotherapists have special abilities in health care that other professionals cannot share. If hypnotherapy is not used as widely as it should be, that's almost certainly because too few doctors know enough about it - and too few patients ask for it.

The doctor sent Janice for 'tests'. In a way, one can hardly blame him; after all, the symptoms of collapse were real enough and it probably comforted them both to know that she was not suffering from disease of the heart or the digestive system. But what then? Tranquillisers were prescribed - and even the most enthusiastic physician would hardly expect these to cure anything.

At best they might have afforded Janice temporary relief from anxiety; but

Janice wanted something better than that. Frankly, who wouldn't?

As we know, the cause of the problem lay 'in the mind'; but neither the psychologist nor the analyst found out what it was. I think the simple reason was that these practitioners - perhaps quite properly - approached Janice with an interest in her health as a whole.

They failed to take seriously the fact that Janice was looking only for relief from a disastrous phobia. Her real 'goal' was the getting rid of a debilitating symptom. Janice came to win - not to play well! Back in 1977 I had not yet realised that hypnotherapy - unlike medicine and psychiatry - was a goalorientated pursuit. Patients come in search of something in particular, and I believe it is our duty to help them achieve it.

In eighteen years of practice, I cannot recall one patient asking for generally better health; instead, like Janice, patients usually ask for freedom from a source of distress.

But what are the implications of this story from 1977 for the clinical practitioner of today?

Let me ask you a question. What were your immediate assumptions when you read how Janice, a healthy young woman, had explained that the object of her phobia was no less powerful a phallic symbol than Nelson's Column?

Almost everyone who has heard this story responded much as I did when Janice first explained her problem to me - and assumed it was a form of sexual fixation. There should be no surprise therefore that I carried my prejudices into the first two sessions. I was looking for a cause that would fit my perception of Janice's problem. Indeed, at first I did not even attempt to treat it as a phobia.

There has been a tendency for practitioners of clinical hypnotherapy to split into three main groups:

1 - Analytical: Those whose methodology is to regress patients to the source of their problems, irrespective of their presenting symptoms. They tend to believe that a cure can be affected only through the re-living and eventual understanding of a patient's traumatic experiences.

2 - Behavioural: Those who believe all behaviour is learned and can thus be unlearned (deconditioned).

3 - Eclectical: Those who are willing to employ any kind of therapy that will affect a beneficial change in their patients.

So, which is the right way? It is obvious to me that in the case of Janice regression wasn't really necessary, though it did provide her with a useful explanation. However, the fact remains that she continued to be frightened even after understanding her problem.

Regressionists may argue that the 'nasty turn' could have been caused by the sight of Nelson's Column triggering some traumatic memory in her past. But Janice had seen the offending statue - and such like objects - hundreds of times before and it never caused her any fear. Also, she responded readily to systematic desensitisation without recurrence - or transformation - of her symptoms.

This, of course, is just the kind of story that would to some behavioural psychologists prove that behavioural disorders and inadequacies are solely matters of stimulus-response sequences mediated by the nervous system. But this does not explain the poor results obtained by behavioural therapies in, say, hysterical conversions. Indeed, as in the case of 'war neurosis', the bringing of repressed experiences into consciousness and the consequent relieving of tensions (catharsis) is usually sufficient to bring about an effective cure.

Eclectics will be happy to employ both analytical and behavioural techniques.

Eriksonian hypnosis, NLP, symptom transformation and amelioration, even symptom removal by direct suggestions, are natural tools for these practitioners and I must admit that I belong in this group.

However, the most important lesson I learned from Janice's story was this: No matter what the presenting symptom, therapists who ignore the Pavlovian bell do so at their peril. Any symptom (response), whatever the cause, will always be preceded (triggered off) by stimuli. In the case of Janice, repeated adverse reaction to the image of Nelson's Column has established a conditioned reflex, so she had no choice in her behaviour even after re-living and therefore intellectualising her 'traumatic experience'. This can also be observed in bulimic patients who, after successful resolution of their psychological problems, still continue to binge. Therefore, any maladaptive conditioned reflex must also be deconditioned or ameliorated.

CONCLUSION

So, what would I do if someone like Janice were to come to consult me today?

There are of course a range of options. Indirect Ericksonian approaches, NLP, plus a variety of dissociation methods developed by the research team at LCCH, would now provide greater scope to help Janice with her problem, probably in just one or two sessions. For instance, I could use Hypnodesensitisation, a technique that relies on the formal induction of hypnosis and a post-hypnotic 'cue' - the word NOWwww - to stabilise, deepen, or reintroduce the relaxation response at any time during the session.

Step-by-step guide:

It might be of assistance at this point to set down a few straightforward instructions describing the way in which hypno-desensitisation can be employed.

First: Construct your hierarchical 'scale' (SUDS).

It is important to obtain as thorough a case history as possible. A simple Subjective Unit of Disturbance (SUDS) scale should be constructed by a combination of interviewing the patient, interpreting the patient's history, prepared questionnaires and, most important of all, the therapist's intuitions. It is not always possible to do all of the above. If, for instance, a patient has a fear of flying, and he or she is due to travel the next day, the therapist's intuitions should become the single most important factor in the construction of the SUDS scale.

Second: Induce as deep a trance state as possible.

Third: Establish an 'instant' deepener.

After deepening the trance the 'cue' word should now be installed...

"..In a few moments time ... you will hear me say the word ... NOWwww ... and ... whenever you hear me say the word ... NOWwww ... every muscle in your body ... from the top of your head to the tips of your toes ... will be relaxing ... all the unnecessary ... unimportant nervous tensions ... will be going out of your body ... and your body will continue to sink down ... more and more limp ... relaxed ... and comfortable too ... in fact ... your body is going to feel ... so pleasantly comfortable ... there may be times when ... you will not even be aware of your body ... won't be aware of your body at all ... in fact ... your body will feel as if it was weightless ... weightless ... so ready ... if you have any unnecessary nervous tension ... in any part of your body ... I want you to ... NOWwww ... let go of that unnecessary nervous tension ... allow every muscle of your body to relax ... a very pleasant ... slightly warm sensation ... may very soon ... begin to spread from your chest ... and shoulders ... and out over your whole body ... and I want you to ... NOWwww ... let this wonderful feeling of relaxation ... go all the way down ... down through your body ... down to your fingertips ... and down to your toes ... and ... NOWwww ..." Take a very deep breath before saying the word "... NOWwww ...".

Use a deep tone of voice, slowly and quietly, concentrating on the outbreath rather than the voice itself. You should also insert the patient's name from time to time, thus making it more personal for them.

Fourth: Install I.M.R. (YES and NO fingers).

Fifth: Scene presentation.

" ... and ... NOWwww ... I am going to ask you to imagine certain scenes ... and each time the scene is clear in your mind ... you will indicate this to me ... by a slight nod of your head ... I will then ask you how you feel ...if you feel comfortable ... safe and secure ... and at ease ... and if your answer is YES ... the unconscious part of your mind will ... signal this to me ... by lifting the first finger of your right hand ... the index finger ... and if the answer is NO ... if you don't feel comfortable ... safe and secure ... and at ease ...then ... your left index finger will lift ... but if your left index finger lifts ... I will ask you to imagine the same scene again ... so if you are ready ... I would like you to ...

NOWwww... imagine that ..."

Scene presentation should now begin with the lowest anxiety value on the SUDS scale (for example, Janice could be asked to imagine herself relaxing on a holiday in a far away country) then gradually guiding her nearer and nearer the object of her anxiety. If you get a YES signal, proceed to the next low value scene on the hierarchical scale. If you have a NO signal, you must re-present the same scene:

"... that's fine ... let the finger go down ..." "... and ... NOWwww ..." If still NO ... "you are feeling calm and relaxed ... and ... NOWwww ..." Or ... "you are feeling safe and secure ... comfortable ... and ... NOWwww ..."

You may vary your suggestions for feelings of comfort, relaxation, safety and

security, etc., (with NOWwww ...) for as long as it takes to get a YES signal. If

you get a persistent NO, present a lower anxiety value scene.

Sixth: 'Short Ego-strengthening' suggestions.

Some form of 'ego-strengthening' suggestions should always be given before bringing the session to a close, whether the desensitisation process has been completed or not.

'And...before I wake you...I would like you to know that...as each day goes by...you are going to become...a little more mentally calm...a little more clear in your mind...each day...which means that...you are going to be able to...think more clearly...see things more clearly...so that nothing...and no one...will ever be able to worry you...or upset you in quite the same way...your mind becomes...more and more clear...crystal clear...allowing you to feel...physically more relaxed too...not only in your body...but you will feel more relaxed...about yourself...about the world around you...and as the days...and weeks...and months go by...and you become...ever more calm and clear in your mind...ever more relaxed in your body...it will be perfectly natural...that you are going to be able to cope better...with anything and anybody...and any situation you have to handle in your daily life...because you are coping more calmly...more relaxedly...and more confidently too...more confidently...because...you will have greater self-control... greater control over the way you think... greater control over the way you feel...and greater control over the way you do things... the way you behave...every day...you are going to experience...a greater feeling of well-being... physical... as well as mental nfeeling of well-being... a greater feeling of safety and security too... than you have experienced in a long... long while... altogether...you will feel as if a weight... a burden has been lifted off you...allowing you to live your life...in a way that will be so much more satisfying...'

Seventh: Awaken the patient.

EPILOGUE

A last word about the original therapy for Janice. It was, of course, quite possible Nelson's Column was a symbol for her - certainly over the intervening years it became one for the author. Attempting to devise therapy for a patient based upon what Nelson's Column so obviously appeared to represent is the type of error therapists can so easily make. The memory of Janice's case has become a personal 'cue' for this practitioner whenever therapy with a patient fails to proceed as envisaged. For the author Nelson's Column has become as near as it can get to a conditioned reflex – an invaluable reminder of the dangers of seeing patients' problems from some preconceived therapeutic stance and the constant need to consider a range of possibilities. It is hoped therefore that this article may remind others in the field of their own Nelson's Column.

------------------------------------------------------------------------

1. Hartland. J.,1996 Medical and Dental Hypnosis & its clinical applications. Second edition. Bailliere Tindall, London

2. Blythe, P., 1976 Self Hypnotism, Arthur Barker, London 1976

3. Wolpe, J., 1973 The practice of Behaviour Therapy, Second Edition, Pergamon Press, New York

Copyright©2002 European Journal of Clinical Hypnosis

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The dangers of starting to smoke

A small-scale study carried out by the University of Minnesota in Minneapolis is reporting that people new to smoking are damaging their health at the genetic level as early as 15 minutes into their new smoking habit. Highlighting the fact that worldwide 3000 lives are lost each day to lung cancer, the report published in Chemical Research in Toxicology shows that cancer-causing chemicals found in cigarettes called polycyclic aromatic hydrocarbons (PAH) begin to damage DNA between 15 to 30 minutes after the first inhalation of smoke.

This salutary piece of research reinforces that it is never too early to quit smoking and provides another useful motivational fact to give to those smoking clients and friends who waver over whether to quit or not.

Zhong Y, Carmella SG, Upadhyaya P, Hochalter JB, Rauch D, Oliver A, Jensen J, Hatsukami D, Wang J, Zimmerman C and Hecht SS (2010) Immediate Consequences of Cigarette Smoking: Rapid Formation of Polycyclic Aromatic Hydrocarbon Diol Epoxides Chemical research in Toxicology Dec 27. (Epub ahead of print)

Check the abstract here at PubMed 

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Relax - Hypnotherapy in Schools

The following article by Caroline Dyson was originally published in issue 49 of SEN Magazine, the UK's leading magazine for special educational need, and is reproduced here with permission from the author.

Say the word ‘hypnosis’ and what do most people think of?  Answers usually include Paul McKenna, clucking like a chicken and more recently thanks to programmes like Little Britain, the phrase, “Look into my eyes, look into my eyes!”  The stereotypical image of a swinging pocket watch is never far away yet schools/children are probably the furthest thought in people’s minds.  However, things may soon change.

Hypnosis involves entering a pleasant, natural state of relaxation referred to as a trance state.  Many of us experience this trance state regularly.  Have you ever been so absorbed in a film or book that you don’t notice someone enter the room or fail to hear something that someone says to you?  This is a trance state, or to put it a different way, an altered state of consciousness.  You are not asleep (a common misconception about hypnosis) but neither are you fully alert and awake.  In this trance state the mind is more suggestible and the active resistance of the conscious mind can be more easily by-passed making hypnotherapy highly effective and often yielding quick results.  If a person is willing to accept the suggestions there is usually no reason why it will not work.  The opposite is also true ensuring that no one can be made to do anything against their will, another popular myth that often prevents people from turning to hypnotherapy for help.

Hypnotherapy is still struggling to shake loose its controversial status that has arisen largely through a lack of accurate knowledge and myths that have become accepted ‘facts’.  If administered by a properly trained clinical hypnotherapist it is perfectly safe with no adverse side effects.  Currently there is still no single regulatory body for clinical hypnotherapy training but plenty of reputable training schools exist and often clinical hypnotherapists voluntarily adhere to a code of conduct associated with other helping professions such as the British Association for Counselling and Psychotherapy (BACP).

In the past there has been a distinct lack of well-grounded research into hypnotherapy.  This is beginning to change however.  People are opening their minds to the possibility that hypnotherapy does not have to be a last resort and has many uses far removed from what can be seen in stage hypnosis shows which bear very little resemblance to clinical hypnotherapy – using hypnosis for clinical benefits and not entertainment.  The NHS is now beginning to recognise the potential benefits and some training for doctors now includes information on hypnotherapy as well the National Institute for Health and Clinical Excellence (an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health) now acknowledging hypnotherapy in their guidelines as a recommended form of treatment for irritable bowel syndrome.  The tide is certainly turning in the medical sector but where does that leave education? 

Schools are dynamic places continually changing as they are pushed and pulled by new initiatives and policies.  Most education professionals would now agree that no child will ever learn effectively and achieve their potential academically if they are not emotionally comfortable and secure.  Education has steadily become more holistic and now appreciates the impact of personal/life events on school performance, recognising that emotional competence and good self-esteem underpin the ability to learn, achieve and be happy within school and beyond.  Never is this more important than for children with SEN, especially those with Social, Emotional and Behavioural Difficulties (SEBD).  So how can hypnotherapy help these incredibly vulnerable pupils?

Hypnotherapy offers something quite different to the usual techniques regularly offered in schools such as stickers, incentive charts and strategies based on operant conditioning principles.  That is not to say that such techniques do not have their place and can work extremely well but often pupils with SEN (especially SEBD) can be on incentive charts most of their school life.  Pupils often find them un-motivating and teachers often rate them as unsuccessful in establishing long-term behaviour change.  Hypnotherapy is a fun and novel approach which makes it accessible for pupils who struggle with motivation or who may be completely disengaged from previous interventions or therapeutic approaches.  Whilst it still relies on a willingness to change (as it can’t make someone change against their will), it can be presented formally or informally to suit the needs of the pupil and due to its enjoyable nature, pupils are often willing to practise the techniques between sessions which makes the whole process more efficient and effective.  It is an extremely versatile approach meaning that a skilled hypnotherapist can adapt the techniques to suit boys or girls, with any cognitive ability from approximately 5 years upwards, regardless of academic attainment.  It can help pupils with other areas of need such as ADHD, learning difficulties, anxiety disorders, speech and language difficulties and ASD although the latter can prove difficult (though not impossible) due to the need to use imagination.  The results of hypnotherapy are generally very rapid which is not only an advantage in this current financial climate where everything is being measured for cost-effectiveness, but is also incredibly useful for maintaining motivation and raising self-esteem.  One of the fundamental principles behind hypnotherapy is the premise that the client (be that an adult or child) holds all the answers to their own problem and the hypnotherapist works as a facilitator in finding the solution.  This is very useful for pupils with SEBD who often suffer from feelings of low self-worth and believe they are helpless to change things in their lives.  Hypnotherapy can help them realise that they have control over how they respond to life events even if they can do little to actually control the events themselves.  This can be wonderfully empowering and help the pupil accept responsibility for themselves and their actions.  Many of the techniques taught are readily transferable to multiple situations meaning that pupils learn valuable skills they can use in diverse ways to help them in their often rapidly changing and turbulent lives.  This can increase resiliency and hopefully provides a buffer to potential mental health difficulties later in life, something that is sadly all too frequent in pupils who were labelled as SEBD at school. 

Arguably one of the most important things pupils learn from hypnotherapy is how to relax.  So frequently this skill is underestimated yet it is so fundamental to our physical and emotional health.  If we cannot relax appropriately we may find less appropriate ways to do so such as drinking alcohol, smoking or taking drugs.  So often pupils with SEBD are stressed and anxious and this manifests itself in dangerous or socially unacceptable behaviours that are the reason they are identified as SEBD in the first place.  Through hypnotherapy pupils are taught how to relax in a very deep way, physically and mentally.  They learn how they can quieten their minds and ‘escape’ from the stress and pressure of their challenging personal circumstances, albeit temporarily, so that when they return they can view things from a different perspective and with a renewed energy. 

Hypnotherapy teaches pupils ways to manage themselves - physically, mentally and emotionally, a skill that is all too often lacking from many pupils with SEBD.  It can help with a vast range of issues, even anonymous problems that a pupil may choose not to disclose to the hypnotherapist.  It can also help with physical problems (e.g. sleeping difficulties, bed wetting/soiling, eating issues, sensory sensitivity and tics) to emotional difficulties (e.g. coping with anger/anxiety/stress/grief/sadness/obsessive behaviours) to psychological issues (e.g. phobias, stammers, dealing with trauma and bad habits).  It can also help specific school based issues too such as exam anxiety, school phobia, victims of bullying, public speaking, anxiety over making mistakes, concentration difficulties and low confidence with academic work.  The list is almost endless!

Approximately 85% of people can be helped by hypnotherapy but children/young people are the most suitable because they are so open-minded.  Suggestibility has been shown to peak between the ages of 7-14 years when children/young people are developmentally less analytical than adults and more inclined to accept things on face value.  Younger children are in a trance state most of the time, as anyone who works with infant aged children will probably agree with!  Trance for children/young people is anything from daydreaming to making up a story to playing creatively with a toy.  They can be guided into trance far more quickly and easily than adults and are often more creative with their ideas to solve their own problems in terms of metaphors and imagery, which are the most frequently used tools when using hypnotherapy with children/young people.  As Dr Margot Sunderland (Integrative Child Psychotherapist and Director of Education and Training at the Centre for Child Mental Health, London) states in one of her books, “The natural language of feeling for children is that of image and metaphor, as in stories and dreams”.  We need to get into the world of the child and talk to them in their language if we stand any chance of helping to guide them safely through it. 

Hypnotherapy is a safe, effective and enjoyable intervention with huge applications and benefits.  In the not too distant future there is hope that the terms hypnotherapy and schools/children will be closely linked and the relevance between the two acknowledged, accepted, understood and applied.  It may not be the answer for every pupil all of the time but it certainly offers diverse, creative and fun solutions and may provide possibilities for pupils for whom standard interventions have proved unsuccessful.  There is nothing to lose and everything to be gained.

Caroline Dyson – Clinical Hypnotherapist and Behaviour Support Teacher - can be contacted at:

(0121) 240 0694

www.releasehypnotherapy.org.uk

carolinedyson@hotmail.co.uk

www.lcch.co.uk