IPA november 2014 pediatric hypnosis

Franz Baumann

The first pediatrician elected President of the

American Society of Clinical Hypnosis (1950-1970)

Outline Objectives

Developmental Approach to using pediatric hypnosis

Treatment planning with pediatric hypnosis

Problems treated with pediatric hypnosis

Hypnosis as part of child therapy/play therapy; Post

Hypnotic Suggestion (PHS); hypnotic language

Videos

Q & A

Learning Objectives

Objective #1: What is pediatric hypnosis?

Developmental and Experiential Component

Objective #2: Pediatric hypnosis – efficacy &

applications?

Objective #3: Training & integrating into your practice

Thesis

Clinical pediatric hypnosis is a tool to

facilitate the evolution and refinement of

self-regulation skills and capacities.

Ego Integrity

vs. Despair

Intimacy vs. Isolation

Trust vs.

Mistrust

Identity vs.

Role

Confusion

Working Toward Mastery

Autonomy

vs. Shame

& Doubt

Initiative

vs. Guilt

Industry

vs.

Inferiority

Generativity

vs.

Stagnation

Erik Erikson’s 8 Psycho-Social Stages of Development

Pendergrast and Lombard, March 22, 2014

Definitions of hypnosis

www.lisalombardphd.com

Hypnosis: a state of consciousness involving focused

attention and reduced peripheral awareness

characterized by an enhanced capacity for response to

suggestion.

Hypnotizability: an individual’s ability to experience

suggested alterations in physiology, sensations,

emotions, thoughts, or behavior during hypnosis.

Hypnotherapy: The use of hypnosis in the treatment of

a medical or psychological disorder or concern.

The American Psychological Association Division 30, 2014



Hypnosis is a state of inner absorption, concentration and

focused attention. It is like using a magnifying glass to focus

the rays of the sun and make them more powerful. Similarly,

when our minds are concentrated and focused, we are able to

use our minds more powerfully. Because hypnosis allows

people to use more of their potential, learning self-hypnosis is

the ultimate act of self-control.... Recent research supports the

view that hypnotic communication and suggestions effectively

changes aspects of the persons physiological and neurological

functions.

American Society of Clinical

Hypnosis Website


A spontaneously occurring or induced alternative

state of awareness (with or without relaxation,

which may or may not be evident) in which an

individual develops a focused concentration on

some idea or image with the expressed purpose

of maximizing potential, creating a CHANGE,

and/or reducing or resolving some problem (Kohen

and Olness, 2011).


Hypnotizability

Essential traits needed to be hypnotized include:

being able to focus one’s attention being highly responsive to

suggestion.

(Brown & Fromm, 1986)


Hypnosis myths

Bad hypnosis cartoons

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http://www.youtube.com/watch?v=pKDJD2oLWtY

What limits hypnotizability and

effectiveness?

Misconceptions about hypnosis.

May see hypnosis as “magic”

May refuse because of secondary gain of symptoms.

Attitudes of significant adults

Parents


Pediatric Hypnosis

A tool to strengthen children‘s existing or

under-developed skills in self-regulation,

i.e., capacities to shift attention, maintain

focused attention, inhibit and control

reflexive actions, delay gratification, use

problem solving strategies, and self-monitor

and modulate thinking, emotion, behavior,

and psycho-physiological reactivity.

Kaiser, P. Chlldhood Anxiety, Worry, and Fear: Individualizing Hypnosis Goals and

Suggestions for Self-Regulation. Am. J. Clin. Hypn. 2011, 54, 16–31

Daily and Random

Hypnotic Experiences

TV/video games

Sports trance…in the zone

Daydreaming

Booboo and runs to parent

At the hospital, doctor’s office


http://youtu.be/XhLrlhFzAjA


Notice how Disney Introduction uses many of

the same elements:

absorption, narrowed focus, multi-sensory

input, novelty, curiosity about what comes next,

etc.

http://youtu.be/XhLrlhFzAjA

Pediatric Clinical Hypnosis –

Many Shapes

Formal

Conversational

Spontaneous

Self-hypnosis

Books

Drawings

Materials (monotonous)

Metaphors


Imaginative involvement Process where the child is absorbed in a "here and now" fantasy

experience

Present reality is suspended in the interests of the current experience

Used with younger children

Used instead of classic hypnosis

Must pay attention to the (changing) behavioral responses of young

children

Different from Classic Hypnosis which may involve:

dissociated ego state

profoundly relaxed physiological state

distinct altered state of consciousness

Developmental Considerations

Developmental differences in

hypnotic processes


Younger children

less structured

more action-oriented

present-centered

Children 7 years and older

Ability to close eyes during hypnosis

Use creative imagination

More structured

Hypnotic process in adults

Structured

Ability to close eyes

More relaxation

Clinical Hypnosis across development:

Infants and toddlers

Infants and toddlers understand the world through sensory experiences

Hypnosis in infants and toddlers: Sensory or motor based techniques

Auditory

Playing soothing music, singing songs- lullabies, telling a story

Kinesthetic

Rocking- example would be rocking at a pace that approximates maternal heart beat

Soothing

Repetition, familiarity, predictability

Minimally verbal, direct, simple

Integration of play and hypnotic suggestion


Across Development: Preschool

YearsPreschoolers

LanguageSimple and clear; Cognitively concrete and literal in their communication and comprehension

FlexibilityFollow child in and out of trance in a sensitive manner; Unaccustomed to physical relaxation; Move fluidly between fantasy and reality; Move around with eyes open during hypnosis without effecting trance

AttentionAbsorb child's attention in an informal manner; Short attention spans

Avoid lengthy inductions



C Cognitive functioning

Longer attention spans

Better cooperation

Ability to use imagination

More willing to close eyes

Can relax their bodies

Breathing is more regular

Metaphors and suggestions

Focused facial expressions

Tell child that hypnosis is a talent that can be used anywhere

Use child's personal experiences to make hypnosis relevant

School Age Children


Inductions that are useful for school-

aged children

Eye fixation

Coin drop technique

Favorite-place imagery

Learning and control metaphors

Adventure imagery

Superheroes and heroines

Ideo-motor Inductions

Induction and Deepening

Techniques with Children Eyes open story

Mighty oak tree

Raggedy Ann doll

Progressive muscle relaxation (e.g., imagery such as melting snowman)

Favorite place, song, activity…

T.V., movie, computer game

Bouncing ball adventure

Boat ride, magic carpet ride, ride in clouds

Fill sand pail

Eye fixation

Distraction

Ideomotor techniques


Using Hypnosis in Child

Therapy

Thinking(Cognition)

Feeling (Affect)

Doing (Behavior)Sensing

(Physiological/Sensory)

Treatment Goals

Manage Symptoms

Interrupt Old Patterns/

Create New Patterns

Improve Self-Regulation

Develop Discrimination

Skills

Enhance Resources

Build Positive

Expectancies

Model based on Pamela Kaiser’s

work

Elements of Hypnotherapy

Rapport

Induction and Intensification

Suggestions/Metaphors/Themes

Check-in with patient

Contextualization/PHS

Closure, Alert, and Orient

Debrief

Only describe what you

notice

Rather than,

“you are feeling relaxed now…”

invite the patient to notice differences or change…

??????

“Let me know please when you are beginning to notice the relaxation…”

When people are curious they listen carefully

Convey Positive Expectations:

“ I won’t be surprised WHEN…”

“ Won’t it be great WHEN…? ”

Time Use non-specific time references like, “in a few

moments.”

Better than “in 3 minutes….”

Therapeutic Uses of Language

(When…not IF)

“IF you can feel your muscles relax…”When you feel relaxed, then you’ll be very proud of

yourself & comfortable…

“TRY to ….”You may wish to…

“I want you to move your arm down.”You might be curious to notice how it feels to move your arm…

What’s not good about these phrases? How can you improve them?

BecauseWhy is this word important in suggestions?

Because people need a reason to do the suggestion.

Motivating (based on history and treatment plan).

“Allow yourself to relax down to your feet…because ???

You may wish to imagine a beautiful magic carpet

because???

Ego StrengtheningOffer reinforcing suggestions or statements

“You are doing this very well.”

“ As you do this more and more for yourself you will

probably be very proud of what you are learning and

accomplishing…”

“It’s good to know that you are doing this exactly

right.”

Emphasize words like: confidence, competence, comfort,

pride, joy, satisfaction, peace, serenity, comfortable

easily, effortlessly, relaxed, slowly

Post-Hypnotic Suggestions

Post Hypnotic Suggestions (PHS) Offered during hypnosis

Encourages new or different thoughts, feelings,

behaviors, sensations for later!

Basic Structure =

“Later, when you’re in situation

[xyz], you’ll be able to

experience/do/feel/think [abc].”

Five Senses

Touch

Sight

SoundSmell

Taste

Developing Cues for PHS

Range of applications

Anxiety, including PTSD

Phobias (simple/complex)

Learning Disabilities, Asperger’s Disorder

Hypnoanalgesia

Medical Problems Invasive Medical

Procedures

Pediatric Medical Problems

Habit Disorders

Trichotillomania

Nail biting

Thumb sucking

Enuresis

Sleep Disturbances


Specific Pediatric Medical

Problems

Asthma

Hives

Allergies

Itching, scratching, picking

Hyperhidrosis

Warts

Diabetes

Neurologically mediated intractable reflexes

Cerebral palsy

Reflex sympathetic dystrophy

Rehabilitation following central nervous system injury

Pulmonary symptoms related to psychological problems, discomfort because of medication, or fear related to procedures

Dentistry


Cancer

Hemophilia

Gastrointestinal disorders

Juvenile rheumatoid arthritis

Malignancies

Headaches

Seizures

Urine retention

Cyclic vomiting

Sports medicine

Burns

• Thinking

• Doing

• Feeling

Summary: Pediatric hypnosis promotes self regulation in

functioning

• Sensing

• Noticing

Self Regulation - Thoughts

Foster locus of control

• More realistic risk-appraisal

• Cognitive restructuring: catastrophic thinking

• Expand self-efficacy: draw on past mastery experiences

• Compartmentalize

• Create + expectations

Self Regulation - Emotions

• Emotional literacy

• Manage extreme or strong feelings; Compartmentalize anxiety and fear

• Feelings change in degree and over time; Let go of old fear/anxiety

• Label feeling within body; Embodied thinking

• Sense of internal safety and empowerment

• Increase comfort and calmness

• Foster optimism

• Strengthen confidence to manage situation

• Separate-individuate from parental external soothing and reassurance (LOC)

Modulate emotional reactivity

Compartmentalize fear/anxiety/worries

box- balloons


Anxiety/Worry/Fear Reactivity:

Tantrums & meltdowns

Nightmares

Specific fears

Panic

Limited self-soothing

Anxious attachment

Seek reassurance/proximity/contact

Bite/pick (nails, lips, clothes)

Hypervigilance

Gaze aversion

Cry/tantrum

School avoidance/resistance

Avoid-escape-freeze


Brain with dimmer switch in it; emotions go from

sad to happy

Pendergrast and Lombard, March 22, 2014

Self Regulation - Behaviors

• Down-regulate or Up-regulate

• Cause and effect

• Healthy choices

• Adjustment to chronic illness and conditions

MindUp Curriculum: Mindfulness in

Preschool through 3rd Grade


Self Regulation - Attention

• Alert and activate

• Discrimination: essential from non-essential details

• High Interest vs. Low Interest Activities

• Magnification

Self Regulation - Sensing

Modulate Psychophysiological Reactivity:

Dampen initial response - numbing

Relaxation training - belly breathing

Raise sensory threshold

Calm a specific internal organ (e.g., stomach)

Reframe panic episodes - somatization reduction

Modulate PSYCHOPHYSIOLOGICAL REACTIVITY with

hypnotic suggestions

Dampen initial and sustained reactivity

0-10 scales

Control panel (be the “boss”)

Calm and self sooth


Review of Self RegulationLearned ability to control inner states or responses

related to:

Thoughts - Cognition

Emotions - Feeling

Behavior - Doing

Attention - Noticing

Physiological Reactivity - Sensing

How Hypnosis addresses pain

Develops metaphor

Captures imagination

Sustains and promotes hope

Curtails uncertainty and fear

Plays with possibilities

Works with paradox

Envisions optimal outcome

Distorts time



Pediatric hypnosis has been used with these

Medical Problems

Asthma

Hives

Allergies

Itching, scratching, picking

Hyperhidrosis

Warts

Diabetes

Neurologically mediated intractable reflexes

Cerebral palsy

Reflex sympathetic dystrophy

Rehabilitation following central nervous system injury

Pulmonary symptoms related to psychological problems, discomfort because of medication, or fear related to procedures

Dentistry

Cancer

Hemophilia

Gastrointestinal disorders

Juvenile rheumatoid arthritis

Malignancies

Headaches

Seizures

Urine retention

Cyclic vomiting

Sports medicine

Burns


Switch-wire Imagery• Pair hypnosis with new variations of imagery to help

children cope with phobias & pain

• A dissociation-oriented imagery involving a “switch-wire”metaphor can help child turn on/off the anxiety at the sight or experience of the phobic stimulus

• Helps develop mastery and control of fear

• Teaches a child to dissociate his/her body; adds to heightened experience of hypnotic induction and suggestion

• A switch metaphor is more tangible and can be more easily visualized for a younger child

• Children can easily utilize the self-hypnotic protocol once learned


APPLIED ANALGESIA

Suggestions: These classic suggestions use different parts of

the brain.

You feel numbness in your body (Somatosensory).

The sensations seem far away (Thalamus).

If you feel anything, it might be a feeling of pressure or tingling (Prefrontal cortex).


Hypnoanalgesia Hypnosis may reduce endorphin levels therefore inducing relaxation.

With children, focus on mastery, expressing confidence in abilities, giving choices on when and how to practice, and letting them decide which imagery to use.

Techniques: Direct suggestions Distancing suggestions Suggestions for feelings antithetical to pain Distraction techniques Directing attention to pain itself Reinforcement

(Gardner & Olness, 1981)


Magic Glove

Leora Kuttner, Ph.D.

Clinical Psychologist and Clinical Professor of

Pediatrics Vancouver, BC. Canada

http://lifeafterpain.com/info/expert-interviews/managing-pain-

interview-with-doctor-leora-kuttner/

http://youtu.be/cyApK8Z_SQQ?t=32s

http://lifeafterpain.com/info/expert-interviews/managing-pain-interview-with-doctor-leora-kuttner/

http://youtu.be/cyApK8Z_SQQ?t=32s

Applications of Hypnosis in

Chronic Illness

Post-Hypnotic Suggestions: ease of remembering

sensations of comfort, joy, easy breathing, etc.

Amnesia: forgetting prior discomfort, regression to

time before the illness, use of “Affect Bridge” to bring

good feelings back.



Chronic Illness...

Strategies

Create atmosphere of hope, positive expectations for

change, help child to perceive a difference with re-

framing...

Time Distortion - regression, progression

Scales of comfort/discomfort e.g. 0-12 (useful for

pain, anxiety, sleep, etc.)

Dissociation - THAT DISCOMFORT, NOT YOURS



Chronic Illness... Imagery

Color, Size of discomfort > change it

= where you’d rather be imagery

Imagery to turn things down, off...around the body to make repairs, create changes in organs, healing, brain’s computer...


Applications of Hypnosis in Chronic Illness...

Split-Screen Technique:

Problem on one side, desired outcome on the other

side.

Watch (or create) the change, as one gets smaller and

the other bigger...


Pediatric Surgery

Preoperative

Suggestions focus on comfort and calm, easy return to normal body functions, and rapid healing

Hypnotherapy as adjunct to anesthesia

Allows child to be more active

Found to reduce anticipatory anxiety and procedure-related pain, anxiety, distress behavior, duration, and improve the quality of recovery



Go to Resource to get started Kohen, D.; Kaiser, P. Clinical Hypnosis with Children

and Adolescents—What? Why? How?: Origins,

Applications, and Efficacy. Children 2014, 1(2), 74-98;

doi:10.3390/children1020074.

http://www.mdpi.com/2227-9067/1/2/74

Clinical Hypnosis with Children and Adolescents-What?Why?How?: Origins, Applications, and Efficacy

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Anbar, R.D.; Hall, H.R. Childhood habit cough treated with self-hypnosis. J. Pediatr. 2004, 144, 213–217.

Curtis, S.; Wingert, A.; Ali, S. The Cochrane Library and Procedural Pain in Children: An Overview of Reviews. Evid.-

Based Child Health: A Cochrane Rev. J. 2012, 7, 1363–1399. doi:10.1002/ebch.1864.

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Golden, W. Cognitive Hypnotherapy for Anxiety Disorders. Am. J. Clin. Hypn. 2012, 54, 263–274

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639.

Select References Kuttner, L. Pain—An integrative approach. In Oxford Textbook of Palliative Care for Children; Goldman, A., Hain, R., Liben, S.,

Eds.; Oxford University Press: New York, NY, USA, 2006; pp. 332–341.

Kuttner, L. A Child in Pain: How to Help: What Health Professionals Can Do to Help Crown; House Publishing: Bethel, CT, USA, 2010.

Landier, W.; Tse, A. Use of Complementary and Alternative Medical Interventions for the Managaement of Procedure-Related Pain, Anxiety, and Distress in Pediatric Oncology: An Integrative Review. J. Pediatr. Nurs. 2010, 25, 566–579.

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Myers, C.D.; Bergman, J.; Zeltzer, L.K. Complementary and alternative medicine use in children with cancer. In Psychosocial Aspects of Pediatric Oncology; Kreitler, S., Arush, M.B., Eds.; John Wiley and Sons: Hoboken, NJ, USA, 2004; pp. 335–350Richardson, J.; Smith, J.; McCall, G.; Pilkington, J. Hypnosis for Procedure-Related Pain and Distress in Pediatric Cancer Patients: A Systematic Review of Effectiveness and Methodology Related to Hypnosis Interventions. J. Pain Symp. Manag. 2006, 31, 70–84.

Schnur, J.B.; Kafer, I.; Marcus, C.; Montgomery, G.H. Hypnosis to Manage Distress Related To Medical Procedures: A Meta-Analysis. Contemp Hypn. 2008, 25, 114–128, doi:10.1002/ch.364.

Uman, L.S.; Birnie, K.A.; Noel, M.; Parker, J.A.; Chambers, C.T.; McGrath, P.J.; Kisely, S.R. Psychological interventions forneedle-related procedural pain and distress in children and adolescents. Cochrane Database Syst. Rev. 2013, 10, doi:10.1002/14651858.CD005179.pub3.

Uman, L.S.; Chambers, C.T.; McGrath, P.J.; Kisely, S.A. A systematic review of randomized controlled trials examining psychological interventions for needle-related procedural pain and distress in children and adolescents: An abbreviated Cochrane Review. J. Pediatr. Psychol. 2008, 33, 842–854.

Vlieger, A.M.; Menko-Frankenhuis, C.; Wolfkamp, S.C.S. Hypnotherapy for children with functional abdominal pain or Irritable Bowel Syndrome: A randomized controlled trial. Gastroenterology 2007, 133, 1430–1436.

Questions??Please feel free to contact me


[email protected]

National Pediatric Hypnosis Training Institute (NPHTI) www.NPHTI.org

Offices in Oak Park & Streeterville

http://www.lisalombardphd.com

mailto:[email protected]

http://www.NPHTI.org

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IPA november 2014 pediatric hypnosis

Health & Medicine