Current Practices, Experiences, and Views in Clinical Hypnosis: Findings of an International Survey.

An online survey of 691 clinicians who use hypnosis was conducted in 31 countries to gain a broad real-world picture of current practices, views, and experiences in clinical hypnosis. Among 36 common clinical uses, stress reduction, wellbeing and self-esteem-enhancement, surgery preparations, anxiety interventions, mindfulness facilitation, and labor and childbirth applications were the most frequently rated as highly effective (each by ≥70% of raters) in the clinicians' own experience. Adverse hypnosis-associated effects had been encountered by 55% of clinicians but were generally short-lived and very rarely judged as serious. The most common hypnosis approaches used were Ericksonian (71%), hypnotic relaxation therapy (55%), and traditional hypnosis (50%). Almost all respondents reported regularly using other therapeutic modalities alongside hypnosis. Among a range of client variables potentially affecting therapy, most clinicians rated hypnotist-client rapport (88%) and client motivation (75%) as very or extremely important factors for successful hypnotherapy. The majority of respondents had conducted hypnosis treatment via teletherapy, and 54% of those estimated it to be as effective as in-person treatment.

Guidelines for the Assessment of Efficacy of Clinical Hypnosis Applications.

Research on the efficacy of hypnosis applications continues to grow, but there remain major gaps between the science and clinical practice. One challenge has been a lack of consensus on which applications of hypnosis are efficacious based on research evidence. In 2018, 6 major hypnosis organizations collaborated to form the Task Force for Establishing Efficacy Standards for Clinical Hypnosis. This paper describes a Guideline for the Assessment of Efficacy of Clinical Hypnosis Applications developed by the Task Force, which makes 10 specific recommendations. The guideline is intended to be a tool for those who want to assess the quality of existing evidence on the efficacy of clinical hypnosis for any particular indication. The paper also discusses methodological issues in the interpretation and implementation of these guidelines. Future papers will report on the other products of the Hypnosis Efficacy Task Force, such as best practice recommendations for outcomes research in hypnosis and an international survey of researchers and clinicians on current practice and attitudes about hypnosis.

Psychodermatology: An Association of Primary Psychiatric Disorders With Skin / Psicodermatología: asociación de trastornos psiquiátricos primarios con la piel

ABSTRACT The association of nervous system with skin is well documented. Many common psychiatric disorders can involve skin either directly or indirectly. We found an association of 13 primary psychiatric disorders leading to dermatological diseases, with association of 2 of 13 considered to be idiopathic. Association of the mind and body has long been studied. Several skin problems lead to psychological and psychiatric symptoms, however not all skin problems lead to psychiatric symptoms. On the contrary, many primary psychiatric illnesses appear to have associated skin disorders.

RESUMEN La asociación del sistema nervioso con la piel está bien documentada. Muchos trastornos psiquiátricos comunes pueden implicar a la piel directa o indirectamente. Se encontró asociación de 13 trastornos psiquiátricos primarios que llevan a enfermedades dermatológicas, y de las 13, asociación de 2 consideradas idiopáticas. La asociación entre la mente y el cuerpo se ha estudiado durante mucho tiempo. Varios problemas de la piel conducen a los síntomas psicológicos y psiquiátricos, pero no todos los problemas llevan a síntomas psiquiátricos de la piel. Por el contrario, parece que muchas enfermedades psiquiátricas primarias se asocian con trastornos de la piel.

Psychodermatology: An Association of Primary Psychiatric Disorders With Skin.

The association of nervous system with skin is well documented. Many common psychiatric disorders can involve skin either directly or indirectly. We found an association of 13 primary psychiatric disorders leading to dermatological diseases, with association of 2 of 13 considered to be idiopathic. Association of the mind and body has long been studied. Several skin problems lead to psychological and psychiatric symptoms, however not all skin problems lead to psychiatric symptoms. On the contrary, many primary psychiatric illnesses appear to have associated skin disorders.

Mindfulness-Based Cognitive Hypnotherapy and Skin Disorders.

Mindfulness-based cognitive hypnotherapy integrates mindfulness, cognitive-behavioral therapy, and hypnotherapy to improve physical, emotional, mental, and/or spiritual aspects of skin disorders. Meditation, including mindfulness meditation, and hypnosis both utilize trance phenomena to help produce focalization and specific improvements in skin disorders through psycho-neuro-endocrine-immunologic mechanisms. Hypnosis, cognitive hypnotherapy, focused meditation, and mindfulness meditation are discussed with respect to improving various skin disorders including acne, acne excoriée, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythema nodosum, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, prurigo nodularis, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. Their integration into mindfulness-based cognitive hypnotherapy is then discussed and illustrated with improvement in a patient with systemic lupus erythematosus.

Use of hypnosis, meditation, and biofeedback in dermatology.

Hypnosis utilizes trance to access otherwise inaccessible repressed or unconscious memories and features of the psyche and control of physiology not attainable in the ordinary conscious waking state. Medical uses of hypnosis in dermatology include reducing discomfort from itching or skin pain, altering ingrained dysfunctional habits such as scratching, promoting healing of skin disorders, searching for psychosomatic aspects of skin disorders and alleviating them, and reframing cognitive and emotional dysfunctional patterns related to skin disorders. Meditation uses trance to center and balance. Medical uses of meditation in dermatology include relaxation to promote healing of skin disorders and refocusing with respect to the meaning and emotional negative valance of skin disorders. Biofeedback in dermatology employs instrumentation with visual or auditory feedback to permit conscious awareness and alteration of physiologic phenomena such as sweating as measured by galvanic skin resistance and skin temperature measured by temperature detecting devices, promoting relaxation and healing. These methods and techniques permit access to and intervention in otherwise inaccessible areas that can influence skin disorders. With proper use, they are very safe, with minimal, if any, side effects and sometimes produce significant results where other methods have failed.

Chronic Tender Ulcers on the Calf and Both Forearms.

An elderly woman presented with a 3-month history of nonhealing, tender ulcers involving the right calf and both forearms. She denied any history of similar lesions or trauma. Two trials of oral antibiotics had led to no improvement. Her medical history was significant for rheumatoid arthritis treated with methotrexate, hydroxychloroquine, and prednisone. A review of clinical manifestations was otherwise negative for disease. Physical examination of the patient's right calf revealed two punched-out ulcers with central necrotic black eschars, underlying retiform purpuric pattern, and mild fibrinopurulent drainage (Figure 1). Similar lesions were present on her forearms (Figures 2 and 3). No other remarkable skin changes were noted. The differential diagnosis included polyarteritis nodosa, cutaneous necrosis secondary to antiphospholipid syndrome, cryoglobulinemic vasculitis, and an atypical presentation of pyoderma gangernosum.

Spiritual and religious aspects of skin and skin disorders.

Skin and skin disorders have had spiritual aspects since ancient times. Skin, hair, and nails are visible to self and others, and touchable by self and others. The skin is a major sensory organ. Skin also expresses emotions detectable by others through pallor, coldness, "goose bumps", redness, warmth, or sweating. Spiritual and religious significances of skin are revealed through how much of the skin has been and continues to be covered with what types of coverings, scalp and beard hair cutting, shaving and styling, skin, nail, and hair coloring and decorating, tattooing, and intentional scarring of skin. Persons with visible skin disorders have often been stigmatized or even treated as outcasts. Shamans and other spiritual and religious healers have brought about healing of skin disorders through spiritual means. Spiritual and religious interactions with various skin disorders such as psoriasis, leprosy, and vitiligo are discussed. Religious aspects of skin and skin diseases are evaluated for several major religions, with a special focus on Judaism, both conventional and kabbalistic.

Disseminated histoplasmosis in a renal transplant patient.

Histoplasma capsulatum is a common endemic mycosis. Infection typically goes unnoticed by an individual, but in immunosuppressed patients, it may become disseminated. We report a case of disseminated histoplasmosis occurring 6 weeks after a kidney transplant. We discuss disseminated histoplasmosis and review its characteristic clinical, laboratory, and histologic manifestations, as well as current treatment modalities.

Anxiety reduction using hypnotic induction and self-guided imagery for relaxation during dermatologic procedures.

Many patients experience some degree of anxiety during dermatologic procedures. A prospective, randomized-control trial of hypnotic induction followed by self-guided imagery was conducted with patients in 3 groups: live induction, recorded induction, or control. By 20 minutes into the procedure, there was significantly reduced anxiety reported in the live-induction group compared with the control, whereas reported anxiety in the recorded-induction group was similar to that of the control group. All 13 in the live induction, 11 of the 13 in the recorded induction, and none of the 13 in the control group imagined scenes. The findings of this study suggest that live hypnotic induction followed by self-guided imagery can help to reduce anxiety experienced by many patients during dermatologic procedures.

Hypnosis to alleviate the symptoms of ciguatera toxicity: a case study.

Ciguatera toxicity is a poisoning from consuming reef fish that had fed on dinoflagellates such as Gambierdiscus toxicus found along coral reefs. The toxin is oil soluble, odorless, colorless, tasteless, heat stable, and is concentrated in larger carnivorous fish such as amberjack, barracuda, eel, grouper, red snapper, sea bass, and Spanish mackerel. Onset of symptoms is usually within 6-12 hours after ingestion. Gastrointestinal symptoms lasting 1-2 days include abdominal pain, nausea, vomiting, and diarrhea. Neurological symptoms may persist for weeks or several months or--rarely--years and include circumoral and extremity paresthesias, temperature sensation reversal, itching, weakness, ataxia, and others. A patient with burning hands and feet who had not found relief using other methods had diagnosis of ciguatera toxicity assisted by hypnotically refreshed memory followed by rapid relief with hypnotic suggestions in 1 session and remained free of symptoms.

Psychodermatological disorders: recognition and treatment.

Many dermatological disorders have a psychosomatic or behavioral aspect. Skin and brain continually interact through psychoneuroimmunoendocrine mechanisms and through behaviors that can strongly affect the initiation or flaring of skin disorders. It is important to consider these mind-body interactions when planning treatments for specific skin disorders in individual patients. Mind-influencing therapeutic options that can enhance treatment of skin disorders include standard psychotropic drugs, alternative herbs and supplements, the placebo effect, suggestion, cognitive-behavioral methods, biofeedback, and hypnosis. When individual measures do not produce the desired results, combinations of drugs or addition of non-drug therapies may be more successful. Psychophysiological skin disorders may respond well to non-drug and drug therapies that counteract stress. Treatment of primary psychiatric disorders often results in improvement of associated skin disorders. Psychiatric disorders secondary to skin disorders may also require treatment. Therapeutic options for each of these are discussed.

Ideomotor signaling: from divining spiritual messages to discerning subconscious answers during hypnosis and hypnoanalysis, a historical perspective.

Ideomotor movements account for non-conscious motions of the hand held pendulum and Ouija board planchette that once were attributed to external spirits. Chevreul and Carpenter in the mid-1800s pioneered our scientific understanding of ideomotor movements. The intention or thought is transmitted to the motor cortex at a subconscious level, coordinated by the cerebellum, and sent down spinal nerves to the appropriate muscles, inducing micromovements not visible to the naked eye but amplified by the hand held pendulum or by the slow ratchet-like cumulative movements of a finger or other body part. This ideomotor phenomenon has been utilized during hypnotic trance to provide nonverbal communication of "yes" or "no" or "I don't want to answer" using finger signals or hand held pendulum. LeCron first used this ideomotor form of communication in conjunction with psychosomatic hypnoanalysis. Cheek expanded and more recently Hammond, Walsh, Ewin and others have refined its use.

An unusually large eccrine poroma: a case report and review of the literature.

The eccrine poroma is an uncommon benign neoplasm previously thought to originate solely from the eccrine sweat gland. Initially believed to present on hairless acral surfaces, a more extensive distribution has been described. We report a case of a 55-year-old man with a slowly growing, 6-cm eccrine poroma on the medial aspect of his right foot of 40 years' duration. Clinicians should be aware that poromas can be of either eccrine or apocrine origin and can occur in areas other than acral skin. They also should understand the subclassification of the poroma family of neoplasms.

Controversies in skin surgery: electrodessication and curettage versus excision for low-risk, small, well-differentiated squamous cell carcinomas.

BACKGROUND: Electrodesiccation and curettage (ED&C) of low-risk, cutaneous squamous cell carcinoma (SCC) generally consumes less time and resources than excision. Review of the literature reveals few recent studies examining cure rates for ED&C in the treatment of low risk cutaneous SCC. OBJECTIVE: To evaluate via two retrospective studies the efficacy of ED&C in the treatment of low risk cutaneous SCC. METHODS: A small controlled study in a Veterans Administration teaching hospital dermatology clinic compared cure rates of low risk SCC at one year by ED&C to those of surgical excision. A second study examined the cure rate of low risk lesions treated by curettage and electrodesiccation in a private practice. RESULTS: The first study found no significant difference in cure rates between ED&C (14 of 14 cases successfully treated) and excision (15 of 16 successfully treated and one recurrence) (P = 0.1711). The second study found the ED&C cure rate (106 of 106 successfully treated) to be significantly greater than an arbitrary cure rate of 95 percent (P = 0.0091). CONCLUSION: These findings support the efficacy of ED&C as a treatment modality for low-risk cutaneous SCC.

Relaxation strategies for patients during dermatologic surgery.

Patient stress and anxiety are common preoperatively and during dermatologic procedures and surgeries. Stress and anxiety can occasionally interfere with performance of procedures or surgery and can induce hemodynamic instability, such as elevated blood pressure or syncope, as well as producing considerable discomfort for some patients. Detection of excess stress and anxiety in patients can allow the opportunity for corrective or palliative measures. Slower breathing, biofeedback, progressive muscular relaxation, guided imagery, hypnosis, meditation and music can help calm and rebalance the patient's autonomic nervous system and immune functioning. Handheld miniaturized heart rate variability biofeedback devices are now available. The relaxation response can easily be taught. Guided imagery can be recorded or live. Live rapid induction hypnosis followed by deepening and then self-guided imagery requires no experience on the part of the patient but does require training and experience on the part of a provider. Recorded hypnosis inductions may also be used. Meditation generally requires more prior experience and training, but is useful when the patient already is skilled in it. Live, guided meditation or meditation recordings may be used. Relaxing recorded music from speakers or headphones or live performance music may also be employed to ease discomfort and improve the patient's attitude for dermatologic procedures and surgeries.

Psychological interventions in the management of common skin conditions.

The nervous system and the skin develop next to each other in the embryo and remain intimately interconnected and interactive throughout life. The nervous system can influence skin conditions through psychoneuroimmunoendocrine mechanisms and through behaviors. Understanding the pathophysiology aids in selection of treatment plans for correcting the negative effects of the psyche on specific skin conditions. Medication options include standard psychotropic medications and alternative herbs and supplements. Other options include biofeedback, cognitive-behavioral methods, hypnosis, meditation, progressive relaxation, the placebo effect, and suggestion. When simple measures fail, combining medications with other therapeutic options may produce better results. Skin conditions that have strong psychophysiologic aspects may respond well to techniques such as biofeedback, cognitive-behavioral methods, hypnosis, meditation, or progressive relaxation that help to counteract stress. Treatment of primary psychiatric disorders that negatively influence skin conditions often results in improvement of those skin conditions. Abnormal conditions of the skin, hair, and nails can also influence the psyche negatively. Treatment of secondary psychiatric disorders such as anxiety or depression that are triggered or exacerbated by the appearance of these skin conditions or the associated discomfort may also be required.