Hypnosis, behavioral theory, and smoking cessation.

Although nicotine replacement and other pharmacological treatments head the list of popular interventions for smoking cessation, approaches based on psychology can also assist smokers. Hypnosis, suggestion, and behavior therapies have been offered to patients and studied experimentally for several decades. Although no single psychological approach has been found to be superior to others, psychological interventions contribute significantly to successful treatment outcome in smoking cessation. This article describes common hypnotic and behavioral approaches to smoking cessation and critically reviews some of the findings from clinical and experimental research studies. The authors also offer suggestions regarding treatment and future research.

Empirical findings on the use of hypnosis in medicine: a critical review.

Recent changes in health care have been characterized by an increased demand for empirically supported treatments in medicine. Presently, there is moderate support for the integration of hypnotic techniques in the treatment of a number of medical problems. This critical review of the research literature focuses on the empirical research on the effectiveness of hypnotic treatments as adjuncts to medical care for anxiety related to medical and dental procedures, asthma, dermatological diseases, gastrointestinal diseases, hemorrhagic disorders, nausea and emesis in oncology, and obstetrics/gynecology. Wider acceptance of hypnosis as an intervention to assist with medical care will require further research.

The integration of clinical and experimental work.

The work and the professional relationships of clinicians who use hypnosis and their research counterparts always contain a certain degree of tension. This is especially true when one group or the other claims to have a purchase on truth. A review of the strengths and limitations of each subspecialty is provided along with an understanding of some of the differences between the clinical and experimental perspectives. The author raises a number of points with the hope that this article will promote discussion among those who are engaged in clinical and experimental work and those few who are active in both. Several suggestions for integration and collaboration are offered for consideration by both groups.

Psychological predictors of subsequent medical care among patients hospitalized with cardiac disease.

BACKGROUND: There have been numerous reports indicating a relation between psychological distress and coronary artery disease. The authors tried to determine whether psychological distress in patients hospitalized for coronary artery disease is associated with the amount of medical care required after discharge. METHODS: Using a prospective clinical cohort, 210 patients who had been admitted for myocardial infarction (n = 67), percutaneous transluminal coronary angioplasty (n = 75), or coronary artery bypass grafting (n = 68) were followed for 6 months. Index psychological status was determined from questionnaires measuring depression and anxiety. Disease severity was assessed by the index hospitalization medical record of left ventricular ejection fraction, number of stenotic vessels, and number of noncardiac comorbidities. The amount of subsequent medical care delivered was based on the number of days of rehospitalization for cardiac-related illness and for any reason within 6 months after discharge. This was determined from a combination of computer medical record and patient self-report. RESULTS: The authors first determined that both psychological depression and disease severity each predicted days of rehospitalization. (Anxiety was not predictive of rehospitalization.) Next, disease severity was controlled for using partial correlation, and depression was still predictive of rehospitalization. Finally, the authors combined the predictor variables using a regression model to predict rehospitalization. Depression was a significant main effect in all models predicting rehospitalization. CONCLUSIONS: Psychological depression appears to be an important predictor of rehospitalization among persons who have been admitted with coronary artery disease.

Hypnotizability, dissociation, and bulimia nervosa.

This study examined the levels of hypnotizability and dissociation in an outpatient sample of 17 normal-weight bulimic women and 20 healthy controls. Bulimic patients were significantly more hypnotizable than controls (p < .003) and scored higher on a self-report scale of dissociative experiences (p < .02). The results of measures of hypnotizability and dissociation showed a significant positive correlation in the combined subject group. These results are consistent with previous reports on hospitalized patients and college students and suggest that psychological factors associated with hypnotizability might play a role in the etiology and treatment of bulimia nervosa.

Effect of hypnotic suggestion on the delayed-type hypersensitivity response.

OBJECTIVE: To determine whether individuals selected for good general health, high hypnotizability, and the ability to alter skin temperature under hypnotic suggestion can influence the delayed-type hypersensitivity (DTH) response to varicella-zoster (VZ) antigen under hypnotic suggestion. DESIGN: A blinded clinical trial using a repeated measures design with subjects serving as their own controls. Subjects were randomly assigned to undergo a predetermined sequence of four different experimental conditions, occurring at weekly intervals, with each condition including VZ skin testing: (1) hypnosis with suggestions to enhance the DTH response to VZ antigen; (2) hypnosis with suggestions to suppress the DTH response; (3) hypnosis with suggestions for relaxation only; and (4) skin testing without hypnosis. SETTING: A National Institutes of Health-supported clinical research center in a teaching hospital. SUBJECTS: A stratified sample of 24 ambulatory, healthy, highly hypnotizable, volunteer college students selected for their above-average ability to alter skin temperature after hypnotic suggestions and their positive baseline responses to VZ antigen. There were 11 males and 13 females with a mean +/- SD age of 22 +/- 6 years. The mean +/- SD hypnotizability score (Harvard Group Scale of Hypnotic Susceptibility) was 11 +/- 1. INTERVENTIONS: Intradermal skin testing with VZ antigen (Mantoux method) and hypnotic suggestion. MAIN OUTCOME MEASURES: Areas of induration of the DTH response measured at 24 and 48 hours after injection of antigen. RESULTS: The area of the DTH response was not affected by the experimental interventions. The area of erythema was likewise unaffected. CONCLUSIONS: Our subjects were unable to alter their DTH responses using hypnotic suggestion.

Alexithymia ratings in bulimia nervosa: clinical correlates.

Previous reports indicate that some patients with eating disorders have alexithymic characteristics, including affect deficit states and paucity of imagination. This study evaluated whether nonhospitalized patients with bulimia nervosa had elevated ratings of alexithymia in comparison to age-matched controls, and whether severity of bulimic symptoms was correlated with elevations in alexithymia ratings. Because alexithymia may be secondary to concurrent depression, this study was limited to patients with bulimia nervosa who were free of major depression. The authors compared alexithymia ratings for nonhospitalized normal weight women meeting DSM-III-R criteria for bulimia nervosa (N = 20) to healthy female volunteers (N = 20), utilizing the Toronto Alexithymia Scale (TAS) as the primary assessment instrument. Subjects also completed standardized rating scales for bulimic symptoms, depression, and anxiety. Alexithymia rating scale scores were significantly higher for patients with bulimia nervosa than for controls. In comparison to controls, patients had significant elevations on TAS factors reflecting affect deficit states, but normal scores for factors reflecting imagination and abstract thinking. Frequency of binge eating or purging behaviors was not correlated with alexithymia ratings. These data indicate that some patients with bulimia nervosa have alexithymic characteristics. Affect dysregulation was more prominent than limitation in fantasy or metaphorical thought. Additional studies are needed to assess whether presence of alexithymic characteristics may be predictive of response to treatment in patients with bulimia nervosa.

Hypnosis and relaxation in the medically ill.

Interest in the application of hypnotic techniques for patients with medical disorders seems to rise and fall over the years. Enthusiasm for this work comes both from patients and clinicians. Often, however, these techniques are offered without regard to the psychological theories that should inform their operation and the limits that clinical and experimental research suggest. This article offers a brief description of the elements of hypnosis and a review of the history of the use of hypnotic techniques with a variety of medical problems including asthma, habits such as cigarette smoking and medical symptoms such as persistent nausea and vomiting. Special attention is placed on the psychological and physiological principles that help to establish the valid use of this technique.

Failure of hypnotic suggestion to alter immune response to delayed-type hypersensitivity antigens.

The ability to alter delayed-type hypersensitivity via hypnotic suggestion was tested in 12 highly hypnotizable, untrained subjects and 30 nonhypnotized controls. Subjects were skin-tested bilaterally with a standardized panel of delayed hypersensitivity antigens and instructed either to enhance or suppress the skin test response unilaterally. Compared with results in controls, the skin test response reflected no effect of hypnotic suggestion with regard to either the area of induration or the degree of inflammation assessed histologically.

Multidimensional analysis of the symptoms of chronic bronchitis and emphysema.

Subjective symptoms and experiences were explored within a group of 146 severe, chronic bronchitis and emphysema patients. Eighty-nine symptoms and experiences, derived from initial interviews with 29 patients, were rated according to the frequency of occurrence during breathing difficulties. Key cluster analyses were used to derive a Bronchitis-Emphysema Symptom Checklist (BESC) measuring 11 symptom categories: Helplessness-Hopelessness, Decathexis, Fatigue, Poor Memory, Peripheral-Sensory Complaints, Dyspnea, Congestion, Sleep Difficulties, Irritability, Anxiety, and Alienation. The BESC symptom categories are highly reliable and the relationships among categories are stable across two subgroups of patients. The BESC provides one way to describe how patients cope with and experience chronic bronchitis and emphysema.

Characteristics of depression of chronically ill medical patients. An elaboration of personality styles.

In an earlier study, 13 distinct patterns of depression were found among 132 asthma, tuberculosis, and pain patients. The subscales of scale 2 of the Minnesota multiphasic personality inventory (MMPI) which were developed at the Massachusetts Mental Health Center were the basis for the classification via o-type cluster analysis. The present work projected these patterns to the standard three validity and ten clinical scales of the MMPI. In addition, Dirk's panic-fear and Kleiger's alexithymia scales were scored. It was demonstrated that these 13 patterns of depression had important personality correlates associated with them. A useful point of view to take in medical care of the chronically ill is also offered.

Patterns of depression in chronic illness.

An understanding of the existence and action of depression is essential to the medical management of patients with chronic illness. This study found thirteen unique patterns of depression in depressed persons being treated for chronic medical conditions. Of the 132 persons sampled, 96.2% fell clearly into one of these groups. The fact that these people manifested their clinical depression in such a variety of ways argues against a unilateral approach to the treatment of affective distress among those with a chronic medical illness. While patients manifest their affective distress in a variety of ways, self-esteem issues are significantly involved in almost half of the identified patterns.

The battery of asthma illness behavior, III: independence from longitudinal pulmonary functions.

Previous research has demonstrated that the Battery of Asthma Illness Behavior is related to a wide variety of medical outcome variables in bronchial asthma. It has been maintained that BAIB scores reflect the degree to which psychological and behavioral factors can adversely affect medical management and prognosis. The present study advances previous research by investigating the relationship between BAIB scores and average longitudinal spirometry.