Why all child clinicians should be hypnosis-informed. Advantages, benefits, creativity, & development: ABC's & D.

This paper advocates for all child clinicians to learn hypnosis skills as a distinct advantage to enhance their understanding of child development in the treatment of children. It examines the interface of child development and hypnosis. Clinical hypnosis with children follows the child's developmentally determined self-expressions. The clinician must tend to the way in which the child expresses a "problem," structuring treatment goals and pace, and evoking and utilizing opportunities for therapeutic suggestion. This article defines hypnosis as a set of skills and principles. It defines trance as psychoneurobiological plasticity. Eight variables, shared across therapeutic interventions, are explored in the context of working hypnotically with children and adolescents. These are 1) Relationships, rapport, attachment; 2) Attention, absorption, focus; 3) Use of language and therapeutic suggestions; 4) Expectations; 5) Resources; 6) Dissociation and Unconscious; 7) Trauma parallels with trance; 8) Development. Becoming hypnosis-informed is the ABC's, & D, for child clinicians. A case illustrates the application of skills, principles, and variables.

EARLY FLOWERING 3 and Photoperiod Sensing in Brachypodium distachyon.

The proper timing of flowering, which is key to maximize reproductive success and yield, relies in many plant species on the coordination between environmental cues and endogenous developmental programs. The perception of changes in day length is one of the most reliable cues of seasonal change, and this involves the interplay between the sensing of light signals and the circadian clock. Here, we describe a Brachypodium distachyon mutant allele of the evening complex protein EARLY FLOWERING 3 (ELF3). We show that the elf3 mutant flowers more rapidly than wild type plants in short days as well as under longer photoperiods but, in very long (20 h) days, flowering is equally rapid in elf3 and wild type. Furthermore, flowering in the elf3 mutant is still sensitive to vernalization, but not to ambient temperature changes. Molecular analyses revealed that the expression of a short-day marker gene is suppressed in elf3 grown in short days, and the expression patterns of clock genes and flowering time regulators are altered. We also explored the mechanisms of photoperiodic perception in temperate grasses by exposing B. distachyon plants grown under a 12 h photoperiod to a daily night break consisting of a mixture of red and far-red light. We showed that 2 h breaks are sufficient to accelerate flowering in B. distachyon under non-inductive photoperiods and that this acceleration of flowering is mediated by red light. Finally, we discuss advances and perspectives for research on the perception of photoperiod in temperate grasses.

Relationship Factors in the Theater of the Imagination: Hypnosis With Children and Adolescents.

This article examines the spatial and social nature of human relationships with children and adolescents in clinical hypnosis. Beginning with the unique way in which the phenomenon of rapport is intrinsic to the therapeutic uses of hypnosis and is distinct among other therapies, the stage is set for the importance of relational hypnosis. Through the use of case vignettes that illustrate developmental imperatives, relationship factors influencing the clinical interaction are demonstrated in practice. These include transference and countertransference, safety, embodiment, novelty, creativity, respect, trust, equality, being with, loving responses, synchronicity, and empathy. Hypnotic relating exists in a framework through which absorption in play and imagination evokes the child's resources and suggestions are made. In this receptive stance the personalized suggestions lead to an environment for positive change.

Male-inflicted wounds have opposite effects on hair cortisol for captive male and female rhesus macaques (Macaca mulatta) following new group formation.

Sexual dimorphism in body size, aggression, and dispersal patterns may affect the degree to which males and females perceive aggression from either sex as stressful. Whereas male macaques typically disperse to new groups at maturity, thus encountering many unfamiliar individuals of both sexes, females are philopatric, usually only encountering unfamiliar males who transfer into their natal groups. In rare circumstances, however, group fusions can expose both males and females to many novel individuals, which often increases aggression. Here, we use a captive new group formation of rhesus macaques (Macaca mulatta) as a model of social instability during fusions and examine differences in male and female chronic stress responses to male-pattern and female-pattern trauma (i.e., trauma inflicted by males or by females, respectively). We found that male- but not female-pattern traumas predicted hair cortisol concentrations during the first 9 months after new group formation, but in opposite ways for males and females. A greater number of male-pattern traumas was linked to elevated hair cortisol concentrations in females but slightly lower hair cortisol concentrations in males. We suggest that the apparent importance of male-pattern trauma, but not female-pattern-trauma, in predicting higher hair cortisol concentrations in females can be attributed to the more acutely intense but less persistent nature of male aggression toward females.

Coping style and cortisol levels in infancy predict hair cortisol following new group formation in captive rhesus macaques (Macaca mulatta).

Social instability in primate groups has been used as a model to understand how social stress affects human populations. While it is well established that individual cercopithecines have different temperaments or personalities, little is known about how temperament mediates the experience of social instability in large, naturalistic groups. Here, we report findings from a study tracking a newly formed group of captive rhesus macaques (Macaca mulatta). We examine whether inter-individual differences in temperament during infancy affect physiological responses to new group formation years later, measured through hair cortisol 9 months after the group was formed. Our results show that early life measures of temperament characteristics predict later-life hypothalamic-pituitary-adrenal activity following new group formation, though not always in the directions we predicted. Individuals with higher blood cortisol concentrations in response to a novel stressor and lower blood cortisol concentrations following a Dexamethasone Suppression Test in infancy had lower hair cortisol values following new group formation later in life. Individuals characterized in infancy as more emotional or more active exhibited lower hair cortisol profiles 9 months after group formation. We suggest that these two temperament characteristics, emotionality and activity, may represent two different mechanisms leading to low hair cortisol values. That is, the physiological measure of low hair cortisol may have two different meanings depending on temperament characteristics of the individual. Our results demonstrate that temperament and physiological responsiveness measures in infancy can predict individual responses to a new group formation years later.

Hypnosis Training and Education: Distinctive Features of Training Hypnosis Educators.

Much of the field of hypnosis education focuses on what to teach (content) and who to teach (professional identities). A deserving area of focus, and less often addressed, is how to teach basic hypnosis concepts. Worldwide models for teaching hypnosis have mostly included lecture, demonstration, and practice, with little attention paid to the meta-level of educational principles (i.e., what makes an expert trainer). Trainers in hypnosis have been compared to parents: They teach the way they were taught (adults parent the way they were parented). There is a human tendency to repeat what we have experienced. This propensity can be seen while watching the new student use the same induction, in the same way, as his or her first "operator" did when s/he was a subject of his/her first hypnotic experience. Mirroring is a part of all learning, and this article asks what else is needed in faculty education for the trainer to take students beyond mere mimicry to scientifically informed, skilled, and clinically creative uses of hypnosis. This article addresses the unique requirements for teaching hypnosis, reviews a teaching program for clinical hypnosis educators developed by the authors, and looks to future innovations in clinical hypnosis training.

The clinical utility of bivalirudin in patients with coronary artery disease.

Bivalirudin, a direct thrombin inhibitor, is an anticoagulant commonly used in invasive cardiology procedures. It has evolved from relative obscurity, as an anticoagulation option only utilized in rare instances of allergy or resistance to heparin products, to the now preferred antithrombotic anticoagulant in the cardiac catheterization laboratory. On the way to displacing unfractionated heparin as the preferred anticoagulant for percutaneous coronary intervention, multiple studies comparing bivalirudin with heparin have consistently shown equivalent ischemic efficacy endpoints (i.e. cardiovascular death, myocardial infarction, etc.), with significant reductions in bleeding. Bleeding has been directly linked to worse hospital outcomes in cardiac patient's undergoing invasive coronary artery revascularization procedures. More recent bivalirudin studies now demonstrate reductions in mortality, which has led to a paradigm shift to bivalirudin as the anticoagulant choice both in elective and emergent coronary procedures. We present the major studies that have brought bivalirudin to the forefront of coronary artery disease, specifically coronary interventional procedures.

Hypnosis and parents: pattern interruptus.

The role of parents in the use of hypnosis with their children raises many questions worthy of consideration. A survey of the literature reveals that this important topic has not been given the attention or depth it deserves. The author looks at (a) how, when, and whether to incorporate parents in the treatment of their children; (b) how to address attachment and trance between parent and child; (c) engaging parents in their own hypnotic abilities beginning as early as the birthing experience; and (d) improving parenting skills such as teaching parents to pay attention to their use of language with their children in order to shift patterns of communication from unproductive to useful. In addition, the author explores the ways to invite, teach, support and interact with the family system of parent and child in our hypnotic work.

Bivalirudin in patients with coronary artery disease.

Bivalirudin, a DTI, has evolved from relative obscurity as an anticoagulation option in patients resistant to or allergic to either LMWH or UFH to a commonly used, safe alternative. Most of the early studies comparing bivalirudin to UFH with or without a GP IIb/IIIa agent had composite endpoints (death, MI, bleeding) whose statistical significance were driven exclusively by a significant reduction in bleeding. Newer studies now demonstrate reductions in mortality, which has led to a paradigm shift in anticoagulant choice both in elective and emergent coronary procedures. We present the major studies that have brought bivalirudin to the forefront of coronary artery disease, specifically coronary interventional procedures.

Understanding dissociation and insight in the treatment of shortness of breath with hypnosis: a case study.

Training in hypnosis is particularly valuable for the physician seeking to better appreciate the interplay between mind and body. Through such experiences the physician can learn that presentation of symptoms often is affected by patients' psychological states, and that symptoms sometimes serve as solutions for patients' psychological dilemmas. The presented case study demonstrates how an 11-year-old's complaint of shortness of breath becomes an opportunity for an appropriately trained physician to provide treatment by helping the patient to engage his inner resources. The case illustrates the strength of hypnosis for accessing resources outside of conscious awareness and use of dissociative language to both support and alter the patient's defenses. We discuss the role of hypnosis when working psychodynamically with a patient, and whether and when insight is important or necessary for change of behavior.

Hypnotically enhanced dreaming to achieve symptom reduction: a case study of 11 children and adolescents.

Theories about dreams have shaped our thinking about mind-body unity and the influence of thought on the body. In this article, the authors review the sparse literature regarding the use of hypnosis with children's dreams and nightmares, summarize how hypnotically induced dreams have been used to resolve psychological symptoms, and note five themes in the literature worthy of further investigation. Building on the value of both dreams and hypnosis for working through conflicts, the authors united mind-body medicine and hypnotically induced dreaming in a pediatric pulmonary practice. A case series is presented of 11 patients who were offered an opportunity to review their reported nightmares through hypnosis in order to uncover their potential meaning. The recurrent nightmares among these patients decreased greatly in frequency or resolved following the hypnosis enhanced dream review. Thus, we demonstrate that hypnotically induced dream review may be useful in a pediatric population.

Playful metaphors.

The inner world of the child is a community of archetypes potentially available for the child's healthy ego development. Many forces limit and prohibit their utility. Play therapy in the context of a hypnotic relationship can potentiate these archetypes into becoming "playful metaphors" for healing and strengthening ego development. In this article, the author describes her use of playful metaphors in her therapeutic work with two children and explores how metaphor in play therapy is able to connect the child with healing archetypal imagery.