Creating critical palliative hypnotic adjustments: temporality, hope, and meaning.

When cure is not possible, suffering often takes form as pain and distressing symptoms, death anxiety, existential distress, and meaninglessness. This paper describes important elements connecting palliative care principles with hypnotic approaches designed to provide support, palliate symptoms, foster hope, and address existential and spiritual distress. We offer a developmental process for and examples of hypnotic suggestions customized to simultaneously ameliorate physical symptoms and address profound distress arising from physical, social, psychological, existential, and spiritual challenges commonly encountered in terminal illness. This process necessarily requires use of the patient's vernacular to hypnotically deepen inwardly focused attention in order to explore and access internal resources, reframe negative automatic thoughts, and create positive meanings for experiences that disinvite suffering. Effective delivery utilizes cognitive tools such as clinical and scientific principles, artistic forms such as poetry and haiku, and a thorough assessment of needs. This approach strategically addresses an overarching dimension of temporality through suggestions that sequentially address multiple sources of suffering that are layered throughout the various dimensions of self. This requires focus and presence in the present moment; it ultimately fosters a therapeutic relationship that can safely hold past painful experience as helpful new meanings emerge that build resiliency for that experience. This work benefits from inwardly focused concentration and a holding environment to identify and access helpful inner resources, which include an increasingly malleable relationship with temporal memories.

Cancer Palliation: Layered Hypnotic Approaches Mending Symptoms, Minding Hope, and Meaning.

Advanced cancer often produces significant symptoms such as pain, anxiety, insomnia, nausea, and cachexia; many symptoms require medication adjustments in dose and route of administration, and most patients have significant symptom burdens near the end of life. Treatment strategies that integrate mind-body approaches, such as hypnosis, to improve symptoms are increasingly being studied and utilized. The current article addresses the role for adjunctive hypnotic approaches to relieve suffering from pain and other symptoms, while fostering hope, even in the midst of advancing illness, similar to Snyder's (2002) metaphorical painting of "a personal rainbow of the mind" (p. 269). We describe specific clinical indications, technical modifications, and imagistic language used in formulating hypnotic suggestions in the face of illness progression. Furthermore, we specifically describe formulation of layered hypnotic suggestions with intent to intentionally weave suggestions to modify symptoms and link to suggestions to enhance hope and alter time perception. This approach offers the opportunity to transform an experience often defined by its losses to one in which hidden opportunities for growth and change emerge within this transitional life experience.

The Meaning and Experience of Patients Undergoing Rectal High-Dose-Rate Brachytherapy.

BACKGROUND: High-dose-rate (HDR) brachytherapy is a precise form of radiation therapy that targets cancerous tumors by directly applying the radiation source at the site or directly next to the tumor. Patients often experience but underreport pain and anxiety related to cancer treatments. At present, there is no research available concerning the pervasiveness and intensity of patients' pain and anxiety during rectal brachytherapy. OBJECTIVE: The aim of this study was to examine patients' thoughts, emotions, coping strategies, physical sensations, and needs during rectal HDR brachytherapy treatment. METHODS: Twenty-five patients with rectal cancer were interviewed using a semi-structured qualitative interview following the completion of their brachytherapy treatment delivered at a Montreal-based hospital in Quebec, Canada. RESULTS: The experiences of pain and discomfort varied greatly between patients and were linked to the meaning patients attributed to the treatment itself, sense of time, the body's lithotomic position, insertion of the treatment applicator, and the patients' sense of agency and empowerment during the procedure. Patients drew upon a variety of internal and external resources to help them cope with discomfort. CONCLUSION: Staff need to know about the variation in the physical and emotional experiences of patients undergoing this treatment. IMPLICATIONS FOR PRACTICE: Clinical teams can tailor their procedural behavior (eg, using certain language, psychosocial interventions) according to patients' needs to increase patients' comfort and ultimately improve their experience of HDR rectal brachytherapy.

Effectiveness of hypnotherapy with cancer patients' trajectory: emesis, acute pain, and analgesia and anxiolysis in procedures.

Clinical hypnosis in cancer settings provides symptom reduction (pain and anxiety) and empowers patients to take an active role in their treatments and procedures. The goal of this paper is to systematically and critically review evidence on the effectiveness of hypnotherapy for emesis, analgesia, and anxiolysis in acute pain, specifically in procedures with an emphasis on the period from 1999 to 2006. Further, it aims to provide a theoretical rationale for the use of hypnosis with cancer populations in the whole spectrum of illness/treatment trajectory in several clinical contexts. Finally, a treatment protocol for management of overt anxiety and phobic reactions in the radiotherapy suite is presented, with the intent of having such a protocol empirically validated in the future.