CUENTA DE CAPITAL DE APORTACIÓN

Timothy C. Toomey, Ph.D. and Shirley Sanders, Ph.D.

Chapel Hill, North Carolina

INTRODUCTION

The following strategies and suggestions were used in a group hypnotherapy treatment format for working with chronic pain patients. Although only five subjects were used, the treatment was successful in reducing pain levels. (Ed.)

PRODUCTION OF PLEASANT, RELAXING IMAGES AND FANTASIES Patients were encouraged to produce images of relaxation and comfort and to share these with the group. The responses frequently involved simple images of scenes which the patients reported when encouraged by the therapists and other group members. In contrast with traditional relaxation procedures which impose a technique on the patient, the therapists strove to employ the utilization methods described by Erickson (1959) which emphasize starting where the patient is and gaining gradual control over the symptom to demonstrate that change is possible.

Patients were given the following suggestions following the hypnotic induction:

Allow yourselves to imagine a scene of comfort and relaxation. A place where you can feel really secure and peaceful. You may see yourself alone or with another person or in a familiar or unfamiliar place. Let the scene present itself to you and allow yourself to see, smell, hear, touch, or taste anything of special interest to you. After a time, as you continue to experience your special place, with your eyes remaining closed, we will ask you to describe your scene to the rest of the group. You will retain a clear image of your special scene and will be able to recall it with ease anytime you like, especially when you begin to experience the onset of any pain….

ENCOURAGEMENT OF IMAGES AND FANTASIES THAT EMPHASIZE CHOICE AND ALTERNATIVES

As a common feeling elicited from the chronic pain patients in the group was that of being “locked in” and overwhelmed by the pain, the use of a technique that emphasized choices and alternatives seemed important. Thus, patients were encouraged to have a dream while in trance of two roads, one leading to health, the other to sickness and disability. They were asked to image both roads, to describe them, to image choosing the road to health and what that entailed. Patients were given the following suggestion:

You are able to experience yourself at an intersection and can clearly see two paths leading from familiar to unfamiliar terrain. You know that both of these paths are meant for your steps alone. One of these paths is a healthy path and contains clues and directions for your recovery. While on this path some of you may experience a particular image or vision which is a clue to your healing and recovery. Allow yourself to be open to such an image. The other path is a sickness path and has sights and signs of the future should you choose this direction. Allow yourself to ask questions of any one you meet along both of these paths. After a time, we will ask each of you to share your journey with the rest of the group. Frequently the “healthy path” generated images of people, activity, and interesting sights and sounds. The “sickness path” was usually dark, dreary, and isolated.

While in trance, patients were encouraged to attend to the characteristic features of the healthy road as a way of obtaining cues for restoration – including people or activities they may have forgotten or neglected during their illness.

DETERMINATION OF SIGNALS OR CUES ASSOCIATED WITH ONSET OF SEVERE PAIN

Patients were encouraged to recall, while in trance, the feelings and thoughts associated with pain onset and disability behaviors. For one, it was a feeling of cramping and burning in the back; for another, it was a dull throbbing in the head.

Patients were given the suggestion that such signals could be reinterpreted as reminders or cues for use of a coping strategy, e.g., pleasant imaging, deep breathing, muscle relaxation, instead of producing the usual cycle of self-depreciatory thought patterns and disability behaviors. Thus an effort was made to establish novel signal values for pain stimuli. Patients were given the following suggestion:

You are starting to experience an episode of pain. Be very attentive to any beginning clues that pain is coming. Some of you may feel a burning, others may feel cold, others a throbbing sensation. Imagine that your pain clues are changing to interesting, even pleasant, sensations. The burning becomes the warmth from a comforting fire; the cold becomes a refreshing breeze on a hot summer’s day; the throbbing slows as your breathing becomes slow and regular and you imagine the ocean waves gently ebbing, and flowing on the shore. Now, as you become more comfortable and relaxed, no longer concerned with your pain, you have time to use any of the approaches you have learned in the group. You may wish to enjoy your special scene or allow your image of healing to do its work. Others may just want to enjoy deep regular breathing and deeper and deeper levels of relaxation and comfort. Take your time and enjoy the experience. You will be able to clearly recall this exercise and use it regularly whenever you notice any beginning clues of pain.

ENCOURAGEMENT OF PRACTICE AND ACTIVE EMPLOYMENT OF COPING STRATEGIES

In addition to incorporation in the patient’s schedule of a time period each day for relaxing and enjoying pleasant images following self-induction of an hypnotic trance state, patients were encouraged to make active use of coping strategies during periods of pain or when they needed an extra boost to accomplish a difficult task. They were encouraged to view novel or difficult tasks, e.g., a new exercise-activity program or taking a plane trip, in a stepwise fashion and to use trance-induced coping strategies and images as means of simplifying complex tasks and reinforcing successful performance of each step. Although the approach described here is structurally very similar to techniques developed by self-control theorists and cognitive behavior modifiers (Meichen-baum, 1971; Turk, 1980), the emphasis on assisting the patient via the hypnotic environment to discover appropriate coping strategies is different. For example, “Imagine walking down the healthy path as you begin to walk the mile of prescribed exercise.” “Focus on the pleasant and interesting sensation of air rushing past your limbs as you stand up, leave the house, and take your daily walk.” Indeed, the patient actively participates in finding his own solutions.