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Presenter: Ran D. Anbar, MD; D. Corydon Hammond, PhD, ABPH; Philip Shenefelt, MD, ABMH

Self-Hypnosis as a Complementary Airway Clearance Technique In Patients With Cystic Fibrosis
Ran D. Anbar, MD, FASCH

Background: Airway clearance techniques (ACTs) are generally accepted to be instrumental in reducing pulmonary complications in patients with cystic fibrosis (CF). We report on the effectiveness of self-hypnosis chest physiotherapy (SH CPT) as a novel ACT. SH has been reported to be useful for patients with CF in order to achieve relaxation, and relief of discomfort associated with the disease, medical procedures and treatments.

Methods: Nine patients with CF (mean age 16 years, range 11-22 years), who are followed at the SUNY Upstate Medical University CF Care Center, were offered and accepted the opportunity to be instructed in a hypnotic technique intended to augment their daily CPT. The patients were instructed how to enter a state of hypnosis by imagining a favorite place or activity, augmented by multisensory imagery. They were prompted to create a small imaginary character who could help clear their lungs by entering their airways and (1) removing sputum; (2) spraying hypertonic saline into the lungs; and finally (3) photographing their airways in order to verify any remaining sputum that needed to be cleared. The efficacy of the therapy was gauged by observation of expectorated sputum and patient reports regarding their on-going use of SH CPT.

Results: Of the 9 patients, 5 reported that SH CPT prompted expectoration of sputum in a similar or greater amount than the patients produced during their usual ACT. The time utilized for their SH CPT ranged from 5 to 20 minutes, during which time they produced 5-75 ml of sputum. After receiving SH instruction, 4/9 of these patients reported that they used SH CPT at home on a regular basis in addition to employment of HFCC, because they felt the therapies were complementary ACTs.

Conclusions: The mechanism of action and long-term efficacy of SH CPT is unclear, and should be studied further. As there is no down-side to use of SH CPT, this technique should be considered in patients with CF who produce sputum, as an adjunct tool to enhance the effect of traditional ACTs.

During and at the conclusion of this session, the attendee will be able to:
-> Describe how to teach SH to help augment ACT in patients with CF;
-> Demonstrate how to teach self-hypnosis for the purpose of achieving enhanced airway clearance; and
-> Offer another treatment alternative to their patients.

Hypnosis Treatment Planning: Strategies for Style and Technique Selection.
D. Corydon Hammond, PhD, ABPH, FASCH

One of the greatest areas of weakness in the knowledge base that we find in persons taking diplomate board examinations is their difficulty in explicating a coherent methodology for hypnotic treatment planning and technique selection. This clinically oriented presentation will outline 6 strategies under which all the various hypnotic techniques may be categorized. Tentative guidelines will be presented for technique selection based on these overall strategies, as well as associated patient symptom complexity and intensity, reactance level and quality of the therapeutic alliance, patient expectations and preconceptions, stage in the change process, diagnosis and defensive coping style, and hypnotic capacity.

During and at the conclusion of this session, the attendee will be able to:
-> Explain 6 strategies in hypnosis treatment planning; and
-> Identify at least 4 tentative indications for the use of an indirect, permissive hypnotic approach.

Anxiety Reduction Using Hypnotically Induced Relaxation and Self-Guided Imagery during Dermatologic Procedures
Philip D. Shenefelt, MD, ABMH
In this randomized control trial, rapid induction hypnosis followed by deepening and self-guided imagery was shown to be effective in alleviating anxiety associated with dermatologic procedures. When patients chose their own imagery, they remained absorbed in something that they personally enjoy and were able to remain focused on for the duration of the procedure. Advantages of this process had previously been well documented in the interventional radiology literature and include less anxiety, less discomfort, less need for conscious sedation, less hemodynamic instability, and shortened procedure time.

Exclusion criteria for this dermatologic study included age less than 18 years; Mini Mental State Exam score less than 25; hearing impaired; and not being fluent in English. The same script was used for live and audio-recorded inductions. There was no script for the control group. Zero to ten range subjective unit scales were used for rating patient expectancy and motivation prior to the procedure. Zero to ten range subjective unit scales were also used for rating patient anxiety and pain prior to the procedure and at ten minute intervals during the procedure. Blood pressure and pulse rate measurements were also obtained.

The dermatologic procedures were performed by dermatology residents under direct supervision. Hypnotizibility was assessed using the Hypnotic Induction Profile postoperatively. Data analysis of this study revealed that by 20 minutes into the procedure there was significant p < 0.05 reduction in anxiety with live induction compared with controls, while recorded induction results were close to that of the controls with comparatively little anxiety reduction.

During and at the conclusion of this session, the attendee will be able to:
-> Explain the frequent anxiety and concomitant autonomic dysregulation associated
with dermatologic procedures;
-> Describe and use the concepts of rapid induction and self guided imagery to assist patients to overcome anxiety and discomfort;
-> Assess the patient’s response in terms of anxiety and discomfort reduction; and
-> Apply the hypnotic relaxation with self-guided imagery technique to clinical procedures.