Self-hypnosis training as an adjunctive treatment in the management of pain associated with sickle cell disease.

A cohort of patients with sickle cell disease, consisting of children, adolescents, and adults, who reported experiencing three or more episodes of vaso-occlusive pain the preceding year, were enrolled in a prospective two-period treatment protocol. Following a 4-month conventional treatment baseline phase, a supplemental cognitive-behavioral pain management program that centered on self-hypnosis was implemented over the next 18 months. Frequency of self-hypnosis group straining sessions began at once per week for the first 6 months, became biweekly for the next 6 months, and finally occurred once every third week for the remaining 6 months. Results indicate that the self-hypnosis intervention was associated with a significant reduction in pain days. Both the proportion of "bad sleep" nights and the use of pain medications also decreased significantly during the self-hypnosis treatment phase. However, participants continued to report disturbed sleep and to require medications on those days during which they did experience pain. Findings further suggest that the overall reduction in pain frequency was due to the elimination of less severe episodes of pain. Non-specific factors may have contributed to the efficacy of treatment. Nevertheless, the program clearly demonstrates that an adjunctive behavioral treatment for sickle cell pain, involving patient self-management and regular contact with a medical self-hypnosis team, can be beneficial in reducing recurrent, unpredictable episodes of pain in a patient population for whom few safe, cost-effective medical alternatives exist.

Memory liabilities associated with hypnosis: does low hypnotizability confer immunity?

Retrospective analyses of data from the authors' program of research on hypnosis and memory are presented, with special emphasis on effects observed among low hypnotizable individuals. In Experiment 1, participants completed seven forced-recall trials in an attempt to remember a series of pictures that had been shown 1 week earlier. For half the participants, the middle five trials were carried out using hypnotic procedures; the remaining participants performed all recall attempts in a motivated waking condition. Hypnosis failed to enhance correct recall for either high or low hypnotizable participants beyond the hypermnesia and reminiscence effects associated with repeated retrieval attempts over time. However, whereas high hypnotizable participants produced substantial numbers of confident recall errors (i.e., intrusions) independent of the use of hypnosis, low hypnotizable participants exposed to hypnotic procedures reported significantly more intrusions than their counterparts in the waking condition. In Experiment 2, participants were asked to identify whether specific recollections, reported during two forced-interrogatory recall tests conducted 1 week earlier, had originated in the first or second of those tests. A general bias to misattribute previously reported recollections to the first of two recall occasions was observed; however, the effect was greatest among low hypnotizables who had undergone the second recall attempt in hypnosis. The findings imply that highly hypnotizable individuals are not unique in their vulnerability to distortions of memory induced by hypnotic techniques. Individuals of lesser hypnotic capacity also manifest memory alterations when exposed to such procedures.

Psychosocial and immune effects of self-hypnosis training for stress management throughout the first semester of medical school.

This study was a 19-week prospective conducted to determine the effectiveness of a self-hypnosis/relaxation intervention to relieve symptoms of psychological distress and moderate immune system reactivity to examination stress in 35 first-year medical students. Twenty-one subjects were randomly selected for training in the use of self-hypnosis as a coping skill and were encouraged to practice regularly and to maintain daily diary records related to mood, sleep, physical symptoms, and frequency of relaxation practice. An additional 14 subjects received no explicit training in stress-reduction strategies, but completed similar daily diaries. Self-report psychosocial and symptom measures, as well as blood draws, were obtained at four time points: orientation, late semester, examination period, and postsemester recovery. It was found that significant increases in stress and fatigue occurred during the examination period, paralleled by increases in counts of B lymphocytes and activated T lymphocytes, PHA-induced and PWM-induced blastogenesis, and natural killer cell (NK) cytotoxicity. No immune decreases were observed. Subjects in the self-hypnosis condition reported significantly less distress and anxiety than their nonintervention counterparts, but the two groups did not differ with respect to immune function. Nevertheless, within the self-hypnosis group, the quality of the exercises (ie, relaxation ratings) predicted both the number of NK cells and NK activity. It was concluded that stress associated with academic demands affects immune function, but immune suppression is not inevitable. Practice of self-hypnosis reduces distress, without differential immune effects. However, individual responses to the self-hypnosis intervention appear to predict immune outcomes.

Rethinking per se exclusions of hypnotically elicited recall as legal testimony.

In 1993, Boggs argued for a rethinking of the per se exclusion of hypnotically elicited testimony. This article analyzes the Minnesota v. Mack (1980) case that initiated this exclusion and the two Illinois cases Boggs cites in favor of her position. The scientific data on the effect of hypnosis on memory do not support Boggs's position. Rather than providing reasons for rethinking this per se position, these data suggest that it should be retained.

Leukocytosis and natural killer cell function parallel neurobehavioral fatigue induced by 64 hours of sleep deprivation.

The hypothesis that sleep deprivation depresses immune function was tested in 20 adults, selected on the basis of their normal blood chemistry, monitored in a laboratory for 7 d, and kept awake for 64 h. At 2200 h each day measurements were taken of total leukocytes (WBC), monocytes, granulocytes, lymphocytes, eosinophils, erythrocytes (RBC), B and T lymphocyte subsets, activated T cells, and natural killer (NK) subpopulations (CD56/CD8 dual-positive cells, CD16-positive cells, CD57-positive cells). Functional tests included NK cytotoxicity, lymphocyte stimulation with mitogens, and DNA analysis of cell cycle. Sleep loss was associated with leukocytosis and increased NK cell activity. At the maximum sleep deprivation, increases were observed in counts of WBC, granulocytes, monocytes, NK activity, and the proportion of lymphocytes in the S phase of the cell cycle. Changes in monocyte counts correlated with changes in other immune parameters. Counts of CD4, CD16, CD56, and CD57 lymphocytes declined after one night without sleep, whereas CD56 and CD57 counts increased after two nights. No changes were observed in other lymphocyte counts, in proliferative responses to mitogens, or in plasma levels of cortisol or adrenocorticotropin hormone. The physiologic leukocytosis and NK activity increases during deprivation were eliminated by recovery sleep in a manner parallel to neurobehavioral function, suggesting that the immune alterations may be associated with biological pressure for sleep.

Evaluating hypnotic memory enhancement (hypermnesia and reminiscence) using multitrial forced recall.

Two experiments investigated whether hypnosis enhances memory retrieval per se or merely increases a person's willingness to report recollections. Both experiments assessed immediate and delayed (i.e., 1 week) recall for pictorial stimuli. In Experiment 1, following an initial waking baseline recall, subjects of high or low hypnotic ability completed a series of recall trials conducted either in hypnosis or in the walking condition. The classic hypermnesia effect was obtained, but with no supplemental contribution of hypnosis. In Experiment 2, hypnosis was introduced only after 6 waking-recall trials. Hypnosis again failed to enhance retrieval of new correct items, although it increased the production of new incorrect recall among hypnotizable individuals. The findings provide no evidence for alleged hypermnesic properties of hypnosis.

Rock v. Arkansas: hypnosis, the defendant's privilege.

In Rock v. Arkansas (1987) the United States Supreme Court ruled in a 5 to 4 decision that the constitutional rights of defendants to testify on their own behalf take precedence over whatever state rules exist regarding exclusion of hypnotically refreshed testimony. The problem of denying defendants their constitutional rights was the reason we have argued that defendants' hypnotically refreshed testimony should generally be permitted, whereas the unreliability of hypnotically elicited memories and the manner in which hypnosis diminishes the effectiveness of cross-examination make the general exclusion of testimony from hypnotized witnesses essential (M. T. Orne, 1982). We discuss the Rock case, as well as the majority and minority opinions expressed by the United States Supreme Court, and offer reasons why a bifurcated standard--one that admits hypnotically refreshed testimony from defendants and excludes it from witnesses--is consistent both with the Court's ruling and with the scientific evidence regarding the use of hypnosis, as well as being an appropriately fair way in which to protect the constitutional rights of the defendant and the state.

Self-hypnosis and meditation for stress management: a brief communication.

In a 6-month follow-up study, telephone interviews were conducted with 31 male executives who were taught either a self-hypnosis or meditation exercise as part of a stress-management program. Use of and problems with the 2 exercises were similar, with the percentage of Ss using the techniques falling over 6 months from 90% to 42%. The exercises were used primarily for physical relaxation, refreshing mental interludes, aiding sleep onset, and stress-reduction. Problems with the exercises chiefly involved difficulty in scheduling even brief uninterrupted practice times and discomfort with the techniques. The incorporation of these issues into the clinical teaching of self-hypnosis may be useful.

Temporal placement of a nap for alertness: contributions of circadian phase and prior wakefulness.

Napping can enhance alertness during sustained wakefulness, but the importance of the temporal placement of the nap between days and within the circadian cycle remains controversial. To resolve these issues, a between-groups study was conducted with 41 healthy, young adults permitted a 2-h nap at one of five times during a 56-h period otherwise devoid of sleep. Naps were placed 12 h apart, near the circadian peak (P) or trough (T), and were preceded by 6, 18, 30, 42, or 54 h of wakefulness. Visual reaction time (RT) performance, Stanford Sleepiness Scale (SSS) ratings, and sublingual temperature were assessed every few hours throughout the 56 h, which took place in an environment free of time cues. All groups displayed a circadian-modulated decline in RT measures and increases in SSS functions as sleep loss progressed. A nap placed at any time in the protocol improved RT performance, particularly in the lapse domain, but not SSS ratings. Comparisons within groups of circadian temperature cycles for the first versus second day of the protocol indicated that early naps (P6, T18, P30) tended to prevent the mean drop in temperature across days. The earlier naps (P6, T18) yielded more robust and longer lasting RT performance benefits, which extended beyond 24 h after the naps, despite the fact that they were comprised of lighter sleep than later naps. Circadian placement of naps (P vs. T) did not affect the results on any parameter. In terms of temporal placement, therefore, napping prior to a night of sleep loss is more important for meeting subsequent performance demands than is the circadian placement of the nap. SSS ratings suggest that the napper is not aware of these performance benefits. Because the longest lasting RT gains followed early naps, which were composed of less deep sleep than later naps, napping during prolonged sleep loss may serve to prevent sleepiness more readily than it permits recovery from it.

Reduced electrodermal response to conflict, failure to inhibit dominant behaviors, and delinquency proneness.

Antisocial behavior patterns have been hypothesized to result in part from a reduced physiological component of fear, anxiety, and avoidance responses. Electrodermal correlates of antisocial personality have been consistent with such a model, but evidence that the reduced electrodermal response (EDR) of sociopathic and delinquency-prone individuals actually plays a role in their behavior is sparse. This article examines whether the reduced EDR of undersocialized individuals should be conceptualized in terms of reduced inhibitory control rather than in terms of reduced aversive processes and whether the reduced EDR actually relates to relevant behavior of undersocialized young adults. Subjects high and low on a socialization scale (California Psychological Inventory) performed a nonstressful response-conflict (or interference) task while the EDR was recorded. As predicted by the weak inhibitory conflict than on control trials less frequently than did high-socialization subjects and, correspondingly, committed more errors by failing to inhibit a dominant behavioral response.

Random number generation, psychopathology and therapeutic change.

In two studies, 145 psychiatric inpatients were each asked to say 100 numbers in random order, using the numbers 1 through 10. Compared with normative data, patients with personality disorders and neuroses were not impaired on the random number generation (RNG) task and patients with chronic alcoholism and primary affective disorder, depression, were significantly imparied, but not as much as those with schizophrenia and organic brain syndrome. The relationship between RNG performance and psychiatric diagnosis may reflect severity of disturbed cognitive functioning. The Randomization Index was sensitive to changes in symptoms during hospitalization. The RNG task provides a brief objective measure of those components of attention, cognitive capacity, and short-term memory that are affected by severity of psychopathology.

Cross-modal physiological effects of electrodermal lability in the detection of deception.

This study examined the effects of individual differences in electrodermal lability on cardiovascular, respiratory, and electrodermal responses (EDRs) in the detection of deception. One Day 1 each of 74 subjects rested quietly for 3 min. while skin conductance was recorded. Electrodermal lability was scored for each subject, those giving frequent nonspecific EDRs being labiles and those giving few being stabiles. On Day 2, usually 1 week later, 40 of the subjects attempted to deceive a professional polygraph examiner in a field-type test. The 34 remaining subjects attempted to convince the examiner, who was blind as to each subject's condition, that they were indeed being truthful. Deception by stabile subjects was detected less frequently than was deception by labile subjects. Among truthful subjects, the more labile were falsely detected as deceptive on more questions than were their stabile counterparts. Although accuracy of detection was greatest with the EDR, the effects of lability on detection were similar for electrodermal, cardiovascular, and respiratory measures. Labiles also had a higher heart rate during the polygraph test than did stabiles.

Meprobamate reduces accuracy of physiological detection of deception.

Normal male subjects attempted to deceive an experimenter recording electrodermal, respiratory, an cardiovascular activity. Those who had ingested a placebo or nothing were detected with statistically significant frequency on the basis of their phasic electrodermal responses, which clearly distinguished them from truthful suspects. That was not the case with deceptive subjects who had ingested 400 milligrams of meprobamate, nor did the examiner detect which subjects had received the drug.