نتائج الأبحاث من جامعة هارفرد الأمريكية كلية الطب في التنويم الإيحائي

CONTEXT: Hypnosis has been used in numerous medical applications for functional and psychological improvement, but has been inadequately tested for anatomical healing. OBJECTIVE: To determine whether a hypnotic intervention accelerates bodily tissue healing using bone fracture healing as a site-specific test. DESIGN: Randomized controlled pilot study. SETTING: Massachusetts General Hospital, Boston, Mass, and McLean Hospital, Belmont, Mass. PATIENTS: Twelve healthy adult subjects with the study fracture were recruited from an orthopedic emergency department and randomized to either a treatment (n = 6) or a control group (n = 6). One subject, randomized to the treatment group, withdrew prior to the intervention. INTERVENTION: All 11 subjects received standard orthopedic care including serial radiographs and clinical assessments through 12 weeks following injury. The treatment group received a hypnotic intervention (individual sessions, audiotapes) designed to augment fracture healing. MAIN OUTCOME MEASURES: Radiological and orthopedic assessments of fracture healing 12 weeks following injury and hypnotic subjects’ final questionnaires and test scores on the Hypnotic Induction Scale. RESULTS: Results showed trends toward faster healing for the hypnosis group through week 9 following injury. Objective radiographic outcome data revealed a notable difference in fracture edge healing at 6 weeks. Orthopedic assessments showing trends toward better healing for hypnosis subjects through week 9 included improved ankle mobility; greater functional ability to descend stairs; lower use of analgesics in weeks 1, 3, and 9; and trends toward lower self-reported pain through 6 weeks. CONCLUSION: Despite a small sample size and limited statistical power, these data suggest that hypnosis may be capable of enhancing both anatomical and functional fracture healing, and that further investigation of hypnosis to accelerate healing is warranted.

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Study Suggests Hypnosis May Benefit Wound Healing

A small clinical trial performed with women who underwent breast reduction surgery has indicated that medical hypnosis may have contributed to quicker wound healing–even compared to a group that received supportive attention. This is the first randomized controlled study that has tested the ability of hypnotic intervention to accelerate healing of surgical incisions.

Carol Ginandes, HMS clinical instructor in psychology in the Department of Psychiatry at McLean Hospital, and her colleagues studied 18 women scheduled to undergo reduction mammaplasty, who were randomly assigned to one of three groups–usual care only; supportive attention, in which patients received weekly support; and a hypnotic intervention group, in which patients received weekly hypnosis sessions from a study clinician who administered a standardized script composed by Ginandes.

“I targeted what was going on biologically in wound healing week to week and created a sequence that would go along with it, emphasizing accelerated overall physical and psychological recovery as well as incision healing,” she said.

At one and seven weeks after surgery, a nurse and three physicians blind to patients’ group assignments evaluated the incision conditions using the Wound Assessment Inventory. The nurse assessed this in person; the doctors from digital photographs. Patients also were asked to make self-assessments of healing progress and pain.

The nurses’ objective ratings showed the hypnosis group’s wound healing to be significantly greater than that of the other two groups through 7 weeks (p < .001); the usual care control showed the slowest healing. The doctors’ ratings and the patients’ self-assessments did not reach statistical significance, although they all trended in the same direction.

“Even in this small preliminary study, we seem to have evidence that a hypnotic protocol can augment normative wound healing. Although we are not advocating this particular application now, maybe with further research we could suggest it. In the larger sense, we were testing the hypothesis that mental input can actually influence physical healing,” Ginandes said. The research appears in the April 2003 American Journal of Clinical Hypnosis.

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People have been hypnotized to see color where only shades of gray exist, and to see gray when actually looking at brightly colored rectangles.

That result wouldn’t be so surprising at a carnival or stage show, but it comes from a tightly controlled scientific experiment done at a Harvard University medical facility.

Researchers separately hypnotized eight people as they lay in a scanning machine that recorded activity in their brains. These subjects then tried to drain bright color from pictures, or see color where none existed. They also attempted to do the same thing when not hypnotized. The records of cerebral activity clearly show that hypnosis can change the state of the brain.

“Hypnosis has a contentious history,” notes Stephen Kosslyn, professor of psychology at Harvard and leader of the study. “Some insist it’s a state of mind that differs from normal states and involves unique consequences; others say it’s nothing more than state-show gimmickry.”

COLOR ME HYNOTIZED: Under hypnosis, some people see only shades of gray in this pattern of brightly-colored rectangles. Such a result shows that hypnosis can change the state of the brain.

As an example, if you give some men a brick and ask them to hold it at arm’s length for as long as they can, they will be able to do it for about five minutes. But if you hypnotize them, they will hold the brick out for 15-20 minutes. That result favors the idea that hypnotism creates a unique state of mind.

However, if you tell males that some females who were just tested held the brick out for 20 minutes, they, too, will hold it for that long without being hypnotized. That result favors a suggestibility, or role-playing explanation.

“It all comes down to the question of whether the brain is doing something different,” Kossyln says. The answer apparently is yes, at least in the case of color perception.

How the brain changes

To show how controversial hypnotism is among scientists, Kosslyn and colleagues had great difficulty in getting their research published. Two of the world’s largest scientific journals wouldn’t publish the results.

“One of them asked for three separate revisions,” notes William Thompson, a research assistant in Harvard’s department of psychology. “Then they still turned down our report even after we answered all their criticisms.” After three years, their study has finally been published as the cover story in the August issue of the American Journal of Psychiatry.

Both Kosslyn and Thompson emphasize that the experiment worked only on “highly hypnotizable” people, a category that includes only about 8 percent of all people. “We pre-tested 125 subjects and for those who scored lowest in hypnotizability, the results were just garbage,” Kosslyn says. “They couldn’t do the task.”

The highly hypnotizables slid horizontally into a positron emission tomography (PET) scanner at Massachusetts General Hospital, a Harvard teaching hospital in Boston. They inhaled a short-lived, slightly radioactive type of oxygen. The oxygen traces blood flow and makes visible the most active parts of the brain when a subject is hypnotized and not hypnotized.

It took between two and ten minutes to hypnotize the people while they lay in the scanner. A computer screen overhead then presented them with a pattern of yellow, red, blue, and green rectangles, similar to a painting by the Dutch artist Piet Mondrian. They tried to “drain” the color from what they saw on the screen while the PET scanner recorded their brain activity. Under the same conditions, they saw the rectangles in various shades of gray and had to color them with their minds.

When not under hypnosis, people asked to perceive color – whether they actually saw color or not – showed activity on only the right side of their brains. (The brain is split into right and left hemispheres by a furrow filled with nerve fibers that connect the two halves.) When told to see gray, whether looking at color or gray, again changes in activity occurred on the right side only.

That result was expected on the basis of previous research. However, under hypnotism the researchers found what Kosslyn calls “a curious tweak.” Both the left and right hemispheres responded. In other words, the right side of the brain alone responded to what the subjects saw when they were not hypnotized, but both sides responded under hypnosis.

“The left hemisphere color area registered what people were told to see only when they were hypnotized. The right hemisphere registered what people were told to see [independently of what they actually saw] whether or not they were hypnotized,” Kosslyn explains. “If you ask people [who are not hypnotized] to visualize color in a gray pattern, or vice versa, only the right hemisphere is activated during the task. Thus, our findings in the left hemisphere could not have been produced by mental imagery alone.

“What we have shown for the first time,” Kosslyn concludes, “is that hypnosis changes conscious experience in a way not possible when we are not under hypnosis.”

How hypnosis works

Why the hemispheric differences? Kosslyn and his colleagues think that the right hemisphere is more sensitive to goals and expectations. This part of the brain finds it easier to reinterpret sensory experience to match the images a person wants to perceive – to see color where none exists, or to color a gray palette. This idea fits with the fact that, in most people, the left side deals more with logic and reason, so may require an extra boost from hypnosis to disassociate itself from the senses, i.e., to change what is actually seen.

Such disassociation of senses, Kosslyn and Thompson speculate, may account for the success of hypnosis in reducing pain and anxiety, combating insomnia, and helping some people to quit smoking. Pain, anxiety, insomnia, and smoking, might be reduced by the same type of brain activity that allows some people to drain color from brilliantly hued rectangles.

Highly hypnotizables apparently would be better at this than most people or those who show the lowest levels of submission. Thompson is studying the brain differences between high and low hypnotizables. So far, he has found that the middle-part of a brain area called the cingulate gyrus shows more activity in the highs than lows. This area deals with attention and emotion.

Does changing a brain by hypnosis mean hypnotizables can gain more control over what are normally involuntary functions of the brain – responses to stress, regulation of hormones, control of the immune system, for instance? Maybe. David Spiegel of Stanford University School of Medicine, who collaborated on the color experiments, is interested in the possibility of bolstering the body’s defenses against disease by psychological means that might include hypnosis. Evidence exists that strengthening these defenses may reduce the rate of growth of cancer tumor.

At this point, anything beyond changing color perception is pure speculation, Kosslyn and Thompson insist. However, Kosslyn refers to their study as “the thin edge of a wedge that shows that conscious experience can be changed in a willfully directed way by hypnosis.”

Other researchers who participated in these experiments include Associate Professor of Radiology Nathaniel Alpert of Harvard Medical School and Maria Costantini-Ferrando of Weill Medical College, Cornell University. The research was made possible by a grant from the John D. and Catherine T. MacArthur Foundation.

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It’s a common operation for women whose breasts are large enough to cause back and shoulder strain, interfere with routine tasks, or prompt social and psychological problems. The pain and course of healing from such surgery is well-known, and a team of researchers headed by Carol Ginandes of Harvard Medical School and Patricia Brooks of the Union Institute in Cincinnati wanted to determine if hypnosis could speed wound healing and recovery.

“Hypnosis has been used in Western medicine for more than 150 years to treat everything from anxiety to pain, from easing the nausea of cancer chemotherapy to enhancing sports performance,” Ginandes says. A list of applications she provides includes treatment of phobias, panic, low self-esteem, insomnia, sexual dysfunction, stress, smoking, colitis, warts, headaches, and high blood pressure.

“All these functional uses may help a person feel better,” Ginandes continues. “I am also interested in using hypnosis to help people get better physically. That means using the mind to make structural changes in the body, to accelerate healing at the tissue level.”

Four years ago, Ginandes and Daniel Rosenthal, professor of radiology at the Harvard Medical School, published a report on their study of hypnosis to speed up the mending of broken bones. They recruited 12 people with broken ankles who did not require surgery and who received the usual treatment at Massachusetts General Hospital in Boston. In addition, Ginandes hypnotized half of them once a week for 12 weeks, while the other half received only normal treatment. The same doctor applied the casts and other care, and the same radiologists took regular X-rays to monitor how well they healed. A radiologist who evaluated the X-rays did not know which patients underwent hypnosis.

The result stood out like a sore ankle. Those who were hypnotized healed faster than those who were not. Six weeks after the fracture, those in the hypnosis group showed the equivalent of eight and a half weeks of healing. Marie McBrown was invited to test whether or not hypnosis would help heal the scars from her breast surgery. Marie (not her real name) and 17 other women underwent surgery to reduce their breast size.

How to hypnotize

Not everyone is convinced by the results. Some experts claim that the differences can be explained by the extra attention – the increased psychological support – given to the hypnotized patients. So when she was ready to try hypnosis again on 18 breast surgery patients, Ginandes randomly separated them into three groups. All got the same surgical care by the same doctors. Six received standard care only, six also received attention and support and from a psychologist, and six underwent hypnosis before and after their surgery.

Hypnosis sessions occurred once a week for eight weeks. Psychological soothing took place on the same schedule.

Ginandes did not put the patients to sleep by swinging a watch like a pendulum while the patients lay on a couch. “That only happens in the movies,” she laughs. “In hypnosis, people don’t lose control and go into a zombie-like state where they can be made to do things against their will. They don’t have to lie down, you can enter a state of hypnosis standing up, even standing on your head. Patients don’t even go to sleep, rather, they enter a state of absorbed awareness, not unlike losing oneself in a good book or favorite piece of music.”

While in this state, Ginandes offered suggestions that were custom-tailored to different stages of surgery and healing, Before surgery, the suggestions emphasized lessening pain and anxiety. “You can even suggest to a patient that she can reduce bleeding during surgery by controlling her blood flow,” Ginandes notes. Overall, the suggestions focused on things such as expectation of comfort, decreased inflammation, diminished scar tissue, accelerated wound healing, return to normal activities, and adjustments to self-image.

The women received audio tapes of these sessions so they could practice at home.

At one week and seven weeks after surgery, nurses and doctors participating in the study visibly assessed and measured the wounds of all three groups without knowing which group the women were in. They took digital photographs for three physicians to review. Each patient also rated her own healing progress and how much pain she felt on scales of zero to 10.

The result was clear. Marie McBrown and the women who had undergone hypnosis healed significantly faster than the others. Those who received supportive attention came in second.

From hooey to hurrah

The researchers reported these results in the April issue of the American Journal of Clinical Hypnosis. This report, of course, doesn’t prove conclusively that hypnosis will accelerate the healing of wounds. The biggest limitation of the study involves the small number of patients, which makes it difficult to generalize the results to other types of wounds. Then there is the possible effect of expectation, the belief of some patients that hypnotism will work. It’s the same effect seen when people who take a sugar pill for a backache do as well as people who take medicine. It’s going to require more studies involving many more people to get the majority of doctors to shout hurrah instead of hooey.

Ginandes agrees. “Our study underscores the need for further scientific testing of hypnosis,” she says. “Subsequent studies might clarify unresolved speculations about the mechanisms by which hypnotic suggestion can trigger the physical and psychological effects that we see.”

She and her colleagues suggest future experiments to compare the effects of simple hypnotic relaxation versus “targeted suggestions for tissue healing.” They would also like to see more work done using hypnosis for people suffering from other kinds of wounds, such as foot ulcers caused by diabetes.

Nevertheless, Ginandes believes that the study of healing after breast surgery “breaks the ground for studying a broad and exciting range of new adjunctive treatments. Since clinical hypnosis is a noninvasive, nondrug treatment, finding that it can speed healing of wounds and other conditions could lead to fewer visits to doctors’ offices and faster return to normal activities. Also, further investigation might confirm our supposition that