* * *
* * *
18. Ex-smoker
* * *
I’ve heard discussions about telling a patient to become an ex-smoker. I don’t care for the idea of being an ex-anything. Who wants to be an ex-convict, ex-communist, or an ex-beauty queen?
I tell my smoking patients that the goal is to become normal again. It’s normal to breathe air, and it’s so abnormal to inhale smoke that the only living creature that doesn’t run from smoke is the human, who had to learn how to do it.
* * *
* * *
19. Non-smoker
* * *
Who wants to be a nonentity, or a non-Nazi, or a non-terrorist?
Again, if the goal is to characterize the patient, let it be to become normal again.
* * *
* * *
20. Lapse (instead of relapse)
* * *
Relapse implies that we are back where we started, and nothing of value has happened.
If a smoking patient has abstained for a month, and then lights up a few cigarettes, I don’t treat it as a failure, just a lapse in the ongoing success.
All through school we take a vacation every summer, and it’s just a lapse in our ongoing education. In September we don’t start again in first grade – we move ahead to the next year’s class.
I point out that “Every success leads to more success, and if you can succeed for a month, you can do it for two, then four, and eight, and so on.”
* * *
* * *
21. Negative suggestions
* * *
Negative suggestions often backfire.
If I tell you “Don’t think of an elephant,” the first thing you must do is think of an elephant, so you’ll know what not to think about.
So we can predict what will happen when someone says to a person in a long leg cast, “Don’t pay attention if it starts to itch, because you can’t scratch it.”
How many times have I heard a nurse tell a child “This won’t hurt,” just before giving an injection that is routinely followed by a scream. The suggestion that “You will not feel like smoking anymore” is a sure loser.
* * *
* * *
22. Impossible
* * *
Impossible is a word that turns a negative suggestion into a positive one.
Instead of saying “You won’t want to smoke,” I can say “Let it be impossible to put a cigarette in your mouth without first looking at it, and making a conscious choice about protecting your lungs.”
* * *
* * *
23. Addiction
* * *
This word has lost its meaning in scientific communication, and I generally seek to avoid it. It no longer refers to a bodily need for a particular chemical, and is used indiscriminately to describe strong emotional desires such as being addicted to chocolate, sex, sports, and now foreign oil.
The patient who thinks of him/herself as an addict has adopted a fixed idea that he/she is helpless to overcome the problem. This is particularly true with incorrigible smokers (about 21 percent of the US population).
Granted nicotine is a powerful drug, but if a person can wake up and fix a cup of coffee before the first cigarette, it was not a chemical deficit that woke him/her up. The only patients that I put on patches are the rare ones who light up before they get from the bed to the bathroom in the morning. For the others, I point out that the problem is not a chemical addiction, it is a craving, and it can be changed.
* * *
* * *
24. Induction on first visit
* * *
It only takes five minutes to do a simple eye roll induction and give a suggestion that “The next time you are ready to go into trance, you will find it very easy to quickly go twice as deep as you are now.” A patient who comes for hypnosis is prepared for it, and even if he/she doesn’t think anything trancelike happened, will return for the next visit somehow wondering if he/she really will go twice as deep.
For those concerned about hypnotizability, remember that hypnotizability is a stable trait and can be measured at any later time, or the Hypnotic Induction Profile (HIP) can be used as the first induction and simultaneously measures hypnotizability.
I treat smoking patients for three visits, and if the first visit is just a detailed history taking or hypnotizability testing, they did not get the hypnosis they came for, and leave disappointed and smoking as before. At a meeting in Europe I heard a report of a carefully controlled smoking study complete with tests of hypnotizability. No induction was done on the first visit. One third of the subjects deserted, and did not return to participate after the first visit. The doctors blamed it on a lack of motivation on the part of the patients, but I think the failure to do an induction on the first visit was a flaw in the design of the study.
* * *
* * *
25. Three issues maintain
smoking behavior
* * *
One of Aesop’s fables tells of a village with a prize for the strong young man who can break a bundle of sticks. After all the other contestants have failed, the village idiot unties the bundle and breaks the sticks one at a time to win the prize.
I think there are three “sticks” in the smoking bundle, and I endeavor to break them one at a time:
The concept that it has social value (subconscious fixed idea – see Thing 60). All of us who formerly smoked can recall coughing and turning green as we learned to inhale, but we persevered because we believed it had value: the older guys who smoked got all the girls, or you were a sissy if you didn’t smoke, or all the beautiful movie actresses smoked, and so on. We know that if you violate a fixed idea it causes anxiety (Thing 60). I set out to remove this idea first and foremost, usually with a regression. It is the paramount issue for the incorrigible smoker. I have friends who can determinedly (left brain) give up smoking for the forty days of Lent, endure forty days of anxiety, and on Easter Saturday light up and say “It calms my nerves.”
Nicotine has a chemical effect that I think is much less addictive than is generally believed. Patients who put on nicotine replacement patches frequently still experience the anxiety of violating a fixed idea (Thing 93); and some even secretly smoke while wearing the patch. After adrenalin, nicotine is the strongest known stimulant drug, and it’s an oxymoron to say “I take a stimulant to calm my nerves.” What calms the nerves is accommodating to the fixed idea. Once I’ve identified and removed the fixed idea, I have the patient switch to regular Carlton’s (almost nicotine free) for a week, smoking all he/she wants, but reading the Surgeon General’s warning before each cigarette. This removes nearly all of the nicotine from the body, and stopping smoking does not cause much chemical repercussion. It’s interesting that in their study of 12,000 smokers Tindle et al. (2006) noted that people who smoke “light” (low nicotine) cigarettes are more than 50 percent less likely to stop smoking than those who smoke regular cigarettes. That finding is incompatible with chemical addiction.
Habit change is easy with hypnosis. On the third visit I make a personal self-hypnosis tape reviewing the fact that the fixed idea has outlived its usefulness, that breathing air is normal, and that my patient will be pleased and proud of his/her accomplishment. Since I don’t get to do chemical tests at one year, I do not have factual data on my quit rate, but believe I get over 50 percent with incorrigible smokers (Ewin 1977).
* * *
* * *
26. Smokers lie to their doctors
* * *
Smokers lie to their doctors just like alcoholics do.
The British Thoracic Society study (1983) of 1,500 patients coming to clinic for the treatment of smoking related diseases did plasma thiocyanate and carboxyhemoglobin tests at one year.
These texts showed that only 10 percent of these “highly motivated” patients had stopped smoking, and 26 percent who said they had stopped had elevated thiocyanate and carboxyhemoglobin level
s consistent with continued smoking.
Hypnosis was not tested in this study – only doctor’s advice with and without booklet material, nicotine gum, and placebo. We will only have believable evidence-based statistics on the value of hypnosis for smoking cessation when someone does chemical studies at one year.
* * *
Pain
In the emergency room, a skilled hypnotist can use the frightened patient’s spontaneous trance to get rapid relief of acute pain, control bleeding, reduce a fracture, and allay fear. The office-based hypnotist is most likely to deal with chronic pain. Inflammatory processes are a common cause of chronic pain. Pain is an integral part of inflammation, so in these cases anti-inflammatory suggestions of being cool and comfortable are indicated. When the diagnosis is psychogenic pain, we must remember Milton Erickson’s dictum “The symptom is a solution.” Muscle spasm pain is severe and often psychogenic, and once mechanical and chemical causes have been ruled out, our duty is to help find a better solution.
* * *
27. I must believe in what I’m
saying to the patient
* * *
A patient in trance picks up insincerity and uncertainty like it was on radar, and it causes loss of trust and rapport. Sometimes I have to parse my words literally in order for me to believe what I want to say.
With chronic pain patients, I insinuate into my induction “We all know that no pain lasts forever.” By assuming that a dead person does not experience pain, I can rationalize that if my treatment doesn’t work (which happens at times), and the patient ultimately dies still having pain, it literally won’t last forever.
I once said this to a disabled patient during a demonstration, and she came out of trance crying, and hugged me and exclaimed “Nobody ever said that to me!”
* * *
* * *
28. You will have all the
comfort you need
* * *
This is a good positive suggestion that does not mention the word pain.
Also, it doesn’t say there will be no pain at all, and it raises the question of how much comfort suffices. I learned this from the warm and gentle Bertha Rodger, MD, anesthesiologist, and past president of ASCH.
* * *
* * *
29. Tolerable
* * *
Tolerable is a good word to use when seeking to lessen pain on the 0 –10 scale.
If the patient is at 8, “Would it be all right to lower the intensity of the pain to a tolerable level?” With an ideomotor “yes,” then “Would 7 be tolerable for you?” “No,” then 6, 5, 4, 3 (progressively lowering the numbers to an ideomotor “yes”).
Tolerable is an attitude, not a number, and I’ve had patients who could function OK at 5, which would be quite intolerable for me.
* * *
* * *
30. Once everything that can
be done, and should be done, has
been done, pain has no value
* * *
There’s an obvious right time to say this during therapy.
I learned it from Kay Thompson. I point out to my patients that pain is nature’s valuable alarm system.
If I put my hand on a hot stove, the pain is an immediate warning that if I don’t do something I will get tissue damage. But once I remove my hand, any pain I feel has no further value, and needs to be turned off.
* * *
* * *
31. Inflammatory pain
* * *
Celsus gave us the four cardinal signs of inflammation in 45 AD: calor, dolor, rubor, and tumor (heat, pain, redness, and swelling). The patient is aware of the heat and pain (subjective), and the doctor can see the redness and swelling (objective).
The anti-inflammatory suggestion only needs to address the subjective component, so “Let the involved area become cool and comfortable” suffices.
The suffix “itis” in a diagnosis indicates an inflammatory disorder (e.g. arthritis, vasculitis, bursitis, spondylitis, cellulitis, bronchitis). Many of these respond to specific therapies – a steroid injection into an inflamed bursa or colchicine for acute gouty arthritis – and they should be treated accordingly. Nonetheless, nearly any inflammatory pain syndrome can be improved with hypnotic stress relief and direct suggestion to be cool and comfortable. This is particularly true with burns. Only the initial burn pain is from the heat injury, but the longtime background pain is inflammatory.
* * *
* * *
32. Constant pain
* * *
Constant pain is nearly always psychological in my experience. Almost any physical pain can be temporarily relieved by medication, rest, sleep, or positioning.
When a patient says the pain “never goes away” even in sleep, or “it’s always there,” I listen for “I live with it.” That is a subconscious equating of pain with life, and just as one cannot be without life for five minutes, he can’t be without the pain for five minutes.
The intake history will include three things happening simultaneously (Ewin’s triad): (1) a life threatening incident with fear of death; (2) mental disorientation (helplessness) from concussion, drugs, anesthesia, and so on; and (3) pain. At a subconscious level, as long as the pain is there he can’t be dead yet! I have written on the Constant Pain Syndrome and the hypnotic technique for relief (Ewin 1980, 1987).
* * *
* * *
33. Muscle spasm pain
* * *
Muscle spasm pain can be very severe. In a good trance with muscular relaxation, it will clear temporarily, but often recurs out of trance.
John Prussack, MD has a marvelous video of a man with severe torticollis that fully relaxes in trance and recurs immediately on alerting with a count up technique. Finally, he gives the suggestion “When your subconscious mind knows that you can keep your neck muscles as comfortably relaxed as they are right now, you will open your eyes and come back fully alert.” The choice is to get well or stay in trance forever. It worked, and I now use that double bind alerting suggestion for patients with muscle spasm pain.
One common muscle spasm pain is “night cramps” in the legs and feet, usually in older persons. I believe it has to do with the acetylcholine release that normally occurs during sleep. It is relieved by waking up and walking the floor. It’s off-label, but I learned a long time ago that 25 mg of over-the-counter Benadryl will relieve it in 5–10 minutes without waking up and walking.
* * *
Techniques
When I started my surgical training, the first book my mentor recommended was entitled Surgical Errors and Safeguards. We do not need to repeat the errors that have been made in the past. Primum non nocere, first of all, do no harm. Good technique comes from our own experiences and from listening to those who have “been there and done that.” There are things to avoid and there is what to say, when to say it, and how to say it. Hypnosis is an empathetic involvement with another, and as we interact with our patients/clients, we evolve in our tone of voice, choice of words, what we emphasize, and our timing.
* * *
34. Full bladder
* * *
Alexander Levitan (in a personal communication) points out that we should never start an induction if either the patient or the therapist needs to urinate.
Our earliest training in civilized life is “Don’t wet your pants.” This is powerfully embedded in the subconscious mind, and as the bladder fills it will progressively interfere with the other subconscious work being done in trance.
* * *
* * *
35. Inductions
* * *
There are many techniques for the induction of hypnosis. What do they have in common?
It seems to me that all of them tend to turn off left brain conscious logic and encourage a shift into daydreaming (good or bad imaginings, or emotional states).
101 Things I Wish I'd Known When I Started Using Hypnosis Page 2