[escepticos] Hypnosis en The Lancet

[Serge Bobroff <sbobroff@...>]

Con poco tiempo para participar .... pero bueno, la intencion es lo que
vale ?no?

The Lancet (1999, 30 enero, Vol 353, numero 9150) :

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Hypnosis makes headway in the clinic


Exaggerated claims by lay hypnotists have obscured the technique's
proven benefits, say clinicians who routinely use hypnosis in the
treatment of pain, needle phobia, and many other conditions. "There is
a rich scientific literature on hypnosis that stretches back over 100
years--each year there are about 150 articles on hypnosis in
mainstream medical and science journals. It's not one of those fuzzy
interventions for which no research has ever been done", stresses
Michael Nash (University of Tennessee, Knoxville, TN, USA), editor of
the International Journal of Clinical and Experimental Hypnosis. The
American Medical Association and other medical associations have
formally recognised hypnosis as a viable medical treatment, says Nash,
and "we don't even qualify for alternative-medicine research funds".

Donald D Price (University of Florida, Gainesville, FL, USA) says
there is now evidence of a neurobiological basis for hypnosis. "People
think that during hypnosis, the brain goes to sleep. In fact, specific
brain areas become activated." In a study to be published soon in the
Journal of Cognitive Neuroscience, positron emission tomography scans
were done on volunteers during hypnotic relaxation. Scans were also
done during hypnotic suggestion: the volunteers' hands were put in hot
water, and suggestions given aimed at altering pain perception.
Different patterns of regional cerebral blood flow were recorded in
response to hypnosis with and without suggestion (panel).

 Brain activations during hypnosis
 Hypnotic relaxation
   Activity in:
           occipital region (?deep relaxation/decreased arousal)

           caudal area of right anterior cingulate sulcus

           inferior frontal gyri
   Activity in:
           right inferior parietal lobule (?dissociation/reduced sense
           of self)

           left pre-cuneus/posterior cingulate gyrus
 Hypnosis with suggestions
   Activity in:
           frontal cortices (?verbal mediation of suggestions)
   Activity in:
           medial and lateral posterior parietal cortices


These results imply that the hypnotic "trance" state is different from
normal consciousness, and that it facilitates the processing of
hypnotic suggestions, says Price, who has himself been hypnotised. "My
idea is that when you're hypnotised, you experience things
automatically, not deliberately. If someone suggests that your arm is
raising up, it's as if your arm is doing it by itself."

Irving Kirsch of the University of Connecticut (Storrs, CT, USA)
argues that what decides a patient's response to hypnosis is patient
expectations. "You can't get any response with hypnosis that you can't
also get without it, although hypnosis slightly increases the
likelihood of getting the response. How people behave and what they
experience during hypnosis depends almost completely on what they
think is supposed to happen." People who don't want to be hypnotised
won't be, and hypnosis can't make people do things they would normally
refuse to do.

"People have the idea that the hypnotist has the power, and it's
through his cunning techniques that a person experiences hypnosis.
That is wrong", says Nash. In receptive individuals, the hypnotist
"uses in a systematic way the abilities the patient already has. It's
almost like helping them hone their own skills".

Irrespective of whether a person goes into a trance-like state or is
simply open to suggestion, hypnosis is useful in the clinic. Nash
tells of a man who needed cystoscopy every 3 months for 5 years after
removal of a bladder tumour. At his first check-up, "he had to be held
down because of the pain". The man did not want general anaesthesia,
and epidurals were risky, so Nash taught him self-hypnosis. Before the
second cystoscopy, "he took 60 seconds to prepare himself, and that
was it. The procedure was over in 10 minutes, and the six people who
had intended to hold him down went for coffee".

Self-hypnosis "facilitates a sense of control and self-efficacy" in
patients with cancer, adds psychologist Phyllis Alden (Derbyshire
Royal Infirmary, Derby, UK). Alden uses adjunctive hypnosis to help
patients who have nausea and vomiting associated with chemotherapy,
and anxieties associated with other procedures and the cancer itself.
"Hypnosis isn't magic but it is a valuable tool in a cancer centre."

Hypnosis is also helpful in burn centres, where the daily care of
wounds can be more painful than the initial injury, says David
Patterson (University of Washington Burn Center, Seattle, WA, USA).
Large morphine doses are needed for these patients, but may not
adequately relieve pain. Patterson, who has held a National Institutes
of Health grant to research into hypnosis for the past 9 years, has
used adjunctive hypnosis with loggers and other "hardy" types not
typically thought of as hypnosis candidates. In those with intense
pain, "dramatic effects" can be achieved, he says.

Barry Hart, a consultant psychologist in Scunthorpe, UK, has had
similar experiences. For example, a dock worker with persistent pain
and anxiety from a crush injury to his toes learned self-hypnosis and
was able to return to work. Hart also uses hypnosis in patients with
respiratory problems who become panicky because of breathlessness, and
in those with chronic pain disorders.

Referring physicians should properly prepare patients for hypnosis and
other psychological interventions, urges Hart. "If you have chronic
pain because of a real physical problem and you're sent to a
psychologist, you may feel like you're being written off. It should be
explained that the pain is real, but that psychological factors can
alter your experience of it."

Despite their enthusiasm, clinicians who use hypnosis warn against
overstating the technique's benefits. Hypnosis can be easily learned
and used as a tool by general practitioners and other health
professionals, they note, but "hypnosis is a context in which you do
therapy; it's not a therapy itself", says Hart. "Using hypnosis won't
make you a good clinician; you have to be a good clinician, and then
you can use hypnosis in a savvy way", cautions Nash. "I could teach a
high-school student to do hypnosis in half an hour, but using hypnosis
therapeutically is a very different story."

Marilynn Larkin

Serge Bobroff
Ph.D., Post-Doctoral Research Associate
Department of Food Science and Technology
University of California, Davis, CA 95616, USA
email  sbobroff en ucdavis.edu
telephone   (530)-752-5883
fax         (530)-752-4759