Hypnosis and Guided Imagery to Enhance Surgery

Hypnosis and “guided imagery” can be of great benefit in preparing for surgery.  The following text is drawn from the information prepared for physicians below:  Guided imagery is an imaginative technique that is one common part of most hypnosis processes.

Hypnosis and Guided Imagery to Enhance Surgery

“Over 200 research studies in the past 30 years have explored the role of mind-body techniques in helping prepare people for surgical and medical procedures and helping them recover more rapidly. These studies have shown that guided imagery may significantly reduce stress and anxiety before and after surgical and medical procedures. In addition guided imagery has proven to help people:

“Over 200 research studies in the past 30 years have explored the role of mind-body techniques in helping prepare people for surgical and medical procedures and helping them recover more rapidly. These studies have shown that guided imagery may significantly reduce stress and anxiety before and after surgical and medical procedures. In addition guided imagery has proven to help people:

We prepared the following information to give physicians a broader look at the known benefits of hypnotic preparation for surgery.

Patrik Bowe March 29, 2006

The mind and pain

The perception of pain can be dramatically altered using various processes of communication (such as suggestion, distraction, hypnosis, guided imagery, etc.).  As early as the 1800’s it was demonstrated that anesthesia sufficient for complex surgery could be obtained using only the mind.  Dr. James Esdaile of Scotland performed several thousand painless minor operations and 300 major operations, including cataracts, amputations, hydroceles and scrotal tumors, using ‘mesmerism’ as the sole anesthesia. (Esdaile 1846).

Hypnosis has been demonstrated to be a significant tool of mental pain management (Hilgard 1994, Barber 1996).  After exhaustive study, in 1957, the AMA Council on Mental Health unanimously recommended the “Medical Use of Hypnosis” which was officially approved in 1958. Since that time, hypnosis has been used with enthusiasm within the profession by a select group of physicians familiar with its benefit.  There are at least two notable books on hypnosis written by anesthesiologists.  “Hypnosis in Anesthesiology” (1959) was written by Dr Milton Marmer.   Dr..Marmer was Chairman of the Department of Anesthesia at “Cedars Lebanon Hospital” of Los Angeles.  More recent and up-to-date writing can be found on the subject in “The Use of Hypnosis in Surgery and Anesthesiology” (2001) by Lillian Fredericks, M.D..  Dr. Fredericks is retired from the Department of Anesthesiology at the Hospital of the University of Pennsylvania.

Although hypnosis can be used alone as a form of anesthesia, this is rare.  It is far more commonly used as an adjunct to standard protocols. A simple and famous example occurred in the early 1900’s.  The anesthetic death rate from chloroform and ether was one in four hundred at university hospitals. At the time Alice Magaw, at the Mayo clinic, reported over 14,000 consecutive anesthetics without a death. Her father had taught her to use hypnotic principles to reduce the quantity of ether used during major procedures. This skill enhanced the reputation of the clinic. (Magaw 1906).

Additional benefits of hypnosis with surgery

The psychological, physiological and monetary advantages of hypnosis preoperatively, during surgery and post operatively have been documented for at least 30 years. (Kessler and Dane, 1996).   Sobel and Ornstein (1996) indicate, “In an analysis of over 190 studies of psychological preparation for surgery, 80% of the patients showed significant benefits: quicker recovery, fewer complications, less post surgical pain, less need for pain medication, less anxiety and depression and an average of 1.5 days less in hospitals.”

An article on the Cleveland Clinic web site (Cleveland Clinic, 2006) details the following…  “Over 200 research studies in the past 30 years have explored the role of mind-body techniques in helping prepare people for surgical and medical procedures and helping them recover more rapidly. These studies have shown that guided imagery may significantly reduce stress and anxiety before and after surgical and medical procedures. In addition guided imagery has proven to help people:

  • Dramatically decrease pain and the need for pain medication
  • Decrease side effects and complications of medical procedures
  • Reduce recovery time and shorten hospital stays
  • Enhance sleep
  • Strengthen the immune system and enhance the ability to heal
  • Increase self-confidence and self-control”

 

Beyond these basic improvements hypnosis and guided imagery can influence critical physical functions. “There is good documentation that human beings are capable of regulating many autonomic functions, such as blood pressure, heart rate and rhythm, peripheral temperature, etc., which we thought were not under voluntary control.”  (Fredericks, 2001). There are well-controlled studies that demonstrate that hypnotic suggestions can aid with the control of heart rate and rhythm (Bleeker & Engel, 1973a and b), the reduction of blood loss during surgery (Bennett, Benson and Kuicken, 1986) stopping the bleeding by hemophiliacs (Frederichs, 1967), the rapidity of healing and lack of complications, and the enhancement of the immune system (Hall,1983 & Dillon, Minchoff & Baker, 1985).

Hypnosis, guided imagery and the body

To better understand the capabilities described above it is useful to think in terms of information. The human mind is a complex information processing system. The field of hypnotherapy specializes in communication designed to provide and adapt information for the mind to work with. Our mental process is highly flexible.  Much like a computer, when presented with well organized ideas, the mind has the capacity to execute instructions without stumbling on their believability. To the conscious mind the idea of directing blood flow away from a surgical procedure would be frightening or absurd. Yet, when this information is presented in a matter-of-fact way to the subconscious mind (a relatively easy task), it is often executed without doubt or reflection.  Far beyond these benefits described for surgery, experience with hypnosis has shown an extraordinary range of potential medical benefit. (Rossi, 1993) (Hammond 1990).

Hypnosis and guided imagery are closely related tools of communication.  Hypnosis involves a broad spectrum of skills to both convey and gather information.  Guided imagery draws from one facet of this process. It involves delivering information in the form of scripts. It provides some of the benefits of hypnotherapy while distancing itself from the cultural awkwardness of hypnosis used in entertainment. Describing ‘guided imagery’ can simplify communication with patients and is sufficient for many medical applications.  There are many circumstances when the extra potential of hypnosis justifies further explanation.

A specific example of financial analysis

Blue Shield of California is the first health plan in the U.S. to offer a guided imagery program to its surgical patients, and the results of a recent study of its effects are impressive. Blue Shield’s program combines self-care, pre-surgical guided imagery exercises (via video and CD recordings) with one-on-one telephone support from a Blue Shield nurse health coach. According to Blue Shield, of 3500 patients sent guided imagery tapes before surgery, 75% listened to them. Patients who used the guided imagery tapes experienced less anxiety before surgery and less pain after surgery than did patients who did not use the guided imagery tapes. From this study, a sub-sample of hysterectomy patients who listened to the tapes was compared with hysterectomy patients who did not use guided imagery. Those using guided imagery had hospital bills that were an average of 4.5% lower–an average savings of $654 per patient! (APA, 2006).

Using hypnosis and guided imagery with Anesthesia and Surgery

There are several approaches to incorporating hypnosis or guided imagery into surgical procedures. The simplest method is to supply surgical patients with a series of prerecorded discs to listen to.  This can be done with one explanation disc and two or three suggestion discs.

A more comprehensive approach is for the hypnotherapist to meet once with the individual.  The process can be described and fear of surgery can often be worked through.  At this meeting they are presented with suggestion discs and instructed in how to approach the process most effectively.  It is believed that this personal contact improves results.

The most highly effective approach is for the anesthesiologists to be trained and integrated into the process as well. Suggestions and guidance during surgery can divert fear and encourage the responses suggested on the recordings….

Beyond Surgery

Hypnosis is used to manage many facets of pain.  It offers a method to effect sensation as well as the anxiety and emotion that frequently compound discomfort.   This ability of the mind to influence perception and reaction is far reaching and has opened a promising frontier in medicine. A wealth of studies in the last fifty years demonstrate that hypnosis and guided imagery (a subset of hypnosis) impact many elements of treatment and recovery.  The use of this knowledge has been limited by the lack of a delivery system, although the number of hypnotherapists trained to work with medical issues is growing.  There are indications that availability will increase quickly within the next decade.

Some information that can be conveyed on recordings:

Initial

Dispel anxiety.
Encourage confidence in the physicians.
Create a positive attitude toward the benefits surgery.

Before/During Surgery

Ease of ET tube insertion
Ease of incision
Increase comfort during surgery
Blood flow away from surgical activity
Reduce the impact of careless remarks
Encourage B cell and T cell activity through visualization

After

Encourage a feeling of well being and comfort after (reducing pain and the need for medication)
Stimulate healing responses and recovery
Stimulate appetite to limit nausea
Encourage bowel and urinary function (where appropriate).

REFERENCES

APA  (2006). American Psychological Association, Web article describing the use of guided imagery for surgery.

Barber, J. (1996)  Hypnosis and Suggestion in the Treatment of Pain: A Clinical Guide.W. W. Norton & Company

Bennett, H.L., Benson, D.R., & Kuiken, D.A. (1986). Preoperative instructions for decreased bleeding during spine surgery.  Anesthesiology, 65(3A), A245.

Bleeker, E.R., & Engel, B.T. (1973a)., Learned control of ventricular rate in  patients with atrial fibrillation. Psychosomatic Medicine, 35(2), 161- 175.

Bleeker, E.R., & Engel, B.T. (1973b), Learned control of cardiac rate and  cardiac conduction in the Wolff-Parkinson-White syndrome. New  England Journal of Medicine, 288, 560-562.

Cleveland Clinic,  (2006)  Web article on the use of guided imagery in heart surgery and  other procedures.

Dillon, M., Minchoff, B. & Baker, K.H. (1985) Positive emotional states and  enhancement of the immune system.  International Journal of Psychiatry in Medicine, 15:1, 13-18.

Esdaile, J. (1846).  Hypnosis in medicine and surgery. New York, Julian Press.

Frederichs, L.E. (1967). The use of hypnosis in hemophilia.  American Journal of Clinical Hypnosis, 10(1), 1-10.

Fredericks, L. (2001) The use of hypnosis in surgery and anesthesiology.   Charles Thomas Publishers, Springfield IL

Hall, H.H. (1983). Hypnosis and the immune system: A review with the implications for cancer and the psychology of healing. American Journal of Clinical Hypnosis, 25, 92-103.
Hammond, D.C.  (1990) Handbook of suggestions and metaphors. Norton NY, NY.

Hilgard, E.R. & Hilgard J.R., (1984) Hypnosis in the relief of pain.  Brunner/Mazel, Levittown  PA.

Magaw, A. (1906) A review of over fourteen thousand surgical anaesthesias.   Surgery, Gynecology & Obstetrics, 3:795-797.

Marmer, M.J. (1959) Hypnosis in Anesthesiology. Charles Thomas Publishers,  Springfield IL

Pert, C.B. (1997) Molecules of Emotion.  Scribner, NY, NY p.144.

PHC  (2006)  Providence Hypnosis Center website. Barbara Morse Silva  news story on WJAR Channel 10 www.providencehypnosiscenter.com

Rossi, E.L. (1993) The psychobiology of mind-body healing.  Norton NY.

Sobel, D.S., & Ornstein R (1996) The healthy mind, healthy body handbook. Los Altos CA. p259

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