Today is the second part of my ongoing literature review looking at the evidence for the use of clinical hypnosis for children. Prior to reading this today, you are advised to read my previous two blog entries here on hypnosis for children as they build the framework for todays entry.

When I was reviewing the literature for my most recent book ‘Hypnosis For Running’ – I encountered a piece of research that was aimed at helping divers increase their body temperature using hypnosis and self-hypnosis and it had mixed results.

Therefore, my attention really piqued when I encountered similar temperature regulation applications of hypnosis being examined with children.

When I have given demonstrations at lectures and on my seminars of using hypnosis for anaesthesia and analgesia, we very often notice a change in the colouration of the affected area. Often the arm becomes more pale and it is visibly noticeable to those watching the demonstration.   The pieces of research I am about to mention offer up the opposite to that in a sense.

Thermal biofeedback makes use of specialist monitoring equipment when training the participants within these studies to warm an outer part of their body. Within the studies, it is usually the hands that are used. This process tends to also result in accompanying feelings of calmness and relaxation.

Whereas with the anaesthesia, the blood seemed to go elsewhere and leave the body part, within this research with the thermal biofeedback, the participants are learning to direct blood toward the surface of their skin by somehow dilating their blood vessels. Pretty cool, eh?

This type of warming of areas using thermal biofeedback has been used with success to treat migraines and also Raynaud’s disease among other disorders too (Lehrer, Carr, Sargunaraj, & Woolfolk, 1994) and there is additional evidence that shows hypnosis can also be a successful application for treating adults with these disorders (Andreychuk & Skriver, 1975; Barabasz & Wright, 1975).

So what about the uses of this with children? Dikel and Olness (1980) studied and measured the differences in temperature gained by using biofeedback against the changes gained through self-hypnosis (as well as looking at a combination of self-hypnosis and biofeedback). A good number of both boys and girls, with ages ranging from 5 through to 15, were assigned to three groups; the self-hypnosis only group, the  biofeedback plus self-hypnosis group and the biofeedback only group.

Having taken all the children’s temperatures at the start of the study, particpants in both of the groups including self-hypnosis listened to a relaxing audio for ten minutes. Thereafter, when measuring the skin temperature again, the participants in these groups were asked to imagine their hands getting warmer or cooler. All three of the groups were able to raise their temperatures significantly. Showing that simple imagery and suggestion can produce similar outcomes to that of thermal biofeedback in children and could be applied to a number of issues.

One area that hypnosis has thrived in when it comes to research and developments in recent times is that of dealing with pain. I have written about a number of impressive studies and applications of using hypnosis with adults for overcoming pain and dealing with pain following surgery and being used as anaesthesia and so on. Though there are more recent reviews, there is a great one from as far back as 1996 (see Holroyd) which is impressive.

The application of hypnosis being used with children in this way has only really got a single study to support it’s use. I am guessing there are a number of ethical implications in the research design that would permit certain types of trials to be done in laboratory settings. However, Zeltzer, Fanurik, and LeBaron (1989) explored the effectiveness of hypnosis with children for pain relief using a group of participants whose ages ranged from 6 to 12 years. Following a baseline pain threshold test involving ice water submersion of the arm, the participants were assigned to the hypnosis group or the control group.

The hypnosis group experienced imagination-focused hypnosis whereby an experimenter engaged the participants in fantasy imagery following some brief coaching.  The control group participants simply had a very similar experience of measuring the repeated submersion to the ice water as conducted in the baseline testing. The results showed that the children in the hypnosis group experienced significantly more pain reduction than those in the control group. It would suggest that there is real value in the use of imagination based hypnosis in reducing pain.

It seems natural to move from the topic of pain relief to the topic of using hypnosis to help with medical procedures and dealing with the effects of chemotherapy… It is even more natural because more than half of the existing literature (involving control groups) of hypnosis with children explores these areas.

Although there not many credible studies looking specifically at pain thresholds, there are a number that look at the pain and discomfort caused by invasive medical procedures. Procedures such as bone marrow aspirations and lumbar punctures (whereby syringes and large needles are placed directly into bones) are such invasive medical procedures. It is documented that children tend to describe these types of procedures as incredibly painful (Jay, Ozolins, Elliott, & Caldwell, 1983).

Katz, Kellerman, and Ellenberg (1987) examined the effects of hypnosis on the distress caused by bone marrow aspirations (BMA). The children in the study were boys and girls, whose  ages ranged from 6 to 11 who were all leukemic.

Once a baseline of the pain and fear was taken during a BMA procedure prior to the experiment, the children were placed in one of two groups. The children assigned to the hypnosis group were trained in hypnosis and self-hypnosis. The children in this group also had a hypnotic induction and were given a range of suggestions that incorporated the child’s particular interests along with suggestions for relaxation, distraction and positive affect as well as the more obvious pain reduction. They also received posthypnotic suggestions to help with subsequent self-hypnosis during the subsequent BMA.

Those that were in the control group participated in nondirective play sessions and spent the same length of time with the medical staff’s attention as the hypnosis group spent with their own training and hypnosis.

Despite the results showing that self-reported pain significantly was reduced greatly in both groups, there was no difference between the hypnosis group and the control group when it came to pain or fear reduction. As such, some have interpreted the results in a way that suggests other factors were responsible for the results, such as the ongoing support and attention they received throughout. I found this slightly discouraging until I started looking at the following three studies which had similar encouraging results…

Firstly, Kuttner, Bowman, and Teasdale (1988) ran a comparison of hypnosis against distraction and a control group during BMAs.

The children in the hypnosis group had a range of techniques used which included imaginative fantasy as well as a process I use and teach a great deal whereby direct suggestions are delivered for analgesia incorporating the use of a “pain-switch” whereby the children were shown how to shut off pain messages sent by the brain to parts of the body.

The control group had the standard medical care that is given for BMAs whereby the medical staff supplied relevant information as well as giving relevant support and appropriate reassurance.

The results showed that the older children in the hypnosis and distraction groups achieved far greater reductions in pain and anxiety compared with the control group. Also, with the younger children who were in the hypnosis group, they achieved much greater reductions in distress than those in both of the other groups.

Secondly, Zeltzer and LeBaron (1982) ran a comparison of the effectiveness of imagination-focused hypnosis against distraction for relieving the distress caused by BMAs and lumbar punctures (LPs). I am still shuddering at the thought of either…

In the hypnosis group, the child participants were aided in becoming really engaged in imagined activities that they really enjoyed, were unusual, or matched their own personal interests. In the distraction group, the children were taught how to use breathing exercises to divert their attention from outside activities.

Hypnosis was shown to be significantly more effective than distraction in reducing pain and anxiety encountered during BMAs. What’s more, only those in the hypnosis group significantly reduced both pain and anxiety during LPs.

Thirdly, J. T. Smith, Barabasz, and Barabasz (1996) ran a comparison of hypnosis against distraction for reducing pain and anxiety resulting from a range of painful invasive procedures.

In the hypnosis group, the children were helped by their trained parents to develop an imagined fantasy whereby they took a journey together to the child’s favourite place. With the other group, the parents were taught how to distract the child by playing with a pop-up toy.

The children tested to be highly suggestible in the hypnosis group reported significantly less pain and anxiety following intervention than those deemed highly suggestible in the distraction group. The less suggestible children in the hypnosis group reported much less pain and anxiety than the low suggestibles in both the other groups.

The results from these studies suggest that hypnosis has the potential to be an especially effective intervention some children that are going to require painful medical procedures. It also adds to the depth of research on using hypnosis in treating acute pain, and when looking further into the studies, they also suggest that when a therapist is present conducting the hypnosis and interacting with the child, the results are more impressive.

The third and final part of this series of articles will be here tomorrow with a few conclusions to be drawn from it all.

Andreychuk, T., Skriver, C. (1975). Hypnosis and biofeedback in the treatment of migraine headache. International Journal of Clinical and Experimental Hypnosis, 3,172-183.

Barabasz, A. P., & Wright, G. W. (1975). Treatment of collagen vascular disease by hypnotic imagery. Hypnosis Quarterly, 19,15-18.

Dikel, W., & Olness, K. (1980). Self-hypnosis, biofeedback, and voluntary peripheral temperature control in children. Pediatrics, 66, 335-340. 

Jay, S. M., Ozolins, M., Elliott, C. H„ & Caldwell, S. (1983). Assessment of children’s distress during painful medical procedures. Health Psychology, 2,133-147.

Katz, E. R., Kellerman, J., & Ellenberg, L. (1987). Hypnosis in the reduction of acute pain and distress in children with cancer. Journal of Pediatric Psychology, 12, 379-394.

Kuttner, L., Bowman, M., & Teasdale, M. (1988). Psychological treatment of distress, pain, and anxiety for young children with cancer. Journal of Developmental and Behavioral Pediatrics, 9, 374-381.

Lehrer, P. M., Carr, R, Sargunaraj, D., & Woolfolk, R. L. (1994). Stress management techniques: Are they all equivalent, or do they have specific effects? Biofeedback and Self-regulation, 19,353-401.

Smith, J. T., Barabasz, A., & Barabasz, M. (1996). Comparison of hypnosis and distraction in severely ill children undergoing painful medical procedures. Journal of Counseling Psychology, 43,187-195.

Zeltzer, L. K., Fanurik, D., & LeBaron, S. (1989). The cold pressor paradigm in children: Feasibility of an intervention model: II. Pain, 37,305-313.

Zeltzer, L. K., & LeBaron, S. M. (1982). Hypnosis and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer. Journal of Pediatrics, 101,1032-1035.