Following on from from bout of squiffyness on Monday on this blog, here is the first part of my literature review on the evidence for using hypnosis with children. Before I start to introduce processes, strategies and ideas for hypnotherapists wishing to work with children or parents to use certain skills with their children, I think it always makes sense to have a look at the evidence base for it all. In the past I have found that examining the evidence base for a subject also helps you structure how you approach the subject thereafter.
I honestly think that if I authored a book entitled like “Hypnotise Your Children” I might get lynched. The topic of hypnosis is beset with myth and misconception enough as it is and I suspect that for many, suggesting it be used with children may even seem immoral in some way. (when my book ‘Hypnosis For Running’ was launched, someone suggested that using self-hypnosis to help advance running performance was cheating!) Yet, essentially the majority of the literature I have been reviewing draws parallels between hypnosis and things children do anyway already by using their imagination and structuring their thoughts in particular ways. So I think that with careful education, everyone will be able to see the benefits and safe application of using hypnosis in this way.
Believe it or not, as I write this with my recent motivated interest in the use of hypnosis for children, I have an admission to make; I am not the first person to start exploring this field or showing an avid interest in the subject. Since the 1960s, the body of research and literature has developed and grown quite impressively.
For example, some of my recommended and favoured clinical hypnosis text books now have dedicated sections for applications of hypnosis with children (e.g., Heap & Aravind, 2002; Rhue, Lynn, & Kirsch, 1993; Hammond (ed.) 1990). There are also now numerous books devoted exclusively to the topic of hypnosis for children (e.g., Kohen & Olness, 2011; Hilgard & LeBaron, 1984; Wester & Sugarman, 2007).
Aditionally, I read a great deal of anecdotal evidence and case studies and reports from fellow professionals in this field, as well as teachers and trainers who report success in a wide variety of ways when using hypnosis with children. My very first teacher once told me how he drew parallels with the way children engage their imaginations during play to the extent that they truly believed they were there, in that place, and that utilising that amazing, seemingly inherent ability with hypnotic principles made a lot of sense.
As it happens, the literature does suggest that children are actually more suggestible with hypnosis than adults. A number of studies have shown suggestibility to increase steadily from as early as the age of 3! Which initially sounds crazy, but when you think of what else a child has the capacity to learn and pick up at that age, makes a lot of sense.
Studies then state that suggestibility goes on to peak between 8 and 12 years of age and despite declining up to 16 years of age it then remains fairly similar thereafter. (London, 1965; Morgan & Hilgard, 1978/1979).
Such has been the interest in the effects of hypnosis with children, that two main standardised measures of hypnotic responsiveness were created in the 1960s and 1970s. Those in the hypnotherapy field professionally, will recognize the names I am sure; the Children’s Hypnotic Susceptibility Scale (CHSS; London, 1963) and the Stanford Hypnotic Clinical Scale for Children (SHCS:C; Morgan & Hilgard, 1978 /1979). Keeping on the theme of suggestibility, when these measures of hypnotic suggestibility are used with children, they are more likely to score higher than adults (London, 1962).
In light of this, one might start to think that surely hypnosis used clinically or therapeutically would have great benefits for children and would be a potent force for good with children. That is what any review then needs to be led to explore.
Even though there has been a developing level of interest in this area in the past 4 decades, there is still a need for more controlled studies of it’s effectiveness if it is to gather the credibility of other applications for treating children. There are a lot of studies out there, but I am not going to be able to fully exhaust everything ever done. I am more inclined to write about the ones that actually included comparison against a non-hypnotic intervention or placebo to be deemed a controlled trial. The numbers of studies do tend to dwindle at that point when you search through them on PubMed, PlosOne or within the journal archives.
Having been reluctant to work with children in my own professional career prior to gaining any specialist training or qualification, I have worked with children who have continued to wet the bed despite getting to an age where it is generally considered that they no longer do so. So my first stop was to look at and observe the evidence for treating enuresis using hypnosis.
Edwards and van der Spuy (1985) examined the effectiveness of hypnosis by treating a range of enuretic boys whose ages ranged between 8 and 13. Having measured the number of wet nights the boys were experiencing prior to the treatment, they then had sessions comprising of a standardised hypnotic induction with subsequent suggestions for dry nights delivered (the text is included within the study notes). Children in one group, were given same suggestions without entering hypnosis. Another group were given a hypnotic induction but were not given suggestions for dry nights and the final group, the control group, had no induction or suggestions and were offered treatment following the end of the study.
The results of the study showed that by the end of the experiment, the number of wet nights each week for the first two groups groups had decreased significantly in relation to the other groups. This study showed that children were given suggestions for dry nights, be in in or out of hypnosis, the dry nights increased.
Banerjee, Srivastav, and Palan (1993) studied a number of children experiencing nocturnal enuresis, whose ages ranged from 5 to 16. The children were treated with imipramine, which is a commonly used drug for treating this condition, or they were treated with hypnosis.
Those that were treated with hypnosis were also given lessons on anatomy physiology of the bladder. After those lessons, the children listened to a hypnosis induction followed by suggestions for “appropriate use of the toilet during the night.” Additionally, the children treated with hypnosis were also shown how to use self-hypnosis before going to sleep at night.
With the parental interviewing to assess and contrast the progress being made, there was little difference between the two after 3 months of treatment. However when followed up 6 months after the treatments had stopped, there was a significant difference between the two treatments; many of the children in the drug therapy group had relapsed without the medication.
Other authors suggest that the results of this study are similar to other studies of the drug imipramine; at the beginning, it results in a good response but has a high relapse rate when the child stops taking it (Blackwell & Currah, 1973).
These two studies suggest that hypnosis may well be an effective treatment for night time bed-wetting among children and can be considered preferable to the most commonly used medication for this problem. It would be useful to see a study whereby hypnosis is compared against other treatments that claim to have success with overcoming enuresis and those that are interested in a previous review of treatments for enuresis, see Walker, Kenning, & Faust, (1989).
Due to my own therapeutic work and knowledge of how much good work can be done with clients experiencing a variety of anxiety disorders, I hunted high and low for studies that used hypnosis to treat anxiety among children.
In comparison to all the other studies and literature, there is a great deal of focus and numerous studies on treating test anxiety in children. Stanton (1994) examined the use of self-hypnosis as an effective treatment for overcoming test anxiety. A number of boys and girls, with ages ranging from 12 to 15 had ranked in the top 30% on a questionnaire measure of test anxiety. The children were assigned either learn to use self-hypnosis or given education in the control group. The same amount of time was spent learning self-hypnosis or being given the educational sessions.
Compared with the control group, the self-hypnosis group achieved significantly greater reductions on the questionnaire measure of test anxiety both immediately after the treatment and when followed up 6 months later.
I am biased with regards to this as self-hypnosis is a favoured topic of mine, but I have had many anecdotes given to me by colleagues who have worked successfully with children using hetero and self-hypnosis and it is good to see some evidence supporting that.
Cognitive and behavioural approaches dominate the literature when it comes to test anxiety and it would be good to see some studies comparing the two or even using self-hypnosis and/or hetero hypnosis as an adjunct to the treatment as is done in other studies.
This study leads on nicely to the next one here…
When examining the functioning of the immune system, studies have shown that stress can lead to weakening of the immune system (Jemmott et al., 1983; Jemmott & Magloire, 1988). Therefore, it makes logical sense to believe that a reduction of stress should positively effect immune functioning.
A number of studies have found that hypnosis can affect immune functioning in adults (e.g., Barber, 1978) and that led other researchers to build upon that and examine whether hypnosis could effect and advance the immune systems of children.
In 1980, Olness, Culbert, and Uden studied a number of healthy youngsters, whose ages ranged between 6 and 12 years. Each of the children were put into one of three groups. The first was a self-hypnosis group who listened to a tape recording giving them instructions for relaxation and pleasant imagery. The second group listened to a tape recording that had self-hypnosis instructions and contained suggestions to increase the number of immune proteins in the saliva. The third group was the control group, who were engaged in conversation for the same amount of time that the treatment groups listened to the tape recordings.
The first two groups (one that had the relaxation and the group with the suggestions) showed a significant increase in IgA, which is an antibody that protects the upper respiratory tract from infection and plays a role in fighting dental cavities. Though there are varying interpretations of the results, the findings suggest that hypnosis may potentially enhance effective functioning of children’s immune systems.
Ok, that should be enough to get your juices flowing – I’ll be back with the next part of this review tomorrow.
Banerjee, S., Srivastav, A., & Palan, B. M. (1993). Hypnosis and self-hypnosis in the management of nocturnal enuresis: A comparative study with Imipramine therapy. American Journal of Clinical Hypnosis, 36,113-119.
Barber, T. X. (1978). Hypnosis, suggestions, and psychosomatic phenomena: A new look from the standpoint of recent experimental studies. American Journal of Clinical Hypnosis. 23,13-27.
Blackwell, B., & Currah, J. (1973). The psychopharmacology of nocturnal enuresis. In I. Kolvin, R. C. MacKeith, & S. R. Meadow (Eds.), Bladder control and enuresis. Philadelphia: Lippincott.
Edwards, S. D., & van der Spuy, H. I. (1985). Hypnotherapy as a treatment for enuresis. Journal of Child Clinical Psychology, Psychiatry and Allied Health Disciplines, 26,161-170.
Hammond, C. (2000) Handbook of Hypnotic Suggestions and Metaphors. Norton & Company. London & New York.
Heap, M, & Aravind, K. K (2002) Hartlands Medical and Dental Hypnosis (4th Ed). Churchill Livingstone.
Hilgard, J. R., & LeBaron, S. (1984). Hypnotherapy of pain in children and adolescents with cancer. Los Altos, CA: William Kaufmann.
Jemmott, J. B., Ill, Borysenko, J. Z., Borysenko, M., McClelland, D. C, Chapman, R., Meyer, D., & Benson, H. (1983). Academic stress, power motivation, and decrease in secretion rate of salivary secretory immunoglobulin A. Lancet, 1(8339), 1400-1402.
Jemmott, J. B., Ill, & Magloire, K. (1988). Academic stress, social support, and secretory immunoglobulin A. Journal of Personality and Social Psychology, 55,803-810.
Kohen, D. P., and Olness, K. (2011) Hypnosis and Hypnotherapy With Children (4th Ed) Routledge London.
London, P. (1962). Hypnosis in children: An experimental approach. International Journal of Clinical and Experimental Hypnosis, 10, 79-91.
London, P. (1963). Children’s Hypnotic Susceptibility Scale. Palo Alto, CA: Consulting Psychologists Press.
London, P. (1965). Developmental experiments in hypnosis. Journal of Projective Techniques and Personality Assessment, 29,189-199.
Morgan, A. H., & Hilgard, J. R. (1978/1979). The Stanford Hypnotic Clinical Scale for Children. American Journal of Clinical Hypnosis, 21,148-169.
Olness, K., Culbert, T., & Uden, D. (1989). Self-regulation of salivary immunoglobulin Aby children. Pediatrics, 83,66-71.
Rhue, J. W., Lynn, S. J., & Kirsch, I. (1993). Handbook of clinical hypnosis. Washington, D.C.: American Psychological Association.
Stanton, H. E. (1994). Self-hypnosis: One path to reduced test anxiety. Contemporary Hypnosis, 11,14-18.
Wester, W. C., and Sugarman, L. I, (2007) Therapeutic Hypnosis With Children and Adolescents. Crown House Publishing Ltd.