Publisher: American Academy of Pediatrics (AAP News http://www.aappublications.org/)
Hypnotherapy offers another tool pediatricians can add to their arsenal to treat conditions ranging from nail biting to severe asthma.
A 12-year-old girl with severe asthma had been hospitalized more than 20 times, including six times in the intensive care unit.
Despite daily steroid medication, she still experienced shortness of breath and sometimes required rescue medication up to five times a day. Within two months after visiting Ran D. Anbar, M.D., FAAP, she was able to wean herself off the rescue medication and eventually stopped needing the steroid as well. Currently, she uses moderate amounts of medicine but no longer experiences the crippling effects of severe asthma.
This life-altering change occurred thanks to the use of pediatric hypnotherapy, according to Dr. Anbar.
Some symptoms can be a result of stress, especially if the symptoms cannot be medically explained, said Dr. Anbar, who has conducted many studies on hypnotherapy. The asthma patient's symptoms after Dr. Anbar taught her how to use hypnotherapy to calm herself.
"Hypnotherapy can be incredibly powerful especially with symptom management," said Timothy P. Culbert, M.D., FAAP, medical director, integrative Medicine and Cultural Care, Children's Hospitals and Clinics of Minnesota and member of the AAP Provisional Section on Complementary, Holistic and Integrative Medicine.
Hypnotherapy, or therapeutic hypnosis, is defined as "an altered state of consciousness, usually involving relaxation, in which a person develops heightened concentration on a particular idea or image for the purpose of maximizing potential in one or more areas" (Olness K, Gardner GG. Pediatrics. 1978; 62:228-233).
The paper, titled "Some Guidelines for Uses of Hypnotherapy in Pediatrics," also states that "hypnotherapy is one means by which we encourage children to use imaginative skills for their personal benefit."
According to the paper, hypnotherapy can be used to treat:
However, hypnotherapy should be used only after a thorough medication in case there is an underlying condition that should be treated medically, cautions Karen N. Olness, M.D., FAAP, coauthor of the paper.
Robert E. Sapien, M.D., FAAP, points out that there is a difference between hypnosis and hypnotherapy. Hypnotherapy is used as a longer-term treatment with therapeutic goals for healing a condition, whereas hypnosis is the tool used to transition into an altered state of consciousness.
As an attending physician in an emergency department, Dr. Sapien most often uses hypnosis on patients who are experiencing anxiety about a procedure, although he has used hypnotherapy as well.
Dr. Sapien once had a 10-year-old patient with a large laceration behind his knee. He had been given the maximum amount of lidocaine allowed for his weight, yet he still was screaming in pain. After receiving parental permission and finding out that the patient enjoyed miniature golf, Dr. Sapien used hypnosis to relax the boy by having his imagine himself playing a game of miniature golf. When the boy came out of the hypnotized state, he was able to state what his golf score had been.
Most children are susceptible to hypnosis because they naturally move in and out of altered states of awareness all the time, which Dr. Culbert says is developmentally normal. "Using fantasy is common and familiar to them," he said.
"There are a lot of myths about hypnosis, including that a person can get stuck in hypnosis, but that is impossible," said Dr. Sapien, a member of the AAP Committee on Pediatric Emergency Medicine. "Hypnosis is a natural state of mind in which the mind stimulates the parasympathetic and overrides the sympathetic nervous systems, putting a person at complete relaxation."
Because of the stigma attached to hypnosis, Dr. Sapien prefers to refer to it as "medical relaxation" when talking to parents and patients.
"People always remember everything from their hypnotic trance, and most importantly, I as a hypnotherapist can't make anybody do what they don't want to do," he said. "The patient is using (his or her) mind to control (his or her) own body."
In fact, patients with ongoing conditions can be taught self-hypnosis to manage symptoms by focusing on their likes and interests, according to Dr. Olness.
"It is a change in mental state during which it is easier to give yourself suggestions in your best interest and it gives children a sense of being in control," she said. Dr. Olness says that self-hypnosis is similar to becoming absorbed in something like listening to music or reading.
Dr. Olness has experienced the benefits of hypnotherapy firsthand. Before she became familiar with hypnotherapy, another physician offered to teach her self-hypnosis to cure a long-term conditional painful response to stress. She was doubtful, but after performing self-hypnosis every day for two months, the pain disappeared and has never come back.
"I think that, in general, the use of hypnotherapy is spreading, but there is still a lot of skepticism about using hypnotherapy with clinical applications," said Dr. Olness. "A lot of physicians still raise their eyebrows, but there is documentation that shows it is not just hocus-pocus."
Numerous studies are listed on the Web page of the AAP Provisional Section on Complementary, Holistic and Integrative Medicine that investigate the application of hypnotherapy with cystic fibrosis, vocal cord dysfunction, negative school behavior, reduction of post-operative pain and migraine headaches, among others.
Pediatricians naturally use guided imagery and distractions when working with children. Hypnotherapy is an added skill that makes that even better, according to Dr. Sapien. However, Dr. Olness advises physicians to stick to their area of expertise when teaching patients hypnosis.