SYMPOSIA
SYMPOSIA
SYMPOSIA
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Abstracts of the Invited Speakers<br />
demonstrated an association between childhood trauma and the development of somatic disease in adult life. An unanswered question<br />
is: what are the psychological/biological mechanisms that might render trauma in earlier years a risk factor for the development of disease<br />
later in life? The associations between alexithymia, somatization, dissociation and trauma, have led to the suggestion that dissociation<br />
acts as a defense against emotionally distressing memories that are associated with the traumatic avents. Attachment insecurity and<br />
associated deficits in affect development and affect regulation are linked not only to the experience of being raised by parents with<br />
impaired capacities for mentalization, but sometimes also to more severe developmental traumas. Dissociation within emotion schemas<br />
is initially an adaptive response to external danger arousal and is especially severe when the child experiences the parent as a threat, for<br />
then there is no safe place to be.<br />
Key words: Alexithymia, cognitive processing of emotions, trauma, attachment, mentalizing, somatization<br />
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S55-6<br />
Hypnotherapy for painful syndromes in psychiatry<br />
Kerem M. Doksat<br />
MD, Professor of Psychiatry, POLIMED Psychiatric Center<br />
E-mail: doksat@tnn.net, doksatster@gmail.com, doksat@superonline.com<br />
Hypnosis is a misnomer first used by Scottish Surgeon James Braid for a phenomenon probably as ancient as mammalian history. After the<br />
Austrian Neuropsychiatrist Sigmund Freud has fouled hypnosis in order to glorify his own theory, especially American Psychiatrist Milton<br />
Hyland Erickson rebuilt the reputation of hypnosis (1).<br />
In 1846, James Esdaile successfully performed 345 major operations by using mesmeric method in India. English surgeon John Ellitson<br />
mentioned similar success in many operations in 1843. With the introduction of ether in 1846 and chloroform in 1847, the mesmeric<br />
method, which has already serious oppositions, was forgotten. Hypnosis may be used alone or in combination with other methods. Its<br />
use in cancer pain, especially during the terminal phase, may reduce the requirement for opioids, or even totally eliminate them. Hypnosis<br />
may help the patients to experience with their consciousness fully open and free from side-effects like grogginess of the opioids during<br />
last phase before their terminal coma. It can be used in burns and for pain free labor. In dentistry it can be used for analgesia, dentists’<br />
chair phobia, and getting rid of gag reflex. It is effective in 30 to 50 percent of phantom limb pain cases.<br />
Hypnosis is reported to be effective for the treatment of migraine and other headaches and in many other pain syndromes; I also have a lot<br />
of anecdotal evidence. The approach should be adjusted for the patient; the skill and experience of the hypnotist, his or her relationship<br />
with the patient and the patient’s personal characteristics and preferences must be adjusted according to all of these. Indeed, hypnotic<br />
procedures may help people who are not much hypnotizable. For example, in cases experiencing both pain and tension intensively, even<br />
induction of relaxation reduces pain and in many of the hypnotic procedures, relaxation is utilized. If the patients cooperate well and<br />
accepts the procedure seriously, even if they are not hypnotizable, they may practice the hypnotist’s relaxation suggestions with success<br />
while sitting or lying comfortably (2).<br />
The principal techniques are (2,3): 1) Direct suggestion, 2) Utterance of neurophysiological metaphors, 3) Glove anesthesia replacement<br />
technique, 4) Replacement pain symptom’s site or differentiating the pain symptom, 5) Dissociation by using the imagination, 6)<br />
Technique of different interpretation of pain, 7) Auto-hypnosis (self-hypnosis).<br />
As a summary, the effect of hypnosis on pain is mediated by two mechanisms:<br />
1) Muscle relaxation,<br />
2) Change in perception and cognitive distraction.<br />
Hypnotherapy can be effective in many painful syndromes if suitable patients are chosen. Group psychotherapy and hypnosis can be<br />
effective in the treatment of cancer patients’ pain (4).<br />
References:<br />
1. Doksat R. Tatbikatı ve Nazariyatı ile Hipnotizma. İstanbul: Kader Basımevi, 1962. 253-281.<br />
2. Doksat MK. Ağrı ve Psikiyatri. Bursa: Psikiyatri ve Sanat Yayın Evi, 2003. 165-172.<br />
3. Arred Barabasz, Johnn G Watkins Hypnotherapeutic Techniques 2E. New York: Brunner-Routledge. 2005. 219-239.<br />
4. Porter LS, Keefe FJ. Psychosocial issues in cancer pain. Curr Pain Headache Rep. 2011 Aug;15(4):263-70.<br />
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S56<br />
S56 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org