Hypno-psychotherapy techniques can be extremely useful not only in the context of psychological treatment but also for medical, surgical and dental treatment. The WritePass Journal

Hypno-psychotherapy techniques can be extremely useful not only in the context of psychological treatment but also for medical, surgical and dental treatment. 1-Introduction Hypno-psychotherapy techniques can be extremely useful not only in the context of psychological treatment but also for medical, surgical and dental treatment. 1-Introduction2-The history of hypnosis2.1 Franz Anton Mesmer (1734-1815):2.2 Marquis de Puysegur (1751-1825):2.3 Abbe de Faria (1756-1819:3-The history of hypnosis used in surgery3.1 John Elliotson (1791-1868):   3.2 James Esdaile (1808-1859):   3.3 James Braid (1795-1860):   4-The decline of hypnosis in surgery4.1 Sigmund Freud (1856-1939):4.2 Behaviourism:   4.3 Cognitive Therapy:   4.4 Cognitive-Behavioural Therapy:5-Leading names in hypno-psycotherapy   5.1 Alfred Adler (1870-1937):   5.2 Carl Gustav Jung (1875-1961):   5.3 Milton Erickson (1901-1980):   5.4 Friedrich (Frederick) Salomon Perls (1893-1970):5.5 Carl Rogers (1902–1987):6-Techniques used in practice6.1 Hypnosis:   6.2 Suggestion:   6.3 Paradoxical injunction:6.4 Distraction:6.5 Time distortion:6.6 Hypnotic suggestion for pain releif:6.7 Displacement:6.8 Dissociation:6.9 Systematic desensitisation:   7-The application of hypno-psychotherapy in medicine and dentistry7.1 Treatment in surg ery:7.2 Treatment for cancer patients:   7.3 Treatment in obstetrics and gynaecology:   7.4 Treatment in dentistry:   8-Conclusion8.1 Modern day acceptability:   8.2 Advantages and disadvantages:   8.3 Future possibilities:   Reference:Related 1-Introduction Hypno-psychotherapy techniques can be extremely useful not only in the context of psychological treatment but also for medical, surgical and dental treatment.   Techniques can be used to control acute and chronic pain which can help patients during for example, childbirth, minor and major operations, dental treatments, or simply to help with pain associated in minor ailments such as back pain, headaches and irritable bowel syndrome. Not only can techniques be useful in medicine and dentistry for pain relief   as described above but can also be used to deal with the anxiety connected with varying procedures and help with the patients state of mind which in turn can speed healing.   This can be of great advantage before, during and after any surgery or treatment. In this dissertation I would like to discuss in more depth the use of hypno-psychotherapy techniques specifically in medicine and dentistry firstly looking at the history of hypnosis, leading names in the integration of psychotherapeutic techniques over the years looking at their theories, describe the varying techniques which can be useful in medicine and dentistry and look at how these can be applied in practice as a qualified hypno-psychotherapist.  Ã‚   In conclusion there will be a discussion of any advantages, disadvantages and limitations of the use of these techniques and a brief look into future possibilities.    2-The history of hypnosis    The origins of hypnosis can extend back to ancient Greece where there were temples devoted to Aesculapius, the Greek god of healing.   In these temples which were built in pleasant surroundings usually near water, there would be music prayer and incantations.   Sleeping patients believed the Gods were visiting them.   However, the true precursor of hypnosis begins with the practice of mesmerism.    2.1 Franz Anton Mesmer (1734-1815): A German physician and astrologist, who invented what he called animal magnetism and other spiritual forces often grouped together as mesmerism. He was the first person to devise a system which could induce a trance.   The evolution of Mesmers ideas and practices led Scottish surgeon James Braid, later discussed in section 3.3, to develop hypnosis in 1842.   Mesmer hypothesized that the force of animal magnetism had to do with the movement of the sun, planets and stars.   He would use magnets in an attempt to heal his patients. 2.2 Marquis de Puysegur (1751-1825): A former student of Mesmer, described his patients in a state of artificial somnambulism which differed from the mesmeric trance.   He was the first practitioner to identify the importance of psychological factors in illness and healing which lead to recognition of these factors in mesmerism and hypnosis.   His more patient centred approach was later used by Freud, discussed in section 4.1 in the psychoanalytic technique of free-association and indeed in many techniques used today. 2.3 Abbe de Faria (1756-1819: Unlike Mesmer who claimed hypnosis was mediated by animal magnetism, Faria believed it worked purely by the power of suggestion.   Also unlike Puysegur’s somnambulism, Faria believed this state was lucid sleep.   He was the first to document individual differences, the first to state that the process would only happen if the subject was susceptible and not solely down to the powers of the mesmerist and also the first to use the verbal suggestion of sleep for his induction instead of using objects such as magnets etc. 3-The history of hypnosis used in surgery    Up until the 1940’s when hypnosis was still known as mesmerism, medical and dental surgeries were performed without anaesthetic because it was not available at this time.   John Elliotson, a professor of practical medicine, and James Esdaile, a medical officer reported a large number of surgeries performed painlessly, with the mesmeric trance as the only form of pain relief used. 3.1 John Elliotson (1791-1868):   Senior Physician at University College Hospital in London and Professor of the practice of Medicine at the University of London, Elliotson was a student of phrenology and mesmerism.   He hoped that his development of mesmerism would lead to new therapeutic applications in medicine and advocated its use in surgery.   When the New Orleans Medical and Surgical Journal asserted that, compared to ether, mesmerism could perform a thousand times greater wonders and without any of the dangers [2] British Medical Surgical Journal, (1846).   Elliotson agreed, however lost his chair because of his advocation of mesmerism in surgery. 3.2 James Esdaile (1808-1859):   Best known as a Scottish surgeon and pioneer in the use of hypnosis for surgical anaesthesia, Esdaile used mesmerism with patients at a British medical facility in India.   He performed over three hundred surgeries using hypnotic techniques including radical operations such as tumour removal and amputations. At that time the mortality rate for major operations by fellow surgeons was 50%.   In 1961 Esdaile’s mortality rate averaged 5%. 3.3 James Braid (1795-1860):   A Scottish physician and surgeon, specialising in eye and muscular conditions, Braid was an important and influential pioneer of hypnotism and hypnotherapy.   The three main contributions Braid made were the introduction of the term â€Å"Neurypnology† or nervous sleep, secondly his induction technique now known as â€Å"Braidism† or the Braid technique where the subject fixes their gaze on a point above eye level until the eyes close and the subject enters hypnosis, and thirdly his theories suggesting hypnosis was caused by visual fatigue.   It is from Braids influential work that others derived the term hypnosis in the 1880s although he himself did not use this term.   Similar to how techniques are used today, Braid believed that patients should be considered on an individual basis and hypnotic suggestion should be used in conjunction with other medical and chemical techniques and not as a sole cure. â€Å"Although Braid believed that hypnotic suggestion was a valuable remedy in functional nervous disorders, he did not regard it as a rival to other forms of treatment, nor wish in any way to separate its practice from that of medicine in general. He held that whoever talked of a universal remedy was either a fool or a knave: similar diseases often arose from opposite pathological conditions, and the treatment ought to be varied accordingly. He objected being called a hypnotist; he was, he said, no more a hypnotic than a castor-oil doctor.†Ã‚  Ã‚   [3] John Bramwell, 1910. 4-The decline of hypnosis in surgery    Despite both Dr. Elliotson and Dr. Esdailes successes they were condemned by their fellow doctors.  Ã‚   Also the introduction of chloroform and esther brought about the decline in interest of using mesmerism as anaesthia. These, among other chemical procedures, could be used by every surgeon, on everyone patient, were less time-consuming and required little-to-no knowledge of human psychology and therefore chemical anaesthetics became regularly used in dentistry, surgery and obstetrics.   Another reason for the decline of hypnosis was the rise of behaviourism.   Before looking at these schools of thought it is important to mention that hypnotherapy is still a very useful tool if required for simple relaxation therapy, however, in order to be of use for the more complex psychological and physical conditions presented in both Medical and Dental procedures, psychotherapeutic techniques must also be applied.   It is by the integration of these varying schools of thought which wi ll be discussed, and adaption of their techniques that hypno-psychotherapy can be very useful in medicine and dentistry today. 4.1 Sigmund Freud (1856-1939): Freud, a neurologist and psychiatrist wrote of his rejection of hypnosis in Studies of Hysteria written with Joseph Breuer in 1895.   Although Freudian theory has been criticised by many has regardless been studied and continuously developed for more than forty years.   Freud is best known for his theories on the structure of the mind, levels of consciousness, instinct theory, psychosexual stages and the defence mechanisms of repression and tranference.   He also developed the clinical practice of psychoanalysis for treating patients through dialogue, known as free-association and the use of interpretation of dreams and fantasies as sources of insight into the unconscious.  Ã‚   Freud also used regression hypnotherapy which was sometimes known as hypnoanalysis, analytic hypnotherapy, or psychodynamic hypnotherapy. Freud was the founder of the modern day psychotherapeutic interview and not only this but many other aspects of Freudian theories and techniques are integrated and applied to patients in practices today. 4.2 Behaviourism:   The behaviorist school of thought maintains that behaviors can be described scientifically without taking into account internal physiological events or looking at theories of hypothetical constructs such as the mind and it is thought that all behaviour is learned. â€Å"Give me a dozen healthy infants, well formed, and my own specified world to bring them up in and I’ll guarantee to take any one at random and train him to become any type of specialist I might select – doctor, lawyer, artist, merchant-cheif, and, yes, even beggar-man and theif, regardless of his talents, penchants, tendencies, abilities, vocations and race of his ancestors.†[4] J B Watson, 1931.   Ã‚  Ã‚   Behavioural techniques remain implemented by psychotherapists today.   These techniques are based on the phenomena of classic conditioning, operant conditioning and observational learning.   It is believed that behaviour can be improved by the use of certain techniques, such as altering an individuals behaviours and reactions to stimuli through positive and negative reinforcement of adaptive behaviour and/or the reduction of maladaptive behaviour through its extinction, punishment and/or therapy. Systematic desensitisation is a technique based on classic conditioning which can be of great use to medical and dental procedures to deal with anxiety which will be discussed in greater detail in section 4.3 Cognitive Therapy:   One of the major pioneers of CT was American psychiatrist Aaron T. Beck.   The pure cognitive therapies focus on changing certain thought patterns. The theory is that the way we perceive situations influences how we feel emotionally, and so by changing thoughts, then behaviours will also change.   The basic procedures in CT are educating patients with information about the nature of certain feelings, e.g. panic and anxiety, identifying salient thoughts, challenging the thoughts and beliefs, identifying distortions, cognitive restructuring and testing reality. Albert Ellis was the other major pioneer of cognitive therapy who developed Rational Emotive Behavioral Therapy (REBT), a therapeutic approach that stimulates emotional growth and teaches people to replace self-defeating thoughts and actions with more effective ones. REBT gives individuals the power to change the unhealthy behaviors that interfere with their ability to enjoy life. 4.4 Cognitive-Behavioural Therapy: Cognitive behavioural therapy (CBT) aims to help manage problems by changing how the individuals think and act.   CBT encourages talking about how clients think about their selves, the world and other people and focuses on how actions can affect thoughts and feelings.   By talking, CBT can help change thoughts (‘cognitive’) and actions (‘behaviour’). Unlike other talking treatments, such as Freud’s free association, CBT focuses on the problems and difficulties in the here and now, rather than issues from the past. It looks for practical ways to improve the state of mind on a daily basis. 5-Leading names in hypno-psycotherapy      Traditional hypnotherapy has since integrated many more psychotherapeutic approaches such as Freud’s from many other varying schools of thought.   Examples of these influences are Adler and Jung’s theories, Erickson hypnotherapy, Fritz Perls Gestalt therapy and Carl Rogers Humanistic approach.   These historical influences combined with techniques used in cognitive and behavioural therapy resulted in the integrative approach, termed hypno-psychotherapy.   These techniques are often applied in order to modify a subjects behavior, emotional content, and attitudes, as well as a wide range of conditions including dysfunctional habits, anxiety, stress-related illness, pain management, and personal development. 5.1 Alfred Adler (1870-1937):   An Austrian medical doctor and psychologist, was the founder of the school of Individual Psychology.   In collaboration with Sigmund Freud and a small group of Freuds colleagues, Adler was among the co-founders of the psychoanalytic movement as a core member of the Vienna Psychoanalytic Society. He was the first major figure to break away from psychoanalysis to form an independent school of psychotherapy and personality theory.   Adler’s main theoretical contributions are the importance of birth order in the formation of personality, the impact of neglect or pampering on child development, the notion of a self perfecting drive within human beings, and the idea that one must study and treat the patient as a whole person†. 5.2 Carl Gustav Jung (1875-1961):   A Swiss psychiatrist and the founder of analytical psychology.   Though not the first to analyze dreams, he has become perhaps one of the most well known pioneers in the field of dream analysis. He considered the process of individuation necessary for a person to become whole. This is a psychological process of integrating the conscious with the unconscious while still maintaining conscious autonomy.   Individuation was the central concept of analytical psychology.   Many pioneering psychological concepts were originally proposed by Jung, including the Archetype, the Collective Unconcious, the Complex, and synchronicity.   Jung believed individuals had psychological types which were known as Jungian Typology.   A popular psychometric instrument, the Myers-Briggs Type Indicator (MBTI), has been principally developed from Jungs theories. 5.3 Milton Erickson (1901-1980):   An American psychiatrist and psychologist, Erickson developed many ideas and techniques in hypnosis that were very different from what was commonly practiced. His style, commonly referred to as Ericksonian Hypnosis, has greatly influenced many modern schools of hypnosis. He was an important influence on neuro-linguistic programming (NLP), which was in part based upon his working methods.   He is noted for his approach to the unconscious mind as creative and solution-generating.   He is known for using the handshake induction, uses indirect and confusion techniques and also takes into account factors such as resistance. 5.4 Friedrich (Frederick) Salomon Perls (1893-1970): Better known as Fritz Perls, he was a German born psychiatrist and psychotherapist of Jewish descent.   Perls coined the term Gestalt Therapy to identify the form of psychotherapy that he developed with his wife Laura Perls in the 1940s and 1950s.   The core of the Gestalt Therapy process is enhanced awareness of sensation, perception, bodily feelings, emotion and behavior, in the present moment. Relationship is emphasized, along with contact between the self, its environment, and the other.   Gestalt therapy is firmly rooted in the philosophies of Existentialism and Phenomenology and can be described as a holistic and psychodynamic therapy. 5.5 Carl Rogers (1902–1987): An American psychologist and among the founders of the humanistic approach to psychology. Rogers is widely considered to be one of the founding fathers of psychotherapy research.   Rogers developed his person-centered therapy theories to understanding personality and human relationships which resulted in its wide application in psychotherapy and counseling.   His techniques make use of Empathy, Congruence and unconditional positive regard and he believes free will and self responsibility are paramount.   He describes his therapeutic approach as supportive. 6-Techniques used in practice There are many different techniques which can be applied for each patient’s specific requirements in medicine and dentistry, most of which will firstly require the patient to be in a trance like state or under ‘hypnosis’ where the patient is thought to be more open to suggestion.   â€Å"The brain seen in a hypnotic state is quite different from that seen in normal waking or sleeping.† [14] Carter,R (1998).   Smilar studies have also shown that there is increased activity in the brain during hypnosis which can help patients with heightened mental imagery.   A study by R.J. Croft suggests when under hypnosis a patient is able to dissociate and focus internally instead of on the pain they may otherwise experience. [15] R.J. Croft (2002). 6.1 Hypnosis:   Before looking at the techniques which can be used in medicine and dentistry we must look at how the therapist can prepare their patient to enter this heightened state of awareness.   Described below is the basic backbone of what is required when treating a patient using hypnosis however each of these steps will be described in more depth. Prepare the patient. The induction of the hypnotic state or trance. Deepening of the above. Therapy, namely suggestions and imagery-based techniques. Alerting Posthypnosis discussion. The use of self-hypnosis by the patient between sessions. [8] John Hartland, 2002. When preparing the patient is not possible in many situations to completely eliminate noise and distractions, especially in medicine and dentistry, but this need not pose a problem.   The main point to remember when preparing the setting is that the patient is comfortable.   This can be achieved by providing a chair or somewhere to lie down if appropriate and making sure the temperature is comfortable.   It is important that the patient feels relaxed and at ease with the therapist.   The therapeutic allience can be a very important part of the treatment in alleviating pain [16] Shapiro 1964.   Carl Rogers’s supportive approach could be used for this purpose. The induction and deepening can be achieved through a series of instructions and suggestions which will help the patient to enter a trance like experience.   There are many different ways to achieve this, for example using the Braid technique described in section 3.3 or another example is using Erickson’s handshake induction mentioned earlier in section 5.3.   The handshake induction is a confusion technique where the therapist begins to shake hands with the patient then interrupts the flow of the handshake in some way.   If the handshake continues to develop in a way which is out-of-keeping with expectations, a simple, non-verbal trance is created, which may then be reinforced or utilized by the therapist. All these responses happen naturally and automatically without telling the subject to consciously focus on an idea. For the purpose of medical and dental procedures, to help the patient undergo uncomfortable or anxiety provoking treatments, the use of distraction (section 6.?) and relaxing imagery (section xxx) can be extremely useful.   These techniques may also help the patient tolerate pain.   The induction and deepening is thought to enhance the patient’s responsiveness to the suggestions which will follow in the next stage, which is the therapy.   To ensure the patient is in a trance like state the therapist may ask for a signal off the patient and use an ideomotor response to get the patient to raise a finger.   This will show the patient is ready for the next stage (Please refer to section 6.2 – 6.? For techniques used during therapy). When alerting the patient suggestions of wakefulness and mental alertness are given.   This is also a good time for a post hypnotic suggestion, in the case of dentistry the therapist could say â€Å"You will find that in the future every time you experience these procedures you will become even more easily relaxed, even more quickly than this time, and into an even deeper state of relaxation.†Ã‚   The patient is then asked to be fully alert of their surroundings and to open their eyes (if shut), this can be achieved by counting the patient up or down suggesting increased awareness with each count. Once the patient is alert again this is when the therapist can discuss with the patient how they feel and make a plan for future sessions.   Time should always be given for the patient to adjust back to their surroundings, awaken all their senses and discuss any worries they may have had about their session.   The therapist may wish even at this stage to include some positive suggestions.   Before concluding the session self hypnosis can be taught to the patient for help between treatments which will also go towards helping the patient relax faster at future sessions.   A CD can also be given for use in between treatments to reinforce suggestions made. The following chapters will describe some of the techniques which can be applied in practice to control pain for medical and dental procedures.   The patient would firstly go through all the preliminaries described above, with the technique itself being integrated into the ‘therapy’ stage. 6.2 Suggestion:   Much of the practice of hypnosis entails giving suggestions directly or indirectly which will promote the desired change, an example of this is saying â€Å"Gradually you are feeling the pain easing away, as it is becoming more and more comfortable† or for a post-hypnotic suggestion and example would be â€Å"After your operation, you will feel stronger each day; any discomfort you feel will not really bother you, and you will have little bleeding.† [13] John Hartland, 2002.   Ego-strengthening is always used during therapy which is achieved by repeating positive suggestions (similar to positive reinforcement descibed in section 4.2) to the patient to reinforce any progress being made and to enhance feelings of self confidence and self worth.   This will give the patient the feelings they have the strength and resources to deal with the situation they are in now and after therapy.    Imagery NLP Anchoring 6.3 Paradoxical injunction: Hypnotic imagery (section 6.?) is widely used in pain management – particularly for longer-term pain conditions. One approach is to ask the client in hypnosis to create an image of a scale or dial (or something similar) going from 1-10 to represent their current experience of pain. It is then possible to suggest that they use the dial to ‘turn the pain down’.   If the client increases the pain then a reassuring suggestion could be given that if you can control the pain in one direction then you can also control it in the other to lesson the pain. 6.4 Distraction: Distraction techniques, similar to Erickson’s ‘confusion’   are often used in medicine and dentistry while performing uncomfortable procedures, however, for the purpose of hypnosis, imagery is again utilised.   The client is to engage their attention on something which appeals to them therefore distracting their attention from the pain. 6.5 Time distortion: Direct suggestions can be given during hypnosis to condense the experience of time if experiencing pain.   An example of this would be to say to the client ‘1 minute seems to pass as fast as a second’.   An example of when this could be used is in minor surgery when a procedure is being preformed without anaesthetic.   This technique would be used alongside relaxation and distraction techniques.   This could also be useful in a post-hypnotic suggestion to alter the patient’s memory of how long the actual procedure took. 6.6 Hypnotic suggestion for pain releif: This can be coupled with suitable imagery to give sensations of numbness and insensitivity.  Ã‚   A technique called ‘hand analgesia’ can be used in minor surgical, medical and dental procedures and also in childbirth.   The therapist simply suggests a feeling of coolness then numbness in the hand and the patient can then apply this feeling to the necessary part of the body.   Imagery techniques can also be used to create a metaphorical or symbolic image of the pain which can then be modified to experience pain relief.   One example of how this can be used is if a patient experienced arthritic pain they may imagine this as ‘grating cogwheels’, an image which can be helped by ‘oiling the cogwheels’ helping to relieve the pain. 6.7 Displacement: Peripheral pain can often be more bearable than centrally located pain therefore a suggestion can be made that the pain is located in another part of the body.   Reinterpretation is another technique similar to this where the patient can either imagine the pain is being caused by a positive activity, possibly sport, or they can convert the experience of pain to something more pleasurable like warmth. 6.8 Dissociation: In some patients this occurs naturally as a defense technique for pain such as in severe widespread pain or cardiac resuscitation where the patient may have an out-of-body experience.   Suggestion can be used by the therapist so the patient can imagine the pain is being separated from the part affected, perhaps to another part of the room, or even the affected part itself is separated. 6.9 Systematic desensitisation:   Systematic desensitisation, used primarily to treat phobias related to one particular issue, is also a simple process whose effectiveness depends on practice. Essentially you create an anxiety hierarchy (a graded list of anxiety-provoking items) and then proceed to pair each item with the feeling of being deeply relaxed. Eventually this training process allows you to remain relaxed even when thinking about the anxiety-provoking situation. Finally, you learn to confront the real situation while remaining calm and relaxed. 7-The application of hypno-psychotherapy in medicine and dentistry Pain relief is one of the main ways patients can benefit from hypno-psychotherapy techniques in medical and dental procedures.   Neuro-physiological work has shown if subjects are asked to imagine pain increasing or decreasing, the anterior cingulate cortex which registers pain changes accordingly whereas the somatosensory area which registers the sensory component, is unchanged [6] Rainville et al 1997.   Differing from these results studies have also shown that highly susceptible subjects who can relieve themselves from all perception of pain appear to be able to diminish the sensory component by absorbing themselves in some other cognitive activity.   [7] Crawford, 1994.   The other main way these techniques can benefit patients is through the reduction in anxiety throughout many procedures.   Described below are some of the many procedures where hypno-psychotherapy techniques are applied in medicine and dentistry.    7.1 Treatment in surgery: Uncomfortable minor surgical procedures where pain releif can be aided through hypnotherapeutic techniques include injections, blood taking, stitching and their removal, opthalmic surgery, dressing of burns, removal of drain tubes and many more.   Entire operations have been reported where hypnosis was the only method of analgesia, however, the main use is in facilitating major surgery and general anaesthesia.   Applications include relaxing the patient in the preoperative period, thus reducing preoperative sedation, muscle relaxants, and general anaestetic requirements and facilitating intubation. [9] Kessler, 1997.   Also with the use of positive suggestion the patient is instilled with thoughts of a successful outcome leading to reduction in post-operative pain and anxiety and need for chemical pain relief. Techniques have also been successful for the control of blood loss.   There are many metaphors which can be used for this, for example, blood vessels being tied with a ‘magic thread’. 7.2 Treatment for cancer patients:   There are many ways in which Hypno-psychotherapy techniques can help cancer patients.   General relaxation, the control of negative emotions and the sense of control over the disease can be achieved using techniques such as self hypnosis and ego strengthening.   Chemotherapy and radiotherapy can often take several months before completion of treatment, by enhancing future rehearsal the therapist can replace the any negative thoughts about their illness with a positive future outlook of their lifestyle.   Similar to its use in general surgery, techniques can be used to alter the patients state of mind pre and post-operatively and help with pain relief. 7.3 Treatment in obstetrics and gynaecology:   Hypno-psychotherapy techniques can be used before pregnancy using relaxation techniques to help with infertility treatment, during pregnancy using ego-strengthening, self hypnosis, imagery and relaxation to help with morning sickness, hypertension and premature labour or miscarriage caused by anxiety, and after pregnancy to help with bonding with the baby and post natal depression. Anxiety during pregnancy can affect blood flow and fetal stress and can lead to complications such as pre-eclampsia, forceps delivery, prolonged labour, clinical fetal distress and primary postpartum hemorrhage [10] Crandon 1979.   It is not only reducing stress and anxiety however which can help during pregnancy, analgesia in childbirth using hypnotherapy can be used which reduces and can sometimes even remove the need for chemical analgesia and other medication which can be potentially harmfull to both mother and baby.   Methods which can be used are ‘hand analgesia’, the use of imagery, or dissociation which has been previously mentioned in section 6.   Some painful gynaecological conditions may also be helped by hypnotic pain management techniques such as dysmenorrhoea, endometriosis, vulvodynia and idiopathic pelvic pains. 7.4 Treatment in dentistry:   Hypnosis has been used in the dental industry as far back as the 19th century when John Elliotson (section 3.1) used mesmeric passes for analgesia for many surgical procedures.   As mentioned earlier pain management and reduction of anxiety are the main advantages to using these techniques, however in dentistry the treatment of anxiety is extremely important.   This is one of the main problems in dental surgery and not surprisingly one adult in three has a moderate to severe fear of dental procedures [11] British Dental Association 1995. Techniques commonly used by dentists are relaxation (combined with anchoring), imagery, distraction, ego-strengthening and in some cases self hypnosis to aid future treatments.   Hypnoanalgesia can be achieved similar to the way it can in childbirth by using the hand analgesia technique (section 6.5) where this can not only be successful giving a numbing sensation in the required area but can also demonstrate to the patient that the technique works, which will in turn leave them more open to suggestion.   Desensitisation (MAKE SURE ITS IN!!) can also be extremely successful if used building up to the treatment.   Control of bleeding can sometimes be achieved by direct suggestions of ‘less bleeding’ or ‘the ice cold sensation is consticting blood vessels’.   The most important technique to include in hypnosis and dental surgery is to give the patient control over the treatment they are being given and this can be achieved by using a signal such as rai sing the hand or finger similar to the ideomotor response mentioned in section 6, so the patient can stop the procedure immediately if need be.   Dental phobias can often stem from a bad experience in the dental surgery [12] Ãâ€"st 1985, or from hearing horror stories as children, or from deeper routed experiences where psychodynamic approaches can be of great use. 8-Conclusion    8.1 Modern day acceptability:   In 1955, the Brittish Medical Association was sufficiently interested in hypnosis to set up an enquiry, the second one in its history (the first being in 1892), which reported favourably on hypnosis as a therapeutic medium, even recommending that hypnosis should be taught at medical schools and on courses for psychiatrists, and possibly anaesthetists and obstetricians [5] John Hartland, 2002.   This was followed in 1958 by the American Psychological Association forming a specialty in hypnosis and establishing a certifying board of examiners in both clinical and experimental hypnosis.   At a formal meeting of the American Medical Association (AMA) in 1959, hypnosis was granted official status of an adjunctive tool.   Also, in 1961, the AMA recommended that medical professionals receive 144 hours of training in hypnotherapy.   Hypnosis has become represented by numerous professional organizations and leading national and international journals have been established for publishi ng research. A committee commissioned by the British Medical Association formally concluded that: In addition to the treatment of psychiatric disabilities, there is a place for hypnotism in the production of anaesthesia or analgesia for surgical and dental operations, and in suitable subjects it is an effective method of relieving pain in childbirth without altering the normal course of labour. [17] (BMA, Medical use of hypnotism’, BMJ, 1955, vol. I, 190-193) 8.2 Advantages and disadvantages:   8.3 Future possibilities:   For conclusion see page 363 in Hartland. For advantages and disadvantages see pages 390-391.   Also the case study on page 403. Reference: 1. Mesmer, Franz (1980). Mesmerism. Los Altos: W. Kaufman 2. British Medical Surgical Journal (1846)35:   Page 542. 3. Bramwell (1910) Hypnotism and treatment by suggestion.   Page 203. 4. Watson, J B (1931) Behaviourism.   London:   Kegan Paul.   Page 104. 5. Hartland, John (2002) Hartland’s Medical and Dental Hypnosis.   Fourth edition. Page 14. 6. Rainville P, Duncan G H, Price D D et al (1997) affect encoded in human anterior cingulated but not somatosensory cortex.   Science 277:   Pages 968-971. 7.   Crawford H J (1994) Brain dynamics and hypnosis:   Attentional and disattentional processes.   International Journal of Clinical and Experimental Hypnosis 42:   Pages 204-232. 8.   John (2002) Hartland’s Medical and Dental Hypnosis.   Fourth edition. Page 61. 9.   Kessler R (1997) The consequences of individual differences in preparation for surgery and invasive medical procedures.   Hypnosis:   Swedish Journal for Hypnosis in Psychotherapy and Psychodynamic Disorders 24:   Pages 181-192. 10.   Crandon A (1979)   Maternal anxiety and obstetric complications.   Journal of Psychosomatic Research 23:   Pages   109-111 11.   British Dental Association 1995 Dental Phobia.   Fact File, June.   British Dental Association, 64 Wimpole Street, London WIM 8A. 12.   Ãâ€"st L G 1985 Mode of acquisition of phobias.   Acta Universitatis Uppsaliensis (Abstracts of Uppsala Dissertations from the Faculty of Medicine) 529: 1-45 13.   John (2002) Hartland’s Medical and Dental Hypnosis.   Fourth edition. Page 84. 14.   Carter R (1998) Mapping The Mind. Phoenix. London. Page 318. 15.   Croft, R.J., Williams, J.D., Haenschel, C. and Gruzelier, J.H.,(2002) Pain perception, hypnosis and 40 Hz oscillations.   International journal of Psychophysiology.   Vol. 46 Issue 2.   Pages 101-108. 16.   Shapiro (1964) Page 134   xxxxxxxxxxxxxxx get proper ref off diss by Karen H!! 17.   BMA, Medical use of hypnotism, BMJ, 1955, vol. I.   Pages 190-193.