Hypnosis, Relaxation and Suggestion from a CBT Perspective
NILS NORRSELL
Hypnosis, Relaxation and Suggestion from a CBT Perspective Handbook for clinicians, especially within dentistry
© 2018 Nils Norrsell Layout: BoD – Books on Demand Printing: BoD – Books on Demand, Stockholm, Sweden Production: BoD – Books on Demand, Norderstedt, Germany ISBN: 978-91-7785-301-5
Contents Introduction
7
1.
Development of hypnosis
11
2.
The origin and frequency of dental fear
16
3.
Classical conditioning. Odontological views
23
4.
Desensitization in dentistry
28
5.
Operant conditioning. Exposure
31
6.
Cognitive behaviour therapy (CBT)
34
7.
What is hypnosis, suggestion and susceptibility?
38
8.
Direct och indirect suggestion. Motivation to relax
47
9.
Susceptibility to suggestion and hypnotic capacity
53
10. Hypnosis, emotion och spontaneous attention
56
11. Relaxation instruction for group or individuals
61
12. Suggestibility tests
64
13. Coué’s laws of suggestion. Ideomotor and ideosensory effect
75
14. Preparing for hypnosis. Induction principles
86
15. Three simple inductions suitable for practicing with subject sitting in a comfortable dental chair 91 16. Norrsell’s standard induction (https://youtu.be/OvYeNbW-B61) 94
17. Dave Elman’s induction, here adjusted to treatment of bruxism (https://www.youtube.com/watch?v=W5rXsq3ZL9o) 98 18. Hypnosis for children
103
19. Deepening and maintaining the trance state
108
20. Hypnosis and CBT in collaboration
114
21. Hypnosis and pain relief
117
22. Nausea reflexes
121
23. Spontaneous attention is influenced by words and conversation topics 124 24. Communication, motivation and rapport
129
25. Preparing and implementing hypnosis in dental care
134
26. To end trance. Post-hypnotic suggestions. Anchoring
137
27. Deviant behaviours; possible reasons and explanations
140
28. Case reports
145
29. Self-hypnosis, self-expression and self-knowledge
149
30. Ethics
155
31. Interior design and outfit of the dental clinic
157
Literature
159
Index
162
Introduction
The word hypnosis has to do with sleep. Deep relaxation sometimes can be experienced as a form of sleep, but the word hypnosis is not optimal, as clinical hypnosis in general is more like a waking state with a sense of deep relaxation and calmness. Due to lack of a better name the word hypnosis is still in use. There has been different names during different times. In the antiquity the state was called temple sleep, at the end of the 1800th century the name mesmerism or animal magnetism were used. Today much focus is on mindfulness and meditation, that can be seen as variants of hypnosis. A common name for these mental states is an altered state of consciousness (ASC). This means that it is different than the ordinary waking mental state. Hypnosis can be a great help for many patients in dentistry and medical treatment, in fact for the majority. The primary aim is often relaxation. With the right technique this can be achieved within a couple of well used minutes. The treatment will be well tolerated, the patient will be more content and happy and for the caregiver the job satisfaction will increase. Many patients will learn to relax automatically during treatment. Even if the induction technique may be easy to learn, hypnosis is a comprehensive subject calling for great engagement for a successful practise. After induction it is important to know how to maintain and use the altered mental state in the best way. The combination of hypnosis and 7
Cognitive behaviour therapy (CBT), will make teaching of new behaviours, including relaxation, very effective. Problems that the patients often need help with are phobia of different things inclusive pain and needles, exaggerated gagging reflexes, bruxism, motivation for dental care and also health promoting behaviours in general like stress management and smoking cessation. This book has two principal aims. One is to promote understanding of theories behind hypnosis and suggestion together with treating principals, collected mainly from CBT. Another is to teach suitable relaxation induction techniques and inspire dental and health caregivers to study and use hypnosis and suggestion in their working field. Practitioners that don’t see any possibilities to influence patients showing signs of tension and suffering often disregard such signs or belittle them. That can initiate a life lasting phobia. Hypnosis gives great possibilities to influence. Observation skills are basic when practising hypnosis, and the insight that you can help patients with problem behaviours facilitates to observe them and to take them into account. It calls for a little extra from the care provider, but with the right knowledge and willingness to help the reward in the form of grateful patients will be rich. No extraordinary gift is required to become a good hypnotist. It is enough to be interested, to be willing to put the patient in the center, and to be receptive to his or her needs. There is a lot of interesting literature on hypnosis and related subjects. To study this and also some video demonstrations on the internet is recommended. Of course it is of great importance to get an approved education, to practise and to learn by observing other professionals. As a beginner you should take all opportunities to practise in order to gain confidence. Within dentistry I recommend the use of the standard induction that I have elaborated and used for 40 years with small variations. It 8
is quick, you must not think of how to start and it has the necessary ingredients to reach your goals. It is well suited for the clinical environment where you want to evoke a scientific and professional image of yourself. From the patient’s responses you will understand how well your induction has succeeded and with practice you will get skilled. CBT deals with learned responses, unlearning of negative reflexes and behaviours and learning of new, more appropriate ones. I divide thought responses and body responses into two categories, reflexes and behaviours. That is different from the current view, but it facilitates the understanding. The combination of hypnosis and CBT is so effective that it alone could help the majority of those phobic patients, who are today relying on expensive general anesthesia or nitrous oxide. Everybody knows the fact that tension can be built up in seconds, but it is not so well known that relaxation can be triggered as quickly. Well-tried and effective methods for helping suffering patients in clinical settings are described and explained.
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