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Presented by Dr Colin Carbis in Hong Kong China at the
Inaugural 2008 Asia Pacific Rim International Counselling Conference
Counselling in the Asia Pacific Rim: A Coming Together of Neighbours
Traditional methods in clinical hypnosis use speech and tone of voice as the only form of communication. About 7% of human communication is channeled through speech and 38% through tone of voice. Normally, hypnosis inductions are conducted with eyes closed, so body language, which consists of about 55% of human communication, can't be used.
Traditional methods in clinical hypnosis have also overlooked communication from the environment, which is not only significant, but more than likely - subliminal. Subliminal communication emanating from body language or the environment (e.g. color, photoperiod, biophilia etc) stimulates neural pathways to the more primitive part of the human brain (limbic system) where an emotional or behavioral response may be activated independent of rational thought.
Speech evolved in parallel with analytical thinking, so, understandably, words tend to activate the process of logical and analytical thinking. Verbal suggestions, during either waking or altered states of consciousness, are normally analyzed and compared to pre-existing beliefs before they're accepted, modified, or rejected. The challenge for clinicians practicing traditional methods in clinical hypnosis, therefore, is to use language patterns and narrative metaphors etc that bypass the logical, thinking part of the brain.
Virtual Medicine Pty Ltd (Melbourne Australia) recently developed a new therapeutic technique, known as Virtual Reality Therapy (VRT), which makes additional use of non-verbal visual and auditory messages from body language and the environment. During VRT, the patient wears a head-mounted display, which removes auditory and visual distractions from the "real world" environment.
VRT has some parallels to traditional forms of hypnosis in its use of hypnotic language patterns, tone of voice, imagination, association, repetition, pleasure, fixation of attention, anchoring, imbedded commands, and narrative, metaphors.
VRT differs from hypnosis by inducing the patient with eyes open, and using methods including visual images, visual metaphors, story telling, dual scripting, music, dance, body language, colors, visual and auditory symbols, photic stimulation, reframing, matching and mirroring, environmental sounds, binaural beats and other nonverbal messages and cognitive behavioral techniques.
The visual images used in VRT are nonverbal messages designed to activate mirror neurons, and provide a largely unchallenged, subliminal access to the emotional centre of the brain. This argument is supported by qualified hypnotherapists using the VRT device, who reported altered states of consciousness and changes in emotional states in non-English speaking clients (personal communication Terry Suckling and Anastasia Konis).
Research at the Brain Sciences Institute (Melbourne Australia) indicates that VRT induction techniques produce changes in electroencephalographic (EEG) coherence. This finding is consistent with reports from previous studies using traditional methods in clinical hypnosis. The authors suggested that VRT is a more effective method for inducing an altered state of consciousness in people at the lower end of hypnotic susceptibility, which support the claims by Patterson et al., (2003) who argues that visual stimuli can make the induction process less effortful. The VRT induction disturbs gamma coherence, which according to Croft et al., 2002 is associated with changes in pain perception.
VRT was used to alter pain perception in a 28 year old survivor of a terrorist bombing in Bali Indonesia. The patient had burns to 45% of his total body surface area. Physical progress and medical management were compromised within 10 days post admission when the patient manifested symptoms consistent with acute stress disorder (ASD), characterized by anxiety, tearfulness, nightmares, insomnia, panic attacks, low mood, depression and irritable outbursts. He refused radio and television connections, was agitated by nursing staff opening curtains in his room, and refused all visitors - except his immediate family. He described depersonalization and derealization experiences, was uncooperative with medical and nursing interventions, and he had limited interaction with hospital staff.
VRT was provided as an adjunct to existing therapy after ASD symptoms began to impact significantly on his recovery and pain management requirements. After two VRT sessions (four hours apart), he slept for several hours without nightmares or recall of dreams. The following morning, his dread, tachycardia, hyperventilation, sweating and other panic related symptoms had subsided, and his requirements for burn pain analgesia were managed at reduced levels.
Staff and patient reports indicated that analgesia requirements and clinical signs of ASD rapidly improved in the period following treatment with Virtual Reality Therapy. According to the patient, VRT prevented insomnia, panic episodes and nightmares, and helped him to overcome feelings of depression. Staff reported reduced analgesic requirements and reduced patient calls for nursing assistance. Sequential psychiatric assessment revealed reduced symptoms of anxiety, panic and negative cognitions. The patient was discharged from hospital 43 days after the Bali bombing, and there were no signs of post traumatic stress disorder (PTSD) or related co-morbidities two years after his discharge from hospital.
Pain specialists from the anesthesiology department decided to examine the process further, so they commenced a pilot study using VRT as an analgesic adjunct during burns debridement. In this study, self reported pain scores were more than 30% less than controls. The pilot study was followed by a larger, double blinded clinical trial, which is still recruiting patients.
In the USA, VRT was used in a blinded clinical study
to induce a preoperative hypnotic state in pediatric patients scheduled
for elective burn reconstruction. High levels of preoperative anxiety
have been associated with postoperative regression, nightmares, separation
anxiety, eating problems and fear of physicians. Various pharmaceutical
regimens have been devised that reduce preoperative anxiety. However,
patient response is variable and side effects often limit the efficacy
of this approach.
This trial showed that viewing a VRT session the night before and the
morning of surgery can significantly reduce preoperative self reported
anxiety scores in teenagers scheduled for reconstructive burn surgery.
None of the patients had any untoward behaviors postoperatively, and almost
50% of patients in the VRT group asked if they could use the device on
the day after surgery.
Virtual Medicine Pty LTD is developing an extensive
library of VRT programs, and, to date, VRT has been successfully used
to help people with nicotine addiction, chronic and acute pain, acute
stress disorder, insomnia, sleep disorders, shingles, migraine, generalized
anxiety disorder, minor depression, hypnosedation, autism, and psychooncology
symptoms.
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