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Hypno-Potamize Pediatric Hypnosis Helping Children Help Themselves

Hypno-Potamize Pediatric Hypnosis Helping Children Help Themselves. Hypnovations III - Intermediate Workshop Burlington, VT April 2010 Lnda Thomson, APRN, ABMH. 1. Objectives. Describe how developmental age is more important than chronological age when using hypnosis with children

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Hypno-Potamize Pediatric Hypnosis Helping Children Help Themselves

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  1. Hypno-PotamizePediatric HypnosisHelping Children Help Themselves • Hypnovations III - Intermediate Workshop • Burlington, VT • April 2010 • Lnda Thomson, APRN, ABMH 1

  2. Objectives • Describe how developmental age is more important than chronological age when using hypnosis with children • Demonstrate two hypnotic techniques that are effective with children 2

  3. With hypnosis the art of interacting with children in pediatrics is taken to a higher level. • Sugarman 3

  4. Introducing Hypnosis to Children and Families • Learn about the patient • Learn about the problem • Learn why the child wants to change • How would life be better without the problem • Explain about the mind body connection • Discuss the power of imagination • Explain and demystify hypnosis 4

  5. RAPPORT • Relationship, especially one of mutual trust or emotional affinity. 5

  6. Learn about the Problem(while developing rapport and obtaining history) • Medical history • Experiences with the symptom or problem • Imaginative description of symptoms • Worries and dreams • Cognitive re-framing • Roles of parents, other relationship • Kohen 6

  7. Integrate the child and the problem • “How will life be better when it is gone?” 7

  8. Hypnosis is about learning what you never knew you knew and controlling what you never knew you could. . • Using your mind. . . • Daydreaming on purpose. . . • Thinking to help yourself. . . • Learning how to work to control your mind. . . 8

  9. Studies show that children • Have greater hypnotic capacity • Most hypnotizable 11 years (8 – 12) • Their ability to alter behavior/physiology with hypnosis related to depth/creativity of imagery 9

  10. Hypnosis uses imagination to change:symptomatologyphysiologyandbehavior 10

  11. Developmental StageAge 0 - 2 • Piaget – Sensorimotor • Preverbal • Reflex activity - - - - -purposeful activity • Rudimentary thought • Erikson – Trust vs Mistrust 11

  12. Hypnosis with young children • Absorbing Attention: • Tactile: patting, rubbing, massage • Kinesthetic: rocking, motion • Auditory: singing, rhyming, white noise • Visual: peek-a-boo, puppets, mobiles, dolls 12

  13. Hypnosis with young children • Pertinent characteristics: • Enter their world • Fantasy is spontaneous • Ease of Fractionation • Importance of parents • Importance of transistional objects • Activity in hypnosis 13

  14. Developmental StageAge 2 - 6 • Piaget – Preoperational & Prelogical • Initial reasoning • Erikson – Autonomy vs Shame • 11/2 – 31/2 yrs • Iniative vs Guilt • 31/2 – 6yrs • Skills broaden thru play and imagination • Guilt restricts development of play skills and imagination 14

  15. Hypnosis with Pre-school Children • Playful, flexible, do the unexpected • Shifts easily in/out of trance • Trance created when child focuses attention on something external or in inner world • Eye closure and relaxation rare • Mastery, initiative, autonomy important 15

  16. Hypnotic inductions with Pre-school Children • Let’s Pretend • Story telling or favorite place • Puppets and other props • Songs, rhyming • Blowing bubbles, pinwheels • Stereoscopic viewer, pop-up books 16

  17. Developmental StageAge 6 - 12 • Piaget - Concrete operational • Logical • Problem solving restricted to real objects • Erikson – Industry vs Inferiority • Competence, mastery 17

  18. Hypnosis with School-age Children • Concrete thinkers • Active use of fantasy and identification with real and imagined characters • Increasing self-awareness, rules, fairness • Increasing control over new feelings/desires • Mastery and achievement 18

  19. Hypnotic Inductions and Techniques with School-age Children • Favorite place imagery, adventure imagery, Harry Potter, Magic Carpet • Yoyo or belly breathing, Helium balloon, bucket of sand, magnetic forces, coming down a mountain • Controls, wires and switches • Videogames, television imagery 19

  20. Developmental StageAge 12 + • Piaget • Comprehension of purely abstract or symbolic content • Development of advance logical functions (eg. Complex analogy, deduction) • Erikson – Identity vs Identity Diffusion • Self-certainty vs self-doubt • Trying on various roles 20

  21. Abstract Reasoning • This begins to come into thought processing at an average age of 16 years. The range may be 12 to 20 years. 21

  22. Hypnosis with Adolescents • Period of tremendous change, great variability • Ego-centricity of adolescence - imaginative audience • Illusion of immortality • Autonomy, independence and mastery 22

  23. Changes in Hypnotic Techniques with Advanced Development • Simple language • “Let’s pretend” • Imitative • Repetitive themes • Familiar key roles and events • More flexible with sex and age roles • Fewer preconceived notions • More complex language • “Perhaps you’d like to learn • Creative • True inventiveness • Adventurous, more daring • More rigid with sex and age rolls • More hypnosis stereotypes 23

  24. Hypnotic Inductions and Techniques with Adolescents • Eye fixation, coin watching • Safe Place imagery, Sports activity • Diaphragmatic breathing, progressive relaxation • Arm levitation and reverse levitation • Playing or listening to music, dancing • Driving a car, snowmobile, dirt bike • Video or computer games, television • Maturity and mastery imagery 24

  25. Induction • Simply as much as the patient needs. • Narrowing focus of attention • Intensifying self-awareness • Permission to imagine • Creating positive self-expectancy 25

  26. Let patients notice that they are in control • “Relaxing at the speed that is right for you. 26

  27. There is no correct or right way to experience hypnosisAllow patient to feel good and okay about whatever they do experience 27

  28. Office Procedures • Physical Exams – use of transistional objects, humor, play, magic • Throat Cultures • Immunizations: Pinwheels, Bubbles, Viewfinders • Attenders or avoiders • Other procedures – belly breathing, yoyo breathing, diaphragmatic breathing, distraction – game boy, story telling 28

  29. Hypnosis in a Primary Care PracticeSugarman J Dev Behav Ped, 1996 • Problems • Enuresis • Headaches • Abdominal Pain • Anxiety • Asthma • Chronic Disease • Habit Disorder • Tics • ADD • Encopresis • 14 females, 25 males • Age 5 – 18 (10) • Visits 1 – 7 (2) • 20-75 minutes (45) • 59% >50% improved • 80% of those attribute change to hypnosis 29

  30. Hypnosis in Behavioral EncountersKohen, J Dev Behav Peds,1984Hypnotherapeutic interventions in 505 children followed for up to 2 years with: • Enuresis • Pain • Habit disorders • Asthma • Obesity • Encopresis • Anxiety 30

  31. Hypnosis in Behavioral EncountersKohen, J Dev Behav Peds,1984 (continued) • Response of 505 Pediatric Patients to Relaxation Mental Imagery ________(Self-Hypnosis): Number of Visits_________ • Response # of Pts # of Visits • to RMI* 1 2 3 4 >5 • 0 37 7 6 7 7 10 • 1 46 1 7 10 5 23 • 2 163 30 23 23 26 21 • 3 259 90 49 58 31 31 • 0 – no change; 1- demonstrated initial improvement, but did not practice exercises; 2- more than 50% reduction in symptoms; 3- complete resolution of problem 31

  32. Hypnosis in Behavioral EncountersKohen, J Dev Behav Peds,1984 (continued) • Conclusions • Long or frequent office visits not required • Effectiveness of hypnosis • Parental reminders negate success / mastery • Spillover of therapeutic efficacy 32

  33. Usefulness of hypnosis in managing anxiety • Stimulates the relaxation response – physiologic changes that occur with physical/muscular relaxation • Children don’t like to feel anxious • Children are interested in self-mastery and how their mind and body works together • Hypnosis cultivates imagination 33

  34. The first hypnotic intervention for pain came when a mother first kissed her child’s booboo and told him it would be all better, 34

  35. Childhood PainRoss & Ross, Pain, 1984 • Interviewed 994 elementary children • 384 had a painful procedure with MD or DDS • Only 21% used any sort of coping strategy • Only 13 children reported having been taught pain coping techniques 35

  36. Blowing away painFrench, Pediatrics • 149 4-7 year olds divided into control and test group • Test group taught to blow away pain of immunizations • Test group had significantly fewer pain behaviors p <.04 36

  37. Hypnosis with Pediatric Surgical PatientsLambert, JDBP, 1996 37

  38. Hypnosis and Headaches2 year F/U on 126 children taught self-hypnosis for recurrent headachesDP Kohen, ISH, 2004 • 87.7% had a decrease in frequency • 86.9% had a decrease in intensity • 88.6% had a decrease in duration • 25.7% were completely headache free 38

  39. Functional Abdominal PainAnbar, Clinical Pediatrics, 2001 • Most common recurrent physical symptom attributable to psychological factors among children and adolescents • 4 out of 5 improved after one hypnosis session 39

  40. Hypnotherapy for Children with FAP or IBSVlieger, et al 2007 40

  41. Psychoneuroimmunology:Self-Regulation of Salivary IgAOlness, et al Pediatrics, 1989Hewson-Bowers, • 3 groups: hypnosis, relaxation and control • Hypnosis was able to statistically reduce the frequency and duration of respiratory infections by increasing salivary IgA 41

  42. Hypnosis for Childhood AsthmaKohen, Hypnos, 1995 • N= 28 7-12 yr.olds RCT • As compared to control hypnosis significantly reduced (p<0.05 – 0.001) • Symptom severity • School absence • Emergency visits 42

  43. Asthma and Anxiety • 767 children 11-17yrs with asthma • 9% met DSM-IV criteria for anxiety disorder • Children with both asthma and anxiety had significantly more asthma symptom days • Children with both asthma and anxiety more likely to be taking more medication • Richardson, Pediatrics, 2006 43

  44. Hypnosis with Children with CF • Improved attitude about health • Sense of independence • Decreased anxiety • Increased control over pain, taste and nausea • Anbar, Pediatrics, 2000 44

  45. Adolescents with IDDM • No changes in management other than the addition of hypnosis • Reduced HgbA1C from 13.2% to 9.7% • Reduced avg FBS from 426 to 149 • Ratner, et al AJCH 1990 45

  46. Hypnosis and EnuresisBanerjee, et al, AJCH, 199350 children divided into 2 groupsTofranil Hypnosis • After 3 months • 76% dry • After treatment discontinued • 24% dry • After 3 months • 72% dry • After treatment discontinued • 72% dry 46

  47. Patients do the changing:they have the ability and get the credit 47

  48. Ego Strengthen whenever possible • Breathe in self-confidence, breathe out self-doubt • Breathe in self-esteem • That’s right, you’re doing great • You are doing this very well 48

  49. Ego Strengthen whenever possible • As you do this more and more for yourself, you will probably be very proud of what you are learning and accomplishing. • It is good to know that you are doing this exactly right, and the more you do it, the better you get. 49

  50. Ego Strengthening Suggestions • Mastery • Positive Coping • Control • Self-esteem • Self-appreciation • Confidence and ability 50

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