Isidro Pérez Hidalgo: Psicólogo Clínico. Director de CHC Psicólogos.
Presidente de la Sociedad Hipnológica Científica
Introduction
Chronic pain is one of the most common problems we encounter in clinical practice, both in medicine and psychology. One of the fundamental characteristics of chronic pain is that it loses its function of warning or protecting our health, as occurs in acute pain, and instead produces a hypermemorisation of the pain, which has a negative impact on the patient’s quality of life.
Chronic pain, as shown in the following diagram, has different interacting components:
We speak of a biopsychosocial model of pain. This approach leads us to:
- A better understanding of pain.
- More effective pain treatments.
- Improvement of the patient’s quality of life.
See Martinez Pintor, F., and Pérez Hidalgo, I., (2014).
Hypnosis and pain management
Hypnosis is one of the most widely used techniques in chronic pain with good results (Adachi et al. 2013; Thompson et al. 2019; Langlois et al. 2022).
Self-hypnosis is a tool that complements hetero-induced hypnosis very well, to the extent that we could say that it is indispensable in the case of chronic pain management.
Self-hypnosis aims to achieve the following objectives:
- To encourage self-control strategies in real situations.
- Increase the perception of self-confidence.
- Having the patient learn to self-administer suggestions.
- Extend the effect of suggestions to other areas of the patient’s daily life.
- Facilitate the generalisation of the results obtained in consultation.
Self-hypnosis applied to pain produces:
- A reduction, which may become permanent, in the daily perception of pain.
- The production of periods of rest and comfort, in which pain is momentarily diminished.
In my clinical career, I have looked for different self-hypnosis programmes for pain management, especially for chronic pain, and I have designed a six-step programme, which has given me good results, and which I am going to explain in this article.
I have started from a base, Autogenic Training, making a number of modifications, not to overcome the effectiveness of this technique that has been used for more than a century, but to offer an alternative approach that can be more easily applied to some patients and that includes dissociative elements that are not present in the original Autogenic Training.
Let us now go into detail on the most important features of this ancient approach, which is still widely used today and has been the subject of much research, especially in Europe.
Autogenic Training.
The A.T. was designed by J. H. Schultz and first published in 1932. His work was based on the previous studies of Oskar Vogt, an expert in hypnosis. Schultz found that some of the physiological reactions produced by hypnosis could be induced directly by self-applied suggestion (e.g., heaviness in the limbs or warmth in the hands). The subject used a series of «autogenic formulas», namely, phrases repeated several times to bring about these changes and achieve a «neurovegetative switch» (Schultz, 1969).
Schultz’s main disciple was Wolfgang Luthe, who popularised A.T. in the United States, Canada and other English-speaking countries, expanding the methodology of the system into Autogenic Therapy (Luthe, 1969-1973). By now, A.T. has evolved from the original six-step method to a series of additional steps, which are considered the superior level of the system.
Luthe elaborated the concept of «Passive Concentration», which had previously been postulated by Schultz in an attempt to differentiate A.T. and Self-Hypnosis.
A.T. has been found to be beneficial in reducing chronic pain, although more research is needed (Kohlert, 2022). Other recent research indicates that eight weeks of A.T. practice significantly improves anxiety, stress and depression in addition to pain (Shaker et al., 2024).
What are the six steps used in Basic A.T.?
- Heaviness in the limbs.
- Warmth in the hands.
- Regulation of the heartbeat.
- Breathing experience.
- Warmth on the solar plexus.
- Freshness on the forehead.
These steps are ordered in such a way that a series of physiological responses are chained together leading to «Neurovegetative commutation», through the use of the so-called «Autogenic Formulas» (Let us remember that the word «autogenous» means «self-generated»). In the following, we will give examples of such formulas in the six steps, with some slight variations on Schultz’s original formulas:
My proposal
After many years of practising A.T., undoubtedly a technique that at least initially was considered to be self-hypnosis, I have been able to see that, practising it on a daily basis, A.T. is an effective method to reduce chronic pain and to improve a variety of symptoms.
My proposal is not intended to improve on A.T., which has been the subject of numerous studies, but to use the six-step structure to introduce more flexibility by adapting it to some patients who have difficulty achieving the full set of exercises. You can also say that my 6-step programme is more focused on chronic pain and is closer to standardised hypnosis. Normally the results will be quicker than if we use the Schultz protocols which require six months according to the original thorough approach.
For the application of my proposal, the therapist must teach the patient in the practice to achieve a sufficiently deep and effective hypnotic state. Instead of recording the procedure, I recommend that the patient memorise the steps, dedicating 20-30 minutes each day to training. In essence:
- 1st step – Muscle relaxation, starting with the lowering of the arm.
- 2nd step – Vascular relaxation, from hyperesthesia focused on the hands.
- 3rd step – Cardiac relaxation associated with breathing.
- 4th and 5th step – Self-suggestions of immobility + analgesia (In A.T. there are no self-suggestions of this type).
- 6th step – Mental calm.
In my clinical experience, most patients who use this six-step system at home achieve significant improvement. However, I am aware that further research is needed, and I encourage clinicians who read «Hipnológica» to see the results for themselves and ideally share their experiences.
References
- Adachi, T., Fujino, H., Nakae, A., Mashimo, T., & Sasaki, J. (2014). A meta-analysis of hypnosis for chronic pain problems: a comparison between hypnosis, standard care, and other psychological interventions. The International journal of clinical and experimental hypnosis, 62(1), 1–28. https://doi.org/10.1080/00207144.2013.841471
- Kohlert, A., Wick, K., & Rosendahl, J. (2022). Autogenic Training for Reducing Chronic Pain: a Systematic Review and Meta-analysis of Randomized Controlled Trials. International journal of behavioral medicine, 29(5), 531–542. https://doi.org/10.1007/s12529-021-10038-6
- Langlois, P., Perrochon, A., David, R., Rainville, P., Wood, C., Vanhaudenhuyse, A., Pageaux, B., Ounajim, A., Lavallière, M., Debarnot, U., Luque-Moreno, C., Roulaud, M., Simoneau, M., Goudman, L., Moens, M., Rigoard, P., & Billot, M. (2022). Hypnosis to manage musculoskeletal and neuropathic chronic pain: A systematic review and meta-analysis. Neuroscience and biobehavioral reviews, 135, 104591. https://doi.org/10.1016/j.neubiorev.2022.104591
- Luthe, W (Ed), (1969-1973): Autogenic Therapy. 6 vols. Grune & Stratton, New York.
- Martinez Pintor, F., Pérez Hidalgo, I., (2014). Control del dolor. Pag 77-104. En Perez Hidalgo et al., (eds.) Hipnosis en la Práctica Clínica. Vol. II: Aplicaciones clínicas. Madrid: EOS.
- Schultz, J.H. (1969). El Entrenamiento Autógeno. Editorial Científico-Médica. Barcelona.
- Shaker, N. A. L. A., Majumdar, A., Straiton, N., Bird, J., Ashby, S., Sharma, R., Waller, S., & Hughes, J. G. (2024). Autogenic training for chronic health conditions: A service evaluation. Journal of evaluation in clinical practice, 30(6), 1024–1028. https://doi.org/10.1111/jep.14014
- Thompson, T., Terhune, D. B., Oram, C., Sharangparni, J., Rouf, R., Solmi, M., Veronese, N., & Stubbs, B. (2019). The effectiveness of hypnosis for pain relief: A systematic review and meta-analysis of 85 controlled experimental trials. Neuroscience and biobehavioral reviews, 99, 298–310. https://doi.org/10.1016/j.neubiorev.2019.02.013