This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution CC BY license http: This article has been cited by other articles in PMC. Clinical hypnosis is an important mind—body tool that serves as an adjunct to conventional medical care for the adolescent patient.
Clinical hypnosis specifically uses self-directed therapeutic suggestions to cultivate the imagination and facilitate the mind—body connection, leading to positive emotional and physical well-being. Clinical hypnosis can be used by health care providers to teach adolescents coping skills to deal with a wide variety of conditions such as chronic headaches, recurrent abdominal pain, anxiety, depression, grief and bereavement, phobias, anger, family stressors, sleep disorders, or enuresis.
Clinical vignettes are given to help illustrate the effectiveness of hypnosis in adolescents. Introduction Mind—body medicine is a philosophy and a system of health practices that enlist the mind in improving emotional well-being and physical health. Mind—body therapies focus on balancing the autonomic nervous system ANS by activating the parasympathetic branch of the ANS to reduce the sympathetic physiological response to stress and by regulating the hypothalamic pituitary adrenal axis, both of which are indicators of stress.
This reduction of stress on the mind and body may help control or reverse certain underlying disease processes. Evidence suggests that the mind and body have constant bidirectional communication through neuro-endocrine, neuro-chemical, immunological, and energetic pathways.
Higher cognitive centers and limbic emotional centers are capable of regulating virtually all aspects of the immune system and therefore have a profound effect on health and illness-termed psychoneuroimmunology [ 1 , 2 , 3 ]. These therapies may improve the quality of life and reduce the physical symptoms for adolescents with various chronic diseases. Data from the National Health Interview Survey show that mind—body therapies were used in adolescents aged 13 to 17 years, and more often among females versus males 5.
Children and youth were more likely to use mind—body therapies for pain-related conditions or emotional, behavioral, or mental conditions and if they received specialty or mental health care. Mind—body therapies such as clinical hypnosis are considered safe and can be effective for adolescents with medical conditions such as tension or migraine headaches, enuresis, recurrent abdominal pain, constipation, sleep difficulties, acute or chronic pain, anxiety, and other emotional and stress-related symptoms [ 6 , 7 ].
Stress and the Developing Adolescent Brain Adolescence is a period of rapid physical growth, intellectual and cognitive development, as well as a time for creating autonomy, and promoting both self-esteem and strong peer relationships. During adolescence, teens experience the ebb and flow of emotions between self-confidence, insecurity, invincibility, anxiety, worry, doubt, and self-worth as a result of rapid changes occurring in the brain and neuro-biological and neuro-endocrine systems.
The rapidly developing adolescent brain is sensitive to stress and adverse events due to changes in hormones and the plasticity in the structure and function of the brain [ 8 ].
Brain development during adolescence involves changes in the frontal and parietal cortices, the site of higher-order cognitive and socioemotional processes i. The cortex is fine-tuned through synaptic pruning in areas that play a role in judgment, impulse control, planning, and emotion regulation [ 9 , 10 , 11 ]. Glucocorticoid receptors are found in the amygdala, hippocampus, and prefrontal cortex PFC ; exposure to stressful experiences leading to increase in glucocorticoids has been shown to alter the size and neuronal architecture of these areas as well as lead to functional differences in learning, memory, and other aspects of executive functioning.
Specifically, chronic stress is associated with hypertrophy and over-activity in the amygdala and orbitofrontal cortex, and can lead to loss of neurons and neural connections in the hippocampus and medial PFC.
The PFC turns off the cortisol response and regulates the autonomic balance i. The consequences of structural changes in the brain include more anxiety related to both hyper activation of the amygdala and less control as a result of PFC atrophy, as well as impaired memory and mood control due to hippocampal reduction [ 13 ].
Executive functions, such as the ability to direct attention and solve problems efficiently, the awareness of threat, and effective fear processing are diminished when there are significant emotional stimuli during adolescence [ 14 , 15 , 16 , 17 ]. Rapid neurobiological changes during times of emotional stress may predispose adolescents to difficulties with emotion regulation [ 8 ].
Difficulties in emotion regulation are a feature of many emotional and behavioral problems seen in adolescents, including anxiety, depression, conduct problems, cutting, disordered eating, and substance abuse [ 18 , 19 , 20 ]. Anxiety disorders are the most common condition These morbidities may lead to stress-related problems such as chronic headaches, abdominal pain, anxiety, depression, and other emotional problems [ 23 ]. Adolescents who experience emotional stress often complain of chronic physical symptoms that respond poorly to standard medications.
Cognitive and emotion regulation, including the ability to modulate responses to stress, is increasingly found to contribute to overall adjustment, including social emotional development e.
They may reduce the impact of stress-related conditions, lessen depression and anxiety, alleviate pain, improve quality of life, and increase emotion regulation and subjective well-being [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. However, clinical hypnosis specifically uses self-directed therapeutic suggestions to cultivate the imagination and facilitate the mind—body connection, leading to positive physical, emotional, and behavioral change. Using brain imaging, cognitive neuroscientists have identified the power that therapeutic suggestions have on attention functions and associated brain networks and their impact on physical and mental experience [ 35 , 29 ].
Clinical hypnosis is a teachable coping skill that most adolescents except those with moderate to severe mental retardation are able to learn with minor effort, and it is safe, effective, and has no adverse side effects in trained hands. Although there is no universally agreed-upon definition of hypnosis, it can be best described as the cultivation of the imagination in an altered state of consciousness awareness and alertness within a focused state with or without physical relaxation , in which an individual is selectively focused, absorbed, and concentrating upon a particular idea or image aimed at improving mental or physical health.
In this state, perceptions and sensations can be enhanced, modified, or changed to inhibit and control reflexive actions, delay gratification, use problem-solving strategies, increase self-esteem, and decrease anxiety, stress, or discomfort. Hypnosis in adolescents is more permissive and less directive than in adults, as it utilizes the natural hypnotic abilities that teens bring to the clinical encounter.
Hypnotherapy allows the adolescent to gain a sense of control, increase self-esteem and competence, and reduce stress. Clinical hypnosis is indicated when 1 an adolescent is responsive to hypnotic suggestions; 2 a problem is treatable with hypnosis; 3 good rapport exists between the adolescent and provider; 4 the adolescent is motivated to remedy the problem; and 5 no iatrogenic harm is anticipated by use.
Caution is indicated in adolescents with a history of physical, sexual, or emotional abuse and those with post-traumatic stress disorder PTSD , in which case coordination of care with a qualified mental health expert is strongly advisable.
Clinical hypnosis is an effective and powerful tool and with appropriate clinical pediatric hypnosis training skills-based pediatric hypnosis workshops, www.
Hypnosis can also be effective for managing procedure pain [ 48 ] and chronic pain related to disease—i. Hypnosis can be beneficial in teaching them to quiet their mind, slowing and focusing, so that they can sort out frustration or anger produced when the mind works faster than the ability to communicate, and direct them in a positive manner [ 55 , 56 , 57 , 58 ].
For more detailed descriptions and references of the wide range of clinical conditions for which hypnosis is applicable and effective in adolescents, readers can consult the two standard textbooks on clinical hypnosis by Kohen and Olness, Sugarman and Wester [ 59 , 60 ], as well as an excellent review article by Kohen and Kaiser [ 61 ]. Application of Clinical Hypnosis—Clinical Vignettes Through clinical vignettes, this article illustrates common applications of clinical hypnosis in adolescent health care.
The success of clinical hypnosis depends on establishing a strong rapport with the adolescent and individualizing the therapy to the specific goals and characteristics of the adolescent. They should reinforce whatever happens, get feedback from the teen, and address anxiety as well as pain. The use of other cognitive and behavioral strategies should be incorporated as well to address the symptom.
Chronic Daily Headaches A year-old female was referred by her neurologist for chronic headaches. Her neurological work up for headaches was negative, with no anatomical or pathological etiology.
She had a history of daily headaches, that did not wake her up from sleep but did cause her to miss school and not socialize with her friends. She would sleep to help her headaches. Past medical history and social history were non-contributory. No history of depression, anxiety, or school problems. Mental status evaluation revealed normal cognition and no apparent psychiatric disorder such as a conversion disorder, psychosis, or thought disorder. The patient and parents were receptive to learning clinical hypnosis.
The patient was motivated to get rid of her headaches and resume her normal life. A second visit was scheduled to teach the patient clinical hypnosis techniques. The adolescent is taught to use techniques such as progressive muscle relaxation, focused breathing, and visual imagery to help them get into a relaxed and focused state with or without physical relaxation. In this relaxed state, the brain is more focused and receptive to learning techniques to feel better and ultimately make the headache pain dissipate.
Prior to incorporating visual imagery and giving a therapeutic suggestion to alleviate the symptom or problem, the clinician asks the adolescent what they would like to imagine that is fun and makes them happy i.
In this deeper relaxed state, the mind is open and receptive to ideas to help them with their symptoms. In this case the clinician asked the patient to draw a picture of what her headache felt like to her. She drew a picture of a hammer pounding her head. Then both the clinician and the patient devised a method to stop the hammer from pounding her head. The patient used her imagination to visualize having a stop sign come up before the hammer hit her head which would stop the hammer and thus would stop the headache.
She then practiced visualizing the stop sign coming up and saying stop to the hammer before it hit her head the therapeutic suggestion. The clinician then developed a concrete plan with the teen to help practice her clinical hypnosis techniques. Some clinicians ask their patients to keep a calendar of their practice easy to do on their smartphone.
The focus is on practicing clinical hypnosis, not on the symptoms. At the follow up visit a month later, she was practicing her clinical hypnosis, she had kept a calendar of when she practiced hypnosis and pain scale of the headaches. Her headaches were infrequent and not interfering with her daily activities or school. Needle Phobia This was a year-old male was referred by his primary care doctor to learn clinical hypnosis for needle phobia.
He became very anxious and hysterical prior to obtaining any immunizations or blood draws and was therefore behind on immunizations and screening lab tests. Past medical history was significant for attention deficit hyperactivity disorder, treated with methylphenidate. There was no history of other psychiatric diagnosis. He was motivated to learn clinical hypnosis.
He recognized that he needed immunizations to stay healthy but was afraid of shots. Also, exposure therapy with desensitization is the treatment of choice for phobias. He was exposed to the equipment e. He did well in the practice session. The patient came back two days later and went through the clinical hypnosis technique of distraction and disassociation and successfully received his immunizations. Primary Nocturnal Enuresis A year-old male was referred by his pediatrician for management of primary nocturnal enuresis.
He was in the ninth grade and played hockey with practices late at night and quite a few games away from home. He was very embarrassed about his bedwetting and thus very motivated to stop. Family history was positive for nocturnal enuresis in father until age He reported drinking a lot of fluids after each hockey practice and game.
He had a difficult time unwinding and falling asleep and was a deep sleeper. He denied drugs, alcohol, or tobacco use and did well in school. There were no other stressors at home or school. He was motivated to learn clinical hypnosis and stop bedwetting. The clinician discussed the mind—body connection—i. He was told that his brain and bladder talked to each other very well, and cooperated and worked well because during the day he never wet his pants even if he had to go really badly, he could hold his pee.
He was shown a drawing of genitourinary anatomy and physiology, and was engaged in building curiosity about how the body works, thus helping him be in a spontaneous hypnotic state. The drawing showed how urine was sent from the kidneys to the bladder. The bladder was shown as a container with a muscle at the tip that has a gate that is closed and keeps the urine in the bladder until he goes to the bathroom and the mother computer i.
The drawing showed the brain and bladder connection, with bi-directional arrows communicating between the full bladder and the brain, keeping the gate closed until he gets the message from the brain to open it.
Then the clinician had him imagine having this conversation in his head to practice how he would have the brain and bladder talk to each other.