28.9 Hypnosis
883
Results
Behavior therapy has been used successfully for a variety of dis-
orders (Table 28.8-3) and can be easily taught (Table 28.8-4). It
requires less time than other therapies and is less expensive to
administer. Although useful for circumscribed behavioral symp-
toms, the method cannot be used to treat global areas of dysfunc-
tion (e.g., neurotic conflicts, personality disorders). Controversy
continues between behaviorists and psychoanalysts, which is
epitomized by Eysenck’s statement: “Learning theory regards
neurotic symptoms as simply learned habits; there is no neu-
rosis underlying the symptoms, but merely the symptom itself.
Get rid of the symptom and you have eliminated the neurosis.”
Analytically oriented theorists have criticized behavior therapy
by noting that simple symptom removal can lead to symptom
substitution: When symptoms are not viewed as consequences
of inner conflicts and the core cause of the symptoms is not
addressed or altered, the result is the production of new symp-
toms. Whether this occurs remains open to question, however.
Behavioral Medicine
Behavioral medicine uses the concepts and methods described
above to treat a variety of physical diseases. Emphasis is placed
on the role of stress and its influence on the body, particularly
on the endocrine system. Attempts to relieve stress are made
with the expectation that either the disease state will lessen or
the patient’s ability to tolerate the disease state will strengthen.
Table 28.8-4
Social Skills Competence Checklist of Therapist-
Trainer Behaviors
1. Actively helps the patient set and elicit specific interpersonal
goals.
2. Promotes favorable expectations, a therapeutic orientation,
and motivation before role playing begins.
3. Assists the patient in building possible scenes in terms
of “What emotion or communication?” “Who is the
interpersonal target?” “Where and when?”
4. Structures the role playing by setting the scene and assigning
roles to the patient and surrogates.
5. Engages the patient in behavioral rehearsal—getting the
patient to role play with others.
6. Uses self or other group members in modeling appropriate
alternatives for the patient.
7. Prompts and cues the patient during the role playing.
8. Uses an active style of training through coaching, shadowing,
being physically out of a seat, and closely monitoring and
supporting the patient.
9. Gives the patient positive feedback for specific verbal and
nonverbal behavioral skills.
10. Identifies the patient’s specific verbal and nonverbal behavioral
deficits or excesses and suggests constructive alternatives.
11. Ignores or suppresses inappropriate and interfering behavior.
12. Shapes behavioral improvements in small, attainable increments.
13. Solicits from the patient or suggests an alternative behavior
for a problem situation that can be used and practiced during
the behavioral rehearsal or role playing.
14. Evaluates deficits in social perception and problem solving
and remedies them.
15. Gives specific attainable and functional homework assignments.
(Courtesy of Robert Paul Liberman, M.D., and Jeffrey Bedell, Ph.D.)
One study measured the effects of a behavioral medicine
program on symptoms of acquired immunodeficiency syndrome
(AIDS). The treatment group received training in biofeedback,
guided imagery, and hypnosis. Results included significant
decreases in fever, fatigue, pain, headache, nausea, and insom-
nia and increased vigor and hardiness.
Another study of immunological and psychological outcomes
of a stress reduction program was conducted with patients with
malignant melanoma. Results included significant increases in
large granular lymphocytes (defined as CD57 with Leu-7) and
natural killer (NK) cells (defined as CD16 with Leu-II and CD56
with NKHI), along with indications of increased NK cytotoxic
activity. Also noted were significantly lower levels of psycho-
logical distress and higher levels of positive coping methods in
comparison with patients who were not part of the group.
Many other applications of behavior therapy are used in medi-
cal care. In general, most patients feel they benefit from such inter-
ventions, especially in their ability to cope with chronic illness.
R
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▲▲
28.9 Hypnosis
The concept of hypnosis conjures up myriad perceptions among
clinicians and the lay public. Even the term
hypnosis
can be mis-
leading, coming as it does from the Greek root
hypnos
(meaning
“sleep”). In reality, hypnosis is not sleep. It is more likely a com-
plex process that requires alert focused and receptive attention.
Hypnosis is a powerful means of directing innate capabilities of
imagination, imagery, and attention. Many also believe the myth
