Basic HTML Version
CLINICAL
FORUM
57
Montgomery, DuHamel,
&
Redd, 2000; National Institutes
of
Health,
1996)and uncomfortable surgical/medical procedures (Adams
&
Stenn,
1992; Faymonville et al., 1997; Simon, 1999).However, as indicated by
searches on MEDLINE, ClinPSYCH, and the Cochrane Library, as of
May 4,1999, extant clinical literature has failed to document the utility of
hypnosis as a method of controlling LP procedural distress for other
than a pediatric population. Curiously, theclinical literature on hypnosis
with LP has not been expanded to include adult patients, even though
it
is not uncommon for adult dementia patients to undergo an
LP
and
experience significant procedural distress (Porter, 1995;Wilson-Barnett,
1992). Furthermore, there are no extant articles discussing the use of
hypnosis for dementia patients. Although one case study documents the
successof hypnotic treatment for controlling the involuntary choreiform
movements associated with Huntington's Disease (Moldawsky, 1984),
the patient's cortical functions were not limited as they are with a
dementia patient.
Most therapists believe that hypnosis requires sustained attention/
concentration abilities (Spiegel
&
Spiegel,1978).Thus,
it
isnot surprising
that hypnosis is rarely attempted with dementia patients. Nevertheless,
given the benefits obtained with children undergoing LP, we sought to
adapt a hypnotic procedure for
an
adult, needle-phobic patient suffering
fromdementia. Toward this end,we drew upon three (albeitsmall)bases
of literature: (a) use of hypnosis to alleviate LP procedural distress in
pediatric patients, (b)use of hypnosis to treat needle phobias, and (c)use
of hypnosis with cognitively impaired patients.
THEPEDIATRIC
L TERATURE
ON
INVASIVE MEDICAL PROCEDURES
In
the early stages
of
using hypnosis to alleviate distress during
uncomfortable medicaIprocedures in pediatric patients, clinicianscould
merely draw upon case studies that documented the efficacy of this
treatment approach (Dash, 1981; Ellenberg et al., 1980).Thereafter, the
effectiveness of hypnosis was documented with greater scientific rigor
by multiple baseline designs (Hilgard
&
LeBaron, 1982;Kellerman et al.,
1983)and randomized controlled trials (Katz, Kellerman,
&
Ellenberg,
1987;Kuttner, Bowman,
&
Teasdale, 1988;Wall
&
Womack, 1989;Zeltzer
&
LeBaron, 1982).Although two studies suggested that hypnosis did not
decrease behavioral distress (Katzet al., 1987;Wall
&
Womack, 1989),the
general trend in the literature is that hypnosis is reasonably effective in
helping to alleviate the distress typically associated with uncomfortable
medical procedures in pediatric populations.
Hypnosis has been shown to be effective in reducing pain-related
behaviors (Kuttner et al., 1988),behavioral distress (Hilgard
&
LeBaron,
1982; Kuttner et al., 1988),self-reported distress (Ellenberg et al., 1980;
Hilgard
&
LeBaron,1982;Katz et al.,1987;Kellermanet al., 1983;Zeltzer
&
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