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CLINICAL
FORUM
63
cessof dissociationand help focus the patient away
from
the procedural
discomfort
and
her extreme anxiety about needles. For example:
...
and
youmay feel
a
swishingmotion onyourback..
.
oryoumaysimply
prefer to attend to
a
swishing,circular sensationon your hand
. .
.
or you
may
be swishing
around
in
Kaneohe
Bay
as
a
child,
just
wonderingwho
you
would
be
when
you‘re
all grown
up
.
.
.
or
you
may
be swishing
around
in
your
pool.
.
.
followingtheprecisedirections
of
your
water
aero-
bics
class instructor.
. .
The patient was then slowly lowered on to her side by the therapist,
her pressure was checked by the neurologist, and samples of
cerebrospinal fluid were drawn. During this entire time, the patient re-
mained comfortably in hypnosis with seemingly little reality orienta-
tion, as hypnotic suggestionswere continually given in the manner out-
lined above. Mary was then counted out from hypnosis, at which time
her eyes opened and shewas told that the procedure was completed. She
responded with disbelief that the procedure was actually over and great
satisfactionabout this.
In
fact, she reported complete amnesia for the en-
tire procedure.
In
addition, Mary reported a temporal constriction, be-
lieving that we were merely talking together for
2
minutes.
In
fact, the
entire procedure lasted approximately
30
minutes, and the neurologist
remarked that it was her easiest
LP
to date. Mary’s cerebrospinal levels
of AB42 peptide
(707
pg/mI), tau protein (276 pg/ml), and ApoE geno-
type (allele
1
=
3,
allele
2
=
4)
were consistent (withhigh specificity)that
Alzheimer’s disease is the cause of her neurological symptoms.
Procedriral
Dificulties
Three unexpected difficultiesarose during the lumbar puncture hyp-
nosis
procedure. First,
a
nurse, just prior to the procedure, remarked to
the therapist in the presence of the patient, “Thiswon’t reallywork, will
it?” Second, an observing staff member verbally engaged with the
patient and remarked, “These procedures can often be very scary.”As
may be clear to the reader, these remarks can serve as negative sugges-
tions, reducing thepatient‘sconfidencein her doctors as well as expecta-
tion for positive treatment outcome. These suggestions, however, did
not seem to have a significant negative impact on the procedure, possi-
bly due to the patient’s severely impaired memory. Finally, because it
was not clearlydiscussedin advance,both the neurologist and the thera-
pist thought that each other would be guiding the patient from the sit-
ting position to lying on her side. This led to momentary confusion.The
patient, however, exhibited no noticeable awareness of the disruption.
SUMMARY
AND
RECOMMENDATIONS
Although
a
strong literature base documenting the effectiveness of
hypnosis
for
LPs
in pediatric patients exists, no studies discuss its use
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