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way to conditions of consciousness that are conducive to psychological
adjustment and growth.(2)
Hypnosis in Special Procedures
Procedures performed under local anesthesia with or without sedation are
often anticipated by the patient with the same apprehension as those
requiring general anesthesia. The idea of being conscious during a procedure
may be reassuring in one respect and unsettling in another. On one hand,
the patient's sense of control is maintained; on the other hand, the patient
may feel uncertain as to how he or she will deal with the experience. Even a
simple procedure, like a spinal tap, can be approached with dramatic
imagery: the mental picture of a needle may be much larger than the actual
size of the needle. Similar distortions may also occur with regard to other
procedures, such as cardiac catheterization, bone marrow biopsy, or
sigmoidoscopy.
The anticipatory anxiety generated by the patient's fantasies about a
procedure should not be neglected. It can turn a routine stay in the hospital
into a nightmarish experience and negatively sensitize the patient to future
hospitalizations.
The following case history illustrates some of the principles of hypnosis when
used in the hospital with certain medical procedures:
A 52-year old woman who had never been hospitalized was admitted for
workup of a lung shadow. She was to undergo a bronchoscopic examination
the following day. When she became agitated and highly anxious, a
consultation was requested. Hurriedly wiping away some traces of tears to
appear more presentable, she looked distraught and restless in her bed.
Anticipation of the procedure, which had been explained to her in a cursory
and hurried fashion, had left her in a state of panic. She imagined a large,
cold, straight metallic tube being pushed into her throat and saw herself in
the agonies of choking. Yet, on another level, she spoke amazingly candidly
and rationally: "Doctor, I've been a smoker for many years. I think tomorrow
they will find that I have cancer. But I think I can come to terms with it."
The procedure was explained once more to her. The tube was described--a
picture of it was even drawn--as flexible and as leaving plenty of space for
air to pass. She was told that the more relaxed she would be, the more easily
air could pass. The benefits of deep, autonomic nervous system relaxation
were evident to her, and she heartily agreed to attempt a hypnotic
experience.
Because of her high level of anxiety, an approach more directive than
normally used for outpatient office procedures was invoked. With her
permission, her wrist was taken; gently and slowly her arm was brought
straight out in front of her. She was presented with images of heaviness and
relaxation, and her arm slowly waved itself downward, the hand gently
releasing itself until it came to rest on the bed. With her eyes closed, all
muscle tightness disappeared; her respiration adopted a slow, tempered