Nick Sharpe 2177 words

Choose a medical condition that interests you and research it. Write about the possible uses of hypnosis in the treatment of the condition as you see them.

I will be looking at the impact that chronic illnesses have on a person’s life with particular reference to the illness Myalgic encephalomyelitis’ (M.E.) sometimes known as ‘Chronic Fatigue Syndrome’ (C.F.S). I will explore the role that hypnotherapy can have in pain relief and stress reduction. M.E. is an illness about which there is currently much disagreement among medical professionals regarding its classification, aetiology and recommended treatment. Estimates of it’s prevalence in the UK for example have ranged from 6 to 2600 in 100’000 across 10 years of study (1). Estimates by national health organizations say 450’000 people in the UK suffer. it occurs more often in women and is less prevalent among children and adolescents. Most research done has been on the assumption that they’re the same and this is gives good enough information at least for therapeutic purposes. CFS didn’t gained acceptance as a bona fide illness until 1988 because it is a ‘diagnosis by exclusion’ illness that can’t be tested for directly. Also the primary symptoms of fatigue, lethargy and muscle aches are similar to psychological conditions like depression, leading it to be dismissed by many as ‘all in their head’, a viewpoint is still held by some authorities. The Centre for Disease Control does in fact legitimise C.F.S. (2) For a diagnosis the they require that it not be a life-long condition and that they have experienced at least six months of Unrelenting, unexplained fatigue that is described as ‘chronic and severe mental and physical exhaustion’ Also at least four core symptoms are required from a list including: prolonged aching muscles and joints, swollen lymph nodes, un-refreshing sleep and post-exertional fatigue. There are scores of additional symptoms that may also exhibit, which further complicate diagnosis and treatment. Patients can suffer mild, moderate or severe symptoms depending on severity of symptoms. Mild sufferers can continue with life mostly unimpaired while severe sufferers are completely disabled. Currently most medical authorities have M.E. being equated to or subsumed under C.F.S. generally. The distinction between the two is more than a semantic one; it may lead to patients being wrongly diagnosed and given counter productive treatment. The ‘National Institute for health and Care Excellence’ published results to this effect which was highly criticised for its flawed methodology and the involvement of no M.E. specialists in their research. The World Health Organisation however disagrees: “The term CFS covers many different conditions, which may or may not include ME. The use of the term CFS in the I.C.D. Index is merely colloquial and does not necessarily refer to M.E. It could be referring to any syndrome of chronic fatigue, not to M.E. at all. ” If for instance, fatigue is viewed as a psychological symptom, it would be best treated - and often has been - with exercise. M.E. however is identified by its unique post-exertional fatigue, which, being quite different from ordinary fatigue causes severe depletion of energy after exercise for hours afterwards. So, it is argued, it’s unsafe, unreliable and unrealistic to equate C.F.S with M.E. on a medical level yet, without ubiquitous consensus on if it’s mental or neurological nature, doctors can choose arbitrarily which diagnosis to make and what treatments to give. The specific aetiology of CFS is not fully understood and it may have multiple causes. Suggestions include viral, environmental and psychological causes. Genetics has shown to predispose people to the illness although an external trigger event often accompanies its onset. Biochemical causes such as A.N.S. dysregulation and mitochondrial dysfunction (cells being unable to extract energy from food) have been suggested and my own meta-analysis convinced me the latter to be the most likely cause for M.E. Dr. Myhill (2009) outlines evidence for this in her paper (3) and shows how this explanation relates to symptoms, particularly poor stamina and delayed post-exertional fatigue. Stress is a contributing cause. When it becomes a persistent negative factor it can cause a collapse in body’s defences lowering resistance to illness. In fact evidence shows CFS sufferers have a higher ‘Allostatic load’ than normal. (4) This represents the physiological consequences of exposure to heightened neural response that results from chronic stress or the ‘wear-and-tear’ that stress has on the body. So stress has more of an effect on CFS patients than normal and so will be a primary focus for therapy The other main focus will be on pain relief. M.E. Patients suffer from prolonged chronic pain in muscles and joints and ‘paroxysmal’ pain which is characterised by sudden, intermittent bursts of acute pain. Quite besides the immediate somatic disadvantages, on-going pain can cause additional stress, anxiety and fear. Most pain is caused by ‘nociceptor’ cells, detecting a pain stimulus, relaying this message to the brain along neurons and the brain then generates the pain sensation. Pain can be relieved by use of the signal molecules endorphin and encephalin when bound to specific receptors in the brain. (5) The intensity of pain is subjective and varies between people. Intensity depends on: Fear and anxiety (often of further pain), emotional state, environment, gender, culture, and previous experience. Possible secondary gains (side-benefits from the illness) need to be considered too as they may affect motivation for therapy to work. When making a therapeutic treatment plan for chronic illness, there are numerous considerations to be made as not just health is affected. An outline suggested by Dr K. Downing-Orr (2010) (6), for a ‘psychological path to wellness’ involves 5 elements to be considered for therapy; their emotions, environment, physiology and behaviour and also their own thoughts on each of these. These elements can be expressed in the simpler ‘biopsychosocial’ model theorized by psychiatrist George L. Engel (2005) The biological component of this model looks at the illness itself directly. It is necessary when working with any medical illness that they have written consent from their G.P. who has diagnosed them. Hypnotherapy must never replace or modify medical treatment and must take into account any medical limitations that exist. Exercise for instance is needed for M.E. to avoid muscle atrophy but only at their doctor recommendation. The use of any medications used should be decided on by their G.P. but made aware to the therapist. a history of physical and mental illness, particularly any chemical dependency would be needed too. For the social considerations, details of their support network of friends and families and the nature of important relationships will be useful. If there are any perceived problems here, these may be addressed separately in therapy too. Aspects of their lifestyle such as living conditions, socio-economic standing, their culture and beliefs fall under this category and should be learned about in detail. If they have a carer, their well-being should also be considered. This can easily be overlooked especially if they are relative with no training and understanding of the physical or psychological demands of their work. The psychological aspects of their condition will be of most interest to a therapist. Their belief system, emotional outlook, both present and past and any recurring thought patterns will serve to inform the direction and extent to which therapy can be applied. Denial about the extent of their illness or the limitations it puts on them can be an expected response that should be looked out for. They exaggerate or play-down the degrees to which they’re suffering which needs to be carefully assessed. If the illness is not new, any information about previously help sought and how effective it was will be useful for evaluating potential treatment strategies. Unless they have the foundations in place for a lifestyle that’s conducive to recovery, any therapeutic work could be undermined. Some practical considerations might be their diet and if they smoke or drink. (If they drink in excess, it may indicate a coping behaviour which may need to be addressed separately.) Reducing stress is an important part of therapy and so any practical ways of doing this such as avoiding stressful places, situations or people in their lives should be examined first. When forming a treatment plan we must identify problem areas, set goals for treatment and decide on methods for reaching goals. Negative emotions are commonly associated with the onset of a chronic illness such as stress, low Self-esteem, irritability depression, guilt, anxiety, and loss (of hopes for the future and a sense of identity). These have a deleterious psychosomatic effect which, make symptoms even worse. This cycle can only be broken by helping them to accept and adjust emotionally to their condition. Stress and anxiety can be from physical stress directly from having it, from the lifestyle changes that have to be made, potential financial concerns and social factors. M.E. is a notoriously misunderstood illness and many feel a lack of sympathy from people sometimes leading to pressure to try and hide it. Relieving stress will therefore be a primary focus The other focus will be on pain. Although this is common for M.E. the specific nature, intensity and areas affected can differ greatly, necessitating a detailed assessment. Goals for therapy then will be: 1) to reduce stress and anxiety, 2) to reduce pain or better cope with pain and 3) to improve their emotional outlook. Methods to reduce stress and anxiety will first involve a personalised but general relaxation induction. Specialised additional stress reduction sessions will be written to deal with specific identified stressors in their life. Pain management will come in two sections; coping strategies and pain reduction. Reducing stress will not only help with the hypnotherapeutic aspect of therapy but being relaxed actually reduces the perception of pain anyway. Continued relaxation exercises will therefore be a key component in pain management. The two inductions used will be on general and specific pain control. Since much of the perception of paroxysmal pain is in the fear and anticipation of it, the general pain control induction is about embracing and preparing for the pain to minimise the psychological impact it has. Essentially this part is about implanting suggestions to tolerate pain in a measured and appropriate way. This skill helps with the second part which is the actual reducing of it. Pain reduction must never be attempted unless the source is fully understood. The pain mustn’t ever be eliminated either as it conveys information about changes in health. When taught to ignore pain, they must never ignore new pain. The primary method of pain control is to describe the shape and colour of their specific pain and that of pain relief but without being given time to consider it. This gives us an idea of how their subconscious perceives the pain allowing us to work more effectively. The general pain induction screed for pain reduction will include relaxation sections which will make it more effective, and suggestions will then be given to reduce it. First changing shape to the harmless form and then leaving the body. Before this though they will first be suggested to manipulate it other ways, such as moving it or perhaps even increase it. This is Paradoxical injunction (6). This could increase their feeling of control and confidence in the method but the therapist must be very confident in their justification for doing it and in their own skill. The words in the screed chosen to describe the pain, where the pain will leave the body and how they will feel afterwards will all come from the client’s earlier descriptions. Another approach is by having the subconscious affect biological aspects of the pain pathway themselves. It’s possible to increase endorphin production by hypnotic suggestion. Suggestion can be given that they have control of endorphin production either directly or via a dial in the brain that can be turned at will. Another approach to is glove anaesthesia. This is embedding a post-hypnotic suggestion to numb all sensation first in their hand and then when they place their hand on the painful area they are given the suggestion to transfer across the loss of sensation. This can potentially be very effective especially for M.E. where the onset of pain is unpredictable in both when and where on the body it can act. It does take a lot of practice however and so more sessions will be needed if this strategy is desired. The final sessions will be on promoting a positive out-look for the future. Sessions will involve Enhance coping strategies, Encouraging acceptance and increasing self-esteem. Clear images of themselves when they are better will increase motivation and maintain better long-term health. It is important when using motivating images of them selves being better that goals are realistic. In chronic conditions these won’t mean ‘healed’, instead these will be of them living their life happily and fully within the limits of their illness and of them coping well with pain rather than being free of it. Because M.E. is so varied in its effects on patients, the time frame for therapy will depend on how many treatment methods will be attempted. This will depend on the severity and nature of the illness and also on the client’s own outlook and ability to cope.

Bibliography

1) Alison Adams Chronic Fatigue, ME and Fibromyalgia: The natural recovery plan (2010) Watkins Publishing London

2) Centers for Disease Control and Prevention 2014 Chronic fatigue syndrome (CFS) http://www.cdc.gov/cfs accessed 3/9/2014

3) Myhill, S et al. 2009 Chronic fatigue syndrome and mitochondrial dysfunction. International Journal of Clinical and Experimental Medicine 2, 1-16

4) Elizabeth Turp Chronic fatigue syndrome / M E (2011) Jessica Kinglsey Publishers

5) N, A Campbell & Jane, B Reece (2005) Biology 7th edition. Pearsons, Benjamin Cummings.

6) Dr, Kristina Downing-Orr beating chronic fatigue (2010) Piatkus

7) Chrysalis, (2010) Hypnotherapy and counselling skills -. Year one, Module eight.

8) Josie Hadley and Carol Staudacher hypnosis for change (3rd edition) New harbinger publications, 1996

9) Segi, S. (2012). "Hypnosis for pain management, anxiety and behavioural disorders". Factiva. Retrieved December 7, 2012.

10) Susan R. Lisman, MD Karla Dougherty Chronic fatigue syndrome for dummies (2007) wiley publishing inc