Teamwork Approach to Clinical Hypnosis at a Pediatric Pulmonary Center

American Journal of Clinical Hypnosis,  Jul 2005  by Anbar, Ran D,  Hummell, Kim E

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The aim of this report is to demonstrate the success of a teamwork approach for providing instruction in self-hypnosis at a Pediatric Pulmonary Center. In order to add to the hypnosis service provided by a pulmonologist at the Center, the Center social worker learned how to use clinical hypnosis. During a 3-year period, she instructed 72 patients (average age 11.6 years) in self-hypnosis. Eighty-two percent of the patients reported improvement or resolution of the primary symptoms, which included anxiety, asthma, chest pain, dyspnea, habit cough, hyperventilation, sighing, and vocal cord dysfunction. The social worker and pulmonologist consulted with each other on a regular basis regarding their hypnosis work, and achieved similar successful results following their hypnosis interventions. Thus, clinical hypnosis at a Pediatric Pulmonary Center can be provided by a team of varied professionals. As a team, these professionals can support each other in their on-going development of hypnosis skills.

Keywords: Dyspnea, habit cough, hypnosis, social work, vocal cord dysfunction

Instruction in self-hypnosis is helpful in the management of pediatric patients with respiratory problems such as asthma, chest pain, cystic fibrosis, dyspnea, end-stage lung disease, habit cough, hyperventilation, sighing, and vocal cord dysfunction (Anbar, 2000; Anbar, 2001; Anbar, 2002; Anbar & Hall, 2004; Anbar & Hehir, 2000; Hackman, Stern, & Gershwin, 2000). Further, it has been shown that over half of adolescents referred to Pediatric Pulmonary Centers may benefit from psychological intervention (Anbar, 2005). Therefore, referral to individuals specializing in clinical hypnosis (such as developmental-behavioral pediatricians, psychiatrists, psychologists, or social workers) can be useful. One disadvantage of such a referral to individuals outside of Pulmonary Centers is that they may have little experience with respiratory problems that could be amenable to clinical hypnosis. Also, patients may resist referral to mental health providers because they may not believe they have issues amenable to psychologically oriented therapy.

Since 1998, patients at the SUNY Upstate Medical University Pediatric Pulmonary Center have been instructed in self-hypnosis by their pediatric pulmonologist, as described by Anbar (2002). As the demand for clinical hypnosis grew rapidly at the Center, a teamwork approach was needed in order to provide this service in a timely fashion. Therefore, in 2001 the social worker at the Pulmonary Center agreed to learn how to use clinical hypnosis with children in this setting. Subsequently, after medical evaluation by the pulmonologist, appropriate patients were referred to her for instruction in self-hypnosis.

The traditional work for social workers assigned to Pediatric Pulmonary Centers includes assessment of patients' family structure and coping with their illness (including their adherence to prescribed therapies), academic performance, developmental and emotional issues, and financial concerns (Cystic Fibrosis Foundation, 1997). The social worker addresses these issues through provision of education and counseling to the patients and their families. The social worker may not be considered by pulmonologists or physicians referring patients to a Pulmonary Center as a staff member who might provide clinical treatment for patients' respiratory symptoms. Therefore, we present the results of our experience to demonstrate the clear benefit of expanding the Pulmonary Center social worker's role to include hypnosis for pulmonary symptoms amenable to a psychological intervention. Also, we demonstrate how the social worker and pulmonologist worked together as a team to provide essential service within a Pediatric Pulmonology practice.

Method

The social worker was an M.S.W., with a concentration in health care. She attended two 20-hour workshops regarding pediatric clinical hypnosis, which were approved by the American Society of Clinical Hypnosis. The pulmonologist, an M.D., had attended five 20-hour workshops regarding clinical hypnosis, and had used hypnosis in his practice for 4 years. Initially, the social worker's supervision by the pulmonologist was conducted live. Within a month the social worker and pulmonologist began meeting for consultation on a weekly basis.

Patients referred for clinical hypnosis included those thought to have pulmonary symptoms attributable to psychological problems or concerns, (e.g., habit cough or anxiety-induced dyspnea as described by Anbar (2005), or fear of medical procedures).

Patients were instructed in self-hypnosis by the social worker in 30-60 minute sessions. A typical session consisted of the following:

(I) A pre-hypnotic interview about the presenting complaints.

(II) An explanation regarding the nature and utility of hypnosis, and concerns or misconceptions regarding hypnosis were addressed.

(III) A hypnotic induction and deepening based on patients' aptitude and preferences. For example, an induction might have included imagery of helium balloons levitating an arm, imagining inhalation of air that was the patients' favorite color, imagining a favorite place, or relaxation of muscle groups progressively from head to toes or toes to head. Indications that patients were in hypnosis included observation of eyelid fluttering, catalepsy, and slowed respiration.