Clinical Hypnotherapy: Improving Patient Care

Course #9690L-


Self-Assessment Questions

    1 . Which of the following statement(s) is/are correct?
    A) Hypnosis involves the conscious state and is similar to meditation.
    B) Hypnosis refers to a state of deep relaxation and focused attention.
    C) Hypnosis describes a state of attention that people can naturally enter.
    D) Both B and C.

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    2 . Which of the following behaviors have been shown to result in similar brain wave activity to hypnotic trance?
    A) High-level artistic performance (e.g., a child imagining that he is Superman)
    B) Sleep, meditation
    C) Rocking a baby (for both adult and baby)
    D) Both A and C

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    3 . Which is correct about the use of testimony provided with hypnotic suggestion in forensic proceedings?
    A) Such testimony is considered as credible as a consciously delivered witness statement.
    B) The examiner must be very careful not to make leading suggestions to the witness.
    C) A licensed psychologist must perform the hypnosis for it to be considered admissible in court.
    D) Testimony provided from witness recollection after hypnotic suggestion is NEVER acceptable in legal or criminal proceedings.

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    4 . Which of the following statements is TRUE?
    A) Dr. Milton Erickson posits that "All hypnosis is self-hypnosis."
    B) Dr. Franz Mesmer preferred psychoanalysis over hypnosis.
    C) Dr. Milton Erickson used the term "lucid sleep" to describe hypnosis.
    D) Dr. Sigmund Freud popularized modern hypnotherapy.

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    5 . Which of the following statements is TRUE?
    A) Subjects are completely in control during trance, but involuntary parasympathetic activity such as increased salivation and lacrimation can occur.
    B) Subjects can get "stuck" in trance forever.
    C) Deep trance is required for hypnotic suggestions to be therapeutic.
    D) Memories elicited while in trance are reliable.

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    6 . Where are the majority of our serotonin receptors located?
    A) The peripheral nervous system
    B) The central nervous system
    C) The gastrointestinal tract
    D) The amygdala

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    7 . Which of the following involves forms of hypnotic suggestion or techniques?
    A) Guided imagery in practicing the arts or sports
    B) Use of motivational interviewing
    C) Studying and reciting text
    D) Both A and B are true

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    8 . Which of the following statements regarding placebo and nocebo responses is TRUE?
    A) These responses involve conscious thought and have nothing to do with hypnotic methods.
    B) Such responses are believed to be triggered or accentuated based on the belief that something will or will not work. The mere suggestion of a potential response triggers a belief system, affecting mood and perception, which can affect both objective and subjective responses to treatment. These outcomes are real and measurable but may or may not last as long as a true treatment effect.
    C) It depends on whether formal hypnotic suggestion was deliberately used on the subject.
    D) The placebo response is an example of hypnotic suggestion; the nocebo response is not, as it involves negative suggestion.

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    9 . Which of the following describes an accurate relationship between the area of the brain and the listed function?
    A) The prefrontal cortex is associated with spatial and daily routine memory and mood regulation.
    B) The amygdala is involved with anxiety, fear, and aggression and is often overactive in trauma responses.
    C) The hippocampus is responsible for decision making and self-regulation.
    D) The hypothalamus is considered the "master gland" and regulates other hormones.

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    10 . Which statement is NOT correct?
    A) Almost any symptom can be potentially improved with the use of hypnosis.
    B) Although hypnosis can help treat symptoms of disease, a thorough clinical evaluation is prudent.
    C) A symptom or condition can only be improved with hypnosis if there is an identifiable psychological trigger.
    D) Hypnotic suggestion can sometimes be used as monotherapy but is more commonly used with other treatment methods.

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    11 . Which of the following information is INCORRECT?
    A) Athletes frequently utilize trance states, and many have received formal training in hypnotic methods. These methods become more important when physical training options are limited.
    B) In a 2016 study in sports medicine, electromyography (EMG) revealed variations in measured muscular activity when patients imagined lifting heavier objects compared to lighter ones.
    C) Hypnosis does not create a state of concentrated attention and heightened suggestibility. It does not require concentration and is a passive process.
    D) Neuroimaging research has identified brain patterns indicating EMDR demonstrates increased activity in regions involved in memory processing and emotional regulation, and hypnosis reveals alterations in areas linked to attention and self-awareness.

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    12 . Which of the following statements is correct regarding varying hypnosis techniques used by children and adults?
    A) Children in trance may appear to play and have eyes open in an awake-looking state.
    B) Musicians rarely enter a trance state.
    C) Formal adult hypnosis induction rarely has eyes closed.
    D) Children are less creative, less flexible, and harder to hypnotize as compared to adults

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    13 . Which of the following statements regarding pain is accurate?
    A) Utilizing hypnosis to express gratitude to the subconscious for highlighting areas that require attention reinforces the idea that pain has a purpose.
    B) Hypnosis can assist in reshaping the patient's perception of pain, offering greater control over both its intensity and the emotional reactions associated with it.
    C) Acknowledging the patient for "taking control" and being prepared to "move forward" in exploring the deeper mental, spiritual, and emotional dimensions of pain are essential for a more comprehensive and effective management strategy.
    D) All are true.

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    14 . In busy clinical settings, like emergency departments or pre-operative areas, there is often not enough time for formal hypnosis sessions, which makes that an impractical expectation. More experienced clinicians are better equipped to integrate informal suggestions and hypnotic language into their patient interactions to facilitate positive outcomes. Which statement is unlikely to yield a positive outcome?
    A) "As soon as you wake up, your healing can begin. You can imagine your body working to keep you safe and help you heal. You will know just how much inflammation and just how much bleeding/clotting you need."
    B) "You will be pleasantly surprised how little discomfort you will have."
    C) "Hang on, this will just hurt for a while."
    D) "You will be amazed at your ability to tune out any incoming stimuli that are not necessary for your healing/recovery. Feel free to reframe anything you hear/see/feel into sensory input that will only serve to help you during this time."

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    15 . Consent for procedures involves discussion of possible negative outcomes, most of which are rare. Which of the following is NOT helpful when discussing consent?
    A) Keeping the discussion "left brained" by using numbers, all while avoiding activation of the right hemisphere
    B) Having patients imagine and picture potential negative outcomes
    C) Speaking in third person when discussing potential risks
    D) Avoiding eye contact unless the patient's eyes are already latched on to yours

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    16 . Which statement is the least helpful in leaving a conversation on a positive note?
    A) "I'll bet it will feel great to be back on the golf course."
    B) "I am not sure this procedure will help, and it might hurt a bit"
    C) "I'll bet your family will be happy to see you preparing meals again."
    D) "I can't wait to see what you make once you're feeling well enough to get back to crafting again."

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    17 . Although the hypnoanalysis method requires significant training and expertise, identifying the most prevalent subconscious motivators that may trigger or exacerbate unwanted behaviors or symptoms can aid in discovery and comprehension and is a powerful technique in patients who suffer conversion disorders. Which of the following is NOT a common motivator per the COMPISS acronym?
    A) Conflict
    B) Organ language
    C) Past experience
    D) Possession

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    18 . Which of the following statements is FALSE?
    A) There are many studies that implicate the anterior cingulate cortex (ACC) as key in hypnosis.
    B) A study in 2004 used a painful thermal stimulus to the hand and demonstrated a subsequent reduction in patient-reported symptoms with the use of hypnosis. Shultz-Stubner showed that, during hypnosis, there is an increase in BOLD signals in the left hemispheric anterior cingulate cortex and the basal ganglia.
    C) Raz and Posner studied the elimination of the" Stroop Effect" by suggestion with functional MRI data revealing that under posthypnotic suggestion, both ACC and visual areas presented reduced activity in highly hypnotizable persons compared with either no-suggestion or less-hypnotizable controls.
    D) "Amir Raz wrote: "At least for highly suggestible people, words framed as part of a carefully crafted suggestion can NEVER change focal brain activity in a way any drug we have can do."

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    19 . In an obstetrics and gynecology study that examined the advantages of utilizing hypnosis for pain relief as a complement to childbirth education, the authors, Harmon, Hynan, and Tyre, found all the following, EXCEPT:
    A) The hypnosis group indicated a pain relief level of 38%, compared to just 7% in the control group. While the control group anticipated a pain level of 4.3/5, those receiving hypnosis reported a significantly lower level of 2.9/5.
    B) The hypnosis group experienced shorter stage 1 and stage 2 labor durations, with an average of 248 minutes for stage 1 in the control group compared to just 79 minutes in the hypnosis group.
    C) The non-hypnosis group liked their birth experience more than the hypnosis group.
    D) Higher Apgar scores were recorded at both the one-minute and five-minute marks for the hypnosis group, with scores of 8.7 versus 7.1 and 9.3 versus 8.7, respectively.

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    20 . Which of the following statements may demonstrate a bias favoring the pharmaceutical industry?
    A) A 2002 study included 250 patients with IBS. The treatment group received 12 sessions of hypnotherapy during a 3-month period, plus home practice between these sessions. Marked improvements were seen in all measured IBS symptoms, and all other parameters of IBS severity were reduced by more than 50% on average compared to the control group. The IBS hypnosis studies show results that were measured up to 6 years, which indicated the results were maintained.
    B) In a review article, Miller et al. noted "the effect of hypnotherapy in a large cohort of refractory IBS patients." A total of 1,000 IBS patients fulfilling Rome II criteria, mean age 51.6 years (range: 17 to 91 years), 80% female, received 12 sessions of hypnotherapy over 3 months with a primary outcome of a 50-point reduction in the IBS Symptom Severity Score and improvements in scores for noncolonic symptoms, quality of life, and anxiety or depression as secondary outcomes. They reported a 30% or more reduction in patient-reported abdominal pain, which met the requirement for "successful treatment" as defined by the U.S. Food and Drug Administration.
    C) In the Miller article, overall, 76% met the primary outcome, which was higher in females (females: 80%, males: 62%, P <0.001) and those with anxiety (anxious: 79%, non-anxious: 71%, P = 0.010) with the mean reduction (improvement) in other scores included: IBS Symptom Severity Score, 129 points (P <0.001), Noncolonic Symptom Score, 65 (P <0.001) and Quality of Life Score, 66 (P <0.001). 67% reported a 30% or more reduction in abdominal pain scores. Pain days fell from 18 to 9 per month. Patient reported anxiety and depression scores fell from 63% to 34% and 25% to 12%, respectively (P <0.001). A total of 760 (76%) patients exhibited a 50-point or more reduction in their total score, which was clinically significant.
    D) Despite thousands of patients treated in many well-designed control studies, the Cochrane group still states hypnosis as a primary treatment for IBS is "a promising treatment but there is insufficient evidence to allow any conclusion about the effectiveness of hypnotherapy for the treatment of IBS. More research with well-designed studies is needed."

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    21 . When using hypnotic techniques with a child receiving an infection, which statement is the most accurate?
    A) Children cannot focus well enough to experience deep trance states.
    B) It is best to encourage the child to be involved in all details of the procedure.
    C) Having a child blow bubbles and telling them that this will make their leg more numb for the injection can provide a sense of control, increase parasymphathetic tone, and channel their focus elsewhere.
    D) Giving the child multiple options helps increase the child's sense of autonomy.

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    22 . Which of the following dermatologic conditions is theorized to have the weakest emotional/psychological trigger?
    A) Basal cell carcinoma
    B) Psoriasis
    C) Dyshidrosis
    D) Alopecia

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    23 . Regarding hypnotizability, which of the following is a true statement?
    A) Measured hypnotizability significantly predicts the outcome of hypnotic methods.
    B) People measured with "low hypnotizability" do not respond to hypnotic suggestions.
    C) There is currently no accurate way to measure hypnotizability, even for research purposes.
    D) Patient readiness and rapport with the therapist are more impactful for hypnotic success than measured hypnotizability with validated methods.

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    24 . Which of the following is an accurate statement about the pain experience?
    A) Pain is experienced in the brain, not only in the body part that supplies the nociceptors.
    B) Malingering for secondary gain is likely if a physiological cause for pain is not found.
    C) Pain is never necessary to protect the individual.
    D) Hypnotic methods are often ineffective for pain that cannot be localized.

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    25 . Concerning hypnosis and disease states, which is the most accurate statement?
    A) Hypnosis should not be used until the underlying disease has been fully evaluated and medical treatment has been completed.
    B) While hypnosis can be started for many symptoms, it is important to make sure that the standard of care for appropriate medical evaluation has been initiated or is ongoing.
    C) When hypnosis is being used as monotherapy, a full medical evaluation is not necessary.
    D) It is appropriate to have the full approval of all medical professionals in care of the patient prior to proceeding with hypnotic suggestions.

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