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021 IY

Letters to the Editor Comments

on Syrjala et al., PAIN, 48 (1992) 137-146 PAIN

Dr.

Syrjala

ct al. (IYYZ)

presented

a sorely needed control

in the area of behavioral interventions ment.

The

scientific

methodological

major flaw that justifies

reconsideration.

provide adequate information their hypnotic treatment

study

for pain during cancer treataspects of their

in their

Specifically, procedural

(experimental

study

had a

Response

they failed to

section to repeat

group). This

02170

is a critical tlaw

to G.K. Mills

We agree with Dr. Mills if experimenters experimental permit

treatment.

complex individual

instructions

inspection

of their

on all the behavioral interventions

refer to ‘indivrdually

patient which makes experimental instructions/scripts ing!. ratification. standardized

reveals

detailed

except hypnosis.

tailored’ (p. 140) hypnotic instructions

ative aspects of Ericksonian

intervening

procedure

for rapport post-hypnotic

building,

impossible.

The

situation.

crc-

replicablr

trance induction.

such as experimenter

etc., could account for the result

for each

notwithstanding,

suggestion,

in the experimental variable

duplication

hypnosis

They

deepenhe

such scripting.

plea of therapy

of potentially

behavtoral procedures.

enthusiasm.

helpful.

trained

rather than the hypnotic treatment

as hypnoses deserve

experimentally

controlled

exploration

as an unrcplicable

‘art form’ until

standarized

in

the

but will continue

hypnotic instructions

results

of pain (e.g.. Barber

specific. standardized

and therefore

As it stands. the Syrjala specifically was done/said

using Ericksonian

hypnosis

1977) have been based on

replicable instructions.

et al. study leaves questions

ability

aspect of a hypnosis

in the hypnosis

treatment

phase.

while retaining clinical realities followed

therapists

with

enough detail

rntcrvrntion

Syrjala.

is usually

nerd not he acrtptcd to these

to indivtdualize jtmilarity

interventions.

IY (1977) training

cancer treatment:

analgesia: a clinical report,

of method is a sign of a to respond to the

of treating cancer pain.

it would be helpful to reiterate

consistently

by the therapists.

the steps of the hypnosi\

tlypnosis

induction

then proceeded to relaxation

the muscle groups of the hody. followed hy dcepen-

toward the targeted

mlagrry.

content

to the individual

was tailored

As

described

in the paper. imagery

preterrnces

ot the patient.

most often a place the patient wished to gcr. Within

this

suggestions

of symptoms

for

comfort,

well-bring

as described.

an indirect

for the reduction a controlled

The

All

approach.

and \elf-control

hypnotrc suggestions meaning

that

tmagery.

were provided

patients

design of the study provides two controls

other therapist

C. and Donaldson,

G., Hypnosis

or cognrtive

of pain and nausea during

clinical trial.

Pain, 48 (1992)

137-

qualities.

The

for the effect of attention

therapist

were not in-

for ‘charisma‘ and

contact control

for the same amount of time as

of charisma or enthusiasm,

along with relaxation

Gary K. Mills

Finally,

of these additions

training,

through

the theraprsts

hut with-

further

testing

the use of hypnost\.

as stated in the text. there was no theraptst

outcome variables:

training.

group ,rlso allowed for effects

out the addition of deepening, imagery or suggestion. henefit

group testctl

group hut wcrc not provtdcd skills

cognitive behavioral coping skills

the distinct

to tecl

altogether.

or ‘charisma’ and found no effect. Patient\

in this group were seen hy therapists patients in the hypnosis The

146.

hcgan

suggestions,

ing hy such common methods as moving down \tcpa or along a path

Am. J. Clin.

13X-147.

The

aspect\ of treatment

structed as to what they won/d lerl but were given permission

K.. Cummings.

behavioral

to allow

rcplrcrrtc such

with the investigators

and the capacity of a treatment

with a focus on breathing.

using

J., Rapid induction

Hypnosis,

is a

to the usual

a certain way or to not lee1 that way or to feel differently Barber.

princi-

this

and cognitive

our approaches. To

an over-arching

treatment

were offered

References

If

our hypnosis

not science’ label from

of trained

robust

tntervcntions

direct correspondence

moving through as to what

procedures.

and C‘lancy IYXX). we described

to understand

the ‘art

Perhaps

Some of the more impressive

Turner

therapists

Every

arc made available. in the treatment

IY83:

coping skills

a significant

management of acute and chronic pain conditions

clinical pain sumnrari7c

Subject

‘charisma’,

such

of persistent

and must adhere to systematic

than to invariant

space limitations.

Otherwise,

treatments

Although pains may

and Bloom journal

should

effective therapeutic

scripts.

brief-episode

research tc.g.. Spiegel

remove

The evolution

studies

variability

rather

treatment

and single,

‘critical flaw’. it is shared by most clinical trials

and resolution

per \e.

precise

pain treatments

in light of the fact that their hypnosis group proved to be an effectrve Careful

that studies would be easier to replicate

would supply

were charrsmatically

etfect on the homogeneous.

References Spiegel,

D., Bloom,

J.R.

and Yalom.

with metastatic cancer. Arch.

Grn.

I.. Group Psychiat..

support

for patients

3X (IYXI)

527-533.