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Positive Thinking Skills MP3 Downloads

has shown that 68 out of 88 people (77%) who used self-hypnosis - positive thinking skills techniques had clinically significant improvement.

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Back Pain Research with Hypnotherapy Tapes

Last modified 2014-04-25 16:33

Text of a paper published in Hypnos - The Journal of The European Society of Hypnosis vol 27 No 2 2000 pp94-101. Research performed by Dr Mike Matthews

Back Pain Taped

A study to identify the effectiveness of a taped hypnotherapy intervention for Back Pain using an interrupted time series design.


Back Pain is a huge problem with a multitude of possible treatments from drugs to major surgery via manipulation therapies of all sorts. It is estimated to cost the British economy nearly £6 billion (Euro 8.5 B) annually and to cause the loss of at least 110 million working days every year (National Back Pain Association statistics). As with all pain the sufferers of chronic back pain will develop a negative self-image and thus be discouraged and disempowered when the medical and surgical treatments are unsuccessful or less successful than hoped for.

Pain is one of those symptoms readily helped by talking therapies and hypnosis has been demonstrated as successful since the earliest days.

  • Braid's case 29 tells the story of a man who came to him "suffering anguish with every step" who walked home 6 miles after one of his lectures (Braid 1843).
  • Esdaile records 3 people cured in 4 days (Esdaile 1846).
  • Bernheim's case 90 notes a cure of sciatica after 6 weeks in hospital with repeated hypnosis (Bernheim 1887).
  • Later similar successes with pain appear in the standard reference books of their times. Forel (1906), Hollander (1910), Heidenheim (1906).

Up to our times the text books mention the successful use of hypnosis in chronic pain. Brown and Fromm in their book 'Hypnosis and Behavioral Medicine' state that pain control is one of the few areas where the efficacy of hypnosis has been well demonstrated but also comment on the paucity of carefully controlled outcome studies (Brown and Fromm 1987).

Spinhoven and Linssen report a study which concludes that education in combination with self-hypnosis forms a non-invasive, inexpensive treatment which could be of value in teaching even more severely disabled low back pain patients to cope more adequately with their pain problem (Spinhoven and Linssen 1989). Crasilneck reports 2 studies of chronic pain. His earlier (1979) with 24 patients producing a group of 20 who had a 70% relief of their symptoms over 31 sessions in 9 months. This study used a single hypnotic technique of pain blockade but his later (1996) and that of Spinhoven and Linssen used a 'menu' of approaches.

Crasilneck's 'Bombardment Technique' utilises relaxation displacement. age regression, glove anaesthesia, hypnoanaesthesia and self-hypnosis consecutively for 7 to 10 minutes each. Spinhoven and Linssen use relaxation and imaginative inattention, pain displacement and transformation. metaphorical pain transformation and future orientated coping imagery followed by an individualised audiotape.

Brown and Fromm advocate such multimodal techniques and, indeed, the last two papers mentioned above produced impressive results by allowing the patient in some way to subconsciously select what worked for them.

Both these approaches are very time-consuming and there is some evidence that audiotaped interventions are useful in a clinical setting despite the disappointing results of Schafer reported by Johnson and Wiese (1979). However, audiotapes have been successfully used in the operating theatre to provide positive suggestions and reduce post-operative analgesic use. indirectly suggesting their usefulness in pain. (McLintock et al., 1990, Evans and Richardson 1988).

This study sets out to show that a menu of pain relieving strategies on an audiotape will produce a statistically significant improvement over a three week baseline period when used properly and when the measures are repeated over fifteen weeks of tape use. It also sets out to demonstrate that it is possible for a single-handed researcher, armed only with a calculator and enthusiasm, to produce useful results and thus encourage those who have the wealth of experience and patient case load to contribute to our knowledge of practical hypnotic techniques.

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The study used an interrupted time series design using a single group of participants with a three week baseline and fifteen week follow-up. Measurements were made on a daily basis for the baseline period, producing 21 data points, and weekly on Mondays for the follow-up period referring to the symptom experiences of the preceding week. This produced a 15 data point follow-up.

Data Collection


The data were collected via a self-administered modified Oswestry questionnaire (the standard Back Pain Questionnaire in Great Britain). The full questionnaire was thought to be too complicated for selfadministration on a daily basis at home and too intrusive for most of the participants. The measures chosen were pain, sitting, walking. standing and sleeping.

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The Oswestry scale scores run from 1 (normality) to 6 (maximum incapacity) and a change of one is a doubling or halving of the incapacity (see box 1 for the scoring of pain and walking). The daily scores were entered on a questionnaire to produce a total daily score which was averaged over a 21 day baseline. It was felt that a more sensitive calculation would involve scoring normality as zero instead of one, as on the Oswestry scale. and so the daily range of scores was zero (no disability) to 25 (max. disability) - (0 x 5 to 5 x 5) after this adjustment.


One of the difficulties in solo General Practice researching is the difficulty in recruiting sufficient numbers and being rigorous in diagnosis. Back Pain is such a polymorphic problem that selection on a refined diagnosis would have been impossible. It was decided, therefore, to abandon any pretence of a pathological diagnosis and allow a self-diagnosis of Back Pain to be sufficient.

An article was written for The British National Back Pain Association Magazine 'Talkback' asking for volunteers and explaining the ideas behind hypnotherapy in Back Pain. It is recognised that members of self-help charities are likely to be better educated and more articulate than the average sufferer and may therefore be more receptive to ideas like hypnosis. As a result it could be argued that this group will respond better than a 'normal' group of sufferers from Back Pain. However, any group is, in a sense, unrepresentative and abnormal if drawn from Hospital or other medical practice as a significant number of people avoid doctors when they have back pain preferring instead osteopathy. chiropractic or, indeed, simple self-medication with over the counter analgesics. The group studied includes some sufferers who are practitioner averse and it is argued that they are as representative as any other studied group of Back Pain sufferers.

As the participants were spread throughout Great Britain and had no personal Contact with the researcher no measurement of hypnotisability was attempted. Nor, in a real world context, was it considered desirable.

The baseline period was completed by 104 participants who returned the relevant questionnaire.

The protocol required exclusion of extreme severities of less than a daily score of 5 and more than a daily score of 20 and 10 participants were excluded on these grounds, but by way of thanks were sent a complimentary tape, their follow-up being disregarded.

  • 6 sets of results were incomplete and were excluded.
  • 11 withdrew due to personal difficulties (moving house, bereavement etc.)
  • 13 failed to return the post-tape questionnaires despite follow-up letters and appeals in the magazine of The National Back Pain Association.

This left 55 whose results were analysed.

  • 45 were women
  • 10 were men
  • Age range 25 - 75
  • Mean .. .51.44
  • Median .. .51
  • S.D.10.56

The sex difference is felt to reflect the profile of membership of The National Back Pain Association and their willingness to participate in this kind of research.

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The audiotape was a 2 sided tape professionally produced lasting roughly 20 minutes each side.

Side one explains the ideas behind the tape and leads to a general relaxation technique Induction is by Elman's Eye Roll and deepening is by the Glasgow Dental Hospital Technique of 3 big breaths and is sustained by the visualisation of a favourite place. A general problem solving routine takes place and the user is asked to play this side until competence ensues.

Side two is a menu of pain relieving techniques following a re-induction based on side one's technique and a brief explanation of the physiology of pain. The techniques involve future pacing, 2 sorts of visualisations, a Kinesthetic process. ideomotor finger signals and an eclectic reframe.

The tape represents the technique the researcher uses in the Consulting Room face-to-face which has become standardised over 15 years of usage and is modified a little for recording purposes. The participants were asked to play the tape daily until they were happy with the results and at least weekly thereafter.

Side Effects

None reported

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55 Analysable sets of records were returned by the cut off date. Daily scores were calculated for each symptom cluster and for an average overall daily score for the baseline. The once a week daily score for the follow-up was similarly treated. The results are presented in table one. The results were calculated using a Casio fx - 85 WA calculator and with the help of a simple text book. (Robson 1983). These calculations produced a value of t. using a 2 tailed student t. tests. The results are presented in Table 1.

table of arithmetic means of daily scores and t test

The values of "t" were then checked in the statistical tables and as all were greater than 3.483, with 54 degrees of freedom, the results were statistically significant at the 0.005 level on all symptom scores and overall. It is concluded that the hypothesis that a menu of pain relieving strategies on an audiotape does produce a statistically significant improvement when used properly over the trial period.

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An audiotaped intervention was chosen for a number of reasons.

First, it was impossible to recruit a satisfactory number of patients from the researchers own patient list and thus the route of recruiting from a National Self Help Group was chosen. It was therefore clearly impossible to perform face-to-face hypnosis for logistical reasons even in a small country like Great Britain.

Secondly, due to time constraints, the audiotape had the benefit of needing to be recorded once only. As the patient had the tape personally the intervention could be applied as often as necessary limited only by the patients time and enthusiasm. The intervention was completely standardised and did not suffer from the day-to-day change of mood of the researcher or suffer from any element of transference or counter-transference. The actual operation of the research was quickened allowing the process to be completed within 18 months, by post, at a reasonable cost in time and money both to participant and researcher.

Finally, it represented the closest that could be got to Real World Research where the user is as free as possible to react how they like without artificial researcher Laboratory constraints. While a simple intervention has been taken and its effect measured in a Real World Situation and found to be of statistically proven benefit, it should be noted that with large numbers of participants it is possible to show such an effect without any noticeable clinical change.

The patient in his normal environment is properly only interested in feeling better.

Earlier it was noted that the Oswestry score change of one represented that noticeable clinical effect. It was thus decided to recognise a daily average score change of one as being clinically significant.

Table 1 shows an overall mean improvement from 11.348 to 9.746 which is a change of 1.602 (overall scores) so confirming a clinically significant mean improvement. If the last 3 week period is considered this improves to 2.388 (Figure 1).

table of improvement in average daily scores

The techniques - as all process techniques in hypnosis - represent learning tools. The patients are presented with the mental tools with which to work and any benefits which accrue are related to their efforts - not those of the therapist. As they are learning tools it would be expected that the observed improvement would increase steadily over time and Figure 1 shows this. This steady change bears out the progressive learning features previously noted and seen in the hypnotherapist's consulting room.

It is also expected that the changes would be more pronounced in those participants who worked more diligently and examination of the results in table 1 shows an increase in the standard deviations of the scores which would support an appropriately increased spread of results due to this phenomenon.

Figure 2 shows the number of participants who fall into each score change group and its positive skew would also support this view.

modified oswestry scores on a daily basis over last three week period in graphical form

Most practitioners of hypnosis take this specialised form of communication and adapt it to their personal way of behaving. Hypnosis as practiced by each individual therapist is therefore as diverse and eclectic as humanity itself. Because of this it is difficult to extrapolate from one therapist's technique to another's but Crasilneck and Spinhoven and now this study, using different techniques as befits their cultural and personal differences, have shown that a 'menu' approach produces benefits in back pain.

It would be tempting to conclude that it did not matter what was on the menu as long as it involved a choice of suitable techniques and that within the armoury of every hypnotherapist there should he such a menu.

Whilst this study involved back pain for pragmatic and logistic reasons the author has found no evidence that such a 'menu' technique could not be extended to pain of any origin.

Back pain is probably not high on the list of conditions treated by hypnotherapy in most practitioners' minds - Mackett's series of 160 showed only 6 patients with chronic pain and the site of the pain is not specified (Mackett l990) but it is a problem suffered by most people at some time in their lives.

We should consider a 'menu' regime of our usual techniques when faced with back pain.

The second objective of this study was to demonstrate to the average reader of Hypnos that it is possible to research hypnotherapy without huge resources (except enthusiasm) and hopefully to produce useful results. A great deal of academic research is done in the laboratory and most clinical research in a hospital environment yet the vast majority of human morbidity occurs away from such establishments and probably away from health care professionals. We need in these days of Governmental cost restrictions to prove our worth scientifically or risk being excluded from the cash that is available to treat patients.

We all know the huge cost of hospital and drug interventions. For instance, the cost in such interventions to treat back pain in Great Britain is £480 million each year (1998 Figures) Such large sums would be better spent on techniques which empower and enable our patients to help themselves rather than on drugs and surgery which frequently disempower and induce dependency.

More studies are needed of common conditions performed by ordinary front-line professionals to prove the worth of hypnotherapy or we risk (certainly in Great Britain) being marginalised. I hope this study will encourage others to do similar work.

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  1. BERNHEIM H. (1887). Suggestive Therapeutics. Associated Booksellers of Westport, Connecticut Reprinted 1957 pp. 382-384
  2. BRAID J. (1843). Neurypnology or The Rationale of Nervous Sleep. Adam and Charles Black. Edinburgh pp. 227-228
  3. BROWN D. AND FROMM E. (1987). Hypnosis and Behavioral Medicine. Laurence Erlbaum Associates, 365 Broadway, Hillsdale, New Jersey 076-12, I.S.B.N. 0 - 89859 - 915. 3 pp. 59-75
  4. CRASILNECK H. B (1979). Hypnosis in Control of Chronic Low Back Pain, American Journal of Clinical Hypnosis, 22. 2 pp. 71-79
  5. CRASILNECK H. B. (1996). The Use of the Crasilneck Bombardment Technique in Problems of Intractable Organic Pain. Hypnos Vol. 23 No. 1. pp. 19-39
  6. ESDAILE J. (1846). MESMERISM IN INDIA AND ITS PRACTICAL APPLICATION IN SURGERY AND MEDICINE. Longman, Brown. Green and Longmans. London pp. 184-185
  7. EVANS C. AND RICHARDSON D. (1988). Improved Recovery and Reduced Post-Operative Stay After Therapeutic Suggestions during General Anaesthesia. The Lancet August 27th. pp. 491-494
  8. FOREL. A. (1906). Hypnotism or Suggestion and Psychotherapy. Rehman Ltd. 129 Shaftesbury Ave London, p. 229.
  9. HEIDENHEIM R. (1906). Hypnotism or Animal Magnetism Kegan. Paul, Trench. Truber & Co. Dryden House, Gerrard Street. London. p. 19
  10. HOLLANDER B. (1910). Hypnotism and Suggestion in Daily Life Education and Medical Practice. Sir Isaac Pitman & Sons Ltd. No. l Amen Corner. London. p. 237
  11. JOHNSON L. AND WIESE K. (I979). Live Versus Tape-Recorded Assessments of Hypnotic Responsiveness in Pain Control Patients. International Journal of Clinical and Experimental Hypnosis. Vol. 27 No 2 pp. 74-84
  12. MACKETT J. (1990). Hypnotherapy in Family Medical Practice (A Review of I60 Cases). British Journal of Experimental and Clinical Hypnosis Vol.7 No.1 pp. 59-64
  13. MACKLINTOCK T., AITKEN H., DOWNE C., AND KENNY G. (1990). Post Operative Analgesic Requirements in Patients Exposed to Positive lntra-Operative Suggestions. B. M. J. October 6th, No. 6755.Vol. 301 pp. 788-790
  14. ROBSON C. (I973). Experiment Design and Statistics in Psychology. Penguin I.S.B.N.
  15. SPINHOVEN P. AND LINSSEN A. C. G. (1989). Education and Self Hypnosis in the Management of Low Back Pain: A Component Analysis. British Journal of Clinical Psychology, 28 pp. 145-153

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