The Lemon Experience by Ron Eslinger

If you don’t mind let your eyes gently close as you take in a nice abdominal breath.
Imagine or pretend that you’re at home in your kitchen.
Look around the room and pay attention to the sounds the sights and the light.
Listen for the hummm of the refrigerator…
Walk over to the refrigerator and as you do pay attention to your footsteps as you walk
across the floor …you may or you may not hear your steps on the floor.
Open the door to the refrigerator… feel the cool air as it spills out onto your body.
Hear that hiss as the vacuum releases as you open the door… now today whether you
normally have one or not today there’s a lemon in your refrigerator…
Look at the lemon… pay attention to its color as you reach in and take the lemon.
Notice the texture, the temperature, the size and the shape. Now take the lemon over to a
place where you would normally cut up fruits or vegetables…
Take out your favorite knife… now slice the lemon… you may slice it lengthwise from
end to end or down the center. If you sliced from end to end then make a second slice
creating a wage. If you sliced it down the center make another slice creating a ring and
then cut the ring in half…
You may have noticed the juice as it oozes out on the cutting area … reach down and
take either the wage or the half ring and bring it up and smell the fragrance…you may
notice memories being created…
Now open your mouth and take a big bite into that lemon. Feel and taste the juices as it
squirts on your teeth and on your tongue… experience the increased salivation and notice
the tart and tangy feeling at the corners of your jaw. Now swallow the lemon juice.

Open your eyes. What did you notice? What did you experience? What senses were
stimulated?

Increased salivation was a biochemical the physiological response from a thought and
every thought that you have creates some type of biochemical physiological responses in
some part of your body. What the mind possesses the body expresses
 Pain Management
The H.A.V.E. E. Model
NGH # 21111

Ron Eslinger RN, CRNA, APN, BCH, CI

www.eslinger.net

H.A.V.E.E.
• Hypnosis
• Affirmation
• Visualization
• Expectation
• Education
☯ Endorsed by the AMA in 1958
☯ Around since the beginning of time
☯ Simple
☯ It Works!!

Hypnotizability
☯ 20% can reach a light stages of Hypnosis
☯ 80% can reach the medium stages of Hypnosis
☯ 20% can reach the deeper stages of hypnosis

Affirmation & Coue’s Law

• Suggestions only become permanent with repetition
• Suggestions tend toward dominant effect
• Law of reverse effect
• Law of will power Vs imagination
Self - Talk Affirmations
Must Be

• Simple
• Realistic
• Believable
• Measurable
• Positive
• Presence tense
• Rewardable
Meditate & Affirmate
• I meditate 2 times daily and walk 20 minutes daily so that I am healthy and
comfortable.

Positive Affirmations

• I am relaxed and in control.

• I feel good.
• I control how I feel.

Visualization
• Putting the Affirmations into pictures
• Albert Einstein uses creative day dreaming
• See yourself as you want to be as if you have already achieved it.
• Use the Limbic System
Expectations
• Play a central role in pain experience
– Expectations of the hypnotists
– Expectations of the Client
• Directly related to the placebo effect
• Self full filling prophesy
• How did they get the expectation they have?
Education
• Client
– Pre session knowledge
– Personal experience
– Pre-talk
– Hand outs before and after session
• Hypnotist
– Development of treatment plans
– Are they prepared
– Reading

How do we bring this together?

Suggestibility
Limbic System Functions
• sets the emotional tone of the mind
• filters external events through internal states (emotional coloring)
• tags events as internally important
• stores highly charged emotional memories
• modulates motivation
• controls appetite and sleep cycles
• promotes bonding
• directly processes the sense of smell
• modulates libido

Limbic System Problems

• moodiness, irritability, clinical depression
• decreased or increased sexual responsiveness
• increased negative thinking
• perceive events in a negative way
• decreased motivation
• flood of negative emotions
• appetite and sleep problems
• social isolation

Hypothalamus

• Concerned with homeostasis

• Homeostasis is the process of returning something to some “set point.”
• It works like a thermostat

So Why is the Hypothalamus important to hypnotists?

Hypothalamus
The hypothalamus is responsible for regulating your hunger, thirst, response to pain,
levels of pleasure, sexual satisfaction, anger and aggressive behavior, and more.

It also regulates the functioning of the parasympathetic and sympathetic nervous

systems, which in turn means it regulates things like pulse, blood pressure, breathing,
and arousal in response to emotional circumstances.
Limbic System Functions
• sets the emotional tone of the mind
• filters external events through internal states (emotional coloring)
• tags events as internally important
• stores highly charged emotional memories
• modulates motivation
• controls appetite and sleep cycles
• promotes bonding
• directly processes the sense of smell
• modulates libido

Limbic System Problems

• moodiness, irritability, clinical depression
• increased negative thinking
• perceive events in a negative way
• decreased motivation
• flood of negative emotions
• appetite and sleep problems
• decreased or increased sexual responsiveness
• social isolation

Hypothalamus

• concerned with homeostasis

• Homeostasis is the process of returning something to some “set point.”
• It works like a thermostat

So Why is the Hypothalamus important to hypnotists?

• The hypothalamus is responsible for regulating your hunger, thirst, response to pain,
levels of pleasure, sexual satisfaction, anger and aggressive behavior, and more.
• It also regulates the functioning of the parasympathetic and sympathetic nervous
systems, which in turn means it regulates things like pulse, blood pressure, breathing,
and arousal in response to emotional circumstances.

Cortisol - Stress Hormone

• It is an essential hormone for survival because it is responsible for producing and
maintaining high levels of glucose necessary for the response to stress
• Can be destructive because
 – High Levels of glucose breaks down the protein in muscle and inhibits the
replacement of calcium
– Can contribute to these pain syndromes
• Fibromyalgia
• Rheumatoid arthritis
• Chronic fatigue syndrome
• Lupus
Ronald Melzack & Patric D. Wall Handbook of Pain Management

☯ Mind/Body Therapy
☯ Changes Stress Response
☯ Improves Healing
☯ Facilitates Rapid Recovery
☯ Gives the Patient Control
☯ Endorsed by the AMA in 1958
☯ Around since the beginning of time
☯ Simple
☯ It Works!!

Catastrophizing
From many practitioners those suffering from chronic pain take on the behaviors of
Catastrophizing and Learned Helplessness.
These are the people that have basically thrown in the towel and are coming to, or being
referred to hypnosis because of the earlier mentioned confounded practitioner. That
provider at the time of the referral will be a pivotal point. The provider sets the air of
expectation and it can be either a negative (I doubt if it will help but try this) or a
positive (this has been very beneficial to many and I think you will do well).
Hypnotize yourself out of Pain now, Bruce N. Eimer, Ph. D., ABPP, 2002.

Pain Cycle
Measuring Pain
☯ Pain is entirely subjective
☯ Have to believe what is reported
☯ Use many scales to “measure” pain
– Descriptive analog scale
– Numeric analog scale
– Visual analog scale
– Wong-Baker Faces scale
☯ Everyone has to use same scale

Assessment Tools
Hypnotic Procedures for Pain Management
☯ Glove anesthesia
– o Numbness from local anesthesia
– o Cold
– o Arm or leg falling asleep
☯ Bouncing ball
☯ Shrinking ball

Substitute for Morphine

A raisin might not always be a substitute for morphine, but it appears that meditation can
help people control their response to pain -- and their outlook on life. "The raisin
exercise makes you aware of sights, sounds, scents, and tastes," says Benson.
Self-Hypnosis

Can enable you to channel your ability to put your whole brain to work for you when you
need it.

Subliminal Tapes / CDs

May help the hypersensitive neurotransmitters and nerve endings to work to the client
advantage. The format should aim at banishing negativity or frustration. For
extremely analytical clients subliminal tapes can be a way to open the mind to the
power of subconscious healing.

The End
 HEALTHY VISIONS WELLNESS CENTER
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I am willing to be guided through relaxation, visual imagery, creative
visualization, hypnosis, and stress reduction processes and techniques for Mark Pain Areas
the purpose of vocational or avocational self-improvement. I understand
that the hypnosis I am receiving is not a substitute for normal medical care
and I have been advised to discuss this hypnosis with any doctor who is
taking care of me now or in the future. Additionally, I should continue any
present medical treatment and consult my medical doctor for treatment of
any new or old illnesses. Sessions may be video taped for our protection
and for yours.

Signature:__________________________Date:________

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© 2000, Healthy Visions Hypnosis

Limbic System (controls mood and attitude)
Functions

• sets the emotional tone of the mind

• filters external events through internal states (emotional coloring)
• tags events as internally important
• stores highly charged emotional memories
• modulates motivation
• controls appetite and sleep cycles
• promotes bonding
• directly processes the sense of smell
• modulates libido

Problems

• moodiness, irritability, clinical depression

• increased negative thinking
• perceive events in a negative way
• decreased motivation
• flood of negative emotions
• appetite and sleep problems
• decreased or increased sexual responsiveness
• social isolation

The deep limbic system lies near the center of the brain. Considering it's size -- about that of a walnut -- it is
power-packed with functions, all of which are critical for human behavior and survival. From an evolutionary
standpoint, this is an older part of the mammalian brain that enabled animals to experience and express
emotions. It freed them from the stereotypical behavior and actions dictated by the brain stem, found in the
older reptilian brain. The subsequent evolution of the surrounding cerebral cortex in higher animals,
especially humans, gave the capacity for problem solving, planning, organization and rational thought. Yet, in
order for these functions to occur one must have passion, emotion and desire to make it happen. The deep
limbic system adds the emotional spice, if you will, in both positive and negative ways.
This part of the brain is involved in setting a person's emotional tone. When the deep limbic system is less
active there is generally a positive, more hopeful state of mind. When it is heated up, or overactive, negativity
can take over. This finding actually surprised us at first. We thought that excessive activity in the part of the
brain that controlled emotion might correlate with enhanced feelings, not necessarily negative feelings. Yet,
we noticed, again and again, when this area was overactive on SPECT it correlated with depression and
negativity. It seems when the deep limbic system is inflamed, painful emotional shading results. New
research on depression from other laboratories around the world has born this out. Due to this emotional
shading, the deep limbic system provides the filter through which you interpret the events of the day. It tags
or colors events depending on the emotional state of mind. When you are sad (with an overactive deep
limbic system) you are likely to interpret neutral events through a negative lens. For example, if you have a
neutral or even positive conversation with someone whose deep limbic structure is overactive or "negatively
set" he or she is likely to interpret the conversation in a negative way. When this part of the brain is "cool" or
functions properly, a neutral or positive interpretation of events is more likely to occur. Emotional tagging of
events is critical to survival. The valence or charge we give to certain events in our lives drives us to action
(such as approaching a desired mate) or causes avoidance behavior (withdrawing from someone who has
hurt you in the past).
PMS, discussed in the last chapter, is a classic example of this emotional shading principle. As mentioned, in
our study of PMS within 5-10 days before the onset of the menstrual cycle the deep limbic system becomes
inflamed or more active with the drop in hormones. This deep limbic activation colors events in a more
negative way. My best friend's wife has a fairly severe case of PMS. He tells me that during the first week of
her cycle she looks at him with love and affection, and almost anything he does seems to be right. She is
more loving, more affectionate and sees things in a positive light. Ten days before her period things are
dramatically different. She doesn't want to be touched. She "has a different look" which he describes as a
combination expression of scowl and "don't mess with me." Little he does is right. She emotionally colors
most events in a negative way. Then a few days after her cycle starts, she's back to being more positive,
loving and affectionate.
The deep limbic system, along with the deep temporal lobes has also been reported to store highly charged
emotional memories, both positive and negative. If you have been traumatized by a dramatic event, such as
being in a car accident or watching your house burn down, or if you have been abused by a parent or a
spouse, the emotional component of the memory is stored in the deep limbic system of the brain. On the
other hand, if you have won the lottery, graduated magna cum laude, or watched your child's birth, those
emotional memories are stored here as well. The total experience of our emotional memories is responsible,
in part, for the emotional tone of our mind. The more stable, positive experiences we have the more positive
we are likely to feel. The more trauma in our lives the more emotionally set we become in a negative way.
These emotional memories are intimately involved in the emotional tagging that occurs.
The deep limbic system also affects motivation and drive. It helps get you going in the morning and
encourages you to move throughout the day. Overactivity in this area, in our experience, is associated with
lowered motivation and drive, which is often seen in depression. The deep limbic system, especially the
hypothalamus, controls the sleep and appetite cycles of the body. Healthy sleep and appetite is essential to
maintaining a proper internal milieu. Both of these components are often a problem with limbic abnormalities.
The deep limbic structures are also intimately involved with bonding and social connectedness. When the
deep limbic system of animals is damaged they do not properly bond with their young. In one study of rats,
when the deep limbic structures were damaged mothers would drag their offspring around the cage as if they
were inanimate objects. They would not feed and nurture the young as they would normally do. This system
affects the bonding mechanism that enables you to connect with other people on a social level; your ability to
do this successfully in turn influences your moods. Humans are not like polar bears, wandering the tundra
alone eleven months out of the year. We are social animals. When we are bonded to people in a positive
way we feel better about our lives and ourselves. This capacity to bond then plays a significant role in the
tone and quality of our moods.
The deep limbic system directly processes the sense of smell. The olfactory system is the only one of the
five sensory systems that goes from the sensory organ to directly where it is processed in the brain. The
messages from all the other senses (sight, hearing, touch and taste) are sent to a "relay station," the
thalamus, before they are sent to their final destination in different parts of the brain. Because your sense of
smell goes directly to the deep limbic system it is easy to see why smells can have such a powerful impact
on our feeling states. The multibillion-dollar perfume and deodorant industries count on this fact: beautiful
smells evoke pleasant feelings and draw people toward you, whereas unpleasant smells cause people to
withdraw. Expensive perfumes and colognes can make you beautiful, sexy and attractive to others, whereas
a disagreeable body odor can make the other person want to rush to the far side of the room.
Bonding, smells, sexuality and the deep limbic system are intimately connected. Napoleon once wrote to
Josephine to ask her not to bathe for 2 weeks before he came home from a battle. He wanted her scent to
be powerful, because it turned him on sexually. Likely, positive, sexual smells cool the limbic system and
make us more in the mood for love. Deep limbic overactivity, often associated with depression, frequently
result in decreased sexual interest. For many years, I have hypothesized that decreased sexual activity is
associated with increased deep limbic activity and more vulnerability to depression. Of course, my wife tells
me that I would say that as an excuse to make love more often.
I studied this phenomenon in an adult male who had problems with depression and increased activity in his
deep limbic systems on SPECT. I asked him to make passionate love with his wife. I then rescanned him
within an hour. His limbic activity was significantly decreased. Orgasm has been described as a mini-seizure
of the limbic system and tends to release or lessen deep limbic activity. Sexuality is good for the bonded
human brain.
Whenever a person is sexually involved with another person, neurochemical changes occur in both their
brains that encourage limbic, emotional bonding. Yet, limbic bonding is the reason casual sex doesn't really
work for most people on a whole mind and body level. Two people may decide to have sex "just for the fun of
it," yet something is occurring on another level they might not have decided on at all: Sex is enhancing an
emotional bond between them whether they want it or not. One person, often the woman, is bound to form
an attachment and will get hurt when the affair ends. The reason it is usually the woman is that the size of a
female's limbic system, in comparison to the rest of her brain, is larger than it is for a man. Consequently,
she is more likely to get limbically connected.
As mentioned above, current research has demonstrated that females, on average, have a larger deep
limbic system than males. This gives females several advantages and disadvantages. Due to the larger deep
limbic brain women are more in touch with their feelings, they are generally better able to express their
feelings than men. They have an increased ability to bond and be connected to others (which is why women
are the primary caretakers for children - there is no society on earth where men are primary caretakers for
children). Females have a more acute sense of smell, which is likely to have developed from an evolutionary
need for the mother to recognize her young. Having a larger deep limbic system leaves a female somewhat
more susceptible to depression, especially at times of significant hormonal changes such as the onset of
puberty, before menses, after the birth of a child and at menopause. Women attempt suicide three times
more than men. Yet, men kill themselves three times more than women, in part, because they use more
violent means of killing themselves (women tend to use overdoses with pills while men tend to either shoot
or hang themselves) and men are generally less connected to others than are women. Disconnection from
others increases the risk of completed suicides.
The deep limbic system, especially the hypothalamus at the base of the brain, is responsible for translating
our emotional state into physical feelings of relaxation or tension. The front half of the hypothalamus sends
calming signals to the body through the parasympathetic nervous system. The back half of the hypothalamus
sends stimulating or fear signals to the body through the sympathetic nervous system. The back half of the
hypothalamus, when stimulated, is responsible for the fight or flight response, a primitive state that gets us
ready to fight or flee when we are threatened or scared. This "hard-wired response" happens immediately
upon activation, such as seeing or experiencing an emotional or physical threat. In this response the heart
beats faster, breathing rate and blood pressure increases, the hands and feet become cooler to shunt blood
from the extremities to the big muscles (to fight or run away) and the pupils dilate (to see better). This "deep
limbic" translation of emotion is powerful and immediate. It happens with overt physical threats and also with
more covert emotional threats. This part of the brain is intimately connected with the prefrontal cortex and
seems to acts as a switching station between running on emotion (the deep limbic system) and rational
thought and problem solving with our cortex. When the limbic system is turned on - emotions tend to take
over. When it is cooled down, more activation is possible in the cortex. Current research on depression
indicates increased deep limbic system activity and shut down in the prefrontal cortex, especially on the left
side.

Amygdala and Hippocampus

Amygdala
A little almond shaped structure, deep inside the
antero-inferior region of the temporal lobe,
connects with the hippocampus, the septal
nuclei, the prefrontal area and the medial dorsal
nucleus of the thalamus. These connections
make it possible for the amigdala to play its
important role on the mediation and control of
major affective activities like friendship, love and
affection, on the expression of mood and, mainly,
on fear, rage and aggression The amygdala,
being the center for identification of danger, is
Hippocampus
Is particularly involved with memory phenomena,
specially with the formation of long-term memory (the
one that, sometimes, lasts forever). When both
hippocampi (right and left) are destroyed, nothing
can be retained in the memory. The subject quickly
forgets any recently received message. The intact
hippocampus allows the animal to compare the
conditions of a present threat with similar past
experiences, thus enabling it to choose the best
option, in order to guarantee its own survival.
fundamental for self preservation. When
triggered, it gives rise to fear and anxiety which
lead the animal into a stage of alertness, getting
ready to flight or fight. Experimental destruction
of both amygdalas (there are two of them, one in
each hemisphere) tames the animal, which
becomes sexually non-discriminative, deprived of
affection and indifferent to danger. The electrical
stimulus of these structures elicits crises of
violent aggressivity. Humans with marked lesions
of the amygdala, loose the affective meaning of
the perception of an outside information, like the
sight of a well known person. The subject knows,
exactly, who the person is, but is not capable to
decide whether he likes or dislikes him (or her).
Working with Chronic Pain

Ron Eslinger RN, CRNA, APN, MA, BCH, CMI

www.eslinger.net

www.eslinger.net 1
 Objectives
• Understand the basics of pain management
• Discuss specific hypnotic session ideas
• If time the Limbic System and its role in
hypnosis and specifically pain management

www.eslinger.net 2
 H.A.V.E.E.

• Hypnosis
• Affirmation
• Visualization
• Expectation
• Education

www.eslinger.net 3
 Why Hypnosis

☯ Mind/Body Therapy ☯ Endorsed by the

☯ Changes Stress AMA in 1958
Response ☯ Around since the
☯ Improves Healing beginning of time
☯ Facilitates Rapid ☯ Simple
Recovery
☯ It Works!!
☯ Gives the Patient
Control
 Hypnosis
An Altered State of Consciousness

☯ 20% can reach a

light stages of
Hypnosis
☯ 80% can reach the
medium stages of
Hypnosis
☯ 20% can reach the
deeper stages of
hypnosis
 Affirmation & Coue’s Law

• Suggestions only become

permanent with repetition
• Suggestions tend toward
dominant thought
• Law of reverse effect
• Law of will power Vs
imagination
 Self - Talk Affirmations

Must Be

• Simple
• Realistic
• Believable
• Measurable
• Positive
• Presence tense
• Rewardable

www.eslinger.net 7
 Meditate & Affirmate

• I meditate 2 times daily and walk 20 minutes daily

so that I am healthy and comfortable.

I feel good.
Positive Affirmations

• I am relaxed and in control.

• I feel good.
• I control how I feel.
www.eslinger.net 8
 Visualization

• Putting the Affirmations into

pictures
• Albert Einstein uses creative
day dreaming
• See yourself as you want to
be as if you have already
achieved it.
• Use the Limbic System
www.eslinger.net 9
 Expectations

• Play a central role in pain experience

– Expectations of the hypnotists
– Expectations of the Client
• Directly related to the placebo effect
• Self full filling prophesy
• How did they get the expectation they have?

www.eslinger.net 10
 Education
• Client
– Pre session knowledge
– Personal experience
– Pre-talk
– Hand outs before and after session
• Hypnotist
– Development of treatment plans
– Are they prepared
– Reading
www.eslinger.net 11
How do we bring this together?

www.eslinger.net 12
Pain Cycle

www.eslinger.net 13
 Measuring Pain

☯ Pain is entirely subjective

☯ Have to believe what is reported
☯ Use many scales to “measure” pain
– Descriptive analog scale
– Numeric analog scale
– Visual analog scale
– Wong-Baker Faces scale
☯ Everyone has to use same scale
www.eslinger.net 14
 Assessment Tools
Adult/Verbal Pain Rating Scales (12 y.o. and over)

0 1 2 3 4 5 6 7 8 9 10

No pain Moderate Worst Possible pain

Comfortable Uncomfortable

Numerical Ratings Scale (NRS) - COMMAND

CHOICE - Ask the patient to rate his pain on a scale of
zero to ten, with zero being no pain and ten being the worst
pain he has ever experienced.
www.eslinger.net 15
 Hypnotic Procedures
for Pain Management

☯ Glove anesthesia ☯Erase pain scale (comfort

– o Numbness from level) as deepen hypnosis
☯ Coloring book or computer
local anesthesia
graphics
– o Cold ☯ Color
– o Arm or leg falling ☯ Warm/cool orange colored
asleep liquid
☯ Bouncing ball ☯ Cell memory
☯ Religious and spiritual needs
☯ Shrinking ball

www.eslinger.net 16
 First Session
• Why and what do you know about hypnosis
• What are the Concerns / Expectations
• The Basics
– Gain Rapport today just learn to relax
– Suggestibility testing
– Explain Hypnosis
– Expectations / Goals / Comfort scale / Sleep Scale
– What do to me to make me feel like you (Brewer)
– What do different if pain 2 points less

www.eslinger.net 17
 First Session (cont)
• Progressive Relaxation Induction / CD
– Unless acute pain
– Severe chronic pain
• Create two themes of treatment and two metaphors for
each treatment
– Theme Example is Ego Strengthening
• Metaphor example ?
– Theme 2 ?
• Home work

www.eslinger.net 18
 Second Session

☯ Elman induction to
Glove anesthesia
☯ Discuss previous session and
☯ Memory image of
home work
dental work
☯ Answer questions / self talk ☯ Walk through the
☯ Discuss Coue’s law of process
suggestion ☯ Remote control

www.eslinger.net 19
 Third Session

☯ What do you want me to talk to you about today

☯ Self-induction
☯ Warm orange liquid
☯ Imagery, Visualization
☯ TV seeing what is to happen
☯ Block negative / accept Positive

www.eslinger.net 20
 Fourth Session

☯ Their Choice of entering hypnosis

☯ Reinforce previous success
☯ Reinforce glove anesthesia
☯ Practice self Hypnosis

☯ Follow up plan

www.eslinger.net 21
 Substitute for Morphine

A raisin might not always be a substitute

for morphine, but it appears that
meditation can help people control their
response to pain -- and their outlook on
life. "The raisin exercise makes you
aware of sights, sounds, scents, and
tastes," says Benson.
"Now I relax, slow down, and take time to appreciate things
around me -- a bird or a cricket, the wind in the trees.
Meditation makes my life a little more peaceful. It's made
me a better me.
www.eslinger.net 22
 Self-Hypnosis

Can enable you to channel your

ability to put your whole brain to
work for you when you need it.

The goal of hypnosis is for you to

gain control-over behavior,
emotions or physiological
processes.

www.eslinger.net 23
 Subliminal Tapes / CDs

May help the hypersensitive

neurotransmitters and nerve endings
to work to the client advantage. The
format should aim at banishing
negativity or frustration. For
extremely analytical clients
subliminal tapes can be a way to
open the mind to the power of
subconscious healing.

www.eslinger.net 24
 Suggestibility

Conscious Subconscious
Analytical Literal
 Suggestibility

Conscious Subconscious
Analytical Literal
 Suggestibility in Hypnosis

Conscious Subconscious
Analytical Literal
Limbic System Parts & Location

www.eslinger.net 28
 Limbic System Functions

• sets the emotional tone of the mind

• filters external events through internal states (emotional
coloring)
• tags events as internally important
• stores highly charged emotional memories
• modulates motivation
• controls appetite and sleep cycles
• promotes bonding
• directly processes the sense of smell
• modulates libido
www.eslinger.net 29
 Limbic System Problems

• moodiness, irritability, clinical depression

• decreased or increased sexual responsiveness
• increased negative thinking
• perceive events in a negative way
• decreased motivation
• flood of negative emotions
• appetite and sleep problems
• social isolation

www.eslinger.net 30
 Hypothalamus

• Concerned with homeostasis

• Homeostasis is the process of returning
something to some “set point.”
• It works like a thermostat

So Why is the Hypothalamus important to

hypnotists?

www.eslinger.net 31
 Hypothalamus

The hypothalamus is responsible for

regulating your hunger, thirst,
response to pain, levels of pleasure,
sexual satisfaction, anger and
aggressive behavior, and more.

www.eslinger.net 32
 Hypothalamus

It also regulates the functioning of the

parasympathetic and sympathetic nervous
systems, which in turn means it regulates
things like pulse, blood pressure, breathing,
and arousal in response to emotional
circumstances.

www.eslinger.net 33
 Limbic System Functions

• sets the emotional tone of the mind

• filters external events through internal states (emotional
coloring)
• tags events as internally important
• stores highly charged emotional memories
• modulates motivation
• controls appetite and sleep cycles
• promotes bonding
• directly processes the sense of smell
• modulates libido
www.eslinger.net 34
 Limbic System Problems

• moodiness, irritability, clinical depression

• increased negative thinking
• perceive events in a negative way
• decreased motivation
• flood of negative emotions
• appetite and sleep problems
• decreased or increased sexual responsiveness
• social isolation

www.eslinger.net 35
 Hypothalamus

• concerned with homeostasis

• Homeostasis is the process of returning
something to some “set point.”
• It works like a thermostat

So Why is the Hypothalamus important to

hypnotists?

www.eslinger.net 36
 Hypothalamus
• The hypothalamus is responsible for regulating
your hunger, thirst, response to pain, levels of
pleasure, sexual satisfaction, anger and aggressive
behavior, and more.
• It also regulates the functioning of the
parasympathetic and sympathetic nervous
systems, which in turn means it regulates things
like pulse, blood pressure, breathing, and arousal
in response to emotional circumstances.

www.eslinger.net 37
 Cortisol - Stress Hormone
• It is an essential hormone for survival because it is
responsible for producing and maintaining high levels of
glucose necessary for the response to stress
• Can be destructive because
– High Levels of glucose breaks down the protein in
muscle and inhibits the replacement of calcium
– Can contribute to these pain syndromes
• Fibromyalgia
• Rheumatoid arthritis
• Chronic fatigue syndrome
• Lupus
Ronald Melzack & Patric D. Wall Handbook of Pain Management
www.eslinger.net 38
 Catastrophizing
From many practitioners those suffering from chronic pain
take on the behaviors of Catastrophizing and Learned
Helplessness.
These are the people that have basically thrown in the towel
and are coming to, or being referred to hypnosis because of
the earlier mentioned confounded practitioner. That
provider at the time of the referral will be a pivotal point.
The provider sets the air of expectation and it can be either
a negative (I doubt if it will help but try this) or a positive
(this has been very beneficial to many and I think you will
do well).
Hypnotize yourself out of Pain now, Bruce N. Eimer, Ph. D., ABPP, 2002.
www.eslinger.net 39
www.eslinger.net
www.eslinger.net 40
PAIN: THE 5TH VITAL SIGN

In 2000 the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) put into
place a new standard for managing pain that opened the door to complementary therapies. This
standard became know as “the 5th Vital Sign.” Vital Signs are taken seriously; therefore, if pain is
assessed with the same zeal as other vital signs, it has a much better chance of being treated
properly. So by training doctors and nurses to measure pain as a vital sign quality of patient care
improves.

WHY HYPNOSIS?

RI.1.2 Section of the JCAHO Standards calls for patients to be involved in all aspects of their care
and requires that they be provided with a statement of their rights. They are given information
about pain and pain relief measures that are available to include a special emphasis on non-
pharmacological methods of pain management. Because of these standards many hospitals, such
as Columbia, Harvard, and Yale along with freestanding pain management centers provide
complementary care as a part of their pain management programs. Hypnosis, Acupuncture,
Massage, and Biofeedback are the standards for these clinics. However, hypnosis, as evidenced by
its multi-century history, is one of the first and most enduring modalities in the management of
organic pain problems. In proper perspective, hypnosis may not only relieve pain, but may also
help to maintain the dignity and the well being of the patient without dependence on large
quantities of medication. Hypnosis is evidenced based. Hypnosis works!

When one considers JCAHO standards along with the National Institutes of Health research
which revealed that over 41% of the population in 1995 used some form of Alternative or
Complementary Care, and the fact that as early as 1990 Americans invested over 13 billion dollars
in alternative/complementary therapies that “lack scientific evidence” it is easy to understand why
JCAHO placed an emphasis on non-pharmacological pain management methods. This emphasis
on non-pharmacological management opened up a huge untapped market, which became the
target of hospitals and pain centers across the country and a great opportunity for those of us
trained in the complementary therapies.
David G. Stanley, MD, FACS
988 Oak Ridge Turnpike
Oak Ridge, TN 37830

RE: John Doe DOB: 11-13-1946

Dear Dr. Stanley:

The above patient has contacted us and wishes to undergo hypnotic conditioning for the following
purposes:

Pain Management

Since we require that the attending physician be aware and a DX code in such cases, we would
appreciate your signature below indicating your approval. A progress report will follow.

Thank you for your attention.

Sincerely,

M. Ron Eslinger, RN, CRNA, APN, BCH, CMI

For The Doctor

I have examined my patient, and see no contradiction to the use of hypnotic suggestion in this
case. Diagnostic code (for your convenience, the following is a list of our most commonly used
diagnostic codes for which we receive referrals):

____278.00 Obesity ____307.80 Somatoform Pain Disorder

____300.29 Simple Phobia ____305.10 Nicotine Dependence
____305.00 Alcohol Abuse ____300.02 Generalized Anxiety Disorder
____307.60 Functional Enuresis ____Other__________________________

Additional comments and/or instructions:

______________________________________________________________________________

______________________________________________________________________________

Physician’s Signature________________________ Date_____________________

Healthy Visions, 800 Oak Ridge Turnpike, Suite A-208, Oak Ridge, TN 37830,
865-220-0777, Fax 865-220-0270, roneslinger@yahoo.com, www.eslinger.net
 ORDER FORM www.eslinger.net 1-866-312-3159

Title Price Quantity Total Price

Single CD's
Bonding with Baby $15.00
Freedom Flight $15.00
Nature's Odyssey $15.00
Noble Isle $15.00
Reflections $15.00
Rhapsody in the Rain $15.00
Serenity $15.00
Shenandoah Spring $15.00
Sweet Dreams $15.00
The Athlete Within $15.00
The Magic Monarch $15.00
Total Relaxation $15.00
Tranquility $15.00
Transformation $15.00
Sleep Now - Andy's $15.00
Relax Now - Andy's $15.00
Mind Over Mush $30.00
Lose Weight While You Tan $30.00
Double CD's – including information booklet
Dental Visits a Pleasure $30.00
General Anesthesia & Conscious Sedation $30.00
Quit Smoking with Self-Hypnosis $30.00
Preparing for Surgery $30.00
Pain Management $30.00
White Noise $30.00
6-Pack CD Sets
Weight Management 6-Pack 99.95
Royalty Free 6-Pack $149.95
Lecture Series
Pain Certification on DVD (The 2-day certification course on DVD $395.00
Introduction to HypnoAnesthesia for Chronic Pain 5 CDs + Bonus $49.95
Phantom Limb Pain – The Story of Bill (4 complete sessions on $59.95
DVD)
Sara’s Rib Pain 2 Sessions for letting of psychosomatic pain $39.95
Integrating Hypnosis in Pain Management – Double CD $30.00
Preparing Patient for Surgery with Hypnosis – Double CD $30.00
Hypnosis an Adjunct to Nursing Practice – 1 CD $20.00
Stress: Cost, Implications and Preventions – 1 CD $20.00
Books
My Method $12.95
Consumer Guide To Hypnotism $10.95
Eye Movement Technique $13.95
Other
Sound Spa + Tranquility CD (a must for your office) $79.95
Tricks For The Trainers (5 amazing ways to start a presentation) $40.00
Method of Payment  Check  Cash  Credit Card
10% discount if you attended my NGH Pain
_____________________________________________________ Management Class. Must call to get discount.
Name ( PRINT) Offer good until October 1, 2006 1-866-312-3159

_____________________________________________________
Address Credit Card #__________________________________
_____________________________________________________ Exp. Date__________________

Email:_______________________________________________ Signature_____________________________________

Healthy Visions Wellness Center, 800 Oak Ridge Turnpike, Oak Ridge, TN 37830 1-865-220-0777
 BIBLIOGRAPHY
From Ron Eslinger
www.eslinger.net

Andersen, U.S., The Magic in Your Mind, North Hollywood: Wilshire, 1961.
Barabasz, Arreed F. Ed.D., New Techniques in Behavior therapy and Hypnosis. South Orange: Power Publishers,
Inc., 1977.
Barber, Joseph, Hypnosis and Suggestion in the Treatment of Pain, W. W. Norton & Company, 1996
Caprio, Frank S. and Berger, Joseph R., Helping Yourself with Self-Hypnosis, New York: Warner Books, 1963.
Copeland, Rachel, How to Hypnotize Yourself and Others, New York: Harper and Row, 1982.
Coue’, Emile. My Method. Leidecker Institute, 1999
Crasilneck, Harold A. , Ph.D. and Hall, James A. , M.D., Clinical Hypnosis: Principles and Applications, New York:
Grune and Stratton, 1975.
Eimer, Bruce N. Ph.D., ANPP, Hypnotize You rself Out of Pain Now! New Harbinger Publications, Inc. 2002
Friedberg, Fred Ph.D. Foreword by Matthew McKay, Ph.D. Eye Movement Technique for Emotional Healing,
New Harbinger Publications, Inc. 2001
Heap, Michael and Kottiyattil K. Aravinhd, Hartland’s Medical and Dental Hypnosis,. Churchill Livingstone, 1989,
2002
Henderson, Charles L. You Can do it with Self-Hypnosis, New Jersey: Prentice-Hall, 1983.
Hilgard, Ernest R. and Josephine R. Hilgard, Hypnosis in the Relief of Pain, Brunner/Mazel, Inc. 1994
Hollander, Bernard, M. D., Hypnosis and Self-Hypnosis, North Hollywood: Wilshire Book Co., 1957.
Karlins, Marvin and Andrews, Lewis M., Biofeedback, New York: Warner Books, 1972.
Kroger William S., M. D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology , 2nd ed.
Philadelphia: J. B. Lippincott Cmpany, 1977.
Kroger, William S. , M.D. and Fezler, William D. , M.D., Hypnosis and Behavior Modification: Imagery
Conditioning, Philadelphia: J. B. Lippincott Company, 1976.
Kroger, William S., M. D., Child Birth With Hypnosis. North Hollywood: Wilshire Book Co., 1958.
Kuhn, Lesly and Russo, Salvatore , Ph.D., Modern Hypnosis , North Hollywood: Wilshire, 1958.
LeCron, Leslie M., The Complete Guide to Hypnosis, New York: Harper and Row, 1971.
Murphy, Joseph , D.R.S., Ph.D., D.D., L.L.D., The Power of Your Subconscious Mind (New Jersey: Prentice-Hall,
1977.
Pelt, S. J. Van M.D., Secrets of Hypnotism, North Hollywood: Wilshire, 1958.
Powers, Melvin, Advanced Techniques of Hypnosis. Beverly Hills: Hal Lighton Printing Co., 1953
Sarno, John E. M.D. The Mindbody Prescription, Warner Books, 1998
Temes, Roberta, Ph.D. The Complete Guide to Hypnosis. Alpha Books, Pearson Education Company. 2000.
Yapko, Michael D. Trancework, An Introduction to the Practice of Clinical Hypnosis. New York, Brunner-
Routledge, 2003.
 THIS OFFERING IS MADE IN APPRECIATION OF THOSE WHO
HONOR ME BY ATTENDING MY TELESEMINAR ON JUNE 24, 2005

Thank you very much

RON

1. Healthy Visions Hypnosis Basic Induction

2. Ego-strengthening script adapted form the Hartman script
3. Generic pain management script

1
 ------------ HVH - PROGRESSIVE RELAXATION INDUCTION -----------

Once rapport has been established and the client is sitting in a comfortable
position:

“Let yourself get into a very comfortable position, a position that will let you feel
very relaxed. If you feel your mind beginning to wonder, as quickly as you can, bring
your thoughts and concentration right back to the sound of my voice. You will be aware
of sounds and all the other activities of life around us, but just let my voice dominate your
thoughts.

The first thing I’m going to ask you to do is take in a deep breath and to hold it.
(You demonstrate with a deep breath- breathing from the abdomen - pushing the
abdomen out for a count of four… holding the breath for account of four… and a
breathing out for count of eight) In- now hold it - let it out. Breathe normally. Now we
are going to go through a deep breathing exercise where you will take in and hold a deep
breath just as you did a moment ago. Allow your eyes to gently close as you hold that
breath in for a slow count of four, then, let the breath out for a count of eight. As you
take each breath in and let it out you will begin to relax. At the end of the third breath,
breathe normally and let your whole body relax deeper and deeper.

Now as your body continues to relax more and more, I’m going to count
backwards from 10 to 1. And as I count you will count with me, but stay one number
ahead of me at all times. So, when I say the number 10, you will be thinking of the
number 9, and tracing the number 9 over and over as if tracing it on a marker board. You
will stay one number ahead at all times. Every time you inhale, you will think to yourself
– “relax”, and every time you exhale, you will think to yourself – “deeper or calmer”. So
with every breath you take it will be - relax and deeper or calmer. (As you say relax and
deeper, make sure you coordinate it with the subjects breathing pattern unless you are
doing a group)

We will now begin--

Ten--you are now tracing the number nine, over and over as if writing on a
marker board somewhere in your mind. And as you are tracing the numbers, you are
thinking, with every breath (with the subject’s rhythm) relax and deeper. So you can see,
your mind is quite busy at this point. One part of your mind is tracing numbers and
another part is keeping track of your respirations. And all the while that you are doing
this, your whole body is beginning to relax all over.

2
 Nine--Now you are tracing the number eight, over and over. You can also feel
your. It’s such a nice feeling. Just let all the tensions begin to escape as you drift to a
very peaceful state of relaxation.

Eight--Now you can feel the relaxation in your neck & shoulders and your neck
and shoulders relax deeper and deeper. A nice, deep comfortable feeling of relaxation as
you continue to breathe easily and comfortably.

Seven--Your arms are now relaxing. They may begin to feel ever so heavy or
very light and floaty what ever you so desire for this is your relaxation. You are in
control and you will become as relaxed as you yourself decide to be.

Six--The lower these numbers go the more you will let yourself relax, as these
numbers go lower and lower, you will feel the relaxation entering your lungs and chest
bringing relaxing oxygen into the lungs and transporting to the muscles of the body as
you relax deeper and deeper.

Five--Now you can feel it in your abdomen, All the abdominal muscles are
relaxing. You can feel the relaxation going into every organ and nerve within you.

Four--Now your hips relax and the relaxation flows down into your legs as they
become ever so relaxed. You can feel the relaxation in the thighs as it drifts to the knees
and then all the way to your ankles and feet. Such a nice peaceful feeling.

Three--Now the back is beginning to relax. Starting at your lower back and
radiating out each and every nerve root. Moving again into your neck and shoulders all
the way into the scalp.

Two--Your facial muscles are now relaxing. You can feel it across your
forehead, around your eyes and ears, in your cheeks and in the muscles of your jaw. It’s
such a comfortable feeling. You can even feel your neck muscles relaxing more and
more.

One—Tracing the number zero now over and over feeling very relaxed now,
feeling good all over in every way. And now, as your whole body begins to take on these
very comfortable sensations, I’m going to talk to you about you. And all the while that I
am talking to you, the more you’re going to relax. You’re going to relax more and more
as I talk on and on, so, the more that I talk, the more relaxed you’ll become.”

At this point you then go into the patter to implant the suggestions. This is an
especially good induction technique in that it covers many different inductions, i.e.
deep breathing, counting backwards, confusion, progressive relaxation, and a little bit
of imagery conditioning.

3
Give Suggestion, Deepen, Guided Imagery, Ego Strengthening

Terminate by saying I will now count from 1 to 5 and at the number 5 you will feel fully
alert refreshed and happy.

Between each number give suggestions of alertness and well being.

This induction will work on just about any client and.

4
 EGO-STRENGTHENING SUGGESTIONS

Every day you are physically stronger and fitter. You are more alert, more wide-
awake, and more energetic.

Every day you are so deeply interested in whatever you are doing, so deeply
interested in whatever is going on that your mind is much less preoccupied with yourself
and you are much less conscious of yourself and your own feelings.

Every day your nerves are stronger and steadier. Your mind is calmer and clearer,
more composed, more placid and more tranquil.

You think more clearly, you concentrate more easily, your memory improves and
you see things in their true perspective, without allowing them to get out of proportion.

Every day you are emotionally much calmer, much more settled, much more
tranquil.

Every day you feel a greater feeling of personal well being, a greater feeling of
personal safety and security, more than you have felt in a long, long time.

Every day you become, and you remain, more and more completely relaxed and
more tranquil, both mentally and physically. And as you become and as you remain
more relaxed and more tranquil each day, you develop much more confidence in
yourself, much more confidence in your ability to do, not only what you have to do each
day, but much more confidence in your ability to do whatever you ought to be able to do,
and to do it optimistically, happily and confidently.

Because of this every day you feel more and more independent, more able to stick
up for yourself, to stand on your own feet, to hold your own, no matter how difficult or
trying things may be.

And, because all these things will begin to happen – exactly as I tell you they will
happen, you will begin to feel much happier, much more contented. Much more cheerful,
much more optimistic, every day you will do better and better.

5
Pain Script from Teleseminar – Ron Eslinger, RN, CRNA, APN, BCH, CI

Start with the breathing technique described during the teleseminar – If you do not
remember the technique go to the NGH web site and listen to the teleseminar.

After your induction

With every breath that you take in allow yourself to relax more deeply and as you
continue to focus on the sound of my voice you can also focus on getting a sense of
control over yourself… your thoughts… your feelings… your body…

Let me remind you that what matters most right now is getting your thoughts together
and keeping a cool head… and by a cool head I mean of course a sense of calmness and
also a clear sense of purpose and there have been times in your life when you've done
exactly that stayed cool under tough circumstances.

I wonder if you'll decide to create this coolness throughout your body or if your decision
will be to just allow yourself to be comfortably calm. In all probability you will
determine what you create and what you feel within your body.

One of the first things you can become aware off… is the fact that only you are aware at
this time of what your comfort level is… but as I speak and as you create within your
mind different thoughts and different images of how you want to feel… I would like you
to appreciate the fact that through your thoughts you are in control of your mind and of
your body. Therefore, the more you focus your thoughts on my voice… the more you
will have control over how comfortable you choose to be. And in

I wonder if you'll be reminded of a time… a time in your past when you were aware… of
how comparable your body could be. Perhaps even now you're beginning to notice either
heaviness or a lightness of your body... and I wonder just how you will experience the
coolness and the calmness that I mentioned earlier.

(Name) you know better than anyone your ability to create coolness, comfort and
calmness. I wonder if you have begun to notice yet… that your body is becoming more
relaxed… and I wonder which is more relaxed your left side or your right side… your left
side over there your right side over here… and that area which in the past was
uncomfortable… is it there is a here… is it close? Is it far?

I can remember looking through binoculars and seeing how large things would become. I
wonder if you noticed that when you think of that place of discomfort that it is like
looking through binoculars. It gets so big… so close… almost as if it is right up on
you… yet… I wonder how surprised you will be when you discover that if you turn those
binoculars around… how distant… how far away… how tiny… what you're looking at
becomes.

6
I wonder if you can imagine or just pretend… maybe even… role-play as if you are a
child… turning the binoculars around looking through the big end and seeing how
distant… how tiny that area of discomfort becomes when you look at it in a totally and
completely different way.

I would like for you to imagine now that your feet are like vacuums… and they begin to
suck up into your body… starting at the ankles and the lower part of your legs… then up
into your knees… and into your thighs… every cell is filling with this cool orange
colored magnetic liquid… now moving into your hips… into your pelvic area and into
your abdomen… all the organs all the cells of your abdomen… and now it flows into
your lungs and into your chest and I wonder how surprised you will be to discover how
easily it is to breathe with your lungs filled with this cool orange colored magnetic liquid.

Now I know and I know that you know… that there are areas of your body that
something warm would be more pleasing than coolness… therefore, it is OK to replace
the coolness in those areas with a sense of warmth… that's right… you're doing so very
well allowing every breath to continue to allow you to drift gently and peacefully into
this wonderful state of hypnotic rest.

And now as the chest continues to feel that warm or cool orange colored liquid... that
magnetic liquid… it begins to flow over into your arms… from your fingertips all the
way up to your shoulders… every cell, every vessel, every part of your body now from
your neck down fills with this warm or cool orange colored liquid… this magnetic liquid.

I wonder what you will discover… as this cool orange colored magnetic liquid fills your
head… all of your head… your ears… your eyes… your sinuses… and even your brain.

It may be that you are already aware… of how this coolness… of how this orange colored
magnetic liquid… has already begun creating comfort and calmness.

I am sure that you are aware of what magnets do… and I think you're going to enjoy
being surprised to discover that it's OK …to allow that magnetic orange liquid… to pull
from every cell… the anxiety… the tension… and the discomforts that are located
there… YOU… are worthy of allowing yourself the comfort that comes from letting this
amazing orange colored magnetic liquid… this cool and soothing liquid… to pull from
every cell of your body anxiety, tension and discomfort.

You have the right to be comfortable… allow every cell now to remember what normal
feels like… I wonder how surprised you will be… when you think back to a time… a
time in your past… when you can remember being able to do the things you like to do…

I wonder just what that thing may be… only you know if it's a sport…a hobby or even
your job. It really doesn't matter what it is or was a and… all that matters is that you
allow your thoughts… allow your memories to focus on that time in your past. I'll give

7
you a few moments now to focus on that time… that happy memory… that comfortable
memory…

So that you can imprint that memory on every sale of your body and… and as you do so
that cool or warm orange colored magnetic liquid will continue to pull from every cell…
the anxiety… the tension… and the discomfort so that you can replace those
uncomfortable memories with the memories of comfort… serenity… tranquility in every
cell

Do that now while I'm silent as you go deeper and deeper… (just a few moments of its
silence).

Wonderful… I am so proud of how well you're doing… now allow your fingers and your
toes to be like water faucets… open them up and allow that cool or warm orange colored
magnetic liquid to drain from your body… leaving behind cells that are restored with
comfortable… relaxed… calm… and peaceful feelings.

Now each and every cell of your body knows what normal is. I wonder how surprised
you are to discover how wonderful it feels to remember what normal is... what comfort is.

It is OK now to let go and to enjoy the fact that you have the right and that you are
worthy off feeling your best.

It is OK to let go of guilt…just let it go.

Allow yourself to have forgiveness for yourself and others.

(And Continue with the suggestions for self-hypnosis at home and emerge now in
whatever method you as the hypnotist prefer to use)

8
 Vocal Local and OK Anesthesia
NGH # 32104

M. Ron Eslinger
RN, CRNA, APN, BCH, CI
www.eslinger.net

Objectives
☯ Discuss the roll stress plays in medical/surgical and dental procedures.
☯ Discuss the proper suggestions for preparing for, during and after medical/surgical and
dental procedures.
☯ Go over the type of music to use for medical dental procedures
☯ The participants will receive via email a PowerPoint presentation for training medical
staff.
☯ The participant will gain insight into the rewards and pitfalls of working in the
medical/surgical and dental communities.

Frequently Ask Questions

Fear is the Enemy

Fear causes tension
Tension causes pain
Pain causes more fear
Which causes more pain
• Fear comes from
– Lack of education
– Negative comments
• Family
• Friends
• Hospital staff
• Catecholamins are released in large quantities which causes resistance which causes
pain

Why Hypnosis
☯ Mind/Body Therapy
☯ Changes Stress Response
☯ Improves Healing
☯ Facilitates Rapid Recovery
☯ Gives the Patient Control
☯ Endorsed by the AMA in 1958
☯ Around since the beginning of time
☯ Simple
☯ It Works!!
MRI
Shorten procedure with better quality product

Cardiac Catherization
Shorten procedure by 17 minutes with 85% decrease in resedation

Fear is the Enemy - What are the fears?

☯ Not waking up
☯ Waking up during surgery
☯ Pain
☯ Needles
☯ Nausea & Vomiting
☯ Claustrophobia

Preparing Patients at Presbyterian

☯ New York Presbyterian Hospital offers complementary therapies to its heart surgery
patients.
☯ Hypnosis is encouraged.
☯ Less pain
☯ Less N/V
☯ Less hospital days

When does the fear start?

Two weeks prior to the procedure

How stress effects the body

Whenever our Bodies are Stressed
• Whether the stress is real or imagined – our brains take over and respond.
• The stress, by the way, can come in many forms:
– an impending deadline,
• an inability to complete your work tasks
• a verbal lashing from another person.
– Yet, the physiological response is basically the same

HERES HOW THE BODY

RESPONDS TO STRESS:
☯ Increased heart rate
☯ Elevated blood pressure
☯ Increased breathing rate (rapid and shallow)
☯ Release of stored energy from liver into bloodstream
☯ Dilation of pupils to let in more light
☯ Heightening of senses
☯ Tensing of muscles for movement or protection
☯ Shutdown of digestive processes; blood diverted to muscles and brain
☯ Constriction of blood flow to extremities
☯ Perspiring
Florence Nightingale
Notes on Nursing, Published in 1859
• Volumes are now written on the effects of the mind upon the body
• Music and color have a beneficial effect on the patient
It’s OK
• Just relax
• We are almost done
• You are doing fine
• Take a nice deep breath in your stomach
• Just let your eyes close
• You are doing great
• You will feel better than you thought you would soon
• Take this it will help you to feel better

Hypnotisability
• 20% can reach a light stages of Hypnosis
• 80% can reach the medium stages of Hypnosis
• 20% can reach the deeper stages of hypnosis
• Endorsed by the AMA in 1958
• Around since the beginning of time
• Simple
• It Works
The Mayo Brothers
How they became such famous surgeons
Alice Magaw
A Review of Over Fourteen Thousand Anaesthesias
• Without an anesthesia death for Mayo Brothers
• Suggestions is a great aid in producing a comfortable narcosis
• The subconscious or secondary self is particularly susceptible to suggestive influence
• Patients are told what to expect
SUGGESTIONS
• .I am relaxed and comfortable.
• .My surgery is going well.
• .I am healing more quickly than I thought I would.
• .I am feeling better than I thought I would.
• .My stomach is warm and comfortable.
• .I have normal bowl and bladder habits.
• .All my body functions are normal.
• .Everyday I’ll feel a greater feeling of personal well being, a greater feeling of
personal safety and security than I have felt for a long long time.
• .I will cough and deep breath easily and comfortably.
• .I are relaxed, calm, peaceful and at ease.
• .I feel good and my surgical site is comfortable.
• .My blood pressure and pulse are normal.
• .Everyday I do better and better.
• .I feel good about my surgery I feel good about myself.
• .I am healing more quickly than I thought I would.
• .When surgery is over I will feel alert and enthusiastic.
• .I feel good about my surgery.
• .I feel happy with a warm calm feeling in my stomach.
• .I am healthy and happy and I feel good.
• .I feel good about the care I am receiving.
• .I have a good feeling in my stomach.
• .I have a calm feeling in each and every part of my body.
• .Every day in every way I will do better and better.
• .I will heal much more quickly than I thought I would.
• .I will be much more comfortable than I thought I would have.
• .My surgical side is more comfortable than I thought it would be.
• .My surgery is going well, I am feeling well.
• .I am feeling much better than I thought I would.
• .I am comfortable and I am happy.

The Good Dental Patient

• Strong desire to keep healthy teeth
• Continued clinical examinations and treatment
• Understands the dentist’s policy for payment
• Have good hygiene, body and mouth
• Be friendly and appreciative of office staff
• Follow recommended treatment
• Be on time and give 48 hour cancellation notice

• Negative Words

– Hurt or pain

– Doctor is cutting
 – Putting you to sleep

– Labor pains

– It won’t be long

– Are you having pain?

– Are you feeling sick?

– Little Bee sting

• Positive Words

– Comfort

– Incision or getting started

– Drifting off to sleep

– Contractions / labor process

– In a short time

– Are you comfortable?

– You will be hungry

– Feel a little pinch

Intra-operative Techniques

• Establish Rapport

– Appropriate introduction

– Listen carefully

– Respond appropriately

– Create a positive environment

– Focus completely and

• Foster Patient Control

 – Give appropriate information

– Prepare patient for noxious stimuli (IV start, noise, cold) and use positive
suggestion

– Tailor to patient’s coping style

PAY ATTENTION

• Control the Environment

• Focus on the Patient

– Talk continuously during peri-induction period

– Guide patient to his “safe” place

– Reinforce positive suggestions

– Head phones with suggestions & Music

Post-Operatively
Continue Positive Reinforcement

– Talk to patient continuously through emergence and transport

• PACU / PUKE-U

• Educate PACU personnel

– Utilization of Positive Words and Concepts

– Reinforcement of positive suggestions

– Tailoring care to patient’s coping style

Pain Management
• JCAHO - Joint Commission Association of Health Care Organizations
– 5th Vital Sign
– Specific for non-pharmacological management of pain
• NIH research supports for pain and sleep
 – Hypnosis
– Relaxation techniques
What can be accomplished

• Decrease in preoperative anxiety

• More positive attitude toward surgical experience

• More cooperative patient and family

• Greater rapport and trust

• Diminished blood loss

• Better wound healing

• Decreased pain

• Decreased PONV

• Better overall experience and outcome

Presentation to Medical or Dental

• What can be accomplished
• Why Hypnosis
• Evidenced based treatment
• Questions and Misconceptions
• Dr. Oz at Columbia Presbyterian
• MRI and Cardiac Cauterization
• JCAHO

The End