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Table 3 Description of the phases and components of the hypnotherapeutic session

From: Hypnotherapy for procedural pain, itch, and state anxiety in children with acute burns: a feasibility and acceptability study protocol

Phase Core components Description of components Goal
Induction Positioning Ask children to be in a comfortable position for hypnosis [8]. To promote comfort and relaxation [8].
Eye fixation and abbreviated progressive muscle relaxation Ask children to focus their attention on the hypnotherapist’s hand while tensing their hand’s muscles for a few seconds before releasing tensions [8]. To elicit relaxation, shift of attention, absorption in hypnosis, and dissociation from the painful stimulus [43, 44].
Eye closure Ask children to optionally close their eyes [8]. To block external distractions and promote internal absorption [37].
Lifting of the hand Ask children to keep their hands in a vertical position.a To promote numbness in the hand and response expectancies during glove anaesthesia.
Deliberate faster breathwork and suggestions for relaxation Ask children to maintain faster and deeper rhythmic breathing for a few minutes then to gradually relax body muscles following pleasant imagery suggestions (e.g. blowing tensions away and inhaling relaxing lights) [8]. To enhance suggestibility by inducing mental and physical relaxation; promote positive coping by distraction; establish the hypnotic context; and promote response expectancies [8, 43, 44].
Favourite place imagery Give suggestions for favourite place imagery with few details that allow children to project their own experiences and preferences (e.g. imagine your favourite place) [8].
Ideomotor signalling Ask children to make a physical movement (e.g. lifting a finger) as a sign of positive response to suggestions [8]. To reflect the inner experience of children, test response to suggestions and promote children’s sense of control [8].
Metacognitive suggestions Notify children on the nature of subsequent procedures or what is next in the intervention [63]. To promote children’s cooperation, positive response expectancies and prepare them for subsequent intervention steps [44].
Deepening/intensification suggestions Deepening/intensification ideomotor suggestions Give suggestions for movement without conscious muscle activity (e.g. eyelid catalepsy, arm heaviness) then test responses to suggestions [8]. To reinforce suggestions; accentuate dissociation from the external setting, focus of attention and absorption in the hypnotic experience [8].
Compounding suggestionsb Give suggestions for absorption in hypnosis accompanying physical experience and sensations (e.g. As your hand drops back down to your side, you can slowly and gently go deeper into hypnosis) [8].
Counting and stairs imagery Give suggestions for relaxation and absorption involving visualisation (e.g. count out-loud as you go downstairs, go deeper into hypnosis) [8].
Therapeutic suggestions Hypno-analgesia and hypno-anaesthesia suggestions Deliver direct suggestions for ideosensory alterations (e.g. numbness and coolness) [8]. To reduce pain sensations by inducing analgesia and anaesthesia [8].
Give indirect suggestions of pleasant imagery involving regression into enjoyable pain-free past events; glove-anaesthesia technique, metaphors for dissociation or substitution of pain-related sensations, cognitions, and feelings (e.g. darkness representing discomfort is transformed into a relaxing light) [8].
N.B. Suggestions for pleasant imagery can involve a detailed description of elements to visualise to assist imagination or fewer details that enable children to project their experiences and preferences (e.g. imagine flowers that you like) [8].
To target sensory, cognitive, and affective components of pain by respectively inducing sensory (analgesia, anaesthesia), perceptual (altered perception and expectations) and affective (agreeable feelings, reduced pain unpleasantness) alterations; accentuate dissociation from pain and absorption in pleasant internal experience; promote relaxation, comfort, positive change, and reduced alienation; guide the use of children’s internal resources for better coping and sense of control [8, 10].
Suggestions for positive conditioning Describe the setting as a place for healing rather than a source of distress and portray pain as a signal of injury to be treated rather than an enemy to be defeated [8]. To promote positive conditioning involving trust and positive views towards clinicians, treatment procedures, pain, and the medical setting [8].
Post-hypnotic suggestions Anchoring Use “anchoring techniques” and test the response to the anchor under-hypnosis (e.g., re-experiencing itch relief at hand clap) [8]. To teach children effective ways to reduce itch and distress while promoting autonomy, confidence, and positive coping [8].
Self-hypnosis training Give suggestions to practise self-hypnosis at home [8].
Future progression Give suggestions for pleasant future imagery using children’s preferred element as a gateway to future events (e.g. crossing a bridge to a pleasant future) [8]. To promote positive conditioning with enhanced comfort, relaxation, and cooperation in future dressing changes; itch relief; enhanced healing [8].
Emergence from hypnosis Counter suggestions Give alerting suggestions while counting; then ask children to open their eyes and gradually switch to a seated position when ready after their awareness is back to the usual state (e.g. at the count of five you can open your eyes, feeling alert) [8]. To remove numbness and anaesthesia while inducing alertness and switching of awareness to the external surrounding [8].
Post-hypnosis phase Post-hypnotic talk Invite children to ask questions and discuss their experience; debrief those with negative reactions [8]. To promote safety, trust, and positive coping [8].
Self-hypnosis tape and test of anchoring Test children’s response to the “anchor” and give them a recording for self-hypnosis [8]. To reinforce therapy outcomes, positive coping, and sense of control [8].
  1. aChildren are asked to keep their hands in a vertical position throughout the session
  2. bCompounding suggestions: continuous establishing of new responses onto the foundation of past responses