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

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 suggestions^b

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].