HYPNOSIS AND FIBROMYALGIA

Detailed papers on the subject. Some may be rather deep and technical for the average sufferer, but do a details background of research and opinion as to the use of hypnotherapy in relation to helping with fibromyalgia symptoms.

Altered states of consciousness and hypnosis in the twenty-first century John Gruzelier * Division of Neuroscience and Mental Health, Imperial College London, UK

email: John Gruzelier (email) *Correspondence to John Gruzelier, Division of Neuroscience and Psychological Medicine, Imperial College London, St Dunstan's Road, London, W6 8RP KEYWORDS altered states of consciousness . attention . frontal lobe .

hypnosis . relaxation

ABSTRACT

The contemporary perspective on altered states of conscious is surveyed as an introduction to commentaries on Kallio and Revonsuo's lead article in Contemporary Hypnosis(2003). It is noted that the study of consciousness, unconscious processing, and altered states of consciousness are central issues in neuroscience, heralding fresh approaches to the neuroscientific understanding of hypnosis. These include attempts to bring together new neurophysiological methods with phenomenological report. The alteration in hypnosis of anterior brain processes including the anterior cingulated cortex and left dorsolateral prefrontal cortex are particularly productive areas of research. The lack of engagement with neuroscientific evidence from theorists with a purely social and cognitive orientation to hypnosis is noted, with examples provided from research on attention and relaxation.

Unifying the field awaits active collaboration between scientists with neurophysiological and social orientations. Copyright C 2005 British Society of Experimental and Clinical Hypnosis

Understanding the multidimensional mechanisms of hypnotic analgesia Giuseppe De Benedittis * University of Milan and Policlinico Hospital, IRCCS, Milan, Italy

email: Giuseppe De Benedittis (g.debenedittis@planet.it) *Correspondence to Giuseppe De Benedittis, Pain Research and Treatment Unit, Institute of Neurosurgery, University of Milan, Policlinico 35, Via F. Sforza, 20121 Milan, Italy KEYWORDS hypnosis . hypnotic analgesia . mechanisms . review ABSTRACT Pain is a multidimensional sensory experience, mainly based upon a three factorial model: sensory-discriminative, motivational-affective and cognitive. Each dimension of the pain experience is subserved by discrete neuroanatomical pathways and is apparently coded at different levels and sites of the central nervous system. An increasing body of evidence has shown that hypnosis can be effective in the down-modulation of the pain sensation in both acute and chronic pain states. In acute pain, the effect of hypnotic analgesia is specific, positively correlated with hypnotic responsiveness and unrelated to endogenous opioid mechanisms. The neural mechanisms underlying hypnotic states and responses to hypnotic suggestions of analgesia remain largely unknown.

On a psychophysiological basis, the neo-dissociation theory by Hilgard and Hilgard (1994) has provided a heuristic framework to explain some aspects and apparent paradoxes of hypnotic analgesia. On neurophysiological grounds, recent evidence has shed, at least, some light on the mystery of pain relief in hypnosis. It is likely that hypnotic suggestions of analgesia may modulate pain processing at multiple levels and sites within the central nervous system. At the peripheral level, hypnosis may modulate nociceptive input by down-regulating A delta and C fibres stimulation and reducing sympathetic arousal. At a spinal level, sensory analgesia during hypnosis has been shown to be linearly related to a reduction of the nociceptive flexion (RIII) reflex, a polysynaptic spinal reflex. At supraspinal cortical level, neuroimaging and electrophysiological studies have shown that hypnotic suggestions of analgesia can modulate directly both sensory and affective dimensions of the pain perception (the affective being reduced significantly more than the sensory), thus confirming, at least partially, the neo-dissociation theory. Moreover, highly hypnotizable subjects possess stronger attentional filtering abilities than do low hypnotizable subjects.

This greater cognitive flexibility might result in better focusing and diverting attention from the nociceptive stimulus as well as better ignoring irrelevant stimuli in the environment. Cognitive control processes are associated with a supervisory attentional system , involving the frontotemporal limbic cortices. Multiple, hierarchical pain control systems during hypnotic suggestions of analgesia provide a new description of the neurobiological basis of hypnotic analgesia, demonstrating specific patterns of peripheral and central activation associated with the hypnotic state and with the processing of hypnotic suggestions. Copyright C 2003 British Society of Experimental and Clinical Hypnosis

Interdisciplinary treatment for fibromyalgia syndrome: Clinical and statistical significance Dennis C. Turk, PhD 1 *, Akiko Okifuji, Phd 2, J. David Sinclair, Md 2, Terence W. Starz, MD 3 4 1Anesthesiology and Pain Research, University of Washington School of Medicine, Seattle, Department of Anesthesiology, University of Washington School of Medicine, Seattle 3Division of Rheumatology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh 4Fibromyalgia Clinic, Pain Evaluation and Treatment Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania *Correspondence to Dennis C. Turk, University of Washington, Department of Anesthesiology, Box 356540, Seattle, WA 98195-6540 KEYWORDS Fibromyalgia . Interdisciplinary treatment . Treatment outcome .

Clinical significance . Reliable Change Index ABSTRACT Objectives. The primary purposes of the study were to: evaluate the treatment efficacy of an outpatient, interdisciplinary treatment program for fibromyalgia syndrome (FMS); examine whether treatment gains would be sustained for 6 months following the treatment; assess whether improvements were clinically significant; and delineate the factors associated with clinically significant improvement in pain severity.

Methods. Sixty-seven FMS patients completed a 4-week outpatient program consisting of medical, physical, psychologic, and occupational therapies.

Six-month followup data were available for 66% of treated patients.

Results. Comparisons between pretreatment and posttreatment measures revealed significant improvements in pain severity, life interference, sense of control, affective distress, depression, perceived physical impairment, fatigue, and anxiety; however, there was no improvement in interpersonal relationships or general activities. Clinically significant improvement in pain severity, using the Reliable Change Index, was obtained by 42% of the sample and was predicted by the pretreatment levels of depression, activity, perceived disability, solicitous responses of significant others, and idiopathic onset. Pretreatment level of pain severity was not a significant predictor of the degree of pain improvement. Comparisons among pretreatment, posttreatment, and 6-month followup data revealed that the patients maintained treatment gains in pain, life interference, sense of control, affective distress, and depression. However, the quadratic polynomial analysis revealed that relapse occurred in the subjective rating of fatigue.

Conclusions. The results suggest that, overall, an outpatient interdisciplinary treatment program was effective in reducing many FMS symptoms. Treatment gains tended to be maintained for at least 6 months.

However, there were large individual differences in response to treatment.

These results suggest that identification of subgroups of FMS patients and their specific clinical characteristics may be useful for maximizing treatment efficacy.

HYPNOSIS AND M.E.

By Ronald Shone BSc, MA, D. Hyp, MBSCH

Myalgic encephalomyelitis (M.E.) has been very little discussed in the hypnosis literature. The many books on clinical hypnosis deal with pain, cancer, obstetrics and dentistry (to name a few) but no mention of M.E. The popular book on M.E. by Dr Charles Shepherd, entitled Living with M.E. , dismisses the use of hypnosis in two brief paragraphs, arguing that it may be useful in dealing with the emotional difficulties of M.E. but not with M.E. itself. Such a dismissal of the use of hypnosis in dealing with M.E. is unjustified. Yet a more recent book by Joyce Fox entitled Surviving M.E . makes no reference to hypnosis whatsoever! Undoubtedly it can be used for the emotional difficulties attached to M.E., but it can also be used to help M.E. sufferers deal directly with their problems. It is this aspect which is emphasised in this article.

The number of M.E. sufferers is increasing, and the medical profession at the moment has little to offer them. The fact that a person can suffer from M.E. for many years, sometimes up to ten or more years, with little comfort from the medical profession is itself disheartening to such individuals. As with other difficulties, sufferers of M.E. are turning to hypnotherapists for help. In this article just one particular approach is offered as a possibility. The approach is eclectic for the obvious reason that the cause of M.E. is unknown at the present time. Some of its obvious symptoms are clearly visible: the most conspicuous being muscle fatigue and being unable to concentrate for any long periods of time. Given this lack of knowledge, then only the symptoms can be dealt with in any positive way. Even so, the approach does allow the individual themselves to take some control over their own rehabilitation. This is important. M.E. sufferers tend to be ignored and left to fend for themselves, and yet are given little guidance in what to do in this regard B except to rest. This is the typical passive role of the patient in traditional medicine. But individuals want to be, and can be, more directly involved in their own improvement.

To use hypnosis in dealing with M.E. it is important to have some idea of what M.E. sufferers go through. This is essential for two reasons. First, the approach needs to deal with the two basic characteristics of the problem: namely, muscle fatigue and loss of concentration. Second, the approach needs to emphasise the role of the client. If the problem is going to be around for many years, then the approach needs to be one which leaves the client capable of handling the situation themselves and not attending therapy every week (not least because the average sufferer could not afford it).

In the next section we outline a case history B a typical M.E. suffer. It was based on Robert's (not his real name) treatment that the approach taken here was devised. I am grateful to Robert for the long discussions about his problem and his views on M.E. Although no two persons are alike, the symptoms of M.E. appear to be fairly consistent across individuals. To see this the next section gives a general outline of what typically M.E. patients go through. The final section deals with a treatment plan. In line with the Journal's policy, Robert kindly agreed to give his own views on the approach taken here.

A Case History

Robert was a very fit 39 year old. Running two miles twice per week, weight training three or four times per week and was very rarely ill. This exercise was to balance his demanding job, which was very much mental.

Aching in the joints began in 1991 but he put this down to the exercise. As the following year progressed the aches in the joints increased and there was more frequent pain. During this year he was working excessively, with work related stress occurring. By 1993 he began to sleep badly and found himself very exhausted on many mornings. Even so, he drove himself on as if quite normal. It was during this year that poor concentration developed, which was occurring on a regular basis. But again, forced himself into effort and trying to perform as normal.

It was during 1993 that he came to realise he needed more rest, fresh air and sunshine. He was feeling overloaded at work and was taking life far too seriously. Although aware of all this, he rarely reduced his workload. In the second half of the year he came to the realisation that his tiredness was related to the way he felt and was not arising because of the exercise.

He became grouchy and lacked enthusiasm. His concentration continued to deteriorate and at work became somewhat dull witted and slow. He became progressively more tired and ached all over. Furthermore, he began to look tired. Throughout this year he progressively reduced the amount of exercise he undertook.

During the following year he noted increased tiredness and doziness, with his mind drifting. His lack of concentration now began to concern him, more so because his job required a clear head. His physical symptoms now increased, with more aching joints and more bouts of exhaustion. Eventually he stopped exercising altogether. By April of 1994 he had begun to have a number of memory lapses and was unable to sleep at all well. By June/July of this year he began to deteriorate rapidly, which coincided with major frustration with his circumstances at work. In August of 1994 he was diagnosed as having M.E. but was given little guidance of what to do - other than rest. He began to see me in March 1995.

Symptoms

M.E. usually arises after an acute infection, which can be triggered by something specific or at other times can be traced back to some mild upset.

The initial symptoms are like bouts of flu, with general feeling of being unwell and tired. The main symptoms now begin, with occurrences of muscle fatigue and brain malfunction. Both these symptoms increase in intensity with stress. Although generally M.E. develops after some specific infection, for others it just gradually develops.

The symptoms of M.E. can be usefully grouped under three headings:

1.

1. Muscle fatigue and pain.

2. Brain fatigue and malfunction.

3. Responses of the nervous system.

Muscle fatigue and pain

Exercise-induced muscle fatigue is a necessary but not a sufficient condition for the presence of M.E. It is the arms and legs which are most affected, with the legs bearing the main brunt, which become tired merely by the individual standing still for long periods of time. If the individual persists in doing what they are doing when such fatigue is present, then exhaustion soon follows. In a number of cases, severe fatigue leads the individual to be house-bound. Where patients find themselves involved in physical and mental activities they can become very tired. There appears to be no medical solution to muscle fatigue.

Muscle pain (myalgia) affects about three quarters of M.E. sufferers, and can become the most prominent feature of the illness. It can also become the most distressing. It often starts in the shoulders, neck and chest and then generalises. Another common feature is muscle twitching, which can occur in any part of the body (i.e., in both the large and the small muscles). It varies throughout the day and is often associated with bright light. It is, however, intermittent.

Brain fatigue and malfunction

These are a major part of the illness and vary according to exertion. Mental malfunction can be devastating to individuals whose work is largely mental.

The two most common signs are (a) loss of concentration, and (b) loss of recent memory. Very few M.E. patients can carry on a mental task beyond thirty minutes, and this can often be much shorter.

The typical problems patients encounter are:

1.

1. switching words - usually their opposite;

2. inability to remember familiar words;

3. clumsiness;

4. difficulty in coordinating legs on stairs or escalators;

5. deterioration in handwriting when writing a long letter or report.

Such intellectual malfunction fluctuates over the illness.

Responses of the nervous system

It appears that the hypothalamus is affected, resulting in difficulty in maintaining body temperature. The individual can experience severe cold resulting in shivering or can experience night sweats. The resulting overactivity of the sympathetic nervous system can result in a rapid increase in their pulse rate and heart beat. Reduced blood flow to the tiny blood vessels can also occur, which leads to cold hands and feet.

M.E. sufferers can feel faint, especially when suddenly standing up from a lying position. Problems with balance is also common.

Treatment Plan

In our discussion of the symptoms, and in highlighting Robert's situation, we emphasised the fatigue felt by M.E. sufferers and their lack of concentration. It is essential to deal with these two aspects separately.

But we also highlighted an often held view that M.E. is more likely in individuals who are involved in constant stress which possibly has some impact on their immune system. There is little point in dealing only with the symptoms of fatigue and concentration. It is also necessary to aid the individual to change their life-style and either reduce stressful situations or provide better coping strategies for handling stress.

The treatment plan has eight elements to it as follows.

1.

1. Establish the individual's circumstances.

2. Establish the person's life-style, especially prior to the on-set of

M.E.

3. Train the individual to enter trance and to utilise imagery.

4. Establish imagery to represent the individual's immune system.

5. Establish a variety of images for building up energy.

6. Teach the individual self hypnosis.

7. Discuss a possible new life-style.

8. Construct an individualised set of tapes.

Some comments on each of these elements are necessary.

1. Establish the individual's circumstances . This is the case history. It should deal with their treatment, if any; the symptoms they have and their present copying strategies.

2. Establish the person's life-style . Again, part of the case history. It is necessary to establish their work/family situation when M.E. began.

Emphasis here is on the degree of stress they were under and whether they felt they were not coping with the stress.

Comment . It is possible to establish this information over a number of sessions. It is important to establish trance and begin to provide the M.E.

sufferer with new possibilities. They are likely to be quite negative, especially if they have been suffering for many years, and so positive suggestions at an early stage will be beneficial.

3. Entering trance and utilising imagery . The client must be trained to enter and deepen the trance. This is no different from any other hypnotherapy. What this therapist emphasises, however, is imagery and so a number of basic images are pursued to establish the individuals most effective mode of imagery. This is an important preliminary step to later therapy. At this stage such images can be used for relaxation, deepening and confidence building.

4. Imagery of the immune system . This is one of the most important parts of the therapy, and may be done in one or two session. The aim is to get the client to imagine their immune system as a sort of regulator, where some of the body's chemicals (or whatever) require enhancing while others require subduing. It is necessary to establish three things.

a) An image of the immune system which is the individual's own image.

b) An image which shows what is 'normal' or 'balanced'.

c) An emphasis on the right amount of change at the present moment of time.

This imagery once established to the client's satisfaction should be utilised from then on. Emphasis throughout should be on just the right amount of change .

5. Images for energy . It is necessary to raise the client's energy. This can be done by direct suggestion or the use of metaphors, especially imagery metaphors. After trying a variety it will be possible to establish those the client likes or feels comfortable with. The client will need to balance sufficient rest with a sufficient increase in energy. Again emphasis should be on just the right amount of rest and just the right amount of energy.

6. Teach self hypnosis . As the therapy builds up it is essential to convince the client that they are to take control over their improvement and that they can do this through self hypnosis. The client should be trained in this and in the use of imagery.

7. Discuss a possible new life-style . Throughout the sessions the importance of reducing stress should be emphasised. But also the importance of changing their life-style if that is what contributed to their stress and to the on-set of M.E. Training in a variety of coping strategies would be most beneficial.

8. Tapes . The final element is to make a series of four individualised tapes (or 2 tapes with four topics on the four sides). The four topics are:

a) Relaxation

b) Energising

c) Immune system

d) Change of life-style

The tapes should include all the features established in the earlier sessions , utilising the client's imagery . One important consideration is no tape (or side) should exceed 30 minutes. This is important in the early treatment. Too much concentration on suggestions - consciously or unconsciously - can drain the client's already low energy level. Anything longer will be counter productive.

It is also necessary to keep the themes quite distinct in the tapes. The client can then pick and choose what they feel they require at any moment of time. The first, and most general, can of course be used frequently.

A final observation is worth making. Throughout the therapeutic sessions constant use of IMR's can be very useful. One reason for this is because the client needs to obtain just the right amount of something - whether this be rest, energy, or changes in the immune system. Only the client will know when this occurs, and a simple IMR is enough to indicate to the therapist that he or she can move on. Unfortunately this is not possible in the use of tapes, but sufficient time on the tapes should be allowed for appropriate responses to take place.

By Ronald Shone BSc, MA, D. Hyp, MBSCH

Hypnosis and Chronic Fatigue Syndrome

By Maurice Kouguell Ph.D., BCETS

This article is in response to one of our readers, a hypnotherapist, from Australia. Who is requesting help in finding scripts for helping sufferers of Chronic Fatigue Syndrome.

Chronic Fatigue Syndrome (CFS) is a debilitating fatigue described as exhaustion, poor stamina (if any) and flu-like symptoms. The symptoms include extreme fatigue, general pain, mental fogginess and at times gastro-intestinal problems.

It is also referred to as chronic fatigue immune dysfunction syndrome (CFIDS).

In the past the syndrome has been known as chronic Epstein-Barr virus(CEBV).

The treatment of the syndrome is primarily in the province of the medical field and must remain in the good hands of an internist or endocrinologist.

However, hypnosis or other forms of altered states such as meditation or guided imagery are a welcome addition to the welfare of the patient.

Perhaps one of the better sources for the understanding of CFS is a book by

William Collinge Ph.D. Recovering from Chronic Fatigue Syndrome. It is published by Putnam/Perigee in the US and by Souvenir Press in the UK and Commonwealth. This is an excellent source of insight and is recommended to patients as well as therapists.

ALTERED STATES AND HEALING

In cooperation and consultation with the physician, patients can benefit from one or all the approaches discussed below:

HYPNOSIS: Patients with CFS may also have one or more of the following

issues: depression, self-directed anger, poor self-esteem, loss of self-confidence, stress.

All these can be approached by using standard protocols or induction's. Ego-

strengthening and stress reduction and confidence building can all be approached with standard scripts.

Although I appreciate that some hypnotists like to use other people's scripts (or induction's) I chose to approach my clients with the idea that each person is unique and the reaction to each symptom is unique.

LISTEN TO THE PATIENT.

Listen to the patient's verbal and non verbal communication. The patient will reveal consciously what needs to be done in order to alleviate his discomfort and proceed towards health. Always access the patients'

unconscious, for there lies the key to the problem. If you are a psychologist you can of course use projective techniques.

Before hypnosis or guided imagery are initiated 3 questions need to be considered.

1. Is hypnosis safe in this instance?

2. Is it indicated?

3. What do we know about the unconscious of our client?

One technique which can offer answers to the above is based on the house-tree-person test, the DAPTH@ (see book review section).

SUGGESTED SCRIPT

Start by making the client comfortable and then you can use all or part or any adaptation you wish from the following induction. Some modifications are left to your good judgment in order to incorporate the clients' symptoms.

"...Suspend your judgment...be accepting... I would like for you to take as much time as you need and ....find your own place, your own space...make yourself comfortable and..before you enter an altered state of awareness, it is fine if you decide to move to make yourself more and more comfortable and only you know when you reach that state.. that state of comfort which is.... necessary... for you ...to start your journey toward achieving peace, relaxation, quietness.

Let your mind go wherever it wants to go.... Let your feelings go wherever they want to go, let your sensations go wherever they want to go....and....I would like for you to accept yourself... whatever your mind, body, spirit are doing. Should you be standing on top of the mountain, you may choose to imagine a soft gentle glow of a rainbow. And... for a moment...you feel that the rainbow contains all the answers you need...all the secrets of life... Giving yourself permission to take another deep comfortable breath, you find yourself drifting deeper and deeper... into a profound hypnotic sleep. And... you feel drawn towards the rainbow. In just a moment or so you feel you will finally fulfil your wishes of touching the rainbow, of accessing it, of enveloping yourself with it's colors... and something very special will happen to you as I guide you through this wonderful healing journey...And now imagining, picturing yourself so light...so full of energy as you enter the rainbow...The first color you enter is the red band...the beautiful red band...feel it...experience it...feel it all around you enveloping you...feel the redness against you...breathe in the redness and begin to notice how good you are beginning to feel....REDNESS IS STRENGTH.... PHYSICAL STRENGTH... EMOTIONAL STRENGTH...MENTAL STRENGTH...the strength you call upon to replenish your strength, to achieve your goals of "______(To hypnotist: fill in the blank per the needs of the individual patient)....and now...from now on, anytime you need to replenish your strength all you need to do... is close your eyes and surround yourself, visualize yourself surrounded, enveloped by the color red of the rainbow...and...now, allowing yourself to go into a deeper level of mental relaxation, see yourself now...leaving the red band and entering the orange one....feel the color against your skin...as you breathe in... smell it, fill your lungs with it see it entering your blood stream....

ORANGE REPRESENTS HEALING.....Physical healing, mental healing and emotional healing....as a matter of fact, the healing process is taking place within you right now.....see and feel the orange molecules as millions of microscopic "Scrub Brushes" cleaning you of any impurities... stress... tension....anxiety... worry.... and discomfort...orange can heal you from any assaults that you may encounter in your life's experience...by simply closing your eyes and breathing deeply into the color orange....

...Take one final breath of the color orange and allow yourself to float into the yellow band...as you enter the yellow band feel how warm the yellow is. feel how energetic you feel...feel this energy circulating through your body...the yellow represents...POWER....sense the power ...and now combine the power of the yellow with the strength of the red and the healing of the orange...simply let it fill you...let it rejuvenate you...notice how much better you are beginning to feel... now... whenever you feel "run-down"...or you need your "battery" recharged... just close your eyes and breathe yourself into the power of the yellow...blending in the strength of the red...and the healing of the orange...and your needs will be met.

...Begin to let yourself drift from the yellow into the green band...as you enter the green band let yourself drift deeper and deeper relaxed...now feel the green on your skin...it feels cool and refreshing...breathe in the green...feel the coolness in your body...green represents Self-control...any time you find your temper and anger heating up...in your personal life...or in your work life...you need only to close your eyes and breathe yourself into the green...and you will feel your anger and temper cool with every breath you take.

...Take one final breath of the cooling color green...and let yourself float into the blue band...as you enter the blue you feel safe and secure...the blue represents PROTECTION...we are all exposed to times of trial...times of trouble...times of sadness...and times of stress...and sometimes we need to withdraw...in order to protect ourselves for short periods of time...so now, you have the ability to close your eyes...any time anywhere...whether alone or with others...and breathe yourself into the protective embrace of the color blue...you will discover that blue will protect you and aid you...as you continue to achieve your goals.

...I want you to prepare yourself for the most interesting of the colors of the rainbow...just let yourself now drift from the blue into the purple band...purple represents TRANSITION...purple will allow you to make the transition from your conscious mind's dominance...into your deeper mind...the purple opens up a whole new world to you...new realizations in your mind...when you are in the purple band... your conscious mind is at rest...and your unconscious mind is free to achieve insights very quickly...so now, any time you wish to achieve insight into a problem...merely close your eyes and breathe yourself into the color purple

--------------------

The induction may be terminated here. Then say, "... At your own rate, allow yourself to leave the rainbow with all the wisdom... power and new knowledge... you have gathered... and take few moments of total peace...comfort....and tranquillity before you reopen your eyes.

--------------------

If the hypnotist chooses to go on and reinforce the above, continue with...

"...allow your eyes to fall on the next mountain... and go beyond it towards infinity...be on the highest peak so that nothing obstructs your vision and begin to feel whatever you feel. Maybe you are becoming aware of slight changes within yourself, for there is nothing at this time between your vision, hearing, and sensations that requires your conscious participation and maybe you would like to choose to look at yourself experiencing this sensation. That's right... letting go for a moment of those feelings...

those experiences of being in communion with the universe you may wish to choose to imagine; visualize yourself the way you would like to be, the way you would like to feel when everything is comfortably getting together and offering a well deserved sense of balance. I will be quiet now for a period of 3 minutes of clock time... a good time for you to take all the time you need... slowly... comfortably.. for yourself and after you have created and found your peace the way you would like it to be... spiritually, physically, psychologically, take that imprint inside you... look at the horizon...beyond the fields of flowers or ....the horizon of the ocean, and in that journey which will begin in a few moments...allow yourself, allow your deeper mind, allow your intuition... to connect you to what you need to know. Now I will be quiet for the next 3 minutes...that's right...you may wish to allow yourself, your being ...your soul... your guide to dance a comfortable dance for you... you may find yourself smiling inside and out... feeling liberated and free and feeling comfortable and dancing and running and feeling free and liberated... feeling free and liberated mentally and physically and letting go of pain and hurt and feeling that you are allowing yourself to feel to just be you.... you may wish to take some more time to dismiss.... to slow down to turn your back to all the issues that are not necessary for you....

..with each out breath you may welcome releasing the pressures and taking as much time as you need allowing yourself to come back... free.. when your mind and body are reconnected once again you will feel a sense of well being... again I will stop talking and you may reopen your eyes knowing that you can always return to that journey.....

--------------------

The following is based on HEALING IMAGERY is from Dr. Friedberg's book COPING WITH CHRONIC FATIGUE SYNDROME

Your healing can now begin, yes...your healing begins from within yourself... an inner radiance that begins as a mere speck of light...thats right, an inner point of light and warmth....radiating strength and power...that's right... warm and radiant...inner strength, physical strength. Feel it, experience it...fully, thoroughly... growing stronger... and now directing it to yourself, directing the healing towards your weakened system and watch it slowly....and surely gaining strength....gaining strength...becoming stronger and stronger, re-experiencing the vitality, the enthusiasm an the spark in every cell of your body.....

Feel that inner sense of strength beginning, working within your body.

Feeling revitalized, re-energized...strengthening as your inner radiance strengthens and energizes. Feel the warm, intense energy doing its work; reactivating, restoring your body....yes, restoring your body. Experience that strengthening fully,

thoroughly, that inner boosting, growing even stronger now, stronger, more powerful than before. As you feel that strength, you believe in yourself and your ability to succeed in your goal of rebuilding your body. Yes, believing in the strength of your thoughts, images and the totality of your internal powers. You believe so strongly, feeling that boost even now, yes, yet remaining tolerant, letting time pass, knowing that any worthwhile goal takes time, any worthwhile goal. And you have resolved to accomplish your goal, believing that you can...re-energizing, boosting your system. You hold firmly to that belief; yes, so firmly...feeling less fatigued...and this message remains with you, far beyond these words, far beyond these words.

Now, slowly bringing yourself back to wakefulness, eyes opening gradually, feeling relaxed and refreshed.

Maurice Kouguell Ph.D., BCETS

Our thanks to Jo Goss, Research Director, National Council for Hypnotherapy Ltd http://www.hypnotherapists.org.uk for their help with research of the above reports.