Standardised Hypnosis in Oral and Maxillofacial Surgery. - Asociatia ...

Hypnosis Jn Oral and Maxillofacial SurgeryStandardised Hypnosis in Oral andMaxillofacial Surgery.Three-Year Experience and First Study ResultsDirk Hermes, Samer G. Hakim, Peter SiegDepartment of Maxillofacial Surgery (Prov. Head: Prof. Dr. Dr. P. Sleg)University Hospital Schleswiq-Holstein / Campus LuebeckLuebeck, GermanyAbstract:Surgical treatment of diseases of the oral and maxillofacial region under local anaesthesia is quitecommonly restricted by limited compliance from the patient. Hypnosis could be an alternative totreatment under pharmacological sedation or general anaesthesia. Own preliminary investigationsprove a high potential level of acceptance of this treatment option by oral and maxillofacial patients.Within a 3-year period, 340 procedures under combined local anaesthesia / tape recorded hypnosiswere carried out on non-preselected patients between the ages of 13 and 87. The surgical range coveredoral, plastic and reconstructive, oncological, septic and trauma operations.Hypnosis turned out to be a reliable and standardisable method with high patient consent. Remarkableimprovements in treatment conditions for both patient and surgeons were achieved in 96,5% ofall procedures. In selected cases of polypathic but very cooperative and susceptible patients, majorsurgery could be performed without general anaesthesia. Following positive experiences during thesurgical routine of our department, first clinical studies were initiated which proved the effectivenessof hypnosis-induced intraoperative effects in oral and maxillofacial surgery.Keywords:Hypnosis, Oral and Maxillofacial Surgery, Anxiety, Stress reduction, Clinical StudyEuropean JoLirnal ol Clinical Hypnosis; 2006 volume 6 - issue 4

Dirk Hermes, Samer G. Hakim, Peter SieqIntroductionSurgical therapy of oral and maxillofacialconditions using local anaesthesia demandsa high degree of co-operation from thepatient and is for many people a source ofgreat anxiety (Faymonville et al., 1999). Toachieve satisfying treatment conditions forpatient and surgeon, procedures capable ofbeing carried out under local anaestheticare often performed in combination withpharmacological sedation or under generalanaesthesia.Hypnosis represents a theoretical alternativeto this. Its auto- and external suggestive procedurescan be used for anxioiytic purposes,relaxation, sedation and. ideally, analgesiaduring medical procedures (Khalil. 1969;Brown and Mclnnes. 1986; Faymonviile etal.. 1999).Numerous clinical case reports and studiesprove the successful use of this suggestiveprocedure in various disciplines of somaticmedicine. Its use is widely accepted nowadayswithin modern dental medicine (Finkelstein.1991: Schmierer, 2001; Schmierer andKunzelmann, 1993; Schuetz and Freigang,2000).As a pragmatic development to "Live Hypnosis"which is closely connected to thehypnotherapist, specially designed tape recordingsare now available ("Tape RecordedHypnosis") which find particular interest ofsurgeons. As such tapes consist of severaltakes each with deli ned purposes, length andcharacteristics of intraoperative hypnosis canbe adjusted to the surgical measures.After controlled clinical studies confirmedthe effectiveness of hypnotic recordingsused in oral and maxillofacial proceduresunder general (Enquist et al.. 1995; Enquistand Fischer. 1997) and local anaesthesia(Ghoneim et al.. 2000), own studies on thetherapeutic efficiency of the procedure onlocally anaesthetised patients seemed appropriate.The following will report on our clinicalexperience and the results of initial clinicalstudies on the intraoperalive use of standardisedhypnosis in our department.Material and MethodsAim of studiesThe Department of Maxillofacial Surgery ofthe University Hospital Schleswig-Holstein /Campus Luebeck established intraoperativehypnosis for the treatment of both in and outpatientcare in 2002. An initial testing periodattempted to determine the acceptance ofmedical hypnosis in a current treatment situation.Furthermore the extent to which medica!hypnosis can be applied in the field as apracticable and efficient therapy option forintraoperative stress reduction and improvedtreatment modalities was investigated. Possibilitiesof time reduction through proceduralstandardisation was seen as another importantfactor for our surgical purposes.Patient acquisitionA brochure placed in the waiting-rooms ofthe department gave patients interested inhypnosis first standardised information.Patients then were medically examined andcounselled on an individual basis. If personalinterest in the combined method oftreatment (local anaesthesia and hypnosis)was expressed by patients, an explanation ofthe surgical procedure was given along witha detailed explanation regarding hypnosisand the primary study. Exclusion criteriafor study patients were checked. Due to thegeneral aim of our studies, no further pre-selectionof patients (e.g. testing of individualacceptance of hypnosis or susceptibility)took place.HypnosisAfter completion of surgical preparation,all patients received standardised and OToricntedpre-hypnotic seedings. Positiveformulations on several aspects of surgicaltreatment (e.g. intraoperative sensations,unpleasant stimuli, postoperative restrictions,healing process and pain) were usedto reduce preoperative anxiety and prepareintraoperative trance. All preoperative hypnosispreparations were performed by onesurgeon / hypnotherapist.European Journal of Clinical Hypnosis: 2006 volume 6 • issue 4

Hypnosis in Oral and Maxillotacial SurgeryTo minimise the therapeutic effort and the influenceof surgeons on the combined therapy,standardised "Tape Recorded Hypnosis" wasexclusively used for patients participating ineither the clinical evaluation of the therapyor controlled studies. According lo similarstudies (Enquist et al.. 1995; Enquist andFisher. 1997; Ghoneim et al.. 2000). all patientswere given standardised hypnosis CD(Schmierer. \995) which showed significantanxioiytic effects in a dental treatment situation(Schmierer et al.. 1999). Patients wereinstructed to listen to the CD twice betweenpreoperative appointment and operation.signs of hypnotic trance had been clinicallydetermined, surgery started without furthercommunication with the patient (Figures 3-3).Surgery under HypnosisFigure 2: Induction of hyptwsis in the operatingtheatreFigure 1: Comfortable patient positioningon the operating table with air mattress, softhead holder and knee rollAfter comfortable patient positioning on theoperating table (Figure I), the standardisedseedings were repeated directly before thestart of surgery. Hypnosis was induced bya portable CD player (Sony D-F22I). headphones(Sony MDR-301, Philipps SBC HP840) and hypnosis CD (Figure 2).Figure 3: Resection of a basal cell carcinomaof the noseRegarding the intensity of painful and otherunpleasant stimuli in oral and maxillofacialsurgery, complete abstinence from pharmacologicalanaesthesia was not consideredworthwhile. Consequently, all patientsreceived local anaesthesia (Ultracain DSforte®. Aventis Pharma. Frankfurt) in regularinitial doses. Depending on patient request.local anaesthesia was given either before orafter induction of hypnosis. Once objectiveFigure 4: Surgical correction of posttraumaticectropion of the lower lidEuropean Journal of Clinical Hypnosis: 2006 volume 6 • issue 4

Dirk Hermes, 5amer G. Hakim, Peter SieqFigure 5: Cheek rotation flap for plastic closureof a defect of the lower lid and cheekIn case of major surgery and/or severe generaldiseases of the patient (e.g. coronary heartdisease, pulmonary disease), surgery wasperformed under non-invasive monitoringof heart rate, blood pressure, oxygen saturation,intravenous infusion and insufflation ofoxygen by staff members (Figure 6).Figure 6: Intraoperative patient monitoringduring resection of a tumor of the parotidgland on a polxpathic patientAfter completion of the operation, standardisedre-orientation of the patient by the"dehypnosis" tracks of the CD was accomplished.At least 30 minutes after surgicaltreatment interviews with patients and surgeonswere held.Three-Year ExperienceParticipants of this primary study showed ahigh degree of acceptance to use hypnosisadjuvantly during oral and maxillofacialoperations. Only seven patients of the nonprc-selectedstudy group refused to undergothe combined procedure after standardisedinformation. Seven other operations werecancelled by surgeons after learning of existingacute or chronic mental disabilities of thepatients.Within a three-year period, a totai of 340procedures under Tape Recorded Hypnosiswere carried out on 295 patients between theages of 13 and 87 (Table I, page 6). Evaluationof patients' and surgeons' assessmentof the combined therapy showed no negativeeffects of the oral and maxillofacial treatmentsituation on individual susceptibilityand trance ability of the study group. Eightpatients (23% of all procedures) did notexperience any personal benelit from thecombined treatment and did not show anyobjective signs of trance (therapeutic failure).Four more patients (1.2%) with severetreatment anxiety indicated clinical signs oftrance and were treated under good surgicalconditions, but experienced no subjective reliefof anxiety from the therapy. In all otheroperations (n=328. 9^.5^/r), success criteriafor patient and surgeon were met. Patients inthis group indicated subjective feelings andclinical signs of hypnoidal to medium trance.Along with marked relaxation and inhibitedmotor skills, increased tolerance towardsphysically invasive surgery was particularlynoticeable. Active co-operation, along withthe option for complete re-orientation at anytime, was seen as very helpful in the case ofany necessary changes in the surgical procedure(e.g. intraoperative x-ray). Overallimproved surgical experience was especiallynoticeable in patients preoperatively indicatingsevere treatment anxiety.Emergency circumstances of surgical treatmentdid not show negative effects on patientacceptance or trance ability: results include29 successfully treated patients needingseptic (e.g. facial abscess) or reconstructivesurgery (e.g. extensive facial wounds), inwhich the interval between first informationabout the adjuvant therapy and beginningEuropean Journal of Clinical Hypnosis: 2006 volume 6 - issue 4

Hypnosis in Oral and Maxiliofacial SurgeryOcELOCOCO TII -^c oT— h*-CD"^'^OJT—T—II II II It II II II IIN- CO CO CD COII 11 II II IIC C C C C$ 5-a:LUorCDCO0_ i:ro "o"r^ 0. ^ ^CO 4-0 O3 Co roe 3Q- QO)3COo.^u3^(ACo•oc(0lasticxtensi>losureull thicorreetiecondorreetiheek rilobedQ.0inOO"O§oUJo0J^CJrooOCDO)cCOCOCOcLLCnopiiing0o coO_roOEroCOCOrooCO"ro14—ocoOa.cgCD-1—'oOQ.roCDa)O)3w15.ylogEocoCD0O"raCOCDroEocoroCJ"0OMS 5-2^cro Q- , o •o — o roCOCOCOOcro'EocuCDO"0J- Og "roCOacoCJ ro •J3- 0 "(3X CD X XO UJ LU iz UJOU-OQLOCD CDCN egII IIc cCO COCO OJT— T—II IIc c^—LO OiII IICOCM •^ Ol T-II il II IIc c c coT- OJII 1103OOis^ zQ ^o ^4- CO 0>< CO CD0 ."^*i o 1^ o ro 1^ o1" 0I- crCO g -^o -t± roCD 5 XCO i ^ ^^o ~c ^> C roo ra Ef P- 00 0 -i^Cd Cd S"ro 2oCD1—'-COC/J0oCO:raoX0c/jCO0oCOro roQJ QJro ro_c _c>i ro ro^ 1— k_0)-o -o3 t^ ==(rt ro ro., c: d•-9 9.Q.:«;«m O CJ/A C CEuropean Journal of Clinicai Hypnosis: 2005 volume 6 •

Dirk Hermes, Samer G. Hakim, Peter Siegof surgery under hypnosis was less than 30minutes.During post-operative interviews patients reportednotieeable relaxation, anxiolysis. anda general feeling of mental distanee from thesurgical situation. Although some patientsexperienced temporary painful intraoperativesensations, subjeetive distancing fromthe procedure meant that hardly any patientsrequired additional doses of local anaesthetic.As a result of the typical time distortionoccurring from the hypnotic trance, durationof surgery was estimated mueh shorter bythe overwhelming majority of patients. A seriesof patients eould only remember parts ofthe procedure due to the amnesiac effects ofhypnosis, while five patients did not remembersurgery at all.All patients having a positive trance experiencewould consent to another operation performedunder medical hypnosis. 26 patientshad multiple procedures (2-,'S) under combinedlocal anaesthesia / hypnosis during thestudy interval.On the surgeon's side, the specific effects ofhypnosis improved treatment modalities signifieantly.Patients with a history of severetreatment anxiety eould be operated underloeal anaesthesia. In seleeted eases, majorsurgery on very cooperative and susceptiblepatients with a high risk for general anaesthesiawas possible under stand-by conditions.Nevertheless, the special requirements forhypnotic treatment {e.g. consistent reductionof noise and moving inside the operatingtheatre) initially required serious restructuringof treatment sequences. In brief proeedures(e.g. extraetions performed on patientswith severe treatment anxiety), good therapyconditions were acquired through extendedpreoperative preparation time due to hypnosis.In the daily routine of a surgical department,the use of hypnosis is limited by theavailability of specially trained staff members:although therapeutie measures werehighly standardised, tape recorded hypnosiscombined with preoperative preparation andintraoperative aecompanimcnt of the patientsby a surgeon without hypnosis qualiheationsfrequently resulted in certain mental relaxation,but not stable intraoperative tranee.In direet eomparison with treatment eircumstancesin other surgical fields, a furtherminor but specific disadvantage of the use ofmedical hypnosis in oral and maxillofacialsurgery became evident: at least patients inthis group who needed oral surgery (e.g. surgicalremoval of third molars, apieeetomy)had to endure intraoperative stimuli suchas extraction motions and/or low frequencynoise or vibrations that resonate by bone conduction(e.g. drilling). Neither live hypnosisnor hypnotic recordings adequately shieldedthe patient from such irritants. Consequently.such stimuli (at least with iirst-timc application)regularly led to a short-lived re-orientationwith a remission of the hypnotie tranee.Patients undergoing more invasive and timeconsumingoncological or reconstructivesoft tissue surgery (n=61; figure 4,5) did notshow this phenomenon and success criteriawere met in each procedure.First Study ResultsAcceptance of hypnosis by oral and maxillofacialpatientsBefore introducing hypnosis into the clinicalroutine in 2002. it seemed advisable to eollectinformation concerning the individualmotivation of patients for accepting sueh atreatment option. 310 in and out-patients ofour department completed a questionnaireconsisting of 21 questions. It turned out thatalthough a very low percentage of thosequestioned had detailed knowledge or personalexperience of hypnosis, the procedurehad a high level of theoretieal aeceptanee.1^.4% of all patients believe that hypnosisis an enrichment of medical therapy. 86.5 %find further research on the use of hypnosisin medicine useful, and only a small minorityrejects the adjuvant use of hypnosis insomatie medicine on the whole (Hermes andSieg. 2004).Treatment anxiety and susceptibility oforal and maxillofacial patientsSusceptibility as a characteristie feature ofpersonality is one basic condition for hypnosis,which could be modified by treatmentstress and anxiety. To investigate this possi-European Journal of Climcdi Hypnosis: 2006 volume 6 - issue 4

Hypnosis in Oral and MaxJIIofacial Surgeryble relation. 24 patients undergoing surgicalprocedures were tested with the "State TraitAnxiety Inventory" (STAI) and "HarvardGroup Scale of Hypnotic Susceptibility"(HGSHS:A) one week before surgery, directlybefore and one week after surgery.Results showed a significant increase ofboth variables directly before the operation(Hermes., Mielke and Sieg).Intraoperative stress reduction in oralsurgery by hypnosis50patientsseheduled forelectiveoral surgery(dental extractions, apieeetomy. eystectomy)under local anaesthesia were ineluded in aprospective study. Members of the controlgroup (n=25) were treated under sole localanaesthesia, whereas the verum group (n=25)received adjuvant tape recorded hypnosis.Individual anxiety was evaluated by the StateTrait Anxiety Inventory (STAI). Both groupsshowed a signitieant increase of preoperativestate anxiety. Anxiety of the patients treatedunder hypnosis intraopcratively decreased tobaseline level whereas scores of the controlgroup remained on the high preoperativeleveUHermeset al.. 2003).Patient satisfaction after oral and maxillofacialprocedures under hypnosis70 patients of the department treated undercombined local anaesthesia/hypnosis withinone year rated their postoperative satisfactionwith the surgical therapy in standardisedquestionnaires. Aeontrol group of equal sizeand demographie / surgieal features consistedof patients that underwent similar procedureswithout hypnosis in the same interval.Patients in the hypnosis group expressedsignificantly higher treatment satisfaetionconcerning various aspects of preoperativepreparation (e.g. "patient information","surgical positioning"), intraoperative feelings("trust in the surgeon", "intraoperativepain") and postoperative eondition. 86% ofall questioned aseribed their satisfaction directlyto the adjuvant hypnosis. High motivationto recommend surgical treatment undersuch conditions was particularly notieeable.(Hermes et al.)DiscussionParallel with other surgical and technical developmentsin oral and maxillofacial surgery,improving patient comfort and adequatelyattending to patients with severe treatmentanxiety is taking on new meaning (Desjardins.2000). A scries of pharmaeologiealand non-pharmacological therapy optionsis available nowadays, all having their ownindividual pros and cons. All pharmacologicalmethods (pre-medication. sedation,analgosedation, general anaesthesia) havedisadvantages sueh as technical expenditure,pharmaeologieal side-effects and risks aswell as additional costs. The evoked limitationof the patient's active co-operation eanparticularly complicate oral surgery. A therapcuticallyimportant, enduring reduetionof treatment anxiety is only achievable bynon-pharmaeologieal. primarily anxiolyticalmethods (Dc Jongh el aL. 1995: Joehren etal.. 2000). Non-pharmacological methodsfor redueing treatment anxiety (e.g. psychotherapeutieintervention, acupuncture,audioanalgesia) have only been acceptedand practised by patients and surgeons ona limited basis due to lack of acceptance,therapeutic dependence on other fields andtime-consuming implementation.It ean be concluded that a rational, side-effectfree and widely accepted method forimproving surgieal conditions is currentlynot available.Hypnosis could be such an option. It has beenused in various surgical fields (Blankfield.1991; Montgomery ct aL. 2002) and dentistry(Schmierer. 2001) for more than halfa decade. Although numerous case reportsand clinical studies illustrate its theoreticalpotential, it has been used and investigatedto a very limited extent in oral and maxillofacialsurgery so far.Three clinical studies (Enquist et al.. 1995;Enquist and Fischer. 1997: Ghoneim et al.,2000) have been published. Enquist andeo-vvorkers (1995) demonstrated significanteffeets of pre and intraoperative Tape ReeordedHypnosis (lowered intra and postoperativeblood pressure and blood loss) ofa study group which underwent bimaxillaryorthognatic osteotomies under generalanaesthesia. Enquist and Fischer (1997)8 European Journal ot Clinical Hypnosis: 2006 volume 6 - issue 4

Dirk Hermes. Samer G. Hakim, Peter Siegshowed that a similar teehnique significantlyreduced intraoperative treatment anxiety andpostoperative consumption of analgesicsafter surgical removal of third molars underloeal anaesthesia. Ghoneim and co-workers(2000) described identical anxioiytic effectsof preoperative Tape Recorded Hypnosisin the experimental group of a study whichunderwent dental extraetions or surgical removalof teeth under local anaesthesia andeonseious sedation (fentanyl. midazolam.nitrous oxide). For no apparent reason therewas also a significant increase of postoperativevomiting in the experimental group.The intent of own investigations was to gaininformation about the effeets of standardisedhypnosis during a wider range of oral andmaxillofaeial operations on locally anaesthetisedand non-sedated patients. The basic underlyingquestions were, in how far subjectiveand clinical effects of such a procedurejustify the intensification of its therapeuticuse in oral and maxillofaeial surgery and furthermore,require scientific evaluation usingcontrolled clinical studies.In this respect, systematic applications ofhypnosis in our department indicated interestingperspectives. Hypnosis is a suggestiveprocedure for perioperative stress reduetionshowing a high degree of theoretical andpractical patient consent. Procedural standardisationfor special purposes (e.g. tape recordedhypnosis vs. live hypnosis) minimisesnecessary ehanges in the surgical setting andreduces variables in the design of possibleclinical studies. Meta-analysis of the adjunctiveuse of hypnosis in surgery (Montgomeryct al., 2002) proved that such standardisationis not accompanied by reduced effectivenessof hypnosis. Interpretation of our maxillofacialstudy supports this thesis as the datamatches the success rates of intraoperativehypnosis in the literature. Furthermore, itshows that the specific treatment situation inoral and maxillofacial surgery does not createa negative infiuenee on trance ability andintensity of patients.Positive intraoperative effects of hypnosisinclude sedation, anxiolysis. inhibited motorskills and increased tolerance towardsphysically and psychologically demandingsurgieal procedures. Overall preparationtime (information, seedings and induction)of approximately \5 minutes, complete postoperativereorientation of the patient withinless than 1 minute and low technical costsare further advantages of hypnosis in direetcomparison with established pharmaeologiealprocedures.Nevertheless, hypnosis cannot serve as a serioussubstitute for pharmacological sedationor general anaesthesia. Specific limitationsand contraindications have to be taken intoaecount. surgeons with detailed knowledge,individual patient preparation and specialtreatment modalities are necessary. Its therapeuticuse is limited to mentally healthy andfully co-operative patients who are at leastopen to the procedure.ConclusionIntraoperative hypnosis is an interestingsupplementation to anxioiytic and sedativepharmacological procedures. It showedseveral positive intra- and postoperative effeetsfor both patient and surgeon during athree-year evaluation period. Its potentialfor surgeons should be evaluated in furtherclinical studies.Corresponding author:Dirk Hermes, M.D.. D.M.D.Department of Maxillofacial SurgeryUniversity Hospital Schleswig-Holstein /Campus LuebeekRatzeburger Allee 16023538 LuebeckGermanyPhone: 0049 451 500 2269email: hermesddd@aol.comEuropean Journal of Clinical Hypnosis; 2006 volume 6 - issue A

Hypnosis in Oral and Maxillofacial SurgeryTranscript of the Hypnosis CD"Somehow it is quite normal that you are still feeling a little uneasy here during this dental treatment and that you arethinking about what we intend to do with you and how long it is going to take and whether you are going to feel anythingand it is a very normal reaction that you tense up waiting for something lo happen, and il is really difficult to leisonicbod\ come so ne;ir. but in your mind you know that you will do it to be able to laugh afierwards and show yourlovely leelh and have no more pain and ihis subconscious clinging to the dental chair and brciithing faster in thissituation is a very normal thing which we learned from om ancestors who always, when there Wiis danger around, hadto be on the go and when suddenly a bird or iirioihcriinimal llcw away or made a noise and luiknown sounds werearenind. our ancestors had lo be able to jump up al any lime and run away or to lake on the opponent and we took overthis reaction and whenever something starts we are afraid at least subconsciously, adrenaline is set free, our pulse goesfasler and we prepare lo run away, and if we cannol manage, we hold on and the more we lensc up the more inlensely weexperience what is happening.And ihe more we relax and ihe more relaxed our muscles are and the calnu'r our brciithing is. the less we experiencewhat is going on. and so be guided lo relax your bod> more and more trvon more quiet and relaxed, iuid you c;inlislen to the music You can listen lo my voice, or you caii use all the sounds you hear in Ihe background to feel moreand more eomfortable in your body, and you ean feel lingers touching your head, your eheek, but you ean feel as wellhow your back and your buttocks are lying on the chair, how your legs and feet are lying there and lei your hands becomerelaxed, shoulders soft, and you can close your eyes and create images in front of your inner eye whieh eonespund lo allihis and you can use all you hear lo remember very beautiful and coml'orlable images.Imagine your holiday resort, your favourite holiday reson. of which you have always been dreaming and tiivc yourselfall [he freedom lo use all your imagination to really recall yourself [here or think forward where you will have fell veryeomfonable. those days in the fuiure. when you were lying on this wonderful beach wiih the salty smell of the sea.ihe air smelling so delicious and whal there was to eat there. Imagine all these wonderful pleasures you eould enjoy.nol to forget drinking, and how you enjoyed il and how you are enjoying it now in your imaginaiion. whiie you arc relaxingyour btidy more and more And you ean relax systematically, and you begin down at your feel, experiencing howit feels when fine sand is trickling between your toes, how il gives under your steps how warm il is and how heavyyour feel are becoming meanwhile .... and Ihis heaviness ean spread further And il might be that meanwhile, youexperience sounds iti your body, a lillle growling from yoursloiiiach. and il is a sign of relaxation, and yoti can iidd all thesounds you happen lo hear into your most pleasant holiday experience .... and ihe sound of ihe Nuclit)ii couid be ibe windthai cools your forehead and an exotic bird could sing and you eould change Ihe sound of the drill into the bird's voice,or you could sil on a molorbike and ride along the beach and fee! the bumps and the vibralion and hold onto thehandlebars in your faninsy and you can take all the sounds and touches with you to Ihis beautiful holiday resort anduse ihem lo relax even niort-, lei your legs become even heavier feel your feet your lower legs yoiirihighslaying Ihere nothing lo do jusl letting your body feel very comfortable heavier, and heavier, and more andmore heavy even more heavy, very heavy and il is a very pleasanl feeling to feel how your body beeomesheavier your pelvis heavy even heavier your pelvis more and more heavy very heavy and warm streamingwarmih in your stomach tot) and now search for ihc heaviest pail of your body your back heavy heavierand heavier very heavy And the heaviness can spread to your shoulders lo your arms slowly over yourshoulders to your upper arms your lower arms your hands heavy. Arms and shoulders heavy arms.shoulders and hands heavy heavier and heavier even more heavy very heavy yes. And concentrate on thecalm of your brealh. lei il How deep down lo your stomach .... letting it flow \ery relaxed so ihat it breathes wiihinyou .... in deep calm brealhs .... and meanwhile you can imagine Ihe pendulum of an old cloek maybe the kind of clockyou have seen in ihe house of an old person maybe al your grandparents or in a museum A clock whosependulum swings once in a second imagine the calm pendulum of this clock, and just let it swing as you can seeit swinging in front of your inner eye .... and your breath becomes very calm and all those muscles in your body becomevery smooth and soft and relaxed muscle fibres smooth and relaxed like cooked spaghetti .... and you can havefun during Ihis lime and remember funnj or pleasanl things as you watched somebody and you were so pleased andwere laughing from the bottom of your heart and you know that you can divert so easily when the things you arethinking aboul arc just more beautiful .... more impttrtanl more pleasajil and you do nnl have to lell me afterwardswhal you were ihinking aboul Ihe main thing is that your inner experience is so beaulitul. so beautiful that youfeel all warm and pleasanl in your body and you can imagine thai you gave away your mouth for repair, simply gaveil away, and you stand opposite yourself and crilically wateh .... and wateh yourself lying there the headphonesimply being calm letting things happen and being lost in yourown Ihoughis which lead you away from this limeand this room .... far away to pleasanl coutilrics lo pleasant acliviiies, and choose the ones you would like to domosl and Icl your imaginaiion riui wild .... lo picluie ihings as mosl beautiful experiencing each delail. And ihalyou watch yourself in the meantime, your surroundings experiencing them exactly wiih each detail and whethersoniebt)d}' L'Ise is with you The colour of vour skin, your eyes, ihe v\armlh inside yiRir body, the pleasanl feeling insideyour body and the calmness simply doing nothing ctimplelely relaxed being carried, and the more youlet yourself be carried, ihe lighter you ean feel and il can be thai you feel like floating on a cloud like in a pleasantdream seeing everything from high above ihe litlle people and the little landscape far away from your well-being,.... and wateh from up there, from that distance, happy and relaxed, what is happening down there, and it does nol havelo concern yoti on your beautiful, beauliful cloud any longer what is happening down there because il is brighl sun-•\Q European Journal of Clinical Hypnosis: 2006 volume 6 - issue 4

DJrl( Hermes, Samer G. Hakim, Peter Sieglight up here everything so soft, so iighi. so pleasantly relaxed and the colours around you maybe a yellowrape seed field the orange of the roofs ur the green of the woods, which spread far. and fade into the blue ofheaven at the horizon and even further away into violet, beautiful And you do not have to listen to each of mywords take everything you hear as a pleasant background sound like the rush of a waterfall when you sleepin fresh air .... and somewhere in Ihe distance there is Ihe calming sound of the water .... whieh accompanies you andmakes you dream so pleasanily and beautifuly and you ean use everylhing, even touches, because they are meant tobe very kind, these soft touches and they serve a kind purpose, and they will help you to feel even belter andeverything you can smell and taste reminds you of pleasant ihings of a pleasant taste and a pleasanl smell .... yesand you can help to make ihe trealnieiil continue quickly and comfortably by simply relaxing your head, your neck, yourtnoulh make il very sofl.as soil as a cuddly toy Feel how ihe skin of your head becomes smooth and your foreheadlike ihe smooth surface of a lake whose shores you can imagine now yourself and you can make the plaee insideyour mouth, whieh is deali with, cool and furry by turning off the blood fiow. Somewhere there is a stop valve you cantighten, a big stop valve, you can pul in both hands and tighten step by step And wiih every turn you swiich off theblood flow a little more one two Ihree fourth lurn five turn off more six let everylhing becomecold .... seven, cold and insensitive, and you can imagine how you are lying in a wonderful, warm bath tub andyour body rests in Ihe warm water and you bear ihe w:iter drop, and you breathe m ibe humidity and thii warmib andwatch the drops as some fall from ibe tap fall into the bathwater and cause lillle waves which spread more and moreand maybe you pul in the warm water a nice bath essence, whose smell you can inhale and whose eare you ean feelon your skin and you can allow your lefl hand lo lift jusl slightly oul of the waler .... and hear tbe sound, whicharises, and feel, how these fine hairs tin your left hand lie flat as the water runs down Iheni and how fa.st the handbecomes eool. when il rises above ihe warm waler and enjoy ihe coolness of your left hand because you cantransfer ihis coolness on to your head, your forehead, your moulh now your fingers your thumb as a liitletickling shows the increasing numbness of the hand how uumbfhe hand ean become when it rises from the warmbath waler. And it can help you to really relax and unwind in this bath water, while your head and hand rise from thewaler and they feel pleasantly ctwl and more and more insensitive, furry and ealm yes And, while this ishappening, you can simply allow your hand to do what il would like todo and you really do nol have Io worry aboutit and afler a while you can briefly check, whal il is really doing Coneenirate fully on your other hand, on yourrighl hand and lei il become warmer and warmer while you hear this sound because il is siill in the waler andihe blmid in your hand is pulsating strongly so that the blood flow in ihc lell hand becomes less and less while theblood How in Ihe righl hand becomes more and more, more and more warm and sensible and you can imagine, thatyou can breathe oul through your righl hand everything that still bothers you .... and ihat Ihe left hand feels as though itis covered with an ic-y glove, completely insensitive il feels, as if it is completely strange, no longer belonging to you,and you can now transfer this feeling to your mouih because it ean learn from your hand and when you experiencethis feeling now very intensively, this difference between lefl and right, then you can make the differenee moreand more iniense cooler and cooler warmer and wanner more and more numb lighter and lighterheavier and heavier. And it is definitely an ania/ing experience to feel ibis difference more and more, and you can allowyour hand to find a comfortable place somewhere, where il feels completely well and meanwhile beeomes even moreinsensitive so thai the righl one can become even more warm because it is your lightning conductor, you canbreaihe oul everything thioiigh it. and the left one helps you to feel less and less and when you, later at home, wantlo cope with pain then note now very exaclly. how your body feels, and beg your body for a sign somewhere, afeeling, a litlle noise, an image whicb comes lo your eyes now and give [his .sign a name, so that al any lime, whenyou say this name inside, you ean relurn lo ihis lovely relaxation and make the difference belween left and right more andmore noiiceable by lying down and breaihing deeply into your siomach. And simply allow your body to become heavierand ihis difference appears and when you say the name and when you have the feeling again which you havenow then you can lei your left hand go to where you feel the pain and it will be as if the pain disappears into thinair. after you have taken note of il again and have shown it your respeet and reverence, simply let il How out wiih thehelp of your left hand by lying in a meadow on a lovely soft carpel and dream aboul heaven and let everylhing[!y upwards with ihe help of your left hand, while you smell Ihe fragranee of Ihe grass and bear all ihese littlenoises around you when a blade of grass brushes against another blade of grass and a liitle ladybird runs along ityes And you can piclure your meadow yourself what you can see there and also Ihe surroundings of themeadow and how you feel more and more comfortable wonderful enjoying the peace, which has spread inyour body and hanging on lo your dreams that come and go all on their own su ihat another piclure canappear And you can use the time and meanwhile forgel completely, huw time passes by And il can be that itall feels very short ihal you would have liked to dream longer because, as in a dream, yuu can, while you are suwonderfully relaxed, simply forget time and you ean make pleasant moments la.st longer and if you have toovercome sumething. let this time pass by quickly allow yuurself to really enjoy the pleasant muments and youcan take your lime during ibese times to forgei time by thinking of limes, lor which you normally du nol have ihelime and it can be before ihis time or after this time it can be in the past, or it can as easily be in the future andyou have all the freedom Time, yuu can use to think of really pleasant thoughts develop pleasant, positive things.revel in lovely old memories and simply enjoy having time."European Journal of Clinical Hypnosis: 2006 volume 6 - issue 4ii

Hypnosis in Oral and MaxJIIofacial 5urgeryOriginal text of the hypnosis CD (German),.Bs isi eigentlich gan/ normal, wenn Sie sich zu diesem Zeitpuiikl bei so einer /.ahnarztlichen Behiuidlung noch etwasunruhig fuhlen und sicli Ihre Gedanken tnaehen. was wir ailes mil Ihncn vorhaben und wie lange es dauem wird. undobSie etwas spliren werden und es ist eine gan/. naturlichc Reaktion, da.ss man sich zunachsl einmal aiispaniit in derHrwariung dessen, was da kummen wird. und es ist schon sehwierig. jemanden su nah an sicti heran /u lassen. aber inIhreni Kupl'wis.sen Sie ja, dass Sie es dafiir tun.dass Sie nachher wieder lacheri knruien und Ihre schonen Ziihne /.eigen,und dass Sie hinterherkeine Schmerzen mehrhaben ... und dieses unbewussle Sich-etwas-Verklammern am Stuhl. diesesschnellere Aimen in dieser Situatiun. isi eine gan/ naturliche Sache, die wir von unseren Vurfahren gelertit haben. .. dieimmer. wenn Ciefahrgedrohl hal.auf dcm Sprung sein mussteti. utid wenn da plol/.lieh ein Vogel oderein anderes wildesTier in der Niihe war und aufflog uder seine Gerausehe gemaehl hat .. und unbekannte Cieriiusche in der (legend waren,musslen unsere Vurfahren jedcr/eit \n der Lage sein. ploi/lieh auf und davon /u springen oder sich dcm Gegnerzu slellen.. und dicsL' RL'aktiun haben wir ubornummen und imniLT. wcnn t'twas losgeht. von dcm wir /.inniiides! unbewusst einegewisse Angst haben. wird .Xdrcnalin :lll^geschultet. gcht der Puls scbncllcr und wir iiiachcn uns bcreit davon/ulaufen,und wenti wir es nichl konnen. haiten wir uns fesl und je mehr wir uus anspannen je mehr wir uns verkrainpfen. um sodeullicher spiiren wir. was geschiehl.Und je mehr wir uns entspannen ... und je lockerer unsere Muskeln sind ... undje ruhigerunser Aiem geht.um so wenigerkonnen wir spiiren von detn, was da vor sieh geht, und deshalb lassen Sie sieh anieiten. Ihren Korper jei/i mehr undmehr... immer ruhiger und enlspannter werden /.u lassen, und Sie konnen dabei der Musik zuhoren Sie konnen aufmeine Slimmc lioren. oder Sie konnen alle GeriUische, die Sie su nebenher mitbekommen. da/u vcrwetiden. sicli immerwuhler in Ihrcni Kurper /u fiihicn und Sie kuniien Beriihrungcn spiiren. ati Ilirem Kupf. an I brer Waiige. aber Sic kunnciiauch spiiren. wio Ihr Riickcn und !lir CiesiiB auf dcm Suibl aulliegt. wic Ihre Beinc und I-'iii.le su daliegcn und llur llaiideliickerer werden lassen. die Schulieni weich. und Sie kunnen Ihre Augen sclilieBen und sich vur Ihreni imieren AugeBildcr entstehen lassen, die /u all dcm passcn. uud Sie kunnen das, was Sie hiireii. benui/en, um sich an selir schime undangeiiehnic Biider zu erinnern.Malen Sie sich Ihren Uriaubsurl aus. den Lieblingsurlaubsorl. von dem Sie schon immer getriiumt haben. luid lassenSie sieh alle Freiheil.all Ihre Phatitasie zu beuillzen, um sich wirklieh dorlhin zu erinneni oder vuratiszudenken, wo Sieeinmal ganz besonders wohl sieh gefuhlt haben werden. damals in der Zukunfl als Sie an dem wunderschonen Strandlagen .... mil dcm sal/igen Duft des Meeres. dass die I.ufl so kusiiich geruchen hat .... und was es dorl /u essen gab. Alldie sehunen Genusse. die [nan sich auf der Zunge /.ergehen lassen kunnte. das Trinken nichl /u vergessen. und wie Siees genossen haben und wie Sie es jetzl genieBen konnen in Ihrer Erinnerung. wahrend Sie Ihren Korper immer mehrentspannen Und Sie kunnen diese Entspannung systemaiisch maehen. und Sie fangen an. untcn an den FiiBen,fiihien Sie. wie es sieh anfuhlt. wenn feiner Sand dureh die Zehen rieselt. wie er unter Ihren Sehritten nachgibi sanftabledcrl, wie warm er ist und wie sehwcr dabei die RiLle werden ... und diese Schwcre kann sich wciler ausbrcitcnUnd es kann sein. dass Sie dabei Gerausehe in Ihrem Korper wahrnehmen.ein kleines Brummen aiis Ihreni Baiich. undes isi cin Entspannungszeichen. und Sie konnen alle Gcriiusche. die Sie nebenher noch horen.einbauen in Ihr schonstesUrlaubserlebnis .... und das Geriiusch des Saugers kann der Wind sein. der iiber Sie hinwegstreifl und Ihre Slirne kiihll.... und es kann ein exutischer Vogel pfeifen. und Sic konneu das Geriiusch des Buhrors umwaiidehi in dieseii cxoiischenVogel. oder Sie konnen sich auf ein Mutorrad setzen und darnil den Strand entlang tegen und das Holpern und RCittelnspiiren .... und sich dabei festhalien am Lenker iu Ihrer Phantasie .... und alle Geriiuschc imd Beriihrungen kunnen Siein diesen schonen Urlaubsurt mitnehmen und dazu verwenden. sieh nneh mehr zu entspaimcn ihre Beine sehwererwerden zu lassen fiihien Sie ibre FiiBe ihre Untcrschenkel ihre Oberscheukel. wie Sic su daiiegen nichts /utun nurden Kurpersich gan/ wt)hl fiihicn lassen sehwerer, und sehwerer. und immer sehwerer .... noch sehwerer.ganz sehwer .... und es ist ein sehr angenehmes Gefiihl zu spuren. wie der Korper sehwerer wird das Becken sehwer..... noch schwerer .... immer sehwerer das Becken .... ganz sehwer und warm .... stromeud. warm auch im Bauch ....und suchen Sie jetzt den schwersien Punkl Ihres Korpers der Riicken sehwer .... sehwer wird der Riicken immersehwerer .... gan/ sehwer Und die Sehwerc kann sich aiisbreiten in die Sehultcrn in die Arme langsam iiberdie Schullern in die Oberarmc die Linteraniie in die Hiinde .... sehwerArnK' und Schullern sehwer Aime, Schiiltern, Handc sehwer .... immer scbwercr nucli sehwerer .... gan/ sehwer.... ja .... Und kun/entrieren Sie sich auf die Ruhe Hires Alems. lassen Sie ihn lief liinunlcr bis /um Bauch ausslriimen..... ganz enlspannl IliefJen lassen so dass es Sie atmet .... in ruhigen lielen Atemzilgen .... und Sie kunnen sich da/udas Peudcl cincr alien Uhr vorstellcn viclleicht cine Uhr. die Sic einmal bei eincm alien Mcnschen in der Wuhiuuiggesehen haben vielieichl bei den GroBeltern .... oder in eiiiem landeskundlichen Museum So eine Uhr. derenPendel in der Sekunde einmal sehwingt .... slellen Sie sich dieses ruhige Pendel dieser Uhr vor. und lassen Sie es einfaehschwingen so. wie Sie es jelzt vor Ihrem inneren Auge sehen konnen .... und der Atem wird ganz ruhig .... und all dieMuskeln in Ibrem Korper werden weieb und locker und enlspannl Muskelfasern weich und lucker wie gekoehte Spagetli.... und Sie konnen ruhig Ihren SpaB haben in dieser Zeil und sich auch an lusiige und angenehme Dinge erinnern,wie Sie einmal zugeschaut haben .... und sich unheimlich dabei gefreui haben und so gan/ aus innerstem Herzen gelachthaben .... und Sie wissen ja, man kann sich so leicht ablenken wenn das, woran man denkt, einfaeh schoner ist ....wiehliger angenehmer und Sie brauchen uns nachher nicht /u er/ahlen, wuran Sie gedaehl haben die Hauplsacheist, dass dieses Ihr inneres Rrleben, so schiin ist, su schon dass Sie sich in Ihrem Korper ganz warm und wuhlfiihien und Sie knnnen sich vorstellen.dass Sie Ihren Mund zur Reparalur abgegebeti haben. ihn einfaeh weggegeben12 European Journal of Ciinicai Hypnosis: 2006 volume 6 - issue 4

Dirk Hermes, Samer G. Hakim, Peter Sienhaben und sclbsl kritiseh beirachtend vur sich hiti slehen .... und sich anschauen, wie Sie so daliegen den Kopfhorer.... und eintach ruhig sind geschehen lassen und dabei Ihren eigenen Gedanken nachgehen die Sie aus dieser Zeiloder aus diesem Raum herausfiihren .... weit weg .... in angenehme Lander zu angenehmen Tatigkeiten. und suchenSiesichdieraus.dieSieam allerliebsten lun ....und tassen Sie Ihrer Phanlasie dabei alle Freiheit es sich wunderschtinaus/umalen wirklieh jedes Detail wahr/unehmen. .Und. dass Sie sieh selbst dabei sehen, die Umgebuug. in der Siesind sie wirklieh genau wahrnehmen mit alien F.in/elheiten .... und ob nueh jemand dabei ist. ... Die Farbe der Haul,der Augen, die Wiirme im Korper. das angenehme Gefiihl im Kiirper .... imd die Ruhe einfaeh uichts zu lun .... gan/entspannt .... sich tragen lassen undje mehr Sie sich tragen lassen. um so leiehtcr konnen Sie sich fuhlen. .... und eskann sein. dass Sie sich fiihien, als ob Sie auf eiiier Wolke schwcben wie in einem schonen Traum .... allcs vun weiluben sehen die kleinen Menschen und die kleiiie Laudsclial'l da unten so weit weg von Ihrem Wulilbeliiideii .... undbctraehten Sie von da uben, aus ihrer Dislanz froh und enlspannt, was da unten so alles vor sich geht. und es muss Sieuberhaupt nichl in Ihrer scbonen, wunderschonen Wolke weiler interessieren, was da unten vor sich geht denn es ist sostrahlendhell daoben alles so weieh, so leicht so angenehm enlspannt ....und die Farben um Sie herum vielieichlein gelbes Rapsfeld das Orange der Ditcher .... oder das Griin der Wiilder. das sich weil ausdehnl. untl am Horizon!Cibergeht in das Blau des Himmels .... und noch weiler weg .... ins Violetl. schiin Und Sie brauchen nicht jedem meinerWorte /uzuhoren nehmen Sie alles. was Sie hiiren, als ein angenehmes Hintergrundgerausch .... wie das Rau.scheneines Wasserfalls wenn Sie in einer guten Lufi erholsam sehlafen .... und irgendwo in der Feme das beruhigendeGerauseh des Wassers ist das Ihren Schlaf tragi. begleilel .... und Sie so angenehni und schun triitimen lassi .... undalles konnen Sie beniit/.en. auch die Beriihrungen denn sie sind licb gemeinl. diese sanften Beriihrungen .... und siehaben einen guten Zweck, und sie werden Ihnen helfen, sicb noeh wohier /.u fiihien und alles, was Sie sehmeekenund rieehen. kann Sie an angenehme Dinge erinnern an einen angenebmen Gesehmaek und an einen guten Dufl .... ja.... und Sie konnen niithelfen.dass die Behaiidfung nisch und bequetii vunstatlen geht. indem Sie auch Ihren Kopf, IhrenNacken. Ihren Mund einfaeh locker lassen ganz weich machcn.su weich wie ein Kuscheltier Spiiien Sie. wie IhreKopfliaut glatt wird und Ihre Stirn wie die glatte Oberflaehe eines ruhigen Sees..... dessen Uferiandsehalt Sie sieh selbstausmalen konnen und Sie konnen die Stelle im Mund, an der gearbeilet wird. kilhl und pelzig maehen. indem Sie dadie Durchbluiungabstellen-Esgibt da irgendwuein Handrad,das Sie zudrehen konnen.ein gruBesAbsperrveniil, das Siemit beiden Hiindeii lassen und Schriti fiir Scbriit /udrehen..... Und mil jeder Umdrehung slellen Sie die Diirchbhilung in Ihrem "Mund nocb ein biBehen mehr ab .... eins zwei.....drei..... vierte Umdrehung fiinf nocb mehr abstellen sechs alles kail werden lassen sieben.kalt undunempfindlieh, und Sie konnen sich vorstellen wie Sie in einer wunderschonen, warmen Badewanne llegen und ihrKorper ruht in dem warmen Wasser .... und Sie hiiren das Wasser Iroplen und atmen die Feuchtigkeit und die Warmeund schauen den Tropfen zu. wie sie noch vereinzell sich vom Wasserhahii losen hineinfallen in Ihr Badewasserund kleine Welleii austusen. die sich immer weiter aiisbreiten .... und vielieichl haben Sie einen schonen Badezusalzin das warme Wasser getan dessen Duft Sie einatmen konnen und dessen Pflege Sie auf der Haut spiiren wieein wtieher Balsam empfangt es Sie ..-. und Sie konnen ihrer linken Hand erlauben sieh etwas aus dem Wasser /.uheben .... und dieses Gerausch horen, das dabei enisteht. und spiiren. wie die feinen Harchen un ihrer linken Hand sichflachlegen. weun das Wasser an Ihiieri herunler laufl .... und wie schuell die Hand kiihl wird. wenn sie aus dem warmenWasser herausragi .... uud genieBen Sie diese Kiihle an ihrer linken Hand denn diese Kiihie konnen Sie iibertragen aufIhren Kopf, Ibre Stirn, Ihren Mund jetzt .... den kleinen Finger Zeigefinger den Daumen wie ein leicbtesKribbein das/unehmende Pel/igwerden der Hand anzeigt wie die Hand unempfindlieh werden kann wenn sie ausdem warmen Badewasser herausragt. Uud cs kann llmen hellen. sich wiiklich schon in diesem Badewasser /ii erholenund zu entspannen. wahrend Ihr Kupf und Ihre Hand aus dem Wasser herausragen .... und angenehm kiihl .... und immerimenipfindlicher. pelziger. ruhiger .... ja .... Und wiihrend Sie ihre Hand einfaeh lun lassen. was sie lun mochte .... undSie brauchen sich uirklich nichl um sie kiimmern .... Und Sie konnen ja nach einiger Zeit kur/ iiberpriifen. was IhreHand wirklieh tut Kuiizenlrieren Sie sich gan/ auf Ihre andere Hand, auf die rechle .... imd lassen Sie die bei diesemGerausch immer warmer werden weil sie [luch im Wasser ist und das Blul in der rechten Hand kriiftig pulsieren,....damit die linke immer weniger durcbblutet wird, wahrend die rechte immer mehr durcbblulet wird. immer warmer undsensibler wird .... und Sie konnen sich vorsiellen, dass sie dureh die rechte Hand alles ausatmen, was Sie noeh slortund dass die linke wie mit einem eisigen Handschuh iiberzogen. vol I kummen laub wird so ein Gefiibl.als ob sie ganzfremd ware, nicht mehr zu Ihnen gehuren vviirde und dieses GefiibI kunnen Sie aul' Ihren Mund uberlragen denner kann von der Hand lernen .... und wenn Sie die.ses Gefiihl jetzt ganz genau spiiren, diesen Unterschied zwisehen linksundrechls.dann konnen Sie diesen Unlersehied immer deutlicher werden lassen immer kiihier immer warmerimmer pel/iger sensibler immer leichler immer schwerer.Und es isi schon ein aufregendes Friebnis, die.sen Unlersehied immer deutlicher zu spiiren. und Sie kounen Ihrer linkenHand erlauben. sich irgendwo einen ganz bequemen Plai/ /u suchen. an dem Sie sich wirklieh wt)bl liihli und dabeinoch uuempfindlicher wird damil die rechle noch warmer werden kann denn sie ist ihr Blilzableiter, durch siekonnen Sie alles ausatmen. und die linke hilft Ihnen immer weniger /u empfinden und wenn Sie einmal spater. zuHause.mil einem Schmerz fertig werden wollen dann merken Sie sich jet/1 gan/ genau. wie sich Ihr Kuqier anfiihll.und bitten Sie Ihren Korper um ein Zeichen .... irgendwt). ein Ciefiihl. ein kleines Gerausch. ein Bild. das Ihnen jet/tvur Augen kumml .... und geben Sie diesem Zeichen einen Nameii, damil Sie jeder/eit, wenn Sie sieh diesen Nameniiuierlich sagen. wieder in diese schone Knispannung /uriickgehen konnen und einen Unterschied zwisehen links undrecbts deutlieher werden lasseu konnen, indem Sie sich hinlejien und tief in den Baucb almen und einfaeh geschehenEuropean Journal of Clinical Hypnosis: 2006 volume 6 • issue 4 13

Hypnosis in Oral and Maxillofacial Surgerylassen. dass der Korper sehwerer wird und dieser Unlersehied auftriti wenn Sie den Namen nennen und wenn Siedieses Gefuhl im Korper wieder haben. das Sie jetzl habendann konnen Sie die linke Hand dahin gehen lassen. woSie den Schmerz spuren .... und es wird sein, als ob er sich in Lufi auflosi, nachdem Sie ihn nochmals genau zur Kenntnisgenotnmeii haben .... und ihni ihren Respekt und Ihre Referenz erwiesen haben. lassen Sie ihn mil Hilfe der linken Handeinfaeh hinaus llicBeii indem Sie sich iu eine Wicse legen auf einen schonen weicheti Teppich und in deii Himmeltraumen .... und alles nach oben hinausfliegen lassen .... mit Hilfe Ihrer linken Hand, wiibrend Sie den Duft der Graserrieehen und die vielen Gerausehe um Sie herum horenwenn der Grashalm am Grashalm reibl .... und ein kleinerMarienkafer darauf entlanglauft .... ja Und Sie konnen sieh Ihre Wie.se selbsl ausmalen was Sie durt alles .sehenund aucb die Umgebung der Wiese .... und sich immer wuhler fiihien sehon und die Riihe genieBen. die sieh inIhrem Korper eingeslelll hai .... und Ihren Triiumeu nachgehendamit ein anderes Bild sich einstellen kunudie gan/ von alleine kommen und geheu konnenUnd Sie konnen die Zeil nutzen .... uud dabei ganz vergessen, wie dieZeit vergeht Und es kann seiu. dass alles sich sehr kurz anfiihit dass Sie gerne noeh linger getraumt hatlendenn wie in einem Traum konnen Sie, wenn Sie su schun entspannt sind. die Zeil einfacb vergessen .... und Sie kounendie angenehmen .Mumenle lang werden lassen .... uud wenn Sie elwas /.u bewaltigen haben. diese Zeil ganz schnellverstreicheu lassenum wieder die angenehmen Momente wirklieh zu genieBen .... und Sie konnen in dieser Zeit sichwirklieh Zeit nehmen. um die Zeil /.u vergessen indem Sie an Zeiten denken, fur die Sie sonst keine Zeil haben ....und es kann vor dieser Zeil sein oder nach dieser Zeit sein .... und es kann in der Vergangenheil sein. oder es kann auchin der Zukuufl sein .... und Sie baben alle FreiheilZeil. die Sie nutzen konnen. um wirklieh an angcnebme Gedankenzu denken sehone. positive Diuge /u eniwickein in scbonen alten 1-j innerungen /v kramen .... und es einfaeh /ugenieBen. Zeit zu baben."Schmierer A (1995) Beim Zahnarzt ganz entspannt. CD, Hypnos, StuttgartReferencesI. Blankfieid RP. Sugyeslion. relaxation, and hypnosis as adjiiiKls m tlic care iil' sLirj:L'ry palicnK: A review ol ihi: iiltraltirc. AmcriuanJournal of Cliriioil HvVu'sis. I'Wf. vol. 33.pp' I72-IS62. BroiMi 11. Mt fnncs D. Hypnosis and ils CITI^LIS on pain coiUroL British Dt'intal Journal. 1486, vol. Ihl. pp. 222 2253. Davis LW. Hu.sbanil RW. A study olhypniitic suscL-piibiliiy. Journal ol Abnormal and Social Psychology. 1931. vol. 26, pp. 175-1824. De Jongh A, Muris P. Ter Horst G, Van Zuuren F. Schoenmakers N. Makkes P. One-session treatment of dental phobia: preparingdental phobics for treatment by reconstruct ur ing negative cognitions. Befiaviour Research and Therapy, 1995, vol. 33. pp. 947-545. Desjardins PJ. Palieni pain and anxieiy: the medical and psycboloyical cbaflenges facing oral and miixlllofatial suriiL-ry. Journal ofOral and Maxilfufacial Surgcr>. 2(HM1, vol. 5S. Suppl. 2. pp. 1-36. Enquist B. Fiscber K. Preoperative hypuolic lecfiniLiues reduce Lonsunipliou ot analgesics al'ier surgical removal ol'lhird uiaudibularmokirs: a brief commuuicat inn Inteinaiiouiil .lounial ot Clinical nud H>;peri mental Hypnosis. 1947. vol. 45. pp. 102-1 OK7. Enquisi B. von Konow I.. BystetU H. Pre- and posioperalive suggestion in maxillofatial surgery: effects on hlotnl loss and recovery,fnternaiional Journal of Clinical iind Experimenial Hypnosis. 1995, vol. 43, pp. 284-2948. Faymonville MR. Meurisse M. Fissclle J. Hypnosedation: ;i valuable allcnialivc !o Iradilional anaeslhetii leLhniques. Aela fbiiurgieaBelgica, 1999, vof. 4,pp. 141-1469. Finkelstein S. Hypnotically assisted preparation ol ibe anxious palieni lor medieal and denial Ireaimeni. American Jonrrial ol ClinicalHypnosis. 1991. vol. 33. pp. 187-19110. Gboneim MM. Biwk Rl. Sarasin DS. Davis CS, Marcbman JN. Tape-recorded bypnosis instructions as adjuvant in ibe care ofpaiienis scbeduled lor ibird molar surgery. Anesibesia Analgesia. 2(MI0. vol. 90. pp. W-ftS11. Hermes D.Gerdes V.Truebger D. Hakim .SCJ.Sieg P. Evaluation des perioperaiiven Einsai/es standardi^ierier Hypnose miueisState-Trai(-AngstinventarlSTAI). Mund-. Kiefer- und Gesicfitscbirurgie. 2O()4, vol. 8. pp 111-11712. Henries D, Mielke M.Sieg P. Auswirkungcn von chirurgiscbem Stress auf die Suggcsiibilitai mund-. kiefer- und gesichtschirurgischerPatienten. Hypnose und Kogniiion. Accepted for publicaiion.f3. Hermes D. Sieg P. Acceptance otmcdiL'al bypnosis by oral and maxillotacial patients. Inicrnational Journal of Clinical andExpenmental Hypnosis. 20(14. vol. 52. pp. 389-39914. Hermes D.Truebger D. Hakmi SCi. Sieg P. f'iiiienten/ufnedenbeil nach mund-. kiefer- und gesicblscliirurgischen Operaiionen unterHypnose. Hypnose und Kogniiion. Accepted for pubiicalion.15. Hermes D, f'ruebger D. Hakim S Hypnoseionbandes in enier 7abnaer/llitbetiPraxis. Hypnose und Kognition, 1999, vol. 16. pp. 111-11920. Schmierer A, Kun/efmann KH. Hypno.se in der Zahnheilkunde. Chapler in Rcvenslorf D (tid.i, Kiini.scbe H\ pno.se. Berlin: Sprtnger1993 (pp. 393-42012f. Schmierer A. Beim Zahnar/.l gan/. enlspannt |CD|. StuItgaiT: Hypnos 199522. Schtiiierer A. liinfuebrung in die /abnacr/llicbe Hypnose. Berlin: Quintessen/ 200123. Schueiz G. Freigang H. Zaliiiaer/iliche Hypnose. Siuttgail: Hypnos 2000•J4 European Jourridl of Clinical Hypnosis: 2006 volume 6 - isi.ue 4