CCHN(C) cheat sheet

Mesmer's animal magnetism (18th century) was discredited by the 1784 Franklin commission; Braid reframed the phenomenon as a physiological 'nervous sleep' and coined hypnosis.

Braid introduced 'hypnotism' around 1843; later Faria and Liébeault framed the effect as suggestion, and Bernheim popularized the idea at the Nancy school.

Charcot's Salpêtrière school treated hypnosis as pathological; the Nancy school held it to be ordinary suggestibility, a debate that shaped modern views.

Hull (1933) treated hypnosis experimentally as heightened suggestibility; his work influenced the development of standardized scales.

Hilgard's neodissociation theory posits a hierarchy of cognitive control systems and a hidden observer during hypnotic analgesia.

Social-cognitive theories (Kirsch, Spanos) emphasize expectancy, role enactment, and response set rather than a trance state.

Hilgard and Weitzenhoffer developed the Stanford Hypnotic Susceptibility Scales, establishing individual differences as measurable.

Hypnotizability is a stable trait with a roughly normal distribution; about 10-15 percent of adults are highly responsive and a similar fraction minimally responsive.

Common hypnotic phenomena include analgesia, amnesia, age regression, catalepsy, ideomotor responding, positive and negative hallucination, and time distortion.

Ideomotor suggestions (arm levitation, pendulum) are among the most reliably elicited; negative hallucinations and posthypnotic amnesia are less common.

Hypnotizability, not depth of 'trance', best predicts responsiveness to hypnotic suggestion.

Absorption, fantasy proneness, and expectancy correlate with hypnotic response; personality measures alone are weak predictors.

Hypnotic susceptibility is generally stable across adulthood and shows little change with training; test-retest reliability is moderate to high.

Children show higher hypnotizability in middle childhood, declining in adolescence; older adults may show slightly reduced scores.

Suggestibility is context-dependent and influenced by wording, perceived authority, and expectancy; compliance differs from genuine experience.

Standardized measures include the Stanford Hypnotic Susceptibility Scale and the Harvard Group Scale of Hypnotic Susceptibility.

Screen for psychosis, dissociative disorders, severe depression with suicidal ideation, and active substance intoxication before hypnosis.

Hypnosis is not a reliable memory-recovery tool; avoid using it to 'refresh' eyewitness memory due to confabulation risk.

Assess expectations, motivation, prior hypnosis experience, and any fears about loss of control.

Obtain medical clearance when symptoms may indicate an undiagnosed medical condition; hypnosis is adjunctive, not diagnostic.

Assess for secondary gain, malingering, and litigation context that could distort reported outcomes.

Contraindications are relative, not absolute; document rationale when proceeding despite risk factors.

Screen for claustrophobia or trauma history that may make eye closure, relaxation, or immobility distressing.

Assess hypnotizability informally through ideomotor response; formal scales are optional and time-consuming.

Informed consent should cover the nature of hypnosis, expected benefits, possible risks, alternatives, and the right to withdraw.

Clarify that hypnosis is not sleep and that the client retains control and can terminate the session at any time.

Obtain written consent for recording, teaching, or research use; specify retention and destruction.

Maintain clear boundaries: avoid dual relationships, and never use hypnosis for entertainment or coercion.

Do not suggest behavior that conflicts with the client's values or that the client would reject while alert.

Confidentiality limits (mandated reporting, imminent risk) must be disclosed during consent.

Scope: practice within training and licensure; refer when the presenting problem exceeds competence.

Document consent, goals, techniques, and outcomes as part of the clinical record.

Common inductions: eye fixation, progressive relaxation, hand levitation, and imagery-based methods.

Pacing and leading: match the client's breathing and language, then gradually shift toward relaxation and suggestion.

Use permissive language ('you may notice') rather than authoritarian commands to reduce resistance.

Deepening techniques include counting down, staircase imagery, fractionation, and repeated deepening suggestions.

Fractionation (briefly re-alerting then re-deepening) often increases perceived depth.

Tailor imagery and metaphors to the client's preferences, culture, and sensory style.

Watch for signs of deepening: slowed breathing, reduced swallowing, catalepsy, and altered facial tone.

If resistance appears, reduce pace, use permissive phrasing, or switch to a different induction.

Direct suggestion targets symptom change; indirect suggestion uses metaphor, storytelling, and embedded messages.

Ego-strengthening suggestions build self-efficacy and coping resources and are widely used across presentations.

Posthypnotic suggestions should be specific, realistic, and linked to a clear cue and context.

Hypnotic analgesia can reduce pain perception; combine with medical care and avoid implying cure.

Age regression should be used cautiously; frame it as imaginal and avoid suggesting recovered memories.

Cognitive-behavioral hypnosis integrates hypnotic suggestion with restructuring of maladaptive thoughts.

Suggestion should align with the client's goals and be reviewed for unintended meaning.

Rehearsal of coping responses under hypnosis can support generalization to daily life.

Evidence supports hypnosis for acute and chronic pain, procedural pain, and chemotherapy-related nausea.

Hypnosis is used adjunctively for anxiety, insomnia, smoking cessation, and weight management, with variable evidence.

Irritable bowel syndrome has moderate evidence for gut-directed hypnotherapy.

For smoking cessation, combine hypnosis with behavioral and pharmacological support; hypnosis alone is not sufficient.

In pediatric settings, hypnosis can reduce distress during procedures when developmentally appropriate.

Avoid hypnosis as a sole treatment for serious psychiatric or medical conditions; coordinate with the care team.

Tailor interventions to the condition's evidence base and the client's motivation and readiness.

Track outcomes with validated measures to justify continuation or referral.

Teach self-hypnosis by having the client practice the induction and deepening with clinician coaching.

Provide a brief, repeatable script or cue (e.g., a breath and a word) for daily practice.

Assign practice frequency (often daily, brief sessions) and review adherence at follow-up.

Use posthypnotic cues tied to real-world contexts to promote generalization.

Encourage self-monitoring of symptoms and coping to reinforce gains.

Adjust homework to the client's schedule and literacy; simplify scripts for accessibility.

Review and revise self-hypnosis scripts as goals change.

Document homework instructions and reported practice in the record.

Emergence should be gradual: count up, orient to the room, and confirm full alertness before ending.

Allow extra time for clients who appear drowsy or disoriented; reorient and assess.

Adverse reactions include headache, dizziness, anxiety, and unexpected emotional release; respond calmly and contain.

If abreaction occurs, support grounding and do not force continuation; process only when stable.

Avoid abrupt termination; it can leave residual drowsiness or confusion.

Document any adverse reaction and the response taken.

Screen for and manage risk of falls or driving after a session if the client remains groggy.

Debrief the session and confirm the client's understanding of what occurred.

Record consent, goals, induction and deepening methods, suggestions used, and client response.

Note start and end times, emergence status, and any adverse events.

Keep records confidential and secure; follow jurisdiction-specific retention rules.

Document referrals and consultations when the case exceeds the clinician's scope.

Avoid recording verbatim scripts unless clinically relevant; summarize interventions.

Scope of practice is defined by licensure and training; hypnosis is an adjunct, not a separate license.

Use objective language and avoid conclusory statements in progress notes.

Review records for accuracy and completeness after each session.