Hocus Pocus: What are the Ethical Issues Involved in Utilizing Self-Hypnosis as a Stress Management Strategy

1. Kathleen Jones-Trebatoski Hocus Pocus: What are the Ethical Issues Involved in Utilizing Self-Hypnosis as a Stress Management Strategy? CEDER 2010 Kathleen Jones-Trebatoski, Ph.D., LPC-S, NCC kajtrebatoski@stx.rr.com Mary Louise Holt, Ph. D., LPC

2. Kathleen Jones-Trebatoski Presentation Agenda Stress Nature, Myths, & Misperceptions Hypnotic Phenomena & Treatment Planning Principles and Process of Hypnotic Induction Demonstration and Practice How to Formulate Suggestions Demonstrate the Importance of Self-Hypnosis Ethical Principals of ASCH and Process of Certification Application of Hypnosis to Psychological Disorders

3. Kathleen Jones-Trebatoski Stress Management Managing stress involves the increased self awareness of your personal reaction to stress and building your sense of control and mastery over the stressors in your life Stress is an everyday fact of life . You cannot avoid it. Stress is a change to which you must adapt, ranging from the extreme negative to the most euphoric. It is how you respond to these experiences that determine the impact stress will have on your life. (Davis,M., & Eshelman, E., & McKay,M., 2000).

4. Kathleen Jones-Trebatoski Coping with Stress There are numerous research studies dedicated to stress management. Some recommendations have been to review the support network, to attend stress management workshops, and to develop one�s spirituality. (Smith, R., & Maroney, K., & Nelson, K., & Able, A., &Able, H., 2006).

5. Kathleen Jones-Trebatoski Stress of being in the Educational System Stressors include finances, careers that are currently in place, community issues, family issues, and significant relationship issues which create barriers to learning and success rates. �Stress becomes a constant, and too often a destructive, force.� Psychological stress can be observed in poor concentration, reduced motivation, frustrated learning and performance anxiety. Physical stress can include disruptive sleep patterns and weaken immune systems. (Smith, R., & Maroney, K., & Nelson, K., & Able, A., & Able, H., 2006).

6. Kathleen Jones-Trebatoski Some Negative Psychological Effects of Stress are: Anxiety Depression Lowered Self-esteem Exacerbation of Chronic Pain

7. Kathleen Jones-Trebatoski Some Negative Psychological Effects of Stress are:

8. Kathleen Jones-Trebatoski According to reports from the Center for Disease Control and Prevention�s National Center for Health Statistics (NCHS) the 2004 preliminary mortality data for the United States shows that the 15 leading causes of death in the United States for the calendar year of 2004 were: Diseases of the heart (heart disease) Malignant neoplasms (cancer) Cerebrovascular diseases (stroke) Chronic lower respiratory diseases Accidents (unintentional injuries) Diabetes mellitus (diabetes) Alzheimer�s Disease Influenza and pneumonia Nephritis, nephritic syndrome and nephrosis (kidney disease) Septicemia (blood poisoning, esp. that caused by bacteria or their toxins) Intentional self harm (suicide) Chronic liver disease and cirrhosis Essential (primary) hypertension and hypertensive renal disease (hypertension) (high blood pressure) Parkinson�s disease; and Pneumonitis due to solids and liquids Many of these top 15 causes of death are stress-related illnesses where stress can either be the causative factor or a contributing factor to the illness. Blonna (2005), Greenberg (2004), and Jones and Bright (2001)

9. Kathleen Jones-Trebatoski Self-hypnosis is the fundamental nature of mind-body connection, enabling the mind to direct the body how to respond and adjusting the messages the body sends to the brain and modifying how they will be interpreted (Rossi, 1986). The professional organizations for counselor educators encourage support for reducing effects of stress for counselors and counseling students. However, master�s level counseling programs may be lacking in the development of student wellness programs (Frame & Stevens-Smith, 1995). Frame & Stevens-Smith (1995) emphasized the need to be concerned about the impairment of the student and the impairment of current counselors leading to the decreased quality of services to clients.

10. Kathleen Jones-Trebatoski Hypnosis: Myths and Misperceptions 1. Fear of loss of control, surrender of will, of being dominated 2. Losing consciousness/having amnesia 3. Being influenced against their will 4. Contaminating memory and producing false memory (hypnosis is not a truth serum)

11. Kathleen Jones-Trebatoski Nature, Myths & Misperceptions History of Hypnosis Known since �the existence of time� Practiced through out the centuries since the time of �Egypt� Franz Mesmer considered to be the modern inventor of hypnosis(1734-1815) Techniques included staring into his patient�s eyes and making hand movements over their bodies. Minimal verbal suggestions Olness, K. & Kohen, D., (1996). Hypnosis and Hypnotherapy with Children. New York: Guilford Press

12. Kathleen Jones-Trebatoski Early Uses of Hypnosis John Elliotson (1791-1868) English physician who was influenced by mesmerism. The Zoist, 1842 Numerous Cases of Surgical Operations Without Pain in the Mesmeric State (1843) Olness, K. & Kohen, D. (1996).

13. Kathleen Jones-Trebatoski Early Uses of Hypnosis James Braid (1795-1860) English Surgeon Discarded mesmerism Coined �hypnosis� from the Greek word hypnos, meaning sleep Abandoned hand passes and instead, required his subjects to fix the gaze on an object and concentrate on a single idea Olness, K. & Kohen, D. (1996).

14. Kathleen Jones-Trebatoski Early Uses of Hypnosis Jean-Martin Charcot (1835-1893) A French neurologist Gave hypnosis a new measure of respectability Hypnosis as a pathological state, a form of hysterical neurosis Olness, K. & Kohen, D. (1996).

15. Kathleen Jones-Trebatoski Early Uses of Hypnosis School of Nancy devoted to the investigation of hypnosis. Freud (1883) incorporated hypnosis into practice but became disenchanted with results and stopped its use in 1896. Olness, K. & Kohen, D. (1996).

16. Kathleen Jones-Trebatoski Early Uses of Hypnosis Clark Hull (1930�s) stimulated the reuse of hypnosis. Benjamin Rush (1930�s) utilized hypnosis. World War I � �shell shock� World War I and World War II, use of self-hypnotic anesthesia as a means to get disabled soldiers back on the battle field. British Medical Association endorsed hypnosis in1955. American Medical Association endorsed hypnosis in1958. American Psychological Association endorsed hypnosis in 1969.

17. Kathleen Jones-Trebatoski Early Uses of Hypnosis Milton H. Erickson, M.D. Foremost hypotherapist of the twentith century Erickson described hypnosis as a valuable therapeutic tool for enhancing a client�s self-awareness and for facilitating therapeutic communication. A means by which the client can have responsibility for self healing from emotional or physical pain. For the client to build on their own internal resources that otherwise may be ignored or overlooked. Havens, R. & Walters, C. (1989). Hypnotherapy Scripts, A Neo-Ericksonian Approach to Persuasive Healing. New York: Brunner/Mazel, Publishers.

18. Kathleen Jones-Trebatoski Early Uses of Hypnosis Milton H. Erickson, M.D. The �unconscious mind� is not the repressed unconscious described by Freud or the collective unconscious of Jung. Erickson used the term unconscious mind to refer to all of the cognitions, perceptions and emotions which occur outside of a person�s normal range of awareness. That the unconscious mind has more resources and a better sense of reality than the conscious mind that must act as a filter. Havens, R. & Walters, C. (1989).

19. Kathleen Jones-Trebatoski Early Uses of Hypnosis Erickson became the founding leader and first president of the American Society for Clinical Hypnosis and the founding editor of its journal. That the subtle hypnotic suggestions are based in person-center approach. Gunnison, H. & Renick T (1985)

20. Kathleen Jones-Trebatoski Hypnosis in General Utilized by mental health and medical professionals alike Characterized by a state of attentive, receptive concentration containing three concurrent features of varying degrees: Dissociation Absorption Suggestibility Procedure during which changes are suggested in sensations, perceptions, thoughts, feelings or behavior that promote healing explore causes of symptoms

21. Kathleen Jones-Trebatoski Hypnotic Phenomena &Treatment Planning

22. Kathleen Jones-Trebatoski Utilizing Hypnotic Phenomena in Treatment Planning Hypnosis Fact: Not a strategy or therapy by itself Purpose of treatment tools: shortens the length of time in therapy, helps control symptoms & stress management techniques, encourages self responsibility, decreases therapist codependency encourages independent living

23. Kathleen Jones-Trebatoski Cooperative Venture Dual process learn about your client�s personality, interests and hobbies while building rapport will only add to the individuation of the hypnotic experience Conscious reframing change client�s belief system about the problem from complex to simple

24. Kathleen Jones-Trebatoski Principles of Hypnotic Induction Positive Wording Imagery as well as Suggestion Make Suggestions Flexible Allow time for change Repetition through synonymous words and phrases Avoid Suggestions that Imply Failure or Doubt

25. Kathleen Jones-Trebatoski The Process of Hypnotic Induction One: Assessment & Establishing Rapport Two: Orienting the Patient Three: Fixation of Attention & Deepening Involvement Four: Facilitating Unconscious (Involuntary) Response Five: Trance Ratification Six: Removing Suggestions & Re-Alerting the Patient

26. Kathleen Jones-Trebatoski Types of Hypnotic Inductions Eye Fixation Induction Progressive Relaxation Induction The Catalepsy Induction The Arm Levitation Induction The Coin Drop Technique Rapid Eye Roll Induction

27. Kathleen Jones-Trebatoski DEMONSTRATION

28. Kathleen Jones-Trebatoski How & When(to formulate suggestions) Must have the attention of the client when giving the suggestions. Client must be motivated to experience extreme relaxation. Client should have motivation to overcome the concern (It is possible to increase motivation by suggestion). Suggestions should be worded simply (Sentence structure should be simple to lessen the opportunity for misunderstanding). Be clear in your own mind about the purpose of the given suggestion.

29. Kathleen Jones-Trebatoski How & When (to formulate suggestions) The suggestion should be repeated. In most cases a suggestion should be phrased so that a definite time is not indicated. The client should be led into a compliant, positive attitude before the specific suggestions are given. Use positive, rather than negative suggestions. Demonstrate a persuasive and confident attitude. Whenever possible make an implied contract with the client to carry out a suggestion.

30. Kathleen Jones-Trebatoski How & When(to formulate suggestions) Suggestion should not be given until you determine that the client is in a hypnotic or very relaxed state. Suggestions should be fitted to the client. Make suggestions permissive rather than commanding (Avoid �must�, �should� etc.) Minimize the use of the word �try�. Use visual images to enhance suggestion. Limit goals.

31. Kathleen Jones-Trebatoski How & When(to formulate suggestions) Avoid ambiguity. Vary verbal delivery of suggestions by: alteration in voice volume. change in pace. stress key words. change in inflections and modulation of voice. Give only one suggestion at a time. Make suggestions refer to immediate future to allow time for them to be absorbed and acted upon. Create suggestions that use as many senses as possible.

32. Kathleen Jones-Trebatoski Phrasing for Hypnotic Suggestions One of the things I'd like you to discover is... I want you to notice something that's happening to you... Maybe it will surprise you to notice that... It�s very rewarding to know that... And you can be pleased... It's very positive and comforting to know� ... in a way that meets your needs... I wonder if you will enjoy how naturally... how easily...

33. Kathleen Jones-Trebatoski Phrasing for Hypnotic Suggestions I wonder if you will enjoy how naturally... how easily... I'd like you to begin allowing... Your unconscious mind can enable you to... Give yourself the opportunity (to see if)_______� Perhaps sooner than you expect...

34. Kathleen Jones-Trebatoski Demonstrate Process and Importance of Self-Hypnosis Advanced Self-Hypnosis Five: Return to Neutral Imagery Six: Re-orient Seven: Post-Hypnotic suggestion for post-trance feeling Eight: Exit Cue

35. Kathleen Jones-Trebatoski Ethical Principles of American Society of Clinical Hypnosiswww.ASCH.net Process of Certification MD, DDS, DMD, DO, DPM, PhD, PsyD Master�s degree in the health field Hold valid state licensure for independent practice 40 hours post-degree, ASCH approved education 20 hours of beginning trining 20 hours of intermediate training 20 hours of individual training with an ASCH approved consultant 2 years of independent practice using hypnosis

36. Kathleen Jones-Trebatoski AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE OF CONDUCT Introduction The ASCH Code of Conduct is comprised of two sections, Ethical Principles and Ethical Standards. The Ethical Principles serve as philosophical guidelines that help to structure a members' practice of hypnosis. The Ethical Standards serve as practical or applied guidelines for the members' practice. Members should take adequate measures to discourage, prevent, expose, and correct unethical conduct of colleagues. Additionally, members should be equally available to defend and assist colleagues unjustly charged with unethical conduct.

37. Kathleen Jones-Trebatoski AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE OF CONDUCT Ethical Standards I. ASCH members uphold the professional standards, ethics, and codes of conduct of their primary discipline. II. ASCH members remain in good standing in the association or society that oversees the member's primary discipline. III. ASCH members maintain a license to practice at the independent, unrestricted, or unsupervised level.

38. Kathleen Jones-Trebatoski AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE OF CONDUCT Ethical Principles I. Competence: Members strive to attain the highest levels of professional competence. 1. A. members use hypnosis in the treatment of patients only within the bounds of their training and expertise; within their primary discipline; and within the context of a professional relationship; 2. A "professional relationship" is defined by the member�s primary discipline and includes consultation or supervision of colleagues. B. member�s expertise is determined, in part, by their professional education, training, licensure, and experience; C. members recognize, and are respectful of, any limitations to their expertise; D. members strive to maintain current knowledge of research, issues, and methods in hypnosis; 1. members participate in continuing education activities.

39. Kathleen Jones-Trebatoski AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE OF CONDUCT II. Professional Responsibility: Members serve the best interests of their clients or patients. A. members accept responsibility for the care of their clients or patients consistent with their discipline and licensure; B. members seek out consultation and/or supervision when in doubt regarding their clinical practices or when questioned by others about their clinical practice; C. members participate and cooperate with inquiries regarding their practices; D. members accept responsibility for, and when necessary the consequences of, their behavior; E. members accept responsibility to monitor and make appropriate changes in their practice to comply with the Ethical Principles or Ethical Standards of this Code; F. members seek to educate the public about the proper and scientific use of hypnosis.

40. Kathleen Jones-Trebatoski AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE OF CONDUCT IV. ASCH members do not support the practice of hypnosis by laypersons. A. The "practice of hypnosis" means the provision of services, or the offer to provide services, utilizing hypnosis to individuals or groups regardless if a fee or honorarium is charged, offered or paid. B. A "layperson" is: 1. an individual lacking professional education and clinical training in a health care discipline, including but not limited to those recognized by ASCH for membership and/or certification, or 2. an individual not pursuing a degree from a regionally accredited institution, in a health care discipline including but limited to those recognized by ASCH for membership and/or certification. C. Except as authorized by Sections V. B and C below, members do not provide hypnosis training to laypersons.

41. Kathleen Jones-Trebatoski AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE OF CONDUCT V. Public and Media Presentation: A. ASCH members do not use or endorse or assist in the use of hypnosis for entertainment purposes. B. Electronic recordings may be prepared by members for private patient treatment. Electronic recordings may also be prepared for purchase by health care professionals and/or the general public, but only for the purpose of educating individuals about the proper and scientific use of hypnosis, or to teach individuals who are not the member's patient/client the use of self-hypnosis for his or her own private use. C. When members appear in public forums, such as on television or some other electronic format, they take care to ensure that any demonstration of hypnosis is done in such a way as to prevent or minimize risk to unknown audience participants. D. ASCH members ensure when they present hypnosis, in any format, to the public the member does so within the spirit of this Code and within the guidelines of their primary discipline. E. Members honestly and fairly represent their professional competency, qualifications and capabilities

42. Kathleen Jones-Trebatoski AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE OF CONDUCT VI. Nothing in this Code shall prohibit members from: A. teaching hypnosis to individuals or groups who, upon completion of such training, would be eligible for ASCH membership, B. teaching students of health care disciplines, including but not limited to those recognized by ASCH for membership and/or certification, C. teaching patients or clients the use of self-hypnosis for that individual's own therapeutic use, or D. teaching about hypnosis in any forum that serves to properly educate and inform the consumer or professional public about hypnosis.

43. Kathleen Jones-Trebatoski AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE OF CONDUCT VII. When ASCH members engage in human subjects research, they do so within the accepted standards of their primary discipline, taking precautions not to cause emotional or physical harm to their subjects. VIII. When this Code is unclear on an issue, question, or complaint and when deemed appropriate by the ASCH Executive Committee, guidance is sought from the ethical standards of the member's primary discipline professional association and/or the member's licensing board.

44. Kathleen Jones-Trebatoski AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE OF CONDUCT Enforcement I. Any person, whether or not a member of ASCH, may initiate a charge of ethical violation against a member of ASCH. II. Any charge must be submitted in writing to the Ethics Committee, must specify the time and place of the violation, and must be signed by the complainant. III. The Ethics Committee shall inform the member in writing of the charges against the member and solicit the member�s response to the charges. IV. If, upon receiving the response of the member, the Ethics Committee determines that cause for further inquiry exists, the Ethics Committee shall set a time and place for a hearing and shall notify the member and the complainant, by certified mail, of the time and place. S:\ASCH\Ethics\code of conduct-amended_2009.wpd

45. Kathleen Jones-Trebatoski AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE OF CONDUCT Enforcement VI. No later than thirty days following the hearing, the Ethics Committee shall submit a report of its findings to the Executive Committee and recommend either: A. dismissal of the charges, B. censure or warning, C. suspension, or D. expulsion. The Ethics Committee shall send by certified mail a copy of its report and recommendation to the charged member. S:\ASCH\Ethics\code of conduct-amended_2009.wpd

46. Kathleen Jones-Trebatoski Dangers of Hypnosis Amateur Operators Entertainment Uses Forgetting to Remove Suggestion No significant dangers with hypnosis per se, only person using it!

47. Kathleen Jones-Trebatoski Application of Hypnosis to Particular Concerns Pain Management Anxiety Depression Ego-Strengthening Scripts can be designed to aid in your treatment plan when focusing on a particular disorder

48. Kathleen Jones-Trebatoski Pain Management Purpose: To alleviate cases of acute pain To remove pain under four main conditions Surgery Terminal Patients Acute pain in obstetrical and dental patients Phantom Limb pain Cautionary Note: Leave �signal pain� for prevention of injury Method: Direct or Indirect Suggestions Use of Imagery

49. Kathleen Jones-Trebatoski Pain Management Target Population: People who experience chronic or acute pain Those who do not wish to be under anesthesia Strategies & Techniques: Anesthesia or Analgesia Through Suggestion Time or Body Dissociation Dissociation of Body Parts Displacement of Pain

50. Kathleen Jones-Trebatoski Is It OK To Remove All Pain? What is the function of pain Four Situations when all pain maybe removed: Terminal illness Child bearing labor Phantom pain Surgery

51. Kathleen Jones-Trebatoski Anxiety Purpose: To decrease level of anxiety To enhance general coping abilities and effective living To minimize anxiety and worry Method: Direct or Indirect Suggestions Use of Imagery Target Population: People who experience panic, phobias and other related symptoms Strategies & Techniques: Progressive Relaxation

52. Kathleen Jones-Trebatoski Depression Purpose: To alleviate feelings of unhappiness, fatigue, or depressive moods Cautionary Note: Not useful with severe clinically depressed or suicidal Method: Direct and Active Suggestions Use of Suggestions that will motivate client to interact with environment Target Population: People who experience feelings of dissatisfaction People that are unmotivated Strategies & Techniques: The Affect Bridge Crystal Ball Technique

53. Kathleen Jones-Trebatoski Ego Strengthening Purpose: To increase the client�s sense of self-efficacy To enhance general coping abilities and effective living To minimize anxiety and worry To enhance self esteem Method: Direct or Indirect Suggestions and Metaphors Age regression to happy and positive life experiences Age progression and mental rehearsal Use of trance ratification to demonstrate to the client the power of his or her own mind and potential

54. Kathleen Jones-Trebatoski Ego Strengthening Target Population: Generally indicated for all clients A Flexible, Generalized Ego-Strengthening Technique: Physical Relaxation, using breathing or other method Mental Calmness, using imagery such as a still pond Disposing of mental obstacles, using imagery such as rubbish being dumped down a chute Removal of barrier representing all self-imposed obstacles in the life of the client, using imagery such as a wall or fence made up of representations of those obstacles Enjoyment of a special place where client feels content, tranquil, and at peace, where the client imagines self as able to do what they want or need to do

55. Kathleen Jones-Trebatoski Contact Information: Mary Louise Holt, Ph. D, LPC Professor Texas A&M University-Corpus Christi Email:mary.holt@tamucc.edu Kathleen Jones-Trebatoski,Ph.D., LPC-S, NCC Private Practice Email:kajtrebatoski@stx.rr.com

56. Kathleen Jones-Trebatoski REFERENCES APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271�285. Abel, H. S. (2005). The evaluation of a stress management program for graduate students (Doctoral Dissertation, Texas A & M University-Corpus Christi, 2005). Abouserie, R. (1994). Sources of stress in relation to locus of control and self esteem in university students. Education Psychology: An International Journal of Experimental Educational Psychology, 14, 323-330. Appel, P. R., & Bleiberg, J. (2006). Pain reduction is related to hypnotizability but not to relaxation or to reduction in suffering: A preliminary investigation. American Journal of Clinical Hypnosis, 48, 153-161. Barton, L. M. (1986). Development, implementation, and evaluation of a course in stress Baggaley, A. (2001). Human body. New York: Dorling Kindersley Publishing, Inc. Barker, J. B., & Jones, M. (2006). Using hypnosis, technique refinement, and self modeling to enhance self-efficacy: A case study in cricket. Sport Psychologist,20, 94-110. Barlow, D. H., & Hersen, M. (1984). Single case experimental designs. New York: Pergamon Press. Bassman, S. & Wester, II, W. C. (1992). Hypnosis, headache, and pain control: An integrative approach. Columbus, Ohio: Ohio Psychology Publications, Inc. Benson, H. (1975). The relaxation response. New York: Avon Books, Inc. Benson, H. (1984). Beyond the relaxation response. New York: Times Books. Blonna, R. (2005). Coping with stress in a changing world (3rd ed.). New York: The McGraw- Hill Companies, Inc.

57. Kathleen Jones-Trebatoski REFERENCES Brannock, R. G., Litten, M. J., & Smith, J. (2000). The impact of doctoral study on marital satisfaction, Journal of College Counseling, 3, 123-131. Cannon, W. (1939). The wisdom of the body. New York: W.W. Norton Carver, C.S., Scheier, M.F., & Weintraub, J.K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267-283. Center for Disease Control and Prevention National Center for Health Statistics. (2005). Deaths: Preliminary data for 2004.Retrieved April 19, 2006, from http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimdeaths04/preliminarydeaths04.htm Charlesworth, E.A. (1981). Stress management skill for nursing students. Journal of Clinical Psychology, 37, 284-90. Clow, A. (2001). The physiology of stress. In Jones, F., & Bright, J.,Stress: Myth, theory and research. (pp. 47-61). Harlow, England: Pearson Education Limited. Council for Accreditation of Counseling and Related Educational Programs (2001). Accreditation manual. Alexandra, VA: Author. Crasilneck, H.B. (1985). Clinical hypnosis: principles and applications (2nd ed.). New York: Grune & Stratton. Crasilneck, H. & Hall, J. (1985). Clinical hypnosis: Principles and applications.(2nded.). Boston: Allyn & Bacon. Corsini, R.J. & Wedding D.(2005). Current Psychotherapies. R.J. Corsini & D. Wedding (Eds.), (7th ed.). Belmont, CA: Brooks/Cole.

58. Kathleen Jones-Trebatoski References Davis, M., Eshelman, E.R., & McKay, M. (2000). The relaxation & stress reduction workbook. (5th ed.). Oakland, CA: New Harbinger Publications, Inc. Deckro, G.R., Ballinger, K.M., Hoyt, M., Wilcher, M., Dusek, J. Myers, P., et al. (2002). The evaluation of a mind/body intervention to reduce psychological distress and perceived stress in college students. Journal of American College Health, 50, 281-287. Deffenbacher, J., Filetti, L., Lynch, R., Dahlen, E., & Oetting, E. (2001). Cognitive- behavioral treatment of high anger drivers. Behaviour Research and Therapy, 40, 895-910. Deffenbacher, J.L., Huff, M.E., Lynch, R.S., Oetting, E.R., & Salvatore, N.E. (2000). Characteristics and treatment of high-anger drivers. Journal of Counseling Psychology, 47, 5-17. Deffenbacher, J.L., & Stark, R.S. (1992). Relaxation and cognitive-relaxation treatments of general anger. Journal of Counseling Psychology, 39, 158-167. DeVos, H., & Louw, D. (2006). The effects of hypnotic training programs on the academic performance of students. American Journal of Clinical Hypnosis, 49, 101-112. Dorff, T.A. (1997). A needs assessment of the stressors and coping resources of graduate students in clinical psychology. (Doctoral Dissertation, Rutgers the State University of New Jersey, 1997). Abstract retrieved November 01, 2007 from ProQuest database.

59. Kathleen Jones-Trebatoski References Dziegielewski, S. F., Turnage, B., & Roest-Marti, S. (2004). Addressing stress with social work students: A controlled evaluation. Journal of Social Work Education. 40, 105-119. Ebert, B.W. (1988). Hypnosis and rape victims. American Journal of Clinical Hypnosis, 31, 50-58. Echterling, L.G., & Whalen, J. (1995). Stage hypnosis and public lecture effects on attitudes and beliefs regarding hypnosis. American Journal of Clinical Hypnosis, 38, 13-21. Eysenck, H. J. (Ed.). (1981). A model for personality. New York: Springer-Verlag. Feldman, J.B. (2004). The neurobiology of pain, affect and hypnosis. American Journal of Clinical Hypnosis, 46, 187-200. Feldman, J.B. (2009). Expanding hypnotic pain management to the affective dimension of pain. American Journal of Clinical Hypnosis, 51, 235-254. Fields, R.D., & Stevens-Graham, B. (2002). New insights into neuron-glia communication. Science, 298, 55-93. Florio, C. M. (1999). Efficacy of stress management techniques in reducing self-reported anxiety and enhancing internal locus of control in persons diagnosed with anxiety disorders. (Masters Dissertation, Southern Connecticut State University, 1999). Frame, M.E., & Stevens-Smith, P. (1995). Out of harm�s way: Enhancing monitoring and dismissal processes in counselor education programs. Counselor Education and Supervision, 29,268-274.

60. Kathleen Jones-Trebatoski REFERENCES Genuis, M. L. (1995). The use of hypnosis in helping cancer patients control anxiety, pain, and emesis: A review of recent empirical studies. American Journal of Clinical Hypnosis, 37, 316-325. Gerson, M.S. (1998). The relationship between hardiness, coping skills, and stress in graduate students. (Doctoral dissertation, Adler School of Professional Psychology, Illinois, 1998). Abstract retrieved August14, 2009 from ProQuest database. Girdano, D.A., Everly, G.S., & Dusek, D.E. (2001). Controlling stress and tension (6th ed.). Needham Heights, MA. Glaser, R., Kiecolt-Glaser, J.K., Speicher, C.E., & Holliday, J.E. (1992). Stress-induced modulation of the immune response to recombinant hepatitis B vaccine. Psychosomatic Medicine, 54, 22- 29. Graham, K.R., Marra, L., & Rudski, J.M. (2003). Hypnotic susceptibility as a predictor of participation in student activities. American Journal of Clinical Hypnosis, 46,139-145. Graham, M.A., & Pehrsson, D.E. (2008). Bibliosupervision: A multiple-base line study using literature in supervision settings. Journal of Creativity in Mental Health,3, 428-440. Greenberg, J. S. (2004). Comprehensive stress management (8th ed.). New York: McGraw-Hill Companies, Inc. Grover, R., & Hughes, A., & Bergman, R.L., & Kingery, J.N. (2006).Treatment Modifications Based on Childhood Anxiety Diagnosis: Demonstrating the Flexibility in Manualized Treatment. Journal of Psychotherapy: An international study, 20 (3), 275-286.

61. Kathleen Jones-Trebatoski References Gunnison, H. (1990). Hypnocounseling: Ericksonian hypnosis for counselors. Journal of Counseling & Development, 68, 450- 455. Gunnison, H., & Renick, T. (1985). Hidden hypnotic patterns: Implications for counseling and supervision. Counselor Education and Supervision, 25, 5-11. Hammond, D. (1990). Handbook of hypnotic suggestions and metaphors. New York: Norton & Company. Hammond, D. (1998). Hypnotic induction & suggestions. Chicago: American Society of Clinical Hypnosis. Hammond, D., & Elkins, G. (2005). Standards and training in clinical hypnosis. Bloomingdale, IL: American Society of Clinical Hypnosis.

62. Kathleen Jones-Trebatoski References Hammond, D.C., Mutter, C.B., Frischholz, E., Hibler, N., Scheflin, A., & Wester,W. (1995). Clinical hypnosis and memory: Guidelines for clinicians and for forensic hypnosis. United States of America: American Society of Clinical Hypnosis Press. Harper, G.W. (1999). A developmental sensitive approach to clinical hypnosis for chronically and terminally ill adolescents. American Journal of Clinical Hypnosis, 42, 50-60. Havens, R. A., & Walters, C. (1989). Hypnotherapy scripts: A neo-ericksonian approach to persuasive healing. New York: Brunner/Mazel Publishers. Heppner, P., Kivlighan, D., & Wampold, B., (1999). Research design in counseling (2nd ed.). New York: Brooks/Cole-Wadsworth. Hilgard, E.R. (1963). Ability to resist suggestions within the hypnotic state, responsiveness to conflicting communication. Psychological Report, 12, 3-13. Holmes, T. H. & Rahe, R. H. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, II, 213-218. Horton-Huasknecht, J.R., Mitzdorf, U., & Melchart, D. (2000). The effect of hypnosis therapy on the symptoms and disease activity on rheumatoid arthritis. Psychology & Health, 14, 1089-1105. Iglesias, A. (2004). Hypnosis and existential psychotherapy with end-stage terminally ill patients. American Journal of Clinical Hypnosis, 46, 201-213. Johnson, M.E., & Hauck, C. (1999). Beliefs and opinions about hypnosis held by the general public: A systematic evaluation. American Journal of Clinical Hypnosis, 42, 10-16. Jones, F., & Bright, J. (2001). Stress: Myth, theory and research. Harlow, England: Pearson Education Limited.

63. Kathleen Jones-Trebatoski References Kaplan, D.M., Smith, T., & Coons, J. (1995). A validity study of the subjective unit of discomfort (SUD) score. Measurement and Evaluation in Counseling and Development, 27, 195-199. Kazdin, A. E. (1982). Single-case research designs: Methods for clinical and applied settings. New York: Oxford University Press. Kazdin, A. E. (1992). Research design in clinical psychology (2nd ed.). Boston: Allyn & Bacon. Keeney, B. (2007). Shaking medicine: The healing power of ecstatic movement. Rochester, Vermont: Destiny Books. Kingsbury, S.J. (1988). Hypnosis in the treatment of posttraumatic stress disorder: An isomorphic intervention. American Journal of Clinical Hypnosis. 31, 81-90. Kirsch, I., Montgomery, G., & Sapirstein, G. (1995). Hypnosis as an adjunct to cognitive behavioral psychotherapy: A meta-analysis. Journal of Consulting & Clinical Psychology, 63, 214-220. Krippner, S. (1979). The use of hypnosis and the improvement of academic Achievement. Journal of Special Education, 4, 451-459. Lazarus, R. S. (1969). Patterns of adjustment and human effectiveness. New York: McGraw-Hill, Inc. Lazarus, R. S., & Folkman, S. (1984). Stress appraisal and coping. New York:Springer. LeCron, L.M. (1961). Techniques of hypnotherapy. New York: Julius Publishers. Levitt, E. E. (1980). The psychology of anxiety. Hillsdale, NJ: Erlbaum Associates. Liggett, D.R. (2000). Enhancing imagery through hypnosis: A performance aid for athletes. American Journal of Clinical Hypnosis, 43, 149-157. Linn, B.S., & Zeppa, R. (1984). Stress in junior medical students. Journal of Medical Education, 59, 7- 12.

64. Kathleen Jones-Trebatoski References MacHovec, F., & Oster, M.I. (1999). In the best of families: Understanding hypnosis complications in graduate and post-graduate training experiences. American Journal of Clinical Hypnosis, 41, 3-8. Maier, S.F., Watkins, L. R., & Fleshner, M. (1994). Psychoneuroimmunology: The interface between behavior, brain, and immunity. American Psychologist, 49, 1004- 1017. McEwen, B.S. (2005). Stressed or stressed out: What is the difference? Journal of Psychiatry and Neuroscience, 30, 315-316. Mertler, C. A. & Vannatta, R. A. (2005). Advanced and multivariate statistical methods: Practical application and interpretation (3rd ed.). Glendale, CA: Pyrczak Publishing. Meyers, J.E., & Sweeney, T.J. (2004). Manual for the Five Factor Wellness Inventory 5F- Wel. Greensboro, NC: Author. Monat, A. & Lazarus, R. S. (1991). Stress and coping: An anthology (3rd ed.). New York: Columbia University Press. Morgan, A.H. & Hilgard, J.R. (1975). Stanford Clinical Hypnotic Scale (SCHS). In E.R. Hilgard & J.R. Hilgard, Hypnosis in the relief of pain. Los Altos, CA: Kaufmann, 209-221. Morton, P. (2003). The hypnotic belay in alpine mountaineering: The use of self-hypnosis for the resolution of sports injuries and for performance enhancement. American Journal of Clinical Hypnosis, 46, 45-51.

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