Bums (1990) 16, (6) 441-444 printd zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA in Great Britain 441 Burn pa tie nts’ use of a utohypnosis: making a painful e xp e rie nc e b e a ra b le D. Gilboa, A. Borenstein, D. S. Seidman and H. Tsur Bum Unit, The Chaim Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Israel Autohypnosis (that is performing hypnwis in tk absence of the thmpkt) was used for a&want analgekc andanziolytic therapy in 18 bumpatients. It combines the advantages of hypnosis without being limited by tk availability of the hypnotic therapid immediately prior to painful activities. Autohypnosis is less time ad labour consuming, and therefore less expemive. Out of 180 patients treated with autogenic r&ration techniques only 48 (Z7 per cent) entered a state of hypok that enabled them to cope with their pain, and 78 (10 per cent) achieved autohypnosis. Most of these patients neea% d some awcillary &vim such as recoded instructions or telephone culls. Introduction The use of hypnosis has become increasingly popular in recent decades for the relief of pain (Hilgard, 1975; Holden, 1977; Miller and Bowers, 1986); hypnoanalgesia can be used alone or as an adjuvant for chemoanalgesia and chemo- anxiolysis. Hypnosis has also been used with burn patients for reversal of anorexia, physical relaxation, and increasing the patient’s active participation in physiotherapy exercises (via posthypnofic suggestion) (Udolf, 1981). Premeditation with opiates for pain relief, unlike hypno- sis, imposes an extra load on the body systems. The patient is too drowsy to invest energy in eating, in getting out of bed, in performing physiotherapy exercises and the like. Hypnosis is limited by the patient’s capacity to respond to hypnotic suggestion and is time and labour consuming. A major disadvantage of the technique is the need for the therapist to be present immediately prior to painful activi- ties. This shortcoming served as the impetus for developing a model of autohypnosis for the treatment of bum patients. M ethod Between 1985 and 1989, 180 patients were treated using relaxation exercises at the Burns Unit of Sheba Medical Center, Tel Hashomer, Israel. In the first stage, as a preparation for hypnosis, muscular relaxation is performed using Schulz and Luthe’s autogenic training method, not during the pair&l dressing changes, but when the patient is comfortable (Schulz and Luthe, 1959). The method involves generating thoughts concen- trated on creating a feeling of softness and pleasant lightness in all parts of the body. The patient is told that he/she can 0 1990 Butterworth-Heinemann Ltd 0305/4179/90/060441-04 use this ‘tool’ any time he/she feels the need to relax himself/herself and feel comfortable. In the second stage, after achieving muscular relaxation, guided imagery is performed. The patient is instructed to imagine himself/herself in a relaxing situation, generally according to his/her own choice. The guide tells the patient to integrate a water source with a calming sound in the imagined situation. The patient imagines himself/herself in various activities, both passive and active, related to this water source, such as bathing a part of the body in water, cooling the body in water, floating on a mattress or on waves, swimming, diving, and the like. The use of water-related imagery is extremely important in alleviating the sense of fear and pain associated with daily bathing. In addition, the water image makes possible: (a) a variety of other positive feelings and experiences, both physical (such as relief of burning pain by putting the hand under running cold water), as well as emotional (such as reducing anxiety and tension through the imagery of a relaxing, floating feeling of rocking on water); and (b) active movement or body parts for the purpose of physiotherapy (such as performing movements of swimming or diving). This stage is initially performed in the patient’s bed, later in the hydrotherapy area, and finally during the active, painful physiotherapy treatment itself. At the end of the second stage, the patient’s ability to advance to deeper levels of hypnosis is assessed, by means of the arm levitation test. Patients who reach a sufficiently deep level of suggestion progress to the third stage, in which they are given posthypnotic instruction so that they can dissociate them- selves from the painful situation at any time that they need or want to. The posthypnotic instruction is combined with a ‘personal code’ (for instance, a word that the person chooses, or counting to a certain number). By repeating this code to himself/herself, the patient enters the hypnotic state. At the end of the painful treatment the patient can come out of the trance by applying another posthypnotic instruction. At this point, an assessment is made of the depth of hypnosis that the patient reaches in his/her readion to painful stimuli, according to both his/her own report of how he/she felt after leaving the painful state and through observation of his/her ability to cooperate with the treat- ment and cope with painful stimuli during dissociation. Some of the patients succeed in performing hypnosis in the absence of the therapist (that is, autohypnosis) only in