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Efficacy of virtual reality hypnosis versus conscious sedation with nitrous oxide in the management of dental anxiety in pediatric dentistry: protocol for a prospective randomized controlled trial
Background
Dental anxiety is defined as a persistent and excessive fear of dental treatment. It often leads to interruptions during procedures and, frequently, avoidance of dental care. For patients over the age of 7, nitrous oxide-oxygen inhaled sedation (NOIS) represents one of the most effective and well-established pharmacological approaches to reducing anxiety and pain during dental treatment. Meanwhile, medical hypnosis offers an interesting non-pharmacological alternative by inducing a hypnotic state, potentially serving as a means of sedation to alleviate anxiety or pain. The advancement of virtual reality (VR) technology makes medical hypnosis more accessible to dental practitioners, yielding promising outcomes. To our knowledge, no clinical trial has evaluated the efficacy of medical hypnosis associated with 3D immersive virtual reality devices for pediatric dental procedures.
Methods
This prospective, controlled, single-blind clinical study including anxious patients aged 7 to 10 years old aims to demonstrate non-inferiority of virtual reality approach. Using a split-mouth design, each patient will attend two separate visits for two comparable conservative dental procedures. At the first procedure, they will randomly be assigned to receive either hypnosis via VR or NOIS. The alternative method will be administered during the second visit. The primary outcome is the sedation success based on the completion of the dental procedure. A score of 3 or higher on the Modified Venham Scale noted more than twice ends the session and qualifies as a sedation failure. The secondary outcomes involve assessing children’s tolerance and the temperament influence on sedation success.
Discussion
This study will evaluate the efficacy of a novel non-pharmacological sedation for the management of anxious children in a dental setting. The results may help practitioners choose the appropriate anxiolytic therapeutic option, based on different psychometric and temperament parameters.
Trial registration
ClinicalTrials.gov NCT05167331. Registered on December 22, 2021.
Journal Article
Therapeutic trances : the cooperation principle in Ericksonian hypnotherapy
\"Therapeutic Trances is a manifesto of the fundamental principles and techniques of Ericksonian hypnotherapy. This innovative volume lays out the principles and practice of developing relationships with patients and creating a hypnotic environment in which true healing can take place. The book offers therapists specific questions to ask and practical ideas to pursue, thereby illustrating how therapists may cooperate with clients to translate problems into solutions. Stephen Gilligan synthesizes the approaches of Erickson, Bandler & Grinder, and Bateson to bring a new perspective to the field\"--Page 4 of cover.
Book
Beyond failure: a case report on brain state changes during virtual reality-induced hypnosis in pediatric patient
Background
Management of fear in anxious patients is challenging, particularly in children. Virtual reality induced hypnosis may help during the procedures, changing vital parameters and brain states. Modifications in brain activity can be easily traced with wearable instruments.
Case presentation
An 11-years old boy was scheduled for avulsion of teeth 15 and 25, which were misplaced in the hard palate. Due to his fear of procedure, he was exposed to virtual reality-induced hypnosis. The brain state was continuously monitored, showing light sedation, associated to low spectral edge frequency values, below 20 Hz, indicating a relaxed/hypnotic state. In both sessions, the electrical activity was higher in the right hemisphere compared to the left, which is conceivable in hypnotic state. During the first session, a technical problem ensued, which was detected by the patient and readily managed with additional anesthesia. Despite the negative experience, one week later the hypnotic state was readily induced and tooth extraction was accomplished without any problem.
Conclusions
Virtual reality-induced hypnotic state may be an easy and safe procedure to use with anxious patients even in pediatric age. If coupled to brain state monitoring, also adverse events can be promptly managed. In addition, hypnotic state may be induced also after the negative experience due to unexpected problems, prompting for the use of this technique in the dental setting also after initial, partial failure.
Journal Article
Medical Hypnosis Primer
This brief Primer , assembled by top recognized hypnosis authorities, briefly presents the basic concepts of modern medical hypnosis and encourages mental health care practitioners to learn how to use hypnosis as an adjunct to standard medical care. It also lays the groundwork for the teaching and practice of hypnosis as part of the required syllabus for every medical and nursing school as well as graduate programs in clinical and counseling psychology. Medical Hypnosis Primer goes far in advancing the medical and factual aspects of this still greatly misunderstood field, and is of great value to practitioners, teachers, and students.
Introduction. Barabasz, Christensen, Hypnosis Concepts. Spiegel, Hypnosis Testing. Patterson, Acute Pain. Jensen, Chronic Pain. Olness, Kohen, Childhood Problems. Vermetten, Christensen, Posttraumatic Stress Disorder (PTSD). Thomson, Surgery. Irland, Childbirth. Yapko, Hypnosis and Sleep. Alladin, Depression. Kahn, Stress and Anxiety. Lang, Procedural Hypnosis. Appendix A: Hypnosis Glossary. Appendix B: Contributor Contacts. Appendix C: International and National Societies of Hypnosis. Appendix D: Further Study.
eBook
Trait phenomenological control predicts experience of mirror synaesthesia and the rubber hand illusion
In hypnotic responding, expectancies arising from imaginative suggestion drive striking experiential changes (e.g., hallucinations) — which are experienced as involuntary — according to a normally distributed and stable trait ability (hypnotisability). Such experiences can be triggered by implicit suggestion and occur outside the hypnotic context. In large sample studies (of 156, 404 and 353 participants), we report substantial relationships between hypnotisability and experimental measures of experiential change in mirror-sensory synaesthesia and the rubber hand illusion comparable to relationships between hypnotisability and individual hypnosis scale items. The control of phenomenology to meet expectancies arising from perceived task requirements can account for experiential change in psychological experiments.
The authors present large sample studies showing substantial relationships between measures of embodiment (the rubber hand illusion and mirror synaesthesia) and trait imaginative suggestibility in the hypnotic context. These measures of striking experiential change may therefore be confounded by suggestion effects.
Journal Article
An Identification Method for Road Hypnosis Based on the Fusion of Human Life Parameters
A driver in road hypnosis has two different types of characteristics. One is the external characteristics, which are distinct and can be directly observed. The other is internal characteristics, which are indistinctive and cannot be directly observed. The eye movement characteristic, as a distinct external characteristic, is one of the typical characteristics of road hypnosis identification. The electroencephalogram (EEG) characteristic, as an internal feature, is a golden parameter of drivers’ life identification. This paper proposes an identification method for road hypnosis based on the fusion of human life parameters. Eye movement data and EEG data are collected through vehicle driving experiments and virtual driving experiments. The collected data are preprocessed with principal component analysis (PCA) and independent component analysis (ICA), respectively. Eye movement data can be trained with a self-attention model (SAM), and the EEG data can be trained with the deep belief network (DBN). The road hypnosis identification model can be constructed by combining the two trained models with the stacking method. Repeated Random Subsampling Cross-Validation (RRSCV) is used to validate models. The results show that road hypnosis can be effectively recognized using the constructed model. This study is of great significance to reveal the essential characteristics and mechanisms of road hypnosis. The effectiveness and accuracy of road hypnosis identification can also be improved through this study.
Journal Article
An Identification Method for Road Hypnosis Based on Human EEG Data
The driver in road hypnosis has not only some external characteristics, but also some internal characteristics. External features have obvious manifestations and can be directly observed. Internal features do not have obvious manifestations and cannot be directly observed. They need to be measured with specific instruments. Electroencephalography (EEG), as an internal feature of drivers, is the golden parameter for drivers’ life identification. EEG is of great significance for the identification of road hypnosis. An identification method for road hypnosis based on human EEG data is proposed in this paper. EEG data on drivers in road hypnosis can be collected through vehicle driving experiments and virtual driving experiments. The collected data are preprocessed with the PSD (power spectral density) method, and EEG characteristics are extracted. The neural networks EEGNet, RNN, and LSTM are used to train the road hypnosis identification model. It is shown from the results that the model based on EEGNet has the best performance in terms of identification for road hypnosis, with an accuracy of 93.01%. The effectiveness and accuracy of the identification for road hypnosis are improved in this study. The essential characteristics for road hypnosis are also revealed. This is of great significance for improving the safety level of intelligent vehicles and reducing the number of traffic accidents caused by road hypnosis.
Journal Article
Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting
BackgroundMedical management of acute pain among hospital inpatients may be enhanced by mind-body interventions.ObjectiveWe hypothesized that a single, scripted session of mindfulness training focused on acceptance of pain or hypnotic suggestion focused on changing pain sensations through imagery would significantly reduce acute pain intensity and unpleasantness compared to a psychoeducation pain coping control. We also hypothesized that mindfulness and suggestion would produce significant improvements in secondary outcomes including relaxation, pleasant body sensations, anxiety, and desire for opioids, compared to the control condition.MethodsThis three-arm, parallel-group randomized controlled trial conducted at a university-based hospital examined the acute effects of 15-min psychosocial interventions (mindfulness, hypnotic suggestion, psychoeducation) on adult inpatients reporting “intolerable pain” or “inadequate pain control.” Participants (N = 244) were assigned to one of three intervention conditions: mindfulness (n = 86), suggestion (n = 73), or psychoeducation (n = 85).Key ResultsParticipants in the mind-body interventions reported significantly lower baseline-adjusted pain intensity post-intervention than those assigned to psychoeducation (p < 0.001, percentage pain reduction: mindfulness = 23%, suggestion = 29%, education = 9%), and lower baseline-adjusted pain unpleasantness (p < 0.001). Intervention conditions differed significantly with regard to relaxation (p < 0.001), pleasurable body sensations (p = 0.001), and desire for opioids (p = 0.015), but all three interventions were associated with a significant reduction in anxiety (p < 0.001).ConclusionsBrief, single-session mind-body interventions delivered by hospital social workers led to clinically significant improvements in pain and related outcomes, suggesting that such interventions may be useful adjuncts to medical pain management.Trial registrationTrial Registry: ClinicalTrials.gov; registration ID number: NCT02590029URL: https://clinicaltrials.gov/ct2/show/NCT02590029
Journal Article