MD Anderson Cancer Center
Lisa Garvin: Welcome to Cancer Newsline, a podcast series from the University of Texas MD Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment, and prevention, providing the latest information on reducing your family's cancer risk. I'm your host, Lisa Garvin. And today, our guest is Dr. Ian Lipski. He is an Associate Professor in MD Anderson's Department of Anesthesiology and Perioperative Medicine. He's an anesthesiologist who has tried medical hypnosis recently and found it to be pretty successful. Dr. Lipski, what was your first experience with this? How did you come to incorporate it into your work?
Dr. Ian Lipski : First, thanks for having me Lisa. Several years ago, I attended a conference in Boston, and this is a hypnosis conference through the Society for Clinical and Experimental Hypnosis.
Lisa Garvin: So after learning about this at a conference, when were you able to actually put this into practice?
Dr. Ian Lipski Yeah. So at the conference, we learned by 20 hours of actual practice of clinical hypnosis. And first, let me dispel some myths about it. This is not mind control. We don't make people quack like ducks or anything of that nature. This is a shift or change in focus of awareness from what's in the center of your attention to what is in the periphery of your awareness. And this can be used in multiple environments within the perioperative setting, including the operating rooms, but also, what we've been using quite a bit is in the off-site kind of domain which includes MRI settings, bone marrow, interventional radiology, just to name a few. So that's primarily where we're using it.
Lisa Garvin: When did you first put your skills to the test?
Dr. Ian Lipski: Yeah. It's been several years now and actually I'll--just to give you a brief example. Commonly, anesthesiologists were called in to sedate patients who are claustrophobic for MRIs. And there's actually quite a lot of data that exists already in that environment of MRIs and the use of hypnosis to relax patients, decrease their needs for medication, and also to decrease scan incompletions. Meaning, if a patient is more comfortable staying stilled in the scan, the MRI scan can actually be completed. And I've had several patients over the last couple of years where I use some of the techniques that I learned to calm patients, relax them, and kind of go through the process of a formal hypnotic induction. In addition to that, it speaks to patient rapport, getting to know a patient a little bit more than we typically do. And also, using our bodies, our body language to invite a patient to become a part of their own care in a sense to actually empower patients to step up to the plate, so to speak, and tap into their inner resources to make it easier on everybody, especially themselves.
Lisa Garvin: How does medical hypnosis differ from what people might commonly think of it like a parlor trick or a magician's trick?
Dr. Ian Lipski: Yeah. There are actually two completely different animals. The kind of the parlor trick, party trick-type stuff is more of what I would classify as a sham hypnosis. Usually, these people are in on it. The participants, you know, have a stake in it or the person they whisper, "Hey, if you go along with this, you know, I'll give you some cash" or something like that. These are--I actually wish there was a different word for it. We refer to it as the H word or guided imagery, focus relaxations, kind of things like that. What this is, this is just a shift in awareness and the patient is actually in control the entire time. It's not mind control. We don't make them do things that they don't want to do. We're just setting up an environment and inviting them into an experience that will relax them and get them through whatever procedure or scan or test that they're having with dignity.
Lisa Garvin: How do you invoke that state? I mean, obviously, again, harking back to the typical imagery or the stereotypical imagery we see is focusing on a shiny or spinning object.
Dr. Ian Lipski: Correct.
Lisa Garvin: How exactly do you guide them into this state?
Dr. Ian Lipski: That's a great question. I think part of the reason as an anesthesiologist that I'm interested in this and probably a very small part, but in anesthesia, there's an induction, meaning patients go to sleep, there's a maintenance, we keep them asleep and then an actual emergence where we wake them up after an anesthetic. And procedural or medical type hypnosis actually has those three factors in it as well. There's an induction, a maintenance, and an emergence phase during the induction phase, and there's actually countless numbers of types of induction. The one that we use primarily devised by Dr. Elvira Lang is called an eye roll technique. And what you do is invite the patient to look up, take a deep breath, count backwards from three to one, and follow some other very simple instructions to sort of unlock or expand the mind and be more open to suggestion.
Lisa Garvin: Now, as far as--if someone is--and obviously you're an anesthesiologist, you're dealing with these people in the perioperative or before surgery time.
Dr. Ian Lipski: Yeah.
Lisa Garvin: When do you this? Is it--I guess the anesthesia is given first and then you do the hypnosis or what's the sequence of events?
Dr. Ian Lipski: Yeah. It depends on the setting. In several of these MRI cases, there's no anesthesia needed at all, no pharmacology, no drugs, so we do it while the patient's actually kind of walking into the MRI scan. But really, if we just backtrack a little bit, the whole process of the patient rapport and kind of setting the stage for this begins with the first--the patient's first encounter with the first person they meet on--for their procedure, the receptionist at the desk. And what this entails is kind of a way of speaking to somebody where you emphasize positive suggestions or neutral suggestions, and avoid negative suggestions. And really allow the patient to feel like they have a sense of control, that they're not being led kind of blindly down, you know, to a scanner, and would have perhaps had that experiences. And it's important to differentiate that this experience will be different than the last experience. In the operating room, I use some of the language, if I'm putting in an epidural or even starting an IV, there's quite a few induction techniques for needle phobia for example. And I'll use language and my body language and things of that nature really to relax the patient to where a lot of the medicine that we give kind of upfront to relax patients isn't even needed.
Lisa Garvin: How do you--and you say there are phases to this hypnosis, how do you know when they've reached the optimal phase?
Dr. Ian Lipski: Yeah.
Lisa Garvin:I mean, it's not like waiving a hand in front of their face or whatever. How do you know that they're in that state?
Dr. Ian Lipski: I would describe it as a spectrum. Some patients are highly hypnotizable, some patient are not so much. And there's different scales and ways to figure out who is or who is not hypnotizable. So, the way, for example, I'm going to MRIs but if I switch to bone marrow for example, in the hospital on a daily basis, there's anywhere from 75 to 100 bone marrow aspirations and biopsies that are done, about ten percent of those we see in anesthesia, we essentially do an almost the general anesthetic for those patients. It's a very fast procedure. The other 90 percent of patients get that done up in the clinic with no sedation. And just with a local anesthetic at the site, we're called in to assist with the sedation for that ten percent if they've had--if patients have had a prior bad experience, or if they're on some pain medication, or have some kind of comorbid issues related to pain or anxieties, things of that nature. So, what we would do in that sense is induce the patient, using whatever induction technique we like, which, as I said is kind of an "I rule'"-type technique. And then prep the patient and give them medicines on an "as needed"-type basis.
Lisa Garvin: How do you introduce this to the patient? I mean, obviously, you know, hypnosis has weird connotations, like it or not, how do you introduce the technique to them and what sort of people do you introduce this to?
Dr. Ian Lipski: Yeah. So the--I'm glad you brought that up. It is important to differentiate what we're doing which is procedural-based hypnosis. It's a short intervention. This isn't psychotherapy. We don't take patients back into their childhood or anything of that nature. And the invitation is essentially an open one, it's, "Would you like to learn a way how to relax?" And it's--if the patient is receptive, then we go forward. We go into some details, kind of what we're doing. But the, kind of the blueprint of a procedural type hypnosis is actually a script and anybody can read a script. And it's literally one or two pages of something that's been drafted already. But very deliberate language in there, some of it is confusional. Some of it grounds a person in a place of safety, for example. And so every word within these scripts that we use, it's all deliberate, there's not one wasted word. And those of us that are trained in doing it essentially read the script.
Lisa Garvin: How many times do you use hypnosis in a typical year here at MD Anderson?
Dr. Ian Lipski: We're--that's a great question too. We're just--I would describe this as we're at the infancy of introducing it. It is kind of outside the box. In my department, there's four of us that are trained in doing it, myself, Dr. Ken Sapire, Dr. Shreyas Bhavsar and Dr. Jackson. And among the four of us, through formal inductions, I would say on a monthly basis perhaps, maybe 10 or 15, something like that. But again, it's tough to differentiate a true hypnosis from a lot of these rapport techniques that we've learned which all of us use everyday with every patient interaction.
Lisa Garvin: And what about clinical or other types of research? Have you like measured brain scans of people who have undergone hypnosis? Have you been able to have a causal relationship between hypnosis and the decreased use of like drugs or sedation?
Dr. Ian Lipski: Yeah. Yeah. There's actually a huge body of evidence that already exist, specifically with MRIs, outpatient type procedures. And over in Europe, they're performing thyroid surgeries under local anesthesia and hypnosis.
Lisa Garvin: Are you yourself involved? Is MD Anderson involved in any research on this?
Dr. Ian Lipski: Yes. So there's a couple of protocols that we're writing up at the moment. One specifically, you spoke about brain waves. There's a device that we use in the operating room that is a--for lack of a better term, a processed EEG, and we use it under general anesthesia to kind of measure the depth of sedation of a patient who's under general anesthesia. And we're planning--we're writing up a protocol to see after a hypnotic induction, if we put these monitors on, it's just a simple strip that goes across somebody's forehead to see exactly what that number is going to be, to see if it will reduce to a comparable level of general anesthesia or pharmacological sedation. Another protocol that we're currently doing is, here in the hospital, we do--we're one of the busiest centers for awake craniotomies. And without going into too much detail, depending on where a patient's brain tumor is, we have to wake them up during surgery to assess their speech or motor before the surgeon actually takes the portion of tumor. And so, I'm working with one of the neurosurgeons here, Dr. Prabhu in getting something going 'cause there is some evidence. There's a guy in Germany, an anesthesiologist, who does these awake craniotomies under a local--with no medication, just hypnosis, and the local kind of numbing medicine.
Lisa Garvin: And in closing, what would you say if--should patients even bring this up or should--I mean, how should this be approached? I mean, obviously, we have people who aren't going to do an MRI no matter what. Is there something they should proactively ask for or how do they broach the subject?
Dr. Ian Lipski: Yeah. And like I said, at the moment, this is so new to the hospital that there's not too many of us that even know what it is and people's own kind of knowledge or thought process about what hypnosis is, may persuade them not to even investigate something like this. But let me assure you that, again, it's not--this isn't a sham type thing. This is just a shift in consciousness or awareness to provide more compassionate care to the patients.
Lisa Garvin: And I do know here at our complementary therapy in the Integrative Medicine Center, we actually teach people things like guided imagery and self-hypnosis techniques.
Dr. Ian Lipski: Yeah.
Lisa Garvin: So it's just kind of working that into the clinical setting.
Dr. Ian Lipski: Yes. And actually I'm glad you brought that up. I'm also working with Dr. Lorenzo Cohen, Dr. Richard Lee, and Dr. Alejandro Chaoul, along with some of my anesthesia partners and my chairman, Tom Rahlfs and Kenneth Sapire, to actually introduce a wellness program for the perioperative enterprise for patients undergoing surgery. I view hypnosis as one piece of a puzzle within this wellness program that also includes yoga, and meditation, and guided imagery, nutrition exercise, music therapy, massage, kind of all these things to prep patients and to guide them and help them through kind of the six or eight weeks before an operation while they're perhaps undergoing some chemo or radiation. And then on the day of surgery, and then also in the recovery period which, you know, may take a week or six weeks, or something like that. So that's a project that we've just initiated and it's underway at the moment.
Lisa Garvin: So in summary, what is your final hope or your goal in integrating hypnosis into the clinical setting?
Dr. Ian Lipski: Yeah. The ultimate goal is to provide more compassionate care to patients and kind of to change the culture of the doctor-patient relationship, and to actually shift the focus of power, perhaps somewhat away from the physician, and nurses, and PAs, and actually have the patients be more empowered and feel more in-control of their treatment process. Hypnosis, that seems like a--perhaps a lofty goal through hypnosis. But, again, I see the procedural aspects of this just as one piece of more of the larger picture of overall wellness and well-being.
Lisa Garvin: Great, interesting stuff. Thank you very much Dr. Lipski.
Dr. Ian Lipski: My pleasure, thanks for having me.
Lisa Garvin: If you have questions about anything you've heard today on Cancer Newsline, contact askMDAnderson at 1-877-MDA-6789, [Background Music] or online, at mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in for the next podcast in our series .
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