Designing effective research protocols for medical applications of hypnosis.

This issue of the Journal focuses on medical applications of hypnosis. The contributed articles describe a spectrum of clinical hypnosis in the primary care fields of obstetrics (VandeVusse, Irland, Berner, Fuller, & Adams, 2007) and pediatrics (Berberich, 2007), as well as the specialty fields of dermatology (Shenefelt, 2007), immunology (Torem, 2007), and pediatric pulmonology (Anbar, 2007). Additionally, two articles describe intriguing advances in our understanding of the neurological mechanisms of hypnotic effects and their potential impact on selection of appropriate treatment for specific patients (Raz, Lamar, Buhle, Kane, & Peterson, 2007; Raz & Michels, 2007). The importance of hypnosis is underscored by its impact on many different fields of medicine, as illustrated by the clinical hypnosis work reported in this issue. These encouraging findings should prompt the development of convincing clinical research in order to gain broad acceptance of hypnosis within medicine. The majority of published reports regarding hypnosis in medicine are based on uncontrolled, non-blinded interventions, or retrospective analyses; thus their outcome cannot be attributed exclusively to an effect of hypnosis. Therefore, the impartial medical practitioner may wonder about its proposed effectiveness. It is up to those of us who practice clinical hypnosis to design clinical trials that will be convincing to the medical community. We will need to explain to the medical community that efficacy of hypnosis must be judged by somewhat different standards than is allopathic medicine. For example, hypnosis instruction does not allow blinding of a study in the same way as does administration of a placebo pill. We must exercise special care in the design of clinical trials, lest we minimize the effect of hypnosis because of an inadequate research protocol. For example, it is important for hypnosis instructions given to study subjects to be as individualized as possible in order to achieve an optimal hypnotic effect, as demonstrated in the clinical hypnosis articles in this issue. As the rapport established with the therapist is a key for the success of hypnosis, researchers might want to consider how to assess whether this goal has been achieved. For example, subjects may be asked during a research trial to rate