LCCH News Autumn / Winter 2002

should show the patient coping calmly, confidently and with appropriate self-control. Again the therapist needs to be realistic with regard to the outcome. Self-hypnosis should be taught and the patient encouraged to practise these imagination techniques. If the patient has specific fears with regard to their stay in hospital, for example needle phobia, these need to be dealt with as a separate issue.

Life style Issues

Many patients presenting for cardiovascular surgery will be advised to make life style changes. These may include reducing their alcohol intake, stopping smoking or reducing their weight. Here hypnosis takes an obvious role and standard approaches are used. For the patient there is the added incentive of the increased health risk should they not change which will provide a strong motivator that can be used during therapy. Care should be taken, as some may view these lifestyle changes as a short-term adaptation and may subsequently revert to old behaviours once they have recovered (a possible indication that they are experiencing denial with regard to the seriousness of their heart condition).

Stress management should be taught, as stress responses will place an added burden on an already damaged heart. The use of self-hypnosis should be included and encouraged, as the trance state will reduce any stress-induced increase in cardiac activity. It is also known that the trance state will reduce blood pressure (high blood pressure, or hypertension, is a major risk-factor in coronary disease).

Post-surgery

In many cases pre-surgical hypnotic intervention will help to prevent post-surgical depression. However, biochemical changes occurring after the use of anaesthetics may result in the patient developing an endogenous depression. This state should be dealt with appropriately.

A positive mental attitude towards the healing process needs to be encouraged. Various approaches can be taken with an emphasis placed on healing the body: asking the patient to imagine the heart healing and becoming more healthy; imagining the wound healing, the tissue and bone knitting together with the minimum of scarification; imagining the body protecting the wound, the immune system guarding the incision and preventing infection. Pain may be an issue and the full range of pain control techniques should be employed: glove anaesthesia; imagination approaches; control room of the mind; dissociation.

The therapist should also help the patient to maintain recommended lifestyle changes.

Cardiophobia

Some patients develop cardiophobia: an abnormal awareness of their heart beating. This can provide a focus for neuroticism after any heart event or surgical intervention, as the patient may believe that naturally occurring changes in the beating of the heart herald a catastrophic heart event. Consequently they become over-protective towards their cardiovascular system and this may lead to a sedentary lifestyle (that in its own right will be damaging to the heart). Desensitization approaches and reframing should be used.