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Chest wall pain can be indicative of serious medical conditions. A heart attack often involves chest wall pain (but is also accompanied by dizziness, shortness of breath, sweating, and nausea. Pneumothorax (collapsed long) also causes chest wall pain, but is again accompanied by other signs such as shortness of breath, blueness of the skin, and rapid heart rate. Angina pectoris (extreme chest pain) is ischemic and due to coronary heart disease (plaque buildup in the arteries). While these conditions include chest wall pain as a feature, they are serious and complicated conditions in which chest wall pain is only one of a litany of symptoms.

Chest wall pain is often caused by non-life threatening issues in which controlling the pain and letting the body’s natural healing process proceed is the best treatment. The pain can be related to a physical trauma such as a car wreck or other injury. Another common cause is costochondritis, in which the cartilage that sits between the ribs and the sternum become inflamed. With costochondritis, the treatment generally just involves getting the pain under control and letting the inflammation subside on it’s own. This is the most common cause of benign chest wall pain. Myalgia (literally, muscle pain) can come from overuse of the muscles, in this case the muscles of the chest wall including the internal and external intercostals, the innermost intercostal, the subcostals, and finally the transversus thoracis (all of these are muscles attached to your ribs). Chest wall pain is often simply overuse of the chest wall muscles! People with fibrositis / fibromyalgia often experience chest wall pain with no determinable cause, so again the best way to handle it is usually just by controlling the pain.

Generally, unless accompanied by other disdressing symptoms, chest wall pain is just an inflammatory and painful response to injury or other minor insult to the thoracic wall. Although it can be very uncomfortable and disconcerting, treatment is usually easy and simply involves controlling the pain that is present and reducing inflammation if possible. To see more on how hypnosis can control chest wall pain, check out hypnosis and pain control

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There are many types of chronic pain therapy. The distinctions between biological, medical, psychological and behavioral blur (for instance, taking a pill has psychological consequences, and psychological interventions can stimulate the body to create and release it’s own “brand” of morphine). I will cover a few of the major types of chronic pain therapy and try to make useful distinctions between the classes of pain therapies, even though they aren’t necessarily strict.

Pharmacological Therapies

Nonopioid Analgesics: These include NSAID (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen, aspirin and Tylenol. It also includes prescription drugs like Etodolac / Lodine and Keterolac / Toradol. These are sometimes used therapeutically for chronic pain, particularly if the chronic pain is mild to moderate and intermittent such as with recurring headaches. These relieve pain and inflammation, and also work to reduce fever. They do take a toll, however. They can cause stomach bleeding, and some can cause liver damage particularly in people who smoke or drink.

Opioid Analgesics: Opioids are a strong class of drugs used in chronic pain therapy where intense and otherwise-unbearable pain is. This class of drugs include morphine, heroin, and codine. While usually quite effective (opioids effect chronic pain symptoms in the brain, peripheral nervous system and the GI tract), they have a litany of side effects including addiction, respiratory  depression, constipation, itching, and nausea. Opioids can also effect gene expression.

It’s worth noting that endorphins are a type of endogenous (produced naturally in the body) opioid, and that this can be triggered with hypnosis without the use of drugs.

Antidepressants: The way that antidepressants act as a chronic pain therapy is a highly technical topic. There is disagreement about whether they work by vasodilatation (widening of the arteries/arterioles/capillaries etc) or by the actual anti-depressant effects. Not unsurprisingly, the drugs effect chronic pain differently depending on where in the body it is as well as what type of pain it is (neuropathic or nociceptive). Obviously, the anti-depressants carry a wide range of side effects including altering mood. Responsiveness depends on genetic factors, and individuals will have individual responses to the medication.

Topical Medications: Topical medications are most commonly used for acute pain, although they may sometimes be used as a chronic pain therapy with an injury such as a burn which has left a patch of skin hypersensitive and painful. This is an atypical chronic pain therapy, and is rarely employed.

Hypnosis as Chronic Pain Therapy

Hypnosis is a powerful therapy for chronic pain patients. There are two major ways that hypnosis can be employed. The first is via regular hypnotic sessions with a trained hypnotist. This allows for the hypnotist to custom tailor the therapy to the chronic pain issue at hand. The hypnotist should educate you on how hypnosis for chronic pain is employed. Chronic pain therapy in a hypnotic context will include the use of mental imagery as well as hypnotic and post-hypnotic suggestions.

Hypnosis has been used in the management of acute and chronic pain for hundreds of years. Hypnosis can raise the threshold for pain, lessen the pain present, and reduce the perception of pain, along with creating physiological effects (such as reducing swelling and increasing the strength of the immune system) which serve to naturally eliminate pain. Dr. Tinterow, writing about hypnosis for pain related to surgery stated that hypnosis “raises the threshold of pain and is the only means of anesthesia which carries no danger to the patient“. This fact alone makes hypnosis the smartest choice in alternative pain relief.

Cancer is an area with a dire need for pain relief where the strong results of hypnosis have been well-studied and well-documented. Cancer is often associate with chronic pain, and a significant amount of the pain is attributable to the medical procedures (especially surgery) involved in treating cancer.

Hypnosis and pain control are key factors in chronic pain therapy. However, hypnosis can go beyond simple pain control. Chronic pain is typically accompanied by heightened states of anxiety, a reduced sense of well being, a reduced sense of control, as well as feeling down, sad, or hopeless. Hypnotherapy can effectively address all of the symptoms related to chronic pain, not just the pain itself. With hypnosis as the therapy, the chronic pain will be handled, but a greater sense of well being and energy will be restored into the person’s life. Through hypnosis and subsequent training in self-hypnosis, the chronic pain patient can replace their suffering with a renewed sense of control. Control over their body and symptoms, as well as their lives and livelihood. In other words, rather than just turning off a symptom, when hypnosis is used as a chronic pain therapy, it works to give the person their life back, not just a more comfortable body.

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Pain is a multi-dimensional phenomena. To understand hypnosis and pain control, and why hypnosis is such an effective intervention, we must talk about how pain happens.

Pain sometimes (but not always) starts with stimulation of nociceptors. Nociceptors are specialized neurons in the peripheral nervous system that encode and transmit ‘noxious stimuli’ to the brain. The activation of nociceptors does not necessarily result in pain, but the brain often does respond to interpret nociceptor activation with the perception of pain. There are several different types of nociceptors in the body.

Mechanical nociceptors send pain signals up to the brain when they are stretched, squashed, or when the skin is cut.

Silent nociceptors signal pain when an inflammation response occurs in damaged tissue.  This is particularly relevant to hypnosis and pain control because hypnosis is an excellent tool to reduce inflammation and swelling.

Temperature or thermal nociceptors are activated when certain thresholds of temperature (both hot and cold) are reached.

Another type which may come as a surprise is chemical nociceptors. These are custom made to activate upon exposure to certain chemicals. The most common of these chemicals is capsaicin. Capsaicin is the chemical which makes food spicy. To some this is pleasure, and others pain. This is both a process of interpretation as well as that of endorphin release (which is released both into the blood stream as well as in the brain).

The pain signals travel from the peripheral nervous system into the spinal cord and up to the brain. Two main regions in the brain are involved in the perception of pain. The somatosensory cortex and the anterior cingulate cortex. The somatosensory cortex receives physical sensation nerve impulses from the entire body. It registers the texture, temperature, pressure and vibration. It also registers impulses from the pain nerves (nociceptors). The second area, the anterior cingulate cortex, also receives pain input. The anterior cingulate cortex is a key in the perception of pain. The ACC can be thought of as being in charge of the emotional-perceptual experience of pain. The somatosensory cortex is what tells us ‘yes, I feel the needle go through the skin’, while the anterior cingulate cortex is the part that goes ‘That hurts!!’ (Rainville, Duncan, Price, Carrier, & Bushnell, 1997). This area is key in the affective / emotional experience of pain.  When we experience emotional pain (anguish), the anterior cingulate cortex is at work (while the somatosensory cortex is not). This is an important key in hypnosis and pain control because hypnosis is well documented in its ability to inhibit and change the way the anterior cingulate cortex works.

Now that we have laid out the way pain happens, we can talk about hypnosis and pain control. In particular, we can talk about the ways and levels that hypnosis can stop pain.

First, hypnosis can control pain by stimulating the release of endorphins. Endorphins work both as a neurotransmitter in brain blocking perception of pain, and also by working at the site of discomfort in the body by release into the bloodstream (OLNESS, WAIN, & NG, 1980). Although hypnosis and pain control can be achieved through the release of of endorphins, that is not its only method of pain control. Researchers found that hypnosis could be used for pain control even when the chemical endorphin antagonist (blocker) naloxone was administered (Spiegel & Albert, 1983). This is really quite a phenomenal point, so take a moment to think about it… hypnosis provides endorphins on command!

A second way hypnosis and pain control work is by reducing inflammation and irritation to an area. If you’ll recall, one type of nerve cell sends pain signals to the brain when the surrounding tissue behaves as though it is damaged. The main mechanism here is inflammation. Hypnosis can dramatically reduce inflammation symptoms (Laidlaw, Booth, & Large, 1996; Zachariae & Bjerring, 1990), thus eliminating the additional pain created by the inflammation.

A third way hypnosis and pain control work is via relaxation of the muscle tissues (Edmonston, 1981). This is especially important in refractory or chronic pain therapy (Elkins, Jensen, & Patterson, 2007). Muscle tightness reduces the flow of nutrients, oxygen and medication to an injured area. Tightness of the muscles also creates hypersensitivity in the nerves, making pain control more difficult. As the muscle gets tighter, it becomes easier to feel pain, and more difficult to control pain. Hypnosis can directly influence spastic and tight muscles (Chappell, 1964; Vickers, 1999). As the muscles relax, the mind automatically perceives less pain (Lang, Joyce, Spiegel, Hamilton, & Lee, 1996), and the body is better able to heal and correct any biomechanical dysfunction.

A fourth way hypnosis and pain control work is via moderation of particular areas of the brain. Remember, the two areas most important to pain perception in the brain are the somatosensory cortex and the anterior cingulate cortex. Hypnosis can effect pain control by modulating the response of the somatosensory cortex to painful or noxious stimuli (Spiegel, Bierre, & Rootenberg, 1989).  Hypnosis can control pain by altering the anterior cingulate response to pain signals as well (Faymonville et al., 2000; Ploghaus, Becerra, Borras, & Borsook, 2003). Interestingly, hypnosis can do one, the other, or both, depending on how it is applied to control pain (dissociation, analgesia, anesthesia, pleasure substitution etc).

Amazingly, hypnosis is able to intervene at any point in the cycle of physical, electrical (nerve), and perceptual/interpretive (brain) interactions that result in the experience of pain. Hypnosis is also highly effective for reducing anxiety, another key point in pain control when it is chronic pain. This powerful flexibility not only makes hypnosis and pain control a natural match, it also means that healing will be sped up or opened up as a possibility even in someone with a longstanding, debilitating illness. While medical treatment should always be sought for pain, hypnosis is a powerful method of pain control that can be used in nearly any injury or illness.

References

Chappell, D. T. (1964, July). Hypnosis and Spasticity in Paraplegia. The American journal of clinical hypnosis.

Edmonston, W. E. (1981). Hypnosis and relaxation: Modern verification of an old equation. Wiley.

Elkins, G., Jensen, M. P., & Patterson, D. R. (2007). Hypnotherapy for the management of chronic pain. The International journal of clinical and experimental hypnosis, 55(3), 275.

Faymonville, M. E., Laureys, S., Degueldre, C., DelFiore, G., Luxen, A., Franck, G., et al. (2000). Neural mechanisms of antinociceptive effects of hypnosis. Anesthesiology, 92(5), 1257.

Laidlaw, T. M., Booth, R. J., & Large, R. G. (1996). Reduction in skin reactions to histamine after a hypnotic procedure. Psychosomatic medicine, 58(3), 242. Am Psychosomatic Soc.

Lang, E. V., Joyce, J. S., Spiegel, D., Hamilton, D., & Lee, K. K. (1996). Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use. The International journal of clinical and experimental hypnosis, 44(2), 106-19.

OLNESS, K., WAIN, H. J., & NG, L. (1980). A pilot study of blood endorphin levels in children using self-hypnosis to control pain. Journal of Developmental & Behavioral Pediatrics, 1(4), 187.

Ploghaus, A., Becerra, L., Borras, C., & Borsook, D. (2003). Neural circuitry underlying pain modulation: expectation, hypnosis, placebo. Trends in Cognitive Sciences, 7(5), 197-200.

Rainville, P., Duncan, G. H., Price, D. D., Carrier, B., & Bushnell, M. C. (1997). Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science (New York, N.Y.), 277(5328), 968-71.

Spiegel, D., & Albert, L. H. (1983). Naloxone fails to reverse hypnotic alleviation of chronic pain. Psychopharmacology, 81(2), 140–143. Springer.

Spiegel, D., Bierre, P., & Rootenberg, J. (1989, June). Hypnotic alteration of somatosensory perception. The American journal of psychiatry.

Vickers, A. (1999). Hypnosis and relaxation therapies. BMJ, 33(11), 923-926. doi: 10.1016/j.drugalcdep.2011.05.036.

Zachariae, R., & Bjerring, P. (1990). The effect of hypnotically induced analgesia on flare reaction of the cutaneous histamine prick test. Archives of dermatological research, 282(8), 539–543. Springer.

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Many medical doctors recommend and prescribe additional or alternative pain management methods as part of their practice. If you are thinking about an alternative pain relief method, you are not alone. According to the CDC’s National Health Statistics Report for 2007, nearly 20% of people with back pain used an alternative method for relieving pain, about 7% used something alternative for neck pain, and another 5% for joint pain. The reason isn’t as simple as traditional medicine not working. Usually people are using both traditional routes (such as taking an analgesic) as well as an alternative (or alternatives).

While I am going to focus on the science and precedent for using hypnosis or hypnotherapy as an alternative pain relief, there are many methods out there. A short laundry list would include nutritional supplements, meditation, acupuncture, ayurvedics, homeopathy, naturapathic, chelation, chiropractic, dietary, yoga, osteopathic, strain counter-strain, Feldenkreis, guided imagery, intuitive healing, shamans and on and on. Some of these have very solid scientific basis for the claims of pain relief (guided imagery, acupuncture, yoga, meditation), while others consistently fail to find scientific support.

Again, most people do not use just a single method when they are looking to find pain relief. Many people do all they can with traditional pain relief therapies, and then move on to other techniques to stop the pain. Many people use multiple methods at the outset, while others who are averse to typical western medical practices may seek out alternative pain relief solutions first and get medical attention as the last resort.

Hypnosis is the most powerful “alternative pain relief” method that is known, and is often the most responsible chronic pain therapy choice. The fact that is considered an ‘alternative’ rather than a mainstream intervention used by default is mostly a matter of historical and cultural accident (as well as training), but it is widely used for pain management at the level of medical doctors and psychologists all the way to the person seeking comfort with great success. In fact, some of the very first uses of hypnosis and pain control was to eliminate pain for surgeries before chemical anesthetics were invented. Hypnosis controls pain to such an excellent extent that it is even used as an alternative to anesthesia for people that are allergic to chemical anesthesia or would like to avoid the negative effects associated with them. You can watch someone undergo gall bladder surgery with hypnosis as the alternative pain relief (with no chemical anesthesia) filmed by the British Broadcasting Corporation video from 2005 here:  Hypnosurgery on the BBC

James Esdaille was a surgeon who pioneered the used of hypnosis to relieve and prevent pain. Operating in India, he performed several hundred surgeries (including amputations) using hypnosis as the “alternative” pain relief (although back then, it was the alternative to alcohol!) Patients survived surgery twice as often, recovered quicker, and were less prone to infection. This is back in the mid-1800s! Hypnosis has continued to researched for its capacity to reduce and eliminate pain, and also assist with related problems such as anxiety, tension, insomnia, anger, and drug dependency.

The application of hypnosis for reducing and eliminating pain are far-ranging and the research has been ongoing for nearly 200 years. I couldn’t begin to reference all the studies that demonstrate the use of hypnosis as an alternative pain relief, but I will pick out a few examples.

Hypnosis is proven as an alternative pain relief for:

- Lower back pain (Crasilneck, 1979; Hoffman, Papas, Chatkoff, & Kerns, 2007; McCauley, Thelen, Frank, Willard, & Callen, 1983)

- Headaches (Kohen & Zajac, 2007; Melis, Rooimans, Spierings, & Hoogduin, 1991; Spanos et al., 1993)

- Neck pain (E. R. Hilgard & J. R. Hilgard, 1994; D. P. Lu, G. P. Lu, & Kleinman, 2001)

- Fibromyalgia (Castel, Pérez, Sala, Padrol, & Rull, 2007; Haanen & Hoenderdos, 1991; Millea & Holloway, 2000)

- Cancer (Foley, 1985; Kellerman, Zeltzer, Ellenberg, & Dash, 1983; Spiegel, 1985; Syrjala, Cummings, & Donaldson, 1992)

- Spinal Cord Injury (M P Jensen,  a J. Hoffman, & Cardenas, 2005; M.P. Jensen & Barber, 2000; Report et al., 2009)

The list, of course, goes on and on. Hypnosis is a pain intervention that works on a basic bio-mechanical level, on a nociceptic level, as well as on a neurological and perceptual level. This means that while we still should demand proof in a particular pain condition, we should EXPECT hypnosis to be a successful way to get pain relief in any situation involving pain and discomfort. In summary, hypnosis is probably the most widely-applicable and effective alternative pain relief possible. It is powerful enough to be used as a substitute for chemical anesthetics and analgesics (morphine etc), and works brilliantly as an adjunct in controlling and eliminating pain.

References

Castel, A., Pérez, M., Sala, J., Padrol, A., & Rull, M. (2007). Effect of hypnotic suggestion on fibromyalgic pain: comparison between hypnosis and relaxation. European journal of pain (London, England), 11(4), 463-8.

Crasilneck, H. B. (1979). Hypnosis in the control of chronic low back pain. American Journal of Clinical Hypnosis, 22(2), 71-8. American Society of Clinical Hypnosis.

Foley, K. M. (1985). The treatment of cancer pain. New England Journal of Medicine, 313(2), 84–95. Massachusetts Medical Society.

Haanen, H., & Hoenderdos, H. (1991). Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. The journal of, 292(19), 2388-95.

Hilgard, E. R., & Hilgard, J. R. (1994). Hypnosis in the relief of pain. Journal of personality and social psychology (Vol. 53, pp. 563-71). Routledge.

Hoffman, B. M., Papas, R. K., Chatkoff, D. K., & Kerns, R. D. (2007). Meta-analysis of psychological interventions for chronic low back pain. Health psychology, 26(1), 1. American Psychological Association.

Jensen, M P, Hoffman, a J., & Cardenas, D. D. (2005, December). Chronic pain in individuals with spinal cord injury: a survey and longitudinal study. Spinal cord.

Jensen, M.P., & Barber, J. (2000). Hypnotic analgesia of spinal cord injury pain. Australian Journal of Clinical & E xperimental Hypnosis, (April), 251-261. Australian Society of Hypnosis.

Kellerman, J., Zeltzer, L., Ellenberg, L., & Dash, J. (1983). Adolescents with cancer:: Hypnosis for the reduction of the acute pain and anxiety associated with medical procedures. Journal of Adolescent Health Care, 4(2), 85–90. Elsevier.

Kohen, D. P., & Zajac, R. (2007). Self-hypnosis training for headaches in children and adolescents. The Journal of pediatrics, 150(6), 635-9. Lu, D. P., Lu, G. P., & Kleinman, L. (2001). Acupuncture and clinical hypnosis for facial and head and neck pain: a single crossover comparison. The American journal of clinical hypnosis, 44(2), 141-8.

McCauley, J. D., Thelen, M. H., Frank, R. G., Willard, R. R., & Callen, K. E. (1983, November). Hypnosis compared to relaxation in the outpatient management of chronic low back pain. Archives of physical medicine and rehabilitation.

Melis, P. M. L., Rooimans, W., Spierings, E. L. H., & Hoogduin, C. A. L. (1991). Treatment of Chronic Tension-type Headache With Hypnotherapy: A Single-blind Time Controlled Study. Headache: The Journal of Head and Face Pain, 31(10), 686–689. Wiley Online Library.

Millea, P. J., & Holloway, R. L. (2000). Treating fibromyalgia. American family physician, 62(7), 1575-82, 1587.

Report, S. C. I. F., Askay, S. W., Medicine, R., Pain, S. C. I., Pain, S. C. I., Pain, S. C. I., et al. (2009). Using Hypnosis for Spinal Cord Injury Pain Management.

Spanos, N. P., Liddy, S. J., Scott, H., Garrard, C., Sine, J., Tirabasso, A., et al. (1993). Hypnotic suggestion and placebo for the treatment of chronic headache in a university volunteer sample. Cognitive therapy and research, 17(2), 191–205. Springer.

Spiegel, D. (1985). The Use of Hypnosis In Controlling Cancer Pain. CA: A Cancer Journal for Clinicians, 35(4), 221-231. doi: 10.3322/canjclin.35.4.221.

Syrjala, K. L., Cummings, C., & Donaldson, G. W. (1992). Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial. Pain, 48(2), 137–146. Elsevier.

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Positive punishment is a foundational concept in operant conditioning. There are four key procedures in operant conditioning that modify behavior. Positive punishment is one of two types of punishment (the other being negative punishment). The positive part of the punishment refers to the fact that something is being ADDED to the situation. Positive is not a valance or a ‘judgement call’. When most people think of a punishment, they are typically thinking of the behaviorism term positive punishment (although they may actually be referring to a negative punishment) , but the word positive can trip people up. It does not mean the punishment is in any way pleasant.

Similarly to reinforcement, an event can be defined as a punishment on punisher if it meets these criteria:

1. The event must be a consequence of a behavior
2. The behavior of which it is a consequence must decrease in strength
3. The reduction in strength of the behavior must be a result of the event (punisher)

A few examples of (potential) punishers: Parking tickets, spankings, pinches, and verbal reprimands.

All of the above qualify as punishers if they were a consequence of a behavior and if they served to reduce the behavior. For example, if someone parks illegally, comes back to find a ticket on their car (a consequence of their behavior), they subsequently cease or reduce their illegal parking (behavior reduces in strength), and we can correctly attribute the reduction or cessation to the ticket (resultant), then the ticket was indeed a punishment.

Positive punishment contrasts with negative punishment in which something is taken away (and this consequence results in a reduction of the behavior). Negative punishment is known as a response cost.

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All secondary reinforcers start out being linked to a particular primary reinforcer. You tell your dog ‘good girl’, and you give her a treat. At first, the phrase ‘good girl’ means nothing to the dog. However, if you continue to pair ‘good girl’ with food, the dog will associate the two. At this point the secondary reinforcer is not generalized. It is associated only with food. Because of this, the potency of ‘good girl’ as a reinforcer is directly related to how interested the dog is in a treat (see establishing operation for more on the topic).

You can turn a conditioned reinforcer (secondary reinforcer) into a  generalized reinforcer by pairing it with different types of primary reinforcers. If the dog cannot predict what primary reinforcer will follow a secondary reinforcer, the (now) generalized reinforcer simply becomes paired with good feelings/reward. It is no longer a cue that the dog is about to get food. To generalize a reinforcer, it should be inconsistently paired with many types of primary reinforcers. For a dog, this might include physical affection, different types of food treats, 30 seconds of tug-of-war, being allowed to cross a threshold they want to cross, being allowed to eat dinner, opening a gate to allow them into a dog park, or drinking from their water dish.

There is a very common generalized reinforcer that YOU respond to. Can you guess? It’s money! Money is a generalized reinforcer for humans. It is (or can be) paired with access to every primary reinforcer that WE have (a meal, having a place to sleep, having access to play etc).

The excellent thing about a generalized reinforcer like money is that the ‘I want it!’ and ‘That was rewarding to receive!’ factor is not tied to any need which acts as a primary reinforcer. Money isn’t less rewarding when you’re full or when you’re well rested. It’s rewarding all the time.  Similarly, you can train a dog to experience ‘good girl’ or ‘yes’ or a click the same way that you experience money. Just make sure to vary the types of reinforcers that you pair it with.

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Establishing operations are not simply a matter of deprivation or satiation, however. For example, an establishing operation that would have increase the reinforcing impact of the water would be giving the rat salty food. The rat was not deprived of water per se, but it still increased the physiological need for water with the establishing operation.

Primary reinforcers are typically themselves establishing operations. Because the strength of reinforcement depends on a physiological need, the less the physiologic need, the less reinforcing. Every time an organism receives a primary reinforcer, it’s need for that reinforcer is reduced. Each time a child takes a bite of food, they become less hungry, and each subsequent bite of food is less rewarding. Some needs are psychological, such as affection.

An example of an establishing operation affecting a psychological reinforcer is a play session. If a dog has had two hours at the dog park playing and running and jumping, a training session in which throwing a frisbee for the dog will not be nearly as strong of a reinforcer.

It is important to note that secondary reinforcers do not generally have a wide range of establishing operations impacting their effectiveness. There is one primary establishing operation that does affect secondary reinforcers universally, however… being paired with a primary reinforcer. If a secondary reinforcer stimulus was paired with the primary reinforcer it is typically paired with recently, the pairing with the primary reinforcer acts as an establishing operation bolstering the effectiveness of the secondary reinforcer. If the past 10 times the secondary reinforcer stimulus was NOT paired with a primary reinforcer, the establishing operations have lessened the reinforcing impact (it has moved closer to being a neutral stimulus once again).

Establishing operations are particularly scarce in relation to secondary reinforcers which have become generalized reinforcers. In this case, the secondary reinforcer is not part of an expected chain leading to a specific or particular primary reinforcer. Because it is not tied to a particular primary, there is little to change in terms of the need (psychological or physiological). Money is a great example. Money is generally no less reinforcing for wealthy people. People don’t generally make ten million and decide “Welp, that’s plenty for me. Money doesn’t do anything for me anymore!”

Establishing operations are critical. They provide the context for reinforcement. A large part of remaining aware of the ecology of the organism which you are reinforcing is tracking the establishing operations which are impacting the effect of the reinforcers you provide. This will have a dramatic impact on the effectiveness of your training or intervention.

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There is a surprising amount of genetic basis to phobias. Obviously our genetics are needed for anything we are capable of doing, but we have an apparent ‘preparedness’ for developing particular phobias such as a fear of spiders. For instance, we are much more likely to have a fear of spiders than we are to have a fear of pillows or flowers. OK yes, you are less likely to have a sensitizing experience with those two, but we are similarly less likely to become phobic of cars or guns, even with a painful experience! Interestingly, the rates between men and women does vary, with women being far more likely to develop arachnophobia than are men. (Kendler, Myers, Prescott, & Neale, 2001)

If you do have a fear of spiders, the good news is that it is highly treatable, and that most people who share your fear get over it during their lifetime even without treatment. The maintenance of the fear of spiders (that is, what someone with the fear is doing or not doing that keeps the fear alive) is actually fairly straightforward: avoidance.

By avoiding contact with spiders (visually, bodily, etc), the person with a fear of spiders reduces their fear in that moment. Makes a lot of sense… I feel scared of the spider, I kill it or leave the area where it is in, and then I’m not as scared. However, this creates a positive experience from avoiding. There is no chance to experience a spider (kinesthetically, visually, or otherwise) and not have a negative consequence.  Avoidance then becomes reinforced as a way to reduce the fear, and so the fear never extinguishes.

Hypnosis is an effective, well-studied and established way to address with irrational fears and phobias. (Crawford & Barabasz, 1993; Horowitz, 1970; Kluft, 1986; McGuinness, 1984) Other established methods and treatments are generally behaviorism / behaviorally based are classified as ‘exposure’ therapies. Essentially the opposite of avoidance, the person would be exposed to spiders in various scenarios. This can range from extremely intense methods like flooding to a less anxiety-producing method such as systematic desensitization. In folk psychology terms, this type of therapy would be ‘facing your fears’, which is actually quite sound advice although HOW they are faced dramatically impacts how quick, effective, and sustainable the approach is. A hypnotic approach would use suggestion and post-suggestion techniques, active imagination or visualization, classical conditioning and more. This approach is gentler still, and can produce results without as confrontational approach.

If you are hoping to kick a fear of spiders without any professional help, it would be best to begin doing the opposite of what your fear is motivating you to do. If you feel like running away from a spider, try taking a step toward it, focusing on your breath, and allowing yourself to relax. This trains your brain to associate a more relaxed feeling with the spider, rather than a fear response. If you find yourself staring at the spider and being vigilant, try moving your eyes somewhere else and again focusing on bringing a relaxed feeling to yourself.

Fear of spiders is common. It is something that we seem to be genetically predisposed to responding to with fear (Öhman & Mineka, 2001), but it is actually a fear that is easily changed, despite how uncomfortable it may be in the moment. There is an evident gender bias with the typical finding being that women display an ‘irrational fear’ or phobic response more often than men (irrational fear by the way, is not a judgment per se, but instead means a fear of spiders at a subclinical level). Hypnosis and behavioral techniques (exposure therapy) are the favored methods for countering the fear.

References

Agras, S. (1969, March). The epidemiology of common fears and phobia. Comprehensive Psychiatry.

Crawford, H. J., & Barabasz, A. F. (1993). Phobias and intense fears: Facilitating their treatment with hypnosis. American Psychological Association.

Horowitz, S. L. (1970). Strategies within hypnosis for reducing phobic behavior. Journal of abnormal psychology, 75(1), 104-12.

Kendler, K. S., Myers, J., Prescott, C. a, & Neale, M. C. (2001). The genetic epidemiology of irrational fears and phobias in men. Archives of general psychiatry, 58(3), 257-65.

Kluft, R. P. (1986). Hypnosis in the treatment of phobias. Psychiatric Annals. SLACK.

McGuinness, T. P. (1984, April). Hypnosis in the treatment of phobias: a review of the literature. The American journal of clinical hypnosis.

Öhman, A., & Mineka, S. (2001). Fears, phobias, and preparedness: Toward an evolved module of fear and fear learning. Psychological Review, 108(3), 483-522.

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