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Hypnotic Communication in
Emergency Medical Settings

This fascinating book demonstrates how hypnotic communication has the

potential to improve patient outcomes in emergency care, integrating insights on
the connection between mind and body for paramedics and other first responders.
Providing a step-by-step guide to using these skills around a range of contexts,
from managing pain to cardiovascular emergencies to burns to respiratory
distress, the book asks paramedics and first responders to become aware of
what they say to patients, as well as how they say it. It offers ways to allow
targeted communication to complement standard medical procedures, creating
a symbiotic rapport that will provide the basis for an improved outcome for the
patient.
Fully referenced and based on a robust range of evidence, the book is written
by an active paramedic with over 20 years’ experience with a Ph.D. in Human
Development with a focus on paramedic decision-making; and a professor with
doctorates in Health Psychology and Education who field tested the skills as a
professional EMT. This book will interest any professional working in emergency
care, including paramedics, EMTs, trauma nurses, and psychiatric nurses.

Four Arrows (Don Trent Jacobs), Ph.D., Ed.D., is the author of more than 20
books on wellness, education, and Indigenous worldview. A former firefighter/
EMT and Vice President of the Northern California Society of Clinical Hypnosis,
he is currently a professor of educational leadership for change at Fielding
Graduate University. Reach him at www.fourarrowsbooks.com.

Bram Duffee, Ph.D., is a full-time paramedic, researcher, and speaker from

Houston, Texas, who teaches interpersonal communication and leadership. As
a specialist in conversation analysis, he examines paramedic interactions with
the goal of improving emergency healthcare. He is currently a Research Fellow
with the Institute for Social Innovation at Fielding Graduate University. Reach
him at www.BramDuffee.com.
Hypnotic Communication in
Emergency Medical Settings
For Life-Saving and Therapeutic Outcomes

Four Arrows (Don Trent Jacobs)

and Bram Duffee
Designed cover image: © Getty Images
First published 2024
by Routledge
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and by Routledge
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© 2024 Four Arrows (Don Trent Jacobs) and Bram Duffee
The right of Four Arrows (Don Trent Jacobs) and Bram Duffee to be identified as authors of this
work has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and
Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form
or by any electronic, mechanical, or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or retrieval system, without permission
in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library

ISBN: 978-1-032-55349-8 (hbk)

ISBN: 978-1-032-36002-7 (pbk)
ISBN: 978-1-003-43026-1 (ebk)
DOI: 10.4324/9781003430261
Typeset in Times New Roman
by codeMantra
Contents

Preface ix

Introduction 1

PART I 7

1 Credibility 9

2 Confidence 19

3 Rapport 25

4 Expectation 37

PART II 47

5 Directives (An Overview) 49

6 Images 52

7 Believability 57

8 Literal Interpretation 61

9 Enthusiasm 65

10 Managing “Pain” (“Discomfort”) 69

viii Contents

11 Stopping Bleeding 79

12 Cardiovascular Emergencies 83

13 Hypnotic Treatment for Burns 90

14 Respiratory Diseases 96

15 Anaphylaxis 101

16 Childbirth and Pediatric Emergencies 106

17 Psychological Emergencies 113

18 Self-hypnosis 120

19 The Planetary Emergency 125

Index 133
Preface

A non-fiction book’s preface usually tells why authors are motivated to write
about their topic. At the end of this section, we (Bram and Four Arrows) com-
municate our personal reasons for writing this book. For now, we begin with
our shared belief that words spoken to an emergency medical or trauma victim
within the first hour or so have the potential to make a difference that will save
lives, alleviate suffering, and initiate healing. We have learned this mostly from
our nearly 40 years of combined field experience in emergency medicine and
hypnosis. However, as academics, both of us with research doctorates, we also
know the research that supports this belief. Although we minimize academic
jargon supportive citations in the rest of the book, we offer some studies here
that refer to such research. The following abstracts are examples of many that
prove how hypnosis can be an effective medical intervention for the kinds of
medical emergencies that occur worldwide, many of which we address in this
text.
First, we offer our working definition of hypnosis so you know what these
research conclusions really show. The word “hypnosis” can refer to an altered
consciousness that makes a person able to activate responses differently from
normal consciousness. More specifically, during this alternative consciousness,
there are cognitive/sensory changes in the frequency of the brain as well as nerv-
ous system oscillations. Lower frequencies, such as theta oscillations, seem to
facilitate responding to mental or verbal directives or suggestions, and at the
same time, an effect on a higher frequency (gamma) links different circuits in
the brain to create physiological responses such as a reduction in pain sensation.i
Researchers from the University of Turku, Finland, also found that during hyp-
nosis the brain shifted to a state where individual brain regions acted more in-
dependently of each other.ii It is interesting to note that for decades, scientists
refused to believe that hypnosis actually changed brain activity. However, with
improved technologies, they have proven that the ability of hypnosis to control
pain and reduce anxiety is clearly associated with functional changes in brain
activity. For example, a systematic review of 10, 404 peer-reviewed articles
x Preface

identified significant differences in brain activity during hypnosis relating to lo-

cation and frequency.iii
The word “hypnosis” is also used to describe the process by which such neu-
rological changes take place, whether in hetero-hypnosis or self-hypnosis. Here,
scientific research offers little beyond describing the particular techniques used
in various experiments because there are so many approaches. There are com-
mon threads in clinical hypnosis and in stage hypnosis we could describe. How-
ever, our goal in this book is not to teach hypnotic induction techniques per se.
It is to convince readers that spontaneous states of hypnotic consciousness occur
during trauma that makes whatever is said to a patient by a first responder a po-
tential hypnotic suggestion. After presenting the following list of abstracts that
support this assertion, we have more to say about spontaneous hypnosis and why
our belief in it has motivated us to write this text.

Abstract #1: Hypnosis in Emergency Medicine:

Let’s Change Our Habits!
The effectiveness of hypnosis in the management of pain and anxiety has been
widely demonstrated today. While this technique is commonly used in anesthe-
sia and psychiatry, its use in emergencies is still poorly developed. The fields
of application in hospital and extra-hospital emergency are however multiple,
and, contrary to popular belief, emergencies are the ideal place for the practice
of hypnosis. Hypnosis is a reliable, safe, effective, and inexpensive technique
that any caregiver can learn. It strengthens the caregiver-patient relationship and
helps us to treat differently, more humanly, and more serenely.iv

Abstract #2: The Use of Hypnosis in Emergency Medicine

Hypnosis can be a useful adjunct in the emergency department setting. Its ef-
ficacy in various clinical applications has been replicated in controlled studies.
Application to burns, pain, pediatric procedures, surgery, psychiatric presenta-
tions (e.g., coma, somatoform disorder, anxiety, and posttraumatic stress), and
obstetric situations (e.g., hyperemesis, labor, and delivery) are described.v

Abstract #3: Hypnosis as Emergency Treatment for the

Mentally Ill and in Disaster Situations
For an individual as well as for a group of people, a disaster may be associ-
ated with acute physical and/or mental collapse. As well as taking swift physical
measures in such situations, it may be necessary to give equally rapid mental
help. To this end, hypnosis, or more properly, hetero-hypnosis is an important
method.vi
 Preface xi

Abstract #4: Adjunctive Non-pharmacological Analgesia for

Invasive Medical Procedures

A Randomized Trial

Non-pharmacological behavioral adjuncts have been suggested as efficient safe

means in reducing discomfort and adverse effects during medical procedures.
Non-pharmacological adjuncts have a positive effect on patients’ comfort levels
compared with standard conditions despite the use of half the analgesic and anti-
anxiety medication. The trend toward less pain and anxiety over time, found
with structured attention, reached significance with the addition of hypnosis.vii

Abstract #5: Autonomic Cardiac Reactivity to Painful Procedures

Under Hypnosis in Pediatric Emergencies

The aim of this study was to investigate the impact of hypnosis on pain per-
ception in children during clinical procedures. Specifically, the researchers
examined the autonomic responses of pediatric patients undergoing sutures un-
der hypnosis in emergency settings. Pain sensation is characterized by abrupt
changes in central nervous system activity producing autonomic reactivity.
Time-frequency analysis was applied on RR intervals (heart rate intervals, or
RRI) to estimate parasympathetic reactivity. To conclude, hypnosis in pediatric
emergencies reduces sympathetic cardiac pain reactivity and could be a marker
of pain relief under hypnosis, while parasympathetic activity seems to be a better
marker of hypnosis.viii

Abstract #6: Hypnosis for Asthma: A Controlled Trial

An investigation of hypnosis in asthma was made among patients aged 10 to 60
years with paroxysmal attacks of wheezing or tight chest capable of relief by
bronchodilators. Independent clinical assessors considered asthma to be “much
better” in 59% of the hypnosis group and in 43% of the control group, the differ-
ence being significant. There was little difference between the sexes. Physicians
with previous experience of hypnosis obtained significantly better results than
did those without such experience.ix

Abstract #7: The Hypnotic Control of Blood Flow and Pain

Case histories show that hypnosis can control massive bleeding and pain, and it
can remove warts, probably by stopping blood flow to them. We propose that blood
flow to cancerous tumors can likewise be controlled, which could destroy them
outright, or which control could be a useful adjunct to chemo- or radiotherapy.x
xii Preface

Abstract #8: Use of Relaxation and Hypnosis in Lowering

High Blood Pressure
Investigation was made to determine whether high blood pressure (hyperten-
sion) could be lowered through (a) muscular relaxation and (b) hypnosis. Six
non-­medicated hypertensive patients were used as controls, while another six
served as treatment group receiving muscular relaxation and hypnosis proce-
dures. Nine patients on stabilized anti-hypertensive medication also received
muscular relaxation and hypnosis procedures. Significant lowering of both sys-
tolic and diastolic pressures was obtained in both the no-drug and drug groups
receiving treatment, but there was no significant reduction in the control group.
Hypertensive levels were reduced through muscular relaxation and completely
eliminated during hypnosis. Instruction was given in self-relaxation and self-
hypnosis to promote the continuation of beneficial effects beyond hospitaliza-
tion.xi

Abstract #9: An Hypnotic Suggestion: Review of Hypnosis

for Clinical Emergency Care
Hypnosis has been used in medicine for nearly 250 years. Yet, emergency
­clinicians rarely use it in emergency departments or prehospital settings. This
review describes hypnosis, its historical use in medicine, several neurophysi-
ologic studies of the procedure, its uses, and potential uses in emergency care.
It suggests methods of increasing its use in emergency care. Although it is safe,
fast, and cost-effective, emergency clinicians rarely use hypnosis. This is due,
in part, to the myths surrounding hypnosis and its association with alternative-­
complementary medicine. Genuine barriers to its increased clinical use include
a lack of assured effectiveness and a lack of training and training requirements.
Based on the results of further research, hypnosis could become a powerful and
safe nonpharmacologic addition to the emergency clinician’s armamentarium,
with the potential to enhance patient care in emergency medicine, prehospital
care, and remote medical settings.xii
In this last abstract, the author notes the unfortunate fact that the use of hyp-
nosis for medical emergencies is rarely used—owing to myths about it and a
lack of training in it. We intend for this book to address both of these restraints
to saving lives. We know that with the kind of practical “training” we offer,
more and more first responders and EMS agencies will want to start bringing our
communication strategies that recognize spontaneous hypnosis in victims. Two
studies reveal that learning about this power of words does motivate professional
medics. Perhaps it is because they intuitively realize that they have always had
this power, though no one had named it for them. One study shows how nurses
changed their communication behaviors after learning about hypnotic tech-
niques designed to manage pain in children undergoing medical procedures.xiii
 Preface xiii

Another is a soon-to-be-published doctoral dissertation by Michael Moates.

He surveyed over a thousand professional first responders about whether they
thought their words could potentially have a positive hypnotic effect on treat-
ment outcomes. Then, he had them read a short description of the phenomenon.
Over 50% changed from a negative response to a positive one.
Thomas Elmendorf, M.D., former past president of the California Medical
Association, refers to the barriers to bringing this book’s message to the fore of
emergency medicine. Written in 1991 for the original manuscript that inspired
this publication, he writes:

The material presents both an opportunity and a challenge to all prehospital

care personnel. The opportunity is to develop patient communication at a
level previously unknown, a level that may enhance positive and possibly
lifesaving physiological responses. The challenge is to break through the bar-
riers of bias, preconception, and mind-set that deter objective evaluation.

Spontaneous Hypnosis

Another important thing to note in the abstracts cited above is that they all in-
volved hypnotic induction techniques. Whether or not that was necessary for
those related to medical emergencies is not discussed. This brings us back to the
idea of spontaneous hypnosis. Our book’s approach assumes that the emergency
victim is spontaneously in a state of hypnosis and that no “induction” per se is
necessary. The American Academy of Orthopedic Surgeons apparently agrees
with this assumption when in their 4th edition of Care and Transportation of the
Sick and Injured, the author says that first responders must be “extremely careful
about what is said at the scene. During periods of great stress, words that seem
immaterial or are uttered in jest might become fixed in the patient’s mind and
cause untold harm. Conversation at the scene must be appropriate.” Of course,
they do not explain why, and in this and all of their many subsequent editions,
they go no further than to tell their readers that a first step in care management is
to “calm and reassure” the patient.
Not giving attention in academic studies to spontaneous hypnosis is un-
derstandable. If intentionality in a laboratory or hospital for hypnosis existed,
it could not be spontaneous. This said, there is sufficient anecdotal evidence
for the existence and importance of spontaneous hypnosis for us to feel this
book can save many lives and alleviate much suffering. Arreed F. Barabasz
is someone who agrees with us. Before we cite his position on this, we note
his exceptional credentials. At only 23 years of age, Arreed Franz Barabasz,
EdD, Ph.D., American Board of Professional Psychology (ABPP), completed
his first doctoral degree in Counseling Psychology at State University of New
York at Albany. His Ph.D. in Clinical and Human Experimental Psychology is
xiv Preface

from the University of Canterbury, New Zealand, where he conducted the first
studies of EEG and Hypnosis in Antarctica. His postdoctoral Clinical Fellowship
was at Harvard Medical School & Massachusetts General Hospital. Dr. Barbasz
is a Full Professor and Director of the Laboratory of Hypnosis Research at
Washington State University. He was an Associate Professor of Psychology at
Harvard University Medical School prior to his current position. Dr. Barabasz is
the Editor of the International Journal of Clinical and Experimental Hypnosis
(IJCEH) (2002–2018), the highest citation index-ranked journal in the field. He
is a licensed psychologist and Diplomat of the ABPP—the highest distinction in
professional psychology. Arreed holds a Fellow status for “Outstanding and unu-
sual contributions to the science and practice of psychology,” from the American
Psychological Association (APA).
Barbasz’s work is important to mention in our preface if only to show we are
not the only ones concerned about the lack of attention given to the phenomenon
of spontaneous hypnosis. In an article criticizing the APA for omitting spontane-
ous hypnosis in its newest definition of hypnosis,xiv he says that “A definition
that fails to include spontaneous hypnosis gives researchers ‘license’ to fail to
experimentally control for the potential influence of this variable on their find-
ings.” He gives an example where in one study that has been influencing hyp-
notic research for decades failed to discuss one of five subjects in spontaneous
hypnosis that had the same hypnotic responses as those who were profession-
ally hypnotized. He continues explaining how hypnosis literature is littered with
studies that ignore potential occurrences of spontaneous hypnosis. “It is naïve
for a clinician to assume that if he or she is not formally using hypnosis it does
not occur.” He also says that “Exposure to a traumatic event is a common excita-
tion leading to spontaneous hypnosis.”
Another article referring to spontaneous hypnosis comes from psychiatry law
and forensics. The author, John O. Beahrs, M.D. says “Hypnotic-like phenom-
ena and transactions occur spontaneously, in either covert or overt forms.” He
describes four overlapping types of spontaneous hypnosis. In one section titled
“Trauma and Spontaneous Hypnosis,” he says “the experience of a catastrophic
stressor is nearly always accompanied by profound alternations in subjective vo-
lition, sense of time, and other cognitive/perceptual alterations that meet criteria
for overt hypnotic states.”xv

Our Individual Personal Reasons for Writing This Book

Don Trent Jacobs, Ph.D., Ed.D., aka Wahinkpe Topa (Four Arrows)
I learned about the potential benefits of hypnotic language at the emergency
scene long ago in the 1980s. Simultaneously renewing my EMT training; taking a
course in hypnotherapy during my doctoral work in health psychology; respond-
ing to many medical emergencies as a firefighter/EMT for the Marin County Fire
Department; and training wild mustangs (Search YouTube for “Wild Horse Hyp-
notist), I started using “emergency hypnosis” on some calls. While working as an
 Preface xv

EMT, I got my doctorate in health psychology. Eventually, I quit the fire service
and started a hypnotherapy practice. I became the vice president of the Northern
California Society of Clinical Hypnosis and taught hypnosis at UC Berkeley as
an adjunct for Marriage, Family and Child Counseling hypnosis certification.
During the transition from EMT to clinical hypnotherapist, I created a video1
with a number of respected physicians and my team of EMTs who were using it.
I think that it might be the first introduction of this topic to the world. Norman
Cousins, author of Anatomy of an Illness, saw the video. At the time, he was do-
ing research at UCLA with actors and actresses “imagining” different emotions
to see how they influenced their biochemistry. He contacted me and suggested to
write a book about it. I created the manuscript and sent it out for endorsements.
I received the following for the original manuscript:

“This book should be in every person’s library and should be studied care-
fully by all of us…the knowledge we absorb here may save many lives.”
David Cheek, M.D., author of The Psychobiology
of Mind/Body Healing

“This book presents field tested techniques proven to have an invaluable in-
fluence on patient recovery.”
Journal of Emergency Services

“This approach presents an opportunity to develop patient care at a level pre-

viously unknown.”
Thomas Elmendorf, M.D. (former) president of the
California Medical Association

“This material is on the cutting edge of an exciting an innovative approach to

pre-hospital care.”
Benny Cooper, Director of Emergency Medical
Training at Murray State University

“…It provides valuable information on multiple aspects of the patient/physician

relationship. I cannot imagine any patient or emergency care provider who
would not benefit from this approach to treating a person in trauma.”
Norman Cousins, UCLA School of Medicine, author
of Anatomy of an Illness

Unfortunately, the 1980s and early 1990s were the right time for my book.
I say “unfortunately” because I know that many lives could have been positively
affected if this book had been available to first responders over these many years.
In the era we are now facing, with a likely increase in medical emergencies, per-
haps the world will now embrace this life-saving, easy-to-use form of communica-
tion as an adjunct to standard first-aid and emergency medical care everywhere.
xvi Preface

This said, there still exists much skepticism about the hypnosis phenomenon.
Too many see it as something “make believe” that does not really relate to a bio-
logical transformation in nervous system functioning. Here are just three studies
that can help clarify that hypnosis is real and proven clinically:

Antonio Del Casale, Stefano Ferracuti, Chiara Rapinesi, Daniele Serata,

Gabriele Sani, Valeria Savoja, Georgios D. Kotzalidis, Roberto Tatarelli &
Paolo Girardi. (2012). Neurocognition under hypnosis: Findings from recent
functional neuroimaging studies, International Journal of Clinical and Ex-
perimental Hypnosis, 60(3), 286–317, DOI: 10.1080/00207144.2012.675295
Study 1: Brain scans show that when people are hypnotized, the front part
of their brain helps them to pay more attention. This part also helps to separate
out different thoughts. Other parts of the brain also change and help with seeing
things differently. Finally, there are changes in the back part of the brain which
help with how people act on different suggestions.

Kosslyn, S. M., Thompson, W. L., Costantini-Ferrando, M. F., Alpert,

N. M., & Spiegel, D. (2000). Hypnotic visual illusion alters color processing
in the brain. American Journal of Psychiatry, 157(8), 1279–1284.
Study 2: When people were hypnotized, the left and right sides of their brains
lit up when they were asked to see color. But the same parts got less light when
they were asked to see gray. This only happened during hypnosis, and it was
different on the left side than on the right side. People who can be hypnotized
can have changes in their feelings and thoughts that show up in their brains. This
means hypnosis is real and not just pretending.

Tuominen, J., Kallio, S., Kaasinen, V., & Railo, H. (2021). Segregated brain
state during hypnosis. Neuroscience of Consciousness, 2021(1), niab002.
Study 3: This group conducted an experiment to investigate how the brain
responds to a type of magnetic energy that affects electrical activity. The experi-
ment revealed that when an individual is prescribed a single-word suggestion,
the connections in the brain are altered, and it becomes difficult for stronger
signals to be transmitted between different areas. The results of this experiment
suggest that hypnosis can alter events occurring in the brain, possibly influenc-
ing how people react under hypnosis.
As an Indigenous-based scholar, I believe in the Indigenous idea that words
are sacred vibrations. Traditional Indigenous cultures and all of our distant pre-
colonial ancestors knew the power of trance-based learning and healing and used
it regularly. The reader can learn more about this in other books that I have writ-
ten, including Point of Departure, Primal Awareness, and Restoring our Kinship
Worldview.
 Preface xvii

Bram Duffee
In 1998, I became a paramedic at 19 and was given a great deal of responsi-
bility at a young age. I was very young to be doing a job that requires strong
leadership, and I found out quickly that my words and how I said those words
influence everyone in the environment. This is especially true on the scene of
an emergency when everyone is already experiencing some degree of stress. So,
when I am communicating to my crew on the scene or to the dispatcher by radio,
they are listening for how to interpret the situation based on nonverbal parts of
my message like tone and volume. If I am stressed or emotional or fearful, they
might know, and I did not want to ever seem as if I could not handle the stress
because of my age. Similarly, if my coworkers or the bystanders could tell that
the person in charge is stressed, then of course that stress transfers to the patient
as well. To mitigate that issue early on, I focused on adhering to the principles
that I was taught as an Eagle Scout that influenced my professional look, trim
haircut, and always perfect uniform.
I realized that my image makes a real difference in my ability to provide the
best medical care. But, even with this realization, and giving maximum effort
to be effective as a clinician, I still had patient encounters where the patient
died because they refused to go to the hospital by ambulance. The most com-
mon scenario would be an older man who has severe heart attack symptoms and
emphatically refuses to go to the hospital even with my medical opinion and the
urging of family. I know the patient was refusing to go to the hospital because
they are in denial and afraid. So, refusing to acknowledge the situation by get-
ting treatment or going to the hospital would help the patient feel as if they were
maintaining control. In some cases, I had very argumentative interactions with
patients because I was able to bluntly tell them what I thought was wrong with
them and how I wanted to fix it. I would be in situations where the patient might
die if I am not successfully persuasive enough to convince them to go with me
to the hospital. These “arguments” I was having, usually with older men in rural
settings, were something I was interested in studying.
While working as a paramedic I studied conversational analysis under Phillip
Glenn, Ph.D. my first master’s degree in speech communication. My initial
orientation to analyzing conversation was through the deep study of one par-
ticular aspect of language, laughter. I used transcription equipment that ad-
vanced a tape by foot pedal to manually type each utterance of sound I recorded.
Laughter was not just “LOL.” I began to understand the unlimited ways that
someone could laugh, and how different each utterance can be. “Hhaa,” “haa
ha,” “HAAAAaha,” and “Haaahaa” have much different sounds, for example.
Through this narrow view of understanding, a small aspect of language was born
a big awareness of the world involving nonverbal communication. It helped me
understand other forms of nonverbal communication and how they influence the
meaning of messages.