One of the many psychological and hypnosis services that I provide is the psychological preparation of patients for both major and minor surgery. What follows is some information about what this entails.

Good preparation for surgery should promote confidence and relieve apprehension. The intent of the surgeon is to take the patient safely through surgery and on to a rapid return to health. This requires the patientís cooperation during diagnostic studies and the removal of doubts and fears so that the patient's body and mind stay strong from the beginning of the surgery journey all the way to its successful completion.

The goals of any surgery, in addition to the primary goal of physically repairing what needs to be repaired, include avoiding stressful anesthetic responses, minimizing drug toxicity from chemoanesthesia, early ambulation

after the surgical procedure, freedom from post-operative complications, and the patient's early return to maximum functionality. Much of this can be accomplished without hypnosis. However, employing hypnotic trance and suggestion as tools achieves these desired results more efficiently and consistently.

The best time to deal with physical and psychological post-operative complications is preoperatively. Good psychological preparation for surgery clarifies misunderstandings, explains what is to come, protects the patient from harmful conversations in the operating room, and promotes the expectation of a rapid and a comfortable recovery. In an ideal world, a good pre-operative preparation for the surgery in the waking state would be given by all of the physicians that matter to the patient: the referring physician, the anesthesiologist, and the surgeon.

It would also be ideal if each important physician were trained to employ hypnosis. Ideally, the key physicians and nurses should confer and be aware of each otherís preoperative visits with the patient. If one doctor has taught the patient a self-hypnosis exercise, it would be great if the other clinicians involved in the case reinforced and validated its employment by the patient. Unfortunately, this is seldom the case. This is where a clinical/medical psychologist like myself trained in hypnosis and psychotherapy, and well versed in medical hospital protocol, comes into the picture.

In preparing patients for surgery, my approach is first to learn everything that I can about the patient's physical/medical condition and the procedure that is to be performed. Then, I endeavor to learn as much as is relevant about the patient's personality and life circumstances. My goal is to impress upon the patient the importance of maintaining a healthy, optimistic outlook about the upcoming procedure and how it is going to help the patient get better. I then assess any obstacles that the patient faces that stand in the way of maintaining a positive outlook and address them. My goal is to teach the patient how to deal with negative thoughts, and how to dismiss them, but at the same time, maintaining a realistic perspective so that realistic concerns are addressed.

Negative thinking by the patient is to be avoided as much as possible and the patient is taught techniques for maintaining a healthy, positive outlook. The patient is also supported and coached in establishing healthy communication with his or her doctors and the surgeon. Any issues that need to be resolved or clarified are addressed both objectively in the waking state and on a feeling/emotional level under hypnosis.

I teach the pre-surgical patient how to use self hypnosis for relaxation, positive thinking and positive self-affirmation, positive goal-directed visualization, and for obtaining restorative sleep. I also teach the patient how to use self hypnosis to alleviate anxiety or depression. Anxiety and depressive symptoms are addressed both in the waking state using reality based counseling and cognitive-behavioral therapy as well as in hypnotic trance so as to address the subconscious issues that need to be dealt with.

I typically make a personal hypnosis audio CD for the patient that contains on it an individualized self hypnosis/self relaxation exercise along with protective suggestions that I want the patient to thoroughly internalize. Some examples of protective suggestions that have been repeatedly found to be helpful include:

1. You will have an easy day during the surgery.

2. The night before the procedure you should let yourself feel safe and comfortable, sleeping soundly, accepting the fact that you are turning this over to your doctors now.

3. You can help your body heal best by having an attitude that nothing will bother you. Nothing will bother you.

4. In the morning, you wonít want to eat or drink anything, so that all of your body functions will be at rest.

5. When you receive your pre-op injection in your room, you should empty your bladder and let the sedative take effect while you relax and go to your "laughing place" (I have already helped the patient find his/her "laughing place").

6. From the time you leave your room until you return from the recovery room, you should simply enjoy your laughing place and completely ignore anything that people say unless you are spoken to directly by name. [Repeat]. Completely ignore anything that people say unless you are spoken to directly by name.

7. When your anesthesia is started, all pain sensation is blocked. Some people hear sounds during their operation, and if you do, you will ignore it because you will be feeling no pain and enjoying your laughing place.

8. You will get a constant supply of oxygen through a small tube in the back of your throat.

9. When the surgery is completed, you will be moved to a stretcher and taken to the recovery room. You will gradually awaken just as you do from natural sleep, relaxed and refreshed.

10. You will wake up remarkably comfortable, with a good appetite, and your normal bladder and bowel functions will resume quickly.

11. You will be up walking later in the day [if appropriate].

12. Whatever you need for comfort will be supplied, and your tissues will heal rapidly.

13. Now, I want you in your imagination just to picture all that I have just told you taking place, and then project ahead in time to when you feel healed and well and ready to leave the hospital. And when you do that, signal by raising your right index finger, and a date or the number of days will come into your mind so that you can tell me when it is.

The patient is encouraged to practice using self hypnosis to go to his "laughing place" in his imagination so that he can enjoy himself, totally free of responsibility, and just goof off, worry-free. The intent is for the patient to do this at the time of the surgical procedure and to leave the rest to his doctors.

In sum, my work in preparing patients for surgery is devoted to alleviating all of the negative factors that can work against the patient's having an as comfortable as possible experience and a positive and successful surgery outcome. Research shows that positive expectations promote positive outcomes.

Bruce N. Eimer, Ph.D., A.B.P.P.