Characterization of Patients with Functional Syndromes and Paradoxical Response to Hypnotic Relaxation

Hypnotherapy is effective for treating functional symptoms; however, some studies describe a paradoxical response to hypnotic relaxation. We hypothesized that functional patients who: 1) are aware of a stressful antecedent event and 2) recognize that stress is causing or exacerbating their symptoms would have reduced symptom-severity with hypnotic relaxation, whereas patients who do not perceive a stressful antecedent and do not recognize stress as causing symptoms, would more commonly experience paradoxical response (PR) of increased symptom intensity. In this retrospective analysis, records between 2013-2017 were obtained from the Functional Neurology Clinic (FNC) in Soroka Medical Center, Israel. Patients with functional disorders who underwent a three-session hypnotic relaxation course were included. Ninety patients participated. Patients with low stress awareness exhibited significantly higher PR rates during the first session and throughout the three-session treatment. Specificity of PR as a criterion for lack of insight was 90%. For functional patients who find themselves at an impasse and are resistant to considering psychological etiologies, understanding PR to hypnotic relaxation may serve as a gateway to facilitating psychological treatment.