Personalised evaluation of self-hypnosis as a treatment of chronic pain: a repertory grid analysis

Pain, 35 (1988) 155-169

Elsevier

155

PAI 01291

Personalised evaluation of self-hypnosis as a treatment of chronic pain: a repertory grid analysis

Robert G. Large * and Frances R. James * *

Departments of * Psychiatry and Behavioural Science and * * Psychology, University of Auckland, and Pain Clinic,

Auckland Hospital, Auckland (New Zealand)

(Received 16 December 1988, revision received and accepted 19 May 1988)

SummarY Self-hypnosis was taught to 5 highly hypnotisable patients referred to Auckland Hospital Pain Clinic. Evaluation

included the Illness Self-Concept Repertory Grid (ISCRG) and follow-up was at 1 and 6 months post treatment. Consensus grids

indicated the subjects initially identified with physical illness but this association decreased over the course of the study. There

appeared, therefore, to be a shift in self-concept away from physical illness, in association with the learning and practice of

self-hypnosis. This change was especially evident in the grids of those subjects who experienced the most pain relief.

An association between pain reduction and self-concepts is thus noted. This study does not identify whether self-concepts merely

reflect therapeutic change or whether strong self-identification with physical illness indicates a poor prognosis for pain relief. This is a

question which deserves further study.

Key words: Self-hypnosis; Personal&d evaluation; Chronic pain; Grid analysis

Introduction

The role construct repertory grid was devised by George Kelly [6] as a means of exploring an individual’s view of the world. Grid technique has since been adapted to a variety of purposes and good overviews of this literature are provided by Bannister and Fransella [l] and by Beail [2] including some discussion on the validity and reliability of repertory grids.

A form of the repertory grid has been used in Auckland to explore self-concepts in patients with chronic pain, viz., the Illness Self-Concept Reper-

Correspondence to: Dr. R.G. Large, Dept. Psychiatry and Behavioural Science, School of Medicine, University of Auck-

land PB, Auckland, New Zealand.

tory Grid (ISCRG), which is described in 2 previ- ous papers. The distance between ‘self’ and ‘ideal self concepts predicted outcome in a trial of EMG feedback [7] and self-concepts shifted in association with a pain management programme utilising education and cognitive-behavioural techniques

PI. In this study we were interested in tracking

shifts in self-concepts associated with self-hypnosis (SH) training. Further details of the design and execution of the study are described in a compa- nion paper [4]. Hypnosis has been said to alter an individual’s emotional reaction and attitude towards pain [3,9] and the ISCRG is a sensitive instrument in defining attitudes towards the self and towards illness.

03043959/88/$03.50 0 1988 Elsevier Science Publishers B.V. (Biomedical Division)

150

TABLt I

SUBJt’(‘T DETAILS

Subject Sex Age Location Duration SHC’S of pal” of pain

(years)

I RG F 45 L. chest I 5 2 K<; F 21 L. head 1 4 3 PD M 31 R. shoulder 10 5 4DM F 22 R. knee I 5 5 IC‘ M 51 Low back 5 5

___

Methods

A series of 28 new patients at Auckland

Hospital Pain Clinic were assessed using the Stan-

ford Hypnotic Clinical Scale (SHCS) [ll]. Five were selected for high hypnotisability, clinical sui- tability and interest in learning self-hypnosis. Each subject had tried other forms of treatment in-

cluding medication, acupuncture, physiotherapy and a wide range of alternative therapies. Subject details are presented in Table I. Apart from subject 2, who saw a local electro-acupuncturist, none of the patients had any other therapy apart from

learning self-hypnosis during the course of the

study.

Subjects 1, 3 and 5 had chronic musculoskeletal pain, otherwise not specified. Subject 2 had con-

stant left parietal headache for which no cause

could be found, and subject 4 had a post-trau- matic neuralgia. All subjects were judged to have

psychological factors affecting their physical con- dition, but no other psychiatric diagnosis.

The purpose of this study was to attempt controlled clinical assessment of the use of self-hypnosis in the management of chronic pain per se. We therefore selected from a consecutive series of patients attending the clinic for the first time with chronic non-malignant pain regardless of diagnosis. We preferred to apply the most appropriate treatment programme for each individual, as we wished to test the utility of hypnosis as it is applied in the field, rather than a standardised treatment package. Consequently, single-case design was most appropriate to this study; to allow individual variation in treatment strategy to exist,

aud he controlled for [14]. Specificity of effect MX~ ttvaluated by using a hatterc of questionnaires in addition to daily pain. medication and sleep rcc- ords and interview data.

Treatment was administered in the context of a multiple baseline design across subjects with a delay of 1 week between subjects. The advantages of single-case designs in clinical research and the

range of designs available are discussed in Kazdin

151. All patients were seen by the same therapist (RGL) who worked individually with each person

to arrive at a suitable self-hypnosis strategy for

each to use in their own time. The average length of treatment was 5.2 one hour sessions, with a 1

month follow-up. Two of the patients were taught

the technique of glove anaesthesia. two used rc- taxation techniques and the final subject used

distraction imagery. Assessment included questionnaires. daily mea-

sures and interview findings. Research interviews

were conducted independently of the therapist by the researcher (FRJ) and consisted of the McGill Pain Questionnaire (MPQ) [lo], the Health Locus of Control survey (HLC) [13] and the Illness Self- Concept Repertory Grid (ISCRG). Interviews oc- curred prior to treatment. and at the end of the treatment phase with follow-up at 1 and 6 months

post treatment. The MPQ was also completed at the initial assessment for inclusion in the study.

Subjects were asked about the effect of pain on their daily life. Daily self-report measures included: rating of pain intensity on a numerical

scale O- 10, rating quality of sleep as: (1) uninter-

rupted; (2) interrupted: (3) very bad: or (4) no sleep at all. Details of the analgesic medication required each day and of self-hypnosis practice

were recorded. The ISCRG has 6 elements which are rated

against 8 constructs. Constructs are presented as bipolar visual analog scales. Elements and constructs are detailed in Appendix A.

ISCRG data were analysed using lngrid 72. This program was developed by Patrick Slater and has been carefully described in great detail in his 2 volume work on the measurement of intra-per-

sonal space [12]. The output from each grid analysis is very extensive and space would not permit us to give all of these data on the 16 grids described

157

in this paper. Instead, the grids will be presented in the form of composite diagrams and Appendix B is attached as an example of the data output on

one grid. Essentially, Ingrid 72 performs a prin-

cipal component analysis on the raw data, which are the ratings of each element against each of the

bipolar constructs. These data form the grid matrix from which the components are computed. In effect, there are 2 mathematical ‘spaces,’ a con-

struct space and an element space. The elements can be defined in terms of their positions in the construct space whilst the constructs can be defined in terms of their positions in the element space. The components are computed by a sub- routine applied to the covariance matrix between the elements. It is condensed into a tridiagonal

matrix with the same latent roots and its k roots are all obtained simultaneously by direct solution

of the determinantal equation. Finally, the ele-

ment vectors are derived and stored as an m x k array. Construct vectors are then calculated from

these results. The components therefore describe the connections between the construct and element spaces. The orientation of the component

axes is determined in the construct space by the element vectors and in the element space by the construct vectors. In grids of the size described in this paper, most of the variance is accounted for by the first 2 or 3 principal components. It is therefore possible to represent the data succinctly and with acceptable accuracy in the form of composite diagrams according to Siater’s method. Here

the first 2 principal components are taken as the horizontal and vertical axes of the graph. The constructs are plotted as angles to the components and are represented as bipolar points at the cir-

cumference of a circle drawn at a convenient

radius around the intersection of the component axes. The elements are plotted as points within this construct space. It is possible to represent the relationship of each element with each construct by simply dropping a perpendicular line from the element point to the construct axis - thus depict- ing the position of the element along the dimen- sion of the bipolar construct [8,12].

The ISCRG was recently evaluated on a sample of 21 ‘well’ volunteers. Test-retest reliability of the ISCRG, with 1 week delay, was found to be

0.80. These data are being prepared for publication.

Results

This section consists of a brief summary of the

overall results of the study followed by discussion

of the ISCRG. There was a great deal of variation in response

to treatment, even in this small sample. An overall reduction of pain was indicated by the decrease in the MPQ scales of ‘Number of words chosen’ and ‘Pain rating index.’ Breakdown of the PRI indicated there was a specific decrease in the affective

and the evaluative dimensions of pain. There was no overall decrease in daily measures of pain. Pain-related measures of medication intake, qual-

ity of sleep and daily activity levels suggest that

some improvement in lifestyle did occur. There

was a significant increase in personal locus of

control across all subjects. On an individual level,

two of the subjects totally removed their pain, two showed some improvement and one experienced no change in pain intensity.

There are 3 aspects to the discussion of the ISCRG. First the consensus findings, second the

analysis of consensus change over time, and finally the grids from 2 patients will be discussed to highlight the variation which existed between subjects.

Consensus grids

The consensus grids from each assessment time

are displayed in Fig. 1. Appendix B gives a condensed version of the output from a single grid

using the pre-treatment grid of subject 4 as an

example. The output includes the raw scores, cor- relations between constructs, distances between

elements, latent roots of the principal components and loadings of the constructs and elements on the first 2 components.

The pre-treatment grid is an example of the typical response of an individual who has chronic pain. There is an identification of the self as physically ill, a rejection of the concept of hypochondriac, with its implications of psychological factors in the illness, and an expression of iso- lation from friends and family (‘others’). The doc-

CONSENSUS GRID

Pre treatment Post treatment

One Month Follow up Six Month Follow up

Fig. 1. The consensus grids for all 5 patients are shown at the 4 occasions of testing. The horizontal axis represents the first principal component and the vertical axis the second principal component. Constructs are represented as directional arrows at the

circumference of the circle and may be drawn by completing the line through opposing arrows and the mid-point of the graph. The

positive poles are unsigned. The negative poles are signed. Elements are represented by the open circles. Both elements and constructs

are labelled according to the list shown in Appendix A.

tor is seen as understanding that they are physically ill.

The series of post-treatment and follow-up grids represent the move towards feeling understood by others and of rejecting the concept of physical illness. Physical illness becomes associated with the hypochondriac at the negative poles of the constructs.

The final assessment at 6 months post treatment indicates that they now feel understood by both doctor and family. The ‘doctor’ believes that they bottle feelings up while ‘others’ believe that they express feelings more than they do. It is of interest that the ‘physically ill’ element and the ‘ideal self’ are both more expressive of feelings than the patients see themselves.

159

Time series grids from each test occasion, on 1 grid. The results The dimensions of the grid are determined by indicate both changes in the conception of an

each set of data. This means that distances be- element across time and changes in the rela-

tween elements for different grids may not be tionship between the elements (Fig. 2). Note that

directly comparable. To obtain further informa- the construct alignment is identical and that dis- tion about the changes in self-concept we plotted tances are now directly comparable. the self, ideal self, and the physically ill element, Within elements. The concept of self changed

TIME SERIES CONSENSUS GRID

Pretreatment

One Month Follow up

A : as I am

Post treatment

Six Month Follow up

B : as f would like to be C : like a physically ill person

Fig. 2. The grids are displayed using the same conventions as Fig. 1. On this occasion construct alignment is kept constant, negative

poles are unsigned, and only 3 elements are plotted for each test occasion.

160

from being irritable, with many problems other I’he concept of ideal self remained consistent than pain, to being less worried about their illness, during the study and was a rather idealised picture

less depressed and less anxious and notably to- of health. with no problems and no emotional

wards being able to express feelings. distress.

SUBJECT FOUR


b

5

7 7

- 4


Fig. 3. Individual grids for subject 4 are shown using the same conventions as Fig. 1. Only the construct poles on the left of each grid are labelled. Positive poles are unsigned, negative poles are signed.

Initially the physically ill element was pre- having an emotional component to the pain and sented as worried about illness, anxious and de- as bottling feelings. It is interesting that the rating pressed. At the post-treatment assessment this al- of physical illness at this stage corresponds with tered and the physically ill person was seen as the rating of self initially, After 1 month the

SUBJECT FfVE

c

i 4 7 -8



Fig. 4. Individual grids for subject 5 are shown using the same conventions as Fig. 1. Only the construct poles on the left of each grid

are labelled. Positive poles are unsigned, negative poles are signed.

physically ill element is rated at the extremes of illness, worry and distress but by the 6 month assessment it has returned to the initial position.

Between elements. During the treatment phase of the study there is a close association of the self

and physically ill element. This changes during the

follow-up phase as the self begins to be identified

more positively. There is also a slight increase in

the distance between the ideal self and the physi-

cally ill element at the end of the study. The change in orientation of the elements at post

treatment indicates that the constructs on which

they vary have altered. The actual self is separated from the idea1 by being less emotionally expres-

sive, having more outside problems and having a greater emotional component to the pain. The

actual self is now less worried about the pain, less anxious and less depressed than the physically ill person. The ideal self has less emotional problems and more expression of emotion than the physi-

cally ill person.

Subject 4. A cluster of the elements ‘as I am,’ ‘as others see me,’ ‘ as the doctor sees me’ and ‘like

a physically ill person’ was found for both subjects

2 and 4. The ’ ideal self’ and ‘ hypochondriac’ were

positioned at the positive and negative poles of the constructs, respectively (Fig. 3). These subjects showed the least improvement, although they both

demonstrated pain control during the treatment sessions. They identified themselves by their health

problem. Unlike the other patients in this study these two felt understood by their family and friends. Feeling understood may, for these individ- uals, have trapped them in the role of patient.

There was little variation in subject 4’s grid during the study, although the physically ill element was more closely associated with the self at

the end of the study. Subject 5. The notable feature about subject 5 is

that initially he had a small distance between the elements of ‘actual’ and ‘ideal’ self which were

both aligned with the ‘hypochondriac.’ The ‘physically ill person’ was at the extreme on the

worry and distress constructs (Fig. 4). At the end of treatment this has changed and

the ‘ideal self’ is associated with the ‘physically ill’

person. The ‘actual self’ is now aligned with ‘as the doctor sees me.‘ This suggests that subject 5 now sees himself as wanting to be physically ill rather than believing himself a hypochondriac.

The hypochondriac element ia at the negative extreme of the grid.

At the 1 month follow-up the actual self is now associated with both ‘as my doctor sees me’ and

with ‘as others see me.’ The ideal self has moved away from this cluster having more non-pain

problems than the actual self. At this assessment both the hypochondriac and the physically ill element have moved to the edge of the distress scales.

whilst, at 6 months, both elements moved to the extreme of the grid, representing 2 poles of negative attributes and the actual self was more closelv associated with the ideal.

This subject experienced chronic low back pain as the result of an injury. He was involved in a legal battle with the Accident Compensation Cor- poration over the validity of his claim. They argued that there had been no precipitant injury. As he

continued with the treatment this patient became more convinced of the validity of his claim, as

expressed by the separation between hypochondriac and self and the association of ideal self

and physically ill. By the 1 month assessment he

had significantly improved the pain and had ceased to identify himself as ill. Relationships with his family had improved and he reported feeling understood by both others and the doctor. This situation was repeated at 6 months, with some increase in distance between himself and his

family.

Discussion

The patients who took part in this study were deliberately selected for high hypnotisability in order to maximise the effects of SH. Despite this selection and despite the fact that all subjects experienced some alteration in their pain during therapy sessions, improvement was variable. Two patients had complete remission of pain, one remained unchanged but continued to work and function adequately and two continued to suffer disabling pain. The consensus grids suggested ini-

163

tial identification of the self-concept with physical illness, with a loosening of this identification in

the follow-up phase. Since the Health Locus of Control scale showed a significant shift towards

personal locus of control [4], it is tempting to interpret these findings as indicating a cognitive shift away from perceiving oneself as a helpless

victim of illness towards a self-concept of relative wellness, with an ability to alter one’s pain experience. This interpretation would view the grid

changes as being a consequence of the experience of being able to alter pain by using a self-directed

technique. When one considers the individual grids, how-

ever, an alternative interpretation presents itself.

The 2 patients whose grids are described in detail

illustrate the extremes of the patterns of changes found. Subject 4 saw herself at the start of the

study much as she believed her doctor and others did, i.e., as a physically ill person. At the 6 month follow-up little had changed, even though this

patient could experience dramatic pain relief during therapy sessions. She could experience pro- found glove anaesthesia and could transfer this sensation to her painful knee, but the effect remained transient and she remained unconvinced

of her ability to help herself. In contrast, subject 5 saw himself closer to being a hypochondriac than a physically ill person and felt alienated from others whom, he felt, viewed him as being healthy. At follow-up his self-view was more congruent

with that of others, but closer to wellness and a considerable distance away from physical illness or hypochondriasis. He had experienced good

success using hypnotically mediated imagery of relaxing and healing his back muscles and now

felt well in control of the situation.

Subject 2, who stopped using SH and gained little benefit, showed a very similar grid pattern to

subject 4, whilst subjects 1 and 3 showed marked increases in the distances between the self and physical illness elements. This happened for subject 3 despite little change in his level of pain. One

might hypothesise, therefore, that subjects 2 and 4 found themselves ‘locked’ into a self-view of being physically ill and this being congruent with the way they believed their doctor and others viewed them.

It is possible that the experience of pain relief using hypnosis created a sense of cognitive disso- nance which was resolved by preserving the self- concept of physical illness and negating the effects

of self-hypnosis; for subject 2 by ceasing to practice and for subject 4 by reducing the reliability

and durability of the hypnotically induced pain relief. The latter is not suggested as being a de- liberate and considered action, but this patient

had a history of dissociative symptoms, including amnesia and brief fugue states. She was caught up in compensation issues and remained angrily re-

sentful towards the person who had injured her and caused her pain problem. Clinically it did not

seem unreasonable to suggest that classical con-

version mechanisms were operating to produce

and maintain psychogenic pain.

Clearly, this small group study cannot be used

to draw any valid conclusions on this matter, but it does raise a potentially important clinical and research question. Essentially this is whether the

experience of pain relief can so powerfully alter

self-concepts that the self-view will shift from illness to wellness; or alternatively whether a fixed self-view of illness neutralises treatments such as hypnosis, which are aimed at producing subjective pain relief. We suggest that this issue could use- fully be explored using the ISCRG with extended

groups of patients in trials of pain relieving proce- dures.

The ISCRG is a useful research tool in that it is highly flexible and yet can produce quantifiable

data which allows comparison across both individ- uals and time. Clinically it provides insight into

the individual and can be used to guide the clini-

cian in evaluating and planning treatment. The results of this study are similar, but not identical,

to our findings in a study of a small group pain management programme [8]. In that study there was a clear shift towards viewing illness as an undesirable state. There was some shift away from viewing the self as physically ill but this was not statistically significant. It may be that the shifts in attitude shown in the pain management sample were a reflection of the educational content of the programme whilst the samples reported here were more influenced by the change in their pain experience. The fact that the ISCRG has once again

identified clinically meaningful change> III self- concepts is further evidence of the utility of this

method.

Acknowledgements

Our thanks to the patients who took part in this study and to Mr. John West and Dr. Alex Serge-

jew for help in computer programming.

References

1 Bannister. D. and Fransella, F., Inquiring Man: The Psy-

chology of Personal Constructs. 2nd edition, Penguin Books.

New York. 1980.

2 Beail. N., Consensus grids: what about the variance? Br. J.

Med. Psychol.. 57 (1984) 193-195.

3 C‘ovino. N.A. and Warfield, C.A., Hypnosis and the

management of pain, Hosp. Pratt.. 20 (1985) 48g-48t.

4 James, F.R. and Large. R.G., Self-hypnosis in chronx pain:

a multiple baseline study. Submitted for publication.

5 Kazdin. A.E.. Single-Case Research Designs: Methods for

Clinical and Applied Settings. Oxford University Press.

New York. 1982.

(1

7

8

Y

IO

11

12

13

14

I.arge. R.G. Prcdlcrlon of treatment response in pam pa-

tlents: the ~llnebs self-concept repertory grid .tncl EM(;

feedback. Pam. 21 (1985) 27% 2x8.

I..lrge. R.G.. Self-concept> and illness attitudes m chronrc

pain A repertoq grid study of ;\ pain management pro-

gramme. Pain. 23 (19X5) 113 119.

1x,1. P.A.. Ware. P.D. and Monroe. R.R.. The hypnotic

control of intractable pun. Am. J (‘Iin. Hypnox.. 3 (1960)

: h.

Melzack. R.. l‘he McG11l Pain Questionnaire: maJor prop-

crtw and scoring methods. Pam. 1 (1980) 277 ~299.

Morgan, A.H. and Hilgard, J.R., The Stanford Hypnotic

Clinical Scale for Adults. Am. J. Clin. Hypnw.. 21 (1979)

I34- 147.

Slater. P. (Ed.). The Measurement of Intrapersonal Space

by Grid Technique. Vols. 1 and 2, Wiley, London, 1976.

Wallston, B.S., Wallston, K.A., Kaplan, G.D. and Maides.

S.A.. Development and validation of the Health Locus of

Control (HLC) scale. J. Cons. Clin. Psychol., 44 (1976)

580.-588.

Wilson, B., Single-case experimental designs In neuropsy-

chological rehabilitation. J. Clin. Exp. Neuropsvchol.. 9

(1 Y87) 527-544.

Appendix A: elements and constructs of the ISCRG form A

Elements

A=Asl am C = As others see me E = Like a hypochondriac

Constructs

B = As 1 would like to be D = As my doctor sees me F = Like a physically ill person

1.

2.

3.

4.

5.

6.

7.

8.

I am worried about illness in general: Not at all . a great deal.

I see my illness or pain as:

Extremely serious . . . . not serious.

The part emotions play in causing or maintaining my pain or illness is:

Not important . most important.

Regarding feelings I : Bottle all feelings up . . express all feelings regardless of consequences

The extent of my depression is: Nil . . . so severe that suicide is contemplated

My degree of anxiety is: So severe that I am panic stricken . . . . I have problems apart from my pain which are: Not important . .

My irritability is Extreme .

nil

most important.

nil

165

Appendix B: sample output of Ingrid 72

It! SUBjiCT 4 - PRETRERTHiNi

'f~'?~Tii!l# ,I A

5c!:.5050

7:59.:m 5046.9333 8090 .@OC:I 527j.5010 502i.X; Si23r1,OOOi' 10~40.3~~j

AS PER CEN 9.60

14.49 9.66

15.49 lO.!C 9.61

1i.3

19.30

166

167

ELEHENT 3 4 0.!98 : 0.134 6 -0.159

ELMENT 4 5 _(),2;2 b -,>,!5Z

ELEKNi 5 b -0.9:4

169

l.-il.!39 2 -0.928 3 0.360 CONSTRUCT 2 WITH ELEiYENT

1 0.363 2 -0.942 3 O-63? CWTRUCT 3 Y!lH ELEHENT

1 -O.!% 2 -0.921 3 0.354 C!J#SiCliCT 4 WITH ELEYEK

1 -0.906 2 -0 .d 055 3 -0.603 CMiRUCi 5 YITlf ELKIT

1 Ij . !J" *I 2 -53.981 3 0.557

Ci?!~WUii 6 MIT!! ELEWT 1 -s.113 2 -0.913 3 0x1 ..Jd CW!RUii ! llIiH ELEXE!dT

1 -c.;i: 2 -0.79.i ; 6.X? CWSTRUCT S KiX iLiYE!T

! C.5!7 2 -O.B?‘j ; n li?C “.__,

4 -0.020

4 0.347

4 -G.OO?

4 -0.845

4 O.l!Z

4 0.020

4 -G.Z4

4 0.66:

5 c.955 6 -0.090

5 0.603 6 -0.002

5 0.953 6 -0.113

5 0.674 6 0.X

: O,SiE 6 -O.??l

5 0.943 6 -C.OS7

5 0 ., C,4 6 -C .‘A. 171

5 0.207 6 X0.676

CCl;SiLsCT 1 UiTh) ELEREfii

! 93.5 2 !5?.! 3 64.9 PNSTRUCT 2 kiilH ELE?!ENT

I 68.1 2 160.4 3 511.3 CCHSiRtlCT 3 EITK ELEZi#i

! 99.0 2 !57.! 3 69.3 CWTRUCi 4 Ir'iTH ELEW!T

1 154.9 2 94.9 3 !27.1 CFHSiRKT 5 YiiH ELXNT

1 37.! 2 1t9.9 3 A.! COHSTFJCT 6 Yii!! ilE$E?T

1 96.5 2 i58.9 3 69.4 C3NSTRUCi ! WITH ELEMENT

1 !12.!j 2 142.5 3 X.6 CONSKL!C: 8 !+'I%! ELXXT

1 58.9 2 !49.1 3 34.9

4 91.1 : 17.2 6 95.1

4 69.7 : 52.9 6 9L1.1

4 FC.5 5 16.6 6 96.5

4 !4;.6 5 4i.6 6 67.!

4 7?.9 5 ZS.6 6 lc:.!

4 93.9 5 !F.4 6 95.?

4 lG3.G j !3.1 6 5ib.9

4 4'1.4 5 59.5 6 132.5

Documents

Personalised evaluation of self-hypnosis as a treatment of chronic pain: a repertory grid analysis