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Hypnosis and Fibromyalgia



I am not a physician and do not "treat" or "cure" fibromyalgia. As a hypnotist I use hypnotism to induce trance and deliver suggestions, which have been shown to provide significant relief from the symptoms of fibromyalgia. Any person suffering from chronic pain should consult a physician first before seeking hypnosis. I use hypnotism for chronic pain only with a referral from a qualified medical professional.


Fibromyalgia is a chronic disorder affecting over 5 million Americans, with 80-90% of those affected being women. Symptoms include widespread muscle pain, tenderness, painful trigger points, problems sleeping, fatigue, and depression. This article presents the scientific evidence that hypnosis is effective in providing relief from the symptoms of fibromyalgia. As this fact has become well established, the focus of research has shifted to the role of the brain, the comparison of hypnotic methods, and the effects of hypnosis when combined with other interventions. From the controlled studies on hypnosis and fibromyalgia, the hypnotist and hypnotherapist can draw conclusions concerning the best hypnotic approach and the likely results when using hypnosis for fibromyalgia.

Studies are conclusive
In the 1990s there were a number of studies on fibromyalgia and mind-based interventions, such as hypnosis, mindfulness meditation, and stress reduction exercises.[1] Generally, results have shown that psychological treatment is more effective than the conventional pharmacological approach, especially when hypnosis is added.[2] Hypnosis has proven so effective that German and Israeli guidelines for the treatment of fibromyalgia now include hypnosis.[3]

Two meta-analyses have assessed the effectiveness of hypnosis for fibromyalgia based on the combined results of multiple studies. One considered six separate studies with 239 subjects and concluded that hypnosis with guided imagery does reduce pain.[4] A more comprehensive meta-analysis considered the results of all known controlled studies and concluded that hypnotherapy and guided imagery are recommended.[5]

The findings that hypnosis reduces fibromyalgia symptoms are supported by the observation that cerebral blood flow in patients with fibromyalgia changes during hypnotic analgesia, compared to the waking state. Studies indicate the involvement of multiple areas in the brain and suggest an interplay between the cortical and subcortical brain structures.[6]

Length of treatment
Treatment protocols in these studies are based on experimental design, rather than evaluations of the individual patients. Nevertheless, it may be helpful to know the length of treatment used. In the largest meta-analysis, patients had a median of nine hypnosis sessions.[7] In one study fibromyalgia patients saw a significant decrease in physical and mental discomfort with 12 weeks of hypnotherapy and a follow up at 24 weeks.[8] In another, the patients experienced better overall change and significant improvement of sleep with five sessions over two months, and were also encouraged to practice self-hypnosis.[9]

Which symptoms are affected most?
Hypnosis does reduce strong feelings of physical and psychic pain from fibromyalgia.[10] Using hypnosis, fibromyalgia patients have also experienced significant improvements of sleep[11] and less fatigue on awakening.[12] There is less evidence that hypnosis reduces the general fatigue and depression that can accompany fibromyalgia. In one study hypnosis reduced pain but did not significantly improve the patient’s perceived quality of life as it relates to health.[13] This may suggest that the hypnotist should focus specifically on the reduction of pain, better sleep, and less fatigue on awakening, instead of the patient’s perception of quality of life, general fatigue, or depression.

While hypnotherapy patients did show significantly better outcomes with regard to overall pain, the pain response to manual pressure remained the same.[14] This may be communicated to the patient in order to establish reasonable expectations, lest the patient attempt to test the effectiveness of hypnosis by pressing upon tender areas.

Comparison of hypnotic approaches
Studies on hypnosis and fibromyalgia indicate that certain methods of hypnosis work best.

Relaxation exercises help fibromyalgia patients, but hypnotic trance is distinct from mere rest and has been found particularly effective. Fibromyalgia patients in hypnosis experienced less pain during hypnosis than patients at rest.[15] One study showed that the Ericksonian hypnosis method of analog marking (giving verbal or nonverbal cues to emphasize certain words) was more effective than Schultz’s Autogenic Training method, which is a self-directed form of relaxation with autosuggestion.[16]

Suggestions alone (without a hypnotic induction) can significantly reduce pain, but patients report greater reduction of pain and claim greater control over their pain when suggestions follow a hypnotic induction.[17] Suggestions of analgesia have a greater effect than suggestions of relaxation. In fact, the effect of hypnotic induction followed by suggestions of relaxation was no greater than the effect of relaxation alone.[18]

When working with someone who suffers from chronic pain, it is important to remember that there is more to hypnotic analgesia than direct commands for diminished pain or increased comfort. The scientific study of pain makes a distinction between two components of pain, the sensory component and the suffering component. Sensory pain is the perceptual response to irritation or injury; suffering is the reaction that follows such pain.[19] When the suffering is removed, the sensory aspect tends to become tolerable or may even disappear.[20] Suggestions to relieve the suffering component of pain may be directed, for example, at alleviating the subject’s non-acceptance or fear of the condition, separating sensory from suffering and quality of life, or placing a time limit on suffering. Where appropriate, suggestions may also be directed at releasing self-destructive feelings like guilt and resentment, and addressing any secondary benefit that the subject might gain from the condition or the limitations that it may place on carrying out the responsibilities of life.

Hypnosis and other interventions
Recognizing the effectiveness of both cognitive behavioral training (CBT) and hypnosis for treating fibromyalgia, several studies have investigated the combined effects of CBT and hypnosis. It has been found that psychological treatment provides greater relief from symptoms than conventional pharmacological treatment only, especially when hypnosis is added.[21] A 2012 study of 93 patients with fibromyalgia concluded that hypnosis enhanced the effectiveness of CBT to show greater improvements than drug intervention in terms of pain, catastrophizing, psychological distress, functionality, and sleep.[22]

Summary
Hypnosis for fibromyalgia should be considered as a way to alleviate symptoms. A hypnotist is not a physician and does not “treat” or “cure” fibromyalgia.
• Cognitive behavioral therapy is most effective when combined with hypnotherapy.
• Stress reduction and relaxation (in the form of Jacobson’s Progressive Relaxation technique, for example) can alleviate fibromyalgia symptoms. The hypnosis subject should be taught relaxation techniques and/or self hypnosis.
• Hypnotism in which a hypnotist or hypnotherapist induces trance and delivers suggestions (such as Ericksonian analog marking) is more effective than a self-directed approach (such as autogenic training).
• The trance state is particularly important and should be maximized.
• Suggestions should focus on the improvement of generalized pain, sleep, and fatigue.
• Suggestions for analgesia can address both the sensory and suffering components of pain.
• Experimental treatment designs generally employ weekly sessions for 2-3 months.
This approach learned from understanding hypnosis and fibromyalgia may also have application to other chronic pain disorders.


Sources:

[1] Lauche, R., Cramer, H., Häuser, W., Dobos, G., & Langhorst, J. (n.d.). A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome. Evidence-Based Complementary and Alternative Medicine, 1-13.

[2] Martínez-Valero, C., Castel, A., Capafons, A., Sala, J., Espejo, B., & Cardeña, E. (n.d.). Hypnotic Treatment Synergizes the Psychological Treatment of Fibromyalgia: A Pilot Study. American Journal of Clinical Hypnosis, 311-321.

[3] Ablin, J., Fitzcharles, M., Buskila, D., Shir, Y., Sommer, C., & Häuser, W. (n.d.). Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies. Evidence-Based Complementary and Alternative Medicine, 1-7.

[4] Bernardy, K., Füber, N., Klose, P., & Häuser, W. (n.d.). Efficacy of hypnosis/guided imagery in fibromyalgia syndrome - a systematic review and meta-analysis of controlled trials. BMC Musculoskeletal Disorders BMC Musculoskelet Disord, 133-133.

[5] Thieme, K., Häuser, W., Batra, A., Bernardy, K., Felde, E., Gesmann, M., . . . Köllner, V. (2008). Psychotherapie bei Patienten mit Fibromyalgiesyndrom. Der Schmerz Schmerz, 295-302.

[6] Wik, G., Fischer, H., Bragée, B., Finer, B., & Fredrikson, M. (n.d.). Functional anatomy of hypnotic analgesia: A PET study of patients with fibromyalgia. European Journal of Pain, 7-12.

[7] Bernardy.

[8] Haanen HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP, Hekster GB. Department of Rheumatology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. J. Rheumatol. 1991 Jan;18(1):72-5.

[9] Picard, Jusseaume C, Boutet M, Dualé C, Mulliez A, Aublet-Cuvellier B. Hypnosis for management of fibromyalgia. Int J Clin Exp Hypn. 2013;61(1):111-23.

[10] Haanen.

[11] Picard.

[12] Haanen.

[13] Bernardy, K., Füber, N., Klose, P., & Häuser, W. (n.d.). Efficacy of hypnosis/guided imagery in fibromyalgia syndrome - a systematic review and meta-analysis of controlled trials. BMC Musculoskeletal Disorders BMC Musculoskelet Disord, 133-133.

[14] Haanen.

[15] Wik.

[16] Rucco V, Feruglio C, Genco F, Mosanghini R. Servizio di Terapia Fisica, Ospedale di Medicina Fisica e Riabilitazione, Udine. Autogenic training versus Erickson's analogical technique in treatment of fibromyalgia syndrome. Riv Eur Sci Med Farmacol. 1995 Jan-Feb;17(1):41-50.

[17] Whalley MG, Oakley DA. Fibromyalgia pain and its modulation by hypnotic and non-hypnotic suggestion: an fMRI analysis. Eur J Pain. 2009 May;13(5):542-50.

[18] Castel, A., Pérez, M., Sala, J., Padrol, A., & Rull, M. (n.d.). Effect of hypnotic suggestion on fibromyalgic pain: Comparison between hypnosis and relaxation. European Journal of Pain, 463-468.

[19] Hilgard, E., & Hilgard, J. (1975). Hypnosis in the relief of pain (pp. 27-28). Los Altos, Calif.: W. Kaufmann.

[20] Ewin DM, “Relieving suffering—and pain—with hypnosis” Geriatrics. 1978 Jun; 33 (6): 87-9.

[21] Martínez-Valero.

[22] Castel, A., Cascón, R., Padrol, A., Sala, J., & Rull, M. (n.d.). Multicomponent Cognitive-Behavioral Group Therapy With Hypnosis for the Treatment of Fibromyalgia: Long-Term Outcome. The Journal of Pain, 255-265.

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How Psychology Emerged From Hypnosis



Until the late 1800s psychology was a branch of philosophy dealing with speculations about the human mind. There was no experimental or therapeutic practice of psychology as it is known today. Many people think that depth psychology originated solely from Freud’s analytical insights presented in his work The Interpretation of Dreams in 1899. However, depth psychology and psychoanalysis actually originated from the practices of hypnosis, mesmerism, and earlier esoteric disciplines.

Franz Anton Mesmer (1734-1815)
“The great thing of the eighteenth century is not the Encyclopedia…it is the sympathetic and miraculous physics of Mesmer.”
- Alphonse Louis Constant
mesmer-hypnosis-and-psychology
Franz Anton Mesmer was a medical doctor in Austria around the time of the French Revolution. He followed the ideas of the sixteenth century Swiss physician Paracelsus (1493-1541). Paracelsus rejected the idea that illness was due to an imbalance of bodily humors, and was the first to theorize an “unconscious” that could cause disease. Influenced by Paracelsus' ideas, Mesmer produced an altered state of consciousness in his patients to establish communication with the unconscious, then removed their symptoms. He called his process “mesmerism,” which in a later form gave rise to “hypnotism.” Mesmer demonstrated that there are deeper portions of the mind that are not accessible in the usual state of consciousness, and that in certain altered states of consciousness the mind has the power to do extraordinary things, such as healing illnesses.

Jean-Martin Charcot (1825-1893)
Charcot-hypnosis-and-psychology
Mesmer’s discovery was a matter of great interest in medicine, especially in France, where he did much of his work. It was here that Jean Martin Charcot, a French medical doctor and the founder of modern neurology, inspired depth psychology. Charcot was a highly regarded teacher who gave lecture demonstrations of hypnotism. By suggestion, he produced various symptoms (ex: blindness, deafness, the inability to speak, paralysis) in his hypnotic subjects, and invited his medical students to verify their authenticity. Then when he brought his subjects out of the hypnotic state, their symptoms disappeared. Mesmer had demonstrated that the unconscious could heal illness; Charcot’s lectures made it evident that the unconscious could also produce symptoms of disease.

Sigmund Freud (1856-1939)
Freud-hypnosis-and-psychology
As a young, recently graduated medical doctor, Sigmund Freud attended Charcot’s lectures in France. He considered that if one could produce symptoms by giving suggestions to the unconscious, as Charcot did, then it is also possible that the unconscious might produce illness on its own. From this Freud theorized that a patient might be freed from symptoms by gaining access to the unconscious. He practiced hypnosis for a time, but was unable to get his patients into trance effectively. Freud determined that since sleep is an altered state of consciousness like hypnosis, and dreams occur during sleep, one could gain access to the material of the unconscious through dreams. He published his theories on The Interpretation of Dreams in 1899, which was the beginning of modern psychoanalysis.


Freud-couch-hypnosis-and-psychology_gallery
Freud's couch. The traditional image of the psychoanalysis patient reclining on a couch remains as a relic of hypnosis.


Carl Jung (1875-1961)
Jung-hypnosis-and-psychology
Carl Jung was a young Swiss medical doctor specializing in mental illness. After Freud, he could be considered the second founder of psychology. Jung and Freud agreed that the unconscious speaks in the language of symbols, but for Freud the unconscious forces are almost always of a sexual nature. Jung was deeply in touch with his own unconscious. Like Mesmer, Jung studied Paracelsus. He recognized that there are unconscious forces which are not of a sexual origin, but which originate from a “collective unconscious,” and which are of a transcendental, symbolic, mythological, poetic, and inspirational nature. Jung arrived at these insights from his own dreams and visionary experiences. He also put his cousin under hypnosis repeatedly, and from her trance communications he determined that different parts of her psyche presented themselves as different personalities, but all with the same intention of coming together. He concluded that these parts were trying to unify and become a whole person. From this Jung theorized that there are unconscious forces within us trying to come together, and that the work of our lives is to be in communication with these deeper parts of ourselves and become more whole. This process he called “individuation,” referring to becoming an indivisible unity. Jung published his work Transformations and Symbols of the Libido in 1912, which precipitated his break from Freud.

Summary
Originally it was Paracelsus who presented the idea of the unconscious. Mesmer discovered that in altered states one could heal diseases. Charcot demonstrated Mesmer’s discovery, also showing that one could induce symptoms by suggestion in hypnosis. This led Freud to the idea that symptoms might be caused by internal unconscious forces, so he explored the unconscious through hypnosis and then dreams. Jung then returned to Paracelsus and the process of using trance to communicate with the unconscious. In this way, the theory of the unconscious, mesmerism, and hypnosis became great contributions to human knowledge and tremendously important influences in modern psychological theory.

Implications
Man is a vast being of mind, and a substantial portion of this mind is inaccessible during ordinary waking consciousness. In a way, we are alienated from our own inner natures and incomplete. Wholeness and happiness occur when we come to know our inner natures through non-rational processes, such as trance and meditation, for example. That knowing is not intellectual knowledge, but the empirical knowledge of experience, a “knowledge of the heart.” When you stop to listen to your innermost self and learn to maintain communication with your unconscious, your life is enriched.

This article is inspired by and adapted from a lecture entitled “Wisdom Beyond Psychology” from the C. G. Jung Lectures of Dr. Stephan Hoeller.

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Hypnosis for Fertility



Each year in the U.S., approximately 6.7 million women have an impaired ability to become pregnant or carry a baby to full term,[1] and over 176,000 in vitro fertilization cycles are performed.[2] With the average cost of an in vitro fertilization cycle ranging from $10,000 to $15,000, women are using hypnosis to make the procedure more effective and nearly double the odds of conceiving.[3]

What the research shows
Several studies have demonstrated that hypnosis promotes fertility:

▪ In 2006 a significant study on the impact of hypnosis during the in vitro procedure compared pregnancy and implantation rates between two groups: 98 procedures using hypnosis versus 96 procedures without hypnosis. The group using hypnosis obtained 52 pregnancies (53%) with an implantation rate of 28%. The group without hypnosis had 29 pregnancies (30%) with an implantation rate of 14%. Researchers concluded that the use of hypnosis during embryo transfer may significantly improve pregnancy and implantation rates.[4]


▪ In 1999 a study of 1156 women having in vitro fertilization, women who received psychological support, including hypnotherapy, had a higher rate of pregnancy (56%) than those who did not (42%).[5]


▪ The most recent study in 2013 followed 554 couples with “unexplained” reproductive failure (meaning stress-related or otherwise psychosomatic) over a period of 28 years. Using hypnosis to alleviate the stress of infertility as well as marital stress yielded a pregnancy success rate of 72%. Researchers concluded that unexplained reproductive failure is reversible when stress is alleviated with hypnosis.[6]

How does it work?
The human body is built for survival and can adapt to almost any condition. When a person is under physical, mental, or emotional stress, the body responds by mounting an automatic response, called the ‘stress response’ or ‘fight or flight response’ in the central nervous system and endocrine system. The stress response is great for dealing with short-term dangers, but long-term stress can cause serious conditions, including infertility, menstrual problems, and sexual dysfunction. Under stressful conditions, the body undergoes the following changes, which prevent fertilization/conception and carrying a baby to full term:

▪ The stress response prioritizes blood supply to peripheral muscles and the heart, which means decreased blood supply to the digestive and reproductive systems.


▪ When the body is under stress it uses up the pregnancy hormone progesterone to make the stress hormone cortisol. The resulting progesterone deficiency is a problem because progesterone is needed to conceive and to maintain pregnancy.


▪ Cortisol also inhibits the body’s main sex hormone, gonadotropin releasing hormone (GnRH), suppressing sperm count, ovulation and sexual activity.[7]


▪ Physical stress can increase levels of the hormone prolactin, which may disrupt or stop ovulation.

These are some of the mechanisms nature uses to prevent pregnancy under unsuitable (i.e. extreme stress) conditions. The primary mechanism by which hypnosis promotes fertility is probably the reduction of stress hormones by relaxation. Also related to reducing stress, it has also been theorized that hypnosis helps the fallopian tubes relax and dilate so that the ovum can travel successfully down the tube to implant in the uterus.[8] To address the stress that causes infertility, the hypnotic procedure should be relaxing (and train the patient to relax on their own), and posthypnotic suggestions should be given to eliminate stress and tension in general.

Some women have seen remarkable evidence that stress and belief prevent pregnancy when they become pregnant after the misdiagnosis of “blocked tubes.” As soon as they stop worrying about their infertility, they conceive. It can be helpful to give the patient the suggestion that she can stop worrying about becoming pregnant.[9]

Hypnosis can also address other psychosomatic causes of infertility. Sometimes behind the outward desire to get pregnant is a fear of pregnancy, fear of childbirth, or fear of being unprepared for motherhood. The conflicting emotions are a form of stress that affects the physiology and prevents fertility. When appropriate, hypnotherapy for fertility can encourage feelings of motherliness and help the patient resolve fears.[10]

Finally, hypnosis can help soon-to-be mothers stop smoking, eat better, and sleep better, all of which promote better health overall. With so many benefits of hypnosis for pregnancy, it’s no wonder that more women are using hypnosis as a natural approach to increase the odds of conceiving and delivering healthy babies.

----------
[1] Lepkowski, J. M., & National Center for Health Statistics (U.S.), National Survey of Family Growth (U.S.). (2010). The 2006-2010 National Survey of Family Growth: Sample design and analysis of a continuous survey. Hyattsville, MD: U.S. Dept. of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics.

[2] National Center for Chronic Disease Prevention and Health Promotion (U.S.). (2012). Assisted reproductive technology surveillance --- United States, 2012. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

[3] "You're getting sleepy ... and pregnant". (2006). Psychology Today.

[4] Levitas, E., Parmet, A., Lunenfeld, E., Bentov, Y., Friger, M., & Potashnik, G. (2006). Impact of hypnosis during embryo transfer on the outcome of in vitro fertilization-embryo transfer: a case-control study. Fertility and Sterility, 85(65), 1404-8.

[5] Poehl, M., Bichler, K., Wicke, V., Domer, V., & Feichtinger, W. (1999). Psychotherapeutic counseling and pregnancy rates in in vitro fertilization. Journal of assisted reproduction and genetics, 16(6), 302-5.

[6] Vyas, R., Adwanikar, G., Hathi, L., & Vyas, B. (2013). Psychotherapeutic intervention with hypnosis in 554 couples with reproductive failure. Journal of the Indian Medical Association, 111(3), 167-9, 173.

[7] Stress increases putative gonadotropin inhibitory hormone and decreases luteinizing hormone in male rats. E. D. Kirby, A. C. Geraghty, T. Ubuka, G. E. Bentley, D. Kaufer. Journal: Proceedings of The National Academy of Sciences 2009

[8] Everly, G. S., & Lating, J. M. (2003). A clinical guide to the treatment of the human stress response. New York: Kluwer Academic/Plenum.

[9] Kroger, W. S. (1977). Clinical and experimental hypnosis in medicine, dentistry, and psychology. Philadelphia: Lippincott.

[10] Kroger, 1977.

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The Signs of Hypnosis



A person in hypnosis can experience a variety of phenomena. The following summary lists the outward signs that a person usually exhibits under hypnosis. Not all of these are experienced by every person in hypnosis, so one should not dismiss the presence of trance if some signs are absent. Many of the signs of hypnosis are subtle and could be recognized by an experienced hypnotherapist, while the person in hypnosis or an observer might miss them altogether.

Body
The muscles relax, and the subject makes efforts to become more comfortable. A person in hypnosis does not remain physically tense. Muscular relaxation is often most noticeable in the facial expression. A person in hypnosis has a smooth, ironed out expression on the face, which usually goes along with a vacant look in the eyes.

Stillness. A person does not have to be frozen still to experience trance, but a person in hypnosis does not make restless movements such as hand wringing or foot shaking, for example. Even people who normally experience tics or twitches do not usually manifest them while in hypnosis. When a person in trance does move, they will be slow and efficient in their movements.

Body warmth is frequently an indication of hypnosis.

Eyes
A person entering trance begins to blink more slowly.

Fluttering of the eyelids occurs during the initial phase of trance. This is one sign of hypnosis that cannot be imitated.

The eyes sometimes roll upward, so that you see only the whites of the eyes.

Increased lacrimation (watering of the eyes).

In hypnosis there is often a reddening of the eyes.

Though not observable outwardly, a person in trance often reports fogging or blurring of the vision. Hypnosis can also cause tunnel vision, or even changes in the colors, sizes, and shapes of things.

Attention
A person in hypnosis will be less distracted by outside sounds. To the extreme, the subject may become so inwardly absorbed that he or she no longer make the effort to listen to the hypnotherapist.

Pulse and respiration
Pulse rate and breathing slow down, although sometimes a person entering hypnosis will experience a temporary increase in pulse and respiration caused by the realization that they are in hypnosis.

Swallowing
The swallowing reflex slows or disappears during trance. Of course, if attention is drawn to it, the subject will usually swallow.

Psychomotor retardation
There is often a lag of time between the time when a suggestion is given and when the subject in hypnosis carries it out.

Signs of reorientation
When the feet and hands begin touching each other restlessly it is a good sign that the subject is exiting trance. Other signs of a person reorienting themselves to the body and the waking state are wetting the lips, shifting the posture, opening the eyes, blinking, yawning, and stretching.

A checklist for meditation and self-hypnosis
Many of the common instructions for meditation and relaxation imitate the signs of hypnosis. Here is a very simple checklist of things you can do to facilitate meditation and trance states.

1. Make sure you are not cold.

2. Find a comfortable position.

3. Be still. If you must move, do it slowly and efficiently.

4. Relax your body, especially your face.

5. With your eyes open, stare at something slightly below eye level. Notice the loss of detail in objects in your peripheral vision.

6. Roll your eyes upward gently.

7. When you cannot keep your eyes open any longer, close your eyes and relax them.