OConnor, Le 1

Matt OConnor, Dan Le

Ginger Lordus

FSN 315-01

9 June, 2014

Self Mastery Hypnotherapy: Kim Bothwell

My name is Matthew OConnor and I am a first year Nutrition Major at California

Polytechnic State University. I have experience shadowing a Lifestyle Counselor, Kerry Hill
MD. I am a Health Ambassador for the STRIDE program of the Universitys Kinesiology
Department. Additionally, I am the Food Science and Nutrition Department Sales Manager. I
plan to use the skills obtained from my experiences and apply them in an innovative way to
create nutrition businesses. Currently, I am developing my first PLLC, Life Nutrition Happiness,
planned for beta-testing in fall, 2014 with full launch planned for January, 2015. This company
consists of systemization of multiple health factors into an affordable and available health
program. As part of this project, it is important to learn about many approaches to health in order
to develop a complete system. Also, I am interested in toxicology; this field deals with many
issues that can be approached through hypnotic techniques. Accordingly, it is important to learn
a little about hypnotherapy especially because of its application as a pain treatment and as a
stress management technique. Therefore, I decided to investigate hypnotherapy with hopes that
the subject may be very applicable and beneficial to my career interests and current affiliations.
I am Dan Le and I am a third year nutrition major. My career goal is uncertain at the
moment, but I know I want to work in healthcare. I have narrowed it down to becoming either a
Registered Dietitian or and Physician Assistant, with a strong background in nutrition. The
reason why I want a strong background in nutrition is because I believe that healthcare providers
do not have very much knowledge of nutrition. From what I understand, doctors only get a few
classes in nutrition. Foods are drugs too and they can help the body heal itself. I want to be able
to help people through nutrition therapy so they do not have to resort to taking medication on a
daily basis.
In our investigation, we interviewed hypnotherapist Kim Bothwell. We met Mr. Bothwell
at his Self Mastery Hypnotherapy office located at 1150 Grove Street, San Luis Obispo. This
interview lasted about 2 hours and gave a good coverage of hypnosis. Mr. Bothwell discussed
the subconscious in depth and then described how hypnotic techniques can be applied to the
elements of the subconscious in order to provide beneficial therapy and treatment for disease. To
understand the subconscious, it is helpful to juxtapose it with everyday life. For example, if you
analyze the action of eating, it shows use of the subconscious. First, when one is a child, he/she
has to be fed by a parent and taught how to eat. Once a child learns how to eat on his/her own,
he/she will become more and more comfortable with eating. Eventually, a this person will begin
to eat while doing other tasks such as traveling or reading. Such a practice of double tasking
allows an individual to be more efficient as favored by natural selection. Similarly, the
subconscious obtains the ability to perform often exercised actions. This allows the brain to
focus on novel tasks while well-known tasks are being performed without thought. This
mechanism leads to formation of habits so that one can double task throughout everyday
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happenings and live a more efficient life. Habits are actions that have been incorporated into the
subconscious and therefore can occur without conscious awareness by processing of.
Kim Bothwell is a very successful hypnotherapists. He informed us that many
psychologists or even hypnotherapists will take months to obtain favorable results from patients.
On the other hand, Mr. Bothwell completes almost all of his missions within 3 sessions. After
these 3 sessions, Mr. Bothwell has found that changes are usually permanent and that very few
will return. Mr. Bothwells most successful practice is smoking cessation in which he completes
in 3 session as well and receives about an 85% success rate. Mr. Bothwell also deals with
phobias quite often. Phobias require extra work and may even require exposure to the phobia in
many cases. Mr Bothwell has trouble with correcting dietary problems; he said it is hard to
present the material in an appealing way. Mr. Bothwell finds great success with performance
enhancement and trauma relief (Morone). (In place of Client Survey, which was not transferred
from Mr. Bothwell to clients).
There are two general categories of pain as discussed by Jensen in Effects of
Self-Hypnosis Training and EMG Biofeedback Relaxation Training on Chronic Pain in Persons
with Spinal-Cord Injury. The two categories are neuropathic pain and nonneuropathic pain.
Neuropathic pain is resultant from dysfunctional or damaged nerves whereas nonneuropathic
pain is resultant from other dysfunctional or damaged physical structures such as bones, muscle,
or skin. Under these two classifications, there are 6 subgroups of pain. Neuropathic pain includes
spinal cord injury, transition zone, and radicular pains. Nonneuropathic pain includes visceral,
mechanical spine, and overuse pains. The following excerpt from the reviewed study offers more
information on pain as well as the distribution of participants that were identified to be suffering
from each type. (Jensen)

Seventeen had one of three types of neuropathic pain: 12 of these had SCI pain, defined as a
neuropathic diffuse pain below the level of injury in areas without normal sensation and not
affected by position; 4 had transition zone pain, defined as bilateral allodynia at the level of
injury; and 1 had radicular pain, defined as pain at any dermatomal level, usually unilateral,
usually radiating, related to activity, affected by position, and not worse with light touch. Twenty
of the participants had one of three types of nonneuropathic pain: 4 had visceral pain defined as
pain in the abdomen not related to activity or affected by position or made worse with light
touch; 9 had mechanical spine pain, defined as pain in the back or neck, often bilateral, related to
activity and sometimes position but not worse with light touch; and 7 had overuse pain, often
above the injury in areas of normal sensation or below in incomplete injury, related to activity,
sometimes affected by position, and not worse with light touch.

Common pain treatments include the use of hypnotherapy which has proven
effectiveness in treating neuropathic pains but not nonneuropathic pains. Usual pain treatments
include acetaminophen commonly known as Tylenol, Nonsteroidal anti-inflammatory drugs such
as ibuprofen, anticonvulsants such as Lyrica, opiates such as Vicodin, as well as others. These
various pains can become chronic in given situations. The evaluated research project investigates
the effectiveness of hypnotherapy techniques similar to Kim Bothwells and their effectiveness
in alleviating chronic pain with a special focus on pain reduction in sufferers of chronic spinal
cord injury.
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This research was lead by Mark Jensen, PhD from the Department of
Rehabilitation Medicine of the University of Washington, Seattle. Students were supervised and
contributed to research below Jensen. The official research article was completed in July 2009
and published on July 1, 2010. Most references are from 1994-2006. However, few references
are listed from the 1980s and 90s. This study aims to identify the effects of hypnosis specific
factors and their abilities to address chronic pain. The test population consisted of humans who
failed to appease various categorizations of chronic pain, resulting from spinal-cord injury, by
previous traditional attempts. Study size started at 37 participants and finished with a reduced 31
participants by the 3 month follow-up assessment point.(Jensen)

The inclusion criteria for this study were: (a) having an SCI for at least 6 months; (b) reporting
chronic daily pain that was bothersome; (c) being 18 years old or older; (d) being able to speak,
read, and write English; and (e) expressing an interest in participating in a clinical trial
comparing two treatments for chronic pain. Exclusion criteria were: (a) evidence of severe
psychopathology (i.e., symptoms of psychosis on interview or endorsement of active suicidal
ideation with intent within the past 6 months) and (b) a score of 21 or greater on the Telephone
Interview of Cognitive Status (Brandt, Spencer, & Folstein, 1988), indicative of severe cognitive
deficits that could potentially interfere with the focused attention required for hypnosis.

This study conducted in vivo research and utilized a combination of medical scales in
order to analyze the various factors of hypnosis analgesia and their effectiveness. This study was
conducted in 2009 and focused on a 10 session, 2 week span of hypnotherapy as well as a 3
month follow up period. This study is most relevant to victims of chronic pain caused by
spinal-cord injury (SCI). However, implications of this study can be applied to include a much
more vast populationpotentially all chronic pain suffers. This possibility is tangible because
participants suffered from different types of pain and relevant trends arose. The independent
variables consist of the two different approaches being used: hypnotherapy and EMG
biofeedback relaxation. More specifically, the independent variable is the presence or absence of
hypnosis specific factors of treatment. EMG biofeedback relaxation was used a control in
attempt to isolate these differences. The dependent variable consists of a catalogue of different
factors related to chronic pain control. Such factors include, but are not limited to, level of
immediate pain relief, endurance of alleviation, and resultant change in quality of life. This study
uses standardization of treatment and response mechanisms in order to fabricate meaningful
results. Subjects are split into either of the previously listed test groups. Comparison of
hypnotherapy with EMG biofeedback relaxation acts to determine the results from hypnosis
specific methods. Therefore, the excluded methods of hypnotherapy are tested for their
contribution to hypnotic methods as a whole in treatment of chronic SCI pain. Nevertheless, this
isolation method may be limited in its validity due to the suggestion of biofeedback relaxation as
a successful treatment being a hypnotic suggestion in itself. Nevertheless, participants were
systematically surveyed throughout the 10 week and 3 month study periods.(Jensen)

Results indicate that hypnotherapy does show a significant reduction in chronic pain and
associated variables. However, this study was unable to identify a significant result arising from
variation in the two treatments. Thus, it cannot be stated that hypnotic success is due to the
hypnotic specific methods. Nevertheless, results do show different potential for hypnosis and
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emg biofeedback relaxation in treating specific types of chronic pain. More specifically,
hypnosis may contribute to solely neuropathic pain alleviation while EMG biofeedback
relaxation may contribute to solely nonneuropathic pain. Thus, hypnotic analgesia may show an
even greater significance if used in neuropathic pain treatment but may lack effect on
nonneropathic pain. It is also important to note that almost all participants stated that
hypnotherapy helped reduce pain and promote control over pain. Also, all but one participant
expressed satisfaction with hypnotherapy and claimed it was worth while. Nonetheless and due
to a small population, there is a possibility but not a confirmation of potential refinement of
practices and effective use of hypnotic techniques in pain treatment.(Jensen)
Osteoarthritis (OA) affects nearly 14% of adults older than 25 years of age and 33.6% of
people older than 65 years in the United States. This figure is set to rise with the increase in
obesity and age of our population. Osteoarthritis is a degenerative joint disease that progresses
slowly, and it is the most common form of musculoskeletal disorder and leading cause of pain
and disability in most Western developed countries. In recent studies, researchers deduct that
more than 67 million people in the United States will have osteoarthritis by 2030.
The symptoms of OA include joint pain and stiffness. OA occurs when smooth cartilage
that covers the end of the bones within a joint becomes rough and no longer allows a smooth
gliding motion between articulating bones. Over time, the cartilage wears away and the
bone-to-bone contact causes pain, swelling, bone reshaping, and motion loss. Another symptom
of OA is the deposition of bone along the edges of the joint. This may cause osteophytes to
break off, float inside the joint space, and cause further damage and pain.
Pain is the primary reason why OA patients seek care. Along with the loss of tissue,
there is also a production of new tissue, including fibrocartilage and attempts by the cartilage to
regenerate due to the evidence of increased protein synthesis by chondrocytes. OA has also been
regarded as hypertrophic arthritis, emphasizing that there is also tissue production and
remodeling as its characteristic features. Inflammation in OA is influenced by the following
structures: ligaments, bones, tendons, and effusions. In normal physiology, cartilage is an
avascular and aneural structure, and pain mediation may be arising from other joint structures.
As joint destruction occurs, osteophyte formation, which impairs joint mobility and induce pain
by impinging on other local joint structures, can be observed in surrounding bone structures.
Other potentially relevant features include bone sclerosis and subchondral cysts. Several
pro-inflammatory mediators are recruited into the OA-affected joint associated with damage.
These mediators include nerve growth factor, nitric oxide, and prostanoids. These inflammatory
mediators may cause damage the tissues as well as the peripheral nociceptors.

The nociceptive system can become sensitized in chronic disease, and it will cause a heightened
sensitivity to noxious stimuli. The activation of nociceptors is transmitted via the dorsal root
ganglion, up the spinothalamic tract to higher cortical centers where signals are processed and
perceived as pain. Mediators of pain at the DRG level in OA are believed to include NGF,
calcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP), vanilloid receptor 1
(TRPV1) and opioid receptors (ORs). Transient receptor potential cation channel subfamily V
member 1 (TRPV1) is also known as vanilloid receptor 1 and the capsaicin receptor. Chemical
mediators of pain in the brain include agents such as substance P, serotonin and glutamate
(Sofat 2158).
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Diagnosis of osteoarthritis begins when the patient reports symptoms of joint pain and
stiffness. Although radiography is a frequent next step in the diagnostic process, studies show
that they do not reveal early-stage osteoarthritis (Shagam 41). Synovial fluid assessment is a lab
test used to diagnose OA. It serves to reduce pressure in the swollen joint and to test viscosity
and clarity, microorganisms, blood cells, and other disease markers.
Currently, it is not possible to cure OA, but there are ways to manage or reduce pain and
improve joint mobility and quality of life. Many healthcare providers encourage patients to
consider self-managed OA therapies such as exercise, weight loss, and eating a healthy diet.
Research shows that regular physical activity plays and important role in OA management.
Regular exercise maintains joint function and extends joint range of motion, along with
improving emotional outlook and cardiovascular fitness, reducing bone loss, and helping
maintain a healthy weight (Shagam 42). Exercise can help maintain or restore joint function and
reduces arthritic pain by moving lubricating fluids into the joint that is affected. Excess weight
is a risk factor that is associated with OA of the knees, hips, and feet. Therefore, achieving and
maintaining a healthy weight is an effective OA management strategy.
The most common drugs that are used for OA are Acetaminophen and nonsteroidal
Antiinflammatory Drugs (NSAID). Acetaminophen, a common over-the-counter drug, is the
first choice because of its effectiveness in pain relief and its relative safety compared to other
medications. Unfortunately, it does not reduce inflammation. Patients must take caution when
taking acetaminophen because excess levels can cause liver tissue damage. NSAIDs can be
recommended to a patient who does not find sufficient relief in acetaminophen. NSAIDs, such
as Ibuprofen, can reduce pain associated with inflammation.
Corticosteroid or cortisone injections are also available to reduce inflammation in and
around the joint; pain relief does not occur until 3 days after the injection but lasts a few weeks.
A relatively new OA treatment consists of the injection of a naturally occurring lubricant named
hyaluronic acid. Hyaluronic acid is destroyed in the joint by inflammation and replacing it via
injection can reduce pain and increase mobility.
Surgical treatments are also an option for OA patients but are usually the last resort when
self-manage treatment, medication, and physical therapy fail to provide sufficient reduction of
pain, stiffness, and compromised mobility. Cartilage repair is usually not an option for older
patients. Long term effects of obesity and a lifetime of physical activity and repetitive motions
make it unlikely for spot repairs. Therefore, older patients are more likely to undergo
arthroscopy and total knee replacements (Shagam 48). Arthroscopy is a minimally invasive
procedure that can be used to diagnose OA of the knee and other weight-bearing joints. After
one or more small incisions are made, miniature surgical tools are used to scrape and debride
rough surfaces, repair torn menisci, and irrigate and flush out debris.
Other ways to relieve joint pain include massage, traditional Chinese medicine, and
hypnotherapy. Gently rubbing the joints can increase blood flow to the affected areas and ease
sore spots. Because joints can be sensitive due to OA, patients are advised to see a massage
therapist who specializes in treating people with arthritis. Traditional Chinese medicine, such as
acupuncture and acupressure, are often used in lieu of taking medication or surgery. These work
by increasing blood flow to affected areas that energy blocked off.
Hypnosis is one of the many alternative ways to relieve pain associated with OA.
Although not commonly used for OA pain, hypnotherapy is often used to manage chronic pain.
Fundamental research has established that hypnosis is efficient as a cognitive intervention to
 OConnor, Le 6

produce analgesia and to alter pain perception or to decrease or increase pain threshold. The
response to hypnosis treatment is highly variable. The studies include group average differences
in pain and some subjects do not see any changes.
A study in 2002 tested if there was a reduction in pain using different techniques of
relaxation and hypnotherapy. The study was aimed to investigate whether a controlled hypnosis
treatment was effective in reliving OA pain. In this study, thirty-six adults with knee OA and/or
hip OA volunteered to participate in the study. Patients were told that they were going to be
participating in a research project investigating the effectiveness of psychological interventions
for OA pain, imagery and relaxation. In order to prevent bias, hypnosis was labeled as
imagery because some people might have been frightened or attracted to the mystical aspects
of the technique. Subjects were to be part of the research for the duration of 8 months and were
randomly assigned to a condition and control group that would not receive any psychological
treatment.
Before the treatment period, participants were asked to complete a questionnaire
assessing the various dimensions of OA pain. The questionnaire also included questions
regarding relaxation and hypnosis and the subjects beliefs in the psychological treatment. The
assessment of pain was taken halfway through the treatment, a third time 1 week after the
treatment, and 3 and 6 months after the treatment.
The hypnosis treatment was based on Ericksons technique. It restricts the individuals
perceptions of the external world by focusing his or her attention on specific internal stimuli,
such as breathing. This focus would result in feelings of being removed from the environment
and usually involves mental imagery. Patients were asked to sit in an armchair, close their eyes,
and tell the experimenter about a pleasant vacation memory. Patients were asked to relax their
muscles one by one and be away of proprio- and interoceptive sensations. Patients were also
asked to remember a positive childhood memory that involved joint mobility, which included
walks and learning to ride a bicycle. The relaxation treatment only had to relax their muscles
one by one and be aware of proprio- and interoceptive sensations, which lasted about 30 minutes.
The control group did not receive any treatment and only came in for evaluation.
Pain ratings and medication reported were the measures taken for the evaluation. Pain
was assessed on a scale of 0 (no pain) to 10 (unbearable pain). It was recorded for three different
periods: present pain, pain felt in the week prior, and pain felt a month prior. Dosage and types
of medication were reported at each assessment.
Results of the study suggest that hypnosis was effective in significantly reducing
perceived OA pain and medication use; relaxation seemed to be less rapidly effective. The
difference of hypnosis treatment and relaxation suggest that the active component of hypnosis
treatment cannot be reduced to a placebo effect. On a clinical level, patients may benefit from
hypnotic treatment for reducing OA pain even without specific imagery. Imagery was elicited
when encouraged by the hypnotherapist, but patients with imagery might benefit in the long run.
In conclusion, hypnotherapy is a promising method to manage pain; although, it might
not work for everybody. Research linking hypnotherapy and OA was very difficult to find, but
other research linking hypnotherapy and chronic pain was more prevalent. There have been new
trends in OA treatment that should be explored. Stem cells that are isolated from fat tissue may
be able to regenerate damage cartilage. Another new treatment that has shown promising results
includes a drug called strontium ranelate, which has been used to treat bone loss in Europe. It is
thought to inhibit the activity of osteoclasts, cells that break down bone.
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I, Dan Le, would highly recommend hypnotherapy to someone who is suffering from
chronic pain since it changes the minds perception of pain. In my session with Kim Bothwell,
certified hypnotherapist, I was able use guided imagery and focused thought to prevent the
feeling of pain in my right arm as he pinched my skin. I think that there is a stigma behind
hypnosis and hypnotherapy because of the movies and stage shows that are associated with it.
They usually portray it as brainwashing or to make someone do your bidding. Hypnotherapists
in the healthcare field usually have a graduate degree and are trained for health counseling and
therapy. I do not think people know that fact and see hypnotists as someone who is trained in a
short course. Further research I would like to see includes hypnotherapy as a form of anesthesia.
In the early 1800s, it was recorded that hypnotherapy was used in lieu of drug anesthesia during
surgical procedures. I would like to see more research on this because we do not know how long
the effects of drug anesthesia can last.
I, Matt OConnor, would also recommend hypnotherapy. Although I did not feel a
significant hypnotic state when in Mr. Bothwells office, I still learned a lot from this session.
Also, what I learned has helped me look at the world in a more peaceful and controlled manner.
It is amazing how one session can change perceptions so effectively. Accordingly, I would
suggest hynotherapy on the basis that even if symptoms are not alleviated, one can still benefit
psychologically. This improved psychological outlook can improve ones standard of living.The
most important thing we learned from this project is that life can be interpreted differently by
different perceptions and that these perceptions can actually be change. These changes use
imagination and placebo effects and allow us to take control of our lives because the world is as
we perceive it.
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References

Ng, Norman Tiong Meng, Kristiann C. Heesch, and Wendy J. Brown. "Strategies for Managing
Osteoarthritis." International Journal of Behavioral Medicine 19.3 (2012): 298-307.
Web.

Mcdonald, Deborah Dillon, and Bonnie Molloy. "Factors Predicting Older Adults Use of
Exercise and Acetaminophen for Osteoarthritis Pain." Journal of the American Academy
of Nurse Practitioners 24.11 (2012): 669-74. Web.

Girbes, E. Lluch, J. Nijs, R. Torres-Cueco, and C. Lopez Cubas. "Pain Treatment for Patients
With Osteoarthritis and Central Sensitization."Physical Therapy 93.6 (2013): 842-51.
Web.

"New Ways to Beat Osteoarthritis Pain." Harvard Women's Health Watch May 2013: 1+. Web.

Thomas, Jenny, and Len Kravitz. "Exercise Benefits People With Osteoarthritis." IDEA Fitness
Journal (2004): 16-19. Web.

Jensen, Mark P., and David R. Patterson. "Hypnotic Approaches for Chronic Pain Management."
American Psychologist 69.2 (2014): 167-77. Web.

Sofat, N., V. Ejindu, and P. Kiely. "What Makes Osteoarthritis Painful? The Evidence for Local
and Central Pain Processing." Rheumatology 50.12 (2011): 2157-165. Web.

Jensen, Mark P. "Hypnotic Approaches for Chronic Pain Management."American Psychologist

69.2 (2014): 167-77. Web.

Morone, Natalia E., and Carol M. Greco. "Mind/Body Interventions for Chronic Pain in Older
Adults: A Structured Review." Pain Medicine 8.4 (2007): 359-75. Web.
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Kim Bothwell Hypnotherapy Practitioner Questionnaire

Objective: To explore hypnotherapy and its effects on pain and osteoarthritis.

1. How did you choose your profession?

I was always drawn to hypnotherapy. I had many other professions before but after reading and
doing research, I knew that it was what I wanted to do.

2. What kind of schooling is required?

Typically, health care professionals must have a minimum of a graduate degree. After that, in
order to be a certified hypnotherapist, 50 hours of classroom instruction is required. Another 30
hours of clinical hypnotherapy training is required for be Board qualified.

3. What percentage of your clients are 65+?

About 20% of my clients are over 65 and 87 is the oldest.

4. What kind of clients do you typically see?

Clients come in for many reasons. To name a few: smoking, anxiety, diet, phobias, performance,
and trauma.

5. What are the top 3 reasons why your clients come in?
Smoking, anxiety, and phobias.

6. How long do sessions last?

Sessions can last an hour to two hours.

7. How many visits are required to see results?

It really depends on the client. Some clients can get results in as little as 2 sessions and some
need up to 5 or 6. Some people have the ability to relax and put themselves in a trance and some
need help. My goal is to only have 3 sessions.

8. Can you explain the typical process for hypnotherapy?

First, I teach the patient how to enter a hypnotic state through relaxation and breathing
techniques. During this time, I offer hypnotic suggestions. I observe this process and come up
with a personalized approach to help them. Watching a patients response will tell me a lot about
which techniques to use. I then apply the game plan in guiding the patient in mastering self
hypnotherapy.

9. Do clients ever wake during the process?

Its rare, but I guide them back into their relaxed state.

10. After a session, are there instructions to follow? Things to avoid?

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After a session, on should make sure to apply the thought processses that were introduced. Self
hypnotherapy should be administered as well in order to mold the subconscious in a way that
will increase quality of life. Bad habits should be avoided and corrected by self-suggestions.
11. What is the cost of a visit to your office?
I charge $150 for a two hour session and $90 for an hour session.

12. Does insurance cover your work?

Some insurances do and some dont. Insurance companies only pay for the problems that are
already going on. Hypnotherapy works very well as a preventative measure. Its all very
bureaucratic and I think that there needs to be more lawmakers that would see alternative
medicine as a part of health care.

13. Do you guarantee results?

I get results at least 80% of the time. Ill continue to work with the patient if theyre not satisfied
with the results

14. How do you deal with patients that have sessions but dont think its working?
They are usually the ones who dont believe that the method is working. I, typically, ask them to
come back for a couple of more sessions and to practice the techniques that I taught. Usually,
when they come back theyre are easier to put under.

15. Do patients ever return with a problem that was already fixed?
Rarely, I provide them with take-home self techniques that help them when the problem arises
again.

16. How do you incorporate nutrition health into your sessions?

I tell patients that they really need to be aware of what theyre eating. When people are at home
watching TV and eating a meal, they dont realize that theyre eating. They go into a state of
hypnosis and all of their attention is on the TV. Eventually, theyll look down and wonder where
all of the food went. I tell them to move away from TV and eat at the dinner table. I also
emphasize to them that there is no crash diet that works. Theyre just not sustainable to the
body. Attitude, when eating, is also important. People love to eat when theyre happy, mad, sad,
anything. As I liked to say, you cant feed feelings.