Hypnosis: The most effective treatment you have yet to prescribe

Despite robust evidence for myriad ailments and sound mechanistic data, hypnosis is underused by internists. Using hypnosis fulfills our pledge to abide by evidence-based treatments that alleviate suffering with the least collateral harm, but there is a discrepancy between its benefits and physicians who offer the treatment.

Although hypnosis may appear in the medical curricula at academic powerhouses like Baylor, Harvard, Columbia, and Stanford, hypnosis training is rare even at these institutions. Here is why a modern resurrection of the oldest Western form of psychotherapy should inspire internists to get trained and offer medical hypnosis broadly.

Hypnosis, and its myths and misconceptions, have evolved since the 18th century when Franz Mesmer inadvertently led hypnosis into obscurity with his theory about manipulating a force called “animal magnetism.” These claims were dispelled by the French Royal Academy of Sciences, and it took nearly 100 years for Scottish physician James Braid to first describe a mental and suggestive theory of hypnosis as a waking physiologic state.

The 2014 definition from the American Psychological Association’s Division 30 describes hypnosis as “a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion.”

Long-standing empirical evidence demonstrates that hypnosis impacts perception, symptoms, and habits, which have recently been explained by advanced diagnostic modalities like functional magnetic resonance imaging (fMRI). Changes during hypnosis include reduced activity in the dorsal portion of the anterior cingulate cortex (a key component of the salience network) and connectivity between the prefrontal cortex and the insula (a pathway for mind-body control).

Augmented by data on neurotransmitter metabolism and genetics, the neurophysiologic basis of hypnosis is no longer mysterious. Though our understanding of the mechanism of action of hypnosis is more robust than that of even acetaminophen, this has not sufficed to enhance its use.

Skeptics describe hypnosis in 1 of 3 ways: dangerous mind control, an ineffective farce, or placebo. It is often viewed as a loss of control and, therefore, dangerous, when in fact it is a powerful means of teaching patients how to control mind and body. The ability to enter into hypnosis, termed hypnotizability, is a stable trait possessed by most people, which can be entered into or terminated by the patient.

It is not effective in the presence of conditions such as stroke or schizophrenia or impaired focused attention or language processing. Hypnosis is more powerful than placebo (though patient expectancy is a moderating factor), and placebo effect is blocked by administration of naloxone, while the hypnotic analgesia is not.

Reviews on hypnosis for internal medicine topics are impressive, with demonstrated efficacy for migraine headache,4 irritable bowel syndrome,5 and anxiety.6 Hypnosis improves procedural pain and emotional distress and reduces medication consumption up to 40%7—in short, if hypnosis were a drug, it would be standard of care. Internists should prescribe hypnosis particularly when it outperforms the current standard of care by safety and efficacy, as in the case of opioids and sedatives.

Patients have a strong appetite for taking charge of their symptoms; online hypnosis videos for anxiety and insomnia boast 15-19 million views, and medical hypnosis is quite acceptable by patients.8 But patients cannot be expected to differentiate between legitimate and manipulative sources of hypnosis online any more than if they bought pills off the street. This treatment modality falls under the purview of medicine, and our duty is to provide safe access. To do this, we must improve the supply.

Formal training for medical providers is offered through national societies, such as the American Society of Clinical Hypnosis (ASCH) and Society for Clinical and Experimental Hypnosis (SCEH). Trainings span 4 days and include ethics and informed consent in addition to practical skills. Hospital credentialing for the privilege of hypnosis may be required: If none exists, designing one to include formal training and mentorship requirement is advised. For institutional trailblazers, individuals in the hypnosis societies can provide mentorship.

Hypnosis training includes tools for helping our patients to help themselves, which benefits all our patients even outside a formal session. Telling a patient: “Don’t think about purple elephants” will assure that they do. Through the lens of hypnosis, one appreciates that even the common phrase “How bad is your pain” is fraught with negative associations.

With all their capacity to trust their physician, patients internalize “You have bad pain.” Contrast this with the phrase, “How comfortable are you right now?” The patient scans their body for comfort rather than pain and, if discomfort is reported, can be followed up with the 0-10 scale. These subtle adjustments acknowledge comfort without the disservice of anticipatory suffering. This is the healing art of medicine.

Additionally, the trained physician can practice self-hypnosis for stress management, insomnia, or performance anxiety, thereby avoiding medications that blunt their focus. Our patients, colleagues, trainees, and families stand to benefit.

Hypnosis research is funded by the National Center for Complementary and Integrative Health (NCCIH), and researchers are making inroads into the genetic aspects of hypnotizability and response to treatment and studying hypnosis for pain management for cancer and surgery, smoking cessation, and stress management in health care.

The automation of hypnosis using recordings, web-based applications, and smart-speaker devices is being tested to expand access to hypnosis interventions. From basic science to clinical efficacy to medical education, hypnosis research of all kinds has relevance for internal medicine.

Internists are the ambassadors of evidence. Our broad training and scope maximizes our effectiveness as healers, but we mustn’t lose sight of that which experiences illness: the human mind. When the technique of hypnosis is properly illuminated, its role will be welcomed and respected by our patients.

They will benefit from less pain, anxiety, insomnia, habits such as smoking, and the side effects that accompany many pharmacological treatments. We will benefit from the satisfaction of reacting nimbly to the best evidence for safer treatments and, perhaps, also enjoy a better night’s sleep. This is a call to action for broader use of hypnosis with intrepid internists leading the charge.

by: Jessie Kittle, MD and David Spiegel, MD

Paul on WBZ radio

Radio host invited Paul Gustafson to talk about hypnotherapy on WBZ’s Nightside with Dan Rea.

Smoker’s account of quitting

I see many smokers who are struggling to quit. Initially we talk about their smoking history, past attempts to quit and any health concerns for themselves or if they know someone whose health was compromised by smoking.

Smokers are very quick to say they hate smoking; they hate the smell, the cost and don’t like the fact that they have to go ‘somewhere else’ to smoke.

A recent client said she was at a family function and a couple of cousins were also smokers. The routine was for them to step outside and chat while they smoked.

The client had already come for her first of two office visits and had been listening to MP3 of her session daily at home. While recounting this particular smoke break story, she said it was very different from previous times. ‘We were standing in the cold next to the chimney to the back side of the house. I remember feeling so stupid because I was freezing to death and isolated from the rest of my family just to smoke.’

She spoke at length about how, in the past week, she became much more aware of the absurdity and certainly the health risk of smoking. I reminded her how hypnotherapy enhances mindfulness, we become very careful thinkers and impulsivity fades. This was likely why she saw this situation in a new light.

I asked her why she ever smoked in the first place, what was the upside? If she was so eager to condemn the cost, stink and health risk what could she possibly be getting from smoking.

She said ‘I guess I just want to smoke.’ To that I asked her to drill down into the ‘want’ a little more. Could she logically want something that checked off the cost, stink and health boxes? She paused and then responded with an emphatic ‘of course not’.

I asked if it made sense that the ‘want’ was just a habit that had taken on a life of its own out of simple repetition? That made sense to her.

Then I asked if it also made sense that by continuing to repeat the relaxing process that reinforced a comfortable smoke-free transition could fix the problem? She just smiled and nodded. After our chat we did her hypnotherapy session and she left the office feeling very focused and confident.

I routinely engage in these types of conversations with clients prior to initiating a hypnotherapy session because it helps them sort through all the details on a subconscious level. Once the session is concluded clients typically are much more focused and confident about moving forward to healthy change.

By: Paul Gustafson

Hypnotherapist Mentoring Program

With over 20 years’ of clinical experience I have developed a multilevel approach including a therapeutic in-office/remote client experience, digital session recording, MP3 file sharing, cable TV show production/editing, SEO, blogging and social media distribution.

This approach has supported a lucrative, self-sustaining, private practice that allows me the freedom to do the work I was meant to do. No advertising, promotions or discounts.

Clients are routinely surprised by the high quality intro videos emailed to them prior to initial appointment. They also appreciate the live session recordings and being able to access them on any smart phone.

Consistent positive client experience is the result a blended audio tapestry of soothing music, binaural beats and nature sounds with creatively effective, deep-trance hypnotherapy sessions. Sessions are mixed live into audacity, converted to MP3 format and end up in client’s in-box before they get home.mentoring sign

The key to top shelf search engine prominence requires a steady stream of information of value. This includes a professionally designed, key word optimized, WordPress website and consistent quality content posting.

Google values video. I post narrated info videos as well as client testimonials edited from my cable access TV show. All posted content includes appropriate key words and is automatically distributed to social media.

My 6-class mentoring program for new hypnotherapists helps practitioners establish a solid professional foundation so you too can do the work you were meant to do. [more]


  • Class 1: Finances, regulations, pc skills, website
  • Class 2: Getting started, conducting office visits/sessions
  • Class 3: Blogging, search engine optimization, reviews
  • Class 4: Equipment, music, recording, file sharing
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Hypnotherapist Paul Gustafson RN CH offers a 6-class mentoring program for new certified hypnotherapists interested in taking the fast track to professional success. Paul incorporates high-end audio and video along with creatively effective sessions which offers eager clients consistently positive results. [more]

Paul’s multilevel approach includes a dynamic client office experience, digital recording of client sessions, MP3 file sharing, cable TV show production with search engine optimization, blogging and social media distribution. [contact]