Hypnosis has long been used to treat and manage a host of psychiatric and neurologic symptoms. However, not all patients respond equally to this therapy type. About two thirds of the general adult population are estimated to be at least somewhat hypnotizable, and 15% are highly hypnotizable.
Through brain imaging, the Stanford team found that high hypnotizability is associated with greater functional connectivity between the left dorsolateral prefrontal cortex (DLPFC) and the dorsal anterior cingulate cortex.
“A novel aspect of this trial is that we used the person’s own brain networks, based on brain imaging, to target the right spot,” Co-senior author Nolan Williams, MD, with Stanford University, California, said in a news release.
The team chose patients with chronic pain because hypnosis has been shown to be a “highly effective analgesic that has a far better risk/benefit ratio than widely overutilized opioids that have serious fatal overdose potential,” Spiegel told Medscape Medical News.
The pre-to-post SHIFT change in hypnotic induction profile scores, a standardized measure of hypnotizability, was significantly greater in the active vs sham group after just 92 seconds of stimulation (P = .046).
Only the active SHIFT group showed a significant increase in hypnotizability following stimulation, an effect that lasted for about 1 hour.
“Increasing hypnotizability in people who are low-to-medium hypnotizable individuals could improve both the efficacy and effectiveness of therapeutic hypnosis as a clinical intervention,” the researchers wrote.
They note that because this was a “mechanistic study,” it did not explore the impact of increased hypnotizability on disease symptoms. They also note that further studies are needed to assess the dose-response relationships of SHIFT.
Transformative Research
“This line of research is fascinating,” Shaheen Lakhan, MD, PhD, neurologist, and researcher in Boston, told Medscape Medical News.
“We are nearing an era of personalized, noninvasive brain modulation. The ability to individually modulate the DLPFC opens new possibilities for brain health beyond hypnotizability for fibromyalgia,” said Lakhan, who wasn’t involved in the study.
“The DLPFC is involved in executive functions (and disorders) like attention (ADHD), emotional regulation (depression), motivation (schizophrenia), and impulse control (addiction),” he noted.
“Soon we may no longer need large expensive devices like transcranial magnetic stimulators as in this research study. Smartphones could deliver tailored digital therapeutics by engaging specific brain circuits,” Lakhan predicted.
“Imagine using an app to receive treatment customized to your unique brain and needs — all without anything implanted and delivered anywhere. The potential to precisely modulate the brain’s wiring to enhance cognition and mental health, without surgery or physical constraints, is incredibly promising. The possibilities are intriguing and could truly transform how we address brain diseases,” he added.
The study was supported by a grant from the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health (NIH). Williams is a named inventor on Stanford-owned intellectual property relating to accelerated TMS pulse pattern sequences and neuroimaging-based TMS targeting; has served on scientific advisory boards for Otsuka, NeuraWell, Magnus Medical, and Nooma as a paid advisor; and holds equity/stock options in Magnus Medical, NeuraWell, and Nooma. Spiegel is a cofounder of Reveri Health, Inc., an interactive hypnosis app (not utilized in the current study).
Introduction:
Hypnotherapy, a powerful and often misunderstood therapeutic technique, has been gaining recognition for its efficacy in addressing many common problems such as stress, fear, smoking, obesity, pain, IBS, insomnia, and substance abuse. This article delves into this fascinating modality, unraveling its mysteries and shedding light on its profound impact on the human mind.
The Basics of Hypnotherapy:
At its core, hypnotherapy involves inducing a state of deep physical relaxation, focused attention along with heightened suggestibility. Contrary to common misconceptions, it is not a form of mind control, but rather a collaborative process between practitioner and the client. A hypnotherapist guides the client into a more receptive level of thought and then offers positive suggestions supporting healthy change.
Understanding the Hypnotic Trance:
Think of hypnotherapy as goal-oriented meditation. With simple direction and creative scenarios clients are comfortably guided into a deep daydream state, which is something we all routinely experience in the form of ‘zoning out’ or becoming momentarily ‘lost in our thoughts’. Another example is the phenomenon referred to as ‘highway hypnosis’ when, on long drives, we can slide into that daydream state and reach our destination with no clear memory of the journey.
These are common, everyday examples of when the subconscious mind is more open and active. It’s also important to understand that we as humans can shift from one level of awareness to another. Hypnosis is a language tool enabling this therapeutic transition.
Benefit of Accessing Subconscious Thought:
This is why hypnotherapy is such a powerful tool. Think of the subconscious as the hard drive; the home of all habits, memories, emotions, values and beliefs that shape the routine patterns of our daily lives. If we routinely repeat any pattern of action, thought, or emotion, and its repeated long enough, it becomes rooted in the subconscious mind for better or worse.
In life, it’s all about our routine pattern of thought, how we think and what we most routinely think about that dictates our life experience; how we feel, how we appear, and how we respond to the world around us.
It’s also important to know that the subconscious doesn’t care if the pattern is good or bad; healthy or not. It also doesn’t matter what we intellectually or consciously may prefer. Once problem patterns are rooted, they can feel automatic. Smokers know that smoking is a potentially 
deadly habit, and they are also certainly aware of the cost. Along with the addictive qualities of nicotine, the repetitive, ritualistic pattern of smoking reinforces the habit to continue, despite what we might consciously prefer.
Another example of a pattern problem is dieting. There is a good reason why there are dozens of diets to choose from, dieting doesn’t work. Slick, manipulative advertising promises rapid results often involving extreme restrictions or unsustainable practices, leading to short-term weight loss followed by rebound weight gain when normal eating resumes. UCLA posted this study: in less than two years, 23% of dieters gained back more weight than they lost. In more than two years that percentage rose to 83%.
The dieting concept implies a temporary, conscious level change with eating habit patterns which reside on a much deeper, subconscious, level. It’s not a pound problem, it’s a pattern problem. Dieting is like weeding your garden by only clipping them off at the ground level. It looks great for a while, but the problem always returns.
For lasting results, it’s crucial to adopt a more permanent and balanced lifestyle, focusing on nourishing the body rather than just restricting calories. Desperate overweight individuals continue searching for an answer that is not readily available.
With hypnotherapy, we can create an emotional disconnect from the problem pattern and plant seeds supporting healthy change. Clients then take the same approach to establish sustainable relief as they previously took to secure the problem, repetition.
My clients have easy access to mp3 recordings of their sessions via Dropbox and listen daily for a minimum of 3 months. Without repetition the office session is like a massage; it feels good in the moment but it’s always back to business as usual.
A great longevity study confirmed that 71% of patients with irritable bowel syndrome, who listened daily to home recordings of IBS specific
hypnosis sessions for 3 months were still symptom-free after 5 years. (Gonsalkorale WM 2003)
Just follow the feeling. The advantage hypnotherapy has over other options is that it feels wonderful. When that feel-good connection is made on the initial visit, clients never see listening to home sessions as a chore.
Applications of Hypnotherapy:
Hypnotherapy has proven to be effective in treating a wide range of conditions. These include, but are not limited to:
- Anxiety and Stress Management: Hypnotherapy helps individuals achieve deep relaxation, alleviating anxiety and stress by reprogramming negative thought patterns.
- Smoking Cessation: By targeting the subconscious mind’s associations with smoking, hypnotherapy aids in breaking the habit and promoting a smoke-free lifestyle.
- Weight Loss: Addressing the root causes of unhealthy eating habits, hypnotherapy supports individuals in adopting positive behaviors for sustainable weight loss.
- Pain Management: Chronic pain sufferers can benefit from hypnotherapy as it helps modulate the perception of pain and promotes relaxation, reducing reliance on medication.
- Phobias and Fears: Hypnotherapy assists in uncovering the origins of phobias and fears, facilitating their resolution through targeted suggestions.
- Substance abuse: Hypnotherapy can initiate a sense of euphoria which clients can enjoy daily. With repetition, this new experience can become a preferred alternative to drugs and/or alcohol.
The Therapeutic Process:
In my practice, the initial visit involves a discussion of the client’s goals and concerns, followed by a review of how/why hypnotherapy can help. Then I teach clients how to listen to a session properly, and what to experience in terms of physical sensations such as warmth, tingling, weightlessness or feeling peacefully heavy.
I also review the potential of unique visual imagery such as colors or unexpected imaginative scenarios and how personal experiences with hypnotherapy can vary from day to day. It’s best to allow each session to be uniquely right for you that moment in time.
Prior to conducting the hypnotherapy session, I also teach my clients how to do self-hypnosis. This is a simple technique that empowers individuals to access meditative relaxation on their own which only takes about 10 minutes.
With self-hypnosis the client is in a light meditative trance which makes it so easy to then transition into the hypnotherapy session. Most clients have no previous experience with hypnotherapy and this approach makes it so much easier for anyone to get into the flow of the process on the first visit.
Once the session begins, I help clients into deeper mediative relaxation and then guide them through creative scenarios supporting specific goals. This is very much a collaborative process where clients are actively participating in their own healthy transformation.
Ethical Considerations:
This empowering modality is rapidly becoming more widely embraced thanks in part to the many meditation apps readily available to anyone searching for healthy relief. However, there is still a long way to go.
At the time of this writing there are thirty states offering specific standards of practice for hypnotherapy [more]. Fifteen states defer to the guidelines presented by the National Guild of Hypnotists and the remaining states currently have no formal recommendations.
Conclusion:
Hypnotherapy, once relegated to the realm of mysticism, is now experiencing growing recognition as a legitimate and effective therapeutic modality. As our understanding of the mind continues to evolve, hypnotherapy stands as a beacon of hope for those seeking positive and lasting changes in their lives. The key lies in unlocking the potential of the subconscious mind, harnessing its power for personal transformation and self-healing.
by: Paul Gustafson RN CH
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
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
