Is hypnosis just a trick of stage magicians or hocus-pocus for gullible New Agers? Not according to new research just presented at the European Anaesthesiology Congress in Amsterdam.
Professor Fabienne Roelants and Dr. Christine Watremez, from the Department of Anesthesiology at the Cliniques Universitaires St. Luc, UCL, in Brussels, Belgium, found, that by using a combination of hypnosis and local anesthesia (LA) for certain types of surgery, patients can avoid general anesthesia. That, the scientists said in a media statement, can aid the healing process, reduce drug use, shorten time spent in the hospital — and it could help cancer patients avoid cancer recurrence and the spread of cancer (metastasis), too.
The research team studied the impact of using LA and hypnosis in certain kinds of breast cancer surgery and in thyroidectomy (removal of all or part of the thyroid gland). “In all of these procedures local anesthesia is feasible but not, on its own, sufficient to ensure patient comfort,” Professor Roelants explained in the press statement.
So what makes local anesthesia work well enough to use for these operations? Adding hypnosis. For the first study, 18 women out of 78 had hypnosis for a variety of breast cancer surgical procedures including partial mastectomy, sentinel node biopsy (examination of lymph nodes likely to become cancerous from metastasis) and axillary dissection (opening the armpit to examine or remove some or all of the lymph nodes). The remaining women in the group had general anesthesia for the same surgical procedures.
The results showed that the patients who were hypnotized spent a few minutes more in the operating room but their post-operation opioid drug use was greatly reduced. What’s more, they recovered more quickly from their surgery and spent less time in the hospital.
The scientists also compared the outcomes of thyroid surgery in 18 patients who had a combination of LA and hypnosis with outcomes of 36 people who underwent surgery with general anesthesia. In order to decrease the invasiveness of the procedure, both groups had the same type of video-assisted thyroidectomy. The outcome was the same as in the breast cancer surgery — once again, drug use, recovery, and hospital stay times were greatly reduced among the patients in the LA/hypnosis group.
“In addition to reducing drug use and hospital stay time, being able to avoid general anesthesia in breast cancer surgery is important because we know that local anesthesia can block the body’s stress response to surgery and could therefore reduce the possible spread of metastases,” Professor Roelants stated.
“There is still a lot of debate around the exact mechanism that allows hypnosis to reduce pain perception,” Professor Roelants said in the media statement. “But what is absolutely clear is that it does so. The result is that one-third of thyroidectomies and a quarter of all breast cancer surgery carried out at the UCL hospital are performed under local anesthetic with the patient under hypnosis.”
“We believe that our studies have shown considerable benefits for the LA/hypnosis combination and that such benefits are not only for patients but also for healthcare systems. By using hypnosis combined with LA we can reduce the costs involved in longer hospital stays, remove the need for patients to use opioid drugs, and increase their overall comfort and satisfaction levels.
To date, there are few publications about the use of hypnosis in surgery, and we hope that, by contributing to the body of evidence on its efficacy, our research will encourage others to carry out this procedure to the advantage of all concerned,” Dr. Watremez concluded.
By: Sherry Baker
Hypnosis has become a common medical tool, used to reduce pain, help people stop smoking and cure them of phobias.
But scientists have long argued about whether the hypnotic “trance” is a separate neurophysiological state or simply a product of a hypnotized person’s expectations.
A study published on Thursday by Stanford researchers offers some evidence for the first explanation, finding that some parts of the brain function differently under hypnosis than during normal consciousness.
The study was conducted with functional magnetic resonance imaging, a scanning method that measures blood flow in the brain. It found changes in activity in brain areas that are thought to be involved in focused attention, the monitoring and control of the body’s functioning, and the awareness and evaluation of a person’s internal and external environments.
“I think we have pretty definitive evidence here that the brain is working differently when a person is in hypnosis,” said Dr. David Spiegel, a professor of psychiatry and behavioral sciences at Stanford who has studied the effectiveness of hypnosis.
Functional imaging is a blunt instrument and the findings can be difficult to interpret, especially when a study is looking at activity levels in many brain areas. Still, Dr. Spiegel said, the findings might help explain the intense absorption, lack of self-consciousness and suggestibility that characterize the hypnotic state.
He said one particularly intriguing finding was that hypnotized subjects showed a decreased interaction between a region deep in the brain that is active in self-reflection and daydreaming and areas of the prefrontal cortex involved in planning and executing tasks.
That decreased interaction, Dr. Spiegel said, suggested an explanation for the lack of self-consciousness shown by hypnotized subjects. “That’s why the stage hypnotist can get a football coach to dance like a ballerina without feeling self-conscious about what he’s doing,” Dr. Spiegel said. He added that it might also explain, at least in part, why hypnosis is an effective tool in psychotherapy for getting people to look at a problem in a new way.
The researchers screened more than 500 potential subjects for susceptibility to hypnosis and then compared brain activity in 36 who scored very highly on tests measuring susceptibility to hypnosis and 21 who had very low scores on those tests.
Brain activity during hypnosis was also compared with activity during resting periods and during a memory task, for both high and low susceptibility groups.
In the hypnosis task, the subjects were guided through two procedures for hypnotic inductions: in one, they were instructed to imagine a time when they felt happiness; in the other, they were told to remember or imagine a vacation.
All the subjects were asked in the study to rate how deeply hypnotized they felt during the inductions. Although some researchers continue to argue that hypnosis is a state produced by people’s expectations, not by biology, Dr. Spiegel said, “At some point, I just think it becomes a kind of self-fulfilling word game.” “I see hypnosis as a kind of app you haven’t used on your cellphone,” he said. “It’s got all kinds of capacity that people are just figuring out how to use, but if you haven’t used it the phone doesn’t do that.”
By: ERICA GOODE
A study identifies brain areas altered during hypnotic trance. By scanning the brains of subjects while they were hypnotized, researchers at the School of Medicine were able to see the neural changes associated with hypnosis. Your eyelids are getting heavy, your arms are going limp and you feel like you’re floating through space. The power of hypnosis to alter your mind and body like this is all thanks to changes in a few specific areas of the brain, researchers at the Stanford University School of Medicine have discovered.
The scientists scanned the brains of 57 people during guided hypnosis sessions similar to those that might be used clinically to treat anxiety, pain or trauma. Distinct sections of the brain have altered activity and connectivity while someone is hypnotized, they report in a study published online July 28 in Cerebral Cortex.
“Now that we know which brain regions are involved, we may be able to use this knowledge to alter someone’s capacity to be hypnotized or the effectiveness of hypnosis for problems like pain control,” said the study’s senior author, David Spiegel, MD, professor and associate chair of psychiatry and behavioral sciences.
A serious science
For some people, hypnosis is associated with loss of control or stage tricks. But doctors like Spiegel know it to be a serious science, revealing the brain’s ability to heal medical and psychiatric conditions.
“Hypnosis is the oldest Western form of psychotherapy, but it’s been tarred with the brush of dangling watches and purple capes,” said Spiegel, who holds the Jack, Samuel and Lulu Willson Professorship in Medicine. “In fact, it’s a very powerful means of changing the way we use our minds to control perception and our bodies.”
Despite a growing appreciation of the clinical potential of hypnosis, though, little is known about how it works at a physiological level. While researchers have previously scanned the brains of people undergoing hypnosis, those studies have been designed to pinpoint the effects of hypnosis on pain, vision and other forms of perception, and not the state of hypnosis itself. “There had not been any studies in which the goal was to simply ask what’s going on in the brain when you’re hypnotized,” said Spiegel.
Finding the most susceptible
To study hypnosis itself, researchers first had to find people who could or couldn’t be hypnotized. Only about 10 percent of the population is generally categorized as “highly hypnotizable,” while others are less able to enter the trancelike state of hypnosis.
Spiegel and his colleagues screened 545 healthy participants and found 36 people who consistently scored high on tests of hypnotizability, as well as 21 control subjects who scored on the extreme low end of the scales.
Then, they observed the brains of those 57 participants using functional magnetic resonance imaging, which measures brain activity by detecting changes in blood flow. Each person was scanned under four different conditions — while resting while recalling a memory and during two different hypnosis sessions.
“It was important to have the people who aren’t able to be hypnotized as controls,” said Spiegel. “Otherwise, you might see things happening in the brains of those being hypnotized but you wouldn’t be sure whether it was associated with hypnosis or not.”
Brain activity and connectivity
Spiegel and his colleagues discovered three hallmarks of the brain under hypnosis. Each change was seen only in the highly hypnotizable group and only while they were undergoing hypnosis.
First, they saw a decrease in activity in an area called the dorsal anterior cingulate, part of the brain’s salience network. “In hypnosis, you’re so absorbed that you’re not worrying about anything else,” Spiegel explained.
Secondly, they saw an increase in connections between two other areas of the brain — the dorsolateral prefrontal cortex and the insula. He described this as a brain-body connection that helps the brain process and control what’s going on in the body.
Finally, Spiegel’s team also observed reduced connections between the dorsolateral prefrontal cortex and the default mode network, which includes the medial prefrontal and the posterior cingulate cortex. This decrease in functional connectivity likely represents a disconnect between someone’s actions and their awareness of their actions, Spiegel said.
“When you’re really engaged in something, you don’t really think about doing it — you just do it,” he said. During hypnosis, this kind of disassociation between action and reflection allows the person to engage in activities either suggested by a clinician or self-suggested without devoting mental resources to being self-conscious about the activity.
Treating pain and anxiety without pills
In patients who can be easily hypnotized, hypnosis sessions have been shown to be effective in lessening chronic pain, the pain of childbirth and other medical procedures; treating smoking addiction and post-traumatic stress disorder; and easing anxiety or phobias. The new findings of how hypnosis affects the brain might pave the way toward developing treatments for the rest of the population — those who aren’t naturally as susceptible to hypnosis.
“We’re certainly interested in the idea that you can change people’s ability to be hypnotized by stimulating specific areas of the brain,” said Spiegel. A treatment that combines brain stimulation with hypnosis could improve the known analgesic effects of hypnosis and potentially replace addictive and side-effect-laden painkillers and anti-anxiety drugs, he said. More research, however, is needed before such a therapy could be implemented.
By: Sarah C.P. Williams
