Therapeutic Hypnosis

Hypnosis, in some form or another, has been used for more than two hundred years. It began gaining credibility as a medical tool in the early decades of the last century as psychiatry and psychoanalysis began to show how the subconscious mind often rules daily life. Its usefulness was cemented when combat physicians reported using it during World War II for the wounded. As more doctors were able to document their experiences in the war, the American Medical Association certified the technique in 1958 as a legitimate treatment tool. Although few doctors employed it on a regular basis, the National Institutes of Health ruled in 1996 that hypnosis was an effective intervention for alleviating pain from cancer and other chronic conditions. In the present time, as more people accept that stress can exacerbate illness, the potential curative power of hypnosis is becoming more acceptable.

Brief History of Hypnosis

Few therapies in the history of medicine have enjoyed simultaneously such widespread acclaim and such universal condemnation as has hypnosis. To some extent these opposing attitudes still prevail (Hammond, 1990). However, recent years have witnessed advances in experimental and therapeutic hypnosis which have tended to establish hypnotherapy firmly as a scientific treatment method (Kappas, 2001).

Although trance and trance-like states have been used for centuries in many cultures, in the belief that there are benefits from using the mind to control body processes, there has been little interest or belief in that theory in recent Western culture (Hammond, 1990). Practitioners using techniques to induce a trance-like state were relegated to the stage and treated as charlatans. Although people who watched performances of hypnotic trance behavior on stage were entertained, a fear arose among the general population that the hypnotist was somehow able to control the subjects on stage by exerting his will over theirs, thus making them say or do things that were beyond their control (Hammond, 1990 Kappas, 2001).

Franz Anton Mesmer (1765) was an early practitioner of hypnosis, calling it magnetism, and believing that all living beings contained magnetic energy, and that this energy could be controlled by using the mind (Monte & Sollod, 2003). He first called his technique magnetism, later changing it to Mesmerism. He would place his subjects into trance by staring deeply into their eyes, and then directing their magnetic energy to cause changes in behavior or to promote healing. Hence, we have adopted the terms “mesmerize” and “animal magnetism” into our vernacular (Kappas, 2001; Monte & Sollod, 2003).

James Braid (1840) was an ophthalmologist who did not agree with the magnetism theory, but who believed that subjects were able to enter a trance state through suggestion, and he observed that many physiological changes occurred during this state (Hammond, 1990; Kappas, 2001). These changes resembled sleep state changes, like rapid eye movement and deep breathing, but the subjects were suggestible to verbal cues during this state in a way that they were not suggestible during sleep nor during wakefulness. He called his technique hypnosis , after the Greek Hypnos, the god of sleep (Hammond, 1990; Kappas, 2001).

Sigmund Freud, influenced by his mentor Jean-Martin Charcot, employed hypnosis on his patients whom he believed suffered from hysteria, or hysterical conversion syndromes. It was clear that people whose physical symptoms had an underlayment of emotional distress responded in a seemingly miraculous way to the effects of hypnosis (Monte & Sollod, 2003). It was also clear that the term “hysteria”, which was coined to describe the emotional symptoms in women that were believed to have been the result of a “wandering womb”, was also applicable to symptoms present in men who had suffered extreme emotional distress and were afflicted with physical ailments that could be attributed to no other cause (Hilgard, 1968; Monte & Sollod, 2003).

Both Freud and Charcot abandoned hypnosis for lack of skill in using it beyond the treatment of “hysteria” (Monte & Sollod, 2003). Others persisted in investigation such that the American Medical Association recognized it as a viable medical practice in 1958, and the National Institutes of Health funded grants for further study beginning in 1996 (Kappas, 2001; Harris, 2005).

Current Study Direction

During the past decade, with the aid of neuroimaging technology, notably functional magnetic resonance imaging (fMRI), the study of the brain during the hypnotic state is revealing that when hypnotized people act on hypnotist’s suggestions, their brains really do process information differently (Rainville & Hofbauer, 2002; Derbyshire & Whalley, 2004; Harris, 2005; Raz & Fan, 2005). People who are hypnotized show less activity in the anterior cingulate cortex, which is active when people are trying to resolve conflicting information from differing sources(Raz & Fan, 2005). Another study showed that there was activation in the right fusiform gyrus in hypnotized people who were told that they could see gray-scale prints in color. That area of the brain did not show increased activity in non-hypnotized subjects who were given the same suggestion to imagine that gray-scale prints were in color (Raz & Kirsch, 2006).

Another study revealed that hypnotically induced pain activated the same brain areas that were activated in the presence of “real” pain (Derbyshire & Whalley, 2004). There was activation in the pain-processing areas of the brain – the thalamus, the anterior cingulate cortex – as in subjects experiencing actual pain. The stimulation could not be reproduced in subjects who were not hypnotized, but were told to imagine the pain. The evidence suggests that people respond to hypnotic suggestion by actually “feeling” or “seeing” the suggested stimulus, be it kinesthetic sensation or visual (Derbyshire & Whalley, 2004).

Clinical Applications for Hypnosis

Medical Applications Hypnosis is defined by the American Psychological Association as a procedure during which a health professional or researcher suggests while treating someone that he or she experience changes in sensations, perceptions, thoughts, or behavior. Although some hypnosis is used to make people more alert, most hypnosis includes suggestions for relaxation, calmness, and well-being (Hammond, 1990; Kappas, 2001; Harris, 2005). Instructions to imagine or think about pleasant experiences are also commonly included during hypnosis. People respond to hypnosis in different ways (Kosslyn & Thompson, 2000; Rainville & Hofbauer, 2002). Some describe hypnosis as a state of focused attention, in which they feel very calm and relaxed (Hilgard, 1968). Most people are surprised that it is not a state of oblivion, as in chemically-induced anesthesia, nor is it a state of complete stillness of mind, as in meditation. They report being aware at all times, and are often not convinced that they were actually “under” (Hilgard, 1968; Harris, 2005).

Hypnosis has been proven to be useful adjunct therapy in somatoform disorders such as irritable bowel syndrome, ulcers and Crohn’s Disease. Allergies, asthma, chronic pain, high blood pressure, Raynaud’s disease and even hemophilia have been helped by the addition of hypnosis to the treatment regimen (Montgomery & David, 2002; Derbyshire & Whalley, 2004). A separate discipline within the domain of therapeutic hypnosis, called hypnobirthing, uses hypnosis often as the only analgesic during labor and childbirth. This eliminates the risk that medications can pose for both mother and child (Hammond, 1990; Kappas, 2001; Raz & Fan, 2005).

Hypnosis is not only effective for pain, but when hypnotic anesthesia and feelings of coolness are created in the first few hours after a significant burn, it appears that there is reduced inflammation and accelerated healing. Surgical patients are given hypnotic preparation before the procedure and during surgery to control blood flow, pain, heart rate and anxiety with the result that anesthesia times are reduced, and recovery times are shortened. The need for blood transfusions is often eliminated because the flow of blood is controlled away from the surgical area through hypnosis (Montgomery & David, 2002; Derbyshire & Whalley, 2004).

Psychotherapeutic and Behavioral Applications Hypnosis has been shown to be effective adjunct therapy in the treatment of trauma — specifically rape, incest and cult abuse – as well as lesser forms of anxiety and stress-induced symptomatology. Additionally, there is considerable evidence for the benefits of hypnosis in athletic performance, test-taking, smoking cessation and obesity control (Hammond, 1990). Sexual dysfunction, sleep disorders, enuresis, and concentration difficulties can be aided by hypnosis, along with depression, learning disorders and habit control (Kappas, 2001). Guided imagery and self-hypnosis provide dramatic results when added to treatment plans for people suffering from phobic disorders. Hypnotic imagery, conducted in the form of virtual reality experience, is very successful when used with systematic desensitization, as it can be used to replace negative associations with positive ones with respect to the object of the phobic response (Rainville & Hofbauer, 2002; Raz & Fan, 2005).

Dental Applications Use of hypnosis in dentistry benefits both the patient and the dentist by enabling control of anxiety and aversion to the procedures. Tongue thrusting, gagging, reverse swallowing, bruxism and clenching leading to tympano-mandibular joint malfunction and pain can be controlled using hypnosis as adjunct therapy. Pre-treatment desensitization renders the patient more amenable to treatment, improves the outcome of the treatment, and makes the job safer for the dentist, who must protect against the hazards of being bitten during the procedure (Montgomery & David, 2002; Derbyshire & Whalley, 2004).

Modes of Treatment

Use of Imagination Practitioners encourage the use of imagination. Mental imagery is very powerful, especially in a focused state of attention. The mind is capable of using imagery, even if it is only symbolic, to assist in bringing about the things being imagined. As an example of imagery used in the treatment of ulcerative colitis, a patient would be asked to imagine what her distressed colon looks like. If she were to imagine it as a tunnel, with very red, inflamed walls that are rough in texture, then she would be encouraged in hypnosis (and also in self-hypnosis) to imagine this image changing into a healthy one (Hilgard, 1968; Hammond, 1990; Kappas, 2001; Harris, 2005).

Presenting Suggestions A second basic hypnotic method is to present ideas or suggestions to the patient. In a state of concentrated attention (unlike meditation, where the mind is unfocused or “still”), ideas and suggestions that are compatible with what the patient wants have a more powerful impact on the mind. The key, though, is to first ascertain cognitively exactly what the patient wants before attempting to use suggestions. It is also critically important to use language that is compatible with the language the patient uses to ensure that the suggestions are effective (Hammond, 1990; Kappas, 2001; Rainville & Hofbauer, 2002; Raz & Fan, 2005).

Neurolinguistic Programming , or NLP, is the study of the effects of language on the brain, and takes into account the manner in which a person creates sensory representations when examining the language patterns to which the individual is most sensitive or responsive. NLP divides sensory awareness into three main systems: visual, auditory and kinesthetic. Thus, visual people will create representational systems that are more two-dimensional, reliant on color, brightness, shape and focus. Auditory people will create primary sensory representations with sound images, such as vibratory character, volume, timbre, and pitch. Kinesthetic people create sensory representations around feelings, textures, temperature, smell, taste, and so on (Dilts & Grinder, 1980).

Words matching these representational systems must be used for suggestions to be effective. (Dilts & Grinder, 1980; Kappas, 2001). Thus, if a visual person seeks calm, then words that match visually soothing images must be used for the visual person to understand and accept the suggestion while under hypnosis. “Look above and see a clear, blue sky, with fluffy white clouds passing slowly by” would affect a visual person far more than to suggest, “Listen to the sound of a crystal bell, ringing in the distance” (Dilts & Grinder, 1980).

Unconscious Exploration Hypnosis is also used for unconscious exploration, to better understand underlying motivations or identify whether past events or experiences are associated with the cause of a problem. Hypnosis avoids the critical censor of the conscious mind, which often defeats what we know to be in our best interests. The effectiveness of hypnosis in this application comes from the way in which it bypasses the critical observation and interference of the conscious mind, allowing the client’s intentions for change to take effect (Hilgard, 1968; Hammond, 1990; Kappas 2001).

Self-Hypnosis With training and practice, people can continue and enhance the experience of the therapeutic hypnosis by using self-suggestions after entering the state of hypnosis on their own. Patients can manage pain, anxiety, fatigue and improve concentration by using simple breath techniques and counting, while setting an intention for the self-hypnosis session (Hilgard, 1968; Hammond, 1990; Kappas, 2001; Harris, 2005).

Discussion

All people experience various states of what is called hypnosis, where the attention is focused and the generalized responsiveness to external stimuli is diverted or altered. Anyone who has driven safely home from work and not realized how he got there was operating under the primary influence of his subconscious mind, and therefore in a hypnotic state (Kappas, 2001). The suggestibility to being hypnotized by another, called “hetero-hypnosis” varies greatly among people, with some people achieving greater depth states than others. This is partly because of individual traits, but also because the skill of practitioners varies, and the use of specific language is critically important to the outcome of a hypnotic session (Hilgard, 1968; Hammond, 1990; Kosslyn & Thompson, 2000; Kappas, 2001).

Stage hypnosis, with its flamboyance and reliance on the use on pre-chosen or exhibitionistic volunteers, has harmed the perception of hypnosis as a therapeutic tool. Therapeutic hypnosis practitioners spend a great deal of time explaining and reassuring potential clients that they will not be harmed, they will not be forced to do anything that will embarrass them, nor will they reveal deep secrets that they would otherwise never tell. Like any modality, hypnosis can be more effective on some than on others, and the careful choice must be made for suitability and appropriateness before treatment. It is not magic. It is not miraculous. It is not even therapy. It is a tool that can be used in conjunction with other healing and therapeutic modalities to improve well-being, increase awareness and insight, and to give both patient and practitioner another means to reach the goal of better health (Hilgard, 1968; Dilts & Grinder, 1980; Hammond, 1990; Kappas, 2001; Rainville & Hofbauer, 2002; Harris, 2005; Raz & Fan, 2005).