Hypnotherapy
Hypnotherapy is a therapeutic technique that involves inducing a hypnotic state, characterized by heightened focus and deep relaxation, to facilitate positive changes in a person's thoughts, feelings, and behaviors. This state is distinct from both sleep and normal wakefulness, allowing individuals to be more open to suggestions from the hypnotherapist. Common applications of hypnotherapy include managing anxiety, reducing pain, assisting with addictions, and addressing sleep disorders, although the scientific evidence supporting its effectiveness varies and is often inconsistent.
Sessions typically last between 30 to 60 minutes and may include teaching self-hypnosis techniques to reinforce treatment benefits. While recognized by professional organizations such as the American Psychological Association, the effectiveness of hypnotherapy can be challenging to evaluate due to the complexities of placebo effects and study design. Safety concerns are generally minimal when conducted by a licensed practitioner, though the potential for ethical misuse exists, highlighting the importance of selecting a qualified therapist. Overall, hypnotherapy presents a unique approach within the broader field of psychological therapies, offering potential benefits for various conditions, albeit with a need for further research and validation.
Hypnotherapy
Definition: Technique involving hypnosis to produce a therapeutic benefit.
Principal proposed uses: Cancer treatment (reducing side effects), surgery support, warts
Other proposed uses: Asthma, burn injury (reducing pain), fibromyalgia, hay fever, irritable bowel syndrome, labor and delivery, nocturnal enuresis, psoriasis, smoking cessation, tension and other forms of headache, weight loss
Overview
Hypnotherapy is a poorly understood technique that has multiple definitions, descriptions, and forms. It is generally agreed that the hypnotic state is different from both sleep and ordinary wakefulness, but just exactly what it consists of remains unclear. Hypnosis is sometimes described as a form of heightened attention combined with deep relaxation, uncritical openness, and voluntarily lowered resistance to suggestion. Thus, one might say that when a person watches an engrossing film and allows himself or herself to surrender to it as if it were reality, then that person is undergoing something indistinguishable from hypnosis.
In therapeutic hypnosis, the hypnotherapist uses one of several techniques to induce a hypnotic state. The best-known (but dated) technique is the swinging watch accompanied by the suggestion to fall asleep. Such “fixed gaze” hypnosis is no longer the mainstay.
More often, hypnotists use progressive relaxation methods. Other methods include mental misdirection (as when a person is fooled during a suspenseful film) and deliberate mental confusion. The net effect is the same; the person being hypnotized is in a state of heightened willingness to accept outside suggestions.
Once the person is in this state, the hypnotherapist can make a suggestion aimed at producing therapeutic benefit. At its most straightforward, this involves direct affirmation of the desired health benefit, such as, “You are now relaxing the muscles of your neck, and you will keep them relaxed.” Indirect or paradoxical suggestions may be used, too, especially in schools of hypnotherapy, such as Ericksonian hypnosis and neurolinguistic programming. It is also possible to learn to give oneself suggestions by inducing a state of hypnosis; this is called self-hypnosis.
Uses and Applications
Hypnotherapy is commonly used for the treatment of addictions and for reducing fear and anxiety surrounding stressful situations, such as surgery or severe illness. Other relatively common uses for hypnotherapy include insomnia, childbirth, pain control in general, and nocturnal enuresis (bed-wetting). However, the evidence that hypnotherapy is effective for these uses remains incomplete at best.
Scientific Evidence
It is more difficult to ascertain the effectiveness of a therapy like hypnosis than a drug or a pill for one simple reason: it is difficult to design a proper double-blind, placebo-controlled study of this therapy. Researchers studying the herb St. John’s wort, for example, can use placebo pills that are indistinguishable from the real thing. However, it is difficult to conceive of a form of placebo hypnosis that cannot be detected as such by both practitioners and participants. For this reason, all studies of hypnosis have made various compromises to the double-blind design. Some studies randomly assigned participants to receive either hypnosis or no treatment. In the best of these studies, results were rated by examiners who did not know which participants were in which group (in other words, the examiners were blinded observers). However, it is not clear whether benefits reported in such studies come from hypnosis or less specific factors, such as mere attention.
Other studies have compared hypnosis with various psychological techniques, including relaxation therapy and cognitive psychotherapy. However, the same issues arise when trying to study these latter therapies as with hypnosis, and the results of a study that compares an unproven treatment to an unproven treatment are not meaningful.
In some studies, participants were allowed to choose whether they received hypnosis or some other therapy. Such nonrandomized studies are highly unreliable; the people who chose hypnosis, for example, might have been different in another way.
Even less meaningful studies of hypnotism simply involved giving people hypnosis and monitoring them to see whether they improved. Studies of this type have been used to support the use of hypnotherapy for hundreds of medical conditions. However, for many reasons, such open-label trials prove nothing.
In studies of most medical therapies, researchers must be sure to eliminate the possibility of a placebo effect. This concern, however, loses its relevance when hypnotism is in question. It is not a criticism of a study on hypnosis if an observed benefit turns out to be caused by the power of suggestion. After all, hypnosis consists precisely of the power of suggestion. (The placebo effect is only one of many problems with open-label studies, however.) Given these caveats, this article discusses what science knows about the medical benefits of hypnotherapy.
Possible benefits of hypnotherapy. A minimum of twenty controlled studies, enrolling more than fifteen hundred people in total, evaluated the potential benefit of hypnosis for people undergoing surgery. The combined results of the studies suggest that hypnosis may provide benefits both during and after surgery, benefits including reducing anxiety, pain, and nausea; normalizing blood pressure and heart rate; minimizing blood loss; speeding recovery; and shortening hospitalization. Many of these studies, however, were of poor quality. Even so, it is important to consider using hypnotherapy as a safe form of treatment following surgery, especially as rates of opioid abuse and addiction have skyrocketed during the early twenty-first century.
Hypnosis has also shown some promise for reducing nausea, pain, and anxiety in adults and children undergoing treatment for cancer. It also may be useful in persons with breast cancer who also have hot flashes.
Numerous anecdotal reports suggest that warts can sometimes disappear in response to suggestion. In three controlled studies enrolling a total of 180 people with warts, the use of hypnosis showed superior results compared to no treatment. In one of these studies, hypnosis also was superior to salicylic acid (a standard treatment for warts). In that trial, hypnosis also was better than fake salicylic acid, hinting that the power of suggestion is greater with hypnosis than with an ordinary placebo.
Many smokers have tried hypnotherapy to break their addiction. While hypnotherapy benefits some smokers, it does not appear to be superior to other methods. In a review of nine studies, researchers found no consistent evidence that hypnotherapy was better than fourteen other interventions for nicotine addiction. Also, a later trial found that, when combined with a nicotine patch, hypnotherapy was no better than cognitive behavioral therapy.
Other conditions for which hypnosis has shown promise in controlled trials include the following: asthma, burn injury (reducing pain), fibromyalgia, hay fever, irritable bowel syndrome, gynecologic procedures, nocturnal enuresis, chest pain of unknown cause (unrelated to the heart), peptic ulcers, psoriasis, pain associated with diagnostic procedures, tension headache and other forms of headache, and vertigo and headache caused by head injury. However, the quality of many of the supporting studies was poor, and their results were frequently inconsistent.
Hypnosis is particularly popular as an aid to weight loss. However, a careful analysis of published studies shows that hypnosis is not effective for this condition; at best, the evidence points toward only a marginal benefit.
A common form of hypnosis used in labor and natural delivery is known as hypnobirthing, or the Mongan method, for its creator, Marie Mongan. Following the hypnobirthing curriculum, instructors teach expectant mothers visualization, meditative, and breathing techniques, so they can reach or be brought to a deeply relaxed, hypnotic state to reduce fear and anxiety and to manage pain. It may be used alone or with other pain management methods, from Lamaze breathing to epidural anesthetic medication. Hypnosis for childbirth has shown mixed results in clinical trials. A 2016 systematic literature review of nine trials found a link between childbirth hypnosis and lower rates of analgesic use but little difference in the rates of spontaneous vaginal births, epidural use, maternal satisfaction with pain control, or coping levels. The evidence for those outcomes was weak, however, and all but one study evaluated women who attended hypnosis training sessions in the first or second trimester of pregnancy. None of the studies examined the hypnobirthing curriculum specifically. While proponents of hypnobirthing continued to cite research highlighting the benefits of elements of the method, such as deep breathing, self-hypnosis, and meditation, many experts emphasized that, especially as it was studied further, women should balance adhering to the method with following medical advice during delivery.
What to Expect during Treatment
Hypnotherapy sessions usually last thirty to sixty minutes. They typically involve some questions and answers, followed by the hypnosis itself. Some hypnotists teach their clients self-hypnosis so they can reinforce the formal session.
Choosing a Practitioner
As with all medical therapies, it is best to choose a licensed practitioner in states where a hypnotherapy license is available. Where licensure is not available, one should seek a referral from a qualified and knowledgeable medical provider. Some experts in the psychological field have advised that it would be beneficial for people seeking treatment in the form of hypnotherapy to choose a licensed psychiatrist or psychologist who has also received licensed training in hypnotherapy so that it can be applied in combination with other methods, such as cognitive behavioral therapy. For these experts, it is important for hypnotherapy to be seen as a supplemental therapy so that patients can potentially benefit from multiple approaches, particularly for those who are considered less hypnotically suggestible. It is important to note that the American Psychological Association and the American Medical Association have recognized hypnotherapy as a valid medical procedure since the 1950s. Since the late 1990s, the National Institutes of Health has recognized hypnotherapy as a valid treatment for chronic pain.
Safety Issues
In the hands of a competent practitioner, hypnotherapy should present no more risks than any other form of psychotherapy. These risks might include worsening of the original problem and temporary fluctuations in mood.
Contrary to various works of fiction, hypnosis does not give the hypnotist absolute power over his or her subject. However, as with all forms of psychotherapy, the hypnotherapist does gain some power over the client through the client’s trust; an unethical therapist can abuse this power.
Bibliography
Abbot, N. C., L. F. Stead, and A. R. White. “Hypnotherapy for Smoking Cessation.” Cochrane Database of Systematic Reviews (2000): CD001008. Available through EBSCO DynaMed Systematic Literature Surveillance at http://www.ebscohost.com/dynamed.
Carmody, T. P., et al. “Hypnosis for Smoking Cessation.” Nicotine and Tobacco Research 10 (2008): 811-818.
Elkins, G., et al. “Randomized Trial of a Hypnosis Intervention for Treatment of Hot Flashes among Breast Cancer Survivors.” Journal of Clinical Oncology 26 (2008): 5022-5026.
Heid, Markham. "Is Hypnosis Real? Here's What Science Says." Time, 4 Sept. 2018, time.com/5380312/is-hypnosis-real-science/. Accessed 4 May 2020.
“Hypnosis: What It Is, Why It's Done, Benefits & Risks.” Cleveland Clinic, 1 Apr. 2022, my.clevelandclinic.org/health/treatments/22676-hypnosis. Accessed 16 Aug. 2023.
“Hypnotherapy.” Psychology Today, 7 Nov. 2022, www.psychologytoday.com/us/therapy-types/hypnotherapy. Accessed 16 Aug. 2023.
Jones, H., et al. “Treatment of Non-Cardiac Chest Pain.” Gut 55 (2006): 1403-1408.
Langewitz, W., et al. “Effect of Self-Hypnosis on Hay Fever Symptoms.” Psychotherapy and Psychosomatics 74 (2005): 165-172.
Madden, K., et al. "Hypnosis for Pain Management during Labour and Childbirth." Cochrane, 19 May 2016, www.cochrane.org/CD009356/PREG‗hypnosis-pain-management-during-labour-and-childbirth. Accessed 20 Feb. 2018.
Marc, I., et al. “Hypnotic Analgesia Intervention during First-Trimester Pregnancy Termination.” American Journal of Obstetrics and Gynecology 199 (2008): 469.
Richardson, J., et al. “Hypnosis for Nausea and Vomiting in Cancer Chemotherapy.” European Journal of Cancer Care 16 (2007): 402-412.
Slack, D., et al. “The Feasibility of Hypnotic Analgesia in Ameliorating Pain and Anxiety among Adults Undergoing Needle Electromyography.” American Journal of Physical Medicine and Rehabilitation 88 (2009): 21-29.
Sutton, Jeremy. "Does Hypnotherapy Really Work? 10+ Scientific Findings." Positive Psychology, 28 Feb. 2022, positivepsychology.com/hypnotherapy/. Accessed 2 May 2022.
Varner, Corry A. “Comparison of the Bradley Method and HypnoBirthing Childbirth Education Classes.” The Journal of Perinatal Education, vol. 24, no. 2, 2015, pp. 128–36. PMC, www.ncbi.nlm.nih.gov/pmc/articles/PMC4744344/. Accessed 20 Feb. 2018.