Hypnotherapy
‘Ah, hypnosis? No thanks.’ ‘I’m sceptical. It’s an old wives’ tale.’ Or ‘I’m scared. What do you mean, you’re going to mess with my brain?’
There is a great deal of speculation about hypnosis in public discourse, Hollywood films and the mass media. As a result, the word is widely familiar, while people generally know very little about the phenomenon itself, and what they do know often bears little resemblance to reality. Hypnosis has acquired an air of mystery and somehow come to seem ‘scary’. This makes some people sceptical about using it and others openly anxious about it.
Why hypnotherapy?
The use of hypnosis for clinical purposes is called hypnotherapy. There is solid scientific evidence for the method from more than 200 statistical studies and from other forms of research, such as functional magnetic resonance imaging (fMRI). It has been found to be effective, with exceptionally good results in pain relief and in treating anxiety disorders, addictions and other problems. The average course of therapy is shorter than with almost any other method. Combining traditional cognitive behavioural therapy with hypnotherapy produces results in fewer sessions, on average, than cognitive behavioural therapy alone.
As well as being highly effective, the method is also very pleasant. Hypnosis is a controlled state of trance, and the trance itself is pleasant, relaxing and therapeutic.
It is telling that Stanford University, one of the leading centres for mental health research, studies and uses hypnotherapy under the leadership of Dr David Spiegel.
Hypnosis — myths and facts
There are many widespread myths about hypnosis. They range from how hypnosis is induced and who can induce it to what happens during and after a trance.
There are two conflicting myths about how people enter hypnosis.
The first says that a hypnotist can put someone into hypnosis however and whenever they like, for example with a look, even against the person’s will. In reality, a person needs to agree to enter hypnosis. We could hardly have evolved to be so helplessly susceptible to another person’s will. Yes, people can manipulate us, but we are also very sensitive to it. If we realise someone is trying to manipulate us, we become extremely wary and may avoid them or even become aggressive towards them. The same applies to hypnotic induction. Even if we somehow managed, with great difficulty, to induce a brief, light trance in someone against their will, the most we would achieve would be to make them deeply uncomfortable. They might even start avoiding us. In hypnotherapy, though, this is out of the question. The hypnotist and the person being hypnotised are allies working towards shared goals, which are the goals of the person being hypnotised. The client or patient enters hypnosis willingly and, generally speaking, goes as deep as they wish.
At the opposite extreme is the idea that induction must follow a precise procedure, such as swinging a watch in front of someone’s eyes. In fact, there are many ways to induce hypnosis, even simply by telling a story. The principles are to make use of what is happening in the moment and to draw on the person’s own experience, history, language and goals.
Another myth is that people completely lose control of their actions once they enter a trance. The idea is that a hypnotist could plant extreme suggestions that go against their interests and values, such as revealing a closely guarded secret, transferring money to the hypnotist or killing the president. The same reasoning applies here as with induction. We are far less helpless in the face of someone else’s will or suggestions than the myth implies. If the therapist said something absurd during a trance, such as ‘You’re going to go and kill the president’, the person would be so taken aback that they would come out of the trance and, at the very least, probably never set foot in that therapist’s office again. Once hypnosis has been induced, imagery and experiential techniques are used to pursue the patient’s own goals. The patient is motivated to achieve them, which is also why they are willing to enter a trance.
A related myth is that a person might simply stay in hypnosis and carry on walking around and doing things. This is far from reality. In hypnosis, people almost always remain still and silent and have no desire to speak or move. If the agreed plan and technique call for some conversation with the patient, this is made explicit, and the hypnotist takes care to help the person stay in trance while speaking. Without the client’s motivation and the therapist’s effort, speaking and moving tend to bring a person out of trance.
There is also a myth that people remember nothing after hypnosis. It is possible to forget suggestions and images that arose during a hypnotic trance, but this is uncommon. The client and hypnotist can agree that the hypnotist will suggest that the client remember them. Even if the client cannot recall exactly what the therapist said, they are clearly aware that they did not fall asleep and that they heard everything. They remember just as clearly that they stayed still and did not speak. The fantasies and images themselves, along with the therapist’s words, can feel hazy, like a dream, and may even fade altogether.
In my practice, I have also come across a vague fear that simply entering hypnosis might somehow harm you. Trance itself has a therapeutic effect, as does the closely related state of sleep. Especially with the right suggestions, people usually feel extremely well and rested after hypnosis. If the idea is that I can go in and directly ‘tinker with’ someone’s software, meaning how they think, feel and act, that is possible to the extent that the person is motivated to make those changes willingly. Suggestions are often quite open-ended, leaving a great deal to the patient’s own unconscious mind, experiences, fantasies, memories and thoughts.
There is also a belief that you might get stuck in a trance. ‘What happens if you suddenly leave or have a heart attack?’ Well, nothing particularly unusual. There are two possibilities. You either come out of the trance on your own, or you fall asleep and wake up out of trance. I sincerely hope I don’t have a heart attack, and it seems highly unlikely that it would happen during a hypnotherapy session.
Does hypnosis work?
One last myth is worth mentioning, and it goes in the opposite direction from the others. While those myths portray hypnosis as so powerful that it must be dangerous, another version dismisses hypnotherapy as old-fashioned quackery and doubts its value as a serious intervention.
Hypnotherapy traces its origins to the practices of Franz Mesmer, which were later discredited. Given the state of medicine in Mesmer’s time, though, simply staying away from the doctor was a good idea. Often, the doctor’s only intervention was to bleed the patient. Choosing mesmerism over medicine in those days may actually have improved a person’s chances of recovery.
As I mentioned earlier, a number of studies have examined the effectiveness of modern hypnotherapy. In my own practice, I have seen a single session produce remarkable results, which is extremely rewarding for both the person undergoing hypnosis and me.
What happens during hypnosis?
And so we come to what actually happens during hypnosis.
The session begins with induction, followed by deepening. The therapist uses a range of techniques to help the person enter a trance and deepen it. These may include counting, imagery and other techniques.
Several phenomena are typical of trance. Researchers at Stanford University have linked them to specific patterns of brain activity.
The first is a shift of attention towards the inner world, with reduced or absent awareness of the outside world. Thoughts about what might happen later, worries and even thoughts about what is happening right now begin to fade. This is largely due to reduced activity in the dorsal anterior cingulate cortex, a brain region that plays an important role in directing attention according to the context or situation. Functional MRI studies have identified this reduction in activity. Research has also found greater activity of GABA, a calming neurotransmitter, in this region in people who are more hypnotisable. The overall effect is that they can disengage more easily from their surroundings, pay less attention to what is happening around them and turn their attention inward or towards what they are imagining.
What matters most is increased cognitive flexibility, or suggestibility. This is the ability to approach an old event in a new way and see it differently, with an open mind and without judging it. The same can apply to a harmful habit or behaviour. A person can see harmful patterns of behaviour in all their emotional complexity and experience new behaviours that could take their place. Cognitive flexibility is, in fact, enormously important in every therapeutic approach.
The third phenomenon is a distancing from the ego, from one’s sense of who one is and what a particular behaviour says about one’s identity. This is extremely important for cognitive flexibility and for developing new ways of thinking and behaving. The second and third phenomena are most likely linked to inverse functional connectivity between two brain regions. When one is active, the other is less active. The first is the dorsolateral prefrontal cortex, which plays a major role in executive functions such as willpower, attention and working memory. Its increased activity occurs alongside reduced activity in the posterior cingulate cortex, a region that is active when we think about who we are and what our actions mean for our self-image. Its activity decreases during both meditation and hypnosis, leading to a meditative distancing from the self, or dissociation. You experience something without evaluating it or thinking about what it says about you. This increases cognitive flexibility. If you think, for example, ‘Someone like me doesn’t do that sort of thing’, you may stop yourself from trying it. This flexibility may help even if your usual view is ‘Someone like me doesn’t take hypnosis seriously’. It also explains why children are highly hypnotisable. Everything is play to them, they exercise less control over what is happening, and their sense of self is still developing. When this changes, hypnotisability declines and remains stable from early adulthood into old age.
Another important phenomenon is increased conscious control over bodily functions. For example, this allows us to experience stressful past or imagined events while the body remains calm. It changes how we relate to those events, allowing us to see them as something in the past that no longer bears on the present. It also helps with pain control. This phenomenon is due to stronger functional connectivity between the left side of the dorsolateral prefrontal cortex mentioned above, which plays an important role in executive functions, and the insula, which helps the brain regulate bodily functions. In other words, activity in these regions is more closely coordinated. The result is greater conscious control over what happens in our bodies.
Combining hypnotherapy with cognitive behavioural therapy and schema therapy
Hypnotherapy lends itself particularly well to being combined with other methods.
Combining it with cognitive behavioural therapy (CBT) is almost a natural fit. In the early sessions of CBT, we develop a formulation of what is happening for the patient. The formulation connects the person and their current difficulties and helps explain why this is happening to this particular person at this particular time. It also shows how vicious circles of thoughts, emotions and behaviours can keep the problem or disorder going and make it worse.
Once people become aware of these thoughts, emotions and behaviours, they can work on changing them in hypnosis. Hypnosis can also be used for desensitisation in anxiety disorders, whether the fear is of germs, public speaking, spiders, heights or whatever else comes to mind.
Schema therapy also uses a formulation, approaching the problem through the lens of a different therapeutic method. It makes extensive use of imagery techniques, in which the person re-experiences distressing events in a new way, with someone there to support them. The memory itself stays the same, but the way the person relates to it and to the marks it has left changes substantially. These imagery techniques can also be used after inducing a trance, which naturally strengthens their effect.
Няколко заключителни думи
The message is clear. Hypnotherapy is a highly effective method and lends itself well to being combined with other therapeutic approaches. Using trance to change thoughts, behaviours or the way we relate to memories is both useful and very pleasant. The results are rapid and surprisingly good.
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