Therapeutic Hypnosis

Updated: Sep 20, 2017
  • Author: Jeffrey S Forrest, MD; Chief Editor: Glen L Xiong, MD  more...
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Overview

Overview

Psychiatrists and psychologists use hypnosis to treat a variety of conditions, including generalized anxiety disorder, phobias (simple, social, performance anxiety), panic disorder, pain, irritable bowel syndrome, and certain dermatological disorders. Therapeutic hypnosis may also be used to aid in smoking cessation or weight loss.

Indications

Cognitive behavior therapy with exposure to the feared situation is typically the therapy of choice for phobias. [1] However, hypnosis has been used in the treatment of various phobias including simple phobia, social phobias, and performance anxiety. Hypnosis can reduce symptoms of anxiety by inducing a more tranquil state that is associated with the induction technique. Additionally, hypnosis has been shown to augment patient’s resilience when dealing with stressful situations and decreasing avoidance behavior. [2, 3, 4, 5, 6, 7]

Various meta-analyses have pointed to hypnosis as an adjunct therapy for smoking cessation, with reinforcement by regular contact with medical professionals and counselors as an integral part of the treatment. [8] Although hypnosis is not a definitive treatment, it has been successfully used as an adjunct treatment. [9] However, in some studies hypnosis was not found to be more effective than cessation trials without hypnosis. [10]

Some meta-analyses have indicated that hypnosis may enhance weight loss. Patient undergoing cognitive-behavioral therapy for weight loss were compared to patients undergoing similar therapy with the addition of hypnosis, with favorable results reported for 70% of the patients receiving hypnotic therapy. Mean weight loss was 6.03 lbs for patients not receiving hypnosis and 14.88 lbs for patients receiving hypnosis. Further correlational analyses indicated that the benefits of hypnosis for weight loss increase over time. [11, 12, 13, 14]

According to one meta-analysis, hypnotic suggestions relieved pain in 75% of 933 subjects participating in 27 different experiments. The pain relief from hypnosis often matched or even exceeded the relief given by morphine. [15] Another study showed that participants who were highly suggestible received the greatest benefit from reduction in pain when compared to placebo. A participant’s responsiveness to suggestion was the primary determining factor in the extent of pain reduction. [16]

One of the most studied uses of hypnosis in medicine is the treatment of irritable bowel syndrome. Treatment methods typically consist of medication and dietary changes, but the addition of hypnosis has been shown to decrease and even eliminate symptoms. Palsson et al. showed that hypnosis benefitted patients suffering from irritable bowel syndrome for at least 10 months. Initially, imagery directed at reducing pain was used, but the authors found that hypnosis alone gave patients the most benefit. [17]  Hypnosis has further been demonstrated to be effective for irritable bowel syndrome for patients when conventional treatment approaches have proven ineffective or insufficient. There is evidence that even patients that are less susceptible to hypnosis than others may benefit from hyphnotherapy interventions. Benefits of hypnotherapy in irritable bowel syndrome include symptom attenuation and even remission. In some instances, symptom improvement has continued even after a hypnotherapy intervention has concluded. [22]

Some studies have shown that hypnosis can be used as an adjunct treatment for various skin conditions, including alopecia areata and psoriasis. These studies had a limited number of participants but showed that hypnosis therapy could help alleviate stress in patients suffering from dermatological conditions. The patients were broken into two groups, with one group receiving active suggestions and another receiving hypnosis. Patients who were shown to be highly hypnotizable displayed greater improvement than moderately hypnotizable patients, regardless of which modality of treatment was used. [3, 18, 19]

Hypnosis has been demonstrated in randomized clinical trials to be effective in treating sleep impairment in patients with posttraumatic stress disorder (PTSD). Improvements in sleep performace have then been noted to result in corresponding reduction of depression and PTSD symptoms after subsequent interventions such as cognitive processing therapy (CPT). However, hypnosis has not been demonstrated to assist PTSD symptoms as a standalone intervention. [21]

Another consistently documented application of hypnotherapy is its potential role in palliative care. Hypnotherapy has been demonstrated to assist in symptom control, stress reduction for patients and caregivers, and overall quality of life improvement. Numerous studies have suggested that hypnotherapy should not be delayed for appropriate qualified palliative care patients when such an intervention is available. [23]

Contraindications

When evaluating a patient for potential hypnosis, it is important to consider possible contraindications, including the emotional state of the patient and the desired outcome. Cooperation is an essential element for effective hypnosis. If an individual is uncooperative or hostile, hypnosis may not be the best treatment option. Additionally, some patients will not be able to be hypnotized due to brain trauma or cognitive deficits. In these cases, hypnosis is contraindicated.

The use of hypnosis is generally not advisable for patients with borderline personality disorder, dependent personality disorder, or psychosis. For patients with borderline personality disorder or dependent personality disorder, there is a risk that the patient will want to form intense or inappropriate relationships or interactions with the practitioner. Perhaps the most important concern is that hypnosis could exacerbate a pre-existing psychosis. Therefore, hypnosis is contraindicated for a patient displaying signs of psychosis.

Technical Considerations

An abreaction is a negative response that can occur at any time during hypnosis. It is sometimes caused by unpleasant or uncomfortable memories that are brought into awareness during hypnosis. Some practitioners of hypnosis use abreactions as part of the therapy; others seek to limit these experiences. An abreaction is often an uncomfortable situation that may be followed by crying or angry outbursts. Addressing the concerns of the participant by acknowledging the abreaction is often the safest way to deal with the situation.

Many myths are associated with hypnosis, including that people lose control while in a hypnotic state and that they can become “stuck” in a trance. Hypnosis is a voluntary act and patients are always in control of their actions. For example, if a practitioner suggests something that is not agreeable to a patient, the patient will not do it. In addition, hypnosis is not a permanent condition; it usually ends as soon as the practitioner starts the termination process. However, a patient can end the hypnotic state at any time he or she chooses.

Next:

Technique

Approach Considerations

Before hypnotherapy can begin, a detailed clinical history should be obtained to identify dysfunctional behavior patterns. After the history is obtained, a case formulation should be developed for an effective treatment plan.

An eight-step case formulation can be organized as follows:

  1. List the major symptoms and problems in functioning
  2. Formulate a formal psychiatric diagnosis
  3. Formulate a working hypothesis
  4. Identify the precipitants and activating situations
  5. Explore the origin of negative beliefs
  6. Summarize the working hypothesis
  7. Outline the treatment plan
  8. Identify strengths and assets and predict obstacles to treatment

Hypnotic Induction

Hypnosis is usually initiated using a technique known as hypnotic induction, which is usually composed of a long series of instructions and suggestions. Rapid induction is a technique that uses instructions but is typically delivered in less than 2 minutes. These instructions can be delivered by the hypnotist or can be self-administered by the subject. Although different types of induction exist, the following five techniques are most commonly used in practice.

Four-step induction

Four-step induction is a type of rapid induction that can also be applied in self-hypnosis. It is a common technique that can be applied to many patients.

The following is a typical script for four-step induction [20] :

  1. "When you are ready, close your eyes."
  2. "Now engage your imagination. Imagine that your eyes will not open and or that they are even glued closed."
  3. "While pretending you cannot open your eyes, try to open them and you will find that they are difficult to open."
  4. "Finally, relax your eyes and allow the feeling of relaxation go throughout your body."

Eye-fixation technique

Another basic induction technique involves having the subject fixate their gaze on a specific stimulus, such as a spot on the ceiling or wall, a light source, or another object. While the subject stares at the stimulus, the therapist encourages the subject to become aware of his or her eyes becoming relaxed and tired. The subject should want to close his or her eyes and become very relaxed.

The following is a typical script for the eye-fixation technique [3] :

"Make yourself comfortable in the chair. Choose a spot on the wall and fixate your eyes on it. Do not move your gaze from the spot; just focus on that location. Let yourself become limp and slack; relax as much as you are able. Gradually, you will begin to feel your eyes becoming tired and your eyelids heavy. If you feel your eyelids need to blink, let them blink as needed. Soon the blinking will become slower; your eyelids will become heavier and want to close. As your eyes want to close, let them close tighter and tighter, letting yourself drift off into a relaxed state."

Arm-drop technique

In the arm-drop technique, one of the subject’s arms is held horizontally to the ground. The hand is held vertically so that the subject can look at the back of the hand.

The following is a typical script for the arm-drop technique [20] :

"Stare at one of the fingers on the hand or the thumb and fix your gaze so that the other fingers go out of focus. As you continue to stare at your finger, you will notice your arm becoming heavier and beginning to drift downward. As you follow the finger down, you will notice yourself becoming more relaxed and your eyelids beginning to get heavy. As your arm gets heavier and heavier and finally reaches your lap, your eyes can close."

Progressive relaxation technique

The progressive relaxation technique is sometimes used if prior techniques have failed to work. In this case, the technique leaves the burden of induction on the subject as it is purely physical in nature.

The following is a typical script for the progressive relaxation technique [20] :

"Make yourself comfortable and take a few breaths. As you breathe in and out, you notice that you become more relaxed. As each breath leaves your body, you will become more and more relaxed. Concentrate on the feet and move slowly up the body, feeling the relaxation spread upward through your body."

Imagery

Imagery involves creating a scene in which the subject feels safe and relaxed. This procedure is often initiated before the induction starts to lay the groundwork of the image or special place. It is often common for the description of the image to change as the induction progresses.

The following is a typical script for imagery [3] :

"Think about a place where you would like to be. You can close your eyes or leave them open. Now take some deep breaths and slowly let them out. With each breath, you will feel more relaxed and you will be in your favorite place. You will feel comfortable and safe. The longer you stay in this place, the more relaxed you will become."

Deepening of Hypnosis

Once the subject has been induced, the hypnotic state can be increased by techniques to increase the hypnotic depth. By increasing the depth of the hypnotic state, the subject is sometimes more likely to respond to suggestions and treatment. External distractions, the amount of time set aside for hypnosis, and motivation on the part of the subject can influence the effectiveness of deepening techniques. It should be noted that many of the techniques used for induction can be used to increase the depth of the hypnosis. Some techniques include the following [20, 3] :

  1. Progressive relaxation
  2. Visual imagery
  3. Periods of silence
  4. Breathing and counting
  5. Counting

Posthypnotic Suggestions

A common practice is to place posthypnotic suggestions before terminating the hypnotic session. The suggestions are given to counter problems with behavior, to help with smoking cessation, or to help manage pain symptoms. These positive or negative reinforcements are a type of conditioning to help achieve the desired behavior.

The following is an example of a posthypnotic suggestion [20] :

"After this treatment, you will become less preoccupied with smoking cigarettes and your cravings for nicotine will diminish."

Termination

The most common method of terminating hypnosis is to count from either 1 to 5 or vice versa; the choice is completely arbitrary.

The following is a typical script for termination [20] :

"When I count down from 5 to 1, you will open your eyes and be alert without feeling tired or drowsy."

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