What is hypnotherapy?

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 the 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.

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, labor and delivery and other 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.

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.

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.

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.

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.