Is it really possible to reduce anxiety, sleep better and stop overeating just by relaxing and letting a therapist lull you off to “sleep”?
Join us as we speak with experts about how hypnotherapy works and which chronic conditions it’s been shown to treat. You’ll learn about studies proving its effectiveness, where you can find a trusted hypnotherapy practitioner and why some medical professionals still don’t support hypnosis as a treatment.
As always, our expert guests answer questions from the audience.
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Rick Turner:
Hello and welcome to Health Now. I’m your host, Rick Turner, filling in for Judy Foreman.
Is it really possible to reduce anxiety, sleep better and stop overeating just by relaxing and letting a therapist lull you off to sleep? Tonight we are going to be talking about how hypnotherapy works, what it’s been proven to treat, and how to find a trusted practitioner.
I’m very pleased to welcome to our program today Dr. David Spiegel. He is associate chair of psychiatry and behavioral sciences at Stanford University School of Medicine, and he is also medical director at the Stanford Center for Integrative Medicine. Dr. Spiegel, welcome.
Dr. David Spiegel:
Thank you very much. Glad to be with you.
Rick:
Let’s jump right in with a definition, Dr. Spiegel. How do you define hypnotherapy?
Dr. Spiegel:
First of all let me say that there is a difference between hypnosis and what’s called hypnotherapy. Hypnosis is a state of highly focused attention with a suspension of peripheral awareness. It’s something like looking through a telephoto lens of a camera. What you see, you see in great detail, but you are less aware of the context. That state of highly focused attention can be used for many therapeutic purposes, and that’s the case in which hypnosis is used in the service of some kind of psychotherapy. But the phenomenon itself is different from the treatment for which it is used.
Rick:
So hypnosis is the state that you achieve?
Dr. Spiegel:
That’s correct.
Rick:
How is hypnosis different from the state that a person could achieve through meditation, for example?
Dr. Spiegel:
I think many people who meditate, particularly those who meditate easily, turn out to be pretty hypnotizable, and I wouldn’t know how to teach someone who is very hypnotizable and meditates not to be in a hypnotic state at the same time. It’s a state of self-altering attention. It seems effortless. You just flow with the state that you are in. People who aren’t hypnotizable who meditate often find it to be more work. It’s more effort. They don’t just naturally slide into it. They have to keep working at it. So clearly when some people meditate if they are hypnotizable, they are probably also in a hypnotic-like state.
Rick:
Let’s address another definition there. A meditative state or hypnosis, are those different from a trance? Is there anything actually called a trance?
Dr. Spiegel:
Yeah, there is. Our textbook on hypnosis, “Trance and Treatments” [defines] the trance state as really an intense hypnotic state of self-altering attention where you get so into the focus of the state that you forget your ordinary surroundings. You separate yourself from everyday preoccupation. Time may go much quicker than you realize, and you tend to respond to suggestions in a relatively uncritical way. You just accept doing them rather than thinking about them. So the trance state is an altered state of consciousness that you can be in if you are experiencing hypnosis and if you happen to be reasonably hypnotizable.
Rick:
When a person undergoes hypnosis and it’s someone else who is hypnotizing them, who is in charge? We have all heard that you can’t really make a hypnotized person do something that he or she would not do otherwise. But is that true?
Dr. Spiegel:
Well, no, not entirely. There is an old saying that it’s a smart hypnotist that knows who is hypnotizing whom. In general the person inducing hypnosis is trying to structure the experience, and the person experiencing it is accepting that structure. On the one hand, you have absolute control. My dad, who is a psychiatrist who has been using hypnosis since World War II, when people asked him, “Can you hypnotize me and make me do anything you want?” he says, “If I had that much power, do you think I would be wasting my time sitting here with you?” It usually converts fear into anger, but it is also the case that people who are in this state of hypnosis are less likely to critically judge and evaluate what’s going on.
We have all had that “it seemed like a good idea at the time” experience. We are all susceptible to social influence. Highly hypnotizable people in a trance state are more susceptible to social influence. So are there situations where people might, under hypnosis, do things they otherwise ordinarily would not do? Yes. And you see that with a group of people I don’t particularly like, which is stage hypnotists.
They will get some big wrestler dancing around like a ballerina making a fool of himself. Ordinarily you would think that he wouldn’t do that. It’s not that there is any magical power or control. It’s that it’s a way of maximizing our social sensitivity in a state in which we are not really thinking through what we are doing. We are just doing it.
Rick:
Is that another way of saying that our inhibitions are lowered?
Dr. Spiegel:
Yes. To some extent that’s right – it’s a way of reducing inhibitions, again just because you are not thinking about it. It’s not that if you thought about it you wouldn’t say, “Why on earth would I do that?” It’s just that you are not in a state of critically judging and evaluating. You are in a state in which the thought tends to lead immediately to action. In that sense you are a little more impulsive. You can be a little more impulsive and a little less inhibited.
Rick:
What about the term “self-hypnosis”? Is that sort of an oxymoron?
Dr. Spiegel:
No, it isn’t actually. Oddly enough, in a sense all hypnosis is really self-hypnosis. That is, when I hypnotize a patient, I am not taking over control. I am not projecting anything on them. I’m helping them really just explore and discover their own hypnotic capacity. I immediately then turn around and teach them how to do that for themselves. So it is entirely possible and most effective to just teach people to enter a state of self-hypnosis and use it for whatever problem it is you are trying to help them with. You don’t need a hypnotist to go into a hypnotic state once you learn how to do it.
Rick:
Let’s talk about the medical uses of hypnotherapy. Are there specific diseases, specific symptoms that it seems to be especially helpful for?
Dr. Spiegel:
Sure. One of the oldest and best accepted uses is for pain control. There was a Scottish surgeon named Esdale who, in the middle of the 19th century, went to India and reported 80 percent surgical anesthesia using hypnosis during amputations. We published a study in The Lancet in the year 2000 with patients undergoing invasive radiological procedures, having catheters inserted into their arteries to their liver or their kidneys, and we were able to reduce their use of medication by 50 percent. They had half the pain despite that, and by the end of two hours virtually no anxiety at all. They had fewer complications, and the procedures took 17 minutes less time on average. So, it can be very effective in reducing pain and anxiety in the medical setting.
Rick:
You mentioned pain and anxiety, and I was going to address those both because I wondered, how can it actually reduce pain? Doesn’t it just work on the anxiety part of it?
Dr. Spiegel:
No, actually not. Interestingly, there are four ways in which hypnosis can literally reduce pain. One is to reduce the way the brain responds to the signal. So, if I tell you if you have got an injured hand, and I tell you your hand is cold and numb, it’s in ice water, you will feel a sense of cool, tingling numbness. We can record in parts of the brain that actually register pain, and they will report significantly less pain signals, not just reaction to the pain, but less.
Another way is altering how people feel about the pain. Does it make you anxious? Are you worried about it? Do you think something terrible is going to happen? You know the difference between a kind of chronic lower back pain you have dealt with for years and a new chest pain. Even if the intensity is the same, hopefully you treat new chest pain very differently – and it usually hurts more just because you are scared you may be having a heart attack.
So you can turn down a different part of the brain called the anterior cingulate gyrus that helps us to focus and pay attention, and there the hypnosis works by reducing how much you are worrying about the pain, not how much pain you are having, although in both cases the pain ratings are reduced.
The third way is just shifting attention. Right now, if you are sitting down, you have got sensations in your bottom touching the chair, but hopefully unless you are really bored, you won’t even notice it. So, all the time, we pay attention to different parts of our brain. Pain tends to hijack attention. We feel we need to pay attention to it all the time, but you know what? Once you have got the message, you don’t necessarily need to continue attending to it.
The fourth way is relaxation. Typically when a part of our body hurts, what do we do? We splint it. We stiffen the muscles around it, and that actually creates more pain because you are pulling on the part of your body that hurts. [With hypnosis] you can induce muscle relaxation. So in those four ways hypnosis can be very effective in reducing pain.
Rick:
How about beyond pain, Dr. Spiegel? Are there other chronic diseases for example that this seems to be especially helpful for?
Dr. Spiegel:
It’s very useful among psychiatric illnesses, things like phobias, airplane phobias. I’m in an airport. There are a lot of people afraid to fly. We can in one session reduce or eliminate airplane phobias in half the people we see. It’s useful in helping people with post-traumatic stress disorder who are having nightmares, flashbacks, irritability, numbing, difficulty coming to terms with a trauma. And it can be very helpful in treating those symptoms as well. It’s useful for problems like irritable bowel syndrome.
Rick:
Really?
Dr. Spiegel:
Yeah, and there have been some good randomized trials that show significant improvement in irritable bowel syndrome in people who used self-hypnosis. It’s useful for habit problems, particularly smoking. After a single session of self-hypnosis, we have shown that half will stop right away, half of them or a quarter of the sample won’t touch a cigarette in two years.
It’s useful for modest weight control. We have shown in a randomized trial that people can take off maybe 20 pounds and keep it off for three months, which is better than you often find with various weight control programs. So it’s not a big adjunct, but it can be helpful for dietary control as well. So those are some of the things we use it for.
Rick:
That’s fascinating. Are there people, Dr. Spiegel, for whom hypnotherapy maybe is not a good idea?
Dr. Spiegel:
You deal with most of them by initially testing their hypnotizability, and if they are not hypnotizable, it’s not a good idea because they just don’t have the ability to use it.
Rick:
It would just be a waste of time?
Dr. Spiegel:
Yes, exactly. But you can learn that in five minutes, which is better than a lot of other treatments where it takes a lot longer to find out they are not likely to benefit from it. There are some people who are psychotic, who have great difficulty with just judging reality who may experience hypnotic induction as taking control of their mind. The easiest way out of that is if they don’t want you to do it, don’t do it.
I had one in one study we were testing hypnotizability of people with schizophrenia, and the psychologist working with me said, “Spiegel, you are testing this guy, not me.” And I said, “Why?” And he said, “He is a paranoid schizophrenic and his core delusion is that his brother-in-law is controlling his mind with hypnosis. I’m not going near him.” So I went and explained the wonders of science to [the patient]. And he said, “Go right ahead, doc. I’ve always wanted to know how that son of a bitch (his brother) does it to me.” And he was not even a little bit hypnotizable.
So, by and large it’s not a problem. The other thing we worry about a little is people with severe suicidal depression who may experience a failure with hypnosis as one more of their many failures. But good clinical judgment helps with that too. So by and large it’s a very benign procedure, and the worst thing that usually happens is it doesn’t work.
Rick:
When it does work, are the effects normally short-term, long-term? Do you have to come back to it and revisit it? How lasting is it?
Dr. Spiegel:
It can last indefinitely if you teach people how to do it for themselves. Some of my patients with more serious and chronic, for example, post-traumatic, psychiatric problems come back for a long time, but a lot of people just get the hang of it, learn to use it, and use it when they are having pain or anxiety or confronting their phobic situation. That they can learn in a couple sessions and do quite well with it on their own, and it can last indefinitely.
Rick:
I understand that you specifically have been using various brain scanning techniques such as PET and MRI to study people while under hypnosis. What is it that you hope to find, and what are you actually finding?
Dr. Spiegel:
We are hoping to document what parts of the brain are involved when people experience hypnotic states and the extent to which the changes that we induce with hypnosis are genuine changes, not just telling the doctor what they think the doctor wants to hear. There have been studies showing, for example, as I mentioned earlier with pain control, that you can reduce the brain’s response to pain stimuli. So if you shock somebody on the wrist and in one condition they just experience it and in another if you tell them your hand is going numb, you can show reduced activity in the parts the brain that process pain or that process anxiety about pain.
We did a PET study (positron emission tomography) where you look at people’s ability to alter color perception. The reason we did that was that my colleague, who was a little skeptical, thought maybe with pain they are just turning the brain down altogether, kind of shutting down. I wanted something where they have to keep paying attention but change what they are looking at. So we had them look at a grid, like a Mondrian painting that was very colorful, and had them drain the color out of it, and in other conditions they looked at a black and white grid and added color to it, and we could show reversible changes in the part of the occipital lobe, the back of the brain, that processes color vision. So I call that my “believing is seeing” experiment. When there is color, they were looking at color, and when they thought it was black and white, they were looking at black and white.
In many ways perception is always part imagination. In order to understand what we perceive, we match the visual input or the other input to what our expectation is about what’s going on. So, here you are setting up competition between expectation and perception, and you can literally change the perception and how the brain sees things.
Rick:
If you are able to identify the parts of the brain that are affected by a hypnotic state, what would you do with that information?
Dr. Spiegel:
We might find ways to test how we can better strengthen our hypnotic inductions – can you in fact produce a stronger effect than you otherwise would? But we also just want to understand more about brain activity and hypnosis – what is the brain actually doing when the patient is hypnotized? Which are the salient parts the brain so that we can understand what’s going on? Hypnosis is not something that just popped into human experience 200 years ago. It’s a part of how the human brain works, and we want to better understand that. So it’s a way of using hypnosis to understand how the brain functions.
Rick:
Are there different physical tests that show changes while under hypnosis? For example, I am thinking of heart activity, that sort of thing.
Dr. Spiegel:
I don’t know of any evidence about cardiac activity per se. Certainly when you are imagining something that involves intense physical activity or is stressful, your heart rate may go up a little bit. I don’t know of any particular changes in the EKG, for example, although it’s possible.
So, that kind of thing, no. But another clinical example is hypnosis has been very helpful in treating asthma. Asthmatics who have difficulty breathing can change their level of wheezing pretty quickly just through self-hypnosis.
Rick:
In terms of fitting in with regular psychotherapy, how prominent is hypnotherapy at this point?
Dr. Spiegel:
It’s an accepted treatment by the American Psychiatric Association and the American Medical Association. It is taught at many of the better medical schools but certainly not at every medical school. I would say there is some penetration of the market, but we have a way to go.
Rick:
It’s been said that hypnotherapy goes to a very deep level in the brain, even the subconscious. Is there any truth to that?
Dr. Spiegel:
Yes. I think the case is that, because they are more intensely focused and because they may bypass their usual defensive ways of reacting to things, it’s entirely possible that people who are hypnotized can have access to experiences that they were not normally conscious of. For example, I have helped people find things that they lost, that they put away somewhere and couldn’t remember what they did with them. Using hypnosis, they have been able to recover that ring that they hid away somewhere. So you could argue that that was not fully in their consciousness until we used hypnosis to find it.
Rick:
Another question, we have all heard about subliminal messages, those things that may be flashed on the TV or movie screen briefly and go into our subconscious and then affect our behavior. Is that anything like a state of hypnosis, or is it completely different?
Dr. Spiegel:
That’s a little different. It is sort of perception without full awareness, but you don’t necessarily have to be in any kind of an altered mental state to respond. You are just not consciously aware of the perception. So I’d say subliminal perception is a little bit of a different phenomenon.
Rick:
It’s interesting that you mentioned that case of being able to help somebody find their lost key because I have read that hypnotherapy can also allow someone to recover repressed memories. Obviously it’s a controversial topic. How can you tell whether someone in a hypnotic state is telling the truth about a repressed memory or just parroting a suggestion offered up by a therapist?
Dr. Spiegel:
It’s a complicated area, but in a sense, all memories are repressed memories. That is, what the brain does, we process so much information that if we remembered just one percent of it at one time, we would be completely immobilized. So, in sense, if I ask you what you had for breakfast this morning, you will remember it. If I ask you what you had for breakfast a week ago, you start thinking about the kind of things you usually have on a weekday morning for breakfast, and you would make an informed guess.
Most of the time memories involve a recollection of what happened and a kind of reconstruction based on probabilities or what we call associations. That’s how we trigger memories. And an example of it is if you go back to where you went to high school. You’re walking down that hallway seeing the old lockers, and you may start remembering things you haven’t thought of in many years because the environment triggers those associations. So, all memory is to some extent recovered or repressed. The notion of a repressed memory in particular is tied more to an emotional [reason] for not recalling, for example, a traumatic event.
There is evidence that people who have suffered, for example, severe physical or sexual abuse may have loss of conscious recollections for some or all of those events, and hypnosis is a tool that can help to bring those memories back to consciousness. Also repeated efforts to recall it can do that. The studies on accuracy, that is creating false memories, show that in general, people will report more information with hypnosis. It’s not any more accurate. It’s kind of being a percent correct, but people may tend to believe it a bit more. They may think that it’s more likely to be accurate because they recalled it in hypnosis. The way the questions are asked influence it, but police know that anyway.
Rick:
So the notion of false memories sounds like it’s a little murky. What about the issue of past lives? I know that some people under hypnosis recall past lives. Is that an example of a false memory induced by hypnosis?
Dr. Spiegel:
There are a lot of people who believe in past lives who don’t get there with hypnosis, who believe it for other reasons. But yes, it is possible. There is a phenomenon with hypnosis called age projection where people imagine what they are going to be like 200 years from now. I think that’s a hypnotically induced fantasy. And I think if people are hypnotized and told “Let’s go back and see what you were like 500 years ago,” that would be a hypnotically induced fantasy.
We once had a journalist who was doing a story on a trance channeler, who was somebody who claimed that she channeled the spirit of some 800-year-old Indian gentleman, and she would go into what was an obvious trance state and come up with all this baloney that people seemed very impressed by and would pay a lot of money to go witness. So I said to her, “Bring me a highly hypnotizable subject, and I’ll give you a trance channeler.” So, she brought in one of her staff who was very hypnotizable, and I had him picture the last time he had seen one of these trance channelers. And I said, “Now let the spirit enter your body,” and his head started to shake. And he said, “I am Zofra and I bring you a message of peace,” and he created this whole trance channeling story. I asked him to point to his boss and say who she is, and he couldn’t remember her name. Her first name was Wendy, and he kept saying, “Wu, Wu, Wu,” but he couldn’t say her name. And when I later showed him the videotape of it, he was blown away. He said, “I can’t believe that I did that.”
Yeah. She couldn’t get out of my office fast enough. She said, “Doctor, I am glad you do what you do and I do what I do. Good-bye.”
So, that was an experiment, and it was done with the full awareness of everybody. But just as people can be pushed to say things that they later will tell you weren’t true, hypnosis can intensify that if that’s what you are trying to do. On the other hand, if you are just trying to get them to recall as best they can what happened to them, it may be that you can help them do that. So it’s a kind of two-edged sword. It can be helpful in recovering real information. It can also be used to produce fantasies.
Rick:
That brings us to the issue of training for hypnotherapists. What sort of training is required? Do you have to get a license from the state?
Dr. Spiegel:
You should be licensed and trained in a primary professional area like medicine, psychology or dentistry and then have additional training in hypnosis. There are two reputable professional hypnosis societies at which people get training, and as I said, many medical schools and psychology programs teach it as well. The key issue is clinical training in assessment and treatment, not being a hypnotist. So I advise people to go to a licensed and trained professional who also uses hypnosis, not to go to a hypnotherapist who doesn’t have professional training.
Rick:
I see. So that’s what they should look for?
Dr. Spiegel:
Right.
Rick:
You may have touched on this earlier, is hypnotherapy considered a valid treatment by the American Psychiatric Association?
Dr. Spiegel:
Yes, it is, and they are revising their position paper on it now, but they consider it to be a valid treatment as does the American Medical Association.
Rick:
You mentioned that it’s probably not a good idea just to go to a hypnotherapist. Why not?
Dr. Spiegel:
Because the real skill is in assessing the person and the problem and being able to select, among the many treatments available, the ones that are most likely to be beneficial. That takes a fair amount of clinical training. Just inducing hypnosis is something that can be done pretty easily, but knowing how to assess what’s going on, if there are any complications or other problems related to it, how to take responsibility if a patient gets depressed or suicidal, are things that come with clinical training and not with just learning how to do hypnosis.
Rick:
In general, is hypnotherapy reimbursable through insurance?
Dr. Spiegel:
I’ve got a bigger question: Is medical care reimbursable through insurance?
Rick:
Touché.
Dr. Spiegel:
It varies. Some programs will pay for it, some won’t. Sometimes you have to call what you are doing evaluation or psychotherapy, and it doesn’t matter whether you add hypnosis to it. In other cases they will pay for what they call hypnotherapy, but our insurance system is such a fundamental disaster that this is just a footnote on it. In general, if you are going to a licensed and trained professional, the odds are that some aspect of what they do with you is reimbursable.
Rick:
And it’s probably a good idea to check with your insurance company first?
Dr. Spiegel:
Yes.
Rick:
We checked with the National Center for Complementary and Alternative Medicine (NCCAM). It’s part of the National Institutes of Health, and there wasn’t a lot of information on hypnotherapy. Why do you suppose that is?
Dr. Spiegel:
I find myself in a strange position with this because to many people in mainstream medicine, hypnosis is considered an alternative or complementary treatment, and to people in the complementary and alternative treatment world, hypnosis is too mainstream.
So NCCAM considers hypnosis alternative when it’s used to treat a medical problem like irritable bowel syndrome, for example, or if there is an effective hypnosis on cancer progression, that they consider an alternative use of hypnosis. But using it for pain or anxiety control they consider so mainstream that it’s not a complementary or alternative treatment.
Rick:
Interesting. Let’s go through, specifically, some of the areas you mentioned where hypnotherapy can be helpful. Losing weight – how strong is the evidence that it can help people lose weight?
Dr. Spiegel:
The big problem with weight in our country is that we have this horrible diet that is full of fat and worthless carbohydrates. We eat overprocessed junk food that is sold to us instead of good, fresh, healthy food, and we are in all kinds of energy trouble because we drive around in these motorized wheelchairs that we call automobiles instead of walking. So, we are kind of imprisoned by our own wealth and all this stuff we have around us. We would be a lot better off if we ate better, exercised more and did not eat this industrialized junk that corporations feed us or want us to eat. Maintaining a normal weight is a difficult thing.
Diets don’t work. Diets are a disaster. Anybody can starve themselves for a while and lose weight, and all they are doing is dysregulating their ability to control when they are hungry and when they are full. So, what we tend to do is get on these roller coasters, go down and up and down and up, and that’s worse for your health than just staying fat.
With that said, hypnosis can be helpful in controlling your impulse to eat, but also oddly enough in becoming more sensitive to your own hunger and satiety signal. One thing I get people to do in hypnosis is to focus on, when you are hungry, eat. Eat it and enjoy it. Eat like a gourmet. Enjoy the flavor, the texture, the aroma, the temperature of the food. Don’t watch television, eat, but pay attention when your body tells you it’s full, and when you are starting to feel full, stop eating. If you get hungry again, eat. But learn to get back in tune with your body’s own signals of hunger and satiety.
The other thing is that people often eat for a whole host of reasons that have nothing to do with nurturing their bodies, if they are anxious or lonely or something else. I encourage people to eat with respect. To think of your body as if it were a trusting, innocent child. Just because you are anxious, you wouldn’t stuff your baby full of more food than it wanted to take in, but your body is as dependent on you as a baby, so I teach people to rethink their connections to their own bodies. That can be useful in conjunction with a sensible program of eating properly and exercise to help people get a better handle on how they manage their eating.
We find that, as I mentioned earlier, people who randomize to a condition in which they learn self-hypnosis in addition to some other dietary management things can take off about 20 pounds and keep it off. That’s a good thing, and it’s better than most weight loss programs wind up helping people to do. So it’s not a cure-all, but in conjunction with a sensible change in diet and exercise, can be helpful in controlling weight.
Rick:
How effective has hypnotherapy proved for quitting smoking?
Dr. Spiegel:
It’s very effective for smoking control. We have a single session in which we teach people a similar approach, not that cigarettes will taste bad or anything, but that smoking is a poison for your body. I need my body to live. I owe my body respect and protection. So you focus on protecting your body. And when you have an impulse to take a cigarette, don’t fight it, admit it, but go into a state of self-hypnosis and re-establish your commitment to protect your body. We find that after one 45-minute session, half the people we see will stop. Half of them will not touch a cigarette in three years. So one out of four has pretty much stopped smoking for good.
Rick:
And one other area I find interesting is the effect of hypnotherapy on elite athletes to improve performance in competition. How much evidence is there in that field?
Dr. Spiegel:
I don’t know a whole lot of scientific studies. I used it with the Stanford Women’s Swimming Team because they were very good, but they found that their times were better during practice than in meets because they were getting so anxious during the meets that they just were not swimming as well. So I would teach them self-hypnosis and have them practice imagining swimming their best possible race, and some of them found that helpful. I understand that Tiger Woods – who was at Stanford for a while, I did not know him then – was using self-hypnosis as part of his training in golf. Of course what you notice about him is his absolute, Buddha-like calm in the face of just unbelievable pressure. So there is some evidence that many athletes talk about being in the zone – a quarterback says he knows before he lets go of the ball whether the wide receiver is going to catch it, that kind of thing.
Rick:
They can also get in these places where they stop hearing the crowd noise, and they are just really focused on the job in front of them.
Dr. Spiegel:
I had a great student, Eric Mullins, who was a wide receiver for the Stanford football team, and it was at a time when the only thing we had to cheer about was him basically – the team wasn’t doing very well. He was a student working with me and was very hypnotizable, and he would tell me exactly that. He said, “When I am having a good day, I am aware of two things, the ball and the defender. And the other 20 big guys on the field, I don’t notice them. 60,000 people screaming at me, I don’t hear them. I am just in that zone.”
And that kind of intense, focused concentration is hypnotic-like actually. I think they are in a kind of trance state. You don’t have to be immobilized and sitting in a chair to be in a trance. You can be running like hell.
Rick:
Interesting. We do have some e-mail questions coming in, Dr. Spiegel. First, from Angela in South Carolina who sent us this. She writes, “I have major pain and sleep problems, and I am wondering how I can get help in this area. I was hit head-on by a drunk driver, and I have had major sleep problems ever since. I am lucky to gets two hours of sleep a night.” What are your thoughts?
Dr. Spiegel:
That’s a serious problem. Hypnosis, I don’t know the specific kind of injury and how that may be affecting your brain’s ability to sleep. It sounds like there was a brain injury associated with it, or it may not. It may be that she has got some kind of post-traumatic stress disorder and part of what’s keeping her up could be hyperarousal. If that’s the case, there are good psychotherapies for PTSD. Part of it might be that a therapy that got her to address her feelings in relation to the accident and the fears about the accident might help her find it easier to sleep. That’s one possibility.
Hypnosis in particular can help people separate the psychological arousal that comes with just worrying about day-to-day events or what you have to do tomorrow or remembering a traumatic episode and the physical arousal that often comes with it. Sometimes physical arousal is useful, but we are wired as creatures to respond to stress physically, and there was a time when that was very useful. That is if the stress was a saber-toothed tiger, you wanted to run very fast.
But now, most of our stress is just psychological, not physical, and yet we get physically aroused. That, in particular at night, will interfere with sleep because you get your heart rate and your blood pressure up and your sympathetic nervous system going, and you will have more trouble sleeping. Hypnosis can be helpful in learning to separate whatever psychological arousal you have from physical arousal. You get your body floating as if you were in a bath, a lake or a hot tub, and direct your thoughts onto an imaginary screen and separate the psychological from the physiological stress.
Rick:
You mentioned she could be suffering post-traumatic stress disorder, and we hear a lot about PTSD these days with troops coming back from Iraq and Afghanistan. Is it being used a lot for those people?
Dr. Spiegel:
I would say not as much as I would like to see. There are some programs that do teach people to use self-hypnosis.
Rick:
Yes. We got an e-mail from Jay in Wisconsin, and Jay writes, “Can hypnotherapy get to the root cause of my depression and get rid of it? I have tried almost everything else with no success.”
Dr. Spiegel:
Sometimes depression has a root cause. Sometimes it happens because you have got a biological vulnerability to depression, and there may not be a root cause. It may just be you are the kind of person who is more prone to get depressed under stressful conditions, and there is some evidence that there are genetic vulnerabilities to getting depressed when distressed. So that’s one possibility.
There is some evidence that hypnosis can be used. One possibility is to see if there is some hidden or unexplored issue that may be leading to depression, but frankly another is just to help people manage their mood because part of the problem with depression is you tend to have a reinforcement of your mood. Your mood can enhance your thinking that you are not very good and you feel hopeless, helpless and worthless, and you tend to ignore inputs that would change your mood. So, hypnosis can sometimes be helpful in getting off that kind of perpetual cycle of thinking only in a negative way and feeling worse and worse as you do so. It can be helpful in mood management, not just in trying to discover some hidden cause.
Rick:
Cody in Forest Park, Illinois sent us this e-mail, “Are the results of hypnotherapy immediate?”
Dr. Spiegel:
I love working with pain because we know right away whether it’s going to help. I have my patients rate their pain on a zero to 10 scale, and they will tell me whether they are getting better or not.
So, yes. For certain kinds of problems you can get an immediate response, the same with asthma. I’ve seen people who were struggling to breathe and who, a few minutes later, are lying back in their bed, the wheezing is subsiding and they’re feeling better. So there are times absolutely when the results can be immediate.
Rick:
John in Brookings, South Dakota writes, “Does hypnosis work for sexual addiction?”
Dr. Spiegel:
I don’t know of much literature on that. To the extent that it can help you deflect the impulse to act when you have the thought, as it might with smoking or overeating, it’s possible that it could be helpful. I don’t know of any published studies on that, but it’s worth a try.
Rick:
Marsha in South Carolina writes, “Could hypnotherapy help my neuropathy and balance? I have a lot of pain in my legs even though I am on medication.”
Dr. Spiegel:
It certainly can be helpful for pain. Now, whether it will help with balance as well, I don’t know. I don’t know what the source of the balance difficulty is. There may be some other neurologic problem. Sometimes people who have pain in their legs get imbalance because they are trying to reduce the pain. Then they get in awkward positions because of their efforts to avoid the pain. So it’s certainly worth a try. For balance I am not sure, but it might be worth it.
Rick:
How about a condition like multiple sclerosis, speaking of balance issues and pain?
Dr. Spiegel:
For MS it is certainly, it’s not a primary treatment, but it certainly can be helpful. There are many people with MS for example who have difficulty at times with certain kinds of motor function and find that when they are anxious, it gets worse. For example, they get weaker when they are just trying to get on a bus because of all the social pressure to do it. So, to the extent that hypnosis can reduce secondary anxiety, it may be a supplementary help, but it’s certainly not a primary treatment for multiple sclerosis.
Rick:
This may be a good time to remind people that there is a way to find out if you are susceptible to hypnosis in the first place. Right?
Dr. Spiegel:
Yes. We can do formal testing that helps people to understand [susceptibility] – in about five minutes I can do a test. If you want to get a rough idea, people who tend to get so caught up in a good movie that they forget they are watching the movie and enter the imagined world, are usually more hypnotizable on formal testing. People who rate themselves as being highly trusting of others or who are rated by others as being very trusting people tend to be more hypnotizable. So, if you have got that kind of ability to get absorbed in a sunset or a movie or a novel, the odds are that you’re more likely to be hypnotizable.
Rick:
Charles in Illinois writes, “Does self-hypnosis always work, or is it just not possible for some people?”
Dr. Spiegel:
There are some people, about a third of the adult population are just flat out not hypnotizable, and so hypnosis doesn’t add anything to whatever else they would be doing. So, there are some people for whom it doesn’t work. There are others who are hypnotizable who don’t use it or who, just for aesthetic reasons, don’t particularly like it, and they also may have more difficulty getting benefit from it.
Rick:
We have an e-mail from Dell in California who writes, “It has been three years that I suffer from anxiety and depression, ever since I had surgery. How effective can hypnotherapy be for me? I’m willing to try anything but drugs.”
Dr. Spiegel:
A lot of the patients we see at the Stanford Center for Integrative Medicine are like that. They are just not very open to using medication, and it’s certainly worth a try. I don’t know in this case whether Dell’s issue has to do with something neurological or physical that happened during his surgery or just the experience of it, but hypnosis certainly is not a drug. It’s a safe procedure. It can be effective, and as I said, most of the time the worst thing that happens is it doesn’t work, and you haven’t lost that much. So it’s certainly worth a try.
Rick:
We have answer e-mail from Joy in Wisconsin, and she writes, “I just started hypnotherapy for my depression. I am wondering how long treatment lasts, and if you still have to take your medication for depression afterwards.”
Dr. Spiegel:
That’s an interesting question. It depends in part on how severe the depression is, how long she has had it, and to what extent her response is to the combination. Most studies show that about a third of patients with depression will respond to some kind of psychotherapy, about a third to medication, and half or more to both. So the combination is usually more effective. One of the nice things about psychotherapy though is that it tends to last longer after the treatment has stopped than the anti-depressant medications. But I think that’s something to take up with her doctor.
Part of it is, how bad is the depression, how well did she respond, and is she having problems with side effects? If she is not, she may want to stay on the anti-depressants for a while to make sure she is stably feeling better. But in general the combination, if you are not having problems with side effects, is a good thing to do.
Rick:
I wonder if at this point you could maybe tell us a little bit more about the research you are currently doing at Stanford.
Dr. Spiegel:
At the moment one of the studies is on how we can train parents to help children get through medical procedures better. I got calls some years ago about children who had to undergo a procedure where they had to have a catheter inserted into their bladder, and they had to have dye instilled.
If you are an 8-year-old, you can’t use general anesthesia, it’s very unpleasant. They were screaming, crying, struggling. So, I started training the children to use self-hypnosis and imagine that they were playing with friends or in the park or on vacation, and we found that they had less anxiety, that it was easier to do the cath, and the procedure took 20 minutes less time, which is a long time. So we have now made a DVD – we train the parents to do this, and we are going to do a randomized study like the previous one, only this time just with the parents in essence being their child’s hypnotist, and really teaching them in advance and then helping them during the procedure. We want to see whether that can help the children get through the procedures better.
We are also doing some more brain imaging work looking at co-activation in the brain, which parts of the brain fire together when people enter hypnotic states, particularly highly hypnotizable people. We want to understand more the neural map of how hypnosis works.
Rick:
So, with the parents being the child’s hypnotist in effect, how does age figure into that whole dynamic, or does it at all?
Dr. Spiegel:
Well, I assume you mean the kid’s age and not the parent’s, but in general kids from the age – below four or five it’s pretty hard just to maintain their attention, but frankly the peak period for hypnotizability in the human life span is the period between five and ten. You know, all eight-year-olds are in trances all the time. You know, if you call them in for dinner and they are out playing, they don’t hear you. So it’s actually a very good time to get people, get kids involved in hypnosis, and they usually respond very well.
Rick:
Interesting. We have a question from Lonnie in Oregon, and Lonnie writes, “How expensive is hypnotherapy?”
Dr. Spiegel:
It depends on what the routine charge of the professional is. I would say in general it can range from about $125 to about $300 depending on who you are seeing and what the purpose of it is.
Rick:
Is it generally available everywhere you are or do you have to be near a big university hospital or something like that?
Dr. Spiegel:
There are many people throughout the country. There is a Society for Clinical and Experimental Hypnosis. If people just do a search on SCEH, that’s a very good professional society – I’m a past president of it – that will help with referrals. There is also an American Society of Clinical Hypnosis (ASCH) that has members, and they also have a referral service. The alternative is to ask your primary care doctor if they know a professional who uses hypnosis in your area. So it’s not everywhere, but in most places you can find somebody who’s got training and skill.
Rick:
Is it possible to get free care, free hypnosis by entering a research study?
Dr. Spiegel:
There are times when that’s the case, yeah. In some of our studies that has been the case. So you might contact your local university and see if there are any studies involving hypnosis.
Rick:
George in Seattle writes, “Can hypnotherapy help with allergies?” You said it can help with asthma.
Dr. Spiegel:
It sort of makes sense, but I don’t know of much of a literature on that. I think it’s possible. Certainly many people feel sedated or don’t like some of the medications they have to take for allergies, and so as one component of an overall treatment plan it might help, but I don’t know of any studies that demonstrate that.
Rick:
I’m wondering if you could walk us through the process of getting someone into a hypnotic state. What do you actually do?
Dr. Spiegel:
I don’t want to go into great detail or your audience may remain in a trance for some time. But what it tends to involve is just a shift in attention, turning inward basically. I ask people to look up and close their eyes and imagine they are floating in a bath or lake or hot tub, and then doing some other alterations of sensation and movement in various parts of their body. It’s really a very quick shift in attention and a turning inward, not worrying about what’s going on in the world but focusing on your inner experience. It all happens in a minute or so. It’s not a long thing. You don’t have to count upstairs and downstairs. Hypnosis is not sleep. You don’t have to put people to sleep. It’s just a form of focused attention.
Rick:
Do you have to be in a specific physical location, or can it be done in an office?
Dr. Spiegel:
It can be done in an office. Obviously, if there is too much distraction and noise, that can interfere with it, but basically anywhere that’s quiet and reasonably peaceful you can use it.
Rick:
As a psychiatrist, how did you get involved in hypnotherapy?
Dr. Spiegel:
It’s something of a genetic illness in my family. My father is a psychiatrist who’s used hypnosis since he found it very helpful in World War II treating combat reactions. I watched him, as I was growing up, treat patients and make movies of them occasionally. It was just a fascinating phenomenon. When I was in medical school, the first hypnosis patient I had was an asthmatic who was sitting up in bed, bolt upright. Her mother was crying, and medications weren’t working, and I just asked her if she wanted to learn a hypnosis exercise, and she nodded. I hypnotized her and then remembered we hadn’t gotten to asthma in the class yet, and so I just said, “Each breath you take will be a little deeper and a little easier.” Within five minutes, she was better. So, I got hooked by the fact that something that simple could be that effective.
Rick:
I am curious if you ever get negative reactions either from colleagues or just people in the general public about the idea of hypnotherapy. Do they think it’s just a bunch of bunk?
Dr. Spiegel:
You run across people like that everywhere, but there is a flat earth society too. I think most professional colleagues are respectful. They may not do it themselves, but they are interested in it, and may refer. There are people who consider it either useless or dangerous or both, which I find kind of amusing. But in general I don’t run across much really negative reaction.
Rick:
I guess the bottom line is the data. Can it be shown to be effective?
Dr. Spiegel:
Yes, and the data are very strong for a number of the issues that we have been talking about. That’s right. And that’s the way you have to do it. It’s science, and either it works, or it doesn’t, and you just do the right studies and determine whether or not it works.
Rick:
Is it mostly being done by psychiatrists, psychologists or which?
Dr. Spiegel:
I would say that the largest professional group is psychologists, Ph.D.s. There are some psychiatrists who use it as well, but the biggest group, there’s a division of the American Psychological Association that is totally focused on hypnosis, and that’s probably the largest group of professionals who do this. There are also some dentists who use it for pain control during dentistry.
Rick:
In general, where do you see the field headed? What is around the corner for the field of hypnotherapy?
Dr. Spiegel:
I hope that there will be more and more science and less and less mysticism and mystery about it, none of the dangling watches and purple capes. We will get smarter about the kinds of therapeutic interventions we use, and we will know more about what’s going on the brain when it happens.
Rick:
Do you have any other final thoughts that you would like to leave us with about hypnotherapy?
Dr. Spiegel:
I think many people are afraid of it because they feel like they will lose control, somebody will take over control. And actually it’s the opposite. It’s a way of enhancing people’s control over their mental state and over certain aspects of how their body functions. So you are not losing control, you are gaining control with hypnosis, and it’s a very valuable tool.
Rick:
Dr. David Spiegel of Stanford University, thank you so much for being with us on this program. I would like to thank you, the listeners, for joining us.
And until next week, I am Rick Turner filling in for Judy Foreman. Good night.
