Hypnosis in one form or another has been around for thousands of years, but until recently, evidence to support its biological and clinically powerful effects have been lacking. Today hypnosis is used by clinicians around the world to help manage pain, childbirth, phobia and anxiety – particularly in children.
What is hypnosis?
Hypnosis is thought to be a state of conscious awareness which most people experience transiently many times each day.
Hypnotic experiences and responses tend to involve:
absorption or a state of focused concentration or attention;
dissociation, where the patient’s perception of the external environment diminishes; and
suggestibility (the ability of an individual to respond, in a non-volitional way, to a verbal or non-verbal communication).
People describe the hypnotic mindset in different ways such as, “being beside oneself”, “out of body experiences”, “daydreaming”, “tuning out” or a meditative state.
Until the 19th century, hypnosis was the only means of having surgery comfortably. James Braid), a Scottish surgeon working in Bengal in the 1840s, operated on several hundred patients using hypnosis and his success subsequently received widespread acclaim.
Over the years, clinicians have reported dissociation from pain, decreased bleeding and reduced infection, suggesting an evolutionary basis for why we have the ability to enter a hypnotic “trance-like” state when under extreme stress.
Following the establishment of pharmacological anaesthesia – with its greater effectiveness and reliability – the practice of hypnosis languished for decades, becoming little more than a parlour trick. It was almost forgotten until relatively recently.
Unfortunately, the term “hypnosis” has many negative connotations and its use by stage hypnotists as entertainment has probably contributed to many doctors not taking the clinical use of hypnosis seriously.
How it works
Contrary to popular belief, hypnosis is not sleep; hypnotic responses can be elicited in minutes or less; and a conscious belief that it will be effective is not required to achieve a benefit. Patients experiencing hypnosis can hear what’s happening around them and can halt the process at any stage if they wish.
The success of hypnosis in a clinical setting requires trust between doctor and patient to go along with the process. But a borderline, and sometimes frank, hypnotic state frequently occurs spontaneously in hospital patients where the overwhelming stress of the external environment – or the thought of painful procedures, or feelings of being a victim to illness – can facilitate an internal focus of attention.
Contrary to popular belief, hypnosis is not sleep. This can make patients highly responsive to suggestions, positive or negative. And it means that when a doctor says, before a potentially painful procedure, “this is going to sting”, the communication can function as a hypnotic suggestion and is likely to increase pain. In contrast, the positive suggestion, “the local anaesthetic will numb the area and allow us to perform the procedure more comfortably” is likely to decrease pain of local anaesthetic injection.
What the research say?
Advances in brain function imaging using functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) scanning techniques have allowed us to see that hypnosis modulates activity in the anterior cingulate cortex, which links the limbic (emotions) and sensory cortical areas of the brain during hypnotic pain relief. This appears to allow sensations that would normally be experienced as painful to no longer have the suffering or negative emotions that would normally be associated with them.
A labour contraction, for example, can be felt as either the most terrifying and painful of sensations or a wonderfully fulfilling experience that tells the mother she is getting closer to her baby. These very different perceptions may be experienced despite the intensity of uterine contractions being identical.
Anaesthetists in Belgium have successfully used hypnosis to help thousands of patients minimise their need for general anaesthesia during thyroidectomy (surgical removal of they thyroid gland), mastectomy (removal of the breast) and plastic surgery.
Meanwhile, US researchers are currently investigating the effectiveness of hypnosis and suggestion in the management of chronic and procedural pain including burns.
And our own institution is researching the effectiveness of hypnosis in managing childbirth pain, along with investigators in Denmark, the United Kingdom and the University of Tasmania.
How is it used?
Hypnosis in the formal sense – where a patient receives an induction, treatment, and an alerting procedure – is more commonly practiced by clinical psychologists and not widely used in hospitals. Although a number of hospitals around the world use hypnotic techniques, the main clinical application is to use suggestions to supplement anaesthesia drugs and techniques as part of a multimodal approach to patient care.
Hypnosis has been used at Adelaide’s Women’s and Children’s Hospital for more than three decades, since Dr Graham Wicks, a medical hypnotherapist at the hospital, pioneered its use. Over the years, hypnosis has been used to treat thousands of children with problems as diverse as bedwetting, pain, and helping children comfortably use hypnotic anaesthesia with needles and renal dialysis.
Today, several paediatricians and anaesthetists at our institution are trained in hypnosis and use it to supplement patient care where indicated.
As anaesthetists, we use hypnotic techniques to help patients feel more in control and to supplement and enhance their anaesthesia experience. Common examples include assisting children and adults with their induction of anaesthesia, burns dressings, treatment of needle phobia, assistance with childbirth pain and preparation of patients for surgery.
It’s very rare for procedures to be performed entirely using hypnosis.
The main value of hypnosis as a technique is to assist patients having drips and needles inserted more comfortably and usefully supplement a less than perfect local anaesthetic. The belief that the patient can do more than he or she thinks (and more than the doctor believes is possible) is likely to generate surprising therapeutic responses.
Allan Cyna is affiliated with the Australian Society of Hypnosis (executive member). He has received funding from the NHMRC (for a Hypnosis for childbirth trial, 2007-9) and two ASA grants including a PhD research award and a health sciences award from the University of Adelaide.
Marion Andrew has received funding from the NHMRC.
Hypnosis can be a highly effective treatment for the bowel disorder IBS according to new research. The treatment of IBS using hypnotherapy has been studied before but only at highly specialised "hypnotherapy centres", two new Swedish studies evaluated a form of treatment that could be used in ordinary healthcare. 40% of participants showed a reduction in symptoms.
IBS (irritable bowel syndrome) is one of the most common digestive conditions and can cause bouts of stomach cramps, bloating, diarrhoea and constipation. It's thought that 10%-20% of people experience IBS at some point and it's twice as common in women as in men.
Control
Professor Peter Whorwell from the University of Manchester School of Medicine has been studying hypnosis for IBS for around 25 years and told BootsWebMD that the new studies back up his own findings: "These studies confirm accumulating evidence that hypnotherapy is an effective treatment for patients with irritable bowel syndrome and that its effects are sustained in the long term."
He says hypnotherapy helps both physiologically and psychologically: "Hypnosis relaxes you and reduces your anxiety but we've done studies over the years showing that hypnotherapy has a direct effect physiologically. There are studies that show it reduces acid secretion. It reduces the hypersensitivity that IBS patients have. It reduces the contractions in the gut."
He says hypnosis also helps IBS patients with bowel function, pain and bloating.
He calls the therapy gut-focused hypnosis: "The mantra is: you are controlling your gut, rather than your gut controlling you."
Swedish studies
The studies, conducted by researchers at the University of Gothenburg, involved a total of 346 patients. They showed that hypnotherapy alleviated symptoms in 40% of those affected and that the improvement was long-term.
In one of the studies, published in the American Journal of Gastroenterology, 138 patients with IBS received hypnotherapy treatment for one hour a week over 12 weeks. The study showed that 40% demonstrated a satisfactory reduction in symptoms, compared with 12 per cent in the untreated control group.
In a press statement researcher Magnus Simrén from The Sahlgrenska Academy of Gothenburg University said: "The treatment involves the patient learning to control their symptoms through deep relaxation and individually adapted hypnotic suggestions. The idea is for the patient to then use this technique in their everyday life."
The positive effect was sustained for the entire year the study ran and led to an improvement in the quality of life experienced by the treatment group.
In the second study, which was presented in the Scandinavian Journal of Gastroenterology, 208 patients who had previously received hypnotherapy were examined. The results showed that 85 per cent of those who had been helped by hypnosis still felt the benefits of the treatment up to seven years later and that the majority still actively use the technique in their everyday lives.
"In this group, use of the healthcare system as a result of stomach and bowel symptoms had also reduced by 70%," said Magnus Simrén.
Effective
He believes the studies show that hypnosis belongs in the arsenal of treatments for IBS: "Overall, our studies show that hypnotherapy is an effective method of treating IBS."
Youth suicide, and suicide generally is not a new thing in our community, but it seems that modern day pressures have exacerbated the issue. The highest number of suicides occurs among males aged 25 to 34 years. Suicide occurs across all socioeconomic levels. It can be an impulsive act or a well thought out plan. All people - not just mental health professionals - can help those people experiencing suicidal thoughts by providing emotional and practical support.
What are the 'warning signs'? Predicting suicide is difficult. Changes in behaviour outside the person's normal range of behaviour, and which do not make sense to those close to them, may be a warning sign. Other warning signs may include:
Loss of interest in previously pleasurable activities
Giving away prized possessions
Problem behaviour and substance misuse
Apathy in dress and appearance, or a sudden change in weight
Sudden and striking personality changes
Withdrawal from friends and social activities
Increased ‘accident proneness’ and self harming behaviours.
About 80 per cent of young people who complete suicide told someone they intended to kill themselves.
An innumerable amount of issues and life situations can precipitate a suicidal event. Stress can contribute to suicide. A young person may experience an overwhelming and immediate stress, or stress that builds up over a long time.
Stressful episodes can trigger suicide. These include:
Loss of an important person through death or divorce
Incest or child abuse
A sense of failure at school
A sense of failure in relationships
Breaking up with a girlfriend or boyfriend
Experiencing discrimination, isolation and relationship conflicts with family, friends and others because the young person is gay or lesbian
The recent suicide of a friend or relative, or an anniversary of a suicide or the death of someone close to them.
Those who have a history of harming themselves deliberately are also at higher risk of suicide.
You maybe able to help, but not always, by doing all or some of the following:
Listen and encourage them to talk, show that you are taking their concern seriously,
Tell the person you care
Acknowledge their fears, despair or sadness
Provide reassurance, but do not dismiss the problem
Ask if they are thinking of hurting or killing themselves, and if they have a plan
Point out the consequences of suicide for the person and those they leave behind
Ensure they do not have access to lethal weapons or medications
Stay with the person if they are at high risk
Immediately tell someone else, preferably an adult
Get help from professionals, offer to go with them to provide support
Let them know where they can get other help
Provide contact numbers and assist them to ring if necessary.
It does not help by:
Interrupting with stories of your own
Panicking or becoming angry
Being judgmental
Offering too much advice.
The bottom line is, listen and watch. One cannot always avert the issue, but, without being excessively paranoid about another's behaviour, it may be possible to defuse a potentially tragic situation, with some very simple approaches.
Keep in mind also that:
You don't have to be a trained professional to help a person experiencing suicidal thoughts.
Take all suicide threats seriously.
You can help by offering emotional and practical support, by listening and by helping to link the person with professional help.
In emergency situations which you fear may be spiraling out of control, don't be afraid to ring (within Australia) "Suicide Help Line Tel. 1300 651 251".
Milton Erickson is well known for the vast amount of work he did related to Clinical Hypnosis, which we now know as Hypnotherapy.
Many clients that I have arrive, with the belief that the process of hypnosis is complex, mystical and controlling in some way. It's not. All that it requires is a level of expertise in it's induction, and then, importantly in the case of related therapy, a wealth of knowledge of the approaches required for your client's issues.
Here is a very old clip that I found, of Erickson, simply demonstrating the use of inferred directives, amnesia, catalepsy, but most importantly I believe, the gentleness and speed of the induction into the trance state itself.
This is a short article, for both Hypnotherapists and people with an interest in the mind. There are four distinct, very subtle, sometimes confusing questions, which can be utilised in any therapy session. They can also be used by oneself in order to create solutions for personal issues.
These questions set in train a deeper pattern of thinking, which more often than not becomes an enlightening answer.
With the final question of the four, I can almost guarantee that it will send your mind into a really deep thinking mode, almost akin to a light hypnotic trance. Try them for yourself and see. Where I have inserted (change), you can substitute it for whatever issue you're attempting to resolve. For example, 'lost that excess weight', 'become less stressed' .... you get the picture.
The four questions go like this:
What would happen if you did (change)?
What would happen if you didn't (change)?
What would not happen if you (changed)?
What would not happen if you did not (change)?
There we have it. Looks simple, does it not. Try it. Feel free to comment.
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