When you think of hypnosis, you may imagine the stereotype stage hypnotists, using hypnosis to manipulating suspects into behaving in unexpected or embarrassing ways, to the delight of the audience.
As many people now know, this depiction is far from the hypnosis used in clinical hypnotherapy to help people overcome mind-body related problems such as anxiety, low mood and unwanted habits.
So, what exactly are hypnosis and hypnotherapy?
“The best bridge between despair and hope is a good night’s sleep.”
Hypnotherapy comes from the Greek words for sleep and healing. Superficially then, ‘hypnotherapy’ is healing through sleep.However, hypnosis is not an exact equivalent to sleep, but more accurately mimics the part of the sleep process known as Rapid Eye Movement (REM) sleep. The speed of brain waves was first explored in 1929 by Hans Berger using an EEG machine and it is now known that the slow brainwaves labelled ‘Theta’ relate both to REM sleep and to the hypnotic state. In this state, we are withdrawn from the outside world and focused on our state within. This state may be accompanied by vivid imagery and physical phenomena such as eye catalepsy (perceived inability to open the eyes).
It is a common misconception that the subject is under the control of the hypnotherapist. This is not the case. Subjects who do not wish to undergo hypnotherapy are not susceptible to it.
The other misconception is that hypnosis is exactly the same as sleep. On the contrary, a hypnotic state is a condition of acute focus.
So far, so comprehensible. But why is this mental state important for personal change?
“I cannot say whether things will get better if we change; what I can say is that they must change if they are to get better.”
A study by researchers at Stanford University in July 2016 examined what happens in the brain during hypnosis. Functional magnetic resonance imaging (fMRI) was used to view brain activity in 57 subjects in hypnosis1. Changes were observed in three specific areas of the brain:
1. Reduced connectivity between the dorsolateral prefrontal cortex (part of the control system involved in planning and decision making) and the posterior cingulate cortex (the part of the system which is during self-monitoring).
2. Increased connectivity between the dorsolateral prefrontal cortex and the insula (the part of the significance network involved in identifying and controlling internal bodily processes).
3. Reduced activity in the dorsal anterior cingulate cortex (part of the system involved in the appraisal of errors and worrying).
This shows that a hypnotic state is a very real construct and points to the science behind what hypnotherapists have observed and its physical basis.
Essentially, we are lest self-conscious, more available to learning and less anxious during hypnosis.
“Imagination is the beginning of creation.”
So, what does a hypnotised person actually experience? Usually, suggestibility, relaxation and heightened imagination. The subject is aware or semi-aware of their surroundings, but is in a similar state to daydreaming, becoming absorbed in internal stimuli. Subjects report a wide range of phenomena from visual colours and patterns, being ‘absent’ some or all of the time, feeling unusual body symptoms such as weightlessness. The important thing is that all experience is valid and normal. Just as we all experience reality differently, so we experience hypnosis differently. There is no right or wrong.
Hypnotic states are a common and natural occurrence in everyday life; driving to the supermarket while being unaware of the route taken is one example. However, without the ‘therapy’ side of the process, the unconscious primitive part of the mind is not subject to change.
The therapist’s suggestions, provided they are in tune with those of the subject, are the key to change.
“Until you make the unconscious conscious, it will direct your life and you will call it fate.”
The danger it perceives, however, is both physical and psychological. That’s to say that it does not discriminate between real physical threat and the negative thoughts that are said to be ‘all in the mind’. Dismissing them as such is doing a disservice to the sufferer of mental health problems. The unconscious responds to threat of all kinds by triggering a true physical response.
Panic attacks2, agoraphobia3, migraine4, IBS5 and skin conditions6 are just a handful of conditions triggered or worsened by the unconscious mind.
During hypnotherapy, the suggestions of the therapist are taken on board by the unconscious mind as if they were physical reality. Imagery and sensation can be experienced by the subject along with spontaneous impressions that haven’t been specifically mentioned.
A hypnotised subject is relaxed and absorbed in their inner life, modifying or erasing their usual concerns in the same way as reading a good book or watching a film might achieve.
The therapist’s suggestions then become easy to embrace. Current thinking is that hypnosis allows the therapist to work with the unconscious mind directly7. Usually, we are not aware of the unconscious (the clue’s in the name!) but we know that the unconscious is working behind the scenes to ensure automatic functions are preserved. During sleep, the conscious mind is dormant, and the unconscious is active.
The unconscious controls your sensations and your emotions. When the door to the unconscious is opened, those feelings can be triggered by the therapist, for example, to bring calm feelings to those who suffer panic attacks and feelings of empowerment to those with phobias.
The unconscious mind also stores memories. Past events may be accessed more readily and links between the past and the present uncovered or remembered more vividly.
“Almost all people are hypnotics.”
The thorny question of how we can demonstrate that someone has entered ‘another state’ is often something asked of hypnotherapists. The idea of ‘going under’ is to misunderstand the reality of hypnotherapy.
In a number of studies, the physical signs of hypnosis have been compared with those who have not been hypnotised8:
- Catalepsy – rigidity of the body, or part of it, in position
- Eyelid fluttering
- Slowing of respiration
- Smoothing of facial muscles
- Reduction or absence of swallow reflex
- Inner absorption
- Response attentiveness
Some or all of these phenomena may be seen by the therapist.
Researchers have also examined the changes to the cerebral cortex that happen during hypnosis. (Obviously, the therapist is not aware of this). Interestingly, hypnotic subjects showed lower activity in the left hemisphere, while activity in the right hemisphere increased. The left hemisphere of the cortex is considered to be the rational control centre of the brain. It works on reasoning and logic. The right hemisphere, on the other hand, is responsible for imagination and creativity. So, a lower functioning left hemisphere fits the premise that hypnosis reduces inhibition, while a higher functioning right hemisphere suggests that the unconscious takes the lead being a creative and spontaneous entity.
The over-riding question for the therapist, however, is not whether the subject is experiencing trance, but whether they are experiencing change. If you were given three types of tablet by your GP, would you wonder, once you felt better, which one of the tablets was responsible or whether you just recovered spontaneously?
“You use hypnosis not as a cure but as a means of establishing a favorable climate in which to learn.”
Trance is encouraged when the subject is positive about the experience, there is rapport with the therapist and feels comfortable9. The therapist should therefore initially have taken a history and conversed with the subject to ensure they feel relaxed and comfortable about safety and confidentiality as well as trusting the therapist. The subject is then, most often using muscle relaxation and visualisation into a pleasant state of calm, deepening into trance.
Hypnotherapy is used for a wide variety of applications, including anxiety and depression, physical symptoms of mental distress, and unwanted habits. A change of mental perspective, rather than a change in superficial behaviour, is the key to permanent change. In the same way that an unpleasant sensation, emotion or habit can become ‘anchored’ in the subject’s unconscious, similarly calm, pleasant emotions and positive habits can be attached in the unconscious through hypnotic techniques.
During professional sessions, the therapist may work with long standing personal problems such as irrational fears. The mind-body link can also be used to use hypnotherapy to reduce physical pain such as that experienced during labour, for example. There is also evidence that hypnotherapy has helped cancer patients manage the side effects of treatment with the hypnotised group experiencing faster surgery recovery times and less analgesia10.
Although more research is needed to verify the efficacy of hypnotherapy in some areas, a recent literature review in the effectiveness of hypnotherapy11 indicate positive outcomes for subjects. Based on that data, Dr Leon W Cowen suggests that hypnotherapy is already established as a beneficial part of some treatment programmes and should be contemplated within treatment protocols for a wide array of disorders. He concludes that ‘overall hypnosis interventions were considered safe, effective, clinically valuable and statistically significant.’
1 Jiang, H., White, M. P., Greicius, M. D., Waelde, L. C., & Spiegel, D. (2016). Brain Activity and Functional Connectivity Associated with Hypnosis. Cerebral Cortex.
2 Locke, A., Kirst, N., & Shultz, C. G. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American family physician, 91(9), 617-624.
3 Porter, E., & Chambless, D. L. (2015). A systematic review of predictors and moderators of improvement in cognitive-behavioral therapy for panic disorder and agoraphobia. Clinical Psychology Review, 42, 179-192.
4 Dikmen, P. Y., Yavuz, B. G., & Aydinlar, E. I. (2015). The relationships between migraine, depression, anxiety, stress, and sleep disturbances. Acta Neurologica Belgica, 115(2), 117-122.
5 Pellissier, S., & Bonaz, B. (2017). The place of stress and emotions in the irritable bowel syndrome. In Vitamins and hormones (Vol. 103, pp. 327-354). Academic Press.
6 Lin, T. K., Zhong, L., & Santiago, J. L. (2017). Association between Stress and the HPA Axis in the Atopic Dermatitis. International journal of molecular sciences, 18(10), 2131.
7 Palfi, B., Parris, B. A., McLatchie, N., Kekecs, Z., & Dienes, Z. (2018). Can unconscious intentions be more effective than conscious intentions? Test of the role of metacognition in hypnotic response. Cortex.
8 https://britishhypnosisresearch.com/recognising-the-minimal-cues-of-trance/ Accessed 10th February 2020
9 Fit, A. P. (2017). Hypnosis and Clinical Social Work Practice. Social Work Treatment: Interlocking Theoretical Approaches.
10 Singh, P., & Chaturvedi, A. (2015). Complementary and alternative medicine in cancer pain management: a systematic review. Indian journal of palliative care, 21(1), 105.
11 Cowen, L. (2016). Literature Review into the Effectiveness of Hypnotherapy. ACR Journal 10 (Volume 1). Pages 1-55
With thanks to Jonas Verstuyft, Johannes Plenio, Caleb Woods, Hendrik Morkel, Chris Lawton at Unsplash for images.