Don't laugh -- this drug-free treatment has gained respect from doctors who treat everything from hot flashes to surgical pain. And it has also helped people lose weight and quit smoking.
By Daryn Eller
What It's Like
When I was growing up in Los Angeles, one of the hottest tickets was to see Pat Collins, a Sunset Strip impresario known as the "hip hypnotist." Collins, wearing cat-eye makeup and voluminous caftans, called volunteers up on stage, coaxed them into a trance, and then had them do embarrassing things. Audiences howled with laughter, especially when people "woke up" and professed to have no memory of the crazy stuff they'd just done.
It's a far cry from Sunset Strip to the nation's top medical institutions. But that's where hypnosis is taking center stage these days. Doctors are using trance states to help relieve pain, mitigate hot flashes, and manage anxiety -- even enhance fertility. "When I went to medical schools to lecture on hypnosis 25 years ago, it always ended with me being laughed out of the auditorium," says Steven Gurgevich, PhD, director of the Mind-Body Clinic at the Arizona Center for Integrative Medicine. "Now I have more speaking invitations than I can handle."
Doctors have very different techniques and goals than entertainers, of course. But whoever does it, hypnosis generally starts with guiding someone into a state of deep concentration with words that help her focus and relax.
"Have you ever had the experience of being so immersed in a book you're reading that you don't notice somebody walk into the room? That's a trance," says Ted Grossbart, PhD, senior clinical supervisor at the Massachusetts Mental Health Center. During a trance your mind is fully focused on something that you are imagining at the direction of your therapist -- a memory or future goal. In this state you're more open to imagery and suggestion, but only to images and suggestions you are comfortable with. Neither a pendant-swinging Svengali nor a psychologist in a lab coat can make you do something that you don't want to do.
When you're in a trance you feel everything you're asked to visualize more vividly and intensely. Whether your goal is to quit smoking, lose weight, or get over a phobia , the trance state allows you to experience, as if it were real, how it feels to resist those urges: breathing fresh, smoke-free air; craving healthy foods; or sitting on a plane without feeling anxious. After the hypnotherapy session those images continue to resonate, helping you resist the inclination to smoke, eat fast food, or panic on the tarmac.
That's how Christine Donohoe, 45, of Holland, Pennsylvania, lost 65 pounds. Donohoe -- who had been virtually living on cake, cookies, and candy -- went to a hypnotherapist so she would stop craving sweets. After four monthly treatments, plus listening to take-home tapes, his suggestions worked. "I actually came home from a hypnosis appointment, gobbled down three chocolate-chip cookies, got sick and didn't pick up another one for six solid years," says Donohoe, who's kept off the weight. "And you're talking to the former cookie monster."
The "realness" of hypnotic suggestion can cause physiological, not just behavioral, changes. That's why it helps with medical conditions as diverse as irritable bowel syndrome, skin conditions, and stress-related infertility. To show how hypnosis works, Dr. Gurgevich invites patients into the Tucson heat, then has them close their eyes and imagine the bone-chilling cold of a Minnesota winter: To their surprise they get goose bumps.
Using this same power of thought can help calm your shaky stomach if you have irritable bowel syndrome or redirect blood flow to minimize a migraine. A recent study at Baylor University found that hypnosis reduces the severity and frequency of hot flashes by 68 percent. "We provided calming images that may have caused women to produce less cortisol, a stress hormone that may trigger hot flashes," says the study's lead author, Gary Elkins, PhD, a professor of psychology and neuroscience.
Hypnosis also helps control pain -- maybe by blocking pain signals from reaching the brain or perhaps just by making people less aware of their discomfort. When German researchers did brain scans on volunteers touched with a heating element, those who were hypnotized showed reduced activity in the areas of the brain that perceive pain. "It's similar to the way a football player doesn't notice pain while he's focused on a game," says Elvira Lang, MD, an associate professor of radiology at Harvard Medical School. "That's the relief we try to get with hypnosis."
Doctors use hypnosis with procedures such as outpatient surgery and root canal to help patients either forgo anesthesia entirely, thus avoiding side effects, or to reduce the amount needed. In a 2006 study Dr. Lang and her colleagues discovered that hypnotized women reported less pain and anxiety during a breast-tissue biopsy than nonhypnotized volunteers (both groups were injected with a mild painkiller). Women who got the short hypnosis treatment, which was performed in the biopsy room, were encouraged to imagine that their bodies were floating somewhere safe, such as a warm bath -- and told to transform any discomfort into something cooling or warming. These women reported much less distress later because hypnosis had focused their attention on pleasant sensations.
Everyone isn't equally susceptible to hypnosis. Experts have found that explaining how the technique works, however, can help enhance someone's openness to the process.
Deep Relaxation
Four words you most likely won't hear when you visit a hypnotherapist: You are getting sleepy. "People imagine that they're going to be in a coma and can't move or remember anything afterward," says Jean Fain, a psychotherapist who teaches hypnosis at Harvard Medical School. "It's more like sitting in front of a fireplace where you're focused and relaxed." Most sessions last 30 to 60 minutes and begin with a conversation so the hypnotherapist can pinpoint the best types of suggestions and imagery for you. Then you'll be asked to close your eyes or to look at a point on the ceiling and take deep breaths while the therapist guides your mind to a place you've chosen. Once you have entered a trance, suggestions begin, geared toward your goal: Starting today you will savor every bite of food and eat only until you're comfortably full.... When you feel the urge to scratch your rash, you will place your hand lightly on the spot and feel soothing sensations flow from your fingers.
Often a hypnotherapist will suggest actions you can perform to counter the problem. "When someone feels an attack of irritable bowel syndrome coming on, for instance, we tell them to put their hand on their abdomen, feel it become warm and slow the cycle down so they don't have to run off to the bathroom," says Charlene Williams, PhD, a psychologist and the clinical program coordinator of the Mind-Body Medicine Group at UCLA. Fain sometimes suggests to weight-control patients that whenever they put thumb and forefinger together they will automatically feel relaxed and more in control of their eating. After the session -- you may or may not remember all that happened -- you'll likely go home with a recording. Practice helps cement suggestions and, if you need a refresher, you can just pop in the recording. Pat Carroll, of Meriden, Connecticut, takes a portable tape player and headphones with her every time she goes to the dentist.
After almost dying from an allergic reaction to antibiotics while having her wisdom teeth removed, Carroll developed such a powerful fear of the dentist that her husband had to literally carry her into the office. She uses the tape to put herself into a trance while the dentist works on her.
Expect to pay $100 to $250 per session for hypnosis from someone with an MD, PhD, or other professional degree. The number of treatments you may need will vary depending on your problem and response to the therapy.
And be aware that hypnosis is far from a cure-all, especially for its most popular uses: pain management, weight loss, and quitting smoking. Only a few studies have found that people lose more weight with hypnosis than without. While some research shows that hypnosis works better against smoking than a nicotine patch, the success rate is still low. One study comparing the effect of a patch alone to using the patch plus hypnosis found that 24 percent of the combination-therapy group remained nonsmokers after a year (for the patch-alone group it was 16 percent).
So when is hypnosis worth the time and money? If you're very motivated to achieve your goal, believe hypnosis can work for you, and can imagine how it would feel to be free of your problem. "Those are the three main ingredients for success," says Dr. Gurgevich.
I'd tried to quit my pack-a-day habit about 12 times before but nothing worked. I was able to stop when I was pregnant but went right back to smoking. The hypnotherapist put me in a comfy chair and asked why I wanted to quit. He then had me gaze at a spot on the ceiling and began to offer me suggestions, mostly related to what I'd told him: I could work out longer, not smell like smoke, and be honest with my family. It took about an hour. I felt refreshed but not like I'd been asleep. That was almost three years ago and I haven't smoked since.
She Beat Car Phobia Through Hypnosis
Carly Milne, 33, Los Angeles, California
After being rear-ended hard I kept freaking out whenever another car got too close. A friend recommended hypnosis and I thought, "I've tried weirder things." During our four sessions the hypnotherapist would give me suggestions such as, "Every time you see red taillights you will feel calm." It didn't change things overnight but my fear lessened each session. He made me a CD, which I downloaded onto my iPod. Now I'm very relaxed when I drive. In fact, when a car suddenly stopped in front of me one day, I stayed totally calm. My fear had vanished.
Originally published in Ladies' Home Journal, July 2009.
Hypnotherapy to Quit Smoking? Tip of the Day7/27/2009
Tobacco is the most addictive drug in common usage in the world, and nicotine is one of the strongest stimulants known. It is difficult to quit smoking - but it is possible. Thousands of people quit each year, and are an inspiration to those who want to stop. There are a number of ways to quit, including cold turkey, acupuncture, or using nicotine patches or gum. Hypnotherapy is another option. Steve Gurgevich, Ph.D., a DrWeil.com expert, is an experienced hypnotherapist who has studied smoking cessation through hypnosis. He says that it takes just three days to get over the physical symptoms of nicotine withdrawal - think of it as a long weekend. The more difficult part is addressing the habitual nature of the act of smoking. According to Dr. Gurgevich, patients have to be truly motivated to quit smoking if they expect hypnotherapy to work. The habit will not be eradicated in one session.
Is hypnosis magic? No, but it certainly can help with weight control. Steven Gurgevich, Ph.D., an experienced hypnotherapist teaches integrative medicine practitioners that mind-body techniques can be very helpful for reinforcing motivation, self-discipline and willpower. They can also help people change their behavior and attitudes about eating, physical activity, shopping for food and restaurant dining. According to Dr. Gurgevich, the suggestions offered to your unconscious mind during a hypnotic trance can remove psychological obstacles to weight loss and strengthen the ego, as well as encourage changes in body image, metabolism and the body's set point (its comfortable weight).
New Clues on How Hypnosis Works
Researchers Observe Changes in Brain Activity During Hypnosis
June 26, 2009 -- University of Geneva researchers say they found in a series of experiments using functional magnetic resonance imaging (fMRI) that brain activity is different under hypnosis.
Their study is published in journal Neuron.
The study concludes that hypnosis induces a disconnection of motor commands from normal voluntary processes under the influence of brain circuits involved in executive control and self-imagery, Yann Cojan, PhD, of the Neuroscience Center and Medical School at the University of Geneva, tells WebMD in an email.
The researchers used fMRI to scan brains of 12 people who were tested on hand movement before and after hypnosis for left hand paralysis.
Despite the paralysis, neurons in the motor cortex region were still firing away in preparation for the task, Cojan tells WebMD.
He says his team confirmed "subjective reports of hypnotic phenomenon" and also that "functional connectivity is a very important process in the brain" that hypnosis is capable of modifying.
What was surprising was that the cortex appeared to be ignoring parts of the brain with which it normally communicates in controlling movement, the researchers say.
Hypnosis produced changes in areas involved in attention, and also modified connections between the brain's motor cortex and other regions, Cojan tells WebMD.
Besides the 12 who were hypnotized, the researchers also scanned the brains of six people who had not been hypnotized but who had been told to feign hand paralysis for testing. They comprised the comparison group.
"These results suggest that hypnosis may enhance self-monitoring processes to allow internal representations generated by the suggestion to guide behavior but does not act through direct motor inhibition," Cojan says in a news release. "These findings make an important new step toward establishing neurobiological foundations for the striking impact of hypnosis on the brain and behavior."
In the study participants, messages weren't sent through normal brain channels, so when hypnotized subjects were told to move their left hands, they couldn't, Cojan says.
Hypnosis, the researchers found, induces a disconnect in normal voluntary processes involved in planning to move a body part. "Hypnosis is a very old tool in many medical domains but it is still unclear how it works," Cojan says.
Hypnosis Works
On one, I want you to do one thing: Look up.
On two, do two things: Slowly close your eyes and take a deep breath.
On three, do three things: Breathe out, relax your eyes, and let your body float.
Imagine you are floating in a bath, a lake, a hot tub, or just floating in space.
Each breath is getting deeper and easier...
THE PATIENT IS 80 YEARS OLD. SHE is lying under the bright lights of an operating room at Harvard's Beth Israel Deaconess Medical Center, where radiologist Elvira Lang is about to thread a catheter through her arteries. The tiny tube will work its way to one of the woman's kidneys, where it will block the organ's blood supply. A surgeon is scheduled to remove the kidney the next day. Embolizing the kidney will help keep the operation simple, safe, and tidy. But the woman is running a fever, and her kidney may be infected. Because she ate earlier in the day, she can't be given a sedative. What should have been a routine procedure has become an ordeal.
"This is your safe and pleasant place to be" one of Lang's associates reads from a laminated card. "You can use it in a sense to play a trick on the doctors. Your body has to be here, but you don't."
Lang is one of a growing number of hospital physicians who use hypnosis in addition to anesthesia. Together with David Spiegel, a professor of psychiatry at Stanford University School of Medicine, she has conducted extensive studies of hypnosis in the operating room, often with dramatic results.Hypnosis and interventional radiology interest Lang for the same reason: Both are ways of making a visit to the hospital less horrific. A tiny incision is all that's required. By threading a stent into an artery, for example, Lang can help her patients avoid far more invasive surgery. "I'm your medical plumber," she says. By adding hypnosis, she can make an operation shorter, less painful, and less dependent on drugs. The hardest part of the procedure is getting other doctors to accept it.
Over the years, a number of rigorously controlled studies have proved that hypnosis reduces pain, controls blood pressure, and can even make warts go away. But because very few studies have attempted to find out how it works, most scientists are skeptical of its power. Critics suggest hypnosis is no different from the placebo effect. They both use the power of suggestion to get the mind to heal the body; both are no substitute for medicine.
That skepticism has driven Spiegel and other researchers to take a hard look at what happens in the brain during hypnosis. Trance, they've found, opens a window onto the nature of the imagination. Through it, we are beginning to glimpse how the mind distinguishes daydreams from reality.
SPIEGEL IS A SECOND-GENERATION HYPNOtist.His father, Herbert Spiegel, is a psychiatrist who first used hypnosis as a battlefield surgeon in World War II. In 1943 he even used the technique on himself when he was struck by a mortar from a German tank in Mateur, Tunisia. A steel shell fragment protruded from his ankle, but he managed to tune out the pain.
Soon after returning home, Spiegel was hired as a professor of combat psychiatry at the School of Military Psychiatry at Mason General Hospital in Brentwood, New York. There, he treated hundreds of returning veterans with hypnosis, becoming ever more convinced of its effectiveness. At the same time, the first clinical studies of hypnosis began to appear. In 1961 psychiatrist Ralph August published a study of 850 women who gave birth under hypnosis. Only 4 percent--34 women--required painkillers. Other studies found that hypnotized subjects could resist intense pain for a full minute longer than those who weren't hypnotized, and for 30 seconds longer than those who had been given a placebo painkiller.
By the 1960s, Spiegel was teaching clinical hypnosis at Columbia University, and his son was among his students. David Spiegel went on to attend medical school at Harvard and to specialize in psychiatry and clinical hypnosis as his father had. In 1978 the two Spiegels coauthored the standard textbook in the field: Trance and Treatment: Clinical Uses of Hypnosis.
Now 58, David Spiegel is tall and a bit disheveled, with his father's oval face and serene features. He speaks in complex but reasoned sentences and listens with the stoic patience of a man who has faced many disbelievers. "Hypnosis has been controversial since the beginning,' he says. "The thing is, it just won't go away. There's so much about the phenomenon that's interesting." Among researchers in the field, Spiegel says, there are two schools of thought and a growing chasm between them. One school claims that hypnosis fundamentally alters a subject's state of mind; the other believes that hypnosis is simply a matter of suggestibility and relaxation. Spiegel belongs to the first school, and over the years he has had a running debate with two scientists on the other side: Irving Kirsch, a psychologist at the University of Connecticut at Storrs, and Stephen Kosslyn, a professor of psychology at Harvard.
Kirsch often uses hypnosis in his practice, and he doesn't deny that it can be effective. "With hypnosis you do put people in altered states," he says. "But you don't need a trance to do it." He likes to illustrate the point with an ancient talisman of the hypnotic trade: the pocket watch hanging on a chain. Put your elbow on a table, he says, holding the chain between your thumb and forefinger, and let the weight swing freely. Now, keeping your hand as steady as possible, imagine that the pendulum is moving back and forth parallel to your chest. "Just focus on it moving in that direction. Side to side," he says. "Ignore everything else and imagine it going side to side at its own rhythm." Once it's swaying that way, and it inevitably will, imagine it swinging another way--clockwise, say, or toward you--just to prove to yourself that it's not a coincidence. Once again, the weight will obey your mind. This little trick works on even the most skeptical and unhypnotizable of people. You don't have to enter a trance for your subconscious and your body--in this case, the tiny muscles in your fingers--to respond to a suggestion. "I could have hypnotized you and done the same thing, but it wouldn't have been a result of the hypnosis," Kirsch says. "It would have been a result of your focusing on moving it in a particular direction."
Spiegel disagrees. One of his best-known studies found that when subjects were hypnotized and given suggestions, their brainwave patterns changed. He admits that suggestion alone is a powerful tool but believes that hypnosis magnifies its effects. In another of Spiegel's studies, people under hypnosis were told their forearms were numb, then given light electrical shocks to the wrists. They didn't flinch or respond in any way, and their brain waves resembled those of people who experienced a much weaker shock.
To Kirsch, this still wasn't enough to prove the power of trance, but Stephen Kosslyn was willing to be convinced. Kosslyn is an exceedingly polite man, with a gray, philosophical beard and perpetually raised eyebrows. The hypnosis literature is rife with examples of subjects aping what they believe is hypnotic behavior, he says. Such "demand effects" are exactly what make placebos so effective. As for the brain-wave study, other events in the lab--such as interaction with the investigators--could have caused the shift in the subjects' state of mind. "Is it just playacting?" Kosslyn wondered, when he first saw Spiegel's data. "Or is there something really going on in the brain?"
TO FIND OUT, SPIEGEL AND KOSSLYN DECIDED TO collaborate on a study, focusing on a part of the brain that is well understood: the fusiform circuit. Located on the occipital lobe, the circuit has been found to process the perception of color. Neuroscientists zeroed in on it by placing subjects in a positron-emission tomography (PET) scanner to measure blood flow in the brain, then having them look at cards with color rectangles. Spiegel and Kosslyn wanted to see if subjects could set off the same circuit by visualizing color while under hypnosis.
The first step was to find the right study subjects. Only a small fraction of the population--known as highs in hypnotic circles--can enter a deep trance, just as only a few people cannot be hypnotized at all. The rest of us fall on a spectrum in between. (See "Can You Be Hypnotized?" page 60.) Spiegel and Kosslyn selected eight people from a pool of around 120 subjects, then Kosslyn's team ran the experiment at Massachusetts General Hospital in Boston. As in the previous studies, subjects were put inside a PET scanner, shown a slide with color rectangles, and their brain activity was mapped. Then they were shown a black-and-white slide and told to imagine its having a color. Both tasks were repeated while under hypnosis.
The results, published in the American Journal of Psychiatry in 2000, were striking. When the subjects truly saw the color rectangles, the fusiform circuit lit up on both sides of their brain; when they had to imagine the color, the circuit only lit up in the right hemisphere. Under hypnosis, though, both sides of the brain became active--just as in regular sight. Under hypnosis, imagination seemed to take on the quality of a hallucination.
After the experiment, Kosslyn's raised eyebrows, for once, came down. "I'm absolutely convinced now that hypnosis can boost what mental imagery does," he says. "It sort of gives it a shot of vitamin A or something." But Kirsch remains skeptical. The color experiments demonstrate that people "are really experiencing the effects of hypnotic suggestion," Kirsch says, but not necessarily that they enter a trance. The subjects were told to see the card in color when they were hypnotized but only to imagine it in color when they weren't, Kirsch points out. "Being told to pretend that you're having the experience is a very different thing than the suggestion to have the experience."
"Technically, he's right," Kosslyn says. Because the eight subjects were all highly hypnotizable--or at least highly suggestible--Kosslyn and Spiegel were afraid that if the subjects were told to see the color, just as they had been when hypnotized, they would slip into a trance. Kosslyn doubts that changing the wording would have made a difference. "The hypnotized people would tell you that they could literally see. 'Lows' couldn't even do the task. They simply couldn't do it."
To Kosslyn, the hypnosis study shows how the brain distinguishes between imagination and perception. The right side of the brain processes specific examples of things, while the left side processes more general concepts and categories. The left side knows that Spot is a dog, for instance, while the right side knows that the dog is Spot. That's why the right side of the brain lights up when we imagine a particular color, but the left side is left cold: The details of the daydream may seem real, but they don't apply to a larger reality.
"The realms of imagination and perception are not entirely distinct," Spiegel says. "This goes back to philosophers as far as Kant. What we take as reality is our processing of perceptual input)' We make assumptions about what's real from small cues that are far from the complete picture. If you are expecting to meet a friend at a restaurant and a stranger comes in with the same jacket and hair, you might call out your friend's name, but as soon as you see his face your mistake will be obvious. "Rather than passively accepting perception, we set up a competition between imagination and perception" Spiegel says. "Imagination can alter perception--in a sense it always does. But we're not aware of it." Under hypnosis, that distinction breaks down.
Kosslyn believes that hypnosis allows the body to tap into hidden reserves. He compares its effect to that of breaking a world record in sports: It changes our sense of the possible. "For years and years and years, no one could run a mile under four minutes," he says. "It was like the sound barrier--people thought that limbs would start falling off)' Yet only six weeks after the record was finally broken, by British runner Roger Bannister in 1954, it was broken again by another runner. "Nowadays 40-year-olds can do it." Hypnosis may have the same effect, Kosslyn says. "It shifts what I call the assumed norm. It can play the part that Roger Bannister did in the four-minute mile."
SPIEGEL IS A CLINICIAN FIRST AND A scientist second. The whys of hypnosis aren't as important, he believes, as that doctors recognize its power and start to use it. To that end, he and Lang have put the technique to the test in the operating room, just as he and Kosslyn did in the PET scanner. Seven years ago, Spiegel and Lang took 241 patients slated for vascular or kidney surgery and divided them into three groups. One group received standard care; another received standard care with an "empathic care provider"; and the third received standard care, an empathic care provider, and hypnosis. During the operation, the patients lay with their heads behind an opaque, soundproof barrier, so surgeons couldn't tell what care they were receiving. Every 15 minutes, the patients were asked to rate their level of anxiety and pain. They were also hooked up to an IV and given as much painkilling medication as they wanted.
The results of the study were published in The Lancet. On average, Spiegel and Lang found, the hypnotized subjects used less medication, experienced less pain, and felt far less anxiety than the other two groups. Patients who weren't hypnotized felt more pain over time regardless of how much medication they received; those who were hypnotized stayed equally comfortable throughout the surgery. Operations on hypnotized patients averaged 17 minutes shorter than those of other patients, and the cost of a standard radiological procedure fell from $638 to $300.
Lang has since bolstered those findings with two other ongoing studies, involving more than 330 patients. Once again, the hypnotized patients used less medication, recovered faster, and spent less time in the hospital than those with standard care.
Lang doesn't test her patients to see if they are highly hypnotizable. The more anxious they are about a procedure, she says, the more likely they are to benefit from hypnosis. "A person with a worst-case scenario about what's going to happen is somebody that has good imagery potential. It takes a very vivid mind to do that." Studies have shown that phobic people tend to be highly hypnotizable. Lang believes that people slip in and out of trances daily--that everyone has such moments of utter absorption when they can't hear what others are saying to them. "The ability to tune out is practiced throughout the world. Particularly in married couples," she says. Learning to control that absorption offers a way to learn to control pain.
The kidney operation Lang performed that day at Harvard was a good example. The 80-year-old patient came out of her trance at one point--"What is this rubbish about the beach?" she said--but the doctors soon put her under again with a simple hypnotic suggestion: "Your eyes won't close until your inner mind gives you permission." If hypnosis is ever to work its way into the mainstream, physicians will need to overcome their reluctance to say such things, knowing there is solid science behind what sounds like mysticism. "I think it should be based on data, not on belief," Spiegel says. "But in the end it doesn't matter why it works."
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