Hypnotherapy is a poorly understood technique that has multiple definitions, descriptions, and forms.
It is generally agreed that the hypnotic state is dif‑ferent from both sleep and ordinary wakefulness, but just exactly what it consists of remains unclear.
Hyp‑nosis is sometimes described as a form of heightened attention combined with deep relaxation, uncritical openness, and voluntarily lowered resistance to sug‑gestion. Thus, one might say that when a person watches an engrossing film and allows himself or her‑self to surrender to it as if it were reality, then that person is undergoing something indistinguishable from hypnosis.
In therapeutic hypnosis, the hypnotherapist uses one of several techniques to induce a hypnotic state.
The best‑known (but dated) technique is the swinging watch accompanied by the suggestion to fall asleep. Such “fixed gaze” hypnosis is no longer the mainstay.More often, hypnotists use progressive relaxation methods. Other methods include mental misdirec‑tion (as when a person is fooled during a suspenseful film) and deliberate mental confusion. The net effect is the same; the person being hypnotized is in a state of heightened willingness to accept outside sugges‑tions.
Once the person is in this state, the hypnotherapist can make a suggestion aimed at producing thera‑peutic benefit. At its most straightforward, this in‑volves direct affirmation of the desired health benefit, such as, “You are now relaxing the muscles of your neck, and you will keep them relaxed.” Indirect or paradoxical suggestions may be used too, especially in schools of hypnotherapy such as Ericksonian hypnosis and neurolinguistic programming. It is also possible to learn to give oneself suggestions by inducing a state of hypnosis; this is called self‑hypnosis.
Uses and Applications
Hypnotherapy is commonly used for the treat‑ment of addictions and for reducing fear and anxiety surrounding stressful situations, such as surgery or severe illness. Other relatively common uses for hypnotherapy include insomnia, childbirth, pain control in general, and nocturnal enuresis (bed‑wetting). However, the evidence that hypnotherapy is effective for these uses remains incomplete at best.
It is more difficult to ascertain the effectiveness of a therapy like hypnosis than a drug or a pill for one simple reason: It is difficult to design a proper double‑blind, placebo‑controlled study of this therapy. Re‑searchers studying the herb St. John’s wort, for ex‑ample, can use placebo pills that are indistinguishable from the real thing. However, it is difficult to conceive of a form of placebo hypnosis that cannot be detected as such by both practitioners and participants. For this reason, all studies of hypnosis have made various compromises to the double‑blind design. Some studies randomly assigned participants to receive ei‑ther hypnosis or no treatment. In the best of these studies, results were rated by examiners who did not know which participants were in which group (in other words, the examiners were blinded observers).
However, it is not clear whether benefits reported in such studies come from the hypnosis or less specific factors, such as mere attention.Other studies have compared hypnosis with var‑ious psychological techniques, including relaxation therapy and cognitive psychotherapy. However, the same issues arise when trying to study these latter therapies as with hypnosis, and the results of a study that compares an unproven treatment to an unproven treatment are not meaningful.
In some studies, participants were allowed to choose whether they received hypnosis or some other therapy. Such nonrandomized studies are highly un‑reliable; the people who chose hypnosis, for example, might have been different in another way.Even less meaningful studies of hypnotism simply involved giving people hypnosis and monitoring them to see whether they improved. Studies of this type have been used to support the use of hypno‑therapy for hundreds of medical conditions. How‑ever, for many reasons, such open‑label trials prove nothing.
In studies of most medical therapies, researchers must be sure to eliminate the possibility of a placebo effect. This concern, however, loses its relevance when hypnotism is in question. It is not a criticism of a study on hypnosis if an observed benefit turns out to be caused by the power of suggestion.
After all, hypnosis consists precisely of the power of suggestion. (The placebo effect is only one of many problems with open‑label studies, however.) Given these caveats, this article discusses what science knows about the med‑ical benefits of hypnotherapy.Possible benefits of hypnotherapy.
A minimum of twenty controlled studies, enrolling more than fifteen hun‑dred people in total, evaluated the potential benefit of hypnosis for people undergoing surgery. The com‑bined results of the studies suggest that hypnosis may provide benefits both during and after surgery, bene‑fits including reducing anxiety, pain, and nausea; nor‑malizing blood pressure and heart rate; minimizing blood loss; speeding recovery; and shortening hospi‑talization. Many of these studies, however, were of poor quality.
Hypnosis has also shown some promise for re‑ducing nausea, pain, and anxiety in adults and chil‑dren undergoing treatment for cancer. It also may be useful in persons with breast cancer who also have hot flashes.Numerous anecdotal reports suggest that warts can sometimes disappear in response to suggestion. In three controlled studies enrolling a total of 180 people with warts, the use of hypnosis showed supe‑rior results compared to no treatment. In one of these studies, hypnosis also was superior to salicylic acid (a standard treatment for warts). In that trial, hypnosis also was better than fake salicylic acid, hinting that the power of suggestion is greater with hypnosis than with an ordinary placebo.
Many smokers have tried hypnotherapy to break their addiction. While hypnotherapy benefits some smokers, it does not appear to be superior to other methods. In a review of nine studies, researchers found no consistent evidence that hypnotherapy was better than fourteen other interventions for nicotine addiction. Also, a later trial found that, when com‑bined with a nicotine patch, hypnotherapy was no better than cognitive behavioral therapy.
Other conditions for which hypnosis has shown promise in controlled trials include the following: asthma, burn injury (reducing pain), fibromyalgia, hay fever, irritable bowel syndrome, labor and de‑livery and other gynecologic procedures, nocturnal enuresis, chest pain of unknown cause (unrelated to the heart), peptic ulcers, psoriasis, pain associated with diagnostic procedures, tension headache and other forms of headache, and vertigo and headache caused by head injury. However, the quality of many of the supporting studies was poor, and their results were frequently inconsistent.
Hypnosis is particularly popular as an aid to weight loss. However, a careful analysis of published studies shows that hypnosis is not effective for this condition; at best, the evidence points toward only a marginal benefit.
What to Expect During Treatment
Hypnotherapy sessions usually last thirty to sixty minutes. They typically involve some questions and answers, followed by the hypnosis itself. Some hypno‑tists teach their clients self‑hypnosis so they can rein‑force the formal session.
Choosing a Practitioner
As with all medical therapies, it is best to choose a licensed practitioner in states where a hypnotherapy license is available. Where licensure is not available, one should seek a referral from a qualified and knowl‑edgeable medical provider.
In the hands of a competent practitioner, hypno‑therapy should present no more risks than any other form of psychotherapy. These risks might include worsening of the original problem and temporary fluctuations in mood.Contrary to various works of fiction, hypnosis does not give the hypnotist absolute power over his or her subject. However, as with all forms of psychotherapy, the hypnotherapist does gain some power over the client through the client’s trust; an unethical thera‑pist can abuse this power.