Most scientists and laymen alike would blindly agree that “the mind is a powerful thing”. What premises are used to defend this statement? What definition do we give to the concept of the mind? The mind is not a physical organ or aspect of our organism so why is it that we almost unanimously agree that this invisible, ill-defined structure is more powerful than perhaps any other creation or natural process known to man? What relationship does the mind play to the brain or to other physical systems and where does the controversial sub-system of psychology coined “hypnotherapy” fit into the conundrum?
As you contemplate these ideas, the electrical activity in your brain reflects your state of attention. As you actively focus on the words and the concepts, chances are that your brainwaves could be measured in the beta range (13-30 Hz). When you respond to suggestions to relax and focus your concentration on internal systems such as the breath, the electrical activity in the brain changes and the frequency slows. Typically, one relaxes into an Alpha range (7-13 Hz) which is characteristically seen just before falling asleep at night or while meditating. Deeper relaxation associated with dreams, hypnosis, and deep meditation reflects the Theta range (4-7 Hz) and deeper yet, we drift into the Delta. This is a bit simplified as there can be alpha waves present during a more delta state of consciousness, etc. It is the frequency that is prevalent during these active or inactive times that is considered.
Hypnotic trance generally occurs during the alpha and delta stages of consciousness. There are, however many different definitions of just exactly what hypnosis and hypnotherapy actually are. The APA’s Division 30 Definition and Description of Hypnosis:Hypnosis typically involves an introduction to the procedure during which the subject is told that suggestions for imaginative experiences will be presented. The hypnotic induction is an extended initial suggestion for using one’s imagination, and may contain further elaborations of the introduction. A hypnotic procedure is used to encourage and evaluate responses to suggestions. When using hypnosis, one person (the subject) is guided by another (the hypnotist) to respondto suggestions for changes in subjective experience, alterations in perception, sensation, emotion, thought or behavior. Persons can also learn self-hypnosis, which is the act of administering hypnotic procedures on one’s own. If the subject responds to hypnotic suggestions, it is generally inferred that hypnosis has been induced. Many believe that hypnotic responses and experiences are characteristic of a hypnotic state. While some think that it is not necessary to use the word “hypnosis” as part of the hypnotic induction, others view it as essential. Details of hypnotic procedures and suggestions will differ depending on the goals of the practitioner and the purposes of the clinical or research endeavor. Procedures traditionally involve suggestions to relax, though relaxation is not necessary for hypnosis and a wide variety of suggestions can be used including those to become more alert. Suggestions that permit the extent of hypnosis to beassessed by comparing responses to standardized scales can be used in both clinical and research settings. While the majority of individuals are responsive to at least some suggestions, scores on standardized scales range from high to negligible. Traditionally, scores are grouped into low, medium, and high categories. As is the case with other positively-scaled measures of psychological constructs such as attention and awareness, the salience of evidence for havingachieved hypnosis increases with the individual’s score. (American Psychological Association, Division of Psychological Hypnosis. http://www.apa.org/divisions/div30/define_hypnosis.html)The British Medical Association defines it as:A temporary condition of altered attention in the subject which may be induced by an-other person and in which a variety of phenomena may appear spontaneously or in response to verbal or other stimuli. These phenomena include alterations in consciousness and memory, increased susceptibility to suggestion, and the production in the subject of responses and ideas unfamiliar to him in his usual state of mind. Further, phenomena such as an aesthesia, paralysis andrigidity of muscles, and vasomotor changes can be produced and removed in the hypnotic state. (BMA, 1955)Although widely acknowledged for therapeutic applications in medicine and psychology, there seems to be no universally accepted definition. The U.S. Department of Education, Human Services Division defines it as, “The by-pass of the critical factor of the conscious mind (a persons analytical andjudgmental ability) followed by the establishment of acceptable selective thinking.” A hypnotherapist is simply a professional (such as a mental health professional, medical doctor, or one who performs hypnosis for anesthesia of dental procedures) who utilizes hypnosis in his/ her practice.
The History of Hypnosis
The history of hypnosis is extensive and it is said that written accounts of its use date back as far as 3000 BC and are found in areas of medicine as well as religion. The earliest records depict miraculous healing by priests and demigods who induced sleeplike states by ceremonial rites. Areas that some have later attributed to hypnosis such as healing with magnets, exorcisms, laying on of hands, and even prayer are still debatable and controversial areas subject to philosophical, religious, and scientific scrutiny. An interesting thought to ponder is that prior to Isaac Newton, “legitimate” hypnotists were separated from “fake” hypnotists by their ability to levitate subjects. It was assumed that people could levitate under hypnosis so reputable people would test for wires and other devices that caused the levitation. If they didn’t find any, the hypnotist was “real”, if he did, he was “fake”. Although impossible to list all important historical figures involved in this study, William S. Kroger (1977) mentions many of the most important in Clinical and Experimental Hypnosis, 2nd Edition some of which are as follows. Franz Anton Mesmer (1734-1815), an Austrian physician plagiarized writings of Richard Mead (1673-1815) and Maximilian Hell (1771) to develop a method of healing which purported to use magnetic energy and a theory of “universal fluid”. Mesmer was exposed by a commission in 1784 who stated that the cures were due to imagination. A pupil of his, Charles d’Eslon commented, “If the medicine of imagination is best, why should we not practice the medicine of imagination.” French surgeon Recamier and American Wheeler were among the first to perform surgical procedures utilizing hypnosis, Wheeler being the first to introduce this idea to the United States. In 1837, John Elliotson was the first professor of medicine at the newly founded college hospital attached to the University of London and became an advocate of ‘˜mesmerism’. Although Elliotson was a renowned physician and introduced the stethoscope to England, he was called a quack and an imposter. The university banned the use of mesmerism and the church opposed its use. Elliotson resigned his position and published the Zoist , a journal in which numerous painless operations were reported. James Braid merits the title, “Father of Modern Hypnotism”. Braid emphasized clinical observation and experiment and coined the terms “hypnostism” and “hypnosis”. Ambroise-Auguste Liebeault who treated poverty stricken patients for free using hypnosis and Hippolyte-Marie Bernheim, a renowned neurologist of the late 1800s together developed Braid’s theories. The duo treated over 12,000 patients and considered hypnosis a function of normal behavior and introduced the concept of suggestion and suggestibility. When hypnosis was commonplace, anesthesia was a curiosity and shows were given demonstrating the effects of laughing gas at its discovery. When anesthesia became more commonplace, hypnosis became the oddity. Historically, many medical fads have been deemed discredited procedures but hypnosis has survived. It is argued that the practice has been ignored due to irrational prejudice. Dr. William S. Kroger states, “This is not surprising, since prejudice is ignorance educated, and it is difficult for any individual, in any given era, to see through the “smoke screen” of his own culture.” (Kroger, 1977)
Theory and Practice
“Any therapist who utilizes hypnosis will do so under his/ her theoretical frame of reference and professional belief system” (Vandvik, 1988). Hypnotherapy should not necessarily be construed as a specific type of therapy. Instead, it is a tool that many different types of therapies and therapists may utilize within the framework of their practices. Two broad approaches to hypnotherapy are suggestion hypnotherapy and analytical hypnotherapy. Suggestion hypnotherapy is a direct or indirect suggestion given under a hypnotic trance. Analytical hypnotherapy strives to get to the roots of the client’s issues. Suggestion hypnotherapy can be utilized in conjunction with analytical hypnotherapy.
One cannot mention modern day hypnotherapy without mention of Milton Erickson. Another example of a scientist who can be seen through his work, Erickson’s interest in the power of mental imagery began at the age of 17 while infected with a very severe case of Polio from which he was not expected to recover. Unable to move from the chair that he was strapped to for hours, he discovered that while he was daydreaming and longing deeply to go outside, his chair began to rock. Excited about this development, he attempted to give direct commands, “Move legs! Rock the chair” but nothing happened. Again he drifted into daydream and again the chair began to rock. It was the intense visualization, the indirect command that had effect. Erickson taught himself to walk using this technique over the next two years and spent much of his ‘˜incapacitated’ time taking note of how people communicate with one another and in understanding the unconscious mind. Ericksonian hypnotherapy is known for being client-centered and tailoring the induction and therapy to the biases of the client. The assumption is that the client knows how to get ‘˜to his destination’ and the therapist’s job is to “keep his attention on the road” (http://www.ericksonian.com/milton-erickson.html)
There are many different models and styles of hypnotherapy. Some are based off of Cognitive-Behavioral approaches to therapy, others are motivational, some utilize NLP (Neuro Linguistic Programming), some are direct, others indirect. The uses of this tool are as diverse as the use of various types of therapy within the mental health profession. Generally, there is a pre-therapy or initial consultation (assessment) in which the therapist meets with the client, discovers his/ her reason for requesting services, explains the process of hypnosis to some extent, and becomes acquainted with the client. During the hypnotherapy session there is some form of induction technique to bring about the hypnotic trance. There are deepening techniques to bring the subject into a deeper trance. There is a wide array of therapeutic processes that are utilized during the hypnotic state and also certain testing techniques to establish whether the subject is in the appropriate frame of mind. There is then the awakener to return to a wakeful, beta producing state.
There has been a tremendous amount of research on the therapeutic applications of hypnosis in both medicine and behavioral science. Researching for this paper has given way to numerous study abstracts and some legitimate journal articles. There have been some quality, controlled studies but others that were not. Because there have been so many studies, meta analysis was a useful research tool. A meta analysis of hypnotically induced analgesia analyzing 18 studies revealed a moderate to large hypnoanalgesic effect. This effect was found in both clinical and experimental pain (Montgomery GH, DuHamel KN, Redd WH., 2000). A meta analysis published in the journal of Consulting and Clinical Psychology reviewed studies to determine whether the addition of hypnotherapy to Cognitive-Behavioral therapies improved the effectiveness of the therapy. Problems treated included obesity, phobia, and pain. The conclusion of this analysis showed a significant advantage of adding hypnotherapy to Cognitive-Behavioral models with 70% of the subjects who received the additional hypnotherapy technique showing greater improvement than those who received the Cognitive-Behavioral therapy alone, with the greatest benefit being seen in obesity (Kirsch, I., Montgomery, G., & Sapirstein, G., 1995).
One study by scientists at the Israel Defense Forces, Mental Health Department, Israel investigated the benefit of add-on hypnotherapy for the treatment of Post Traumatic Stress Disorder. The subjects were 32 patients being treated with psychotherapy and drug interventions. The subjects were randomly assigned to 2 groups. One group received Zolpidem nightly for 2 weeks. The other group was treated with symptom oriented hypnotherapy twice/ week for 2 weeks. There was a significant main effect of the hypnotherapy treatment with PTSD symptoms as measured by the Posttraumatic Disorder Scale. This effect was preserved at follow-up 1 month later. Additional benefits for the hypnotherapy group were decreases in intrusion and avoidance reactions and improvement in all sleep variables assessed (Abramowitz, Eitan G., Barak, Yoram, Ben-Avi, Irit & Knobler, Haim Y. ,2008).
Perhaps one of the most compelling of aspects of research into hypnotherapy is the documented physiological effects that can result from hypnotic suggestion. The implications of this “mind over matter” phenomenon are incredible. We are now aware that people whose brains have been damaged by trauma or illness are often able to compensate for the loss and form new circuits within the brain. This ‘˜rewiring’ capacity is a fascinating event and creates a sense of wonder in this researcher’s mind as to the role of the unconscious mind and physiological processes, even to the point of cellular reconstruction (?).
One study examining the ability to illicit physiological change with hypnotic suggestion used a suggestion of warm tub bathing with either the whole body or an arm. Vasodilatation was recorded with decrease in forearm resistance and increase in forearm blood flow just as in actual passive local warming. With whole body visualizations, there was a decrease in total peripheral resistance and an increase of cardiac index just as in real whole body passive warming (Casiglia et al, 2006).
Another area of claim of physiological effect of hypnotic suggestion is in the body’s ability to heal after injury or surgery. Carol Ginandes of Harvard Medical School and Daniel Rosenthal, professor of radiology at Harvard Medical School conducted an experiment to determine whether hypnotic suggestion could speed the healing of broken bones. They recruited 12 people with broken ankles who did not require surgery. Half of these people also received hypnotherapy to speed the healing. The same doctors and radiologists took the regular X-rays to determine the rate of healing. The radiologists did not know which patients were receiving hypnotherapy. Those that received hypnotherapy healed faster. Six weeks after fracture, those receiving hypnotherapy healed an equivalent of 8 Â½ weeks. There were those who suggested that perhaps this was the result of the added support and attention given by the hypnotist/ therapist. In response to this, four years later Ginandes and Patricia Brooks conducted an experiment on 18 breast surgery patients who were having breast reductions. This time Ginandes separated them randomly into three groups. All patients received the same surgical care by the same doctors. One group was given only standard care, one group received attention and support from a psychologist, and the third group received hypnotherapy directed toward healing. Patients were assessed for healing by physicians who also took photographs for 3 physicians to review. None of the physicians involved knew which group the women were in. The women also did self-reports of their healing. The results were very clearly in favor of the hypnosis group, with the therapeutic support coming in second and standard care last (http://www.spiritrevival.com/files/Articles/Hypnosis_Healing_Faster.pdf).
The studies mentioned in this research do not even come close to the tip of the ice berg. It should be mentioned that while there are many uses for hypnosis and hypnotherapy, there are also claims made by others that should be taken with caution. The mind truly appears to be a powerful tool and one in which there is still much room for research and growth.
Objective Measures of Hypnosis
Harvard has recently contributed quite elaborately in the area hypnotherapy as a scientific study. One such study was done in an attempt to develop an objective measure of hypnotic trance. Such measures would be beneficial in determining whether hypnotherapy has failed due to failure of the therapy or due to the subject never having entered a hypnotic trance. Measures such as EEG, fMRI, and PET scans have shown significant but non-consistent results. The hypothesis of this study was that the heart rate variability (HRV) signal could also be used to determine a hypnotic state. Typically, HRV contains a high frequency component near respiratory rate. Peng et al. found exaggerated heart rate oscillations associated with slow breathing during meditation that were significantly different from metronomic breathing and from spontaneous nocturnal breathing by normal adults or elite athletes (Peng, Mietus et al.1999). Ten final candidates who were not shown resistant to hypnosis participated in the study. The results did show that objective measurements in this study were consistent with self-reported hypnotic phenomena by the subjects. “In the broadest sense, these results suggest that an ECG monitor together with the proposed dynamic HRV model objectively measure hypnotic depth. Such a device, a “hypnometer,” could be used as a standard in clinical hypnosis to improve the reliability of hypnotic interventions.” This study did not have many subjects and further research is needed to verify the findings (Diamond and Howe).
Can I Be Hypnotized?
Research has shown that there are certain people who are more likely to be easily hypnotized than others. It has been shown that around 15% of the population are very responsive to hypnosis and about 10% are very difficult or impossible to hypnotize. Children are generally more susceptible to hypnosis as are people who are easily absorbed in activities such as daydreaming, listening to music, or reading (http://www.scientificamerican.com/article.cfm?id=the-truth-and-the-hype-of&sc=I100322). Some therapists such as Michael D. Yapko, PhD, believe that all people can be hypnotized but some require specialized techniques. Yapko lists “losing control, inability to distinguish ambiguous (for them) internal states such as tension or relaxation, fear of impending change, negative situational factors, etc.” as possible reasons why some people are less responsive at some times. He states that when the points of resistance are identified and resolved, the difficult person can become a good subject. Yapko criticizes statistical averages in regard to hypnotizeability stating that they are of little use to the clinician and that running test subjects through a standardized procedure is not sufficient means by which to test this ability. He states that, “Using the same technique with each person without variation is one way of assuring failure with a significant number of people” (Yapko, 1990).
There are many myths associated with hypnosis that have been “religiously” passed down through the ages. Some people today still believe that hypnotists are powerful, that anyone who can be hypnotized must be weak minded, one can be hypnotized to do or say something against his will, hypnotism can be hazardous to the health or spirit, one can become “stuck” in a trance, hypnosis may be used to accurately recall everything that has happened to you, and more (Yapko, 1990). Fortunately today the evidence for the value of hypnosis as a therapeutic tool is too large to ignore and scientists are paying heed. However with newly publicized articles instilling fear of false memories (a topic for another discussion), much of the public are as fearful today as they were at times when demons or Satan were thought involved. Only now, people are less likely to believe in ‘˜otherworld’ phenomena to be fearful of and are instead fearful of their own minds.
Abramowitz, E. G.-A. (2008). Hypnotherapy in the Treatment of Chronic Combat-Related PTSD Patients Suffering From Insomnia. International Journal of Clinical and Experimental Hypnosis , pp. 270-280.al, C. e. ( 2006). Local and systemic vasodilation following hypnotic suggestion of warm tub bathing . International Journal of Psychophysiology , 60-65 .APA. (n.d.). http://www.apa.org/divisions/div30/define_hypnosis.html. Retrieved May 7, 2009, from http://www.apa.org/divisions/div30/define_hypnosis.htmlBMA. (1955). http://www.ukhypnosis.com/Definitions.htm. Retrieved May 7, 2009, from http://www.ukhypnosis.com/Definitions.htmCromie, W. (2007). http://www.spiritrevival.com/files/Articles/Hypnosis_Healing_Faster.pdf. Retrieved May 7, 2009, from Harvard Gazette: http://www.spiritrevival.com/files/Articles/Hypnosis_Healing_Faster.pdfHowe, D. &. (n.d.). Measuring Hypnosis: Relating the Subjective Experience to Systematic Physiological Changes. http://biorobotics.harvard.edu/pubs/Hypnometer.pdf .http://www.scientificamerican.com/article.cfm?id=the-truth-and-the-hype-of&sc=I100322. (n.d.). Retrieved from http://www.scientificamerican.com/article.cfm?id=the-truth-and-the-hype-of&sc=I100322Huynh, V. a. (2008). Hypnotherapy in Child Psychiatry: The State of the Art. Clinical Child Psychology and Psychiatry .I., K., G., M., & G., S. (1995). Hypnosis as a adjunct to cognitive-behavioral psychotherapy: A meta-analysis. Journal of consulting and clinical psychology , pp. 214-220 .Kroger. (1977). Clinical and Experimental Hypnosis 2nd edition. Philadelphia: J.B. Lippincott Company.Montgomery GH, D. K. (Montgomery GH, DuHamel KN, Redd WH., 2000). A meta-analysis of hypnotically induced analgesia: how effective is hypnosis? International Journal of Clinical and Experimental Hypnosis .O’Brien. (2002-2004). http://www.ericksonian.com/milton-erickson.html. Retrieved May 7, 2009, from http://www.ericksonian.com/milton-erickson.htmlThe United States department of Education, H. S. (2001). http://www.robertottohypnosis.com/resources/articles/EthicsUtilizingRapidInduction.pdf. Retrieved May 7, 2009, from http://www.robertottohypnosis.com/resources/articles/EthicsUtilizingRapidInduction.pdfYapko, M. D. (1990). Trancework, An Introduction to the Practice of Clinical Hypnosis. Florence: Taylor & Francis.