Most People Fear Hypnosis — Until They Discover This

Once the preserve of music hall stage shows and often shunned and even parodied by the public, the media and the scientific community alike, hypnosis is now centre stage and considered a front-line treatment for a number of behavioural issues including addictive behaviours, weight loss and smoking (Andrean & Makeful, 2022; Roslim et al, 2022). Hypnosis is also used in medical settings for help with analgesia, for example treating anxiety in people facing dental surgery and those suffering pain as they undergo cancer treatment (Sine et al, 2022; Wolf et al, 2022). People have been known to experience what we now call a hypnotic state for thousands of years (Avicenna, a Persian doctor wrote about being in a trance as long ago as the early 11th century, (Hall, 2021)), but the modern-day movement of hypnosis was greatly influenced by the late 18* century physician, Franz Messmer. In fact, hypnotism was so influenced by the German doctor that entering into a hypnotic or trance like state became known as being mesmerised.

So, what exactly is hypnosis?

Essentially it is the state of having focussed attention, during such a state you may well have less awareness of peripheral distractions and be more able to respond to suggestion. It is, in essence, a method of inducing dissociation, so that peripheral events can be largely disregarded by the client, as they focus attention on the hypnotist and at the same time have less awareness of what is going on around them.

Far from being the gimmicky set of techniques often depicted by film and fantasy to manipulate people into behaving in a way the hypnotist designs, hypnosis is much more an approach for helping induce deep relaxation and increase a client's susceptibility to suggestion which they, of course, willingly enter as they seek help with a specific problem. 'Hypnotisability' is the degree to which we are susceptible to hypnosis, with work that emerged from Stanford and Harvard Universities suggesting about 10% of people are low, 10% high and 80% medium, in terms of susceptibility. Interestingly, there are specific characteristics which increase hypnotisability and it is probably the fantasisers amongst us who are the most susceptible. Amongst clinical groups, it is people with dissociative identity disorder followed by those with PTSD (Spiegel et al, 2011).

Does hypnosis work?

An older meta-analysis (a study combining the results of numerous studies into one was produced in 1995 (Kirsch et al) and this was recently updated (Ramondo et al, 2021). The essential details of the findings of both studies are that CBT, when used alone or with hypnosis, appears to show a greater affect with the addition of the hypnotherapy. Furthermore, the more recent of the two meta-analyses suggests enhanced treatment with hypnosis-supplemented CBT, for example, in the treatment of pain, depressed mood and obesity. In essence, these meta-analytic studies look for an 'effect size', essentially the difference in treatment outcome that can be accounted for by adding on the ingredient (in this case hypnosis) of interest.

For CBT alone compared with CBT integrated with hypnosis, there was a resounding support of the idea that CBT+H was superior in effect with Kirsch in the first study stating that analysis revealed subjects undergoing the "hypnotherapy enhanced CBT" improved in more than 70% of cases when compared to CBT alone. Using the specific example of weight loss, Kirsch and colleagues, in a separate study (Kirsch et al,

1996) found that long-term follow up of weight loss treatment showed that the hypnotherapy enhanced subjects had not only lost more weight but also maintained this at 2 years post-treatment.

Milton Erickson, the founding president of the American Society for Clinical Hypnosis, suggested that the practice of hypnotherapy with various forms of cognitive behavioural therapy showed overlap and influenced each other (Alladin,

2008). Erickson also suggested that the depth of hypnosis was not the issue in its success but that, in fact, the quality of the psychotherapy outweighed the need for 'deep' hypnosis (Erickson, 1976).

Another good question is what does hypnosis not work for?

Whilst pain relief, weight loss, and addictive behaviours are where evidence seems strongest, there is clear indication that hypnosis is probably not be a good fit for those people suffering with hallucinations, schizophrenia, and psychotic episodes, with research indicating the approach is contraindicated with significant risk of worsening of symptoms.

Integration

Essentially, positive suggestions, made under the influence of a hypnotic state, are called post-hypnotic suggestions. This is because they are supposed to have an effect after the person is no longer in the hypnotic state. The argument is that we are all frequently in a hypnotic state i.e., every time we drift off into a reverie that absorbs us... for example, how often have you driven a familiar route, say to work and have absolutely no memory of the journey/driving the car? This, in essence, is hypnosis. Clients might, therefore, learn self-hypnosis techniques to help with clearly stated behavioural goals. Let's say a client wants to gain more confidence/ be less anxious in social situations (many clients of course present for counselling with this exact issue). They could experiment with a four-stage self-hypnosis exercise which is essentially:

-Putting themselves into a suitable environment (calm spot).

-Following a relaxation technique.

-Introduce a clear positive suggestion.

-Return to baseline state.

Naturally, the calm spot would need to be somewhere they felt they were safe, would not be disturbed or overheard and in all probability quiet. Once that has been achieved, a relaxation technique e.g., paired muscle relaxation/breathing exercise would help.

By pairing muscle contractions in all body parts, starting with the lower limbs, and holding breath-followed by simultaneously breathing out and relaxing the body part after holding for 4/5 seconds. Next the client needs to introduce a suggestion (something clear and positively stated such as: / am calm and accepting in social gatherings), then practise this over some specific time (potentially briefly at first and then building up). Obviously, what happens is a deeper sense of relaxation is coupled with the positive statement. Finally the person would bring themselves back to the awareness of their surroundings.

References

Alladin, A. (2008). Cognitive hypnotherapy: An integrated approach to the treatment of emotional disorders. John Wiley & Sons.

Andrean, J., & Makful, M. R. (2022). Hypnotherapy as a method of smoking cessation: a systematic review. BKM Public Health and Community Medicine, 359-364.

Erickson, M. H., Rossi, E. L., & Rossi, S. (1976). Hypnotic realities. New York: Irvington.

Kirsch, I., Montgomery, G., & Sapirstein, G. (1995). Hypnosis as an adjunct to cognitive-behavioral psychotherapy: a meta-analysis. Journal of consulting and clinical psychology, 63(2),

Kirsch, I. (1996). Hypnotic enhancement of cognitive-behavioral weight loss treatments: Another meta-reanalysis. Journal of Consulting and Clinical Psychology, 64(3), 517-519. https://

doi.org/10. 1037/0022-006X.64.3.517

Ramondo, N., Gignac, G. E., Pestell, C. F., & Byrne, S. M.

(2021). Clinical hypnosis as an adjunct to cognitive behavior therapy: An updated meta-analysis. International Journal of Clinical and Experimental Hypnosis, 69(2), 169-202.

Roslim, N. A., Ahmad, A., Mansor, M., Aung, M. M. T., Hamzah, F., Shahril, M. R., & Lua, P. L. (2022). Does hypnosis result in greater weight loss compared to conventional approach?. American Journal of Clinical Hypnosis, 65(2), 99-109.

Sine, H., Achbani, A., & Filali, K. (2022). The effect of hypnosis on the intensity of pain and anxiety in cancer patients: a systematic review of controlled experimental trials. Cancer Investigation, 40(3), 235-253.

Spiegel, D.; Loewenstein, R. J.; Lewis-Fernández, R.; Sar, V.; Simeon, D.; Vermetten, E.; Cardeña, E.; Dell, P. F.

(2011). "Dissociative disorders in DSM-5" (PDF). Depression and Anxiety. 28 (9): 824-852. doi: 10.1002/ da.20874. PMID 21910187. S2CID 46518635. Archived from the original (PDF) on May 1, 2013

Wolf, T. G., Schlappi, S., Benz, C. I., & Campus, G. (2022). Efficacy of hypnosis on dental anxiety and phobia: A systematic

review and meta-analysis. Brain Sciences, 12(5), 521.