Facts of Life:
Issue Briefings for Health Reporters

Vol. 3, No. 7 November 1998
Minding the Body: The Science of Hypnosis

The Issue
The Facts
Interview: 'An Altered State'
Interview: Treating Disorders
Defining Hypnosis: 'Controlled Imagination'
Telling Your Blood Where To Flow
The Hypnotized, Not the Hypnotist
How To Find a Good Hypnotist
The Research

The Issue:

Science is demonstrating that hypnosis is one of the most versatile and useful of health care tools. It can be used to help correct eating disorders, help smokers quit, filter away some of the pain and emotional distress of cancer, ease the hurt and anxiety associated with invasive medical procedures such as bone marrow transplants, even reduce blood loss and quicken recovery from surgery. Yet hypnosis remains mostly on the margins of mainstream medical care, in large part because the research has not yet overcome either the prejudice born of a long history of stage hypnotists and quackery or the difficulty of understanding how a mental technique can so profoundly affect the body.

The Facts:

Strong evidence for the use of hypnosis in alleviating cancer pain was found by a scientific panel convened by the National Institutes of Health. (7) In one 10-year follow-up of 86 cancer patients, those who received self-hypnosis training along with group therapy had 50 percent less pain and survived a year and a half longer than did those who had routine medical care. (8,12,13)

Hypnotic suggestion can speed recovery from surgery. Twenty patients were told before abdominal surgery, "Your stomach and intestines will begin to move and churn so that you can eat your favorite food soon after the operation." On average, they recovered gastrointestinal functioning in 37 percent less time than did a control group and were discharged from the hospital in 6.5 days, compared to 8.1 days for the controls. Savings averaged $1,200 per patient. (6)

Self-hypnotic relaxation could reduce substantially the need for pain- and anxiety-reducing intravenous drugs used in the 1.3 million angioplasty and arteriography procedures done each year in the U.S. (9)

Three experimental sessions of hypnotic analgesia led to a highly significant reduction in the pain and distress of 15 adults with chronic low back pain. Participants reported increased psychological well-being and better sleep as well.(5)

Interview: 'An Altered State'

David Spiegel, MD, a member of the Mind-Body Research Network of the John D. and Catherine T. MacArthur Foundation, is Professor of Psychiatry and Medical Director of the Complementary Medicine Clinic at Stanford University School of Medicine.(8, 10-14)

Q. Can hypnosis and more traditional medical treatments work together?

A. Not only can they, they must. When we are ill, we "mind" what is going on in our bodies, one way or the other. The way we respond to the stress of medical illness has a lot to do with not just the immediate problem but with the interpretation we put on it.

Disease-related pain, anxiety, and stress affect the way we cope with the illness in many ways. Conversely, how we manage these symptoms and cope with the illness can affect the body. Hypnosis is a simple state of highly focused attention, coupled with a heightened ability to put unwelcome thoughts, feelings, and perceptions outside of conscious awareness.

It's becoming increasingly clear that people can modulate those perceptions with hypnosis. They can change the painful and distressing effects of stressors on their minds and their bodies.

Q. How do you see this in your clinical work?

A. Just this morning I worked with a 7-year-old girl. We had to insert a catheter through the urethra to inject a dye into her bladder. We couldn't anesthetize the child because we needed her cooperation, but it's a terrible thing for a small girl to have done to her.

The last time they did it, it took three nurses and her father holding her down, while she was screaming and struggling. This time, I used hypnosis, restructuring the stressor for her, getting her to focus on being in a place where she'd rather be than in the procedure room. In her case it was a Beanie Baby store. She got through the procedure with a few tears and mild discomfort, but in far less time and with no struggling at all. Best of all, nobody had to hold her down.

Hypnosis is particularly good in situations such as this because it involves a highly focused central state of attention, helping people put outside of their conscious awareness the things that they would ordinarily be focusing on. It's like looking through a telephoto lens: what you see is detailed but your range of vision is narrow.

Q. How do you get patients into a state of hypnosis?

A. If the patient has the requisite hypnotic capacity, entry into the hypnotic state is easy and rapid. It can occur in just a few seconds. It takes about five minutes to induce hypnosis and assess hypnotizability. I formally hypnotize my patients only the first time I see them. Then I'll say, "Now I'm going to show you how to go into self-hypnosis."

The task is to get patients to utilize their hypnotic capacity to restructure their approach to the problem. The aim is to get them to see their old problem from a new point of view. If, for example, the problem is smoking, we don't say, "Don't smoke." Rather, we focus on what the patient is for, which is protecting the body.

We teach three points. First, for your body, smoking is a poison. Second, you cannot live without your body; your body is a precious physical plant through which you experience life. And third, to the extent that you want to live, you owe your body respect and protection.

Q. Why is that message more powerful in hypnosis?

A. Because the patients are in an altered state, solely focused on the message, soaking it up, rather than in a psychological mode in which they can trivialize or ignore it.

Q. Once you've taught people to hypnotize themselves, how often do they do it?

A. For smokers and those with pain, I recommend every one or two hours at first. I tell them any time you have an urge to smoke or feel pain, don't fight it. Go into a state of self-hypnosis for a minute or two, reestablish your commitment to protecting your body or altering the perception of pain, and go on about your business. After a while it may become second nature and they just sort of shift into a hypnotic state without realizing it.

Q. Can most people be hypnotized?

A. About one person in four isn't capable of experiencing hypnosis, although most children are. About 5 percent show extremely high hypnotic ability and can do extraordinary things, such as completely eliminate pain. The great majority are somewhere in the middle. For them hypnosis can also be very helpful.

Q.You've said hypnosis is not a treatment you use alone but a facilitator for other types of care.

A. Cancer is a good example. We use group therapy to deal with the emotions, relationships in the patients' lives, and their social isolation. At the same time, we teach them self-hypnosis. In one trial, patients who went through group therapy experienced 50 percent less pain at the end of a year, even though they used very low amounts of medication, than a control group that had routine care. While not everyone in the therapy group received hypnosis, those who did got the most pain relief. (8,12,13)

In another trial, we taught self-hypnosis to half a group of patients who were undergoing invasive radiological procedures - dye injections, cut-downs to access the arteries, and other painful procedures where bad things can happen. Everybody was given access to patient-controlled intravenous analgesia if they wanted it. Those who were taught self-hypnosis used one-ninth the medication, and yet they had significantly less pain, less anxiety, less instability of their heart rate and blood pressure, fewer procedural interruptions, and got out of the recovery room sooner than those who were not taught self-hypnosis.(9)

Q. If it's so wonderful, why isn't hypnosis used more often?

A. People seem to have a hard time conceptualizing the notion that an intangible treatment has tangible benefits. Yet we now know that talking treatments have physiological effects - especially the highly focused interactions that we have in hypnosis. It's a powerful tool that we ought to be using more often to our patients' benefit.

Interview:

Treating Disorders

Arreed Barabasz, PhD, EdD, Professor of Psychology at Washington State University and Director of its Attentional Processes Laboratory, is President-Elect of the Society for Clinical and Experimental Hypnosis. He has been treating obesity and other disorders for 20 years, much of his work in collaboration with his wife, Marianne Barabasz, EdD, also a professor at the university. (1,2)

Q. You use hypnosis to treat eating and other disorders. Can you tell us how that works?

A. Hypnosis is an added ingredient. It shouldn't be thought of as a treatment in itself, but hypnosis increases the success rate by about 70 percent.

One process I use involves setting up a weight graph and working for a 20 pound weight loss over 90 days. The patients chart their weight day by day. Food portion control is of key importance - to feel satisfied with what you put on your plate, to feel full with that. We add hypnosis for those who are of average hypnotizability or better. We give them specific suggestions in hypnosis about sticking to the serving portions of the program they are following. We suggest to them, "You're becoming more comfortable eating less, it's easy to eat less." We also give positive instructions for exercise, another key to weight loss.

Q. What about anorexia and bulimia?

A. . My wife, Dr. Marianne Barabasz, has worked with really severe cases of both. Hypnosis is particularly helpful with bulimia patients, because these bingers and purgers generally have much higher hypnotizability than the average population. They easily dissociate from reality when they are binging or when they purge.(2)

Q. How do anorexics respond to hypnosis?

A. They don't have the same advantage as bulimics. Their hypnotizability scores are all over the board, just like the rest of the population.

Marianne has used hypnosis to get anorexic people in better touch with their body image. She has them look at themselves in a mirror while under hypnosis to normalize their notions of what constitutes acceptable amounts of body fat.

Q. What do you suggest to overweight or obese persons in hypnosis?

A. That depends on the particular problem. For example, some people binge on potato chips or taco chips. The suggestion in hypnosis then is based on the Spiegel model, that patients reframe their attitudes toward the desired foods, from positive to fixing on the foods' negative effects on their bodies. Very often people have two or three problem foods. If you can get rid of those right away, it makes the rest of the job much easier.

Defining Hypnosis: 'Controlled Imagination'

"Many people associate hypnosis with sleep. But, whatever sleep is, hypnosis is not. There is, however, a similarity: in both sleep and hypnosis you have a contraction of peripheral awareness. But the focal attention goes in opposite directions: in sleep it dissolves; in hypnosis it intensifies. A short definition of hypnosis is 'attentive perception and concentration, which leads to controlled imagination.'

"But controlled by whom? By the individual, not the hypnotist. Many people think hypnosis is something that is projected onto the subject, like bad breath. It's not that at all. If the subject is listening to the instructions and generates this shifting of concentration, it comes from within. It's not projected onto them.

"Another gross misconception is that hypnosis occurs only when the hypnotist uses it. Most people who are hypnotizable will often go into a trance spontaneously. It's an ideal way to concentrate. Ultimately, all hypnosis is self-hypnosis.

"In dealing with pain, for example, hypnosis introduces a new option. By using controlled imagination, you can imagine a tingling numbness in the area of the pain. Now, part of your brain is telling you there's pain there, and another part has generated a tingling numbness. By choosing to feel the numbness more than the pain, you filter the hurt out of the pain."

From a conversation with Herbert Spiegel, MD, a pioneer of medical hypnosis and former faculty member at the College of Physicians and Surgeons, Columbia University. Now in his 80s, he practices in New York City.(14)

Telling Blood Where To Flow

Surgery is a major life stress that patients can participate in alleviating, says research psychologist Henry L. Bennett, PhD, president of Patient Comfort, Inc., in Chatham, NJ.

Bennett uses the power of suggestion to prepare patients for surgery. He describes it this way: "You involve them in the operative process. There is a sense of active involvement, saying to the patient: 'We would like your help. It will be better for you and better for us. I would like to speak with you about becoming a more active participant in your anesthesia and your surgical repair.'"

While under anesthesia, his patients aren't expected to do anything consciously. Instead, their body functions respond involuntarily, such as the way blood flows to your face and makes you blush when you're embarrassed.

For example, Bennett tells patients about to undergo spinal surgery: "To make sure you will have very little blood loss in your surgery, it is important that the blood move away from the area of the spine and out to other parts of your body during the operation. Therefore, the blood will move away from your back during the operation. Then, after the operation, it will return to that area to bring nutrients to heal your body quickly and completely."

In a trial with 93 such spinal surgery patients at the University of California (Davis) Medical Center, those who received Bennett's specific instructions about blood movement lost an average 500 cubic centimeters of blood, compared to 900 cubic centimeters lost on average by both the controls and a third group taught relaxation techniques. (4)

Bennett calls behavioral interventions for surgery "win-win-win" programs. Patients are more satisfied because they participated in their recovery, surgeons win because they have happier patients, and health providers save money.

Bennett has tried to persuade hospitals, HMOs, and other medical institutions to offer behavioral intervention programs like his but says "I have yet to be successful in implementing any kind of program, despite my offers to do it essentially for free."

The Hypnotized, Not the Hypnotist

How completely a person experiences hypnosis "has almost nothing to do with the technique of the therapist or experimenter or any other hypnotist-related factor," according to Michael Nash, PhD, editor of the International Journal of Clinical and Experimental Hypnosis.

It has almost everything to do with the hypnotizability the individual brings to the therapist. And that is as stable over time as IQ, Nash says. A highly responsive person, in the upper reaches of hypnotizability scales, will become hypnotized under a wide range of therapeutic settings and conditions, Nash notes, while someone in the lower ranges will not.

Nash trains graduate students in the use of hypnosis as Associate Professor of Clinical Psychology at the University of Tennessee, where he also conducts hypnosis research. "An important thing to remember," he says, "is that hypnosis is not some sort of panacea or hokus pokus - anything you can do with hypnosis you can do without it. For example, there are other ways to help people manage pain or deal with obesity. Hypnosis is clearly helpful for a subset of patients, both those who score high on hypnotizability scales and the folks in the medium ranges."

How To Find a Good Hypnotist

"First, don't look for a hypnotist," Nash says. "Look for a specialist who can treat the malady you have, with or without hypnosis." Then, if you're still interested, two societies offer lists of appropriate hypnotists:

Society for Clinical and Experimental Hypnosis (509) 332-7555
American Society of Clinical Hypnosis (847) 297-3317

The Research

1. Barabasz, A, Barabasz, M (1996) "Neurotherapy and Alert Hypnosis in the Treatment of Attention Deficit Hyperactivity Disorder" Casebook of Clinical Hypnosis, Kirsch, J and Rhue, S eds., American Psychological Association, pp. 271-291.
2. Barabasz, M (1990) "Treatment of Bulimia with Hypnosis Involving Awareness and Control in Patients with High Dissociative Capacity," International Journal of Psychosomatics, pp. 53-56.
3. Bennett, H et al. (1993) "Preparing for Surgery and Medical Procedures," Mind-Body Medicine, Goleman, D and Gurin, J, eds., Consumer Reports Books, Yonkers, NY, pp. 401-427.
4. Bennett, HL et al. (1986) "Preoperative Instruction for Decreased Bleeding During Spine Surgery," Anesthesiology 65:A245.
5. Crawford, HJ et al. (January 1998) "Hypnotic Analgesia: Somatosensory Event-Related Potential Changes to Noxious Stimuli, and Transfer Learning to Reduce Chronic Low Back Pain," International Journal of Clinical and Experimental Hypnosis, pp. 92-132.
6. Disbrow, ED, Bennett, HL et al. (May 1993) "Effect of Preoperative Suggestion on Postoperative Gastrointestinal Motility," Western Journal of Medicine, pp. 488-492.
7. JAMA (July 24-31, 1996) "NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches in the Treatment of Chronic Pain and Insomnia" pp. 313-318.
8. Kogan MM, Biswas A et al. (1997) "Effect of Medical and Psychotherapeutic Treatment on the Survival of Women with Metastatic Breast Carcinoma," Cancer, 80(2): 225-230.
9. Lang, EV, Joyce, J, Spiegel, D et al. (April 1996) "Self-Hypnotic Relaxation During Interventional Radiological Procedures: Effects on Pain Perception and Intravenous Drug Use," International Journal of Clinical and Experimental Hypnosis, pp. 106-119.
10. Spiegel, D et al. (August 1997) "Imagery and Hypnosis in the Treatment of Cancer Patients," Oncology, pp. 1179-1195.
11. Spiegel, D (1991) "Uses of Hypnosis in Managing Medical Symptoms," Psychiatric Medicine, pp. 521-533.
12. Spiegel D, Bloom JR (1983) "Group Therapy and Hypnosis Reduce Metastatic Breast Carcinoma Pain," Psychosomatic Medicine, pp. 333-339.
13. Spiegel, H and Spiegel, D (1978/87) Trance and Treatment - Clinical Uses of Hypnosis, Basic Books, New York, NY; American Psychiatric Press, Washington, DC.
14. Spiegel D, Bloom JR et al. (October 14, 1989) "Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer," The Lancet, 2:888-891.

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