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Hypnotherapy

Alternative Names

  • Ericksonian Hypnosis
  • Hypnosis
  • Neurolinguistic Programming
  • Self-hypnosis

Overview

Hypnotherapy is a poorly understood technique that has multiple definitions, descriptions, and forms. It is generally agreed that the hypnotic state is different from both sleep and ordinary wakefulness, but just exactly what it consists of remains unclear. Hypnosis is sometimes described as a form of heightened attention combined with deep relaxation, uncritical openness, and voluntarily lowered resistance to suggestion. Thus, one might say that when you watch an engrossing movie and allow yourself to surrender to it as if it were reality, you are undergoing something indistinguishable from hypnosis.
In therapeutic hypnosis, the hypnotherapist uses one of several techniques to induce a hypnotic state. The most famous (and 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, such as those described in the article on relaxation therapies . Other methods include mental misdirection (think of a suspense movie that leads you down the wrong path) and deliberate mental confusion. The net effect is the same; the person being hypnotized is in a state of heightened willingness to accept outside suggestions.
Once the client is in this state, the hypnotherapist can make a suggestion aimed at producing therapeutic benefit. At its most straightforward, this involves 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 as well, especially in schools of hypnotherapy such as Ericksonian hypnosis and Neurolinguistic Programming (NLP).
It is also possible to learn to give oneself suggestions by inducing a state of hypnosis; this is called self-hypnosis.

Uses of Hypnotherapy

Hypnotherapy is commonly used for the treatment of addictions, as well as 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.

What Is the Scientific Evidence for Hypnotherapy?

It is more difficult to ascertain the effectiveness of a therapy like hypnosis than a drug or a pill for one simple reason: it isn’t easy to design a proper double-blind, placebo-controlled study of this therapy.
Researchers studying the herb St. John’s wort , for example, can use placebo pills that are indistinguishable from the real thing. However, it’s difficult to conceive of a form of placebo hypnosis that can’t be detected as such by both practitioners and patients. For this reason, all studies of hypnosis have made various compromises to the double-blind design. Some randomly assigned participants to receive either hypnosis or no treatment. In the best of these studies, results were rated by examiners who didn’t know which participants were in which group (in other words, blinded observers). However, it isn’t clear whether benefits reported in such studies are due to the hypnosis or less specific factors, such as mere attention.
Other studies have compared hypnosis to various 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 very meaningful.
In some studies, participants were allowed to choose whether they received hypnosis or some other therapy. Such nonrandomized studies are highly unreliable; 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 hypnotherapy for hundreds of medical conditions. However, for at least a dozen reasons, such open-label trials prove nothing at all, and we do not report them here. The reasons why are discussed in the article Why Does This Database Rely on Double-blind Studies? Note, however, that one criticism of open-label studies discussed in that article does not apply here: concerns regarding the placebo effect.
In studies of most medical therapies, researchers must take pains to eliminate the possibility of a placebo effect . This concern, however, loses its relevance when hypnotism is in question. It isn’t 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. For more information, see the article referenced above.)
Given these caveats, the following is a summary of what science knows about the medical benefits of hypnotherapy.

The Possible Benefits of Hypnotherapy

At least 20 controlled studies, enrolling a total of more than 1,500 people, have evaluated the potential benefit of hypnosis for people undergoing surgery . 1 Their combined results suggest that hypnosis may provide benefits both during and after surgery, including reducing anxiety, pain, and nausea; normalizing blood pressure and heart rate; minimizing blood loss; speeding recovery; and shortening hospitalization. Unfortunately, many of these studies were of very poor quality.
Hypnosis has also shown some promise for reducing nausea, pain, and anxiety in adults and children undergoing treatment for cancer . 2-4,27 It also may be useful in breast cancer survivors suffering from hot flashes. 30
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, use of hypnosis showed superior results compared to no treatment. 5,6 In one of these, hypnosis was also superior to salicylic acid (a standard treatment for warts)! 6 In that trial, hypnosis was also superior to fake salicylic acid, hinting that the power of suggestion with hypnosis is greater than with an ordinary placebo.
Many smokers have tried hypnotherapy to break the habit. While hypnotherapy benefits some smokers, it does not appear to be superior to other methods. In a review of 9 studies, researchers found no consistent evidence that hypnotherapy was better than a 14 other interventions for nicotine addiction . 17 And, a more recent trial found that, when combined with a nicotine patch, hypnotherapy was no better than cognitive-behavioral therapy. 29
A review of 4 randomized trials with 273 patients found hypnotherapy was over 4 times more effective compared to a control in treating nicotine addiction. The patients, however, were only followed for an average of 6-12 months, indicating that hynotherapy may produce short-term results. 36
Hypnotherapy has shown some promise for irritable bowel syndrome (IBS). 10,33,34,35 In one trial, 90 people with IBS were randomized to receive hypnotherapy provided by an experienced psychologist or supportive therapy. 33 In a related second trial, 48 people with IBS were randomized to hypnotherapy with a less experienced psychologist or to a waiting list. In both trials, which lasted three months, those who received hypnotherapy showed an improvement in their IBS symptoms. In another trial, the addition of hypnotherapy to supportive talks and usual care improved IBS symptoms when compared to supportive talks and usual care alone in a randomized trial of 100 adults suffering from severe IBS. Over 54% of patients receiving hypnotherapy had symptom improvement for up to 15 months compared to 25% in the control group. 37 In a review of 5 trials with 278 patients, hypnotherapy was associated with lower risk of no improvement when compared to a control group or usual care. There were some biases in the studies, but hypnotherapy has been shown to be a beneficial for people with IBS. 39
Hypnotherapy has also been studied for IBS in children. 34 Fifty-two children with functional (unknown cause) abdominal pain or IBS were randomized to hypnotherapy or standard care. After 3 months of treatment, those in the hypnotherapy group reported less pain. A follow-up study found that these effects lasted for almost 5 years in about 2/3 of the children. 35 In a review of 24 randomized trials with 1,390 children who experience functional abdominal pain, hypnosis was associated with symptom improvement when compared to usual care or a waitlist. Results in some trials lasted from 6 months to 5 years.41
A review of 7 quasi-randomized and randomized trials with 1,213 pregnant women during labor compared self-hypnosis training or hypnosis therapy to no hypnosis. There were no significant differences in the use of pharmocologic pain relief, anesthesia, or spontaneous vaginal delivery in 7 trials with 1,106 women. Hypnosis significantly reduced cesarean section in 2 trials with 562 women, but had no significant difference in 1 trial with 305 women. 38 An additional randomized trial with 680 women compared self-hypnosis to usual care during weeks 28-32 of pregnancy. There were no significant differences in epidural use during labor between the two groups.40
Other conditions for which hypnosis has shown promise in controlled trials include the following:
However, the quality of many of the supporting studies is poor, and their results are frequently inconsistent.
Hypnosis is particularly popular as an aid to weight loss . However, a careful analysis of published studies throws cold water on the belief that hypnosis has been shown to be highly effective for this condition; at best, the evidence only points toward a marginal benefit. 21

What to Expect in a Hypnotherapy Session

Hypnotherapy sessions usually last 30 to 60 minutes. They typically involve some questions and answers, followed by the hypnosis itself. Some hypnotists teach their clients self-hypnosis so they can reinforce the formal session.

How to Choose a Hypnotherapist

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, seek a referral from a qualified and knowledgeable medical provider.

Safety Issues

In the hands of a competent practitioner, hypnotherapy 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 subject. However, as with all forms of psychotherapy, the hypnotherapist does gain some power over the client through the client’s trust; an unethical therapist can abuse this.

References

1
Montgomery GH, David D, Winkel G, et al. The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. Anesth Analg . 2002;94:1639-1645.
2
Zeltzer L, LeBaron S. Hypnosis and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer. J Pediatr . 1982;101:1032-1035.
3
Zeltzer LK, Dolgin MJ, LeBaron S, et al. A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer. Pediatrics . 1991;88:34-42.
4
Syrjala KL, Cummings C, Donaldson GW. Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial. Pain . 1992;48:137-146.
5
Spanos NP, Stenstrom RJ, Johnston JC. Hypnosis, placebo, and suggestion in the treatment of warts. Psychosom Med . 1988;50:245-260.
6
Spanos NP, Williams V, Gwynn MI. Effects of hypnotic, placebo, and salicylic acid treatments on wart regression. Psychosom Med . 1990;52:109-114.
7
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8
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9
Haanen HC, Hoenderdos HT, van Romunde LK, et al. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. J Rheumatol . 1991;18:72-75.
10
Whorwell PJ. Use of hypnotherapy in gastrointestinal disease. Br J Hosp Med. 1991;45:27-29.
11
Martin AA, Schauble PG, Rai SH, et al. The effects of hypnosis on the labor processes and birth outcomes of pregnant adolescents. J Fam Pract. 2001;50:441-443.
12
Freeman RM, Macaulay AJ, Eve L, et al. Randomised trial of self hypnosis for analgesia in labour. Br Med J (Clin Res Ed) . 1986;292:657-658.
13
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14
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15
Whorwell PJ. Use of hypnotherapy in gastrointestinal disease. Br J Hosp Med . 1991;45:27-29.
16
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17
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18
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19
Spinhoven P, Linssen AC, Van Dyck R, et al. Autogenic training and self-hypnosis in the control of tension headache. Gen Hosp Psychiatry . 1992;14:408-415.
20
Zitman FG, van Dyck R, Spinhoven P, Linssen AC. Hypnosis and autogenic training in the treatment of tension headaches: a two-phase constructive design study with follow-up. J Psychosom Res . 1992;36:219-228
21
Allison DB, Faith MS. Hypnosis as an adjunct to cognitive-behavioral psychotherapy for obesity: a meta-analytic reappraisal. J Consult Clin Psychol . 1996;64:513-516.
22
Melis PML, Rooimans W, Spierings ELH, et al. Treatment of chronic tension-type headache with hypnotherapy: a single-blind time controlled study. Headache . 1991;31:686-689.
23
Banerjee S, Srivastav A, Palan BM. Hypnosis and self-hypnosis in the management of nocturnal enuresis: a comparative study with imipramine therapy. Am J Clin Hypn . 1993;36:113-119.
24
Cedercreutz C, Lahteenmaki R, Tulikoura J. Hypnotic treatment of headache and vertigo in skull injured patients. Int J Clin Exp Hypn . 1976;24:195-201.
25
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26
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27
Richardson J, Smith JE, McCall G, et al. Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence. Eur J Cancer Care (Engl). 2007;16:402-412.
28
Marc I, Rainville P, Masse B, et al. Hypnotic analgesia intervention during first-trimester pregnancy termination: an open randomized trial. Am J Obstet Gynecol. 2008 Mar 28. [Epub ahead of print]
29
Carmody TP, Duncan C, Simon JA, et al. Hypnosis for smoking cessation: a randomized trial. Nicotine Tob Res. 2008;10:811-818.
30
Elkins G, Marcus J, Stearns V, et al. Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors. J Clin Oncol. 2008 Sep 22. [Epub ahead of print]
31
Slack D, Nelson L, Patterson D, et al. The feasibility of hypnotic analgesia in ameliorating pain and anxiety among adults undergoing needle electromyography. Am J Phys Med Rehabil. 2009;88:21-29.
32
Abrahamsen R, Baad-Hansen L, Zachariae R, Svensson P. Effect of hypnosis on pain and blink reflexes in patients with painful temporomandibular disorders. Clin J Pain. 2011;27(4):344-351.
33
Lindfors P, Unge P, Arvidsson P, et al. Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials. Am J Gastroenterol. 2012;107(2):276-285.
34
Vlieger AM, Menko-Frankenhuis C, Wolfkamp SC, Tromp E, Benninga MA. Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial. Gastroenterology. 2007;133(5):1430-1436.
35
Vlieger AM, Rutten JM, Govers AM, Frankenhuis C, Benninga MA. Long-term follow-up of gut-directed hypnotherapy vs. standard care in children with functional abdominal pain or irritable bowel syndrome. Am J Gastroenterol. 2012;107(4):627-631.
36
Tahiri M, Mottillo S, Joseph L, et al. Alternative smoking cessation aids: a meta-analysis of randomized controlled trials. Am J Med . 2012 Jun;125(6):576.
37
Moser G, Trägner S, Gajowniczek EE. Long-term success of GUT-directed group hypnosis for patients with refractory irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol . 2013;108(4):602-609.
38
Madden K, Middleton P, et al. Hypnosis for pain management during labour and childbirth. Cochrane Database Syst Rev. 2012:CD009356.
39
Ford AC, Quigley EM, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: Systematic review and meta-analysis. Am J Gastroenterol. [Epub ahead of print 2014 Mar].
40
Downe S, Finlayson K, Melvin C, et al. Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness. 2015;122(9):1226-1234.
41
Rutten JM, Korterink JJ, Venmans LM, Benninga MA, Tabbers MM. Nonpharmacologic treatment of functional abdominal pain disorders: a systematic review. Pediatrics. 2015;135(3):522-535.
42
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