Hypnotherapy is a commonly used term, but it is in fact a little misleading. The word suggests that hypnosis itself has a therapeutic effect, when in fact in most situations it probably has relatively little direct impact. Am I saying that hypnotherapy doesn't work? No I am not, but let's do a little unpacking and try to see what is going on when people are hypnotised. I will explain some of the underlying mechanisms of hypnosis, and show how these processes can account for therapeutic effects.
Is hypnosis 'real'?
Until recently there was a good deal of debate as to the true nature of hypnosis, with some theorists adopting a very sceptical stance. They pointed out that many people prefer to go along with what's expected of them (a tendency called compliance by psychologists) and suggested that hypnosis was an extreme form of compliance – effectively an act, so as to appear hypnotised and do what the hypnotist expected. In his 1981 book, Hypnosis, Compliance and Belief the British psychologist Graham Wagstaff argued just this position, even suggesting that the apparent ability of some hypnotised people to tolerate pain was not all that it seemed.
Brain scanning and hypnosis
By the end of the Twentieth Century brain scanning techniques were being used to try to see what was going on in the head of a hypnotised person. The results have not dispelled all debate, but it is now clear that people who are susceptible to hypnosis are able to influence their brain activity in unusual ways. For example, Stewart Derbyshire, at the University of Birmingham, has shown that activity in parts of the brain termed the pain matrix (this matrix becomes active when we are in pain) can be increased and decreased by suggestions in hypnosis.
The treatment of pain
From the above it is not surprising that hypnosis is a valuable vehicle for pain control, and it has been used successfully in treatments, ranging from helping children undergoing painful medical procedures to eliminating intractable pain following amputation. I mentioned that hypnosis doesn't have a great deal of direct impact, but the treatment of pain is perhaps the closest it comes to being 'direct'. Even here, simply to be hypnotised is unlikely to be very effective; it is necessary for the therapist to give appropriate suggestions, for example that the painful area is becoming numb.
Hypnosis and imagery
Hypnotic suggestions are often accompanied by instructions to form rich imagery. For example, a pain sufferer could be asked to imagine sitting by a pure mountain stream, and to feel the cool water gradually taking away the pain. We could all imagine such things, but in hypnosis the experience often feels far more real than simply imagining. In 2000 Stephen Kosslyn and colleagues published research in the American Journal of Psychiatry, which used brain scanning to see how the brain behaved during a hypnotic hallucination. It turned out that brain activity during the hypnosis was far more like the activity observed when a person really looked at something compared with than when the person simply imagined it.
Making the imaginary real
Even without hypnosis, when we imagine something the resultant pattern of neural activity (i.e. the active brain cells) has a good deal in common with the pattern when we actually have the real experience. However, we obviously know that we are just imagining, and there are some crucial differences from reality in the activity of some of the frontal regions of the brain – the regions associated with the directing of attention and being conscious of our experiences. Hypnosis seems to be achieved by letting these frontal regions behave as if imaginings were real events.
Being able to imagine so vividly is very useful in the treatment of phobias. The usual (non-hypnotic) approach is to give the phobic person gradually increasing exposure to whatever frightens them; this is called desensitization. If they are afraid of heights they might start with standing near the edge of somewhere not very high, and with good solid railings. Once they felt at ease with that, they would be taken to somewhere just a little more adventurous, and so on. That's not too difficult to arrange for a height phobic, but what about arachnophobia - fear of spiders? We'd have to get a set of spiders of carefully graded scariness! That's where hypnosis is useful; the person can picture their own phobic objects so realistically that the phobia is overcome as effectively as with real-life desensitization.
The ability to generate a realistic make-believe world can be useful for treating more complex issues than phobias. For example, a person might return to an event in the past that had unresolved issues, or they might picture themselves as they would like to be in the future.
Combining with conventional therapies
You will appreciate that these uses of visualisation are not producing cures through hypnosis. It is merely a useful vehicle to facilitate processes that could have been carried out by more conventional means. The conventional therapy of choice for many problems with psychological elements is Cognitive Behavioural Therapy (CBT). There is evidence (much collected by Irving Kirsch and co-workers) that combining this with hypnosis can result in enhanced efficacy (see for example the work of Schoenberger, published in the journal Behavior Therapy, 1997).
Is hypnosis safe?
Hypnosis is safe – it's what people do with it that may not be! The clue here is to be found in the fact that hypnosis is generally used as a vehicle for other treatments. Anyone can quickly learn how to get someone to feel hypnotised; it takes years of study to become a GP or a clinical psychologist. Since these more medical procedures are the real substance of the hypnosis session it follows that one should choose a therapist who knows how to use them. This is likely to be a GP or psychologist who has gone on to receive training in hypnosis, rather than a lay person who has done a course on hypnotherapy, including some medical information.
Wrongly used, hypnosis might conceal a pain that should have been treated as a serious medical symptom and it can re-traumatise someone hoping to get over an earlier traumatic incident. A notable danger is the generation of false memories. Some misguided therapists become convinced that current problems are the result of material from the past that has been 'repressed' out of memory. They set about 'recovering' the material. This approach should never be used. The vivid visualisation of possible (but not true) past events easily produces material that feels like a genuine memory.
The British Society of Clinical and Academic Hypnosis is an organisation that admits only trained health professionals. Their site includes further details about the nature of hypnosis and therapy.
Taking it further
If you'd like to know about 'making the imaginary real' in some depth, I have expanded elsewhere on the above ideas (for example in 2006, in the journal Contemporary Hypnosis) but more easily accessible is a (reasonably accurate!) transcript of an interview, on Australia's Radio National website.
To get a feel for what hypnosis is really like, watch an extended video I was involved in at Science Live.
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What did Kathy discover?
In Alternative Therapies, Kathy found that hypnosis is being investigated by a number of mainstream scientists and that hypnotherapy is currently offered for a wide variety of conditions.
Kathy discovered there is often a lack of strong supporting clinical evidence but even so, there are a number of conditions where it seems hypnotherapy really could be of value.
She investigated two of these: meeting a dentist who uses hypnotherapy as a spectacular form of pain relief for a patient undergoing extreme dental surgery without an anaesthetic and a doctor who has had great success using it to treat the most severe form of Irritable Bowel Syndrome.
Find out more about the hypnotherapy programme.
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