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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.
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 It also may be useful in breast cancer survivors suffering from hot flashes. 3 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. 4 In one of these, hypnosis was also superior to salicylic acid (a standard treatment for warts)! 5 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 . 6 And, a more recent trial found that, when combined with a nicotine patch, hypnotherapy was no better than cognitive-behavioral therapy. 7 Other conditions for which hypnosis has shown promise in controlled trials include the following:
- Asthma 8
- Burn injury (reducing pain) 9
- Fibromyalgia 10
- Hay fever 11
- Irritable bowel syndrome 12
- Labor and delivery , other gynecologic procedures 13
- Nocturnal enuresis 14
- Chest pain of unknown cause (unrelated to the heart) 15
- Peptic ulcers 16
- Psoriasis 17
- Pain associated with diagnostic procedures 18
- Tension headache and other forms of headache
- Vertigo and headache caused by head injury 19
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. 20
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.
- Montgomery GH, David D, Winkel G, Silverstein JH, Bovbjerg DH. The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. Anesth Analg. 94(6):1639-45, table of contents.
- 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. 101(6):1032-5.
- Elkins G, Marcus J, Stearns V, Perfect M, Rajab MH, Ruud C, Palamara L, Keith T. Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors. J Clin Oncol. 26(31):5022-6.
- Spanos NP, Stenstrom RJ, Johnston JC. Hypnosis, placebo, and suggestion in the treatment of warts. Psychosom Med. 50(3):245-60.
- Spanos NP, Williams V, Gwynn MI. Effects of hypnotic, placebo, and salicylic acid treatments on wart regression. Psychosom Med. 52(1):109-14.
- Abbot NC, Stead LF, White AR, Barnes J, Ernst E. Hypnotherapy for smoking cessation. Cochrane Database Syst Rev. (2):CD001008.
- Carmody TP, Duncan C, Simon JA, Solkowitz S, Huggins J, Lee S, Delucchi K. Hypnosis for smoking cessation: a randomized trial. Nicotine Tob Res. 10(5):811-8.
- Hackman RM, Stern JS, Gershwin ME. Hypnosis and asthma: a critical review. J Asthma. 37(1):1-15.
- Patterson DR, Ptacek JT. Baseline pain as a moderator of hypnotic analgesia for burn injury treatment. J Consult Clin Psychol. 65(1):60-7.
- Haanen HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP, Hekster GB. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. J Rheumatol. 18(1):72-5.
- Langewitz W, Izakovic J, Wyler J, Schindler C, Kiss A, Bircher AJ. Effect of self-hypnosis on hay fever symptoms - a randomised controlled intervention study. Psychother Psychosom. 74(3):165-72.
- Whorwell PJ. Use of hypnotherapy in gastrointestinal disease. Br J Hosp Med. 45(1):27-9.
- Marc I, Rainville P, Masse B, Verreault R, Vaillancourt L, Vallée E, Dodin S. Hypnotic analgesia intervention during first-trimester pregnancy termination: an open randomized trial. Am J Obstet Gynecol. 199(5):469.e1-9.
- 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. 36(2):113-9.
- Jones H, Cooper P, Miller V, Brooks N, Whorwell PJ. Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy. Gut. 55(10):1403-8.
- Whorwell PJ. Use of hypnotherapy in gastrointestinal disease. Br J Hosp Med. 45(1):27-9.
- Zachariae R, Oster H, Bjerring P, Kragballe K. Effects of psychologic intervention on psoriasis: a preliminary report. J Am Acad Dermatol. 34(6):1008-15.
- Slack D, Nelson L, Patterson D, Burns S, Hakimi K, Robinson L. The feasibility of hypnotic analgesia in ameliorating pain and anxiety among adults undergoing needle electromyography. Am J Phys Med Rehabil. 88(1):21-9.
- Cedercreutz C, Lähteenmäki R, Tulikoura J. Hypnotic treatment of headache and vertigo in skull injured patients. Int J Clin Exp Hypn. 24(3):195-201.
- Allison DB, Faith MS. Hypnosis as an adjunct to cognitive-behavioral psychotherapy for obesity: a meta-analytic reappraisal. J Consult Clin Psychol. 64(3):513-6.