Chapter 23

Clinical Hypnosis:
Cultivating Your
Brain for Healing

“The voice talking to you gradually becomes more
distant, and you find yourself forgetting that it is
there…but somehow the soothing voice continues to
affect you, gently and almost automatically.”

—Dr. Olafur Palsson, Clinical Psychologist,
University of North Carolina

My patients are always eager to hear about one of my favored techniques, a powerful tool that I recommend for chronic pain. I tell them it is a perfectly natural therapy that is remarkably effective with virtually no negative side effects. Research has shown it can reduce the intensity, duration, frequency, and intrusiveness of chronic pain. It is beneficial for a multitude of chronic pain conditions (including cancer, low back pain, headache, neck pain, arthritis, temporomandibular disorders, burns, sickle cell disease, fibromyalgia, complex regional pain syndrome, and physical disabilities).

Whew! What is this medical marvel?

That’s when I break the spell and tell them, “It’s clinical hypnosis.” Their eyes drop a bit, and they lean back in their chair. You don’t have to be an expert in body language to realize they are a little apprehensive about the idea of being hypnotized. I’ve seen this reaction many times, and the story is always the same. They generally have no idea of what clinical hypnosis really is. Their understanding of hypnotism usually is based on what they have seen in movies and on TV. And like everything else that comes out of Hollywood, it is long on entertainment value and short on truth.

They picture Svengali or Count Dracula, who seize control of the minds of beautiful maidens with a mesmerizing stare and a simple command: “Look into my eyes!” Other popular images are a pocket watch on a chain swinging back and forth, or a spiral disc that rotates to hypnotic effect. “You are feeling sleepy…” In a fan-favorite movie, it is the recurrent sound of a spoon stirring a cup of tea.

Regardless of how the hypnosis is induced, the effect is always the same. The subjects fall into a trance and their minds are reprogrammed by the hypnotist to carry out evil deeds against their will. When the subjects wake up, they don’t remember any of it. Sounds scary, doesn’t it?

Yes, this sort of hypnosis is a great plot device, but it is complete hogwash.

This is where I launch into my spiel about all the things that are wrong with this view of hypnosis.

The Five Fallacies of the
Hollywood Hypnosis Hoax

Fallacy One: When you snap out of a hypnotic state, you won’t remember anything.

Fact: People generally remember most of what happened while they were hypnotized. Amnesia during hypnosis is very rare.

Fallacy Two: You can be hypnotized against your will and lose control over your actions.

Fact: Hypnosis works best when the patient voluntarily participates in the treatment. Many studies have shown that the patient cannot be hypnotized into doing something against their will or value system.

Fallacy Three: Hypnosis will make you lose consciousness.

Fact: Numerous EEG studies have demonstrated that hypnosis is not sleep. Most often, the patient will be conscious of everything going on while in the hypnotic state. However, sometimes you may relax so much during hypnosis that you drift off and lose track of what is happening. And if you are sleep-deprived, you might even fall asleep from the deep relaxation!

Fallacy Four: Hypnosis will force you to reveal secrets about yourself.

Fact: As mentioned above, hypnosis will not cause you to do or say things against your will. Hypnosis during psychotherapy may sometimes be used to explore unconscious material, but this is only done with the mutual consent of patient and doctor. When hypnosis is used for relief of a physical problem such as chronic pain, no such uncovering is typically needed.

Fallacy Five: People who can be hypnotized are more gullible or simpleminded.

Fact: Wrong! If anything, the capacity to experience hypnosis correlates more with openness to new experiences, rather than gullibility.

That other branch of show business that uses hypnosis for the sake of entertainment—stage hypnosis—is largely built on these same fallacies. You may have attended a convention or party where they hired a stage hypnotist. This is someone who is not a health professional, but has learned enough to put somebody into a trance. I can understand how people may enjoy watching a group of volunteers from the audience start barking like dogs. But this is a distortion of what hypnosis is. Worse yet, when your first exposure to hypnosis is riddled with fallacies, it is hard to take it seriously as a safe and useful treatment for distress.

Natural Hypnosis

The great irony of hypnosis is that it seems like such a mystery, yet we naturally enter hypnotic states every day:

•When you daydream during an activity

•When you get so involved in a hobby or other activity that you lose track of time

•When you watch a movie or TV

Experts in hypnosis have identified three basic features that characterize the genuine hypnotic state: dissociation, absorption, and suggestibility. You are likely to be familiar with all three.

1.Dissociation—We’ve discussed dissociation previously as a coping technique of disconnecting with pain by ignoring sensations. Basically, any kind of disconnection with what is happening in us and around us is dissociation. It is what you mean when you say someone is “spaced out.” They are in their own world and are not paying attention to anything outside it. It’s like that time you were driving home from work and started wondering about what was going to happen next on The Crown. You started reviewing in your mind all the key scenes from last season. You’re in the middle of a great scene—when suddenly you are forced to stop daydreaming because you find yourself pulling into the driveway in front of your house! You had no memory of all the turns and roads you took to get home. You were spaced out. You were dissociated. You were hypnotized! Under this kind of natural spell, people commonly lose track of time. And they frequently report having a floating sensation, which makes sense because they certainly aren’t grounded.

2.Absorption. Being absorbed in something you are doing is an act of full concentration. Absorption is being totally immersed in an activity. People say they are “in the zone” or “in the flow.” A jazz artist might say he is “in the groove.” When you are totally focused on your activity—whether it is gardening, making music, or playing sports—you are oblivious to everything else going on in the world. Another way of saying it is that nothing distracts you. The NFL quarterback in the final seconds of a tight game pays no attention to the deafening crowd noise. Anyone seriously involved in a hobby knows this state. Think of how time flies and you become totally engaged in cooking, reading, painting, or gardening.

You are in a similar absorbed state when you watch a movie or a play—you suspend disbelief and forget about the outside world. That’s why you hate it so much when someone starts talking in the theater—it breaks the spell. That’s also why you can binge-watch a TV series and have no clue as to how many hours you just wasted. It also explains why some people can’t stop playing video games. That could be considered the downside of this naturally occurring hypnotic state. But for those who are practicing their craft, there is nothing more desirable than being “in the zone.”

3.Suggestibility. It is a feature of the hypnotic state that a person’s mind has a heightened openness to suggestions. An everyday example is when the mother kisses away her child’s boo-boo, and makes the pain go away. When the toddler falls and scrapes her knee, she starts crying with all her might. But when Mommy reassures her and kisses the injury, the pain goes away, the crying stops, and the little girl smiles. The mother’s gesture changed her child’s perception of pain. This phenomenon works for adults, too, which is why many clinicians use hypnosis to treat chronic pain. It is this same openness that makes hypnosis a door to the mind and body where positive suggestions can enter.

A common feature that runs through all these aspects of hypnosis is a distorted sense of time. When you are sitting through a boring lecture or a dull meeting, it feels like time is standing still. The clock moves so slowly you think the event will never end. But when you’re on a great vacation, time speeds by and it’s all over before you know it. It is common for people to underestimate the length of time they have been hypnotized.

Clinical Hypnosis

Clinical hypnosis is where a trained health professional induces a hypnotic state and uses therapeutic suggestions with a patient, primarily with the goal of relieving pain or suffering. One definition of hypnosis comes from the American Psychological Association: “A set of techniques designed to enhance concentration, minimize one’s usual distractions, and heighten responsiveness to suggestions to alter one’s thoughts, feelings, behavior, and physiological state.”

In this way, clinical hypnosis methodically makes use of the features of natural hypnosis—dissociation, absorption, and suggestibility—to serve a broader therapeutic purpose.

It is important to emphasize that clinical hypnosis is not a treatment in and of itself. Rather, it is a procedure that can be used to facilitate other types of therapies and treatments. For example, hypnosis is not a type of psychotherapy, but it is a technique that can enhance the effectiveness of psychotherapy.

People commonly confuse hypnosis with meditation. There are similarities between them, but their differences are important. Both are beneficial forms of focused awareness that usually bring a feeling of calmness and relaxation. However, relaxation may not always be a goal of hypnosis. Such is the case with active-alert hypnosis, a method used by athletes, test-takers, and others to maintain focused attention during activity to enhance performance. Another primary difference between hypnosis and meditation is the goal of each practice. In meditation, the goal is to enhance nonreactivity of the mind, which may reduce stress levels and ultimately calm the body. Both hypnosis and meditation are worthwhile practices that are helpful for healing from chronic pain. In hypnosis, the goal is to take advantage of this receptive state to offer specific therapeutic suggestions to create changes in your thoughts, emotions, and physiology.

The Importance of Suggestions

Hypnotic suggestions can effectively change certain ways that your body/mind functions. During hypnosis, I will offer a suggestion designed for a specific patient. For example, I may say, “You will find that the tight constriction around your head will start to loosen” or “You’ll be pleasantly surprised to notice yourself falling asleep at night much more easily and waking up refreshed and rested.” Notice that these suggestions can either have an immediate effect, or instill positive inclinations for the future. The remarkable thing about suggestions made during this receptive state is the effect they have on autonomic (that is, automatic) processes. Suggestions give you the ability to rewrite your inner narrative. It is an effective way to begin to root out negative habits by replacing them with positive ones. Self-hypnosis can be viewed as the ultimate act of self-control. It allows people to change the way they feel and to use more of their potential.

Other hypnotic suggestions can be used to bring healing and relief. In a state of concentrated attention, ideas and suggestions that are compatible with the patient’s desires can have a powerful effect on mind and body. For example, a patient with low back pain may be given a suggestion to picture being able to move, sit, and bend in the future while feeling increasingly comfortable and confident in his body’s ability to heal from back distress.

Practitioners conduct clinical hypnosis in different ways, but virtually all encourage the use of the imagination. Mental imagery can be very powerful in a state of focused attention. For example, a patient with a chronic muscle tension headache may be asked to imagine what her distressed head feels like. If she imagines it as a constricting belt around her forehead that is being continually tightened, I can suggest she imagines the belt is being gradually loosened and her forehead is becoming more relaxed and comfortable. Activating the imagination can yield beneficial physiological changes.

How Does Hypnosis Work
for Treating Chronic Pain?

Research has established that hypnosis can be a powerful way to change the way we use our mind to enable new physical and emotional responses. We are also seeing studies that attempt to track what is going on in the brain and nervous system during hypnosis. We are still in the early stages of mapping out the neurophysiology of hypnosis, but we are developing some useful hypotheses that give us an idea of what is going on.

One main tool in such research is fMRI—functional magnetic resonance imaging. Images captured during hypnosis indicate that some areas of the brain become more active and other places become less active. As I discussed earlier, patients with chronic pain commonly suffer from dysregulation of the autonomic nervous system. Several studies have demonstrated that hypnosis helps regulate autonomic balance, often by activating the parasympathetic branch, the one that calms us down. It may also downregulate the sympathetic system—the activating branch that carries out the fight-flight response. This combination can be very helpful for reducing autonomic dysregulation. Occasionally, hypnosis helps by up-regulating the sympathetic branch.

One important study (Dillworth, Mendoza, and Jensen, 2012) suggests that hypnosis is able to disrupt pain because it alters the brain’s pain network. (Refer back to Chapter 2, “How Pain Works in Your Brain and Nervous System,” for a discussion of the pain network.)

It seems to be that activating these brain regions through hypnosis allows for some of the beneficial changes that we see in our patients. For example, hypnosis may allow for the ability to focus deeply on hypnotic suggestions without distraction, and the ability to experience actual physical changes through a hypnotic suggestion.

Some research has monitored brain wave activity during hypnosis. Several studies have shown a high frequency of theta waves, which are often observed during deep relaxation, daydreaming, or focused concentration. This supports the idea that hypnosis is different than a sleep state. These studies also suggest that people who are more susceptible to hypnosis show greater theta activity than those who are not susceptible.

So what does all that mean? As a practitioner, this research suggests that different sorts of hypnotic suggestions can tap into different areas of the brain. It all depends on the purpose of the suggestion: reducing the intensity of pain, decreasing anxiety or depression associated with pain, improving sleep quality, spurring interest in physical activity, and so on.

Part of what makes hypnosis such a valuable treatment for chronic pain is that it can affect multiple pain-related outcomes. Hypnosis can decrease pain, increase comfort, improve the ability to ignore pain, or shift attention away from pain. One can even learn to change the sensation of pain to another sensation, such as tingling or numbness. More broadly, suggestions may focus on improvements in other areas of life that affect the experience of pain—or vice versa. Suggestions can be used to improve self-confidence, to become more involved in activities of daily living, to change beliefs or attitudes, or to improve self-care habits.

Even though hypnosis can provide comfort and relief for the chronic pain sufferer, it doesn’t mean that the pain was psychosomatic or all in your head. Hypnosis works through its effects on multiple pathways through the brain and nervous system.

What Happens in the
Hypnotic Experience

Since clinical hypnosis is not a standalone therapy, the decision to use it is made in the overall context of the patient’s therapeutic program and objectives. Perhaps the most important aspect of entering the hypnotic experience is the quality of the therapeutic relationship between doctor and patient. The first step in the process of using hypnosis is a thorough discussion between the two to clarify the patient’s goals for healing from chronic pain. Your answers to the pain assessment will guide how we work together with hypnosis.

The Three Stages of Hypnosis

There are many variables that make each session of clinical hypnosis unique, but they typically follow the same basic three-stage structure: induction, application, and the re-alerting phase.

Induction Phase

Hypnosis begins with the induction phase. In the movies, this is where the hypnotist swings a pocket watch back and forth or uses some other device to focus the attention of the subject. Medically trained hypnotist-clinicians seldom use such clichés to guide the subject into a calm and receptive state of mind. I have adopted the common practice of having you focus on your breath as a way to begin the experience. Another common option is to have you stare at a fixed object in the room. The type of induction used varies depending on the individual patient and type of problem. During induction, you focus your attention away from any thoughts or abstractions and gradually fall into a trance state.

Application Phase

The application phase comes once you have achieved a receptive state of mind. I will address the goals you have selected for treatment by making various suggestions. Your goal may be, “reduce my headache intensity,” “sleep through the night better,” or “feel less trapped by the pain and more hopeful.” We may address several goals. One of the wonderful things about hypnosis is that one hypnotic session can include suggestions for many therapeutic objectives—such as decreased pain, increased comfort, improved sleep, improved interest in practicing self-care exercises, etc.

Some of my suggestions are direct, such as “You will have reduced pain and increased comfort in your neck.” Other times I will use metaphorical suggestions that are more indirect. I may say, “Notice how the dark storm clouds start to diminish, revealing a beautiful blue sky underneath.”

Another powerful strategy in clinical hypnosis is the use of post-hypnotic suggestions. This is a helpful tool to incline you toward desired changes in the future. An example of a post-hypnotic suggestion would be, “And every time that you listen to this recording, you will find even more relaxation and comfort and will look forward to practicing this even more regularly.” When we use hypnosis for treating chronic pain, post-hypnotic suggestions often have you “picture yourself in the future with more comfort and flexibility, being able to return to more and more desired activities of daily living.”

We typically record your hypnosis session so you can practice it at home every day. That way it becomes an ongoing part of your healing process. The only time I don’t record the session is when the purpose of the hypnosis is exploratory. On rare occasions, patients sometimes decide it would be beneficial for me to probe into some of their deeper feelings or concerns regarding the pain, or to explore unforeseen barriers to their progress. I use exploratory hypnosis only with your consent and only after a frank and open discussion about whether it would be useful.

Re-Alerting Phase

The last step in the hypnosis progress is the re-alerting phase. I facilitate a smooth, gentle transition from the hypnotic trance to normal wakefulness. This phase may last from thirty seconds to several minutes. Many patients tell me that the hypnotic state was so comfortable that they’d rather stay in it much longer! Once you are back in a wakeful state, we discuss your experience. You can tell me what the hypnosis was like for you, ask questions, and possibly have new insights about your pain and healing.

Susan’s First Hypnosis Experience

Susan was a relatively new patient, but we had come to a point in her treatment where hypnosis seemed like a good next step. She was a fifty-three-year-old business executive with chronic pain who had spent ten years seeing numerous physicians, chiropractors, and massage therapists. Several years ago she had surgery to correct a herniated disc, but that didn’t stop the pain. She described it as an ongoing, low-grade deep ache across her entire low back, with occasional spikes of sharp stabbing pain in her buttocks and hips. Every so often she’d have a burning sciatic pain radiate down her left leg. By the time she came to me, Susan felt like she had run out of options and was ready to try something new.

When I first told her about hypnosis, she was open to the idea, but was rather dubious.

“I’m quite sure I’m not hypnotizable,” Susan said. “I do best when I maintain full control, and I can’t imagine letting go of that.”

“That might be true,” I told her. “But let’s proceed and just see what happens.”

People do vary in their ability to be hypnotized. If you really resist the idea, then you won’t fall into a trance. But people are not always the best judge of whether they are hypnotizable or not. I think the major factor is whether they are willing. We have a saying in the hypnosis field: “All hypnosis is self-hypnosis.”

What follows is an abbreviated version of Susan’s first hypnosis experience. The typical session lasts for about twenty minutes.

I dimmed the lights and had Susan sit comfortably in an easy chair. I spoke to her in a gentle, reassuring manner.

“Start with your eyes open and take a few deep breaths…”

I paused for about half a minute to let her develop her rhythm of deep breaths. Frequent pauses—anywhere from five seconds to a minute or more—are an important ingredient in the procedure. They slow the pace and give the subject ample time to focus on their feelings and sensations.

“Eventually you may find it more comfortable for your eyes to stay comfortably closed… Good… No effort required, nothing you need to do… Just notice as the relaxation and comfort spread easily with every breath…”

Contrary to her suspicions, Susan was becoming quite relaxed.

“And now, if you’d like to experience an even deeper level of comfort and healing, we are going to count down from ten to one…”

By the time I reached one, Susan had reached a receptive hypnotic state. She was pleasantly surprised to find this sense of calm, even though she did not feel “out of it.” She still knew who she was and where she was.

She felt a deepening sense of calm throughout her chest, abdomen, and legs. Her arms and hands were feeling increasingly heavy and warm, and a little tingly. She could still hear my voice, but it was drifting more and more into the background.

Then I engaged her imagination with a visualization.

“And now…if you’d like to experience yet an even deeper level of relaxation, relief, and comfort…I’m going to invite you to picture that you are sunbathing in one of your favorite places… You can feel the gentle warmth of the sun soothe and comfort your low back…”

Susan found herself relaxing on the dock of her summer cabin on a pleasant summer day. But she thought to herself, “There’s no way that my back is going to feel any differently.”

“Whatever scene you see right now, see it in close, vivid detail, as if you are actually there right now… Allow yourself to fully let in the beauty surrounding you.”

Despite her skepticism, Susan’s body and emotions were responding to the hypnotic suggestions.

“And now…without any effort at all…allow a gentle wave of relaxation…just like a gentle wave or ripple on a lake…to bring an increasing sense of comfort…calming…balance…healing…relaxation…”

To her surprise, Susan felt the tension unwinding in her low back. The deep ache faded for the first time in months!

While she was still in the trance, I gave her a post-hypnotic suggestion.

“Isn’t it good to know…that a deeper part of you…is learning this sense of healing…deep comfort…and relaxation?… It can help you return to this state more effectively…every time that you practice this…and a deeper part of you…can sense exactly where the relief is needed most…”

Eventually it was time to bring her back to her normal state of alertness.

“We are going to count again, and this time, from one to ten… And when we reach ten, you can bring your attention totally back to this room where you are sitting now…feeling relaxed and refreshed and feeling good about your experience…”

After she opened her eyes and her mind was back in my office, we started discussing her experience.

“How long did you think it lasted?” I asked.

“Oh, about eight or ten minutes,” she replied.

“Well, if you look at the clock you can see that twenty minutes went by.”

She looked at the clock in disbelief and we both started laughing.

“Tell me about your experience.”

“A part of me was able to stand back and observe the whole thing—what you were saying, even what I thought about what you were saying. But meanwhile, I noticed very interesting changes occurring internally.”

We continued our talk for a while and then I gave her a recording of the session for her to use at home. She made a practice of listening to it every day. After a month or so she told me, “My back pain hasn’t entirely disappeared, but the hypnosis has really turned down the intensity so that I can get back to more of my daily activities!”