Hypnotherapy, Hypnosis

Content provided by the Faculty of the Harvard Medical School

Hypnotherapy, Hypnosis

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

Background

Hypnotherapy-like practices were used in ancient Egypt, Babylon, Greece, Persia, Britain, Scandinavia, America, Africa, India and China. The Bible, Talmud, and Hindu Vedas mention hypnotherapy, and some Native American and African ceremonies include trance states similar to hypnotherapy. Hypnotherapy (also called hypnosis) comes from the Greek word hypnos, meaning sleep.

Modern Western hypnotherapy can be traced to the Austrian physician Franz Anton Mesmer (1734-1815); the word "mesmerize" is based on his name. Mesmer suggested that illness is caused by an imbalance of magnetic fluids in the body and can be corrected by "animal magnetism." He believed that a hypnotherapist's personal magnetism can be transferred to a patient. His beliefs were initially questioned but were revived by 19th century English physicians. In the mid-20th century, the British and American Medical Associations and the American Psychological Association endorsed hypnotherapy as a medical procedure. In 1995, the U.S. National Institutes of Health issued a consensus statement noting the scientific evidence in favor of the use of hypnotherapy for chronic pain, particularly pain associated with cancer.

There are three main phases of hypnotherapy: presuggestion, suggestion, and postsuggestion.

The presuggestion phase involves focusing one's attention using distraction, imagery, relaxation or a combination of techniques. The aim is to reach an altered state of consciousness in which the mind is relaxed and susceptible to suggestion.

The suggestion phase introduces specific goals, questions or memories to be explored.

The postsuggestion phase occurs after the return to a normal state of consciousness, when new behaviors introduced in the suggestion phase may be practiced.

Hypnotherapy sessions may vary from a brief visit to longer, regularly scheduled appointments.

Some people seem to be more susceptible to hypnotherapy than others are, and there are several tests designed to determine a person's degree of hypnotizability or suggestibility.

The goals of hypnotherapy vary. They can include behavior change or treatment of a psychological condition. It is important that the person being hypnotized is under his or her own control at all times and is not controlled by the hypnotherapist or anyone else. Self-hypnosis is sometimes used in addition to sessions with a hypnotherapist, although study of self-hypnosis is limited.

In the United States, there is no universally accepted standard or licensing for hypnotherapists. There is wide variation in training and credentials. Certification is granted by multiple organizations, with different requirements. Many hypnotherapists are not licensed medical professionals. However, some doctors, dentists and psychologists use hypnotherapy in their practices.

Books, audiotapes and videotapes are available for training in self-hypnosis, although they have not been scientifically evaluated. Group sessions may also be offered. Hypnotherapy may be used with other techniques such as cognitive behavioral therapy.

Theory

The way that hypnotherapy works is not well studied or understood. Some research reports that changes in skin temperature, heart rate, intestinal secretions, brain waves and the immune system occur. However, similar changes are reported with other forms of relaxation. Neurologic and endocrine effects have been proposed, including alterations to the hypothalamic-pituitary-adrenal axis or the limbic system (the emotional center of the brain).

There has been scientific debate about whether hypnotherapy represents a specific altered state of consciousness. There are reports that suggestion alone, without hypnotherapy, may achieve many of the same results. However, this research is not conclusive.

Evidence

Scientists have studied hypnotherapy for the following uses:

Pain

Studies of hypnotherapy suggest a benefit for various types of pain, including low back pain, surgery-related pain, cancer pain, dental procedure-related pain, burn pain, repetitive strain injury, temporomandibular joint disorders, sickle cell disease-related pain, irritable bowel syndrome, oral mucositis, tension headache and chronic pain. A 1995 consensus statement by the U.S. National Institutes of Health notes that, "Evidence supporting the effectiveness of hypnosis in alleviating chronic pain associated with cancer seems strong... with other data suggesting the effectiveness of hypnosis in other chronic pain conditions, which include irritable bowel syndrome, oral mucositis, temporomandibular disorders, and tension headaches." However, most studies are small without clear design or results. It is not clear if a specific hypnotherapy technique or treatment duration is best, or what types of pain are most affected. Therefore, although the early evidence is promising, better research is necessary to make a strong recommendation.

Anxiety

Several studies in children and adults report that hypnotherapy reduces anxiety, especially before dental or medical procedures. However, most studies are small without clear design or results. There are no reliable comparisons of hypnotherapy with anti-anxiety drugs. It is not known if hypnotherapy produces different results than does meditation or biofeedback. Some research suggests that hypnotherapy may be less effective than group therapy or systematic desensitization. Better research is necessary to make a strong recommendation.

Tension headache

Reports suggest that several weekly hypnotherapy sessions can improve the severity and frequency of headaches. Preliminary research suggests that hypnotherapy is equivalent to other relaxation techniques, biofeedback or autogenic training. However, most studies are small without clear design or results. Better research is necessary to make a strong recommendation.

Adjunct to cognitive behavioral therapy

Hypnotherapy is sometimes combined with other techniques, such as cognitive behavioral therapy, to treat anxiety, insomnia, pain, bedwetting, post-traumatic stress disorder and obesity. Initial research reports benefits, although most studies are not well designed.

Labor

Preliminary research does not provide clear answers about the effectiveness of hypnotherapy on labor. Better studies are necessary to make a conclusion.

Nausea, vomiting

Research on the use of hypnotherapy for nausea and vomiting related to chemotherapy, pregnancy (hyperemesis gravidarum) and surgical recovery has mixed results. Better research is needed to make a firm conclusion.

Chemotherapy side effects