Hypnosis is a state of extreme self-focus and attention in which minimal attention is given to external stimuli. In the therapeutic setting, a clinician may use relaxation and suggestion in an attempt to alter the thoughts and perceptions of a patient. Hypnosis has also been used to draw out information believed to be buried deeply in someone’s memory. For individuals who are especially open to the power of suggestion, hypnosis can prove to be a very effective technique, and brain imaging studies have demonstrated that hypnotic states are associated with global changes in brain functioning (Del Casale et al., 2012; Guldenmund, Vanhaudenhuyse, Boly, Laureys, & Soddu, 2012).

Historically, hypnosis has been viewed with some suspicion because of its portrayal in popular media and entertainment (Figure 4.20). Therefore, it is important to make a distinction between hypnosis as an empirically based therapeutic approach versus as a form of entertainment. Contrary to popular belief, individuals undergoing hypnosis usually have clear memories of the hypnotic experience and are in control of their own behaviors. While hypnosis may be useful in enhancing memory or a skill, such enhancements are very modest in nature (Raz, 2011).

Figure 4.20 Popular portrayals of hypnosis have led to some widely-held misconceptions.

How exactly does a hypnotist bring a participant to a state of hypnosis? While there are variations, there are four parts that appear consistent in bringing people into the state of suggestibility associated with hypnosis (National Research Council, 1994). These components include:

• The participant is guided to focus on one thing, such as the hypnotist’s words or a ticking watch.
• The participant is made comfortable and is directed to be relaxed and sleepy.
• The participant is told to be open to the process of hypnosis, trust the hypnotist and let go.
• The participant is encouraged to use his or her imagination.

These steps are conducive to being open to the heightened suggestibility of hypnosis.

People vary in terms of their ability to be hypnotized, but a review of available research suggests that most people are at least moderately hypnotizable (Kihlstrom, 2013). Hypnosis in conjunction with other techniques is used for a variety of therapeutic purposes and has shown to be at least somewhat effective for pain management, treatment of depression and anxiety, smoking cessation, and weight loss (Alladin, 2012; Elkins, Johnson, & Fisher, 2012; Golden, 2012; Montgomery, Schnur, & Kravits, 2012).

How does hypnosis work? Two theories attempt to answer this question: One theory views hypnosis as dissociation and the other theory views it as the performance of a social role. According to the dissociation view, hypnosis is effectively a dissociated state of consciousness, much like our earlier example where you may drive to work, but you are only minimally aware of the process of driving because your attention is focused elsewhere. This theory is supported by Ernest Hilgard’s research into hypnosis and pain. In Hilgard’s experiments, he induced participants into a state of hypnosis, and placed their arms into ice water. Participants were told they would not feel pain, but they could press a button if they did; while they reported not feeling pain, they did, in fact, press the button, suggesting a dissociation of consciousness while in the hypnotic state (Hilgard & Hilgard, 1994).

Taking a different approach to explain hypnosis, the social-cognitive theory of hypnosis sees people in hypnotic states as performing the social role of a hypnotized person. As you will learn when you study social roles, people’s behavior can be shaped by their expectations of how they should act in a given situation. Some view a hypnotized person’s behavior not as an altered or dissociated state of consciousness, but as their fulfillment of the social expectations for that role (Coe, 2009; Coe & Sarbin, 1966).

Hypnosis (also called hypnotherapy) has been studied for a number of conditions, including irritable bowel syndrome (IBS), state anxiety (e.g., before medical procedures or surgeries), menopausal symptoms, hot flashes in breast cancer survivors, headaches, and post-traumatic stress disorder. It has also been studied for pain control and smoking cessation.

• Some studies have suggested that hypnosis may be helpful for gastrointestinal symptoms, anxiety, depression, disability, and health-related quality of life in people with IBS. A 2018 recommendation from the American College of Gastroenterology, however, said that the evidence for using psychological therapies, including hypnosis, for IBS is “weak,” with a “very low” quality of evidence.
• A growing body of evidence suggests that hypnosis may help to manage some painful conditions.
• Some studies have shown promising results on hypnosis for anxiety related to medical or dental procedures, but the overall evidence is not conclusive.
• Studies of hypnosis to help with quitting smoking have had conflicting results.
• There is some evidence suggesting that hypnosis may help improve certain menopausal symptoms, such as hot flashes. A 2015 position paper from the North American Menopause Society recommended hypnosis for managing hot flashes but acknowledged that favorable evidence is limited.

Hypnosis for Health

Can Trances Work?

Have you seen someone get hypnotized? They may have been put in a trance and told to do silly things. But hypnosis can be used for more than just show. It’s also being studied to treat certain health conditions.

Medical hypnosis aims to improve health and wellness. It can help relax and focus your mind—and make you more open to new ideas.

The technique usually has two parts. First, the health care provider gets your attention by inviting you to focus on something, such as an object or breathing. When you focus like this, your brain becomes more open to suggestion.

“Focusing makes the brain more flexible,” explains Dr. Mark P. Jensen, a pain expert at the University of Washington who researches hypnosis.

Then the health care provider can offer a helpful suggestion. For example, if your goal is to manage pain, the provider may suggest that you feel greater comfort. Or they may suggest that you focus on being able to handle the pain more easily.

“Hypnosis takes advantage of the fact that people are able to be open to absorbing new ideas,” Jensen says. “You get someone’s attention and then you offer them a new way of looking at a problem that will make the problem easier for them to manage.”

In addition to pain, studies suggest that hypnosis may help manage irritable bowel syndrome and post-traumatic stress disorder. Researchers are also studying hypnosis for mood disorders.

“There’s emerging evidence that it’s useful for helping people to manage depression and anxiety, including anxiety around medical procedures and surgery,” Jensen says.

Some people respond to hypnosis more easily than others. It’s also more effective if you want to be hypnotized. Hypnosis is not mind control by another person.

“We’re all open to new ideas at some level,” he says. “With people who have more hypnotic talent, it just takes fewer sessions. But everybody can respond at some level to hypnosis.”

Imaging studies are shedding light on what happens in the brain during hypnosis. “Hypnosis is a particularly powerful technique for changing brain activity,” Jensen says.

Researchers have found that different hypnotic suggestions can affect different parts of the brain. Pain involves both sensation and emotion.

A hypnotic suggestion for greater comfort changes the brain activity in the areas that process the intensity of the sensations.

“If I make the suggestion that these sensations don’t bother you anymore, then the part of the brain that processes how upset you are by pain decreases in activity,” Jensen says. “But the part of the brain that processes intensity of sensation doesn’t necessarily change.”

The way a drug treats pain is different. If you take an opioid to relieve pain, your whole brain can be affected, including the parts that process sensation. The pain may go away, but there can be side effects. These may include constipation, breathing problems, and even addiction.

More studies are needed to fully evaluate the potential benefits of hypnosis and how it might work. We do know hypnosis doesn’t work for everyone. “There are some people—very few—that it only helps a little,” Jensen says. “There are others whose lives can be completely turned around for the better with hypnotic treatments. Most people are somewhere in between.”

If You’re Interested in Hypnosis

• Talk with your health care provider about whether hypnosis may be able to improve your health or well-being.
• Ask your health care provider to refer you to someone certified in medical hypnosis.
• Choose a hypnosis provider who is trained to treat your condition. Dentists, doctors, psychologists, social workers, nurses, physical therapists, and others may be certified in hypnosis.
• Find studies recruiting people for research on hypnosis.

Hypnosis may be helpful for pain caused by cancer itself or by procedures used in cancer care, for nausea and vomiting in people with breast cancer, and for anxiety and distress around surgical and medical procedures. It also may be helpful for hot flashes in women with breast cancer.

There is some moderate-quality evidence that relaxation techniques may improve anxiety symptoms in people with cancer who are undergoing treatment. In addition, there is some low-quality evidence that guided imagery with progressive muscle relaxation may help patients experiencing general pain from cancer treatment.

What Does the Research Show?

• According to the 2022 Society for Integrative Oncology/American Society for Clinical Oncology joint guideline on integrative medicine for pain management in oncology, guided imagery with progressive muscle relaxation may be offered to patients experiencing general pain from cancer treatment (Type: Evidence based, benefits and harms not assessable; Evidence quality: Low; Strength of recommendation: Weak). The guideline also recommends that hypnosis may be offered to patients experiencing procedural pain in cancer treatment or diagnostic workups (Type: Evidence based, benefits outweigh harms; Evidence quality: Intermediate; Strength of recommendation: Moderate).
• In the 2023 joint guideline issued by the Society for Integrative Oncology/American Society for Clinical Oncology on integrative oncology care of symptoms of anxiety and depression in adults with cancer, relaxation therapies may be offered to people with cancer to improve anxiety symptoms during active treatment (Type: Evidence based; Quality of evidence: Intermediate; benefits outweigh harms; Strength of recommendation: Moderate). The guideline recommends that hypnosis may be offered to people with cancer to improve anxiety symptoms during cancer-related diagnostic and treatment procedures (Type: Evidence based; Quality of evidence: Intermediate; benefits outweigh harms; Strength of recommendation: Moderate).
• A 2018 review found that hypnosis may help treat symptoms of nausea and vomiting in people with breast cancer, manage pain in a variety of contexts, and also reduce levels of anxiety and overall distress around surgical and medical procedures.
• In 2017 the Society for Integrative Oncology issued guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment and suggested that hypnosis (based on two trials from a single research group) can be considered for use for fatigue during treatment (Grade C). These guidelines also indicate that hypnosis can be recommended as a therapy for pain (Grade C).
• A 2022 randomized controlled trial involving 109 adult cancer survivors with chronic pain found that recorded hypnosis and relaxation interventions are similarly effective in reducing pain and the pain-related sequelae of pain interference and anxiety. In addition, the study found that the hypnosis intervention also reduced fatigue and sleep disturbance.

Safety

• Hypnosis is a safe technique when practiced by a trained, experienced, licensed health care provider.

• Relaxation techniques are generally considered safe for healthy people. In most research studies, there have been no reported negative side effects. However, occasionally, people report negative experiences such as increased anxiety, intrusive thoughts, or fear of losing control. There have been rare reports that certain relaxation techniques might cause or worsen symptoms in people with epilepsy or certain psychiatric conditions, or with a history of abuse or trauma.

Clinical Hypnosis is the process of (a) deliberately triggering a trance state and then (b) utilizing that state to encourage helpful cognitive, emotional, or physical healing responses. A trance is a natural biological state of inner absorption, concentration and focused attention.

Clinical Hypnosis and Hypnotherapy are not the same as hypnosis.

Hypnosis is the process of triggering a trance state in an individual. It not usually geared towards therapeutic change, but just for relaxation or increasing compliance. Without a clinician using additional tools to cause change while the person is in trance, there rarely is lasting benefit to hypnosis beyond relaxation and temporary stress reduction.

Clinical Hypnosis and Hypnotherapy are advanced skills in which a trained professional uses hypnosis to cause specific change. Clinical Hypnosis and Hypnotherapy are used extensively in the medical and Mental Health fields.

Background and Policy on in VA

Clinical Hypnosis (or Hypnotherapy) is one of the evidence-based complementary and integrative health (CIH) approaches covered by the Veterans medical benefits package when deemed clinically necessary by their care team per VA Directive 1137 — Provision of Complementary and Integrative Health (recertified December 2022). Based on literature review these approaches were found to be safe and have sufficient evidence of benefit to be recommended as appropriate components of care for the Veteran population.

Clinical Hypnosis Safety and Effectiveness

An evidence map of Guided Imagery, Biofeedback, and Hypnosis was developed by VA’s Health Services Research & Development. This evidence map limited itself to meta-analysis studies.

Conditions with evidence of positive effect include: anxiety disorders, anxiety related to medical procedures, insomnia, Irritable Bowel Syndrome. High-confidence evidence that clinical hypnosis is effective for anxiety in cancer patients, breast cancer care, obesity and weight loss.

A summary of double-blind studies suggests Clinical Hypnosis as a tool to consider as possible efficacious or better for additional areas: pain management, headache and migraine, asthma, sleep disorders, depression, dermatological conditions, anxiety, procedural pain and anxiety, and other areas.