This chapter will cover the following topics:
- History of Hypnosis
- Background to Hypnosis
- Evidence about Hypnosis
- Adverse Effects of Hypnosis
- Hypnosis Outside a Medical Setting
- Further Resources
- References
- Site Index
I have chosen to include a section on hypnosis in this section about CAM although it is used by many conventional practitioners. They include doctors, dentists, clinical psychologists and possibly specialist nurses.
History of Hypnosis
Hypnosis has been associated with sorcery, magic and mysticism over the centuries. In ancient rituals, people may have worked themselves into a hypnotic trance.1The Oracle of Delphi who went into the cave before coming out to prophesy, had probably been inhaling volcanic gases from the cave and this contributed to her psychological state. Hence it is not really hypnosis.
The first study of hypnosis is usually attributed to 2Franz Mesmer who was a German physician who used hypnosis in the treatment of patients in Vienna and Paris in the late 18th century. Mesmer believed that hypnotism made use of an occult force which he termed “animal magnetism”, that flowed through the hypnotist into the subject. He was soon discredited but his technique was called mesmerism and so his name survives.
It was used, but not really understood, until the middle of the 19th century, when the English physician 3James Braid studied the phenomenon. He coined the terms hypnotism and hypnosis, after Hypnos, the Greek god of sleep. Sigmund Freud used the technique “to help neurotics recall disturbing events that they had apparently forgotten” but he abandoned it is favour of free association.
Hypnosis has been used over the years both in the clinical environment and as a stage show. The latter is undesirable, both because it often humiliates its subjects and because it can have quite profound effects on the recipient.
Background to Hypnosis
The Encyclopaedia Britannica defines 4Hypnosis as, “a special psychological state with certain physiological attributes, resembling sleep only superficially and marked by a functioning of the individual at a level of awareness other than the ordinary conscious state. This state is characterized by a degree of increased receptiveness and responsiveness in which inner experiential perceptions are given as much significance as is generally given only to external reality.”
There are many different ways to perform hypnosis. It is not really a state of deep sleep but deep relaxation. In this state the patient concentrates entirely on the hypnotist’s voice. The therapist can suggest ideas, concepts and changes and these are firmly implanted in the patient’s mind.
It has been suggested that hypnosis works by altering the state of consciousness so that the analytical left side of the brain is subdued whilst the right side is made more alert. There is some evidence for this from techniques known as “functional neuro-imaging”.5How psychotherapy changes the brain Most of the literature about hypnosis concentrates on outcomes rather than the theoretical basis.
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Hypnosis has been described as a self-induced placebo. That is not a pejorative statement. The person enables the very real benefits of placebo to take control so that pain or anxiety is tolerable.
Evidence about Hypnosis
There are a great many papers on hypnosis and a PubMed search on that term alone produced more than 14,000 results. More than 1,500 were reviews. These numbers can be trimmed considerably by adding a condition to the search such as “hypnosis for pain control in labour”. Hypnosis can be used in a wide variety of conditions. It is frequently used in pain control which includes pain in labour, palliative (terminal) care or painful procedures such as dental surgery. The mind is very important in the interpretation of pain and the presence of fear and anxiety adds greatly to the distress. Hypnosis appears to be very effective in children. As there is a considerable amount of evidence, I shall be quite frugal with the references, tending to concentrate on systematic reviews where possible. The Cochrane reviews are very strict in terms of the quality of research that they will accept but the general theme with hypnosis seems to be that there are comparatively few papers of adequate quality.
- A Cochrane review concluded that both acupuncture and hypnosis may be of value for pain in labour.6Complementary and alternative therapies for pain management in labour However, it also called for more research as the volume of evidence was poor.
- Needle related pain and phobia in children and adolescents may be helped by behavioural therapies including hypnosis.7Psychological strategies to reduce pain and distress for children and adolescents getting needles
- A review of hypnosis for children undergoing dental procedures found only three acceptable papers and was unable to form a conclusion. However, that review was withdrawn in 2017 and at the time of writing (early 2019), Cochrane is still awaiting a more up to date review.
- A review of “Complementary and miscellaneous interventions for nocturnal enuresis (bed wetting) in children” found weak evidence to support the use of hypnosis but there were single small trials, some of dubious methodology. Robust randomised trials are required with efficacy, cost-effectiveness and adverse effects carefully monitored.8Complementary treatments such as hypnosis, psychotherapy, acupuncture, chiropractic and medicinal herbs for bedwetting in children
- Irritable bowel syndrome is a condition that has a psychological component but a Cochrane review found that the quality of the evidence was too poor to permit a conclusion.9Hypnotherapy for treatment of irritable bowel syndrome.
- There was no evidence that it was any more effective than standard counselling in smoking cessation.10Does hypnotherapy help people who are trying to stop smoking Many of the enthusiastic studies were uncontrolled but controlled studies showed no superiority of treatment.
To turn to other sources of reviews:
- It is well known that cancer chemotherapy produces very unpleasant side effects, especially nausea and vomiting. Hypnosis may be of value for reducing this in children but more evidence is needed for adults.11Hypnosis for nausea and vomiting in cancer chemotherapy
- A review of the effectiveness of hypnotherapy for headaches and migraines was very positive.12Clinical hypnosis with headaches and migraines
- A systematic review of various forms of CAM for cancer pain, including hypnosis, failed to find that the quality of the evidence was adequate to recommend any of the CAM interventions.13Efficacy of complementary and alternative medicine therapies in relieving cancer pain
- Hypnosis can be self-induced and so the patients can be taught to do it themselves without the need for a therapist.14Helping children and adults with hypnosis and biofeedback This has obvious advantages; especially in situations that may provoke anxiety in everyday life.
- Most of the work on hypnosis in the treatment of addiction relates to smoking cessation. There is remarkable little about hypnosis in the management of addiction to alcohol or drugs such as heroin or cocaine. There are problems associated with its use for alcoholism.15Problems in the evaluation of hypnosis in the treatment of alcoholism
- Hypnotherapy may be of value in weight reduction, but other forms of CAM are not.16Complementary therapies for reducing body weight
Adverse Effects of Hypnosis
Reports of hypnosis give remarkably few adverse effects and so it appears to be comparatively safe. However, anything that controls the mind must be treated with respect and if therapy is required it is important to consult a practitioner who has been adequately trained. Outside environments such as the NHS, there is very little regulation. Stage hypnosis as a form of entertainment is to be depreciated.
The serious problem of implantation of false memories is considered below.
Hypnosis Outside a Medical Setting
Hypnosis has also been used in forensic investigations. It is claimed that it may be valuable in helping to recall memories more accurately.17Solving crimes with hypnosis Witnesses are extremely poor at recalling an event. Where there are several witnesses, it often seems incredible that they are reporting the same event. However, there are problems with the use of hypnosis and a technique called “cognitive interviewing” is often used instead.18. Enhancing witness memory with techniques derived from hypnotic investigative interviewing A particularly contentious area is “recovered memories” where it is claimed that the intervention has led to suppressed memories being recovered.19Recovered memories These might include such events as abuse in childhood.
Recall can often be very poor. Implantation of false memories in vulnerable children or others must be avoided.
There have also been allegations that the intervention may have implanted a false memory. Hypnosis and related interventions may be of value in obtaining some recall, whether it is an accurate report of a recently witnessed event or recalling something that was witnessed many years ago, perhaps in childhood. Anyone who is involved in such interventions must be extremely skilled and objective.20Children’s autobiographical reports about sexual abuse It is possible to implant false memories or recall may be inaccurate for other reasons. This is a difficult area that must be managed with extreme care and some scepticism. An innocent person could be imprisoned and put on the sex offenders’ register with devastating consequences if false memories are implanted. It is a dangerous area and it is essential that those involved are objective.
Further Resources
The organisations listed below all claim to be a register of competent and ethical practitioners but remember that there is no statutory regulation of hypnotherapy. Nevertheless, their aims are to be applauded. Doctors, dentists and other health professionals have statutory regulation and there is quality control in the NHS. There seem to be so many registers that it suggests fragmentation and an unsatisfactory lack of confidence by the professionals to allow so many to exist. Every one claims to be the leading organisation.
- British Hypnotherapy Association
http://www.hypnotherapy-association.org/
Founded in 1958. It claims “The organisation of practitioners who have had at least four years of relevant training and who comply with the best professional standards of competence and ethics in hypnotherapy”. - British Society of Clinical Hypnosis
https://www.bsch.org.uk/
It says, “The British Society of Clinical Hypnosis (BSCH) is a national professional body whose aim is to promote and assure high standards in the practice of hypnotherapy. Registration demands good quality training, ethical practice and adherence to our code of conduct. You can choose a therapist with confidence.” - General Hypnotherapy Standards Council and General Hypnotherapy Register
https://www.general-hypnotherapy-register.com/
The headline is, “Protecting the Public and Promoting Good Practice, Unity and Continuing Development within the Profession”. It says, “The General Hypnotherapy Standards Council (GHSC) and General Hypnotherapy Register (GHR) are the UK’s largest and most prominent organisations within the field of Hypnotherapy and together present an exemplary model for the simultaneous protection of the public and the provision of practitioner credibility and services.” - National Council for Hypnotherapy
https://www.hypnotherapists.org.uk/
They say, “The NCH is the UK’s leading not-for-profit hypnotherapy professional association, representing over 1800 professional hypnotherapists. All our practising members are fully insured and trained to the highest standards, so you can choose a hypnotherapist with confidence.” - British Society of Clinical and Academic Hypnosis
www.bscah.co.uk
This is slightly different in that it was formed in 2007 by the merger of the two professional societies of the British Society of Medical & Dental Hypnosis (BSMDH) and the British Society of Experimental and Clinical Hypnosis (BSECH). It aims to promote the safe and responsible use of hypnosis in medicine, dentistry and psychology. The members are all doctors, dentists, psychologists and other health professionals who use hypnosis as an adjunct in their work.
References
- Oracle of Delphi. Department of History. Ohio State University
https://ehistory.osu.edu/articles/oracle-delphi - Franz (originally Friedrich) Anton Mesmer. Whonamedit.com
http://www.whonamedit.com/doctor.cfm/313.html - James Braid. Whonamedit.com
http://www.whonamedit.com/doctor.cfm/314.html - Orne MT, Hammer AG. Hypnosis. Encyclopaedia Britannica
https://www.britannica.com/science/hypnosis - Linden DE. How psychotherapy changes the brain–the contribution of functional neuroimaging. Mol Psychiatry. 2006 Jun;11(6):528-38.
http://www.ncbi.nlm.nih.gov/pubmed/16520823 - Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews 2006.
https://www.cochrane.org/CD003521/PREG_complementary-and-alternative-therapies-for-pain-management-in-labour - Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews 2018.
https://www.cochrane.org/CD005179/SYMPT_psychological-strategies-reduce-pain-and-distress-children-and-adolescents-getting-needles - Huang T, Shu X, Huang YS, Cheuk DKL. Complementary treatments such as hypnosis, psychotherapy, acupuncture, chiropractic and medicinal herbs for bedwetting in children. Cochrane 2011.
https://www.cochrane.org/CD005230/INCONT_complementary-treatments-such-as-hypnosis-psychotherapy-acupuncture-chiropractic-and-medicinal-herbs-for-bedwetting-in-children - Webb AN, Kukuruzovic R, Catto-Smith AG, Sawyer SM. Hypnotherapy for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews 2007.
https://www.cochrane.org/CD005110/IBD_hypnotherapy-treatment-by-hypnosis-for-the-treatment-of-irritable-bowel-syndrome - Barnes J, Dong CY, McRobbie H, Walker N, Mehta M, Stead LF. Does hypnotherapy help people who are trying to stop smoking. Cochrane Database of Systematic Reviews 2010.
https://www.cochrane.org/CD001008/TOBACCO_does-hypnotherapy-help-people-who-are-trying-to-stop-smoking - Richardson J, Smith JE, McCall G, Richardson A, Pilkington K, Kirsch I. Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence. Eur J Cancer Care (Engl). 2007 Sep;16(5):402-12
http://www.ncbi.nlm.nih.gov/pubmed/17760926 - Hammond DC. Review of the efficacy of clinical hypnosis with headaches and migraines. Int J Clin Exp Hypn. 2007 Apr;55(2):207-19
http://www.ncbi.nlm.nih.gov/pubmed/17365074 - Bardia A, Barton DL, Prokop LJ, Bauer BA, Moynihan TJ. Efficacy of complementary and alternative medicine therapies in relieving cancer pain: a systematic review.. J Clin Oncol. 2006 Dec 1;24(34):5457-64.
http://www.ncbi.nlm.nih.gov/pubmed/17135649 - Olness K. Helping children and adults with hypnosis and biofeedback. Cleve Clin J Med. 2008 Mar;75 Suppl 2:S39-43
https://www.ncbi.nlm.nih.gov/pubmed/18540145 - Stoll MJ. Problems in the evaluation of hypnosis in the treatment of alcoholism. J Subst Abuse Treat. 1989;6(1):31-5.
http://www.ncbi.nlm.nih.gov/pubmed/2651684 - Pittler MH, Ernst E. Int J Obes (Lond). 2005 Sep;29(9):1030-8. Complementary therapies for reducing body weight: a systematic review. Int J Obes (Lond). 2005 Sep;29(9):1030-8.
http://www.ncbi.nlm.nih.gov/pubmed/15925954 - Wester WC 2nd, Hammond DC. Solving crimes with hypnosis. Am J Clin Hypn. 2011 Apr;53(4):255-69.
http://www.ncbi.nlm.nih.gov/pubmed/21598840 - Wagstaff GF, Wheatcroft JM, Caddick AM, Kirby LJ, Lamont E. Enhancing witness memory with techniques derived from hypnotic investigative interviewing: focused meditation, eye-closure, and context reinstatement. Int J Clin Exp Hypn. 2011 Apr;59(2):146-64.
http://www.ncbi.nlm.nih.gov/pubmed/21390976 - Loftus EF, Davis D. Recovered memories. Annu Rev Clin Psychol. 2006;2:469-98.
http://www.ncbi.nlm.nih.gov/pubmed/17716079 - Sjöberg RL, Lindholm T. Children’s autobiographical reports about sexual abuse: A narrative review of the research literature. Nord J Psychiatry. 2009 Nov;63(6):435-42.
http://www.ncbi.nlm.nih.gov/pubmed/19672784
Site Index
This website is now completed, although I shall continue to do updates. The following list shows the sections or chapters. Just click on the topic in blue to go to that part of the site.
