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Vol. LXVII, No. 13
June 19, 2015
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‘Tranceformation’
How Can Hypnosis Treat Medical Problems?

On the front page...

Dr. David Spiegel

Dr. David Spiegel

That time you were totally absorbed, whether you were sinking every jumpshot or flying around Hogwarts? Well, you just might have been under hypnosis. Researchers believe that super-focused trance-like states can be harnessed to treat medical problems—to reduce pain or control neuromuscular disorders, for instance.

“[Hypnosis] is the oldest Western conception of a psychotherapy,” said NIH grantee Dr. David Spiegel in a recent NCCIH Integrative Medicine Research Lecture. “It’s the first time a talking interaction was thought to have therapeutic potential. It’s useful as a model system for understanding how brain-body interactions work.”

Continued...

Spiegel is medical director of the Center for Integrative Medicine at Stanford University School of Medicine. His talk, “Transformation: Hypnosis in Brain and Body,” covered several aspects of the field including hypnotizability, brain regions involved in hypnosis, modulation of perception and integrative medicine.

History of Hypnosis

First addressing what he called the “long and checkered past” of hypnosis, Spiegel offered a brief history. Viennese physician Franz Anton Mesmer founded the field. In the 18th century, “he theorized that magnetic fields flow through the body. When people got sick, something went wrong with their magnetic fields. [Mesmer believed] if he put his magnetic field next to their magnetic field, theirs would get better. I don’t know why his didn’t get worse.”

Mesmer moved to France, where his practice flourished. Not really surprising, Spiegel said. Compare hypnosis with what French doctors were using back then—bloodletting. Patients under the care of French physicians were more prone to die.

Mesmer’s success did not endear him to the French medical establishment, which begged King Louis to investigate the Viennese doctor. A panel that included Benjamin Franklin and “pain-control expert” Dr. Joseph-Ignace Guillotin, inventor of the execution device that bears his name, concluded Mesmer’s method was “nothing but heated imagination.”

That episode ended Mesmer’s career and recorded perhaps the first doubt about trances as medicine. It did not prevent further pursuit of hypnosis’s potential healing powers nor further skepticism.

Hypnosis, Spiegel quipped, “has been something like the oldest profession—everybody’s interested in it, but no one wants to be seen in public with it…It was at the foundation of many very important movements, including psychoanalysis.”

Sigmund Freud began psychoanalysis by using hypnosis as “a royal road to the unconscious,” Spiegel said. When Freud found some patients formed irrational feelings for their physicians during hypnosis, he stopped the practice. Instead of entering trance-like states, patients were urged to free associate. At the end of his career, however, Freud returned to an interest in hypnosis.

You Are Not Getting Very Sleepy

“I’m here to tell you hypnosis shouldn’t get rejected,” said Spiegel, whose research—with funding over the years from NIH, NCI, NIMH and NCCIH—spans four decades in such areas as psycho-oncology, stress and health, pain control and clinical applications of hypnosis.

Hypnosis, Spiegel quipped, “has been something like the oldest profession—everybody’s interested in it, but no one wants to be seen in public with it.”

Hypnosis, Spiegel quipped, “has been something like the oldest profession—everybody’s interested in it, but no one wants to be seen in public with it.”

Photos: Ernie Branson

Defining hypnosis as a “state of aroused, attentive, focused concentration with diminished peripheral awareness,” Spiegel also refuted a common misconception. “You don’t go to sleep,” he said. “Hypnosis is not sleep. It’s a narrowing of the focus of attention. Hypnosis is to consciousness what a telephoto lens is to a camera: What you see you see with great detail, but you’re less aware of the context.”

So, can hypnosis make folks flap their arms and squawk like a chicken? No, usually not. Some vulnerability does come with the practice, though.

“People in hypnosis are less likely to critically judge what you say to them,” noted Spiegel, explaining suggestibility. “You’ve got to be careful what you say to them, because they’re less likely to correct your mistakes…It makes people nervous, because we are all social creatures. We all respond to social cues and sometimes we do so irrationally. Hypnosis is an example of how much we can allow input from other people—even people we don’t know very well—to control our perception, judgment and behavior.”

In the Zone?

We use hypnotic-like states in normal activities, Spiegel said. “Self-hypnosis is what people do when they want to enhance performance.” Top athletes commonly describe their training techniques for competing at their highest levels as involving intensely focused imagination. They visualize their best performance to the exclusion of all else around them. Spiegel said that type of laser-focused attention is a form of self-hypnosis.

“People who are more highly hypnotizable have more self-altering states of attention—total absorption—in everyday life all the time,” Spiegel noted. “They get lost in a sunset or a movie or reading a novel.”

Studies indicate that hypnotizability cannot be taught. In fact, Spiegel said, it’s a more stable trait over the lifespan than IQ. Researchers estimate that about one-third of people cannot be hypnotized, while 15 percent of the population is considered highly hypnotizable. The rest of us have varying degrees of hypnotizability that we can be trained to use.

In terms of neurophysiology, Spiegel said researchers see brain differences between people who are high and low in hypnotizability. The brain’s anterior cingulate cortex (ACC) region—where tasks such as attention, monitoring and pain management are located—seems to play a significant role in hypnotic experience.

Scientists have collected “data showing how if you change how distressing pain is—not the sensation itself, but how much it bothers you—then you reduce activity in the [ACC] as well,” he explained.

Highly hypnotizable individuals have more functional connectivity—an fMRI term for neurons that fire together—between the dorsal ACC and portions of the executive control network in the dorsolateral prefrontal cortex, Spiegel pointed out. This means that paying attention and carrying out a task are highly coordinated among high hypnotizables, he said.

Researchers conducted brain scans of study participants while they were under hypnosis. Scientists examined which brain regions turn on and off and which areas work together. These studies helped clarify how dissociation occurs, Spiegel said.

“When you’re engaged in hypnosis, you’re not ruminating about yourself,” he noted. “People will engage in hypnotic experiences and they often won’t remember what they did…We think it has to do with an inverse relationship between being hypnotized and functioning of the [brain’s] default mode network…We’re beginning to understand what goes on in the brain when people enter these altered states.”

Change Your Mind

Spiegel showed videos of some of his clinical work. In one clip, a patient with Parkinson’s disease who experienced near-constant involuntary tremors in his hand was able, under self-hypnosis, to rest his hand. He imagined himself in his happy place—Hawaii, in this case—and the tremors stopped.

Spiegel shared results from some of his group’s other studies:

  • One out of four patients under hypnosis can permanently quit smoking.

  • Self-hypnotized metastatic breast cancer patients were able to cut their pain levels in half.

  • Children taught to imagine themselves elsewhere better tolerated a painful invasive medical exam; procedure time was reduced by 17 minutes.

“In hypnosis, you actually use words to transform perception,” Spiegel concluded. “So some of our ability to manipulate experience is not just from speech and motor activity but also from the ability to control our own perceptual processes…We have an amazing ability in our brain to alter not just how we react to perception but also what it is that we perceive…If you think it is taking away control, it isn’t. Hypnosis is teaching people control.”

Watch the full lecture at http://videocast.nih.gov/summary.asp?Live=15741&bhcp=1.


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