Harvard Medical School Commentaries: Minding Your Mind

Oct262008

Hypnosis -- Mental Health Therapy

by Michael Craig Miller, M.D.
Harvard Medical School

Hypnosis is one of the oldest forms of psychotherapy in the Western world. It may also be the most misunderstood, given its association with entertainers and charlatans. But, in fact it is a specialized form of meditation and a relaxation technique. Clinicians have proposed many uses, but it is most helpful for treating pain and anxiety.

What Happens During Hypnosis?

Hypnosis involves focusing attention inward and using your imagination and positive mental images to alter your perceptions. It's similar to what happens when you daydream or meditate, and are unaware of what's going on around you. It may seem as if you're in a trance, but hypnosis is actually a heightened state of concentration. The aim is to focus the mind on a specific image, sensation or goal while ignoring distractions. This tends to make you more open to suggestions that can help with treatment.

The main concerns people have about hypnosis are:

  • The therapist controls you when you're under hypnosis. You don't surrender your free will when hypnotized; you control how much influence the therapist has. It's no different than with any other type of therapy. Of course, the hope is that any therapist influences you in positive ways.
  • You may be too suggestible. In hypnotherapy, as in any treatment, you should figure out what your goals are. A therapist's suggestions should always be in line with what you want out of the treatment.
  • You can be hypnotized against your will. A hypnotherapist requires your cooperation in order for the technique to work. As with any psychotherapy, if you do not trust the hypnotherapist to be helpful to you, then you should feel free to find a different therapist.

Hypnosis Can Make a Difference

The American Medical Association approved hypnosis as a therapy in 1958. The American Psychiatric Association followed in 1961. Hypnotherapy has been most successful for managing pain and anxiety.

Pain relief

A meta-analysis (a combined analysis of many studies) published in 2000 concluded that hypnosis offered moderate to major relief for many types of pain. For example, it can reduce the pain of labor and can help you control pain during dental procedures or minor surgical procedures. A 2003 analysis found that hypnosis was at times more effective than other pain relief methods, even painkilling medications.

Hypnosis may be used along with sedation during surgery. A 1999 review concluded that compared to general anesthesia, hypnosis combined with conscious sedation may shorten recuperation times. A 2007 study found that women who were hypnotized before undergoing a breast biopsy or lumpectomy required less sedation during the procedure, and experienced less pain, nausea and emotional distress afterward.

Studies also report that hypnosis can be effective for relieving pain caused by chronic tension and migraine headaches.

Anxiety

Hypnosis also helps to alleviate anxiety. Many studies have reported that hypnosis:

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  • Reduces anxiety levels prior to surgery
  • Lowers blood pressure before surgery
  • Enhances recovery from surgery by shortening hospital stays
  • Reduces complications, such as nausea and vomiting
  • In a 2006 study, for example, patients in one group received suggestions of well-being under hypnosis before surgery. A comparison group of patients received the usual presurgical care. Upon entering the operating room, the anxiety levels of the people in the hypnosis group were 56% lower than before hypnosis. People in the usual-care group reported much higher anxiety levels than the first group.

    Questions Remain

    The evidence about the effectiveness of hypnosis is mixed or insufficient when it comes to other conditions.

    Depression

    In one study, 84 people with depression were randomly assigned to 16 weeks of treatment with either hypnosis or cognitive behavioral therapy (CBT). Both groups improved with treatment. The hypnosis group improved slightly more than the CBT group when symptoms were rated on scales such as the Beck Depression Inventory and the Beck Anxiety Inventory.

    Eating disorders

    An analysis of existing studies found that many of them lacked the necessary details to evaluate them. More research in this area is needed.

    Smoking cessation

    Some studies suggest that hypnosis might help you stop smoking by reducing cravings, bolstering willpower or increasing motivation to take care of your health. Hypnosis can be used to soothe yourself while you have a craving. It also can help you replace your preoccupation with smoking with thoughts like, "I feel good about taking care of my body." But a comprehensive review found that most of the current evidence is based on case reports or poorly designed studies. It concluded that hypnosis is no better than other interventions — or even no treatment at all — for increasing six-month quit rates.

    Finding a Qualified Hypnotherapist

    Many states do not regulate hypnotherapy. To make sure a therapist is qualified, ask if he or she is licensed (not just certified) to practice. Or check for membership in the American Society of Clinical Hypnosis or the Society for Clinical and Experimental Hypnosis , two nationally recognized organizations for licensed professionals in this field.

    Remember that the technique of hypnosis, which is intended to induce a meditative, focused state of mind, is easy to learn. You don't need any specialized training to invoke a soothing voice or to suggest focusing on some repetitive stimulus or a relaxing image.

    But a hypnotherapist does need specialized mental health training to understand emotional and behavioral problems, to evaluate them and plan a treatment. Most therapists who practice hypnosis employ it as one tool among many that they are trained to use.

    Hypnosis, after all, is not magic. Rather, it's a specialized technique that may help you harness your brain power to solve problems. Now that's worth taking seriously.

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