Honestly, I wondered whether I was actually in labour, because surely it was meant to be more painful than this. Thats Shona, describing the recent birth of her daughter. Her secret? Hypnosis. During pregnancy, she learned how to hypnotise herself into a state of mind that allowed her to minimise the pain of labour and, in her own words, quite enjoy the whole thing. The word hypnosis may call to mind a swinging watch or an entertainer getting people to believe they are naked on stage for an audiences amusement. Its history is one of sorcery and magic, tales of the occult and exploitative charlatans. Practitioners are rarely doctors or counsellors, clinical trials struggle to get funded and there is still no regulatory authority that monitors the practice. Yet despite these issues, people are turning to the technique to help with everything from labour to hot flushes, anxiety and chronic pain, and a growing body of research is starting to confirm its benefits. We are also beginning to get a handle on how it actually works and what happens in the brain during hypnosis. The result is that how we define hypnosis is changing, and its use in mainstream medicine is increasing. The UKs Royal College of Midwives now accredits hypnobirthing courses and funds training in the technique. Some anaesthetists now include hypnosis in their toolkit, and it is even being touted as a solution for the opioid addiction crisis. Hypnosis is certainly no cure-all, but learning what works, why it works and how to do it ourselves may help us harness the power of the mind for some of lifes toughest battles. Hypnosis has a long history in medicine. The earliest recorded use dates to 1550 BC, but it took off in the 18th century when German physician Franz Mesmer decided that the planets physical influence on people could be manipulated using magnets to cause a trance and treat disease. Mesmer was later denounced as a fraud and hustler, but the idea of changing peoples behaviour through trance persisted, and gained more credibility in the 19th century when the Scottish surgeon James Braid began to investigate what physiology might underlie this strange phenomenon. Youve probably been in a trance, when you were so absorbed you didnt notice the passage of time Today, hypnosis is used for a vast range of conditions. But even as its use has become more common, its reach within medicine has been limited. In part that is because few can agree on what exactly hypnosis is. Cobbling together opinions from several researchers, a hypnotic trance could be described as a state of focused attention, concentration and inner absorption, accompanied by a loss of awareness of the other things around you. It is a state you are likely to have experienced before when you have been so absorbed in an activity that you dont notice anything around you or the passage of time. We also now know that the success of famous illusionists getting people to do weird and wonderful things on stage has more to do with peer pressure than it does with being hypnotised.
Smoke and mirrors
No hypnotist can make you do something against your will, despite what TV mentalist Derren Browns stunts may suggest. Back in 1939, scientists did show that hypnotised volunteers would perform risky acts, like picking up poisonous snakes, suggesting they werent acting of their own volition. But later experiments revealed that most people would do these things whether hypnotised or not, merely because they had been put under pressure by a person in authority. When asked to perform the same acts outside such settings, participants all said no. Its true that the people who are brought on stage and hypnotised feel compelled to behave in the way they do, says Michael Heap, a clinical psychologist at the University of Sheffield, UK. Mainly its because these people are placed in front of an audience. They know whats expected of them. Theyre actually just obeying the hypnotist, theyre cooperating, complying with authority. When it comes to how to actually hypnotise someone, there is no standard method. A common approach starts with thinking of a calming image, before imagining yourself in a peaceful setting that stimulates all your senses, followed by a deepening procedure and affirmations that help you achieve your goal. It can be induced by another party or by yourself. As well see, there are good reasons to keep calling the process hypnosis, but its fuzzy definition and controversial history have made it difficult to figure out what works and what doesnt. Its classification as complementary rather than mainstream therapy by the UKs National Health Service (NHS) hasnt helped either, says Jane Boissière from the British Society of Clinical and Academic Hypnosis, because it makes obtaining funding for trials, training or setting up relevant services in the NHS virtually impossible. In spite of this, the UKs National Institute for Health and Care Excellence does recommend hypnosis for one condition: irritable bowel syndrome. IBS causes painful cramps, bloating, diarrhoea and constipation. The cause isnt known and there is no cure, but some drugs and diet changes can ease symptoms. And for treatment-resistant IBS, there is overwhelming evidence that hypnosis can improve symptoms and quality of life. During hypnosis, patients might picture the gentle waves of the sea, and imagine their bowels are moving in a similar regular, quiet rhythm, says Carla Flik at University Medical Centre Utrecht in the Netherlands. In the US, both the American Psychological Association and the National Institutes of Health now promote hypnosis as part of standard care for pain. Numerous studies have shown that it can improve a variety of chronic problems, such as lower back pain and side effects of cancer treatments often offering more relief than physical therapy and cognitive behavioural therapies alone.
How to hypnotise yourself
Start with 5 minutes of calming imagery, such as imagining your favourite colour washing over you, or thinking about floating in a pool of water, while concentrating on your breath. Next, imagine yourself in a happy place somewhere peaceful that stirs your senses; you can smell, touch, hear and see the different aspects of the images around you. If you are imagining a day at the beach, for instance, you can visualise the bright sky above you, feel the warmth of the sun on your skin, taste and smell the salt in the air and hear the sounds of the waves rolling in and out. Next, it is time to go deeper. To make yourself feel even more relaxed, think about descending a spiral staircase, for instance. Now repeat affirmations that help you achieve your desired outcome. Hypnosis can be so effective for pain relief that, since 1992, it has been used in many surgical procedures including biopsies, laparoscopies and plastic surgery as an alternative to general anaesthesia. The technique is simple, says Aurore Marcou at the Curie Institute in Paris, France. The patient receives a local anaesthetic and mild sedation. We sit beside them and guide them to concentrate on their inner world, their breathing, and help them bring their attention to a safe space. We help them relive experiences in the past. All of your brain is focused on those memories. The major benefit is fewer side effects. You dont feel drowsy, or sick from the general anaesthetic, says Marcou. Guy Montgomery at the Icahn School of Medicine at Mount Sinai, New York, has found that women who had hypnosis before breast cancer surgery reported less pain, anxiety, nausea and fatigue afterwards. And the benefits werent just physical. His team predicted that if 90 per cent of people needing a breast cancer biopsy in the US were to undergo hypnosedation, it would save the country more than $135 million a year.
This reported reduction in mental and physical symptoms makes it no surprise that pregnant women like Shona flock to hypnobirthing classes. Officially, though, the jury is still out on this one a 2011 review of 13 studies concluded that hypnobirthing holds promise as an intervention for labour pain, but so many of the trials were poorly designed that a more definitive answer wasnt possible. A 2015 trial found the technique made little difference to whether women requested pain relief during childbirth, but it did significantly reduce their reported levels of fear and anxiety. Indeed, many see promise for its use in mental health. Anxiety disorders are some of the most impairing and common conditions in the US. This year, in the first analysis of its kind, Keara Valentine at the University of Hartford, Connecticut, and her colleagues quantified the effect of hypnosis for reducing anxiety by analysing all of the controlled studies of this intervention. The results were impressive: the average participant receiving hypnosis showed more improvement than 84 per cent of people who didnt receive it. Whats more, there was no difference in benefit between those who used self-hypnosis and those given guided hypnotherapy. Hypnosis isnt just used for pain and anxiety, of course. It is increasingly popular as a way to help people learn new behaviours or kick bad habits. But, again, the research is mixed because of poor trial design. In June, Jamie Hartmann-Boyce at the University of Oxford and her colleagues published a review of 14 studies analysing the use of hypnosis to help people give up smoking and couldnt find sufficient evidence to recommend it. The problem wasnt that hypnosis definitely didnt help, she says, but that the trials were a mess. They had lots of bias, were imprecise or had too few participants, Hartmann-Boyce says. Its such an important issue that we need to produce bigger, better trials. In other areas, results are more consistent. For instance, in the early 1990s, a meta-analysis of weight-loss studies showed that adding hypnosis to cognitive behavioural therapy more than doubled how much weight people lost. Another meta-analysis done in 2018 had equally encouraging results. Despite this increasing evidence of hypnotisms potential, there remain many questions regarding how it actually works. But that too is starting to change. I dont think anyone should say yes we know exactly what hypnosis is, says Laurence Sugarman at the Rochester Institute of Technology in New York, but we have some ideas. First, he says, we shouldnt think about hypnotism as something that induces a single state, but as a discipline that influences the brains ability to adapt and learn. Its a skill we can use to help us change our mind.
This adaptability which is also known as plasticity lets the brain modify its neural connections and rewire itself so that we can perform novel behaviours, remember new information and adapt to the variety of experiences life throws at us. There are times when the brain is more plastic the first few years of life, for instance, or when we experience strong emotions. It is likely that hypnosis puts our brain in a state that is conducive to remoulding, not in one specific way, but in many different ways depending on the individual and the therapy involved. For treating anxiety, self-hypnosis or guided hypnosis were equally good. For instance, imaging studies show that the relaxation part of hypnotic induction significantly suppresses activity in our frontal cortex, the brain area responsible for planning, decision-making and attention. This releases the brake that it normally puts on other areas involved in filtering and integrating salient information from inside and outside our body, which we use to generate new memories, ideas and behaviours. Something similar happens when we drink alcohol, a time when you might also feel more suggestible. It seems that while in the hypnotic state, we can generate more intense sensations in our mind. Marie-Elisabeth Faymonville, head of the pain clinic at Liège University Hospital in Belgium, has found that people who are hypnotised and asked to imagine a pleasant memory show more activity in brain areas responsible for movement and sensations than people who are merely imagining the same scene without hypnosis. There was no real stimulation coming from the outside world, but those who were hypnotised were seeing as if their eyes were open and information was coming in. It was similar to real perception, she says. The stronger such sensations are imagined or otherwise the more easily they can be incorporated into a learned behaviour. When it comes to controlling pain, hypnotism seems to help in a different way. Pain perception is generated by the brain, and we know that it can be influenced: consider the gymnast who breaks their leg halfway through a routine and carries on, or a mother who saves her child from a burning building before noticing her own injuries. Hypnotism seems to allow us to do something similar.
On your wavelength
When Faymonville hypnotised volunteers before pressing a warm or painfully hot stimulus on their palm, it lowered the perceived unpleasantness and intensity of the pain by about 50 per cent compared with subjects who were just resting, and by about 40 per cent compared with those told to distract themselves with a pleasant memory. A closer look at the brain in this context shows that hypnosis lowers activity in the anterior cingulate cortex, a region that receives information about sensory stimuli and is linked to areas that organise an appropriate emotional, behavioural response. Lower activity in this area may mean that pain signals are given less attention than normal. Other research suggests that hypnosis gets people into a state of mind where the associated brainwaves patterns of neural activity are similar to those seen during deep meditation. In a small study of people with multiple sclerosis who underwent hypnosis to treat chronic pain, Mark Jensen at the University of Washington, Seattle, and his colleagues found that enhancing the theta brainwaves generated during a hypnotic trance increased the potency of the pain relief. That may be because the brainwaves generated during a hypnotic trance aid the brains ability to learn and adapt to the new information it is receiving during the therapy. Despite this progress, there remain challenges: not least convincing doctors to keep an open mind. According to Montgomery, many trainees ask: Do we have to call it hypnosis? That word may scare patients off. The short answer is yes. When people undergo the same procedure labelled either hypnosis or relaxation or suggestion, it works better when called hypnosis. Motivation to be hypnotised, as well as believing it is a credible therapy, can also increase the likelihood that it is effective. As with the placebo effect, it may be that your belief hypnosis will make a difference is in fact a critical part of the success of the treatment. Giving hypnosis a fair shot in mainstream medicine could have big pay-offs. Studies show that people with chronic pain can lower their use of painkillers through hypnosis. In the US, more than 130 people die every day from overdoses involving addictive prescription painkillers, most notably opioids. Speaking at last years World Economic Forum, psychologist David Spiegel at Stanford University in California pointed out that hypnotism isnt addictive and doesnt kill people, yet it can have a considerable effect on pain, and is therefore worth taking seriously. Does hypnosis work for everyone? No. But you can try it on yourself for free and it comes with minimal risks, says Marcou. Thats whats so nice about hypnosis the results can be really good; you just need to be willing to give it a go.
New Scientist, 6 November 2019