Question 1

What training programs would you recommend for psychologists interested in making hypnosis part of their clinical repertoire?

David Spiegel · Accepted Answer

Join Division 30 of the American Psychological Association, which has training programs every year at the APA annual meeting. Or there are good annual meetings and workshops of the Society for Clinical and Experimental Hypnosis (SCEH.US), the American Society of Clinical Hypnosis (ASCH.net), and the International Society of Hypnosis (https://www.ishhypnosis.org/).

Question 2

Is everyone hypnotizable?

David Spiegel · Accepted Answer

No. About 1/3 of the adult population is just not hypnotizable, so do something else, like progressive muscle relaxation or appropriate medications.

But the remaining 2/3 of adults range from somewhat to extremely hypnotizable. And most children in the latency years are very hypnotizable.

I start every clinical and research session (and I’ve done about 7,000 of them) with a brief measure of hypnotizable called the Hypnotic Induction Profile. In 5 minutes, I can tell what a person’s degree of hypnotizability is, and this helps me know how to use it. The principles of this approach are in a textbook I co-authored with my late father, Herbert Spiegel, entitled Trance and Treatment: Clinical Uses of Hypnosis. American Psychiatric Publishing, Washington DC, 2004 (https://www.amazon.com/Trance-Treatment-Clinical-Uses-Hypnosis/dp/1585621900).

Question 3

Why is there so much controversy about the use of hypnosis within the scientific community? Is it due to lack of evidence or something else? What are the main misconceptions?

David Spiegel · Accepted Answer

I wish I knew. The scientific evidence has accumulated, but there is still considerable prejudice against it, perhaps based on the history of stage shows or poorly trained people offering hypnosis without having adequate clinical training and licensure. People seem to think that hypnosis is either useless or dangerous, when in fact, it is very useful and far less dangerous than most of the medications we use for pain and anxiety problems. Many fear that hypnosis involves loss of control, when really it is a powerful means of enhancing control over the brain and body.

Question 4

Can hypnosis go really wrong?

David Spiegel · Accepted Answer

Not really – it is far safer than any drug.

Very rarely people may have an upsetting memory emerge during hypnosis, but a trained clinician can readily help them deal with that and learn from it. Hypnosis enhances control over the mind and body – you don’t lose control, you gain it.

Question 5

Where can I receive training in hypnosis for chronic pain?  I live in Ontario, Canada.

David Spiegel · Accepted Answer

Please contact the Canadian Society of Clinical Hypnosis – Ontario Division. http://csch-od.ca/  Also, feel free to give Reveri (https://www.reveri.com/) a try.

Question 6

How do you suggest hypnotherapy for chronic pain is best delivered and by who - e.g. which setting, how many sessions, by which health care providers etc.?

David Spiegel · Accepted Answer

There are expert pain psychologists who use hypnosis, also general psychologists and psychiatrists. More and more pain clinics are including integrative techniques such as hypnosis, mindfulness, and acupuncture in their pain treatment programs.

Sometimes one session is enough to teach the basis for utilizing it on your own, but often a course of weekly sessions can help to enhance and consolidate gains.

Question 7

Is hypnotic analgesia a strong placebo effect?

David Spiegel · Accepted Answer

If you are at least moderately hypnotizable, hypnosis is stronger than the placebo effect, which is another non-pharmacological means of effectively reducing pain. Expecting to be helped by any pain-relieving procedure has a placebo component that can indeed help. But many people can enhance their pain reduction by learning techniques to modify the pain, transform it, or focus attention elsewhere.

Question 8

Does hypnosis show similar promising effects on chronic pain as it does with acute pain?

David Spiegel · Accepted Answer

Yes. One can think of it as a skill that is acquired acutely and becomes a learned ability that is useful chronically. When pain starts or intensifies, people can learn to ‘nip it in the bud’ by doing a self-hypnosis exercise that helps them to modulate the sensation (e.g., cool tingling numbness or comforting warmth), try to move the pain around – learn to modulate it, or imagine leaving your body here and go somewhere you would rather be – use dissociation to modulate the pain.

We have conducted randomized clinical trials with women who have metastatic breast cancer. Their pain is, of course, worsened by fear that the pain signals the progression of the disease. We taught them to use self-hypnosis for pain control, and we found that by the end of a year, those in the support group program teaching enhanced coping and self hypnosis had half the pain on the same and very low amounts of medication. So, hypnosis is a useful tool. You can learn more about hypnotic pain control by downloading the Reveri app from the App Store on any iOS smartphone. It has guided interactive hypnosis exercises for pain control and other problems. If you have an Android phone, Reveri (www.Reveri.com; a company I co-founded) has a sign-up list where you can leave your email and be notified when it is ready, likely later this year.

Question 9

What are the neuronal/neurochemical mechanisms that are influenced by hypnosis?

David Spiegel · Accepted Answer

Experiencing hypnosis is associated with functional change in several key regions of the brain:
a. Activity in the dorsal anterior cingulate cortex is reduced. This is a key node in the Salience Network, a brain region that detects changes in context and grabs your attention in the face of danger or the need to pay attention to something new. More hypnotizable people have more GABA receptors in this brain region. They are inhibitory and function like a natural anti-anxiety medication.
b. Coordinated activity between the left dorsolateral prefrontal cortex, a key region in the executive control network, and the insula, a major brain-body control node, also part of the salience network, is increased. This means that in hypnosis, the capacity for mind-body control, including pain reduction, is enhanced.
c. Activity between the executive control network and the posterior cingulate cortex (PCC) is reduced. The PCC is part of the default mode network, which is active during periods of self-reflection. The effect in hypnosis is to enhance and control dissociation, separating aspects of experience and components of identity.

Question 10

I mostly only hear about hypnosis being researched for use in chronic pain. Has there been any recent research on the use of hypnosis for behavioral or emotional issues? If not, why?

David Spiegel · Accepted Answer

Yes, hypnosis is very helpful for problems related to stress and anxiety, which we’ve seen plenty of in the last two years. Stress triggers psychophysiological reactions such as muscle tension, increased heart rate, sweating, and rapid shallow breathing. Just learning to control these reactions to stress can be the first step to better managing stress altogether – even if you cannot control the stressor immediately, you can learn to control your response to it. Then you can picture alternative means of better managing the stress.

Hypnosis is also very helpful for insomnia, both for falling asleep and getting back to sleep if you awaken at night, using similar methods – also available on Reveri (https://www.reveri.com/).  Hypnosis has been effectively utilized to help with more serious stress-related problems, such as post-traumatic stress disorder. It is also helpful for habit problems such as managing healthy eating and smoking cessation.

Question 11

Do you know of any useful scripts or strategies to help one sleep when pain is intense, and it is difficult to be quiet and tune into one’s body?

David Spiegel · Accepted Answer

Yes – Reveri (https://www.reveri.com/) -  has such scripts that I have recorded for both pain and insomnia. Often enhanced dissociation is helpful – go in your mind to somewhere else you would rather be. Don’t fight the pain, but see how you can modulate it while forgiving your body for the trouble it is causing you, the way you would if your child were in pain.

Question 12

Are certain types of pain condition more responsive to clinical hypnosis than others?

David Spiegel · Accepted Answer

The evidence is not clear about this, but those that involve a combination of pain and anxiety seem to benefit more from the ability to reduce both pain perception and associated stress about the pain. Both acute and chronic pain can be helped.

Hypnosis for Chronic Pain