Hypnosis - so does it work?
Anyone who is a hypnotherapist has been asked many times whether it works. It’s a skill in itself to be able to put together a two sentence answer to this question that yes it does and this is how. As you can read, this article is not a two sentence answer, but I hope to clarify some important misunderstandings and to show you why I believe hypnotherapy is such an important practice today.
Defining hypnosis is complicated in itself. The Oxford English Dictionary (OED) offers this:
“The induction of a state of consciousness in which a person apparently loses the power of voluntary action and is highly responsive to suggestion or direction. Its use in therapy, typically to recover suppressed memories or to allow modification of behaviour, has been revived but is still controversial.” (1)
This definition implies that ‘hypnosis’ is a verb, something that is done, or that we do, and so when you ask ‘does hypnosis work?’ it can seem a fair question. Let’s come back to that question in a while, but first I’d like to examine this definition more closely.
The OED definition is confusing and, as carefully conducted research over decades demonstrates, frankly inaccurate on several counts. First, there is no agreement among researchers that hypnosis is a state of consciousness in itself (2) (3). Second, recognising a tendency of involuntariness in response to suggestion is not the same as losing the power of voluntary action (4). Third, we now know that hypnosis increases responsiveness to suggestion only slightly, that we individually have different levels of suggestibility, and that the single strongest marker to how suggestible we are in hypnosis (called hypnotisability), is how suggestible we are out of hypnosis (5). Fourth, I challenge that most hypnotherapists typically use hypnosis to recover suppressed memories, as we do not, particularly as there is evidence to show that hypnosis cannot do this, although people might more strongly believe fabricated memories they ‘recall’ (6). Finally, as for whether hypnosis is controversial, it is now well evidenced that hypnotherapy is helpful for a wide range of issues including pain relief, digestive symptoms and many forms of anxiety. (7)
I also challenge that ‘hypnosis’ is a verb. It is not, it is a noun. The word ‘hypnosis’ describes a state, an experience, a way of being at a particular time. Therefore, when asked if it works, we need to clarify first what ‘it’ is.
More accurate definitions of hypnosis have been attempted by academics for a long time. James Braid coined the term ‘hypnosis’ back in 1853 and there has been debate ever since over what hypnosis is, particularly by the active research group, Division 30 of the American Psychological Association. Their most recent definition, agreed in 2014, I think is the clearest yet:
Hypnosis: “A state of consciousness involving focused attention and reduced peripheral awareness characterised by an enhanced capacity for response to suggestion”
The working group have also helpfully added the following:
Hypnotic Induction: “A procedure designed to induce hypnosis”
Hypnotisability: “An individual’s ability to experience suggested alterations in physiology, sensations, emotions, thoughts, or behaviour during hypnosis”
Hypnotherapy: “The use of hypnosis in the treatment of a medical or psychological disorder or concern” (8)
By defining hypnosis as the experience, the state of being, we begin to understand that the question ‘does hypnosis work?’ is a question about whether our own mind processes work for us. The role of the hypnotherapist is to first induce the experience of hypnosis and then to use suggestions to guide the client (the procedure) towards insights and imagined experiences that help to reach the agreed goals.
What you really mean when you ask ‘does it work?’ is ‘does the procedure work?’ Then as a therapist we must take responsibility to explain that the outcome of hypnotherapy is the result of a collaboration between therapist and client. Yes, we the therapist must have the skills and knowledge to help you to define the issue and your goal for therapy, yes, we must understand how to form and deliver appropriate suggestions. But how motivated you are to want to change, and what your own capacity is to be hypnotised are important factors in the success of therapy. Some clients are more hypnotisable than others, a fact well researched and measured (5), and relied on by the stage hypnotist if he wants to put on a good show.
Once hypnosis is induced, what changes are actually occurring in your brain that allows you to be more open to certain suggestions? That’s when it starts to get even more interesting.
There is, to date, no firm evidence of specific markers in the brain that can identify a unique state of hypnosis (6) . However, as all hypnotherapists know, hypnosis does feel different and people in hypnosis respond differently to when they are wide awake. As well as increased suggestibility, research shows that hypnosis is connected to focused attention, an experience of absorption, enhanced imagination and responding involuntarily. (4) In hypnosis you can forget words if this is suggested to you, you can imagine being in situations if suggested to you, and you can enhance feelings if this is suggested to you.
Task-specific studies show that in hypnosis you are not just pretending to do these things – you do actually experience something if it is suggested to you to experience it. An important finding by Kosslyn et al (9), was that when we see objects in colour this enhances specific colour-perceiving areas in our brain that can be identified using brain imaging methods. If I suggest to a hypnotised person that a grey object is in colour, they not only report that they see it in colour, but brain images show that they experience the colour.
This and other research has huge implications for successful hypnotherapy. By suggesting to you in hypnosis that you are now experiencing your feared event in a calm and confident way, you actually do. By suggesting to you in hypnosis that you are now turning down your experience of pain, you actually are. This is not acting as-if, or trying hard to imagine this happening. This is quite close to how you experience a dream, although I am not implying that hypnosis is dreaming.
As I said above, there are yet no identified markers for the experience of hypnosis being a unique state in itself. Although most researchers recognise that hypnosis is something quite special, the jury is still out in the academic world on whether it can be defined as a special state in the same way that dreaming can. But, more modern research using neuroimaging techniques is opening up possibilities that are exciting for the world of hypnosis. Recent research, using more sophisticated fMRI methods, has for example shown that inducing hypnosis reduces activity in a particular pattern of brain responses called the Default Mode Network (DMN) (10).
What’s particularly interesting about this is that the DMN is a pattern of normal psychological processes that is activated when we are resting, and is usually associated with boredom, letting our mind wander, relaxing and daydreaming. Hypnosis is not relaxation and neither is relaxation a vital ingredient to being hypnotised. Researchers have for example, induced hypnosis in participants while they are pedalling exercise bikes (11) to show this and they have concluded relaxation commonly associated with hypnosis may simply be a response to suggestions to relax. How often does a hypnotherapist suggest our client relaxes? Very often indeed in my experience.
In connection to the DMN, research is currently concluding that although hypnosis may feel like a relaxing, mind-wandering, daydreaming experience, it reduces activity in the DMN rather than what we might expect that it would increase DMN activity as found when daydreaming or relaxing. Thus, as a mental experience, hypnosis is quite an active process that involves focusing on tasks and responding to suggestions, and not the passive ‘lay back and let it happen’ experience that you might think it is or indeed that you might experience it to be.
A recent TED talk by Manoush Zomorodi (12) focuses on the connection between an activated DMN and boredom. She fears that in our modern world we are now not allowing ourselves to use boredom in the way that it might be serving an important function. We are, she says, distracted by too much multi-tasking which results in us losing the bigger picture around our values, life goals and the journey we take to achieve them. Apparently we now check our emails on average 74 times a day and we switch tasks on our computer on average 566 times a day. Zomorodi is concerned that we are using our relationship with our technology to move away from activating our DMN and therefore increasing a tendency to stress, depression and anxiety. Perhaps hypnosis research will show that there is more than one way that experienced changes in the DMN network are helpful to reduce stress, depression and anxiety.
All good therapy recognises that a person will change only if they want to change. Attempts to coerce or condition people to change will only be successful if that person already wants that change. It is why hypnotherapists who specialise in stopping smoking will always challenge the client to consider whether they really want to stop, or whether they think they should stop, because the two are not the same.
Traditional talking therapy knows that it is vital for the therapist to create the right environment for you, the client, to change. This external environment, experienced internally by the client, involves providing what Carl Rogers termed the Core Conditions – therapist’s empathy, prizing and genuineness towards the client. Regardless of the approach that the therapist might take with their client, over time these conditions support the client to safely explore feelings and ideas and to discover who he is and what is important to him. (13)
I suggest that hypnotherapy can take this a stage further, by enabling you to not just experience this supportive external environment, but also to enhance an internal environment that is conducive to change. This internal environment of focused attention, increased imagination, and absorption into a key idea allows you to take on board new learnings and to blend memories, beliefs, emotions and imaginings in a positive way. An experiencing outside of the box, I might say.
Hypnotherapy can, I believe, serve a very important purpose in our modern world that we might be ignoring. If we find it too easy to be distracted, to multi task and to switch tasks, then having formal time and space to focus just on key ideas and goals gives us back something that we are moving too far away from in our modern world. Instead of asking google, we learn to ask ourselves again. Our use of the experience of hypnosis has much to offer that we have barely tapped into yet, but it is important to know what it is and what it is not.
1. Oxford English Dictionary. www.oed.com. [Online] September 13 2018. http://www.oed.com.
2. Barber, T.X., Fromm, E. and Shor, R.E., . Hypnosis: Developments in research and new perspectives. 1979.
3. Altered state of hypnosis: Changes in the theoretical landscape. Kirsch, I. and Lynn, S.J., . 1995, American Psychologist, 50(10),.
4. Kihlstrom, J.F. Kihlstrom, J.F., 2008. The domain of hypnosis, revisited. [book auth.] M., Barnier, A. Nash. The Oxford handbook of hypnosis: Theory, research, and practice, . Oxford : Oxford University Press, 2008, pp. pp.21-52.
5. Imaginative suggestibility and hypnotizability: an empirical analysis. . Braffman, W. and Kirsch, I. 1999, Journal of Personality and Social Psychology, 77(3).
6. Hypnosis and the relationship between trance, suggestion, expectancy and depth: Some semantic and conceptual issues. . Wagstaff, G.F. 2010, American Journal of Clinical Hypnosis, 53(1), pp. pp.47-59.
7. Kirsch, I., Lynn, S.J. and Rhue, J.W. eds. Handbook of clinical hypnosis. . . : American Psychological Association., 2010.
8. Advancing research and practice: The revised APA Division 30 definition of hypnosis. . Elkins, G. R., Barabasz, A. F., Council, J. R., & Spiegel, D. 2015, International Journal of Clinical and Experimental Hypnosis, 63(1), pp. 1-9.
9. Hypnotic visual illusion alters color processing in the brain. . Kosslyn, S. M., Thompson, W. L., Costantini-Ferrando, M. F., Alpert, N. M., & Spiegel, D. 2000, American Journal of Psychiatry, 157(8), , pp. 1279-1284.
10. Hypnotic induction decreases anterior default mode activity. . McGeown, W.J., Mazzoni, G., Venneri, A. and Kirsch, I. 2009, Consciousness and Cognition, pp. 848-855.
11. A comparison of active-alert hypnotic induction with traditional relaxation induction. . Banyai, E. I., & Hilgard, E. R. 1976, Journal of Abnormal Psychology, p. 218.
12. Zomorodi, M. Bored and Brilliant: How Spacing Out Can Unlock Your Most Productive and Creative Self. . s.l. : St. Martin's Press., 2017.
13. Rogers, C. On Becoming a Person: A Therapist's View of Psychotherapy. London : Constable, 1961.
14. Searching for a baseline: functional imaging and the resting human brain. . Gusnard, D.A. and Raichle, M.E. 2001, Nature Reviews Neuroscience.
15. Modulating the default mode network using hypnosis. . Deeley, Q., Oakley, D.A., Toone, B., Giampietro, V., Brammer, M.J., Williams, S.C. and Halligan, P.W. 2012, International Journal of Clinical and Experimental Hypnosis, 60(2),, pp. pp.206-228.
16. What, if anything, is regressed about hypnotic age regression? A review of the empirical literature. Nash, M. 1987, Psychological Bulletin, 102(1).
17. Norcross, J.C. Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. New York : Oxford University Press, 2002.