Clinical hypnosis recognized but still underutilized

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By Nina Flanagan

Hypnosis is gaining traction in the integrative mental health and medical communities, even though it was acknowledged by the American Medical Association (AMA) more than 60 years ago.

A 2018 national survey of 1,000 adults reported that 38.6 percent had a positive view of clinical hypnosis and 45.6 percent acknowledged moderate or strong scientific evidence backing it as a real therapy. Its efficacy has been proven in thousands of clinical studies, yet its use still lags behind other complementary therapies such as acupuncture, meditation, and yoga. Pop culture depictions of hypnosis reinforce misconceptions and create another hurdle for its adoption.

“It’s the oldest Western psychotherapy, but somehow it gets tarred with a brush of weird fakery, mind control, and all that,” said David Spiegel, MD, associate chair of psychiatry and behavioral sciences at Stanford University School of Medicine. After successfully using hypnosis with approximately 7,000 patients and research subjects, Spiegel said he wonders why it’s not used more.

In a 2017 study, published in the journal Cerebral Cortex, Spiegel looked at how hypnotherapy changes the brain and pinpointed specific affected areas. While under hypnosis, three brain networks are modified to allow more focus while dimming distracting thoughts. This increases engagement. “You’re more engaged because you’re less worried about having to do something else,” Spiegel said.

The study findings establish the neurophysiology of hypnosis that “helps us make sense of it and indicates that something real is happening,” he said. “It’s not you losing control of your mind, it’s gaining control of your mind.”

This information has important implications for providers using hypnotherapy for mental health, as well as for medical applications. Ana Tucker, LCSW, MPH, CHt, owner of a private coaching practice in California, said she has been using hypnosis for 20 years. “Hypnotherapy changes the neural pathways in the brain,” she said. “The goal of hypnotherapy is to look at any patterns or beliefs that are limiting someone’s ability to live a full life.”

Tucker added that the combination of psychotherapy and hypnosis has proven successful for treating anxiety, insomnia, weight control, addictions, and sexual issues. More clients in her practice are embracing hypnotherapy, Tucker said, and the scientific community is catching up.

Clinical studies have proven hypnotherapy’s potential to reduce anxiety, pain, stress, and insomnia, assist with weight control and smoking cessation, and to help alleviate symptoms of post-traumatic stress disorder (PTSD) and irritable bowel syndrome (IBS). Researchers at Baylor University found it effective in controlling hot flashes in menopausal women, reducing frequency by 72 percent.

Hypnotherapy prior to surgery has also shown promising results. Guy Montgomery, PhD, professor of psychiatry at the Icahn School of Medicine at Mount Sinai, discovered using hypnosis prior to breast cancer surgery reduced pain, nausea, and fatigue compared to the control group. His 2007 clinical study also showed it reduced procedure time and costs, approximately 10 fewer minutes in surgery, leading to a $772 saving per patient.

“Hypnosis is a wonderful adjunct,” said Montgomery. When it’s used for pain control it’s not used to replace analgesics, he said. “This is a complement – it’s not meant to take the place of other things.”

Montgomery said hesitation to use hypnosis may be, in part, due to financial reasons. “We have a lot of data showing that cognitive behavioral therapies are effective for depression,” he said. “But, taking a pill is far more popular and cheaper, and it requires less effort and time by everyone involved, whether you’re the patient or the provider. I think all those things combine to create a little bit of resistance.”

However, Montgomery said there is a bright future for hypnosis and he hopes to explore using it in people close to end of life for pain control. In addition to ongoing clinical studies, there are increased educational efforts by professional organizations, such as the American Society of Clinical Hypnosis (ASCH), which saw a spike of 300 new members this year, according to Bridget Bongaard, MD,FACP, HCMD, president of the ASCH. It created educational programs in collaboration with the U.S. Department of Veterans Affairs (VA) hospital system and the Children’s Hospital of Philadelphia, she said.

The true potential of hypnosis has yet to be reached. Spiegel urged its use more broadly in a recent commentary, and after presenting its demonstrated efficacy, wrote: “…if hypnosis were a drug, it would be standard of care.”