Overview
Psychiatrists and psychologists use hypnosis to treat a variety of conditions, including generalized anxiety disorder, phobias (simple, social, performance anxiety), panic disorder, pain, irritable bowel syndrome, and certain dermatological disorders. Therapeutic hypnosis may also be used to aid in smoking cessation or weight loss.
Indications
Cognitive behavior therapy with exposure to the feared situation is typically the therapy of choice for phobias.
However, hypnosis has been used in the treatment of various phobias including simple phobia, social phobias, and performance anxiety. Hypnosis can reduce symptoms of anxiety by inducing a more tranquil state that is associated with the induction technique. Additionally, hypnosis has been shown to augment patient’s resilience when dealing with stressful situations and decreasing avoidance behavior.
Various meta-analyses have pointed to hypnosis as an adjunct therapy for smoking cessation, with reinforcement by regular contact with medical professionals and counselors as an integral part of the treatment.
Although hypnosis is not a definitive treatment, it has been successfully used as an adjunct treatment.
However, in some studies hypnosis was not found to be more effective than cessation trials without hypnosis.
Some meta-analyses have indicated that hypnosis may enhance weight loss. Patient undergoing cognitive-behavioral therapy for weight loss were compared to patients undergoing similar therapy with the addition of hypnosis, with favorable results reported for 70% of the patients receiving hypnotic therapy. Mean weight loss was 6.03 lbs for patients not receiving hypnosis and 14.88 lbs for patients receiving hypnosis. Further correlational analyses indicated that the benefits of hypnosis for weight loss increase over time.
According to one meta-analysis, hypnotic suggestions relieved pain in 75% of 933 subjects participating in 27 different experiments. The pain relief from hypnosis often matched or even exceeded the relief given by morphine.
Another study showed that participants who were highly suggestible received the greatest benefit from reduction in pain when compared to placebo. A participant’s responsiveness to suggestion was the primary determining factor in the extent of pain reduction.
One of the most studied uses of hypnosis in medicine is the treatment of irritable bowel syndrome. Treatment methods typically consist of medication and dietary changes, but the addition of hypnosis has been shown to decrease and even eliminate symptoms. Palsson et al. showed that hypnosis benefitted patients suffering from irritable bowel syndrome for at least 10 months. Initially, imagery directed at reducing pain was used, but the authors found that hypnosis alone gave patients the most benefit.
Hypnosis has further been demonstrated to be effective for irritable bowel syndrome for patients when conventional treatment approaches have proven ineffective or insufficient. There is evidence that even patients that are less susceptible to hypnosis than others may benefit from hyphnotherapy interventions. Benefits of hypnotherapy in irritable bowel syndrome include symptom attenuation and even remission. In some instances, symptom improvement has continued even after a hypnotherapy intervention has concluded.
Some studies have shown that hypnosis can be used as an adjunct treatment for various skin conditions, including alopecia areata and psoriasis. These studies had a limited number of participants but showed that hypnosis therapy could help alleviate stress in patients suffering from dermatological conditions. The patients were broken into two groups, with one group receiving active suggestions and another receiving hypnosis. Patients who were shown to be highly hypnotizable displayed greater improvement than moderately hypnotizable patients, regardless of which modality of treatment was used.
Hypnosis has been demonstrated in randomized clinical trials to be effective in treating sleep impairment in patients with posttraumatic stress disorder (PTSD). Improvements in sleep performace have then been noted to result in corresponding reduction of depression and PTSD symptoms after subsequent interventions such as cognitive processing therapy (CPT). However, hypnosis has not been demonstrated to assist PTSD symptoms as a standalone intervention.
Another consistently documented application of hypnotherapy is its potential role in palliative care. Hypnotherapy has been demonstrated to assist in symptom control, stress reduction for patients and caregivers, and overall quality of life improvement. Numerous studies have suggested that hypnotherapy should not be delayed for appropriate qualified palliative care patients when such an intervention is available.
Contraindications
When evaluating a patient for potential hypnosis, it is important to consider possible contraindications, including the emotional state of the patient and the desired outcome. Cooperation is an essential element for effective hypnosis. If an individual is uncooperative or hostile, hypnosis may not be the best treatment option. Additionally, some patients will not be able to be hypnotized due to brain trauma or cognitive deficits. In these cases, hypnosis is contraindicated.
The use of hypnosis is generally not advisable for patients with borderline personality disorder, dependent personality disorder, or psychosis. For patients with borderline personality disorder or dependent personality disorder, there is a risk that the patient will want to form intense or inappropriate relationships or interactions with the practitioner. Perhaps the most important concern is that hypnosis could exacerbate a pre-existing psychosis. Therefore, hypnosis is contraindicated for a patient displaying signs of psychosis.
Technical Considerations
An abreaction is a negative response that can occur at any time during hypnosis. It is sometimes caused by unpleasant or uncomfortable memories that are brought into awareness during hypnosis. Some practitioners of hypnosis use abreactions as part of the therapy; others seek to limit these experiences. An abreaction is often an uncomfortable situation that may be followed by crying or angry outbursts. Addressing the concerns of the participant by acknowledging the abreaction is often the safest way to deal with the situation.
Many myths are associated with hypnosis, including that people lose control while in a hypnotic state and that they can become “stuck” in a trance. Hypnosis is a voluntary act and patients are always in control of their actions. For example, if a practitioner suggests something that is not agreeable to a patient, the patient will not do it. In addition, hypnosis is not a permanent condition; it usually ends as soon as the practitioner starts the termination process. However, a patient can end the hypnotic state at any time he or she chooses.