Hypnosis spells relief
Long misunderstood, this technique gains respect as a tool to manage pain and help patients change behavior.
By Dennis O'Brien
August 19, 2005
When Marija Trieschman gave birth to her daughter three years ago, she felt no pain. But it wasn't a drug that helped her cope. She credits hypnosis.Trieschman, a horse trainer who uses herbal remedies and other alternative therapies, began attending twice-a-week hypnotism classes when she was three months pregnant. They were held at the home of a friend trained in a California-based practice known as "HypnoBirthing."
At her Harwood home, Trieschman practiced hypnosis on herself every day for six months, and when she finally delivered at Anne Arundel Medical Center, she was able to focus so intensely on her breathing that she put the pain aside.
"You get into this mental state of peace," said Trieschman, 40. "My body just took over and let it happen. There was absolutely no pain at all."
Long regarded as a fringe therapy, hypnosis is now getting what advocates say is well deserved attention. Doctors are studying its effectiveness at Stanford University and Mayo Clinic and using it to speed surgical recoveries at prestigious teaching hospitals such as Yale, Harvard and New York's Mount Sinai .
The studies and other hypnosis issues will be up for discussion today and tomorrow at the American Psychological Association's annual convention in Washington.
As a therapy, hypnosis has been around for well over a century. It's most commonly applied to help people quit smoking, curb their eating, manage anxiety, ease pain and combat ailments ranging from alcoholism to bed-wetting.
"There are about 3,000 ways to use hypnosis," said Victor Fitterman, a clinical social worker and an assistant professor of psychiatry at the University of Maryland School of Medicine who uses hypnosis as director of the Maryland Group Faculty Practice.
"It's catching on, but it is still one of the least understood and least used therapeutic tools available," added Marty Sapp, a psychologist at the University of Wisconsin-Milwaukee.
Sapp, who has hypnotized patients for 17 years, plans to attend the APA meeting to discuss a study he conducted that found hypnosis combined with cognitive therapy worked better than cognitive therapy alone. But as with most forms of therapy, the patient has to be open to hypnosis, he said.
"For motivated people, it does tend to be effective," he said.
According to an APA survey, psychologists see pain management as the most fruitful avenue for future hypnosis therapy. Several studies have shown that cancer patients treated with a combination of traditional therapy and hypnosis reported less pain than with traditional treatment alone.
"Pain is a hot area of research right now," said Steven Lynn, a psychologist at the State University of New York at Binghamton who supervised the survey.
The word hypnosis, loosely translated, means "sleep" and comes from Hypnos, the Greek god of sleep. But some experts say that definition is misleading. For example, UM's Fitterman and other researchers note that people under hypnosis remain aware of their surroundings and in control of mind and body.
Sessions can last anywhere from 10 minutes to an hour or two. During that period, experts say, hypnotized patients are able to limit distractions, focus better and become more receptive to suggestions directed primarily at the unconscious mind. "It's not sleep. You can't be made to do things you don't want to do," Fitterman said.
Fitterman has been using hypnosis since the mid-1980s, when he coaxed a University of Maryland psychiatrist, now retired, to let him attend classes on hypnosis for medical school students. The classes are no longer held, but Fitterman says he has used hypnosis ever since to help people quit smoking, lose weight, deal with stress, manage chronic pain and stop biting their nails.
"You won't forget something you're not willing to forget," he declared.
He said hypnotism should be used more for pain relief in hospitals, particularly for cancer patients. "There are a lot of myths and misconceptions about hypnosis, and I think that's held things back," Fitterman said.
For many doctors and patients, hypnotism still suffers from the image created by stage-show theatrics: the subject who stares at a swinging pocketwatch, falls into a trance and then clucks like a chicken.Legally and medically, the image of hypnosis also suffered in the 1980s, when hypnotized children were coaxed into creating false memories about child-care providers that resulted in wild and unfounded accusations of sexual abuse.
"I'm kind of doubtful about whether it is being more accepted," said Dr. James Stewart, an internist who specializes in vascular medicine at the Mayo Clinic College of Medicine in Jacksonville, Fla.
Before they hypnotize someone, most therapists review the patient's medical and psychological history. They also will review myths and misconceptions about hypnotism and try to clarify the client's goals.
Stewart said that one problem is the lack of standardized training and testing for hypnotists or "hypnotherapists," who may charge up to $100 an hour. Although hypnotism is employed by reputable psychologists, social workers and physicians, it's also practiced by many who are self-trained - and there is no way to objectively assess their effectiveness, he said.
"It's done any number of ways and there's not any one established or accepted program," said Stewart, who published a recent review of dozens of hypnosis studies for the Mayo Clinic newsletter.
Consumer Reports recommends that anyone seeking a hypnotherapist consult a physician, inquire at a hospital or seek referrals from either the American Psychological Association, the American Society for Clinical Hypnosis or the Society for Clinical and Experimental Hypnosis. All three groups have Web sites.
Another problem is that not everyone can be hypnotized. Only about 10 percent of the adult population is highly susceptible to hypnosis, with most of us susceptible to lesser degrees. Children are generally more susceptible, peaking at about age 12 and tapering off gradually, researchers say.
Generally, hypnosis works best for people who are trusting, able to focus and willing to work at it. (Many hypnotists provide audio tapes for follow-up training at home.)
The best way to know if someone is susceptible is by using one of several standardized diagnostic tests, including the Stanford Hypnotic Clinical Scale and the Hypnosis Induction Profile.
Skeptics can also be good prospects for hypnosis. "Some of my best subjects were people who were very skeptical," said Amir Raz, an assistant professor of clinical neuroscience at Columbia University Hospital.
In a study published last month, Raz hypnotized eight highly suggestible volunteers and told them they would later be asked to name the color in which a word is written. The task was tricky because the word itself was the name of a different color - the word "blue" would be written in red ink, for instance.
He also told the hypnotized volunteers that when they emerged from hypnosis and later heard a cue, such as a cough, they would see the printed words as gibberish and focus only on the color of the ink.
The hypnotized volunteers completed the task 10 percent faster than a control group. Their brain scans also showed less activity in a midsection of the brain used to resolve conflict, known as the anterior cingulate cortex.
The results show that hypnosis has a measurable biological effect, said Raz, who published the study in Proceedings of the National Academy of Science.
"What I'm showing is that words being suggested to someone can be very powerful. If practitioners carefully craft their words, and the individual is highly suggestible, they can bring about focal changes in the brain that no drug can produce," he said.
In another study, Stanford University researchers showed brightly colored shapes to eight hypnotizable patients and eight who resisted hypnosis. Then they told the subjects to imagine the shapes being drained of any colors but gray, black and white. They also told them to look at black and white shapes and imagine them as brightly colored.
The researchers found that when the suggestible volunteers were hypnotized and told to imagine color shapes, there was an increase in blood flow in brain regions that process color vision. The results, published in the American Journal of Psychiatry, showed that hypnosis can sometimes override what a hypnotized subject actually sees, the researchers say.
Experts say that hypnosis can be a unique tool, but works best when combined with other forms of treatment, such as psychological counseling or some type of therapy tailored to an individual patient.
"It's not a panacea, its not a cure-all kind of thing," Raz said. "It can be part of a clinician's arsenal. In some people, it works with everything, in others it would work only in a few ways."