Dr Robert London

Hypnosis: A Call for Training

Clinical Psychiatry News - Volume 37, Issue 7, Page 13 (July 2009)

Television programs and newspapers promote regularly the use of multiple alternative treatments in medicine, surgery, and dentistry. Amid all the promotions for alternative and complementary medical techniques, one word has been conspicuously absent: hypnosis.

Yet, compared to other ancillary treatments, hypnosis is more sophisticated, better studied, and more codified.

More than 30 years ago, I began using hypnotic/relaxation techniques, coupled with a behavior modification strategy, for smoking cessation and weight control. These techniques were later expanded to numerous psychiatric disorders.

I also used these techniques with patients referred to me by orthopedists and neurosurgeons for pain control—usually for headache and musculoskeletal problems.

In addition, I worked with cancer patients referred by oncologists who were concerned about the adverse effects of chemotherapy (“Psychiatry and Medicine Working Together,” The Psychiatrist's Toolbox, June 2005, p. 67).

A Scottish surgeon, Dr. James Braid, first introduced the word hypnosis in 1843, when he was attempting hypnoanesthesia for his surgical patients. Dr. James Esdaile, another surgeon working in India, performed surgical procedures alone with the use of hypnosis before chemical anesthesia was available.

As hypnosis became popularized in the latter half of the 19th and early 20th centuries, greats such as Sigmund Freud, Ivan Pavlov, Pierre Marie Félix Janet, and Jean-Martin Charcot, used and worked at defining the phenomenon of hypnosis.

Today we know it's there. We know it works. We've got two societies dedicated to it—the Society for Clinical and Experimental Hypnosis and the American Society of Clinical Hypnosis.

Throughout the 20th century, discussions of hypnosis became an ongoing source of medical, psychiatric, and psychological investigation. By the 1950s, the American Medical Association and the British Medical Association recognized hypnosis in policy statements as a legitimate treatment in medicine and dentistry. What exactly is hypnosis?

Definitions of hypnosis are many, and theories as to what it is are varied from the physiologic to the psychological as well as a combination of both. The exact type of substrate—biological, physiologic, or psychological—has not been clearly elucidated. But one clear message emerges: The hypnotic phenomenon is a real mental event, and appears to include some form of relaxation and intense concentration. It does not appear to be sleep.

During hypnosis, many therapeutic strategies can be used to treat psychological or physical problems as well as certain chronic pain syndromes such as headache and musculoskeletal pain.

Symptom removal has been an ongoing process, used in altering a person's perception of a specific problem with good success, contrary to older psychiatric ideas that symptom removal would lead to another form of problem or symptom. I do believe that in certain situations, symptom substration does occur, but not as a general rule. This observation is another indication that skilled mental health professionalism with a substantial base of knowledge is important when using hypnosis.

Over the years, multiple scales have been developed to measure hypnotizability. Some have been tied to personality traits; others measure levels of suggestibility. The Harvard Group Scale, the Stanford Susceptibility Scale, and the Hypnotic Induction Profile (HIP) introduced by Dr. Herbert Spiegel and Dr. David Spiegel (“Trance and Treatment: Clinical Uses of Hypnosis” [New York: Basic Books, 1978]), are examples of measurements assessing a person's hypnotic capacity.

I have used the HIP with some modifications over the years as a rapid and clinically accurate measure of hypnotic capacity.

An important aspect of these scales is they offer a measure of hypnotizability that defines where people rest on a continuum. Some people are not hypnotizable. Such scales allow for different treatment approaches as well as offer alternative approaches when the individual does not fit the criteria for this type of intervention.

Even in the use of acupuncture, it's assumed that all people respond the same way. That also seems to be an underlying assumption of other techniques, such as meditation and yoga. However, the impact of these techniques is not measurable, and anecdotal reports suggest that each person is affected differently by these modalities.

As helpful as many other of these techniques might be when it comes to medical/psychiatric problems, the impact is negligible, compared with what can be achieved when psychiatrists or psychologists use hypnosis and hypnotic strategies.

Considering that some of the best psychiatric and psychological thinkers of the last century have worked at codifying, understanding, and using hypnotic techniques, you would think that these technqiues would be a mainstay in treating psychological problems and a lynchpin in teaching patients how to relax. Sadly, that is not the case.

While researching this column, I called Dr. Marissa Kaminsky, a New York forensic psychiatrist, to get her insights. She cut to the chase: There was no training in hypnosis in her 4-year residency.

It would have been valuable, Dr. Kaminsky said, to have learned how to do smoking cessation techniques, weight control, and other modalities of care using a hypnotic base in caring for patients.

In addition, Dr. Kaminsky said, learning about the value of hypnosis or hypnotizability in forensic settings would have been particularly helpful—given her subspecialty choice.

It is difficult to understand how hypnosis—a procedure with a solid evidence base that has been used effectively by skilled mental health professionals—has been supplanted by so many alternative approaches. As we explore various options for overhauling our health care system, let's find ways to improve psychiatric training programs by teaching hypnosis and hypnotic strategies.

Let me know your thoughts about training psychiatrists and other mental health professionals in the use of hypnosis as part of their basic education, and I will try to pass this along to my readers.

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