Dr Robert London

The Value of Medical Hypnosis

Clinical Psychiatry News - Volume 33, Issue 12, Page 26 (December 2005)

It's been 30 years since I first began using hypnosis. For me, it's been a great therapeutic tool. As an adjunctive technique, hypnosis has allowed me to integrate several behavioral therapies that often formed the basis of my treatment strategy.

My early education in its use taught me that hypnosis is a method of sustained, focused concentration. Hypnosis allows the subject to process information in a manner different from the way it is processed in the alert state. Because of the power of hypnosis, when used with a behavior modification strategy, it can be used in various ways to treat many disorders.

Hypnosis allows patients to focus and sustain concentration so they can be taught a well- thought-out behavior modification program. Hypnosis should be viewed, however, as an adjunctive part of an ongoing therapeutic plan. For example, a dentist who uses hypnosis for pain or anxiety control is aiding his primary therapy—the practice of dentistry—in an adjunctive way.

This tool can help patients working on issues such as smoking cessation, weight control, nail biting, phobia mastery, insomnia, anxiety, and stress-related problems that might be rooted in such physical problems as hypertension, headache, or pain control.

An example that comes to mind involved a gentleman who had been stuck in an elevator for nearly 6 hours and subsequently suffered posttraumatic stress disorder with incapacitating flashbacks, agitation, and depression. Several traditional therapies—and one approach involving cognitive-behavioral therapy—failed.

However, as luck would have it, my approach worked. Using hypnosis and guided imagery, within a period of four sessions, I was able to get this man to project his flashbacks and anxiety onto a large movie screen. Essentially, we were able to get those memories out of his thoughts and onto the screen, which was linked with the imagery of pleasant association. I taught him this strategy so that, after our session ended, he could continue practicing it on his own. I believe the focused concentration that he developed through the hypnosis allowed this imagery to work. Eventually, he conquered the PTSD.

Those of us in psychiatry and psychology are best equipped to handle hypnosis, but other disciplines may be able to do this work as well. In general, the goal is the same, regardless of who is conducting the hypnosis: a positive therapeutic result, using the primary specialty as the basis of the treatment.

Patients should beware of the stage hypnotist who hypnotizes just for the sake of doing so. That's entertainment—not health care. As a formal procedure, medical hypnosis takes training and experience, and needs to be used by those who are aware of the appropriate uses, strengths, and contraindications. In the mid-1950s, the British Medical Association and the American Medical Association issued a policy statement that recognized hypnosis as a legitimate treatment in medicine and dentistry.

Theories about the use of hypnosis abound. Some focus on physiologic responses, as described by Russian physiologist Ivan Pavlov, M.D. His research concentrated on selective inhibition of certain cortical centers. Other theories emphasize various aspects of the power of excessive suggestibility.

Debates surrounding the psychological, physiologic, neurochemical, or emotional responses prompted by hypnosis continue. Like those other adjunctive therapies, the mechanism that makes hypnosis effective is either unclear or unknown. Documentation of scientific proof of its effectiveness is vague and often anecdotal. Culture, psychology, trends, belief systems, mystery, and hope often enter the clinical picture. I believe the similarities of these adjunctive procedures have much in common. As I see it, these are different ceremonies that appeal to different people at different times.

The ability to be hypnotized appears to be an inborn skill that lets people sort of shift gears and enter a focused state of concentration at varying levels of intensity. People often enter different states of concentration and awareness in daily life. But when hypnosis is used as an adjunct to treat a specific problem, the operator usually guides the person in the hypnotic state in a formal, structured manner.

Unfortunately, these therapies can attract unschooled or poorly trained practitioners who advertise, offering magic cures. Some cures or remissions cannot be explained, such as the canes and wheelchairs left at Lourdes, France. But that kind of religious experience should not be confused with cultlike folks who stumble into a technique, accidently help a person or two, and go on to become self-styled healers.

I knew a man once who took over a meditation program—with no training at all. In no time, he linked his work to various “cures.” Many followers, who paid $20 a pop in group sessions, believed him. But as the actor/director Clint Eastwood's character “Dirty Harry” Callahan once said, “A man's got to know his limitations.”

Many fine educational programs offer seminars and courses in medical hypnosis. Contact the Society for Clinical and Experimental Hypnosis to learn about programs offered across the United States and around the world. Of the many books and articles I've read and learned from, “Trance and Treatment: Clinical Uses of Hypnosis,” by Herbert Spiegel, M.D., and David Spiegel, M.D. (New York: Basic Books Inc., 1978), is still one of the most clinically relevant and easily understood.

As a rapid and reasonable approach, I think the use of hypnosis should be an integral part of the psychiatrist's and the mental health professional's toolbox.

Let me know what you think about hypnosis and your experiences, and I will try to pass this along to my readers.

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