Hypnotherapy - The Facts

Hypnotherapy is therapy that is undertaken with a subject in hypnosis.

The word 'hypnosis' (from the Greek hypnos, 'sleep') is an abbreviation of James Braid's (1843) term 'neuro-hypnotism', meaning 'sleep of the nervous system'.

A person who is hypnotised displays certain unusual characteristics and propensities, compared with a non-hypnotised subject, most notably hyper-suggestibility, which some authorities have considered a sine qua non of hypnosis. For example, Clark L. Hull, probably the first major empirical researcher in the field, wrote,

"If a subject after submitting to the hypnotic procedure shows no genuine increase in susceptibility to any suggestions whatever, there seems no point in calling him hypnotised..."

Hypnotherapy is often applied in order to modify a subject's behaviour, emotional content, and attitudes, as well as a wide range of conditions including dysfunctional habits, anxiety, stress-related illness, pain management, and personal development.

Hypnotism versus Mesmerism

Hypnosis is often confused with Mesmerism, its historical precursor.

As Hans Eysenck writes.,

"The terms 'mesmerise' and 'hypnotise' have become quite synonymous, and most people think of Mesmer as the father of hypnosis, or at least as its discoverer and first conscious exponent. Oddly enough, the truth appears to be that while hypnotic phenomena had been known for many thousands of years, Mesmer did not, in fact, hypnotise his subjects at all. It is something of a mystery why popular belief should have firmly credited him with a discovery which in fact was made by others." (Eysenck, Sense & Nonsense in Psychology, 1957: 30-31)

Franz Anton Mesmer held that trance and healing were the result of the channelling of a mysterious 'occult' force called 'animal magnetism.' In the mid-18th Century, this became the basis of a very large and popular school of thought termed 'Mesmerism'. However, in 1843, the Scottish surgeon and physician James Braid proposed the theory of hypnotism as a radical alternative, in opposition to Mesmerism. Braid argued that the occult qualities of Mesmerism were illusory and that its effects were due to a combination of 'nervous fatigue' and verbal suggestion. A bitter war of words developed between Braid and the leading exponents of Mesmerism.

"I beg farther to remark, if my theory and pretensions, as to the nature, cause, and extent of the phenomena of nervous sleep [i.e., hypnotism] have none of the fascinations of the transcendental to captivate the lovers of the marvellous, the credulous and enthusiastic, which the pretensions and alleged occult agency of the mesmerists have, still I hope my views will not be the less acceptable to honest and sober-minded men, because they are all level to our comprehension, and reconcilable with well-known physiological and psychological principles." (James Braid, Hypnotic Therapeutics, 1853: 36)

In their original committee report on hypnotherapy, the British Medical Association (BMA), likewise, made a point of condemning the occult theories of Mesmerism and sharply distinguishing them from hypnotism.

"The Committee, having completed such investigation of hypnotism as time permitted, have to report that they have satisfied themselves of the genuineness of the hypnotic state. No phenomena which have come under their observation, however, lend support to the theory of 'animal magnetism'." ('Report on Hypnotism', British Medical Journal, 1892).

Nevertheless, as Eysenck complains, the confusion of Mesmerism and hypnotism continued to be perpetuated by popular fiction, the media, and its portrayal in comedy stage hypnosis shows.

Basically, whereas Mesmerism is a supernatural theory, hypnotism attempted to explain the same phenomena in more established scientific terms, by reference to psychology and physiology. As Braid puts it, "it is a scientific and 'psycho-physiological' (mind-body) discipline."

There is no doubt that some individuals have suffered the ill effects of being involved in stage hypnotic shows. Stage hypnotists are not trained to care for individuals and are not qualified therapists. They use words like 'magic' and 'control' in an attempt to mystify the effects of hypnosis. In addition, using various tests of hypnotic suggestibility, they focus on 'hypnotic virtuosos' and provide the audience with hours of entertainment at the participants' expense.

Stage hypnotists, thus, according Dr David Kraft, do the opposite to what hypnotherapists do. Trained hypnotherapists, or rather therapists who use hypnosis as an adjunct to their treatment programme, create an environment by which the clients can access their inner resources in their own, unique way. Therapists, unlike stage hypnotists, who give the illusion that individuals are 'out of control', give the control to the individuals.

Hypnotherapy: modalities

Hypnotherapy takes many different forms, and has integrated elements from, and in turn influenced, other psychotherapeutic traditions throughout its history.

Traditional hypnotherapy

The form of hypnotherapy practised by most Victorian hypnotists, including James Braid and Hippolyte Bernheim, mainly employed of symptom removal, with some use of therapeutic relaxation and occasionally aversion to alcohol, drugs, etc. This simple form of treatment employed relatively direct methods and few theoretical constructs, but has continued to influence most subsequent forms of hypnotherapy.

Hypnoanalysis

In 1895 Sigmund Freud and Joseph Breuer published a seminal clinical text entitled Studies in Hysteria (1895) which promoted a new approach to psychotherapy. Freud and Breuer used hypnosis to regress clients to an earlier age in order to help them remember and abreact supposedly repressed traumatic memories. Although Freud gradually abandoned hypnotherapy in favour of his developing method of psychoanalysis, his early work continued to influence many subsequent hypnotherapists. However, as Freud later conceded, his French rival Pierre Janet had already published a case study describing the use of age regression in hypnotic psychotherapy, a few years earlier.

Subsequent regression hypnotherapy was sometimes known as 'hypno-analysis', 'analytical hypnotherapy', or 'psychodynamic hypnotherapy'. Many practitioners worked in ways that bore only faint resemblance to Freud's original approach, although others continued to be influenced by later psychoanalytic theory and practice.

Hypnoananalysis found support in both world wars where it was used by military psychiatrists as a rapid alternative to psychoanalysis in the treatment of shellshock, now known as posttraumatic stress disorder (PTSD).

Considerable controversy developed regarding the use of regression to uncover allegedly repressed memories in the 1990s as the result of several high-profile legal cases, where clients sued their therapists over claims of false memory syndrome.

Ericksonian hypnotherapy

Milton H. Erickson was one of the most influential hypnotists of the 20th century. From around the 1950s onward, Erickson developed a radically different approach to hypnotism, which has subsequently become known as 'Ericksonian hypnotherapy' or 'Neo-Ericksonian hypnotherapy'. Erickson made use of a more informal conversational approach with many clients and complex language patterns, and therapeutic strategies. However, this very divergence from tradition led some of his colleagues, most notably André Weitzenhoffer, to dispute whether Erickson was right to label his approach 'hypnosis' at all. Nevertheless, Erickson's work continues to be one of the most influential forces in modern hypnotherapy.

The founders of Neuro-Linguistic Programming (NLP), a methodology similar in some regards to hypnotism, claimed that they had modelled the work of Erickson extensively and assimilated it into their approach. However, other experts have disputed whether NLP bears any genuine resemblance to Erickson's work.

Cognitive/behavioural hypnotherapy

From the 1980s onward a growing number of clinical textbooks written by contemporary researchers such as Steven Jay Lynn, Irving Kirsch, E. Thomas Dowd, William Golden, Assen Alladin, and others, began to appear. These combined hypnotherapy with elements of cognitive and behaviour therapy. Theodore Barber and his colleagues published an influential review of the research which argued, following the earlier social psychology of Theodore R. Sarbin, that hypnotism was better understood not as a 'special state' but as the result of normal psychological variables, such as active imagination, expectation, appropriate attitudes, and motivation. Barber introduced the term 'cognitive-behavioural' to describe the nonstate theory of hypnotism, and discussed its application to behaviour therapy.

The growing application of cognitive and behavioural psychological theories and concepts to the explanation of hypnosis paved the way for a closer integration of hypnotherapy with various cognitive and behavioural therapies. However, many cognitive and behavioural therapies were themselves originally influenced by older hypnotherapy techniques, e.g., the systematic desensitisation of Joseph Wolpe, the cardinal technique of early behaviour therapy, was originally called 'hypnotic desensitisation' and derived from the Medical Hypnotism (1948) of Lewis Wolberg.

The traditional style of hypnotherapy can be seen as a precursor of cognitive-behavioural therapy insofar as both place emphasis upon 'common sense' theoretical explanations and the use of relaxation, and rehearsal of positive ideas and imagery in therapy. Modern cognitive therapy primarily differs from previous hypnotherapy approaches by placing much greater emphasis upon the direct Socratic disputation of negative beliefs. However, cognitive-behavioural hypnotherapists, like those mentioned in this section, have assimilated this technique alongside their use of hypnosis.

New-age hypnotherapy

Many 'new-age' or 'pseudo-scientific' approaches to hypnotherapy abound, some of which actually resemble Mesmerism in their claims that hypnotherapy employs subtle energy or produces paranormal abilities. Many new-age therapists employ past-life regression which usually combines belief in reincarnation with techniques of hypnotic regression ultimately derived from Sigmund Freud. These approaches are generally considered to lie outside the mainstream of 'scientific' or 'evidence-based' clinical practice in hypnotherapy.

Hypnotherapy: uses

Hypnosis in childbirth

Main article: Hypnotherapy in Childbirth

Hypnotherapy has long been used in relation to childbirth. It is used during pregnancy to prepare a mother for birth, and during childbirth to reduce anxiety, discomfort and pain.

Hypnosis in surgery

Main article: Hypnosurgery

In the middle of the 19th century, Mesmerists used hypnosis to alleviate pain and distress during surgery. Most notably, James Esdaile in India and John Elliotson in England were renowned for their work in this area. The founder of hypnotherapy, James Braid was a surgeon himself, specialising in muscular conditions, and reported many cases of minor surgery using hypnotism.

Psychotherapy

Hypnotism was originally used to treat the condition known in the Victorian era as hysteria. Modern hypnotherapy is widely used in the treatment of anxiety, subclinical depression, and certain habit disorders, as well as in the treatment of conditions such as insomnia.

Hypnotherapy: research

Systematic reviews

In 1892, the British Medical Association (BMA) commissioned a team of doctors to undertake an extensive evaluation of the nature and effects of hypnotherapy. They reported.,

"The Committee, having completed such investigation of hypnotism as time permitted, have to report that they have satisfied themselves of the genuineness of the hypnotic state." (British Medical Journal, 1892) adding...

"The Committee are of opinion that as a therapeutic agent hypnotism is frequently effective in relieving pain, procuring sleep, and alleviating many functional ailments" [i.e., psycho-somatic complaints and anxiety disorders].

This report was approved by the general council of the BMA, thereby forming BMA policy and rendering hypnotherapy a form of 'orthodox', as opposed to complementary or alternative, medicine.

Subsequent research on hypnotherapy has tended to highlight three main areas in which its efficacy as a treatment has been demonstrated in: Anxiety., Insomnia., Pain management., Psycho-somatic disorder, i.e., stress-related illness.

Hypnotherapy has many other applications but research into its effectiveness has tended to focus upon these issues. More mixed results have been obtained for its efficacy in relation to the treatment of addictions, an area where high relapse is common with most treatments.

In 1955, the Psychological Medicine Group of the BMA commissioned a Subcommittee, led by Prof. T. Ferguson Rodger, to deliver a second, and more comprehensive, report on hypnosis. The Subcommittee consulted several experts on hypnosis from various fields, including the eminent neurologist Prof. W. Russell Brain, and the psychoanalyst Wilfred Bion. After two years of study and research, its final report was published in the British Medical Journal (BMJ), under the title 'Medical use of Hypnotism'. The terms of reference were.,

"To consider the uses of hypnotism, its relation to medical practice in the present day, the advisability of giving encouragement to research into its nature and application, and the lines upon which such research might be organised." (British Medical Journal, 1955)

This is a much more thorough and extensive report, and constitutes one of the most significant documents in the history of hypnotherapy research. With regard to efficacy, it concludes from a systematic review of available research that.,

"The Subcommittee is satisfied after consideration of the available evidence that hypnotism is of value and may be the treatment of choice in some cases of so-called psycho-somatic disorder and Psychoneurosis. It may also be of value for revealing unrecognised motives and conflicts in such conditions. As a treatment, in the opinion of the Subcommittee it has proved its ability to remove symptoms and to alter morbid habits of thought and behaviour."

"In addition to the treatment of psychiatric disabilities, there is a place for hypnotism in the production of anaesthesia or analgesia for surgical and dental operations, and in suitable subjects it is an effective method of relieving pain in childbirth without altering the normal course of labour." ('Medical use of hypnosis', British Medical Journal, April, 1955)

According to a statement of proceedings published elsewhere in the same edition of the BMJ, the report was "officially approved at last week's Council meeting of the British Medical Association." (BMA Council Proceedings, BMJ, April 23, 1955:1019). In other words, it was approved as official BMA policy. This statement goes on to say that.,

"For the past hundred years there has been an abundance of evidence that psychological and physiological changes could be produced by hypnotism which were worth study on their own account, and also that such changes might be of great service in the treatment of patients." (British Medical Journal, cited)

Soon afterwards, in 1958, the American Medical Association (AMA) commissioned a similar (though more terse) report which endorses the 1955 BMA report and concludes.,

"That the use of hypnosis has a recognised place in the medical armamentarium and is a useful technique in the treatment of certain illnesses when employed by qualified medical and dental personnel." ('Medical use of hypnosis', JAMA, 1958)

The AMA council approved this report rendering hypnotherapy an orthodox treatment.,

"The Reference Committee on Hygiene, Public Health, and Industrial Health approved the report and commended the Council on Mental Health for its work. The House of Delegates adopted the Reference Committee report." (AMA Proceedings, JAMA, September 1958: 57)

In 1995, the National Institute for Health (NIH), in the US, established a Technology Assessment Conference that compiled an official statement entitled 'Integration of Behavioural & Relaxation Approaches into the Treatment of Chronic Pain & Insomnia'.
This is an extensive report that includes a statement on the existing research in relation to hypnotherapy for chronic pain. It concludes that.,

"The evidence supporting the effectiveness of hypnosis in alleviating chronic pain associated with cancer seems strong. In addition, the panel was presented with other data suggesting the effectiveness of hypnosis in other chronic pain conditions, which include irritable bowel syndrome, oral mucositis [pain and swelling of the mucus membrane], temporomandibular disorders [jaw pain], and tension headaches." (NIH, 1995)

In 1999, the British Medical Journal (BMJ) published a Clinical Review of current medical research on hypnotherapy and relaxation therapies. It concludes.,

"There is good evidence from randomised controlled trials that both hypnosis and relaxation techniques can reduce anxiety, particularly that related to stressful situations such as receiving chemotherapy. They are also effective for panic disorders and insomnia, particularly when integrated into a package of cognitive therapy (including, for example, sleep hygiene). A systematic review has found that hypnosis enhances the effects of cognitive behavioural therapy for conditions such as phobia, obesity, and anxiety."

"Randomised controlled trials support the use of various relaxation techniques for treating both acute and chronic pain. Randomised trials have shown hypnosis to be of value in asthma and in irritable bowel syndrome. Relaxation and hypnosis are often used in cancer patients. There is strong evidence from randomised trials of the effectiveness of hypnosis and relaxation for cancer related anxiety, pain, nausea, and vomiting, particularly in children." (Vickers & Zollman, 'Clinical Review: Hypnosis & Relaxation Therapies', [British Medical Journal, 1999]

In 2001, the Professional Affairs Board of the British Psychological Society (BPS) commissioned a working party of expert psychologists to publish a report entitled The Nature of Hypnosis. Its remit was 'to provide a considered statement about hypnosis and important issues concerning its application and practice in a range of contexts, notably for clinical purposes, forensic investigation, academic research, entertainment and training.' The report provides a concise (c. 20 pages) summary of the current scientific research on hypnosis. It opens with the following introductory remark.,

"Hypnosis is a valid subject for scientific study and research and a proven therapeutic medium." (BPS, 2001)

With regard to the therapeutic uses of hypnosis, the BPS arrive at much more positive conclusions.

"Enough studies have now accumulated to suggest that the inclusion of hypnotic procedures may be beneficial in the management and treatment of a wide range of conditions and problems encountered in the practice of medicine, psychiatry and psychotherapy." (BPS, 2001)

The working party then provided an overview of some of the most important contemporary research on the efficacy of clinical hypnotherapy, which is summarised as follows.,

"There is convincing evidence that hypnotic procedures are effective in the management and relief of both acute and chronic pain and in assisting in the alleviation of pain, discomfort and distress due to medical and dental procedures and childbirth. Hypnosis and the practice of self-hypnosis may significantly reduce general anxiety, tension and stress in a manner similar to other relaxation and self-regulation procedures. Likewise, hypnotic treatment may assist in insomnia in the same way as other relaxation methods."

"There is encouraging evidence demonstrating the beneficial effects of hypnotherapeutic procedures in alleviating the symptoms of a range of complaints that fall under the heading 'psychosomatic illness'." These include tension headaches and migraine; asthma; gastro-intestinal complaints such as irritable bowel syndrome; warts; and possibly other skin complaints such as eczema, psoriasis and urticaria [hives]. There is evidence from several studies that its [hypnosis'] inclusion in a weight reduction program may significantly enhance outcome." (BPS, 'The Nature of Hypnosis', 2001)

Hypnotherapy: meta-analyses

In 2003, perhaps the most recent meta-analysis of the efficacy of hypnotherapy was published by two researchers from the university of Konstanz in Germany, Flammer and Bongartz. The study examined data on the efficacy of hypnotherapy across the board, though studies included mainly related to psychosomatic illness, test anxiety, smoking cessation and pain control during orthodox medical treatment. Most of the better research studies used traditional-style hypnosis, only a minority (19%) employed Ericksonian hypnosis.

The authors considered a total of 444 studies on hypnotherapy published prior to 2002.
By selecting the best quality and most suitable research designs for meta-analysis they narrowed their focus down to 57 controlled trials. These showed that on average hypnotherapy achieved at least 64% success compared to 37% improvement among untreated control groups. (Based on the figures produced by binomial effect size display or BESD.)

According to the authors this was an intentional underestimation. Their professed aim was to discover whether, even under the most sceptical weighing of the evidence, hypnotherapy was still proven effective. They showed conclusively that it was. In fact, their analysis of treatment designs concluded that expansion of the meta-analysis to include non-randomised trials for this data base would also produce reliable results.

When all 133 studies deemed suitable in light of this consideration were re-analysed, providing data for over 6,000 patients, the findings suggest an average improvement in 27% of untreated patients over the term of the studies compared with a 74% success rate among those receiving hypnotherapy. This is a high success rate given the fact that many of the studies measured included the treatment of addictions and medical conditions. The outcome rates for anxiety disorders alone, traditionally hypnotherapy's strongest application, were higher still (though a precise figure is not cited). (Flammer & Bongartz, 'On the efficacy of hypnosis: a meta-analytic study', Contemporary Hypnosis, 2003, pp179 - 197.)

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