What is Clinical Hypnosis?
Brief Definition
The history of hypnosis is characterized by much mystique, myths and controversies. While these myths clearly stem from the apparently esoteric and “mysterious” nature of hypnosis, it has been unfortunately perpetuated by much sensationalism and ignorance regarding the true essence of hypnotic phenomena.
First of all, it is important to differentiate “clinical hypnosis” from “stage hypnosis,” which is the way most of us become initially acquainted with hypnosis; typically attending some stage hypnotist show in the high school auditorium, or watching a scene from a thriller movie showing a hypnotist with an exotic-sounding foreign accent.
Hypnosis is best described as a “altered state of consciousness” that, although it resembles sleep (hence the word “hypnos” from the Greek god of sleep), it differs from sleep because the hypnotized subject maintains some level of focused awareness throughout the experience. In addition, a subject entering a hypnotic state maintains their attention fixed on the hypnotist who guides them through the experience. More specifically, a hypnotic state is induced through an intense focusing of attention, with a resulting narrowing of experience that’s referred to as “psychological absorption;” just like when you’re immersed watching a very interesting movie and become intensely “absorbed”, while becoming less aware of other surrounding stimuli. A state of normal “dissociation” (different than pathological dissociation) also results, by which we disconnect from certain aspects of our experience, while becoming more absorbed on others. This is similar to the state of altered sensation and perception that meditators experience through entering a state of focused attention and deep relaxation.
A third core aspect of hypnosis, besides absorption and dissociation, is the fact that the hypnotized subject experiences enhanced suggestibility to suggestions made by the hypnotist. This is perhaps the main characteristic of hypnosis that reinforces its’ esoteric association, and one which is often misunderstood, given that the subject is always a “willing participant” and never forced to do anything against their will, as the stage hypnosis stereotype suggests.
Another central characteristic of a hypnotic state is that it is induced through active imagination, which allows the hypnotized subject to experience sensations, perceptions, and emotions quite vividly. Entering an altered state of consciousness provides experiential vividness and enhanced suggestibility, which allow subjects to create new associations to change certain behaviors. This state also allows greater access to exploring internal psychological experience that’s often below the level of conscious awareness, and which can facilitate making behavioral and emotional changes.
What conditions can be successfully treated with Clinical Hypnosis?
A substantial body of empirical research supports the effectiveness of clinical hypnosis as an adjunct clinical tool in the treatment of (this is only a partial list):
Stress management
Anxiety, both generalized and acute (i.e., panic, phobias, performance anxiety, social anxiety)
Chronic pain conditions (e.g., headaches, neuromuscular pain, TMJ, osteoarthritic pain, fibromyalgia and IBS)
Smoking cessation
Sleep disorders (particularly insomnia)
Weight management (as an adjunct to nutrition and exercise program)
Skin disorders (psoriasis, acne, alopecia, etc.)
Sexual disorders
Pregnancy and childbirth
In addition, clinical hypnosis can be a great adjunctive tool to behavioral health therapies, like CBT, as well as more psychodynamic approaches.
How does clinical hypnosis actually work?
Hypnosis can be very useful as an adjunctive clinical tool to help patients in the treatment of a variety of mental health and medical conditions. Some more specific clinical applications of hypnosis include:
Promoting and deepening relaxation
Although relaxation is not always the primary goal of hypnosis, inducing a hypnotic state is typically attained through a deep state of relaxation. Therefore, learning how to enter into a deeply relaxed state is a common byproduct of a hypnotic state. Clinically, we can then capitalize on this aspect of hypnosis to teach patients, especially those suffering from anxiety conditions, to use self-hypnosis as a way of learning to decrease their anxiety. This can also be useful for any patients who can benefit from more effective stress management skills.
Conditioning/deconditioning of behavioral responses
Hypnosis allows us greater access to our internal experience, including our thoughts, emotions, and sensations. Given that many health conditions, including both mental and physical, are associated with maladaptive behaviors (e.g., smoking, overeating, skin-picking, etc.), hypnosis can be useful in facilitating the extinction of old maladaptive behaviors (e.g., smoking to relax, or overeating to soothe negative emotions), and conditioning of new healthier behaviors (e.g., going for a walk or meditating to relax).
Cognitive changes
As we discussed above, one of the core aspects of hypnosis is experiencing a state of “hyper-suggestibility.” In other words, hypnotized individuals willingly enter into a state where they become more impressionable, or hyper-suggestible. This appears to result from an apparent blurring of self and other as one enters into an altered state of consciousness. Although the hypnotized subject never loses complete awareness to distinguish between self and other, the softening of this differentiation can facilitate the internalization of suggestions made by the hypnotist. Again, it’s important to emphasize that this is a volitional state in which the subject chooses to enter, and which is never imposed by the hypnotist against the subject’s will. Such “openness to this new experience” renders the consenting individual like a receptive sponge that can internalize messages suggested by the hypnotist with greater ease. Thus, a therapist may reinforce cognitive changes that they’ve previously identified as important changes the patient wants to make, and take advantage of this state of hyper-suggestibility. For example, an individual who struggles with social anxiety may hear the suggestion made by the hypnotist: “I’m a likeable and competent person, and most people in my life value my numerous personal qualities,” which they may have already discussed in a regular therapy session. Repeating this statement during a hypnotic state can facilitate the internalization of this new belief to replace older maladaptive ones that reinforce the social anxiety. Of course, this cognitive shift will take time and practice, but the patient may be more likely to internalize this new belief while in a hypnotic state characterized by greater suggestibility.
Imaginal exposure
Behavioral exposure is a technique commonly used in CBT to allow patients to decondition fears or phobias that have become associated with particular factors or situations. For example, an individual may start to experience feelings of intense anxiety as they’re getting ready to board an airplane. Although the gold standard in exposure work is always to do in vivo exposure whenever possible, given the experiential vividness of hypnosis, individuals can imagine themselves in situations that are difficult to access for in vivo exposure, like in a flying phobia, or a fear of heights.
Enhances attention & concentration
Entering a hypnotic state is typically done by focusing our attention and deepening our concentration on specific stimuli, a narrowing and deepening of attention, while disconnecting from other surrounding stimuli (the processes described above as “psychological absorption” and “dissociation”). Through routine self-hypnosis practice, individuals can enhance their competence increasing focusing on certain stimuli, while learning to disconnect from other distracting stimuli. Although this won’t cure severe cases of attention-deficit disorder (ADD), this training can be a great adjunct to the treatment of ADD in combination with other therapeutic strategies (i.e., medications, CBT skills, etc.), as well as for anyone wanting to improve their concentration.
Sensory alteration
One of the core aspects of the altered state of consciousness associated with hypnosis is the modulation of sensory experience. Individuals can learn, under hypnosis, to increase or decrease the quality and intensity of various sensations. Hypnotic anesthesia (loss of sensation) and hypnotic analgesia (loss of pain) are common phenomena that can be experienced in a hypnotic state. Therefore, through routine hypnosis practice individuals can learn to modulate certain sensations at will by selectively shifting their attention and concentration. Again, although hypnosis won’t “cure” chronic pain conditions (nothing does, really…), it can be a great adjunct to decrease pain intensity for patients willing to put the time into practicing self-hypnosis exercises for pain management.
Enhances memory recall
There’s plenty of evidence that hypnosis can greatly facilitate memory recall, and even allow the accessing of “dissociated memories” (i.e., memories that have been stored out of conscious awareness, typically as a result of the intense emotions associated with them, as in the case of traumatic memories). However, this is an area that, unfortunately, is surrounded by significant misconceptions and, thus, generated much controversy. Memories uncovered during hypnosis—in fact, any memories for that purpose--are always an approximate reproduction of real events that took place at a given place and time. It is well established that our memory can be fallible, and that memory recalls are vulnerable to distortions. Of course, certain factors can make memories more vulnerable to distortion, and a memory associated with a traumatic event is one of these. In most cases, an individual’s memory recall may distort certain details of an event, but the main essence of the event won’t typically be distorted. For example, a victim of an assault may remember an attacker as wearing a red shirt when the shirt was, in fact, orange. But, that same victim isn’t typically going to remember having been abducted by extraterrestials, instead of having been violently assaulted by an attacker. In cases in which the details (e.g., red vs orange shirt) don’t matter, memory recall facilitated through hypnosis can be very useful. However, in cases in which the details matter, like in a courtroom with an individual accused of such assault, memories recalled through hypnosis aren’t considered “admissible evidence” of facts. A competent-ethical clinician should be able to discern situations in which hypnosis can be useful for promoting greater memory recall, from those where the details make all the difference.
Exploratory work / Facilitates access to subconscious processes and material
Given that hypnosis allows greater access to memory and subconscious processes and material, it can be a great adjunct to help explore material that may underlie certain problems, and that may not be as readily accessible through wake-state conscious exploration. This aspect of hypnosis can, thus, be very useful in psychodynamic explorations of deeper roots of problems that can’t be easily uncovered through more behavioral approaches. This can also be very useful when a patient reaches a ceiling effect showing some limits in the progress they’re attaining in treatment, and a “deeper exploration” of the roots of the problem seems reasonable.
Who’s a good candidate for treatment with clinical hypnosis?
Some of the individual characteristics that represent a good fit for clinical hypnosis include:
Openness to a new experience
Willingness to “let go” and explore the benefits of deep relaxation
Basic ability to generate imagery actively (i.e., “active imagination”)
Curiosity and openness towards exploration of material that may lie beyond conscious awareness
*It is estimated that approximately 10% of individuals in the general population are “highly hypnotizable,” 20% “low hypnotizable,” and around 70% “moderately hypnotizable.” This means that approximately 80% of the general population are at least “moderately hypnotizable,” which are individuals with sufficient aptitude to potentially benefit from clinical hypnosis. Even the 20% of “low hypnotizables” represent a diverse category, among which, probably many experience some initial resistance that could potentially lessen with time, and which may allow them to use hypnosis effectively. Therefore, most individuals could potentially benefit from clinical hypnosis.
What specialty training do clinical hypnotists have?
As the term implies, “clinical hypnosis” should only be practiced by professionals who have undergone “clinical training,” in other words, by healthcare clinicians. Therefore, clinical hypnosis is simply one more clinical tool at the disposal of clinicians. Although most clinical hypnotists tend to be mental health clinicians, it is also often practiced by: dentists, nutritionists, and pain clinicians, among others. You should never seek services for a clinical problem using hypnosis with someone who does not have adequate clinical training. Clinicians who undergo training in clinical hypnosis typically undergo a minimum of 40 hours of introductory and intermediate training, plus several hours of supervised practice before they can ethically brand themselves as “clinical hypnotists”. Although official certification isn’t legally required to practice hypnosis, it’s important for consumers to ensure that clinical hypnotists have undergone appropriate training. This is usually done through one of the reputed professional clinical hypnosis organizations, like: The American Society of Clinical Hypnosis (ASCH), The Society of Clinical and Experimental Hypnosis (SCEH), The Milton H, Erickson Foundation, or the American Psychological Association’s (APA) Society of Psychological Hypnosis (Division 30). Consumers should beware of a multitude of legitimately sounding organizations that offer credentialing in hypnosis without the adequate scrutiny from experts in the field.
Suggestions for further readings in B-Med:
1) Brown, D. P., & Fromm, E. (2013). Hypnotherapy and hypnoanalysis. Routledge.
2) Brown, D. P., & Fromm, E. (2013). Hypnosis and behavioral medicine. Routledge.
3) Elkins, G. R. (2016). Handbook of medical and psychological hypnosis: Foundations, applications, and professional issues. Springer Publishing Company.
4) Hammond, D. C. (Ed.). (1990). Handbook of hypnotic suggestions and metaphors. WW Norton & Company.