Hypnosis Therapy
Definition of the term hypnosis has been highly contested, with argument about whether it is a process or product of a process. The most recent definition was formulated by APA division 30 and defines hypnosis as a “A state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion (Elkins et al., 2015, p. 382). Another definition describes hypnosis as “an altered state of consciousness in which a person is able to bypass certain aspects of reality, tolerate logical inconsistency, experience distortions of perception and memory as real, and feel a compulsion to follow cues from an outside source” (Covino & Bottari, 2001, p. 340). Hypnosis has had a checkered history despite its moderate acceptance in the modern times. Its practice dates back to the pre-medieval times. Egypt had healing temples in the 5th B.C that were used for rituals that involved curative sleep and suggestions. It was then adopted by people in Greece and the Roman Empire. Another commonly referred healer, using similar techniques is Franz Anton Mesmer (1734-1814) who called his method animal magnetism. In the middle ages, there were physicians who used the magnetic healing. Later in 1874, it was found that imagination was used to induce hypnotic trance and Mesmer’s method of healing was despised (Whorwell, 2005)
In the 19th century, resurgence in the research of mesmerism referring to hypnotic process led to its application in reducing pain in surgical procedures. James Braid who lived between 1795 and 1860 has been known as the originator of modern hypnosis (Whorwell, 2005). He rejected the magnetism idea in mesmerism and argued that trance had the healing and analgesic effects. In 1829, there is evidence of use of mesmerism by Doctor Chapelian to relieve pain in Madame Plantin who was undergoing breast cancer surgery (Montgomery, Schnur, & Kravits, 2012). In the twentieth century, hypnosis has been more comprehensively studied. The field of behavioral medicine has been created after realizing the role of behavior in health, health care and disease prevention. Behavioral medicine combines psychosocial knowledge with biomedical knowledge in order to come up with novel techniques of preventing diseases, diagnosing, disease management and therapy. Interest has increased in the use of hypnosis in the recent past (Fisher, 2011). Hypnotic induction refers to the procedure of hypnotizing people. Hypnotizable people are able to experience hypnosis. Therapeutic use of hypnosis is called hypnotherapy. Hypnotherapy has resulted from identified clinical benefits of hypnosis in health care and psychology (Elkins et al., 2015). Also, the method has been found useful in patients who are refractory to drugs as an alternative to pharmaceutical treatment. The method is a cost-effective clinical therapy that saves on medicine. The following is an examination of four articles that indicate the efficacy of hypnotherapy in managing various illnesses.
Hypnotherapy intervention has been explored for management and relieve of symptoms in patients with irritable bowel syndrome (IBS). Lindfors et al. (2012) carried out a research entitled “Effects of Gut-Directed Hypnotherapy on IBS in Different Clinical Settings-Results from Two Randomized, Controlled Trials”. Previous studies that had been performed from highly specialized gastroenterology centers and gut-directed hypnotherapy found hypnosis to be effective for patients who are refractory to IBS drugs. Lindfors et al. (2012) carried out a randomized, controlled study to find out relative efficacy for gut-directed hypnotherapy carried outside a specialized hospital setting. In the research, Lindfors and colleagues chose participants who were patients diagnosed with IBS using Rome II criteria and they were also supposed to be refractory to pharmacological treatment. The patients were required to be not using antidepressants or psychotropic drugs. They were trained on self-hypnosis in order to have mental and muscular control and also control of symptoms by distraction or enabling focus. Hypnosis was done according to the method used by University Hospital of South Manchester in the1980s. For study 1 carried out in highly specialized gastroenterology center, 45 patients received gut-directed hypnotherapy from specialists while the another group of 45 acted as control and were subjected to supportive therapy in the waiting list. In study 2, 25 patients received the same therapy but from a small county hospital, while 23 acted as control by waiting for one year (Lindfors et al., 2012).
Efficacy was measured through assessment of quality of life using nine dimensions of health for study 1 and SF-36 with 36 items for study 2. Depression and anxiety were evaluated using Hospital Anxiety and Depression scale that uses Likert scale for each of the 7 items. Third component was measurement of the severity of gastrointestinal symptoms at 3 months and after a year using questionnaires. Excluding the control groups, the results indicated significant improvements in patients after 3 months for both studies. However, more improvement in severity was observed in study 1 carried out in a specialized gastroenterological center (p < 0.05) compared to study 2 (P= 0.017) even after one year follow-up. The researchers concluded that gut-directed hypnotherapy is effective for treatment of refractory IBS but efficacy is dependent on whether therapy is carried out in a highly specialized health institution (Lindfors et al., 2012). Thus, hypnosis can be used to manage IBS and better when such patients are under specialized or skilled hypnotherapists. Given that discomfort or pain is the main cause of distress, leading to anxiety and depression, psychological intervention is viable for IBS symptoms.
IBS is a functional disorder that affects the gastrointestinal tract. It causes abnormal functioning of the gut leading to persistent abdominal pain and distress, bloating, alteration of bowel working leading to constipation or diarrhea or both. Patients may also experience non-colonic symptoms including nausea, backache, lethargy and bladder symptoms. It is a common disorder that has a worldwide prevalence ranging from ten to fifteen percent of the population. Majority of the victim are female who constitute 70 percent of people diagnosed with the disease. Currently, diagnosis of IBS is based on the symptoms as described in the Rome III criteria as “Abdominal pain or abdominal discomfort at least 3 days a month in the last 3 months, where at least 2 of the following were also true: The pain/discomfort was relieved by defecation and/or the start of the pain/discomfort was associated with altered stool frequency and/or the start of the pain/discomfort was associated with altered stool form (appearance)” (Freeman, 2010). The disease greatly lowers the quality of life of the patient. IBS patients have been treated with pharmacological drugs that are specific to bowel symptoms and gender. The drugs include antidepressants, laxatives, antispasmodics, and bulking agents. Also dietary changes are used, for example, fiber-rich diet for constipating patients. Nonetheless, both pharmacological and usual relieve methods such as colon cleansing, are not good enough for alleviating the IBS symptoms (Freeman, 2010).
Asthma is among disorders that are refractive to pharmacological treatment, and whose symptoms have high psychological association. Zobeiri et al. (2009) in a study called “Self-hypnosis in attenuation of asthma symptoms severity”, the researchers tested efficacy of self-hypnosis in treatment of asthma or improvement in lung function. Asthmatic patients (n=40) were randomly selected and diagnosed using spirometric findings. The patients had mild to moderately severe asthma and had been on agonist and corticosteroids dugs for the last one month. The patients were randomly divided into two equal groups, where one was self-hypnotized and the other acted as control group. Relaxation through use of imagery was taught to the patients as well as relieving of dyspnoea through imagery. The control group did not use hypnotherapy and used only pharmaceutical drugs. Severity was measured using Forced Vital Capacity (FVC) and Forced Expiratory Volume for one second (FEY1) using spirometry at the beginning and the end of one month and symptoms. Loss of breath (dyspnoea) was measured using Modified Medical Research Council Dyspnoea Scale (MRC scale) ranging from 0-4, at three intervals for ten days. Median changes in FVC, FEV1% and FEV1 were assessed for the two groups by comparing the variance using Kruskal-Wallis test. Lessening of dyspnoea symptoms and reduction in suffering was detrmined using logistic regression. The results of the 29 patients who completed the randomized trial indicated that median change in loss of breath (dyspnoea) was higher in the group that used self-hypnosis than for the control group (p=0.004). The results indicated no significant changes in FEY, FVC and FEV% in each group and between them. The researchers concluded that self-hypnosis improves symptoms but does not appear to alter lung function in asthmatic patients for short durations (Zobeiri et al., 2009).
Asthma is a chronic inflammatory illness that affects of respiratory system due to various factors including allergens, environmental, genetic, infectious and psychological aspects. Psychological stressors are effective in triggering asthmatic symptoms. There have also been clinical studies associating stress with asthma. Initially, asthma had been thought to be caused by psychological factors only. Pharmaceutical drugs have been used to treat but long term use of the drugs has side effects and psychogenic causes of asthma can exacerbate the disease (Zobeiri et al., 2009). Thus, alternative complementary remedies are sought after. Hypnosis has been used to manage asthma but efficacy of hypnotherapy has been contested. In some patients, asthma can be triggered by a mere look at photo of an allergen. Strong emotions are also recognized to precipitate asthma in some people. It is therefore logical to conclude that psychological stress and suggestions stimulate asthma. Therefore, due to the ability of hypnosis to induce relaxation and think on suggestions, it can be a suitable remedy for asthma. Due to limited clinical trials, there is no adequate evidence to support use of hypnosis to support the observed benefits and generalize to the public.
Asthma involves obstruction of the airway and bronchitis mainly caused by reactivity of the smooth muscle. Studies on pathophysiology of inflammation in asthma have found a number of cells involved including mast cells, macrophages, lymphocytes, eosinophils, and epithelial cells. Thus, therapies are intended to reduce inflammation. There are various inflammatory mediators; lipids secretion in the mucus, secretion of chemokines and cytokines along the airway cause chronic inflammation. Emotions can precipitate asthma reaction, and studies have confirmed anxiety and depression to be prevalent among asthmatic patients (Kumari & Rana, 2012). Thus psychological approaches can involve alterations of the emotions that cause pathogenesis of the symptoms. Also, research can be done on how the biochemical released can be inhibited using psychological methods such as hypnosis.
Migraine is another disease caused by psychological stressors and, therefore, behavioral therapy can be exploited through hypnosis. In a 1975 research entitled “Migraine and hypnotherapy”, Anderson, Basker, and Dalton carried out a controlled study among 47 migraine patients, aged 14 years and above in order to compare the results of pharmacological treatment (n= 24) and hypnotherapy (n= 23). The participants had at least a year of migraine distress. Medication included prochlorperazine and ergotamine. The 23 were subjected to six sessions of hypnotic therapy by skilled hypnotherapists using the 1971 Hartland’s model after 10 to 14 days. The patients were hypnotized to alleviate anxiety, tension and apprehension. A suggestive therapy was induced whereby they were required to visualize head and neck arteries that were pulsating and swollen contracting and easing the discomfort. The patients were trained on self-hypnosis to reduce migraines and instructed to practice hypnosis daily. Outcomes were measured based on the number of people and frequency of migraine attacks and the severity of the migraines. The patients were assessed for a year (Anderson, 1975).
The hypnosis group had a lower frequency of migraines and blinding attacks per month compared to the group under medication with p < 0.0005 and p < 0.005 respectively. The hypnosis group had a monthly average of 0.5 migraines while the group under medicines had 2.9. Pharmaceutical treatment lowered the recurrence of grade 4, severe migraines more significantly compared to hypnosis. In the last three months of the tear, 10 patients, constituting 43.5% of the patients under hypnosis experienced a reduction in recurrence of migraines compared to only 3 patients after one year follow up. A difference of p< 0.39 was observed significant to conclude that hypnosis had higher efficacy in reducing migraine attacks compared to pharmaceutical treatments (Anderson, 1975).
The name migraine originates from the Greek word ‘hermikrania’ meaning ‘half the head’. It is a symptomatology characterized by sporadic headaches causing unilateral, pulsating moderate pain or severe. It has symptoms of nausea, irritability, constipation or diarrhea, photophobia and vomiting. Chronic migraines have been associated with psychological conditions such as depressive personality, environmental stress, compulsiveness, hostility, feelings of vulnerability and inadequacy. Interactions between physiological and psychological factors occur when psychosomatic factors trigger neurological, biochemical and vascular responses. Factors such as depression and anxiety can trigger serotonin imbalance. Body organs are stimulated by the brain following information gathered from external environment. Stimulation of organs occurs in a negative feedback loop regulated from the brain. A falter causes disorganization leading to psycho-physiological imbalance (Rothrock, 2008). Hypnotherapy can be exploited through various routes of interaction that cause migraine. Self-hypnosis can be used to self-manage stress and anxiety. Also, depression can be alleviated by relaxation techniques of hypnosis that would change secretion of serotonin. Physiological factors can be controlled through hypnotic relaxation. Vasoconstriction and vasodilatation can be controlled through hypnotizing.
Studies show that hypnotherapy is an efficient means of controlling pain in women undergoing breast cancer surgery. In 2007, Montgomery et al. undertook a study called “A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients”. 200 patients were randomly selected averaging at 48.5 years of age and who were waiting to go through a lumpectomy or excisional biopsy. The patients were divided into two groups. One group underwent through a hypnosis session of 15 minutes guided by a trained psychologist while the other group received only a compassionate listening session for control of attention. The participants were not blinded. Use of analgesics was assessed together with recording of side effects and self-reports of pain using a visual analog scale (Montgomery et al., 2007).
The results indicated that the pre-hypnotized patients required lesser analgesic than those in the control group ( propofol, mean of 64.01 mg Vs 96.64 mg, confidence interval (CI) = 3.95 to 10.68 and lidocaine 24.23ml Vs 31.09ml). Comparative analysis of the outcomes of the two groups using self-reports was analyzed using multivariate analysis of variance (MANOVA). The six outcomes were recorded from a visual analysis scale (VAS) that ranged from 1 to 100. The following were the means and mean differences for each outcome measured between hypnosis and the control groups.
| VAS Measure | Means Hypnosis | Mean
Control |
Mean Difference | 95 % Confidence Interval | |
| Hypnosis | Control | ||||
| Pain Intensity | 22.43 | 47.83 | 25.40 | 17.56 | 33.25 |
| Nausea | 6.57 | 25.49 | 18.92 | 12.98 | 24.87 |
| Fatigue | 29.47 | 54.20 | 24.73 | 16.64 | 32.83 |
| Discomfort | 23.01 | 43.20 | 20.19 | 12.63 | 28.02 |
| Emotional Upset | 8.67 | 33.46 | 24.79 | 18.56 | 31.03 |
| Pain Unpleasantness | 21.19 | 39.05 | 17.86 | 9.92 | 25.80 |
Figure 1. Table of Summary of MANOVA results of VAS outcomes from Montgomery et al., 2007
The results indicate that the hypnosis groups experienced less severity of each symptom than the control group. There was no significant difference in the use of midazolam, fentanyl, and recovery room analgesics. The results indicated that patients in the hypnosis group required less propofol and lidocaine, reported less pain intensity, pain unpleasantness, nausea, fatigue, discomfort, and emotional upset (Montgomery et al., 2007).
Surgical procedures cause physical and psychological stress leading to somatic discomfort and feelings of anxiety before, after and in the course of surgery. Hypnosis can supplement psychological interventions in order to alleviate anxiety and as an appendage to analgesics. It can help the patients to cope with pain experienced during surgery. Thus, it can be used for palliative care in cancer patients, and also to relieve the symptoms associated with surgical invasions. In addition, self-hypnosis can be trained to cancer patients for clinical management of the various symptoms of cancer. Relieving pain experienced during surgery is vital in improving the quality of life of cancer patients. Therefore, hypnosis can act as a suitable non-pharmacological intervention.
In conclusion, the role of hypnotherapy in treating various illnesses is being discovered by modern researchers. One of the roles includes improving skin conditions by hypnosis due to the ability to reduce stress (Shenefelt, 2000). Another role is in digestion system where pains of IBS, peptic ulcers can be relieved through hypnosis. Patients are able to control pain as well as control bowel functioning. Asthma, a common inflammatory disease involving psycho-physiological interactions can also be treated by altering emotions. It is also a novel tool for stress management that would prevent extents of depression. Prevention of diseases is vital for public health and hypnosis offers remedy for controlling addictions such as smoking. Although there lacks enough information on hypnosis, application of hypnosis started long time ago. It is therefore important that as researchers look into ways of exploiting hypnosis for therapeutic use, parallel studies on its occurrence in the body and brain should be investigated. The phenomenon of creating a single state of mind needs to be understood and how psychological and social factors such as imagination and potent responses to suggestion. The role-playing effect during hypnotic induction indicates a social process and learning.
Hypnotherapy has been found to work for a number of diseases and disorders especially by lessening symptoms and alleviating pain. The Joint commission requires hospitals to assess pain experienced by patients. Ensuring that patients experience minimum pain as possible has been the clinical practice. Coping with pain has been a notable benefit of hypnotherapy. Thus, hypnosis introduces a solution to the various painful ailments and an aid to clinicians. A limitation in its use is due to hypnosis being not possible all people. Psychotic patients are among the contraindication group. Also, the ability to hypnotize is limited to some specialized psychologists and traditional specialists. Thus, it means that health care workers will require training and understanding of the process for them to apply the method. Nurses are involved in care giving and thus there is need for increased training of medical hypnosis. Training is necessary because appropriate suggestions need to be given for the subject to imagine and form imagery that causes hypnosis. Reduction of chronic pain can conceal a serious ailment when people use hypnosis as an exercise or routine relaxation. Besides, false memories can be generated during hypnosis that needs to be erased from the mind.
References
Anderson, J. A. D., Basker, M. A., & Dalton, R. (1975). Migraine and hypnotherapy. International Journal of Clinical & Experimental Hypnosis, 23, 48–58.
Covino, N. A., & Bottari, M. (2001). Hypnosis, behavioral theory, and smoking cessation. Journal of dental education, 65(4), 340-347.
Elkins, G. R., Barabasz, A. F., Council, J. R., & Spiegel, D. (2015). Advancing research and practice: The revised APA Division 30 definition of hypnosis. American Journal of Clinical Hypnosis, 57(4), 378-385.
Fisher, E. B., Fitzgibbon, M. L., Glasgow, R. E., Haire-Joshu, D., Hayman, L. L., Kaplan, R. M., & Ockene, J. K. (2011). Behavior matters. American Journal of Preventive Medicine, 40(5), e15-e30.
Freeman, K. (2010). Irritable Bowel Syndrome. Retrieved April 21, 2016, from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/irritable-bowel-syndrome/
Hofbauer, R. K., Rainville, P., Duncan, G. H., & Bushnell, M. C. (2001). Cortical representation of the sensory dimension of pain. Journal of Neurophysiology, 86 (1), 402-411.
Kumari, K., & Rana, A. C. (2012). A review on epidemology, pathopysiology and management of asthma. J. Appl. Pharm. Sci, 2, 55-64.
Lindfors, P., Unge, P., Arvidsson, P., Nyhlin, H., Björnsson, E., Abrahamsson, H., & Simrén, M. (2012). Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials. The American Journal of Gastroenterology, 107(2), 276-285. doi:10.1038/ajg.2011.340
Milling, L. S. (2014). Hypnosis in the treatment of headache pain: A methodological review. Psychology of Consciousness: Theory, Research, and Practice, 1(4), 431.