SCIENCE BASED
HYPNOTHERAPY IS SCIENCE BASED
HYPNOTHERAPY IS SCIENCE BASED
How Hypnosis Works, According to Science by Eleanor Cummins Apr 28, 2022 11:37 AM PT When you think about hypnosis, what do you visualize? For many, it’s a clock-swinging magician or a comedy act that forces an unwitting volunteer to make embarrassing public admissions on stage. But hypnosis has a surprisingly robust scientific framework. Clinical research has shown that it can help relieve pain and anxiety and aid smoking cessation, weight loss, and sleep. It can help children and adolescents better regulate their feelings and behaviors. Some people can even use “self-hypnosis” to manage stress, cope with life’s challenges, and improve their physical and emotional health. Hypnosis creates “a non-judgmental immersive experience,” says Dr. David Spiegel, a Stanford University psychiatrist and leading researcher of hypnosis. It’s been used in various forms for centuries, but it wasn’t until 1843 that the Scottish surgeon Dr. James Braid popularized the term “hypnosis.” Braid’s central discovery—that concentration can guide the brain toward a more suggestible state—was and remains controversial. But physicians have continued to test and teach the technique over the centuries with great success, Spiegel says. Today, a psychologist, psychiatrist, or other healthcare professional certified in hypnotherapy will first screen a potential client for their ability to be hypnotized using a validated suggestibility scale. (Not everyone is equally susceptible to hypnosis, but research has found that about two-thirds of adults are.) The hypnotherapist will talk with them about what sort of sensory experiences make them feel safe, like a lakeshore retreat or a beach vacation. Then, the hypnotherapist will conjure that imagery—focusing, for example, on the salt spray of the ocean, seagulls calling overhead, and sun-kissed skin—to help the person go deeper into the calming visualization. If done right, the patient’s physical surroundings will melt away. The result is a powerful combination of dissociation, immersion, and openness to new experiences, which culminates in what was once called a “trance,” but which modern hypnotherapists simply refer to as a “hypnotic state.” It can be achieved in just a few minutes, Spiegel says. Such scene-setting techniques can create the ideal stage for positive transformation, says Binghamton University psychology professor Steven Jay Lynn. During hypnosis, people are more open to the suggestions of the hypnotherapist, whether those ask the patient to detach themselves from a past painful experience or visualize a solution to their problem. For some people, these changes may be catalyzed in a one- or two-hour session. For others, hypnotherapy or self-hypnosis may be a regular part of their mental health care. “Hypnosis can modify consciousness in many ways,” Lynn says. This state of deep relaxation isn’t particularly difficult for most people to dive into or emerge from. It’s similar to a “flow state,” Spiegel says, or an altered state of consciousness in which a person is so immersed in a given activity, their focus narrows and their sense of time shifts. It’s also reminiscent of what happens during meditation, except instead of training people to tune into the present moment, hypnosis makes them more receptive to suggestion. Like meditation practice, many people are capable of doing hypnosis on their own, Spiegel says. In 2020, he co-founded Reveri, a subscription-based self-hypnosis app that’s structured a lot like Calm or Headspace. A user can access recordings that guide them into a hypnotized state, after which they’re given suggestions or statements that lead them toward a goal the person selects before the session. “We do it all the time,” Spiegel says of entering and exiting these mental states, “but in hypnosis you do it more.” Brain-imaging studies have helped to illuminate what happens inside the hypnotized brain, though much still remains a mystery. During hypnosis, activity in a brain region that helps people switch between tasks quiets down, Spiegel says. This same region seems to disconnect from another area responsible for self-reflection and daydreaming—which may be why hypnotized people aren’t worried about who they are or what they’re doing. Researchers have also found that hypnosis can calm brain regions that help control autonomic functions like heart rate, blood flow, and breathing. This is likely what leads to the physical relaxation that’s a hallmark of hypnosis, Spiegel says. One of the most interesting modern applications of hypnosis is in the operating room, says Lorenzo Cohen, director of the Integrative Medicine Program at the University of Texas MD Anderson Cancer Center. For some localized breast cancer surgeries, namely lumpectomies, the center lets patients choose between general anesthesia or a localized anesthetic and hypnotherapy. Those who choose the second option remain fully awake during their surgery, but a hypnotherapist first helps them enter a state of deep relaxation, or “hypnosedation,” Cohen says. “The local [anesthesia] should be doing its thing,” Cohen says. “The rest is in your head.” More than 30 clinical trials have affirmed the use of hypnosedation, says Cohen (who is also researching the practice). Studies have shown that people who received hypnosedation experienced less preoperative anxiety, required less pain medication during surgery, and reported less post-operative pain intensity, nausea, fatigue, and discomfort than people who chose general anesthesia, Cohen says. “The hypothesis is that the patients who are under general anesthesia, even though they’re not conscious, are having an intense stress response,” he says. This can suppress an immune system that, in cancer patients, is already compromised by the disease and its treatments. When patients choose hypnosis, Cohen believes the body’s fight-or-flight response may be reduced. Despite the mounting evidence, hypnosis is not without skeptics. Randomized controlled trials have found that hypnosis can help with pain and anxiety associated with a range of medical conditions, but even the best studies can’t meet the gold-standard of a double-blind design, Spiegel says. While patients and practitioners can be kept in the dark about what pill they’re administering or receiving, it’s almost impossible to design a study where neither side knows hypnosis is being delivered, he adds. And historically, the power of hypnosis hasn’t always been wielded responsibly. The imaginative potential of hypnosis has been shown to create false memories—sometimes with devastating effects. At least 27 states ban hypnotically-elicited testimony from appearing in court. Hypnotherapists should avoid using the technique to “recover” memories, Lynn says. But when conducted by a trained professional and properly applied, modern hypnotherapy can provide powerful results. Susceptibility to suggestion is often “viewed as a liability or a weakness,” Spiegel says, “but it’s really a strength.”
Stanford researchers found changes in three areas of the brain that occur when people are hypnotized. July 28, 2016 Study identifies brain areas altered during hypnotic trances By Sarah Williams By scanning the brains of subjects while they were hypnotized, researchers at the School of Medicine were able to see the neural changes associated with hypnosis. Your eyelids are getting heavy, your arms are going limp and you feel like you're floating through space. The power of hypnosis to alter your mind and body like this is all thanks to changes in a few specific areas of the brain, researchers at the Stanford University School of Medicine have discovered. The scientists scanned the brains of 57 people during guided hypnosis sessions similar to those that might be used clinically to treat anxiety, pain or trauma. Distinct sections of the brain have altered activity and connectivity while someone is hypnotized, they report in a study published online July 28 in Cerebral Cortex. "Now that we know which brain regions are involved, we may be able to use this knowledge to alter someone's capacity to be hypnotized or the effectiveness of hypnosis for problems like pain control," said the study's senior author, David Spiegel, MD, professor and associate chair of psychiatry and behavioral sciences. A serious science For some people, hypnosis is associated with loss of control or stage tricks. But doctors like Spiegel know it to be a serious science, revealing the brain's ability to heal medical and psychiatric conditions. David Spiegel "Hypnosis is the oldest Western form of psychotherapy, but it's been tarred with the brush of dangling watches and purple capes," said Spiegel, who holds the Jack, Samuel and Lulu Willson Professorship in Medicine. "In fact, it's a very powerful means of changing the way we use our minds to control perception and our bodies." Despite a growing appreciation of the clinical potential of hypnosis, though, little is known about how it works at a physiological level. While researchers have previously scanned the brains of people undergoing hypnosis, those studies have been designed to pinpoint the effects of hypnosis on pain, vision and other forms of perception, and not the state of hypnosis itself. "There had not been any studies in which the goal was to simply ask what's going on in the brain when you're hypnotized," said Spiegel. Finding the most susceptible To study hypnosis itself, researchers first had to find people who could or couldn't be hypnotized. Only about 10 percent of the population is generally categorized as "highly hypnotizable," while others are less able to enter the trancelike state of hypnosis. Spiegel and his colleagues screened 545 healthy participants and found 36 people who consistently scored high on tests of hypnotizability, as well as 21 control subjects who scored on the extreme low end of the scales. Then, they observed the brains of those 57 participants using functional magnetic resonance imaging, which measures brain activity by detecting changes in blood flow. Each person was scanned under four different conditions - while resting, while recalling a memory and during two different hypnosis sessions. "It was important to have the people who aren't able to be hypnotized as controls," said Spiegel. "Otherwise, you might see things happening in the brains of those being hypnotized but you wouldn't be sure whether it was associated with hypnosis or not." Brain activity and connectivity Spiegel and his colleagues discovered three hallmarks of the brain under hypnosis. Each change was seen only in the highly hypnotizable group and only while they were undergoing hypnosis. First, they saw a decrease in activity in an area called the dorsal anterior cingulate, part of the brain's salience network. "In hypnosis, you're so absorbed that you're not worrying about anything else," Spiegel explained. It's a very powerful means of changing the way we use our minds to control perception and our bodies. Secondly, they saw an increase in connections between two other areas of the brain - the dorsolateral prefrontal cortex and the insula. He described this as a brain-body connection that helps the brain process and control what's going on in the body. Finally, Spiegel's team also observed reduced connections between the dorsolateral prefrontal cortex and the default mode network, which includes the medial prefrontal and the posterior cingulate cortex. This decrease in functional connectivity likely represents a disconnect between someone's actions and their awareness of their actions, Spiegel said. "When you're really engaged in something, you don't really think about doing it - you just do it," he said. During hypnosis, this kind of disassociation between action and reflection allows the person to engage in activities either suggested by a clinician or self-suggested without devoting mental resources to being self-conscious about the activity. Treating pain and anxiety without pills In patients who can be easily hypnotized, hypnosis sessions have been shown to be effective in lessening chronic pain, the pain of childbirth and other medical procedures; treating smoking addiction and post-traumatic stress disorder; and easing anxiety or phobias. The new findings about how hypnosis affects the brain might pave the way toward developing treatments for the rest of the population - those who aren't naturally as susceptible to hypnosis. "We're certainly interested in the idea that you can change A treatment that combines brain stimulation with hypnosis could improve the known analgesic effects of hypnosis and potentially replace addictive and side-effect-laden painkillers and anti-anxiety drugs, he said. More research, however, is needed before such a therapy could be implemented. The study's lead author is Heidi Jiang, a former research assistant at Stanford who is currently a graduate student in neuroscience at Northwestern University. Other Stanford co-authors are clinical assistant professor of psychiatry and behavioral sciences Matthew White, MD; and associate professor of neurology Michael Greicius, MD, MPH. The study was funded by the National Center for Complementary and Integrative Health (grant RCIAT0005733), the National Institute of Biomedical Imaging and Bioengineering (grant P41EB015891), the Randolph H. Chase, M.D. Fund II, the Jay and Rose Phillips Family Foundation and the Nissan Research Center. Stanford's Department of Psychiatry and Behavioral Sciences and Department of Neurology and Neurological Sciences also supported the work. About Stanford Medicine Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu.
Hypnosis Medically Reviewed.Last updated on 01/28/2025. Hypnotherapy is a heightened state of concentration and focused attention. A trained, certified hypnotist or hypnotherapist will guide you. Hypnosis allows you to be more open to suggestions about making healthful changes in your perceptions, sensations, emotions, memories, thoughts or behaviors. Overview What is hypnosis? Hypnosis, also called hypnotherapy, is a state of deep relaxation and focused concentration. It’s a type of complementary therapy. These are therapies you may receive along with typical medical or psychological treatments to manage conditions or issues. A trained, certified hypnotist or hypnotherapist will guide you. They’ll use verbal cues, repetition and imagery to put you under hypnosis. This intense level of concentration and focus can help you make healthy changes to your habits or behaviors. What can hypnosis help treat? Hypnosis can help you manage a wide range of conditions. Some people use it to treat mental health conditions like: •Depression •Panic attacks •Phobias •PTSD •Stress or anxiety (especially if you’re anxious before medical or dental appointments) It can also help relieve symptoms of chronic conditions, including: •Asthma •Chronic pain •Fibromyalgia •Insomnia •Irritable bowel syndrome (IBS) •Migraine headaches Other uses include: •Encouraging weight loss to manage obesity and overweight •Managing side effects from other treatments (like nausea and vomiting from cancer treatments) •Quitting smoking •Relieving hot flashes and other menopause symptoms Treatment Details How does hypnosis work? You might have an image in your mind of how hypnosis works from TV or a movie. In real life, there are no magicians waving watches in front of your eyes to put you under their spell. Instead, your hypnotherapist will guide you through a series of exercises and meditations that help you relax and focus your mind. There are four stages of hypnosis: 1.Induction 2.Deepening 3.Suggestions 4.Emergence It’s a common myth that you lose consciousness or go to sleep when you’re under hypnosis. Most people remember everything that happens during a session. In fact, hypnosis can be a very active process. You’ll be focusing on and thinking about making positive changes in your life, and you’ll always be in control of your mind and thoughts. Induction Induction means to begin. During induction, you’ll start relaxing. Your therapist will help you focus your attention and ignore distractions. There are a few ways they might encourage you to relax, including: •Focusing your thoughts on a specific image or thought in your mind •Slow, controlled breathing •Tensing your muscles as you breathe in, then relaxing them as you breathe out (progressive muscle relaxation) Deepening Deepening is just what it sounds like — increasing your relaxation and focus. Think about induction like walking into the shallow end of a pool. Deepening is safely submerging your whole body under the water. In fact, your therapist might encourage you to think of images like slowly walking down a staircase or sinking into a comfortable bed. These first two stages will help you become more open to suggestions. Suggestions Suggestions are the actual changes in your behavior or experience you want to make. Your hypnotherapist will use imagery and carefully chosen language. They’ll gently suggest that you change how you think, act or respond to something. It can be a specific suggestion, like helping you quit smoking, or a more general one, like feeling less job stress. Emergence Your therapist will help you come out of hypnosis. If entering hypnosis is like sinking into a pool, emergence is floating back up to the surface. Your therapist will ask you to focus on reverse images of your deepeners. They’ll have you picture climbing back up the stairs or gently removing the covers and getting out of the comfortable bed. How long does a hypnosis session last? Hypnosis sessions usually last around an hour. You’ll probably need several sessions before you start seeing or feeling changes in how you think about your health or conditions you have. Risks / Benefits What are the benefits of hypnosis? Hypnosis is a safe, low-risk way to help you manage symptoms or some conditions. It’s becoming a more accepted and recognized form of therapy. Many of the benefits people experience are anecdotal. This means we haven’t been able to prove exactly how or why hypnosis helped in a scientific study. But that doesn’t mean it’s fake or doesn’t work. The changes can be very real. In other words, if you feel better, it’s a helpful treatment. Experts are still studying hypnotherapy to better understand it and how it helps people. What are the risks of hypnotherapy? It’s rare, but you might experience some side effects after a hypnotherapy session, including: •Dizziness •Drowsiness or feeling fatigue •Headaches •Increased anxiety •Trouble sleeping Tell your hypnotherapist if you experience any side effects or negative feelings. Is hypnotherapy dangerous? Hypnotherapy is safe when you work with a trained, certified therapist. Hypnosis isn’t mind control or brainwashing. And your hypnotherapist isn’t tricking your body or brain into changing. Any changes in your health or habits will come from you choosing to make them. There’s always a chance hypnosis doesn’t help you. Be honest with yourself and your therapist. Your therapist wants to help you accomplish your goals. They won’t be offended if you find that hypnosis isn’t working well for you. Recovery and Outlook How long will I need hypnotherapy? There’s not a set amount of time you’ll need hypnotherapy. Your therapist will monitor your progress. You might need only a few sessions to start seeing results, but it may take longer. Your therapist will develop a treatment plan for future sessions with your input and feedback. When To Call the Doctor How do I choose a hypnotherapist? First, look for a healthcare professional who’s properly trained, licensed and credentialed in a healthcare field such as medicine, dentistry, psychiatry, psychology, social work or nursing. They should have additional training in hypnosis and hypnotherapy techniques. The most important part of hypnosis is trusting your therapist. Like any healthcare provider or counselor, you should feel comfortable with them. Your hypnotherapist will get to know you before you start your first session. You shouldn’t have to do any special preparation, just be yourself and be honest about what you hope to accomplish. Your regular healthcare provider may be able to suggest a hypnotherapist. The American Society of Clinical Hypnosis, the Society for Clinical and Experimental Hypnosis or the American Association of Professional Hypnotherapists have information available about how to find a hypnotherapist near you. When should I call my healthcare provider? Complementary medicine like hypnosis works alongside traditional medical approaches. Talk to your regular primary care provider if you’re experiencing any new or different symptoms. You may need other treatments alongside hypnosis to help you make healthy changes or manage symptoms. A note from Cleveland Clinic Hypnosis can be a great way to help you manage a wide range of symptoms and conditions. You might be surprised to find that you don’t have to stare at a twirling spiral or get put under a spell for it to work. In fact, it’s the exact opposite. You’ll actively work with your hypnotherapist to find ways to make healthy changes in your daily routine. Like any type of therapy, hypnosis can take some time. Don’t be discouraged if you don’t see immediate results. But at the same time, be honest about your progress. Some people find hypnosis benefits them a lot — others never quite click with it. There’s no right or wrong answer. If it works for you, it can be a great tool. If not, your healthcare provider can help you find other treatment options.
Monitor on Psychology • 2024 April/May, April 1, 2024, Vol. 55 No. 3, p. 47 Uncovering the new science of clinical hypnosis With decades of data and new research supporting its effectiveness, practitioners are embracing hypnosis to treat certain conditions By Kirsten Weir Years ago, as a psychology grad student, Amanda Barnier, PhD, did a pair of experiments in which she gave people a pile of stamped postcards and asked them to send her one each day for the next few months. She asked a group of people to mail the cards as a favor to her; for another group, she administered a posthypnotic suggestion to send the cards. Both groups were equally likely to mail the cards, day after day, until their stacks ran out. But their motivations and experiences, she found, were quite different ( Psychological Science , Vol. 9, No. 4, 1998). The people she asked to do her a favor had an internal explanation for the action. “They felt they made a decision to comply with my social request,” said Barnier, now professor of cognitive science and pro vice-chancellor of research performance and development at Macquarie University in Australia. “The hypnotized people felt it was a compelling urge they had to meet. Hypnosis made the action feel more involuntary.” That reduced sense of personal agency may be precisely what makes clinical hypnosis such a powerful tool in psychotherapy and behavior change, said Barnier, who has studied the power of hypnosis ever since. “By changing the person’s sense of authorship, the effort becomes external to them. Hypnosis kick-starts the process by making it easier to change.” Hypnosis is as old as the field of psychotherapy itself, but today, advocates pointing to its evidence base say it deserves a fresh look—and a much wider audience. “Hypnosis has a certain historical mystique that can sometimes make it difficult for practitioners to understand its modern relevance,” said David Godot, PsyD, a clinical psychologist in Long Beach, California, and president of APA’s Division 30 (Society of Psychological Hypnosis). In fact, clinical hypnosis has clear benefits in psychotherapy, improving outcomes in areas such as pain management, anxiety, depression, sleep, and more. “Over the past few decades, there have been tremendous advances in understanding hypnosis and its benefit for research and practice,” Godot said. Editing consciousness Division 30 defines hypnosis as “a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion” (Elkins, G. R., et al., International Journal of Clinical and Experimental Hypnosis, Vol. 63, No. 1, 2015). Yet the definition of hypnosis has been the subject of debate for the better part of a century. While some experts believe hypnotic induction results in an altered state of consciousness, others argue it’s not so much a distinct state as a shift in attention. What experts on both sides of the debate agree on, however, is that hypnosis allows for a special kind of focused attention that opens people up to suggestion. In hypnotherapy, a clinician starts with a hypnotic induction, spoken prompts that encourage the client to shift their focus and deepen relaxation. Then, the clinician provides therapeutic suggestions to guide the client toward the wanted change. “Our brains soak up information from the environment and combine it with our prior beliefs and experiences and memories to form a conscious experience of the moment,” said Afik Faerman, PhD, a postdoctoral fellow in clinical neuropsychology at Stanford University and president-elect of Division 30. “Hypnosis is one context during which our brain edits that conscious experience. As the facilitator of a hypnosis session, I can provide guidance about how to edit those experiences, but it’s up to that person to act on my suggestions.” Those suggestions are what set hypnosis apart from meditation and mindfulness-based interventions. Both mindfulness and hypnosis are built on the backbone of focused attention; however, mindfulness aims for nonjudgmental awareness and acceptance. “Hypnotherapy has some important advantages,” said Guy Montgomery, PhD, a professor of psychology and director of the Center for Behavioral Oncology at the Icahn School of Medicine at Mount Sinai in New York City, who uses and studies clinical hypnosis for reducing pain in cancer patients. “Whereas meditation helps you accept a problem, hypnosis allows people to make changes to do something about the problem,” he said. Research has shown evidence that posthypnotic suggestion can elicit striking changes in perception and behavior. Two classic—and colorful—studies illustrate the power of hypnotic suggestion. In one, Amir Raz, PhD, a cognitive neuroscientist at McGill University in Montreal, and colleagues showed that hypnosis could disrupt the Stroop effect, the popular laboratory task that instructs participants to name the font color of written words. People respond much slower and make more mistakes when these words are color names and the word and the font color are different and thus interfere with each other (for example, the word “blue” written in red font). But when highly hypnotizable participants were instructed under hypnosis to pay attention only to the font color and not the text, the Stroop interference effect disappeared ( Archives of General Psychiatry , Vol. 59, No. 12, 2002). The study has been replicated many times by multiple labs. One recent example showed that while hypnosis itself did not eliminate the Stroop effect, posthypnotic suggestion did—a finding confirmed by electroencephalogram (EEG) (Zahedi, A., et al., Neuropsychologia, Vol. 96, No. 1, 2017). Such findings offer a vivid example of the ways that hypnosis can exert a top-down influence on cognition, even for automatic processes like reading. In another experiment, David Spiegel, MD, a professor of psychiatry and behavioral sciences at Stanford University, and colleagues gave participants a suggestion to view color when looking at grayscale images. Brain scans showed that the color-processing regions of their brains lit up even though the photos in front of them contained nothing but shades of gray ( The American Journal of Psychiatry , Vol. 157, No. 8, 2000). Both studies tested people considered “highly hypnotizable,” those who become hypnotized quickly and easily and respond strongly to hypnotic suggestions. Spiegel’s research suggests that people who are higher in hypnotizability have more functional connectivity—essentially, more communication—between the central executive network, which manages executive functions such as decision-making and working memory, and the salience network, which is tasked with prioritizing important incoming information (Hoeft, F., et al., Archives of General Psychiatry, Vol. 69, No. 10, 2012). “We believe that the executive network of individuals who are high in hypnotizability has a greater ability to moderate where their attention goes during hypnosis,” said Faerman, a postdoctoral scholar in Spiegel’s lab. Hypnotizability is a trait that follows a normal distribution: 10% to 20% percent of people aren’t very hypnotizable, and about the same proportion are highly responsive; everyone else falls somewhere in between. Several measures exist to assess a person’s potential to respond to hypnosis, such as the brief Hypnotic Induction Profile (Spiegel, H., & Spiegel, D., Trance and Treatment: Clinical Uses of Hypnosis, American Psychiatric Association Publishing, 2004) or the Elkins Hypnotizability Scale (Kekecs, Z., et al., International Journal of Clinical and Experimental Hypnosis, Vol. 69, No. 1, 2021). While responsiveness varies, however, most people can benefit from hypnosis to some degree, said Gary Elkins, PhD, ABPP, a professor of psychology and neuroscience at Baylor University. “People in the higher range may respond more quickly, but almost anyone can be a candidate for clinical hypnosis,” he said. “If people are in the lower range, they may just need more sessions or more practice to achieve the same results.” Elkins’s research has indicated that clinical hypnosis may have benefits even in people who are not especially high in hypnotizability. In recent work, he’s tested a hypnotherapy intervention for treating hot flashes in menopausal women and breast cancer survivors. In one trial, menopausal women received five weekly sessions of clinical hypnosis or a structured-attention control intervention. Those in the hypnosis group reported hot flashes were reduced by more than 74%, whereas the control group reported a 17% reduction in hot flashes. Objective physiological monitoring of hot flashes supported their reports, showing a 57% reduction in hot flashes for women who had hypnosis compared with a 10% reduction for control participants (Menopause , Vol. 20, No. 3, 2013). Hypnosis combinations Research suggests that hypnotic suggestion may be useful for a host of other behavioral health problems, including improving sleep, managing stress, and quitting smoking. One meta-analysis found, for instance, that hypnosis was a promising treatment for sleep problems (Chamine, I., et al., Journal of Clinical Sleep Medicine, Vol. 14, No. 2, 2018). And a meta-analysis of hypnosis for depression found that hypnosis appears to be an excellent treatment option for depression (Milling, L. S., et al., American Journal of Clinical Hypnosis, Vol. 61, No. 3, 2019). Yet hypnosis is not a therapy in itself, Elkins and other clinicians stress. “Hypnosis is not a primary intervention. But it’s clear it has an important role to play as an adjunctive approach to psychotherapy,” Elkins said. And incorporating hypnosis into psychotherapeutic interventions might boost their benefit. Research dating back 3 decades found that hypnosis could enhance the effectiveness of cognitive behavioral therapy (CBT). An updated meta-analysis showed that when the two were combined, they had a small-to-medium, but statistically significant, advantage over CBT alone for managing depression or pain (Ramondo, N., et al, International Journal of Clinical and Experimental Hypnosis, Vol. 69, No. 2, 2021). Another analysis found that hypnosis was more effective in reducing anxiety when combined with other psychological interventions than when it was used alone (Valentine, K. E., et al., International Journal of Clinical and Experimental Hypnosis, Vol. 67, No. 3, 2019opens in new window). Dialing down pain Some of the most robust evidence for clinical hypnosis is in controlling pain, as evidenced by two recent meta-analyses. The first assessed 85 controlled studies of experimentally evoked pain and found hypnosis delivered meaningful pain relief for most people, with the greatest effects in those who rated high on hypnotic suggestibility (Thompson, T., et al., Neuroscience & Biobehavioral Reviews, Vol. 99, 2019)In a separate analysis, researchers assessed 42 controlled studies of hypnosis for treating clinical pain. They concluded that hypnosis is “very efficacious,” with a mean weighted effect size in the medium range (Milling, L. S., et al., International Journal of Clinical and Experimental Hypnosis, Vol. 69, No. 3, 2021opens in new window). “Hypnosis can help turn down the volume on pain, both acute and chronic,” Montgomery said. In his work with cancer patients, he has demonstrated its benefit in a series of clinical trials—including a forthcoming study suggesting that hypnosis could reduce the joint pain that is a common side effect of a drug used to treat breast cancer. His program has funding from the National Cancer Institute to provide free training to any cancer care providers who want to learn hypnosis to help patients manage pain. “Hypnosis works. And the cool thing is that in our randomized trials, we don’t find effects due to race or ethnicity. This is something that can help anybody,” said Montgomery. Hypnosis in the brain While researchers continue to build the evidence base for hypnosis, they’re also exploring what hypnosis can reveal about the brain. The picture that is emerging is complicated. Neuroimaging studies have found little consensus in pinpointing brain regions and networks involved in hypnotic states and suggestions. That makes sense considering the varied nature of hypnosis, said Devin Terhune, PhD, a cognitive neuroscientist at King’s College London. “If you look across the literature, some studies use hypnosis to induce visual hallucinations, others to modulate pain or memory. Given these very different phenomena, it’s not that surprising that we don’t find a single brain region or network involved in hypnotic suggestion,” he said. Yet patterns are emerging. In a comprehensive review of the literature, Raz and colleagues found three key networks associated with hypnotizability and hypnotic response: the central executive network, the salience network, and the default mode network, which is associated with internal attention and mind-wandering. They also found involvement of the lingual gyrus, a region that plays a role in mental imagery (Landry, M., et al., Neuroscience & Biobehavioral Reviews, Vol. 81, Part A, 2017opens in new window). The involvement of the default mode network makes sense with people’s experiences of hypnosis, said Michael Lifshitz, PhD, an assistant professor of psychiatry at McGill University and a coauthor of the review. “This network is really active when people are daydreaming. It’s as if they’re rehearsing their habitual thoughts about their place in the world. But activity in the default mode network seems to go down in hypnotic states,” he explained. “It’s almost as if you’re letting your usual ways of making sense of the world relax and soften, making space for something new to emerge.” To dig deeper into the neurocognitive mechanisms of hypnosis, Faerman and Spiegel explored the link between hypnotizability and perseveration, the tendency to apply previously learned rules to new information, even when presented with a new and better rule. Perseveration can be thought of as a marker of cognitive inflexibility, and it draws on the same executive and salience networks implicated in hypnosis. They found people who are higher in hypnotizability tend to be lower on perseveration, more easily adopting new information that overrides previous knowledge. In other words, those who are more responsive to hypnotic suggestions appear to have more cognitive flexibility. Hypnotizability, they conclude, may share common cognitive mechanisms with evaluating errors and implementing logical rules ( Scientific Reports , Vol. 11, No. 5704, 2021) But Terhune has found being highly hypnotizable could be “a double-edged sword.” His research uncovered a link between hypnotic suggestibility and higher rates of dissociative problems like functional neurological disorders and posttraumatic stress disorder ( Neuroscience & Biobehavioral Reviews , Vol. 139, 2022 opens in new window). “These seem to be individuals who have a capacity to modulate their awareness and perception in response to verbal suggestion. But because their subjective experience is so malleable, they may be more at risk of developing dissociative disorders in response to traumatic episodes,” Terhune said. Much more work needs to be done to understand how hypnosis works, and for whom. But there are good reasons to press on. “If we can better understand how hypnosis works, we can actually design interventions to improve it or provide it in a more efficient way,” Faerman said. In a study forthcoming in Nature Mental Health, Faerman, Spiegel, and colleagues applied transcranial magnetic stimulation (TMS) to targeted brain regions in people with the central pain disorder fibromyalgia. Their goal was to inhibit the executive network and increase its functional connectivity with the salience network, mimicking the patterns seen in highly hypnotizable people. The group that received TMS had significant increases in hypnotizability that were not seen in the group that received a sham TMS. The next step will be to see whether such an intervention may increase their response to hypnosis treatment, such as one designed to reduce pain. “This is just a proof of concept,” Faerman said. “But my vision for the future is that someday, a person can come in before their psychotherapy appointment to get a quick TMS session that will increase the effectiveness of hypnosis and improve treatment outcomes.” Experts are also looking for ways to expand the reach of hypnotherapy. Spiegel has developed an app called Reveri to deliver hypnosis outside the clinic, for indications including improving sleep, managing pain, and reducing stress. Elkins is advising Mindset Health, which has developed the hypnotherapy app Finito for quitting smoking, Evia for managing symptoms of menopause, and Nerva for irritable bowel syndrome. As these apps make hypnosis more accessible to the public, advocates say more psychotherapists should consider adding hypnosis to their own clinical skills. “Hypnosis is a loaded term, and people in professional settings are sometimes uncomfortable with it because of its association with entertainment,” Faerman said. “But not learning about it is a mistake for clinical psychology. This is a tool that can improve the lives of our patients in a safe and evidence-based way.”