Is Neuroscience the Key to Understanding the Mechanism of Action of Hypnosis?
By Kathy Kravits, RN, HNB–BC, LPC, NCC, ATR–BC
Hypnosis is a safe and effective therapy for managing many complex symptoms, including anxiety, distress, and pain. Even though most individuals are able to have a successful hypnosis experience, hypnosis is not widely integrated into practice despite a substantial body of evidence from well-designed randomized clinical trials that support the use of hypnosis. In 1996, a National Institutes of Health Technology Assessment Panel endorsed the use of hypnosis and recommended that it be integrated into healthcare practice.
Hypnosis is effective in both adult and pediatric populations in the management of acute and chronic pain, anxiety, distress, nausea and vomiting, sleep disturbances, post-traumatic stress disorder, childbirth, mood, and stress. In fact, hypnosis has been found to be superior to structured attention, empathy, and intravenous analgesia for procedural pain, anxiety, and distress.
This article promotes the integration of hypnosis into standard mental health counseling practice and reviews the role of neuroscience as a body of knowledge that clarifies the mechanism of action of hypnosis. A framework for using hypnosis in a manner that is evidence-based will be discussed.
What Creates a Hypnosis Experience?
The definition of hypnosis is controversial and depends on the theoretical framework embraced by the practitioner. Division 30 of the American Psychological Association, the Society of Psychological Hypnosis, defined hypnosis in 2005 as “focused attention experienced by a receptive individual in response to an experience either facilitated by a hypnotist or self-guided. Suggestions are offered during the experience for changes in sensation, perception, cognition, affect, mood, or behavior.” Though the Division 30 definition represents a compilation of many thoughts and sources of evidence, and it describes the process of creating a hypnosis experience, it does not actually describe the mechanism of action that creates that hypnosis experience.
The techniques for creating a hypnosis experience are varied. The most commonly employed hypnosis technique is initiated by an induction, followed by deepening and therapeutic suggestion, and concluded by reversal (see Table 1 below).
TABLE 1. Elements of Hypnosis Technique
- Controlled breathing
- Progressive relaxation
- Guided imagery
- Suggesting feelings of heaviness or lightness
- Suggesting increasing feelings of relaxation
- Suggestion constructed to address a specific therapeutic goal
- May be framed in direct terms or indirect terms
- Counting backwards in conjunction with suggestions to become more and more awake
- Behaviors (e.g., taps) used to signal a return to a more typical state of consciousness
Typically a hypnotist facilitates the state of hypnosis for and with a client; however, hypnosis may be self-delivered or facilitated by the use of aids such as pre-recorded CDs. The use of therapeutic suggestion is the critical technical element that separates a hypnosis experience from a relaxation, guided imagery, or meditation experience.
In fact, some hypnosis theorists and researchers actually define hypnosis as therapeutic suggestion.
Barriers to Practice: Common Myths and Misconceptions
Many myths and misconceptions still persist regarding hypnosis, creating barriers to the use of hypnosis and its successful inclusion in standard mental health counseling practice. It is, therefore, important that clinicians and clients understand what hypnosis is and is not.
Here are the facts:
- Anyone may be hypnotized. It is not a sign of weakness to be able to be hypnotized; however, some individuals are able to achieve deeper levels of the hypnosis experience than others, based on measurable degrees of hypnotic suggestibility. This difference is similar to the varying skills and abilities associated with throwing a ball: Everyone can throw a ball. Not everyone can throw a ball well enough to be a professional baseball player.
- Hypnosis is not sleep. The client should not expect to be oblivious to what is happening during a hypnotic experience. The hypnotist should explain that the client will be aware of everything that is said and done and will be able at any point to terminate the experience. Under hypnosis, you cannot be made to do something against your will. The client is a full participant in the experience and is not being controlled or possessed by the hypnotist.
- Hypnosis is a safe technique when practiced by a well-trained, experienced, licensed healthcare provider. Side-effects associated with hypnosis reported in the literature are rare. The most commonly encountered undesirable effect is the inadvertent retrieval of unpleasant memories. A well-trained hypnotist can anticipate this effect, assess for risk factors, and generate a hypnotic experience that minimizes the risk. Note, however, that hypnosis is contraindicated with patients who have a history of psychosis, cognitive impairment that leads to an inability to concentrate, or personality disorders, particularly if associated with psychotic features.
- Symptom removal means a new symptom appears. The belief that using hypnosis to remove a symptom such as pain means that a new symptom would appear as a substitute for the one that has been removed is not accurate. Symptoms are managed by several strategies that promote changes in our perceptions and or thoughts about the symptom. The hypnotist works to ensure that the therapeutic suggestions are constructed in such a way that the client experiences a reduction in the original symptom and any associated symptom distress without any associated undesirable effects.
The best treatment for dispelling the common myths and misconceptions associated with hypnosis? Dialogue. Conversations with colleagues and clients about hypnosis promote a better understanding of this very useful therapeutic technique.
The advances in neuroscience in the last decade have brought a new understanding of the neural correlates of the hypnosis experience. Two structures of the brain play a particularly important role in the hypnosis experience. They are the prefrontal cortex and the anterior cingulate cortex. These structures influence intentional physical self-regulation, cognitive control, and response to suggestions. They also play a role in integrating information relevant to ongoing social, cognitive, emotional, and psychological stress.
The prefrontal cortex serves as a critical structure in hypnosis due to its role in decision-making and its influence over autonomic nervous system activation. The prefrontal cortex is preferentially triggered as part of the stress response. Normalizing prefrontal cortex activation is critical to any therapy for stress-related issues.
The anterior cingulate cortex is located along the corpus callosum in the brain’s frontal lobe and influences cognitive functioning. It plays a significant role in attention and motivation. It is through the use of therapeutic suggestion that attention and motivation are focused on achieving desired outcomes. Normally, there is a functional connection between the prefrontal cortex and the anterior cingulate that allows the prefrontal to influence attention and motivation. During a hypnotic experience, there is a functional disconnection between these two structures, allowing attention to be more easily focused by the therapeutic suggestions. A growing body of evidence suggests that this is the mechanism of action that allows hypnotic suggestion to produce a therapeutic effect.
Hypnosis Warrants More Widespread Use With Clients
Clinical mental health counselors should consider using hypnosis to manage their clients’ psychological as well as physical symptoms since it has been shown to be a safe and effective therapy. Developments in neuroscience have clarified the potential mechanism of action for this valuable technique. As mental health counselors, we know it is important to use as many effective therapies as possible in order to be able to assist our clients in the best possible manner. Hypnosis is a therapeutic technique that warrants our attention and use.
Kathy Kravits is a registered nurse and licensed professional counselor who works at City of Hope Comprehensive Cancer Center in Duarte, Calif. She conducts research in hypnosis and professional stress reduction and burnout. She presented on this topic at AMHCA’s Annual Conference in Orlando in July. Kravits may be contacted at firstname.lastname@example.org.