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Hypnosis

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Natural Standard Monograph, Copyright © 2009 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified health care professional before making decisions about therapies and/or health conditions.

Related Terms

  • Abreaction therapy, altered states of consciousness, antenatal self-hypnosis, autogenic training, auto-hypnosis, aversion therapy, biofeedback, cognitive hypnotherapy, conditioning therapy, creative visualization, dream therapy, guided imagery, hypnoanalgesia, hypnobirthing, hypnosis, hypnotherapy, imagery, imagination training, meditation, mesmerism, pain relief therapy, post-hypnotic suggestion, regression therapy, relaxation, relaxation mental imagery (RMI), selective attention, self-hypnosis, shamanism, switch-wire imagery, symptom relief therapy, trance, visualization.

Background

  • Various forms of hypnosis, trance, and altered states of consciousness have played roles across cultures throughout history. Hypnosis-like practices can be traced to ancient Egypt, Babylon, Greece, Persia, Britain, Scandinavia, America, Africa, India, and China. Wong Tai, a father of Chinese medicine, made an early written reference to hypnosis in 2600 BC. Hypnotic practices have played roles in religion and religious ceremonies. Mention is made in the Bible, Talmud, and Hindu Vedas, and trance-states are included in some Native American and African ceremonies.
  • The term hypnosis is derived from the Greek word hypnos, meaning sleep. The origin of modern Western hypnotherapy is often traced to the Austrian physician Franz Anton Mesmer (1734-1815). Mesmer believed that illness is caused by an imbalance of magnetic fluids in the body that can be corrected through "animal magnetism." He asserted that the hypnotist's own personal magnetism can be transferred to a patient. The term "mesmerize" is derived from Mesmer's name.
  • In the mid 20th Century, the British and American Medical Associations and the American Psychological Association endorsed hypnosis as a medical procedure. In 1995, the U.S. National Institutes of Health (NIH) issued a consensus statement noting the scientific evidence in favor of the use of hypnosis for chronic pain, particularly pain associated with cancer.
  • The process of hypnotherapy can be divided into pre-suggestion, suggestion, and post-suggestion phases. The pre-suggestion component may include selective attentional focusing with distraction, imagery, and relaxation methods. An aim is to reach an altered state of consciousness in which the conscious mind is relaxed, the unconscious mind is more accessible, and the subject is susceptible to suggestion. In the suggestion phase, specific goals or impressions are presented, questions may be asked of the subject, or memories may be explored. The post-suggestion phase occurs after a return to a normal state of consciousness, and new behaviors based on hypnotic suggestions may be practiced. It has been suggested that there is a risk of false memories (confabulation) as a result of some types of hypnotherapy, although scientific research is limited in this area.
  • The degree of susceptibility to hypnosis and suggestion appears to vary between individuals. The therapeutic goals of hypnotherapy also vary, and may include the treatment of psychological or medical conditions or alteration of behaviors/habits. Subjects may seek hypnotherapy to gain control over behaviors or emotions. Self-hypnosis techniques may be used as an adjunct to sessions with a hypnotherapist.
  • There is wide variation in the training and credentials of hypnotherapists. Certification is granted by multiple organizations, with different requirements. In the United States, there is no universally accepted standard or licensing for hypnotherapists. Although many therapists are not licensed medical professionals, some doctors, dentists, and psychologists are trained in hypnotherapy and may use hypnosis in their practices. Books and audiotapes are available for training in self-hypnosis, although these have not been well evaluated scientifically. Group sessions may also be offered. The length of hypnosis sessions may vary from a single brief encounter to regularly scheduled longer appointments.

Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • The way hypnosis works is not well understood. Some changes in the body have been associated with hypnosis, including changes in skin temperature, heart rate, intestinal secretions, and immune response. During hypnosis, decreases have been noted in heart rate, blood pressure, body temperature, and brain wave patterns (alpha waves). Similar changes have been reported with other forms of relaxation.
  • Some scientists suggest that neuroendocrine pathways in the brain such as the hypothalamic-pituitary-adrenal axis or the limbic system (emotional center of the brain) are central to connecting body functions with the mind, memory, and emotions. Hypnosis is thought to activate these pathways. Various parts of the brain and spinal cord have been proposed as important in the pain-relieving properties of hypnotherapy. It has been suggested that the release of endogenous opioid peptides may play a role, although early evidence suggests that endorphins (chemicals in the brain) may not be involved in the mechanism of action.
  • Hypnosis is associated with a deep state of relaxation. Whether this represents a specific altered state of consciousness is the subject of scientific debate. There are reports that suggestion alone, without the process of hypnosis, can achieve many of the same results, although research in this area is not conclusive. It is not known why some individuals are more susceptible to hypnotic suggestion than others.

Evidence

Uses based on scientific evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare professional.

Grade*

Adjunct to Cognitive Behavioral Therapy (CBT)

Hypnotherapy techniques may be combined with cognitive behavioral therapy for the treatment of conditions such as anxiety, insomnia, pain, bed-wetting, post-traumatic stress disorder, or obesity. Better-quality study is necessary before a strong recommendation can be made.

B

Anxiety

Several studies report hypnosis to reduce anxiety, particularly prior to dental or medical procedures, or in the management of phobias. Early evidence suggests that these effects may last for up to three years with benefits reported in children and adults. Additional evidence is necessary before a strong recommendation can be made.

B

Dental anxiety

Several promising studies in adults and children report that anxiety related to dentist visits can be reduced with the use of hypnotherapy. Benefits may be long-standing (measured at up to three years). However, some research reports that hypnosis may be less effective for this use than group therapy or systematic desensitization therapy.

B

Irritable bowel syndrome (IBS)

Early research suggests hypnotherapy may lower the sensory and motor component of the gastrocolonic response in patients with irritable bowel syndrome. Better studies are necessary to make a conclusion.

B

Pain (various causes)

Hypnotherapy has been studied in the management of pain, including low back pain, surgery-related pain, cancer-related pain, dental procedure-related pain, burn pain, repetitive strain injury, temporomandibular joint disorders, sickle cell disease-related pain, irritable bowel syndrome, oral mucositis, tension headache, and chronic pain from various causes. Various hypnotherapy approaches have been used, and it is not clear what technique or duration of treatment is optimal. Therefore, although the existing research is promising, better-designed trials are necessary before a strong recommendation can be made.

B

Psychosomatic disorders

Hypnosis appears effective in the treatment of psychosomatic disorders. Additional research is needed to support this finding.

B

Tension headache

Several studies report improvements in the severity and frequency of tension headaches following several weekly hypnosis sessions. Early research suggests that hypnosis may be equivalent to other relaxation techniques, biofeedback, or autogenic training. Better quality studies are necessary before a strong recommendation can be made in this area.

B

Academic performance

There is conflicting evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Alcohol dependence

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Allergy/hay fever

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Alopecia areata (hair loss)

Based on early study, hypnosis may help psychological well-being and physiological outcome in patients with hair loss. Larger, well-designed studies are needed before a firm conclusion can be drawn.

C

Asthma

Preliminary research for the use of hypnosis in management of asthma symptoms does not provide clear answers. Anxiety associated with asthma may be relieved with hypnosis. Additional study is needed before a firm conclusion can be drawn.

C

Bed-wetting (nocturnal enuresis)

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Bone fractures

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Chemotherapy side effects

There are several studies of hypnosis for cancer-related conditions, including pain, anxiety, and quality-of-life. Limited research reports mixed effects of hypnotherapy for chemotherapy-related nausea/vomiting or mouth sores. Additional research is necessary before a conclusion can be drawn.

C

Conversion disorder

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Drug addiction

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Duodenal ulcer

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Eating disorders

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Erectile dysfunction

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Fertility

Based on early evidence, hypnosis may improve the in vitro fertilization-embryo transfer cycle. Additional study is needed before a firm conclusion can be drawn.

C

Fibromyalgia

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Gastric disorders (gastric emptying)

Early research indicates that gut-oriented hypnosis may have a beneficial effect on shortening gastric emptying both in dyspeptic and in healthy subjects. Additional study is needed before a firm conclusion can be drawn.

C

Heartburn (dyspepsia)

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Hemophilia

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Herpes

A small study showed potential benefit of a hypnotherapeutic treatment program for patients suffering from recurrent orofacial herpes infections. Further research is needed to confirm these results.

C

High blood pressure

Early study suggests that hypnosis may have short and long-term effects for patients with mild high blood pressure. Additional research is needed to confirm these findings.

C

Insomnia

Several early studies report that hypnosis may decrease the amount of time it takes to fall asleep, increase the duration of sleep, and improve sleep quality. However, this research is not well designed or reported, and cannot be considered definitive.

C

Jaw clenching

Preliminary research suggests jaw clenching may be related to hypnotic susceptibility. Better-designed research is necessary to make a strong recommendation.

C

Labor

Several studies report the effects of pre-natal hypnotherapy on duration of labor and pain medication use. Additional evidence is necessary before a clear conclusion can be drawn.

C

Menopausal disorders

Early evidence shows that hypnotherapy may be beneficial in the treatment of hot flashes and may improve quality of life in women who are experiencing menopausal symptoms. Further research is needed to make a recommendation.

C

Nausea/vomiting

Several studies report on the use of hypnotherapy in people with nausea/vomiting related to cancer chemotherapy, pregnancy (hyperemesis gravidarum), and surgical recovery. Results are mixed and there is no reliable comparison to anti-nausea medications or other relaxation techniques. Better research is needed before a firm conclusion can be drawn.

C

Post-surgical recovery

Research suggests that hypnosis may be helpful for pain and anxiety in various situations, including after surgery. Early research reports that length of hospital stay and psychological well-being may be improved after surgery with the use of hypnotherapy. However, most studies in this area are not well designed, and updated high-quality investigations are needed before a firm conclusion can be drawn.

C

Rheumatoid arthritis

Although multiple trials report diminished pain levels or requirements for pain-relieving medications after hypnotherapy, there is limited research for rheumatoid arthritis pain specifically. Other signs of rheumatoid arthritis, such as joint mobility or blood tests for rheumatoid factor, have not been adequately assessed.

C

Schizophrenia

There is currently not enough evidence to suggest for or against the use of hypnotherapy in this condition. High-quality studies are needed to determine the effect and safety of hypnosis in schizophrenia.

C

Skin conditions (eczema, psoriasis, atopic dermatitis)

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Tinnitus (ringing in the ears)

There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.

C

Vascular damage

Preliminary study results suggest a protective role of hypnosis against vascular damage. Further research is needed to confirm these results.

C

Warts

There is promising early evidence to support the use of hypnosis in the treatment of warts. Larger well-designed trials are needed to further assess the use of hypnosis for warts, and to determine the most effective methodology.

C

Weight loss

Research suggests that hypnosis may be valuable as an adjunct to cognitive behavioral therapy for weight loss. However, it is not clear if hypnotherapy used alone is beneficial in this area.

C

Cancer (radiotherapy side effects)

Hypnosis did not reduce anxiety or improve quality of life in cancer patients undergoing curative radiotherapy in early high-quality studies.

D

Smoking cessation

Hypnosis is a popular therapy used by people trying to quit smoking, and it is often included as part of smoking cessation programs. The available evidence suggests that hypnotherapy does not have significant effects in this area. Better-designed research is necessary before a strong conclusion can be drawn.

D

*Key to grades:

A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

For full grading rationale, click here.

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified health care professional

Acne, aging, agoraphobia, alertness, Alzheimer's disease, amenorrhea, amnesia, anticoagulation (blood thinning), arrhythmias (abnormal heart rhythms), attention deficit hyperactivity disorder (ADHD), bleeding, blindness, blisters, breast enhancement, bruises, cancer, cerebral palsy, chronic diarrhea, chronic dyspnea (shortness of breath), chronic fatigue syndrome, chronic pain (in older adults), concentration enhancement, confidence boosting, congenital ichthyosiform erythroderma (skin disorder), constipation, cystic fibrosis, diabetes mellitus, diagnostic procedure (forensics), dissociative identity disorder (DID), driving performance, dysmenorrhea (painful menstruation), dyspareunia (pain with intercourse), endurance, enhanced immune function, enhanced vision, fear of flying, gag reflex, gastritis, gastrointestinal disorders (functional abdominal pain syndrome), gastroesophageal reflux disease (acid reflux), gout, Graves' disease, grief, heart disease, hemolytic anemia, HIV/AIDS, Huntington's chorea/disease, hyperreflexic bladder, increased strength, infections, ischemic heart disease, lactation stimulation, law enforcement (recalling repressed memories), life transition support, memory enhancement, Ménière's disease, menstrual cramps, migraine, motivation, movement disorders, multiple personality disorder, multiple sclerosis, muscle spasm, musculoskeletal disorders, myasthenia gravis, nail biting, narcolepsy, neurodermatitis, neurological problems (periodic leg syndrome), oral hygiene, pain (heat detection/pain threshold), panic disorder, paralysis, Parkinson's disease, paruresis (psychogenic urinary retention), pemphigus vulgaris (a skin disorder), personality development, phobias, postherpetic neuralgia, postpartum care, postpartum depression, premenstrual syndrome, pruritus (itchiness), quality of life, Raynaud's disease, repressed memory recall, restless leg syndrome, restlessness, saliva production control, scoliosis, seizures (non-epileptic), self-esteem enhancement, sensory stimulation (sensory acuity), sleep terror disorder, speech disorders, stroke, study skill enhancement, stuttering (stammering), sudden infant death syndrome (SIDS), systemic lupus erythematosus, thumb sucking, tics, tongue biting, torticollis (neck spasms), trauma, trichotillomania (compulsive hair pulling), tuberculosis, vaginismus (involuntary spasm of vaginal muscles).

Safety

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

  • The safety of hypnotherapy has not been thoroughly studied. Practitioners sometimes discourage hypnosis in people with psychiatric illnesses such as psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders, due to a proposed risk of exacerbation. Hypnosis is sometimes discouraged in people with seizure disorder, although study is lacking in this area. Disturbing memories may surface in those with post-traumatic stress disorder. It has been suggested that false memories (confabulation) may occur as a result of some types of hypnotherapy, although scientific research is limited in this area.
  • Hypnotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies and should not be used as the sole approach to illnesses.

Authors

  • This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Selected References

Natural Standard developed the above evidence-based information based on a systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Alladin A, Alibhai A. Cognitive hypnotherapy for depression: an empirical investigation. Int J Clin Exp Hypn 2007 Apr;55(2):147-66.
  2. Flammer E, Alladin A. The efficacy of hypnotherapy in the treatment of psychosomatic disorders: meta-analytical evidence. Int J Clin Exp Hypn 2007 Jul;55(3):251-74.
  3. Freeman RM, Macaulay AJ, Eve L, et al. Randomised trial of self hypnosis for analgesia in labour. Br Med J (Clin Res Ed) 3-8-1986;292(6521):657-658.
  4. Green JP, Jay Lynn S, Montgomery GH. A meta-analysis of gender, smoking cessation, and hypnosis:a brief communication. Int J Clin Exp Hypn 2006 Apr;54(2):224-33.
  5. Jensen M, Patterson DR. Hypnotic treatment of chronic pain. J Behav Med 2006 Feb;29(1):95-124.
  6. Kanji N, White AR, Ernst E. Autogenic training for tension type headaches: a systematic review of controlled trials. Complement Ther Med 2006 Jun;14(2):144-50.
  7. Lutgendorf SK, Lang EV, Berbaum KS, et al. Effects of age on responsiveness to adjunct hypnotic analgesia during invasive medical procedures. Psychosom Med 2007 Feb-Mar;69(2):191-9.
  8. Montgomery GH, Bovbjerg DH, Schnur JB, et al. A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. J Natl Cancer Inst 2007 Sep 5;99(17):1304-12.
  9. Moore R, Brodsgaard I, Abrahamsen R. A 3-year comparison of dental anxiety treatment outcomes: hypnosis, group therapy and individual desensitization vs. no specialist treatment. Eur J Oral Sci 2002;110(4):287-295.
  10. Richardson J, Smith JE, McCall G, et al. Hypnosis for procedure-related pain and distress in pediatric cancer patients: a systematic review of effectiveness and methodology related to hypnosis interventions. J Pain Symptom Manage 2006 Jan;31(1):70-84.
  11. Ruddy R, House A. Psychosocial interventions for conversion disorder. Cochrane Database Syst Rev 2005 Oct 19;(4):CD005331.
  12. Schnur JB, Bovbjerg DH, David D, et al. Hypnosis decreases presurgical distress in excisional breast biopsy patients. Anesth Analg 2008 Feb;106(2):440-4.
  13. Stalpers LJ, da Costa HC, Merbis MA, et al. Hypnotherapy in radiotherapy patients: a randomized trial. Int J Radiat Oncol Biol Phys 2-1-2005;61(2):499-506.
  14. Willemsen R, Vanderlinden J, Deconinck A, et al. Hypnotherapeutic management of alopecia areata. J Am Acad Dermatol 2006 Aug;55(2):233-7.
  15. Zeltzer LK, Dolgin MJ, LeBaron S, et al. A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer. Pediatrics 1991;88(1):34-42.
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