Scientific studies for hypnosis

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Shinhypnosis has participated in MTV’s worldwide smoking cessation campaign, and MTV gives hypnosis a top smiley.

Shinhypnosis has treated people with the following problems and where hypnosis has proven to be very effective. Your thoughts can be influenced so that you have a much better life after you have tried hypnosis.

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SCIENTIFIC HYPNOSIS RESEARCH

There are two types of hypnosis research, instrumental and after values:

INSTRUMENTAL RESEARCH
USING HYPNOSIS AS AN EXPERIMENTAL TOOL TO INVESTIGATE MEMORY, CONSCIOUSNESS, PAIN AND ACTIONS.
ACTUAL RESEARCH
IS INTERESTED IN WHAT HYPNOSIS IS AND HOW IT WORKS.
How effective is hypnosis as an analgesic method?
What processes are used when using memory? How do we perceive real and imaginary objects?
Is hypnosis an altered state of consciousness? What areas of the brain are affected by hypnotic suggestions?
Are some people more hypnotizable than others?

In recent literature, hypnosis has been used to explore many topics, including:

  • Memory
  • Attention
  • Perception & hallucination
  • Pain
  • Voluntary control

Clinical studies have looked at how effective hypnosis is as a clinical tool for:

  • Pain
  • Depression
  • Smoking cessation
  • Weight loss
  • Making surgery safer, faster and more convenient

Brain scan studies help us understand what hypnosis is and how it works.

PROPERTIES IN PSYCHOLOGICAL RESEARCH

Martin Orne is a hypnosis researcher, and he suggests that most participants in experiments strive to be “good subjects” and want the experiment to be a success.

Orne realized that this striving motivated participants’ beliefs, expectations and intentions, and this could lead to systematic errors that can hamper the interpretation of any data collected.

One method to counter this, which is particularly favored by social psychologists, was to use deceptive experimental paradigms, to mislead participants about the true purpose of an experiment.

It was designed to minimize participants’ awareness of true research hypotheses and therefore remove the source of systematic bias.

Demanded characteristics can be a particular problem for hypnosis research.

In hypnosis research, deception can be difficult as in the experiment you are often directly informed of the propositions being used.

For example, the requirements for the “pain relief” experiment are clearly to communicate suggestions given for pain relief.

Orne developed methods that allowed investigators to measure the requirements from an experimental measurement.

Particularly useful was his real-life simulator developed so that experiment participants with low hypnotic susceptibility were tested by a researcher who did not measure their level of hypnotic susceptibility. Those who were low hypnotizable were told to act as if they were highly hypnotizable.

In addition, the person who was faking was told that the experimenter would terminate the study if he suspected faking.

The logic of the real-simulator paradigm is constructed such that any differences between the real and simulated subjects can be attributed to true differences in hypnotic susceptibility (a genuine effect), whereas if the results are identical, then the experimenter’s demands cannot be excluded as a critical factor.

An alternative way to establish whether proposed effects are genuine or a product of bias is to use an objective way to measure the effect.

This avoids relying on subjective reports, which are considered more vulnerable to bias.

Some studies investigate automatic treatments that are less vulnerable to conscious bias (see section on attention/conflict), and some of the most interesting studies in recent years have used functional neuroimaging techniques (e.g. ERP, PET, fMRI), which incorporate measures of brain activity that are independent of the subjective report.

HYPNOSIS FOR PAIN

Pain is one of the few areas where hypnosis has been used in clinical treatment in the absence of a broader treatment framework – although hypnosis allied with cognitive behavioral therapy techniques can be highly effective.

A number of studies have examined the efficacy of hypnosis in the treatment of pain, either when used alone or in conjunction with cognitive behavioral therapy. Pain is one of the best studied areas – there have been a number of meta-analyses (literally a survey of studies – one of the most reliable ways to find out if there is an effect) of hypnosis for pain control.

Methods of pain control
Hypnotic approaches to pain relief take three forms:

Direct suggestions for symptom change

Separation strategies – encouraging individuals to mentally “go elsewhere” and leave the pain behind

Resource utilization – a more Ericksonian approach

Meta-analysis Meta-analyses
Meta-analyses are studies of studies. Where individual studies may show conflicting results over time, meta-analyses can be used to assess the results of a treatment over a number of studies – the benefit of a larger sample, hopefully leading to a more reliable result.

Montgomery, David, Winkel, Siverstein & Bovbjerg (2002) Montgomery, David, Winkel, Siverstein & Bovbjerg (2002)

Meta-analysis examined the results of 20 published controlled studies reviewing the use of hypnosis as an adjunct for surgical patients. In these studies, hypnosis has typically been given to patients during a relaxation induction phase, followed by suggestions for controlling (e.g. pain, nausea, anxiety). Only studies where patients were randomly assigned to either hypnosis or control group (no treatment, routine care, or attention control group) were included. The results showed that patients in hypnosis treatment groups had better outcomes than 89% of patients in the control group. It was found that the additional treatment of hypnosis had helped most patients to limit the negative consequences of surgical procedures.

Montgomery, DuHamel & Redd (2000) Montgomery, Duhamel & Redd (2000)

This meta-analysis examined the effectiveness of hypnosis in pain management. It compares studies that evaluated hypnotic pain reduction in healthy volunteers versus those using patient samples, looks at the relationship between hypnotic pain relief efficacy and participants’ hypnotic imagination, and determines the effectiveness of hypnotic suggestions for pain relief relative to other non-hypnotic psychological interventions. Examination of 18 studies showed a moderate to large hypno pain relief effect, supporting the efficacy of hypnotic techniques for pain management. The results showed that hypnotic suggestions were equally effective in reducing both clinical and experimental pain.

Hawkins (2001). Hawkins (2001). Hypnosis and surgery. Hypnosis and surgery.

Patterson & Jensen (2003). Patterson & Jensen (2003). Hypnosis and clinical pain. Hypnosis and clinical pain.

Lang & Rosen (2002). Lang & Rosen (2002). Cost analysis. Cost analysis.

DEPRESSION

There is a lot of evidence that depression can be effectively treated with methods such as cognitive behavioral therapy (Beck & Alford 2009). Hypnosis is not a treatment in itself, but it has been argued that it can be effectively integrated with approaches such as CBT (cognitive hypnotherapy: Lynn, 2010) or psychodynamic therapy (hypnoanalysis). There is now some evidence that programs incorporating hypnosis can be used to treat depression.

Alladin, A. (2009). Evidence-based cognitive hypnotherapy for depression. Contemporary Hypnosis, 26(4). 245-262.

Yapko, MD (2010). Hypnosis in the treatment of depression: An overdue approach for encouraging skillful mood management. International Journal of Clinical and Experimental Hypnosis, 58(2), 137-146.

Yapko, MD (2010). Hypnotically catalyzing experiential learning across treatments for depression: Actions can speak louder than words. International Journal of Clinical and Experimental Hypnosis, 58(2), 186-201.

Loriedo, C., Torti, C. (2010). Systemic hypnosis with depressed individuals and their families. International Journal of Clinical and Experimental Hypnosis, 58(2), 222-246.

SMOKING CESSATION

Can I quit smoking using hypnosis?

If ads for hypnotherapy services are any guide, its use to help people stop smoking must be one of the most popular (and effective!). Most of us know someone who has tried hypnosis to help them stop smoking, and many different smoking cessation programs have been developed – and claim high success. What is a HYPNOTHERAPEUTIC treatment and how effective are they? Fortunately, many studies have been conducted and we can draw some reliable conclusions on the subject.

How hypnosis is used for smoking cessation
Hypnotic techniques are commonly used to treat smoking. Often smokers have images (visualizations) associating cigarettes with unpleasant situations such as a dry mouth, heavy smoke, or other negative side effects such as cancer.

The hypnotic suggestions are often given to encourage smokers to believe that they will lose the desire to smoke, however, it also aims to help them cope with quitting smoking itself. A popular technique called Spiegel’s method encourages smokers to concentrate on three ideas: 1) Smoking is a poison to the body, 2) you need your body to live, 3) to the extent that you want to live, you owe your body respect and protection.

Smokers are taught self-hypnosis and encouraged to repeat these ideas every few hours and experience an urge to smoke. Covino and Bottari (2001) discuss treatment techniques in more detail.

Evidence

It is important to note that hypnosis is not the only way to treat smoking. Many other approaches, such as cognitive behavioral therapy treatments have been developed and as a result, there is a real methodological rigor available to the field – specifically, we know what makes a good (relatively neutral) study.

Crucial factors are:

  • appropriate follow-up: it’s ok to motivate someone to quit for a week, but we are really interested in the long abstinence
    chemical measures in abstinence: It’s one thing for a participant to tell you they’ve quit, but the chemical analyses of abstinence are not subject to the same biases
  • A control group: Some studies only report data from a treatment group. Some of these people may have quit anyway (people try and quit all the time), so you need a control group to help you assess how effective your treatment is
  • Random selection: You need to randomly select participants into a control group and a treatment group. Otherwise, you may just end up with highly motivated people in the hypnosis group and unmotivated people in your control group. This would not give a true picture of how effective hypnosis is.
  • Because so many studies have been done reviewing the use of hypnosis for smoking cessation, it is possible to systematically review all these results. We will look at the results of some of these reviews here.

Green and Lynn (2000)

Green and Lynn reviewed the results of 59 studies of hypnosis and smoking cessation. These studies included “clinical reports” (which did not include non-treatment control groups) and “experimental research” (the best, randomly selected participant for control and treatment conditions).

The best of the research showed that hypnosis was superior to a passive control group, making hypnosis an empirically supported treatment for smoking cessation. The effects of hypnosis were found to be generally comparable to non-hypnotic treatments. Evidence on whether hypnosis was superior to placebo was convincing. Evidence on whether hypnotic susceptibility is related to treatment success was mixed.

Abbot, Stead, White & Barnes (1998)

This is a Cochrane review of the use of hypnosis to promote smoking cessation. Cochrane reviews are high quality assessments of the scientific literature and are updated regularly. They looked at nine studies that compared hypnotherapy with control conditions. They used a high-quality (rigorous) test of outcome by looking at studies that measured abstinence from smoking after at least six months of follow-up. They used biochemically validated measurements where possible.

The reports of success were very different (some studies claim very high success rates, some very low. This is not what researchers like to see in studies – you expect to see treatment X has effect Y. If they’re not reliable, it’s because something else is happening that the researchers haven’t accounted for). With such variable data, they weren’t able to demonstrate that hypnotherapy has a greater effect compared to other interventions or no treatment.

COMPARISON: NON-HYPNOTIC TREATMENT FOR SMOKING CESSATION
A 2004 Cochrane review looking at 123 studies shows that nicotine replacement therapies (gum, inhaler, lozenges, patches) reliably help smokers quit – almost doubling their odds of being abstinent at a 6 month follow-up.

A separate Cochrane review looks at the effectiveness of telephone counseling in helping smokers quit. An analysis of 48 trials indicates a moderate effect (odds ratio about 1.4), with an obvious dose effect – i.e. more calls to the hotline proved more helpful.

Three or more treatments increased a person’s likelihood of quitting compared to simply getting self-help materials.

HYPNOSIS FOR WEIGHT LOSS

The evidence
There have been at least six different studies looking at the effects of hypnosis for weight loss. Like the majority of clinical applications of hypnosis, it is not a treatment in itself – but it can be added to other treatments for obesity such as cognitive behavioral therapy (CBT). The number of studies has been sufficient to perform a meta-analysis (literally a “study of studies”):

The first meta-analysis published by Kirsch, Montgomery & Saperstein in (1995) looked at six studies on obesity and concluded that “the addition of hypnosis significantly improved treatment outcomes”. They noted that participants in hypnosis groups performed particularly well in follow-up treatments, especially as they continued to lose weight after the treatment ended.

Allison & Faith (1996) have criticized the Kirsch et al (1995) study, noting that some of the reported effect sizes were extremely large and variable (both within and between studies), that long-term follow-up data only became available for one study (Bolocofsky et al, 1985), and that not all studies were conducted on obese patients.

They re-analyzed the original data and concluded that when hypnosis is added to CBT there is only a small increase in effect size. Looking at the wider literature, they concluded that “there is currently no silver bullet for the treatment of obesity and… hypnosis is no exception”.

In response to Allison & Faith’s (1996) re-analysis, Kirsch (1996) conducted an analysis of weight loss data using additional data obtained again from the authors of two of the original studies. He concluded that “the addition of hypnosis appeared to have a significant and substantial impact on the outcome of cognitive behavioral therapy treatment for weight loss”. He acknowledged that the amount of weight lost in hypnosis and control conditions in all studies is relatively small, but “nevertheless, the average weight loss reported in the five studies shows that hypnosis can double the effect of a cognitive behavioral therapy treatment”.

The table below shows weight loss (in kilograms) at follow-up (the last data collection point) for the five studies included in the Kirsch (1996) analysis.

The last column showing effect size is a standard measure that can compare how strong the effect of a treatment is (in this case hypnosis) across different studies. Cohen’s (1988) rule of thumb for effect sizes is that 0.2 is small, 0.5 is medium, and 0.8 is large (although these rules of thumb should be used with caution – especially when looking at results based on a relatively small number of participants).

Number of participants Weight loss (kg) at follow-up
The survey Hypnosis mode Control condition Hypnosis mode Control condition Effect size
Bornstein & Devine (1980) 9 9 6.12 3.48 0.67
Deyoub & Wilkie (1980) 17 18 2.72 2.40 0.11
Addan & Flaxman (1981) 10 10 2.08 2.76 -0.28
Bolocofsky et al (1985) 57 52 9.90 3.09 1.52
Barabasz & Spiegel (1989) 16 14 3.40 1.30 0.68
Average for all surveys 6.75 2.73 0.98

HYPNOSIS AND SURGERY

Hypnosis has a long tradition of involvement in surgery. Around the time of the first anesthesia, it was discovered that hypnosis had begun to be used by a number of surgeons to perform supposedly pain-free operations: in the early nineteenth century it was reported that James Braid, John Elliotson and James Esdaile had all successfully used hypnosis on surgical patients (Völgyesi, 1966).

With the development of ether and other anesthetics used in large quantities, a large number of patients who were previously put under hypnosis were put out of action.

In recent years, there has been a resurgence of interest in using hypnosis alongside modern anesthetics. Hypnosis can be used as a local anesthetic technique (where the patient is not unconscious, but is only locally anesthetized), or it can be used prior to a general anesthesia to reduce anxiety and promote well-being. A number of high-quality studies have looked at the use of hypnosis in surgery, and they will be explored further here.

Lang, Benotsch, Fick et al (2000)

Lang and colleagues conducted a randomized controlled trial on 241 patients undergoing surgery to the arteries, veins or kidneys. Three test treatments were compared: self-hypnosis relaxation, attention control and standard care. Approximately 80 patients were randomly assigned to each of these groups and a match was made for disease severity.

The surgery was performed under local anesthesia – patients were given Midazolam, which leaves them awake but sedated.

Standard treatment was as normal care.

The special attention control conditions meant that an additional member of the surgical team paid special attention to the patient’s needs, providing the feeling of control and quick response to patients’ requests.

The hypnotic condition meant that there was an additional member of the surgical team, and this additional member’s role was to provide extra attention, thereby alleviating a state of control, and additionally administering rapid hypnotic inductions – suggestions for a sense of floating and encouraging the patient to use their own developed imagery.

Pain, anxiety and drugs in use were assessed.

Surgery patients had access to a “patient controlled analgesia” device that delivered pain medication at the touch of a button – the amount delivered was recorded.

These graphs show the average pain and anxiety scores reported by patients in each of the three groups at the time of surgery.

The time taken to complete the procedure was significantly shorter in the hypnosis group compared to the standard treatment group with the extra attention between the groups.

Patients in the extra attention and standard care groups reported that their pain got steadily worse when the procedure started, but compared to patients in the hypnosis group, they continued to remain relatively pain-free over the same period.

Patients in the hypnosis and attention group requested and received approximately half the amount of pain medication that patients in the standard care group received.

Montgomery, Bovbjerg, Schnur et al (2007)

Montgomery and colleagues conducted a randomized controlled trial with a group of 200 women undergoing breast cancer surgery (biopsy or lumpectomy). montgomery2007

Patients were randomly assigned to a hypnosis group or an empathic listening group.

The hypnosis group received a 15-minute hypnosis session conducted by a psychologist in the hour before surgery (suggestions were given for relaxation, peace and reduced pain, nausea and fatigue), and the empathic listening group received a 15-minute unsupervised listening session with a psychologist before surgery (patients led the conversation and psychologist provided supportive/empathic comments).

Patients in the hypnosis group experienced significantly less pain, nausea, fatigue, discomfort and emotional disturbances, as can be seen in the graph above (data taken from the original paper).

Of six drugs (analgesics and tranquilizers) given to the patients during and after surgery, the hypnosis group patients needed significantly less than two of them and the same amounts as the others.

The authors measured the amount of time patients spent in the operating room and medication costs and determined that the total cost for patients in the hypnosis group was $17334, versus $24334 per patient in the attention group.

These figures demonstrate the cost-effectiveness of a brief pre-surgical hypnosis intervention.

If you are curious, feel free to write or call us and book an appointment. Contact us and I look forward to hearing from you. Mads Aggerholm.

Shin Hypnose

Melchiors Plads 4, st.
2100 København Ø

Phone: 31 65 84 33
shin@shinhypnose.dk

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