Hypnotherapy

Hypnotherapy is therapy that is undertaken with a subject in hypnosis.

The word "hypnosis" is an abbreviation of James Braid's (1843) term "neuro-hypnotism", meaning "sleep of the nervous system".

A person who is hypnotized displays certain unusual characteristics and propensities, compared with a non-hypnotized subject, most notably hyper-suggestibility, which some authorities have considered a sine qua non of hypnosis. For example, Clark L. Hull, probably the first major empirical researcher in the field, wrote,

If a subject after submitting to the hypnotic procedure shows no genuine increase in susceptibility to any suggestions whatever, there seems no point in calling him hypnotised [...] (Hull, Hypnosis & Suggestion, 1933: 392)

Hypnotherapy is often applied in order to modify a subject's behavior, emotional content, and attitudes, as well as a wide range of conditions including dysfunctional habits, anxiety, stress-related illness, pain management, and personal development.

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Hypnotism versus Mesmerism

Hypnosis is often confused with Mesmerism, its historical precursor. As Hans Eysenck writes,

The terms ‘mesmerise’ and ‘hypnotise’ have become quite synonymous, and most people think of Mesmer as the father of hypnosis, or at least as its discoverer and first conscious exponent. Oddly enough, the truth appears to be that while hypnotic phenomena had been known for many thousands of years, Mesmer did not, in fact, hypnotise his subjects at all. […] It is something of a mystery why popular belief should have firmly credited him with a discovery which in fact was made by others. (Eysenck, Sense & Nonsense in Psychology, 1957: 30-31)

Franz Anton Mesmer held that trance and healing were the result of the channelling of a mysterious "occult" force called "animal magnetism." In the mid-Eighteenth Century, this became the basis of a very large and popular school of thought termed Mesmerism. However, in 1843, James Braid proposed the theory of hypnotism as a radical alternative, in opposition to Mesmerism. Braid argued that the occult qualities of Mesmerism were illusory and that its effects were due to a combination of "nervous fatigue" and verbal suggestion. A bitter war of words developed between Braid and the leading exponents of Mesmerism.

I beg farther to remark, if my theory and pretensions, as to the nature, cause, and extent of the phenomena of nervous sleep [i.e., hypnotism] have none of the fascinations of the transcendental to captivate the lovers of the marvellous, the credulous and enthusiastic, which the pretensions and alleged occult agency of the mesmerists have, still I hope my views will not be the less acceptable to honest and sober-minded men, because they are all level to our comprehension, and reconcilable with well-known physiological and psychological principles. (James Braid, Hypnotic Therapeutics, 1853: 36)

In their original committee report on hypnotherapy, the British Medical Association (BMA), likewise, made a point of condemning the occult theories of Mesmerism and sharply distinguishing them from hypnotism.

The Committee, having completed such investigation of hypnotism as time permitted, have to report that they have satisfied themselves of the genuineness of the hypnotic state. No phenomena which have come under their observation, however, lend support to the theory of ‘animal magnetism’. ('Report on Hypnotism', British Medical Journal, 1892).

Nevertheless, as Eysenck complains, the confusion of Mesmerism and hypnotism continued to be perpetuated by popular fiction, the media, and its portrayal in comedy stage hypnosis shows. Basically, whereas Mesmerism is a supernatural theory, hypnotism attempted to explain the same phenomena in more established scientific terms, by reference to psychology and physiology. As Braid puts it, it is a scientific and 'psycho-physiological' (mind-body) discipline.

Evidence for Hypnotherapy

Evidence from Systematic Reviews

In 1892, the British Medical Association (BMA) commissioned a team of doctors to undertake an extensive evaluation of the nature and effects of hypnotherapy, they reported,

The Committee, having completed such investigation of hypnotism as time permitted, have to report that they have satisfied themselves of the genuineness of the hypnotic state. (British Medical Journal, 1892)

Adding,

The Committee are of opinion that as a therapeutic agent hypnotism is frequently effective in relieving pain, procuring sleep, and alleviating many functional ailments [i.e., psycho-somatic complaints and anxiety disorders]. (Ibid.)

This report was approved by the general council of the BMA, thereby forming BMA policy and rendering hypnotherapy a form of "orthodox", as opposed to complementary or alternative, medicine.

Subsequent research on hypnotherapy has tended to highlight three main areas in which its efficacy as a treatment has been demonstrated,

1. Anxiety.
2. Insomnia.
3. Pain management.
4. Psycho-somatic disorder, i.e., stress-related illness.

Hypnotherapy. has many other applications but efficacy research has tended to focus upon these issues. More mixed results have been obtained for its efficacy in relation to the treatment of addictions, an area where high relapse is common with most treatments.

In 1955, the Psychological Medicine Group of the BMA commissioned a Subcommittee, led by Prof. T. Ferguson Rodger, to deliver a second, and more comprehensive, report on hypnosis. The Subcommittee consulted several experts on hypnosis from various fields, including the eminent neurologist Prof. W. Russell Brain, and the psychoanalyst Wilfred Bion. After two years of study and research, its final report was published in the British Medical Journal (BMJ), under the title ‘Medical use of Hypnotism’. The terms of reference were:

To consider the uses of hypnotism, its relation to medical practice in the present day, the advisability of giving encouragement to research into its nature and application, and the lines upon which such research might be organized. (BMA, 1955)

This is a much more thorough and extensive report, and constitutes one of the most significant documents in the history of hypnotherapy research. With regard to efficacy, it concludes from a systematic review of available research that,

The Subcommittee is satisfied after consideration of the available evidence that hypnotism is of value and may be the treatment of choice in some cases of so-called psycho-somatic disorder and Psychoneurosis. It may also be of value for revealing unrecognized motives and conflicts in such conditions. As a treatment, in the opinion of the Subcommittee it has proved its ability to remove symptoms and to alter morbid habits of thought and behavior. […]

In addition to the treatment of psychiatric disabilities, there is a place for hypnotism in the production of anesthesia or analgesia for surgical and dental operations, and in suitable subjects it is an effective method of relieving pain in childbirth without altering the normal course of labor. ('Medical use of hypnosis', BMJ, April, 1955)

According to a statement of proceedings published elsewhere in the same edition of the BMJ, the report was officially ‘approved at last week’s Council meeting of the British Medical Association.’ (BMA Council Proceedings, BMJ, April 23rd, 1955:1019). In other words, it was approved as official BMA policy. This statement goes on to say that,

For the past hundred years there has been an abundance of evidence that psychological and physiological changes could be produced by hypnotism which were worth study on their own account, and also that such changes might be of great service in the treatment of patients. (Loc. cit.)

Soon afterwards, in 1958, the American Medical Association (AMA) commissioned a similar (though more terse) report which endorses the 1955 BMA report and concludes,

That the use of hypnosis has a recognized place in the medical armamentarium and is a useful technique in the treatment of certain illnesses when employed by qualified medical and dental personnel. ('Medical use of hypnosis', JAMA, 1958).

Again, the AMA council approved this report rendering hypnotherapy an orthodox treatment,

The Reference Committee on Hygiene, Public Health, and Industrial Health approved the report and commended the Council on Mental Health for its work. The House of Delegates adopted the Reference Committee report […]. (AMA Proceedings, JAMA, Sep. 1958: 57, my italics)

In 1995, the National Institute for Health (NIH), in the US, established a Technology Assessment Conference that compiled an official statement entitled ‘Integration of Behavioral & Relaxation Approaches into the Treatment of Chronic Pain & Insomnia.’ This is an extensive report that includes a statement on the existing research in relation to hypnotherapy for chronic pain. It concludes that:

The evidence supporting the effectiveness of hypnosis in alleviating chronic pain associated with cancer seems strong. In addition, the panel was presented with other data suggesting the effectiveness of hypnosis in other chronic pain conditions, which include irritable bowel syndrome, oral mucositis [pain and swelling of the mucus membrane], temporomandibular disorders [jaw pain], and tension headaches. (NIH, 1995)

In 1999, the British Medical Journal (BMJ) published a Clinical Review of current medical research on hypnotherapy and relaxation therapies, it concludes,

• 'There is good evidence from randomized controlled trials that both hypnosis and relaxation techniques can reduce anxiety, particularly that related to stressful situations such as receiving chemotherapy.
• 'They are also effective for panic disorders and insomnia, particularly when integrated into a package of cognitive therapy (including, for example, sleep hygiene).
• 'A systematic review has found that hypnosis enhances the effects of cognitive behavioural therapy for conditions such as phobia, obesity, and anxiety.
• 'Randomized controlled trials support the use of various relaxation techniques for treating both acute and chronic pain, […].
• 'Randomized trials have shown hypnosis to be of value in asthma and in irritable bowel syndrome […].
• 'Relaxation and hypnosis are often used in cancer patients. There is strong evidence from randomized trials of the effectiveness of hypnosis and relaxation for cancer related anxiety, pain, nausea, and vomiting, particularly in children.' (Vickers & Zollman, 'Clinical Review: Hypnosis & Relaxation Therapies', BMJ, 1999)

In 2001, the Professional Affairs Board of the British Psychological Society (BPS) commissioned a working party of expert psychologists to publish a report entitled The Nature of Hypnosis. Its remit was 'to provide a considered statement about hypnosis and important issues concerning its application and practice in a range of contexts, notably for clinical purposes, forensic investigation, academic research, entertainment and training.' The report provides a concise (c. 20 pages) summary of the current scientific research on hypnosis. It opens with the following introductory remark:

Hypnosis is a valid subject for scientific study and research and a proven therapeutic medium. (BPS, 2001)

With regard to the therapeutic uses of hypnosis, the BPS arrive at much more positive conclusions.

Enough studies have now accumulated to suggest that the inclusion of hypnotic procedures may be beneficial in the management and treatment of a wide range of conditions and problems encountered in the practice of medicine, psychiatry and psychotherapy. (BPS, 2001)

The working party then provided an overview of some of the most important contemporary research on the efficacy of clinical hypnotherapy, which is summarized as follows (omitting their detailed references).

• 'There is convincing evidence that hypnotic procedures are effective in the management and relief of both acute and chronic pain and in assisting in the alleviation of pain, discomfort and distress due to medical and dental procedures and childbirth.
• 'Hypnosis and the practice of self-hypnosis may significantly reduce general anxiety, tension and stress in a manner similar to other relaxation and self-regulation procedures.
• 'Likewise, hypnotic treatment may assist in insomnia in the same way as other relaxation methods.
• 'There is encouraging evidence demonstrating the beneficial effects of hypnotherapeutic procedures in alleviating the symptoms of a range of complaints that fall under the heading 'psychosomatic illness.' These include tension headaches and migraine; asthma; gastro-intestinal complaints such as irritable bowel syndrome; warts; and possibly other skin complaints such as eczema, psoriasis and urticaria [hives].
• 'There is evidence from several studies that its [hypnosis'] inclusion in a weight reduction program may significantly enhance outcome.' (BPS, 'The Nature of Hypnosis', 2001)

Meta-analysis of Success Rates

In 2003, perhaps the most recent meta-analysis of the efficacy of hypnotherapy was published by two researchers from the university of Konstanze in Germany (Flammer & Bongartz). The study examined data on the efficacy of hypnotherapy across the board, though studies included mainly related to psychosomatic illness, test anxiety, smoking cessation and pain control during orthodox medical treatment. Most of the better research studies used traditional-style hypnosis, only a minority (19%) employed Ericksonian hypnosis.

The authors considered a total of 444 studies on hypnotherapy published prior to 2002. By selecting the best quality and most suitable research designs for meta-analysis they narrowed their focus down to 57 controlled trials. These showed that on average hypnotherapy achieved at least 64% success compared to 37% improvement among untreated control groups. (Based on the figures produced by binomial effect size display or BESD.)

According to the authors, however, this was meant as a deliberate underestimate. Their professed aim was to discover whether, even under the most skeptical weighing of the evidence, hypnotherapy was still proven effective. They showed conclusively that it was. In fact, their analysis of treatment designs concluded that expansion of the meta-analysis to include non-randomized trials for this data base would also produce reliable results. When all 133 studies deemed suitable in light of this consideration were re-analyzed, providing data for over 6,000 patients, the findings suggest an average improvement in 27% of untreated patients over the term of the studies compared with a 74% success rate among those receiving hypnotherapy. This is a high success rate given the fact that many of the studies measured included the treatment of addictions and medical conditions. The outcome rates for anxiety disorders alone, traditionally hypnotherapy's strongest application, were higher still (though a precise figure is not cited). (Flammer & Bongartz, 'On the efficacy of hypnosis: a meta-analytic study', Contemporary Hypnosis (2003), 179 – 197.)

History

Precursors of hypnotherapy have been seen in the sleep temples and mystery religions of ancient Graeco-Roman society, though analogies are often tenuous. Indeed, some parallels can be drawn between hypnotism and the trance-inducing rituals common to most pre-literate societies.

In the mid eighteenth century Franz Anton Mesmer introduced the concepts and techniques of animal magnetism. Mesmerism became an influential school of esoteric therapy and important Mesmerists like James Esdaile and John Elliotson helped maintain its popularity in medicine until the end of the nineteenth century when it experienced a kind of resurgence in the work of Jean-Martin Charcot, the father of modern neurology.

However, in the 1840s, Scottish physician James Braid, had already pioneered the concept of hypnotism as an opposing tradition to Mesmerism, based upon basic psychological and physiological mechanisms rather than the occult theories of animal magnetism. Braid's work was of limited influence in the UK but in France his ideas were developed into a more sophisticated psychological treatment. Hippolyte Bernheim began as a sceptic but became converted to the importance of hypnotism by observing the work of the celebrated country doctor Ambroise-Auguste Liébeault who rejected the theory of Mesmer and followed Abbe Faria. Emile Coué, a former clinical assistant to Liébeault, proposed a more collaborative and educational alternative to hypnosis called "conscious autosuggestion" which became very popular as a form of self-help in the 1920s.

An important rivalry and debate developed between the Salpetriere school of Charcot, which focused on physiological phenomena induced by Mesmeric practices, and the Nancy School of Bernheim which placed more emphasis upon psychology and verbal suggestion, following the later writings of Braid. However, Charcot's ideas on hypnosis were almost entirely discredited and Bernheim's school effectively won the debate, becoming the most significant precursor of modern psychological hypnotism.

Sigmund Freud was originally a proponent of hypnotherapy. He traveled to France to study hypnosis with the two great teachers of his day, Charcot at the Sapetriere and Bernheim's Nancy School. Freud wrote several articles on hypnotherapy and translated two of Bernheim's books on the subject from French into German. He originally employed hypnotherapy with a small number of clients in the 1890s. By about 1905, he had largely abandoned the procedure in favor of his newly-developed free association technique. However, Freud's description of the basic rule of free association still bears a striking resemblance to certain modern methods of hypnotic induction. Struggling with the great expense of time required for psychoanalysis to be successful, Freud later suggested that it might be combined with hypnotic suggestion once more in an attempt to hasten the outcome of treatment,

It is very probable, too, that the application of our therapy to numbers will compel us to alloy the pure gold of analysis plentifully with the copper of direct suggestion. (‘Lines of advance in psycho-analytic therapy’, 1919)

However, only a handful of Freud's followers were sufficiently qualified in hypnosis to attempt the synthesis, which resulted in a gradual resurgence in popularity of "hypno-analysis" or "hypnotic regression" methods of hypnotherapy.

Milton H. Erickson, M.D. is considered one of the most influential modern hypnotherapists. He has written many books, journals and articles on the subject, and his accomplishments are well-documented.

During the 1960s, Erickson was responsible for popularizing an entirely new branch of hypnotherapy, which we now call Ericksonian hypnotherapy, characterized by, amongst other things, indirect suggestion, confusion techniques, and double binds.

The popularity of Erickson's techniques has since led to the development of neuro-linguistic programming (NLP), which has in turn found use in modern-day sales, advertising, and corporate training. However, NLP has been criticized by many eminent hypnotists as a distortion of Erickson's work. For example, Andre Weitzenhoffer, a leading Stanford researcher and former colleague of Erickson, complained,

[...] Richard Bandler and John Grinder [the founders of NLP] have on the other hand, offered a much adulterated, and at times fanciful, version of what they perceived Erickson as saying or doing guided by their own personal theorising. (Weitzenhoffer, The Practice of Hypnotism, 2000: 592-593)

Training

Training requirements vary greatly worldwide with the key determining factor being whether the use of hypnotherapy is state-recognized in a given area. In many parts of the world there are no requirements and, in theory, anyone can name themselves a hypnotherapist and begin practicing. Other districts, however, to define and legislate for hypnotherapy and these qualifications vary greatly. In the most extreme cases, hypnotherapy is only allowed to be practiced by a qualified medical professional of an other area of expertise such as psychology, psychotherapy or psychiatry. This in effect rules out hypnotherapy as a stand-alone profession in the affected areas. Generally this strict approach is rare and in most parts of the world it's up to the individual to ensure their training is to a suitable standard.

Suitable training will generally last at least 1 year. Hypnotherapy is about working with people - in a college environment you have the opportunity to practice on all your fellow class mates and teachers, with full support whilst you are doing it. Any errors can be picked up when being observed. This can iron out any bad habits you may be developing. This experiential approach to hypnotherapeutic training is essential in order to be able to work effectively with clients in a real therapeutic setting.

Hypnotherapy As A Profession

As the use and public understanding of hypnotherapy increases, more and more people are becoming attracted to the profession. Three main categories of hypnotist can be considered:

• Professional consultants of medical/psychological qualification who use hypnosis as a therapeutic approach, usually amongst other methods.
• Professional hypnotherapists who specialise primarily in the use of hypnosis, if other techniques are used they are only to compliment the hypnotic approach.
• Stage hypnotists who utilise hypnosis for the purpose of entertainment and may also offer limited therapuetic assistance, although not usually for more serious matters such as depression or chronic anxiety.

Having a career as a hypnotherapist can be lucrative however the extent of a hypnotherapist's fees are often due to the very high overheads in running a practise. Pricing can vary greatly and some of the key factors that drive up pricing are as follows:

• Unlike other therapists who enroll clients into ongoing therapy that can last months or years, a hypnotherapist often only sees clients for few sessions. This means the cost of advertising and marketing is significantly higher as new clients are almost always needed.
• The health insurance companies of many countries still do not cover hypnosis under health-cover, making the approach less-appealing for those of a lower-income and in turn reducing the potential client-base for a hypnotherapist.
• The profile of a hypnotherapist is often a key factor in pricing. Unlike other therapies, hypnotherapy can often have a celebrity-factor attached to it. People who recognise a well-known hypnotherapist with a well-known record in achieving success are likely to pay a lot more because of the trust they place in such individuals. This sector of hypnotherapy represents only a small number of hypnotherapists. Some would argue that this is unfair, others would make the point that it is no different to any other form of high-end consultancy and if people are willing to pay the premium for exclusivity then that is their right.

Being a hypnotherapist generally requires good business skills as most hypnotherapists are self-employed and are relient on their own actions to generate new clients.

When it comes to becoming a hypnotherapist, training requirements and state registration requirements vary greatly around the world, ranging from no qualifications being required to pracitse right up to needing to be a state-certified professional in the field of mental health. Those interested in becoming a hypnotherapist should first research the laws in their district and then consider joining a professional organisation that can guide them in proper training and offer a central code of ethics and disciplinary procedure that they can commit to. This provides assurance to clients and a good ethical framework for the therapist in question.

Licensing Boards

USA

• National Board for Certified Clinical Hypnotheraphists: Organized in 1991, the NBCCH certifies professional in the field of hypnotheraphy

• American Council of Hypnotist Examiners: Organized in 1980, ACHE certifies examiners worldwide

United Kingdom

• General Hypnotherapy Standards Council: registers and represents UK based hypnotherapy organisations

Indian Restriction

The Ministry of Health & Family Welfare, Government of India, vide its letter no.R.14015/25/96-U&H(R) (Pt.) dated 25th November, 2003, has very categorically stated that hypnotherapy is a recognized mode of therapy in India to be practiced by only appropriately trained Personnel.

Code for commercial advertising on Doordarshan and All India Radio states that “No advertisement should contain any offer to diagnose or treat complaints or conditions by hypnosis"

UK National Occupational Standards

In 2002 UK Department for Education and Skills developed The National Occupational Standards for hypnotherapy linked to National Vocational Qualification based on National Qualifications Framework under The Qualifications and Curriculum Authority. And thus hypnotherapy was approved as a stand-alone therapy in UK.

Working Group for Hypnotherapy Regulation (United Kingdom)

Moves toward Voluntary Self Regulation in the U.K. hypnotherapy field have led to the formation of a unitary national register which is a one stop resource for members of the public and the National Health Service. The Register currently holds approximately 4,100 entries and is known as the National Regulatory Register for Hypnotherapy. The Working Group for Hypnotherapy Regulation is formed of more than 20 professional organisations that have chosen to work together to progress Voluntary Self Regulation in hypnotherapy and to create agreed standards in all aspects of the profession.

U.S.A.Definition for Hypnotherapist

The U.S. (Department of Labor) Directory of Occupational Titles (D.O.T. 079.157.010) supplies the following definition:

"Hypnotherapist -- Induces hypnotic state in client to increase motivation or alter behavior pattern through hypnosis. Consults with client to determine the nature of problem. Prepares client to enter hypnotic states by explaining how hypnosis works and what client will experience. Tests subject to determine degrees of physical and emotional suggestibility. Induces hypnotic state in client using individualized methods and techniques of hypnosis based on interpretation of test results and analysis of client's problem. May train client in self-hypnosis conditioning.

The Department of Health in the state of Washington regulates hypnotherapists

Techniques

• Age regression - by returning to an earlier ego-state the patient can regain qualities they once had, but have lost.^{[citation needed]} Remembering an earlier, healthier, ego-state can increase the patients' strength and confidence.^{[citation needed]}
• Revivification - remembering past experiences can contribute to therapy.^{[citation needed]} For example; the hypnotist may ask "have you ever been in trance?" and then find it easier to revive the previous experience than attempt inducing a new state.
• Guided imagery - a method by which the subject is given a new relaxing and beneficial experience.
• Parts therapy - a method pioneered by Charles Tebbetts to identify conflicting parts that are damaging the well being of clients, then helps those parts negotiate with each other through the therapist to bring about a resolution.^{[citation needed]}
• Confusion - a method developed by Milton H. Erickson in which the subject is more likely to be receptive to indirect suggestion due to an altered state of confusion.
• Repetition - the more an idea is repeated the more likely it is to be accepted and acted upon by the patient.^{[citation needed]}
• Direct suggestion - suggesting directly. "You feel safe and secure".
• Indirect suggestion - using "interspersal" technique and other means to cause effect.
• Mental state - people are more receptive while relaxed, sleeping, or in a trance.
• Hypnoanalysis - the client recalls moments from his past, confronting them and releasing associated emotions, similar to psychoanalysis.
• Post-hypnotic suggestion - a suggestion that will be carried out^{[citation needed]} after the trance has ended. "When you re-awaken you will feel refreshed and happy!"
• Visualization - being told to imagine or visualize a desired outcome seems to make it more likely to actually occur.

Hypnotherapy in pop culture

• The progressive metal band Dream Theater released a concept album in 1999 about a character named Nicholas who believes to have led a past life. He starts to take hypnotherapy sessions to try to solve this intricate mystery. There are hypnotherapist voiceovers in various songs on the album, as the doctor takes a supportive role in Nicholas' journey into the past.
• In the X-Files episode "The Field Where I Died", there are two long hypnotherapy sessions in which Mulder and another character recount their past life as citizens of Nazi Germany and later participants in the American Civil War. Hypnotherapy is used in several other episodes too, when Mulder tries to recall the abduction of his sister, and when Scully tries to recall her own abduction.

See also

• Atavistic regression
• Autogenic training
• Hypnomotivationalism
• Hypnosis
• Hypnosurgery
• Physical and Emotional Suggestibility and Sexuality
• Psychotherapy
• Subconscious mind
• Suggestibility

References

• BBC Database

Hypnotherapy FAQS