Why some doctors are reassessing hypnosis

TIMES AREIBSIBSCENCENCENCENIBSIBSIBSIBSCBT good in the hypnosis business. On YouTube, channels such as UltraHypnosis offer videos featuring candles, swirling patterns and slow voiceovers, with titles like “Hypnosis to Declutter your Mind Before Deep Sleep”. Some have tens of millions of views. At a recent conference of hypnosis experts in California, David Spiegel, one of the speakers, noted the success of his hypnosis app, “Reveri”, which has gained more than 214,000 users in the past year, and 650,000 since its launch in 2020.The internet is full of dubious “wellness” fads, from cold plunging to ionic foot baths. But Dr Spiegel, a psychiatrist at Stanford University, is not just another influencer on the make. He is one of a small, but growing, band of doctors and researchers who think that hypnosis, which many doctors regard as pseudoscience, has been unfairly maligned.Although the efficacy of hypnosis for most medical treatments has not been proved, for the management of pain and in some mental-health issues, the technique has demonstrated some intriguing results. Dr Spiegel, and his colleagues, are marshalling evidence from a growing pile of clinical trials that explore the effect hypnosis has on the brain, and which have tested it in everything from dulling pain in surgery and easing side-effects of cancer treatment to treating anxiety, irritable bowel syndrome () and depression. In a paper titled “Hypnosis: the most effective treatment you have yet to prescribe,” Dr Spiegel and Jessie (Kittle) Markovits, a doctor at the Stanford Medical Centre, argue that “If hypnosis were a drug, it would be standard of care.”Most advocates of hypnosis split the procedure into two parts. During the “induction”, patients are encouraged to focus on the hypnotist’s voice and a happy memory (such as relaxing on a beach). If all goes well, the result is a state not unlike being deeply immersed in a film: absorption and an altered perception of time.Next comes the “suggestion”, when the hypnotherapist tells the patient that a sharp pain actually feels like warmth, or that broccoli tastes like chocolate. Peter Whorwell, a British gastroenterologist who has written more than two dozen peer-reviewed research papers on and hypnosis, describes how patients with colitis, an inflammation of the large intestine, might be told to imagine that a hand is squeezing their gut, and then imagine the hand slowly relaxing.Mainstream scientists’ scepticism about hypnosis often starts with the question of mechanism—how do suggestions to a patient make them experience useful effects? Proponents of the technique are therefore deploying brain-imaging techniques to look for clues about what is going on inside the heads of people while they are being hypnotised.Changes in brain activity begin with induction, says Mathieu Landry, a neuroscientist at the University of Quebec at Trois-Rivieres and the author of a widely cited review of brain-imaging research related to hypnosis. He points in particular to increased activity in hypnotised people in the central executive network (), a collection of brain circuits known to be involved in regulating attention and focus. There also seems to be greater communication between parts of the and the insula, which helps to monitor and interpret signals coming from the body.The insula is part of the brain’s “salience network”, so named because it brings attention to important changes in the environment. It is involved in processing threats and making people feel scared or uneasy when appropriate—perceptions common with pain and phobias. Dr Spiegel thinks the increased communication between the and the insula might suggest that hypnotherapy allows the to exert more control over unpleasant emotions.Elsewhere in the salience network, hypnosis affects activity in the anterior cingulate cortex, a collar-shaped structure underneath the prefrontal cortex, which, among other things, helps direct a person’s attention, and which is crucial to the processing of pain, as well as of anticipation. There is some evidence that hypnosis also alters connections from the prefrontal cortex to a third brain area, the amygdala, which helps govern emotional responses. All these changes may relate to hypnosis’s ability to reduce anxiety and fear in the face of things—such as , say—that cause pain.Dr Markovits says that these lines of evidence point to the idea that hypnosis capitalises on the power of the brain to interpret what the body experiences. During hypnosis, she says, it may be possible to reprocess pain signals and therefore, literally, to “feel” less pain.All that is suggestive, if not quite conclusive. Clinical trials, which can be helpful in working out whether an intervention works even if its exact mode of action remains fuzzy, are another way that scientists have been gathering intriguing evidence on hypnosis.Take , which can cause uncontrolled bowel movements and daily pain. In 2015 Dr Whorwell found that, of 1,000 people with hard-to-treat , 67% reported a 30% or more reduction in abdominal pain from hypnotherapy. Of some 30 clinical trials, including at least 11 randomised controlled trials—the gold standard of medical evidence—most have concluded that hypnosis significantly improved symptoms.A scientific advisory body for the Belgian government, the Superior Health Council, concluded in a review in 2020 that, when it comes to treating depression and anxiety, hypnosis can make standard methods such as cognitive-behavioural therapy, a talking treatment, more potent. A meta-analysis—which combines the results from many similar studies—published in 2021, found that adding hypnosis to improved outcomes for 66% of patients suffering from depression, pain or obesity.Hypnosis has also been trialled alongside anaesthesia in major surgery. A clinical trial in 2020 looked at using a pair of different hypnosis techniques, alongside standard chemical anaesthesia, on 113 heart-surgery patients in a French hospital. Patients were “invited to focus on a red object” and then “mentally travel to a pleasant location”, before being taken deeper into relaxation and “a trancelike state”, as reported in a research paper published in an American cardiology journal. If that did not work, the patients were bombarded with questions aimed at “saturating the mind”, another induction technique. Both methods resulted in less pain and more sedation than the placebo, which meant that hypnotised patients needed less morphine.This run of encouraging results means medical interest in hypnotherapy is spreading, albeit slowly. Since 2015 all 30 of France’s university hospitals have been using hypnosis to manage pain; 20 offer it, in combination with local anaesthesia, as an alternative to general anaesthesia for some types of procedures that are deemed to have moderate levels of pain and risk. Dutch health authorities have trained radiologists to use hypnosis to help reassure women during screening for breast cancer. It is offered for pain management in the Bethesda Children’s Hospital in Budapest, which treats children with burns from across Hungary.While studies supporting the use of hypnosis in pain relief are generally of good quality, studies are not as robust, so far, for the use of hypnosis in smoking cessation or insomnia. Collecting evidence for those areas has to deal with the poor reputation of hypnosis more broadly. One problem, say supporters, is that hypnosis is often unregulated. It is illegal to pass oneself off as a doctor without having passed professional medical examinations but, in most countries, anyone can call themselves a hypnotist. The field is therefore prone to charlatans and chancers.There are other obstacles, too. If hypnosis were a drug, the results it has demonstrated in trials thus far, combined with the fact that it is relatively cheap and accessible through technology, would make it widely used, says Dr Markovits. But because it is not a drug, it is hard to make money from it.Guy Montgomery, a clinical psychologist at Mount Sinai hospital, in New York, published a study in 2007 looking at breast biopsies and “lumpectomies”, in which cancerous tissue is removed. He showed that hypnosis before surgery reduced the time the operations took, the side-effects experienced afterwards, and the need to prescribe sedatives and painkillers.At the time, he calculated the savings to the hospital as $772.71 per patient, and was sure other oncologists would follow his lead in using hypnosis for their patients. Almost two decades later, he remains disappointed. “Unlike pharmaceuticals,” he says, “the dollars don’t actually wind up in somebody’s pocket.”