Hypnotherapy

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Hypnotherapy, also known as hypnotic medicine, [1] is the use of hypnosis in psychotherapy. [2] [3] The efficacy of hypnotherapy is not well supported by scientific evidence, [1] [4] [5] and, due to the lack of evidence indicating any level of efficacy, [6] it is regarded as a type of alternative medicine by reputable medical organisations such as the National Health Service. [7]

Contents

Definition

The United States Department of Labor's Dictionary of Occupational Titles (DOT) describes the job of the hypnotherapist:

"Induces hypnotic state in client to increase motivation or alter behavior patterns: Consults with client to determine nature of problem. Prepares client to enter hypnotic state by explaining how hypnosis works and what client will experience. Tests subject to determine degree 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." [8]

Traditional

The form of hypnotherapy practiced by most Victorian hypnotists, including James Braid and Hippolyte Bernheim, mainly employed direct suggestion of symptom removal, with some use of therapeutic relaxation and occasionally aversion to alcohol, drugs, etc. [9]

Ericksonian

In the 1950s, Milton H. Erickson developed a radically different approach to hypnotism, which has subsequently become known as "Ericksonian hypnotherapy" or "Neo-Ericksonian hypnotherapy." Based on his belief that dysfunctional behaviors were defined by social tension, Erickson coopted the subject's behavior to establish rapport, a strategy he termed "utilization." Once rapport was established, he made use of an informal conversational approach to direct awareness. His methods included complex language patterns and client-specific therapeutic strategies (reflecting the nature of utilization). He claimed to have developed ways to suggest behavior changes during apparently ordinary conversation. [10]

This divergence from tradition led some, including Andre Weitzenhoffer, to dispute whether Erickson was right to label his approach "hypnosis" at all. [11] Erickson's foundational paper, however, considers hypnosis as a mental state in which specific types of "work" may be done, rather than a technique of induction. [12]

The founders of neuro-linguistic programming (NLP), a method somewhat similar in some regards to some versions of hypnotherapy, claimed that they had modelled the work of Erickson extensively and assimilated it into their approach. [13] [14] Weitzenhoffer disputed whether NLP bears any genuine resemblance to Erickson's work. [11]

Solution-focused

In the 2000s, hypnotherapists began to combine aspects of solution-focused brief therapy (SFBT) with Ericksonian hypnotherapy to produce therapy that was goal-focused (what the client wanted to achieve) rather than the more traditional problem-focused approach (spending time discussing the issues that brought the client to seek help). A solution-focused hypnotherapy session may include techniques from NLP. [15]

Cognitive/behavioral

Cognitive behavioral hypnotherapy (CBH) is an integrated psychological therapy employing clinical hypnosis and cognitive behavioral therapy (CBT). [16] The use of CBT in conjunction with hypnotherapy may result in greater treatment effectiveness. A meta-analysis of eight different researches revealed "a 70% greater improvement" for patients undergoing an integrated treatment to those using CBT only. [17]

In 1974, Theodore X. Barber and his colleagues published a review of the research which argued, following the earlier social psychology of Theodore R. Sarbin, that hypnotism was better understood not as a "special state" but as the result of normal psychological variables, such as active imagination, expectation, appropriate attitudes, and motivation. [18] Barber introduced the term "cognitive-behavioral" to describe the nonstate theory of hypnotism, and discussed its application to behavior therapy.

The growing application of cognitive and behavioral psychological theories and concepts to the explanation of hypnosis paved the way for a closer integration of hypnotherapy with various cognitive and behavioral therapies. [19]

Many cognitive and behavioral therapies were themselves originally influenced by older hypnotherapy techniques, [20] e.g., the systematic desensitisation of Joseph Wolpe, the cardinal technique of early behavior therapy, was originally called "hypnotic desensitisation" [21] and derived from the Medical Hypnosis (1948) of Lewis Wolberg. [22]

Curative

Peter Marshall, author of A Handbook of Hypnotherapy, devised the Trance Theory of Mental Illness, which asserts that people suffering from depression, or certain other kinds of neuroses, are already living in a trance. He asserts that this means the hypnotherapist does not need to induce trance, but instead to make them understand this and lead them out of it. [23]

Mindful

Mindful hypnotherapy is therapy that incorporates mindfulness and hypnotherapy. A pilot study was made at Baylor University, Texas, and published in the International Journal of Clinical and Experimental Hypnosis. Gary Elkins, director of the Mind-Body Medicine Research Laboratory at Baylor University called it "a valuable option for treating anxiety and stress reduction” and "an innovative mind-body therapy". The study showed a decrease in stress and an increase in mindfulness. [24]

Relationship to scientific medicine

Hypnotherapy practitioners occasionally attract the attention of mainstream medicine. Attempts to instill academic rigor have been frustrated by the complexity of client suggestibility, which has social and cultural aspects, including the reputation of the practitioner. Results achieved in one time and center of study have not been reliably transmitted to future generations. [25]

In the 1700s Anton Mesmer offered pseudoscientific justification for his practices, but his rationalizations were debunked by a commission that included Benjamin Franklin.

Uses

Clinicians choose hypnotherapy to address a wide range of circumstances; however, according to Yeates (2016), people choose to have hypnotherapy for many other reasons:

"Ignoring specific issues such as performance anxiety, road rage, weight, smoking, drinking, unsafe sex, etc., those seeking hypnotherapy today do so because of ill-defined, vague feelings that: (a) their health is far from optimal; (b) their worry about past/present/future events is excessive and debilitating; (c) they are not comfortable with who they are; (d) they're not performing up to the level of their true potential; and/or (e) their lives are lacking some significant (but unidentified) thing." [26]

Menopause

There is evidence supporting the use of hypnotherapy in the treatment of menopause related symptoms, including hot flashes. [27] [28] [29] The North American Menopause Society recommends hypnotherapy for the nonhormonal management of menopause-associated vasomotor symptoms, giving it the highest level of evidence. [30]

Irritable bowel syndrome

The use of hypnotherapy in treating the symptoms of irritable bowel syndrome is supported by research, including randomized controlled trials. [31] [32] [33] [34] A 2015 audit of 1000 patients undertaking gut-focused hypnotherapy in normal clinical practice found that hypnotherapy was an effective intervention for refractory IBS. [35] Gut-directed hypnotherapy is recommended in the treatment of irritable bowel syndrome by the American College of Gastroenterology clinical guideline for the management of IBS. [36]

Childbirth

Hypnotherapy is often applied in the birthing process and the post-natal period, [37] [38] [39] [40] [41] but there is insufficient evidence to determine if it alleviates pain during childbirth [42] [43] and no evidence that it is effective against post-natal depression. [44]

Bulimia

Literature shows that a wide variety of hypnotic interventions have been investigated for the treatment of bulimia nervosa, with inconclusive effect. [45] Similar studies have shown that groups suffering from bulimia nervosa, undergoing hypnotherapy, were more exceptional to no treatment, placebos, or other alternative treatments. [45]

Anxiety

Hypnotherapy is shown to be comparable in effectiveness to other forms of therapy, such as cognitive-behavioral therapy, that utilize relaxation techniques and imagery. [46] It has also shown to be successful when used to reduce anxiety in those with dental anxiety and phobias. [47]

PTSD

Professor Charcot, his students, and a woman experiencing hysteria. Pr Charcot DSC09405.jpg
Professor Charcot, his students, and a woman experiencing hysteria.

Post Traumatic Stress Disorder (PTSD) and its symptoms have been shown to improve due to implementation of hypnotherapy, in both long and short term. [48] As research continues, hypnotherapy is being more openly considered as an effective intervention for those with PTSD. [49]

Depression

Hypnotherapy has been shown to be effective when used to treat long term depressive symptoms. It has been shown to be comparable to the efficacy of cognitive-behavioral therapy, and when used in tandem, efficacy seems to increase. [50]

Other uses

Among its many other applications in other medical domains, [51] hypnotism was used therapeutically, by some alienists in the Victorian era, to treat the condition then known as hysteria. [52]

Modern hypnotherapy is widely accepted for the treatment of certain habit disorders, to control irrational fears, [53] [54] as well as in the treatment of conditions such as insomnia [55] and addiction. [56] Hypnosis has also been used to enhance recovery from non-psychological conditions such as after surgical procedures, [57] in breast cancer care [58] and even with gastro-intestinal problems. [59]

Efficacy

Occupational accreditation

United States

The laws regarding hypnosis and hypnotherapy vary by state and municipality. Some states, like Colorado, Connecticut and Washington, have mandatory licensing and registration requirements, while many other states have no specific regulations governing the practice of hypnotherapy. [66]

United Kingdom

UK National Occupational Standards

In 2002, the Department for Education and Skills developed National Occupational Standards for hypnotherapy [67] linked to National Vocational Qualifications based on the then National Qualifications Framework under the Qualifications and Curriculum Authority. NCFE, a national awarding body, issues level four national vocational qualification diploma in hypnotherapy. Currently AIM Awards offers a Level 3 Certificate in Hypnotherapy and Counselling Skills at level 3 of the Regulated Qualifications Framework. [68]

UK Confederation of Hypnotherapy Organisations (UKCHO)

The regulation of the hypnotherapy profession in the UK is at present the main focus of UKCHO, a non-profit umbrella body for hypnotherapy organisations. Founded in 1998 to provide a non-political arena to discuss and implement changes to the profession of hypnotherapy, UKCHO currently represents 9 of the UK's professional hypnotherapy organisations and has developed standards of training for hypnotherapists, along with codes of conduct and practice that all UKCHO registered hypnotherapists are governed by. As a step towards the regulation of the profession, UKCHO's website now includes a National Public Register of Hypnotherapists [69] who have been registered by UKCHO's Member Organisations and are therefore subject to UKCHO's professional standards. Further steps to full regulation of the hypnotherapy profession will be taken in consultation with the Prince's Foundation for Integrated Health.

The National Council for Hypnotherapy (NCH)

The National Council for Hypnotherapy is a Professional Association, established in 1973 to create a National Membership Organisation for independent Hypnotherapy Practitioners.

The organisation is not for profit with a Board of 12-15 people composed of Executives and Directors, the latter usually ‘in practice’ Hypnotherapists and trainers of Hypnotherapy. The current Chair, Tracey Grist has been in position since 2016.

The NCH is a VO (Verifying organisation) for the CNHC, which means that NCH members meet the criteria to become Registrants of the CNHC.

The NCH membership meet the national hypnotherapy training standards via the externally verified Hypnotherapy practitioner Diploma (HPD) through the NCFE.

Members agree to follow the CECP; the NCH’s ethical code of practice, all members are expected to be insured to practice, meet supervision requirements and annual CPD expectations. [70]

Australia

Professional hypnotherapy and use of the occupational titles hypnotherapist or clinical hypnotherapist are not government-regulated in Australia.

In 1996, as a result of a three-year research project led by Lindsay B. Yeates, the Australian Hypnotherapists Association (founded in 1949), the oldest hypnotism-oriented professional organization in Australia, instituted a peer-group accreditation system for full-time Australian professional hypnotherapists, the first of its kind in the world, which "accredit[ed] specific individuals on the basis of their actual demonstrated knowledge and clinical performance; instead of approving particular 'courses' or approving particular 'teaching institutions'" (Yeates, 1996, p.iv; 1999, p.xiv). [71] The system was further revised in 1999. [72]

Australian hypnotism/hypnotherapy organizations (including the Australian Hypnotherapists Association) are seeking government regulation similar to other mental health professions. However, currently hypnotherapy is not subject to government regulation through the Australian Health Practitioner Regulation Agency (AHPRA).

See also

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

<span class="mw-page-title-main">Hypnosis</span> State of increased receptivity to suggestion and direction

Hypnosis is a human condition involving focused attention, reduced peripheral awareness, and an enhanced capacity to respond to suggestion.

<span class="mw-page-title-main">Insomnia</span> Disorder causing trouble with sleeping

Insomnia, also known as sleeplessness, is a sleep disorder where people have trouble sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, irritability, and a depressed mood. It may result in an increased risk of accidents of all kinds as well as problems focusing and learning. Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month. The concept of the word insomnia has two possibilities: insomnia disorder (ID) and insomnia symptoms, and many abstracts of randomized controlled trials and systematic reviews often underreport on which of these two possibilities the word insomnia refers to.

<span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

<span class="mw-page-title-main">Milton H. Erickson</span> American psychiatrist (1901–1980)

Milton Hyland Erickson was an American psychiatrist and psychologist specializing in medical hypnosis and family therapy. He was the founding president of the American Society for Clinical Hypnosis. He is noted for his approach to the unconscious mind as creative and solution-generating. He is also noted for influencing brief therapy, strategic family therapy, family systems therapy, solution focused brief therapy, and neuro-linguistic programming.

Suggestibility is the quality of being inclined to accept and act on the suggestions of others. One may fill in gaps in certain memories with false information given by another when recalling a scenario or moment. Suggestibility uses cues to distort recollection: when the subject has been persistently told something about a past event, his or her memory of the event conforms to the repeated message.

<span class="mw-page-title-main">Irritable bowel syndrome</span> Functional gastrointestinal disorder

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by a group of symptoms that commonly include abdominal pain, abdominal bloating and changes in the consistency of bowel movements. These symptoms may occur over a long time, sometimes for years. IBS can negatively affect quality of life and may result in missed school or work or reduced productivity at work. Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.

<span class="mw-page-title-main">Fibromyalgia</span> Chronic pain of unknown cause

Fibromyalgia is a medical condition which causes chronic widespread pain, accompanied by fatigue, waking unrefreshed, and cognitive symptoms. Other symptoms include headaches, lower abdominal pain or cramps, and depression. People with fibromyalgia can also experience insomnia and a general hypersensitivity.

Self-hypnosis or auto-hypnosis is a form, a process, or the result of a self-induced hypnotic state.

Generalized anxiety disorder (GAD) is a mental and behavioral disorder, specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning, and individuals with GAD are often overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work difficulties. Symptoms may include excessive worry, restlessness, trouble sleeping, exhaustion, irritability, sweating, and trembling.

Mind–body interventions (MBI) or mind-body training (MBT) are health and fitness interventions that are intended to work on a physical and mental level such as yoga, tai chi, and Pilates.

Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances.

The development of concepts, beliefs and practices related to hypnosis and hypnotherapy have been documented since prehistoric to modern times.

Therapeutic effect refers to the response(s) after a treatment of any kind, the results of which are judged to be useful or favorable. This is true whether the result was expected, unexpected, or even an unintended consequence. An adverse effect is the converse and refers to harmful or undesired response(s). What constitutes a therapeutic effect versus a side effect is a matter of both the nature of the situation and the goals of treatment. No inherent difference separates therapeutic and undesired side effects; both responses are behavioral/physiologic changes that occur as a response to the treatment strategy or agent.

Hypnosurgery is surgery where the patient is sedated using hypnotherapy rather than traditional anaesthetics. It is claimed that hypnosis for anaesthesia has been used since the 1840s where it was pioneered by the surgeon James Braid. There are occasional media reports of surgery being conducted under hypnosis, but since these are not carried out under controlled conditions, nothing can be concluded from them.

Age regression in therapy is a psycho-therapeutic process that aims to facilitate access to childhood memories, thoughts, and feelings. Age regression can be induced by hypnotherapy, which is a process where patients move their focus to memories of an earlier stage of life in order to explore these memories or to access difficult aspects of their personality.

Cocaine dependence is a neurological disorder that is characterized by withdrawal symptoms upon cessation from cocaine use. It also often coincides with cocaine addiction which is a biopsychosocial disorder characterized by persistent use of cocaine and/or crack despite substantial harm and adverse consequences. The Diagnostic and Statistical Manual of Mental Disorders, classifies problematic cocaine use as a "Stimulant use disorder". The International Classification of Diseases, includes "Cocaine dependence" as a classification (diagnosis) under "Disorders due to use of cocaine".

<span class="mw-page-title-main">Gil Boyne</span> American hypnotherapist (1924–2010)

Mark Thomas Gilboyne, nom de guerreGil Boyne, was an American pioneer in modern hypnotherapy.

Metacognitive therapy (MCT) is a psychotherapy focused on modifying metacognitive beliefs that perpetuate states of worry, rumination and attention fixation. It was created by Adrian Wells based on an information processing model by Wells and Gerald Matthews. It is supported by scientific evidence from a large number of studies.

<span class="mw-page-title-main">Hypnoanalysis</span>

Hypnoanalysis is the technique of using hypnosis in the practice of psychoanalysis and psychotherapy. It attempts to utilize the trance state induced by hypnosis to effect a conscious understanding of a person's unconscious psychodynamics.

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