Hypnotherapy

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Hypnotherapy is a type of alternative medicine in which hypnosis is used to create a state of focused attention and increased suggestibility during which positive suggestions and guided imagery are used to help individuals deal with a variety of concerns and issues.

Definition[edit]

A hypnotherapist uses non-pharmacological methods that allow clients to explore states of mind. Classically, the most common is the dominant brain wave state using relaxation techniques including deep breathing and self-awareness. Those methods reduce agitation and eventually bring the client to the edge of sleep. In that state, the "conscious" social identity that weighs experience is balanced with the "subconscious" mind that manages physiology and automatic behaviors. Other shifts in mental state affect brain bilaterality (right and left hemisphere activation) and development of expectations (creation of resource states). In Ericksonian practice (see below) clinicians may access memory and perception, and install post-suggestions that trigger hallucinations in waking life.[1]

A skilled hypnotherapist cultivates the optimum state to offer suggestions that facilitate the client's behavioral goals. After consensus is established in waking dialog, the therapist is trusted to articulate those goals, and the hypnotized mind is receptive to new behaviors. As the brain influences every aspect of our existence, applications range from the psychological to the medical to the spiritual.

Hypnosis is a natural state most readily activated through an experience that overwhelms rational thinking. Such experiences range from ecstasy to terror to simple exhaustion (the used car lot, familiarly, but also chronic anxiety). The conscious mind (around 10% of our mental processing) remains active but is thrust aside while the subconscious reacts to events. Hypnosis can also occur when a doctor announces a life-threatening illness. In all cases, the statements of the first authority encountered are accepted by the deepest parts of the mind, having a profound affect on outcomes.[2]

Given this natural prevalence, causes of behavioral difficulties can be difficult to trace. When they are known, some hypnotherapists seek closure through confrontation with the original memories; others prefer to cultivate success in vivo, replacing negative expectations with positive experience, thereby empowering the client to lead a fulfilled life.

Recognizing that frustration of conscious goals results from automatic reactions, the sophisticated hypnotherapist cultivates a return dialog with the subconscious. Techniques include dream incubation, handwriting analysis, journaling, ideomotor response, and imagery journeys that incorporate choice.

The United States' Federal Dictionary of Occupational Titles 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."

GOE: 10.02.02 STRENGTH: S GED: R4 M3 L4 SVP: 7 DLU: 77"[3] (This definition was created in 1973 by John Kappas, hypnotherapist and founder of the Hypnosis Motivation Institute.[4][5])

History[edit]

Modern hypnotherapy has its roots in Catholic exorcism. Anton Mesmer offered pseudoscientific justification for the practices, but his rationalizations were debunked by a commission that included Benjamin Franklin. Individual practitioners kept the methods alive, occasionally attracting the attention of mainstream medicine. However, attempts to instill academic rigor were frustrated by the complexity of client suggestibility, which has cultural aspects, including the reputation of the practitioner. Results achieved in one center of study were not reliably transmitted to future generations.[6]

Traditional hypnotherapy[edit]

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.[7]

Ericksonian hypnotherapy[edit]

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." Given that dysfunctional behaviors are 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). This divergence from tradition led some, including Andre Weitzenhoffer, to dispute whether Erickson was right to label his approach "hypnosis" at all.[8] 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.[9]

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.[10][11] Weitzenhoffer disputed whether NLP bears any genuine resemblance to Erickson's work.[8]

Kappasinian hypnotherapy[edit]

John Kappas attained his orientation to hypnosis from stage practice whose exponents assumed that only half the population could be hypnotized. Through practical experience, Kappas realized that direct suggestion was resisted by the half of the population that is left-brain dominant (analytical). This led Kappas into a lifetime of study of suggestibility, drawing upon personal experience treating tens of thousands of clients. Those cases covered both behavioral and psychological disorders. In recorded training seminars from the seventies, Kappas frequently stated that psychosis was due to hypersuggestibility - a chronic state of hypnosis - that makes the client unable to distinguish real and imaginary experiences.

The dominant factor in suggestibility is brain bilaterality (left/right dominance, generating respectively the "Emotional" and "Physical" patterns of behavior). Kappas saw hemispheric dominance as arising from nurturance, with natural complementarity arising between mother and infant. Preferential laterality carries through to our mature relationships, where we seek similar friends but complementary partnerships. Unfortunately, dysfunctional partnerships tend to exacerbate laterality, leading to alienation. Extending these insights to sexual behavior, Kappas was a successful marital therapist.

Kappas characterized hypnosis as a state of mind - our ideal learning state. Kappasinian therapy is built upon theories of personality development, most respectably the Ericksons' Stages of Development. The stages are extended with accessible theories of the subconscious and mind-body syndromes. These elements are introduced in dialog to increase client receptivity to suggestion.

Solution-focused hypnotherapy[edit]

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.[12]

Cognitive/behavioral hypnotherapy[edit]

Cognitive behavioural hypnotherapy (CBH) is an integrated psychological therapy employing clinical hypnosis and cognitive behavioural therapy (CBT).[13] 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.[14]

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.[15] 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.[16]

Many cognitive and behavioral therapies were themselves originally influenced by older hypnotherapy techniques,[17] e.g., the systematic desensitisation of Joseph Wolpe, the cardinal technique of early behavior therapy, was originally called "hypnotic desensitisation"[18] and derived from the Medical Hypnosis (1948) of Lewis Wolberg.[19]

Curative hypnotherapy[edit]

David Lesser[20] (1928–2001) was the originator of what is today known by the term "curative hypnotherapy".[21] It was he who first saw the possibility of finding the causes of people's symptoms by using a combination of hypnosis, IMR and a method of specific questioning that he began to explore. Rather than try to override the subconscious information as Janet had done, he realised the necessity- and developed the process- to correct the wrong information. Lesser's understanding of the logicality and simplicity of the subconscious led to the creation of the methodical treatment used today and it is his work and understanding that underpins the therapy and is why the term "Lesserian"[22] was coined and trademarked. As the understanding of the workings of the subconscious continues to evolve, the application of the therapy continues to change. The three most influential changes have been in Specific Questioning (1992) to gain more accurate subconscious information; a subconscious cause/effect mapping system (SRBC)(1996) to streamline the process of curative hypnotherapy treatment; and the 'LBR Criteria' (2003) to be able to differentiate more easily between causal and trigger events and helping to target more accurately the erroneous data which requires reinterpretation.

Hypnotherapy expert Dr. Peter Marshall, former Principal of the London School of Hypnotherapy and Psychotherapy Ltd. and author of A Handbook of Hypnotherapy, devised the Trance Theory of Mental Illness, which provides that people suffering from depression, or certain other kinds of neuroses, are already living in a trance and so the hypnotherapist does not need to induce them, but rather to make them understand this and help lead them out of it.[23][24]

Mindful hypnotherapy[edit]

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. Dr. 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.[25]

Uses[edit]

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]

Smoking[edit]

The hypnotherapy has in terms of smoking cessation a greater effect on six-month quit rates than other interventions,.[27]

Childbirth[edit]

Hypnotherapy is often applied in the birthing process and the post-natal period,[28][29][30][31][32][33] but there is insufficient evidence to determine if it alleviates pain during childbirth[34] and no evidence that it is effective against post-natal depression.[35] Until 2012, there was no thorough research on this topic. However, in 2013 the study was conducted during which it was found that: “The use of hypnosis in childbirth leads to a decrease in the amount of pharmacological analgesia and oxytocin used, which reduces the duration of the first stage of labor”.[36] In 2013, studies were conducted in Denmark, during which it was concluded that "The self-hypnosis course improves the experience of childbirth in women and also reduces the level of fear".[37] In 2015, a similar study was conducted in the UK by a group of researchers: "The positive experience of self-hypnosis gives a sense of calm, confidence and empowerment in childbirth".[38] The hypnobirthing is used by stars such as Kate Middleton.[39]

Bulimia[edit]

Literature shows that a wide variety of hypnotic interventions have been investigated for the treatment of bulimia nervosa, with inconclusive effect.[40] Similar studies have shown that groups suffering from bulimia nervosa, undergoing hypnotherapy, were more exceptional to no treatment, placebos, or other alternative treatments.[40]

Other uses[edit]

Among its many other applications in other medical domains,[41] hypnotism was used therapeutically, by some alienists in the Victorian era, to treat the condition then known as hysteria.[42]

Modern hypnotherapy is widely accepted for the treatment of certain habit disorders, to control irrational fears,[43][44] as well as in the treatment of conditions such as insomnia[45] and addiction.[46] Hypnosis has also been used to enhance recovery from non-psychological conditions such as after surgical procedures,[47] in breast cancer care[48] and even with gastro-intestinal problems,[49] including IBS.[50][51]

Efficacy[edit]

Controlled study of hypnotherapy is frustrated by the complexity of behavioral expression. Most controlled studies use scripts that do not account for suggestibility (as understood by Kappas) or leverage utilization (as pioneered by Erickson). Meta-analysis of published studies should account for these factors. If not, they risk mischaracterization of the studies as pertaining to "hypnotherapy" where they are actually concerned with the efficacy of "hypnosis."

A 2003 meta-analysis on the efficacy of hypnotherapy concluded that "the efficacy of hypnosis is not verified for a considerable part of the spectrum of psychotherapeutic practice."[52]

In 2005, a meta-analysis by the Cochrane Collaboration found no evidence that hypnotherapy was more successful than other treatments or no treatment in achieving cessation of smoking for at least six months.[27]

In 2007, a meta-analysis from the Cochrane Collaboration found that the therapeutic effect of hypnotherapy was "superior to that of a waiting list control or usual medical management, for abdominal pain and composite primary IBS symptoms, in the short term in patients who fail standard medical therapy", with no harmful side-effects. However the authors noted that the quality of data available was inadequate to draw any firm conclusions.[53]

Two Cochrane reviews in 2012 concluded that there was insufficient evidence to support its efficacy in managing the pain of childbirth[34] or post-natal depression.[35]

In 2016, a literature review published in La Presse Medicale found that there is not sufficient evidence to "support the efficacy of hypnosis in chronic anxiety disorders".[54]

In 2019, a Cochrane review was unable to find evidence of benefit of hypnosis in smoking cessation, and suggested if there is, it is small at best.[55]

Occupational accreditation[edit]

United States[edit]

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.[56]

United Kingdom[edit]

UK National Occupational Standards[edit]

In 2002, the Department for Education and Skills developed National Occupational Standards for hypnotherapy[57] 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.[58]

UK Confederation of Hypnotherapy Organisations (UKCHO)[edit]

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[59] 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.

Australia[edit]

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[60] (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).[61] The system was further revised in 1999.[62]

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[edit]

References[edit]

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  2. ^ The Worst is Over, Judith Acosta and Judith Simon Prager, 2002, Jodere Group.
  3. ^ "Dictionary of Occupational Titles: Hypnotherapist (079.157-010)". U.S. Department of Labor, Office of Administrative Law Judges. Retrieved 2017-11-15.
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  6. ^ The Cure Within: A History of Mind-Body Medicine, Anne Harrington, W.W. Norton & Company.
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  10. ^ John Grinder; Richard Bandler (1976). Patterns of the hypnotic techniques of Milton H. Erickson. 1. ISBN 978-1-55552-052-6.
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  36. ^ Kenyon, S; Armstrong, N; Johnston, T; Walkinshaw, S; Petrou, S; Howman, A; Cheed, V; Markham, C; McNicol, S; Willars, J; Waugh, J (2013-06-21). "Standard- or high-dose oxytocin for nulliparous women with confirmed delay in labour: quantitative and qualitative results from a pilot randomised controlled trial". BJOG: An International Journal of Obstetrics & Gynaecology. 120 (11): 1403–1412. doi:10.1111/1471-0528.12331. ISSN 1470-0328. PMID 23786339. S2CID 5898195.
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  39. ^ Miller, Anna Medaris. "Kate Middleton said she used hypnobirthing techniques to get through labor — and she 'really quite enjoyed it'". Insider. Retrieved 2020-06-03.
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  41. ^ Savage, George Harvey (1909). The Harveian Oration on Experimental Psychology and Hypnotism Delivered before the Royal College of Physicians of London, October 18, 1909. London: Henry Frowde. OL 26297021M.
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  43. ^ Crawford, Helen J.; Barabasz, Arreed F. (1993). "Phobias and intense fears: Facilitating their treatment with hypnosis". In Rhue, Judith W.; Lynn, Steven Jay; Kirsch, Irving (eds.). Handbook of clinical hypnosis. Washington, DC, US: American Psychological Association. pp. 311–337. doi:10.1037/10274-015. ISBN 978-1-55798-440-1.
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  45. ^ Deirdre Barrett (1998). The pregnant man: tales from a hypnotherapist's couch. New York: Times Books. ISBN 9780812929058.
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  48. ^ Cramer H, Lauche R, Paul A, Langhorst J, Kümmel S, Dobos GJ (September 2014). "Hypnosis in breast cancer care: a systematic review of randomized controlled trials". Integrative Cancer Therapies (review). 14 (1): 5–15. doi:10.1177/1534735414550035. PMID 25233905.
  49. ^ Palsson, O.S. "Effects of hypnosis on GI problems" (PDF). UNCCenter for Functional GI & Motility Disorders.
  50. ^ Tan, Gabriel; Hammond, D. Corydon; Gurrala, Joseph (2005). "Hypnosis and irritable bowel syndrome: a review of efficacy and mechanism of action". American Journal of Clinical Hypnosis. 47 (3): 161–178. doi:10.1080/00029157.2005.10401481. PMID 15754863. S2CID 13994888.
  51. ^ Whorwell, P.J. (2005). "The history of hypnotherapy and its role in the irritable bowel syndrome" (PDF). Alimentary Pharmacology & Therapeutics. 22 (11–12): 1061–1067. CiteSeerX 10.1.1.616.6402. doi:10.1111/j.1365-2036.2005.02697.x. PMID 16305719. S2CID 31618393.
  52. ^ Flammer; Bongartz (2003). "On the efficacy of hypnosis: a meta-analytic study" (PDF). Contemporary Hypnosis. 20 (4): 179–197. doi:10.1002/ch.277. Archived from the original (PDF) on 22 February 2016.
  53. ^ Webb, AN; Kukuruzovic, R; Catto-Smith, AG; Sawyer, SM (2007). "Hypnotherapy for treatment of irritable bowel syndrome". Cochrane Database of Systematic Reviews (4): CD005110. doi:10.1002/14651858.CD005110.pub2. PMID 17943840.
  54. ^ Pelissolo, A (2016). "[Hypnosis for anxiety and phobic disorders: A review of clinical studies]". Presse Med. 45 (3): 284–90. doi:10.1016/j.lpm.2015.12.002. PMID 26944812.
  55. ^ Barnes, Joanne; McRobbie, Hayden; Dong, Christine Y; Walker, Natalie; Hartmann-Boyce, Jamie (2019-06-14). Cochrane Tobacco Addiction Group (ed.). "Hypnotherapy for smoking cessation". Cochrane Database of Systematic Reviews. 6: CD001008. doi:10.1002/14651858.CD001008.pub3. PMC 6568235. PMID 31198991.
  56. ^ "Summary of state laws regarding hypnotherapy compiled by Hypnotherapists Union Local 472".
  57. ^ National Occupational Standards for hypnotherapy http://www.rebhp.org/articles/Hypnotherapy.pdf
  58. ^ "Register of Regulated Qualifications". Ofqual. Retrieved 6 November 2016.
  59. ^ Harry Cannon - harry.cannon@ntlworld.com (2010-12-01). "UKCHO Register search page - The UK Confederation of Hypnotherapy Organisations". Ukcho.co.uk. Retrieved 2011-11-28.
  60. ^ "Australian Hypnotherapists Association".
  61. ^ The accreditation criteria and the structure of the accreditation system were based on those described in Yeates, Lindsay B., A Set of Competency and Proficiency Standards for Australian Professional Clinical Hypnotherapists: A Descriptive Guide to the Australian Hypnotherapists' Association Accreditation System, Australian Hypnotherapists' Association, (Sydney), 1996. ISBN 0-646-27250-0
  62. ^ The revised criteria, etc. are described in Yeates, Lindsay B., A Set of Competency and Proficiency Standards for Australian Professional Clinical Hypnotherapists: A Descriptive Guide to the Australian Hypnotherapists' Association Accreditation System (Second, Revised Edition), Australian Hypnotherapists' Association, (Sydney), 1999. ISBN 0-9577694-0-7.

External links[edit]