Patients struggling with pain often seek out hypnosis when they've run out of options. But if you ask David Spiegel, MD, a leading expert in clinical hypnosis, it should be a first -- not last -- resort.
Hypnosis, sometimes called hypnotherapy, may be far from mainstream, and some dismiss it as medically unfounded, but Spiegel, professor and associate chair of psychiatry and behavioral sciences, has published decades of research investigating its influence on brain activity as well as its effectiveness in controlling pain related to surgery, cancer and fibromyalgia (a chronic disorder that causes musculoskeletal pain and fatigue). His latest study found that there are genetic underpinnings to why some people are more hypnotizable than others. He has also developed and narrated a self-hypnosis app geared toward helping people reduce stress, treat insomnia and even quit smoking.
Spiegel spoke about the use of hypnosis for pain control, how it works, who can benefit and when he uses hypnosis on himself.
How do you define hypnosis in a medical sense?
Hypnosis is just a state of highly focused attention, like getting so caught up in a good movie that you forget you're watching a movie: You enter an imagined world, so you're not purely perceiving; you're experiencing sensation and emotions in a way that allows you potentially to modulate what you're experiencing. For instance, one might imagine they're floating away from the physical sensations of their anxiety.
How does hypnosis work for pain treatment?
Pain is not simply a peripheral sensation; it's also how the brain interprets and manages that sensation -- and we can do a heck of a lot with our brains to modify our levels of discomfort. Hypnosis allows you to alter perception, to narrow the focus of attention. It also allows you to detach yourself from concerns that might amplify the pain.
Using functional MRI, we've found that, during hypnosis, a part of the brain called the salience network is less active. It includes the anterior cingulate cortex - the part of the brain that fires off if, for example, you hear a noise you think could be a gunshot.
Cancer patients experience a new pain and they think, "Oh my God, the cancer is spreading," even if it's not. By turning down activity in the salience network through hypnosis, they're less likely to trigger the alarm button.
For example, a cancer patient may be taught to imagine floating comfortably in a warm bath, applying a warm compress to the pain, or they could think of other imagery to filter the hurt out of the pain. While acknowledging that the pain is there, they can create distance between themselves and the discomfort of the sensation.
Is hypnosis more effective for certain types of pain?
It's probably better for chronic pain when you already know the cause and when it's not a sign of a new injury or condition, so you don't need to pay as much attention to it.
But studies have shown it can work even for acute pain. It's actually been effective in combat, helping soldiers who are wounded on the field better manage the pain, and focus on doing what they need to do to get out alive. It's similar to how football players who've broken their ankle during a play sometimes don't notice until the game is over.
The intensity of pain is directly associated with its meaning, and hypnosis can help prevent an individual from having anxiety over every possible health problem a pain can represent.
Do we understand why some people are more hypnotizable than others? And does your hypnotizability depend on how skeptical you are of the practice?
We have a new paper that suggests some people are genetically more susceptible to hypnosis. They have a particular polymorphism of the gene for an enzyme, catechol-o-methyltransferase, which affects dopamine metabolism in the brain. People who have a moderate metabolic rate -- not too much, not too little -- maintain a level of dopamine that allows them to more easily experience hypnosis.
Life experiences also make a difference. Most children are hypnotizable -- they're in trances most of the time. Call your 8-year-old for dinner and they don't hear you because they're off doing what they do. Some people lose that during adolescence.
The ones who retain that hypnotizability tend either to have had positive experiences of using their imagination -- like parents telling them a bedtime story every night -- or, sadly, to have been physically or mentally abused. They use their imagination to distance themselves from the trauma. However, the hypnotizability you have when you're 21 is what you're going to have 25 years later.
About two-thirds of adults are hypnotizable. People think that whether you believe in hypnosis impacts how hypnotizable you are, but it's not true. It's not a matter of belief; it's a matter of ability and experience.
What hypnosis really helps people do is put aside preconceived ideas about their pain, their stress or their insomnia, and approach it from a new point of view.
Do you use hypnosis on yourself?
I do. Years ago, I had surgery at Massachusetts General Hospital for a recurrent dislocated shoulder, and afterward I did self-hypnosis for pain control. I was working at the hospital then, so I went and read my chart. The resident had written, "Patient using very little pain medication. We mustn't have cut many nerves." I have an incision from the top to the bottom of my shoulder; I can assure you they cut nerves.
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