Early in Mark Jensen’s career as a rehabilitation medicine specialist, he kept running into an issue with his patients. It was the ’90s and he was studying pain management through the use of cognitive-behavioral therapy (CBT), which can help people with chronic pain learn to change their awareness of and develop skills to cope with their persistent discomforts. This method showed some promising, though modest, results: Jensen’s patients confirmed they were better able to manage their reactions to the pain, but the problem was, the pain was still there. Wasn’t there something that could actually make it go away?
“I would have to say to them, ‘Actually, there doesn’t seem to be a lot we can do about the pain itself,’” says Jensen, now a professor and the vice chair of rehabilitation medicine at the University of Washington. “‘It’s really your reaction to the pain that we need to focus on.’”
Like anxiety, pain is not simply a physical sensation, but an experience created by the brain in reaction to environmental cues. If your brain thinks your body is in danger or injured, it will create the experience of pain to alert you. To counter this, Jensen and other pain specialists have found that the best plan of attack aside from pharmacological treatment is to change a person’s state of mind. “When a person focuses their attention on one thing [like breathing], their brain state changes. Their brain activity changes. And that change is associated with pain relief,” he says.
While this change can be achieved in part through things like CBT, meditation, mindfulness, and even music, in the mid-90s Jensen stumbled upon what he thought could be a better vehicle for attaining this altered mental state: hypnosis.
At the time, hypnosis was largely passed over as a party trick performed by hack doctors on daytime TV, used to make volunteers from the audience do the funky chicken dance or cluck like one. But there was mounting evidence that the technique could be an effective treatment for a number of ailments, including pain.
For Jensen, the lightbulb went off when he read the 1994 book A Whole New Life by Reynolds Price. Price recounts the experience of learning to use self-hypnosis to manage his chronic back pain caused by radiation from cancer in his spine. “I thought, ‘Well that’s what these patients have been asking me for, over and over again,’” Jensen says.
Atthe time, there was very little research into the function of hypnosis as a treatment for anything, let alone something that seems to manifest physically as pain. But with anecdotal evidence on his side, Jensen decided to formally study it. His initial discoveries were so promising that he’s spent most of the past 25 years researching and providing the practice to patients with strong results. His most recent small-scale study found that hypnosis helped eight women who were in treatment for breast cancer or were breast cancer survivors reduce the severity of their treatment- and post-surgery-related pain for up to six months after their initial hypnosis sessions.
“[Hypnosis] is one of the few treatments that actually focuses on pain intensity and seems to be effective for reducing pain and tenderness, not just your relationship to pain and not just how you can continue to function despite your pain,” Jensen said.
Pain isn’t the only ailment treatable by the practice. The American Psychological Association (APA) says that “although controversial,” hypnosis is recognized as “a powerful, effective therapeutic technique” for depression and anxiety, weight loss, gastrointestinal disorders such as irritable bowel syndrome, skin conditions, quitting smoking, and more.
A study from 2007 involving 286 smokers found that 20% of the participants who underwent hypnosis quit smoking compared to 14% who received standard CBT. For those who practiced hypnosis, the results proved even stronger for those who had a history of depression, which suggests that even if the goal of hypnosis is focused on one outcome, the benefits of the therapy could have a ripple effect.
What’s more, a 2009 review found that in some small-scale studies, hypnosis can improve people’s immune function in such a way that it actually reduces vulnerability to infection. Then there’s gut health. In a study that involved 204 people suffering from Irritable Bowel Syndrome, 58% of the men and 75% of the women reported significant symptom relief after finishing a round of 12 weekly hypnosis sessions. More than 80% of those who reported initial relief still reported improvements six years later.
“Hypnosis is one of the few treatments that actually focuses on pain intensity and seems to be effective for reducing pain and tenderness, not just your relationship to pain and not just how you can continue to function despite your pain.”
In regards to pain mitigation, another review compared the use of hypnosis with the use of pain killers after invasive surgeries. The findings suggest that those who used hypnosis — and even self-hypnosis, which consists of listening to recordings of past live hypnosis sessions — were not only able to cut their pain medication by half but also reported half the pain than those given only opioids, suggesting that hypnosis treatment could even become an additional tool to help curb the opioid crisis.
Not everyone is responsive to hypnosis; some researchers estimate that the treatment isn’t effective for around 20% of the population, though researchers aren’t sure why. Coupling hypnosis with other forms of therapy such as CBT has shown the strongest results: A 2005 study found that adding hypnosis to CBT helped reduce some acute stress disorder symptoms more than CBT alone. Another study looking specifically at stress disorders found that the benefits of CBT lasted far longer for those who received hypnosis as part of their treatment.
While the evidence suggests that hypnosis can work for some people, it doesn’t answer the question of why it works. “That’s the next question,” Jensen says, “and that, in the next decade, will be the focus of our research.”
Hypnosis is not magic. Though the treatment lacks a widely accepted definition, it’s generally defined as a trance-like state that produces heightened focus and concentration, coupled with suggestions — usually from a second party although self-hypnosis has proven effective — that are aimed at changing one’s behaviors and emotions.
According to Jensen, what this looks like in practice changes from patient to patient and depends on the therapist (which is one reason why the treatment doesn’t have a hard-and-fast definition). However, the general mechanics are usually the same.
To start, a patient is told to focus their attention on something specific, be it a spot on the wall, the therapist’s voice, or their own breathing. Like with meditation, this attention leads to a state of hyperfocus in which the outside world recedes away and “the brain state changes,” according to Jensen. “It’s more flexible, more plastic.”
This is where the clinical suggestions come into play. If the patient is working on chronic pain, for instance, the therapist suggests that they experience the painful area as being completely comfortable, or infused with powerful medicine. This step is supposed to train the mind to break the thought patterns keeping it focused on the pain — or in other cases the desire to smoke, or feelings of anxiety.
While this may sound synonymous with meditation, Jensen says the difference lies in hypnosis’ tailored suggestions aimed at changing behaviors. “In many meditation practices, meditation is the end goal. Hypnosis is more directive and more focused.” As a result, people often walk away hurting less, he says.
But again — why? One preliminary study that sought to answer this question found that during hypnosis, the part of the brain that is activated when there’s something to worry about was less active. It also found that some parts of the brain began syncing up (including the area in charge of planning and the area that regulates body function) while others became less connected (including the planning region and the one that carries out self-reflection), which could help explain why this state can tee up big changes in behavior.
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