Hypnosis

Have you thought about utilizing hypnosis as part of your healing, or have you considered it more "woo woo?" Is there any evidence to support the utilization of hypnosis as part of conventional medicine? You've actually probably been in a hypnotic state before and didn't even realize it.

Everyday 'trance' states are part of our common human experience, such as getting lost in a good book, driving down a familiar stretch of road with no conscious recollection, when in prayer or medication, or when undertaking a monotonous or a creative activity. Our conscious awareness of our surroundings versus an inner awareness is on a continuum, so that, when in these states, one's focus is predominantly internal, but one does not necessarily lose all outer awareness (Williamson, 2019).

Hypnosis is a waking state of awareness, or consciousness, in which a person's attention is detached from his or her immediate environment and is absorbed by inner experiences such as feelings, cognition and imagery (Williamson, 2019). When individuals are hypnotized, their focus of attention and their imagination is consumed so that what they imagine feels real. The hypnotist can then offer suggestions, so that together, they can create a hynotic reality. Maybe you've seen this at company parties or at a comedy club, but in the clinical setting, this might be utilized to assist in ceasing a smoking habit or changing thought patterns.

Hypnosis could be seen as a meditative state, which we can learn to access consciously, and deliberately, for therapeutic purposes (Williamson, 2019). Suggestions, offered either verbally or through imagery, might help to reduce anxiety by accessing calmness and relaxation, or help manage side effects of medications, or even help ease pain or other symptoms (Jensen & Patterson, 2014). There is great interest for utilizing hypnosis in palliative care as well, and the impact on those who struggle with mental health issues, I imagine, could be profound. There are clinical trials involving hypnosis that show it may also be effective for chronic obstructive pulmonary disease (COPD), overeating, sleep, and depression. Depending on the suggestions given, hypnosis is usually a relaxing experience, which can be super helpful for most anyone, particularly those who are tense or anxious. The main use of hypnosis is to access the link between the mind and body, to our unconscious processing.

Keep in mind, hypnosis is not therapy in itself, but it can be the tool that facilitates the delivery of therapy in the same way as a syringe delivers drugs (Williamson, 2019). It doesn't make the impossible possible, but it can help us believe and experience what might be possible for ourselves.

Hypnosis has been used as a healing practice since the beginning of human experience, but because it is also used for entertaining, and because it is portrayed in the media as something mysterious and magical, supposedly out of the hypnotic subject's control, it has been viewed with distrust and scepticism by many health professionals (Williamson, 2019). However, the science here really is growing and we better understand what happens, neurologically, when someone enters a hypnotic state (Gruzelier, 2006; Oakley & Halligen, 2013; McGeown et al., 2015; Jiang et al., 2017; Elkins, 2017; & Terhune et al., 2017). The evidence really is building with regards to integrating hypnosis as a healing modality for a variety of conditions, most especially anxiety and pain.

Our Brain and Hypnosis

The study of hypnosis is complex and many factors such as context, expectation and personality affect hypnotic response as well as the suggestions used (Williamson, 2019). Just because we know something intellectually, such as all the little nuances of anxiety and depression, doesn't mean that we can control our emotions. Many clinicians for example suffer with anxiety, depression, bipolar, ADHD, and addiction in spite of being very knowledgeable in these conditions. These are like two different sides of the same coin, similar to the right and left side of the brain, consciousness and unconsciousness, or intellectual and emotional processing.

When we communicate, we use more than vocabulary. We're also using our imagination. When we explain ourselves and teach, we're often evoking imagery. Great teachers use metaphor, parables and stories to convey their teachings. The brain has two hemispheres, and while we are in our normal waking state, the left brain is a bit more dominant - our conscious mind. This side of our brain communicates verbally and its the more intellectual side of who we are, our more rational self.

When we relax, or become deeply involved in some activity, our right brain becomes more dominant. The right brain is our more emotional, creative part of ourselves. It communicates in symbols and images; its our unconscious mind. There is always a difficulty in telling ourselves not to be upset or anxious because words are not the language of the right brain. We can however, paint a word picture using guided imagery or metaphors. Maybe this oversimplifies the neural processing of the left and right hemispheres, but on a very simple level, this is how hypnosis works.

Subjective changes in response to suggestions are associated with corresponding changes in brain regions related to the specific psychological function in question (Cojan et al., 2009 & Demertzi et al., 2015). When we imagine something - a color, sound, physical activity, and pain - similar areas of the brain are activated whether we are in hypnosis or experiencing it in reality. Both physically induced and hypnotically induced pain are accompanied by activations in areas associated with the classic 'pain matrix.' Similar findings have been shown with visual and auditory suggestions as well.

When individuals are highly anxious, they are operating at an emotional, rather than cognitive level. They are also engaging in creative imagination, which can sometimes mean catastrophizing various scenarios, generating even more anxiety for themselves, and more adrenaline, which can spiral into panic. These emotions can be very overwhelming so the role of the hypnosis clinician is to engage their attention and then direct their imagination to feeling calm or to re-experience some positive past experience or activity and give positive suggestions, then feelings of calm should follow, and a greater capacity to cope (Williamson, 2019).

Chronic Pain and Hypnosis

Pain lasting more than 6 months is complex, requiring multifaceted approaches for both evaluation and treatment (Dillworth et al., 2011). Unfortunately, our profession hasn't managed this well, and has created an opioid crisis, while simultaneously offering real relief to those who suffer. Surgical interventions aren't often much more successful and may cause permanent damage or even add to their pain.

Since gains in physical and social functioning are also important goals, we must focus on more than just the intensity of pain when offering treatment plans for relief and healing. We must also consider emotional suffering, consider one's belief about pain, and evaluate their inactivity, their responses to the overall impact of their pain. Researchers are also evaluating their neurophysiological responses to pain, and hypnosis is increasingly being utilized for conditions such as fibromyalgia, low back pain, disability-related pain, cancer-related pain, arthritis, irritable bowel syndrome, and headache (Dillworth et al., 2011).

Hypnosis can be complementary to other treatments, or used as a stand-alone treatment. Studies have found approximately 70% of individuals with chronic pain are able to experience a short-term reduction in chronic pain during a treatment session or hypnosis practice, and between 20% and 30% achieve more permanent reductions in daily pain (Stoelb et al., 2009 & Melis et al., 1991). There is also evidence that hypnosis may be more effective in treating neuropathic or vascular pain and less efficacious in treating musculoskeletal pain, such as lower back pain.

There are two main theories on why hypnosis may work. The first is related to one's susceptibility to hypnosis, even epigenetically, although there are studies demonstrating that even those with low hypnotic suggestibility also experience improvements in pain after hypnosis (Andreychuck & Skriver, 1975; Friedman & Taub, 1984; and Holroyd, 1996).

The second theory relates to social-cognitive expectations, motivation, and environmental cues. For example, one study found treatment outcomes are improved when there are expectations for improvement set in the treatment plan (Jensen et al., 2009). When hypnosis is used as a treatment for chronic pain, the clinician may focus on simply decreasing pain or on increasing comfort. They may help teach the individual to shift their focus away from the pain, or change their sensation from pain to tingling or numbness. They may even change their beliefs or attitudes about the pain, increase their activity or improve their sleep quality.

Hypnosis is both effective and cost-effective for the treatment of chronic pain with minimal side effects. It seems a very reasonable approach for clinicians to use for helping their clients better manage their pain. Evidence suggests that combining hypnosis with cognitive behavioral therapy enhances outcomes. Whether clinicians integrate this into their practice, or encourage their clients to use self-hypnosis, they can work together to create a plan for improving the individual's experience with pain. When we consider the neurophysiological processes associated with both pain and hypnosis for example, the clinician may focus their hypnotic suggestions on the somatosensory cortex and directly decrease pain intensity, whereas suggesting affecting the anterior cingulate cortex might include positive changes in the affective response to pain. The prefrontal cortex may be targeted with suggestions to change the meaning of pain or focus on meaningful or enjoyable activities. Suggestions can also target the many functional domains that can be negatively affected by pain, such as sleep quality, physical activity, and depression. Goals may even focus on increasing quality of life, returning to work, or improving function in daily activities regardless of pain level.

The Hypnosis Experience

Entering hypnosis is about focused attention. This may come through focusing on the flame of a candle, listening to music or chanting, even speaking mantras. Induction may be kinaesthetic, such as progressive muscular relaxin. One of the simplest methods is to engage the individual's imagination and relive an experience, a daydream or fantasy. This may be a more formal, hypnosis session or even more informally, such as directed conversation, simply guiding their focus and engaging imagination.

The individual can then be taught self-hypnosis, which allows them to enter a hypnotic state intentionally, at will, using their imagination and their own suggestions to help themselves (Dillworth et al., 2011). In a clinical setting such as primary care, this is optimal because time is limited, and ultimately, clinicians don't want their clients to become dependent upon them for this type of healing. One study found that hypnosis, just 15-minutes, following surgery for breast cancer reduced side effects and ultimately medical costs (Montgomery et al., 2007).

Will Hypnosis Work on Me?

Researchers are evaluating who is highly open to hypnosis and who might struggle a bit more to get there. This is thought to depend, at least in part, on a person's proneness to fantasy, tendency towards deep absorption in tasks, ability to focus attention on an internal or external object, and less distractibility. This comes down to our attention and executive control in different brain regions, the ability to be deeply absorbed in tasks such as reading, and the tendency towards fantasizing or disconnecting from thoughts and feelings.

During the hypnotic session, oxytocin - a hormone linked to bonding and social trust - is released both in the hypnotist and in the person being hypnotized. Trust between these two is therefore, important, vital to the experience. One study found that administering oxytocin nasal spray before hypnosis increased their compliance (Bryant & Hung, 2013). Those who are more easily hypnotized are also those who have faster reaction times during complex decision making, as well as shorter latency for auditory, visual, and somatic sensing. Dopamine response in certain regions of the brain is also thought to be involved in the neurological differences in people who are more easily hypnotized.

Interestingly, researchers are finding genetic traits that lean into hypnosis as well, but this means that those being studied in laboratories, are those most easily hypnotized, which isn't at all what this looks like in clinical practice. We rarely understand our client's epigenetics, so when we work with them, sometimes this works and sometimes it doesn't - in fact, about 15% of the population is easily hypnotized while about 15% is not. Therefore, the literature isn't massive with regards to hypnosis, or what we might see out in the wild, because there just isn't a lot of funding to expand focus and evaluate how results differ based on our genetic predisposition to hypnosis. Just as I mentioned previously with pain though, even those with a low propensity towards hypnosis, 2/3rds of people who overeat are benefited from hypnosis so one need not be within the top 15% to take advantage of this healing modality.

Hypnotic therapies isn't likely to generate any wealth, and it's seen as a complementary therapy so of course, this means that many will continue to view it as dubious with little scientific credibility. What is more likely to occur in that clinicians who have intrigue will offer it to their clients in a private practice setting, or maybe a single clinician within an entire department, even one within a large territory of healthcare.

Our understanding is limited, but we aren't questioning if there is benefit. We are simply working to better understand how it works and how we might optimize outcomes. Genetically we understand that the OXTR gene encodes oxytocin receptors and if your oxytocin levels rise, then hypnosis is less likely. The more empathetic and optimistic, the more supportive of others, the less likely your ability to be hypnotized. If you aren't as social within groups, you may be easier hypnotized.

The ORPM1 gene encodes the mu-opioid receptor and studies on individuals with this variant demonstrates they are more susceptible to hypnosis. When pain and fear of pain are reduced, due to epigenetic variants, these individuals often require more opioid medications and more often become dependent, but they are more likely to be hypnotized.

The infamous COMT gene encodes an enzyme involved in neurotransmitter levels, including dopamine. If you have higher COMT activity, or faster COMT, then you likely have a higher pain threshold and if you are like most, Caucasians especially, then you have a pretty intermediate amount of pain sensitivity. Those with slower COMT activity though, lower than about 40% of people, have lower pain thresholds and higher dopamine. They also have more chronic pain and are more likely to be hypnotized, especially when they have high-attention ability.

Our ability to be hypnotized is pretty stable throughout our lives, which supports an epigenetic link to our susceptibility. If you aren't easily hypnotized as a young adult, then you are not likely to respond to hypnosis in middle age either. Interestingly, the time of day does seem to influence our vulnerability, as we are more easily hypnotized in the morning compared to the afternoon. Know that you remain in control of your behavior, and most people remain awake during the session, remembering what happens.

We also know that the frontal lobe is down-regulated during hypnosis, even disassociated. Another study found increased activation in the inferior frontal gyrus for highly hypnotized people. Studies have utilized functional MRIs and EEGs for evaluating people under hypnosis, and there are differences observed in those who are more easily hypnotized (Taghilou et al., 2025).

There are no statutory regulations for hypnosis training or practice, as I am aware, but many organizations do offer training, which may be of varying quality. The first nationally accredited College of Hypnotherapy, offering a mind-body psychology degree, has been training skilled counselors for over 50 years. There are also professional organizations in the United States, such as the American Society of Clinical Hypnosis, the American Hypnosis Society, and the National Guild Hypnotists. These organizations offer resources, certifications, and continuing education for hypnotists and hypnotherapists. There is also an International Society for Hypnosis, which is the world headquarters for researchers and clinicians interested in hypnosis. ISH serves as the umbrella and meeting place for its members and thirty-three Constituent Societies from around the world.

Communicate with your therapist ahead of time to make sure you understand the goals and what is going to happen during the session. Wear comfortable clothes, and make sure you're well rested so you don't fall asleep during your session. Ask about their training and experience. Self-hypnosis is possible, and a hypnotherapist may be able to guide you in how to do self-hypnosis sessions on your own.

References

Bryant, R. A. & Hung, L. (2013). Oxytocin enhances social persuasion during hypnosis. PLoS One, 8(4).

Cojan, Y., Waber, L., & Schwartz, S. (2009). The brain under self-control: modulation of inhibitory and monitoring cortical networks during hypnotic paralysis. Neuron, 62, 862-875.

Demertzi, A., Vanhaudenhuyse, A., & Noirhomme, Q. (2015). Hypnosis modulates behavioural measures and subjective ratings about external and internal awareness. J Physiol, 109, 173-179.

Dillworth, T., Mendoza, M. E., & Jensen, M. P. (2011). Neurophysiology of pain and hypnosis for chronic pain. Translational Behavioral Medicine, 2(1), 65-71.

Elkins, G. R. (2017). Handbook of medical and psychological hypnosis: foundations, applications, and professional issues. New York: Springer.

Gruzelier, J. (2006). Frontal functions, connectivity and neural efficiency underpinning hypnosis and hypnotic susceptibility. Contemp Hypnos, 23, 15–32.

Jensen, M. P. & Patterson, D. (2014). Hypnotic approaches for chronic pain management: clinical implications of recent research findings. Am Psychol, 69, 167-177.

Jiang, H., White, M. P., & Greicius, M. D. (2017). Brain activity and functional connectivity associated with hypnosis. Cereb Cortex, 27, 4083–4093.

McGeown, W. J., Mazzoni, G., & Vannucci, M. (2015). Structural and functional correlates of hypnotic depth and suggestibility. Psychiatry Res, 231, 151–159.

Melis, P. M., Rooimans, W., Spierings, E. L., & Hoogduin, C. A. (1991). Treatment of chronic tension-type headache with hypnotherapy: a single-blind time controlled study. Headache, 31(10), 686-689.

Montgomery, G., Bovbjerg, D., & Schnur, J. (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. J Natl Cancer Inst, 99, 1304-1312.

Oakley, D. A. & Halligan, P. W. (2013). Hypnotic suggestion: opportunities for cognitive neuroscience. Nat Rev Neurosci, 14, 565–576.

Stoelb, B. L., Molton, I. R., Jensen, M. P., & Patterson, D. R. (2009). The efficacy of hypnotic analgesia in adults: a review of the literature. Contemp Hypn, 26(1), 24-39.

Taghilou, H., Rezaei, M., Nazari, M. A. & Valizadeh, A. (2025). Electroencephalography oscillations during prehypnosis and hypnosis in subjects with high and low dissociative experiences. Basic Clin Neurosci, 16, 367-378.

Terhune, D. B., Cleeremans, A., & Raz, A. (2017). Hypnosis and top-down regulation of consciousness. Neurosci Biobehav Rev, 81, 59–74.

Williamson, A. (2019). What is hypnosis and how might it work? Pallit Care, 12.