Thursday, September 11, 2014

Hypnosis: A Critical Analysis


I spent the last month visiting a hypnotist and attempting to practice both guided and self-guided hypnosis.  The office-based sessions and the guided CD hypnosis sessions led to immediate relaxation.  Unfortunately, the calm I derived from these sessions was short lived.  I continue to be plagued by restless sleep.  I fall asleep fairly quickly, but I wake frequently throughout the night despite the hypnotist’s suggesting to my subconscious that I would not be easily awakened and when I was, I would fall quickly back to sleep.  This is not the case.  With regard to my general level of anxiety and “type A –ness,” I perceive an increased level of calm when I harken back to the lessons of the hypnosis sessions.  Overall, however, I am as much of a stress monger as ever.  Hypnosis for me is akin to meditation:  when practiced, I achieve a state of deep relaxation.  I had hoped to go even deeper and be able to have my subconscious manipulated, but I don’t see this happening - not that I won’t continue to try.  Enough about me.  What proof is there that hypnosis works?  Hypnotists claim they can cure smoking addiction, relieve pain, and strip one of all inhibitions.  Where is the proof?  Following is my attempt to summarize the medical literature on the benefits of hypnosis.

            I go straight to my hypnotist’s web page to begin my investigation.  My hypnotist has solid academic credentials as a neuroscientist, and she has summarized several studies on hypnotherapy.  Smoking appears to be a popular vice for which hypnotherapy is utilized.  The website summarizes the results of six studies all addressing smoking cessation via hypnosis.  These studies found wild success in smoking cessation via hypnosis.  Rates of abstinence from tobacco reach upwards of 90%.  If true, these are impressive numbers.  Traditional western methods to stop smoking, nicotine patches, or medications such as Chantix have only shown a 15-30% cessation rate.  Any intervention with a success rate of 90% should be widely embraced; just imagine the lives that could be saved.  I do have one reservation when I review these studies:  they are all in journals I have never heard of.  Smoking cessation is a mainstream goal.  I assume that if a really convincing study had been performed and achieved a rate approaching 90%, it would be published in the New England Journal of Medicine or similarly prestigious journal, but these were published in the International Journal of Clinical and Experimental Hypnosis and in the Journal of Nursing Scholarship.  I do a literature search of my own.  I find several studies addressing hypnotherapy for smoking cessation.  A Cochrane Database Review of the literature in 2010 finds “no evidence of a greater effect of hypnotherapy” when compared to other methods in achieving smoking cessation.  In contrast, an article in the American Journal of Medicine in 2012 suggests hypnotherapy may help smokers quit, but the confidence intervals were too broad to make a definitive conclusion. I find these results to be sobering. 

            What about hypnosis for stress and anxiety?  The benefits here are a bit harder to quantify.  With smoking cessation, it is black and white:  either you quit smoking or you don’t.  I doubt anyone can say they are ever free of anxiety.  The studies reflect this nebulousness.  Participants were classified as “significantly less anxious,” and there was “compelling evidence” that hypnosis may help manage anxiety.  Again, most of these studies were published in non-mainstream journals.  The overall finding suggested benefit, but in my mind, remain inconclusive.

            Pain management?  If you remember my past postings, my hypnotist used self-hypnosis while getting a tattoo. She reported falling asleep during the procedure.  Goodbye oxycodone, hello hypnosis. My research into this area again leaves me unsatisfied.  Similar to anxiety, studies of pain management rely on pain scales and subjective reports.  I found several articles on using hypnosis to cope with labor pain during childbirth.  Although several small studies show evidence of benefits for women receiving hypnosis regarding pain intensity, length of labor and maternal hospital stay, the overall results are inconclusive.  A large study, published in the Cochrane Database System Review, shows no difference in the use of epidural anesthesia with self-hypnosis. The moral of the story is clear . . . give me back my oxycodone.

            Hypnosis has been studied in many other realms.  One interesting study evaluates post-hypnotic suggestion as a means to improve academic performance - it didn’t.  Another evaluates hypnosis to accelerate the healing of bone fractures - it did (although the study only had 12 subjects, 6 in the hypnotherapy group and 6 in the control group).  There are a litany of other uses for hypnosis ranging from treating headaches, menopausal symptoms, and obesity to digging into our long suppressed childhood memories.  With all of these potential benefits, why have I included hypnosis in my exploration of “alternative medicine?” Clearly, it should be mainstream.  Perhaps psychiatry holds the answer. 

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