"No one understands exactly how it works, but we do know that all hypnosis is self-induced," says Myron Pulier, MD, clinical associate professor of psychiatry at UMDNJ-New Jersey Medical School(NJMS). "It cannot be projected onto someone, and even in a trance, you won't accept suggestions that go against your will. You won't flap and cluck like a chicken, unless you want to."
Pulier used hypnosis in his practice for 25 years to treat eating and sleeping disorders, phobias, addictions, stuttering, sexual dysfunction, stress, and chronic pain. "A person in a hypnotic state sometimes gives information that he wouldn't otherwise. That knowledge can be key to the diagnosis and treatment," he says. "And using post-hypnotic suggestion may help a patient comply with the prescribed therapy."
A trained professional can help guide someone into a hypnotic trance, but it can also be done alone. In fact, people put themselves into trances without even realizing it. A person who is daydreaming is in a trance; so is a mother using the Lamaze method of natural childbirth. And concentration at work or play so intense that it blocks out all peripheral stimuli is another example.
"The most familiar trance is probably what's known as 'highway hypnosis,'" Pulier says. "You're driving along and suddenly you've reach your destination with absolutely no recollection of how you got there."
Not everyone, however, has the ability to go into a hypnotic state. "A person must have an innate capacity for it," Pulier says. "The subject also must believe hypnosis can help him, be highly motivated to solve his problem and trust his clinician."
It's estimated that about 25 percent of the population cannot go into a medically useful hypnotic state; approximately 10 percent are highly capable of going into one; and the remaining 65 percent are somewhere in between. People suffering from depression, schizophrenia or dementia, Pulier says, usually can't be guided into a hypnotic state. Those with dissociative identity disorders formerly known as multiple personality disorder can and often do go into trances almost spontaneously.
That was what prompted Chantal Brazeau, MD, assistant professor of clinical psychiatry and family medicine at NJMS, to learn all she could about hypnosis as a psychiatric resident. One of her first patients had the ability to go into a trance within seconds. "I decided any phenomenon that powerful needed to be studied," she says. She attended numerous workshops accredited by the American Society of Clinical Hypnosis.
Brazeau now teaches a 10-hour lecture series on hypnosis to psychiatric residents at NJMS. She gives students an overview of hypnosis, teaches them relaxation techniques and actually demonstrates the phenomenon. She also introduces them to the medical uses of hypnosis often using case histories and encourages them to take additional formal training.
Brazeau points out that although it can be very valuable in treatment, hypnosis is not a cure-all. "It's only one of many medical tools that is usually used in combination with others," she says. "A psychiatrist, for instance, may use it along with medication and/or other forms of psychotherapy."
The same is true with behavior modification. A physician may use hypnosis and also prescribe nicotine gum or a patch for someone who wants to stop smoking. "You can't just go to a therapist and say 'make me stop smoking,'" Brazeau says. "You have to sincerely want to stop and you must work at it." Some people do quit after only one session of hypnosis, she says, but the success rate nearly doubles when the method used includes multiple sessions.
Exactly which personality types can or cannot go into a trance has been the focus of research since the early 1940s and continues today. Herbert Spiegel, MD now in his sixteenth year of teaching postgraduate courses in medical hypnosis at Columbia University College of Physicians and Surgeons and his son David Spiegel, MD, report in their book, "Trance and Treatment," (American Psychiatric Press, 1987) that there are definite correlations between personality and the ability to be hypnotized. Highly hypnotizable people usually display a "bright mood and a somewhat naive and trusting approach to others and are emotionally stable." Other characteristics are extroversion, a capacity for fantasizing and imaginative involvement, the ability to concentrate and a willingness to accept suggestions. People who are suspicious, critical and less outgoing, it was found, are less likely to be able to enter a hypnotic state.
Recent research on the brain's hemispheres has led scientists to a hypothesis that was reported in the March 1997 issue of the Journal of the American Medical Association (JAMA). They believe that "hypnosis is mediated through the right cerebral hemisphere, where information may be processed concurrently (as opposed to linear processing one bit at a time, using language and analytical skills in the left hemisphere) and where wordless visual imagery, aesthetic appreciation, creative ability, and orientation in space abound. If this is true, induction of hypnosis could 'disengage' the analytical functions of the left hemisphere."
According to this theory, JAMA reports, the reason some people cannot go into a trance is because of the way their brains are organized genetically or because of the way their personalities developed. They tend to be skeptical and critical and to deal with problems intellectually, trying never to lose control of the situation.
There are also clinical tests to help determine if someone is hypnotizable. The most widely used method, Brazeau says, is known as the eye-roll. A patient simultaneously gazes upward as high as possible and slowly closes the eyelids. As he does, the clinician observes the amount of sclera (white of the eye) between the lower border of the iris (colored portion of the eye) and the lower eyelid. Theoretically, the more sclera that is visible, the more hypnotizable the patient. "Sometimes those who score low on the eye-roll can still go into a hypnotic trance," she says, "but we may have to try several different methods until we find one that works on a given patient."
Exactly how does one go into a trance? There are literally hundreds of ways, Brazeau says. One method is the eye-roll, which is usually used when a person is doing hypnosis alone. A popular technique is to stare at a fixed spot or object. This fatigues the eyes, she explains, causing the eyelids to become heavy and close. Imagery can also be used. "A person imagines himself in a safe, calm place," Brazeau says. "It can be an island paradise or simply a hammock on the back porch. Whatever works." He can use all his senses to create the most vivid image possible. If picturing a tropical isle, for example, he may imagine smelling and tasting the salt air, hearing the breaking waves and feeling the sand under his feet. Progressive muscle relaxation relaxing every muscle group beginning with the toes and moving up is another technique. Whatever the method, it must be accompanied by a monologue delivered either by a clinician or to oneself. Terminating a trance can be simple or complex, Brazeau says, depending on the therapeutic work that has been accomplished.
With practice, one can visualize the special place and go into a relaxed state very quickly. "It becomes almost automatic," Brazeau says. "And you can do the technique without a therapist. Simply choose a method and when relaxed repeat a specific message to yourself. It's especially helpful in reducing stress and pain." She says to terminate a trance when doing hypnosis alone, a person should slowly reorient himself to his surroundings, then open the eyes. She adds that hypnosis is safe for most people, there are no side effects and if you do it on your own, it's free.
Perhaps one of the greatest myths is that a person in a hypnotic trance is asleep. "It's understandable, since hypnosis is often associated with someone swinging a watch and saying, 'you're getting very sleepy,'" says Brazeau. The word itself comes from the Greek hypnos, which means sleep, and a person in a trance may at times seem to be asleep, but in actuality is in a state of intense concentration.
Laboratory studies reported in "Trance and Treatment," confirm this observation. EEGs done on people in hypnotic states showed high incidences of alpha wave activity, which is present when the brain is alert but resting. The patterns were not the same on EEGs done on sleeping individuals.
A subject is generally so focused when in a trance, that she is able to ignore everything going on around her, even stimuli that cause external pain. For this reason, hypnosis can be used as an anesthetic for a variety of minor procedures, such as filling a tooth and suturing a small wound.
Brazeau has used hypnosis on herself to reduce severe jaw pain the result of TMJ while opening wide for the dentist. "I put myself in a trance and focused on the muscle that hurt," she says. "I imagined that the muscle was rubber and it easily stretched. I continued that thought for about a half hour, and the pain was greatly reduced."
Practicing hypnosis for pain control, however, must be done discriminately, the two psychiatrists warn. The function of pain is to signal that something is wrong with the body. "I know a tennis player who developed a spasm in her back while playing," says Pulier. "She put herself into a trance, eliminated the pain and continued," he says. "A few minutes later, they carried her off the court."
The cause of the pain needs to be diagnosed and the problem treated. If the pain still persists, hypnosis can help. In 1991, 54 pediatric cancer patients, ages 5 through 17, from the University of Texas Health Science Center in San Antonio and Children's Hospital in Los Angeles were studied to determine the effectiveness of hypnosis in reducing chemotherapy-related nausea and vomiting. One-third of the children practiced hypnosis, one-third used relaxation/distraction techniques and one-third were the control group. Those who used hypnosis showed a 31 percent improvement, the group that used relaxation reported a 13 percent improvement and the control group reported their symptoms were 50 percent worse.
Hypnosis has also been used successfully to reduce the pain of childbirth. Barry Dale, DMD, a 1976 graduate of UMDNJ-New Jersey Dental School (NJDS) and his wife Ellen found hypnosis a great help during labor and delivery of their first child, seven year ago. Ellen admits she was the perfect candidate. "I get totally wrapped up in movies and books," she says. "I forget they're not real."
Not wanting to take any drugs during the pregnancy, Ellen, who says she has a low tolerance for pain, looked for an alternative. Barry had taken a course on hypnosis while at the dental school and suggested she try it. They went to three instructional sessions with a psychologist and practiced a few times at home. Barry prompted Ellen as she put herself into a trance and experienced total relaxation.
When labor started, Ellen was able to quickly put herself into a hypnotic state. "I was so relaxed that when Barry stuck me with a pin, all I felt was a pushing sensation," she says. "I was actually able to sleep between contraction, and during the actual birth I felt only pressure, no pain."
When it was over, Barry says the obstetrician, midwives and delivery room nurses were all amazed. "Everyone wanted to talk about it. They said they had never seen anyone have an easier time giving birth."
Ellen, an attorney, says she still uses hypnosis at work when things get stressful. "I put myself into a trance and relax for a few minutes. When I come out of it, I feel refreshed and ready to keep going."
Students currently enrolled at NJDS learn stress management in their freshman year. "It's a very anxious time for them," says Hillary Broder, PhD, course instructor and associate professor in the Department of General and Hospital Dentistry. "Many of them have moved, they have to adapt to and endure a rigorous schedule and they have to establish a new support system. Knowing progressive muscle relaxation techniques can help them tremendously."
In their junior year the students take another course also taught by Broder that deals with managing anxious patients and coping with the challenges of clinical practice. "Most people don't like going to the dentist; they associate it with pain," Broder says. "By suggesting the patient do some of the basics of hypnosis closing the eyes, breathing slowly, relaxing the muscles and imagining a peaceful place a dentist may be able to calm an anxious patient."
During the course, Broder has the students develop a program to manage their own stress as well as one to address the needs of patients. "A particularly anxious student can learn to relax quickly so that his fears are not communicated to his patients," she says.
Besides its most common uses in dentistry decreasing anxiety, anesthesia and pain control Broder says there are numerous case reports of hypnosis being used successfully for gagging and salivary control, hemorrhage control, relief of needle phobia and habit control, such as bruxism (grinding the teeth). In 1991, Oregon Health Sciences University conducted a study of two males and six females, between 27 and 35 years old who suffered from bruxism. Patients were monitored at night using EMG (electromyogram) . Following hypnotherapy, all the bruxers showed a 75 percent decrease in EMG activity, facial pain and bruxing noise, immediately following treatment and after four to 36 months. Two were totally symptom-free.
Hypnosis in dentistry, however, does have its drawbacks. It takes time; not only must the dentist learn the technique, she must educate the patient. Usually it is not covered by insurance, making it an outofpocket expense for the patient. And, it can be difficult for a dentist to predict whether a patient will be a good candidate, since the technique varies with each individual. Pulier and Brazeau both say that before a person agrees to hypnosis as a treatment, a complete medical and psychiatric evaluation should be done. Hypnosis should not be used as a substitute for another method of treatment. "A physician should not only have mastered the technique of hypnosis, he should also have a thorough knowledge of the ailment he's treating," Brazeau says. "Only specially trained therapists should use hypnosis."
"Hypnosis is not for everyone," Pulier says, "but for the right person who has teamed up with the right therapist, it can seem like a miracle."
