Often Misunderstood Modality
Danya Epstein, ND
Hypnosis, or hypnotherapy, is a powerful yet often misunderstood modality that can enhance a naturopathic practice because it is consistent with the fundamental principles of naturopathic medicine. At its core, it is a form of potent self-healing. It is noninvasive, does not require laboratory tests or supplements, and can have significant results. It is most effective on illnesses that have a strong psychoemotional component; as a practitioner, I believe that mind-body healing will be most appropriate in this setting. As a quick literature search will reveal, the indications for hypnosis are vast and include medical and psychological problems. The research on hypnosis for medical indications includes dermatologic conditions (such as warts and psoriasis), gastrointestinal conditions (such as irritable bowel syndrome), obstetrical conditions (such as hyperemesis gravidarum), and others. I most commonly use hypnosis to treat anxiety and to modify habits, such as tobacco addiction and overeating. Contraindications to hypnosis include paranoia, psychosis, severe mental retardation, some personality disorders, suicidal tendencies, epilepsy, and narcolepsy.
Before a hypnotherapy session begins, I interview the patient and inquire about his or her understanding of hypnosis. We discuss the definition of hypnosis, any past experience of hypnosis, and goals for the session. I emphasize that the hypnotic state, or trance, is a common experience that happens many times throughout the day. A classic example of this phenomenon occurs when driving for long distances; somehow you arrive at your destination without even realizing how you got there. Another example of the hypnotic state is total absorption into a movie, TV show, or book. Hypnosis comes from the Greek word hypnos, which means “sleep.” However, hypnosis is not sleep; it is a state of deep relaxation of the mind whereby the subconscious mind is more receptive to suggestions that are in accord with the patient’s best interest and volition.
Many people have the mistaken impression that hypnosis is a form of mind control or brainwashing and that there is a loss of control or consciousness. I emphasize that a guiding principle of hypnosis is that all hypnosis is self-hypnosis. Patients come to me with negative behaviors or thoughts that they are ready to change, yet I cannot compel my patients to do anything unless they are ready and willing to change. Some examples of the negative reactions or behavior patterns that patients wish to eliminate include anxiety, smoking, overeating, or other habits that are no longer serving them. In the interview, I go more deeply into the core issue, teasing out their desired state (ie, what they would like to feel or which behavior they would like to adopt).
Articulating this desired state can be very therapeutic for patients. Patients often have been stuck in a state of just wishing they were otherwise (eg, not in pain, not anxious, not smoking) but are unable to verbalize an affirmative vision of the state they want. I treated a 28-year-old woman for smoking cessation. When I asked about her vision of herself “tobacco free,” she got excited and reported that she looked forward to breathing better, tapering down her asthma medication, and keeping her skin looking youthful and healthy.
I also ask patients if they have any metaphors for how they feel they can achieve this desired state. I treated a 63-year-old woman for sciatica pain; when asked how she imagined releasing the discomfort she felt, she stated that she imagined doing surgery on herself and realigning her pelvis. This metaphor was especially powerful because the patient had also expressed a fear of physicians and medical interventions and was looking forward to letting go of that anxiety. The metaphors, imagery, and affirmations that patients give in their interview can then be used in the hypnotic state.
The first part of a formal session of hypnosis is called the induction. The induction serves to ease the patient into a very relaxed state, or trance, where the mind is more open to suggestions. I often use simple passive progressive muscle relaxation scripts, in which I invite my patient to relax muscle group by muscle group from head to toe. Inductions can be tailored to the patient’s needs. Patients who have anxiety issues surrounding relaxation and who are visually oriented may do better with imagery to help them get into a state of trance. A classic example of a more visual induction involves walking down a staircase into a place of peace. A more in-depth discussion of hypnotic induction is beyond the scope of this article.
Once the patient is in this deeply relaxed state, I use imagery, metaphors, or affirmations to connect with the subconscious mind and to make suggestions for positive change. This can sometimes be very simple; for example, I treated a 65-year-old woman who had an anxiety problem when she performed in her community orchestra concerts. Because she was first violinist, she often had to play solo for a brief moment, and the thought of this gave her anxiety with many concomitant physical symptoms, such as racy heart and shaking arms, before and during the performance. It had gotten so bad that her bow was bouncing around erratically when she played. She said that her desired state was to feel relaxed and calm during the performance. Once in a trance, I invited her to imagine that she was at the concert, felt relaxed and calm, and restated her affirmation. After 1 session, her performance anxiety completely resolved, and the effects have lasted for more than a year and during multiple performances.
Language is the key in hypnosis. The mind has difficulty processing negatives, as in the example of “don’t think about pink elephants!” What the mind hears is “think about pink elephants.” Affirmative language involves avoiding negatives in favor of positive statements. For example, instead of using a suggestion of “don’t bite your nails,” I would make suggestions about releasing the nail-biting habit. I would also perhaps suggest that a female patient get a manicure and admire her neat nails throughout the day.
In addition to using affirmative language, permissive language is also vital. Because individuals are innately resistant to change, permissive language helps bypass this resistance. Permissive language turns commands into options. This gives the patient permission to change and to tap into his or her desire for self-actualization and growth. “You must control your eating” turns into “allow yourself to be aware of your portion size.” Therefore, choosing words like can, may, allow, or invite instead of will, should, or must or commands allows for a more effective session. Moreover, this shift in language transfers the responsibility to the patient; it avoids a paternalistic or authoritarian attitude on the part of the practitioner.
The last part of the hypnosis session involves gently reawakening the patient and reorienting him or her to the room, often using techniques that parallel the induction, such as walking back up a flight of stairs or counting to 5. I then inform the patient that images, dreams, and new insights may appear in the next few weeks and counsel him or her to write these down to review at our next session.
Hypnosis allows the practitioner to be an active listener and to create a partnership with the patient but also allows the practitioner to express a certain creativity and spontaneity. When I am truly “tuned in” to my patients, I find myself in a trance as well, which unlocks my own creativity and intuition. I let my conscious mind rest, while my unconscious mind navigates. For both myself and my patients, letting the unconscious mind take the driver’s seat is a welcome relief. Even if they do not immediately achieve the goals they set out for themselves in hypnotherapy, many patients report a sense of deep relaxation and refreshment after the session, which can be restorative and healing on its own. Hypnotherapy works congruently and can enhance behavioral interventions and naturopathic modalities (ie, botanical medicine, acupuncture, and homeopathy). Included herein is a list of references that provide more information about hypnosis and about training resources.1-9
Dr. Danya Epstein, ND, is a first-year resident at Bastyr Center for Natural Health. She graduated first in her class from Southwest College of Naturopathic Medicine & Health Sciences in 2009. Her interests include mind-body medicine, rheumatology, dermatology, and naturopathic medical education. She can be reached at email@example.com.
1. Shenefelt PD. Hypnosis in dermatology. Arch Dermatol. 2000;136(3):393-399.
2. Wilson S, Maddison T, Roberts L, Greenfield S, Singh S; Birmingham IBS Research Group. Systematic review: the effectiveness of hypnotherapy in the management of irritable bowel syndrome. Aliment Pharmacol Ther. 2006;24(5):769-780.
3. McCormack D. Hypnosis for hyperemesis gravidarum. J Obstet Gynaecol. 2010;30(7):647-653.
4. Chips A. Clinical Hypnotherapy: A Transpersonal Approach. 2nd ed. Kill Devil Hills, NC: Transpersonal Publishing; 2006.
5. Davis M, Eshelman E, Kay M. The Relaxation and Stress Reduction Workbook. 6th ed. Oakland, CA: New Harbinger Publications; 2008.
6. Milton H. Erickson Foundation. http://www.erickson-foundation.org/. Accessed April 27, 2011.
7. Hammond DC. Handbook of Hypnotic Suggestions and Metaphors. New York, NY: WW Norton & Co; 1990.
8. Naparstek B. Staying Well With Guided Imagery. New York, NY: Warner Books; 1995.
9. Rosen S. My Voice Will Go With You: The Teaching Tales of Milton H. Erickson. New York, NY: WW Norton & Co; 1991.
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