Clinical Hypnosis

Hypnotherapy, also known as hypnotic medicine, is the use of hypnosis in psychotherapy. Hypnotherapy is generally not considered to be based on scientific evidence, and is rarely recommended in clinical practice guidelines. However, several psychological reviews and meta-analyses suggest that hypnotherapy can be effective as an adjunctive treatment for a number of disorders, including chronic and acute pain, irritable bowel syndrome, post-traumatic stress disorder (PTSD), phobias, and some eating disorders.

Definition

The United States Department of Labor's '' Dictionary of Occupational Titles'' (DOT) describes the job of the hypnotherapist:

"Induces hypnotic state in client to increase motivation or alter behavior patterns: Consults with client to determine nature of problem. Prepares client to enter hypnotic state by explaining how hypnosis works and what client will experience. Tests subject to determine degree of physical and emotional suggestibility. Induces hypnotic state in client, using individualized methods and techniques of hypnosis based on interpretation of test results and analysis of client's problem. May train client in self-hypnosis conditioning."

Traditional

The form of hypnotherapy practiced by most Victorian hypnotists, including James Braid and Hippolyte Bernheim, mainly employed direct suggestion of symptom removal, with some use of therapeutic relaxation and occasionally aversion to alcohol, drugs, etc.

Ericksonian

In the 1950s, Milton H. Erickson developed a radically different approach to hypnotism, which has subsequently become known as "Ericksonian hypnotherapy" or "Neo-Ericksonian hypnotherapy." Based on his belief that dysfunctional behaviors were defined by social tension, Erickson coopted the subject's behavior to establish rapport, a strategy he termed "utilization." Once rapport was established, he made use of an informal conversational approach to direct awareness. His methods included complex language patterns and client-specific therapeutic strategies (reflecting the nature of utilization). He claimed to have developed ways to suggest behavior changes during apparently ordinary conversations.

This divergence from tradition led some, including Andre Weitzenhoffer, to dispute whether Erickson was right to label his approach "hypnosis" at all. Erickson's foundational paper, however, considers hypnosis as a mental state in which specific types of "work" may be done, rather than a technique of induction.

The founders of neuro-linguistic programming (NLP), a method somewhat similar in some regards to some versions of hypnotherapy, claimed that they had modelled the work of Erickson extensively and assimilated it into their approach. Weitzenhoffer disputed whether NLP bears any genuine resemblance to Erickson's work.

Solution-focused

In the 2000s, hypnotherapists began to combine aspects of solution-focused brief therapy (SFBT) with Ericksonian hypnotherapy to produce therapy that was goal-focused (what the client wanted to achieve) rather than the more traditional problem-focused approach (spending time discussing the issues that brought the client to seek help). A solution-focused hypnotherapy session may include techniques from NLP.

Cognitive/behavioral

Cognitive behavioral hypnotherapy (CBH) is an integrated psychological therapy employing clinical hypnosis and cognitive behavioral therapy (CBT). The use of CBT in conjunction with hypnotherapy may result in greater treatment effectiveness. A meta-analysis of eight different types of research revealed "a 70% greater improvement" for patients undergoing an integrated treatment than those using CBT only.

In 1974, Theodore X. Barber and his colleagues published a review of the research which argued, following the earlier social psychology of Theodore R. Sarbin, that hypnotism was better understood not as a "special state" but as the result of normal psychological variables, such as active imagination, expectation, appropriate attitudes, and motivation. Barber introduced the term "cognitive-behavioral" to describe the nonstate theory of hypnotism, and discussed its application to behavior therapy.

The growing application of cognitive and behavioral psychological theories and concepts to the explanation of hypnosis paved the way for closer integration of hypnotherapy with various cognitive and behavioral therapies.

Many cognitive and behavioral therapies were themselves originally influenced by older hypnotherapy techniques, e.g., the systematic desensitisation of Joseph Wolpe, the cardinal technique of early behavior therapy, was originally called "hypnotic desensitisation" and derived from the ''Medical Hypnosis'' (1948) of Lewis Wolberg.

Curative

Peter Marshall, author of ''A Handbook of Hypnotherapy'', devised the Trance Theory of Mental Illness, which asserts that people suffering from depression, or certain other kinds of neuroses, are already living in a trance. He states that this means the hypnotherapist does not need to induce trance, but instead to make them understand this and lead them out of it.

Mindful

Mindful hypnotherapy is a therapy that incorporates mindfulness and hypnotherapy. A pilot study was made at Baylor University, Texas, and published in the ''International Journal of Clinical and Experimental Hypnosis''. Gary Elkins, director of the Mind-Body Medicine Research Laboratory at Baylor University, called it "a valuable option for treating anxiety and stress reduction” and "an innovative mind-body therapy". The study showed a decrease in stress and an increase in mindfulness.

Relationship to scientific medicine

Hypnotherapy practitioners occasionally attract the attention of mainstream medicine. Attempts to instill academic rigor have been frustrated by the complexity of client suggestibility, which has social and cultural aspects, including the practitioner's reputation. Results achieved in one time and center of study have not been reliably transmitted to future generations.

In the 1700s, Anton Mesmer offered pseudoscientific justification for his practices, but a commission that included Benjamin Franklin debunked his rationalizations.

Effectiveness

General

According to the Royal College of Psychiatrists, “studies have shown that hypnotherapy can help to treat a range of physical and mental health conditions” and “ In many cases, hypnotherapy and other uses of suggestion can provide fast, effective treatment.”

Menopause

There is evidence supporting the use of hypnotherapy in the treatment of menopause related symptoms, including hot flashes. The North American Menopause Society recommends hypnotherapy for the nonhormonal management of menopause-associated vasomotor symptoms, giving it the highest level of evidence.

Irritable bowel syndrome

The use of hypnotherapy in treating the symptoms of irritable bowel syndrome is supported by research, including randomized controlled trials. Gut-directed hypnotherapy is recommended in the treatment of irritable bowel syndrome by the American College of Gastroenterology clinical guideline for the management of IBS.

Childbirth

Hypnotherapy is often applied in the birthing process and the post-natal period, but there is insufficient evidence to determine if it alleviates pain during childbirth and no evidence that it is effective against post-natal depression.

Bulimia

Literature shows that a wide variety of hypnotic interventions have been investigated for the treatment of bulimia nervosa, with inconclusive effects. Similar studies have shown that groups suffering from bulimia nervosa, undergoing hypnotherapy, were more exceptional to no treatment, placebos, or other alternative treatments.

Anxiety

Hypnotherapy is shown to be comparable in effectiveness to other forms of therapy, such as cognitive-behavioral therapy, that utilize relaxation techniques and imagery. It has also shown to be successful when used to reduce anxiety in those with dental anxiety and phobias.

PTSD

Post Traumatic Stress Disorder (PTSD) and its symptoms have been shown to improve due to the implementation of hypnotherapy, in both the long and short term. As research continues, hypnotherapy is being more openly considered as an effective intervention for those with PTSD.

Depression

Hypnotherapy is effective when used to treat long-term depressive symptoms. It is comparable to the efficacy of cognitive-behavioral therapy, and when used in tandem, efficacy seems to increase.

Other uses

Historically hypnotism was used therapeutically by some psychiatrists in the Victorian era, to treat the condition then known as hysteria.

Modern hypnotherapy has been used to treat certain habit disorders and control irrational fears, and addiction.

* A 2003 meta-analysis on the efficacy of hypnotherapy concluded that "the efficacy of hypnosis is not verified for a considerable part of the spectrum of psychotherapeutic practice."
* In 2007, a meta-analysis from the Cochrane Collaboration found that the therapeutic effect of hypnotherapy was "superior to that of a waiting list control or usual medical management, for abdominal pain and composite primary IBS symptoms, in the short term in patients who fail standard medical therapy", with no harmful side-effects. However, the authors noted that the quality of data available was inadequate to draw firm conclusions.
* Two Cochrane reviews in 2012 concluded that there was insufficient evidence to support its efficacy in managing the pain of childbirth or post-natal depression.
* A 2014 meta-analysis that focused on hypnotherapy's efficacy on irritable bowel syndrome found that it was beneficial for short-term abdominal pain and other gastrointestinal issues.
* In 2016, a literature review published in '' La Presse Médicale'' found that there is not sufficient evidence to "support the efficacy of hypnosis in chronic anxiety disorders".
* In 2019, a Cochrane review was unable to find evidence of a benefit of hypnosis in smoking cessation and suggested that if there is, it is small at best.
* A 2019 meta-analysis of hypnosis as a treatment for anxiety found that "the average participant receiving hypnosis reduced anxiety more than about 79% of control participants," also noting that "hypnosis was more effective in reducing anxiety when combined with other psychological interventions than when used as a stand-alone treatment."

Occupational accreditation

United States

The laws regarding hypnosis and hypnotherapy vary by state and municipality. Some states, like Colorado, Connecticut, and Washington, have mandatory licensing and registration requirements, while many other states have no specific regulations governing the practice of hypnotherapy.

United Kingdom

UK National Occupational Standards

In 2002, the Department for Education and Skills developed National Occupational Standards for hypnotherapy linked to National Vocational Qualifications based on the then National Qualifications Framework under the Qualifications and Curriculum Authority
NCFE
a national awarding body, issues a level four national vocational qualification diploma in hypnotherapy. Currently, AIM Awards offers a Level 3 Certificate in Hypnotherapy and Counselling Skills at level 3 of the Regulated Qualifications Framework.

UK Confederation of Hypnotherapy Organisations (UKCHO)

The regulation of the hypnotherapy profession in the UK is at present the main focus o
UKCHO
a non-profit umbrella body for hypnotherapy organisations. Founded in 1998 to provide a non-political arena to discuss and implement changes to the profession of hypnotherapy, UKCHO currently represents 9 of the UK's professional hypnotherapy organisations and has developed standards of training for hypnotherapists, along with codes of conduct and practice that all UKCHO-registered hypnotherapists are governed by. As a step towards the regulation of the profession, UKCHO's website now includes a National Public Register of Hypnotherapists who have been registered by UKCHO's Member Organisations and are therefore subject to UKCHO's professional standards. Further steps to regulate the hypnotherapy profession will be taken in consultation with the Prince's Foundation for Integrated Health.

The National Council for Hypnotherapy (NCH)

The National Council for Hypnotherapy is a Professional Association, established in 1973 to create a National Membership Organisation for independent Hypnotherapy Practitioners.

The organisation is not for profit with a Board of 12-15 people composed of Executives and Directors, the latter usually ‘in practice’ Hypnotherapists and trainers of Hypnotherapy. The current Chair, Tracey Grist, has been in the position since 2016.

The NCH is a VO (Verifying organisation) for the CNHC, which means that NCH members meet the criteria to become CNHC registrants.

The NCH membership meets the national hypnotherapy training standards via the externally verified Hypnotherapy Practitioner Diploma (HPD) through the NCFE.

Members agree to follow the CECP; the NCH’s ethical code of practice. All members are expected to be insured to practice, meet supervision requirements, and meet annual CPD expectations.

Australia

The Australian government does not regulate professional hypnotherapy and the use of the occupational titles ''hypnotherapist'' or ''clinical hypnotherapist.''

In 1996, as a result of a three-year research project led by Lindsay B. Yeates, th
Australian Hypnotherapists Association
(founded in 1949), the oldest hypnotism-oriented professional organization in Australia, instituted a peer-group accreditation system for full-time Australian professional hypnotherapists, the first of its kind in the world, which "accredit dspecific individuals on the basis of their actual demonstrated knowledge and clinical performance; instead of approving particular 'courses' or approving particular 'teaching institutions'" (Yeates, 1996, p.iv; 1999, p.xiv). The system was further revised in 1999.

Australian hypnotism/hypnotherapy organizations (including the Australian Hypnotherapists Association) are seeking government regulation similar to other mental health professions. However, currently, hypnotherapy is not subject to government regulation through the Australian Health Practitioner Regulation Agency (AHPRA).

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References

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Psychotherapy by type

Mind–body interventions
Medical treatments
Pseudoscience
Alternative medicine
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