Training in self-hypnosis, with or without biofeedback, is a valuable adjunct for children and adults with chronic illnesses or behavioral problems. After defining terms and briefly reviewing the evolution of medical hypnosis, this article provides an overview of the clinical utility and applications of self-hypnosis and various issues in its use, including patient assessment, concurrent use with biofeedback, and how health care providers can become trained in self-hypnosis instruction. Because my experience is primarily with medical hypnosis in children and adolescents, portions of this discussion will devote particular attention to the use of hypnosis in children.
Hypnosis is a state of awareness, often but not always associated with relaxation, during which the participant can give him- or herself suggestions for desired changes to which he or she is more likely to respond than when in the usual state of awareness. Spontaneous self-hypnosis may happen while reading, listening to music, watching television, jogging, dancing, playing a musical instrument, doing tai chi, doing yoga, or performing similar activities. Terms often used to describe mind-body training include relaxation imagery, guided imagery, or visual imagery. These include the same training strategies as those used in hypnosis.
Biofeedback is a term coined in 1969 to describe procedures (developed in 1940s) for training subjects to alter physiologic responses such as brain activity, blood pressure, muscle tension, or heart rate. With biofeedback, participants are trained to improve their health and performance by using signals from their own bodies. In so doing, they strengthen awareness of the connections between their mind and body.
Cyberphysiology was defined by Dr. Earl E. Bakken at the first Archaeus Congress, held in Santa Fe, New Mexico, in 1986. “Cyber” derives from the Greek kybernan, meaning steersman or helmsman. From kybernan came the Latinate term govern, meaning “to control.” Thus, cyberphysiology means to control a physiologic response. In scientific terms, cyberphysiology is the study of how neurally mediated autonomic responses—usually viewed as automatic, reactive reflexes—can be modified by a learning process that appears to be significantly dependent on modification of mental images. Both hypnosis and biofeedback are cyberphysiologic strategies that enable the user to develop voluntary control of certain physiologic processes.
HISTORICAL BEGINNINGS OF HYPNOSIS
Franz Mesmer developed a training system that he called animal magnetism. Mesmer believed that normal body processes were disrupted when there was improper distribution of magnetism, a kind of fluid that could penetrate all matter. He described his ability to direct this magnetic fluid through his presence with the waving of a metallic rod and contact with a large wooden tub called a baquet. Mesmer was convinced that the successful therapeutic effects he observed depended on the magnetic rods he used.
When jealous and hostile colleagues challenged Mesmer’s clinical successes, King Louis XVI of France called for an investigative commission chaired by Benjamin Franklin, who was then the American ambassador to France. Other commission members included Dr. Antoine Lavoisier, the first to isolate the element of oxygen, and Dr. Antoine Guillotine, well known for developing a machine for beheading.1 After the commission conducted some clever experiments, they concluded that Mesmer’s success was related to application of the imagination. In fact, we are not far beyond that concept today, although we now have brain imaging documentation of changes in the brain associated with the practice of hypnosis.2–5
CORRECTING MISCONCEPTIONS ABOUT HYPNOSIS
Hypnosis is not sleep
Modern hypnosis is considered to have begun with Mesmer, although the term hypnosis was first used by James Braid, a Scottish ophthalmologist, in 1843. His decision to derive the word from hypnos, the Greek word for sleep, was unfortunate. Hypnosis is not sleep, but the name confuses people.
All hypnosis is self-hypnosis
Another major misconception about hypnosis is that someone—ie, the hypnotist—is in control of a person. In fact, the hypnotist is a coach or teacher who helps the patient to increase his or her self-regulation abilities.6 All hypnosis is self-hypnosis; after the initial training, the learner must reinforce the training with daily practice. Adult learners should anticipate practicing approximately 10 minutes twice daily for about 2 months in order to condition the desirable physiologic change or outcome. Children learn more easily and often can achieve desired changes over a period of a few weeks.
IMPORTANCE OF PATIENT ASSESSMENT BEFORE TEACHING SELF-HYPNOSIS
Every candidate for self-hypnosis therapy deserves a thoughtful, careful diagnostic assessment that includes appropriate laboratory procedures, radiologic procedures, or both prior to decisions about treatment. Patients are sometimes referred for specific cyberphysiologic interventions, such as hypnosis, without adequate diagnostic assessments.7 When a patient is referred for hypnosis training, the health professional who will provide the training should evaluate the extent of the previous diagnostic assessment and do more if indicated. It is also important that the health professional be knowledgeable and competent with respect to the patient’s specific problem. For example, a dentist who is board-certified in dental hypnosis should not be teaching hypnosis to children with migraine, just as a pediatrician who is board-certified in medical hypnosis should not be extracting teeth using hypnosis.
Mental imagery varies from individual to individual. Many children have visual, auditory, kinesthetic, and olfactory/taste imagery abilities and can use these easily in the process of self-hypnosis. In contrast, many adults do not generate multiple types of mental imagery, and many lack clear visual imagery. It is important that the therapist identify which types of mental imagery the patient prefers before embarking on a therapeutic approach.