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The Serious Side of Hypnosis


Galileu Magazine - Issue 269 - December 2013:

Science explains how the technique has helped patients quit smoking, lose weight, combat stress and treat chronic pain by Guilherme Pavarin and Tiago Mali


Psychologist Lina Schlachter hears screams coming from the emergency room of the University of Tennessee Medical Center in the United States and rushes over. In the corridor of the trauma ward, she comes across a 42-year-old mechanic screaming in pain. His right leg was shattered after an accident in one of the region's factories and he is immobilized, sweating profusely. After meeting with Lina, the patient's screams gradually turn into moans, which become lower and lower. Ten minutes later, he reports that the previously unbearable pain no longer bothers him. Instead, there is just a tingling sensation. All this, without any sedatives.

Lina, a doctor in clinical psychology from the University of Tennessee, doesn't do magic. "It was breathing exercises and a series of suggestions to get him to concentrate, think about where he likes to go for walks and start to relax," she says. The case of the accident, presented at a medical conference in the United States in 2008, is an example of how traditional medicine has allied itself with certain hypnosis techniques to combat various health problems. It adds to a series of studies published in some of the world's most rigorous scientific journals, such as Science, The Lancet and Proceedings of the National Academy. And what do these studies say? That it is possible to treat chronic pain, insomnia, migraines, obesity, addictions, phobias, skin diseases and other ailments with hypnosis. But it's not that kind of hypnosis where you snap your fingers and the problem goes away. These are sessions with a defined method, in treatments that can take months.

No wonder there are more and more scientists and researchers "mesmerized" by the subject. The number of studies published per year on the subject has grown by 50% in the last decade, reaching 280 in 2009 alone (the last year with closed figures), according to the Pubmed scientific database. Among the recent studies, a survey of 124 women carried out in 2010 at Stanford University found that the practice of hypnosis can ease the suffering of breast cancer patients. Another study, carried out in 2008 at the University of California, evaluated smokers who used the technique to quit smoking - the group that was hypnotized was 50% more successful in their treatment than the other team.

Today's hypnotists aren't showmen with a dark look, an illusionist's manner and the talk of a charlatan. The new hypnotists have a doctor's, psychologist's or dentist's degree and prefer to be called hypnologists. You won't find them on variety shows, but in places like Hospital das Clínicas, A.C. Camargo and São Camilo, all in São Paulo, as well as renowned medical clinics. "The practice has been growing a lot in Brazil, especially against somatization problems, when a disease manifests or worsens because of some emotional disturbance. The federal councils of medicine, psychology, dentistry and physiotherapy have already approved it," says psychologist Miriam Pontes, vice-president of the Brazilian Society of Hypnosis, which has 2,000 associated professionals throughout Brazil.

How it works:

Stare into my eyes and forget all that pendulum stuff, eating onions thinking they're apples, crowing like a rooster and other pyrotechnics. Scientifically speaking, hypnosis is a state in which someone's perception, memory and actions can be altered by someone else's suggestion. Some people find it extremely easy to be hypnotized; others rarely succeed. "The individual remains conscious, but the brain temporarily suppresses attempts to confirm the information coming from the senses. The critical sense drops and there is greater attention to what the hypnotist suggests," says Osmar Colás, coordinator of the Hypnosis Study Group at the Paulista School of Medicine. If worked on properly, this hyper-attention can, for example, make us ignore sensations sent by the body. It's like a soccer player who suffers a severe blow to the leg during the championship final, but continues playing, only feeling the pain after the match is over.

In the brain, we have already discovered some of the regions where this phenomenon occurs. Neuroimaging studies show that the right anterior cingulate gyrus, an area responsible for taking information from the senses to our rational part, is affected by hypnosis. "The suggestion reaches this intermediate region, which decides where attention goes, as if it were inoculating a thought into the person's head," says Mohamad Bazzi, a Brazilian doctor who has been studying hypnosis for two decades. This is where researchers believe "authentication" fails.

This is probably what happened to the mechanic quoted at the beginning of this article when, after repeated suggestions, he stopped focusing on the pain information from his broken leg. His case, however, is not the rule: only 10% of the world's population is highly susceptible to hypnosis (see how this is measured in the table below). For less susceptible people, it takes time to reach a deep trance - and even then, there is no guarantee that they will be able to achieve this state. Day laborer Andreia Peres Maranhão, 34, for example, had to undergo 12 sessions over the course of a month before she was ready for surgery to remove a breast lump, done in a hypnotic trance. "I'd had a bad experience with anesthesia before and I was breastfeeding [breastfeeding had to be interrupted because of the sedative]," she says.

During the sessions, anesthesiologist Cristiane Hikiji Nogueira made Andreia train her brain to deflect the pain. At first, she rotated a pen in front of the patient's eyes, and she began to relax. Then he would poke Andreia with fine needles and tell her that the area would no longer be felt. In the following sessions, as she managed to ignore the pain, the diameter of the needles increased until they approached the size that would be equivalent to a scalpel. Traditional anesthetics were also prepared during the operation, in case of emergencies, but they proved unnecessary. "I've done more than 30 surgeries with hypnosis alone and I've never had any problems," says Cristiane, who hypnotized Andreia at the Hospital das Clínicas in Ribeirão Preto. As all this preparation takes a long time, hypnosis often ends up being the second option, used mainly when the patient is terrified of or allergic to anesthesia.

It's also possible to combine the two: hypnosis and anesthetics. This is what Gabriela Talarico, a 32-year-old teacher from São Paulo, did when she had two wisdom teeth removed. Gabriela, who was too afraid of anesthesia, was in a panic when she arrived at the office of dentist Marcelo Martins. With repeated suggestions of relaxation, Martins put Gabriela into a trance, making her less susceptible to pain reactions, and administered only a third of the normal amount of anesthetic. "As there was no preparation, the hypnosis wasn't as deep, but it was enough to calm her down and achieve improvements in healing and bleeding control," he says.

At the Pain Center at Hospital das Clínicas in São Paulo, longer techniques are taught to deal with chronic pain such as migraines and fibromyalgia. "We teach self-hypnosis exercises for patients to repeat at home," says Adriana Loduca, a psychologist at the hospital. One of the techniques begins with breathing exercises in six stages and then evolves into concentration on some kind of image, so that the brain is distracted from the pain.

The Science of Hypnosis:

Although impressive, examples of this kind were previously viewed with skepticism by academics. How could we prove that it wasn't a placebo effect, or that some of these cases weren't fabricated? Most of these doubts fell away in 1998, when scientists with a Ph.D. Stephen Kosslyn, from Harvard University, and David Spiegel, from Stanford, used PET (positron emission tomography, a sophisticated imaging test) to "photograph" hypnosis. They asked subjects to see colors on a black and white panel and found that their brains acted as if there really were colored posters in front of them. "The blood flow in the brain repeated the pattern of when a person sees color. In other words, the brain was really 'seeing' it," says Spiegel, who has been studying hypnosis since the 1970s.

Considered a watershed, the study is still bearing fruit today. So much so that in 2010, Oxford researcher Devin Terhune used a similar principle to show how hypnosis could be used for a feat previously thought impossible: reversing synaesthesia. The rare condition leads to a confusion of senses in the brain, such as seeing non-existent images when hearing certain sounds. In the case of the volunteer treated by the experiment, strong colors appeared in her brain every time she saw a face. By inducing the trance, Terhune diverted the "brain pathway" during the phenomenon, causing her to ignore the colors that appeared in her mind. An electroencephalogram confirmed the effect. "She reported that she no longer had color spasms when seeing faces and, at the same time, the area linked to mental confusion in the brain reduced its electrical activity," says Terhune. The researcher points out that all this only worked because the volunteer was highly hypnotizable.

Removal of wisdom teeth after trance:

Every time she heard about anesthesia at the dentist, teacher Gabriela Talarico, 32, felt a chill run down her spine. When she learned that she would have to have two wisdom teeth removed, she couldn't disguise her tension. To calm her down, dentist Marcelo Martins asked her to do some hypnosis exercises and she had a positive response. "It didn't hurt at the time or afterwards," says Gabriela. "I felt unusually calm. "The hypnotic suggestions, according to Martins, also made healing three days faster and enhanced the effect of the anesthetic, which was used in a third of the usual amount.

Too much psychology:

Attacking pain is the best-known effect of this mental reorganization, but it's far from the only one. Most of the possibilities lie in the area of psychosomatic and behavioral disorders. Illnesses such as insomnia, phobias, hypertension and obesity are often closely related to psychological factors. It is in these cases - and not all of them - that hypnosis can be of great help. This is what Irving Kirsch, one of the world's leading experts in clinical hypnosis and a Ph.D. in psychology from the University of Southern California, showed in 1995. In a major review of studies, Kirsch found that the practice improved the positive effects of therapies based on cognitive-behavioral psychology, which is the most popular and widespread form of treatment for these problems, in 70% of cases.

Public relations officer Simone Araújo, 35, has seen this benefit. She suffers from atopic dermatitis, an incurable disease that causes scaling, itching and red patches on the body, and which worsens during times of stress. After trying a series of treatments and taking dozens of drugs, she managed to improve her condition greatly by using hypnosis combined with psychotherapy. "It was my last hope. Before, it was difficult to even hug my children because I felt so much pain with the bruised skin. Today I hug, kiss and even pinch them," says Simone.

She worked on her anxiety in hypnosis sessions. She did a series of breathing exercises that stimulated her relaxation until she went into a trance. This state was enhanced by instructions to imagine peaceful situations. "It eased my anxiety, it was like a good night's sleep. I felt a great improvement until the next session. "Simone's mood improved and, after the second month, so did her spots.

Hypnosis helps with the psychological side, but it also has an effect on addictions such as smoking and can be used to treat obsessive compulsive disorders. For nursing assistant Anderson Soares da Silva, 34, hypnosis was the missing component in his treatments. Before, he had tried to quit smoking with patches and even antidepressants, but he could only go two days without smoking. "It only worked when I combined hypnosis with other remedies. It was a process of two to three months before I managed to quit for good," says Anderson Soares, who has now been cigarette-free for a year.

No stress:

Soon after she finished university, 23-year-old Fabríssia Lima, a publicist from Rio de Janeiro, began to suffer anxiety attacks due to the pressures of her job. "I felt a lot of anguish, I was suffocating, I couldn't go to closed places or take the subway. " At the suggestion of an acquaintance, she went to psychologist Miriam Pontes to try to relieve her stress and tension. In less than four months, with one hypnosis session a week, Fabríssia noticed great improvements in her mood and her ability to concentrate.

Lose weight:

Imagine if someone told you that, in order to lose weight, you didn't need to have stomach surgery, but just pretend to have had one? That's more or less the treatment already sold to 500 patients for around R$3,400 at the Elite hypnosis clinic in Malaga, Spain. The therapy also claims to use the psychological effect of hypnosis. "The patient is suggested to think that they have undergone stomach reduction surgery," says Spanish hypnologist Martin Shirran, a partner in the company. To increase the power of persuasion, a kind of little theater is set up, simulating in the environment the smell, touch and sounds typical of a procedure in an operating room. In the end, says Shirran, the patient is left with an unconscious image that their stomach is smaller, a kind of hallucination, and they feel they can't stand too much food. The treatment has become feverish in the UK after being used by singer Lily Allen and ex-Spice Girl Geri Halliwell.

Architect Felipe Caribe says he was successful with a similar experiment in Curitiba. After several other attempts, he says he lost 14 kilos in three months of psychotherapy sessions combined with hypnosis. "I was suggested to feel that there is an inflated balloon inside my stomach that prevents me from eating too much," says Caribe, who is still 103 kilos and 1.80 meters tall. Despite the extravagant idea, there are serious studies showing that hypnosis can, in cases related to anxiety, help reduce weight - although none mention this type of "hypnotic surgery".

Future of Research:

One of the next steps in the science of hypnosis comes a little closer to the theatrics of the Spanish clinic. A group of British scientists from the University of Greenwich are studying how a virtual reality environment can enhance the effects of the practice. Another group of researchers is trying to understand the genetic characteristics that lead some people to be more hypnotizable than others. At least four studies have already shown that a gene called COMT is related to susceptibility, but its exact action is not yet fully understood.

There are also several study groups that want to simulate illnesses through hypnosis in order to understand them better. One of the leaders of this current is the British David Oakley, Ph.D. in clinical psychology and professor at University College London. He published a review of initiatives in the field in 2009, in which he brings together experiments in which people are hypnotized to feel auditory hallucinations, heat and different types of pain, causing the brain to simulate something imaginary. These induced brain states could be used in a controlled environment to better understand how some diseases affect people. One that is already being researched is conversion disorder, which can lead to paralysis, blindness and motor difficulties.

Other interesting studies have been carried out by Israeli neuroscientist Avi Mendelsohn, who has shown how the brains of people susceptible to forgetting after hypnosis (10% of the population) can block memory activation. His studies also point to the possibility of creating false memories. "In the future, I believe that many people will be able to use hypnosis to block the memories that are disturbing their lives, or at least suppress the bad emotions linked to these memories," he says.

Care:

There is a lot of hi-tech in the new research, but what most scientists in the field still want is to confirm the effectiveness of the treatment for other types of disease. "There is an effort to improve the quality of the studies. Some are good, but many still need to meet higher quality standards if they are not to be challenged," says Donald Robertson, director of the UK College of Hypnosis & Hypnotherapy, which has reviewed dozens of studies on the subject.

  • Francisco Di Biase – Culture of Healthy

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