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Going Under: Self-Hypnosis for Pain Relief

In the movies, hypnosis usually involves someone falling under the magical spell of a villainous character. The hypnotized person then goes into a trace and carries out the hypnotizer’s nefarious plans. In a medical setting, however, self-hypnosis—in which people induce a hypnotic state by themselves—is a tool that people can use to achieve a sense of control, rather than lose it. In fact, studies show self-hypnosis can help people manage pain, anxiety, addiction and phobias, among other problems.

"There is nothing mystical or magical about hypnosis." explains David Spiegel, MD, a professor at the Stanford University School of Medicine in California. "It’s just a state of altered and highly focused attention."

Dr. Spiegel, the past president of the Society for Clinical and Experimental Hypnosis, says that by learning how to attain a hypnotic state on their own, people can gain control over what’s happening in their bodies. Below, he discusses the role of self-hypnosis in pain management.

What is self-hypnosis?
All hypnosis is really self-hypnosis. The person inducing hypnosis doesn’t do anything to a person or control them in any way. Medical professionals are just teaching people how to narrow their focus of attention, turn inward and put outside of conscious their awareness of some things that would ordinarily be in consciousness.

The only time I formally hypnotize a patient is the first time when I am assessing their hypnotizability. After that, I teach people how to enter the state for themselves. Since hypnosis is not sleep, but rather highly focused attention, it’s a state you can enter into very quickly if you’ve got the ability. You can monitor what you’re doing while you’re in it, and you can choose to end it when you want to.

How do you determine someone’s receptiveness to hypnosis?
I do a five-minute test called the hypnotic induction profile. I give people a series of standard instructions for hypnotic experience. I’m basically seeing whether they have the capacity to experience these hypnotically instructed alterations in perception, sensation and motor control. To evaluate their sensory alternation, for example, I ask them to imagine that their hand is light and floating up in the air. If they pull it down, it will float right back up.

It turns out that hypnotizability in adult life is an extremely stable trait. It’s as stable as IQ. The peak period of hypnotizability in the human life cycle is children between the ages of 5 and 10. Most 8-year-olds are in trances most of the time. You know, you call them in for dinner and they don’t hear you. So it’s actually quite easy for most children to go into hypnotic state.

Some people have it as adults, some don’t, and it’s easy to measure. It’s not affiliated with a lot of personality characteristics, but people who are more hypnotizable tend to rate themselves as more trusting of others. They are more likely to get absorbed in movies or novels or plays. They are people who have had early life experiences of imaginative involvement with parents. But people who have experienced physical punishment are more likely to be hypnotizable as well.

What are some of the techniques you use to teach self-hypnosis?
Typically we ask people to look up and close their eyes. There is something about disengaging from the usual scanning visual awareness that seems to help people cut off their usual anxious preoccupation with the world outside, and turn inward. So we recommend that they close their eyes, take a deep breath, let their bodies float and then imagine they are floating or looking at an imaginary screen or hearing sounds that they may not ordinarily hear.

How can hypnosis be used to alter someone’s perception of pain?
There are three main strategies. One is physical relaxation. When people are in pain, they are also often tense. Muscle tension tends to exacerbate the pain by pulling on the area that hurts. So rather than fighting the pain, if one can focus on an image that conveys relaxation, like floating, the pain can be reduced.

The second strategy is sensory alteration. You can actually change your perception of pain. For example, you can imagine that your hand that hurts is in a pool of cold ice water in an icy mountain stream. If you focus on the cool tingly numbness instead of the pain, you learn to filter the hurt out.

Another technique is distraction. You can focus on sensations in some other part of your body, and therefore reduce the attention you’re paying to the pain.

How often do you have to self-hypnotize to maintain pain relief?
I encourage my patients to do it for two to three minutes every one to three hours if they’ve got pain, and then anytime the pain starts to get worse. So it is a technique you can carry with you anywhere and use when you need it.

Has the effect of hypnosis on pain been studied?
There is really solid evidence that self-hypnosis is helpful. We did a trial some years ago for women with metastatic breast cancer that showed that teaching self-hypnosis resulted in a significant reduction in pain compared to patients who were not taught self-hypnosis. Elvira Lang, MD, at Harvard Medical School, did a trial involving 240 people who were having a painful invasive interventional radiology procedure that involved having little cameras inserted through the arteries. All participants were offered pain medication. One group was also offered training in self-hypnosis. Another group had a nurse assigned to them, but no training in self-hypnosis, and the third group had routine care.

The study showed that the patients who received the hypnosis training had far less pain and virtually no anxiety, whereas anxiety was going through the roof for the other patients. The hypnosis patients had fewer complications with the procedure. They used far less medication, and it took 17 minutes on average less time to get through the procedures. So they were more comfortable, less anxious, had fewer problems and got out sooner.

What kind of studies still need to be done?
We need more studies evaluating outcome in different contexts, as we would with any other medical treatment. We need to look at pain in children undergoing medical procedures; pain control during surgery; pain for different sorts of problems, from gastrointestinal to arthritis to other serious chronic pain problems.

Secondly, we need more studies about how hypnosis affects people’s perception of pain. We’re learning that there are specific parts of the brain that are affected by hypnosis for pain relief. One of them is the anterior singular gyrus, a part of the brain that helps us focus attention. That seems to be actively involved in hypnotic analgesia. Parts of the brain that actually process physical sensation also appear to be involved.

Thirdly, I think we need some studies of the effect of hypnotic interventions on the practice and cost of healthcare. In Dr. Lane’s hypnosis study, for example, she found that each procedure cost, on average, $338 less if you taught the patient self-hypnosis. So there are tremendous economic implications, which also need to be studied more.

Do you think that self-hypnosis should be taught more regularly?
Absolutely. It’s a safe, effective procedure with virtually no side effects. A lot of people get scared about the idea of hypnosis or think they are being controlled. It’s really a way of enhancing your control over your body. I think it ought to be part of any pain treatment program. I also think it should be more a part of medical education.

I do think as we do more studies on hypnosis, medicine will become more accepting of the idea that this isn’t mumbo jumbo. This is science. It’s a way in which we can use our own brains to help ourselves feel better.