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DEFINITION

Hypnosis is a procedure that induces an altered state of consciousness in which the patient's mind is more accepting of suggestion. It is believed that during hypnosis the usual evaluative, critical function of the conscious mind is bypassed and more direct communication with the subconscious mind occurs.

HISTORY

Hypnotic phenomena, including trancelike states for medical purposes, have been practiced around the world throughout human history. It was the Scottish surgeon, James Braid, in 1843, however, who coined the term "hypnosis" and laid the foundation for the use of hypnosis in modern medicine. Braid believed the effects of hypnosis were mediated by the mind of the patient. Important early research was conducted in the 1930s by Dr. Clark Hull and his student, Dr. Milton Erickson. In the mid-1950s, the British and American Medical Associations suggested that hypnosis be incorporated into the medical curriculum. In 1960, the American Psychological Association endorsed hypnosis as a branch of psychology. In 1996, an NIH Technology Assessment Panel judged hypnosis to be an effective intervention for alleviating pain.

MECHANISM OF ACTION

The mechanism of action of hypnosis has not been fully elucidated, but its effects are seen at multiple levels, including somatosensory cortex, anterior cingulate cortex (modulation of pain affect via limbic system), spinal cord, and autonomic nervous system (eg, reduction of colonic motility in irritable bowel syndrome). Additional evidence regarding the mechanism includes upregulation of immune-related gene expression (eg, effects on tumor necrosis factor) and reduction of mucosal inflammatory response (in ulcerative colitis). Hypnotic trance is a state distinct from sleep or relaxation, and hypnotic analgesia is distinct from placebo analgesia.

TRAINING & CERTIFICATION

Certification for hypnosis, granted through the American Society of Clinical Hypnosis, has these requirements: (1) health professional degree, (2) 40 hours of workshop training, (3) 20 hours of supervised clinical training, and (4) 2 years of independent practice using clinical hypnosis.

Other certification programs exist. Patients and clinicians should inquire about the training and certification of any practitioner of hypnosis because there are no restrictions limiting its use to licensed health care practitioners.

CLINICAL PRACTICE

The procedure of hypnosis can be divided into three phases: induction (or pre-suggestion), suggestion, and post-suggestion. The induction of a trance is accomplished in a variety of ways with the intention of developing relaxation and focused attention. Once the trance is induced, therapeutic suggestions are offered. In the post-suggestion phase, the patient returns to their usual state of consciousness and the suggestions may be discussed and reinforced. Self-hypnosis may be taught to further reinforce the therapeutic suggestions between sessions.

Although most people can respond to hypnosis, there is great variability in hypnotic susceptibility (suggestibility) in the population. This can be measured with standard instruments such as the ...

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