Dr. David Spiegel: Using Hypnosis to Enhance Health & Performance

Dr. David Spiegel on Hypnosis

• Hypnosis: a state of highly focused attention 
  • Similar to being absorbed in a movie or sports game
  • Involves a narrowing of context and losing of the self
  • Can include body experiences as part of the event

Clinical Hypnosis vs. Stage Hypnosis

• Clinical hypnosis: used for treatment of various ailments of mind and body 
  • Involves changing brain state to make adjustments in brain and body
  • Can improve symptoms of stress, chronic anxiety, chronic pain, and other illnesses
• Stage hypnosis: hypnotist gets a person to do things they would not otherwise do 
  • Different from clinical hypnosis

Hypnotizability

• Not everyone can be hypnotized as readily as others 
  • Dr. Spiegel developed a simple test to determine hypnotizability
  • High, medium, or low degree of hypnotizability

Reverie App

• Developed by Dr. Spiegel based on clinical studies and research 
  • Currently only available for Apple, soon for Android
  • Seven-​​day free trial available
  • Designed with clinical treatments in mind

Breath Work

• Collaboration between Dr. Spiegel and Dr. Huberman’s research lab at Stanford 
  • Developing specific breath work protocols for anxiety, mood, and sleep improvement
    Hypnosis

Getting into Hypnosis

• Hypnosis is often associated with stage hypnosis and entertainment
• Clinical hypnosis is different from stage hypnosis
• Stage hypnosis can be harmful and make fools out of people

Hypnosis in Clinical Settings

• Enhances control over mind and body
• Provides cognitive flexibility and ability to shift perspectives
• Can be a great therapeutic tool if used correctly

Brain Activity during Hypnosis

• Studied using functional MRI scans
• Three main characteristics during entry into hypnotic state:
• Turning down activity in the dorsal anterior cingulate cortex (DACC)
  • DACC is part of the salience network and acts as a conflict detector
• Increased connectivity between the dorsolateral prefrontal cortex (DLPFC) and the insula 
  • DLPFC is involved in executive control, while the insula is involved in body awareness
• Decreased connectivity between the DLPFC and the default mode network (DMN)
  • DMN is involved in self-​​referential thinking and mind-wandering

Exiting Hypnosis

• Failure to exit the hypnotic state can lead to distress and confusion
• Brain activity changes as people exit hypnosis, but more research is needed to understand the specific processes involved
  Hypnosis and Mental State Change
• Mental state change has therapeutic potential 
  • Example: Ketamine treating depression
  • Changing mental state can help regulate and change responses
• Hypnosis can help with unsystematic desensitization 
  • Changing mental states to face problems and see them from a different point of view
  • Can help with phobias, trauma, and stress
• State-​​dependent memory 
  • When in a certain mental state, you enhance your ability to remember things about it
  • Hypnosis can help people remember and deal with memories better because they’re more in the mental state

Hypnosis in Treating Phobias and Trauma

• Hypnosis can help people manage their anxiety and have a wider array of experiences 
  • Can create a network of associations that isn’t so negative and may even be positive
• Can help restructure understanding of trauma 
  • Confront the trauma and engage in self-​​protection strategies
  • Can accomplish things more quickly and effectively than traditional psychotherapy
• Adding hypnosis to PTSD treatment can improve outcomes

Dissociation and Hypnosis

• Going into the state one is trying to deal with, but then dissociating from that state is key 
  • Can help people drop into feeling states and deal with emotions around their experiences
• Hypnosis can help access state-​​dependent memories and deal with them more effectively
  Dissociation and Trauma Treatment
• Dissociation during traumatic episodes is an adaptive strategy 
  • Creates issues and problems
  • Ketamine, which creates a dissociative state, can be useful for trauma treatment
• Carl Dyseroth’s research on ketamine and dissociative states 
  • Rhythmic discharge in the retrosplenial region triggered by ketamine
  • Rats showed dissociative-​​like behavior
  • Human subject reported being in a dissociative state
• Hypnosis can help enhance control over mind and body 
  • Useful for treating trauma-​​related disorders

Hypnosis for Pain Relief and Anxiety

• Hypnosis can provide quick relief 
  • Long-​​lasting changes possible with practice
• Clinical hypnosis vs. self-hypnosis 
  • Start with a licensed professional for assessment and guidance
  • Learn self-​​hypnosis for continued practice and control
• Dr. Spiegel’s study on hypnosis for pain relief during medical procedures 
  • Hypnosis group reduced pain by 80% and used half the amount of opioids
  • Fewer complications and shorter procedure time
• Long-​​term effects of hypnosis 
  • Study on women with metastatic breast cancer
  • Hypnosis group had half the pain after a year on low amounts of medication
  • Hypnosis becomes a skill that people can acquire and use for themselves

Reverie App

• App developed to teach people self-hypnosis 
  • Helps with pain, stress, focus, insomnia, and other issues
  • Provides interactive support for learning and practicing hypnosis
  • Users can see quick results and know if hypnosis is likely to help them
    Hypnosis and Mental Health
• Hypnosis can be helpful for stress reduction, phobias, and pain management 
• Hypnotizability varies among individuals 
  • 1/​​3 of adults are not hypnotizable
  • 15% are extremely hypnotizable
• Hypnotizability is more stable than IQ over a 25-​​year interval
• Hypnosis may not be as effective for those with OCD or ADHD, as they may be less hypnotizable
• Hypnotizability can be measured using the Hypnotic Induction Profile 
  • Helps guide treatment options for patients

Eye Roll Test

• Developed by Dr. Spiegel’s father
• Used to assess hypnotizability
• Involves looking up at the ceiling and closing eyes while looking up
• Highly hypnotizable individuals may show only the whites of their eyes (sclera) when performing the eye roll
• Can help determine the best treatment approach for patients based on their hypnotizability

Hypnosis for Obsessive Thoughts and Superstitions

• Hypnosis may be helpful for some individuals with obsessive thoughts or superstitions
• However, those with OCD may be less hypnotizable and less likely to benefit from hypnosis
• Response prevention can be an effective technique for breaking superstitions 
  • Involves forcing oneself to not engage in the superstitious behavior for a period of time
  • Helps establish a new context in the brain where the desired outcome is achieved without the extraneous behavior
    Spiegel Eye Roll Test and Hypnotizability
• Spiegel Eye Roll Test: measures hypnotizability 
  • Involves looking up at the ceiling, tilting head back, and closing eyes while maintaining upward gaze
  • If white part (sclera) is visible, person is highly hypnotizable
  • If colored part (iris) is visible, person is less hypnotizable
• Eyes and levels of consciousness 
  • Closing eyes when sleeping, rapid eye movement when dreaming
  • Most drugs affecting consciousness can affect eyes and eye movements
• Hypnotizability
  • About two-​​thirds of people can be hypnotized
  • 15% of people are highly hypnotizable
  • Repeated use of hypnosis may slightly increase hypnotizability, but not significantly

EMDR (Eye Movement Desensitization Reprocessing)

• EMDR: therapy for trauma-​​related problems 
  • Involves lateralized eye movements
  • Some claim it coordinates the two sides of the brain or mimics rapid eye movements during sleep
• Criticisms and limitations 
  • Lateral eye movements may not add significant benefits to therapy
  • EMDR may be another form of exposure-​​based therapy for trauma
  • One session may not be enough for lasting results
  • More focus on processing the trauma itself may be beneficial
    Dream States and Hallucinations
• Alan Hobson: sleep researcher, studied brain activity during sleep 
• Dreams can have inconsistent stories and images, but consistent affect (emotion)
• Lateral eye movement may suppress amygdala activity, regulating affect in dreams

EMDR and Hypnosis

• EMDR may incorporate elements of hypnosis
• Lateralized eye movements may suppress amygdala, inducing a calm state
• Exposure therapy through discussion about the issue

Facing Trauma and Phobias

• Getting close to the trauma or phobia is crucial for adjusting the response to it
• Voluntary self-​​exposure is important for effective treatment
• Stress inoculation: exposure to stress can help build resilience and ability to manage stress

Mind-​​Body Connection

• Mind and body signals can be seen as tools to help understand the world and what’s important
• Pain can be categorized and processed differently based on its meaning
• Emotional pain can also be modified by how the brain interprets it
• Blending receptive and active responses can help in managing mind-​​body connections
  Hypnosis and Grief
• Grief is a natural, necessary stage of life 
• Grief rituals help make an incomprehensible loss comprehensible
• Expressing negative emotion can help people be less anxious and depressed over time
• Hypnosis can help individuals face loss, live with the emotion, and reflect on what they gained from the lost person

Hypnosis and Children

• Children can be hypnotized, but may need more structure for self-hypnosis
• Hypnosis can be effective for children in medical settings (e.g., pediatricians, dentists)
• Hypnosis can help children with fear and pain during medical procedures

Hypnosis in Groups and Couples

• Hypnosis can be done in groups, such as support groups for women with advanced breast cancer
• Coordinated hypnosis for couples has not been widely explored, but group hypnosis has been successful

Hypnosis and Drug Therapies

• Hypnosis can have a sedative effect at the chemical level, with a correlation between hypnotizability and GABA activity in the anterior cingulate cortex
• Benzodiazepines can improve hypnotic response for very anxious individuals, but may inhibit hypnotic activity for those who are not very anxious
• Mild stimulants might enhance hypnotic responsiveness, but too much can scatter attention and reduce control
• Hypnosis is generally more of a replacement than a supplement for drug therapies
  Role of Respiration in Hypnosis
• Breathing is a bridge between conscious and unconscious states 
• Breathing patterns can increase or decrease sympathetic arousal
• Sighing (more time spent exhaling than inhaling) may induce parasympathetic activity
• Hypnosis induction often involves taking a deep breath and slowly exhaling
• Breathing is at the edge of conscious and unconscious control, allowing modulation of internal states

Key Elements of Hypnosis

• Breathing
• Vision
• Bodily states
• Directed mental focus
• Can involve physical relaxation or intense activity (e.g., athletic or musical performance)

Resources for Hypnosis

• Reverie app for self-​​hypnosis: reverie​.com
• Society for Clinical and Experimental Hypnosis: sceh​.us
• American Society for Clinical Hypnosis: asch​.net
• Look for licensed and trained professionals in psychiatry, psychology, medicine, or dentistry with training and interest in using hypnosis