| Hypnotherapy | |
|---|---|
| Intervention | |
| ICD-10-PCS | GZF |
| ICD-9-CM | 94.32 |
Hypnotherapy is a therapy that is undertaken with a subject in hypnosis.[1]
The word "hypnosis" (from the Greek hypnos, "sleep") is an abbreviation of James Braid's (1841) term "neuro-hypnotism", meaning "sleep of the nervous system".
A person who is hypnotized displays certain unusual characteristics and propensities, compared with a non-hypnotized subject, most notably hyper-suggestibility, which some authorities have considered a sine qua non of hypnosis. For example, Clark L. Hull, probably the first major empirical researcher in the field, wrote,
If a subject after submitting to the hypnotic procedure shows no genuine increase in susceptibility to any suggestions whatever, there seems no point in calling him hypnotised...[2]
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Hypnotism is often, mistakenly, thought to be the same as mesmerism, its historical precursor.
According to Hans Eysenck,
The terms "mesmerise" and "hypnotise" have become quite synonymous, and most people think of Mesmer as the father of hypnosis, or at least as its discoverer and first conscious exponent. Oddly enough, the truth appears to be that while hypnotic phenomena had been known for many thousands of years, Mesmer did not, in fact, hypnotise his subjects at all. It is something of a mystery why popular belief should have firmly credited him with a discovery which in fact was made by others.(Eysenck, Sense & Nonsense in Psychology, 1957: 30-31)
Franz Anton Mesmer held that trance and healing were the result of the channelling of a mysterious "occult" force called "animal magnetism". In the mid-18th Century, this became the basis of a very large and popular school of thought termed "Mesmerism". However, in 1843, the Scottish surgeon James Braid proposed the theory of hypnotism as a radical alternative, in opposition to Mesmerism. Braid argued that the occult qualities of Mesmerism were illusory and that its effects were due to a combination of "nervous fatigue" and verbal suggestion. A bitter war of words developed between Braid and the leading exponents of Mesmerism.
I beg farther to remark, if my theory and pretensions, as to the nature, cause, and extent of the phenomena of nervous sleep [i.e., hypnotism] have none of the fascinations of the transcendental to captivate the lovers of the marvellous, the credulous and enthusiastic, which the pretensions and alleged occult agency of the mesmerists have, still I hope my views will not be the less acceptable to honest and sober-minded men, because they are all level to our comprehension, and reconcilable with well-known physiological and psychological principles. (James Braid, Hypnotic Therapeutics, 1853: 36)
However, there is agreement that the origin of modern hypnosis is with the methods employed in Mesmerism. Whilst Braid differed in offering an explanation of hypnotic effects that did not rely on supernatual forces, he credited the methods used in hypnosis to the practice of Mesmerism. Braid said of the subject:
Hypnotism might therefore not inaptly be designated, Rational Mesmerism, in contra-distinction to the Transcendental Mesmerism of the Mesmerists.[3]
In their original committee report on hypnotherapy, the British Medical Association (BMA), likewise, made a point of condemning the occult theories of Mesmerism and sharply distinguishing them from hypnotism.
The Committee, having completed such investigation of hypnotism as time permitted, have to report that they have satisfied themselves of the genuineness of the hypnotic state. No phenomena which have come under their observation, however, lend support to the theory of ‘animal magnetism’. ("Report on Hypnotism", British Medical Journal, 1892).
A hypnotherapist is a therapist who utilizes hypnosis as a primary tool for assisting clients to achieve their goals. A hypnotherapist often differs from other therapists because they focus on the role of subconscious behaviors and influences on the client's life.
In 1973, Dr. John Kappas, Founder of the Hypnosis Motivation Institute, wrote and defined the profession of a hypnotherapist in the Federal Dictionary of Occupational Titles:
"Induces hypnotic state in client to increase motivation or alter behavior patterns: Consults with client to determine nature of problem. Prepares client to enter hypnotic state by explaining how hypnosis works and what client will experience. Tests subject to determine degree of physical and emotional suggestibility. Induces hypnotic state in client, using individualized methods and techniques of hypnosis based on interpretation of test results and analysis of client's problem. May train client in self-hypnosis conditioning."[4]
The form of hypnotherapy practiced by most Victorian hypnotists, including James Braid and Hippolyte Bernheim, mainly employed direct suggestion of symptom removal, with some use of therapeutic relaxation and occasionally aversion to alcohol, drugs, etc.[5]
In 1895 Sigmund Freud and Joseph Breuer published a seminal clinical text entitled Studies in Hysteria (1895) which promoted a new approach to psychotherapy.
In the 1950s, Milton H. Erickson developed a radically different approach to hypnotism, which has subsequently become known as "Ericksonian hypnotherapy" or "Neo-Ericksonian hypnotherapy." Erickson made use of an informal conversational approach with many clients and complex language patterns, and therapeutic strategies. This divergence from tradition led some of his colleagues, including Andre Weitzenhoffer, to dispute whether Erickson was right to label his approach "hypnosis" at all.[6]
The founders of Neurolinguistic Programming (NLP), a methodology similar in some regards to hypnotism, claimed that they had modelled the work of Erickson extensively and assimilated it into their approach called the Milton Model.[7][8] Weitzenhoffer disputed whether NLP bears any genuine resemblance to Erickson's work.[6]
Cognitive behavioural hypnotherapy (CBH) is an integrated psychological therapy employing clinical hypnosis and cognitive behavioural therapy (CBT).
In 1974, Theodore Barber and his colleagues published an influential review of the research which argued, following the earlier social psychology of Theodore R. Sarbin, that hypnotism was better understood not as a "special state" but as the result of normal psychological variables, such as active imagination, expectation, appropriate attitudes, and motivation.[9] Barber introduced the term "cognitive-behavioral" to describe the nonstate theory of hypnotism, and discussed its application to behavior therapy.
The growing application of cognitive and behavioral psychological theories and concepts to the explanation of hypnosis paved the way for a closer integration of hypnotherapy with various cognitive and behavioral therapies. However, many cognitive and behavioral therapies were themselves originally influenced by older hypnotherapy techniques,[10] e.g., the systematic desensitisation of Joseph Wolpe, the cardinal technique of early behavior therapy, was originally called "hypnotic desensitisation"[11] and derived from the Medical Hypnotism (1948) of Lewis Wolberg.
Hypnotherapy has long been used in relation to childbirth. It is sometimes used during pregnancy to prepare a mother for birth, and during childbirth to reduce anxiety, discomfort and pain.[12]
Hypnotism was originally used to treat the condition known in the Victorian era as hysteria. Modern hypnotherapy is widely used in the treatment of anxiety, subclinical depression, and certain habit disorders, as well as in the treatment of conditions such as insomnia[13] and addiction.[14]
In 1892, the British Medical Association (BMA) commissioned a team of doctors to undertake an evaluation of the nature and effects of hypnotherapy;
The Committee, having completed such investigation of hypnotism as time permitted, have to report that they have satisfied themselves of the genuineness of the hypnotic state. (Needham F, Outterson T. Report of the committee appointed to investigate the nature of the phenomena of hypnotism. British Medical Journal. 1892 July 23;2(1647):190-1.)
The Committee are of opinion that as a therapeutic agent hypnotism is frequently effective in relieving pain, procuring sleep, and alleviating many functional ailments [i.e., psycho-somatic complaints and anxiety disorders]. (Ibid.)
In 1955, the Psychological Medicine Group of the BMA commissioned a Subcommittee, led by Prof. T. Ferguson Rodger, to deliver a second, and more comprehensive, report on hypnosis. The Subcommittee consulted several experts on hypnosis from various fields, including the eminent neurologist Prof. W. Russell Brain, the 1st Baron Brain, and the psychoanalyst Wilfred Bion. After two years of study and research, its final report was published in the British Medical Journal (BMJ), under the title ‘Medical use of Hypnotism’. The terms of reference were:
To consider the uses of hypnotism, its relation to medical practice in the present day, the advisability of giving encouragement to research into its nature and application, and the lines upon which such research might be organized. (British Medical Journal, 1955)
It concludes from a systematic review of available research that,
The Subcommittee is satisfied after consideration of the available evidence that hypnotism is of value and may be the treatment of choice in some cases of so-called psycho-somatic disorder and Psychoneurosis. It may also be of value for revealing unrecognized motives and conflicts in such conditions. As a treatment, in the opinion of the Subcommittee it has proved its ability to remove symptoms and to alter morbid habits of thought and behavior[...]
In addition to the treatment of psychiatric disabilities, there is a place for hypnotism in the production of anesthesia or analgesia for surgical and dental operations, and in suitable subjects it is an effective method of relieving pain in childbirth without altering the normal course of labor. ("Medical use of hypnosis", British Medical Journal, April 1955)
According to a statement of proceedings published elsewhere in the same edition of the BMJ, the report was officially ‘approved at last week’s Council meeting of the British Medical Association.’ (BMA Council Proceedings, BMJ, April 23, 1955:1019). In other words, it was approved as official BMA policy. This statement goes on to say that,
For the past hundred years there has been an abundance of evidence that psychological and physiological changes could be produced by hypnotism which were worth study on their own account, and also that such changes might be of great service in the treatment of patients.(British Medical Journal, cited)
In 1958, the American Medical Association (AMA) commissioned a similar (though more terse) report which endorses the 1955 BMA report and concludes,
That the use of hypnosis has a recognized place in the medical armamentarium and is a useful technique in the treatment of certain illnesses when employed by qualified medical and dental personnel. ("Medical use of hypnosis", JAMA, 1958)
Again, the AMA council approved this report rendering hypnotherapy an orthodox treatment,
The Reference Committee on Hygiene, Public Health, and Industrial Health approved the report and commended the Council on Mental Health for its work. The House of Delegates adopted the Reference Committee report [...](AMA Proceedings, JAMA, September 1958: 57)
In 1995, the US National Institute for Health (NIH), established a Technology Assessment Conference that compiled an official statement entitled "Integration of Behavioral & Relaxation Approaches into the Treatment of Chronic Pain & Insomnia". This is an extensive report that includes a statement on the existing research in relation to hypnotherapy for chronic pain. It concludes that:
The evidence supporting the effectiveness of hypnosis in alleviating chronic pain associated with cancer seems strong. In addition, the panel was presented with other data suggesting the effectiveness of hypnosis in other chronic pain conditions, which include irritable bowel syndrome, oral mucositis [pain and swelling of the mucus membrane], temporomandibular disorders [jaw pain], and tension headaches. (NIH, 1995)
In 1999, the British Medical Journal (BMJ) published a Clinical Review of current medical research on hypnotherapy and relaxation therapies,[15] it concludes,
In 2001, the Professional Affairs Board of the British Psychological Society (BPS) commissioned a working party of expert psychologists to publish a report entitled The Nature of Hypnosis.[16] Its remit was 'to provide a considered statement about hypnosis and important issues concerning its application and practice in a range of contexts, notably for clinical purposes, forensic investigation, academic research, entertainment and training.' The report provides a concise (c. 20 pages) summary of the current scientific research on hypnosis. It opens with the following introductory remark:
"Hypnosis is a valid subject for scientific study and research and a proven therapeutic medium."
With regard to the therapeutic uses of hypnosis, the report said:
"Enough studies have now accumulated to suggest that the inclusion of hypnotic procedures may be beneficial in the management and treatment of a wide range of conditions and problems encountered in the practice of medicine, psychiatry and psychotherapy."
The working party then provided an overview of some of the most important contemporary research on the efficacy of clinical hypnotherapy, which is summarized as follows:
In 2003, a meta-analysis of the efficacy of hypnotherapy was published by two researchers from the university of Konstanz in Germany, Flammer and Bongartz. The study examined data on the efficacy of hypnotherapy across the board, though studies included mainly related to psychosomatic illness, test anxiety, smoking cessation and pain control during orthodox medical treatment. Most of the better research studies used traditional-style hypnosis, only a minority (19%) employed Ericksonian hypnosis.
The authors considered a total of 444 studies on hypnotherapy published prior to 2002. By selecting the best quality and most suitable research designs for meta-analysis they narrowed their focus down to 57 controlled trials. These showed that on average hypnotherapy achieved at least 64% success compared to 37% improvement among untreated control groups. (Based on the figures produced by binomial effect size display or BESD.)
According to the authors this was an intentional underestimation. Their professed aim was to discover whether, even under the most skeptical weighing of the evidence, hypnotherapy was still proven effective. They showed conclusively that it was. In fact, their analysis of treatment designs concluded that expansion of the meta-analysis to include non-randomized trials for this data base would also produce reliable results. When all 133 studies deemed suitable in light of this consideration were re-analyzed, providing data for over 6,000 patients, the findings suggest an average improvement in 27% of untreated patients over the term of the studies compared with a 74% success rate among those receiving hypnotherapy. This is a high success rate given the fact that many of the studies measured included the treatment of addictions and medical conditions. The outcome rates for anxiety disorders alone, traditionally hypnotherapy's strongest application, were higher still (though a precise figure is not cited).(Flammer & Bongartz, "On the efficacy of hypnosis: a meta-analytic study", Contemporary Hypnosis, 2003, pp179 – 197.)
In 2005 and in 2007, systematic reviews from the Cochrane Collaboration showed no proper evidence that hypnotherapy was useful in the treatment of smoking addiction or in the treatment of irritable bowel syndrome (IBS) [17][18]
The U.S. (Department of Labor) Directory of Occupational Titles (D.O.T. 079.157.010) supplies the following definition:
The Department of Health in the state of Washington regulates hypnotherapists.
In 2002, the Department for Education and Skills developed National Occupational Standards for hypnotherapy [19] linked to National Vocational Qualification based on National Qualifications Framework under The Qualifications and Curriculum Authority. And thus hypnotherapy was approved as a stand-alone therapy in UK. NCFE a national awarding body issues level four national vocational qualification diploma in hypnotherapy. <http://website.ncfe.org.uk/>
The REGULATION of the Hypnotherapy Profession in the UK is at present the main focus of UKCHO, a non-profit making umbrella body for hypnotherapy organisations. Founded in 1998 to provide a non-political arena to discuss and implement changes to the profession of Hypnotherapy, UKCHO currently represents 9 of the UK's professional hypnotherapy organisations and has developed standards of training for hypnotherapists, along with codes of conduct and practice that all UKCHO registered hypnotherapists are governed by. As a step towards the regulation of the hypnotherapy profession UKCHO's website now includes a National Public Register of Hypnotherapists[20] who have been registered by UKCHO's Member Organisations and are therefore subject to UKCHO's professional standards. Further steps to full regulation of the hypnotherapy profession will be taken in consultation with the Prince's Foundation for Integrated Health.
Moves toward Voluntary Self Regulation in the UK hypnotherapy field have led to the formation of a unitary National Register.[21]
Professional hypnotherapy and use of the occupational titles hypnotherapist or clinical hypnotherapist is not government-regulated in Australia.
In 1996, as a result of a three-year research project led by Lindsay B. Yeates, the Australian Hypnotherapists' Association[3] (founded in 1949), the oldest hypnotism-oriented professional organization in Australia, instituted a peer-group accreditation system for full-time Australian professional hypnotherapists, the first of its kind in the world.[22] The system was further revised in 1999.[23]
Australian hypnotism/hypnotherapy organizations (including the Australian Hypnotherapists Association) are seeking government regulation similar to other mental health professions. However, the various tiers of Australian government have shown consistently over the last two decades that they are opposed to government legislation and in favour of self regulation by industry groups.[24]
Reports of unprofessional short course hypnotherapy being used on people by life coaches, unqualified counselors, psychics and various organizations in the metaphysical field in Australia has alarmed some consumer groups.
Consumer organizations are investigating the need to bring in tighter regulation and to license all hypnotherapy practitioners after several incidents of business misconduct. Professional psychologists are entering into voluntary self-regulation, but there are no protections in place by the federal and state governments of Australia to stop counselors, psychics, life coaches falsely claiming they are hypnotherapists.