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The Internet is full of questionable “well-being” methods, from cold showers to ionic foot baths. But Stanford University psychiatrist Dr. Spiegel isn’t just an influencer. He is one of a small, but growing band of doctors and researchers who think that hypnosis, which many doctors consider a pseudoscience, has been unfairly maligned.
Although the effectiveness of hypnosis for most medical treatments has not been proven, in the management of pain and some mental-health issues, the technique has shown some interesting results. Dr. Spiegel and his colleagues are gathering evidence from a growing pile of clinical trials that explore the effects of hypnosis on the brain, and which have shown results ranging from reducing pain in surgery and reducing the side effects of cancer treatment to anxiety. It has been tested in everything till the treatment of. , irritable bowel syndrome (IBS) and depression. In a paper titled “Hypnosis: The Most Effective Treatment You Haven’t Yet Prescribed”, Dr. Spiegel and Jesse (Kittel) Markowitz of Stanford Medical Center argue that “If hypnosis were a drug, it would be a standard of care.” Would have been standard.”
this is just a suggestion
Most proponents of hypnosis divide the process into two parts. During “induction”, patients are encouraged to focus on the hypnotist’s voice and a pleasant memory (such as relaxing at the beach). If all goes well, the result will be not unlike being deeply immersed in a movie: absorption and an altered perception of time.
Next comes the “suggestion”, when the hypnotherapist tells the patient that sharp pain actually feels like heat, or that broccoli tastes like chocolate. Peter Whorwell, a British gastroenterologist who has written more than two dozen peer-reviewed research papers on IBS. Hypnosis describes how patients with colitis, an inflammation of the large intestine, can be asked to imagine that a hand is squeezing their intestine, and then imagine the hand slowly relaxing.
Skepticism among mainstream scientists about hypnosis often begins with the question of mechanism – how does suggestion cause a patient to experience useful effects? Proponents of the technique are therefore using brain-imaging techniques to look for clues about what is going on inside people’s heads while they are hypnotized.
Changes in brain activity begin with the induction, says Mathieu Landry, a neuroscientist at the University of Quebec at Trois-Rivières and author of a widely cited review of brain-imaging research related to hypnosis. He points specifically to increased activity in hypnotized people in the central executive network (CEN), a collection of brain circuits thought to be involved in regulating attention and focus. There appears to be greater communication between parts of the CEN and the insula, which helps monitor and interpret signals coming from the body.
The insula is part of the brain’s “salience network”, so named because it draws attention to significant changes in the environment. It is involved in processing threats and making people feel scared or uncomfortable when appropriate – common connotations with pain and fear. Dr. Spiegel thinks that the increased communication between the CEN and the insula may suggest that hypnotherapy allows the CEN to have greater control over unpleasant emotions.
Elsewhere in the salience network, hypnosis affects activity in the anterior cingulate cortex, a collar-shaped structure beneath the prefrontal cortex that, among other things, helps direct a person’s attention, and which is involved in the processing of pain. Important for, as well as anticipation. There is some evidence that hypnosis also alters connections from the prefrontal cortex to a third brain area, the amygdala, which helps regulate emotional responses. All of these changes may be related to hypnosis’ ability to reduce anxiety and fear in the face of things — like IBS, say — that cause pain.
Dr. Markowitz says these lines of evidence point to the idea that hypnosis uses the power of the brain to interpret what the body experiences. During hypnosis, she says, it may be possible to reprocess pain signals and therefore, literally, “feel” less pain.
All this is suggestive, if not exactly conclusive. Clinical trials, which can be helpful in finding out whether an intervention works even if its exact mode of action is unclear, are another way that scientists are gathering interesting evidence on hypnosis.
Have IBS, which can cause uncontrolled bowel movements and daily pain. In 2015, Dr. Whorwell found that of 1,000 people with difficult-to-treat IBS, 67% reported a 30% or more reduction in stomach pain with hypnotherapy. Of nearly 30 clinical trials, including at least 11 randomized controlled trials – the gold standard of medical evidence – most have concluded that hypnosis significantly improved IBS symptoms.
The Superior Health Council, a scientific advisory body to the Belgian government, concluded in a review in 2020 that, when it comes to treating depression and anxiety, hypnosis is more powerful than standard methods such as cognitive-behavioral therapy, a talking therapy Can make. A meta-analysis – which combined the results of several similar studies – published in 2021 found that adding hypnosis to CBT improved outcomes for 66% of patients suffering from depression, pain or obesity.
Hypnosis has also been tested along with anesthesia in major surgeries. A clinical trial in 2020 looked at 113 heart-surgery patients in a French hospital using a pair of different hypnosis techniques along with standard chemical anesthesia. As described in a research paper published in an American cardiology journal, patients were “invited to focus on a red object” and then “mentally traveled to a pleasant location” before They are taken into a more relaxed and “trancelike state.” If this did not work, patients were bombarded with questions intended to “saturate the brain”, another induction technique. Both methods caused less pain and more sedation than placebo, which meant hypnotized patients required less morphine.
follow the lack of money
This series of encouraging results means that clinical interest in hypnotherapy is, albeit slowly, expanding. Since 2015 all 30 university hospitals in France have been using hypnosis to manage pain; 20 It is offered, in combination with local anesthesia, as an alternative to general anesthesia for certain types of procedures that are considered to have moderate levels of pain and risk. Dutch health authorities have trained radiologists to use hypnosis to help reassure women during breast cancer screening. It is offered for pain management at the Bethesda Children’s Hospital in Budapest, which treats burn children throughout Hungary.
While studies supporting the use of hypnosis in pain relief are generally of good quality, studies for the use of hypnosis in smoking cessation or insomnia are not as strong so far. The bad reputation of hypnosis needs to be tackled more broadly in order to gather evidence for those areas. One problem, proponents say, is that hypnosis is often unregulated. It is illegal to represent oneself as a doctor without passing a professional medical examination, but in most countries, anyone can call themselves a hypnotist. Therefore this sector is plagued with fraudsters and chancers.
There are other obstacles too. Dr. Markowitz says that if hypnosis were a drug, given the results it has shown in trials so far, combined with the fact that it is relatively inexpensive and accessible through technology, it would be widely used. Will go. But because it is not a medicine, it is difficult to earn money from it.
Guy Montgomery, a clinical psychologist at Mount Sinai Hospital in New York, published a study in 2007 on breast biopsy and “lumpectomy,” in which cancerous tissue is removed. He showed that hypnosis before surgery reduced the time taken for the operation. Side-effects were later experienced, and sedatives and painkillers needed to be prescribed.
At the time, he calculated a savings of $772.71 per patient to the hospital, and was confident that other oncologists would follow his lead in using hypnosis for their patients. Even after almost two decades, he is disappointed. “Unlike pharmaceuticals,” he says, “the dollars don’t actually go into someone’s pocket.”
© 2024, The Economist Newspaper Limited. All rights reserved. From The Economist, published under license. Original content can be found at www.economist.com
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