Hypnosis is the most effective way to stop smoking

I regularly provide counseling to help people stop smoking, and often use hypnosis as a part of my approach. One of the first questions I hear from people is: Does hypnosis really work? Can it really help me stop smoking?

I’m not an advertiser — I’m a clinician and a scientist, so I tend to be a little bit conservative about telling people just how much more effective hypnosis actually is than all other available treatments. So I’ve compiled this brief review of the scientific literature on methods to stop smoking so that you can make the comparison for yourself and really see the difference in effectiveness. In putting this together, I’ve focused strongly on rigorous, meta-analytic studies — which are studies that combine the results of many other smaller studies in order to get much more comprehensive results.

Here are the major interventions currently being used to help people stop smoking:

  • Hypnotherapy
    • In a major meta-analysis of 633 studies on smoking cessation, including 48 studies which examined hypnosis on more than 6,000 participants, hypnosis showed a 36% success rate when no distinction is made between different types of hypnotic intervention (Viswesvaran & Schmidt, 1992). This is important to note, because there are many different ways that hypnosis can be used, and they are not all equally effective. Previous studies have shown, for example, that custom-tailored hypnosis is much more effective than the standardized, scripted variety typically used in scientific studies (Lynn, Green, Accardi, & Cleere, 2010). So with this study we can see that even when most of the treatments use a standardized, one-size-fits-all approach, more than 1/3 of participants still achieve and maintain abstinence from cigarettes.
    • An extremely rigorous, randomized controlled study in 2006 found that intensive (8-session) hypnotherapy resulted in 40% of patients being free from cigarettes at 6 month follow-up, as confirmed by measurement of carbon monoxide levels in their blood (Elkins, Marcus, Bates, Rajab, & Cook, 2006). Not a single person in the control group had managed to stop smoking on their own for this length of time.
    • New procedures for enhancing hypnotic responsivity and reinforcing treatment gains may provide even greater effectiveness for the use of hypnosis to stop smoking (Lynn, Green, Accardi, & Cleere, 2010)
  • Counseling
    • A recent systematic review published in the journal Addiction found that behavioral counseling is superior to treatment with medication (Hartmann-Boyce, Stead, Cahill, & Lancaster, 2013)
    • Another meta-analysis showed that a type of counseling called Motivational Interviewing is also effective in enhancing smokers’ ability to quit successfully. (Heckman, Egleston, & Hofman, 2010)
    • However, counseling is substantially more effective when hypnosis is used (Lynn, Green, Accardi, & Cleere, 2010)
  • Acupuncture
    • A meta-analysis of alternative smoking cessation aids published in the American Journal of Medicine found that acupuncture is an effective treatment for smoking — more effective than medication or nicotine replacement — but not as effective as hypnotherapy (Tahiri, Mottillo, Joseph, Pilote, & Eisenberg, 2012)
  • Nicotine Replacement Therapy
    • Nicotine replacement is the most popular method to try and quit smoking, because products such as nicotine gums and patches are readily available over-the-counter, and people believe that replacing the nicotine from cigarettes will help them to break the habit before they have to deal with the physical effects of detoxification from nicotine. A 2008 meta-analysis found that nicotine patches and nasal spray were roughly as effective as other medications (Eisenberg et al, 2008), while nicotine tablets and gum were slightly less effective.
    • In total, only 7 to 9 percent of people succeed in stopping smoking by using this method (Shiffman et al, 2002).
  • Medication
    • A meta-analysis published in the Canadian Medical Association Journal compared 7 popular medications used for smoking cessation including buproprion (Wellbutrin) and varenicline (Champix), as well as nicotine replacement products such as the nicotine patch, gum, or nasal spray (Eisenberg et al, 2008). While each of these medications was more effective than a placebo in helping smokers kick the habit, the overall effectiveness is not very good. All told, less than 10% of patients receiving any of these medications succeeded in remaining abstinent from cigarettes for 6 months.
  • Aversive Smoking
    • This is the method of intentionally making yourself sick by smoking many cigarettes very quickly. This creates an intensely unpleasant experience which causes many people to feel a subsequent aversion to cigarettes. This method is actually slightly more effective than anti-smoking medications (Eisenberg et al, 2008), but not anywhere near as effective — or enjoyable — as hypnotherapy (Tahiri et al, 2012)

From reviewing the literature, my conclusion is that New Scientist was correct when they declared hypnosis “the best way of giving up smoking.” Particularly when used in a personalized manner, in conjunction with motivational interviewing and behavioral counseling, there is simply nothing that comes close to matching its effectiveness.

In 2011, I worked with Dr. Edward Frischholz, Ph.D., ABPH on further developing a brief hypnotic treatment for smoking originally developed in the 1960s and under continuous refinement since that time. The method’s effectiveness has been confirmed in numerous studies. In the most recent published study, from the American Journal of Psychiatry, this method achieved 30% success at a six-month follow-up (in a single session!) — measured by complete 100% abstinence for the entire six month period (Spiegel, Frischholz, Fleiss, & Spiegel, 1993). If a participant smoked even one cigarette at a party a single time during the entire six months, it was counted as a failure.

By studying the real-life circumstances associated with both successful and unsuccessful outcomes, we were able to modify the technique in order to achieve an additional 8% success at 6 months follow-up. I presented these findings to the Society of Clinical and Experimental Hypnosis at their annual conference in 2011.

And as we continue to update and refine this method, we find that more and more of our patients are finding it easy and enjoyable to become non-smokers… permanently.



  • Eisenberg, M.J., Filian, K.B., Yavin, D., Belisle, P., Mottillo, S., Joseph, L., Gervais, A., O’Loughlin, J., Paradis, G., Rinfret, S., & Pilote, L. (2008). Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. Canadian Medical Association Journal, 179(2), 135-144.
  • Elkins, G., Marcus, J., Bates, M., Rajab, J., & Cook, T. (2007). Intensive hypnotherapy for smoking cessation: A prospective study. International Journal of Clinical and Experimental Hypnosis, 54, 303-315.
  • Hartmann-Boyce, J., Stead, L.F., Cahill, K., & Lancaster, T. (2013). Efficacy of interventions to combat tobacco addiction: Cochrane update of 2012 reviews. Addiction, 108(10), 1711-1721.
  • Heckman, C.J., Egleston, B.L., & Hofman, M.T. (2010). Efficacy of motivational interviewing for smoking cessation: a systematic review and meta-analysis. Tobacco Control, 19, 410-416.
  • Lynn, S., Green. J., Accardi, M., & Cleere, C. (2010). Hypnosis and Smoking Cessation: The State of the Science. American Journal of Clinical Hypnosis, 52(3), 177-181.
  • Shiffman, S., Hellebusch, S.J., Gorsline, J., Gorodetzky, C.W., Chiang, Y.K., Schleusener, D.S., & Di Marino, M.E. (2002). Real-world efficacy of prescription and over-the-counter nicotine replacement therapy. Addiction, 97(5), 505-516.
  • Spiegel, D., Frischholz, E.J., Fleiss, J.L. & Spiegel, H. (1993) Predictors of Smoking Abstinence Following a Single-Session Restructuring Intervention with Self-Hypnosis. American Journal of Psychiatry, 150(7), 1090-1097.
  • Tahiri, M., Mottillo, S., Joseph, L., Pilote, L., & Eisenberg, M.J. (2012). Alternative smoking cessation aids: a meta-analysis of randomized controlled trials. American Journal of Medicine, 125(6), 576-84.
  • Viswesvaran, C., & Schmidt, F. (1992). A meta-analytic comparison of the effectiveness of smoking cessation methods. Journal of Applied Psychology, 77, 554-561.

Motivational Enhancement Therapy

Many times the most difficult thing about making a change is deciding to. It is the terrible ambivalence that keeps us from taking steps to improve our health, to strengthen our relationships, and to break free from patterns of behavior that damage and hold us back. Many people take the first major step of coming to therapy for addictions, or depression, or marital discord — only to find that they are fighting an internal battle about whether or not they really want to take action. Sometimes that conflict doesn’t even really show its face until you’re sitting in a therapist’s office being told what to do in order to get what you want. And a part of you, just… doesn’t want to.

Motivational Enhancement Therapy is like the therapy before the therapy. Before you can really dig into the work of making change in your life, you have to make that critical decision — that this is the time. Not with part of your mind, but with all of it.

The Motivational Enhancement procedure takes about four sessions, which are spent examining the situation as it is, the changes you’d like to see, and the reasons why you’d like to see those changes. Most people are surprised at how low-pressure these sessions are. There is no point during a Motivational Enhancement session at which I will try to convince the patient of anything. My job in these sessions is just to ask the types of questions that help a person understand their own reasons for wanting to change. The final decision about how to proceed rests squarely in the hands of the patient.

The way this is done is using the techniques of motivational interviewing:

  1. Open-ended questions – This type of questioning naturally leads into the issues most pertinent not to the therapist, but to the patient.
  2. Affirmations – When we’re feeling ambivalent, it’s often because we’re having trouble recognizing what strengths we can bring to bear on a situation. By helping you recognize the things you’re already doing well, this technique provides a feeling of encouragement and stimulates problem-solving.
  3. Reflective listening – The client’s own ideas and experiences are reflected back in a way that facilitates momentum toward a logical conclusion.
  4. Summaries – Periodically, the therapist provides a summary to help bring it all together and show how each of the ideas discussed connect.

So the purpose of this therapy is not to persuade the client that they should make a change — after all, if they didn’t already want a change, they wouldn’t have showed up. The purpose is to help draw connections between personal experiences and strengths, so that a natural, progressive course of action will become clear.


Relaxation & Stress Management

Are your mind and body working against each other?

Psychological stress is so powerful that it can practically tear your body apart.

Studies correlate stress with chronic pain, heart disease, stroke, diabetes, cancer, dementia, infections, and just about every other medical problem you could possibly experience. Why? Because stress causes inflammation.

And inflammation inhibits your body’s ability to repair itself, causing ordinary problems to spiral out of control — turning into allergies, arthritis, hormonal imbalance, autoimmune disease, asthma, skin problems, hardened arteries… That’s how powerful the mind-body connection is.

Worse, stress is sensitizing. Surviving a very stressful event doesn’t prepare you to handle stress better in the future. Instead, you actually become more likely to experience adverse consequences every time.

What’s the antidote? Relaxation.

In the 1970s, a cardiologist named Herbert Benson was the first to discover that when people engage in active relaxation, their physiological response to stress is reduced… along with all of its negative health effects. He called this natural healing effect the relaxation response.

A lot of people hear this and immediately think they need to spend more time kicking back in front of the TV with a cold beer. But there’s a catch — passive activities like watching television don’t do the trick. (In fact, studies show that TV can actually induce physical stress.)

If you want to trigger your body’s healing relaxation response, you need to practice a technique specifically aimed at doing so (such as diaphragmatic breathing exercises, progressive muscle relaxation, or meditation.) And these activities actually provide a cumulative benefit — they not only make you feel relaxed while you’re practicing them, but over time they bring your body’s baseline for stress down to a more comfortable level. That means that ongoing stressors in your life won’t affect you as much.

The best approach is to work at the problem from both sides.

In the course of providing psychotherapy and counseling, I end up teaching most of my clients some form of meditation, relaxation, or self-hypnosis technique that they can use to achieve these benefits. They’re very effective, and people really enjoy them.

But it’s also important to work on directly improving the stress in your life. That’s why I rarely stop at relaxation. Some of the other important ingredients for maintaining a positive, relaxed state are:

  • Assertiveness: Learning to communicate clearly, authentically, and effectively — so you build deep connection, minimize resistance, and get what you want more often
  • Organization: A good organizational system can relieve stress while allowing you to accomplish more
  • FocusAttention and concentration are strengths that can be exercised and improved over time, using techniques like mindfulness meditation.
  • Acceptance: Worrying uses up valuable time and energy without contributing anything positive. By learning to accept the uncertainty and chaos of life, you can increase your resilience and respond more effectively when stressful events actually occur.

Transpersonal Therapy & Spiritual Counseling

Your spiritual beliefs can be your most powerful tools for positive transformation.

Psychotherapy based on the integration and amplification of spirituality is referred to as “transpersonal” — because the nature of spirituality is that it helps to bring us outside of ourselves, and to connect us with higher powers and higher realities. Transpersonal therapy often incorporates aspects of Jungian analysis, which focuses on understanding the archetypal forces playing out… not only in your unconscious mind but in the external world.

These concepts are not very popular with today’s science-minded psychological community. There are few studies, and few testable hypotheses or techniques. Regardless, I believe that spirituality is the original form of psychotherapy, and it still may be the most powerful.

Even when I’m explaining what I do in terms of scientific tools and medicalized interventions, in my own mind I think of what I do as shamanism. But, in a world where spirituality has become personal and individual — rather than the deeply shared beliefs of our collectivistic past — a shaman’s job is to work with the very personal myths and symbols that have taken root in each individual mind. Peer-reviewed science is only the current mythological system of our culture. For those who subscribe to it, I use empirically based treatments (with just a dash of magic).

But for those who follow the old religions, I prefer to use a more traditional style of treatment.

The induction and utilization of trance states has played a central role in treatment for thousands of years. The explicit practice of hypnosis goes back to the sleep temples of ancient Egypt and the shamanic rituals of all tribal cultures. Judaism, Christianity, and Islam, with their emphasis on prayer, study, and meditation, have been no less reliant on trance.

Even the designs of churches and temples evoke states of consciousness congruent with the spiritual values of the sect they represent — from the humbling grandiosity of mosques and cathedrals, to the wooden stoicism of Lutheran chapels, walking into a place of worship generally triggers a sense of spiritual presence even for those who do not usually subscribe to the beliefs of that particular sect.

Spirituality is about finding a sense of meaning in life. And that sense of meaning, as told in the myths of every religion, imparts a supernatural ability to overcome life’s difficulties.

Every generation has numerous examples of miraculous healings by faith. Descriptions can be found in nearly every spiritual text and — although they are repeatedly discounted by reasonable, scientifically-minded people — they continue to take place all over the world. I believe that this type of healing is at least as accessible to us today as it was thousands of years ago.

For example, I recently worked with a double-amputee who was experiencing phantom leg pain. As he described his strong Christian beliefs, I realized that they were his strongest and most ready tool for overcoming his symptoms. As we talked, he came to trust in my openness enough that he was willing to share his faith with me and to show me how he prayed. After a month or two of working with him to strengthen his prayer by digging more deeply into his own most closely-held beliefs, his pain disappeared.

People usually seek help when they can’t understand the meaning of what is happening to them.

As their lives change, their beliefs no longer seem sufficient to explain their experience and connect them with the unknown. They experience depression, anxiety, obsession, darkness, and longing. I find that I am able to work easily with such people, because I have no beliefs of my own. A part of me believes everything.

I grew up steeped in fundamentalist Christianity, in which the deep symbolism of the Christian Bible was taken as literal truth. And a part of me still believes it is. But other parts have come to similarly subscribe to the truths of Buddhism (that all of life is an illusion to be transcended), of Hinduism (that life is a grand drama playing out between fragments of a single consciousness), of Catholicism, Wicca, Druidism, Spiritualism, Scientism, Illuminism. Parts of me have become initiated in secret magickal societies and experience the power of imagination to act upon the outside world. Parts of me experience the universe in ways that have not yet been named — as a series of quantum fields which can be consciously traversed.

So when a person comes to me for help living in a different kind of world, I create rituals that call that world into being. I help them experience trance states in which they can travel there — and realize that they have the power to choose which world they will live in.

Depression Treatment

Depression is extremely common, and extremely treatable. More than 1 in 5 adults will experience a diagnosable mood disorder at some time during their lives, with major depressive disorder being the most common (this is what some counselors call “clinical depression.”) If you’re suffering from depression, you already know how many different kinds of problems it can cause… problems with work, relationships, health. And it steals your ability to feel joy, enthusiasm, or even simple pleasure.

Now, here’s where things get tricky: depression isn’t really a single thing

There’s no medical test that can definitively diagnose depression — and anyone who tells you that depression is caused by a “chemical imbalance” is either misinformed, or has some medication to sell you. Even the psychological tests for depression are really just lists of symptoms that you check off, or questions that other people who are depressed have been found to answer in a similar way.

The truth is, there are many different causes of depression, many different ways that depression might affect you, and therefore many different types of treatment that might be effective for your particular case. Some examples:

  • Major Depression – already mentioned, this is the diagnosis for people feeling sad, guilty, tearful, and withdrawn
  • Atypical Depression – tends to be reactive to external events, and is characterized by overeating, oversleeping, and an inflamed sense of rejection
  • Dysthymia – a form of low-grade, chronic depression (they used to call this depressive personality disorder)
  • Adjustment Disorder – this situational depression occurs when external events overcome your ability to manage the emotional stress of what you’re going through
  • Postpartum Depression – depression after giving birth, or occasionally during pregnancy
  • Premenstrual Dysphoric Disorder – depression which follows a woman’s monthly cycle
  • Seasonal Affective Disorder – “winter sadness”
  • Bipolar Disorder – where depressive episodes alternate with periods of hyperactivity called mania (this pattern used to be called manic depression)

Depression treatment is very effective. But…

One-size-fits-all treatments are only going to be effective for people that they are actually a good fit for. The treatment should not only be a good fit for your symptoms, but also for you as a person. Your personality dynamics determine what types of psychological problems you might have, how they’ll present themselves, and how you can find your way back to feeling better.

That’s why I like to take a holistic (Adlerian/Ericksonian) approach, creating a customized treatment for each patient. This may incorporate any of the following:

  • Behavioral prescriptions – Targeted action plans can help gradually break the inertia of depression, so you start regaining a sense of yourself as a person who can accomplish things. In the scientific literature, this is referred to as “behavioral activation,” and it is actually one of the most effective techniques — especially for severe depression.
  • Lifestyle modification – I help my clients examine their style of living to identify simple, powerful changes they can make to help support a positive mood — things like exercise, sleep, relaxation, stress management, nutrition, and time  in nature. This ties in with behavioral activation, but goes beyond mere activity for it’s own sake, into choosing activities that will have specific physiological and psychological effects.
  • Cognitive restructuring – This central aspect of cognitive behavioral therapy involves learning to recognize and change the automatic thoughts and mental images that support the depressive symptoms, as well as the core beliefs which make a person susceptible to depression in the first place.
  • Psychodynamic therapy – Many people who are “cured” of depression remain susceptible to experiencing the same thing all over again later on. Through the use of insight-oriented or psychoanalytic techniques, you can discover the source of this susceptibility and develop strategies to help ensure that the rest of your life keeps getting better and better. Research shows that patients who receive this type of therapy continue to improve for years after the treatment is done.
  • Clinical hypnosis – By tapping into your deepest, unconscious resources, hypnosis can enhance and accelerate all of the other therapy techniques I’ve mentioned. Many scientific studies have shown that psychotherapy with hypnosis is more effective in the treatment of depression than psychotherapy alone.

Psychotherapy & Hypnotherapy for Irritable Bowel Syndrome

On this page I’ll explain how and why psychotherapy and hypnotherapy are safe and effective treatments for IBS symptoms. I’ll explain some of the causes of IBS — how it relates to diet, lifestyle, stress, and even relationships. And then I’ll explain some of the techniques that I use to help my clients achieve lasting relief from the pain, bloating, gas, diarrhea, and constipation that disrupt their lives. This page is long and contains a lot of information, so I won’t blame you if you want to just go ahead and call or email me to set up an appointment right away. If you’d like to learn more first, keep reading.

There are so many neural connections in your gut, researchers are calling it the “second brain.”

There are literally about a trillion neural connections in there. And each one of them responds to all the same sorts of things that the ones in your brain do. You probably already know that neurotransmitters like serotonin, dopamine, and GABA affect your brain in ways that control your thoughts and feelings… but did you know they do exactly the same thing inside your intestines?

Emotional experiences have a direct effect on our guts, and this is something we recognize intuitively:

  • When we describe a troubling experience as “gut-wrenching”
  • When excitement causes that feeling of “butterflies in the stomach”
  • When nervousness makes us feel queasy
  • When stress triggers heart-burn

The connection between the gut and the brain, which scientists refer to as the gut-brain axis, works in both directions.

Just thinking about food causes your digestive system to start producing and releasing the acids and enzymes needed to digest that imaginary food. This starts in your mouth. Just imagine sliding your tongue across a big, juicy, sour slice of lemon… feeling the sting of the acid as that strong sour flavor fills your mouth — and it’s likely you can feel the saliva starting to well up in your mouth to neutralize the acid of your imaginary lemon. This is happening all the way down your digestive tract, all the time.

And the gut sends strong signals to the brain as well. All the way back to the Ancient Greeks, the stomach has been thought to be the seat of emotion, and new studies are showing that gut health plays a profound role in psychological well-being. A number of studies have shown that the natural balance of bacteria in your intestines plays a large role in this, with probiotic supplements used to alter that balance causing changes in both brain neurotransmitter activity, and in behaviors related to anxiety and depression.

This two-way communication means that gastrointestinal disruptions like those seen in IBS bring about a lot of emotional problems. It also means that we can use psychological treatments to improve not only the emotional correlates, but also the actual disorder of the gut.

The standard of medical care for IBS is to attempt to simply address the symptoms without discovering or correcting the root causes. I find this completely unacceptable.

There are four main strategies that I use in the treatment of irritable bowel syndrome

1. Lifestyle change & skill building

Skills like relaxation, stress management, assertiveness, dietary enhancement, and meditation can have a major impact on IBS symptoms by balancing your physical, emotional, and social well-being.

I use my scientific training to help patients conduct a personal experiment, discovering what aspects of your behavior have a real effect on the way you feel. And, through ongoing counseling, I help you maintain your focus and motivation to take control.

2. Cognitive therapy

The way that you think about your symptoms affects the way that you perceive them. Most people think that the amount of pain or discomfort that a person feels is proportional to the amount of tissue damage or inflammation. But that’s not actually the case — every person has their own level of tolerance for pain and discomfort. And by restructuring your mental approach to discomfort, you can actually increase your level of tolerance. That means you’ll perceive less discomfort, and won’t be as bothered by the discomfort you do feel.

This component of treatment, combined with the behavioral elements described above, comprise cognitive-behavioral therapy, which a number of clinical studies have shown to be effective for relieving the symptoms of IBS.

3. Insight-oriented psychotherapy

I’ve also found that certain kinds of people are more prone to this type of condition. They generally fall into one of two groups: people who have difficulty controlling their emotions, and people who control their emotions too tightly.

In either case, it is necessary to understand the origins of that predisposition, in order to reshape the dynamic way a person processes emotions. This type of therapy has a way of not only improving symptoms — but producing positive changes across many, often unexpected areas of life.

4. Hypnotherapy

Hypnosis is a highly undervalued psychological technique that makes it possible to achieve big changes quickly. It is renowned for its ability to bridge the mind-body gap, allowing for direct control of involuntary physiological functions. It’s also the single best, most empirically supported treatment for IBS.

The type of hypnosis used for IBS is called gut-directed hypnotherapy, which means the types of imagery and suggestions employed are focused very intentionally on influencing the inner workings of the gut. I generally adapt the University of North Carolina model of hypnosis for IBS, developed by Dr. Olafur Palsson, which has a very high level of scientific support for its effectiveness.

Mind-body psychotherapy is simply one component of your care that can help to enhance your body’s resilience, response to treatment, and rate of healing… as well as your emotional well-being. When you schedule your first appointment, I’ll ask you to sign a release form that will allow me to communicate with your physician, so I can coordinate with them to provide you the best care.

The Problems With Evidence-Based Psychotherapy

There has been a tremendous movement toward evidence-based treatment in clinical psychology over the past decade. On its face, this is a good thing — the idea that we should use scientific findings to make sure the types of treatment we’re using in psychotherapy actually work. My own clinical training included a wide array of these empirically based treatments, and I happily use many of their key techniques. I also continue to pay close attention to new clinical research, and frequently review the literature in the course of formulating treatments for my patients.

However, I see some really serious problems with evidence-based psychotherapy, problems that I believe are actually harmful to the patients, and to the credibility of clinical psychology:

The studies use unrealistic exclusion criteria

In an effort to eliminate confounding variables that could interfere with study results, research psychologists try to exclude patients suffering from any ailments outside of the single diagnosis that the treatment protocol is designed for. This is in line with the medical model of psychology, which attempts to isolate discrete psychological disease processes and treat them directly, much the same way that a physician might take a throat culture and then prescribe antibiotics to treat strep throat.

The problem is that psychological issues don’t really work that way. The diagnoses used in clinical psychology are generally not isolated disease processes the way viral or bacterial infections are. Most people don’t present with a single discrete disorder, but rather a spectrum of symptoms, personality characteristics, and social factors which can all be considered a part of the syndrome which has led them to seek treatment. This requires holistic treatment that identifies and addresses the underlying causes.

In many ways, mental illness is similar to metabolic syndrome — another problem for which the medical model is proving inadequate. All day long I see patients with separate diagnoses of diabetes, hypertension, hyperlipidemia, cardiovascular disease, obesity, sleep apnea. Each one of these identified problems are then treated by suppressing the symptoms. For diabetes there are pills to lower blood sugar, for apnea there is the CPAP device, for high blood pressure there are pills to lower the blood pressure. Even the preventive advice that is rendered is symptom-focused: switch to whole grains so the sugar will enter your system more slowly, take less salt to reduce blood volume. But all of the symptoms are actually related. They all result from the same underlying problem of metabolic dysregulation, and until that total syndrome is addressed, all of the symptoms will continue to get worse over time no matter how well they are managed.

Mental illness is like that. There are genetic, social, and cultural predispositions that contribute, but in order for the syndrome to be expressed a disruption in the management of psychological resources — such as emotions, thoughts, internal imagery, relationships, etc. — must take place. A cascade of compensatory actions are then set in motion, resulting in the symptoms we see on the surface: depression, anxiety, nightmares, panic attacks, hallucinations, substance abuse, etc.

I’ve treated substance abuse, and rarely seen a case where depression or anxiety were not also present. I’ve treated PTSD, and it’s the same story. Would you believe that most sufferers of severe, adult-onset, chronic pain are survivors of some form of childhood abuse? Even your basic top-level disorders, anxiety and depression, actually share many symptoms and frequently develop simultaneously. And many patients’ suffering simply doesn’t fit any currently available psychiatric diagnosis.

So what happens when you pick a single disorder, cherry-pick patients who don’t meet criteria for any other problem, and study their response to an intervention? They get better! In fact, they mostly get better even when you just put them on a waiting list. Because these are the easiest, most uncommonly uncomplicated cases. They are not a good representation of the patients that actually come in for treatment. Therefore, the studies are not generalizable; they tell us very little about how well a treatment will work in the real world.

The studies aren’t repeatable

Because there are so many potential confounding factors in research with live humans, you can never read too much in to any one study. Once a study has been repeated a few times, preferably by different researchers under different conditions, then we can start to get a little more confident that we’re seeing a real treatment effect and not just an artifact of some unpredictable condition of the study. But that’s not happening very much in the field of clinical psychology. Most psychotherapy outcome studies are simply never replicated.

Part of the problem is publication bias: for a variety of reasons, papers describing a failure to replicate previous studies don’t get published as often. Many of the findings could not be replicated regardless, because they are false positives — the study designs do not adequately discern between treatment effects, placebo effects, and random effects. There is tremendous pressure on academic researchers to produce positive results, and this leads to both conscious and unconscious bias in the way research is carried out.

Finally, psychological treatments, like medical treatments, are subject to decline effects. Over time, They get less effective. Later studies find lesser effects than earlier studies, even when the research design is sound. This could be due to changes in researcher enthusiasm, changes in the patient populations that the treatments are being tested on, or changes in the cultural context in which treatments are being administered. Regardless, most published research findings are false. It is therefore highly problematic to make those findings the basis of clinical treatment.

Here are some excellent articles about these problems:

The studies often ignore therapist effectiveness & the treatments fail to utilize therapist skill

A large number of controlled and naturalistic studies have found that the therapist providing treatment is more important to the outcome than the type of treatment being provided. This makes a certain kind of natural sense to most people, yet psychologists remain resistant to the idea and the reasons for it have not been adequately studied. We don’t really know what makes the difference between a really great therapist, a mediocre therapist, and an ineffective therapist. Treatment adherence does not explain the difference.

So what do psychological researchers do? Rather than try to isolate the factors that make a therapist great, they try to eliminate them in order to study the effects of specific treatment protocols. The therapists studied must comply with manualized treatments in ways that often contradict their own highly trained clinical instincts, and then statistical methods are used to cover over any remaining differences.

The result is rigid treatment designs that do not provide therapists with information about how to get the greatest clinical effect out of them. In practice, psychotherapy is fluid and must be adapted to the individual client on a moment-by-moment basis. But because these manualized treatments are supposed to be “evidence-based,” clinicians are obligated to go through a process of supervised practice during which they must comply with the manual at the expense of therapeutic effectiveness. Then, once they are certified to administer this evidence-based treatment, they can go back to doing the things they have found actually help people, while adhering only to the basic structure of the manualized treatment. In my experience, clinicians do their best to pick very “easy” and compliant patients as test cases for certification, since these types of patients are the ones who will generally get better no matter what you do with them.

Significant results in studies are not good enough to be considered clinical success

Even if we ignore the methodological problems and take these studies at face value, the results they achieve are generally insufficient to indicate a treatment effect that I would be satisfied with in my own practice. A “statistically significant” effect just means that whatever happened probably didn’t happen by chance. So with this type of result, we know that the treatment had some effect, but we know nothing about how much of an effect it had.

For that, we need to look at effect sizes. Even a “large” effect size (0.8) really only means that the average person in the treatment group ended up better off than 79% of people who didn’t get the treatment. We’re not talking cures here, we’re talking about less than half of the people getting somewhat better than people who got nothing.

Of course, “better” depends on the measures used. In most studies, outcomes are measured using symptom questionnaires that patients are asked to fill out before and after the treatment. The symptoms on the questionnaire will relate only to the specific disorder being treated, so for most studies we never know how well patients ended up in terms of overall quality of life. The broader the disorder, the bigger this problem becomes.

For example, Dialectical Behavior Therapy (DBT) is widely recognized as the best and most empirically supported treatment for Borderline Personality Disorder. And the studies have shown that DBT does, in fact, reduce self-harm and increase treatment compliance in sufferers of borderline personality disorder. They have not, however, shown DBT to cure borderline personality disorder — and not for lack of trying. So here you have a widely promoted intervention that does not bring about a reversal of the diagnosis for which it is prescribed. There are interventions which have been shown to do this, such as Mentalization-Based Treatment. But, for a variety of reasons, that treatment does not seem to be gaining traction in the evidence-based psychology community. As more money gets thrown at DBT studies, the likelihood increases that someone will eventually manage to get a positive result for reversal of borderline personality disorder, and then that finding will be used to solidify DBT as the mandated choice among healthcare systems using evidence-based treatments.

Study funding and treatment implementation tends to be theoretically aligned

Cognitive Behavior Therapy (CBT) is far and away the most widely studied form of psychological treatment. Let’s set aside for a moment the fact that “CBT” has gradually expanded to include the most widely-used interventions from all theoretical frameworks, as well as longer treatment periods for complicated or difficult presentations. It has been shown effective for a wide range of psychiatric disorders, with more added all the time. Based on its impressive base of literature, many researchers, educators, and clinicians assert that it is the most effective form of psychotherapy. The problem is, it’s not.

Studies comparing CBT to other types of therapy have found similar effect sizes between treatments for decades, with psychodynamically-oriented therapies showing more lasting treatment gains. So why is CBT so much better represented in funding and implementation? Essentially, politics. The cognitive-behavioral theoretical camp got a strong foothold at NIMH and held on for dear life. There are more studies showing that CBT is effective simply because there have been more studies funded for this type of treatment.

The same is true with exposure-based therapies for trauma. Therapies which focus on exposure are the most heavily promoted and widely held to have the best empirical base. However, at least five other types of treatment show equal treatment effects, and a couple of them contain no exposure elements whatsoever. There are underlying factors that are getting lost in the politics. As a clinician I have absolutely no interest in the politics — I’m interested in figuring out what works for each patient. From that basis, we may be able to start to extrapolate ingredients that make treatment more generally effective for all patients (this is the idea of practice-based evidence.)

Treatments studied often have poor theoretical integrity

As I mentioned, CBT has been steadily expanding over the years to encompass more techniques, such as relaxation, visualization, and mindfulness meditation. The exploration of core beliefs and schemas has evolved in a direction very similar to modern brief psychodynamic therapies. The only thing that distinguishes CBT from the less- (but still often well-) supported psychotherapies is its theoretical foundation.

However, the same expansion beyond CBT’s theoretical basis has led to the creation of treatment protocols which are essentially eclectic. Researchers have long lamented their difficulty in isolating the specific factors which lead to successful treatment, and these new ostensibly cognitive-behavioral protocols amplify the problem by introducing a technique-driven, kitchen-sink approach that renders a difficult task impossible. Instead of drilling down into the therapies to identify process variables which highly effective therapists incorporate naturally, we are building up theoretically vapid treatments that seem to work about as well as everything else, but target a specific psychiatric disorder (for which there is also little theoretical or empirical integrity.) Are you confused by all this yet?

Symptom-focused EBTs lead to modularization of treatment, increased total treatment time, reduced overall effectiveness

As this newfound glut of grant-funded “evidence-based” psychotherapies are rolled out in large healthcare systems, the result is a bureaucratization of psychotherapy. Patients are shuffled from one empirically supported group to another, and handed off from one therapist to another based on what symptoms each therapist is certified to treat.

For example, a common case is an obese veteran with chronic pain, depression, PTSD, and alcohol dependence. For the obesity, they’ll be referred to a weight loss group. For the chronic pain they’ll be referred for manualized pain management treatment, either in a group or individual format. The alcohol dependence will likely lead to a referral for a substance abuse treatment group, which will be followed by a referral to a manualized “Seeking Safety” group to transition between substance abuse treatment and PTSD treatment. PTSD treatment might be treated with either Cognitive Processing Therapy or Prolonged Exposure Therapy, either of which may lead to some relief from depression, but an additional referral will likely be needed for a depression treatment group. So in this common scenario, the patient is asked to participate in 6 separate 8-12 week, empirically supported treatments, each of which requires orientation into a separate vocabulary and set of expectations, and each of which has about half a chance of producing remission for its particular symptom. This treatment process will average about 60 weeks, most likely with gaps of 1 month or more in between the start of each treatment, meaning that the whole thing will take a year and a half, conservatively. How long do those non-evidence based treatments take again?

Moreover, decades of studies examining the factors related to positive treatment outcomes have shown that one of the most important factors is the therapeutic relationship. The model which I have described, which is currently in use within some major healthcare systems and which is being heavily promoted for implementation everywhere, simply obliterates the therapeutic relationship which would be established over the course of an 18-month, single-provider course of psychotherapy. That relationship is replaced by a series of much shallower treatment relationships with well-meaning therapists, and one major relationship, to the bureaucracy itself.

Psychological Treatment for Migraines

If severe, recurrent headaches are putting a strain on your ability to live life your own way, mind-body psychotherapy may help you regain your physical comfort and peace of mind. For over a decade, I’ve used the tools of psychotherapy and hypnosis to help people overcome debilitating medical symptoms. On this page, I’ll provide information about how that works. Feel free to call or email me if you’d like to discuss your situation and set up an appointment.

There is no single underlying cause of chronic headache pain, but rather a constellation of contributing factors. There is a genetic component, so a family history of migraine headaches does predispose you to also have migraine headaches. But even if your identical twin has migraines, there is still only about a 50% chance that you will have them as well. Hormones also play a role: women of child-bearing age are two to three times more likely than men to experience migraine headaches, and the headaches often ease up after menopause. Nerve tissue inflammation, skeletal problems, muscle tension, and dietary intolerances can all contribute.

There are also psychological factors. Chronic pain has a strong, cyclical relationship with anxiety and depression. The experience of chronic pain causes anxiety and depression, and these heightened emotional states exacerbate the pain symptoms. On top of that, most chronic pain patients are surprised to learn that certain personality types are more likely to experience chronic pain.

Headaches are complex, and require holistic treatment

Early in my career, I spent a year training at the Diamond Headache Clinic’s inpatient unit in Chicago, which provides treatment for severe, chronic, and intractable headache cases. While mild cases can often be managed reasonably well with medications, more severe cases require a variety of treatment modalities that work synergistically. These may include medication, dietary adjustments, physical therapy, massage therapy, chiropractics, acupuncture, biofeedback, hypnosis, and psychotherapy. The types of treatment used are often selected based on the specific types of headaches you are experiencing and the way that the symptoms present. Migraine headaches with aura, for example, call for a different treatment approach than tension headaches or cluster headaches.

Pain perception is psychological

Most chronic pain sufferers assume that since pain is a physical condition, there is nothing that a psychologist could do for them other than to help them process the feelings of frustration of being ill. But it turns out that pain is not as strictly physiological as you might think.

To begin with, no matter what part of the body feels hurt, the pain itself actually takes place within the brain. The nerve endings that register pain throughout your body simply send signals back to the brain, which processes the signals and decides how much pain sensation it should produce in response. The amount of pain that results is not necessarily related to the amount of nerve damage or activation, but is instead regulated by context, emotional state, beliefs and social expectations about pain experience, and the amount and type of attention the pain is given.

Additionally, there are no pain receptors in the brain itself — no tissue has been damaged in the moments leading up to a headache. Instead, the part of the brain which creates pain has been activated for some other reason. It is very significant that fMRI studies have shown that “painful” emotional experiences such rejection and loss share the same neurological circuitry as physical pain. That is why sufferers of chronic pain are more prone to psychological distress, and those experiencing psychological pain are more likely to develop chronic physical pain. So in many cases, part of the chronic headache pain is a physical manifestation of psychological turmoil.

Has your doctor recommended therapy?

There are many different types of psychological interventions that may be helpful, depending on the nature of your headaches. After a thorough assessment, I develop an individualized treatment plan that may include any combination of the following:

  • Cognitive Behavioral Therapy (CBT)
    • Behavior plays an important role in headache management. By optimizing diet, exercise, sleep, stress management and other behavioral aspects of headache management, we can help to create a relaxed physical state that encourages natural healing.
    • Identifying external triggers for headaches is another important part of psychological treatment. By managing these triggers more effectively, we can reduce headache frequency.
    • Cognitive restructuring provides tools to help you process pain differently, decreasing pain awareness and increasing your ability to tolerate discomfort.
  • Mindfulness – By cultivating your ability to recognize and manage thoughts and feelings, mindfulness-based treatment strategies can be especially helpful for people suffering from emotional disruptions related to chronic pain.
  • Hypnosis – This powerful psychological tool can make it much easier to introduce new behaviors, new ways of thinking and feeling, and to directly modify physical processes. I have seen many patients respond extremely well to treatment which incorporates hypnosis into the psychotherapy.
  • Visualization – By creating new internal representations of pain processes we can change their meaning, and this changes the way that pain is dealt with at the neurological level.
  • Depth-oriented Psychotherapy – Unconscious psychological processes contribute to chronic pain. For example, many people experience more intense and frequent migraines within the year or so following a traumatic experience or a major loss. Certain emotions can’t be expressed, so they get represented in the body. This cycle can be broken by examining and resolving psychological conflicts that stand in the way of dealing with those emotions directly.

Studies have shown that psychotherapy can be very effective for relieving chronic headache pain, with most patients being able to return to work and go back to living normal, happy lives after treatment. In my experience, the key to successful treatment of headache pain is developing a clear picture of what is happening for you as an individual, and addressing the root causes using a customized, targeted, and holistic treatment program.

Mind-body psychotherapy is simply one component of your care that can help to enhance your body’s resilience, response to treatment, and rate of healing… as well as your emotional well-being. When you schedule your first appointment, I’ll ask you to sign a release form that will allow me to communicate with your physician, so I can coordinate with them to provide you the best care.

Treatment of Trauma and PTSD

An extremely frightening or distressing event such as a serious accident, assault, or rape can sometimes inflict a psychological injury that lasts much longer than the event itself. The emotional shock which follows is called post-traumatic stress disorder, or PTSD. The symptoms of this disorder fall under three categories:

  • Avoidance – After exposure to a traumatic event, many people begin avoiding situations and activities that remind them of the event. Additionally, you might begin to avoid emotional experiences that remind you of the trauma, and this can produce feelings of emotional numbness or difficulty remembering important parts of the traumatic event.
  • Hyperarousal – This includes a lot of more common anxiety symptoms like feeling jumpy, tense, or irritable; being easily startled; and having trouble sleeping or having poor quality sleep.
  • Re-experiencing – This can come in the form of nightmares; recurrent, intrusive thoughts or images; or suddenly feeling like you’re back in that traumatic experience.

A Neurological Explanation of PTSD

There are two memory centers in the brain, one of which controls the storage of sequential, autobiographical memories (the hippocampus) and another which controls the storage of emotional memory (the amygdala). Ordinarily, the two work in tandem, producing rich memories that unite the details of an event with its emotional flavor. However, severe stress causes problems in the hippocampus, preventing clear memories from being formed there. This results in powerful emotional memories that are dissociated from the context in which they were experienced. Therefore, the feelings of terror become generalized, and you begin to respond to a variety of loosely-connected situations as if they were a part of the traumatic experience.

The Role of Personality in Post-Traumatic Stress

Going by that neurological theory alone, the severity of the stressor should determine the severity of the PTSD symptoms. But the reality is that some people are more susceptible than others, and personality factors seem to be more predictive of PTSD severity. The characteristic ways that a person relates to themselves, the world, and other people — the attachment style — can either exert a protective effect  or create a heightened susceptibility to traumatic stress. Therefore, in my opinion a comprehensive treatment for PTSD should address not only the symptoms of trauma, but also the underlying vulnerability which allowed those symptoms to develop.

Approaches to Treating PTSD

While much of my clinical training focused on the assessment and treatment of complex and childhood trauma, I have also worked with combat veterans both within the VA system and in private treatment settings. recently spent a year training in a VA hospital where I gained a lot of experience working with veterans suffering from PTSD after exposure to acute trauma. The PTSD treatments in widest use at the moment are Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE). In practice, I prefer to incorporate aspects of these treatments into a more comprehensive and holistic treatment approach that includes attachment-based and relational psychotherapy. In cases where it is appropriate, hypnosis can often help to dramatically accelerate the healing process.

  • Cognitive Processing Therapy aims to re-integrate dissociated traumatic memories, so that the feelings connected to them will no longer generalize to other situations. This is done by examining the details of the traumatic event and the symptoms associated with it while in a relaxed state of mental detachment.
  • Prolonged Exposure Therapy is based on the behavioral principle of habituation, which just means that you can get used to the feelings of anxiety and so they won’t bother you as much. People experiencing PTSD avoid thoughts, emotions, and situations that remind them of the traumatic event because they fear they will not be able to withstand the intense anxiety these stimuli trigger. PET aims to help patients to confront their fears in a gradual, structured, and supportive way. I’m not a fan of exposure-based therapies for trauma, as in my experience many people are re-traumatized by them, causing symptoms to worsen. My work with PTSD focuses on fostering feelings of safety and security, rather than trying to extinguish fear and avoidance.
  • Attachment-focused and Relational Psychotherapy address problems with the way a person relates to self and other, by helping to reshape the social preconceptions formed in early life. This helps not only to relieve symptoms of PTSD, but to open the doors to more lively, spontaneous, and satisfying social interactions in daily life.
  • Hypnosis is a powerful psychological tool which can be used to enhance other types of therapy described above by eliminating mental distractions, interrupting habitual patterns of thought, and producing corrective internal experiences.

I believe strongly in the idea of treating the whole person, not just a collection of symptoms. That’s why, when I begin working with a person, I don’t just assess the symptoms. I need to know about their early life, core beliefs, and social and emotional functioning so that I can develop a customized treatment. Then you can address all the related factors — including the immediate symptoms, but also the underlying causes, and any systemic weaknesses that would be likely to cause more suffering in the future.

How to get help

There are few things more rewarding for a therapist than seeing a patient get their life back. For information about the trauma therapy that I provide, please follow this link: PTSD treatment.

Counseling, Psychotherapy, and Coaching: What’s the Difference?

The terms psychotherapy and counseling are often used interchangeably, but many people believe that there is a difference between them that is important for both clients and clinicians. That is why there are separate degrees and professional organizations for counselors and clinical psychologists.

I personally am a Licensed Professional Counselor, with a Master’s degree in Counseling Psychology. I am working toward my doctorate in Clinical Psychology, which will enable me to seek licensure as a Clinical Psychologist. So I have been well educated in both counseling psychology and clinical psychology, and I see the distinction between them as this:

Clinical Psychotherapy aims specifically to address diagnosable disorders in a way which decreases the presenting symptoms. For example, a clinician operating from the framework of clinical psychology will diagnose Major Depressive Disorder based on a number of diagnostic criteria, and will introduce psychological interventions targeted at reducing such symptoms as poor sleeping patterns, hopelessness, and suicidal thoughts. The most common modes of treatment here are cognitive behavioral therapy (CBT), which focuses on the way that your thoughts affect your experiences, and relational psychotherapy, which focuses on the ways that your relationships and relational style affect your experiences. Psychodynamic psychotherapy has lost some popularity despite significant advances with substantial research support.

Counseling, while still a form of psychological treatment administered by a licensed healthcare professional, often takes a softer and more holistic approach. The focus on counseling tends to be more on facilitating the client’s own exploration of solutions for their problems. So you’ll often see counseling applied to more self-directed therapeutic goals, such as career counseling or drug counseling.

Personally, I see value in both of these approaches and will often switch between them as a therapy client progresses. Often people come to therapy for relief from a particular symptom, but then realize there are some other things they would like to work on in their lives. So a therapist needs to be flexible, in my opinion, to adjust to the changing needs of each client over time.

Coaching is not considered a treatment for any diagnosable disorder, but often resembles counseling. Coaching is usually aimed at generative change — ways to make your life better, rather than ways to fix things that are wrong. There are some specialized areas of coaching, such as business coaching, which should be administered by someone who is accomplished in both the areas of business that you’re seeking help with and the area of coaching. More commonly, people seek life coaching, and in my opinion this should be done only by people who are licensed psychology professionals. This is because the training that you receive in becoming a counselor or psychotherapist gives you the ability to understand the delicate psychological balance that makes up a person’s style of living, and how to safely make adjustments to that balance.

8 Myths About Hypnosis

Hypnosis is a sort of spooky and misunderstood phenomenon. Most of what people generally know about hypnosis comes from movies and stage performers, not real clinical hypnotists.

You may not even realize that clinical hypnosis is a very well-established and scientifically validated medical practice. It’s used by psychotherapists, physicians, nurses, dentists, and anesthesiologists to produce a profound sense of serenity in patients who might otherwise be really freaking out.

As it turns out, hypnosis is an incredibly versatile and powerful psychological technique, so it would be in your best interests to know a little bit about it and to be open to the idea. With that in mind, I’ll dispel some of the major myths about hypnosis and tell you some far-out realities about it as well:

1. Hypnosis has no relationship to gullibility

A lot of people believe that only gullible people can be hypnotized. This is actually a pretty natural assumption, since the hypnotic experience does involve a heightened state of suggestibility. There have even been studies done to measure “gullibility” and “suggestibility” as a personality factor, and to try and correlate those factors with hypnotic susceptibility.

In fact, none of those studies has ever established such a correlation. There seems to be simply no relationship at all between how gullible you are and how susceptible you are to hypnosis. You might be a really hard-nosed critical thinker and be highly hypnotizable, or you could be a real sucker and actually have very low hypnotic ability. There’s simply no relationship at all.

2. There is some correlation to intelligence and creativity

Hypnotic ability is actually somewhat related to IQ. Highly hypnotizable people tend to be just a little more intelligent and a little more creative than the rest of the world. Sound familiar?

3. It’s partly genetic

That’s right, to some extent you actually inherit the ability to be hypnotized. Pretty much anyone can be hypnotized to some extent, however, so the major difference is basically just how good at it you are.

There are also a variety of ways that you can actually improve your hypnotic ability, too. Anything that generally improves your mind-body relationship will also tend to improve your hypnotic ability. So things like mindfulness meditation, biofeedback, and artistic, musical, or theatrical training all tend to enhance your ability to experience hypnotic phenomena.

4. You can’t get stuck in a hypnotic trance

We all want to have an Office Space experience and breeze through a few weeks of our lives on autopilot. Some people are probably a little apprehensive, though, about losing control and getting stuck in some catatonic state.

Rest assured, this is not possible. If someone left you in a hypnotic trance, the worst that could happen would probably be feeling a little confused. More likely, you would probably just fall asleep, and eventually wake up feeling happy and refreshed.

5. You probably do it every day

The hypnotic experience is not at all unusual! Have you ever rocked a baby? It’s such a simple thing to do—but just by introducing a nice gentle rhythm into the baby’s experience, you change its whole frame of mind. You hypnotize babies.

Even my cat hypnotizes me! It lays on my chest and matches its purring to my heartbeat, gradually leading me down into slower and slower rhythms so I won’t get up and spoil its nap. Any time a group of people are in a room together, the tendency is for all of them to fall into a similar breathing pattern.

Basically everything we do involves varying levels of trance phenomena. If you’ve ever been driving in your car and suddenly realized you had arrived without really being able to remember the trip, it’s pretty safe to say that you were experiencing a trance state very much like hypnosis. Another great example is when the credits start to roll and you suddenly realize you’re in a movie theatre! You’ve been enjoying a very nice hypnotic trance.

6. People have surgery with no anesthesia, and have a good time!

Probably not everyone is hypnotically gifted enough to maintain a state of complete comfort through a surgery without any drugs, but it’s not nearly as uncommon as you’d think!

7. Hypnosis can turn off inflammation like a switch

Burns, bites, allergies? Your mind has the ability to completely change your body’s response to any of these.

Under hypnosis, burned skin can be told not to swell up or to detach from the underlying flesh. This means that if you know how, you can actually talk your body out of blistering. You can even talk your body into blistering. I’m not sure why you’d want to, but I’ve seen it done! Allergic reactions can literally be convinced not to happen.

8. Hypnosis might be able to alter your genes

There’s a very famous old case from 1952 that was studied by the British Royal Society of Medicine, where a boy had a congenital skin disorder that gave him crusty, fish-like scales all over his body. The disease is called congenital ichtyosiform erythrodermia of brocq, and it means that your skin’s oil glands don’t develop, so your skin cells won’t flake off as they die.

The boy was unwittingly treated with hypnosis by a doctor who thought he simply had a bad case of warts, since hypnosis is very effective for warts. Actually, it turned out that you can do that!

Nobody knows for sure exactly what changed in the boy’s physiology. In order for this condition to be cured, you’d have to modify the way the boy’s genes are expressed. Modern gene therapy isn’t even close yet, but in the early 50s this guy healed a kid’s genetic skin condition using nothing but the power of the boy’s own mind. Crazier still, there’s actually a lot of more modern scientific evidence that hypnosis can affect the way that genes are expressed. What a ride.

Mind-Body Medicine: 5 Surprising Ways Psychology Can Improve Your Physical Health

On some level, most people recognize that psychological factors affect physical health. People basically seem to know, for example, that a stressful career or a ‘Type A’ personality might give them a heart attack, or that an abrasive colleague can give them a headache.

What most people aren’t fully aware of is the profound interconnection between the mind and the body. The past twenty or thirty years have seen an explosion of research on the ways that the mind and the body relate to each other. The further the research goes, in fact, the less it looks like there is a mind apart from the body, or a body apart from the mind. Everything that happens to your body has an effect on your thoughts and feelings, and every emotional or intellectual event has effects on your body.

The upshot of this is that you can improve your physical well-being through purely psychological means—just by talking to someone, or by thinking a certain way. There are purely psychological ways to:

Prolong your life

Traditional and Stylish! U saw her before in B&WPsychotherapy doesn’t just improve your emotional health and well-being, it actually tends to improve your physical health as well. A particularly dramatic example of this is the effect of psychotherapy on the terminally ill.

At least six good studies so far have examined the potential benefits of psychotherapy for terminal cancer patients by randomly assigning some of these patients to participate in individual or group psychotherapy. We’re not talking about any specific, cancer-focused therapy or mind-body voodoo, just good old regular psychotherapy. So these patients, who had been told they were definitely going to die talked about their feelings, and their backgrounds, and what they were going through and how it related to their past experiences, and so on.

And you know what? These patients ended up living twice as long as their counterparts in the control group. The control group received the exact same medical care, administered by the same staff, in the same setting. But they only lived an average of about 9 months, versus a full year and a half for the psychotherapy group. Imagine if you could double your lifespan just by talking to someone.

Reduce your symptoms

137: this is where i spent xmasWhile those kind of results definitely seem pretty fantastic, I can assure you that psychotherapy can be extremely effective for a wide range of physical illness. A great example is irritable bowel syndrome, or IBS. Psychotherapy is not only an effective treatment for IBS, it is now the preferred treatment for IBS. Psychotherapy is better at calming down an irritable bowel than any medication or combination of medications that have yet been tested.

The patients I saw at the Diamond Headache Clinic suffered from chronic headache pain. Naturally, they tended to have a lot of resistance to the idea of going to psychotherapy, oftentimes because their medical doctors have been telling them the pain is “all in their head” when in fact they feel actual physical pain right there inside of their actual bodies. “I’m not crazy,” they object, “I just have headaches.” And they do. But the fact remains that the patients who seek out and regularly attend psychotherapy tend to improve more than the patients that don’t.

Prevent and control pain

sick...day 10 / year 2Some of the more targeted psychotherapeutic techniques can have particularly amazing results. Clinical hypnosis, for example, involves nothing more than talking to someone in order to help them achieve a state of extremely focused relaxation. And yet, people who cannot tolerate anesthetic drugs can often achieve the same effect through hypnosis.

When I say the same effect, I actually mean a better effect. Patients who undergo surgery using hypnosis instead of anesthetic drugs not only experience no pain, they actually usually enjoy the experience very much. There are also a number of side benefits: these patients tend to bleed less during the surgery, resulting in faster surgery times and lower cost; they tend to require much less pain medication after the surgery; they tend to experience far less physical and emotional discomfort overall; they also tend to heal up much faster, and much nicer.

Convince your body to cooperate

Today´s Mood!When I talk about improved quality of healing, I’m especially thinking about all the great research that’s been done on spinal surgery. Spinal surgery is one of the most delicate and difficult surgeries to perform, because the tissue itself is so complex, unique, and fragile. But you can be an absolute artist of a spinal surgeon, and perform the surgery completely flawlessly, and close everything up so that it looks beautiful and perfect. And in a couple months, the corrected area might very well just heal up into a gnarled mess of scar tissue. Or, it could still look great.

It turns out there are measurable psychological factors involved in this healing process. By administering a quick psychological test before the surgery, we can actually predict how well your surgery is going to heal. By using psychological techniques to modify the factors that interfere with proper healing, we can actually improve the healing of surgical wounds.

Make right what once went wrong

Eggistentialism VIII saw a man with an alcohol burn over 90% of his face. He arrived at the ER with his whole face a big red swollen mess. He was fortunate enough to find himself at a hospital where someone trained in clinical hypnosis was on staff. This doctor placed the man into a nice hypnotic trance, and suggested that his pain and swelling would both begin to reduce and simply go away.

Within a half hour, this guy was voluntarily turning down pain medications. He simply wasn’t in pain. Not only that, but the inflammation response in his skin actually turned off. His face stopped swelling and began returning to its normal size. The damaged layers of skin then began to reattach to the rest of his face, and the affected cells slowly began to be cleared out.

Within two weeks, you couldn’t even tell that this guy had ever been burned. There was one tiny red patch above his eye; that was all that was left. Ordinarily, this type of injury would have resulted in severe and prolonged pain, extensive scarring, and risk of infection that would lead to extremely painful cleaning procedures.

As crazy as it all sounds—and it does sounds crazy—just having someone talk to you in the right way at the right time can do all of these incredible things. Psychological interventions can alter the course of a disease, regulate digestive and immune functioning, alleviate existing pain, prevent new pain, control bleeding, improve healing times, and turn off the types of inflammation responses that happen when you’re burned or have an allergic reaction. In many situations, seeking help from a psychologist could be the best health decision you could make.

Hypno-Oncology: Hypnosis in the Treatment of Cancer


Clinical hypnotherapy has been soundly established as an effective treatment for the symptoms associated with cancer and its related therapies, including chronic and acute pain, nausea and vomiting, fatigue, insomnia, anxiety, and mood disturbances. Its use produces strong tendencies toward improvement of patients’ quality of life and of treatment cost. As the etiology and progression of various forms of cancer become better understood, the potential of hypnotherapy for increasing survival rates by improving medication response and even slowing or reversing the progression of the disease increases. Given the lack of risks to patients and the wide potential for benefit, additional research and clinical experimentation into this area are encouraged, and recommendations for this type of hypno-oncological exploration are discussed.


Cancer presents the patient with a wide variety of symptoms and challenges. Many types of cancer cause intractable and chronic pain or other organ-specific symptoms in the areas they affect. Patients frequently experience a variety of nonspecific symptoms as well, such as fatigue, malaise, and insomnia. Hypnosis and self-hypnosis are extremely flexible and highly effective treatments for all types of cancer-related symptoms (Sunnen, 2004), and also aid in the numerous psychological adjustments that are required of cancer patients: “adjustment to the condition itself, to its treatments, and to the poignant intrapsychic, family, and social changes it may induce” (Kubler-Ross, 1969, as cited in Sunnen, 2004, p.15).

One recent study of 20 terminally ill cancer patients allowed each patient to choose the symptom they would most like to address using hypnotherapy. As a result, 19 of those 20 patients reported dramatically improved quality of life, anxiety status, and ability to cope, as well as better sleep and more energy. The symptoms they successfully addressed during the course of the study included pain, fatigue, malaise, irritability, insomnia, nausea and vomiting (NV), anticipatory NV (ANV), food aversions, anxiety, depression, guilt, anger, hostility, frustration, isolation, reduced self-esteem, and helplessness. Additionally, significant cost savings were realized in the form of reduced need for medication and nursing (Peynovska, Fisher, Oliver, & Mathew, 2005).

On top of being proven effective for symptom management (Liossi, 2006), the beauty of hypnosis is that it can be readily adapted to the needs of the patient, can be used to address physiological as well as psychosocial issues, and is extremely well-tolerated. Christina Liossi explains:

“It is safe and does not produce adverse effects or drug interactions. Patients enjoy the hypnotic experience. They obtain relief without destructive or unpleasant effects. There is no reduction of normal function or mental capacity and no development of tolerance to the hypnotic effect. It is a skill that individuals can easily learn, that provides a personal sense of mastery and control over their problems and that counters feelings of helplessness and powerlessness. An additional benefit is that hypnosis can be generalized to many circumstances. The person who learns hypnosis for management of pain or nausea and vomiting may apply their skills to lessen the distress of insomnia and anxiety, to address dysphagia for pills or to enhance their performance in their favourite sport. For a clinician, hypnosis is an opportunity to be inventive, spontaneous and playful and to build a stronger therapeutic relationship with a patient while providing symptom relief” (2006, p. 55).

This paper will briefly review the literature regarding the efficacy of hypnotherapeutic interventions for symptoms management, and will explore issues surrounding the psychotherapeutic treatment of cancer in general. A general understanding of the etiologies and biomechanics of cancer as they are relevant to hypnotherapeutic treatment will be attempted, and this treatment’s implications and potentials for improving survival rates and directly influencing
the course of the disease will be discussed.

Hypnotherapy for the Control of Pain

Hypnotherapy is particularly effective for the control of primary and treatment-related cancer pain, and has achieved the status of an evidence-based treatment for this purpose (Liossi, 2006). Multiple studies have found it to be superior to acupuncture, massage, or CBT in the treatment of pain and anxiety (Peynovska, Fisher, Oliver, & Mathew, 2005). One randomized, controlled study, for example, found hypnosis highly effective for the prevention of post-operative pain in patients receiving bone-marrow transplants, while an intensive cognitive-behavioral skills program was ineffective for this purpose (Liossi, 2006).

A randomized clinical trial to examine the effects of a single 15-minute hypnotherapy session administered to breast cancer patients immediately prior to lumpectomy surgery found that the treatment group experienced significantly less pain intensity, pain unpleasantness, nausea, fatigue, discomfort, and emotional upset. In addition these obvious benefits to the patients, the intervention was found to be extraordinarily cost-effective: patients in the treatment group costed the hospital 9% less (almost $775 less per patient) than those in the control group, owing to their significantly reduced surgery times and significantly reduced need for anesthesia and analgesics during the procedure.

There is evidence that hypnotherapy can be highly effective with pediatric patients, who experience much less pain from the primary effects of cancer than their adult counterparts—owing to the varieties of cancer to which they are most susceptible, such as leukemia—but are subjected to repeated, painful and invasive procedures and usually consider this to be “the most difficult part of their illness” (Liossi, 1999). Children appear to be far less capable of using self-hypnosis to manage procedure-related pain and distress than adult patients, and so it is necessary for the therapist to remain present with them during the procedures (Liossi & Hatira, 2003).

The hypnotic technique for pain relief typically begins with relaxation, which significantly assists in analgesia by reducing anxiety and thereby dampening the perception of unpleasant sensory experience. After a standard hypnotic induction is used, many patients will respond to direct suggestions that their pain will simply “diminish in intensity to the point of becoming unnoticeable” (Sunnen, 2004, p. 16). Another technique for eliminating pain involves first producing “glove anesthesia,” or a deadening of all sensations in one hand. As Sunnen explains, “the hand is ideally suited as a starting point for hypnotic anaesthesia because it is so richly endowed with sensory innervation and occupies such a prominent place in the cortical homunculus. Once the anaesthetic experience is established in the hand, it is a relatively small step to transfer it to other parts of the body.”

The patient’s mental representation of their pain can also be altered such that it occupies a smaller portion of their phenomenological experience, and the pain’s qualitative aspects may be modified so that they no longer correspond with the patient’s conceptions of what substantial pain is like. If the patient experiences the pain as hot and stabbing, for example, the therapist might suggest that it is becoming cool and soft. Some individuals achieve extremely good results from the use of hypnotic imagery, while others are able to dissociate from the experience by imagining that the pain is falling away from their bodies and out of sight (Sunnen, 2004). It is highly beneficial to assess the patient’s cognitive style and hypnotic ability prior to the intervention in order that the techniques used can be matched to the patient’s own inner experience.

Hypnotherapy for the Control of Nausea and Vomiting

Hypnosis has achieved status as an evidence-based treatment for chemotherapy-induced NV (CINV), with numerous controlled studies attesting to its efficacy (Liossi, 2006). A comprehensive meta-analysis of hypnotherapeutic treatment for CINV found it significantly more effective than the standard treatment, and at least as good or better than CBT (Richardson et al., 2007). The researchers also noted that none of the studies they examined had evaluated the hypnotic ability of their participants. For reasons that will be discussed in a later section, it is reasonable to expect that a clinician who assessed and utilized their patients’ individual hypnotic abilities would achieve even more impressive results.

About 30% of patients receiving chemotherapy experience NV not only following the administration of the chemotherapy, but in anticipation of its administration as well. The most widely accepted model for understanding ANV is a classical conditioning model, in which NV becomes a conditioned response to procedures surrounding the administration of the chemotherapy. Anxiety plays a role in this effect not only by increasing sensitivity to environmental stimuli but also by potentiating the learning of conditioned responses (Marchioroa et al., 2000).

Marchioroa et al. (2000) conducted a study of 16 consecutive adult cancer patients affected by chemotherapy-induced ANV, in which they examined common personality factors of participants in order to surmise traits that may predispose patients to ANV. Common factors identified included “a strong need for approval, a tendency to reveal emotions in an exaggerate or unsuitable way, superficiality, inconstancy and difficulty in giving a detailed description of situations or people.” Each patient was subjected to a two-hour progressive muscle relaxation training session preliminary to hypnotic treatment. The treatment itself consisted of a one-hour hypnotic session immediately prior to chemotherapy administration, using an eye-fixation induction followed by suggestions intended to induce organ anesthesia. The hypnotherapy treatment prevented ANV in all 16 patients, and actually produced significant reduction in post-chemotherapy NV as well for 14 of the 16 patients.

Hypnotherapy for the Improvement of Overall Quality of Life

A number of meta-analyses have demonstrated the profound efficacy of hypnosis in improving cancer patients’ quality of life (Walker, 1998). This improvement involves the alleviation of the intense anxiety and depression that are common among patients diagnosed with cancer, as well as control of the physical symptoms that cancer and its medical treatments produce.

In 1999, Walker and his Behavioral Oncology Unit team randomized 96 consecutive breast cancer patients into a control group receiving general support and a treatment group receiving the same type of support along with guided imagery and relaxation training. As chemotherapy progressed, the quality of life and mood of the control group declined significantly, as expected. The mood and quality of life of the treatment group, however, actually improved. By the end of chemotherapy, members of the treatment group were not only suffering lower levels of anxiety and depression that they had been at the time of diagnosis, they were actually less depressed and anxious than the general population in their community.

A 2001 study of 50 terminally ill cancer patients found that patients receiving hypnotherapy in addition to standard medical care and psychotherapy enjoyed significantly better quality of life, in addition to reduced anxiety and depression. Another study even found that just giving patients tapes teaching hypnotic muscle relaxation and light, slow breathing alleviated anxiety attacks in all 35 study participants (Liossi, 2006).

The flexibility of hypnotherapeutic treatments allow them to accommodate the very specific needs of various groups of cancer patients. For example, post-operative breast cancer patients frequently suffer from “hot flushes” that “cause discomfort, insomnia, anxiety, and decreased quality of life.” They can be treated fairly effectively with a hormone replacement therapy, but that treatment increases the risk of breast cancer recurrence. Compelling case evidence indicates that hypnotherapy may be the preferred treatment for this problem (Liossi, 2006).

Some general hypnotherapeutic techniques for improving psychological adjustment include: learning relaxation and self-hypnosis, which help to improve self-efficacy and self-empathy among patients who often feel that they have lost control and that their bodies have turned against them; hypnotic ego strengthening, in which the adaptive functions of the patient’s personality are brought to the foreground for them and utilized in novel ways; hypnotic imagery, which the patient can play an active role in developing so that it suits their unique style; and enhancement of spiritual practice through the connection to favored religious symbols and ideas and deepening of the feeling of spiritual connection (Sunnen, 2004).

Understanding Etiologies

Connections between temperament and cancer growth have been suspected since ancient times, and have been repeatedly reexamined as new medical paradigms have developed (Harris, 2006). British surgeon David Kissen studied the relationship between emotional repression, cigarette smoking, and the development of lung cancer in the early 1960s. He concluded that smokers who exhibited a repressive coping style were five times more likely to develop cancer, and that the level of cigarette smoking necessary to induce cancer in a smoker was furthermore conversely related to their level of emotional repression. (Kissen and Hysenk, 1962, as cited in Harris, 2006, p. 5). These findings were replicated “in a most spectacular way” in a ten-year Yugoslavian study in which smokers who endorsed fewer than 10 or 11 items on a “rationality and anti-emotionality(R/A)” survey demonstrated no incidence of cancer, “suggesting that smoking alone is not sufficient to cause cancer” (Gossarth-Maticek, 1985, as cited in Harris, 2006, p.5). Harris suggests that the requisite emotional factors are the imprints of childhood experiences, and as such are intertwined with physiological as well as personality development. Clinical success in the treatment of maladaptive personality factors over the last few decades (McWilliams, 1994; Sperry, 2003) may therefore have profound implications for the emerging field of primary care psychology.

Harris (2006, p. 6) goes on to cite research implicating the repression of anger (RA) as a major factor in the development of breast cancer, and demonstrating correlations between this type of cancer and childhood disturbances or feelings of emotional disconnection. Researchers are not in agreement about the existence of such connections. While acknowledging that the link between breast cancer and psychosocial factors has been popular among medical theorists since pre-Christian times, Bleiker and van der Ploeg (1999) found the current evidence insufficient to establish any significant relationship in their informal review. A meta-analysis published the same year (McKenna, Zevon, Corn, & Rounds) found moderate correlations between breast cancer and “denial/repression coping (g = .38), separation/loss experiences (g = .29), and stressful life events (g = .25),” (p. 520) but concluded that the associations were too modest to provide confirmation of “the conventional wisdom that personality and stress influence the development of breast cancer” (p. 520). Butow et al (2000) confirmed this assessment in their own meta-analysis, stating that “evidence for a relationship between psychosocial factors and breast cancer is weak,” with the strongest acknowledged predictors of breast cancer being “emotional repression and severe life events” (p. 169). More recent research, however, continues to implicate life stress in breast cancer incidence and recurrence (Palesh et al, 2007). Participants in one recent prospective study who went on to be diagnosed with breast cancer had suffered significantly more severe stress in the 10 years prior to the study, as well as significantly more moderate and severe personal losses. (Ollonen, Lehtonen, & Eskelinen, 2005). Recent studies also continue to find significant correlations between repressive coping styles and breast cancer incidence (Manna et al., 2007) and survival rates (Reynolds et al, 2000).

A 35-year longitudinal study of Harvard students found a dramatic correlation between perceived familial love and caring and the likelihood of diagnosis with serious diseases (including cancer, cardiovascular disease, and asthma) in mid-life (Harris, 2006, p.6). On the other hand, when Dr. Bert Garssen of the Helen Dowling Institute, a Dutch center for psycho-oncology, reviewed the longitudinal, prospective studies available in 2004, he completely discounted these and other findings, stating that “there is not any psychological factor for which an influence on cancer development has been convincingly demonstrated in a series of studies” (p. 315).

Regardless of these wide discrepancies in findings, it is certain that the basic mechanism for an underlying psychosocial involvement in the development of cancer—damage to DNA, resulting in mutated cells—is present (Gidron, Russ, Tissarchondou, & Warner.) In a critical review of 21 human and animal studies, Gidron et al. find direct causal relationships between acute stressors and DNA damage, as well as significant correlations between DNA damage and ongoing psychological factors such as depression and repressive coping. Ernest Lawrence Rossi (2002) has compiled extensive research on the relationships between psychological factors and gene expression, finding not only significant effects from measurable psychosocial conditions but also psychotherapeutic potential for modifying these responses.

As an example, Rossi cites Stanford University researchers (Zhao et al., 2000, as cited in Rossi, 2002, p. 199-201) in their studies of the changing molecular dynamics of prostate cancer as it transitions from the early, controllable stage to the later, terminal stage. Specifically, this transition involves two genetic mutations which modify the affected prostate cells’ aberrant androgen receptors, which had heretofore been the instigators of uncontrolled growth, into pseudo-androgen receptor sites which can be activated by glucocorticoid stress hormones. From the time this mutation occurs, the advancement of the cancer is very clearly susceptible to psychosocial stressors and to psychological mediation.

It is difficult, on one level, to make any inferences at all regarding the etiology of “cancer,” simply because there are as many different types of cancer as there are types of cells in the human body—more than 200—and at least as many methods of action by which cancer might come about. Finish researchers Vauhkonen et al. (2007) summarize the current genetic understanding as such:

Cancer results from multiple genomic changes that affect DNA and its gene expression. The DNA sequences may be gained, lost or amplified, or translocated into different parts of the genome to form a fusion gene with oncogenic properties. The occurrence of specific chromosomal aberrations may be restricted to only one cancer type and it may be considered a primary carcinogenic event. Furthermore, the aberration profiles may be used to cluster tumors with similar origins. A variety of techniques exist for the detection of specific chromosomal and gene expression changes. However, the etiology of these molecular alterations remains unclear (p. 277).

Vauhkonen et al. investigate the roles of certain bacteria and chemical substances which may play key roles in carcinogenesis. Other researchers have established reliable connections between certain viral infections and almost 15% of all human malignancies, with a substantial number of additional viral etiologies suspected (Butel, 2000; Boccardo & Villa, 2007). Furthermore, it is known that viruses “are usually not complete carcinogens, and the known human cancer viruses display different roles in transformation. Many years may pass between initial infection and tumor appearance and most infected individuals do not develop cancer, although immunocompromised individuals are at elevated risk of viral-associated cancers” (Butel, 2000, p. 405).

These causal linkages between infectious disease, immune functioning, and cancer formation provide a clear inroad for the influence of psychological factors; research in the field of psychoneuroimmunology has soundly demonstrated the profound interrelationship between psychosocial and immunological functioning (Coe & Laudenslager, 2007). To add to this, solid evidence of direct immunological involvement in the phenomena of spontaneous regression of human cancer has been reported (Saleh et al., 2005). This finding gains enormous significance when it is considered that spontaneous regressions have been observed in nearly every type of human malignancy (Chodorowski et al., 2007).

Hypnotherapeutic Treatment of Cancer and Improvement of Survival Rates

It is clear that hypnosis and visualization are capable of having a direct effect on human immune functioning, including differential expression of T-cell subsets and disease-specific immunological activation (Gruzelier, 2002; Wood et al, 2003). It is also clear that these types of immune system changes take place when hypnotherapy and guided imagery are used specifically with cancer patients: natural killer cell counts are improved (Hudacek, 2007);  lymphokine activated killer cell activity is increased, total T-cell count (CD2+) is increased as are mature (CD3+) and activated (CD25+) T-cell counts; circulating levels of tumor necrosis factor alpha (TNF-α) are even decreased. Furthermore, these changes reliably occur in direct proportion to the perceived vividness of the patient’s visualizations (Ogston, et al, 1997, as cited in Walker, 2004).

What is not clear is the reason that these hypnotically-induced immunological changes do not appear to have a significant effect on the course of the disease or on clinical outcome (Hudacek, 2007; Walker, 2004; Spiegel & Moore, 1997), despite a small but compelling set of well-documented cases in which this type of treatment has apparently initiated spontaneous remission (Rossi, 2002, p.216; Chong, Smith Chong, & Fraser, 2001). This is particularly confusing when it is taken into account that standard, supportive-expressive group psychotherapy—which seems to be a less targeted treatment—can sometimes significantly impact the survival of cancer patients (Spiegel, Bloom, Kraemer, & Gottheil, 1989; Walker, 2004; Küchler, Bestmann, Rappat, Henne-Bruns, Wood-Dauphinee, 2007). For those cases in which psychotherapy does improve survival, Walker (2004) suggests enhanced treatment compliance, health-promoting lifestyle changes, improved mood-mediated chemotherapy response, improved host defenses, and amelioration of chemotherapy-induced immunosuppression as possible mechanisms. Other times, however, this type of treatment also appears to have no significant affect (Spiegel et al., 2007; Kissane et al., 2007).

The results are simply too strange for the problem to have been well-understood: there has to be a key ingredient which mediates the clinical success or failure of direct psycho-oncological interventions. Researchers at the University of Colorado Cancer Center, noting the proliferation of conflicting results in this area of research, came to essentially the same conclusion. They demonstrated that a highly significant factor in the success or failure of psycho-oncological treatment is the maturity of the individual patients’ styles of ego defense—a factor which is predictive of psychotherapeutic success in general (Beresford, Alfers, Mangum, Clapp, & Martin, 2006).

It could be noted, furthermore, that these findings are indicative of a confounding trend in psycho-oncological research which is likely responsible for many of the inconsistencies in its findings: failure to account for and accommodate psychological variables which are known to impact clinical outcomes. For example, Spiegel et al. (2007) suggest that their failure to replicate their previous findings may be due to differences between subgroups of breast cancer patients that are distinguished by receptivity to estrogen-replacement therapy. However, they did not report on the measurements of widely accepted therapeutic factors related to general group therapy treatment outcomes, such as group cohesiveness (Yalom, 1995), nor on the psychological
makeup of their participants.

As different styles of psychotherapy are indicated for patients operating at different levels of personality organization (McWilliams, 1994), it should go without saying that psychotherapeutic interventions specifically aimed at cancer must also take these variables into account. The fact that they are not being accounted for in the bulk of relevant research could reflect a basic disconnect between the required specificity of the medical model as a treatment metaphor and the contextual requirements and implications of psychological treatment (Wampold, Ahn, & Coleman, 2001), or perhaps some manner of entrenched condescension or apprehension toward psychotherapy as a potential medical treatment. The complexity of patients’ psychotherapeutic requirements, after all, should not be surprising: as pharmacological treatments have grown more complex, they, too, have acquired a greater need to accommodate individual factors in treatment. Depending on the type of cancer, degree of advancement, and other diagnostic features, a cancer patient may be administered any combination of surgery, radiation therapy, and more than 50 chemotherapy medications, and yet we study just a single mode of treatment called “supportive-expressive group psychotherapy”?

Likewise for hypnotherapeutic treatments: although individual differences in hypnotic susceptibility and absorption are clearly predictive of the efficacy of the treatment in up-regulating immunological functioning (Liossi, 2006), studies of hypnotherapy for cancer patients have almost uniformly failed to measure the hypnotic ability of their subjects (Richardson, et al., 2007). This oversight is problematic for three reasons:

  1. Hypnotizability is a normally distributed, stable personality trait with at least some genetic basis, which is known to be predictive of clinical success in hypnotherapeutic interventions (Wickramasekera, 2003). Hypnotherapy may therefore not be expected to be an appropriate treatment for individuals who fall in the low-hypnotizable range. Research which fails to identify these individuals will both underestimate the efficacy of hypnotherapy for those who can benefit from it and fail to discern elements of the treatment which may be beneficial to those lacking this trait.
  2. Low hypnotic ability may be modified or overcome. A number of techniques, such as biofeedback, have been found to at least temporarily improve hypnotic ability in low-hypnotizable individuals (Wickramasekera, 2002). Additionally, the application of multiple successive hypnotic techniques may be effective in patients who have failed to respond to standard hypnotic techniques (Crasilneck, 1995).
  3. Hypnotic ability is not a unitary trait. If overall hypnotic ability is not measured, then the interventions studied cannot be tailored to utilize the specific hypnotic abilities of each patient. Patients who are unskilled at hypnotic visualization but excel at kinesthetic representations, for example, will receive far less benefit from guided imagery-based interventions than they would from hypnotherapy that utilized their individual, measurable hypnotic strengths (Pekala, 2002).


Hypno-oncological interventions intended to directly alter the progression of the disease have not been yet been studied in controlled trials. However, the theoretical and biological bases for hypnotherapy’s potential as an effective adjunctive cancer treatment appear to be sound. Such interventions should be tailored to the individual hypnotic abilities of the patient and should be designed to foster the development and use of more mature ego defenses.

Additionally, it seems likely that a degree of biological specificity which has yet to be achieved in this type of hypnotic treatment could have the potential to significantly enhance its efficacy. The types of imagery used in the studies we’ve reviewed, when mentioned, have tended to be combative—as though the cancer cells were isolated intruders. Biologically, however, we know that the occurrence of cancer is far more complex. At least two genetic mutations are required to convert healthy cells into malignant ones, and viral, bacterial, or chemical interference is involved in some or all of these mutations a substantial percentage of the time. (Butel, 2000; Vauhkonen et al., 2007; Boccardo & Villa, 2007) Some cancers seem to result from ongoing viral infections and to reverse their course when the immune system is awakened to the presence of the intruder. Other types of cancers seem to occur systemically, with numerous precancerous lesions preceding the development of a site-specific, diagnosable cancer (Baker & Kramer, 2007). If hypnosis is able to directly influence biological events—which it does seem to be able to do (Rossi, 2002)—it would seem logical that more accurate therapeutic metaphors would yield more accurate treatment.

Hypnotic imagery involving the mobilization of cellular warriors does, in fact, increase the mobilization of natural killer and lymphokine activated killer cells (Gruzelier, 2002; Wood et al, 2003; Hudacek, 2007; Ogston, et al, 1997, as cited in Walker, 2004). That alone is essentially cause for celebration; the implications are staggering. Using hypnosis, we can tell our patient’s bodies what to do, and they will do it. Now all that is needed is to understand exactly what human bodies must do to be free of cancer. Increasing T-cell activity and focusing that activity on the site of the cancer is clearly not sufficient. If research in this area is conducted in such a way as to directly compare the efficacy of different pathogenic models for particular types of cancer, the results may very well have implications for the development of new biological treatments as well. Perhaps the body can tell us what it needs in order to heal.

There is presently no evidence of any downside to open experimentation in this area. Hypnotherapy is already conclusively established as a highly effective treatment for many primary and secondary symptoms of human malignancies—acute and chronic pain, chemotherapy-related nausea and vomiting, food aversions, fatigue, insomnia, anxiety and mood disturbances—and is currently under-utilized (Liossi, 2006). Furthermore, there is no evidence that the addition of far-fetched suggestions into existing empirically-based clinical hypnosis protocols would reduce the effectiveness of existing treatments, significantly increase treatment expense, or present additional risk to the patient.

Appendix I: “Hypnotherapy Script for Befriending a Cancer”

[Begin with your induction of choice]

And when you’re just about as deep, and as comfortable, as you know how to be, let me know you’re there…

Good, because now, we are going to learn something, that may at first seem foreign to you. Something that you already have, inside of you, as a skill, that you have not yet learned, to fully use. Learning can be very uncomfortable, at times, and I understand, that you have felt very uncomfortable, in the past. But you don’t have to feel that way. You don’t have, to feel anything, at all that you don’t want to.

And you can keep right on sitting there, just as you are, and you don’t even have to feel it. You don’t even have to feel, like it is even your own body. And you can notice your arms and legs, and you don’t even have to feel that they’re attached to you. And you can notice your breathing, the way it keeps right on breathing without you, automatically, all by itself, and it doesn’t matter where you go, or how far away you, wander off now, and everything back here will, just go on ahead, just the way it is, with no interruptions. And you can keep on hearing the sound of my voice, and you don’t even have to listen. And some part of you will continue listening to the words that I am saying, and you don’t even have to hear them. It’s really amazing, how wonderful it can feel, to let yourself wander off now, completely off the beaten path. And my voice will go with you, as I fade off into the gentle sounds of breezes, the quiet singing of birds nearby, the chirping, and whirring, and crackling of insects and tiny, natural, lively things all around you now.

And you can find yourself, almost as though you had been sleepwalking, wandering through a beautiful countryside now, without a care in the world. One little step at a time through the lush green grass you find here. And as you walk this way, you’ll begin to notice all the interesting scenery around you, And you can notice, if there aren’t too many clouds, how high up in the sky is the sun today? I wonder what time it might be. Take a look around you now, survey the landscape. If you listen carefully, you may be able to hear the sounds of water, bubbling and frothing. Is there a stream nearby? Maybe you’d like to take a closer look, to go and lean down over the warm, smooth, sun-baked stones, and run your fingers through the cool water there. This world is just full of wonderful feelings, that you can find, and you will find, that they all feel, wonderfully, familiar to you. And you can wander around like this for as long as you like. It may be a very long, and very lovely time, that you have here now, just wandering around, just discovering, all the sights, and sounds, sensations, smells, of your, own, private, countryside. Really feeling, right at home here by now. It’s lovely here.

And after, some time, has passed, two-more things, will come to your attention. There is someone else nearby, a stranger. And from a little ways away, this stranger can-sure make you feel, very apprehensive, because they look as though they may be—unusual? strange?—maybe even very, dangerous, to you. But you like most people, I know you’ve found, that you’ve gotten much farther, with people, when you find it in yourself, to be friendly and accepting. And so, knowing now that this place is your very own home, and knowing that you are very brave, you can decide to walk towards this stranger, in a friendly way, with the intention of learning, to understand them, and to befriend them, so that, they will listen to you, when you know the best things for them to do, and you can even, listen to them, when they know what might be best, for all of you. Because, you know, the more deep and meaningful friendships that you allow yourself to build, now, the healthier, and more fulfilling your whole, long and luscious life, will be.

And as you walk toward them and begin to come closer now, you’ll start to notice that the expression on this stranger’s face is not a malicious one at all. You’ll see instead, that they appear to be, simply, confused. And although something about them is very familiar to you, you’re going to find out, how your stranger is having trouble remembering just who they are, and just what their purpose started out to be. And so you can start by just, introducing yourself, and discovering, that the two of you have a great deal, to talk about together. And while you’re having that long, productive conversation with your stranger now, I’ll tell you the story of a stranger that I met.

My stranger was a person whom I happened to befriend, by a stroke of luck, actually, although at first it didn’t seem that way at all. Because, you see, in my college days I had rented a room in large house—it was much, much taller than it was wide. My room was at the very top of the stairs, it must have been at least six or seven stories, and during the summer it would become very very warm up there. But, I had a little window on either side of the room, and it was high enough that if I opened up the both of them then I could usually get a nice breeze in there. My neighbor downstairs was not so lucky, the window on their far wall was stuck closed, and the window on the wall by the bed was so close to the place where they would sleep or sit and study, that it couldn’t be opened either. You see, my friend downstairs was really very tremendously fat, sort of engorged really. I came to find out later that they had started out ordinarily enough, wanting ordinary things just like you, wanting to be a part of something larger than themselves, just like anyone, just like anything. But something had gone wrong for them along the way. You see, when they were small, they developed, like many kids, a real taste for sugar—just couldn’t get enough sugar. So, they started out begging their parents and friends for whatever cakes or candies could be found, and soon enough they had progressed to stealing candy bars in stores. It got to be, that they became so focused on getting and eating all the sugar they could find that, well pretty soon they had mostly forgotten all about their other, wishes, hopes, dreams. all the real purposes for living that they had had. So they floated through life, growing larger and larger, sucking up all the sugar they could get, starving out anyone unfortunate enough to get caught around them, but mostly they just didn’t get noticed much, until one day they were my little downstairs neighbor, and the building inspection committee came through, and was dismayed to find, that my little stranger had grown so large that they couldn’t even be removed from our little building. And what was worse, there was no way for me to even get down around them, so I was stuck with them, and I very upset and, even, actually frightened about what might happen to me being stuck there with this big fattened blob stuck down there beneath me. Would I be able to get out of there to eat, to finish school, to work, to see my family and friends again? What might become of me, I thought. It just got worse and worse for me. Well, a long time passed, with just me and the stranger up there in this tower. People managed to bring me food through my window, but the window wasn’t small enough for me to fit through and the building was too old for them to be able to make a hole in it and take me out, so I was stuck there with the stranger and nothing left to do now except learn to understand how they got to be the way they were so that I could help them get back to being something much more manageable. And you know what? I ended up talking with them for an awful long time, about all sorts of things; a great, long, productive conversation with this stranger, and we talked about life purposes, the way that every little part of everything has a part to play, a purpose of being, and how sometimes we each felt as thought we couldn’t quite remember who we were, or just what we had started out to be, or what task we were meant to be accomplishing. We each got caught in our respective ruts, you understand, and we would just get scared and start running away from our true selves—them eating their sugar all day and all night, stealing from all the folks around them, getting lodged into places they couldn’t fit out of and seeing no way out but to take in more sugar and become bigger and fatter and more malignant, and me, I found, that I was very much the same in my way, so focused on the tiny little aspects of my life that I thought were so important that I would do nothing but gorge myself on them all day long, throwing myself into my tiny personal interests and not being able to grasp the big picture of what my life was supposed to be, you know, my ultimate purpose, my, destiny. And so it was, for the stranger, they just hadn’t remembered, their destiny: and you know, of course, that their destiny was just, just like the rest of us, just to be a part of something larger than themselves, to find meaning, real meaning and worth, in functioning, in society, right there in the middle of the great body of people, making differences, building real deep meaningful relationships, enjoying the purpose of themselves and everyone around them, all the squirming, pumping, growing, healthy parts of a real live society. Of course, there was no way for them serve any kind of greater purpose while they were caged up there in their hot little room, stuck with no way out, caged in by their own appetites and loss of purpose. But as we talked, we both found that it was, irresistible, to follow our true purposes, to learn how we could truly interact with the great human body and live of life in which we were beloved and really integral parts of the systems we belonged to. And as we talked we found that our confusion abandoned us completely, and the stranger and I began to see things perfectly clearly, and found that it was just so easy now, to forget about, whatever it was that we had been distracted by. Day by day, the stranger started shrinking; I noticed all at once that they had stopped eating all their stores of sugary deliciousness, and were instead fully driven by a renewed desire to perform their original function. We became such good friends, as we both became increasingly excited about the potential that we could have and the impact that we could make with these beautiful lives that we had, that I barely noticed how small they were getting, even smaller than me! Shrinking down to just the right size and turning into something entirely different—turning into exactly what they always should have been, a working, thriving part of the system; something valuable and useful; completely and cleanly disappearing into the workings of a beautiful, and important system. When the building inspection committee came back later that term, they didn’t even recognize the stranger at all; my stranger-friend was just another student by then, just another healthy part of the student body, coming and going as they pleased, getting through all the work they had to get through, and better yet, they became so healthy and vital now and they started to impact the whole student body in a positive way—pretty soon I would come home from class and find them scurrying about the building, full of energy, actually cleaning that place up! Making sure that everything was in perfect, healthy, functioning order. The whole situation had a big impact on me, too, as I know you can imagine; I had learned what it was like to be isolated from everyone I knew and loved, locked away in scary place, and I had learned that the way out, the way to feel good again, even better than I had ever felt before, was by building stronger and better and deeper relationships than I had ever built before. I haven’t seen my stranger-friend for a long long time now; they shrank away into my past. But the things that I learned, from meeting them, from being stuck with them, and from surviving the ordeal in order to become a healthier and more active and integrated person, why I wouldn’t trade the experience for anything, no matter how scared I might have been.

And I don’t know whether you’re already starting to feel like your stranger has made that kind of impact on you and on your life, or whether you’re just beginning to feel that way as they shrink off into your memory for good now. But I do know, that it can be really amazing, how sometimes our greatest teachers, and the greatest promoters of our health, and vitality, can start out looking like insurmountable obstacles. And we often think, during those times, that someone is trying to harm us, and they might even think that too, but as you take a closer look, you can quickly discover, that in fact, they were only confused, and only needed a little bit of help, to get right back on track, and that as soon as that happens, then everything can come back together, all at once.

And you can-sur–reptitiously remind yourself… even the stranger, and more frightening parts of yourself, that they don’t have to be afraid and build themselves up into large, and, scary, things. You-, can-cer —, repetitiously, remind yourself… especially the stranger, parts, that there is enough warmth, and nourishment, for all of your parts, and that there is, enough friendliness, there inside, your little world, so that nothing has to grow, out, of proportion, to the rest. And you will be surprised, how quickly, balance will be restored, as you’re thinking this way, and feeling, finally, as though all of your parts, are finally working together, in perfect harmony now. And when you look, inside yourself, you’ll find a world full of friends for you, with no strangers left at all, and no parts left out of the loop, feeling needy, or greedy. You’ll find, instead, only your beautiful landscape running along, just perfectly, amazing everyone.

And when you return, from your wandering, you may find that you have been, filled with wonder, over all the new and delightful sensations, that have come, to replace those feelings of discomfort, that you had experienced, in the past.

[End with your re-emergence instructions of choice]


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