Transcript

Kim Mills: What comes to mind when you think of hypnosis? A swinging pocket watch? A hapless volunteer on a stage clucking like a chicken? Hypnosis, in many people’s minds, is the province of charlatans and showmen. But this image of hypnosis is outdated and misleading. Over the past several decades, psychologists and other researchers have learned more about how hypnosis actually works and found evidence that it can be useful in treating pain, anxiety, and a range of other physical and mental health problems.

So what exactly is happening in people’s bodies and brains when they’re hypnotized? What’s the difference between stage tricks and hypnotherapy used in pain management? Can anyone be hypnotized? What kinds of physical and mental health issues can hypnosis address? And if you want to see whether hypnosis can help you, how can you find a qualified practitioner whom you can trust?

Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I’m Kim Mills.

My guest today is Dr. David Patterson, a professor of medicine and psychology at the University of Washington School of Medicine. Dr. Patterson specializes in pain control and recovery from physical trauma, burn injuries, and other forms of disabilities. He is also internationally known for his work in clinical hypnosis. Over the past several decades, he has led many national institutes of health-funded studies on hypnosis for pain management, has published more than 100 articles on hypnosis in peer reviewed journals, and has written a book for APA on hypnosis for pain control.?

Dr. Patterson, thank you for joining me today.

David Patterson, PhD: Thank you, Kim. It’s an honor to be here, and I wanted to thank you. It’s my understanding that you’ve started this podcast, and I’ve listened to several of them. And it’s a wonderful way to take popular topics and really provide a scientific basis that psychology could provide, so my compliments and appreciation to you.

Mills: Thank you. And I think we’re going to do that today because we will demystify hypnosis, I hope, and explain it scientifically. Let’s start with that image problem I alluded to in the introduction. What is the difference between the hypnosis that you and other psychologists practice and the stage tricks that may come to mind when some people think about hypnosis?

Patterson: I’ll start with stage hypnosis and that most people have a concept of hypnosis based on what they’ve seen on TV. Interesting little trick about stage hypnosis, if you watch a lot of them work, what they will do is get 20 volunteers up on stage, they’ll give them a suggestion, and they’ll see that maybe five of them will really follow the suggestion deeply, like falling asleep on their neighbor’s shoulder. So they send the rest of the people back to their seats, and they work with those highly hypnotizable people and make them do ridiculous things. One thing is that they select for hypnotizability, and the other is, we are at the international meeting for the Society for Clinical Experimental Hypnosis. And we had some stage hypnotists from Las Vegas talk to us. Basically, what they emphasized is, their people want to be part of the act, so the hypnotists are not sure whether they’re hypnotized or not, but it becomes all part of the show.

Okay, so that’s stage hypnosis. What we’ve found as psychologists is, first of all, that it’s far more than a placebo and that it can be a very powerful treatment to, you mentioned pain and anxiety. Irritable bowel syndrome is another one. But the way we do it is, we’re very often looking at what’s happened in the brain while we’re studying people, and we’re also using outcome measures. And the final thing I’ll mention, and I think is very important, is that hypnosis is known to increase the effect size of psychotherapy by a large amount.

Mills: What is happening in people’s brains and bodies when they’re hypnotized? If you put somebody in an fMRI when they’re hypnotized, how will their brains behave in a different way?

Patterson: One of the best people I’ve ever heard talk about this is named Pierre Rainville, and he’s up in Montreal. I asked him once, “Is there a different brain state with hypnosis?”

And he goes, “You’re asking the wrong question because there’s a series of brain changes that happen.”

You initially see activity in the left frontal lobe as people attend to whatever suggestions are, and this is where the swinging watch comes in. That’s just a way to capture people’s attention. But then what happens is, it looks like the dorsal lateral prefrontal cortex shuts down. So the rear of the frontal cortex disengages, and then the ACC, which is a part of our brain that motivates us, engages us at the same time. Basically, what happens is that people give up judging what’s happening to them or caring what’s happening, and they just become very open to suggestion. Finally, as people get suggested, you see different parts of the brain activated, and very often you see a transfer of activity to the non-dominant hemisphere, so it’s really those three phenomena, increased attention, dampening of the prefrontal cortex, and then engagements in various areas of the brain depending on the suggestion.

Mills: And it’s not asleep. People are conscious, they know what’s happening around them when they’re in this state. Is that correct?

Patterson: Yes and no. First of all, we like to dispel myth of hypnosis. A lot of people are afraid they’ll fall asleep with hypnosis. That almost never happens because, in some cultures, that’s a form of embarrassment. For the most part, people are aware of what’s going on. But with some of the deep, complex hypnosis that we use in psychotherapy, very often it’s like saying your brain is shut off in a light sleep. When people are in the space, they’re not asleep, but they will—but if you tell them that, “I’m going to snap my fingers, and you’ll wake up,” they’ll respond to the suggestions. So they’re integrating the suggestions, but there are periods of time where it’s just that their brain goes into a type of twilight form of functioning.

Mills: We talked a little bit about some of the problems that hypnosis can address, and I’ve read about hypnosis for smoking cessation. We mentioned anxiety, insomnia, other kinds of physical and mental health issues. Are most of these backed by research? Where is the evidence the strongest?

Patterson: Most of these are indeed backed by research. I think some of the strongest researches in acute and chronic pain, and particularly my colleague Mark Jensen, has done a number of randomized controlled trials on chronic pain. I did a lot on burn pain and surgeries. There is irritable bowel syndrome, has a lot of literature now to support it, reduction of anxiety, smoking cessation, and the name to look there is Joe Green. He’s done a lot of work on it. There is some evidence that hypnosis helps with weight loss. Not only helps with it, but people who use hypnosis, the weight loss lasts longer. And so those are a few things. I do want to emphasize again that I think the best model to use hypnosis is to have someone in psychotherapy and then basically boost the effects of psychotherapy by using hypnosis at the right time.

Mills: Some people, they just can’t be hypnotized at all. There’s like a range of who can be hypnotized and who can’t be hypnotized. What does that curve look like? Is it a classic bell curve? Can you give us some idea of, statistically, how many? What’s the percentage of the population that can be hypnotized and can’t be hypnotized?

Patterson: First of all, it is a bell-shaped curve, like you said, and there’s maybe 10% of people that just don’t seem to respond, and 10 to 15 people on the other tail that are very responsive. It is a bit skewed to what we would say mild to moderate hypnotizable, so probably the majority of people fall in that category. And just a quick note, the way we measure hypnotizability is, we hypnotize someone, you give them a series of maybe 12 suggestions, and hypnotizability is measured by how many suggestions they follow. And it’s a circular argument because it’s really just saying how many suggestions they respond to rather than something more special than that.

Mills: What can hypnosis not do? For example, could somebody who’s highly suggestible be hypnotized into committing murder or doing something that they wouldn’t do in their waking, non-hypnotized life?

Patterson: Excellent question. First, the answer to committing murder and antisocial acts is no. There’s been a number of studies that have demonstrated that. As a matter of fact, the CIA, I believe this was in the ‘50s or ‘60s, followed the notion of the Manchurian man and tried to hypnotize people to have them be hitmen or hitwomen. It never quite worked. People won’t do antisocial acts. And for the most part, people won’t do what they don’t want to do. There’s the whole cluck like a chicken, but most people won’t do that unless they’re willing to go with the show.

Mills: Is there anyone who shouldn’t try hypnosis because it could harm them more than help them?

Patterson: Yes. And I think I want to really refer to groups of people who have learned to use dissociation as a response to trauma early in their childhood, perhaps with sexual abuse or other types of trauma. They use it so often that it becomes part of their personalities. These are people that can really dissociate with the drop of a hat. I wouldn’t say that they should never use hypnosis, but when you’re using hypnosis with people with really dissociate tendencies, you have to be very structured and, for example, not regress them to early childhood unless it’s very well controlled, because that could bring up a lot of damaging material.

Mills: What about self-hypnosis? There’s always a lot of talk about how you can learn to do this yourself and perhaps control your weight, your smoking, or other things. How well does that work, and is it as effective as being hypnotized by a scientific practitioner like yourself?

Patterson: First of all, what I see us doing with hypnosis is you’re really tricking the logical part of the brain and you’re getting people out of their cognitive automatic functioning. There is a way of capturing attention, and several ways to do that. So I think, for the most part, it’s always better for someone else to hypnotize me, or a patient’s going to have better luck if I’m hypnotizing them. Now, having said that, and this has really changed with smartphones, most of us clinical people, and in our research too, we had the patients record the inductions on their phone and listen to them daily. Our own research shows that really strengthens the effects.

And for an issue like chronic pain, you’re not going to cure anyone in one session. For that matter, you only manage chronic pain, you don’t cure it. But to work with chronic pain, you want people to be practicing it every day and they do indeed get better at it. I guess I have both answers to your question. It’s better if another other people hypnotize you, but you’ll get better and better at it if you do self-hypnosis.

Mills: You do a lot of work with really acute pain people who have been burned. First of all, how did you get into that? What made you decide at some point to give that a try to see if you could help a burn victim through hypnosis?

Patterson: I’m so glad you asked that question because there was one event that happened in the burn ICU that really shifted my whole career. I was hired as the psychologist for the University of Washington Burn Unit on the Department of Rehab Medicine. When I showed up in early ‘80s, Bill Fordyce was on faculty then, and Bill was the grandfather of the psychology pain control, period. I was lucky to overlap with him for a couple of years, and he was very gracious in providing me supervision, so I would ask him all kinds of advice. The burn unit approached me and said, “We need your help with burn debridement.” I went to Bill and I said, “What do you suggest?”

And he said, “Have you tried hypnosis?” And I was amazed that he said that being an awkward behavioral guy.

I found an induction that was published by a psychologist named Joseph Barber. I went up into the ICU and I did this induction where I brought the patient down 20 steps, and then I touched him on the shoulder and I said, “When the nurses touch you on the shoulder, you won’t feel any pain, and you’ll be able to go very comfortably through your burn debridement.” And then I brought them back up. I said to myself, “Yeah, like that’s really going to work.”

Because I want to add that this patient was refusing to go wound cleaning—high doses of morphine, Valium, nitrous oxide—and he said, “I’m not going, just let me die.” And that’s no exaggeration. He went in there. I showed up on the ward later that afternoon, and everyone was so excited, and they said, “What did you do to this guy?”

I said, “I used hypnosis.” And I said, “Why?”

They said, “We touched him on the shoulder, he fell asleep, he looked like he fell asleep, and we did all of his burn debridement.” And for the rest of his hospitalization, they just touched him on the shoulder, he went limp, and they would do all his debridement. And about a month later, after he was discharged, he came back to the outpatient clinic. And I didn’t realize I was doing it, but I said, “Hey, Joe, how are you?” And I touched him on the shoulder, and he collapsed in my arms.

Mills: Wow.

Patterson: I’ve seldom got it to work that well afterwards, but that led to me applying for NIH and getting my first grant in 1989. That grant lasted for 30 years straight, so it was a really great relationship with NIH.

Mills: That’s an amazing story. Now, you combine hypnosis with some other techniques when you’re working with people, how does that work?

Patterson: Yes. After using hypnosis for maybe 10 or 15 years, I met my colleague named Hunter Hoffman, and he designed an immersive virtual world for people going through burn care. We would put people in three-dimensional worlds, and it was called SnowWorld. It’s still out there. So they would be engrossed in this cool world during the burn care, and they wouldn’t be able to see what was going on. We did that for a number of years. Then I did some work to try to combine immersive virtual reality with hypnosis as a vehicle to deliver it. So far, that hasn’t worked particularly well. Immersive virtual reality works great by itself. Hypnosis works great by itself, but I haven’t been able to design a sophisticated enough type of technology to deliver hypnosis through VR. And indeed, they’re two separate processes. We’ve published in Journal of Abnormal Psychology on how you have these. There’s two separate processes going on when we compare them empirically.

Mills: Is hypnosis taught as a matter of course in graduate psychology programs?

Patterson: Less and less. I don’t want this to sound the wrong way, but I think hypnosis has been hijacked by mindfulness. I feel very comfortable saying that because much of my work is around mindfulness now with my patients. I work hard to combine hypnosis with mindfulness. But hypnosis has had a waxing and waning history since the 1800s. One of the reasons it left the stage was the advent of ether, and it was a lot more efficient to use, ether, with patients. It would come back, it would make a comeback. When mindfulness just really overtook graduate schools, there became a lot less interest in hypnosis. But with a lot of the brain studies and so on, I do think it’s making another surge.

Mills: If our listeners, for example, are interested in finding a therapist who can help them maybe with a combination of hypnotherapy and cognitive behavioral therapy because they’ve got a problem that could be addressed by this, how should they go about finding a practitioner who’s qualified to do this?

Patterson: Your question brings up one of the important issues that I talk about is I don’t think hypnosis is owned by psychologists or health professionals, we can’t lay claim to it. There is a whole guild of hypnotherapists that aren’t trained in any type of healthcare, they’re just trained in hypnosis. I think that they can hypnotize people and do things like enhance creativity. But I think if someone has a health issue, particularly any type of significant mental illness, things like pain, it’s best to go to a good psychologist who has hypnosis as part of their treatment package.

In other words, a good psychologist is going to look at a half dozen types of intervention and then based on the patient or based on when we’re in therapy, we enter in hypnosis. A hypnotherapist uses hypnosis as a hammer to hit every nail, so I discourage people away from that. The American Society of Clinical Hypnosis does a lot of training and has list of practitioners. There’s the Society for Experimental and Clinical Hypnosis who also does, and they also do a lot of training, but I do have to admit that it’s difficult to find a psychologist that does hypnosis. Again, it’s part of the waning period that we have, and I think there is going to be more and more of them that are trained as good therapists in hypnosis as well.

Mills: But it sounds like from what you told the story about how you started using hypnosis with a burn victim and that you read a paper and that you hypnotized him, was that described in the paper? How did you really know how to do this? How do you hypnotize a person? Where do you learn this?

Patterson: I had a fair amount of that in my graduate school. I had it in internship and postdoctoral training, so I did. I think a really good example is, most psychologists are trained in progressive relaxation. And progressive relaxation really is the foundation of hypnosis. You’re counting them downstairs, you’re scanning the body, and relaxing them, so I had a lot of training in that, biofeedback. Any good graduate training is going to provide the platform. What the abduction I read is it really targeted a post-hypnotic suggestion for a medical procedure. I think this is one of the strongest uses of hypnosis there is, that if someone’s going through surgery, childbirth, burn care, dentistry, you can work with them when they’re calm, they’re not on a lot of medication, you can hypnotize them, you can make a tape.

But then, it all comes down to this post-hypnotic suggestion that when they’re walking in for the surgery or when they feel that IV line going in, that’s the cue, that’s the stimulus for them to go into a deep relaxed state, so it’s classical conditioning at its very core. But hypnosis, one of the things with hypnosis is, it would drive me nuts to sit there for 30 minutes to do progressive relaxation. The brain when someone’s hypnotized. It’s like you can do a 20-minute progressive relaxation in five minutes, and I just love that. The brain functions differently and much more efficiently. And there’s definitely are changes in the way people process information when or under hypnosis.

Mills: Since the pandemic, a lot of therapy has moved online. Is it possible to do hypnosis remotely?

Patterson: Absolutely. When the pandemic came along—I’m in the area of rehabilitation psychology, and disabilities, and we’ve been screaming for remote treatment for years for people that can’t get into the office. All of a sudden the pandemic comes along, and in two weeks we’re set up with this whole platform. So I was seeing all of my patients through Zoom, and 90% of the hypnosis I did was over Zoom. Again, what I would do is have the patients have their phone and record the session. Zoom’s nice because it’s not nearly as good as live hypnosis, but at least you can see your patient. When you’re with a patient and you’re hypnotizing them, the ultimate scenario is that you’re really in tune with their body. They’re breathing, and you’re breathing with them, and you notice that someone just puts their head back, and you reinforce that, so there’s a real advantage to being able to see the person. Much better in person than in Zoom, but Zoom works.

Mills: I have to ask you another question related to some of these stage hypnotists. Many, many years ago, I went to one of these sessions where hypnotists was going to help people go through past life regression. In this demonstration, this person would hypnotize somebody who would then go back to what was supposed to be a prior life. Is this just quackery? What is going on when that happens and somebody comes along and says, “I’m in the forest. I know I’m a Navajo Indian”? They start telling you a whole story about who they are and where they came from. What is happening with these people?

Patterson: First of all, one of the best researchers that I’ve ever met is Mike Nash, at the University of Tennessee, and someone ran that question by him. He said, “Past life regression is fine if you’re looking at things from the standpoint of religion.” That’s a religious phenomenon. One of the things that really happens with hypnosis is that people have very vivid imagery. Remember, the brain shifts over, so things can become very real. That’s why there was a huge—one of the most embarrassing periods of psychology is when people were planting suggestions for early trauma through hypnosis and not letting the patient arrive to them, but planning those. And hypnosis can make a false memory appear very real.

It reminds me of Mike Nash, who had a patient that reported he was abducted by aliens. So he took him in hypnosis, and they went through the whole abduction and came back. He didn’t really question it, but he used it as a symbolic thing for psychoanalytically. The patient got a lot better, but he didn’t really question whether the abduction was real or not.

Similarly, when you hypnotize, if you give suggestions for past life progression with hypnosis, people, as you said, can have very vivid images. Now, I think it’s very interesting that everyone seems to go back to the 17th century and be run over by a carriage. The way I see regression of past lives, “If you hypnotize me, how far back am I going to go in human evolution?” I often say that if you hypnotize me, I’d probably go back to a newt. I would just be this wiggling thing. Because that’s one of the things, when you really look at science and evolution, we didn’t start in the 17th century or—

Mills: Right.

Patterson: —anytime close to that.

Mills: I’m remembering the primordial slime. Yes.

Patterson: Exactly.

Mills: But it is possible to take people back in their own lives. And that’s legitimate. Those are things that can be checked, right?

Patterson: Exactly. It’s one of the techniques—one of the really powerful, powerful techniques of hypnosis is that if someone’s in pain or they’re depressed, you can take them back earlier in life to happier times, and you can really have them integrate those resources. Then you bring them back to the present, and they still have this really positive affect. I wanted to mention, speaking of past life regression, when I was in graduate school, I read a paper in Journal of Abnormal Psychology that fascinated me. The study is they took adults and they gave them a computer task that you need identical imagery to do. And there’s a theory that we all have identical imagery before language as children. I don’t know how accurate that is, but they regressed these adults to children, and they were able to do the task more. That was, I think, one of the reasons I really got interested in hypnosis. I don’t know if it was replicated, but I think just the concept was so creative and fascinating, but yes, you can definitely regress people. When you’re regressing them, you have to be really careful. If you just let them go anywhere, you can bring up some really damaging material that people can’t really deal with. When I’m using it clinically, I say, “Find yourself going back to early images in time as long as they’re positive images and as long as you feel safe.” So yes, I hope that answers that.

Mills: Some of these sound very similar to some of the psychedelic therapy that’s happening right now. A year and a half ago, I talked to somebody who’s doing that kind of therapy, and it’s the same thing that you need somebody guiding you through it, that you don’t want to take people places that might be too dangerous. Is there something similar? Do you think that’s happening with people who might be doing psychedelic therapy and doing hypnotherapy?

Patterson: Absolutely. I have to respond somewhat personally. I lost a son over the last year. I had been referring some of my terminal patients to psychedelic therapy, but I decided to pursue it myself in Denver with two top-notch therapists. I did a psilocybin trip, again, with the two therapists, but I was amazed at how much similarity there is to the way I do advanced hypnosis. And when the guide was introducing what was going to happen, it sounded very much like advanced hypnosis, and it ended up being very useful for me.

Mills: Last question. I like to ask this often with people who are doing interesting work out there in the field. What are you working on now? What are the big questions you’d like to answer?

Patterson: What I’m working on now is I’m working on a second edition of my APA book, but the real focus is, I’m very interested in the neurophysiology of the way the mind works and the notion that, basically, we don’t really have a self, we can only talk about what ourselves are not. But what we think as our self is always a transient process, very Zen-like type of thing. But a lot of the way I think we get into trouble is by focusing on the past and the future, which are both illusions of the mind. I very often teach patients how to meditate, but then I use hypnosis to, again, I think the greatest use of hypnosis is just to accelerate psychotherapy, different learning process, but to have a good foundation. I’m particularly interested in now is somewhat of a Buddhist understanding of the mind as process rather than a fixed entity, getting away from dualistic thinking, explain that through science, and then augment it through hypnosis.

Mills: That sounds amazing. I look forward to seeing this as you work on the next edition of your book. So I want to thank you, Dr. Patterson, for joining me today. It’s been really a lot of fun talking to you.

Patterson: Thank you, Kim.

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If you have comments or ideas for future podcasts, you can email us at speakingofpsychology@apa.org. Speaking of Psychology is produced by Lea Winerman. Our sound editor is Chris Condayan. Thank you for listening. For the American Psychological Association, I'm Kim Mills.