Hypnosis in Clinical Practice (Physiotherapy, General practice & Dentistry)   

Hypnotic techniques can be used in various fields of clinical care in both Primary and Secondary Care. It is not designed to present the evidence base but rather to share the clinical experiences of some of our members and demonstrate what a vital tool hypnosis can be. Cases from a physiotherapist, GP and dentist are outlined below.

Hypnosis in pain management: Physiotherapist, Oliver Hollis.

Lisa (39) was referred to pain management with persistent head and neck pain, seven years after a road traffic collision in which she sustained a classic whiplash injury. Her sleep had become patchy and unrefreshing, and her pain became more widespread. She had withdrawn from nearly all social activities; everything was an effort and left her feeling continually fatigued. 

The first part of the treatment was gently introducing the concept of how some pain is created through top-down mechanisms and the more familiar bottom-up pathways. The process begins with the patient being curious about why drugs and targeted interventional treatments have not worked as expected. How could that be explained? Lisa was then offered stories and suggestions that took her towards an understanding that if the brain perceives something is “not right” and that it might be “unsafe” then the pain becomes the stereotypical way that we are alerted to danger.
What if the perception of danger was in error, or perhaps over-stated? The approach validates the patient’s daily experience that something is not right and introduces the idea that at least some of the pain she experiences might be “unnecessary” because there’s no actual structural danger, or risk of exercise causing further harm.

Lisa was taught self-hypnosis and as well as ego-strengthening suggestions, a series of metaphors and examples were delivered on the theme of hyper-vigilance for threats and mistaken anxieties. Dissociation was used to allow Lisa to “escape” the feelings of threat and into a state of safety. She was encouraged to notice how the raw sensory cloud she was experiencing, including her perception of pain, changed with feelings of threat or safety. Before re-orientation, post-hypnotic suggestions for refreshing sleep (tied to cues for an early night) and direct suggestions were offered for simple, useful thoughts to try when she was back in her everyday life. (Before the session we had gone over the need for these little pearls of wisdom, e.g. “I’m sore, but safe”, to feel coherent, believable and comfortable to Lisa). 

After the third session, Lisa’s pain levels had not changed much but her distress was significantly lower, her functional activities had improved, and she was re-engaging with her social activities. Lisa sensed that if anyone was going to get her better it wouldn’t be the doctors or the therapists but through her efforts. As such, she was ready to engage with the simple idea that by getting fitter she gives herself a chance to live better.

Chronic back pain

Darren (32) unskilled, manual labourer with a four-year history of low back pain. He interpreted the report of disc degeneration as meaning that his spine was damaged and crumbling. He was terrified at descriptions of surgery and the potential risks. He became very protective of his back and avoided activities which he believed would wear it out quicker.

The idea that not all pain is useful and does not always accurately predict danger was made central in hypnosis imagery used to move Darren forward past any ‘unnecessary pain’.

Darren’s experience was fully positive. He sensed immediate relief from the unnecessary pain of being left behind and had a feeling of being given a fresh start. He was able to commit to a graded rehab programme and, unsurprisingly, did well as he got fitter. He realised that he had misunderstood the orthopaedic information that he was safe to move and that not every twinge from his back signalled doom.

A GP perspective: Dr Ann Williamson

As a GP for many years, I found hypnosis an extremely useful adjunctive tool in helping my patients manage anxiety and depression as well as many chronic health conditions. Anxiety and stress often exacerbate physical symptoms and teaching the patient self-hypnosis can often help combat this. Changing the patient’s focus to what they want to achieve can help lift mood, as well as motivate better compliance with medication and health advice. The use of hypnosis and imagery can give the patient more feelings of control and help maximise their inner ability to heal. Many patients with chronic health conditions suffer from the effects of underlying past trauma of one kind or another and techniques using imagery in hypnosis can often be surprisingly effective in helping to resolve such underlying emotional distress.

Please can you help this patient? He’s climbing the walls and extremely distressed” my practice nurse asked me during one evening surgery. Adam had a needle phobia and needed urgent vaccinations as he was due to travel for work. Having agreed to see him for half an hour we quickly determined that he had had no serious problems in his past and was psychologically well-balanced. He said he thought that his needle phobia had probably started from schooldays when he was waiting with his peers in the playground for a vaccination (probably TB) and they were all telling each other horror stories about what was going to happen. On asking what he enjoyed doing, he reported that his hobby was playing the fiddle for his local Morris team, and he also mentioned that when he woke up worrying about work in the early hours he imagined playing his fiddle until he fell back to sleep. Having asked him to close his eyes and imagine playing his favourite tune and he was then guided into a deeply relaxed state. Whilst he was feeling calm he was asked to ‘capture’ those good feelings by pressing his thumb and forefinger together. He was then asked to imagine that ‘little boy Adam’ ‘over there’, to comfort him and let him know that he needn’t be frightened anymore because he was from his future and with all his current knowledge and experience could now look after ‘little Adam’. Re-iterating that having his vaccinations was helping to keep him healthy and well he was then asked to visualise himself having his vaccination feeling reasonably calm and in control. This he was able to do, so he was asked to step into that image and feel how good it was to have been able to cope calmly. The suggestion was given that what he did in hypnosis he would find he could also do in reality and that if he felt apprehensive he could press his finger and thumb together and reactivate those good feelings of calmness and control. The next morning he went and had his vaccination without incident.

“It’s a purple spiral spinning around very fast!' 

This is the image that came into Emma’s mind when she went into hypnosis to explore her problem. She had presented with vulvodynia for which no discernible medical cause had been found. Upon questioning in hypnosis whilst she focused on this image, she said she felt that what she needed to do was change the colour, so it became paler and slow the spin down. She later decided that she needed to reverse the direction of the spin which she did. She continued to work with her imagery each day during her self-hypnosis and some weeks later her vulvodynia had improved markedly.

“I am washing my insides with healing fluid and as I do this I can see the filmy adhesions dissolving” 

This imagery was used with good effect by Pauline, who had suffered from endometriosis and adhesions for years. Whether her improvement was attributable to her taking time out to do self-hypnosis most days, the imagery she used triggering a physiological change or simply down to chance I have no idea but teaching her these simple hypnotic techniques gave her back some feelings of control and she could work with her body to be as fit and healthy as she could be.

A dental perspective: Dr John Duthie

I have worked in the NHS and private dental practice held various university/hospital posts and was an examiner for the Royal College of Surgeons DGDP(UK) Diploma. In the hospital service, I looked after medically compromised patients, particularly those needing GA and IV sedation. When I was appointed, the hospital had an unacceptable waiting list and my remit was to reduce this. I got together with the consultant anaesthetist and triaged the list. By using hypnosis to reduce anxiety, maximise the placebo effect and amplify the drug responses, we reduced the waiting list for full operating theatre GA from 2 years to 2 months for routine cases and 6 days for emergencies that could not be done the same day. 

In the 1980s, the HIV and AIDS epidemic came under the umbrella of “medically compromised patients” and the hospital received all the referrals of these so-called ‘high-risk patients’. These came with their own set of new anxieties and also created anxieties in the surgical teams. At the time our holistic approach enabled us to cope. Teams that use hypnosis techniques with patients are likely to be calmer, more relaxed and work more safely and more effectively.

Many patients had a variety of bleeding disorders and those for whom Factor VIII was not essential were helped by having the reduced bleeding associated with treatment and suggestion with hypnosis. The positive suggestion of maximising the immune response and healing was beneficial in terms of post-op discomfort, swelling and complications. Any medication for post-operative discomfort and inflammation was given with language to maximise the placebo effect.

The use of hypnotic techniques is useful in controlling the ‘gag response’ which is can be stimulated when taking intra-oral radiographs. Using them leads to faster X-ray taking, more accurate positioning, a stiller patient and better images. The same for CT scans and MRIs.

Patients who use a focused attention technique salivate less, swallow less and are easier to treat. They also tolerate rubber dams and extended endodontic procedures better.

Prescribed drugs to improve post-operative comfort will be more effective if given as post-hypnotic suggestions and the instructions will be followed more closely.

Because we can use reduced dosages and gain better results using hypnosis alongside our dental treatment, it seems extraordinary that it is not more widely utilised.

Procedural hypnosis does NOT have to be formal, 90% of the time in a dental context it is used informally in conversation and does not require formal consent. As all hypnosis is ‘self-hypnosis’, the whole procedure is one of consent anyway. It is important to differentiate between ‘Procedural Hypnosis’ and ‘Hypnotherapy’. Procedural hypnosis can be seen as inducing a state of focused attention with a positive suggestion to help patients cope better with their medical and dental procedures.  It could be seen as mainly ‘sedation without medication’. Hypnotherapy is where hypnosis facilitates various psychotherapeutic approaches in a mental health setting.

All the advantages described in this article lead to reduced clinical time and more cost effective treatment. Patient satisfaction increases (good for those patient satisfaction surveys) and both practitioner and patient benefit from increased calmness. What is there not to like?

All Surgical, Medical and Pharmacological interventions are directed towards helping the ‘mind/body complex’ to heal itself. Over the last few decades our reliance on the science of chemistry, without giving due cognisance to the mind/body concept, means we have been losing the ‘art’ of delivering healing health care.

We often make things worse for our patients with nocebo language (accidentally, and with the best of intentions) but maybe it is time to recognise this and reverse it.

Once trained in the use of clinical hypnosis you will find that it becomes a natural way of gaining rapport with your patient and it does not take any additional time! 

The British Society of Clinical and Academic Hypnosis (BSCAH) is a society made up of healthcare professionals who train other healthcare professionals in the adjunctive use of clinical hypnosis. If you are interested in learning more about clinical hypnosis from other healthcare professionals, check out www.bscah.co.uk for further information.