Good Life Project - The Surprising Science of Hypnosis, Pain & Habit Change | Dr. David Spiegel

Episode Date: December 10, 2023

What if you could rewrite the subconscious scripts controlling your life? Harness untapped mental powers to conquer pain, anxiety, and addictions? My guest Dr. David Spiegel, renowned psychiatrist & director of Stanford's Center on Stress and Health, pulls back the curtain on hypnosis. With 45+ years of researching and successfully treating patients, he's on a mission to reveal hypnosis as a gentler, effective first-line treatment. We dive into the science, address the mythology around it, and learn how his clinically-backed app Reveri brings self-hypnosis to anyone seeking healing and unleashing their full potential.You can find David at: Website | Reveri app (tap from mobile for 2 weeks free) | Episode TranscriptIf you LOVED this episode:You’ll also love the conversations we had with Jill Blakeway about the surprising science behind energy medicine.Check out our offerings & partners: My New Book SparkedMy New Podcast SPARKED.Visit Our Sponsor Page For Great Resources & Discount Codes Hosted on Acast. See acast.com/privacy for more information.

There are people who can learn to just discipline their mind because, you know, the strain and pain lies mainly in the brain. It's an interpretation the brain makes of signals that are coming in from the body. The fact that you can make it better with your brain doesn't mean it's all in your head at all. It just means that you can change the way your brain processes it. So have you ever wondered if your mind contains these untapped powers that could change your life or left unchecked, potentially even destroy it in different ways? Turns out there are these subconscious scripts that run in our brains, controlling so much of our lives without us ever really realizing what's happening. We try everything to feel better or create lasting change

only to keep failing over and over and over again, never realizing. Until we identify, until we surface and rewrite these hidden scripts, our reality remains locked into the same patterns, often fueling suffering, sometimes for life. But what if there was a way to surface and then release and rewrite these scripts, unlocking along the way hidden abilities that let you conquer everything from chronic pain to anxiety, addiction, and more. Turns out there is. And it's all about a word that most people dismiss as fakery or some kind of carnival entertainment with no real value. That game-changing solution is therapeutic hypnosis. And my guest today is Dr. David Spiegel,

a renowned psychiatrist and hypnotherapist on a mission to really untether hypnosis. And my guest today is Dr. David Spiegel, a renowned psychiatrist and hypnotherapist on a mission to really untether hypnosis from the realm of carnivals and late night comedy acts and reveal its true power to heal. With over 45 years researching, practicing, and treating patients with hypnosis, as the director of Stanford's Center on Stress and Help, David knows its transformative potential firsthand. He has published extensively on hypnosis to treat pain, depression, anxiety, and more. And now his clinically backed app Reverie brings self-hypnosis to anyone with a smartphone. Now I have to admit, I was a little bit on the fence about this topic before diving in.

I held many of the same mistaken beliefs about this powerful healing and potential releasing modality. But in our conversation, he pulls back the curtain on the groundbreaking and vast body of research around it, as well as addressing the mythology and mystery surrounding hypnosis. So imagine being able to control pain and anxiety with a few simple mental techniques. According to him, we all have that power within us and so much more. Yet these misconceptions, misinformation, and fear hold many back from even trying hypnosis. David envisions a future where the gentleness and efficacy of this modality make hypnosis a first-line treatment for many conditions in the medical world. Join us for a really fascinating discussion on harnessing the mind's untapped potential

to live our best lives. So excited to share this conversation with you. I'm Jonathan Fields, and this is Good Life Project. We'll be right back. flight risk. The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest charging Apple Watch,

getting you 8 hours of charge in just 15 minutes. The Apple Watch Series 10. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required, first time in glossy jet black aluminum. Compared to previous generations, iPhone Xs are later required. Charge time and actual results will vary. I'm always fascinated with somebody who comes from a sort of a, what I consider to be a fairly traditional classical training in medical field, and then goes in a direction where it seems

like there's something that's calling you to that direction. Yet it's also one of those fields or specializations where I wonder sometimes when you look at hypnosis, if it's also the type of thing where the further you go down that road, the more eyes get raised or eyebrows get raised by those who don't quite get what's happening. Yeah, you're absolutely right. So your initial inquiry to me is what the hell are you doing there, Spiegel? And you're right. Your assessment is exactly right.

Hypnosis is the oldest Western conception of a psychotherapy. The first time a talking interaction between a doctor and a patient was thought to have therapeutic potential. And yet it's been a sideshow for 250 years. And so people either say it's ridiculous, it does nothing, or it's really dangerous or both. And I guess my way of trying to resolve that, Jonathan, is to combine cutting edge, tough minded research about what it is, what happens in the brain, what effects it has with it being really weird. And frankly, I left Boston. I trained at Harvard. I love the place. I learned a lot. But it was at the time very much psychoanalytically controlled. And, you know, who was I to use hypnosis when Sigmund

Freud gave it up? Although he started his work, actually, his first books involved using hypnosis with patients. And there's one in his autobiography. He says, I was relieving a patient of her attacks of pain by tracing them back to their traumatic origins when she threw her arms around my neck. And he said, I was modest enough not to attribute the event to my own irresistible personal attractiveness. And he said, I discovered the mysterious element at work beneath hypnosis, transference. Patients transfer their feelings about their parents and other people to the therapist. So he gave it up. For me, it was also sort of a genetic illness in my family because both of my parents were psychiatrists and psychoanalysts. And they told me I was free to be any kind of psychiatrist I wanted to be. So I took them up on it. too. A Viennese refugee taught him to use hypnosis, and he used it to help combat soldiers

with wounds, with pain, with combat stress reactions. And he came back and was back in his psychoanalytic institute, but he just kind of kept doing it. And he was going to give it up. One of his supervisors said, you can't do this. You'll ruin your reputation. He had a wonderful supervisor named Frieda Frumreichman, a very famous interpersonal psychoanalyst, who said, what are you feeling so precious about your relationship or your reputation, rather, so early in your career? You're going to teach a course at the Institute on Hypnosis, and I know you're going to do it because I'm going to take it. So it encouraged him to keep doing it. And he discovered in the late 40s, early 50s, as he was doing some follow-up on his patients, which most analysts didn't do, that he was getting better results with sometimes a few

sessions of hypnosis than he was with years of three times a week on the couch. And it gets to where I think there are some remarkable differences about hypnosis that actually fit with your three-bucket theory theory in that you want an opportunity to try out what it would be like to be different. That rather than understand why you are the way you are or go through a series of steps to get better in hypnosis, you can actually just sort of suspend this belief and give it a try. See what it would feel like to be different. And there are brain mechanisms we can talk about, about why I think that happens. You concentrate intently on a potential solution for your mind, body problem or something else, and you can see if it works. So I was finding that,

he was finding that. I took a course when I went to medical school on hypnosis and my first patient ever using hypnosis. I walked down the hall and I was a medical student in pediatrics at Children's Hospital. And the nurse said, Spiegel, your patient's in room 345. And I'm following the sound of the wheezing down the hall. And I walk in the room and there's this pretty 15-year-old redhead bent over in bed, knuckles white, bolt upright, struggling for breath. And her mother's standing in there crying and the nurse is there. And they had twice given her epinephrine under the skin, didn't work.

They were thinking about general anesthesia and putting her on steroids. She'd been hospitalized every month for three months. And I didn't know what else to do. So I said, you want to learn a breathing exercise? And she nods. And I said, I got her hypnotized. And I said, oh, well, that's good. Now what?

Because we haven't gotten to asthma in the course yet. So I came up with something very subtle and clever. I said, each breath you take will be a little deeper and a little easier. And within five minutes, she's lying back in bed. Her knuckles aren't wiped. She's breathing comfortably. Her mother stopped crying. The nurse ran out of the room. My intern comes looking for me and I figure he's going to pat me on the back and say, nice going, Spiegel. He said, the nurse has filed an official complaint with the nursing supervisor that you violated Massachusetts law by hypnotizing a minor without parental consent. Now, Massachusetts has a lot of weird laws, but that's not one of them. And her mother was standing next to me when I did it. So he said, well, you're going to have to stop doing this, Spiegel. And I said, oh, really? Why?

He said, it's dangerous. I said, well, you were about to have to stop doing this, Spiegel. And I said, oh, really? Why? He said, it's dangerous. I said, well, you're about to give her general anesthesia and put her on steroids, and you think this is dangerous by talking to her? So he stormed out of the room. And he was telling me, you know, you have to stop doing this. And I said, take me off the case if you want. But as long as she's my patient, I'm not going to tell her anything I know isn't true. So he leaves.

Over the weekend, the attending, the chief resident huddled about this. And they came up after a couple of days of arguing with a radical solution. They said, let's ask the patient. I don't think they'd ever done that before. And she said, oh, I like this. So she had one subsequent hospitalization, but went on to study to be a respiratory therapist. And I figured that anything that could help a patient that much, that fast, She had one subsequent hospitalization, but went on to study to be a respiratory therapist. And I figured that anything that could help a patient that much, that fast, and keep her out of general anesthesia had to be worth looking into.

And I've been doing it ever since. Because you can just see the results. You don't have to speculate. Now, obviously, to really understand it, you've got to see what's going on in the brain and body, and you need to evaluate effects in randomized clinical trials. And we've done all that now. So that's why I'm doing it. Part of my curiosity here is the basis of the perceived threat by sort of establishment approach. Because I'm trying to wrap my head around, okay, so it's non-invasive. There's no risk of overdosing and misprescribing. This is about the gentlest

thing that you could possibly do. So what is the resistance to this? Well, there are a couple of things, Jonathan. I mean, you're being excessively reasonable about this. And I believe that I've asked myself this question many times. I think there are a couple of things. One of them is the prejudice I get as a psychiatrist rather than a surgeon or an internist. And that is, you know, we tend to think in medicine that the only real interventions are the physical ones, you know, incision, injection, ingestion. And by the way, most of the money in medicine is from those three things, right? Part of the problem is, A, people don't believe it's real. Are you

really making a difference just by talking to someone and putting them into this strange state or helping them learn to do it for themselves? So that's one part of the problem. The second part is we tend to think of medicine as auto repair, you know, just fix the parts, replace them. Real interventions happen. If you think about it, the three-pound organ sitting on our body is our major evolutionary advantage, other than the opposing thumb, which is a good thing, but not nearly as important. It's linked to every part of the body. It controls every part of the body. Why in God's name wouldn't doing things differently with it make a difference in your body as well as your mind? And yet, we tend to think it can't be real. Well, it is real, but people just

continue to think that just talking to someone is not going to do it. And then of course, everybody's main exposure to hypnosis is going to some stage. So somewhere where, you know, the football coach made a fool of himself by dancing like a ballerina and people are afraid of it. They think, you know, you're going to control me. You're going to take over control of my mind. So it's a combination of either seeing it used to ridicule people, which is terrible, or people being dismissive of it. It's not possibly having any effect. And the third part is there's no money in it. There are no sends around former cheerleaders to talk doctors into taking all their new drugs. And there's a lot of money in drugs.

And there's not much money in hypnosis. After a lifetime's work in it, I can tell you that we earn a living. But it's not the kind of money that pharma makes selling a product. And so you don't have big industry backing you on it and encouraging you to do it and encouraging endless ads on television to take it. So that's the way we're running uphill with this one. Yeah, that makes a lot of sense to me. If the association that so many people probably have with hypnosis is that sort of like the picture of the carny, or that one hypnotist who came to school when you're in ninth grade, and like you just said, like made people do all sorts of weird things seemingly against their will.

You know, if that is the common association, let's step away from that. And when we're talking about hypnosis in your practice, in this conversation, what are we actually talking about then? Hypnosis is a state of highly focused attention. It's like looking through a camera with a telephoto lens, which you see, you see with great detail, but you're less aware of the context. Do you ever, Jonathan, get so caught up in a good movie or a play that you kind of forget you're watching the movie and enter the imagined world? Yeah, of course. Sure. That's a kind of spontaneous hypnotic state. And research has shown

that people who have these kinds of absorbing experiences are more hypnotizable. But to do that, you have to do two other things. One is dissociate, put outside of conscious awareness, things that would ordinarily be in consciousness. So right now, for example, I haven't hypnotized you, but you've got sensations in your body touching the chair you're sitting in, right? And yet I hope you were not aware of them at all until I mentioned it. If you were, we can just stop the interview now. So typically in the service of focusing on something, you have to put outside of awareness a whole array of other input in order to do it. In hypnosis,

you intensify that. So you forget you're even in a theater watching the movie. You're just entering the world. You're in the movie. You're not in the audience. So absorption, the intense focus, dissociation. And number three is the thing that scares people the most. It used to be thought of as suggestibility, that you will do what I tell you. And in that horrible movie, Get Out, the woman is clinking her teacup and the guy. That scares people. But what that really is, is cognitive flexibility. It's a way of

saying, I'm going to give up thinking for a moment for a while about an old way I understood things, or I understood myself and try something different. It's cognitive flexibility. And we've figured out what's happening in the brain when these things happen. So when you're hypnotized, you turn down activity in the anterior cingulate cortex. The cingulate cortex is like a C inverted in the middle of the brain. The front part is part of the salience network. So if you hear a loud noise and you suddenly think, I better pay attention to that, in the US, sadly enough, it's usually a gunshot. It just keeps disrupting your concentration. In hypnosis, you turn down activity in that part of the brain. And we found that highly hypnotizable people have

more inhibitory neurotransmitters in that part of the brain. So they're able to sort of self-soothe themselves and turn down the salience network. The second thing that happens is increased functional connectivity, that is coordinated activity between the executive control network and the prefrontal cortex and a little part of the brain called the insula, though it's Latin for island. It's a little island in the brain that's a nerve center communicating between the brain and the body, helping the brain control the body and the body affect the brain interoception. How do we experience the way our body is feeling? So hypnosis is very good for mind-body control, for changing sensation, for controlling pain. It's superb for controlling pain. And it's a shame that we don't use it more as a resource

just for that alone. The third thing that happens is there's inverse activity between the prefrontal cortex. So when you're thinking about something in hypnosis, and the back part of the cingulate cortex, call it the default mode network. It's a part of the brain where when you're not doing much, but just reflecting on who you are, who you want to be, what do people think about me? That's the part that's active. That activity then during hypnosis, it gets turned down when you're concentrating on something else. And that is actually one of the coolest parts about hypnosis. That's the part where you say, I'm going to let go just for the moment

of what I usually think or expect of myself and try out being different, try feeling different, try acting differently, try responding differently. And you can watch it happen in front of you. So what was happening with this young redhead was that the more she had genuine bronchospasm and trouble breathing, the more anxious she got, the more she's fighting for breath. You hear that phrase, fighting for breath. It's the worst thing you can do.

So the more, and then of course, she gets even more asthmatic. Right. And just creates this cycle of doom, basically. Yes. So if you can let go of your assumption and just say, wait a minute, I don't want to be in a battle with my body. I can just breathe. I can breathe each breath deeper and easier. And you focus actually on exhaling more than inhaling, which is more soothing. And she interrupted that cycle.

She still had asthma, but the attack was broken just because of that. That's mind-body control. And that capacity to let go of your usual presumptions of what the situation is and who you are, which can be used to make fun of somebody, can also be used to really help heal somebody. And that's what we do with hypnosis. Yeah. The fear of like, well, somebody is actually going to take advantage of me or I'm going to be manipulated into doing something or behaving in a certain way. There is a certain suggestibility, but that also in a therapeutic setting, we're talking about like, how do we use this to reconnect with things that are actually constructive and health enforcing within you? The Apple Watch Series 10 is here. It has the biggest display

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Y'all need a pilot? Flight risk. I'm curious about that third element that you spoke about, the shift in the default network as well. We hear a lot of talk these days about psychedelics. There's some really fascinating research going on in that domain right now in really great institutions with fantastic investigators. And it's exciting to see what's coming out of it. Yes. One of the experiences that is reported often through different types of molecules is what's often described in some way, shape, or form as ego dissolution. Does that relate to the state that you're describing? Yes. It's an excellent question,

and the answer is yes, it does. And many of those drugs work on the serotonin system, which is involved, you know, the front of the brain is more dopaminergic, the back is more serotonergic. And it is involved in meditation to some extent and to many of these psychedelic practices. And what's very interesting about the psychedelics and what can happen with hypnosis too is that it's a whole different model, even if you're trying to use drugs to do it, a pharmacology that is in the traditional pharmacology for depression or anxiety, you give a drug and every, you got to keep giving it day after day. And with the psychedelics, it's really interesting. People can have a couple of guided psychedelic experiences and they don't need any more. You know, I've carefully gone over the literature with dying

patients using psilocybin because I've worked for decades with women dying of breast cancer and in group therapy, helping them deal with it. And it strikes me that the changes they make are very similar, but with just a few sessions of psilocybin. And they'll say things like, you know, I was desperately afraid of even considering the fact that I'm going to die from this disease. And when I took the drug, and you know, I would be worried about having a bad trip, especially when you're dying of cancer, and said, I'd look at it, and I realized it would be terrible. But then I'd also think it's really a miracle that I was ever here at all, that I had the

capacity to experience life. So oddly enough, they came out reassured. And that's what the women in my support groups would say. They'd say that being in the group is like looking into the Grand Canyon when you're afraid of heights. If you fell down, it would be a disaster. But you feel better about yourself because you can look. I can't say I feel serene, but I can look at it.

And I think, Jonathan, that's the experience you had after the World Trade Center, where you really did a rethink about your life and started doing this wonderful work you're doing now, because you realized that it's a surprise gift that we exist at all. And there's no contract that says that you're going to be there tomorrow. So do what you want to do. So I have been very impressed at how these psychedelics really do profoundly affect people. You know, Michael Poland's book is just, you know, excellent how to change your mind, talking about this exposure to alternatives. So it's like what I was saying, and that's where you conceive of being suddenly very different. You know, you kind of let go of a lot of the presumptions you had either of expectations of others or just

what you expected for yourself or what you think your limitations are. And you let go of that and just try being something different. And if you want to go back to the way you were before, fine, but you may find that, you find that the air is clearer on the other side and that you try to take on this mantle of a new kind of you. How much of the effect of this also is wrapped around, let's say before any particular interventions, before someone sits down with you or in a reserve, whatever the setting is, stepping into it. For example, somebody's dealing with pain. It's become chronic. It's in their life. It's been there for years and years and years at this point.

And they've tried all the different things and sort of like there's a sense of inevitability, futility that has settled into them. When somebody shows up and then they say, well, let me try this one thing, right? What else do I have to lose here? How much of the potential therapeutic effect do you think might come from them actually having the experience that for the first time, maybe after being patterned to not believe that feeling different was even possible anymore? They catch a glimpse of that and that simple shift into a state of, oh, this is possible, has this effect sort of like creating a cascade of changes that follow that. I'll give you two examples from sort of either extreme of the hypnotizability spectrum, be done on his hand instead of general anesthesia. It was pretty major work. He wound up with chronic pain in his arm for seven years. He says, my right arm feels like it's burning all the time. He's furious and frustrated. And I had taught him some hypnosis a few months ago, and he came back. And he wasn't feeling that good. But I said, let's try it again and see how you feel. And he began to notice that

his frustration was actually making the pain worse. And it wasn't like he didn't really have pain. He really had pain. He had had damage to his nerve, unfortunately. But I said, why don't you think about your other arm for a while? See how that feels. He said, well, yeah, it feels better actually. And when I do that, the pain in my other arm is still there, but it just somehow doesn't bother me as much. And he was an experienced hiker. He loved hiking. And he had him picture himself doing these very difficult hikes and finding his way through places that he wasn't sure he could get through. And again, when he got absorbed in that, it wasn't like the pain evaporated, but it just didn't bother him the

same way. It didn't hijack his attention as well as his sensation. And so there are people who can learn to just discipline their mind because, you know, the strain and pain lies mainly in the brain. It's an interpretation the brain makes of signals that are coming in from the body. The fact that you can make it better with your brain doesn't mean it's all in your head at all. It just means that you can change the way your brain processes it. And I had another patient who was a lovely young woman, seven months pregnant with terrible

lower back disease. And so, of course, as the baby grew, her back got worse. She's carrying it around and they couldn't give her meds because she was pregnant. And I got her hypnotized and had her imagine she was in her nice warm bath, which was sort of the one part of the day where she tended to feel better. And after a few minutes, her pain started out at the level of seven, it was down to three. And so, you know, I brought her out of the trance state and she looked angry. And I said, what the hell are you angry about? And she said, why in God's name are you the last doctor I got sent to instead of the first? And, you know,

that's the problem. So yes, pain is a remarkably, we've done randomized clinical trials. We had a paper in the Lancet in 2000 showing that 241 people randomized to one of three conditions while they were having arterial cutdowns and catheters threaded into their arteries to chemoembolize tumor in the liver or visualized renal artery stenosis. It's about two and a half hours, no general anesthesia. And it's painful. It's uncomfortable. People get anxious. So in one condition, they got standard care, which is push a button and you get opioids into your bloodstream. And the second is that plus a friendly nurse, you know, just being emotionally supportive. And the third was that plus training and self-hypnosis, filter the hurt out of the pain, your body's floating in ice water, wool tingling or numb or whatever. And after an hour and a half, the pain levels in the standard care group were five out of 10, in this supportive nurse, three out of 10, and in the hypnosis group, one out of 10.

And the hypnosis group was using half the level of opioids that the patients in standard care were doing. We looked at their anxiety levels, five out of 10 in standard care, three out of 10 with nursing, zero in the hypnosis group. And I thought they died or something. I mean, they were just absolutely, totally relaxed. The procedures got done 17 minutes faster because the patients were more comfortable. And you know what? So was the medical staff, right? They didn't see people struggling there. But think about this, Jonathan, if I published that finding and what I had used in condition three was a new medication, every hospital in the country would be doing that now,

but they're not. And what really frustrates me enormously and why we started Reverie to get this out there to people is 70,000 Americans died last year of opioid overdoses. 300,000 Americans died over the last 10 years with opioids. And that's horrifying, you know, because people, opioids, you know, they're effective, particularly in the short run and in reducing pain, sure. But people habituate to them. And then what happens is they habituate to the pain relief part of it and the pleasure part of it.

But the other thing opioids do is they affect different receptors that control respiration. And people don't habituate to that. So they think, oh, well, the pain's getting worse on this dose. I can just take another dose. And what happens is they go to sleep and they don't wake up. And Prince, the wonderful musician, Purple Rain, he just went to sleep one night and didn't wake up. These aren't suicides. They're just drug side effects. So it's a scandal that we're letting drug companies talk us into overusing medications that become more and more dangerous and that we're not developing further and disseminating these other techniques that are safe and effective. Yeah. I mean, it's interesting.

I feel like the medical paradigm has been in flux, but it's been in flux for a really long time and it's moving really slowly. And then you have folks who are saying like, well, there is a different way. But in order for that to become standard of care, there's such a gargantuan shift that needs to happen. It's almost like an impossible shift to steer to actually make that happen. I'm particularly interested in sort of like the, I want to go a little bit deeper into the notion of pain and hypnosis also, because various types of pain, whether it is an event-based pain, whether it's chronic and persistent has become such a normalized part of so many people's lives, especially once you sort of like hit the middle years that it's almost, I think a lot of folks just look at it as, well, this is kind of what happens when I hit a certain age. Like I'm going to start to feel it that it's almost, I think a lot of folks just look at it as, well, this is kind of what happens when I hit a certain age. I'm going to start to feel it and it's going to get slowly worse and worse. And it is what it is. I'm older. And then if I have to take stuff or get the

surgery, whatever it may be. And like we're both saying, we're not minimizing the reality of this and that there may be very real physiological things in the body of damage that is leading to this. And at the same time, as you described, pain isn't just about stimulus, it's about response in the brain. Like the actual experience of pain happens in the brain, no matter what the stimulus or the injury is. And I think that's where we lose the thread. Because if we could say, well, we may not be able to repair the nerve damage itself, but what if we can change the final mile of how it's translated in the brain? And what if we can do that in a very non-invasive, gentle way? I mean, that is powerful. And yet to think that that is not actually standard of care is alarming. You've put it extremely well. And part of the problem is that doctors often misattribute

improvement to saying, well, the pain's all in your head. If you can fix it with your brain, then you don't have pain. Patients feel that too sometimes. And yet you're absolutely right. I mean, we have very strong evidence from studying evoke event-related potentials, from using functional MRI, that you can literally reduce pain signals in the brain just with techniques like hypnosis. You can reduce the brain's response to the signals. So it's not that the signals aren't there. It's not that there isn't tissue damage. It's just that you can retrain people to take the strain out of pain, you know, and it's doable. And, you know, now sometimes patients don't like that. They said, I just want it gone.

I want life back the way it was before all that. I understand that. But you can improve things a hell of a lot and sometimes eliminate pain by just teaching people how to better manage it. I want to run something by you because I'm really curious what your take is on this. I'm somebody who has tinnitus.

I have a sound in my head 24, seven and I have since 2010, so a dozen years now. The first year to two years, it was absolutely brutal. It was really destroying me in a lot of different ways and making it hard to function. I am not the only one who has this tens of millions of people. From what I understand, it's actually one of, if not the main reason for disability in the military. So this is a big prevalent issue. I did the normal thing when it first happened, went to see everybody and they're all like, yeah, this is kind of what you have and deal with it. I eventually found a mindfulness-based cognitive therapist who was a former rock drummer who also had this. And I went to him and I said, you know, I know that mindfulness-based CBT can be really powerful for pain. Do you think

it could help me rewire my brain? I said, when I got to a point where I realized this isn't going away and I asked myself, if this is me for life, what do I make of that? And then I went and I said, if this is me for life, is there a way for me to rewire my brain so that it's still there in theory, but only when I go looking for it and even then I'm fine. And we basically put together a slightly modified, just seated mindfulness and breath oriented practice a couple months into it after sitting. And this was a practice where the classic instruction is, you know, pick an anchor, which generally is your breath. But as he told me when I left his office, he said, you know, what's going to happen is the sound in your brain, the minute you sit in silence,

it's just going to start to come back and basically bombard you. And the instruction will become to then make the sound your mantra, to deepen into it, just surround yourself with, to literally like envelop yourself with it. So the thing you spend 24 seven trying to pretend doesn't exist, make that your reality. And it was brutal and absolutely brutal experience until a couple of months in, I realized I was doing that and my mind drifted off to something entirely different. And like, boom, the circuit was broken. And I realized it was doing that and my mind drifted off to something entirely different. And like, boom, the circuit was broken and I realized it was possible. I've always thought of that as an effect of mindfulness and breathing exercise.

But I'm wondering through our conversation whether there was potentially also some experience of self-hypnosis that played into the rehabituation of the way that my brain experienced the sound. I think you're exactly right. What you were trimming away from the tinnitus experience was your natural instinct to just say, go away and have this sound emotionally irritate you. And instead, you know, it's better the tiger in the tent than the one outside. You were invited it in, paid attention to it. And what you were trimming away was your annoyance at its presence, even though the noise was still there. And after a while, you allowed your brain to habituate to it. So rather than having your salience network, oh, damn, there's that noise again, all the time, making you anxious and upset. The noise was still there, but you were just saying,

oh yeah, it's there. And after a while paying attention to it, it couldn't trigger your salience network because it was right smack in the middle of your attention field anyway. So yes. And I think that's part of it. I've had some patients where I've used hypnosis with tinnitus and not much has happened, but I had a woman who is an attorney came to see me a few months ago who'd had it for like six years, same story, made her life miserable, just awful. And I had her imagine in hypnosis, she was an experienced scuba diver. So I said, well, let's go scuba diving, you know. So she does that. And she's noticing that the one kind of sound that's in her mind is the bubbles from her register in the scuba tanks. And she's saying it's actually the underwater world is very silent, very pleasant, and it's visually very beautiful.

So she's looking at the fish and all that. So she found a way to classify the noise as something less unpleasant, kind of like what you did, and to focus on other things in her imaginary perceptual field. And she came back to me a couple of weeks ago and she said, this is the first time in six years that this has started not to bother me. She said, I can't believe it. And she started to cry. And she said, hey, wait a minute. I'm a lawyer. Lawyers don't cry. You know, you don't show your weakness. And so she was almost more shocked about her crying than she was about the tinnitus being more manageable. But yes, I think there is definitely a self-hypnosis component to what you did. It's fascinating that as you're walking through it,

I'm like, huh. So there was very likely something else happening there the whole time that I wasn't really keying in on. Mayday, mayday. We've been compromised. The pilot's a hitman. I knew you were going to be fun. On January 24th. Tell me how to fly this thing. Mark Wahlberg.

You know what the difference between me and you is? You're going to die. Don't shoot him. We need him. Y'all need a pilot. Flight Risk. The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever,

making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest-charging Apple Watch, getting you eight hours of charge in just 15 minutes. The Apple Watch Series 10. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required, charge time and actual results will vary. What's interesting to me also is that, and this relates back to pain, as I sit here and speak with you now, if I'm focused on anything else, it's not as if I don't hear the sound in my head. It literally doesn't exist for all intents and purposes, which is 24-7. There could be a variety of different things, right? But hearing the sound is a matter of how my brain is interpreting whatever that signal is.

And if my attention is focused anywhere else in a meaningful way, that sound no longer exists for me. It's not that I don't hear it. It literally doesn't exist for me anymore, which was a weird realization the first time I sort of keyed in on that as well. That's cool. And now you've come to see that it's non-existence is real, that it's not just you're pretending it doesn't exist. That as far as your brain, I mean, you know, our brain is an incredibly complex, agile information processor. And if the brain actually thought about everything it knows, you'd be ground to a halt. You know, you just couldn't.

So the capacity to dissociate is a tremendously powerful thing. It's not just what we focus on, but what therefore we're not focusing on. We're pretending doesn't exist and it doesn't feel like it exists. People in trauma do that all the time. When women are being sexually assaulted, their usual experience is of floating above their body. So the brain has very good ways of detaching itself, even from just horrifying situations. You know, I had a patient who was in the World Trade Center as it started when it was attacked, and she was angry with herself. And I said, what are you angry about? She said, I lied to myself.

Well, what do you mean? Well, she was in the second building that went down. She's getting out. And I told myself that if I just get down the staircase, step after step after step, I'll be okay. That's all I thought about. That's all I saw. And she got to the ground floor.

And just when she did, the other building collapsed. And she was blown through a plate glass window and out the building. And she said, so I lied to myself. I said, you kept yourself alive. You know, in times like that, you don't want to know everything that's going on. You want to know what you need to do to stay alive. And you did that. Congratulations. But, you know, in situations, even like that, there's a whole lot of information that as far as they're concerned, just doesn't exist. And that's an adaptive process. There's nothing wrong with that. It's the right thing to do at times like that. And it sounds like that is a quality of what you describe as a quality of self-regnosis to a

certain extent. It's like a narrowing of the field. The narrowing, she was focused so intently on just getting out of there alive that she dissociated everything else. And that's a good, healthy, real thing the brain can do to keep us alive in difficult circumstances. Yeah, that makes a lot of sense to me. Talk to me about hypnosis and anxiety and depression. This is one of the other things that so many of us struggle with, whether it's persistent, whether it's episodic. On the anxiety side, certainly you look at the state of the world, you look at the state of so many different things, and there's reason to be anxious. But then there are things like event-based anxiety, there is social anxiety,

there are panic attacks. Talk to me about hypnosis in the context of these types of experiences. It can be extremely helpful because the same kind of feedback between mental and physical stress that we talked about with asthma, for example, is absolutely true with anxiety. So you're worried about something. Your fear circuit is going, this aliens network is sending off warnings.

There's trouble here somewhere, whether there's actually trouble there or not. I mean, the network can go off. you know, you can have a false alarm. You're giving a speech and you think people in the back look bored and you get, start to get anxious. And then you stumble over your words a little bit. And then you say they have reason to get bored. I'm doing a terrible job and on you go that way. And if you can't stabilize yourself and particularly the interaction with your physical reaction so you start to sweat your muscles get tense tension in your voice and so with hypnosis you can interrupt that and we usually do interrupt that cycle from the bottom up so

rather than analyzing why you don't have to worry about whether the people really liked your talk or not you're saying yes you know i tell them in fact sort of sort of like you did with your tennis i say you know what there is nothing wrong with your audience perceiving that you're a bit nervous about speaking to them. It's actually a sign of respect. It means you care what they think about you. That's a good thing. And many of my patients with anxiety disorders and phobias, they don't look nervous. They look over controlled, you know, because they're trying to control the inside and control the vision of it. And that's just one more thing to feel anxious about. How well am I hiding how anxious I am? That doesn't help either. So I tell people to get themselves in it. Imagine

they're in a place where they're physically comfortable, floating in a bath, a lake, a hot tub or floating in space, get your body comfortable and then picture what it is you have to deal with. So think about your talk as a sort of three-legged stool to keep it steady. You've got to think about the content you're putting forward, how the audience is receiving it, and how you're presenting yourself. And if you get too caught up in any one of those three things, you'll get off balance. So it's fine to examine each of those, but in the same way, keep your body comfortable and keep your focus on the material you want to present, even if you're worried about whether

people are getting it the way you want them to get it. Or with animal phobias, you can have people acknowledge their fear response, but understand that there's a difference between wild and tame animals. And as humans who are pretty pathetic physical creatures, as we evolved, fear of animals was a reasonable thing to have. So it's a matter of deciding, is this animal likely to hurt me or not? Control my somatic reaction to it and classify the animals that approach you as wild or tame and react

accordingly. I'll tell you a story. My father was doing this when a woman was dragged to his office by her husband, who was a very wealthy guy who had been having a fancy dinner party at a big hotel in Manhattan. And she had this terrible dog phobia. She would plan her walks in Midtown when she thought there would be fewer people walking their dogs. Imagine that, you know, like, does that ever happen? And this woman comes in with a cute little white poodle and she screams, jumps up, knocks over the dinner table.

So food and beverages are everywhere, ruined the dinner. And he said to her, you're getting fixed or we're done. You know, this is it. So my father hypnotizes her and has her calm her physiological reaction first. Think about the difference between wild and tame animals. And then he says, get a neighbor, a friend who has a dog and you trust the guy and have him hold the dog and gradually approach it and get to where you can pet it. And so she did that.

She thought dog friend, and she realized that there was a part of a deconditioning component to this, but also just very quickly controlling her physiological response. About six months later, my father called her just to see how she was doing. And a little boy answered the phone and he said, is your mama there? And the boy said, yes. So who's calling please? And he said is your mama there and the boy said uh yes so who's calling please and he said dr spiegel and it was a long pause and the boy said that's funny spiegel's in heat she had gotten a dog and named it spiegel so it's like how do you take that right so it was i guess it was it you might call it a left-handed compliment, but

right, right, right. But it, it worked. So yes, it can be very helpful with depression too. I'll give you an example, Jonathan, of how, and again, it's the reason why I hope people will take advantage of the opportunity we're providing to use Reverie and try out this thing for yourself and see how it works. A woman came to see me who was anxious and depressed, had been depressed most of her life. She was from a country that is famous for not treating women well. And she said, as a teenage girl, my body wasn't my own. Men would say anything to me on the street and things like that. Turned out she had been raped at age 12 by their landlord. And the parents were afraid to do anything because they didn't want to be thrown out

of the apartment building. And she came here. She got educated. She was a health care professional. She retired early. But she was chronically terribly depressed. She was very hypnotizable. And she had just told me about this episode when she was 12. So I said, I would like you now in your mind to picture yourself as your 12-year-old self after you had been raped.

I want you to pretend you're your own mother and tell me what you would do. So she looks at herself in hypnosis, very intent. And again, with this kind of realism that you don't have just remembering it, you're reliving it. And she started to cry and she said, I'm stroking her hair. I'm stroking her hair. I said, was this her fault? And she said, no, no, she's just a little girl. I'm stroking her hair. And so it was a profoundly moving experience for her and for me. And she called me about a week later and she said, Dr. Spiegel, my psychiatrist wants to know what you did to me because I'm not depressed anymore. And she said, my friends don't recognize me.

They don't know who I am. I just got an email from her a couple of weeks ago. It's about six months later saying, I'm still not depressed. I thank God for the doctor who referred me to you. And so, you know, it doesn't always happen like that, but sometimes it does that you, so she was able to let go of the person she'd been feeling excessively and inappropriately guilty about an event that she didn't control. Sometimes we can do that. We can just let go of who we've been and try out being someone different. And sometimes it works. You also bring up another curiosity,

which is not just the efficacy, but the endurability or the sustainability of the outcome. And we talked about this a little bit in the context of in relationship to psychedelics, where in your experience is a hypnotic or hypnosis based therapeutic intervention. Does it sustain? Is this the type of thing where it can be a couple of weeks or a couple of months and then basically you're good for life or you got, there's a tune up that happens every couple of years or how do you look at that? It depends. But the cool thing about hypnosis is that you can do it for yourself. All hypnosis is self-hypnosis.

What I'm doing is I'm not hypnotizing people. I'm teaching them to hypnotize themselves, to go into this intensely focused state and use it. So we did one randomized trial, Jonathan, with women with metastatic breast cancer, and 50 of them were randomized to weekly support groups, which ended each week with training in self-hypnosis. We would have them go through issues that had come up in the course of the group session, but at the end also go into state of self-hypnosis, get their body floating, picture a theme,

grieve somebody who had died in the group, and do self-hypnosis for pain control. If you feel pain, you're floating in a warm bath, filter the hurt out of the pain. Or you can imagine, leave your body here and go somewhere else and enjoy being there instead of here. A number of techniques like that. Over the course of the year while we were doing this, they learned they could do it for themselves. So they'd get a new pain in their chest. And instead of thinking, oh, my God, the cancer is metastasizing. I'm going to die very soon. They would just soothe themselves and their anxiety by going into a state of self-hypnosis

and calming it. By the end of the year, the treatment group had half the pain the control group did on the same and very low amounts of pain medications. So, yes, it works long-term because people can be their own doctors. They can do it for themselves. Sometimes they come back, they want to, sure. And does it always last? No. But the nice thing is that they can self-medicate with hypnosis whenever they need it. Right. You're not going to overdose on that. So do you have the distinction then between,

because you've mentioned a number of times self-hypnosis, like what is the difference between self-hypnosis versus a guided hypnosis? Frankly, Jonathan, it has more to do with what you're doing once you're hypnotized than the hypnosis itself. That is the hypnosis is just shifting into a state of highly focused attention. And you can do that. You can think about a variety of things. Where the guidance makes a difference is what you do with it once you're in that state. One thing that experienced hypnotists always say is the worst thing you can tell someone is don't think about purple elephants.

You know, that's what you think about. So we use techniques that teach people to focus on what they're for. When people want to stop smoking, we teach them to focus not on fighting the urge or something like that, but just respect and protect your body. Think of your body as if it were your baby. Would you ever put tar and nicotine smoke into your baby's lungs? Hell no. Well, your body's as dependent on you as a baby is. So focus on for my body, smoking's a poison.

I need my body to live. I owe my body respect and protection. A lot of what we do is altering the relationship between mind and body. So both protecting and respecting your body, but also not getting angry at it for presenting you with pain or tinnitus or some other fear of getting in an airplane or something. Instead, focus on what you're for. So a lot of the power of hypnosis is not the state itself, but how you use the state, how you use it to focus on a strategy. And that's where going to a good therapist or downloading Reverie from the App Store or Google Play will give you strategies

that are good ways to approach a problem, especially if you're in a state of hypnosis. Let's talk about Reverie. I know you've referenced it a couple of times, which is, it seems from the outside looking in that this is a self-hypnosis app. You're the co-founder, chief science officer. From the outside looking in, what it looks like is, okay, so there's one of you. There are hundreds of millions of people who could probably benefit from various different means and things that they're, and this is an accessibility play. Like how do we take this and effectively democratize it so that almost anybody can have access to it? I'm curious from the inside out, what's actually happening in your mind with

you're saying, I'm going to allocate a meaningful amount of time and energy and resource to actually developing this thing and putting it into the world for people. I am Jonathan. And I'll tell you, this is my contribution bucket. I realized, you know, I've used hypnosis with about 7,000 people in my career. That's a lot of people, but I've learned things that I know can help a whole lot more people than that. And I'm not going to be around to do that forever. So it struck me that what I want to do as a legacy project is make available to anyone who has a smartphone to a technique that can help many people. It doesn't help everybody, but we've studied carefully and evaluated. at the end of my career, at the end of my life, if I've been able to leave behind something usable widely that can help people with pain without getting hooked on opioids, with stress,

without having to take chronic benzodiazepines, with fears, performance anxiety, know how to prepare yourself for it to stop smoking. We get the app, we get one out of five people stop smoking. Now, that's not everybody, but that's permanent abstinence. I just got an email from somebody who's been stopped smoking for four years using the app. And that's, you know, equivalent to the effects of varenicline or bupropion, you know, the medications that are used for it. So I just figure I want people to have the opportunity to take advantage of what we've learned about better utilizing their brains. You know, the brain is an incredible organ, but it doesn't come with a user's manual.

So there are things you can learn about how to use your brain that can really help you live better. And that's what I'm all about. I love just the energy behind it. I'm curious while we're on the topic also of, okay, so you trying to distill a whole bunch of wisdom and ideas and modalities into technology that is available to everybody. I feel remiss if I didn't actually ask you, in the world of AI right now, do you have a sense for if there is a contribution that AI in many of its different forms or the models that are being developed might have in the context of the work that you're doing? Are you looking at that? Do you have a take on it? I do. I mean, you know, it's sort of a remarkable, weird advance. I have this brilliant postdoc from Israel who he and I had to develop a syllabus for hypnosis course, and we couldn't find the old one.

So he said to Chad GBT, develop a syllabus for a hypnosis course in the approach to hypnosis that Spiegel and colleagues developed. Within less than a second, it came up with an outline that... It's scary. It scared me. I mean, I wouldn't have used it per se, but it was damn close. And but where, for example, one of the things that we're thinking about now is translation using my voice. So eventually AI will be able... We've done, we've tried the app for stress management and smoking in Spanish. A great Spanish actor did would be fabulous because we are, you know, unlike some approaches that are more visually based, we have visual components to Reverie, but most of it is language.

It's my voice. So you need to deal with foreign language processing. And I think we will get to a point, and we're going to look into that, of using AI so you can hear me in Spanish or Italian or Chinese or a bunch of other languages. Yeah, it's pretty incredible what's happening. We've been going deep down that rabbit hole ourselves here. I'm wondering also, one of the things that people are looking at this for is almost as to serve as audio companions for elderly people who are alone. And that it's getting to a point where it can be largely conversational and learning very quickly.

So it's almost undetectable that it's not somebody in there. I guess part of my curiosity is with what you're doing, could you develop it into something that was literally conversational and would adapt to what is picking up from the person? Well, we've started already. I mean, even without before AI, it's interactive. So I'll ask a question, is your hand floating in the air? Is it comfortable? And they'll get a different answer from me about what to do if the hand is still floating in the air or if it isn't. So we've started down that path without using AI, but with AI, absolutely. I wanted to make it as interactive and conversational as I could.

There's only so far you can go with pre-recorded answers that you analyze and then give back. I think you're absolutely right that eventually we could do it much more like that. The other thing that's happening with people who are grieving is that people are starting to use AI using recordings of, for example, a dead family member and having them be able to talk with the voice of the family member they've lost. And that's a technique I use with hypnosis with people who are grieving. I'd say, I want you to picture your husband now. And what would he say to you right now as you're grieving him? What would he want you to do? And with hypnosis, it is very vivid and people will cry and start telling you, here's what he would tell me, you know, but you're right. It's like virtual reality too. The capacity to make it more vivid and real is potentially a tremendously powerful thing.

And when people do that, I'll bet you a lot of them are in hypnotic states, even though there is nobody using hypnosis there. But again, the intensity of focus, dissociating the fact that they can't possibly actually be talking to me, and just getting into the experience the way you get into a movie. That's got tremendous potential to help people. Absolutely. Yeah, I'm so excited. I mean, there are a lot of big questions, a lot of ethical issues, but I'm incredibly excited about the potential for AI, especially in the context of just like therapeutic approaches and modalities. I think there's just like so much interesting stuff going

on around them. Absolutely. When I zoom the lens out on the work that you've been doing on how you're sort of like shifting it and installing it in technology that then millions of people can have access to. And the moment that we are at in the world right now, where it seems like people are increasingly set, anxious, estranged, isolated. And it feels like we're getting to a point where people are starting to say, I don't think this feeling will ever end. And I don't think anybody has an answer to that feeling or that expression or experience that somebody who's in that state would believe. When I think about just the generalized state of how so many people are feeling these days. I guess what I'm curious about is,

is there something simple that everyone could do a couple of minutes in the morning, couple of minutes in the evening that would in some way, shape or form bring in the therapeutic aspect of self-hypnosis that might over time have an effect that would help? Well, yeah, I would hope so. And what I would advise people to do, and we help on Reverie to deal with insomnia, for example, to have people, before they go to sleep, go into a state of self-hypnosis where they imagine they're floating in a bath, a lake, a hot tub, or floating in space, let one hand or the other float up in the air like a balloon, and picture themselves, picture one thing that gives them comfort, being in a place of beauty and nature that they feel good about, or picturing a dear friend or a loved one who you've had a good interchange with. And that whatever the hell is going on in this crazy world, waiting for the

plague of locusts next, is a real factor we have to deal with. But also you can use your store of memories and your imagination to take comfort from the things that have always given you joy and comfort. And you can picture if you want to, something that is preoccupying you is particularly terrible, but at a distance, make it smaller. I have people play with images visually and just say, it's there, it's a part of life,

but it's not the whole thing. So put that in the corner and picture what your wife said to you today that made you feel good, or picture one of your children or grandchildren and allow yourself to enjoy the things that make you feel happy, safe, and comfortable, even though there are a lot of other miserable things too. You can kind of rearrange their importance because you don't want them to hijack your attention. You want them to be something you have to deal with, but not all the time. And doing that in the morning when you wake up is a good idea too, to just kind of, as you're kind of collecting yourself for the day, picture what you want to do, what you look forward to, and try and not let the just

overwhelming flood of horrible news occupy all of your processing center. Part of it, yes, not all of it. Yeah, no, that's super helpful. It feels like a good place for us to come full circle as well. So in this container of good life project, if I offer out the phrase to live a good life, what comes up? For me, it has a lot to do with the connection bucket of yours that to be human, we need to connect with others, let them touch us, touch them, make a difference in their lives. And that's, for me, a good life is to have those relationships, to help people, to have people you care about, to have people who care about you, but also to do something that can help people you'll never see and never know, that you hope that you've left. You know, when I was in summer camp, you know, we used to say, leave the campsite better than you found it, you know, cleaner and better. And for me, it's

leave the planet better than you found it in some small way. And that's what, to me, is a good life, a good situation. Thank you. You're welcome. Hey, before you leave, if you love this episode, say, but you'll also love the conversation that we had with Jill Blakeway about the surprising science behind energy medicine. You'll find a link to Jill's episode in the show notes. This episode of Good Life Project was produced by executive producers, Lindsay Fox and me, Jonathan Fields, editing help by Alejandro Ramirez, Christopher Carter crafted our theme music and special thanks to Shelley Adele for her research on this episode. And of course, if you haven't already done so, please go ahead and follow Good Life Project in your favorite listening app.

And if you found this conversation interesting or inspiring or valuable, and chances are you did since you're still listening here, would you do me a personal favor, a seven second favor and share it? Maybe on social or by text or by email, even just with one person. Just copy the link from the app you're using and tell those you know, those you love, those you wanna help navigate this thing called life a little better so we can all do it better together with more ease and more joy.

Tell them to listen. Then even invite them to talk about what you've both discovered because when podcasts become conversations and conversations become action, that's how we all come alive together. Until next time, I'm Jonathan Fields, signing off for Good Life Project. Mayday, mayday. We've been compromised.

The pilot's a hitman. I knew you were gonna be fun. On January 24th. Tell me how to fly this thing. Mark Wahlberg. You know what the difference between me and you is? You're gonna die. Don't shoot him, we need him! I knew you were going to be fun. Tell me how to fly this thing. You know what the difference between me and you is? You're going to die. Don't shoot him, we need him!

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