Speaking of Psychology - Hypnosis in therapy - pain management for the body and mind, with David Patterson, PhD

Episode Date: March 8, 2023

Hypnosis is more than just a stage trick. Psychologists and other researchers have found that it can be useful in treating pain, anxiety, and a range of other physical and mental health problems. David Patterson, PhD, of the University of Washington, talks about what’s happening in people’s bodies and brains when they’re hypnotized, whether anyone can be hypnotized, the differences between stage hypnosis and hypnosis in therapy, the physical and mental health problems it can help address, and what to look for to find a qualified practitioner. Please help us know more about you and what you would like to hear more of from Speaking of Psychology by filling out our 2023 Audience Survey. For transcripts, links and more information, please visit the Speaking of Psychology Homepage. Learn more about your ad choices. Visit megaphone.fm/adchoices

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 But this image of hypnosis is outdated and misleading.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 they found evidence that it can be useful in treating pain, anxiety. 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.

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 it's, you know, 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 can provide. So my compliments an appreciation to you. Well, thank you.

And I think we're going to do that today because we will demystify hypnosis, I hope, and explain it scientifically. So 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 kind of stage tricks that may come to mind when some people think about hypnosis? I'll start with stage hypnosis and that, you know, most people have a concept of hypnosis based on what they've seen on TV. And interesting little trick about stage hypnosis. If you watch a lot of them work, what they would 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 your neighbor's shoulder or whatever so they send the rest of the people back to their seats and they work with those highly hypnotizable people and they make them do ridiculous things so so what one thing is that they select for hypnotizability and the other is we're at the international a meeting for international for society for clinical experimental hypnosis. And we had some stage hypnotists from Las Vegas talk to us. And basically what they emphasized is people want to be part of the act.

And so they're not, the hypnotists are not sure whether they're hypnotized or not, but it becomes kind of all part of the show. Okay. So that's stage hypnosis. What we 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 know, you mentioned pain and anxiety, irritable bowel syndrome is another one. But the way we do it is, I mean, we're very often looking at what's happening in the brain while we're studying people and we're also using outcome measures. And the final thing I mentioned, and I think it's very important is that hypnosis is known to increase the effect size of psychotherapy

by a large amount. So what is happening in people's brains and bodies when they're hypnotized? Like if you put somebody in an fMRI when they're hypnotized, how will their brains behave in a different way? One of the best people I've ever heard talk about this is named Pierre Rainville, and he's up in Montreal. And 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. So you initially see activity in a left frontal lobe as people attend to whatever suggestions are. This is where the swinging watch comes in. That's just a way to capture people's attention. But then what happens is, is it looks like the dorsolateral prefrontal cortex shuts down.

So the rear of the frontal cortex disengages. And then the ACC, which is the part of our brain that motivates us, engages at the same time. So 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. And then finally, as people get suggestions, 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 phenomenon, increased attention, dampening of the prefrontal cortex, and then engagements in various areas of the brain, depending on the suggestion. And it's not asleep. I mean, people are conscious, right?

They know what's happening around them when they're in this state. Is that correct? Yes and no. First of all, we like to dispel myths of hypnosis. A lot of people are afraid they'll fall asleep with hypnosis, and that almost never happens because in some cultures, that's a form of embarrassment. And 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. So if when people are in this phase, 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. 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, and where is the evidence the strongest? Most of these are indeed backed by research. I think some of the strongest research is 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 sensation 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. 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.

So are some people, they just can't be hypnotized at all? I mean, there's like a range, right, of who can be hypnotized and who can't be hypnotized. Like, what does that curve look like? Is it a classic bell curve? Can you give us some idea of statistically, you know, how many, what's the percentage of the population that can be hypnotized and can't be hypnotized? Yeah. 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. And so probably the majority of people fall in that category. And just a quick note, the way we measure it, hypnotize abilities, you hypnotize someone, you give them a series of maybe 12 suggestions, and hypnotize ability is measured by how many suggestions they follow. And it's sort of a circular argument, you know, because it's really just saying how many suggestions they respond to rather than something more special than that. What can hypnosis not do? For example,

could somebody who is highly suggestible be hypnotized into committing murder or doing something that they wouldn't do in their waking non-hypnotized life? Excellent question. And the first, the answer to committing murder and antisocial acts is no. There's been a number of studies that have demonstrated that. And as a matter of fact, the CIA, I believe this was in the 50s or 60s, followed the notion of the Manchurian man and try to hypnotize people to have them be hit men or hit women or whatever. And it never quite worked. But that so people won't do antisocial acts. And for the most part,

people won't do what they don't want to do. You know, there's the whole cluck like a chicken. But But most people won't do that unless they're willing to go with the show. Is there anyone who shouldn't try hypnosis because it could harm them more than help them? 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 her childhood, perhaps with sexual. abuse or other types of trauma. And they use it so often that it becomes part of their personalities. And these are people that can really dissociate with the drop of a hat.

And 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 not. for example, not regress them to early childhood, unless it's very well controlled, because that could bring up a lot of damaging material. What about self-hypnosis? There's always a lot of talk about how you can learn to do this yourself and you can perhaps control your weight or your smoking or other things. How well does that work and is it as effective as being hypnotized by a scientific practitioner like yourself? Well, 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, their cognitive automatic functioning. And there is, there's a way of capturing attention and several ways to do that. And 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 have the patients record the inductions on their phone and listen to them daily. and in our own research shows that that really strengthens the effects. And for an issue like chronic pain, you're not going to cure anyone in one session. Well, 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. So I guess I kind of have both answers to your question. It's better if other people hypnotize you, but you'll get better and better at it if you do self-hypnosis. Now, 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? I'm so glad you asked that question because there was one event that happened in,

a burn ICU that really shifted my whole career. And I was hired as the psychologist for the University of Washington burn unit on a Department of Rehab Medicine. And when I showed up in early 80s, Bill Fordyce was on faculty then. And Bill was the grandfather of the psychology pain control, period. And I was lucky to overlap with him for a couple of years, and he was very gracious and provided me supervision. I would ask him all kinds of advice. And then the bird unit approached me and said, we need your help with burn debreedments. And I went to Bill and he said, I said, what do you suggest? And he said, have you tried hypnosis?

And I was amazed that he said that being kind of an operant behavioral guy. So 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 a nurse is touch you on the shoulder, you won't feel any pain and you'll be able to go very comfortably through your burn debrisments.

And then I brought them back up. Well, I said to myself, yeah, like, that's really going to work. Because I want to add that this patient was refusing. to go in 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. So I showed up on the ward later that afternoon and everyone was so excited and said, what did you do to this guy? And I said, well, I used hypnosis. I said, why? They said, we touched him on the shoulder. He fell in asleep. He looked like he fell asleep. And we did all of his bird debreedment. And for the rest of his

hospitalization, they just touched him on the shoulder. He went limp and they would do his, did all his debreedment. And about a month later, after he was discharged, he came back to the outpatient clinic. And, you know, 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. Wow. So 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, and that grant lasted for 30 years straight. So it was a really great relationship with NIH. That's an amazing story. Now, you combine hypnosis with some other techniques, right, when you're working with people. How does that work? Yes. After using hypnosis,

for maybe 10 or 15 years, I meant my colleague named Hunter Hoffman, and he designed an immersive virtual world for people going through burn care. And we would put people in three-dimensional worlds, and it was called Snow World, is still out there. And 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. So we did that for a number of years. And then I did some work to try to combine immersive virtual reality with hypnosis as a vehicle to deliver it. And 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, you know, and 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. Now, is hypnosis taught as a matter of course in graduate psychology programs? Less and less. I think, I don't want this to sound the wrong way, but I think, think hypnosis has been hijacked by mindfulness. And I feel very comfortable saying that because much of my work is around mindfulness now and with my patients. And then I work hard to combine hypnosis with mindfulness. But hypnosis has had a waxing and waning history since the

1800s. And one of the reasons it kind of left the stage, was the advent of ether. And it was a lot more efficient to use ether with patients. And then it would come back, it would make a comeback. And then when mindfulness just really overtook graduate schools, they 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.

So 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 or something 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? Well, 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. I mean, we can't lay claim to it. There is a whole guild of hypnotherapists that aren't trained in any type of health care.

They're just trained in hypnosis. And, you know, I think that they can hypnotize people and, you know, do things like enhance creativity, things like that. But I think if someone has a health issue, particularly any type of, significant mental illness, things like pain. I think it's best to go to a good psychologist who has hypnosis as part of their treatment package. So in other words, a good psychologist is going to look at a half dozen types of intervention. And then based on a 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, you know, people away from that. The American Society of Clinical Hypnosis does a lot of training and has a list of practitioners. There's a 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 and in hypnosis as well. 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. I mean, was that described in the paper? So how did you really know how to do this? I mean, how do you hypnotize a person? Where do you learn this? I had a fair amount of that in my graduate school. I had it in internship and post-doctoral training. And so I did, you know, and I think a really,

really good example is most psychologists are trained in progressive relaxation, right? And progressive relaxation really is the foundation of hypnosis. You know, you're, you're counting them downstairs, and you're scanning the body and relaxing them. So I had had had a lot of training in that biofeedback. And it's a, I mean, any good graduate training is going to provide the platform. What But what the adduction I read is it really targeted a post-hypnotic suggestion for a medical procedure. And I think this is one of the strongest uses of hypnosis that there is, 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 their 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. And it's, 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, 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 it's much more efficiently, and there definitely are changes in the way people process information

when they're under hypnosis. Now, since the pandemic, a lot of therapy has moved online. Is it possible to do hypnosis remotely? Absolutely. When I, when the pandemic came along, you know, I'm in an 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. And then all of a sudden, the pandemic comes along, and in two weeks, were 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. And again, what I would do is have the patients have their phone and record the session. But Zoom's nice because it's not nearly as good as live hypnosis, but at least you can see, you know, see your patient. And when you're with the 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 does, you know, 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. So 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 a hypnotist was going to help people go through past life regression. And 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? I mean, what is going on when that happens? And somebody comes along and says, well, I'm in the forest. I know I'm a Navajo Indian. I know, I mean, they start just telling you a whole story about who they are and where they came from. What is happening with these people? Well, first of all, one of the best researchers that I've ever met is Mike Nash and that a University of Tennessee. and someone ran that question by me, he said, past life regression is fine if you're looking at things from the standpoint of religion, right? That's a religious phenomenon.

Now, with, if you hit, one of the things that really happens with hypnosis is that people have very vivid imagery. Remember, the brain kind of shifts over, and so things can become very real. And 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 him, but planning those.

And hypnosis can make a false memory appear very real, okay? It reminds me of Mike Nash had a patient that was reported he was abducted by aliens. So he took him in hypnosis and they went through the whole abduction and came back. And he didn't really question it, but he used it as a symbolic thing for psychoanalytically. And a 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 regression 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. Okay. So my question, the way I say, the way I see regression to past lives, if you hypnotize me, how far back am I going to go in human evolution? And I often say that if you hypnotize me, I'd probably go back to a newt, you know, and just I would just be this wiggling thing because that's one of the things. Like when you really look at science and evolution, it's like, you know, we didn't start in the 17th century or any time close to that.

I'm remembering the primordial slime, yes. Exactly. Exactly. But it is possible to take people back in their own lives, right? And that's legitimate. I mean, those are things that can be checked, right? Exactly. Exactly.

And, you know, it's one of the techniques, one of the really 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. And 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. and the study is they took adults and they gave them a computer task that you need idetic imagery to do.

And there's a theory that we all have idetic 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. And that was, I think, one of the reasons I really got. interested in hypnosis. And so 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. So when I'm using it clinically,

I say find yourself going back to early images and time as long as the positive images and as long as you feel safe. So yes, I hope that answers that. You know, some of this sounds very similar to some of the psychedelic therapy that's happening right now. Like a year and a half ago or something like that, I talked to somebody who's doing that kind of therapy. And it's the same sort of thing that you need somebody guiding you through it, that you don't want to take people places that might be dangerous. Is there something similar? Do you think that's happening with people who might be doing psychedelic therapy and doing hypnotherapy? Absolutely. I have to respond somewhat personally. I lost a son over last year and I decided, I'd been referring some of my terminal patients

to psychedelic therapy, but I decided to pursue it myself in Denver with two top-notch therapists. and 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. So 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? What I'm working on now, 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 think when we don't really have a self, we can only talk about what ourselves are not. But what we think is ourself 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 the illusions of the mind. So 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. So I'm particularly interested in now as somewhat of a Buddhist understanding of the mind as process rather than a fixed entity and getting away from dualistic thinking and explain that through science and then augment it through hypnosis. That sounds amazing. I look forward to seeing this as you work on the next edition of your books. I want to thank you. Dr. Patterson for joining me today. It's been really a lot of fun talking to you. Thank you, Kim. You can find previous episodes of Speaking of Psychology on our website at www.Speakingof Psychology.org or on Apple, Stitcher, YouTube, or wherever you get your podcasts. And if you like what you've heard, please leave us a review. We'd also like to learn more about what you think of this podcast and what you'd like to hear more of from us. We'd like to know about you as well.

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