The Checkup with Doctor Mike - Does Hypnosis Really Work? | Dr. David Spiegel

Episode Date: October 2, 2024

Learn more about hypnosis by checking out Dr. David Spiegel's app, Reveri: https://www.reveri.com/ 00:00 Intro 01:15 What is Hypnosis 12:33 Hypnosis vs. Psychology 21:17 Differences Between Practitioners 24:15 Who Is Hypnosis For? 29:27 Controversies 34:11 Does It Really Work? 41:00 Is Hypnosis Just Gaslighting? 49:26 Hypnosis For Smoking 54:17 Why Are We So Susceptible? 1:02:13 Integrative Medicine 1:06:27 My Acupuncture Story 1:11:01 Why Wouldn't It Work? 1:13:09 How He Discovered It / Asthma 1:19:28 How Hypnosis Has Changed / The Future 1:27:43 His Critics Help us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, an exclusive discord community, and many other perks for just $10 a month. Become a Resident today: https://www.patreon.com/doctormike Let’s connect: IG: https://go.doctormikemedia.com/instagram/DMinstagram Twitter: https://go.doctormikemedia.com/twitter/DMTwitter FB: https://go.doctormikemedia.com/facebook/DMFacebook TikTok: https://go.doctormikemedia.com/tiktok/DMTikTok Reddit: https://go.doctormikemedia.com/reddit/DMReddit

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the field of psychology is quote unquote not real, that it's all very suggestive, it's not actually helping people. What do you have to say to those individuals who believe that? Well, I got to say that I have about 7,000 patients who would tell them they're wrong. When I say hypnosis, most probably think of a magic show where people get invited on stage to get hypnotized and perform some ridiculous act. I'm not going to lie, I too thought of hypnosis as more of a silly parlor trick rather than a proper psychological intervention. Well, that's about to change. Please welcome to the Checkup podcast, Dr. David Spiegel,

world-renowned psychiatrist, associate chair of psychiatry and behavioral sciences at Stanford University School of Medicine, and leading expert on hypnosis. Dr. Spiegel has spent decades studying the mind and exploring how hypnosis can help us overcome common medical problems like chronic pain, anxiety, and insomnia. He even claims he's seen it how patients quit smoking. Get ready to hear how you might be able to use hypnosis to address your problems using Dr. Spiegel's new app called Reverie. With Amex Platinum, access to exclusive Amex pre-sale tickets can score you a spot trackside. So being a fan for life turns into the trip of a lifetime. That's the powerful

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What's the official definition of hypnosis? Because I know you're part of the group that kind of formulated, right, the definition? That's right. It consists of three things. Highly focused attention, what we call absorption. Have you ever gotten so caught up in a good movie that you forget you're watching the movie and you enter the imagined world? Is it like a flow state?

It's like a flow state in the sense that, you know, Chick Sent Me High calls it an autotelic experience. You're just in it. You're not judging it. You're not evaluating it. You usually are enjoying. It feels good just to be there. Right.

So like when you get caught up in a movie, that absorption is inherently usually pleasurable. To do that, though, you have to dissociate. That's the second part. You put outside of conscious awareness things that would ordinarily be in consciousness. So right now, Mike, you're sitting in this chair, hopefully you were not aware of your body sensations

touching the chair. If you were, we could stop the interview right now. And so to concentrate that intently, you have to be able to put outside of awareness things that would ordinarily be in consciousness. that can be very useful for dealing with stress or pain, for example, that you can just dissociate, disconnect from it. In a controlled manner.

In a controlled manner, yes. Although sometimes it happens spontaneously, but what we do with hypnosis is show you how it happens and how to better control it. The third part of it is trying out being different, disconnecting from your usual way of being. So the thing that scares people the most about hypnosis is that they've seen one of these awful stage shows,

you know, where the football coach danced like a ballerina made a fool of himself. But I don't like that, but there's a message there. And that is you could try being different. And if you think about it, what we do in psychotherapy is help people figure out what it would be like to be a different kind of person. And in hypnosis, you can do that in a hurry.

So it's what we call absorption dissociation and cognitive flexibility. It's a way of thinking differently. It's been called suggestibility. It isn't really that. It's an ability to disconnect from your usual ways of being and try being different. What is the difference between hypnosis session that would happen in an evidence-based setting like your office versus what happens on these stage shows when someone clucks like a chicken or whatnot?

Well, the phenomenon is similar. The uses to which it's put are different. So the phenomenon is this ability to concentrate intently to suspend your usual means of evaluating yourself and others and try out being different and to dissociate so it's really what you're using it for not the phenomenon itself okay and are there uses of hypnosis that are unethical or problematic that can ever happen well look we're all social creatures you know we all are susceptible of social influence we sometimes swallow things that aren't true and god knows there been enough recent very public examples of that. And so to the extent that we are willing to

take in and act on other people's advice and suggestions, sure, you can get bad advice and suggestions with hypnosis as well. It is true that in hypnosis, you're more intensely focused. You may be less likely at the time to judge and evaluate, you know, the old it seemed like a good idea at the time kind of thing. But there's nothing inherently dangerous about the hypnotic state itself. In fact, it's better to know something about it, to know that you can engage in it to a certain level in that kind of intensely focused attention to kind of protect yourself so that you know when you're likely to get caught up in something, you'd rather not be caught up in. Is there a range of this individual, like for me, I'm not very hypnotizable, but someone

else may be. Is there a range that exists for that? There absolutely is. Now, in the human life cycle, basically all eight-year-olds are in trances all the time. You know, you call them in for dinner, they don't hear you, work and play are all the same thing to a kid. But as we go through adolescence, we go through a period of valuing reason and evaluation more and just plain experience less. It's called formal operations by the psychologist Pige.

And by the time in your early 20s, you get set with a pretty fixed level of hypnotizability. So it's as stable as IQ from the 20s to the 60s. And so some people, about 20% of the population, are very hypnotizable. Their problem is staying out of hypnotic states, not getting into them. There's about 60% of us are somewhat hypnotizable.

So you have an experience, you'll step back and think about it. We call them the diplomats. They negotiate their way in and out of it. And there's about 20% we call the researchers who just aren't hypnotizable at all. in their adult life. What can one do to become less hypnotizable? I don't just stop listening to people.

Which is easier said than none these days, right? Boy, you're not kidding. I would say that the way to deal with the phenomenon is to just make yourself acquainted with it, recognize it, and decide. I had a patient who said, I'm a disciple in search of a teacher, She realized that she was always caught up in one kind of hypnotic influence or another. My late father, who also did hypnosis throughout his career, was a pioneer in the field,

had a playwright who was a very successful playwright. But he found that people would come up to him on the street and just say, hey, I have this great charity, and you would love. And the next thing, you know, he's writing a check. And his accountant said, you know, you're doing pretty well. well, but you're not doing that well. And so we actually had him arrange a checking account where any check over $100 had to be countersigned by his accountant.

Wow, okay. And so he would hand somebody to check and say, and I want to wish you a lot of luck. It's like a level of hypnotic fraud detection. Right, exactly, exactly. What does it say about you if you're easily hypnotizable? Like, what risks do you face? Well, I mean, there are advantages in risks. The advantages are you do get intensely absorbed in things.

You tend to tune into other people very well. You see things from their point of view very easily. Those are all advantages. The risks are that you tend to be influenced. And sometimes you can be influenced by people who don't have your best interest at heart. Many humans are like that, but more hypnotizable humans are more likely to have that kind of vulnerability.

So it's a good idea to try and keep that in mind and protect yourself if you find you're too easily influenced by other people. How long into a conversation with an individual do you know that they're in one of these three categories? Two or three seconds. No. No, I get ahead, but we have a test on reverie, actually, of hypnotizability. It takes about five to six minutes, and I know for sure how hypnotizable you are. And I get the feeling from the kinds of experiences people have.

I had one guy who recently who said I got so caught up in movies I just love doing it so I'm thinking yes you're very hypnotizable he said so I decided to take to study filmmaking and he said I had to stop

the course because it was ruining my experience of movies instead of just enjoying it I'm thinking well why did they put the camera over here and the lighting wasn't right I think that's a dance situation our filmmaker over here yeah

so you can tell pretty quickly that there are people who just get deeply absorbed in things. And there is a correlation between natural absorption in everyday life and being highly hypnotizable, whereas there are other people who are always critical in questioning and never swallow anything whole and don't believe anything they haven't read about a lot and things like that, who tend to be on the low side in hypnotizability. Yeah. What's the biggest bit of misinformation surrounding hypnosis that you think permeates society?

The biggest is that you lose control that somebody takes over your mind and makes you do whatever they want and I made you into someone who would interview me on your pocket. It's not like that. It's a state that you can use to help yourself concentrate more intently on what you want to concentrate on.

And it's not, it's the fear that you lose control. In fact, you gain control. And that's so this image of this Fangali and Trilby thing is just not what... What is that image? That's the image of the story that the fandom of the opera where, you know, this singer is taken over by this evil genius who controls her and makes you do everything she wants. It's really a way of enhancing your own understanding of your ability to control what you do, how you think, control pain, control anxiety, control habits. It's an opportunity to enhance your ability to use your brain to control your mind and your body.

Do you have to be willing 100% to be hypnotized? Or is that something that can happen without your knowledge or consent? Well, by and large, it's done with knowledge and consent. I'm sure there are circumstances where people who don't understand enough about their hypotizability, let themselves get into things. And after all, you know, it seemed like a good idea at the time.

So it's better to know more about it. You can better protect yourself. But it's something that you can protect yourself from. You can recognize the signs and say, no, I've been there before I don't want to deal with this in this way. What are those signs that people can look out for? Just that I let myself get talked into something that I didn't really want.

And there were 12 reasons why that I just sort of ignored about why I shouldn't have bought that property or done what that guy suggested or something else. So it's a way of learning about yourself and learning how gullible, gullible you are. And there are some people who will swallow things pretty easily and not judge them. There are other people who reject perfectly reasonable things because they're so critical and skeptical all the time that they don't engage. Right. Like cynicism as opposed to

skepticism. Yes, that's exactly right. So is being hypnotizable a form of gullibility or being gullible? No, I'd say it's an openness to changing your point of view. And some hypnotizable people or gullible, but it's not, gullibility implies that, you know, you just swallow a hookline and sinker, whether it's reasonable, plausible, or not. And most people who are hypnotizable can evaluate and judge what they're doing and make a decision whether to continue engaging or not. I would say what I try to teach people and what you can learn about on reverie is the idea of recognizing the signs if you're getting sucked into something you'd rather not be. On the other it's also a way of recognizing the ability you have to engage with novel treatments, to

take and to evaluate it, and to help yourself by doing that. The study of hypnosis sounds somewhat familiar in the study of psychology, a study of influence. Is there a lot of overlap in these two fields? The reason I ask it is because my job as a social media influencer is to always be on alert at how marketers prey on insecurities of my patients, how they trick them into thinking that there are shortcuts for certain things, even the pharma industry through their advertisements. So I'm trying to do my best to become more in tune with the psychology of influence and even reading the book psychology of influence.

Does that go in line or overlap heavily with the study of hypnosis? Well, I admire you're doing that, and given the ability you have to influence people, I really admire that you're taking that so seriously. I would sort of flip that question on its head, though, because one of the things that troubles me terribly is that the kinds of problems for which big pharma has used those sorts of media influences and has miserable advertisements every night on television, is to use drugs for things that you can use your brain for instead.

So last year, 88,000 Americans died of opioid overdoses last year. It's drugs for anxiety, drugs for insomnia, are habit forming. And so they're getting people hooked. And people often ask me, well, if this hypnosis stuff is so great, you know, why isn't everybody using it? And I say, well, I don't have a cadre of ex-chairleaders going around the doctor's offices convincing them that hypnosis is the thing to help your patients with. It's drugs. And so I do worry about this kind of influence.

I worry about social media and their capacity to make people worried about things they shouldn't be worried about. You know, or teenage girls is one better looking than another and what's that going to say for their next future. And so I think it's a problem that's, you know, Jackie Gleason used to say it's bigger than both of us. You know, it's a problem that doesn't just involve formal hypnosis. It involves all these things that influence. people's attention and distract them from what really matters to them. So I would say hypnosis is, first of all, when you're using it for pain or anxiety or insomnia, the worst thing that happens is it doesn't work. It doesn't kill you. It doesn't give you serious side. There are no side

effects to hypnosis. So it's relatively safe. And I think it's wise to learn something about yourself and your openness to being influenced by other people. And there are lots of ways that happens. Hypnosis is just one of them. Why do you think, in my medicine, school curriculum, I think hypnosis was maybe covered in terms of quitting smoking. That's probably the only time it crossed my textbooks. Why is it not more well incorporated if it is so evidence-based? You know, I wish I knew. I've been struggling with that my whole career. It's the oldest Western conception of a psychotherapy. It's 250 years old. The first time a talking interaction between a doctor and a patient was thought to have therapeutic benefit. And yet it's still sort of the Rodney

danger field of treatments, you know. Rodda, you know, you remember him, you know, he said they asked me to leave a bar so they could start happy hour. I don't, I, there is not the kind of money to be made in it, that there is pharma. That's, that's one thing for sure. But like in that regard, CBT, there's not a lot of money to be made, we can say, and yet that's widely popular and taught in schools. So what is the divide there? I don't fully understand. any theories i think yeah i think people are are frightened of it i think they you know the the football coach dancing like a ballerina someone quacking like a duck you can make fun of people um i think it's a little hard for people to get to understand you know this three pound organ that sits

on our shoulders connects to every part of the body it controls every part of the body but it doesn't come with a user's manual and so there are things we can do with our brains that we may not be fully aware of. And sometimes that's scary. And you think I just want to stay away from that. I don't know what it is. And so there are, yes, there are other kinds of psychotherapy. But all in all, psychotherapy doesn't get the same respect that psychopharmacology does. You know, we tend to think that the only real treatments are incision, ingestion, or injection. You know, that's the real stuff. And the other stuff, you're just talking to people, doesn't mean that much. And that's not true. And I think hypnosis is sort of the limiting case of that. You go into an

mental state. You can actually reduce the amount of pain medication you need. You can get through some kinds of surgical procedures better with hypnosis than you would with medication. People find that hard to believe and accept, but it happens to be true. Yeah. I think in my many conversations with my patients and even podcast guests or my viewers at home, there's a belief on both sides where some people are very anti the incision medication route and prefer the quote unquote natural methods, which has its own quirks and weirdness because people think everything that's natural

must be safe or healthy. And then on the other hand, you have people like you said, that are only about, give me the medicine, I don't want to do anything, there's no other way to fix this, give me the surgery or give me the scan. And I'm like, well, the scan might not help

or the surgery might have longer recovery than you otherwise would with physical therapy. So I see it on both sides of the spectrum, where I see how in the medical curriculum of things, why maybe hypnosis isn't first line yet, because it may be at some point, is that I feel that there is, A, the stigma that's associated with patients, and B, the idea when you give a medicine, you can study it on population basis. I feel like easier from an objective status, where you could see the dosage you need to give to get therapeutic value. You could see the dosage of the safety profile. You know that on average, if you give it this way, it's going to work. Is the training

of hypnosis and the art or the science of hypnosis taught in the same way, where it's, if I teach it to you this way, you will get the same outcomes that I do? Well, that exists, and it's been done, and I've done it. I mean, I thought when I started my career, in psychiatry half a century ago, that if I just, you know, build it in, they will come, you know, do enough randomized clinical trials, do functional neuroimaging on what happens with hypnosis. We will publish enough that people will have to see it the same way they do the things you're describing very well.

That hasn't happened. We've done it. So I'll tell you an example. We did a study with a colleague in Boston-Ovira-Lang published in the Lancet, randomized clinical trial, 241 subjects getting intravenial cutdowns to do chemo-embolization in the liver and things like that. There were three conditions. They had standard care, which is push a button and get IV opioids. The second was that plus a friendly nurse, the control for just kindly attention. And the third was teaching themselves hypnosis. By the end of two hours,

the hypnosis group's pain levels were one out of ten. The nurse support, were three out of ten. The standard care was five out of ten. And they were using twice the dose of opioids. They were pushing the button. It's like a PCA comp. Right. And we looked at their anxiety. The anxiety in the hypnosis group was zero two hours. I thought they were dead or something. Nurse three, the standard of the care five. And the hypnosis procedures got done 17 minutes quicker than the other two. And there were fewer complications. few less autonomic instability, heart rate and blood pressure were better. So we published that in The Lancet.

Now, if that were a drug that we had, did the study and had the same results, everybody would be using the drug now during procedures like that. They're not. So I think there's just a tendency for people to not believe it, even when it's done right. What was the feedback or reception to the article being published? There wasn't a huge reception. It was positive. There were no substantive criticisms of the study.

Nobody said you can't do that, you know, couldn't, it isn't possible. It just kind of got ignored. Yeah, so you're saying practitioner success rates don't vary from practitioner to practitioner? They do. And I would say that the community, there's some excellent people, psychologists, physicians, dentists who use hypnosis. But there's a whole lot of variation in how they do it. There are at least three good professional societies, the Society for Clinical Experimental Hypnosis,

American Society of Clinical Hypnosis, and the American Psychological Association has a hypnosis division. They teach courses, but there's a fair amount of variation in the way people approach it. And some of it is a kind of hypnosis that I personally don't go for, that involves sort of just talk to the unconscious mind. and the conscious gets in your way,

which I don't agree with. So, you know, there's variation in that. So some of it is us, and I think we make it difficult for people to get access because there just aren't that many of us. It's hard to get to a well-trained professional who uses hypnosis. And you're right, there is variability in how they practice,

but there is in other parts of medicine, too. That's not just hypnosis. So I think we could do a better job. And frankly, that's why, you know, three and a half years ago, with my colleague Ariel Polar, who's a serial entrepreneur, we decided to start reverie. I just thought, you know what, this isn't working. You know, people don't have enough access to it. There's a lot of variability in how people use it. And we have a model that works. We have evidence that it works. We know what's happening

in the brain when we're doing it with people. So let's make it available to as many people as want to use it. And so that's why I took the path I did with very, very. Right. For the study, we always see there's the study results, and then there's like real world outcomes, right? So the typical example I'll use on the channel is condom use in the study versus condom use in real life is lower success rate in terms of decrease likelihood of becoming pregnant. With a study like this, are the people that are having success with hypnosis, are those people who are part of the study that are interested in hypnosis versus if you put this into real world, you might not get the buy-in, and maybe lack of a better term compliance

with the general population? Well, I'm sure there's some of that, but the people who went into that study in particular had enough interest in hypnosis to be willing to be a part of the trial, but they had to accept randomization into three arms, only one of which involved hypnosis. So two out of three didn't get the hypnosis. And that's true with any randomized clinical trial. I don't think, I think it has more to do with the structure of the intervention and less with, you know, how much people want to use hypnosis. People want to get better. They want, they want help. And in general, when you teach them how to do it, if it's got traction, if it can really help them, they'll do it. Well, I wish that was the case. I mean, from my primary

care standpoint, how many times do I explain that, let's say, physical therapy or CBT, DBT, to you, what have you, are avenues to get better, but patients might be reluctant to do that, may have financial barriers, time barriers, access barriers, where they don't end up going for the treatment versus a pill has the simplicity of it, costs not always the case, but it's more standardizable in their eyes in having success,

so the compliance may be a little bit easier. Well, I understand that, Mike, But at the same time, one reason we put Revery out there is there's one big difference. Hypnosis is faster than drugs. So you will know within 10 minutes using Revery, whether it's going to help you or not. We ask people to rate their stress or their pain on a 1 to 10 scale at the beginning and at the end of the exercise. We find that four out of five people have a reduction in their stress level, an average of one and a half points from beginning to end.

So that's faster than a drug because you don't even have the drug from the pharmacy yet. So people can tell right away. And that's one reason I think it needs to be more utilized just because you can try it. If it works, do it. And what indications would someone try the app? For stress management, anxiety, pain control, for sure, to stop smoking, to get to sleep, to get back to sleep. Very common problems.

25% of the U.S. population has an anxiety disorder. 40% have some kind of sleep problem, getting to sleep or staying asleep. So you can try it, and you'll know within 10 or 15 minutes, whether it's helping you or not. Right. Like, frequently I'll give recommendations

of bibliotherapy for my patients who are having mild depressive or mild generalized anxiety disorder symptoms, and I'll recommend a book by a, Dr. David Burns, you know, feeling good or now feeling great. And, you know, statistically, if their case is mild, they'll see the improvement. What is the situation if someone has moderate to severe anxiety? Would still using the app be beneficial, or is there now a risk of tapping into something

that might yield worse outcomes? Well, I don't think it would yield worse outcomes. It just might not help them that much. And there are just huge numbers of people with serious mental disorders. orders who never get any help of any kind. And listening to your talk, I'm thinking, you know, you'd be a good psychiatrist, you know, you're thoughtful, you understand what the problems are, you know how to help people. And the majority of depression in the United States is treated by primary care docs, not by psychiatrists. So most people are not getting what, you know,

some would say is the ideal treatment anyway. And what I think we ought to be doing is deploying techniques that have a decent chance of helping people. I mean, we've looked at tens of thousands of our users. And they report within 10 minutes feeling significant reduction in their, a moderate effect size reduction in their stress symptoms, for example, moderate reduction in their pain. One out of four people stop smoking using it. So that isn't everybody, but it's not a bad place to start. What are the current guidelines in, let's say, in the APA or I don't know what other organization puts out these guidelines, where hypnosis is first-line treatment for a condition?

Well, both the American Psychiatric Association, I helped to write the guidelines on the use of hypnosis and the American Psychological Association recommend that you get guidance in doing it from a licensed and trained professional, mental health care, physician, and that it's a safe and effective treatment. It is a recognized treatment by both major your professional organizations.

Yeah, I find it so strange for me that like, you know the resource up to date? Oh yeah, yeah, I write for it. So like that's frequently a source that I use, you know, being a primary care doctor, I can see anything walk through the door at any moment. I have to get, yeah, I have to get well-versed quick around the most up-to-date evidence.

So this is one way that I do that. And, you know, hypnosis doesn't even cross the threshold for me when looking at generalized anxiety disorder or looking for insomnia, It's there as a potential means, I'm sure, somewhere. But it's not first and forthright. And I'm still struggling as a young primary care doctor to figure out why that is. You know, I'm glad you mentioned that.

You know, I never look up hypnosis and up to date because I know about it. I'm going to look at it. I'm going to go home and look it up now. And I'll take it up with them. I think you're absolutely right. Well, the reason I bring it up is, look, it's great that there is an option for an app for people to try at home, especially if it works quickly, and it's simple, and there's access to it.

I think there's so much value to teaching providers to make it more of a standardized approach, to make it more clear. I have read articles about issues with hypnosis surrounding past life regression therapy and past life trauma therapy. And those are things that are not evidence-based where people are saying that you're feeling

some sort of trauma from your past life, let's get hypnosis to figure it out. Have you seen this sort of issue arise in the field? Oh, yeah, but only in one of my past lives. You know, sure, you know, I know about that stuff. I have no patience with it at all. And, you know, there are a lot of misguided thoughts about a lot of treatments of one kind or another,

and that's, I think, not an ethical use of hypnosis. You know, it can be very helpful in dealing with problems in this life, and including people who have suffered severe trauma of one kind or another, it can be very, I use it as an effective treatment, reliving episodes that happened earlier in people's lives, but I have enough trouble understanding what's going on

in this life, right? Don't bother with previous ones. Makes sense. What's your current stance on the idea of, in general, repressed memories? Look, you know what? All memories are recovered memories. You know, this idea that it can't possibly be true

that you would repress a memory of specially of something traumatic is just flat out wrong, you know, and people who do research in memory point out that if things are trivial, you know, you may just forget them because you never really encoded them very much. If they're extreme, they are accompanied by affective and somatic arousal that is very uncomfortable and painful. And one way people deal with it is dissociating from it, putting it outside of conscious awareness

so that it doesn't disrupt your everyday life. And so it is not at all implausible that people would not recall things that were horribly traumatic, or at least all aspects of things. It doesn't mean that everything you then remember is necessarily true. Hypnosis is not like going back to a video file

and reopening it and seeing it the way it was, but there is nothing implausible about people not all the time being able to remember traumatic events that are terribly disturbing to them. So it doesn't mean that if you recover a memory of childhood sexual abuse, for example, the memory is necessarily correct, doesn't mean it's necessarily wrong. It means it's a memory.

And if you want the truth about it, then you have to do what an investigator would do in dealing with a crime, you know, get other evidence. What people report is one thing. But repressed memories can and do happen, and they can sometimes be recovered, and sometimes that's accurate. How flawed is human memory? I can't remember. Sure, it's, you know, it's reconstructive.

Memory is, it's not, it's not just pulling up the file and playing it again. It's reconstructive. And constructive, perhaps. Yeah, and it can be. You can embellish it in one way or another. But, you know, people have a lot of painful memories that are what really happened, and it hurts them because they are. There are terrible things that have happened to people that they can recover memories of it can be accurate.

So the standard of what you need to rely upon if you're doing psychotherapy for someone, for example, is different than if you're a police investigator trying to get evidence of a crime. You know, it's a different level. But the idea that, you know, memories that come up later are invariably contaminated is just as wrong as saying they're invariably true all the time. How do you approach that with a patient who has a new traumatic memory come up? Because there's an avenue where you can go full affirmation, you can go questioning, you can go full denial, what's like the optimal route here? It's just being open-minded.

You know, it depends on what the purpose is. If the purpose is to help the person deal with the problem that they're having, then the standard is, I'm going to form an alignment. alliance with you and the better you are at giving me a good feeling for what actually happened to you, the better I can be in helping you to deal with it. And so, you know, it's a different thing if they're saying, well, my lawyer says I should bring a, you know, a legal case against my ex-father or something like that. That's a different issue and it's handled a different way. But in general, I'm trying to form an alliance with a patient and assume that they're going to do the best they can to tell me what

happened to them, and I will do the best I can at helping them deal with it. Yeah, there's a world of social media or a part of social media that believes in general psychologists, the field of psychology is, quote-unquote, not real, that it's all very suggestive, it's not actually helping people. What do you have to say to those individuals who believe that? Well, I got to say that I have about 7,000 patients who would tell them they're wrong. I've done this for a long time with a lot of people. And I have seen people get better. I had a woman who was sexually abused. She reported at the age of 12, and the family was afraid to do anything about it. And she realized as a teenage girl that people would, you know, men would comment about her body on the street.

She said, I don't own my own body. None of this seems all that implausible to me, you know, on its face. And she was depressed. She functioned well, but she was chronically depressed. She had a psychiatrist using meds. And she came to see me, and I had her use hypnosis. And, you know, the proof is in the pudding. You know, if I were just contaminating a false memory, I probably wouldn't help.

But I said, I want you to picture yourself as if you were your own mother and look at yourself as a 12-year-old girl who'd just been sexually assaulted. and she starts to cry as she's picturing herself as this little girl and I said I want to ask you one question was this her fault and she said

I'm stroking her hair I'm stroking her hair and she cried for a while and she came out of it 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 they don't recognize me that I don't know who I am so you know even if I'm just massaging a fantasy which I don't think I was doing the proof is in the pudding you know she she came to terms with something and you know many people who have been assaulted blame themselves for things they didn't control they'd rather feel guilty than helpless right it's a it seems like a form of cognitive distortions that we feel on a day-to-day basis. The reason I bring that up is I have patients where it's pretty incredible that you do this

under hypnosis. I, for a very common situation, if someone describes something problematic that happened with them, maybe it's not as severe as in your case, but they got bad grades on a test. Someone was unfair to them. And I say, well, pretend you're sitting next to you. And you're your friend. And the same thing happened. What would you tell your friend? And I have them vocalize it, but not in a hypnotic way. And a lot of times they say something that they're not as kind to themselves as they are to this imaginary person sitting by their side.

And they're kind of wow, why am I being so rude? I just leave them with that question. And a lot of times that has therapeutic value because the way we treat ourselves is oftentimes worse than we treat others, which is surprising because we're always supposed to be about helping ourselves and being selfish as humans. And yet,

at times we that pendulum can swing well that's great you know welcome to psychiatry I think what you're doing is terrific because you're giving them an alternative perspective and one of the things that we're seeing in hypnosis which I think does it in a more intense way but is not entirely different is you're asking them to sort of cut loose a little bit from their routine way of viewing themselves and what's going on and try out being different just being different by acting as if you were somebody else, giving advice to yourself, for example, which is terrific. And we found using functional neuroimaging that in hypnosis, you have increased functional connectivity between the left dorsalateral prefrontal cortex and the posterior cingulate.

That's what we call the default mode network. It's a part of the brain. I call it the my fault mode network. It's the where you think about yourself, you reflect on who you are. And what you were inviting them to do in perhaps a less intense but very reasonable way is to try out being different, see what it would feel like if you weren't you, but you were someone advising you about what you were doing. And that capacity to just let go of who you usually think you are has therapeutic potential. And that's what you're discovering when you do that. And I'm seeing

when I use hypnosis to do it. Have you, I guess, like what would the advice be for, let's say your patient, you want's your primary care doctor, you get the diagnosis of generalized anxiety disorder and they say you should see a mental health specialist. You have the option of seeing a psychologist for CBT, psychologists for hypnotic therapy, a psychiatrist for medications. What would be your recommendation to your family member? Well, it depends, I would say, on what they tried and how serious the symptoms were.

In general, we tend to think of psychotherapy for people who have milder to more moderate symptoms, and a psychiatrist with meds for someone who has more severe symptoms, But sometimes, even with pretty severe symptoms, techniques like hypnosis and CBT can be very helpful. So the other nice thing is if it's not a life-threatening problem, you can try out a series of steps and see what happens. And where someone like you can be very helpful is give them a little outside view and say, well, you've been seeing the psychologist for three months. Are you feeling better or not? If you're not, maybe it's time to try the next step.

How does one find a validated or licensed hypnosis provider? Professional. there are there are um you can go to the website of the society for clinical and experimental hypnosis i think it's sceeh dot net or the american society clinical hypnosis yeah that's how up the date or the american society for clinical hypnosis asc h dot us i think um or the american psychological association there's a division 30 is the hypnosis division and get referrals there, or the other thing is you can go to your primary care doc who may know a local psychologist

or physician who also was trained in hypnosis. Got it. Or reverie, Don, for yourself, yeah. For specifically the topic of pain, because you mentioned that, I am not an MD, I'm a DO. So I'm an osteopathic physician. And we have this intimate focus on being holistic, on the idea that the body heals itself,

It's not us giving you the miracle treatments. It's about your body getting better and optimizing that as much as possible and actually staying out of the way to allow your body to heal. And part of what I do when a patient comes in to see me for pain, whether it's elbow pain, back pain, neck pain, carpal tunnel like symptoms,

is talking about their mental health. And this has been both celebrated and berated by not just my patients, but also by the viewers at home who have heard me talk about this. On one hand, people are very happy that someone is talking about the fact that mental health can impact physical health, which absolutely can. I'm a big fan of Dr. John Sarno's work. Are you familiar with?

A lot of work on psychosomatic conditions and how the mind-body connection is very strong and probably mirrors a lot of the same principles that you talk about when it comes to pain. And people were happy that we're talking about how mental health can impact, not just the experience of pain, but your perception of pain or the volume of pain. Then on the other hand, people are very angry

that they're saying, you're just gaslighting me to believe that my pain is not real. How do you approach that situation? Well, it's related to what you're saying, but a little different because, yes, the danger is that people think

they're being told it's all in your head. There's nothing wrong with your back or your knee or your ankle or whatever it is. And I would, I approach it differently. I say, look, like that Lancet study shows that these are people they all have the same amount of real pain

they were anxious they had a cut down in their femoral artery they were lying there for two and a half hours they had real pain but there was a difference in how they handled it so where I approach it differently is it's not the pain is not all in your head and I'm not telling you you're giving yourself pain if I show you how you can reduce the amount of pain you feel and so a lot of pain that people have

can either be reactive to the frustration of this, how damn this back is bothering me. Again, you know, I just feel awful. I'm so fed up with it that it's like the noisy kid in the classroom. You're paying more attention to it. But the other side of that is the strain and pain lies mainly in the brain. The brain takes input signals through the lateral spino thalamic tract, through the thalamus into the somatosensory cortex, through the salience network,

the insula, the dorsal anterior cingulate, to decide how much should I worry about this and how much does it hurt. And that's a constant equation that's going on, and you can control it. So I find that when people imagine, with chronic pain, with chronic back pain, if they feel better in a warm bath, I have them imagine in hypnosis.

They're taking a warm bath. And you know what? The pain goes down, not because they're making it up, not because they don't have a back problem, but because they can train their brain to process the pain differently. There was a very interesting study at the university, of Montreal by Pierre Rainville and his colleagues.

They gave electric shocks to people on their wrist. They hypnotized them and they said, imagine that your arm is an ice water, cool, tingling numb, filtered their head out of the pain. And they got a significant reduction in pain perception. And the reduction was reduced activity in somatosensory cortex. So in the next experiment, same shocks, same subjects. They said, the pain's there, but it won't bother you. which is kind of the way people on opioids sometimes feel.

And they also got analgesia, but this time it was reduced activity in the dorsal anterior cingulate part of this salience network. So they could change the part of the brain that modulated pain simply by changing what the instruction was. So the brain is a very complex sensory processor, and it decides how much attention to pay to all kinds of signals. So the fact that you can use your brain

to control the amount of pain you have doesn't mean you're making it up. It doesn't mean that you don't have real pain. It means that your brain is learning to handle that real pain differently. I had a patient, a woman who was seven months pregnant, really bad lower back disease, the bigger the baby grew, the more pain she had. They couldn't give her opioids because she was pregnant.

And I had her imagine she was in a warm bath. Her pain was seven out of ten when we started. It was three out of ten after a couple of minutes. And she opened her eyes and she looked angry. And I said, your pain is it? What are you angry? about. She said, why in the hell are you the last doctor I got sent to instead of the first? So if you present it in that way, patients can accept it, they can understand it, and

by the way, they feel better. So just using this central processor we have differently can literally change how much pain people are in. Do you ever struggle with the idea of putting this notion as under more control? Like, so if a patient's in terrible pain, we say you actually have a tremendous amount of control over this. They feel burdened by that new information, and I'll give you why I'm bringing this up. We know that if you go into a caloric deficit, whether by burning more calories

or by consuming less calories, you will lose weight. That's just like a typical scientific formula that we know works. And yet there are now medications that are being created to help us stay away from the foods. And there is a notion that if you say, oh, just burn it off, you're facilitating more of a problem by burdening patients more who failed to lose weight.

Is there a similar line with this pain control concept? Well, the, you know, the Ozypic and the other, you know, drug problems now are, I think, a very problematic way of approaching what is a bigger problem than that. because part of the reason that many people have such a problem with eating and weight is the over-processing of the foods we all eat. And so we lose connection with our body's satiety cues, and we don't eat when we're hungry and stop eating when we're full because we never really feel full because everything is so over-processed

that you don't know. Your body doesn't know when it's full and when it isn't. And so I think that I'm not a big fan of the drug fix for this. And people lose muscle as well as fat when they take these drugs. And it's very hard to rebuild that muscle once you lose it. So I think teaching people, it's cruel to tell people they have mental control over something if they don't. But it's also cruel not to tell them they have mental control when they do. And so what I try to do to help people eat better

is to focus on being more in tune with your body's signals. They eat when you're hungry and stop eating when you're full. And if you're hungry again and a half an hour, eat again. But when you're full, stop eating again. So getting more in touch with your body and using your brain the way it was meant to help regulate your hunger and satiety. How you mentioned that specific distinction

when trying to help giving someone, idea of control when they don't have control could be a problem how would you know if a patient has the capacity of that control well you know the nice thing with hypnosis is try it you know the worst thing that happens is it doesn't work you know i do have patients who don't respond who say thanks doc didn't work okay i can live with that um are there conditions that you see that happen more for um i would say um um um um i would say um um um um um um um um i would say um um um um um um um um um i would say um um um um I mean, regulating eating in this, in the eating environment that we're in now is sometimes difficult. But I had one guy who used reverie because he saw a picture of people at a party.

And he said, that's funny, that guys wearing the same shirt I am. And his son said, Dad, that's you. That belly is yours. You know, he wasn't facing it. And he started eating with respect for his body. He did self-hypnosis with Revery every day. He lost 33 pounds. He started walking to work in a neighboring town.

He used to be the kind of guy who would drive around the parking lot three times to get closer to the door. He stopped using his car, basically, and he's kept off the weight. So, you know, you try it. You know, if it works, it works. If it doesn't, no harm, no foul. Have you ever had a case that wasn't maybe mental health focus, but more physical, where you saw hypnosis made a big change and it shocked you? and it shocked me oh there are a lot of times when when people are surprised at what they can do

and i'm surprised at what they can do and one woman who um saw we were running a study on on using reverie for a smoking cessation and she said i don't even want to stop i smoke for 25 years i really like smoking you know but she said oh it's a study you'll pay me a little money to be in the study be in the study she first time she tried it she hated it she said ass is stupid and that night she went home and she listened to the reverie thing which was for my body smoking is a poison i need my body to live i owe my body respect and protection so she's focusing on what she's for not what she's against you don't say you won't want a cigarette that's not the issue would you do this to your baby would you do this to your dog no so your body depends on you as much as they do and she looked

it to a cigarette and she said, feh, who needs this? And she wrote me, she said, this is some kind of crazy-ass voodoo shit. She said, and I mean that in a good way. She said, and she's helping her friends stop smoking now. They can't believe it. So there is this element of surprise that I bump into with people who use it. They're surprised that it actually worked, that they could help themselves in a way they hadn't thought of before. And I just love that. I think that's so cool. You're obviously very intimately familiar with the steps of change, pre-contemplation, contemplation.

How does that, how does hypnosis kind of skip over some of these steps? Well, that's a very interesting thing you point out. And I know Dr. Prochasca who came up with that and his daughter, Jody Prachasca, is at Stanford and is a leading smoking researcher now. And in fact, it's interestingly, she's working with a different one leaf another hypnosis app to help people stop smoking so it does you're right it does you do kind of jump the line with hypnosis you know it's something

where rather than having to look step by step why you got there analyze your problem and and take small steps toward making a change you just say what if i were different you know what if instead of focusing on my urge i focused on my body and my responsibility for for it. And sometimes people can just find themselves, surprise themselves by being different. And that's one of the neatest things about hypnosis, is that it can happen very quickly and very suddenly. And if it does, great. Have you ever used hypnosis on yourself? I have. I have. You know, what's I'd say about you who is his own doctor for a patient, you know himself um i i i've used it um uh i had i was i took a terrible overnight flight to

london and had a banging headache it was just awful and i was i was kind of tired and i was thinking very well and i put my only shilling into the aspirin dispenser and it swallowed the shilling and i didn't get the ashtron and i'm bouncing on the bus into london and i think you idiot you do this for a and so I imagined a pack of ice on my head cool tingling and numb and I was as surprised as anyone else when the headache was gone I've used it also to water ski I was terrible water skier I like to ski but water skiing and I kept face planting in the water and so I just hypnotized myself before and I said arm straight knees bent arm straight because I was doing the opposite of course my knees were stiff and my arms were bent and I was water skiing you know and

Again, you know, I know this stuff, but I was surprised. So I've used it for that and for some pain issues on a recurrent dislocating shoulder, and it helped me deal with the pain. It's so interesting. There's so many aspects of psychology that people buy into, visualization, for sports psychology, you know, all of these things that are used in hypnosis quite successfully. Right. But because of the title hypnosis, I feel like you lose a lot of buy it.

Is there any movement towards changing? the title of Well, you know, I couldn't get away with it if I'm doing it. It doesn't matter what it is. It's hypnosis. Because like what you were talking about

with water skiing is it's visualization. Yeah. But, you know, Tiger Woods did it for golf. He did he hypnotized himself before every swing. He did it extremely well.

So the Chicago bills used to have a hypnosis practice every morning, you know, before they went out and did their physical practice. So Michael Jordan, you know, did self-hypnosis. Summer's here, and you can now get almost anything you need for your sunny days delivered with Uber Eats.

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It's a sweet summer twist on iced coffee. Your cold brew is ready at Starbucks. Why is the human mind so susceptible or programmable, or whichever word you choose there, to the idea of imagining and then having that imagination play out? So, you know, emotional mimicry or positional mimicry or the idea that you watch a movie and on an fMRI, it's like you're doing the same action as those people are, the same areas of your brain light up. Why does the brain do that? Well, I think it's a way of using our considerable resources. We have a big brain for creatures to anticipate and react well to stress and danger.

So if you can visualize, you know, we have a huge part of our brain. The whole occipital cortex is devoted to visual processing because that's our best sense, actually. If you want to protect yourself, you want to see what's coming at you from various sides. And to then practice or prepare for fighting or fleeing, you know, dealing with what you have to deal with. And I think we use this kind of imagination as a protective device, but also as a developmental device, to know what you need to deal with, what you should worry about, and what you shouldn't.

I work with the Stanford Women's Swimming team. They're terrific swimmers. A lot of them wind up in the Olympics. But the coach noticed that they were doing better times in practice than they were in meets. And you think, what the hell is that about? You know, I mean, your sympathetic nervous system is going. And what we found out when we talked to them was that they were being distracted by worrying about what the girls in the neighboring lanes were doing.

And what I had them do is practice swimming their best race, which meant being in total tune with your body. What does your body need to do? How does it need to do it? Swimming is not a contact sport. Like blinders, full tunnel vision. Tunnel vision. Be in touch with your body. There's a wonderful book called Zen and the Art of Archery in which an anthropologist studied.

Zen archers. And what he learned was that it's a mistake to focus on the target. The Zen teacher says if you are in a correct relationship between your body and the bow and arrow, the arrow will go where it needs to go. But if you think about it, what matters is your relationship to the bow and arrow or to your body if you're swimming, not the target. So if you're worried about whether the girl in the next lane is going to beat you, you're distracting yourself from how you manage your body. and that's one of the wonderful things your brain can do and hypnosis helps you to do is narrow your focus,

don't worry about what's going on next to you, and intensify your focus on how you make your body do its best. And so I think it's, you know, we are not the greatest physical specimens in the animal kingdom, but we have this brain that helps us make the most out of the body we have. And that means being able to plan, assess, and conduct activities

in our body in a way that is optimal. You mentioned the word Zen. I know there's a part of Buddhism where people live high in the mountains, in snowy temperatures. They can thermoregulate their bodies differently. They can feel pain differently. Is that a form of hypnosis?

I think to a certain extent it is. Yes, I think it's a way of being in tune with and to the extent you can able to regulate things that ordinarily we would, And for example, we did a study, this didn't involve Zen, but it involved an hour of self-hypnosis, first thing in the morning before anyone to eat in anything, when they took an augustatory tour of the Bay Area. They ate imaginary meals. And one woman after a half an hour said, let's stop, I'm full. And they had an 89% increase in gastric acid secretion.

So their brain was telling their body, food's coming, get ready. We then had them imagine they were on a desert island somewhere. where no food or drink, but they were comfortable and happy, 39% decrease in gastric acid secretion. And then we injected them with pentagastrin, which stimulates gastric acid secretion. We still got a 19% reduction in the amount in response to pentagin when they were just imagining

being comfortable but not eating. So the brain has a whole lot more ability to control the body than we ever give ourselves credit for. Yeah, and I feel like we're not educate, forget me as a doctor, like the general public isn't educated on the capacity of the brain in that way. Yes. Where it works both ways,

that there's ways that we can control our bodies in such positive ways, right? Like the idea of tunnel vision during sports or performance, but then there's also some negative ways. Like I see very often my patients come in with sleep tracker apps that tell me how terrible their sleeps are when they're chasing that perfect sleep

and they may have woken up feeling fine but the app tells them that they didn't and now they've implanted the idea that they're sleeping badly, and they have worse outcomes. Why isn't there, like, grade five, grade three, here's the power of your brain, here's the power of what you can get it to do. Why don't we do that as society?

Well, I think we're trying to do it, and you can have that problem with sleep trap, I know that well. But I really still think the overall problem, Mike, is our underestimation of what the brain does. not overestimation of it, that we don't view it as a tool. We're willing to say you've got to work out in the gym

three times a week, you know, if you want your muscles to work, do we ever think, if you spend 10 minutes a day focusing on how you manage your pain or your stress or getting to sleep, you will build an ability that your brain has to help you live more happily and more comfortably. Now, to some extent with mindfulness, there have been, you know,

that has taken over and calm and headspace, teach people how to how to do that. But those are not so much directed at regulating mind and body as they are just openness to experience, not creating struggles you don't need, letting feelings and thoughts flow through you. That's a good thing. And I think it builds a kind of wisdom. But we don't view it as a tool the way would, you know, a physical workout. I call it a work in with hypnosis, that you can work in with your brain and figure out very quickly what you can do to make your body and your mind more comfortable. And I wish we spent just, you know, 20% of the time

we spend on physically making our bodies better, on mentally making our bodies better, and reverie's a good example. Yeah, it's so interesting to see how the world of, the transition of the world from your pain is in your mind, rub some dirt in it, full on, like this almost toxic mentality, to now you're not in control of what your brain

does, you need, only this medication can help, and the pendulum has swung so far. I've definitely seen that pattern arise in my patients. Have you seen that in yours or? Yeah, although I think more and more, now I started in 1998, the Center for Integrative Medicine at Stanford, and so I tend to see a lot of patients whose first sentence to me is,

I want help of this, I don't want meds, you know, so show me what else to do. And so more and more people, I think, are looking for alternatives to medication, to deal with common problems like pain and anxiety and insomnia, which is a good thing. Yeah. But I think we still haven't kind of got the idea

that there's a lot you can do in a relatively short time to improve the way you're managing your body. You know, it's sort of like management training for your body, you know. We understand that for businesses. We don't understand it for the way we manage our own bodies. Take me through the idea of like what integrative medicine is.

Integrative medicine is basically trying to utilize the kind of interventions, non-pharmacological interventions by and large, that can be helpful for problems like pain, acupuncture, for example, can be useful for problems like anxiety or insomnia, habit control, dealing with not just smoking, but alcohol, vaping, other problems that people have. and just do something that will help me better manage this situation that doesn't involve medication. I had a doctor on a psychologist just two weeks ago. He is a big proponent of the idea of alternative medicine not being real medicine,

that it's taking certain foundations or liberties that aren't evidence-based and putting it into modern medicine and kind of mixing it up. Do you feel that at all happening? Well, I don't like the term alternative medicine because I don't recommend, I'm a physician, I prescribe meds, I don't recommend that people do, you know, get cancer treatment

that's an alternative to standard care. So that's why the term, the National Center, which used to be for alternative and complementary medicine, now NCCIH, the idea is that in addition to what you would do with standard care, you use other techniques that can supplement and help with that. And that's a good idea, and that's what I do.

And so I'm not in favor of literally alternative medicine. I am in favor of complementary and integrative health. How does hypnosis end in integrative or complementary medicine when it feels like it's so evidence-based? Well, because it is not in the sort of, the collection of what we consider to be standard legitimate treatments in regular medicine, which is incision injection and just... But CBT and DBT are.

You wouldn't call those complementary or integrative? No, that's true. And for some reason, because they're often long and arduous, maybe they're more likely to seem like something you have to do for regular medicine. but it's also more clearly classified in the psychotherapy domain. And so it does complement medical care, because it clearly is not something that's meant to, it's meant to help you better cope with disease-related stressors that you have.

Whereas hypnosis is somewhere in the middle where we're saying, you know what, you can really change that pain experience and get yourself off pain meds. You can get yourself off sleeping pills. get yourself off anti-anxiety drugs. So in a way, we're in trouble because we are in some ways saying try this instead of that.

Whereas I think CBT is often seen more as a supplement to, although now I just saw a very good article under review saying, look, the first step for insomnia should be CBTI. And I do that with my patients. I say, you know, your bedroom is a place for for pleasure and sleep, nothing else, don't work in your bedroom,

don't look at what time it is when you wake up at 3 in the morning because you just wake yourself up. So I do some of that too. So there are places where it is becoming a part of standard medical care. That's a good thing, but that's been a struggle too. Still, most people think,

if they're having trouble sleeping, give me a pill. And CBTI is a very good alternative. So, you know, we tend to confound how we define a treatment with the nature of certain types of treatment. And there's still, I think, is a prejudice for CBT2. It's widely accepted, but it's still,

many people don't think of it as a medical treatment. Yeah. Yeah, from the general public perspective, for sure. Academic, obviously, a different story. The concept of this complementary medicine, like acupuncture, for example, I tend to take a skeptical stance on a lot of treatments that I don't see

very clear-cut evidence-based support for. Like the idea of supplementing all these miracle cure formulas that are in the market. You walk into any pharmacy. It's like there's a cure for everything and yet there's a cure for nothing. So I'm very skeptical.

I'm very skeptical about acupuncture. But at the same time, I had a shoulder injury many years. Shoulder wasn't working well, constant pain. Did acupuncture one session at the behest of a pain management special who's an MD, and after one session, my pain never came back.

And being someone that's so skeptical, not understanding the pathophysiology of what's happening, what is the mechanism of action here, I'm confused that how that worked, and also confused that even though we have some controlled studies of like sham acupuncture where the needle's not really going in, where the patient might not know, I don't see great evidence-based support for it.

But then we do still recommend it at times. Where do you fall on that spectrum? Well, you know, acupuncture, there have been some studies that show that acupuncture analgesia is blocked in reverse with naloxone. So you give an opioid antagonist, and it doesn't work as well. So we have lots of opioid receptors in our brain and our bodies, and it makes sense that acupuncture may stimulate endogenous opioids. That's what that kind of study would tend to indicate.

So it's not all that implausible to me. And it also, you know, to the extent that anxiety and frustration, complicate the course of a painful injury if you can just be doing something that gives you the impression and there was one very good acupuncture study out of Harvard where they had two kinds of acupuncture for real administered pain

and no and they had yeah one kind was you know very supportive warm I'm sorry you're suffering with this you know the long conversation while the acupuncture is going on and the other one was just you know the caricature of an abrupt surgeon You know, just lie there and be quiet

and don't interrupt me and I'll fix you, you know. And they got much more analgesia from the kindly acupuncturist than from that one. And so, look, you know, you can't isolate our brains from our bodies. And so every treatment we do has a mental component to it

as well as a physical component and the nature of both will likely have an effect on the outcome and that's not such a mystery. Yeah, because, you know, in seeing how other acupuncture providers do it, they'll talk about energy levels and like your chi and centering it and there's like Reiki

in some of these places that's being done. I mean, there that's where I get lost. And I start understanding that it's probably a combination of placebo effect plus that warmth that's lost in everyday medicine where the more touch points you have with a provider who you have a good connection with, the better your outcome is going to be,

regardless of their training, whether or not they're a therapist, a social worker, a psychologist, psychiatrist. If you bond and they care, you will have better outcomes than if they don't. You know, that's kind of comfort, and it starts with, you know, how does a mother comfort an injured child?

She hugs them and soothes him. And so if your brain gets into a frame of mind where whatever the injury is, I'll feel better about it if I'm getting soothed and comforted. And that will change the actual, experience of pain. And so it makes sense that some elements of that primal sense of being comforted and soothed would have an effect even when you're a grown-up and dealing with it. But, you know,

it's not like, you know, suddenly you're cut off from the neck up and it's just stuff that's happening to your body. So that makes perfect sense to me, you know, that the combination of the two would have a kind of combining effect. I will end, however, there was one very good study on placebo versus hypnotic analgesia. And so it was a cold old press or task, candid circulating ice water, so you knew how much pain they were getting by what the temperature was. For low hypnotizable people,

the placebo and the hypnotic allergies were exactly the same. For high hypnotizables, they got much more pain relief from hypnotic analgesia than from placebo. So hypnosis adds something to the placebo effect. If they're hypnotizable. If they're hypnotizable. Right.

What's one question about this field that you wish people ask you that no one asks. That's a great question. I wish they would ask me, what is the underlying assumption that makes hypnotic analgesia, for example, plausible? That it makes sense, it's not, why does it happen, but why wouldn't it happen?

That's the kind of question I would like. That makes sense because you described it so well with the default mode network and how the brain process is pain sensory information. Well, and there's one other part that I haven't talked about, and that is one thing we saw very clearly using functional MRI, high and low hypnotizable people in and out of hypnosis, is you turn down activity in the dorsal anterior cingulate.

That's the part of the brain that's the keynote of the salience network. So when you hear a siren like we're hearing outside there now, the salience network said, oh, that could be trouble, pay attention to that. In hypnosis, you turn down activity in that region. You just stop worrying about other possibilities. It allows you to immerse yourself in the experience. And so there are plausible neurobiological reasons why techniques like hypnosis should work.

They literally help your brain shut it down. And that part of the brain is full of GABA, gamma-amino-buteric acid, inhibitory neurotransmitters that are stimulated by benzodiazepines. People who are more hypnotizable have higher levels of GABA in the dorsal ACC. And so it makes sense that you can, can be your own little pharmacy internally and soothe yourself.

Which is why therapy, when we talk about it, is all I have to take a medication to change the chemicals in my brain. Well, no, you can actually change it through function. Exactly right. That's why I think hypnosis is interesting in that it's a combination of so many principles, visualization, mindfulness of being in the moment. It's kind of like all wrapped together in one and trying to make it valuable. Just, I feel like the notion of the word is definitely troubling for some.

And I see, actually, I don't know how I went this. Bankmore on course when you switch to a Scotia Bank banking package. Learn more at scotiabank.com slash banking packages. Conditions apply. Scotia Bank, you're richer than you think. When I found out my friend got a great deal on a wool coat from winners, I started wondering. Is every fabulous item I see from winners? Like that woman over there with the designer jeans.

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Stop wondering. Start winning. Winners, find fabulous for less. Far without asking you, how does one become so interested? I'm assuming it's family-based. But how did you fall in love with studying hypnosis? Well, yes, doctor, you're right. It's sort of a genetic illness in my family.

Both of my parents were psychiatrists and psychoanalysts here in New York. And my father, during his training analysis, the analyst one day actually said something. He said, Herb, would you like to learn hypnosis? My father said, what did I say? Well, there was a Viennese refugee named Gustavannberg, who had a Schofenberg, who had to escape the Nazis from Vienna. He was a forensic psychiatrist. He had a smallpox score in the middle of his forehead. And he noticed that some of these prisoners he'd interview would suddenly just sort of nod off and act differently. And he realized they were being hypnotized

that he hadn't initially intended that. So he taught army docs to use hypnosis. My father used it in combat in North Africa to help with pain control when people were wounded to deal with combat stress reactions. And he came back here and initially went back to his analytic trading but eventually found that he was doing more good for some of his patients with a few sessions of hypnosis than with three times a week on the couch psychoanalysis. So he shifted his practice more and more to hypnosis. And the dinner table conversations were interesting. And I took a hypnosis course in medical school to see if I wanted to do it. And I, you know, I found it remarkably effective. My first patient was in children's hospital in Boston.

And then the nurse says, Spiegel, your next admissions is an asthmatic in room 375. And I followed the sound of the wheezing down the hall. And there's this pretty 15-year-old girl, Knuckles White, struggling for breath. Third admission in three months for status asthmaticus, unresponsed to subcutaneous epinephrine. Mother's standing there crying. I didn't know what to do.

So, but I take in the course. So I said, you want to learn a breathing exercise? And she nods. So I get her hypnotized. And then I think, oh, my God, we haven't gotten to asthma in the course. What do I tell her? so I came up with something very clever I said each breath you take

will be a little deeper and a little easier and within 15 minutes she's lying back in bed she isn't wheezing anymore her knuckles aren't white her mother stopped crying the nurse ran out of the room

my intern comes looking at you weren't afraid that she was fatiguing and needed to be updated in retrospect but she was she was breathing and I couldn't hear the wheezing anymore that was you didn't need a stethoscope you know and and the intern says

I thought he was going to pat me on the back and say, what did you do? He said, the nurse has filed a complaint with a nursing supervisor that you violated Massachusetts law by hypnotizing a minor without parental consent. Now, Massachusetts has a lot of weird laws. That is not one of them. Her mother was standing right next to me.

He said, so you're going to have to stop doing it? And I said, why? He said, it's dangerous. I said, well, you were about to give her general anesthesia and put her on steroids, and by talking to her is dangerous? I don't think so. So take me off the case if you want. So he stomps off the room.

there was a council of war with the resident, the chief resident, the attending, and they came back with a radical idea for Children's Hospital. They said, why don't we ask the patients? And she said, oh, I like this. So she kept doing it. She had one subsequent hospitalization, but went on to study to be a respiratory therapist. And I thought that anything that can help a patient, I mean, right in front of our eyes, faster than most medications would work. And violated non-existent law in Massachusetts had to be worth looking into. So I've been doing it ever since. So you think that there was some kind of effect regulating smooth muscle contraction and inflammation?

Yeah, eventually inflammation. I think that doesn't happen that fast, but certainly autonomic regulation. I think she was, you know, reducing her sympathetic outflow, which could have been, you know, complicating the stricter of her bronchie and some parasympathetic act. as well to just help soothe her because the minute you know the minute it starts to happen people with asthma panic you know they think oh my god i'm not going to be able to breathe it's a horrible thing you feel like you're suffocating and the more anxious they get the worse it gets right conversely if you show her a way in which you can make yourself you she starts to feel

hey you know i'm feeling a little better it breaks that vicious cycle the mind-body interaction that's a big problem with stress and what we do in reverie is teach people start with your body up, get your body comfortable, and then deal with the thing that's making you anxious, because the physical hyperarousal only confirms what your worst fear, that something terrible is going on. So there's no reason why that can't work in reverse, too. You start to feel better. You think, oh, okay, and you can reduce that sympathetic activation that's making the problem worse.

I mean, it's so interesting. I wish you would look at some of the osteopathic curriculum, because so much of what we talk about is this subject. In fact, from one of my main talking points when I give patients counseling on low back pain, for example, if I do a full physical exam and I see that there's no serious injury where they have harm to themselves from just walking around, very commonly a patient will get up in a guarded state, expecting the pain, basically having the volume at full blast, trying to feel the pain as quickly as it can. And they're almost prepping themselves for it. Whereas I'm like, stand up, and if you feel the pain, say,

ouch, and move on, but there is no point expecting it, and you're not actually guarding anything because you're not going to throw out your back by making a slight movement. You're young, you're healthy, there's no serious injury here. And that can break the pain cycle in the same way that you're modulating the sympathetic activity. Well, you see, you're a hypnotist and you don't know what this.

It sounds like all doctors are hypnotists and don't know it. The good ones are there. Yeah, for sure. So that was where you fell in love with. Yeah, I just feel. It would be right in front of my eyes. You know, and I, you know, that my father did it was something of an obstacle,

but I learned a lot from talking to him about it. And I eventually taught in his course at Columbia on hypnosis. But yeah, it was, it was just proving to myself that this thing really works. When you misbehaved, did your father try to throw a little hypnosis your way? I don't think so. What, since you started in the early days, for your young days,

when doing hypnosis, what is one thing that stands out that changed in your understanding of the field? Or you changed your mind on? Well, I was impressed by the fact that we could show, you know, for years we were showing that it worked, but I wanted to know how it worked. And I think a turning point in two ways came when in the 19, in the, in the,

about 10 years ago, we published several papers showing what's happening in the brain, that your inverse functional connectivity between the DLPFC and the PCC, reduced activity in the dorsal anterior cingulate, and hyper-connectivity between the prefrontal cortex and the insula, the mind-body pathway in the brain. I said, okay, we have a pretty good idea how it works. This isn't just magic and smoke and mirrors. We can see what's happening in the brain, and it all makes sense.

and but my the other turning point was you know enough you know we've got evidence that it works it's safer and and often as effective or more effective than things that have significant side effects that are habituating where you have withdrawal hyperalgesia from opioids for example and it's not being used and I just I got to a point where I've just thought you know I can't do this forever and I can't wait forever for people to kind of get it that this is a scientifically proven effective treatment so I I'm going to do everything I can to make it available to anyone. Download Reverie, Mike 20, you'll get a discount on the app, and give it a try.

Because I just, I got tired of waiting. You know, I just thought, you know, be a good Boy Scout, just keep doing the right things, and people will come around. And as you said, there is resistance to the name. I can't do anything about that. But what I can do is try and change it and say, okay, you think it's this, but it's really that. Give it a try. what do you think the next future breakthrough in psychology will be well i think there are a couple things

there are some really interesting breakthroughs now my colleague nolan williams at stanford is using transcranial magnetic stimulation highly effective treatment for depression um where you stimulate the sad node um in the in the singular another part of the singular the subgenual singulate cortex. And it is proving remarkably effective in reversing depression quickly and even suicidal ideation quickly, you know, like within hours to days rather than, you know, the month that an antidepressant typically takes. We're using it to increase hypnotizability, actually. We have some evidence that it works for that. I've even seen some of these tools for chronic insomnia. Yes. Where there's some FDA approved ones that just came out not so long ago.

I thought that was pretty interesting. Have you seen successes with those? I have not seen it with that, but I think it makes perfect sense to me. What you're doing is autonomic re-regulation. You know, you want to decrease sympathetic arousal, increase parasympathetic, you know, the rest and digest component of the autonomic nervous system. It would make perfect sense to me that it would. I think the other thing that's really interesting now is psychedelics. You know, there was just a paper in nature with some of the leading

and functional neuroimagers showing that if they have, they take a psychedelic, and they get disorganization of the posterior cingulate cortex. So it's as though you're kind of taking the pieces apart and rewiring. Neurons that fire together, wire together. And the fascinating thing about psychedelics like psilocybin for dying cancer patients is it's just one or two sessions, and they're different after that. So, you know, the typical model in psychopharmacology is just occupy the receptor along. As long as you do, you'll get the effect.

And this is different, saying you just take a, a couple of times and get some supportive therapy as well and your view of your dying is has been changed you are a different person and i think what we get with hypnosis is a is a lighter version of that it's a suspension of who you are and this is a kind of dissolution of who you think you are and so i think that's a new direction in in psychopharmacology and in psychotherapy of thinking about how we are more flexible as people than we give ourselves credit for and if you know how to change in are willing to, you can in a hurry. Yeah, I think that cognitive flexibility

has been shown to be very valuable for not just problem solving, but resilience after a traumatic episode. You know, I had Dr. George Bernano here talk about the resilience trajectory and how interesting that is. Oh, speaking of that, controversial question perhaps,

but do you think the body keeps the score? Yes, oh, my friend, Bessel van der Kohl, we were residency mates. Oh, really? Oh, really? Yeah. Wow, okay. I've known him for a long time.

Yeah, I think it does. does. I think he's absolutely right. Where do you think that is? Well, you know, I think it's in, likely in the amygdala, it's in the, I think in the interior singular part of what fires off this aliens network is your accumulated recollection of things that pose a threat. And so I think there are these psychophysiological pathways that involve the autonomic nervous system, the glucocorticoid system, you know, the adrenal medulla and cortex regulate our major hormonal regulators of arousal, and it makes sense that

they're connected to parts of the brain that trigger and sense arousal. And so it makes perfect sense to me that when you have been flooded with serious threats to your body safety, your brain would learn and remember it and activate as though you were going to be attacked again. And that's part of why exposure therapy works, I think. Right. I mean, that nervous system hyper-excitability post several aces or adverse childhood events absolutely makes sense. The reason I brought up is because Dr. Bonanno pointed out that while that's true,

the excitability of after having all of these traumas, the idea that you would forget said trauma and the body would remember it to him didn't add up. Does that make sense? Yeah, I think he's wrong. You know, the brain is a keeper of information, but one thing that's important for survival is even if you have been traumatized, and God knows our ancestors were, well, our current humans are as well, if you could not regulate your response to severe threat, you would be in more danger for succumbing to subsequent threats. you know you it needs it needs to be accurate you know you need to be alarmed when there's a real threat to your health and safety but not when there isn't and the fact that it's an overwhelming signal means that the brain probably has to either you know lose itself in response to it or perhaps

oversuppress your reaction to it but if you know if you consider the kinds of trauma that people have gone to every day in this planet you know in the last few years um their brains have to have ways of not living in that misery all the time or they couldn't function. So if the brain in order to do that has to under-modulated times when you ought to be scared or over-modulated times when you really need to think about other things, day-to-day things,

that makes perfect sense to me. So it's not, like the idea of active repression to me makes sense, right? You're trying to suppress the thoughts because you don't wanna feel it. But the idea that your brain automatically does it is also feasible? Well, yes.

And in fact, there have been studies that show that the inability to recall traumatic events starts with a deliberate attempt to suppress thinking about it. So you start the thing actively and then it becomes passive? Right. And the brain says, okay, I got the message. All right, enough. It becomes automatic. And that's just efficient use of computational resources.

Have you ever gotten in the academic space any criticism of your work? Oh, never, nobody does it? Sure. What do they say? Henry Kissinger said the reason academics fight so bitterly is that the stakes are so low. But sure, I published a study in the Lancet in 1989, randomized clinical trials showing that women, given weekly supportive expressive group therapy for advancing cancer,

lived 18 months longer than controls. And there were all kinds of people that couldn't possibly believe that. It was a widely cited article that still is. but there are some people that just couldn't believe that that was possible. And they said it was one or two outliers. Well, it was not, you know, it was a huge effect. And there have been, we've just finished another meta-analysis showing that psychosocial support affects survival.

And there are people that couldn't stand the idea and thought I had to be wrong. But there was an article in the Journal of Clinical Oncology with like 700,000 patients in the U.S. followed over five years showing that being married, extends overall survival four months on average. And they noted... If it's a happy marriage. Overall, you have to take the bad ones too. Interesting, it helped men more than women.

Being married was better for men than it was for women, which I consider... I could see the health advocacy aspect of it. And they commented in the abstract that that's about the overall average length of survival enhancement from chemotherapy. So it's not minor. So we're psychosocial creatures and effects to our psychological and social environment has an effect

on survival. So I took a lot of heat for that. Yeah. But that's all right. Well, you know, whenever there's a trailblazer, there's always naysayers. Yeah, I've noticed. Well, I appreciate your work. Thank you so much for making the time for chatting with us.

I think there's going to be a lot of value to the audience from your words. I hope so. Well, it's been a fascinating interview. Thank you for doing it. Huge thank you to Dr. Spiegel for traveling to New York, for this interview all the way from Northern California. I was fairly undereducated on the medical application of hypnosis coming into this combo.

And I hope we're able to study it more because it's really interesting. I've linked some more information about him below if you wanna learn more. And if you enjoyed this episode, please send us some love by giving us a five-star review as it's one of the best ways to help the show find a new audience.

And if you're looking for something else to watch, might I recommend my recent interview with Brian Johnson, who is trying to become the longest living person of all time. Question a lot of his tactics, and I think you'll find it pretty interesting. As always, stay happy and healthy.