The Food Medic - S10 EP2 How hypnosis can help with healthy habit formation.

Episode Date: October 8, 2023

In this episode Dr Hazel is joined by Dr. David Spiegel, Reveri's Co-Founder and Chief Scientific Officer. Dr Spiegel is a psychiatrist with more than 45 years of clinical and research experience studying stress, pain, sleep and hypnosis. He has written thirteen books, 404 scientific journal articles and 170 book chapters. He was educated at Harvard and Yale and now works at Stanford. This episode covers: What is hypnosis and how does it differ from stage hypnosis? What happens in the brain when we are hypnotized How some people are more hypnotizable than others The use of hypnosis in pain management The use of hypnosis with smoking and vaping cessation How we use hypnosis to support health behaviours and positive habits Cautions and limitations of hypnosis To find out more about Reveri, please visit https://www.reveri.com/Please note: it is not advisable to use hypnosis if you have psychosis or certain types of personality disorder, as it could make your condition worse.In the UK, hypnotherapists do not have to have any specific training by law. This means hypnotherapy can be offered by people with little training who are not health professionals. When looking for a private hypnotherapist please choose someone with a healthcare background – such as a doctor, psychologist or counsellor and check they're registered with an organisation that's accredited by the Professional Standards Authority Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hello, and welcome back to the Food Medic podcast. I'm your host, as always, Dr. Hazel. Today I'm joined by Stanford professor and Reverie's co-founder and chief scientific officer, Dr. David Spiegel. Dr. Spiegel is a psychiatrist with more than 45 years of clinical and research experience, studying stress, pain, sleep and hypnosis. He has written 13 books, 404 scientific journal articles and 170 book chapters. He was educated at Harvard and Yale and now works at Stanford. In this episode we discuss hypnosis which is a psychological procedure that can help to change how you feel and act and has several clinical uses. It's important for me to flag before the episode that it may not be suitable for everyone

and is not advisable if you have psychosis or certain types of personality disorder as it could make your condition worse. I ask that you approach this episode with an open mind and look forward to hearing your thoughts afterwards. Without further ado, here's Dr. Spiegel. Well, Dr. Spiegel, thank you for joining me this morning on the Food Medical Podcast. It's great to have you in the studio virtually. Thank you. I'm virtually happy to be here. For those of our listeners who don't know who you are, it would be great to start there if you could let us know a little bit more about you and your background and what got you interested in hypnosis and psychiatry as a whole. Sure. Well, psychiatry is something of a genetic illness in my family. Both of my parents were psychiatrists and psychoanalysts. And so they told me that I was free to be any kind of psychiatrist I wanted to be. And here I am. The dinner table conversations were

pretty interesting and my father got introduced to hypnosis when he went off to World War II actually. A Viennese psychiatrist who had escaped from Europe came here and he had learned hypnosis as a forensic psychiatrist. He had a smallpox scar in the middle of his forehead, and he noticed that prisoners he was interviewing would suddenly kind of lean their heads over and seem to drift off. And so he studied hypnosis and taught it, and my father learned to use it for pain control

and combat stress in World War II. So we would talk about that, and I got to watch him making videos of patients having hysterical seizure disorders and treating them with hypnosis. So when I got to medical school, I took a hypnosis course. I figured I got to learn more about this. And my first patient, which is now the first of about 7,000 that I've treated, was a young girl, 15 years old. The nurse said, Spiegel, your patient's down the hall. I could follow the sound of the wheezing down the hall.

She's a pretty 15-year-old redhead, bolt upright in bed, knuckles white, struggling for breath. Her mother's standing there crying. Nurse is in the room. I didn't know what to do because they had tried subcutaneous epinephrine twice. It hadn't worked. They were thinking about general anesthesia and steroids. And I said, would you like to learn a breathing exercise? And she nodded.

And so I got her hypnotized. And then I thought, oh, great. I haven't gotten to asthma in the course yet. What do I say? So I said to her, each breath you take will be a little deeper and a little easier. And within five minutes, to everybody's amazement, mine included, she's lying back in bed. Knuckles aren't white. She's breathing normally. Her mother stopped crying. The nurse ran out of the room. My intern came looking for me, and I thought he was going to pat me on the back

and say, what on earth did you do? Instead, he said, the nurse has filed a complaint with the nursing supervisor that you violated Massachusetts law by hypnotizing a minor without parental consent. Now, Massachusetts has a lot of strange laws, but that's not one of them. And her mother was standing next to me when I did it. She said, well, you're going to have to stop doing this. And this is the story, Hazel, with hypnosis, that either people think it's ridiculous, it's a stage show trick, or it's dangerous, or both, but they never seem to get it right. And so I said, well, I'll tell you what, you can take me off the case if you want, but as long as she's my patient, I'm not going to tell her something I know is not true. We just watched her get better. And so he stormed out of the room. And over the weekend, there was a council of war with the attending physician and the chief

resident. And they came back on Monday with a radical idea. It had never been tried before at Children's Hospital. They said, let's ask the patient. And she said, oh, I like this. So she kept doing it. She was hospitalized monthly for three months up to that point, had one subsequent re-hospitalization, and went on to study to be a respiratory therapist. And I thought that anything that could help a patient that much, that fast, violate a non-existent law in Massachusetts and frustrate the head nurse had to be worth looking into. And I've been doing it ever since. And just watching, Hazel, how patients can take hold of their own situation and reconnect to their bodies and themselves suddenly in a very different way is something that I've spent my career studying. Yeah, it's so fascinating listening to that story. And I think what you raise in terms of people's, how they perceive what hypnosis

is and misconceptions around hypnosis, I think still exists today. And I would love to start there with what is hypnosis and what isn't it? Because you did mention stage hypnosis, and I think that's the first thing that comes to many people's mind when they think of that word. Yeah, unfortunately, a lot of people have seen somebody get the football coach dance like a ballerina or fuck like a chicken or something. And it creates the false impression that hypnosis is a loss of control. It's actually a gain of control. All hypnosis is really self hypnosis. And it's just a state, Hazel, of naturally focused attention, like getting so caught up in a good movie that you forget you're watching a movie and enter the imagined world.

It's narrowing the focus of attention, like looking through the telephoto lens of a camera. What you see, you see with great detail, but you're less aware of the context of the surroundings. Hopefully you're so interested now that you're not aware of the chair you're sitting in or your body touching the chair. You're focusing your attention on engaging in the center of what you're attending to. You dissociate or put outside of conscious awareness things that would ordinarily be in consciousness. And the third part that in many ways is most interesting

from the point of view of changing behavior is you become cognitively more flexible. You disconnect from using parts of the brain that have you wondering, what am I like? Who am I? What do people think of me? You're freeing yourself up to be a slightly different person, to try out being different and see what happens. So this girl in the bed was scared to death. She was struggling for breath. She felt more and more trapped. And suddenly, she was able to say, well, you know what? I could try managing my body differently, not fighting the struggle to breath, but allowing myself to breathe. And I could actually be

different. I could breathe differently. So it's this combination of intense focus, putting outside of awareness things that are peripheral, and being open and flexible to being different. And that's a tremendous opportunity for therapeutic change. And what exactly is happening in the brain when someone is being hypnotized? So we've put people in the functional MRI scanner. Magnetic resonance imaging is a very powerful way of studying changes in blood oxygenation. So that's also changes in where the brain is especially active and giving you beautiful pictures of brain anatomy as well. So you know exactly where it's happening. And we took a group of very highly hypnotizable students and a group of very

low hypnotizable students, hypnotized them. We put them in the scanner and we told them to imagine either a happy vacation they'd been on or just being in a situation that put you in a really good mood and compared that with low-hypnotizable trying to do the same thing. And we saw three things that were different in the brain. The first was turning down activity in the anterior cingulate cortex. It's a part of the brain, there's like a part of the brain

that's like a C on its edge in the middle of the brain, and it's called the salience network. The front part of it is our alarm system. It does pattern matching. And so if suddenly you hear a loud noise outside and you turn your head and see what's going on, that's your salience network saying, look out, there's something going on. You better do something about it.

If you turn down activity in that area, you're freer to fully and intensely engage in whatever it is you want to focus on. And that makes sense. That's what you do in hypnosis. The second thing is you increase connectivity between the executive control region in the upper left part of the brain and the insula, which is a little, it's Latin for island, it's a little part in the middle of the brain that connects your brain with your body. So it's a way of sending signals to the body to control what it's doing and receiving information from the body. We call it interoception, being aware of what's happening in your body.

So hypnosis is a great state for brain-body control, behavior control, and understanding what's happening in your body and how to manage it. The third part is you disconnect while you're in the hypnotic state between the executive control network and the back part of the cingulate cortex, which we call the default mode. It's a part of the brain where you think about who you are when you're just ruminating about who you are. You're not engaged in a task. You're just thinking about what kind of a person you are. And you're wondering, what do people think of me? How do they perceive me? And if you disconnect from are and you're wondering what do people think of me how would how do they perceive

me and if you disconnect from that you're freer to be different to be a different person to try it out you know it's what good actors do when they're acting they don't they don't say now this guy this person would say this at this moment they're saying i'm just going to be him i'm going to see what it's like to be him instead of me. And that's what's called the method in acting. So if you can do that, you can try out being a different person, handling, managing your body differently. And those are the three things that happen in the brain when you go into a state of hypnosis. And it means that literally when we use other methods like EEG

to study how people process pain, they literally can reduce pain signals in the brain. The strain and pain lies mainly in the brain. You can literally change how much pain you feel using these components of the brain. You mentioned low and high hypnotizability. Does that mean that only certain people can tap into this and some people can't? Well, everybody can use the approach that we use, for example, on Reverie on our hypnosis app, but there are different ways you use it. So hypnotizability is a very stable trait in adult life. It's as stable as IQ when you're an adult. It's strange but true. Most children, however, most eight-year-olds are in trances most of the time.

You know, work and play are all the same thing. They're totally absorbed in whatever it is they're doing. Gradually, and I think it's a brain feature that allows children to do what they must do, which is fill that empty brain of theirs, you know, learn a whole lot of things. And so learning is a totally absorbing and engaging task. As we get older and through adolescence, we start to think logically more than experientially. So you think about what things should be because this is what logic tells you

more than just what I'm feeling and experiencing now. Some people have less ability to continue that hypnotic mode that they all had when they were children. We've noticed, for example, that if you want to learn a language, the time to do it is when you're seven years old because you'll emerge speaking fluently with a perfect accent. And those of us who have tried to acquire languages, for me it was French. If I'm older, I can speak it, but the accent isn't that good, and I'm always making silly mistakes when I say it. So people in adult life can, to varying degrees, tap into this hypnotic state.

There's a group of the upper quarter who are, we call them feelings-first people, that they're highly hypnotizable. They just lose themselves in things naturally. And it's easy for them to slip into an hypnotic state and just get it and go with it. People in the middle, and that's about half the adult population, we call head and heart. There are people who combine engagement with then stepping back and thinking about it, reflecting, does this make sense? Yes, I'll go with it. If not, maybe I won't. But they can get deeply engaged in situations. There's about 20% who are on the low side, and we call them practice makes perfect people, that they've got to work at it more. But we always combine, on reverie and in my practice, the state of hypnosis with an approach that emphasizes focusing on what you're for

rather than fighting it. We people who use hypnosis always say, the dumbest thing you can tell somebody is don't think about purple elephants. Or I tell myself, don't think about that nice purple image behind you. What do I think about? I think about purple. Instead, you focus on what you're for. And so part of what makes people able to change behavior, to change the way they eat,

to deal with problems like smoking or vaping, or eating better, is the way you approach the problem, not simply being in the state of hypnosis. That's sort of the icing on the cake. It makes it easier and faster for some people, but anybody can benefit from this kind of approach to dealing with behavior and problem solving. Yeah. And I mean, you've mentioned a few uses, even in the case of that young girl with having an asthma attack and also pain management. What are some other clinical uses that you yourself have used hypnosis for? Well, we've used it a lot for habit control. And as an example of the hypnotized ability, we had a woman who just told us at a community

meeting with Reverie that her score was two out of 10. She was low. She was on the practice makes perfect side. But she stopped smoking. She surprised herself. That's one of the coolest things about it. Not only do people change, but they're surprised by it. I had a woman who was a social worker who smoked for 25 years she didn't even want to stop smoking but she saw an ad for a study we were doing and she came in and she said I don't think I like this the what we do with smoking is we have people go into a self-hypnotic state and tell themselves to think of their body as if it were their baby. So for my body, smoking is a poison. I need my body to live.

I owe my body respect and protection. So I told her to focus on what she was for, respecting and protecting her body, rather than fighting smoking. Tell yourself don't smoke. You know, there used to be signs on the highway, are you dying for a smoke? And people would think yes, and they would light up. I mean, they didn't get the cleverness of it.

So the second time, she went home that night, and she lit up a cigarette, and she looked at it, and she said, who needs this? And she hasn't had a cigarette since. And she was amazed. She said, my friends can't believe it. You're always giving out cigarettes. You never wanted to stop smoking. And she said, you know, Dr. Spiegel, this is some kind of crazy-ass voodoo shit, and I mean that in a good way. So she was able to just adopt a different point of view. It isn't about the urge to smoke. I saw a nice gentleman yesterday in my office who's been trying for decades and who has heart disease and respiratory problems,

and his wife just had a part of her lung removed for lung cancer, and he hadn't been able to stop. And I said, this is not about struggling. It's not about fighting urges. It's about focusing on what you're for, respecting and protecting your body. For my smoking is a poison I need my body to live I owe my body respect and protection and by the end of the the session he had two comments one he really liked the chair I have a very nice comfortable chair for people with this and he said the other thing is I actually feel good he said I don't feel bad I don't feel like I'm going to deprive myself I feel good and I don I don't feel good in the offices of many doctors. So thank you for making me feel good. So you can focus on what you're for. So that's

another example. And we do the same kind of thing with vaping. And I heard your podcast on vaping, and you're absolutely right that it's not as bad as inhaling tar and nicotine and smoke but it ain't good and and so um and it can do damage to the lung and so um it's a way of helping people focus on respecting and protecting their bodies yeah i think making and breaking making good habits and breaking bad habits is something that we talk about a lot on this podcast on the platform, The Food Medic. And there's, you know, I'm sure a lot of people listening who want to give up smoking, want to give up vaping. Now, vaping is hugely popular in the UK and I think also where you are as well, especially with young people. And I think like a lot of people adopted it and now are backtracking and wanting to stop.

That's right. For those people, I know you have your app Reverie. Yes. Can they do that themselves? Do they work through a process? Is it a program? Is it a daily practice? So thanks for asking that.

The Reverie, what happened was about four years ago, I was giving a talk on hypnosis at a brain-body summit in Stanford, and this guy, Ariel Poehler, came up to me. He was an MIT grad and Stanford Business School grad and had started, helped to start Strava, which is a terrific exercise app. And he said, you want to try and make an app? And I said, you know, if you're a Stanford professor, you have to have a startup or something, you know. So I said, sure, let's try it. And we used

the Amazon Alexa platform, which at the time was easy to use. And we did the smoking app, the way we talked about it. And I've used it for that and for pain. And we thought, let's see if it works. And we found that one out of five people stopped smoking, using it, which I wish it were higher, but it's as good or better than many of the medications that are used to help people stop smoking. And people can have it anytime they want. So the deal is I wanted to make it as much like being in the office with me as I could. So this means it's interactive. It's not just listen to a dull recording. There are a lot of those people don't listen. It's interactive. It's not just listen to a dull recording. There are a lot of those. People don't listen.

It's an interaction where I give an instruction, is your body floating now, or is your hand floating up in the air? If it is, I give them one instruction. If it isn't, and they say, no, it's not, then I give them a different instruction. So it's as much as I could make it like being in the office with me as possible. And so any time you want, you can just turn on that part of the app. We have it for smoking control, for pain control, to help people eat more sensibly and enjoy eating more while eating in a way that's respectful of their bodies. We have people use it to deal with fear of flying, to get to sleep. It's one of our most popular apps, people to get to sleep or get back to sleep.

You know, I used to worry that it wouldn't be nearly as good as being in the office with me. But then I realized that if you wake up at 3 in the morning and can't go to sleep, hopefully I'm not there in your bedroom hypnotizing you back to sleep, but you can hear my voice and you can hear me doing any. So I'm with you whenever you need it, wherever you need it, as long as you have your smartphone. And so it's something that each exercise, we have little one minute refreshers, but we eat standard exercises about 11 to 13 minutes. And you try it and you see how you feel. And if you need it again in an hour, you can use

it again. So you can choose what type of problem you want to deal with, when you want to deal with it and how often you want to deal with it. You mentioned healthy eating there for a few minutes ago. And that's something I did see on the app. And I was interested to understand how that might work. You know, like, we're surrounded in an environment with lots of different food choices. And we know that it's such a complex interplay of how one would decide what to eat in a day. And some of that's governed by our internal processes. So is it a case of when you feel like you want to binge on food, for example, you tap into the app and that helps you gain control? Or how would it work? Well, it's often good. I tell people who are using it for that purpose to maybe find a time

at the beginning of the day to kind of set your frame for how you're going to approach eating during the day. But the main thing is to focus on what eating is really about, which is feeding your body, nourishing your body, and that's something you talk about a lot on your program, and not so much on following urges. Urges are a problem because there have been studies of people who are drug addicted, and what they show is that there's more fun in the chase than in the catch.

The drug addicts are much more into finding and scoring the drug than feeling good when they take the drug. And the same is true with food. You have an urge, you think, oh, this would be good. But you know what? Most people spend a very small percentage of the time they're eating actually savoring, enjoying the food.

So what we tell people is to think about eating like a gourmet. You know, savor the texture, the flavor, the aroma. You can eat differently but enjoy eating more. You can find a way. So you focus on feeding your body the way you would feed your baby. And we should have the same kind of responsibility in how we nourish our bodies, and that's something you try to teach your listeners to do,

that we would have for caring for a dependent child. Because your body has to take into it anything you put into it, even if it's damaged by it. And so the idea here is to focus on what you're for, on eating with respect for your body, and eating a diet that is nourishing and good for your body, makes your body feel good, and that will make you feel good. So it's not about what you have the urge to eat. It's more about what you, as the sort of parent to your own body, think would be a good diet for your body and to cultivate ways of enjoying it.

So, you know, when you're eating, we tell people in hypnosis, don't watch television, you know, don't read a book. When you're eating, eat, enjoy it. You know, savor the full texture, the flavor, the temperature, the aroma, the seasoning of the food, and make the most of that and then go on and be present and mindful of other things that you do as well. And so it's a better way to live and a better way to nourish your body. Absolutely. And what I'm hearing is there's a lot of crossover with mindfulness and mindful eating practices um yes from from what you're saying yes uh but hypnosis you know i'm often asked this hazel that um you know what's the difference is hypnosis just mindfulness well

no it's it's got similarities You're trying to focus your attention, concentrate on your body the way you do in meditation with a body scan. But it's different in that it's Western. Meditation is Eastern. It's a long Buddhist tradition. The idea is not to be intentional

in mindfulness, to just be. Being rather than doing. Hypnosis is more doing than being. We use it for a purpose. It's very Western. We're practical. You use it to help yourself change a problem. I'm not trying to create a world with reverie

full of people going around in hypnotic states all the time. I'm trying to teach them to use it as a tool. You know, this three-pound object on the top of our bodies is our major evolutionary advantage, but the brain doesn't come with a user's manual. And there's a lot of things the brain can do that we don't fully appreciate, and one of them is this ability to focus attention. But we do it with hypnosis for a purpose, to help yourself stop smoking,

to eat more sensibly and enjoyably, to get to sleep, to handle stress. Those are all things you can learn to do better with hypnosis whereas with meditation the idea is for half an hour once or twice a day just focus on scanning your body having open presence letting thoughts and feelings flow through you and and using it to develop compassion with other people. Those are all very good things, but they're somewhat different from what we do with hypnosis. And it's also briefer and more efficient. You just focus on what you want to do and you do it. Why do fintechs like Float choose Visa? As a more trusted, more secure payments network, Visa provides scale, expertise, and innovative payment solutions. Learn more at visa.ca slash fintech.

When does fast grocery delivery through Instacart matter most? When your famous grainy mustard potato salad isn't so famous without the grainy mustard. When the barbecue's lit, but there's nothing to grill. When the in-laws decide that, actually, they will stay for dinner. Instacart has all your groceries covered this summer. So download the app and get delivery in as fast as 60 minutes. Plus enjoy $0 delivery fees on your first three orders. Service fees, exclusions, and terms apply.

Instacart. Grocer groceries that over-deliver. What I'm particularly interested in is the whole pain management side of things. I used to work as a hospital doctor and in every specialty, be that surgery, acute medicine, whatever it might be, pain management and pain control has always been such a difficult thing to get on top of, regardless of how many pain meds we have. For certain patients, they just constantly live in pain. And I know that's true for a lot of people. Can you talk to us a little bit about how we can use hypnosis in pain management and maybe share some stories that you've had positive results from?

Sure, I'd be glad to. Hypnosis, one of the oldest uses of hypnosis was pain. It was used as a standard analgesic procedure before we discovered ether, before we learned about inhalation and anesthesia. There was a British physician named Esdale who went around to India and used hypnosis with amputations and other terrible procedures that they used. But oddly enough, it actually helped people. And the strain and pain lies mainly in the brain. We have signals that come into our body when it's hurt and it travels through the

lateral spinothalamic tract up to the somatosensory cortex in the brain. It's a separate pathway. But how much pain you're in has a lot to do with how you interpret those signals. And we've done research showing that you can literally reduce by 50% or more the way the brain reacts to the same shocks being given if you hypnotize people. So the EEGs get smaller when they're in the hypnotic analgesic condition. So what I do on Reverie is teach people to try, there are whole different exercises,

but one of them is to just filter the hurt out of the pain. Do what you do naturally to relieve the pain. So if a warm bath gives you relief from your arthritis, imagine you're in a warm bath and just let it filter the hurt out of the pain. So if a warm bath gives you relief from your arthritis, imagine you're in a warm bath and just let it filter the hurt out of the pain. Or you can imagine going somewhere else, just being on a desert island somewhere and leave your body behind. We did a study with children who had to undergo a procedure in which they had to have a catheter inserted into their bladder, avoiding cystourethrogram, you'd be familiar with that,

to see if they're getting reflux into the kidneys and if they needed major surgery to fix it. So it's not a lot of fun. And you're an 11-year-old girl and you're having this done on a cold, hard table among strangers. It's terrible. I had them imagine they were just playing at their friends in hypnosis or going to Disneyland or something like that. And we were able to reduce procedure time by 17 minutes. playing at their friends in hypnosis or going to Disneyland or something like that. And we were able to reduce procedure time by 17 minutes.

And the people doing the procedure rated the children as more comfortable. And that's a long 17 minutes when you're going through that. So we've done the same thing with adults. We published an article in The Lancet, the leading British medical journal, showing that if you randomize people having arterial cutdowns and in one condition, there were three conditions. One, you could push a button and get opioids. Two, you could do that and had a friendly nurse comforting you. And third, we taught them self-hypnosis, filtered the hurt out of the pain. And we found at the end of an hour and a half that the average pain ratings in the standard care group were five out of ten three

out of ten with a supportive nurse and one out of ten with hypnosis they had no anxiety at all and they got done 17 minutes faster too so randomized clinical trials and I have to tell you Hazel as a fellow physician it frustrates me that you can prove that something works that well and it still doesn't get used. If that were a drug we were doing instead of hypnosis, every hospital in Great Britain and in the U.S. would be using the drug, but it isn't a drug.

It's just a technique of teaching people how to handle their pain differently, and virtually everybody can change the way they manage their pain. So I saw a woman yesterday who had breast cancer. She had bilateral mastectomy. The surgery has not healed well, and she has some ongoing tumor activity there and has terrible pain. And it turned out that she, you know, one of the problems with pain and one of the problems she had is that you tend to fight it, you get frustrated with it, and that makes it worse.

You know, it's like the noisy kid in the classroom. And so the more you struggle with it, the worse it feels. And for her, the pain was all intertwined with the fact that she had this serious cancer, and she was worried about the effect she was having on her husband and her adult son. And she felt bad that somehow she was spoiling things for them. And that meant that the pain was a constant reminder of that, and she struggled with it more, and she was suffering terribly. It was like 7 or 8 out of 10, she said at the beginning.

And often, you know this when you interview patients, that you're just talking to them, and you ask how bad is your pain from 0 to 10, she said at the beginning. And often, you know this when you interview patients, that you're just talking to them and you ask how bad is your pain from 0 to 10 and they say it's 9. And you would never have guessed that. So she was really suffering with it. And I had her imagine in hypnosis that she was on a desert island. And I

said, now I want you to invite your husband and your son to join you on the beach there. And they did. And I said to her, I want you to look in their eyes, and I want you to tell me whether you think that they resent the fact that they have to look after you and help you through this. Or can you see the love in their eyes? And she started to cry, and she said, yeah, I can see that.

And she said, you know, I think I've been fighting this too much. And I said, yes, what you should do is let them love you and care for you and just let them know how grateful you are that they're doing it. And by the end of that, the pain was gone. She didn't feel the pain anymore. And she felt that she could be a different person in relation to this very serious problem that she had and in relation to her husband and her son, not feeling guilty for spoiling things for them, but rather letting them do what they

wanted to do anyway, which is to love and care for her. And she was surprised. I was a little surprised at how complete it was. She just said, I don't feel the pain anymore. And so it is really remarkable how we can modulate pain signals and make them different. And there are MRI studies that have been done showing that you turn down activity in two parts of the brain. One is somatosensory cortex, where you feel the signals. If you tell people in hypnosis, filter their head out of the pain, you're in a warm bath,

or you're feeling the warmth of the sun on your body. Or in the anterior cingulate cortex where you process how much things worry and bother you and she was turning it down there she was just saying i'm not going to let this bother me in thinking that i'm bothering them i'm just going to let i'm going to open myself to accepting their love and support so it can be a powerful way of altering pain. Yeah. And I mean, I'm sure there's people listening to these stories and thinking, this is incredible. Why isn't this being used widely in practice? What is the resistance? What are the risks? You know, Hazel, when I started this a long time ago, I thought it was a science problem.

Build it and they will come. Do enough research that proves it. I published that study in The Lancet in 2000. I'm not the only one there. I have colleagues who have done this too, and it hasn't happened. I think partly the bad press that hypnosis has gotten with stage hypnosis and all that partly we've always had this prejudice that the only real interventions in medicine are the physical ones you know treat the body like a broken car incision injection or ingestion those

are the real treatments and nothing else works we have always dissed our the ability of our minds and our brains to control our lives and our bodies. And it's very powerful. And it ought to be the first thing. I had a woman who was seven months pregnant with really bad lower back disease. And as the baby grew, of course, the pain got worse. And they couldn't give her opioids. And I got her hypnotized.

I had her taking an imaginary bath, which did give her actual pain relief. And her pain went from seven at the beginning to three by the end. But she looked angry. And I said, what's the matter? And she said, why in the hell are you the last doctor I got sent to instead of the first? She'd had implanted nerve stimulators, all kinds of things that didn't work. And so we just tend not to take seriously something that's right under our nose, you know, or behind our nose, our brain. We don't take full advantage of it.

And I'll tell you, Hazel, the other thing is there's no big industry pushing it. You know, pharma has, you know, the major job for retired cheerleaders is becoming a detail person and going around the doctor's offices and convincing them to try some new drug. I'm a physician. I use drugs. I use medications with patients when I think it's appropriate. But there's huge industry pushing it. And there's no industry pushing techniques like hypnosis.

It's something that people can learn easily. And that's another reason I made Reverie. I'm sort of going direct to consumer. I'm bypassing physicians. And I admire physicians. I am one. I'm proud of that. But it's the patients themselves making it. It's the one area in medical care where they can actually choose what to do. They don't have to have somebody else tell them it's okay to do it. And they spend more out of pocket on it. So I thought, you know, let's go direct to the people who can use it and make it available to them. And that's why we built Reverie is to make it accessible to anybody who wants to use it. Have you found with this, by creating Reverie

and having more conversations on public platforms, that it's changing people's ideas about hypnosis? Do you find that people are becoming more open-minded towards it? Well, I think we're starting. And the fact that you've got me on your program suggests that you're part of that process too. I think they are. And I've, I just did a program with 250 people who are using Reverie or interested in using Reverie. And it's really fun. We did a group hypnosis session and then they commented on it I think people are catching on and getting more excited and interested in and we've had many thousands of people using it I'm helping more people now through every talk while I'm talking to you then I used to in a month

You know just my regular practice. So I hope and I think it is spreading. And I think just as there's been tremendous growth in interest in meditation, I think there is growth now in the use of hypnosis too. I hope so, because I think a lot of people can get a lot of help in a short period of time. And so my hope is that we're expanding the sort of universe of techniques that people can use to help better manage their minds and their bodies. Yeah, and I guess that's exactly what it is. It's another tool in a toolbox and can also act as an adjunct to other things, like we mentioned pain control and having something like this and understanding how to use it in a way that is helpful because I mean in my mind if this is

like a last resort especially in the case of the woman who was pregnant it's not doing her any harm by using this and it's relieving her pain and that's the most important thing well that's the other thing and you know the striking thing hazel is number one it doesn't hurt and you know i was a little worried at first when we sort of put this out there on on the web and uh in in the app universe that you know people would get themselves into trouble it's not happening you know they're learning to understand and better utilize. It's actually protecting them because they realize that they can slip into these states and not be fully aware of the choices they're making. We do that all the time. So learn to respect that process and control it. But the other thing is you will know right away whether it's likely to help you. And even

when I prescribe a pain med for a patient, they have to get the prescription filled and try it and see how it works and build up a right dose level and all that. With hypnosis, you'll know within 10 minutes whether it's going to help you or not, and we're finding that for pain and stress management, 9 out of 10 people tell us they feel better right away. So you know right away. If it doesn't help, fine, but the worst thing that happens is it didn't help. If it does help, you've got immediate evidence, and you can learn to build on that and make it better.

So the nice thing is it's no risk and you can tell right away whether it's going to help you or not. Yeah. And for people who are maybe apprehensive of trying it, are there certain people who shouldn't? Are there risks associated that we need to be aware of? Well, not many. Usually the worst thing that happens is it just doesn't work. So you tried it and nothing happened. I think there are some people who have more serious mental disorders like schizophrenia who tend to be a little delusional anyway, who might find the difference between self-hyp who tend to be a little delusional anyway, who might find the difference between self-hypnosis and mind control a little hard to get. Although, again, we've had very little trouble.

I think either they just are sort of naturally suspicious and don't want to try it anyway, but we've had very little difficulty with that. I think, you know, if there are people who are in need of medical treatment for other reasons, it's not a substitute for going to a doctor. I wouldn't want people who are having crushing substernal chest pain saying, oh, this is a pain problem. I'll just try hypnosis. You get to an ER and get your heart attack taken care of. But we haven't heard of any of that going on either. So I think people are usually pretty sensible about when they need outside help and when they don't. So it's remarkably safe and often

remarkably effective. And I mean, we've mentioned your app a few times, and that's probably the lowest barrier of entry to trying this. Have you any data from the people who are using the app of of what their what the most effective use is is it stopping smoking um as i mentioned we're getting the actually the interesting thing about smoking we're getting 19 stopping smoking that's pretty good you know that's almost as good as we get when i do it in person it's about 23 to your complete abstinence, which is not bad. But the thing that surprised us with the app is that of those who continue to smoke, the average reduction in number of cigarettes per day was 50%. So my feeling is I want people to just plain stop smoking.

It's not good. One cigarette is bad for your body. But to reduce the cigarette load by half is not bad either. For pain, we're finding that people get something like a 50% reduction in their level of pain using the self-hypnosis on the app. For stress management, we find people report a similar reduction in their general stress level, that they can just handle it better. And over time, when you begin to realize that when you have to see your boss again, you're not having the same terrible physical reaction to talking to him, over time, the same situation becomes less stressful. And

one of the things that we do is we teach people to start with the body up rather than the head down. You know, the sort of traditional psychological approach is you've got to understand, you know, do some cognitive behavioral reintegration of why this person bothers you so much. Or from a psychoanalytic point of view, you know, how did your mother treat you and why did you get this way? We do it from the body up instead. We say part of what's bad about stress is the snowball effect of your physical reaction getting tense when you're talking to your boss or a bad thing is happening at work. And then you notice that and you think, oh, God, this is really bad.

So you then start to sweat some more and your muscles tense more and your heart rate goes up. And it's like a snowball rolling downhill so what we do is we say control the thing you can control which is how your body is reacting to it and then look at the problem and see if you can visualize one thing you can do to make the situation better it may not be the best thing so by then you've interrupted that cycle of physical and mental tension and allowed yourself to picture a better way, perhaps, of handling the problem. And so that's something that can be highly effective, and people like doing it on reverie. They can just get to be experts in handling stress in a way

that doesn't compound it by making them feel bad. Another thing that we have on the app is a breathwork exercise called cyclic sighing. And it's a way of very rapidly breathing differently. So you control your breathing in a way that it doesn't reinforce the stress. So what we have people, and we just published a study showing that people who do this just five minutes a day for a month have better mood and lower average respiratory rate. So they're lowering their sympathetic arousal. And all you do is you inhale first abdominally. If you want to try it, you can. Just so inhale through your nose and just using losing your belly at first so

abdominal diaphragmatic breathing hold halfway inhale halfway and now expand your chest and fully fill your lungs and then slowly exhale through your mouth All right, try it again. Inhale through your nose with your belly, halfway, hold. Now expand your chest. Fill your lungs and again very slowly exhale through your mouth. And one more time. Inhale with your belly belly halfway, hold, fill your lungs, expanding your chest and slowly exhale through your mouth.

So how are you feeling now, Isel? Very relaxed. Yeah, it's surprising, isn't it? Yeah. And part of it is that the slow exhale is a very important part of it. You know, we think of breathing as mostly inhaling, but as you know as a physician, when you exhale, you force a little bit more blood back into your heart, and so the heart is thinking to itself, okay, I've got plenty of blood, and heart rate actually slows down. You trigger parasympathetic self-soothing activity.

And so the slow exhale is a way of triggering natural responses that will slow heart rate, lower blood pressure, and allow you to feel more relaxed. And you can do it very quickly. So just having that ability to regulate your level of arousal can be very helpful. And that's another one of the apps on Reverie. It's so powerful, that technique, and something that everyone can tap into. I would love to wrap up by asking you three questions, which are unrelated to hypnosis and just a bit of fun,

that we ask all our guests. The first is, if you had an extra hour in your day, how would you spend it? I wish I did this more. I would do it making music. Really? I play guitar and banjo. I just played with my wife and a friend over the weekend. And I would say that it's the second most wonderful thing humans can do with one another. You know, it's just, you make harmonies, you're all together, you regulate your breathing in a nice way, you exhale slowly as you sing. And but it's just such pleasure to build harmonies together and sing together. It's a real joy. And I wish I did it more. So that's what I would do more of. That's lovely. I wish I was more musical.

If you were going to a desert island, what three things would you take with you? Well, I take my wife for starters. We always have fun together and I would bring a snorkel and a mask so that I can enjoy the beauty underwater. And we're actually planning to go to Tahiti in a couple of weeks and that's exactly what I'm going to do. Oh, nice. That'll be fab. And finally, what's one thing that you're grateful for today? You know, I'm grateful for the power of human connection. I feel very lucky that I can use that to help people. When I was working with a breast cancer patient yesterday, I had a psychologist who's learning about hypnosis in the Zoom Blank 2 to learn what I was doing.

And she was crying just listening to my patient. And it touches me that just the power of human connection is something that is not only pleasurable but helpful. It's a therapeutic tool. And I am very grateful for that. Absolutely. It's one of the most important things for overall well-being, isn't it? Well, thank you, Dr. Spiegel, for your time today and for sharing your insights.

And for anyone who wants to check out the app, it's available in the App Store, is that correct? Reverie? It's available for if you have iOS phones, it's in the App Store. And if you have an Android, it's in Google Play. You can just download the Reverie app. Amazing. Thank you so much for your time today. It was a pleasure. Thank you. Likewise. It was a pleasure to talk with you. Thank you to all of you at home, on the go or wherever you're listening to the podcast. Before we leave each other, I would love if you could take two minutes to rate the podcast or

leave a review and share it with someone you know will benefit from it too. That's all from me. See you again next time.