Hypnotherapy

Hypnotherapy is a form of psychotherapy used to create unconscious change in the patient in the form of new responses, thoughts, attitudes, behaviors or feelings. It is undertaken with a subject in hypnosis.

A person who is hypnotized displays certain unusual characteristics and propensities, compared with a non-hypnotized subject, most notably heightened suggestibility and responsiveness.

Definition of a hypnotherapist
In 1973, Dr. John Kappas, Founder of the Hypnosis Motivation Institute, wrote and defined the profession of a hypnotherapist in the Federal Dictionary of Occupational Titles:

"Induces hypnotic state in client to increase motivation or alter behavior patterns: Consults with client to determine nature of problem. Prepares client to enter hypnotic state by explaining how hypnosis works and what client will experience. Tests subject to determine degree of physical and emotional suggestibility. Induces hypnotic state in client, using individualized methods and techniques of hypnosis based on interpretation of test results and analysis of client's problem. May train client in self-hypnosis conditioning."

Traditional hypnotherapy
The form of hypnotherapy practiced by most Victorian hypnotists, including James Braid and Hippolyte Bernheim, mainly employed direct suggestion of symptom removal, with some use of therapeutic relaxation and occasionally aversion to alcohol, drugs, etc.

Ericksonian hypnotherapy
In the 1950s, Milton H. Erickson developed a radically different approach to hypnotism, which has subsequently become known as "Ericksonian hypnotherapy" or "Neo-Ericksonian hypnotherapy." Erickson made use of an informal conversational approach with many clients and complex language patterns, and therapeutic strategies. This divergence from tradition led some of his colleagues, including Andre Weitzenhoffer, to dispute whether Erickson was right to label his approach "hypnosis" at all.

The founders of Neurolinguistic Programming (NLP), a methodology similar in some regards to hypnotism, claimed that they had modelled the work of Erickson extensively and assimilated it into their approach. Weitzenhoffer disputed whether NLP bears any genuine resemblance to Erickson's work.

Cognitive/behavioral hypnotherapy
Cognitive behavioural hypnotherapy (CBH) is an integrated psychological therapy employing clinical hypnosis and cognitive behavioural therapy (CBT). The use of CBT in conjunction with hypnotherapy may result in greater treatment effectiveness. A meta-analysis of eight different researches revealed "a 70% greater improvement" for patients undergoing an integrated treatment to those using CBT only.

In 1974, Theodore Barber and his colleagues published an influential review of the research which argued, following the earlier social psychology of Theodore R. Sarbin, that hypnotism was better understood not as a "special state" but as the result of normal psychological variables, such as active imagination, expectation, appropriate attitudes, and motivation. Barber introduced the term "cognitive-behavioral" to describe the nonstate theory of hypnotism, and discussed its application to behavior therapy.

The growing application of cognitive and behavioral psychological theories and concepts to the explanation of hypnosis paved the way for a closer integration of hypnotherapy with various cognitive and behavioral therapies. However, many cognitive and behavioral therapies were themselves originally influenced by older hypnotherapy techniques, e.g., the systematic desensitisation of Joseph Wolpe, the cardinal technique of early behavior therapy, was originally called "hypnotic desensitisation" and derived from the Medical Hypnotism (1948) of Lewis Wolberg.

Hypnosis in childbirth
Hypnotherapy has long been used in relation to childbirth. It is sometimes used during pregnancy to prepare a mother for birth, and during childbirth to reduce anxiety, discomfort and pain.

Psychotherapy
Hypnosis was originally used to treat the condition known in the Victorian era as hysteria. Modern hypnotherapy is widely accepted for the treatment of anxiety, subclinical depression, certain habit disorders, to control irrational fears, as well as in the treatment of conditions such as insomnia and addiction. Hypnosis has also been used to enhance recovery from non-psychological conditions such as after surgical procedures and even with gastro-intestinal problems, including IBS.

Cognitive hypnotherapy and bulimia
Scientific literature suggests a wide variety of hypnotic interventions can be used to treat bulimia nervosa. Similar studies have shown that groups suffering from bulimia nervosa, undergoing hypnotherapy, were more exceptional to no treatment, placebos, or other alternative treatments.

1890s
In 1892, the British Medical Association (BMA) commissioned a team of doctors to undertake an evaluation of the nature and effects of hypnotherapy;

"The Committee, having completed such investigation of hypnotism as time permitted, have to report that they have satisfied themselves of the genuineness of the hypnotic state."

"The Committee are of opinion that as a therapeutic agent hypnotism is frequently effective in relieving pain, procuring sleep, and alleviating many functional ailments [i.e., psycho-somatic complaints and anxiety disorders]."

1950s
In 1955, the Psychological Medicine Group of the BMA commissioned a Subcommittee, led by Prof. T. Ferguson Rodger, to deliver a second, and more comprehensive, report on hypnosis. The Subcommittee consulted several experts on hypnosis from various fields, including the eminent neurologist Prof. W. Russell Brain, the 1st Baron Brain, and the psychoanalyst Wilfred Bion. After two years of study and research, its final report was published in the British Medical Journal (BMJ), under the title ‘Medical use of Hypnotism’. The terms of reference were:

"To consider the uses of hypnotism, its relation to medical practice in the present day, the advisability of giving encouragement to research into its nature and application, and the lines upon which such research might be organized."

It concludes from a systematic review of available research that,

The Subcommittee is satisfied after consideration of the available evidence that hypnotism is of value and may be the treatment of choice in some cases of so-called psycho-somatic disorder and Psychoneurosis. It may also be of value for revealing unrecognized motives and conflicts in such conditions. As a treatment, in the opinion of the Subcommittee it has proved its ability to remove symptoms and to alter morbid habits of thought and behavior[...] "In addition to the treatment of psychiatric disabilities, there is a place for hypnotism in the production of anesthesia or analgesia for surgical and dental operations, and in suitable subjects it is an effective method of relieving pain in childbirth without altering the normal course of labor."

According to a statement of proceedings published elsewhere in the same edition of the BMJ, the report was officially ‘approved at last week’s Council meeting of the British Medical Association.’ In other words, it was approved as official BMA policy. This statement goes on to say that,

"For the past hundred years there has been an abundance of evidence that psychological and physiological changes could be produced by hypnotism which were worth study on their own account, and also that such changes might be of great service in the treatment of patients."

In 1958, the American Medical Association (AMA) commissioned a similar (though more terse) report which endorses the 1955 BMA report and concludes,

"That the use of hypnosis has a recognized place in the medical armamentarium and is a useful technique in the treatment of certain illnesses when employed by qualified medical and dental personnel."

Again, the AMA council approved this report rendering hypnotherapy an orthodox treatment,

"The Reference Committee on Hygiene, Public Health, and Industrial Health approved the report and commended the Council on Mental Health for its work. The House of Delegates adopted the Reference Committee report [...]"

1990s
In 1995, the US National Institute for Health (NIH), established a Technology Assessment Conference that compiled an official statement entitled "Integration of Behavioral & Relaxation Approaches into the Treatment of Chronic Pain & Insomnia". This is an extensive report that includes a statement on the existing research in relation to hypnotherapy for chronic pain. It concludes that:

"The evidence supporting the effectiveness of hypnosis in alleviating chronic pain associated with cancer seems strong. In addition, the panel was presented with other data suggesting the effectiveness of hypnosis in other chronic pain conditions, which include irritable bowel syndrome, oral mucositis [pain and swelling of the mucus membrane], temporomandibular disorders [jaw pain], and tension headaches. (NIH, 1995)"

In 1999, the British Medical Journal (BMJ) published a Clinical Review of current medical research on hypnotherapy and relaxation therapies, it concludes,


 * "There is strong evidence from randomised trials of the effectiveness of hypnosis and relaxation for cancer related anxiety, pain, nausea, and vomiting, [side effects of chemotherapy] particularly in children."
 * "They are also effective for panic disorders and insomnia, particularly when integrated into a package of cognitive therapy (including, for example, sleep hygiene)."
 * "A systematic review has found that hypnosis enhances the effects of cognitive behavioral therapy for conditions such as phobia, obesity, and anxiety."
 * "Randomized controlled trials support the use of various relaxation techniques for treating both acute and chronic pain, [...]"
 * "Randomized trials have shown hypnosis to be of value in asthma and in irritable bowel syndrome [...]"
 * "Some practitioners also claim that relaxation techniques, particularly the use of imagery, can prolong life. There is currently insufficient evidence to support this claim."

Reports
In 2001, the Professional Affairs Board of the British Psychological Society (BPS) commissioned a working party of expert psychologists to publish a report entitled The Nature of Hypnosis. Its remit was 'to provide a considered statement about hypnosis and important issues concerning its application and practice in a range of contexts, notably for clinical purposes, forensic investigation, academic research, entertainment and training.' The report provides a concise (c. 20 pages) summary of the current scientific research on hypnosis. It opens with the following introductory remark:

"'Hypnosis is a valid subject for scientific study and research and a proven therapeutic medium.'"

With regard to the therapeutic uses of hypnosis, the report said:

"'Enough studies have now accumulated to suggest that the inclusion of hypnotic procedures may be beneficial in the management and treatment of a wide range of conditions and problems encountered in the practice of medicine, psychiatry and psychotherapy.'"

The working party then provided an overview of some of the most important contemporary research on the efficacy of clinical hypnotherapy, which is summarized as follows:


 * "There is convincing evidence that hypnotic procedures are effective in the management and relief of both acute and chronic pain and in assisting in the alleviation of pain, discomfort and distress due to medical and dental procedures and childbirth."
 * "Hypnosis and the practice of self-hypnosis may significantly reduce general anxiety, tension and stress in a manner similar to other relaxation and self-regulation procedures."
 * "Likewise, hypnotic treatment may assist in insomnia in the same way as other relaxation methods."
 * "There is encouraging evidence demonstrating the beneficial effects of hypnotherapeutic procedures in alleviating the symptoms of a range of complaints that fall under the heading 'psychosomatic illness." These include tension headaches and migraine; asthma; gastro-intestinal complaints such as irritable bowel syndrome; warts; and possibly other skin complaints such as eczema, psoriasis and urticaria [hives].
 * "There is evidence from several studies that its [hypnosis'] inclusion in a weight reduction program may significantly enhance outcome."

Meta-analysis
In 2003, a meta-analysis of the efficacy of hypnotherapy was published by two researchers from the university of Konstanz in Germany, Flammer and Bongartz. The study examined data on the efficacy of hypnotherapy across the board, though studies included mainly related to psychosomatic illness, test anxiety, smoking cessation and pain control during orthodox medical treatment. Most of the better research studies used traditional-style hypnosis, only a minority (19%) employed Ericksonian hypnosis.

The authors considered a total of 444 studies on hypnotherapy published prior to 2002. By selecting the best quality and most suitable research designs for meta-analysis they narrowed their focus down to 57 controlled trials. These showed that on average hypnotherapy achieved at least 64% success compared to 37% improvement among untreated control groups. (Based on the figures produced by binomial effect size display or BESD.)

According to the authors this was an intentional underestimation. Their professed aim was to discover whether, even under the most skeptical weighing of the evidence, hypnotherapy was still proven effective. They showed conclusively that it was. In fact, their analysis of treatment designs concluded that expansion of the meta-analysis to include non-randomized trials for this data base would also produce reliable results. When all 133 studies deemed suitable in light of this consideration were re-analyzed, providing data for over 6,000 patients, the findings suggest an average improvement in 27% of untreated patients over the term of the studies compared with a 74% success rate among those receiving hypnotherapy. This is a high success rate given the fact that many of the studies measured included the treatment of addictions and medical conditions. The outcome rates for anxiety disorders alone, traditionally hypnotherapy's strongest application, were higher still (though a precise figure is not cited).

In 2005, a meta-analysis by the Cochrane Collaboration found no evidence that hypnotherapy was more successful than other treatments or no treatment in achieving cessation of smoking for at least six months. In 2007 a meta-analysis from the Cochrane Collaboration found that the therapeutic effect of hypnotherapy was "superior to that of a waiting list control or usual medical management, for abdominal pain and composite primary IBS symptoms, in the short term in patients who fail standard medical therapy", with no harmful side-effects. However the authors noted that the quality of data available was inadequate to draw any firm conclusions.

US Definition of hypnotherapist
The U.S. (Department of Labor) Directory of Occupational Titles (D.O.T. 079.157.010) supplies the following definition:
 * "Hypnotherapist – Induces hypnotic state in client to increase motivation or alter behavior pattern through hypnosis. Consults with client to determine the nature of problem. Prepares client to enter hypnotic states by explaining how hypnosis works and what client will experience. Tests subject to determine degrees of physical and emotional suggestibility. Induces hypnotic state in client using individualized methods and techniques of hypnosis based on interpretation of test results and analysis of client's problem. May train client in self-hypnosis conditioning.

The Department of Health in the state of Washington regulates hypnotherapists.

UK National Occupational Standards
In 2002, the Department for Education and Skills developed National Occupational Standards for hypnotherapy  linked to National Vocational Qualification based on National Qualifications Framework under The Qualifications and Curriculum Authority. And thus hypnotherapy was approved as a stand-alone therapy in UK. NCFE, a national awarding body, issues level four national vocational qualification diploma in hypnotherapy.

UK Confederation of Hypnotherapy Organisations (UKCHO)
The regulation of the hypnotherapy profession in the UK is at present the main focus of UKCHO, a non-profit umbrella body for hypnotherapy organisations. Founded in 1998 to provide a non-political arena to discuss and implement changes to the profession of hypnotherapy, UKCHO currently represents 9 of the UK's professional hypnotherapy organisations and has developed standards of training for hypnotherapists, along with codes of conduct and practice that all UKCHO registered hypnotherapists are governed by. As a step towards the regulation of the profession, UKCHO's website now includes a National Public Register of Hypnotherapists who have been registered by UKCHO's Member Organisations and are therefore subject to UKCHO's professional standards. Further steps to full regulation of the hypnotherapy profession will be taken in consultation with the Prince's Foundation for Integrated Health.

Australia
Professional hypnotherapy and use of the occupational titles hypnotherapist or clinical hypnotherapist is not government-regulated in Australia.

In 1996, as a result of a three-year research project led by Lindsay B. Yeates, the Australian Hypnotherapists' Association (founded in 1949), the oldest hypnotism-oriented professional organization in Australia, instituted a peer-group accreditation system for full-time Australian professional hypnotherapists, the first of its kind in the world, which "accredit[ed] specific individuals on the basis of their actual demonstrated knowledge and clinical performance; instead of approving particular 'courses' or approving particular 'teaching institutions'" (Yeates, 1996, p.iv; 1999, p.xiv). The system was further revised in 1999.

Australian hypnotism/hypnotherapy organizations (including the Australian Hypnotherapists Association) are seeking government regulation similar to other mental health professions. However, the various tiers of Australian government have shown consistently over the last two decades that they are opposed to government legislation and in favour of self-regulation by industry groups.