1 The development of hypnotherapy in healthcare
INTRODUCTION
Hypnotherapy is often referred to as an induced state of relaxation in which the mind is more receptive to suggestion. In the main, hypnotherapy is the deliberate use of the trance state to effect change in both conscious and unconscious states of mind. The individual and not the therapist is considered to be in control of the trance state (Rankin-Box & Williamson 2006). Although Heap and Aravind (2002) have suggested that hypnosis is an interaction between two people, it would seem that the self-induced trance state is a common daily occurrence in all people and it is not necessary for a hypnotic trance to be induced by, or dependent upon, a second party for it to occur. In this respect, self-hypnosis can be perceived as a normal state of mind.
The specific induction of the trance state has formed part of many cultural practices over the centuries such as India, China, North America, Africa and Egypt (Conachy 1994). For instance, Bourguignon (1968, 1973) reported that from a sample of 488 societies, 90% had at least one socially accepted method of altering states of consciousness and trance was used in one way or another for the improvement of the individual and the community.
The use of ‘suggestion’ in visualization, should be used cautiously to induce trance since a suggestion may not always invoke a therapeutic response, for instance, strong imagery of hot summer days in a garden full of flowers might stimulate an allergic response such as hay fever or sneezing. Suggestion, refers to the presentation of an idea to a client and the extent to which the client accepts the idea (suggestibility) is influenced by motivation and expectation. There is again, no definitive research to adequately explain this phenomenon. While suggestion remains largely psychological, it is possible using hypnotherapy, to anaesthetize parts of the body and influence the autonomic nervous system commonly considered not to be under voluntary control (Rankin-Box 2006, Whorewell et al 1992).
HISTORY
During the Second World War, Simmel developed a technique called ‘hypnoanalyses for treating neurosis’ (Tamin 1988). However, the word ‘hypnotism’ gained acceptance in Western medical circles and today hypnosis, recognized as a legitimate medical practice, continues to be acknowledged. More recently, Erikson has referred to hypnosis as ‘an inner state of absorption’ (Erikson & Rossi 1980). This appears as a special state described as hypnoidal or hypnotic and trance appears to be the most widely accepted term.
More recent developments in this field are described by Rankin-Box (2001, 2006), Erikson and Rossi (1980) and Spiegel and Spiegel (1978).
In 1955, the British Medical Association commenced a second inquiry into hypnosis and suggested it should be taught to psychiatrists at medical schools (British Medical Association 1955). Clinical hypnosis is now taught in medical training programmes in the USA, France and Germany. It was finally offered as a special study option for undergraduates in Medicine at the University of Oxford Medical School in 2002.
There is continuing debate as to whether hypnosis is a ‘special’ state or not and there is continuing debate concerning sociocognitive vs state explanations of hypnosis. State View (SV) theorists argue that there is a special state called the hypnotic trance. This state is marked by increased suggestibility, current imagery including past memories and reality distortions such as false memories. There is also a belief that future research will discover a physiological rationale for the hypnotic state. Supporters of the SV approach to hypnosis include Erickson and Spiegel. Hilgard also developed the ‘Stanford Scales of Hypnotic Susceptibility, Forms A, B and C’. These scales are one of the measures currently used to objectively measure how susceptible an individual may be to hypnosis (Woody & Sadler 2005).
As early as 1960, Wyke proposed a Reality Testing Theory, also referred to as a physiological theory. Here, the process of formal hypnosis is described as involving the gradual detachment from external sensory perception (this can include closing eyes, remaining still, relaxation and focusing upon internal sensations). This form of ritualistic behaviour can create a partial suspension of reality and increases suggestibility. This could also imply a greater physiological process occurs during hypnosis than previously considered. Reducing sensory input is influenced by the reticular activating system in the central part of the brain stem and it is claimed that this may enhance patient suggestibility (Wyke 1960).
Hilgard’s Neo-dissociation Theory of Hypnosis argues that individuals are constantly assessing and prioritizing events going on around us at any one time. This model suggests that the hypnotic trance modifies this arrangement so that systems become dissociated from each other and thus allowing greater critical analysis, e.g. by enhancing the ability to re-prioritize smoking from a significant daily activity and relegate it both consciously and sub-consciously to a lesser behavioural role. This argument has links with the work of Kallio and Revonsuo (2005) who suggest that the effectiveness of hypnotic analgesia might be explained as re-prioritizing perceptions of pain. Thus one can be aware of pain but develop an ability to block the neural receptors in order to reduce the sensation of pain.
The point at which an individual may be said to be ‘in trance’ has not yet been clearly determined. This may be due to competing theories concerning how trance is achieved and exactly what is happening during hypnosis. Future neurophysiological research may identify a physiological marker capable of defining the state constituting trance and distinguishing between the hypnotized and non-hypnotized states (Heap & Aravind 2002). However, trance appears to be a regular physiological activity of daily life. It is not necessarily dependent upon specific (external) trance induction. It would seem that the debate about which factors initiate trance and the extent to which this state can influence medical care and procedures will continue for some time yet.
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