Hypnotherapy: What is it and How Can it Treat Chronic Pain?

Let’s take a look at what hypnotherapy is, what it involves and how it can make a significant difference for chronic pain patients.


You will no doubt have heard of hypnosis. You might have even seen dramatic hypnosis on stage or on TV. Don’t worry, real hypnosis is not about making you act in a way that is out of your control. Real clinical hypnotherapy is a safe, relaxing way to address psychological problems. It enables you to implement more positive thoughts and coping strategies.

What is hypnosis?

Hypnotic or ‘trance-like’ states have been used to treat physical and mental health since ancient times. The Egyptians used ‘dream temples’ while the Greeks used ‘sleep temples’ (otherwise known as ‘hypnos’) to treat ill health. Evidence of hypnosis techniques can be found in the bible dating back to 1500 BC! From there, hypnosis continued to be used and developed. In 1841 the term hypnosis was first used by a Scottish ophthalmologist named James Braid. He started to realise that hypnosis was psychological rather than anything mystical. Since then hypnosis has been researched and developed scientifically. In the present day it is being used to treat a wide variety of health problems.

Hypnosis makes use of the mind body connection, understanding how our thoughts and feelings can influence our physical health, just as our physical health can influence our mental health. Hypnotherapy uses relaxation and visualisation techniques to guide you into a state of deep peacefulness. Similar to mindfulness meditations, the brain lets go of distractions and becomes more focused. When you’re in a hypnotic state, your pulse and respiration rate slows down, and your brain starts to produce more alpha brainwaves. Alpha brainwaves indicate relaxation, positive mood, reduced anxiety and increased creativity. 

When you’re in this hypnotic state, you are less inhibited. You’re more likely to be able to access memories and face problems that you might have been avoiding, or address feelings that you may have been bottling up. You’re also more open to suggestion. This 2019 study defines hypnosis as, “a waking state of awareness, (or consciousness), in which a person’s attention is detached from his or her immediate environment and is absorbed by inner experiences such as feelings, cognition and imagery”.

During hypnotherapy the therapist can help you to address and solve problems. They can guide you through replacing negative thoughts with positive ones. They can aid you in seeing how you can change your behaviours to live well and better cope with your situation. The therapist may use imagery and ask you to visualize specific situations or scenes in order to guide you towards your goals. They may also speak to you during hypnosis and ask you to interact, in order to get to the root of problems.

The use of imagery is important. During a state of deep relaxation (like during hypnosis), the right side of our brain is being activated more dominantly than the left side. The right side of our brain is like our unconscious mind, the part which is more emotional and creative. While the left side is our conscious mind, the part which is more logical. The right side of our brain responds to imagery and symbols as this study explains. Therefore using imagery helps us to really engage with that side of the brain in this hypnotic state.

Research shows that when someone is imagining something during a hypnotic state, the same areas of the brain are being activated as if the person was actually in that situation. Mirror neurons in our brains activate when we are imagining actions or watching other people perform actions. The use of imagery is powerful with many potential uses. This is the basis for Graded Motor Imagery, a therapy which uses visualisation to train the brain away from pain. Hypnosis can be used to address mental illness such as anxiety, to deal with previous trauma, and to provide relief from many physical health issues.

How can hypnosis treat chronic pain?

People vary in how they will respond to hypnosis and how open they are to hypnotic suggestion. Patients who are fairly suggestable under hypnosis can show improvements in pain relief. This applies to the majority of us. However those who are highly suggestible will have greater relief from pain which is longer lasting. How responsive we are to hypnosis depends on many factors, including our motivation to manage our pain and individual personality traits.

Rather than trying to reduce the pain itself, hypnosis for chronic pain is often more focused on acceptance of your chronic condition, with the aim of reducing fear and anxiety around it. Our perceptions of pain can greatly influence our pain levels and how we manage our pain. If we are fearful, this can often lead to us avoiding situations we perceive might worsen our pain (known as fear avoidance). This avoidance can in fact worsen our symptoms over time. 

Hypervigilance is common in pain patients, meaning patients become extremely aware of painful sensations, and this focus on pain makes pain worse.. This can often lead to pain catastrophizing, meaning patients are worrying about their pain excessively. These negative perceptions and emotions about chronic pain can reinforce to our brain that it needs to continue producing pain messages, therefore perpetuating the pain cycle and even worsening it. They can also be very distressing feelings to live with. By addressing these negative emotions and reducing fear, a patient’s quality of life can be vastly improved and their pain levels considerably reduced.

Some patients may benefit from hypnotherapy sessions which replace self doubt and feelings of helplessness with feelings of confidence and empowerment. In this case, the therapist may guide you through visualising situations which you usually find difficult and pain inducing, for example. They may help you to replace the expectation of pain and the feeling that you are not able to do anything about it, with a feeling of being pain free and taking control of the situation. This type of session can help you to understand that you can do something about your chronic pain and that things can improve.

Some hypnosis sessions focus on inducing an angelisic affect. This means that they use suggestions of being pain free, having reduced pain, or having increased functioning to help patients reduce pain levels. This pain relief technique (known as hypnoanalgesia) has been utilized for many pain scenarios with success. This in depth study on hypnoanalgesia explains that it has been highly effective in treating many types of acute and chronic pain including: “chronic oncological pain, HIV neuropathic pain, pain during extraction of molars, pain associated to physical trauma, pain in surgical procedures, pain associated to temporomandibular joint disorder, phantom limb, fibromyalgia, pain in amyotrophic lateral sclerosis, acute pain in children, lumbago and pain in childbirth”

Some sessions may focus on forgetting past negative memories of pain, effectively trying to retrain the brain to forget that certain situations should cause pain, as this study discusses. Some therapists choose to use imagery to replace the sensation of pain with a more pleasant sensation, such as warmth. For example during hypnosis the therapist could ask you to imagine warmth in the place of pain from now on, anytime that you feel pain. They may incorporate this concept regularly into sessions, until it becomes a ‘habit’ which happens in your day-to-day life without you thinking about it. This could help your brain to break the association between certain painful movements or situations and in turn, help you to break free of the chronic pain cycle.

Since hypnotherapy can put you in a highly relaxed state, it can help to reduce stress levels and break the stress and pain cycle. Muscle tension can be eased and stiffness reduced. If hypnotherapy is engaged in regularly, this reduction in stress can markedly improve chronic pain symptoms. This type of hypnoanalgesia session can have fantastic results for pain patients. This study states that, hypnosis results in greater pain reductions across a variety of chronic pain conditions and pain-related outcomes, including intensity, duration, frequency, and use of analgesic medications when compared to standard care

Hypnotherapy sessions which focus on changing pain beliefs and reducing pain sensations through hypnoanalgesia have been shown to have the most positive outcomes. When therapists work on reducing the physical sensation of pain and building a more positive, helpful perception of pain, chronic pain patients have shown significant improvements. Studies have shown that 70% of chronic pain patients find their pain and other symptoms are reduced in the short term after hypnotherapy, while up to 30% find that these reductions last permanently.

What to expect during a hypnotherapy session

Hypnotherapy is still classed as a complementary therapy by the World Health Organization so is rarely recommended by medical professionals. You can access hypnosis privately, or can find hypnotherapy sessions online, for example through a chronic pain relief app. It’s important that before you attend hypnotherapy, you check that the therapist is trained and registered, just as with any other therapist. Hypnotherapy sessions generally last from between 30 to 60 minutes, but this can vary. 

Before your hypnotherapy session begins you will chat to your therapist about your health issues and what you want to address. As with any other therapy, together you will come up with a treatment plan to address the issues you are dealing with and to set out goals you want to achieve from the treatment. You will likely attend hypnotherapy regularly to get the best results.

Typically, during hypnotherapy, you will lie or sit down in a comfortable position. You will close or relax your eyes, so that you are not focused on anything. The hypnotherapist may have relaxing music on in the background or may have candles lit in their office. The goal is to create a relaxing and comfortable atmosphere. The therapist will then start to talk to you in a calm, slow, relaxing tone. They may ask you to visualise a relaxing situation or ask you to imagine each area of your body relaxing, for example. They may ask you to focus on slowing your breathing, and feeling your muscles relax. Every hypnotherapist will be different, but all will have the same general approach.

Once you’re in a hypnotic state your therapist will then begin to work towards the goals you have set out, most likely using visualisation. For example, if one of the issues you have brought up is being afraid to go for a walk because you are worried about your pain worsening, your therapist may start to work on that. They may ask you to imagine yourself walking down a beautiful path in calm surroundings, imagining your body being completely pain free. They may ask you to visualise a beautiful light at the end of the path, representing you achieving the end of the walk. As you reach the end of the path, they may ask you to feel a warm, happy, empowered sensation as you walk into that light, knowing that you have faced that fear and that you were pain free. This imagery will help you to be less fearful of that situation in the future.

It’s important to remember that unlike common misconceptions, at no point during hypnotherapy are you ever out of control of your own body and mind. You can stop and open your eyes at any time. You can say no, and you are completely in control. Rather than being scary, the experience should be relaxing. The hypnotic state itself will feel different for everybody, but generally is described as being in a pleasant ‘trance-like’ calm state.

Once the session is finished, the therapist will gradually guide you through opening your eyes and becoming readjusted to your surroundings. They will typically give you a few moments to regain alertness. They will then talk through the session with you, asking you how it went and how you felt about it. They may make adjustments for next time once you have expressed anything that you were concerned about, or things that you felt worked particularly well for you.

Therapists may give you exercises or ‘self-hypnosis’ audio to listen to at home between sessions. This audio may be recommended sessions by other providers which aligns with your goals, or may be specifically recorded audio by your own therapist. Sometimes post-hypnotic suggestions will be used. This simply means that the therapist teaches you a certain cue and how to react to it, so that the benefits of the session can be continued in your day-to-day life. For example in regards to chronic pain, your hypnotherapist may teach you that when you feel pain, you find somewhere quiet, close your eyes and practice a specific deep breathing exercise, imagining the pain dissipating and relaxation in its place.

Once your sessions have ended, hypnosis often has lasting results for patients. Some people may choose to continue their hypnotherapy in their own time at home, listening to recordings, if they feel that will be particularly helpful for them. Some other psychological therapies may use hypnosis to take a multidisciplinary approach, such as combining hypnosis with Cognitive Behaviour Therapy (CBT) techniques as explained here.

Hypnotherapy may not be suited to everyone, but for some it can be an effective way to reduce chronic pain. Rather than being scary or magical, hypnotherapy is a scientifically proven way to use the mind body connection to treat health conditions.

References

  • David Cosio, PhD, ABPP, Erica H. Lin, PharmD, BCACP, (2015), “Hypnosis: Tool for Pain Management”. Practical Pain Management, Volume 15, Issue 4.
  • Williamson A. (2019). “What is hypnosis and how might it work?.” Palliative care, 12
  • American Psychological Association, (2004), “Hypnosis for the Relief and Control of Pain”.
  • Lanfranco, R. C., Canales-Johnson, A., & Huepe, D. (2014). “Hypnoanalgesia and the study of pain experience: from Cajal to modern neuroscience”. Frontiers in psychology, 5, 1126. 
  • Dillworth, T., & Jensen, M. P. (2010). ”The Role of Suggestions in Hypnosis for Chronic Pain: A Review of the Literature.” The open pain journal, 3(1), 39–51. 
  • Dillworth, T., Mendoza, M. E., & Jensen, M. P. (2012). “Neurophysiology of pain and hypnosis for chronic pain.” Translational behavioral medicine, 2(1), 65–72. 
  • Elkins, G., Jensen, M. P., & Patterson, D. R. (2007). “Hypnotherapy for the management of chronic pain”  The International journal of clinical and experimental hypnosis, 55(3), 275–287. 

Please note: This article is made available for educational purposes only, not to provide personal medical advice.

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