David Spiegel - Tranceformation - Hypnosis in Brain and Body

[Music] this lecture is being brought to you in part by the generous gifts of these sponsors thank you very much christine and i want to thank dr. ken ford and the florida institute on cognitive and machine learning human and machine cognition it's a pleasure to be here in florida with you and i hope to convince you that techniques for using the brain as a whole can sometimes be far superior to techniques approaching the brain in pieces with medication or other kinds of treatments i do both but there's a lot we can learn from how we use our brains in controlling problems like pain stress and anxiety the way I try to teach this to the students at Stanford is to remind them that the strain in pain lies mainly in the brain now I think I won't sing it I just thought I'd say I so I hope this is a will strike you as a radically different way for us to think about practicing medicine and a colleague of mine in Texas reminded me of a doctor who gave a talk like this in a very wealthy man in the audience said you know if every medical student and doctor in the United States heard your talk medicine would be better so what's your salary and he told them and he said well I will triple it if you'll spend the next year driving around the country giving this talk so he thought about it for a minute and said okay after a couple of months he and the chauffeur who was driving him got to be uncomfortably close and the chauffeur said you know doc I've heard that damn talk of your so many times that I could give it and you're getting paid 50 times when I'm getting paid and the doctor said well okay I'll tell you what the next talk is not very important it's just at Harvard so well I don't I put on the chauffeur uniform and you give the talk and we'll see what happens so he gives the talk and it actually goes surprisingly well and then a hand goes up and a full professor in the audience asks a very long and exceedingly complex question and the chauffeur says you know I've heard some ignorant questions in my day said but this one is so ignorant that I'm going to let my chauffeur answer so I haven't brought my chauffeur but we'll have time for questions so what I hope to do is describe for you the phenomenon of hypnosis both in mind and in body help you understand the concept of hypnotized ability as a trade not everyone's hypnotizable about two-thirds of adults are most children are so you know most eight-year-olds are in trances most of the time you know you call them in for dinner they don't hear you but some of us lose that ability as adults talk about our research on brain regions involved in hypnosis how hypnosis can modulate perception of problems like pain and anxiety how hypnosis can directly influence things going on in the body that you wouldn't think you could control and then how we use it at Stanford as a program of support for patients with a variety of medical and psychiatric problems you may all have heard the term mesmerize you know you mesmerized me with your gaze Franz Anton Mesmer was the doctor who formally introduced hypnosis into Western culture and it is the oldest Western conception of a psychotherapy the first time that a talking interaction was thought to have therapeutic potential he had this theory that hypnosis we called it animal magnetism the idea that there were magnetic fields flowing through our bodies and that when the fields got out of line patients got sick and he thought if he put his magnetic fields near the patient's magnetic fields the patients would get better I don't know why his wouldn't get worse but after a while he started using these pack A's these barrels with this thing doesn't seem to be working with filled with iron filings that could induce things like swooning in this woman you see on the right now that sounds kind of hokey and it is but keep in mind that that the leading Sciences of the day were physics the study of gravity and electricity and thism and so the idea of finding an analogy between what were the leading new scientific understandings and what was going on in the brain was not as bad an idea as it might seem although I think I should warn you that there are side effects to hypnosis so so be careful so Mesmer was left his wife and family in Vienna as soon as he started to become the sort of go-to doctor at the time and moved to Paris and there he competed with the leading French physicians of the day which did not win him a lot of friends in the in the rest of the medical community now if you did a randomized trial sending every other medically ill patient to Mesmer doing this animal magnetism or French physicians how many of you think Mesmer's patients would have done better medically anyone how many think the French physicians patients would have done better nobody well you're both right in a sense think about it what was the major form of treatment in 18th century France bleeding bloodletting France was the world's leading exporter of leeches Voltaire wrote to his brother he said we did everything we could to save father's life we even sent the doctors away and so if you just stayed away from a doctor by going to Mesmer you would actually do better so he was examined by a French panel of experts King Louie convened a panel that included our own Benjamin Franklin who was having a wonderful time in Paris in those days the famous and brilliant chemist love was a who discovered the principles of oxygen chemistry and who also shortly before he died developed the concept of the gross national product so he actually was a leading economist as well as chemist he was beheaded in the revolution and not unrelated was another member of the panel well known for his work in pain control he was dr. D utan the inventor of the guillotine so it was quite a group he kind of created the mind-body problem in a sense and so this group investigated Mesmer and concluded that animal magnetism was due to nothing but heated imagination now that's probably right actually but it was a devastating opinion and that was pretty much the end of Mesmer's career however there were brave followers who carried on including a man named James s Dale who was a Scottish surgeon who went to India and was doing the terrible surgery they did was mostly amputations they had no anesthesia at all so they would typically get a patient drunk and hold him down while they performed the surgery he started using animal magnetism mesmerism in India and was reporting 80% surgical anesthesia which is not bad in a terrible setting so he was fired from his Hospital in Scotland and ten years later at the Massachusetts General Hospital what is now called the ether dome the first use of ether anesthesia was reported and the surgeon strode to the front of the auditorium and and said gentlemen this is no humbug to distinguish what they did with ether from what as Dale had done with hypnosis with mesmerism and they reported 90% surgical anesthesia with ether so so as they'll actually withdrew his paper said sorry I guess I was wrong so it's taken us 150 years to figure out that the brain actually does have something to do with pain control and that there are things one can do with the brain as a whole with not just putting it to sleep but using it that can help people feel better with problems like pain Sigmund Freud started his career and you know hypnosis I sometimes think of as something like the oldest profession everybody's interested in it but nobody wants to be seen in public with it Here I am it's one rejection after another Freud started his studies of psychoanalysis using hypnosis and the famous analytic couch this is his study in Vienna was there because he was using it hypnotized people and you'll notice that in the sacred spot over the couch there's a picture of an archeological dig and Freud was very interested in deeper and deeper levels of understanding in the unconscious and how to reach them when an event occurred early in his career was hypnotizing a woman relieving her of her tax of pain by tracing them back to a traumatic origin and he said he wrote in his autobiography the patient suddenly woke out of the trance and threw her arms around my neck he said I was modest enough not to attribute this event to my own irresistible personal attractiveness and so that was the beginning of the concept of transference the idea that patients transfer feelings about figures early in their life usually parents onto other people in their lives and you use that phenomenon in analysis to better understand the distortions people make about their relationships so Freud gave up hypnosis and move the chair around behind the couch because he didn't like patient staring him in the eye and he had them free associate now this is and to this day most psycho analysts say it's a terrible idea to use hypnosis I visited his last study which is in London he was chased by the Nazis out of Austria and set up this study here and he saw to the arrangement of the study and in the sacred spot over the analytic couch there's now a new picture and it is of the famous French neurologist Charcot demonstrating hypnotic catalepsy so he has a patient who's hypnotized and falls backwards if he didn't hold her and Freud wrote at the end of his career that the baser metal of suggestion probably would have to be alloyed the the pure gold of analysis would have to be alloyed with the baser metal of suggestion so Freud at the end of his career came back to the idea that maybe direct suggestion to people could actually have an effect on them and their symptoms the final example is the experience of this woman she was a woman who suffered from spinal weakness which meant she had to be carried around from room to room by her father this happened through her adolescence through her marriage and even her pregnancy and that was finally too much for her and so she went to see a disciple of Mesmer's named Phineas T Quinn be great name isn't it and he cured her with using animal magnetism and she was very happy and pleased and as time went on they correspond did some people speculate they had some kind of sexual involvement but about five years later she got a letter informing her that he had died suddenly and the next day she went into a period of meditation and mourning she slipped on the ice and re-entered her back and she decided after that that it was not really animal magnetism that I cured her it was the Word of God does anybody know who this woman is Mary Baker Eddy that's right so it was we oughtta hypnosis the the introduction of psychoanalysis into our culture and - one of the better remaining newspapers in the United States the Christian Science Monitor I was touring with some friends from a hypnosis meeting actually in Boston the mother church of Christian site which is a beautiful amazing building big circular building where any person can stand and give testimony about how they had cured themselves with the help of God and this nice lady was taking us around until I happen to mention the meeting we were at the hypnosis meeting and she got cold as ice and couldn't get us out of there fast enough and then I read the lesson plan for next week Asian and modern necromancy alias mesmerism and hypnotism denounced necromancy loving the dead so to this day you can't mention hypnosis around a Christian Scientist so anything that starts so many interesting things and gets so roundly rejected to me had to be worth looking into this is my daughter's depiction of what I do she said my dad hypnotizes people and makes them want to live longer and you see a particularly successful clinical example down here now julia is now an attorney and she says dad are you still using that picture and I say yes I am but it does not represent her current level of artistic ability so how what is hypnosis and how can we use it it is a treatment approach that is useful in a variety of medical and psychiatric and psychological settings and it can be understood as having three main components the first is absorption being hypnotised as something like looking through a telephoto lens in a camera what you see you see with great detail but you're less aware of the context how many of you have had the experience of getting so caught up in a good movie that you forget you're watching the movie and just kind of enter the imagined world anybody how many of you have no idea what I was just talking the former are likely to be more hypnotizable than the latter this it's called been called believed in imagination you don't judge it you just experience it and time a fly by you don't realize how fast it's going people who are more hypnotizable tend to get caught up in sunsets and movies and reading novels and forget time just goes by and they don't notice it so it's a kind of non-judgmental awareness so this means that you have to put outside of conscious awareness things that would ordinarily be in consciousness we call that dissociation right now you're having sensations with your bottoms touching these wonderful chairs that have been provided for you hopefully that was not foremost in your mind until I brought it to your attention if it was you can leave now that's right so in order for us to concentrate intently we have to put outside of awareness things we might otherwise pay attention to the third and for some people the most worrisome part is what's been called suggestibility it's a tendency to respond relatively automatically to instructions or suggestions people see this a caricatured and in stage hypnotist whom I don't like you know having a basket football coach dance like a ballerina or people quack like a duck there are two things you should know about these guys other than that they're exploiting people and please don't pay him on see them but one of them is that they don't do this to everybody what they do if you've been to any of these shows they filter people through they get people up they have them sit down until they find the 10 or 15 percent of the population who are very hypnotizable and they're the ones that they work with and they use it to make fools of them which I don't like I don't agree with but the message is that in hypnosis people are less likely to critically judge and evaluate what you're asking them to do and that puts more responsibility on you as a doctor using hypnosis to be wise and careful about how you're advising people to do things but it's a two-edged sword it can bypass people's usual unwillingness to do things that are good for themselves and change for the better or it can bypass their scrutiny about things that make them seem foolish or worse so it is possible that people will do things in hypnosis they might not otherwise do but if you go to a licensed and trained professional that's not the problem so keep in mind though that your ability to focus attention means that you're less likely to critically judge and evaluate what's going on now people do this spontaneously all the time all hypnosis is really self-hypnosis I just evaluate and help people to do what they have the ability to do and there for example in the Sochi Olympics when Putin decided among his many good decisions to put the Winter Olympics in a place that barely had any snow he a number of the athletes wanted of course to do practice runs down the down the ski runs and they could only do one run because the snow was in such bad shape so they would stand by them and go into a self-hypnotic like state and practice the run mentally because they couldn't do it physically so here's an example of bode miller doing it they would visualize the course twice sometimes eyes closed sometimes eyes open but I'm always kind of zoned out one of the skiers so they do it in a kind of self hypnotic way that allows them to concentrate intently and not worry too much about the fact that they were in actually skiing hypnotizability is a very stable trait in adult life there was a study done at Stanford where 20 we're students former students were tested for hypnotizability 25 years after they had been undergraduates and had their hypnotizability tested and there was a point 7 test retest correlation now for those who don't do statistics what that means is that about I could tell you about half the variance in your hypnotizability score when you were 25 if I knew what it was when you were 50 and that is more stability than you'll see in an IQ test over 25 year interval so it's a very stable trait some people have the ability some don't this is a kind of distribution of scores and about as I said 2/3 of the adult population is at least somewhat hypnotizable we've been very interested in what's going on in the brain that can help us explain that so several years ago we did a study in which we took ten people who tested very highly hypnotizable and ten on the other end of the distribution not at all hypnotizable and put them in a functional MRI scanner magnetic resonance imaging I'm sure you're all familiar with that term is widely used it gives you beautiful pictures of brain anatomy but it can also be used to measure brain function because deoxygenation of blood which happens when blood is flowing through more active regions in the brain looks different on an fMRI image so we can measure brain function as well as structure and we looked at three brain networks and how they related to one another when high versus low hypnotizables were in the scanner and simply resting they weren't doing anything we weren't trying to hypnotize them they were just resting and what we saw was a connection between one part of the brain the anterior cingulate cortex which is in the middle front part of the brain and it's a context detector it helps us decide what to pay attention to and what to ignore if an air traffic controller sees three planes converging on one runway their anterior cingulate cortex is going wild because they know there's a problem they have to deal with and so it's a kind of a part of our worry system we call it the salience network and we found that activity in that region was significantly correlated with activity in dorsal lateral prefrontal cortex that's up here and it's what we call part of our executive control Network so you guys may be sleeping but my executive control network is really working here because I'm trying to convey this information to you we found that in highly hypnotizable subjects those two regions were working together when one was up the other was up and so that's a situation in which if you tend to concentrate intently you tend not to be worrying about what else is going on because those two activities are coordinated so there is a biological signature of people who are highly hypnotizable that distinguishes them from people who are not hypnotizable and it's a substantial and statistically significant difference we have evidence that hypnotizability is correlated with the activity of the neurotransmitter dopamine in the brain it's one of the major neurotransmitters in the brain particularly in the basal ganglia motor regions of the brain and in the frontal cortex it's the neurotransmitter that is depleted when people develop Parkinson's disease for example but it's very much involved in active thought and cognition and we found a significant correlation between levels of a metabolite of dopamine homo vanilla Cassidy and hypnotizability in a large patient sample so it makes sense the thing we saw in the previous study makes sense in terms of dopamine there's actually a genetic connection so people who have a particular variant of the COMT gene that's catechol ol methyl transferase that's a gene that's involved in dopamine metabolism turn out to be more highly hypnotizable than those who have a different variant or polymorphism of that gene so there's a genetic link too and you see here these are the ones who have a valine and methionine version versus the ones who are homozygous for valine or Metheny so there is a genetic connection of these traits we use a scale called a hypnotic induction profile to measure how hypnotizable people are it's the first time I formally use hypnosis with a patient and I'm not trying to do something to them I'm trying to assess how well they can respond to a standard hypnotic and and I use that as the basis of designing the rest of my treatment planning this is another way of looking at the anterior cingulate cortex here and there's evidence that when people control pain using hypnosis they turn down activity in this region because the ACC is also part of the pain network that helps your brain decide yes this really is a painful and unpleasant stimulus and there are other related psychological tests that are influenced by activity in this region as well and the prefrontal cortex is another region that we know from other studies is involved in hypnosis most recently we just published a study in which we looked at what happened when we actually hypnotized people in the fMRI scanner how many of you had an fMRI of you have you had a brain brain or a magnetic resonance imaging study it's a noisy thing you sort of slid into this bore and that the machine is clacking away as its generating the magnetic pulses that provide just enough deformation that when your brain goes back to its normal state the sensors can read and interpret it we we found 36 high and 21 low hypnotizables subjects after screening 545 students we worked hard to get this group and when we put them in the scanner we had four conditions one was just rest as we've done before one was a memory task to control for the effects of memory and two of them were hypnosis conditions where we hypnotized him and one of them said you're on a nice vacation remember how what the vacation was like another think about something that makes you really happy just have some positive feelings and so we looked at what was different between the high and low hypnotizables in and out of hypnosis and we found three major findings the first was a reduced activity in that same region I mentioned before the anterior cingulate cortex so you see the activity went down in that area and the the more it went down the more more hypnotized subjects thought they were the second is higher connectivity functional connectivity between the executive control region the dorsal lateral prefrontal cortex and little grape sized part of the brain called the insula the insula is a part of the brain that regulates activity in the body it regulates blood pressure involved in heart rate and and as well as part of the pain pathway so it helps us interpret pain so it's a state in which people are more closely connected to the part of their brain that regulates how their body is working and feeling the third is inverse connectivity between the executive control region and a deep structure in the brain that we call the default mode network if you're just sitting and reflecting on yourself not particularly doing anything as a task your default mode network is active so when you're doing a hypnotic task you're turning off your self-reflection you're disconnecting your dissociating and that's why people may do things in hypnosis that they ordinarily wouldn't do because they're not so worried about what it means to themselves or to other people if they're doing it so we now have a pretty clear brain signature of what happens when people are in a hypnotic state and the next thing we're going to do is we're starting now to use transcranial magnetic stimulation so this is real magnetism to influence activity in brain regions that can affect hypnosis to see if we can further enhance the hypnotic state so we are they were in a sense trying to amplify hypnotic techniques using real magnetism so in hypnosis you're in a stay in a mental state where you can rather than just reacting to events that come in from the world you can actually manipulate and you can manipulate perception normally we use the front part of our brains to control the world it's our motor cortex the place where we plan the place where we use speech the way I'm using speech now with you and the back part of the brain is our receptor brain where we are responding to sounds and visual input and somatosensory input and typically we react with the back and we act with the front but we can use hypnosis to actually control our ability to perceive the environment and to perceive it in a different way and I'll show you some examples of that this is one clinical example here we did this study some years ago with a man a colleague of mine from Harvard who was sort of skeptical about hypnosis and he said you know maybe if you just turn off perception you can just shut your brain down and it doesn't mean anything very specific he was interested in visual imagery so we identified using a different technique positron emission tomography blood flow in regions of the brain that were associated with looking at color here and we had people look at color and black and white grids they were highly hypnotizable and we ant we asked them in hypnosis to change their perception of the grid sort of like what you're doing here so drain color from the color grid and in another condition add color to the black and white grid and they could do that they would see the black and white grid is colorful and the color grid is black and white and what we found was that when they were adding color to a black and white grid they increased blood flow in those regions and when they were draining color from a color grid they decreased blood flow in those regions so I call that my believing is seeing experiment then in hypnosis you could change perception to the extent that it seemed real but your brain was acting as though it were real so you're not just getting the same perception and acting differently you're actually changing your perception so there continues to be interest in hypnosis in places like Newsweek back when we used to have news magazines this is another study in which we used a different technique called event-related potentials we measure electrical activity on the scalp we gave a series of shocks to the wrists of ten highly hypnotizable people the red line is their brains normal response to those shocks and in the yellow line condition we gave them the same shocks but i hypnotized them and said your hands in circulating ice water it's cold tingling and numb it will filter the hurt out of the pain and here you see that the brain's electrical response to those same signals was half as big out here a tenth of a second after the signals there was no reaction at all so we were really changing the way their brains processed these pain signals and that indicates for some really powerful clinical effects this is a work from a group of in university of montreal pierre Rainville and colleagues where they showed that the words you use change the part of the brain that gives you analgesia so if you say what I said in the previous experiment your hand is cool tingling and nominal filter they heard out of the pain you got pain relief but the pain relief was in somatosensory cortex back here where you're where we process somatic sensation if you told them instead the pains there but it won't bother you very much which is what people sometimes report when they take opiates here the change was in the anterior cingulate cortex the somatosensory cortex was the same here is the anterior cingulate so we we're able to turn on or off different parts of the brain depending just on what we tell people in hypnosis so this is a technique that allows us to not just shut down the brain in general but to use very specific brain regions to obtain very specific results now if you'd like we can try a little self hypnosis exercise here if any of you don't want to do it don't do it just here but I thought I would try to give you an experience that gives you a sense for what hypnosis is really like so if you'd like it as comfortable as you can all right and then on one do one thing look up high as you can on to two things slowly close your eyes and take a deep breath and on three let the breath out let your eyes relax but keep them closed and let your body float imagine you're floating somewhere safe and comfortable like a bath lake a hot tub or just floating in space each breath deeper and easier with each breath out let a little more of the tension out of your body if you have some discomfort in some part of your body imagine that that region is warmer or cooler or tingling or numb if you get relief from pain taking a warm bath imagine you're floating in a warm bath or a hot tub if you get relief from coolness instead imagine you have a bag of eye over that part of your body or that you're floating in a cool mountain lake warm or cool tingling numbness let it filter the hurt out of the pain each breath deeper and easier picture in your mind's eye and imaginary screen it might be a movie screen or a TV screen or a piece of clear blue sky and picture on it a pleasant scene somewhere you enjoy being and notice how quickly and easily you can use your store of memories and fantasies to help yourself in your body feel better now please take a few moments to reflect on what this feels like to you and a private sense and then when you're ready bring yourself out of the state of self-hypnosis by counting backwards from three to one on three we'll get ready to with your eyelids closed roll up your eyes in one open ready three two one everybody okay we didn't lose anyone here I didn't see anybody actually floating but anybody have an experience they want to share with us well think about it for later maybe during the question period if you had some but this gives you an idea of what hypnosis is like it's a simple safe and effective technique how many of you felt some change in your body when you when you did this how many of you felt better did you feel so you see you can very quickly use this state of self-hypnosis to help yourself and your body feel better and this is a kind of thing over a longer period of time and with more instruction that I tend to use to help patients in dealing with problems like pain and stress people over we got we got our raucous crowd over here is there anything you want to share with us they're just uh [Laughter] he said he fell in love with her are you who did you mean by you me or him I take no further responsibility for what happened so as I mentioned the cingulate cortex is a major reason of importance here in turning that down you're able to allow yourself to put aside other concerns and allow your body to feel differently now pain is an important example we know that there is a pain pathway when you stub your toe you'll notice that first you notice you stubbed it and after a few seconds it starts to hurt because the the nerves that carry the pain signals through the lateral spinothalamic tract up into the brain are not well myelinated so they conduct impulses very slow and it's a long way to go so then it starts to hurt and that's how your brain identifies that something's happen to your body and there's pain however we also know that there is top-down regulation of pain as well so you can change the way you experience pain from your brain down as well as from your body on up as you can see here I think you can see that the baby is the one who's getting the shot and the father is the one who's in pain so the brains interpretation of the signal has a lot to do with how much it hurts as an example we did a randomized trial in which we took 241 patients who had to have arterial cut-down we don't use general anesthesia for this but you're on the table for two to three hours you have catheters threaded through your arteries to embolize tumors in the liver or visualize constrictions and arteries around the kidneys or elsewhere you're anxious about what's happening there is pain involved and we randomized into three conditions standard care everybody could push a button and have opiates injected into their vein one was structured attention so you had a nice nurse in addition to the IV and opiates you had a nice nurse comforting you and the third was was someone trained to teach you self Knossos and we randomized patients to those three conditions so they didn't choose it we chose them and here's what happened in terms of their pain reactions so in the first hour they weren't so different but by the end of two and a half hours the pain ratings of the hypnosis group were one out of ten and the pain ratings of the standard care group were four out of ten so they had four times as much pain we looked at their anxiety ratings and I was afraid the hypnosis group had all died because they had no anxiety at all and it was four and a half out of ten in the standard care group and in between for the nursing support group the ones who had the standard care had used twice as much pain medication as the patients in the other group they the average procedure time was 17 minutes shorter for the ones who got the hypnosis and we noted by the way that the staff was less anxious because they could see that they were not making their patients as uncomfortable and there were fewer adverse interoperative events in the hypnosis group 8 compared to the standard care group 34 we actually found that we would save 328 dollars of procedure using the hypnosis even though we had to pay an extra person to be in the room because they were so much more comfortable and used so much less medication and this raises a serious question you know the Opia I know the opioid epidemic is a terrible problem here I understand that today the governor of Florida allocated an extra 26 million dollars to do something about the prescription opiate problems here people are also moving in people who would never be you know street drug abusers are buying opiates like fentanyl and heroin because they're cheaper than the prescription opiates that they are getting or they can't get more of them one out of four Americans with private health insurance has at least one opiate prescription a month so we have a terrible addiction problem and when I start when I was in medical school we were taught that if you have real pain you don't get addicted to opiates well it turns out that's just wrong that opiates are good for acute pain control for a few days but hypnosis can be - but if you're on an opiate for more than three days the odds of you getting addicted start going up and what happens is you get rebound pain it's what keeps people addicted the pain gets worse you're you're occupying the opioid receptors we have endogenous opiates eptas we have our own we make our own endogenous opiates to help us manage pain but you sensitize those receptors when you withdraw the opiates and so these people get hooked and stuck so there's a tremendous need for us to develop nonpharmacologic ways of helping people deal with pain one of them is acupuncture the masterda is responding very well to this approach it works for chronic pain as well this is from a randomized trial we did sponsored by the National Cancer Institute and National Institute of Mental Health in which we taught women with advanced metastatic breast cancer who met once a week for support groups to do self hypnosis like we did together at the end of the group and by the end of the year our treatment patients had half the pain of the control patients on the same and very low amounts of medication and we were able to repeat that finding in another study we did a mere 15 years later so it works for acute as well as chronic pain and it really is a shame that we're not making more use of people's own ability to regulate their brains in regulating their pain experience hypnosis is being used now for breast biopsies to make a diagnosis of breast cancer and even for lumpectomy to actually remove tumors lump from from a breast so it is possible to use it safely and effectively in even fairly major surgical procedures as well as diagnostic procedures he's saying the way we treat a headache here is to divert your attention to something else we're a little more sophisticated than hypnosis is also very helpful helpful in dealing with stress-related disorders we teach people as you learn to imagine they were floating ask them where they'd rather be have a sensory alteration that we did together warmth or coolness and there are a number of major medical diseases that we can treat using self-hypnosis Parkinson's I'll show you an example of how we control stomach acid and several other examples before we stop for questions and part of the problem is that because people can modulate their symptoms with their brain some doctors conclude that there's really nothing wrong physically and nothing could be farther from the truth patients have gone through full childbirth with hypnosis as the only anesthesia and nobody is going to stand here and tell me that childbirth doesn't hurt but you can change the way you respond to it I'll show you an example here of a patient who had Parkinson's disease a young man with Parkinson's they sent him to me because you had to do the electrode implantation into the basal ganglia the patient has to remain awake so you know you've got the electrode in the right place but he interrupted surgery twice so he'd been operated on for an hour and a half twice and couldn't get through the rest of the procedure so his rather frustrated surgeon dr. heit sent him to me and said get him ready to get through the procedure and here he is and what I noticed he was rather hypnotizable and I noticed something when I actually put him in to hit my face okay just like this is involuntary tremors like are you feeling now good a little tight in the ankles oh he has tightening you can't see it but tightening in his license back and long as well lower back to okay good anywhere else or is that pretty much it Emma's up down this line mm-hmm looks like up and down your spine okay okay good alright we're going to get her okay alright good now what I want you to do is to put yourself into the state of self-hypnosis that we've done together and just take yourself to Hawaii okay how'd you see what happened just stop and if you told him stop moving your hand and said I can't that's good deep breath breath down eyes relax let your body float just enjoy the floating and picture yourself on the beach in Hawaii planning planning your activities feel the warmth of the Sun penetrating into your body and with each breath out let a little more the tension out so your muscles start to feel warm and loose that's great each breath deeper and easier now with your eyes closed and remaining in this state of concentration please describe how you're feeling right now on the web within about this em a little wet honey and sand is wet okay what else do you notice so notice that he's imagine he's on the beach in Hawaii he started when it's like the kids playing here - water huh okay and how's your body feeling oh one good so you're feeling comfortable it's hot so you feel that hot Sun good I will need some uh-huh you know what you're worried by getting a sunburn all right we better be careful that's good okay and so you're telling the kids to come come closer good are they listening to you no all right good they never do all right good keep your body floating how do your legs feel now that's not sore anymore good backs nuts are anymore my quads small type still kite a little time all right well concentrate on the Sun and the warmth in the back your legs and just let the tension melt away eh breaths deep burn easier body floating how are they feeling now messing with learning one rustle darts or any workable back isn't life and like ankle will tighten okay all right so I've got Elizabeth good all right we'll just let the warmth enter and let the tension drain away from your legs another deep breath each breath deeper knees your bodies floating so this is the exercise that you'll use in preparation for and during your MRI and during your surgery this coat of Hawaii and enjoy what you can do there as you get your body warm floating and comfortable right now we'll come out of the state of self-hypnosis together by counting backwards from three to one on three get ready to with your eyelids closed roll up your eyes and one open ready three two one how are you feeling now Brian's okay okay you should use your body feel different from the way it did before Maya's different little dream on your back doesn't hurt anymore good not deserve be back doesn't not another slow song the spies little saltiness in your right now I think it said salt water yeah okay okay anything else you know so in the space of just a few minutes you saw that he was able to control an involuntary body movement he couldn't control before he was able to loosen up most of the muscles in his neck and his back and his legs and changes that is now he did still finally eventually have the electrodes implanted but he got through the procedures and so this shows you that our brain has an ability to control functions that we ordinarily wouldn't think are within the reach of voluntary control and techniques like hypnosis can be very helpful to do that another example is this experiment we did where we put down a nasogastric tube and measured gastric acid secretion so secretion of the acid that your stomach makes to digest food and here you see in the first part of the experiment we took these people and in the morning they had to not eat anything since the night before imagine they were eating a breakfast an imaginary meal and they did that one they would go on for an hour I got very hungry just listening to them describe the meal and one woman said after half an hour let's stop I'm full she had eaten enough of this material we got a significant 89 percent increase in secretion of gastric acid just eating imaginary food in hypnosis so in the next condition we said we want you to relax and imagine you're somewhere safe and comfortable that involves anything except food or drink and here we got a significant 39 percent decrease in gastric acid secretion and patients who did this and then we injected them with Penta gastrin which is a hormone that the body uses to promote the secretion of gastric acid and even with that in the hypnosis condition we had a significant 90% decrease in gastric acid secretion so the brain could increase or decrease how much stomach acid you've produced so we have much greater control and that's that connection to the insula in the brain that helps us regulate how our body is reacting to stress the third example is teaching people self-hypnosis to stop smoking this is the smoking gun here and we teach people not to tell themselves don't smoke that's like try telling yourself don't think about purple elephants you know what do you think about but instead to focus on three concepts for my body smoking is a poison I need my body to live I owe my body respect and protection in hypnosis and anytime you have an urge to smoke don't fight it admit it but sit down or lie down go into the state of self-hypnosis and reestablish your commitment to respect and protect your body think of your body the way you would your favorite pet or your child you would never think of putting tar and nicotine into a child's lungs if you took out a can of pet food that said warning the Surgeon General has determined this is dangerous to your dog's health the only people who tell me they would feed that to their dog or people who hate their dog but most people don't so instead you focus on what your for respecting and protecting your body we find that after a single session of pee Qing people self-hypnosis half of them will stop and half of those people will not touch a cigarette in two years so we get 1 out of 4 long-term abstinence from smoking with a single session of self-hypnosis which is better outcome than you get from any of the medications or other programs that you use so teaching people to reprogram their brains and think about the problem of smoking from a different point of view can lead to an important and health-related behavior change my final example is involves this man who was a bricklayer who had a defective ladder fall on his hand and he had a compound fracture of his index finger and this is his hand two and a half years after the injury in full extension he couldn't open his hand more and he you know was a real tragedy for him he'd been making a lot of money more money than I was making as an assistant professor in those days as a bricklayer he lost his job his wife left him he got depressed and yet the insurance company said we're going to have to amputate your index finger you ever have a useful hand and and they were actually secretly filming him now I wouldn't ordinarily believe that but it was in his medical record and they and so they sent him to our a wonderful hand surgeon at Stanford Bob chase who said I'm not going to amputate this finger are you willing to try anything said well yeah even a psychiatrist well maybe even one who uses hypnosis he said I'll try anything doc so he came to see me and I said you know I don't know why your hand is like this and I don't care do you want to get better and he said yes and I said well you have horrible circulation in your hand as you and I would if we held our hand like this for two-and-a-half years you have four centimeters less muscle mass in your left hand than you do in your right so you need to develop tremors in your hand to build up the strength and circulation so he sat on my office for half an hour in hypnosis with his hand shaking sweat pouring off his forehead and I thought this is not a man who's not motivated to get better so he did this twice a day for half an hour and by the end of two months he had full extension of all the fingers except the originally fractured one and dr. chase put a dynamic splint on the on the on the original finger to gradually stretch it we also gave him an old tennis ball to exercise with and he actually ruptured some ligaments in his hand he was trying too hard we had to tell him to slow down take it easy by the end of a year he had full extension of the hand and now he could make a real fist he came to my clinic carrying a 35-pound brick and the Secretary was afraid he was going to throw it through the window he just wanted to prove to me that he could again hold a brick and use the the mortar and go back to brick lane and the insurance company didn't believe that he could actually use his hand and he had to take them to court to get him off to get himself off disability so that he could go back to work and once again he is back at work he's now a contractor and making again more money than than I am and you know the funny thing is that he he would say would sit there you know one of the major misconceptions people have about hypnosis is that it's taking control over somebody and all I was doing was teaching him how to enhance his control of his own body and so when I would be explaining this to the medical students he'd be sitting there and saying doc when do I get to show them what I did and he was right about that it wasn't what I did to him it was what I showed him how to do for himself so hypnosis can be a powerful way of controlling the way our brain functions the way we process signals like pain the way we control motor movement in problems like Parkinson's and in this kind of physical rehabilitation so it's an opportunity that is based on good brain science and clear studies of outcome for us to take much better charge of how we run our bodies anyone interested my late father and I wrote a textbook about this called trance and treatment clinical uses of hypnosis I want to acknowledge our sources of support the National Center what is now called complementary and integrative health the National Institute on Aging the National Cancer Institute National Institute of Mental Health the California Breast Cancer Research Program the Dana and MacArthur Foundation's as well and I am very relieved to have heard while I was in Washington the other day that while President Trump had been threatening to cut the NIH budget by 18 percent it looks like there's a bipartisan agreement that there will be a six percent increase in the NIH budget this is a little time so they have enabled me to do this kind of work and thousands of other scientists to help make everybody's health and life better he says stress is killing you you need an easier job a smaller house and a different family this is our Center for Integrative Medicine at Stanford we've been in business for 19 years using techniques like hypnosis mindfulness acupuncture meditation to help patients cope better with a variety of serious medical and psychological problems we treat pain headache cancer fibromyalgia chronic fatigue a number of problems in which we try to help people learn to better manage their own bodies but the mind-body relationship is nothing to fool around with he's saying what happened here sergeant and he says a placebo overdose we're pretty sure he only thinks he's dead thank you for your attention [Applause] [Music] you so much dr. Spiegel we this was wonderful we do have a few minutes for some questions and we will take this one first what are the similarities and dissimilarities between hypnosis and meditation patient well thank you for that question you know I'm very happy that one of the oldest Eastern traditions in what we might consider psychotherapy is now becoming widely available and popular here part of the difference is what they're used for so in the West we're very problem focused and we want to accomplish things so hypnosis tends to be used to solve a problem smoking pain stress things like that the idea of mindfulness is it's just a way of being and if it happens to help you with some medically related problem that's a good thing in hypnosis we focus attention a lot you do that sometimes in meditation too and what's called the body scan where you move around your body and feel different things but the idea also is not to control what you feel as we do with hypnosis but actually to just let feelings wash through you that's called open presence and mindfulness where if you're angry or fearful or sad or in pain you just kind of sit with the feeling and don't fight it and let it flow by the way a storm would go by so it's a different approach in which you're not trying to regulate in control but simply be open to the experience and the third part and a lot of meditation is focusing on compassion being compassionate with people both people known to you and people not known to you which is somewhat related perhaps to suggestibility and hypnosis but different there are also different things happening in the brain mindfulness tends to be more something that you learn to do and you do better so there's actually the been studies Richard Davidson at the University of Wisconsin has shown increase in activity and sometimes growth of the left prefrontal cortex which tends to elevate mood and there's a group at the University of Massachusetts now that has shown reduction in activity and part of the default mode network that I mentioned earlier the posterior cingulate cortex so there are related but different changes in the brain when people go into these state as well we have more to learn about it we're doing some active research on that now so they're similar but they're not the same thing you've shown how the essential tremors like Parkinson's and I suppose the essential tremors can be controlled at least temporarily I'm wondering if those tremors if there's a way hypnosis can help someone control those tremors like all day long oh well in a more permanent basis one of the things there are two issues that you raised in this question and one of them is well so you can do this acutely but what effect does it have in the long-term well as you saw some of our chronic cancer patients got long-term pain control the nice thing about hypnosis is you don't have to be in a trance all the time but when the problem gets bad you can hypnotize yourself again so you've got the treatment with you all the time and you can just sit down or lie down and go into the state so some people with chronic tremors can get some benefit I have helped some people like that usually it's not the whole story and sometimes some medications that help in combination can be can be very good one of the interesting things about these tremors is that they are very much stress and anxiety related so the person will have the basic tremor but if they're in a social situation like this I mean I've seen people giving lectures holding their hands to not magnify the tremor by magnifying the shaking of the so stress will make it worse and sometimes you can help people better manage the stress not be so anxious about the fact that people might notice that they have this tremor or make a joke about it I know patients will do that he'll say you guys really make me nervous so you're going to see how I say you know something like that so you can teach people to deal with the secondary amplification of a symptom that comes with stress people with MS for example can often get around very well but when they have to get on a bus the symptoms get worse because there's so much social pressure to function physically and get on the bus and not slow it down so they're clearly with a lot of neurologic diseases there is a stress and anxiety related component and that's the part where hypnosis can be very helpful if you expand on acupuncture so acupuncture is an ancient Eastern technique in which needles are usually put under the skin at certain nodes there are 365 points that are meant to represent sort of what are called chakras or lines of energy within the body developed in Japan and in China and there is pretty clear evidence that acupuncture is very helpful particularly for pain some people find it relaxing to on it's different from hypnosis in that you're not formally supposed to go into some altered mental state it's mostly a physical manipulation there are some studies that show that more hypnotizable people actually get better results from acupuncture so it may function as a kind of hypnotic induction ceremony but a big difference is I mentioned earlier the endogenous opiates system if you block the endogenous opiates system with naloxone a commonly used anti opiate drug you block the effective acupuncture so it seems to stimulate the body secretion of its own endogenous opiates hypnosis is not blocked by malach zone so it seems to work by a different pathway the a lot of the endogenous opiates are in the spinal cord and lower parts of the brain so it's a different part of the central nervous system that's involved in in acupuncture analgesia but there is some overlap my name is Barbara tippin's Frigga and I'm a retired physician yes I learned self hypnosis 30 years ago with Gestalt in Student Cleveland it's been invaluable ever since but we're now in North Central Florida in a small city do you have any recommendations here because it really does help to have people have another person help them learn this technique who can we go to here rather than traveling to Stanford I think you should come to Stanford no I it's so there are a couple of key issues about finding a good practitioner to help you with hypnosis and I'm very glad to hear that it's been helpful to you in the past and it does help to get that kind of reinforcement and also think about different ways of using the technique there are two professional hypnosis societies one the Society for clinical and experimental hypnosis and the website is SCE H dot us and the other is the American Society for clinical hypnosis ASC h-net and both of them have referral services can help you get in touch with a professional in this area the other is that sometimes primary care Doc's know of professionals who practice hypnosis the key thing is you don't want a hypnotist you don't want somebody in the in what we used to call the yellow pages who took a weekend course and is doing hypnosis you want a licensed and trained professional in medicine dentistry psychology or other clinical disciplines who also knows about hypnosis but searching those two professional societies can be a path to getting a good referral we have time for one more question here up front okay ma'am you talked about many things here and they were very interesting but one in particular is the area of hypnosis and early onset dementia you're talking about the same areas of the brain that are affected could you expand on that well one of the sad things about dementia early on 7 any kind is that it tends to impair the ability to concentrate so it makes sense that some of those similar regions would be involved but unfortunately from the point of view of hypnosis as a treatment it means that as dementia starts it's much less likely that the person would be able to use it to help with any symptoms that come up so you right there similar brain regions but if those regions are damaged when you turn down the anterior cingulate you still have exquisite control of how active it is but if you start to develop dementia now it's other brain regions as well they hippocampus in other regions that store in between memories which are not directly involved in hypnosis but if people just can't stay with you and remember the instructions unfortunately they're less likely to be able to respond and life to take this opportunity to thank our speaker one last time dr. scooter [Applause]

Channel: TheIHMC

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Id: W21UjAUtFVA

Length: 63min 4sec (3784 seconds)

Published: Thu May 25 2017