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Ask the Mental Health Expert Archives 2001-2004

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Hypnotherapy

Q. I am interested in knowing (1) How successful is hypnotherapy when used to treat personality disorders, (2) Which psychiatric disorders are most helped by its implementation, (3) Which psychiatric disorders either do not benefit or are exacerbated by hypnotherapy, and (4) Who are its current best known and reliable proponents? What is the minimum training that a psychologist/psychiatrist should have before he/she introduces hypnotherapy into his/her practice?

A. These are astute questions, but the science we have available may not be able to answer them. Consider this: there are literally dozens of psychiatric disorders. In order to know how effective hypnotherapy is in each of them, we would need hundreds of patients enrolled in controlled studies, with objective measures of improvement for each group. I can assure you, nobody has done this kind of research on hypnotherapy!

Most of the data we have come from small, uncontrolled studies and case reports. Still, there are some trends emerging from the literature. As a broad generalization, hypnotherapy (or more accurately, hypnosis, since it is really a technique, not a therapy) has been found useful in treating acute stress disorder; conversion disorder; various dissociative states (amnesia or fugue); certain types of sleep disorders; and a variety of pain-related syndromes.

For more details, you may want to see the textbook, Synopsis of Treatments of Psychiatric Disorders, 2nd ed., by G.O. Gabbard & S.D. Atkinson. These authors note the paucity of controlled data with respect to studies of hypnosis. But there are some controlled studies that suggest the effectiveness of hypnosis for the reduction of cancer pain (see Syrjala et al, Pain 1992; 48:137-46); sleep-onset insomnia (see Stanton HE, Int J Psychosom 1989; 36:64-8); and non-organic male sexual dysfunction (Aydin et al, Scand j Urol Nephrol 1997; 31:271-4).

There is a good deal of interest in the use of hypnosis in patients with various traumatic disorders--but also a good deal of controversy. This has to do with claims of false memory syndrome or implanted memories in these patients. There is some evidence that individuals who are highly hypnotizable are also vulnerable to memory distortion, but there is very little evidence that hypnosis itself creates distorted memories (see Gabbard & Atkinson, p. 681). Some of the most prominent clinicians using hypnosis as part of therapy include Richard Kluft MD, David Spiegel MD, and Dr. BG Braun.

Regarding training, you may want to see several articles on this; e.g., Walling et al, "Scope of hypnosis education in academia." in Int J Clin Exp Hypn 1998; 46:150-56. My impression is that training in hypnosis varies widely in psychology internship programs, and that ideal standards are still being worked out. (Also see Elkins et al, Am J Clin Hypn 1998; 41:55-64).

Finally, a personal observation: I know of no psychiatric disorder for which ONLY hypnosis has been found effective. Most clinicians know that hypnosis is merely part of the overall psychotherapeutic approach to the patient, not a therapy in itself.

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September 2001

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