Using Hypnosis to Enhance Mental & Physical Health & Performance | Dr. David Spiegel

The episode introduces Dr. David Spiegel as associate chair of psychiatry and behavioral sciences at Stanford University School of Medicine and director of the Stanford Center on Stress and Health. He is described as both a researcher, running a laboratory on how the brain and body interact, and a clinician who sees patients as a psychiatrist at Stanford. His credentials are given as more than 480 journal articles, 170 book chapters and 13 books, covering hypnosis, psychosocial oncology, stress physiology, trauma and psychotherapy.

The introduction separates two things that share a name. Stage hypnosis is described as a hypnotist getting someone to do things they would not otherwise do. Clinical hypnosis is presented as people changing their own brain state and using it as a portal to make adjustments that benefit them. The introduction also says hypnosis may be a state in which neuroplasticity is heightened, and that clinical hypnosis has been shown to improve symptoms of stress, chronic anxiety, chronic pain and various other illnesses, including many psychiatric illnesses and even outcomes in cancer. These claims are stated in the introduction; the excerpt does not present the underlying data.

Hypnotizability varies from person to person. The introduction notes that not everyone can be hypnotized as readily as the next person, and mentions a simple test developed by Spiegel that classifies people as high, medium or low in hypnotizability.

Some disclosures are relevant. The episode promotes the Reveri app, which was developed by Spiegel and is described as based on clinical studies from his Stanford lab. It is described as Apple-only for now, with Android support coming, and as carrying a nominal cost with a 7-day free trial. The introduction also says the host's own Stanford lab has been collaborating closely with Spiegel on breathwork protocols for anxiety, mood and sleep. A clip of Spiegel hypnotizing the host is said to be posted separately on a clips channel.

hypnosis is a state of highly focused attention. It's something like looking through the telephoto lens of a camera in consciousness. What you see, you see with great detail, but devoid of context.

The everyday analogy is getting so absorbed in a film that you forget you are watching one. You become part of the movie rather than the audience, experiencing it rather than evaluating it. The conversation calls this a hypnotic-like experience that many people have in daily life.

Next comes a harder case: a sports fan who is absorbed in the game but also aware of excitement or anticipation in the body. The answer turns on whether the bodily experience is part of the absorption or a distraction from it. If the body's reaction is part of the engagement with the event, it counts as a self-altering hypnotic experience. If the physical reactions pull attention elsewhere, the experience is less hypnotic-like.

The interest is described as running in the family: both parents were psychiatrists and psychoanalysts. In 1943, the father was training as a psychoanalyst and met Gustav von Aschaffenburg, a Viennese refugee who had studied hypnosis and used it in forensic examinations. Von Aschaffenburg had a smallpox scar in the middle of his forehead. He noticed that some prisoners would fix on that spot, close their eyes and enter what seemed like sleep but was an altered state. He offered to teach young psychiatrists hypnosis before they went to war. The father used it with wounded soldiers in acute pain and with people suffering conversion and post-traumatic stress disorders.

After the war, the father was told to stop using hypnosis because it would ruin his reputation as an analyst. In the story, the famous psychoanalyst Frieda Fromm-Reichmann, one of his supervisors, pushed back. She told him he would teach a course on hypnosis at the Institute, and that she would take it. Over time, he found he was getting better results from a few hypnosis sessions than from daily psychoanalysis, and he changed his practice.

The turning point came during a rotation at Children's Hospital in Boston, where a nurse addresses the narrator as "Spiegel." The patient was a 16-year-old girl with asthma, sitting bolt upright, knuckles white and wheezing. Two doses of subcutaneous epinephrine had not worked, and general anesthesia and steroids were being considered. He had not yet covered asthma in his hypnosis course. He hypnotized her with a single suggestion: "Each breath you take will be a little deeper and a little easier." Within five minutes she was lying back in bed and was no longer wheezing.

The institutional reaction was hostile. A nurse filed a complaint alleging that hypnotizing a minor without parental consent violated a Massachusetts law, which the narrator doubted existed. The intern called the practice dangerous, and the narrator replied that general anesthesia and steroids were the riskier options. After a weekend of argument among the intern, chief resident and attending, the team decided to ask the patient, who said she liked it. She had been hospitalized every month for three months in status asthmaticus. Afterward she had one more hospitalization and later studied to become a respiratory therapist. This is a single patient's account, not a controlled result.

The experience is contrasted with classmates who reached for the newest medication in the New England Journal, and with surgeons who handed over "anything above the neck." From this the speaker concludes that we are born with a brain but no user's manual for it, and do not use it as well as we could.

The conversation is openly critical of stage hypnotists, who "make fools out of people." It describes their method: at the start of a show they bring up a group and effectively run mass hypnotizability testing to pick the most hypnotizable people. In a case involving the father at Columbia, a stage hypnotist told a highly hypnotizable woman that a little bird was in her hand. She began to cry and scream, was taken off stage, and wandered New York City dissociated in the middle of the night before being brought to Columbia, still in an uncomfortable trance-like state. She was the wife of a very wealthy man and felt like "a bird in a gilded cage." The image had triggered her dissatisfaction and fear about her life. The father was able to reorient her and talk with her about what she would do with her life.

They think you're losing control; you're gaining control.

Self-hypnosis is framed as a way to increase control over mind and body. The conversation is also explicit about the risk. The same cognitive flexibility that makes hypnosis useful, the ability to shift sets, set aside the usual judging and evaluating, and suspend critical judgment, can be misused to harm people. The speaker notes plenty of examples of people having fantasies imposed on them that they come to believe are real, and says this is not unusual today.

The host adds his own experience. He was stage-hypnotized in college, chosen from a group, and engaged in bizarre and fairly embarrassing behavior. This included shouting something on the way off stage because of a planted suggestion and finding what he thinks was a torn-up dollar bill in his pocket. He says his memory of it is vague. He also describes himself as very hypnotizable. He then frames the scientific question: if hypnosis has an induction, a hypnotized phase and an exit, what happens in the brain at each stage? He suggests that the woman with the bird may represent a failure to exit.

The imaging work described compared people selected for being highly hypnotizable with nonhypnotizable people, hypnotizing them inside a functional MRI scanner. Three features characterized entry into the hypnotic state.

1. Reduced activity in the dorsal anterior cingulate cortex (dACC), part of the salience network and described as a conflict detector. Turning it down makes a person less likely to be distracted out of what they are doing. 2. Increased functional connectivity between the dorsolateral prefrontal cortex (DLPFC), part of the executive control network, and the insula, which is involved in mind-body control and pain. 3. Inverse functional connectivity between the DLPFC and the posterior cingulate cortex, part of the default mode network.

The dACC is explained with an example: if you are working and hear a loud noise that might be a gunshot, the dACC flags a possible danger and compares it with what you are doing. A separate study is said to have found that highly hypnotizable people, even when not hypnotized, have more functional connectivity between the dACC and the left DLPFC. When one is up, the other is up. This coordination is read as the brain saying, in effect, "carry out that plan and don't worry about other possibilities."

The DLPFC–insula link is backed by an older study on gastric acid. Highly hypnotizable people under hypnosis went on an imaginary culinary tour of their favorite foods, and their gastric acid secretion rose by 87%. One participant asked to stop because she felt full from foods she had never actually eaten. When participants were told to relax and think of anything but food or drink, secretion fell by 40%. Even after an injection of pentagastrin, which triggers gastric acid release, the hypnosis condition produced a 19% reduction. These figures are offered as one example of the brain controlling bodily processes people do not think they can control.