Hypnosis and Relaxation Therapies

A wide variety of the complementary therapies claim to improve health by producing relaxation. Some use the relaxed state to promote psychological change. Others incorporate movement, stretches, and breathing exercises. Relaxation and “stress management” are found to a certain extent within standard medical practice. They are included here because they are generally not well taught in conventional medical curricula and because of the overlap with other, more clearly complementary, therapies.therapies.

Table 1

Definitions of terms relating to hypnosis
Hypnotic trance—A deeply relaxed and focused state with increased suggestibility and suspension of critical faculties
Direct hypnotic suggestion—Suggestion made to a person in a hypnotic trance that alters behavior or perception while the trance persists (for example, the suggestion that pain is not a problem for a woman under hypnosis during labor)
Post-hypnotic suggestion—Suggestion made to a person in a hypnotic trance that alters behavior or perception after the trance ends (for example, the suggestion that in the future, a patient will be able to relax at will and will no longer be troubled by panic attacks)

TECHNIQUES

Hypnosis

Hypnosis is the induction of a deeply relaxed state, with increased suggestibility and suspension of critical faculties. Once in this state, sometimes called a hypnotic trance, patients are given therapeutic suggestions to encourage changes in behavior or relief of symptoms. For example, in a treatment to stop smoking, a hypnosis practitioner might suggest that the patient will no longer find smoking pleasurable or necessary. Hypnosis for a patient with arthritis might include a suggestion that the pain can be turned down like the volume of a radio.

Some practitioners use hypnosis as an aid to psychotherapy. The rationale is that in the hypnotized state, the conscious mind presents fewer barriers to effective psychotherapeutic exploration, leading to an increased likelihood of psychological insight.

Relaxation and meditation techniques

One well-known example of a relaxation technique is known variously as progressive muscle relaxation, systematic muscle relaxation, and Jacobson relaxation. The patient sits comfortably in a quiet room. He or she then tenses a group of muscles, such as those in the right arm, holds the contraction for 15 seconds, then releases it while breathing out. After a short rest, this sequence is repeated with another set of muscles. In a systematic fashion, major muscle groups are contracted, then allowed to relax. Gradually, different sets of muscle are combined. Patients are encouraged to notice the differences between tension and relaxation.

The Mitchell method involves adopting body positions that are opposite to those associated with anxiety (fingers spread rather than hands clenched, for example). In autogenic training, patients concentrate on experiencing physical sensations, such as warmth and heaviness, in different parts of their bodies in a learned sequence. Other methods encourage the use of diaphragmatic breathing that involves deep and slow abdominal breathing coupled with a conscious attempt to let go of tension during exhalation.

Visualization and imagery techniques involve the induction of a relaxed state followed by the development of a visual image, such as a pleasant scene that enhances the sense of relaxation. These images may be generated by the patient or suggested by the practitioner. In the context of this relaxing setting, patients can also choose to imagine themselves coping more effectively with the stressors in their lives.

Meditation practice focuses on stilling or emptying the mind. Typically, meditators concentrate on their breath or a sound (mantra) they repeat to themselves. They may, alternatively, attempt to reach a state of “detached observation,” in which they are aware of their environment but do not become involved in thinking about it. In meditation, the body remains alert and in an upright position. In addition to formal sitting meditation, patients can be taught mindfulness meditation, which involves bringing a sense of awareness and focus to their involvement in everyday activities.

Yoga practice involves postures, breathing exercises, and meditation aimed at improving mental and physical functioning. Some practitioners understand yoga in terms of traditional Indian medicine, with the postures improving the flow of prana energy around the body. Others see yoga in more conventional terms of muscle stretching and mental relaxation.

Tai chi is a gentle system of exercises originating from China. The best known example is the “solo form,” a series of slow and graceful movements that follow a set pattern. It is said to improve strength, balance, and mental calmness. Qigong (pronounced “chi kung”) is another traditional Chinese system of therapeutic exercises. Practitioners teach meditation, physical movements, and breathing exercises to improve the flow of Qi, the Chinese term for body energy.

WHAT HAPPENS DURING TREATMENT?

Hypnosis

In hypnosis, patients typically see practitioners by themselves for a course of hourly or half-hourly treatments. Some general practitioners and other medical specialists use hypnosis as part of their regular clinical work and follow a longer initial consultation with standard 10- to 15-minute appointments. Patients can be given a post-hypnotic suggestion that enables them to induce self-hypnosis after the treatment course is completed. Some practitioners undertake group hypnosis, treating up to a dozen patients at a time—for example, teaching self-hypnosis to prenatal groups as preparation for labor.

Relaxation and meditation techniques

Most relaxation techniques require daily practice to be effective. A variety of formats for teaching relaxation and meditation exist, including classes as well as individual sessions. Relaxation can be taught in 1 session by conducting and audio taping a relaxation session. Using the audio tape, patients can then practice the techniques daily at home. Methods such as progressive muscle relaxation are easy to learn; yoga, tai chi, and meditation can take years to master completely.

Most relaxation techniques are enjoyable, and many healthy individuals practice them without having particular health problems. Relaxation classes can also play a social function.

Unlike in many other complementary therapies, practitioners of relaxation techniques do not make diagnoses. They may use the conventional diagnoses as described by the patient to tailor the prescribed program appropriately. In many cases, however, the method of treatment does not depend on a precise diagnosis.

THERAPEUTIC SCOPE

The primary applications of hypnosis and relaxation techniques are for anxiety, disorders with a strong psychological component (such as asthma and irritable bowel syndrome), and conditions that can be modulated by levels of arousal (such as pain). They are also commonly used in programs for stress management.

Research evidence

Evidence from randomized controlled trials indicates that hypnosis, relaxation, and meditation techniques can reduce anxiety, particularly that related to stressful situations, such as receiving chemotherapy (see box). They are also effective for insomnia, particularly when the techniques are integrated into a package of cognitive therapy (including, for example, sleep hygiene). A systematic review showed that hypnosis enhances the effects of cognitive behavioral therapy for conditions such as phobia, obesity, and anxiety.

Findings from randomized controlled trials support the use of various relaxation techniques for treating both acute and chronic pain, although 2 recent systematic reviews suggest that methodologic flaws may compromise the reliability of these findings. Randomized trials have shown hypnosis is valuable for patients with asthma and irritable bowel syndrome, yoga is helpful for patients with asthma, and tai chi helps to reduce falls and fear of falling in elderly people.

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