The topic of hypnosis and its use in medical and clinical settings is one that, seemingly more often than not, quickly elicits a demonstratively expressed opinion among medical and mental health practitioners, scientists, and observers. These opinions are delivered with widely varied degrees of actual knowledge and understanding about hypnosis, its uses, and its history. This chapter provides a comprehensive resource to those seeking a more substantive understanding of hypnosis and its uses both established and emerging. The use of hypnosis was evident in psychiatric treatment during and following World War I and World War II. The history of hypnosis in medical and clinical settings provides an excellent example of the importance of understanding the historical context in which a particular clinical approach was developed. The history of hypnosis is long, complex, and essential to understanding the current state of knowledge, application, and research of hypnosis in medical and clinical settings.

Hypersuggestibility is not the only property that has historically been claimed for the hypnotic trance. Other alleged properties have included hyperobedience or automatism, profound insensibility to pain, ability to perform superhuman or even supernatural feats, hypermnesia, extreme literalism, and facilitated communication with the unconscious mind. Socio-cognitive theories attempt to explain hypnotic phenomena in terms of normal cognitive and social psychological processes such as imagery, role enactment, compliance, response expectancy, and various combinations of these. Neo-dissociation theory and, in particular, the idea of the hidden observer have proved attractive for many practitioners of hypnosis, notably those for whom the process of dissociation and constructs such as ego states are fundamental to their therapeutic approaches. It also provides a basis for some commonly used hypnoanalytical methods such as ideomotor finger signaling. A recent development that is consistent with dissociated experience theory is the cold control theory of Dienes and Perner.

This chapter examines and summarizes neuroimaging and electrophysiological assays of hypnotizability, hypnotic induction, and post hypnotic suggestions. It delves into the neuroscience of hypnosis by focusing on three central components: interindividual differences in hypnotizability or susceptibility to suggestion, the induction procedure, and the type and content of the hypnotic suggestions. First, hypnotic phenomena seem to engage frontal areas of the human brain. In particular, hypnosis involves regions implicated in mental alertness, executive control, top-down regulation, and monitoring processes. Second, hypnosis induces global changes in neural connectivity patterns-in other words, hypnosis emerges from complex brain dynamics. Third, research highlights the ability of post hypnotic suggestions to selectively engage relevant brain regions. This aspect underscores the precision of suggestion to target and influence specific perceptual, cognitive, or motor processes. Electrophysiological studies of hypnotic induction reveal general fluctuations in neural activity.

Hypnosis is a special word to which patients attribute contradictory meanings and expectations. Based on the assumption that appropriate expectations are a very important element in the effective implementation of hypnosis, the way in which hypnosis is presented to patients is crucial for maximizing therapeutic results and minimizing complications. Appropriate preparation for hypnosis sessions must take into consideration patients’ motivation to be treated using hypnosis, the problem to be treated, the hypnotherapist’s model and the field of hypnosis implementation, patients’ attitudes toward and expectations from hypnosis and the hypnotherapist, and patients’ cultural baggage concerning hypnosis. Adequate explanations supported by demonstrations and a remythification approach to patients’ sociocultural baggage can save a lot of time in preparing for hypnotherapy by preventing complications, reducing resistance, and helping to make the hypnotherapeutic process more effective, satisfying, and fascinating for both the hypnotherapist and the patient.

In a clinical treatment context, the importance of hypnotizability is closely akin to the importance of individual differences in response to other treatments, for example, medications, the appreciation of which is crucial for high-quality health care. Hypnosis produces a number of potentially important subjective effects that can be measured, including feelings of hypnotic depth, transferential phenomena like archaic involvement, and other phenomenological states. However, there is fairly wide agreement that a key subjective effect of hypnosis is an alteration of the sense of agency, such that when the hypnotic subject carries out a suggestion, it feels as if it is happening on its own, extra-volitionally. Hypnosis scales are the foundation for laboratory research on hypnosis, and published laboratory research on hypnosis virtually always uses them. The measurement of hypnotizability through standardized hypnosis scales has provided the foundation of modern hypnosis research but has had relatively little impact on clinical practice.

This chapter presents some of the many laws and principles that are known in the literature as tools of the hypnotic therapist’s everyday practice. The intrapersonal trance follows the laws of perceived reality, subjective interpretation, and expectancy. The expert hypnotist follows the natural flow of the continuum phenomenon from intrapersonal trance where the law of perceived reality, subjective interpretation, and expectancy are dominant to interpersonal trance, where it is necessary to follow the principles of collaboration, individualization, and utilization of what the subject brings. The practical application of these laws and principles are substantiated and reinforced by the three most important Coué laws. Following the laws of concentrated attention, dominant effect, and reversed effect gives us the flexible solidity of a master who knows that all he or she has learned about the theory is now in his or her mind and heart, in his or her conscious and unconscious mind.

In a therapeutic interaction, the patient and clinician share a mutual intention to alter some condition of the patient’s existence. Clinicians are therefore tasked with stoking their patients’ expectancy and motivation for the specific interventions they prescribe. The primary distinction between hypnotic and nonhypnotic styles of suggestion is that a hypnotic suggestion is intended to stimulate motivation from outside the level of conscious awareness so that the desired intentions will be carried out without any need for the suggestion’s recipient to pay attention to them happening or to exert any effort in causing them to happen. The suggested phenomena can then occur naturally and automatically. This chapter introduces the idea of structuring suggestions to establish hypnotic response sets and this idea bears repeating. The more resistant or anxious a patient is, the more useful it may become to draw an explicit distinction between conscious and unconscious processes as they are occurring.

Hypnotic phenomena can include subjective changes as well as behavioral responses to each suggestion. This chapter presents descriptions of two of the more profound types of phenomena, delusion phenomenon and dissociation phenomenon, that can be elicited with hypnosis, keys to successful hypnotic inductions, a technique to help resistant patients respond to hypnosis, and effective deepening protocols. It provides techniques that have been found to elicit hypnotic responses beyond what might be predicted by hypnotizability scale scores. Voluntary behaviors can be carried out without hypnosis, using methods ranging from mere suggestion to simple directions to role-playing by the subject to please the hypnotist. The chapter discusses the experience of an involuntary automatic action, which can be demonstrated by the Kohnstamm phenomenon. The “Verbal-Non-Verbal Dissociation technique” builds upon the Kohnstamm phenomenon. It is worth attempting even with those who have scored in the lowest ranges of the hypnotizability tests.

This chapter offers a scientific perspective on the variety of problems that might emerge between a patient and practitioner during hypnotic induction. Clinical hypnosis is a cooperative endeavor, in which the priming of unconscious associations combines with the creation of a deep expectation that therapeutic change will occur. Experts agree that fear is the most common reasons for resistance to induction and the most common fear is of the hypnotic state itself. Perhaps one of the hapless problems that can occur during hypnotic induction is that of mis-communication. The patient may be highly ambivalent about a large number of things, including trusting others, making changes to behavior, or whether or not to remain in therapy. Before induction, it is important to assess the patient’s history of hypnotic experiences and subsequent attitudes. This knowledge enables the practitioner to select inductions and hypnotic techniques that are compatible with the patient’s expectancies.