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What exactly happens in the brain during hypnosis and why is still not fully understood.
March 4, 2024
Margit Hiebl
Whether pain management, stress coping, or addiction treatment – the applications of hypnosis in medicine are diverse and work in a remarkable way.
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Serious hypnosis is one of the oldest healing methods. The first indications can be found in Babylonian cuneiform scripts. However, it was not until the mid-20th century that it was also scientifically recognized – largely due to the American psychiatrist Milton H. Erickson , who developed an experience-oriented approach to dealing with problems from it.
In the meantime, hypnotherapy is a well-researched psychotherapeutic method with a variety of applications. This includes the treatment of fears, depression , traumatic experiences, addiction, sleep disorders, or burnout. There is also a wide range of applications in the medical context – from psychosomatic disorders to acute pain in surgical procedures, in birth preparation, and for anxiety or pain control in the dental field.
What exactly happens in the brain during hypnosis and why is still not completely researched. Measurements and imaging techniques, however, show that something happens and where: The areas where anxiety or pain are processed are less or not at all active. Brainwave measurements show that pain stimuli are forwarded but apparently processed differently.
Areas responsible for emotions and imagination, on the other hand, are as active as if one were actually experiencing something. Physiologically, it shows that heartbeat and breathing slow down, blood pressure drops. On a mental level, intense calmness and balance are created. Inner images, memories, and feelings are experienced more intensely, noises or other disturbing perceptions can be more easily blocked out, and one can even distance oneself from stressful experiences.
This special state of consciousness is achieved during hypnosis through a so-called induction. “It starts with an instruction to focus attention and to direct more and more inward,” explains psychologist and psychological psychotherapist Norbert Loth from Munich, founding member and lecturer of German Society for Hypnosis and Hypnotherapy and the Milton Erickson Society.
“These are mostly relaxation instructions that lead to the consciousness withdrawing more from activity.” This is also called trance – or more correctly, because it is initiated within the framework of the therapeutic procedure, a hypnotically altered state of consciousness or hypnotic trance. “Many experience it like the pleasant state just before falling asleep when one tends to think in images.”
This special state of consciousness is achieved in hypnosis through a so-called induction.
Most people are capable of it. And sometimes our brain can even do it on its own. For example, in emergency situations or when daydreaming. Here, the inner autopilot takes over.
More precisely: The so-called “Default Mode Network,” a resting-state network of brain regions that are activated when doing nothing. “In hypnosis, it helps us initiate processing or discard the unimportant, to then focus on the targeted goal of the therapy,” says Norbert Loth.
In the further course of psychotherapeutic treatment, the central question is: What does the person need to better cope with a problem? This involves searching for similar experiences or situations in the past that have already conveyed calmness or security.
A valuable resource that is tapped into again in the hypnotic state through suggestions. In cases of exam anxiety, perhaps a previously successful exam is mentally replayed: step by step, the preparation, the confident flow, and the great joy afterward. If nothing sufficiently strong is found in one's own experience, superheroes, power animals, or magical beings can be introduced to help overcome the problem.
Hypnosis is the proven most successful method to say goodbye to cigarettes.
The search for the right resource can also lead to the future. "This can be the story on the subject of depression: What if the depression is gone? How do I live my life? What has changed?" So the right story is the key to success. It is not always found immediately. Accordingly, hypnotherapy can take between 20 and 60 sessions.
Hypnosis works, but not always with the desired result. "These people may have difficulty with hypnosis, resist, have fears. Then the therapist must first address this before, for example, dealing with smoking cessation," says Loth.
"Also, not every person is equally suggestible and open to change." Nevertheless, to say goodbye to cigarettes once and for all, hypnosis is the proven most successful method.
"In medical applications, hypnotizing is much easier because the need and necessity to orient oneself on clear instructions is much greater," explains Loth. Suggestibility is increased, even if hypnosis has not yet been applied. A good example is a new approach in emergency medicine that significantly increases survival chances, for instance in heart attacks, through calming hypnotherapeutic communication.
Hypnotic procedures are also being increasingly used in the operating room. One of the pioneers, the Belgian doctor Dr. Marie Faymonville, has been using them since the early 1990s. Advantages include, besides the calming effect, that the brain can be made to no longer perceive pain with the help of hypnosis.
Hypnotic techniques are increasingly being used in the operating room as well.
Norbert Loth explains it like this: "Pain initially has a signaling function - once consciousness knows this, it brings no new information, and it can miraculously withdraw from the perception of pain."
Thanks to this so-called dissociation, one can safely venture into fantasy worlds. Other proven facts are that anesthesia can at least be reduced, blood loss is less, and recovery is faster.
There is good experience with this, especially in neurosurgery. One of the specialists in this field in Germany is the neurosurgeon Dr. Rupert Reichart, senior physician and head of pain therapy at the Rhön Klinikum Campus Bad Neustadt . He is also a trained physician in medical hypnosis. What makes hypnosis so exciting for him?
“In neurosurgery, sleep-wake procedures are performed to test specific brain functions during surgery,” says Reichart. For example, when a brain tumor affects areas of speech, language comprehension, or movement.
Usually, the procedure is performed under light anesthesia, which can be interrupted repeatedly to check these functions. The problem with this approach is that the patients are responsive but not awake enough for fine testing. However, with hypnosis instead of anesthesia, the patient is immediately fully awake and unrestrictedly testable.
For Reichart, hypnosis has a big advantage in deep brain stimulation. A procedure that is successfully used in Parkinson's patients with tremor. “The challenge here is to find exactly the point where the stimulation works best and the tremor stops,” explains Reichart.
“If patients receive a sedative medication beforehand, they may only tremble slightly or not at all, which distorts the picture.” Under hypnosis, more precise work can be done here.
With hypnosis instead of anesthesia, the patient is immediately fully awake and unrestrictedly testable.
An operation on the brain without anesthesia might seem unimaginable to laypeople. But the brain itself does not feel pain. Painful is the incision into the scalp, which is done under local anesthesia. Uncomfortable is the clamp in which the head is fixed.
Very uncomfortable, but not painful, is the opening of the skullcap – especially because of the penetrating drilling noises. This is precisely where Reichart takes his patients on a journey with a story, which sometimes lasts a few hours.
A big challenge, even for the experienced surgeon who manages hypnosis and surgery in parallel. The advantage of this approach: He knows the procedures better than an outside psychotherapist and can always adjust the story accordingly.
He finds out what fits into each patient's world through preliminary discussions and exercises. Thus, he took a road maintenance employee on a snow clearing trip, and the drill became a snow blower.
Hypnosis can also be effectively used in dental practice.
With others, he might have a helicopter land. The goal is to make the surgery so incidental that the patients feel safe. Still, Reichart says, hypnosis is only used in neurosurgery when it offers a clear advantage. For instance, when patients do not tolerate anesthesia well.
He also sees great opportunities in the field of pain therapy, such as in the area of phantom pain after an amputation. Hypnosis can also be sensibly used in the dental practice not only to block out unpleasant drilling noises or pain, but to resolve deep-seated fears.
And these can already be detected during dental hygiene. Therefore, not only many dentists, but more and more prophylaxis assistants have hypnosis training. With the appropriate disposition, patients are then taken on a relaxation journey in advance.
To better cope with stress distracting stimuli, or pain, everyone can also learn the hypnosis technique themselves. The difference to meditation or autogenic training: "Imaging procedures show that in meditation the cerebrum is evenly activated and not punctually as in hypnosis. Also, the switch between the default mode network and the focused mental process is not as pronounced," says Norbert Loth.
Autogenic training works similarly to self-hypnosis, only the resources are not activated. It first requires an appropriate introduction technique. Some imagine a pleasant situation (at the beach, in a deck chair), others count backwards or take an imaginary elevator down.
For beginners, fixation methods have proven effective. “Here, attention is directed to a point, which basically tells the brain that something else is starting. Until the brain begins on its own to remember natural trance or hypnosis experiences, such as in the form of daydreaming,” says Loth.
Then you say to yourself: I am aware that I am sitting here and now want to go into a trance – in a way, the command to the unconscious to use everything it knows to enter a hypnotic state.
And further: I am aware that I am sitting here and hear (e.g., a honking car outside, chirping birds... – all sounds are included) and feel (the soft chair cushion, the smooth floor) and think (anything that comes to mind).
If hypnosis is used as a sleep aid, one briefly awakens, reorients, and transitions into night sleep.
Soon the brain will start to get bored – and switch to a hypnotic state. This can last without a set time limit for up to two hours. If hypnosis is used as a sleep aid, you then briefly wake up, reorient yourself, and transition into night sleep.
If the trance state is only supposed to last, for example, ten minutes, Loth advises giving oneself – that is, the mind – a specific time in advance and setting an internal clock very precisely.
After a few practices, it works quite accurately. “Perhaps an unconscious awakening stimulus will also come because something has become more important than the trance – you haven’t lost consciousness,” says the expert. Or simply set an alarm.
But relaxation and stress reduction are not the only things achieved with self-hypnosis: top athletes use it to play through and internalize ideal movement sequences exactly. Anyone looking for a solution in work or personal life can also take a wish or assignment. “And often better ideas come from the subconscious, which stress would have blocked,” says the psychologist.
A clear exclusion criterion for the application of hypnosis would be a psychosis. At the slightest suspicion, the psychotherapist – possibly with a psychiatrist – must clarify how treatable the patient is. Because hypnosis could trigger extreme anxiety and dissociative disorders or cause someone to completely decompensate.
That's why Norbert Loth also warns against stage hypnosis. Since the stage hypnotist does not know his "guinea pig" and has no psychotherapeutic experience, even harmless questions or suggestions could lead vulnerable people back into a traumatic situation, with which they are usually left alone.
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Especially in neurosurgery, there is good experience with hypnosis.
