Hypnotherapeutic interventions typically involve induction and deepening methods that usually emphasise mental and physical relaxation, and one or more of the following:
suggestions to encourage desired changes in perception, feelings, thinking and behaviour
the use of self-hypnosis by the client or patient to rehearse relaxation and other self-control methods
suggestions and guided imagery techniques to explore possible problems and conflicts that underlie the presenting complaints.
Clinical studies of the effectiveness of hypnosis have usually involved the first two of the above interventions. Typically, a treatment employing hypnosis is compared with a period of time waiting for treatment, a relatively neutral kind of intervention, such as sympathetic attention, or the usual treatment without the adjunctive use of hypnosis.
There is convincing evidence that hypnotic procedures are effective in the management and relief of both acute and chronic pain for a range of conditions (see meta-analysis by Montgomery et al 2000) and that hypnotic susceptibility is a determining factor in outcome. There have also been clinical trials that attest to the effectiveness of hypnotic procedures in helping patients cope with medical and surgical procedures (see Blankfield 1991 for a review, Lang et al 1996 for a controlled study in radiological treatment, Lang et al 2000 for a controlled trial for percutaneous vascular and renal procedures, Walker et al 1991 for chemotherapy in cancer) and childbirth (Brann & Guzvica 1987, Freeman et al 1986, Jenkins & Pritchard 1993).
There is encouraging evidence demonstrating the beneficial effects of hypnotherapeutic compared with control procedures (or no treatment) in alleviating the symptoms of a range of complaints that fall under the heading "psychosomatic illness". These include headaches, including migraine (Alladin 1988, ter Kuile et al 1994, and review by Holroyd & Penzien 1990); asthma (Collison 1975, Ewer & Stewart 1986, Maher-Loughnan 1970, 1984, Wilkinson 1988, and review by Hackman et al 2000); gastro-intestinal complaints such as irritable bowel syndrome (Galovski & Blanchard 1998, Harvey et al 1989, Whorwell et al 1984, Whorwell et al 1987); warts (DuBreuil & Spanos 1993); psoriasis (Zachariae et al 1996) and eczema in children (Sokel et al 1993).
Therapeutic gains as a result of hypnotic procedures have also been reported in groups of adult and child patients with eczema (Stewart & Thomas 1995) and tinnitus in adults (Brattberg 1983, Marks et al 1985). In hypertension, hypnosis may be a significant component in a broader course of cognitive-behavioural therapy (Tosi et al 1992).
There is evidence from meta-analysis that hypnosis enhances the effectiveness of a course of cognitive-behavioural or psychodynamic therapy (Kirsch 1996, Kirsch et al 1995), although Kirsch (1996) prefers an interpretation based on response expectancy (which he considers to be the basis of hypnotic responding rather than a by-product of hypnosis). Whatever the case, more clinical trials are needed to be confident that, for any given problem, hypnosis may significantly augment psychotherapy.
It will also be important to have a clearer idea about which patients may be more likely to benefit from the inclusion of hypnosis. At present, it seems unlikely that hypnotic susceptibility per se is a significant determinant of outcome, but one factor that may well be relevant is a positive attitude and expectation about hypnosis on the patient's part.
There are now well-structured and validated cognitive procedures for the treatment of anxiety disorders. Hypnosis and the practice of self-hypnosis may significantly reduce general anxiety, tension and stress in a manner similar to other relaxation and self-regulation procedures (see Van Dyck & Spinhoven 1997 for a study of agoraphobia with panic disorder) but it is not clear if there is any superiority for hypnosis.
However, one study on public-speaking anxiety (Schoenberger et al 1997), did find an advantage for including hypnosis in cognitive-behavioural therapy. Relaxation procedures, including self-hypnosis, may assist in insomnia (Anderson et al 1979, Stanton 1989) although there may be no difference in effectiveness in comparison to stimulus control and paradoxical intention (Espie et al 1989, Turner & Ascher 1979).
Hypnotic procedures are probably at least as effective as other common methods of helping people to stop smoking, the abstinence rates being given as 23% and 36% in two meta-analytic studies (Law & Tang 1995, Viswesvaran & Schmidt 1992, respectively). Single-session interventions tend to have a lower rate of success of around 20-25% (Ahijevych et al
2000). It remains unclear if the key ingredients include those specific to hypnosis.
Meta-analyses also reveal that the inclusion of hypnosis in a weight reduction programme may significantly enhance outcome (Bolokofsky et al 1985, Kirsch et al 1995, Levitt 1993), although some consider that its mode of action is enhanced expectancy (Kirsch 1996).
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