Tami Simon: Hello, friends. My name’s Tami Simon, and I’m the founder of Sounds True, and I want to welcome you to the Sounds True Podcast, Insights at the Edge.
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In this episode, my guest is Dr. David Spiegel. He’s one of the world’s most respected experts in the clinical uses of hypnosis. He has personally taught more than 7000 people how to use hypnosis to better manage their minds and bodies, and that’s what we’re going to be exploring, how we can use self-hypnosis in our own lives.
Let me tell you a little bit more about Dr. Spiegel. He’s a psychiatrist with more than 45 years of clinical and research experience studying stress and health, pain control, sleep, psycho-oncology, and more. He is associate chair of psychiatry and behavioral sciences at Stanford University, and he directs the Stanford Center on Stress and Health and the Stanford Center for Integrative Medicine. Dr. Spiegel is also the scientific director and the
co-founder of an app that’s called Reveri. Its mission is to make hypnosis mainstream and give hundreds of millions of people the tools they need to hypnotize themselves. Dr. Spiegel, welcome.
DS: Thank you very much, Tami. I’m delighted to be here with you. There we go. There I am.
TS: As we get started, tell me a little bit how the area of the clinical use of hypnosis became an area of specialization for you. How did that evolve?
DS: Well, Tami, it’s something of a genetic illness in my family. Both of my parents were psychiatrists and psychoanalysts.
TS: Oh, my.
DS: They told me I was free to become any kind of psychiatrist I wanted to be, and here I am. My father was taught hypnosis when he was getting ready to go into combat in North Africa in World War II, and a Viennese refugee who couldn’t himself serve, who was a forensic psychiatrist, had learned to use hypnosis for an odd reason. He had a smallpox scar right in the middle of his forehead, and he noticed when he was interviewing prisoners that some of them would suddenly sort of close their eyes and nod their heads, and seemed to go into some kind of altered state. He started studying hypnosis, and how people could shift into this highly focused but relaxed state of concentration. So he taught my father and a number of other young army docs how to use hypnosis to control pain, to help people with combat stress reactions.
As you can imagine, the dinner table conversations were pretty interesting as I’d hear about these cases, and I got to watch him making movies of patients who would suddenly have pseudo-seizures. That’s an epileptic-like attack without actually having nerve damage in the brain. And so I went to medical school with the idea that I’d learn something about it, and I took a hypnosis course, and the thing that got me hooked was my first patient that I ever tried hypnosis with.
I was a medical student at Children’s Hospital in Boston, and the nurse said to me, “Spiegel, your next patient is in room 433. She’s in status asthmaticus.” Now, this means that she’s got an asthma attack. She can’t fully breathe. Her bronchioles are constricted. And I walk into the room—I follow the sound of the wheezing down the hall, walk into the room, and here’s this pretty 15-year-old redheaded girl, knuckles white, struggling for breath. Her mother’s standing there crying, nurses standing there. They tried giving epinephrine under the skin twice, didn’t work. They were considering giving her general anesthesia and starting her on steroids, and I didn’t know what to do, so I said, “Well, would you like to learn a breathing exercise?”
She nodded, so I got her hypnotized, and then I realized that we hadn’t gotten to asthma in the course yet, so I invented something very clever. I said, “Each breath you take will be a little deeper and a little easier,” and within five minutes she’s lying back in bed. She’s not wheezing anymore. Her mother’s stopped crying. The nurse ran out of the room, and my intern comes looking for me, and I figure he’s going to pat me on the back and say, “What did you do, Spiegel?”
He said, “The nurse has filed a complaint with the nursing supervisor that you violated Massachusetts law by hypnotizing a minor without parental consent.” Now, Massachusetts has a lot of weird laws. That’s not on the list, and her mother was standing next to me in the room, but there are a lot of sort of things crystallized in this experience.
One of them is the misconceptions about hypnosis, that it’s either useless or dangerous or both, and people can’t seem to believe that just an experience in your mind is something that can change what’s going on in your body. We tend to think of people as broken machines, so ingestion, injection, or incision is what you have to do, that’s a real treatment. And people controlling what’s going on in their body with this wonderful organ up here that is connected to every part of the body somehow doesn’t seem like a real intervention.
He said to me, “Well, you’re going to have to stop doing this.” And I said, “Oh really? Why?” He said, “Because it might be dangerous. You might not be able to follow her.” I said, “Well, you were going to give her general anesthesia, put her on steroids, and you think my talking to her is dangerous? I don’t think so, and I’m not going to tell my patients something I know isn’t true, so take me off the case if you want, but otherwise, I’m going to keep doing this.”
Now, she’d been hospitalized every month for three months in status. She had one subsequent hospitalization, but she went on to study to be a respiratory therapist. What my intern did, was he went to the attending, and they had a powwow over the weekend about what to do about this. They came back with a radical idea at Children’s Hospital. They said, “Let’s ask the patient.” I don’t think they’d ever done that before.
She said, “Oh, I like this, I want to keep doing it,” so she did, and I did, and I thought to myself, “If you can help a patient that much that fast without any side effects, that’s something that’s got to be worth looking into.” I’ve been doing it ever since.
TS: Now, you mentioned that there are a lot of misconceptions about hypnosis, and I think that’s true. Can you educate us? What do you think is a realistic set of expectations we can have about the truth of the efficacy of hypnosis?
DS: Well, hypnosis itself, Tami, is just a naturally-occurring state of highly-focused attention, like when you get so caught up in a movie that you forget you’re watching a movie, you enter the imagined world. The human brain has this remarkable ability to pick something to focus on, and really focus intently and put everything else outside of awareness. Right now, Tami, if you’re sitting on something, your body is sending you sensations informing you that that’s what you’re doing, but hopefully you weren’t even aware that that was happening. If it was, we can end the program early.
In the ability to attend, our brain says, “Pay attention to this and put other things outside of awareness,” so you concentrate intently. It’s like looking through a telephoto lens in a camera. What you see, you see with great detail, but you’re less aware of the context. You dissociate other things. And you do a third thing that is very important in making hypnosis such a powerful therapeutic tool. That is, you let go of your usual preconceptions of who you are and what you usually do.
People used to think of that as suggestibility, but it isn’t really suggestibility. It’s cognitive flexibility. You say, “I’m not going to worry about whether I’ve never done this before. I’m just going to do it.” That’s what my 15-year-old asthmatic did. She had never had the experience of aborting an asthma attack like that, so she didn’t realize she couldn’t do it, and so she did it. That’s one of the things that hypnosis can help people with, is changing from the bottom up, not the top down.
Make your body more comfortable, and then you can think more clearly, change your perception of what it is you can possibly do, and try being different. Try being someone who can actually take control over an asthma attack and relax your lungs instead of tensing them even more. Help yourself breathe better.
It’s an opportunity that many of us have throughout our adult lives, but most children have when they’re eight. Your eight-year-olds, you call them in for dinner, they don’t hear you, they’re busy playing or doing things that they’re more interested in. And it’s a mental ability that we under-utilize. We all come with this big brain on the top of our bodies, but it doesn’t come with a user’s manual, and so we often don’t take full advantage of it.
TS: Have you found that there are certain conditions, like, “These are the conditions that hypnosis can really help with, and these are the ones, I don’t know, I don’t think I would,” it’s the wrong treatment for that particular condition?
DS: Yes, it’s very helpful for stress management, for just interrupting the cycle of physical and mental tension that makes stress get worse and worse and worse and leads to panic attacks and things like that. It’s superb for pain control. We’ve done randomized trials, as other people have, showing that you can significantly reduce pain. The strain and pain lies mainly in the brain, and you can learn to control it. Pain is a combination of a physical signal coming to the brain and how the brain interprets it, so it’s a tremendously powerful analgesic, and it doesn’t kill 30,000 people a year the way opioids do in the United States. It’s safer and highly effective.
It helps people go to sleep. That’s one of our most popular uses, is that you can just interrupt that cycle of tension where you think, “Oh God, will I get to sleep?” The more tense, the more you fight it, the worse it gets. It can help people relax, let their bodies drift off to sleep.
It’s very helpful for habit control, like stopping smoking, and we find that one out of five people that learn to use it just stop smoking like that. It helps people eat more sensibly to maintain a body weight that they want, eat a healthy diet and enjoy eating more, eat like a gourmet, even while you change what you eat and how much you eat.
Problems like that, and also some more serious problems. We’re teaching this in Reveri as a health and wellness skill that people can learn to use. All hypnosis is really self-hypnosis, but there are some people with more serious problems like the aftermath of trauma, Post-traumatic Stress Disorder, where hypnosis can also be very helpful.
TS: Have people told you that your voice is very hypnotic?
DS: I’ve heard that, and I’m glad to hear it. I didn’t develop it that way, but I guess doing it enough has led me in that direction. Either that, or you’ve already been hypnotized, Tami, to believe that.
TS: Well, that brings me to my next point. One of the things I learned from your work, I familiarized myself a bit with a technical clinical book that you’re the co-author of, Trance and Treatment, and in it you go into quite some depth about how we’re not all equally hypnotizable.
DS: That’s correct.
TS: Some of us are easily hypnotizable and others aren’t. Tell me more about this idea, and why it’s such an important idea in the work that you do.
DS: Well, Tami, hypnotizability is a very—It’s an odd, oddly consistent trait. As I mentioned earlier, most children are very hypnotizable. You tell them a story, they take off, they’re in it. I used to put my kids to sleep by having them float down an imaginary river and say, “Hi, goodnight,” to the animals, and all this. One time it didn’t quite work, so my son, who’s about six, comes out looking for me and says, “Dad, I need a professional. I really need some help.”
As we mature, as we go through adolescence and we learn to value logic more and experience less, some people lose that ability to engage themselves in intensely-focused attention, hypnotizability. By the time you’re 21, your hypnotizability level is going to be about the same when you’re 50. It’s as stable as IQ. I think it’s an important concept, because people used to be blamed as being resistant if they didn’t go into a hypnotic state. God forbid this brilliant hypnotist couldn’t get them into hypnosis, and blaming the patient is never a good practice in medicine, and it’s not a good practice there, and it’s not true.
The other thing is, some people on the other end go into spontaneous hypnotic states and are little puzzled or troubled by it. “I got so busy writing this paper that I missed dinner time,” or “I forgot three appointments I was supposed to have.” Actors, if you tell good actors, “You were fantastic doing that,” they look a little puzzled, because they’d say, “I was just being that person. I wasn’t trying to make it happen.”
The nice thing is that it’s an ability that some people have. But understanding that, for me as a doctor using it, I don’t blame the patient if they don’t go into hypnotic state, and I don’t take inordinate credit if they do. Because all hypnosis is really self-hypnosis, and my job is to guide them into it, help identify the state that they’re in, and help them use it to deal with the problem that they have. That’s my job. The old-fashioned thing with the dangling watches, and counting upstairs and downstairs, and taking 20 minutes or half an hour to get there is unnecessary. If you’re very hypnotizable, you can get there in seconds, and if you’re not, I can talk to you all day long and nothing’s going to happen. It helps us change our understanding of what it is and how we use it.
TS: Do you have a sense of what percentage of the population falls into the easily hypnotizable, the hard to hypnotize, and then you have this middle category, I guess, for the rest of us?
DS: Well, yes. It isn’t easy or hard, it’s just the level they go to, but about 15% of the adult population is extremely hypnotizable. They’re just there, just like that. About two-thirds of the adult population is at least somewhat hypnotizable, and about 25% just aren’t very hypnotizable at all.
TS: Now, you use these interesting names. The Dionysians in us are that 15% that are easily hypnotizable, and then you have the Apollonians, that small group that’s hard to hypnotize, and then the Odysseans for the moderately hypnotizable. Can you explain the terminology?
DS: Sure. First of all, I thank you for actually reading Trance and Treatment. I can tell you did, so you get an A for that. I appreciate you. Folks, she really prepares. We wanted to use nonclinical terms. I mean, in the old days, they would say “hysterical” and “obsessional” and all this, and we didn’t want that, and we don’t think that’s the issue.
The Dionysians are people who, from the Greek myth, value experience over everything else, so any opportunity to have a good time—drink wine, dance, sing. And it’s a skill that highly hypnotizable people just have, of being able to get engaged. The old saying of the “contact high”. You don’t have to take anything, you’re just around people who have it and you feel it, so it’s a skill they have. They’re very intuitive. They tune into other people very well.
In fact, if they have an interpersonal problem, sometimes they sort of see the other person’s problems and point of view better than theirs, and so they can identify with somebody else. I was talking to one man recently who had three terrible marriages, and he said, “Every time it was that I was always seeing things from my wife’s point of view and not mine.” Now, this is not a typical male problem, but he had it. And so there are people who value and have intense experiences more than thought and reflection about it.
The people on the other end, the Apollonians, are the people who value reason and logic. They don’t believe anything they haven’t read about first, and so they tend to be a little impervious to influence by other people. It’s kind of on the other extreme. Thought and reason is what matters to them, and for them, you try to balance them.
I had two women at the same time who had a disorder called trichotillomania. That’s pathological hair pulling. I don’t have that disorder, and one of them was a Dionysian. She was a very beautiful young woman whose hair was so attractive, and she was, that the hairdresser would do her hair for free just so he could take pictures and put them on the wall of the salon. After a while it got complicated. He started coming on to her and she did not want it, but she couldn’t say that. She sort of felt for him about this, so what did she do? She started pulling her hair out. She had the trichotillomania, so that he wouldn’t be interested in her anymore. She was someone who would stop a car by the road if there was an injured animal and try and help them. Very sensitive, intuitive person.
What I did with her was I hypnotized her and said, “Would you ever pull the hair out of an injured animal?” She said, “Well, of course not.” I said, “Why don’t you treat your body as well as you would treat an injured animal? Respect and protect your body and stroke it instead of hurting it.” And I said, “Stay away from that hairdresser, because you don’t want anything to do with him,” and she did, right away.
At the same time, I had a woman who was an accountant, rather rigid, and she said, “I try to get at my naughty nerves when I have a problem to deal with.” She argued with me about hypnotizability, and she came in the next week with a plotting, the percentage of pre-treatment hair pulling, before and after. At first it got worse, and then it got better. She got better too, but it was a much more interactive, rational discussion about the importance of hypnotizability and maintaining good mind-body relationships, and recognizing where the source of your tension was, and fixing it. They both got better. They both used a hypnotic-like technique, but one was just intense and immediate, and the other was a kind of negotiation.
The people in the middle we call Odysseans. That’s for Odysseus, who would immerse himself in experiences and then step back and think about them. The classic is when he was going—the boat was sailing past the Sirens. And the Sirens’ song—many sailors had crashed because they got so caught up in the song that they didn’t pay attention to where they were sailing, so Odysseus had his sailors tie him to the mast and not listen to what he said, so he got to hear the Sirens, but he didn’t crash the boat.
It’s that kind of back and forth between the two that the majority of people who are hypnotizable will have, where they can let themselves get caught up in something, they can consider changing, but then they’re also going to stop and reflect and say, “Does he know what he’s talking about? What’s going on, and why should I do this?” For me, the issue is not trying to get someone somewhere, but to identify what their style of responding is and work with them in that way.
TS: I think one of the fears I’ve had, as someone who is easily hypnotizable, is that I’m gullible, suggestible, and that that’s a kind of lack of intelligence, actually. I wonder what you have to say about that. Is that an unfair?
DS: Well, Tami, people have that fear. And it bothers me, because it’s one of the reasons people are afraid of hypnosis, where they’ve been to some stupid stage show and they see the football coach dance like a ballerina and make a fool of himself. If you think about it, though, for us to learn anything, when you’re in class as a student, you’re taking in information from the teacher, and hopefully most of it is right. Some of it may not be, but we’re social creatures. We give and receive information, and there’s nothing wrong with being good at receiving information, at understanding what it means and taking it in.
Hypnosis is a state that involves the capacity to take in new information, to identify with it, and to change yourself by learning it, but not necessarily to believe everything you’re told. What the opportunity in hypnosis, as I mentioned, is that you let go of your usual way of thinking about yourself and what you do and who you are, and try on being something different.
Now, sometimes you won’t like it or it’ll be the wrong thing to do, but on the other hand, if we’re too resistant to input, we never learn anything and we never change. It’s a kind of a dialectic, where you do it, but you also then step back and say, “Was this the right thing to do? Do I feel better or worse?” One of the things—the nice thing about hypnosis is, when you’re changing your level of stress or your pain, you can feel it right away, if it’s going to happen. You will know within minutes whether this procedure is going to help you, and if it does, keep doing it. If it doesn’t, try and do something else.
TS: Now, I spent some time with the Reveri app, and congratulations for creating a tool like that.
DS: Thank you.
TS: It’s very user-friendly, and one of the things that I noticed was that each of the self-guided, self-hypnosis practices that you can interact with had the same entry protocol. You kind of take people through the same beginning steps, and I wonder if you can talk us through those beginning steps, and then maybe we’ll do a practice together.
DS: Sounds good, sounds good. I mean, there’s nothing sacred about any one hypnotic induction. The idea is to turn inward and concentrate intently, and so what we do in this one is I ask people first to look up, on one-to-one thing, look up. Now, why look up? As we’re fairly pathetic physical creatures, there are animals that hear better and smell better and see better than we do, but our major protection is vision. If you want to be alert to possible danger or problems, look around. And when you’re doing that, you’re not letting yourself just relax and focus on what you want to attend to. You’re scanning the environment. When we go to sleep, we close our eyes, and we lose that scanning awareness, more with our hearing than with our vision.
What you do when you look up—and there’s an old meditative practice called looking at the third eye, looking inward—you’re still alert, but you’re not scanning the environment anymore. It’s a physical signal of, turn inward, look at what’s going on inside you instead of outside you. You look up, and as you look up, you close your eyes slowly. Take a deep breath, let the breath out, let your eyes relax, but keep them closed, and let your body float. It’s a way of turning inward and beginning to concentrate inward in a structured way.
Now, my father, I mentioned that I watched him hypnotize people who were having hysterical seizures. They would suddenly go into a state where they looked as though they were having a true epileptic fit. We call it pseudo-epilepsy, and he noticed that when this one particular woman did it, her eyes rolled way up to the top of her head and all he could see was sclera, no iris at all.
It happened that the next Monday, he had a really obsessional businessman who just was not hypnotizable at all, and his induction, then, was to look at the light on the ceiling and close your eyes. He noticed that this guy’s eyes had to come down. Now, yours, let’s see. Look up, Tami, high as you can. Keep your chin down, but look up. That’s good. Look up past your eyebrows. Close. Close. All right, now notice, folks, thank you. You can open it now. Two things happened. Your eyes came down, but then they popped up, so you saw mostly sclera, white, not the iris, but you also converged your eyes spontaneously. That would make you about a three out of four.
He started guessing how hypnotizable people would be based on their ability to keep their eyes up while they closed them, and there is a modest correlation between that and hypnotizability, so you would be likely pretty hypnotizable, just on the way you did that.
TS: Now interestingly, looking up like that and showing the whites of your eyes, I mean, now I’ve done it on camera, it’s fine. It’s one of the things that makes you definitely look like you’re a crazy person, Dr. Spiegel. I mean, just from an appearance standpoint.
DS: Well, Tami, I’m just looking for business. What can I say? It is a little strange. It’s unusual, but you’re turning inward.
TS: Did you develop this as the first step of your hypnotizable approach? Is it something you created?
DS: That was something I inherited from my father. He did that, because he—
TS: Very interesting. The Spiegel technique.
DS: The Spiegel eye-roll technique. He used it then to make a prediction, but he also said, “We’ve got to do a more formal measurement.” Then we had a structured test of hypnotizability that involved imagining your hand would float up in the air. We can try it if you’d like, and a series of instructions, and seeing how well you carry out those instructions. You can score people on a scale of zero to 10 on how hypnotizable they are.
TS: All right, why don’t we do a self-hypnosis practice? What should we focus on, Dr. Spiegel? Should we focus on— something that will be common, that everyone will get benefit out of?
DS: Well, stress is one example. A lot of us have that.
TS: I think we can count on that being a common human thing.
DS: There will be things like anxiety disorders.
TS: Either one. How about stress and anxiety? Do you want to pick one?
DS: Stress and anxiety? Sure. Well, we can do both. Stress is a kind of acute thing, and anxiety is a more chronic maladaptive reaction to stress, so that would be fine. We can do that.
TS: Why don’t you take us into it. In five minutes, something like that? Let’s see what we can accomplish.
DS: Let’s see what we can do. OK, so get as comfortable as you can. Look up to the top of your head, all the way up, high as you can. Slowly close your eyes. Close, close, close. That’s good. All the way. Let your eyes close. Take a deep breath. Slowly let the breath out. Let your eyes relax now, but keep them closed, and let your body float. Imagine that you’re floating somewhere safe and comfortable, like a bath, a lake, a hot tub, or just floating in space. Each breath, deeper and easier. And as you feel your body floating, let one hand or the other float up in the air like a balloon.
That’s good, all the way up, and if you like, you can either leave it up that way or let your elbow come and rest against your chest so that your forearm is up, but the rest of your arm is down. Whatever feels most comfortable to you. Imagine you’re floating in a bath, like a hot tub, or just floating in space, and picture in your mind’s eye an imaginary screen, and picture a pleasant scene, somewhere you like being. Each breath, deeper and easier. Now, with your eyes closed and remaining in the state of concentration, please describe how your body is feeling right now. What do you notice about how your body is feeling, Tami?
TS: I notice some stress in my shoulders, some tension in my shoulders, and I also feel kind of grounded and happy.
DS: Good. Where do you picture your body being?
TS: I’m in a bathtub.
DS: In a bathtub. Good. All right, so I want you now to let your upper arm lower, keep your forearm straight up in the air, and just rest it against your body. Good, and I want you right now to take your left hand and push your right hand back down with this instruction, that when you let go, your left hand will float right back up to the upright position. You’ll find something pleasant and amusing about that sensation. Now the other hand is going up. What’s happening with your right hand?
TS: Just kind of flopped.
DS: It just flopped, and so the lightness transferred to your left hand instead of your right. Is that it? Does the left hand want to be up?
TS: Yes, yes.
DS: OK. All right, so you interpreted that instruction in your own way and you’re feeling it, but now on the other side of your body. That’s fine. Is it comfortable up there or do you want to rest your elbow down? That’s good. Good. All right. Now, please take your right hand and pull your left hand down and then let go, and let’s see what happens. Now your right hand wants to go up again. All right. Now, you’re picturing yourself in the bath. Is that right?
TS: Yes.
DS: What do you notice? What other sensations do you have?
TS: I feel kind of dissolve-y.
DS: Dissolve-y, good, like you’re melting into the water, huh?
TS: Yes.
DS: All right. Do you feel a sense of warmth?
TS: Not really, no.
DS: No. OK, but comfortable floating?
TS: Yes.
DS: Now, notice how quickly and easily you can use your store of memories and your imagination to help yourself and your body feel better. Take a breath in about halfway, hold it, now expand your chest all the way and fill your lungs, and then slowly exhale through your mouth. One more time. Inhale halfway. Hold, now expand your chest, fill your lungs, and then slowly exhale through your mouth. How’s your body feeling now?
TS: More melty.
DS: Good, so notice how quickly and easily you can help your body feel melty. Now, I’d like you to do something else. I’d like you to divide this imaginary screen in half. Keeping your body melty and floating, I want you to picture one problem that has been troubling you on the screen, but with the rule that no matter what you see on the screen, you keep your body melty and comfortable. Are you comfortable sharing with us the problem that you’re looking at on the screen?
TS: No.
DS: OK. Well, just look at it and think about it. Then, I want you to use the other side of the screen as your brainstorming or problem-solving screen. Picture one thing you could do about the problem on the left that might help. Are you able to see something that would help you deal with that problem?
TS: Yes.
DS: Good. Is it something you thought of before or is it something new?
TS: Kind of in between. I thought of it but I wasn’t really necessarily going to do it.
DS: OK, and now you think you might.
TS: Yes.
DS: Good, so please notice how much more clearly and comfortably you can think, even about something that troubles you, when you get your body comfortable first. You’re in a different matrix now, and you can address the problem without the snowball effect of mental and physical attention interacting with one another. You can see it from a more centered and novel point of view. You’re just trying out an idea you thought of before but maybe hadn’t actually thought of doing. How’s your body feeling now?
TS: I feel good.
DS: Good, so notice also that we’ve been thinking about something that troubles you, and you wind up feeling good. You’re able to dissociate your physical reaction from your mental reaction, and that will help you feel better physically, but also deal with problems better. Now, please take a few moments to reflect on what this means to you, in a private sense. Then, when you’re ready, we’ll come out of the state of self-hypnosis by counting backwards from three to one. On three, you’ll get ready. On two, with your eyelids closed, roll up your eyes, and one, let your eyes open. Ready? Three, two, one. Let your hand float back down, make a fist, open it, and that’ll be the end of the exercise. How do you feel?
TS: I feel quite good. I feel a little bit like I’ve been in a meditation, and I’m curious what the relationship is between a meditative practice and a self-hypnosis practice from your experience, knowing there’s a lot of different kinds of meditation, but still…
DS: Well, they’re related, but they’re not the same. In hypnosis, you’re focusing intently on a problem. You’re dissociating your somatic, your physical reaction, from your mental one. In mindfulness, you’re supposed to shift from doing to being. You’re supposed to not be intentional, not try to solve a problem. Hypnosis is very Western. You use it for a purpose, to solve a problem. In meditation, that is a problem. You’re supposed to just let feelings and problems and thoughts flow through you and not try to do anything about them.
I had one woman who was a 10-year meditator who had terrible migraines, and she decided to use Reveri to get rid of her migraines, and she did. She said, “Ten years I’ve been meditating, I’ve had this headache.” She said, “Thank you for freeing my intentionality, that it was OK for me to use this state to solve a problem.”
The second thing that you do in mindfulness is you do body scans, which is something like what we do in hypnosis where you concentrate on feelings in some part of your body. The third is develop compassion, mostly for other people. That’s a very good thing, but I tend to focus in hypnosis on having people develop compassion for themselves and their bodies. Treat your body that way I did the woman who had the pathological hair-pulling. Think of your body as a trusting innocent creature that has to absorb anything you do to it, even if it’s damaged by it. Focus on having compassion for your body.
Hypnosis is shorter, it’s more problem-focused. You do it to solve a problem, whereas meditation, half an hour twice a day or something like that, with Mindfulness-based Stress Reduction, and you’re not supposed to use it to solve a problem, although Jon Kabat-Zinn has just written a wonderful book called Mindfulness Meditation for Pain Relief, so they’re beginning to come together in some ways. But it’s still much more Western, much more problem-focused, and much more designed to help you control body and mind.
TS: Help me understand the theory behind the split screen. I get being very relaxed inside and breathing and looking at the problem, but tell me about the screen itself.
DS: Well, what I found is that the screen is a concrete visual symbol for conflict or disagreement. That it’s a way of helping you recognize that you can focus on two conflicting or irreconciled issues and see them together. I use it a lot in helping people with stress, so you’re seeing the stress, the thing that makes you upset, and then you’re thinking at the same time, “Well, what can I do about this?” You’re holding these two things together, and you can think about them, deal with them better. I’ve used it a lot in treating people who have Post-traumatic Stress Disorder.
I had a woman who comes from a country that is well-known for treating women terribly, and she found as a teenage girl that her body wasn’t her own. That men felt free to say whatever they wanted, to do what they wanted. She had turned—She was depressed, she’d been depressed most of her life. She got out of the country, was a healthcare professional, but retired early, wasn’t feeling good. She told me that she had been raped at age 12 by the landlord, and I felt that that must be tied to how bad she was feeling throughout her life. Her family was afraid to do anything because they didn’t want to get thrown out of the apartment. I had her in hypnosis picture, on the one hand, herself as a 12-year-old girl, right after she’d been raped. I said, “I want you to look at her and ask the question, ‘Is this her fault?'” I wanted her to imagine she was her own mother, so you use a disassociation to have two points of view about the same thing.
She started to cry and she said, “No, it’s not her fault. I’m stroking her hair, I’m stroking her hair.” She cried some more, and then we came out of the hypnosis, and she had lived her life feeling that somehow this was her fault. As many assault victims do, that they blame themselves. We’d rather feel guilty than helpless. Think you could have controlled the situation that you couldn’t. She called me about a week later and she said, “Dr. Spiegel, my psychiatrist wants to know what you did to me, because I’m not depressed anymore.” She said, “My friends don’t recognize me. They don’t know me this way.” There are times when in a very focused and powerful way, you can see the same situation from two very different points of view, and that’s why I use the screen.
TS: Let me ask you a personal question, if that’s OK. Have you ever used hypnosis with yourself to solve some intractable problem, and did it work, and how’d you do it?
DS: Sure. I had a recurrent dislocating shoulder that was causing me a lot of trouble, and painful, and so I decided to have surgery on it. It was a three-hour operation and I had general anesthesia, but afterwards I thought, “I can control this pain. It’s not so bad. It’s a reminder to me that I’m getting this fixed, and I’m not going to have the same problem afterwards.” I had a great surgeon, and so I didn’t use any pain meds at all. I just did self-hypnosis while I was in the hospital.
You weren’t supposed to read your record in those days. Now, everybody has the right to, but not then, but I worked at Mass General, so I just went up and read my chart, and the surgical resident wrote, “Patient using very little pain medication. We mustn’t have cut many nerves.” Now, I’ve got a scar from here to here. I can assure you, they cut a bunch of nerves, but it felt very good to me. It felt like, “I can master this, I can control this, and it’s not so bad.” Yes, I felt some obligation to try it myself, and I did, and it worked.
TS: Can you tell us more about hypnosis for pain management? I don’t think that’s one of the things that I would’ve been like, “Oh, that’s really good. Hypnosis will really work for that.”
DS: Well, we started studying this many years ago, and I was doing an experiment with Stanford undergraduates measuring with electroencephalography their brain’s reaction to a series of shocks, painful shocks administered to the wrist. We found that, same students, same shocks, but when I then hypnotized them and said, “Imagine your hand cool, in a mountain stream, cool tingling numbness, let it filter the hurt out of the pain,” and there are three common peaks of what we call event-related potentials, where you see how the brain is reacting to the stimuli. The first one, the P100, is a 10th of a second after the shocks. It disappeared. Same shocks, same people, no response at all. The P200 and the P300, which has more to do with how much attention you’re paying to it, how important it is, was half as big. Within a 10th of a second, the brain is taking the same signals and just turning them down.
I realized that it isn’t just people hurting and then saying, “Oh gee, Doc, it wasn’t really that bad.” They’re changing the way they process the signals, and we’ve shown this now using other imaging techniques. Other investigators have, too. There’s a group in Montreal that showed—Pierre Rainville showed that using MRI, if you do the same kind of thing and you change the words you use, you change the part of the brain that gives you the anesthesia. If you say, “Your hand’s in ice water, cold, tingling, and numb,” you turn down activity in the somatosensory cortex here. If you say, “Well, the pain’s there, but it won’t bother you,” which is sort of the way people on opioids sometimes feel, it was in a different part of the brain, the dorsal anterior cingulate, which is a part of the brain that we’ve shown turns down activity when you go into hypnosis, so we understand how the brain is doing it.
It has several different ways of doing it, depending on what you tell people. We’ve done now randomized clinical trials comparing people undergoing surgical procedures who get hypnosis, who have a friendly nurse, or who have standard care, which is just pushing a button and giving yourself opioids. We found, in a randomized trial with 241 people getting arterial cut-downs and surgical procedures, that at the end of an hour and a half, the people under hypnosis have a pain level of one out of 10. The people with a friendly supportive nurse, pain is three out of 10. And the ones who get standard care, five out of 10, and they’re using twice as much opioids as the other patients, have more complications. And the people with hypnosis got done 17 minutes quicker, on average. We have not only evidence of what’s happening in the brain, but from randomized clinical trials that proves that it works better.
They get done faster with less distress. They had no anxiety at all, the hypnosis group. I was afraid they’d die. They were just fine, and so if I had a drug that did that—and we published it in The Lancet, which is a leading British medical journal. If I had a drug that did that, every hospital in the country would be using it, but people just don’t seem to get that the power that we have in our own brain, if we use it right, to manage problems like pain, it’s very powerful and very effective.
TS: Let’s just say I want to experiment with this in a safe way. For an example, I’m going to the dentist and normally I’d be a little edgy and maybe I’d say, “I don’t know if I really need Novocaine, I’m not sure,” and I wanted to try self-hypnosis in that moment. What’s the core of what I would be doing inside? What would I be doing?
DS: I would say, first of all, you’ve got to convince your dentist that it’s OK to do that.
TS: Well, I would just say, “No, I don’t need anything today. I’m good, I’m good.”
DS: Yes, good, good. Yes.
TS: I’m just talking about a safe trial, maybe a deep clean or something, where it’s on the edge and it’s like, “I can take this.” Something like that.
DS: Got it, got it. One technique that people use in the dentist’s office that’s very effective is just say, “You know what? I’m going to leave my body here, and I’m going somewhere else.” You just decide that you’re going to take a vacation to Tahiti or wherever you like to go. And picture yourself lying on the beach, sunning yourself, drinking pina coladas, or snorkeling and looking at the beautiful fish, and just disconnect from what your body’s doing. Say, “Body, you’re going to be safe and comfortable.” You’ll feel the comfort of the water soothing your body, making it feel good, but just go somewhere else and don’t waste your time paying attention to what the dentist is doing.
TS: You don’t think there are any negative ramifications from sort of being, “dissociated” like that for a period of time and then coming back into your body and stuff? No problem?
DS: No, as long as you’re not driving a car, or doing the dental work yourself, it’s not a problem. You don’t need to be there mentally. You can just go somewhere else. Absolutely not.
TS: Right. Now, interestingly, in your book, Trance and Treatment, I was interested in this section on weight control, and I thought, “This is a pretty easy thing I could try.” You write about how, if you’re less than 15% overweight, than your desired weight, this might be effective. I went through the practice that was described, and the interesting thing to me was this statement that, “Eating more than what I need is like giving my body poison.”
You don’t want to do that. I don’t want to do that. I don’t want to give my body poison, and I thought, “Wow, this is so powerful.” And it really had a huge impact on me, just reading it and kind of thinking that through. I wonder if you can talk more about that, and specifically this notion of implanting, if you will, or trying on ideas about being different. How we treat our body, and being different in how we treat our body. Respecting our body in a different kind of way.
DS: Respecting and protecting your body. I’m glad you picked up on that, Tami, because one of the key things that often good practitioners with hypnosis keep in mind is, you focus on what you’re for, not what you’re against. The worst thing you can tell somebody, and even more so in hypnosis, is, “Try this. Don’t think about purple elephants.” What are you thinking about? If you focus on the urge to eat, in general, you’re going to want to eat more. The urge gets bigger and more important. “Well, I’ve got the urge, I’ve got to do something about it.”
If instead you take a different point of view, you say, “I want to understand better my relationship to my body, and I want to treat my body with respect, the way I would treat a child, the way I would treat a pet, a dog.” Would you stuff more food into your dog’s mouth or your baby’s mouth than it wanted or needed? No, you would never do that. We kid ourselves, we say, “Well, I’m doing this to myself,” and then the idea is, “Well, if I stop doing it, everything will be fine.”
In fact, you’re doing it to your body. And your body is as dependent and trusting an innocent a creature as you’re ever going to come across in your life, so treat that dependent creature with respect. Treat your body with respect, and focus on what you’re for, which is eating with respect, feeding your body what it needs, what nurtures it, what makes it feel good, and not more than it needs or less than it needs. Think of your responsibility to treat your body with respect.
One of the other principles here, Tami, is that one of the rules in psychology is the best way to change behavior is intermittent positive reinforcement. If you just yell at people, “Don’t do something,” they just get angry. They don’t want to hear it. Your kids, you just say, “Stay out of the cabinet,” or something, they don’t really process what’s happening. It’s just, what they remember is an unpleasant interaction. But if, when the child eats properly, you say, “Hey Johnny, you did such a good job finishing that food. And you didn’t eat ice cream in the afternoon, good for you, you’re taking such good care of your body,” that’s something that people like and they’ll come back for more of it. You do the same with yourself, in relation—you think of yourself in relation to your body and you focus on what you’re for, eating with respect.
And the icing on the cake, and I choose that metaphor carefully, is that you get to feel that you can actually enjoy eating more. If you think about it, if you’re thinking about the way gourmets eat, it’s a total experience, the texture, the aroma, the flavor, the temperature. One bite, they can write a whole article on what that’s like and what it reminds them of. Most of us will taste the first bite, and then we do something else. We look at our phone, we watch television. We don’t enjoy eating much, and sometimes that’s when you eat more, when you haven’t even noticed what you’ve eaten. I advise people to eat like a gourmet, pay full attention to everything you eat and don’t do anything else, and you can enjoy eating more even when you eat in a way that conveys respect for your body.
TS: OK, so now we had the opportunity with you to go through a sample little exercise, to taste how we could use self-hypnosis for stress. And you’ve shown how it can be applied in some different situations, but I think the thing that I’m still not really clear on would be, if I were to take away a set of fundamental principles, “This is what Dr. Spiegel says, for self-hypnosis to work, you have to be amenable, hypnotizable to some degree or another,” and then, all of these different applications, “Here’s the common fundamental principles underlying effective self-hypnosis.”
DS: Well, Tami, the first principle is to concentrate intently, intensely, so narrow the focus of attention. Pick a problem and pick an approach to the problem, and go for it, and that means not having a lot of second doubts, thoughts and doubts. “Well, maybe it won’t work,” or, “It didn’t work for my friend,” or whatever it is. Cut loose the things that keep you stuck in the behavior that you’re in. And just say, “For this period of time, I’m going to focus on what I’m doing. And I’m not going to worry about whether I could do it or it makes any sense or not. I’m just going to give it a try.”
The second thing is, start with your body and work up. Don’t spend a lot of time worrying about how you got to be the way you are or who taught you to be like that. Just say, “I’m going to try out a different approach. I’m going to let go of my resistance, my constraints, my embarrassment, my whatever it is. I’m just going to try it and see if I like it, and I’m going to start with my body. I’m going to start helping my body feel more comfortable as we go about it.”
Your floating in your bath is a perfect example of that.
Then say, “In that context, I’m going to see if I can concentrate on eating with respect, on eating like a gourmet. I’m going to give myself to this new approach to the problem and see what happens.” You’re in a kind of exploratory, experimental mood, and you’re concentrating intently on it, and you’re focusing on what you’re for.
That’s the third thing. You find something to focus on that makes you feel good. “I can leave myself in the chair and go to Tahiti and let the dentist do whatever he or she wants to do. That’s fine.” It’s a different way of approaching the experience, and just really give it a try, see what it feels like, and then register, “Do I feel better? Is the pain better?” You managed to feel pleasant, good, dealing with a problem that you didn’t particularly like. So that’s a kind of dissociation too, where you’re separating how you feel because you got your body comfortable, from the way the problem usually made you feel, and it gave you an opportunity to think about doing it in a different way, so it’s focused, it’s different, and it’s bottom-up. It’s help your body, use your brain to help your body, and then you can deal with the problem better.
TS: All right, and then finally, here you’ve created and been part of a team that’s created this app, Reveri, that you’re hoping many, many, many people will use over time.
DS: Yes.
TS: You’ve also conducted lots of research experiments and published that research in a way that it helps create more acceptance of the clinical applications of hypnosis. What’s your sort of dream vision, Dr. David Spiegel’s big vision, for hypnosis in the world over the next few decades?
DS: I want people to see hypnosis as a tool and an advantage, not something that makes you feel silly or foolish or people make fun of you. I want them to see it as a strength, not a weakness. The thing that people worry the most about, Tami, is that they’re losing control. “Someone will take over my mind,” and in fact, it’s an occasion to gain control.
There are athletes who use it to train—to play golf, to play tennis, to swim better. I worked with the Stanford women’s swimming team. They were swimming better in practice than they were in meets because they were too worried about the woman in the next lane, and I got them to focus on swimming their best race. I see it as a way of strengthening yourself, as an additional resource you can use to better manage your body and live better, and I want people to see it that way.
I’ve used it, as you’ve mentioned at the beginning, with some 7000 people. I feel good about that. I’ve helped a lot of people, but I wanted to leave, as a kind of legacy, Tami, what I’ve learned, that anybody can use if they just have a smartphone, and they can hear my mellifluous voice. I used to think, “Well, can it be almost as good?” I used to think, “Will it be almost as good?” That’s why we made it interactive, so I ask you a question. Depending on how you answer, I give a different instruction. So it’s like being in my office, but I thought, “In some ways this is better, because if you’re having trouble getting back to sleep at three in the morning, hopefully I’m not there in your bedroom instructing you what to do, but you can turn me on on the phone.” I wanted to leave a legacy of what we have learned in decades of studying hypnosis, so that anybody who wants it has the benefit of it.
TS: I’ve been speaking with Dr. David Spiegel. He’s the co-founder and the scientific director for the Reveri app. Also, with his father, Herbert Spiegel, wrote the book, Trance and Treatment: Clinical Use of Hypnosis, if you’re interested in a deep dive. Thank you so much for coming on and being part of Insights at the Edge.
DS: You’re welcome, Tami. Thanks.
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