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You believe hypnosis has the potential to transform healthcare. How so?

Many problems we bring to our doctors have a psychophysiological component: irritable bowel syndrome, recurrent migraines, anxiety-related symptoms. And we know that people can somehow keep powerful medications from being effective. Access to mental healthcare is important here, but it鈥檚 physicians who are most often in a position to help those people self-regulate.

Clinical hypnosis is about learning how to interpret nonverbal cues and improve trust, communication and empathy. It is about educating the patient to be a better boss of their body and mind. That is improving care.

Then why is hypnosis not widely used?

In part, because nobody knows what it is. We first need to be able to say, this is what hypnosis is, and this is all it is. Then we can say how we think it works.

So, tell us what hypnosis is and how you think it works.

My colleagues and I propose that hypnosis is simply a . It involves facial expression, language, body movement, tone of voice, intensity, metaphor, understanding how people interpret and represent things. It isn鈥檛 something you鈥檙e in, or that you do: hypnosis is something you use. That means it鈥檚 not a therapy; it鈥檚 a means to therapy.

In strategies like psychoanalysis or cognitive behavioural therapy (CBT), the most therapeutic influence tends to be the act of being heard. The skills that facilitate that are part and parcel of the influence of hypnosis.

Where does the hypnotic trance fit?

Trance is a process of intense learning. It happens when we change our minds in significant ways, when we become neuroplastic; we are thoughtful, we pause, change our breathing. There is a shift in the parasympathetic part of the autonomic nervous system 鈥� an intensified focus of attention and narrowed peripheral awareness. Trance happens when we are traumatised, and when we fall in love. There鈥檚 no such thing as 鈥渉ypnotic trance鈥� as distinct from the trance of yoga or of prayer, for example. But part of the skill set of hypnosis is recognising and facilitating trance, because it makes whatever you鈥檙e learning more effective.

So the stage and the swinging watch鈥�

No.

The popular conception of hypnosis is quite wide of the mark, then?

Hypnosis is widely attributed to the power of the hypnotist. Everything from the evil fictional character of Svengali to movies and the occult has contributed to this mistaken notion that somebody else can control our physiology 鈥� our minds. And certainly, entertainers who claim to use hypnosis can and do play on that myth.

People can be influenced into cults and violent religious movements, . If I have poor self-esteem and self-efficacy, I may let people use hypnosis to 鈥渙verpower鈥� me. But ultimately the power to change lies with the person who, as we say, 鈥渙wns the trance鈥�. It still takes two to tango.

You鈥檙e a medical doctor. How did hypnosis ever enter your radar?

I spent 20 years as a solo primary care paediatrician, and I was struck by how inadequate my training was for the behavioural and psychophysiological issues I encountered. All of my training was only to do things to help kids, whereas I saw a clear need to better help kids help themselves. This got me interested in hypnosis.

What convinced you it could make a difference?

I saw a little girl who was 8. She had a serious disease and needed an injection every week. Each time it was a very difficult process because she was so anxious and traumatised from illness and long hospitalisations.

I said, 鈥淚 know it鈥檚 scary to come here, I bet you would rather be somewhere else.鈥� She was sitting on her mother鈥檚 lap with her eyes closed. She said, 鈥淚 would rather be home playing with my kittens.鈥� So I said, 鈥淕o play with your kittens, how do they feel, what do they sound like, how do they smell?鈥� I kept talking her through and saying less and less and letting her fill in more and more. After it was done, she looked up and said, 鈥淲here鈥檚 the shot?鈥�

Now, do I think she really didn鈥檛 know she got a shot? I think part of her knew, but part of her wanted the hypnosis to work, so she made it work.

Is clinical hypnosis a sort of non-deceptive placebo?

Hypnosis is a medium for delivering placebo effects (see 鈥�Tap the placebo effect to unlock your body鈥檚 healing powers鈥�). Pill colour or shape isn鈥檛 hypnosis, but my interpersonal communication is. My definition of placebo is the use of conditioning, expectation, social relationships and narrative paradigm to change a person鈥檚 physiology in a way that they attribute to an external intervention. But if they don鈥檛 externally attribute it 鈥� to a pill or therapist, for instance 鈥� then they鈥檙e doing it themselves. The challenge is to use placebo responses without relying on a placebo. I would argue that hypnosis, as a strategy, is not a non-deceptive placebo. It鈥檚 the anti-placebo, the opposite of external attribution.

How is hypnosis different from things like mindfulness meditation?

I may offend lots of people by saying that mindfulness meditation is an example of hypnosis 鈥� but it鈥檚 what I think. In the West, it is used as a therapy to practise coping or decreasing stress. It can be really helpful when someone is sick and tired of having thoughts overtake them and needs to practise dropping out of them, for instance. But that鈥檚 where it stops. It doesn鈥檛 direct change. I think a lot more can be done.

How well can we tell whether hypnosis makes a therapy more effective?

One found that, of patients being treated for obesity, those receiving CBT with hypnosis had better results, even after long-term follow up, than those just receiving CBT. That is impressive because, the hypnosis aside, the therapy was so similar. A for depression also showed more benefit for the hypnosis group. I expect more studies of this type.

Can we use hypnosis on ourselves?

We use it all the time. Most of our self-hypnosis is not very nice. Most of it is: 鈥淚 suck at that, I鈥檓 not a very nice person, I鈥檓 lazy, I deserve this abuse, every time I do that I鈥檓 going to get a headache.鈥� If trance is this intense learning process, we use a lot of that plasticity to reinforce our ruts.

Clinical hypnosis is a way of helping somebody change their self-hypnosis, to understand what trance-formation looks and feels like, and use both the novelty and intensity of conversation to teach them to do their own trance.

Can this approach truly be as powerful as you suggest?

If we want to really change healthcare, we have to help people recognise their own potential. We have to tell people, look, you can do this. You are the man behind the curtain.

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This article appeared in print under the headline 鈥淵ou are the man behind the curtain鈥�