Dr. David Spiegel, MD is Associate Chair of Psychiatry & Behavioral Sciences, Director of the Center on Stress and Health, and Director of the Center for Integrative Medicine at Stanford University School of Medicine. His clinical and research experience focuses on hypnosis, stress physiology, and psychotherapy. Dr. Spiegel is the founder of the Reverie app, a self-hypnosis tool available for iOS.
Andrew Huberman and Dr. David Spiegel take a deep dive into self-hypnosis. They examine the role of clinical hypnosis for the treatment of chronic anxiety, chronic pain, trauma, stress – and even applications in cancer. Dr. Spiegel explains how to determine your level of ‘hypnotizability’, how breathing, vision, and directed mental focus can modulate internal states and enhance performance, and much more.
Host: Andrew Huberman (@hubermanlab)
Hypnosis: a state of highly focused attention, like looking through a camera lens
Any experience that draws us in is a form of hypnosis
Hypnosis involved a narrowing of context and loss of self
An experience is not considered hypnotic if the physical reaction is distracting or makes you think about something else
Stage hypnosis: what we stereotypically think of – someone performing with a pen or hypnotic tool trying to alter the state and actions of others for entertainment, basically making fools of people
Clinical hypnosis: enhances control of mind and body by inducing cognitive flexibility and allowing you to shift set easily and change the way you evaluate events
Clinical hypnosis allows you to suspend judgment and provides an opportunity for therapeutic benefit
Hypnosis has been useful for enhancing focus and narrowly focusing on something
“We underestimate our ability to regulate and change responses – to be cognitively, emotionally, and somatically flexible.” – Dr. David Spiegel
Induction state = deep hypnosis
Three things characterize entry into a hypnotic state: (1) turning down activity in the dorsal anterior cingulate cortex (dACC) responsible for cognition and motor control; (2) dorsal lateral prefrontal cortex (DLPC) has higher connectivity with insula (part of mind-body control system); (3) inverse functional connectivity between DLPC and posterior cingulate cortex (part of the default network, activity decreases in things like meditation)
Reducing the activity of dACC makes it less likely that you’ll be distracted and pulled out of whatever you’re in
The posterior cingulate cortex allows for the dissociation piece in hypnosis and allows you to put things outside of conscious awareness without worrying what it means, adding to cognitive flexibility
It’s likely that these specific brain networks are getting stronger with repeated self-hypnosis
Hypnosis is an effective problem-based treatment
Clinical applications: sleep, trauma, pain, phobia, stress, anxiety – and emerging research with cancer patients
Enhancing the mind-body connection is good for stress relief because it allows for the dissociation between somatic and psychological reactions
Self-hypnosis can be extremely helpful in falling back asleep when you wake up in the middle of the night
Hypnosis allows you to confront phobias: if you avoid your phobias or things you fear, the only association you have of those things/events/objects is tied to being afraid without any good experiences
Self-hypnosis allows for a wider array of experiences that aren’t negative and might even be positive for treating phobias
You have to confront trauma to restructure your understanding of it
Hypnosis is usually quicker than traditional psychotherapy approaches, allowing to go deeper into feeling states
State-dependent memory: when you’re in a certain mental state you enhance your ability to remember details about it
The essence of trauma is helplessness – you feel in control with self-hypnosis because you can turn it on and off
It’s best to see a specialist who can be sure to address underlying issues requiring hypnosis, and not just the symptom
Self-hypnosis often requires just 1-2 visits or periodic sessions, not regularly
A physician or practitioner will assess how hypnotizable you are and take you through self-hypnosis, teaching you how to do it so you can practice on yourself later
Even a 1-minute refresher has been shown to be quite helpful
The goal is for self-hypnosis to become an acquired skill without needing to see a clinician
Hypnotizability: capacity to have hypnotic experiences
The peak period of hypnotizability is childhood, around 6-10 years old
Dentists and phlebotomists can use hypnosis to shift focus
By the time you’re in your early 20s, hypnotizability becomes fixed
Rates of hypnotizability: about 1/3 of adults are not hypnotizable, 2/3 are hypnotizable – with about 15% extremely hypnotizable
Are you hypnotizable? Try the Spiegel eye-roll test
There’s a correlation between the capacity to keep eyes up and hypnotizability
Tilt your chin back so you’re looking up toward the ceiling
Direct eyes upward while open
Close your eyes, trying to keep the eyes up while closing the eyelids
If eyes roll back and you see the whites of your eyes, you’re highly hypnotizable; if eyes roll down and you see the iris (colored part of the eye) you’re less hypnotizable
Highly hypnotizable people have more functional connectivity & synchroneity between dACC and left dorsal lateral prefrontal cortex (key in executive control)
Some people are not that hypnotizable: people are overly controlling and busier evaluating than experiencing
Sometimes we’re too rigid and controlled and don’t let emotions guide us to protect ourselves or other
People with OCD are generally difficult to hypnotize because the evaluative component of the brain overrides the experiential side
People with superstition are also difficult to hypnotize because the imagination supersedes the reality
Eye movements have a lot to do with consciousness: stimulants make eyes big, opioids constrict pupils, rapid eye movement takes place during sleep
Eye movement desensitization and reprocessing (EMDR) EMDR: psychotherapy designed to alleviate the distress associated with traumatic memories by reducing activation of the amygdala and associated anxiety and reducing the amplitude of threat reflex
EMDR is most successful for single event trauma, like a car crash, robbery, etc. – not prolonged experiences like childhood abuse, divorce; it may be helpful but is ultimately an incomplete treatment because it doesn’t change the narrative of the event
“It’s not just about the state you get into but whether you brought yourself there voluntarily.” – Dr. Andrew Huberman
The hallmark of treatment and getting over things is confronting it head-on
“It’s not a matter of ‘are you exposed to it’ that’s upsetting – it’s ‘how are you handling it?’ ‘what do you make of it?’ and ‘are you feeling in control?’” – Dr. David Spiegel
Stress inoculation: we have to deal with stressful things in life to be better equipped the next time we face stress
You’ll become a stronger person if you face problems and stress
We need to think of our brain and body signals as a tool to help us understand what’s going on in the world – and something that can be managed
Reflect on and categorize pain: is it something that is healing and leading us to get better? Or is it bad and making it worse?
Leverage pain and discomfort as an opportunity to take action and do something about it
It can be necessary and useful to going into a grief state – on the flip side, you want an anchor to hold on to and come back to
“An incomprehensible loss has to be comprehended.” – Dr. David Spiegel
Grieving death, ask yourself: what have they left you?
Face a loss, live with the emotion that comes with it and embrace that the pain is because of how much they mean to you – reflect on what you gained from knowing the person