January 5, 2026 • 55 mins
What exactly is hypnosis? We’ve all heard of circus-like versions, but is there a real element to hypnosis that psychiatrists and neuroscientists are able to leverage? Can attention and expectation change what we feel (such as pain or anxiety)? What do suggestible states reveal about the brain’s pathways? How does hypnosis compare to meditation, flow states, or psychedelic drugs? Today we speak with David Spiegel, Stanford psychiatrist and one of the world’s experts in hypnosis.
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Speaker 1 (00:05):
What exactly is hypnosis? We've all heard about the circusy
versions of it, but is there something about hypnosis that
is real and that can be studied and leveraged by
psychiatrists and neuroscientists. Can attention and expectation change what we
feel like pain or anxiety? And how does that work?
(00:25):
What do suggestible states reveal about the brain's typical pathways
and what happens when we're knocked off of those, and
how does hypnosis compare to meditation or flow states or
psychedelic drugs. Today, join me as we talk with doctor
David Spiegel, Stanford psychiatrist and one of the world's experts
(00:46):
in hypnosis. Welcome to Innercosmos with me, David Eagleman. I'm
a neuroscientist and author at Stanford, and in these episodes
we sail deeply into our three pound universe to understand
how how we see the world, the outside world and
also the inside world. Okay, so first I'm going to
(01:20):
point out one of my central sources of amazement that
surfaces and all these episodes, the fact that inside each
of us there's an entire universe of eighty six billion neurons,
never seeing the light of day, pulsing in the dark,
and these are somehow weaving together your world, and in
ways we don't yet fully understand, we get all this
(01:41):
private subjective experience out of this, like color which doesn't
actually exist in the outside world, or pain, which is
just signaling along nerves, just like all the rest of
the signaling running around in your nerves, but somehow you
have the impression that it hurts. And somehow all the
act activities zooming around on all these little cables equals
(02:03):
your mind. Your thoughts are nothing but this electrochemical activity.
And we know this because if you ingest particular molecules,
that changes your thoughts, like if you consume alcohol or drugs,
or if you bunk your head on the cabinet, you
might lose consciousness and not have any thoughts for some minutes.
And when someone gets a neurodegenerative disorder, many of their
(02:25):
neurons die and that changes their thoughts. Same with tumors
or strokes or dozens of other things that we see
in the clinics every day. And that's how we know that.
Speaker 2 (02:35):
You are your biology.
Speaker 1 (02:40):
But the question is our thoughts the end consequence of
the activity, or do they somehow feedback in such a
way that they influence the activity. Now this is an
open question in neuroscience, but we do know that somehow
a change in expectation can reshape what we feel in
our own bodies, are pain or anxieties, our sense of self.
(03:03):
We get glimpses of this with let's say placebos. These
are things that should have no medical effect, but they
often have clinically significant effects on people. And what's weird
is that sometimes these work even when people know they
are placebos. And then you've got practices like meditation that
can alter attention and emotion and make subtle changes to
(03:24):
the structure of the brain over time. But there's one
laboratory of the mind where these questions become especially vivid,
where you can watch how a change and attention changes
the brain, and that laboratory is hypnosis. Now, let me
be crystal clear about something. I'm not talking about hypnosis
of the stage show stereotype. I'm not talking about mind
(03:45):
control or swinging watches. Instead. To psychiatrists, they're talking about
something when they use the term hypnosis, but it looks
more like a rearrangement of attention. The world narrows inner
experience becomes more vivid. External suggestions begin to feel more
like internal ideas, and a person can dissociate slightly from
(04:07):
their normal neural pathways. Think about it like this. If
you look at any ski mountain, there are only a
few runs going down the mountain, But in theory you
could ski down the mountain in lots of ways. You
don't have to stay right on those established runs. And
in our own brains we get these runs established in them,
(04:28):
and the question is how do we ever get off
our own beaten path? So my guest today has spent
his career at this frontier. David Spiegel is a psychiatrist,
a leading researcher on hypnosis in the brain at Stanford,
and a clinician who has leveraged these methods to help
lots of people manage pain, anxiety, trauma, illness, and the
(04:50):
breaking of habits. Through his work, we get a window
into how flexible our perceptions and physiology can be. So
let's step with David Spiegel in to the inner cosmos. So, David,
often when people think about hypnosis, they think about, you know,
(05:10):
a state fair, magic show or something like that, And
that's not what you do. Tell us how you define
hypnosis scientifically.
Speaker 2 (05:19):
David, hypnosis is a state of highly focused attention. It's
like getting so caught up in a good movie that
you forget you're watching the movie. You enter the imagined world.
And to achieve that state of focus, you have to
do to other things. You have to dissociate, put outside
of conscious awareness, things that would ordinarily be in consciousness.
We're not aware of how much information our brains, as
(05:42):
you know better than anyone, is processing at any one time.
Right now. To listen to me, for example, you have
to ignore sensations in your body touching these very nice
chairs here. Hopefully you weren't aware of that until I
mentioned it. If you were, we could stop. Now you're
already born. So absorption, highly focused attention, dissociation, and the
(06:03):
other used to be called suggestibility. It's what scares people
about hypnosis. You know, the you know, the football coach
being made to dance like a ballerina in front of
an audience and all that. I don't like making fun
of people anyway, but it's different. It's cognitive flexibility. It
allows you to let go of presumptions of who you are,
what you are, what you can do. So the football
(06:26):
coach is not thinking of what he's going to get
in the locker room when he goes back after the performance,
but it allows him to do something different, to try
out being different. And as a psychiatrist and psychotherapist, I
love seeing people who are willing to try out being
different and who are surprised by themselves say my god,
I didn't think I could do that, and I did.
That's a great template for change.
Speaker 1 (06:48):
What is the difference between a hypnotic state and let's
say meditation, a flow state, or an dissociative state.
Speaker 2 (06:57):
Well, it is a kind of dissociative state. To focus
so intently, you have to put outside of conscious awareness
things that might ordinarily be in consciousness. And people who
have a dissociative disorder are usually highly hypnotizable, so they
go intensely. People with associative identity disorder, when they're being
one of their altars, they're not being all the other
(07:19):
parts of themselves, and it's a kind of firm boundary
between these different parts of themselves. Now, that's a mental
disorder usually associated with trauma. But hypnosis is a much
milder state of focused attention that is enabled by dissociation.
Speaker 1 (07:35):
Okay, and how about a flow state or a meditative state.
Speaker 2 (07:39):
So the flow state is kind of like the highly
focused attention.
Speaker 1 (07:44):
And by the way, give an example of a flow.
Speaker 2 (07:46):
Slow state is just getting so lost in an activity.
For example, that you're painting something. Let's say that you
realize you've missed an appointment with a friend, or you're
two hours late for dinner or something. You're just so
engaged in it. You check sent me Hi who wrote
the book Flow, and he used to call it an
autotellic state. It's one that is so enjoyable that you
(08:07):
would do it just to do it, regardless of what
the outcome of it is. And that's part of flow.
You're not doing it for a purpose. You're doing it
just to do it, to be in that state, to
be fully engaged.
Speaker 1 (08:17):
What does autot mean.
Speaker 2 (08:19):
Autotelic just means self rewardings. It's rewarding just for doing it,
not because it's going to get you somewhere into something.
Actors are like that, you know. The method in acting
is just you know, be that person. And when a
good actor does that and you say, hey, you were terrific,
that was a great performance, they say, what performance I
was just being that guy. You know, that's who I was.
(08:41):
So hypnosis is very similar to flow states in that
sense of being totally into it, being fully absorbed in it.
Now meditation there are similarities, but there are differences. Meditation
is more about being and hypnosis is more about doing so.
In meditation, there are three major components to meditation. There's
(09:03):
open presence, where you just let feelings and thoughts flow
through you. You don't try to judge them or use them.
You don't try to use it to solve a problem.
It's just it's to become a way of being where
you are more open to just whatever things are, let
them be. You do a body scan, which is a
little bit like hypnosis. You can become more connected with
(09:23):
things going on in your body or better control things
going on in your body, like pain, like the symptoms
of anxiety, for example. The third thing is compassion and
meditation where you try to have compassion for other people
compassion for yourself. And that's a good thing too, and
you can use hypnosis to enhance compassion. I can give
you some examples of that, but you don't use it
(09:45):
to solve a problem. I had a woman who was
a ten year meditator twice a day for ten years,
thirty minutes a day each time. And she said, but
I still have migrain headaches and they're driving me crazy
and I can't get rid of them. Would you help me?
So I hypnosis whether to imagine that she had a
cap full of ice on her head, and because people
(10:06):
with migraines often have vasodilitation in the scalp and they
feel hot and uncomfortable, and she imagined having this cap
of ice in her head. And she called me a
week later, as she said, doctor Spiegel, my migraines are gone.
Thank you, and thank you for freeing me to use
my intentionality. Wow, because you're not supposed to be intentional
(10:28):
in meditation, and you are intentional in hypnosis.
Speaker 1 (10:31):
Oh, I see, I see. So vasodilation is where the
blood vessels are expand instead are contracted. But she was
able to use her intention to take control of the
diameter of her blood vessels as well.
Speaker 2 (10:43):
I can't measure it, but I think it's probably the case.
There are situations where people you can see them if
they're concentrating on their hands being warm, you can see
them sort of flush on their hands. There was one
amazing study done a mass general years ago. They had
people in hypnosis. They instructed them. They had a bunch
(11:03):
of people who had body warts and they're unpleasant, but
there was word that you could use hypnosis to eliminate warts,
and they actually got people to eliminate warts on one
side of their body. Think about that. That's mind bending.
So but if you're thinking about the brain controlling the
nervous system, the nervous system is divided into branches, and
it occupies different parts of the body, and you can
(11:26):
imagine changes that may sometimes happen in the body.
Speaker 1 (11:30):
What would curing warts look like? How does one intentionally
make that happen.
Speaker 2 (11:37):
You instruct them to imagine that the warts are just
drying up and falling off, that they just disappear, and
for some people that actually happens.
Speaker 1 (11:48):
How is hypnosis used in your practice, for example, for pain,
for anxiety, for trauma, for dealing with habits that people
want to break. Give us a sense of.
Speaker 2 (11:59):
How sure I'll be glad to do that. The way
we use it is to first first I test people's hypnotizability,
because people differ in their ability to experience hypnosis, and
that helps me structure the way I approach it with them.
If you're highly hypnotizable, which about twenty five percent of
the population is, you just tell them to do it
(12:20):
and they do it like the ward thing you can.
And I'll tell you what the approach is with each
of these kinds of problems. Mid range you kind of
negotiate with them more and they try it and they
reflect on it. And with low hypnotizables, it's more of
a cognitive activity where you think about approaching the problem
in a different way. So don't fight the pain, but
learn to filter the hurt out of the pain, don't
(12:40):
let it get you angry, figure that you can find
a way to master it. So for you know, we
start from the body up with hypnosis, and this is
different from cognitive behavioral therapy, for example, where you kind
of think your way through the steps to the problem.
With hypnosis, if somebody is stressed, what I do is say,
(13:01):
there's one part of this stressor that's bothering you that
you can do something about right away before you figure
out actually how to get rid of the stressor or
deal with the stressor. And that is the effect of
the stress on your body. So when you feel stressed.
What happens you know what happens to you, David when
you get stressed physically?
Speaker 1 (13:20):
Yeah, I think my muscles start to hurt.
Speaker 2 (13:22):
Your muscles hurt, they get tense, you start to sweat,
you fidget. But there's a kind of snowball effect where
you start to feel that and you think, oh my god,
this must be really bad because my body's reacting, and
so you get more anxious, and then your body reacts
and on it goes. So with hypnosis, you start with
the excellent control you have over your body, and hypnosis
(13:42):
better than normally. And so I say, look up close
your eyes, take a deep breath, and imagine that you're
floating in a bath of lake, a hot tub, or
floating in space. And I teach them a breathing exercise
where you inhale through your nose, starting with your abdomen,
and then slowly exhale through your mouth. And if you
(14:03):
try that, you'll notice that very quickly your body. Do
you try it? Try it? Just inhale through your nose,
hold and then slowly exhale through your mouth. How's your
body feel?
Speaker 1 (14:17):
Good?
Speaker 2 (14:18):
Good? Good? It's a little different.
Speaker 1 (14:19):
I don't think I was stressed before. But I'll try
that when I'm okay. But you're saying that I one
should be able to feel that difference. Right after how
many breaths.
Speaker 2 (14:30):
Like three breaths, wow, is you start to feel it.
And so then you you with your eyes closed, you
imagine you're floating in a bath of lake, hot tubber,
floating in space, and typically people feel less physiologically aroused.
And then you say, okay, so you've already done one
thing about the stressor, which is the effects that's not
(14:51):
on your body. Now, picture in your mind's eye, an
imaginary screen could be a movie screen, a TV screen,
or a piece of clear blue sky. And and then
divide the screen in half, and on the left side,
picture that stressor one thing that's stressing you. But with
the rule that you keep your body floating while you
do it, so you're beginning to separate this feedback between
(15:13):
the mind and the body about stress. And then once
you've been able to do that, I say, now picture
on the right side of the screen. Make that your
brainstorming screen. One thing you could do to deal with
the stressor It may not be the best thing or
the only thing, but something you could do about it,
and so typically people will picture something. You know, I'll
explain to my boss why I was late, or I'll
(15:34):
make sure the kids wear their seat belts when they
get in the car, whatever it is. And then say,
notice how you've been able to think more clearly about
how to deal with the stressor once you're able to
separate the stress from your physiological reaction. And we found, David,
in studies of tens of thousands, like sixty eight thousand
of our Reverie users our self hypnosis app that within
(15:58):
ten minutes they get a fifty eighty percent reduction in
their stress levels pre to post. And that's not bad
for a treatment that has no side effects, hasn't killed
anybody yet, and is fast faster than going to a
pharmacy and getting a drug, so they immediately get an
(16:18):
immediate reaction. So I help people deal with stress in
that way from the body up rather than from the
head down.
Speaker 1 (16:24):
That's amazing. So if we're talking pain, anxiety, trauma, things
like this, does this apply to all of the equally or.
Speaker 2 (16:31):
Different approvals with different approaches. So for pain, common and
terrible problem that is very terribly treated in this country.
You know, last year one hundred and eighteen thousand Americans
died of opioid overdoses in the United States. You know,
opioids kill people, and so I built Revery, our hypnosis
(16:51):
app in part to stop that, to get into people's
hands and minds and intervention that they can use to
really help themselves. And there's tons of evidence We've done
randomized control trials showing that hypnosis can control pain. And
the fact that you can reduce your pain with hypnosis
doesn't mean the pain is all in your head. It
means that the strain in pain lies mainly in the
(17:13):
brain that does signal. An input signal is painful or not,
depending on how your brain promulgates it and classifies it.
And you can teach your brain to treat pain differently.
My lovely wife Helen, had both of our children with
self hypnosis as the soul anesthetic in childbirth and Dan
the first one was ten pounds, so it was serious,
(17:34):
you know, And this shit. At one point in the
middle of my having rhibnitize, I had her floating in
Lake Tahoe. She said, David, you know I teach pharmacologey
at Stanford. Are there are drugs for this? And I
said keep floating, cool, tailing, and and Dan was born fine,
and I had no pain at all, you know it
(17:55):
was so hypnosis really is a terrific treatment for pain.
And we have on our app four different approaches to it.
So one is just sensory alteration, filter the herd out
of the pain. Imagine whatever makes your body feel better.
And if you think about this, if you get pain
(18:17):
relief for whatever your problem is with an ice pack
or floating in a warm bath, that means that when
you are in one of those states, your brain is
in a certain state that interprets what's going on as
a comforting sensation overriding the pain. And there are pet
studies done at Maygill by per Rainville showing that if
(18:38):
you tell people to have the sensory alteration filter the
head out of the pain, you get reduced activity in
some metasensory cortex just where you would hope it would happen.
Speaker 1 (18:48):
This is what is measuring the activity from your.
Speaker 2 (18:52):
Body from your body in specific regions of the brain,
and as you feel the analgesia, you feel a reduction
in the in the cemetasensory cortex. I did an experiment
with a bunch of Stanford undergrads highly hypnotizable. We screened
them for that and I had we gave them shocks
to the forearm and they would report the pain, and
(19:13):
then I hypnotized them and said, you're a forearm is
an ice water cool tingling. They got the same shocks.
We were recording some metasensory event related potentials, and the
P one hundred disappeared the first tenth of a second.
The brain stopped the initial processing of the pain signal,
and the P two hundred and P three hundred, these.
Speaker 1 (19:32):
Are EEG signals.
Speaker 2 (19:34):
Collected EEG signals in response to a series of shocks
were half as big. So just telling them to do
that changed the way their brain transmitted the pain signal.
Speaker 1 (19:44):
And I assume this wasn't just repetition suppression.
Speaker 2 (19:47):
No.
Speaker 3 (19:48):
No, We had a control group that wasn't hypnotized. Yeah,
and then they would get the same well they did
that group. They were their own control because when they
were not hypnotized and just feeling it, they got the
full sensation for the same period of time. They didn't
habituate to it a hypnosis, They just persistently and immediately
(20:10):
reduced the amplitude of the evoked response by overall fifty
percent starting with a tenth of the second. It wasn't
like it was rattling around the brain for a while.
It changed the settings for how you process those signals.
My colleague pr Rainville, when he studied activity in the
brain after a similar analgesic instruction, if instead of saying
filter the head out of the pain, your hands cold
(20:31):
and numb, he said it's there, but it won't bother you,
which is the way people on opioids sometimes respond, well,
I know there's a sensation there. And then he got
the same level of analgesia, but now the reduction was
in the dorsal anterior cingulate cortex, part of the salience
network that tells you whether something is a threat or not.
(20:51):
So you can change just the words you use in
hypnosis will change the part of the brain that reacts
to the analgesic construction.
Speaker 1 (21:00):
Using people who are highly hypnotizable, this actually sounds like
a great advantage for them, and let's say the case
of pain. What about people who are not so hypnotizable.
Does that mean they can't help themselves there?
Speaker 2 (21:13):
What we find is that the results are less dramatic,
but they get results, okay, in part because we're teaching
them a cognitive strategy. We're saying, look, you know, I'll
give you an example. I had a very lovely woman
came to me the other day who has chronic pain
and who said that it really inhibits what she can do.
(21:38):
She also had kind of a tick from an old
neck injury that she'd had, and it was getting worse
and worse, and she got more and more angry about it,
and it was inhibiting her life and what she could do.
And she turned out to be three out of ten
instead of seven out of ten, less hypnotizable on our measure,
(21:59):
the hypnotic conduction profile. And I said, you know, pain
and this tick that you have are like the noisy
kid in the classroom. You know, you pay more attention
to it than it deserves. You have other sensations, other
things you could think about, but you open into that.
She said, well, I'm a teacher. I was a teacher.
I taught for twenty seven years. I loved teaching best
part of my life. And I said, well, what did
(22:20):
you do with a noisy kid, a kid who was disruptive?
She said, well, I was pretty good with them. Actually
she was rather strict, you know, but she said I
would take their hand at a time when teachers finally
were allowed to touch a student, and I would hold
their hand, and I say, I know you're upset, and
I know this was bothering you, but there are better
ways to handle it, and I'm going to show you how.
(22:42):
And so, in a very kind, accepting, loving way, she
was saying, what you've been doing is no good, but
I will show you how to do it better. That's
a cognitive approach that keeps you from making things worse
by exacerbating the irritation you have. And I said so,
and she said, I was so good at it that
I got all the troublesome students in the school, you know,
(23:04):
and send them to me. But I love doing it.
And I said, so you know how to do it,
but why don't you use that same approach with your
own body? Because you get more and more frustrated the
more you have these ticks in this pain. And if
you can just treat your body the way you would
treat one of those students, I'll bet you feel better.
And she did. She found that the ticks were not
(23:25):
getting worse because they would, you know, the more it
would happen, the more she would shake because she was
so angry and frustrated that it was still happening, and
the more discomfort she had. So part of it is
using hypnosis to literally alter perception, and part of it
is taking an approach that involves focusing on what you're for, now,
what you're against, and then what you've written. I'm sure
(23:47):
you're familiar with this, that you exacerbate the problem by
fighting against it. We people and hypnosis say, the worst
thing you can tell somebody is don't think about purple elephants, right,
you know, And that's what you do. So you focus
on what you're for and you can modulate it, even
if you don't get as big a sensory alteration as
as you might otherwise have done.
Speaker 1 (24:08):
In this example, what is the thing that you are
focused for? It's you can't say I want to be
free of pain, because interesting of the pain, what's there?
Speaker 2 (24:17):
You're you're focusing on filtering the herd out of the pain,
soothing it. I say, imagine, treat your treat your body
as if it were your baby, your child, you know,
if your child were hurting if you were hurt, would
you get angry at him for crying and fussing? No,
they say, I'd I'd pick them up, I'd hug them,
I soothe them. So you know what, your body is
(24:37):
as innocent as your baby. You know it has to
deal with whatever happens to it. So focus on respecting
and protecting your body the way you would your child.
And that's the that's what you're for, is this respect
and protection of your body and not making it worse
by getting angry and frustrated.
Speaker 1 (24:55):
How about anxiety? How is this using it?
Speaker 2 (24:58):
Well? Anxiety disorders. Again, it's this sort of feedback between
between brain and body. And I have people, first of all,
deal with just the way what do you perceive in
your body when you're getting anxious and so imagine, you know,
feel that tension, but imagine that you can do something
(25:19):
or imagine the thing you do to keep from being anxious,
and then think about how you could approach that problem differently.
So I had a woman who was a CEO of
a company here, tough lady, but she had a terrible
dog phobia. She get awfully anxious when she got anywhere
near a dog. And I said, well, imagine. Let's imagine
(25:41):
that this guy is bringing his dog into your office.
And she said, no, I just freeze and see what
the dog is going to do. And I said, well,
if one of your employees who was performing badly walked
into your office, would you just freeze and see what
he'd do? She said, hell, no, I'd tell him off,
you know, I'd fire him. I'd do whatever I had
to do. So I said, so, why don't you instead
(26:02):
of freezing immobilizing yourself, which only amplifies the reason you
would be afraid, picture how you will handle the dog.
What will you do and decide, first of all, is
it really a physical threat to you or not? And
if it is, protect yourself. If it isn't, then decide
whether you want to just usher the dog out of
the office or call someone to get rid of it,
or whatever it is, and do it that way.
Speaker 1 (26:41):
What is the difference between that and let's say cognitive
behavioral therapy.
Speaker 2 (26:45):
Well, with cognitive behavioral therapy, you kind of think it through.
There's less about this sort of direct psychophysiological control. So
you're trying to think about it in a way that
is logical and maybe is less likely eventually to trigger
your anxiety, but we sort of go for the money.
We go for handling the way the body is reacting
first and teaching her that once she had this realization that, yeah,
(27:09):
there are times when you want to be afraid of
an animal, including a dog, but is this one of
those times? And so you're acknowledging the cause your anxiety,
but you're controlling the way your body feels. So your
body is floating and comfortable. You can picture it without
having that automatic, you know, physiological protection. And the funny
thing is about people with anxiety and phobias in particular,
they often don't have an event. It's not that they
(27:32):
were bitten by a dog a long time ago. It's
just that they have developed this. And what happens with
phobias in particular is the more you avoid it, the
worse it gets. And if you think about it, you
know what you do if you avoid it is you
reaffirm psychologically that there must be a reason for being
so scared of this, and that's why you avoid it.
(27:53):
And the other thing is you deprive yourself of success stories,
so you don't get close enough to a dog to
have a good experience. You know, he just licked your
hand and it was very nice. You just have the
fact that you got more and more anxious and more
and more avoidant, and it replicates itself. So it's not
about thinking it through or understanding what happened to you
(28:13):
early in life that led to this. It's a matter
of trying to intervene with the psychophysiological reaction that tends
to reinforce the strength of the phobia anxiety.
Speaker 1 (28:24):
I want to take at tense for one second. I
was going to ask you about your origin story. So
your father did the exact same thing that you're doing.
Speaker 2 (28:30):
Yeah, well, both of my parents were a psychiatrists psychoanalysts,
so they told me I was free to be any
kind of psychiatrist. I wanted to be here. I am.
But so the dinner table conversations were pretty interesting, and
I got to watch him make movies of patients who
had you know, had a woman who had pseudo seizures,
hysterical pseudo seizures, and he would hypnotize her and take
(28:53):
her back to the last time she had a seizure
and she would have another seizure.
Speaker 3 (28:57):
You know.
Speaker 2 (28:57):
So either way, he taught control, and I do this too.
Is not by telling them, don't make it happen, because
that's you know, don't think about purple elephants, but rather
make it happen. That's a way to have control, you know.
So she would think back to the last time she'd
have a seizure, and gradually they became milder and milder,
(29:18):
and instead of feeling frightened and angry and frustrated and
humiliated when it happened, it was kind of like, oh,
good for me. You know, I made it happen. So
you teach them a method of control. That's the opposite
of fighting it. And I had a woman from who
I lived up in Napa and was part of one
of these big wine families. She was having hysterical seizures
(29:40):
and we don't use that term anymore than's pseudo seizures now,
But it got bad when her daughter had her first
baby and the daughter said, Mom, you can't hold the
baby because I don't want you to have a seizure
and drop the baby. And that did it for her.
So it turned out that her problem was that she
(30:03):
was caught between two generations of a family that were
fighting one another. So the father was the originator of
the winery. The sons were fighting him in court over
the ownership and control of the winery, and she kept
trying to get them together for Thanksgiving and Christmas, and
both of them, both sides would be yelling at her.
And I said, she would call her father every day
(30:24):
and get yelled at again. And I said, I'll tell
you what. I'm going to teach you how to control
these seizures. But you have to do something else, and
that is, if your father starts screaming at you on
the phone, hang up, and sooner or later he will
learn that if he wants to talk to his daughter,
he better not yell at her. And after a while,
you know, there were a bunch of times where she
(30:46):
had to hang up, he stopped yelling at her. And
I said, it's not your responsibility to make these guys
stop fighting with each other. You do what you want
to do. If they come to Thanksgiving dinner, good if
they don't, okay, and learn to control this. And she's
she was holding the baby. You know she was able
and she felt good about it. So you're changing the
affective tone of the experience with the stimulus that is
(31:09):
making her anxious, and in this case, changing her ability
to manage the interactions that we're leading to this distress and.
Speaker 1 (31:17):
Just going back to the origins for me, how old
is the h How old is this field of.
Speaker 2 (31:24):
It's the oldest Western conception of a psychotherapy. It's two
hundred and fifty years old. Wow. It started with Franz
Anton Mesmer. You know the term mesmerized. He mesmerized me.
He was a Viennese physician who noticed that some of
his patients would suddenly go into one of these altered states,
like a pseudo seizure. And he thought that it may
(31:45):
have to do with badly acting magnetic fields in their bodies.
And he thought if he put his magnetic field, which
he thought was better, next to theirs, theirs would get better.
I don't know why his wouldn't get worse, but and
he then started He had these packets, these buckets full
of iron filings that were weakly magnetized, and he would
put them near that, and some would fall into a
(32:06):
trance state of some kind, and often they would get better. Actually,
so there's something about just altering your mental state that
allows you to just experience difficult things in a different way.
And he became so popular in Vienna that he left
his wife and family there and moved to Paris, where
he became like the celebrity doctor. And if you think
(32:26):
about it, two hundred and fifty years ago, what was
the major treatment in medicine. You know what? It was?
Blood letting. Yeah, let the bad humors out of your body.
So unless you happen to have polypythemia vira or congestive
heart failure, you were going to do worse. Seeing a doctor,
Voltaire wrote to his brother, We did everything we could
to save father's life. We even sent the doctors away.
(32:49):
And his office was cheerful. It was brightly lit. There
were patients hanging around, just helping other patients, talking to
them about how well they were doing. Regular doctor's officers
were great. There wasn't there. There wasn't a painting on
the wall. They were cold and dark, and you got
bad news and you got blood taken out of your body.
That was it. It wasn't much fun. So he was
(33:09):
the The other doctors complained to King Louis about him,
and he he convened a panel to investigate Mesmer, and
it included our own Benjamin Franklin, who was having a
good time in Paris. Back then, it included the famous
chemist Lauasier, who developed the principles of oxygen chemistry. Shortly
(33:32):
before he died, developed the idea of the gross national product.
Brilliant guy. He was beheaded in the revolution. And another
person on the panel was the inventor of the guilloteae,
doctor Guillotine too, and he kind of created the mind
Bobby body problem. And they concluded that hypnosis was nothing
(33:59):
but heeded imagination. Now, you know what, that's not a
terrible definition of hypnosis. It's highly focused attention. It's a
change in brain state. But that was the end of
Mesmer's career basically. And the problem is that there's been
one rejection after another. You know, a Scottish surgeon named
Isdale was traveling around India using hypnosis as general anesthesia.
(34:21):
You know what was anesthesia before ether? It was, you know,
getting people drunk and holding them down. It was terrible,
but hypnosis was actually very effective. It was. And I
gave a lecture mass general to ether Dome on tolari
Ago where ether was introduced here and a surgeon strode
(34:42):
to the front of the amphithiter efforts to say, gentlemen,
this is no humbug to distinguish hypnosis from ether. You know,
hypnosis is no humbug. It works, and you know, would
we use it all the time now, But I've used
hypnosis in surgical procedures where you don't use general anesthesia,
and it's an extremely effective analgesic.
Speaker 1 (35:04):
Still incredible, but it depends on the suggestibility of the
pain part.
Speaker 2 (35:08):
But even in randomized trials that include people of different
levels of hypnotizability, we show a significant difference. We did
one where they were injecting through arterial cutdowns in catheters,
chemo ambolizing tumors in the liver, expanding the renal artery,
and in all comers, we found if you randomized to
(35:30):
the standard care condition with able to push a button
and get opioids into your bloodstream, pain level at the
end of an hour and a half doing this was
five out of ten, if you had a supportive nurse
comforting you, three out of ten, hypnosis one out of ten. Wow,
and the hypnosis and they were all and the hypnosis
(35:52):
group was using half the amount of opioids that the
standard care group was using. And the procedures got done
seventeen minutes.
Speaker 1 (36:14):
So what do you see as the thing that gets
in the way of hypnosis or why it gets rejected.
Speaker 2 (36:19):
I don't know. I mean, we published that study in
the Lancet, you know, not yet big randomized trial. If
what we had used was a drug, everybody, every hospital
in the country would be using it now. And I think,
I think there are a couple of things, David. You know,
we're both in the psychiatry department at Stanford. We know
that psychiatry. You know, we're like the Rodney Dangerfield of
(36:41):
medical things. You know, we don't get no respect. You know.
He once said, they asked me to leave a bar
so they could start happy hour, you know. And people
have this prejudice against what goes on in the brain,
and they think if you use your brain to solve problems,
the problem started in your brain. Well that's not true.
(37:01):
You know, you have people, we have people who've had
injuries to their knees, have knee replacements, and they do
better with hypnosis plus other kinds of analgesia than those
who just have the standard analgesia, and they're less likely
to get addicted to opioids. It's teaching this brain is
this incredible instrument, as you have depicted beautifully in your writings,
(37:22):
that we don't that doesn't get the respect it deserves.
And we think that the only real interventions in medicine
are ingestion, injection or infusion, and that is not true.
You know, we do remarkable things with our brains that
can make our lives better. And so it's it's a
kind of prejudice that we have to get over, and
I'm sorry to see it, but that's what we're still
(37:43):
stuck with.
Speaker 1 (37:44):
And have you you've done brain imaging in your Yeah.
Speaker 2 (37:48):
I've done functional magnetic residence imaging. We've taken highly hypnatizable people,
put them in the scanner and compared to low hypnotizables.
Put them in the scanner, give them a bunch of
tasks and so control tasks, and then we look at
what are the things that happen only in the highly
hypotizable people and only when they're in a hypnotic state,
and we find three things happen. One is reduced activity
(38:11):
in the dorsal anterior cingulate cortex. So that's part of
the salience networks, the brain's alarm system. It does pattern matching,
and you hear a loud noise and you get distracted.
That's your dorsal anterior singular thing. There's trouble here. You
better divert what you're doing and focus on that. So
it's a it's a safety system for the body. If
you turn down activity there, you're allowing yourself to focus
(38:34):
more intently on other things. And that's what happens in hypnosis.
We found in another study that highly hypnotizable people have
more GABA menu butteric acid, the inhibitory neurotransmitter in the
brain than low hypnotizable people. So it's like having your
own little pharmacy on standby because what bendza diezepines do.
(38:56):
They increase GABA in the brain and so they can
mobilize more gabba to inhibit anxiety, inhibit pain response than
people who are less hypnotizable. So that's one thing. The
second thing that happens is more functional connectivity. So the
first thing I said was activity, How active is the area?
The second is when one area is active, is a
(39:19):
related area active or not? And we find more functional
connectivity between the prefrontal cortex, particularly on the left and
the insula, which is you know this insula means island
in Latin. This island of tissue in the middle of
the frontal cortex that is a mind body pathway. So
it's a way in which the brain controls the body,
(39:41):
and it's also a place where you have greater inter reception.
You're better able to perceive what's going on in your
body so that it makes sense in hypnosis. You can
better feel what's going on in your body and better
control what's going on in your body. We had a
group of students years ago that we brought in first
thing in the morning, no breakfast, and had them eat
(40:01):
imaginary meals for an hour. They would take we'd take
a gastronomictory of the Bay area, and Ken Klein was
a gastorineurologist worked with me, had a nasogastric tube down
and he would measure a gastrior gacid secretion. And one
woman was so caught up in this imaginary food that
she said, after about half an hour, let's stop. I'm full,
(40:22):
you know, So it seemed real. Those subjects had an
eighty nine percent increase in gastric acid secretion. So we're
narrowly David. You wouldn't think you could do that, but
you can. You can change your stomach's preparation for a meal.
We then did the opposite. We had them imagine and
hypnosis that they were on a desert island doing anything
(40:43):
but eating or drinking. Thirty nine percent decrease in gastrior
acid secretion, and then we injected them with pentagastrin, which
triggers maximal prietal cell output of gastric acid. We still
in the hypnosis condition had a nineteen percent decrease. So
the brain is much better better at controlling what's going
on in the body than we give ourselves credit for.
(41:04):
The third thing that happens in the MRI scanner, you
see inverse functional connectivity between activity and the prefrontal cortex
and activity in the posterior singulate. Now that is, you know,
as part of what we call the default mode network.
It's what your brain does when you're not working or
doing anything particular, but thinking about who you are, what
(41:24):
you are, what people think of you, what your mother
wanted you to be, all kinds of things like that,
and it's the thing that kind of keeps you on course.
Sometimes you know who you are and what you are
and what you're supposed to do. But it also can
keep you in a kind of rigid state where you
don't want to change. I should be like this, I
shouldn't be like that, And yeah, you know, I sometimes
(41:45):
call it the my fault mode network, where you just
you know, think about what's wrong with you. And so
when you're active in hypnosis, you're inhibiting activity in the
posterious singulate. Now, interestingly, that's the same thing that happens
in studies of long term meditators that they have lower
natural activity in the posterior singular cortex. And it's also
(42:07):
the major finding with psychedelics.
Speaker 1 (42:09):
I was just going to ask about that. So your
interpretation of that is when the default mode network is
running strong, people are essentially running in the same loops.
Let's take the mountain analogy. You've got a certain number
of ski runs down the mountain, and everyone's just staying
in those ski runs.
Speaker 2 (42:25):
That's exactly right.
Speaker 1 (42:26):
But when you inhibit that, people think, oh, I can
actually ski down the mountain this other way that nobody's
taking with it.
Speaker 2 (42:33):
Well, just you know, for example, you know I've been there,
you know where you think, oh god, that's steep. I
am not the kind of skier can do that. You know.
But if you're loosening up your default mode network, and
if you're getting more engaged in what you're doing, you say,
you know what if I take it this way in
that way, If I don't make this the bad skiers
mistake of leaning backwards going down the hill, which gives
(42:55):
me less control over the skis. But you allow yourself
to lean forward, the edges work better and you actually
have more control over how you're turning and how you
can stop if you need to. So I, when I
do that, I have to suppress activity in my default
mode networks is saying, are you crazy? You can't do that?
And give it a try. So that's right. And so
I actually think that hypnosis is a kind of less toxic,
(43:20):
much more controllable psychedelic experience where you just allow yourself
to try out things that are different and see what
it feels like. But you can turn it on and
you can turn it off.
Speaker 1 (43:32):
Do you suppose if you look across the population, so
some people are more hypnotizable. I'm totally speculating here, but
do you suppose that those are the people that are
more attracted to literature? Because when I go into the bookstore,
I notice that some read fiction, some only go to
the nonfiction section, right, But for the people who are
going and they want to read a story and step
into the shoes of a protagonist and be someone else,
(43:54):
do you suppose it would be a correlation there?
Speaker 2 (43:55):
I think so, I think. I mean, I haven't seen
a study like that, but I think, you know, in
role we actually it's interesting. On the every app we
call people who test out to be highly hypnotizable, the
poets that you know, they just the imagined world and
the real world can become the real world for you,
and so it's easy to go into that. Whereas we
(44:15):
call the low hypnotizables the researchers you know that, and
low hypnotizalar people that just you know, have to analyze
everything and read about it, just just what you're saying now.
They may read books, so they may be part of
who's populating the bookstores, but it's different kinds of books.
And the mid range people we call diplomats who will
try and experience and then step back and think about
(44:37):
what it's like. I had one day in the office
when it was perfect, you know, the first person was
at ten on the hypnotic in very hypnotizable. She had
some really bad neck pain and it just went away.
You know. I just had her imagine you had this
hot pack on your neck filter their head out of
the pain. Thank you doctor. She's out the door. She
(44:58):
loved it. The second patient with somebody who had had
a knee injury seven years earlier. He was carrying a
very heavy crate with a guy who dropped it and he,
you know, did real damage to his knee. And it's
seven years later and his knee still isn't working right.
But he've been going from one doctor to another who
all say, well, you know, you've got some problem there,
but it's not that bad. And he would say, no,
(45:20):
there's got to be a solution to this, you know.
And he was like a zero. He was just not hypnotizable.
And I said, you know, I don't know how much
I can help you, but I'm wondering if maybe your
doctor's are right, and it's your irritation at whatever limitation
you have that is really what's causing you more pain
than the actual pain itself. And he said, you know, Doc,
(45:43):
you're the first doctor who's ever told me that. And
I think you're right. See, I said, I think you're
just so irritated by it that even the slightest hint
and you go off the rails. And so I had,
you know, two people with opposite extreme. I was a
hypnotizability who be helped, but in rather different ways.
Speaker 1 (46:03):
In general, if you're looking at this spectrum across the population,
from the zero to ten, the not so hypnotizable to
very hypnotizable, what are the pros and cons. Let's say
we're looking at the up end of the scale. If
you're a highly hypnotizable person just walking around in daily life,
what are the pros and cons of that?
Speaker 2 (46:21):
Y you know, imaginative involvement. You can easily get into things,
and you can tune into people, and you can, you know,
see things from their point of view. They're often very intuitive,
they relate well to people, but sometimes they get kind
of taken in by it. You know, they can it's
they're so cognitively flexible that they can be talked out
(46:42):
of a position that they know is pretty good and
reasonable and affiliate with something that in the long run
may not be the right thing to affiliate with. They
tend to enjoy these sort of emotional experiences. They get
into movies in theater and things like that. The low
hypnotizables are more large, logical and rational and want to
(47:02):
think things through before they accept much of anything. And
the world needs people like that too. You know, they
don't they don't just give themselves to it, but they
can acquire it if they do it on their terms.
So it's a matter of, you know, sort of more
of the poet or more the researcher kind of approach,
but both people can do well. I had I'll tell
you I just I had a lawyer who had tenadis
(47:24):
for like five years. Was driving her nuts and she
told me, I said, what do you do that you enjoy?
I she's a scuba diver, and I said, okay, here's
what we're going to do. And I got her hypnotized,
and I said, I want you to imagine that the
tenadus is the sound of your the bubbles and your regulator,
and just picture how you feel. Because she loved diving
(47:46):
and she would go to the greatest places and just
enter that other world. And I want you to experience
it as the bubbles in your regulator. And she thanked me.
She said, this is the first time I felt comfortable
in five years.
Speaker 1 (48:00):
The thing that gets people about tenetus is they pay
attention to it and they try to make it they're
fighting against it instead of thinking it's a very pleasant
sort of thing.
Speaker 2 (48:08):
That's exactly.
Speaker 1 (48:10):
Yeah. So what advice would you give to listeners here?
Speaker 2 (48:15):
Well, you know, I've David found, you know, over fifty
years of doing work with using hypnosis and using it
with about seven thousand people, that it helps a lot
of people and it doesn't hurt anybody, and that's not
true of most of the things we do in medicine,
and so but I realized, I'm glad about that, but
(48:37):
so many more people could get help from this, you know,
and because they don't know about it, or what they
know is wrong, because of their prejudice against it, because
people think it's weird, or it's not possible that you know,
people could just do it with their head, or if
they do it was it wasn't real in the first place.
All of these misconceptions, a lot of people are missing
an opportunity to help themselves feel better and do better.
(48:59):
And so I thought, my legacy gift is going to
be making it available to anybody who wants it. So
about five years ago I was talking at a brain
Mind summit at Stanford, and Aeriel Pohlar, who's a helped
found Stravo, which is a really good, you know, cycling app,
came up to me in Stanford Business School mit and
(49:21):
he said, David, would you you want to try an app?
See if I could put it, put it on an
app and see what Amazon it is at a time
when Amazon was pushing Alexa and they were making it
easy to program your own app. So we did, and
I said, well, let's help people stop smoking. So the
approach there was focus on what you're for. So think
(49:43):
of this for my body smokings of poison. I need
my body to live. I owe my body respected protection.
You would never put hot air laced with tory nicotine
into your dog's lungs or your baby's lungs. Your body's
as innocent as they are, so protect and respect your body.
And so we had people do that, and one out
(50:07):
of four stopped after a single use of the of
the app, and the rest cut down their average cigarette
and consumption by about fifty percent. I had one social
worker who said I didn't even want to stop smoking.
I smoked for twenty five years. I signed up for
your study. I didn't like it the first time. The
second time, I looked at the cigarette and said, who
(50:29):
needs this? And I put it out and I haven't
had a cigarette since. My friends can't believe it. I
can't believe it. She said, this is some kind of
crazy as voodoo shit, and I mean that in a
good way. Said, so we figured it's working. So Ariel
and I formed a company where every stand or professor
like you has to have a startup. We do, and
(50:53):
we've had one point two million downloads. Now we have
a terrific team. We're using AI to manage my responses
that you can actually have an interaction with me as
if you were in my office. And you know, I
used to think, is it as good as being in
my office? While the smoking results were just the same.
And I want to leave this world with an opportunity
(51:17):
to manage these very common, very serious problems like pain
and anxiety and insomnia and bad habits in a way
that often helps and never hurts.
Speaker 1 (51:33):
That was doctor David Spiegel for me. A few things
really stand out from the conversation. First, I have to
confess that I was surprised when I first learned about
a decade ago that one of my departmental colleagues studies hypnosis,
because my assumption had been that that was some sort
of party trick. But after talking with David Spiegel, one
learns that what he refers to as hypnosis is built
(51:54):
from the systems our brains use every day, attention, expectation, imagination.
What changes in hypnosis is how tightly those systems are linked,
which allows people, and some people more than others, to
really dissociate and ski down different parts of the mountain. Second,
on a brain level, we heard that hypnosis involves measurable
(52:16):
changes in specific networks, for example, regions that handle focus
and executive control, regions that monitor self reflection and mind wandering,
and areas that integrate body sensations and emotion. When these
networks reconfigure, people can experience what seem to be clinically
meaningful reductions in pain and anxiety and trauma. This is
(52:40):
observable in brain imaging and in clinical outcomes. I'm linking
several papers to the show notes. The third thing I
want to point out is that hypnotizability is a trait
with a whole spectrum of individual differences, influenced by how
your brain organizes attention and control. Some people are naturally
very wonts of others are less so, and everywhere along
(53:02):
the spectrum. I'm very interested to see how our science
develops an understanding of this, Like, are some people just
better at popping out of their default mode network? And
here's my silly hypothesis, are these the people who get
more deeply pulled into works of literature? Who knows if
that's right, But it'll be great to see how this
(53:23):
science evolves. We're just at the beginning of understanding how
all these networks work together. But as you heard from
David Spiegel today, hypnosis can be used as a serious
tool in medicine and mental health to help some people
manage pain, to reduce anxiety and distress, and to work
with aspects of trauma and habit breaking. Is it a
(53:44):
cure all No, It has its limits and is probably
best positioned side by side with other evidence based approaches.
But for me, the awe inspiring part is that hypnosis
gives us a small experimental window into how the brain
constructs reality. If your arm hurts, it seems like that
should just be a raw signal, but it's not. It's
(54:05):
a signal that gets interpreted through attention, through beliefs, through context.
If you change those ingredients in the right way, the
experience can change again. I'm linking papers that demonstrate this.
This doesn't mean that we can think away every symptom
or circumstance, but it does tell us that our experience
(54:26):
is slightly more adjustable than it may first appear. The
boundary between expectation and sensation just might be more flexible
than most of us were taught. If this episode was useful,
consider sharing it with someone who's dealing with pain or anxiety,
or who's simply curious about how much influence our thoughts
can have on our experience. Go to eagleman dot com
(54:53):
slash podcast for more information and to find further reading.
Join the weekly discussions on my substack and check out
some Pbscribe to Inner Cosmos on YouTube for videos of
each episode and to leave comments until next time. I'm
David Eagleman, and this is Inner Cosmos.
What exactly is hypnosis? We've all heard about the circusy
versions of it, but is there something about hypnosis that
is real and that can be studied and leveraged by
psychiatrists and neuroscientists. Can attention and expectation change what we
feel like pain or anxiety? And how does that work?
(00:25):
What do suggestible states reveal about the brain's typical pathways
and what happens when we're knocked off of those, and
how does hypnosis compare to meditation or flow states or
psychedelic drugs. Today, join me as we talk with doctor
David Spiegel, Stanford psychiatrist and one of the world's experts
(00:46):
in hypnosis. Welcome to Innercosmos with me, David Eagleman. I'm
a neuroscientist and author at Stanford, and in these episodes
we sail deeply into our three pound universe to understand
how how we see the world, the outside world and
also the inside world. Okay, so first I'm going to
(01:20):
point out one of my central sources of amazement that
surfaces and all these episodes, the fact that inside each
of us there's an entire universe of eighty six billion neurons,
never seeing the light of day, pulsing in the dark,
and these are somehow weaving together your world, and in
ways we don't yet fully understand, we get all this
(01:41):
private subjective experience out of this, like color which doesn't
actually exist in the outside world, or pain, which is
just signaling along nerves, just like all the rest of
the signaling running around in your nerves, but somehow you
have the impression that it hurts. And somehow all the
act activities zooming around on all these little cables equals
(02:03):
your mind. Your thoughts are nothing but this electrochemical activity.
And we know this because if you ingest particular molecules,
that changes your thoughts, like if you consume alcohol or drugs,
or if you bunk your head on the cabinet, you
might lose consciousness and not have any thoughts for some minutes.
And when someone gets a neurodegenerative disorder, many of their
(02:25):
neurons die and that changes their thoughts. Same with tumors
or strokes or dozens of other things that we see
in the clinics every day. And that's how we know that.
Speaker 2 (02:35):
You are your biology.
Speaker 1 (02:40):
But the question is our thoughts the end consequence of
the activity, or do they somehow feedback in such a
way that they influence the activity. Now this is an
open question in neuroscience, but we do know that somehow
a change in expectation can reshape what we feel in
our own bodies, are pain or anxieties, our sense of self.
(03:03):
We get glimpses of this with let's say placebos. These
are things that should have no medical effect, but they
often have clinically significant effects on people. And what's weird
is that sometimes these work even when people know they
are placebos. And then you've got practices like meditation that
can alter attention and emotion and make subtle changes to
(03:24):
the structure of the brain over time. But there's one
laboratory of the mind where these questions become especially vivid,
where you can watch how a change and attention changes
the brain, and that laboratory is hypnosis. Now, let me
be crystal clear about something. I'm not talking about hypnosis
of the stage show stereotype. I'm not talking about mind
(03:45):
control or swinging watches. Instead. To psychiatrists, they're talking about
something when they use the term hypnosis, but it looks
more like a rearrangement of attention. The world narrows inner
experience becomes more vivid. External suggestions begin to feel more
like internal ideas, and a person can dissociate slightly from
(04:07):
their normal neural pathways. Think about it like this. If
you look at any ski mountain, there are only a
few runs going down the mountain, But in theory you
could ski down the mountain in lots of ways. You
don't have to stay right on those established runs. And
in our own brains we get these runs established in them,
(04:28):
and the question is how do we ever get off
our own beaten path? So my guest today has spent
his career at this frontier. David Spiegel is a psychiatrist,
a leading researcher on hypnosis in the brain at Stanford,
and a clinician who has leveraged these methods to help
lots of people manage pain, anxiety, trauma, illness, and the
(04:50):
breaking of habits. Through his work, we get a window
into how flexible our perceptions and physiology can be. So
let's step with David Spiegel in to the inner cosmos. So, David,
often when people think about hypnosis, they think about, you know,
(05:10):
a state fair, magic show or something like that, And
that's not what you do. Tell us how you define
hypnosis scientifically.
Speaker 2 (05:19):
David, hypnosis is a state of highly focused attention. It's
like getting so caught up in a good movie that
you forget you're watching the movie. You enter the imagined world.
And to achieve that state of focus, you have to
do to other things. You have to dissociate, put outside
of conscious awareness, things that would ordinarily be in consciousness.
We're not aware of how much information our brains, as
(05:42):
you know better than anyone, is processing at any one time.
Right now. To listen to me, for example, you have
to ignore sensations in your body touching these very nice
chairs here. Hopefully you weren't aware of that until I
mentioned it. If you were, we could stop. Now you're
already born. So absorption, highly focused attention, dissociation, and the
(06:03):
other used to be called suggestibility. It's what scares people
about hypnosis. You know, the you know, the football coach
being made to dance like a ballerina in front of
an audience and all that. I don't like making fun
of people anyway, but it's different. It's cognitive flexibility. It
allows you to let go of presumptions of who you are,
what you are, what you can do. So the football
(06:26):
coach is not thinking of what he's going to get
in the locker room when he goes back after the performance,
but it allows him to do something different, to try
out being different. And as a psychiatrist and psychotherapist, I
love seeing people who are willing to try out being
different and who are surprised by themselves say my god,
I didn't think I could do that, and I did.
That's a great template for change.
Speaker 1 (06:48):
What is the difference between a hypnotic state and let's
say meditation, a flow state, or an dissociative state.
Speaker 2 (06:57):
Well, it is a kind of dissociative state. To focus
so intently, you have to put outside of conscious awareness
things that might ordinarily be in consciousness. And people who
have a dissociative disorder are usually highly hypnotizable, so they
go intensely. People with associative identity disorder, when they're being
one of their altars, they're not being all the other
(07:19):
parts of themselves, and it's a kind of firm boundary
between these different parts of themselves. Now, that's a mental
disorder usually associated with trauma. But hypnosis is a much
milder state of focused attention that is enabled by dissociation.
Speaker 1 (07:35):
Okay, and how about a flow state or a meditative state.
Speaker 2 (07:39):
So the flow state is kind of like the highly
focused attention.
Speaker 1 (07:44):
And by the way, give an example of a flow.
Speaker 2 (07:46):
Slow state is just getting so lost in an activity.
For example, that you're painting something. Let's say that you
realize you've missed an appointment with a friend, or you're
two hours late for dinner or something. You're just so
engaged in it. You check sent me Hi who wrote
the book Flow, and he used to call it an
autotellic state. It's one that is so enjoyable that you
(08:07):
would do it just to do it, regardless of what
the outcome of it is. And that's part of flow.
You're not doing it for a purpose. You're doing it
just to do it, to be in that state, to
be fully engaged.
Speaker 1 (08:17):
What does autot mean.
Speaker 2 (08:19):
Autotelic just means self rewardings. It's rewarding just for doing it,
not because it's going to get you somewhere into something.
Actors are like that, you know. The method in acting
is just you know, be that person. And when a
good actor does that and you say, hey, you were terrific,
that was a great performance, they say, what performance I
was just being that guy. You know, that's who I was.
(08:41):
So hypnosis is very similar to flow states in that
sense of being totally into it, being fully absorbed in it.
Now meditation there are similarities, but there are differences. Meditation
is more about being and hypnosis is more about doing so.
In meditation, there are three major components to meditation. There's
(09:03):
open presence, where you just let feelings and thoughts flow
through you. You don't try to judge them or use them.
You don't try to use it to solve a problem.
It's just it's to become a way of being where
you are more open to just whatever things are, let
them be. You do a body scan, which is a
little bit like hypnosis. You can become more connected with
(09:23):
things going on in your body or better control things
going on in your body, like pain, like the symptoms
of anxiety, for example. The third thing is compassion and
meditation where you try to have compassion for other people
compassion for yourself. And that's a good thing too, and
you can use hypnosis to enhance compassion. I can give
you some examples of that, but you don't use it
(09:45):
to solve a problem. I had a woman who was
a ten year meditator twice a day for ten years,
thirty minutes a day each time. And she said, but
I still have migrain headaches and they're driving me crazy
and I can't get rid of them. Would you help me?
So I hypnosis whether to imagine that she had a
cap full of ice on her head, and because people
(10:06):
with migraines often have vasodilitation in the scalp and they
feel hot and uncomfortable, and she imagined having this cap
of ice in her head. And she called me a
week later, as she said, doctor Spiegel, my migraines are gone.
Thank you, and thank you for freeing me to use
my intentionality. Wow, because you're not supposed to be intentional
(10:28):
in meditation, and you are intentional in hypnosis.
Speaker 1 (10:31):
Oh, I see, I see. So vasodilation is where the
blood vessels are expand instead are contracted. But she was
able to use her intention to take control of the
diameter of her blood vessels as well.
Speaker 2 (10:43):
I can't measure it, but I think it's probably the case.
There are situations where people you can see them if
they're concentrating on their hands being warm, you can see
them sort of flush on their hands. There was one
amazing study done a mass general years ago. They had
people in hypnosis. They instructed them. They had a bunch
(11:03):
of people who had body warts and they're unpleasant, but
there was word that you could use hypnosis to eliminate warts,
and they actually got people to eliminate warts on one
side of their body. Think about that. That's mind bending.
So but if you're thinking about the brain controlling the
nervous system, the nervous system is divided into branches, and
it occupies different parts of the body, and you can
(11:26):
imagine changes that may sometimes happen in the body.
Speaker 1 (11:30):
What would curing warts look like? How does one intentionally
make that happen.
Speaker 2 (11:37):
You instruct them to imagine that the warts are just
drying up and falling off, that they just disappear, and
for some people that actually happens.
Speaker 1 (11:48):
How is hypnosis used in your practice, for example, for pain,
for anxiety, for trauma, for dealing with habits that people
want to break. Give us a sense of.
Speaker 2 (11:59):
How sure I'll be glad to do that. The way
we use it is to first first I test people's hypnotizability,
because people differ in their ability to experience hypnosis, and
that helps me structure the way I approach it with them.
If you're highly hypnotizable, which about twenty five percent of
the population is, you just tell them to do it
(12:20):
and they do it like the ward thing you can.
And I'll tell you what the approach is with each
of these kinds of problems. Mid range you kind of
negotiate with them more and they try it and they
reflect on it. And with low hypnotizables, it's more of
a cognitive activity where you think about approaching the problem
in a different way. So don't fight the pain, but
learn to filter the hurt out of the pain, don't
(12:40):
let it get you angry, figure that you can find
a way to master it. So for you know, we
start from the body up with hypnosis, and this is
different from cognitive behavioral therapy, for example, where you kind
of think your way through the steps to the problem.
With hypnosis, if somebody is stressed, what I do is say,
(13:01):
there's one part of this stressor that's bothering you that
you can do something about right away before you figure
out actually how to get rid of the stressor or
deal with the stressor. And that is the effect of
the stress on your body. So when you feel stressed.
What happens you know what happens to you, David when
you get stressed physically?
Speaker 1 (13:20):
Yeah, I think my muscles start to hurt.
Speaker 2 (13:22):
Your muscles hurt, they get tense, you start to sweat,
you fidget. But there's a kind of snowball effect where
you start to feel that and you think, oh my god,
this must be really bad because my body's reacting, and
so you get more anxious, and then your body reacts
and on it goes. So with hypnosis, you start with
the excellent control you have over your body, and hypnosis
(13:42):
better than normally. And so I say, look up close
your eyes, take a deep breath, and imagine that you're
floating in a bath of lake, a hot tub, or
floating in space. And I teach them a breathing exercise
where you inhale through your nose, starting with your abdomen,
and then slowly exhale through your mouth. And if you
(14:03):
try that, you'll notice that very quickly your body. Do
you try it? Try it? Just inhale through your nose,
hold and then slowly exhale through your mouth. How's your
body feel?
Speaker 1 (14:17):
Good?
Speaker 2 (14:18):
Good? Good? It's a little different.
Speaker 1 (14:19):
I don't think I was stressed before. But I'll try
that when I'm okay. But you're saying that I one
should be able to feel that difference. Right after how
many breaths.
Speaker 2 (14:30):
Like three breaths, wow, is you start to feel it.
And so then you you with your eyes closed, you
imagine you're floating in a bath of lake, hot tubber,
floating in space, and typically people feel less physiologically aroused.
And then you say, okay, so you've already done one
thing about the stressor, which is the effects that's not
(14:51):
on your body. Now, picture in your mind's eye, an
imaginary screen could be a movie screen, a TV screen,
or a piece of clear blue sky. And and then
divide the screen in half, and on the left side,
picture that stressor one thing that's stressing you. But with
the rule that you keep your body floating while you
do it, so you're beginning to separate this feedback between
(15:13):
the mind and the body about stress. And then once
you've been able to do that, I say, now picture
on the right side of the screen. Make that your
brainstorming screen. One thing you could do to deal with
the stressor It may not be the best thing or
the only thing, but something you could do about it,
and so typically people will picture something. You know, I'll
explain to my boss why I was late, or I'll
(15:34):
make sure the kids wear their seat belts when they
get in the car, whatever it is. And then say,
notice how you've been able to think more clearly about
how to deal with the stressor once you're able to
separate the stress from your physiological reaction. And we found, David,
in studies of tens of thousands, like sixty eight thousand
of our Reverie users our self hypnosis app that within
(15:58):
ten minutes they get a fifty eighty percent reduction in
their stress levels pre to post. And that's not bad
for a treatment that has no side effects, hasn't killed
anybody yet, and is fast faster than going to a
pharmacy and getting a drug, so they immediately get an
(16:18):
immediate reaction. So I help people deal with stress in
that way from the body up rather than from the
head down.
Speaker 1 (16:24):
That's amazing. So if we're talking pain, anxiety, trauma, things
like this, does this apply to all of the equally or.
Speaker 2 (16:31):
Different approvals with different approaches. So for pain, common and
terrible problem that is very terribly treated in this country.
You know, last year one hundred and eighteen thousand Americans
died of opioid overdoses in the United States. You know,
opioids kill people, and so I built Revery, our hypnosis
(16:51):
app in part to stop that, to get into people's
hands and minds and intervention that they can use to
really help themselves. And there's tons of evidence We've done
randomized control trials showing that hypnosis can control pain. And
the fact that you can reduce your pain with hypnosis
doesn't mean the pain is all in your head. It
means that the strain in pain lies mainly in the
(17:13):
brain that does signal. An input signal is painful or not,
depending on how your brain promulgates it and classifies it.
And you can teach your brain to treat pain differently.
My lovely wife Helen, had both of our children with
self hypnosis as the soul anesthetic in childbirth and Dan
the first one was ten pounds, so it was serious,
(17:34):
you know, And this shit. At one point in the
middle of my having rhibnitize, I had her floating in
Lake Tahoe. She said, David, you know I teach pharmacologey
at Stanford. Are there are drugs for this? And I
said keep floating, cool, tailing, and and Dan was born fine,
and I had no pain at all, you know it
(17:55):
was so hypnosis really is a terrific treatment for pain.
And we have on our app four different approaches to it.
So one is just sensory alteration, filter the herd out
of the pain. Imagine whatever makes your body feel better.
And if you think about this, if you get pain
(18:17):
relief for whatever your problem is with an ice pack
or floating in a warm bath, that means that when
you are in one of those states, your brain is
in a certain state that interprets what's going on as
a comforting sensation overriding the pain. And there are pet
studies done at Maygill by per Rainville showing that if
(18:38):
you tell people to have the sensory alteration filter the
head out of the pain, you get reduced activity in
some metasensory cortex just where you would hope it would happen.
Speaker 1 (18:48):
This is what is measuring the activity from your.
Speaker 2 (18:52):
Body from your body in specific regions of the brain,
and as you feel the analgesia, you feel a reduction
in the in the cemetasensory cortex. I did an experiment
with a bunch of Stanford undergrads highly hypnotizable. We screened
them for that and I had we gave them shocks
to the forearm and they would report the pain, and
(19:13):
then I hypnotized them and said, you're a forearm is
an ice water cool tingling. They got the same shocks.
We were recording some metasensory event related potentials, and the
P one hundred disappeared the first tenth of a second.
The brain stopped the initial processing of the pain signal,
and the P two hundred and P three hundred, these.
Speaker 1 (19:32):
Are EEG signals.
Speaker 2 (19:34):
Collected EEG signals in response to a series of shocks
were half as big. So just telling them to do
that changed the way their brain transmitted the pain signal.
Speaker 1 (19:44):
And I assume this wasn't just repetition suppression.
Speaker 2 (19:47):
No.
Speaker 3 (19:48):
No, We had a control group that wasn't hypnotized. Yeah,
and then they would get the same well they did
that group. They were their own control because when they
were not hypnotized and just feeling it, they got the
full sensation for the same period of time. They didn't
habituate to it a hypnosis, They just persistently and immediately
(20:10):
reduced the amplitude of the evoked response by overall fifty
percent starting with a tenth of the second. It wasn't
like it was rattling around the brain for a while.
It changed the settings for how you process those signals.
My colleague pr Rainville, when he studied activity in the
brain after a similar analgesic instruction, if instead of saying
filter the head out of the pain, your hands cold
(20:31):
and numb, he said it's there, but it won't bother you,
which is the way people on opioids sometimes respond, well,
I know there's a sensation there. And then he got
the same level of analgesia, but now the reduction was
in the dorsal anterior cingulate cortex, part of the salience
network that tells you whether something is a threat or not.
(20:51):
So you can change just the words you use in
hypnosis will change the part of the brain that reacts
to the analgesic construction.
Speaker 1 (21:00):
Using people who are highly hypnotizable, this actually sounds like
a great advantage for them, and let's say the case
of pain. What about people who are not so hypnotizable.
Does that mean they can't help themselves there?
Speaker 2 (21:13):
What we find is that the results are less dramatic,
but they get results, okay, in part because we're teaching
them a cognitive strategy. We're saying, look, you know, I'll
give you an example. I had a very lovely woman
came to me the other day who has chronic pain
and who said that it really inhibits what she can do.
(21:38):
She also had kind of a tick from an old
neck injury that she'd had, and it was getting worse
and worse, and she got more and more angry about it,
and it was inhibiting her life and what she could do.
And she turned out to be three out of ten
instead of seven out of ten, less hypnotizable on our measure,
(21:59):
the hypnotic conduction profile. And I said, you know, pain
and this tick that you have are like the noisy
kid in the classroom. You know, you pay more attention
to it than it deserves. You have other sensations, other
things you could think about, but you open into that.
She said, well, I'm a teacher. I was a teacher.
I taught for twenty seven years. I loved teaching best
part of my life. And I said, well, what did
(22:20):
you do with a noisy kid, a kid who was disruptive?
She said, well, I was pretty good with them. Actually
she was rather strict, you know, but she said I
would take their hand at a time when teachers finally
were allowed to touch a student, and I would hold
their hand, and I say, I know you're upset, and
I know this was bothering you, but there are better
ways to handle it, and I'm going to show you how.
(22:42):
And so, in a very kind, accepting, loving way, she
was saying, what you've been doing is no good, but
I will show you how to do it better. That's
a cognitive approach that keeps you from making things worse
by exacerbating the irritation you have. And I said so,
and she said, I was so good at it that
I got all the troublesome students in the school, you know,
(23:04):
and send them to me. But I love doing it.
And I said, so you know how to do it,
but why don't you use that same approach with your
own body? Because you get more and more frustrated the
more you have these ticks in this pain. And if
you can just treat your body the way you would
treat one of those students, I'll bet you feel better.
And she did. She found that the ticks were not
(23:25):
getting worse because they would, you know, the more it
would happen, the more she would shake because she was
so angry and frustrated that it was still happening, and
the more discomfort she had. So part of it is
using hypnosis to literally alter perception, and part of it
is taking an approach that involves focusing on what you're for, now,
what you're against, and then what you've written. I'm sure
(23:47):
you're familiar with this, that you exacerbate the problem by
fighting against it. We people and hypnosis say, the worst
thing you can tell somebody is don't think about purple elephants, right,
you know, And that's what you do. So you focus
on what you're for and you can modulate it, even
if you don't get as big a sensory alteration as
as you might otherwise have done.
Speaker 1 (24:08):
In this example, what is the thing that you are
focused for? It's you can't say I want to be
free of pain, because interesting of the pain, what's there?
Speaker 2 (24:17):
You're you're focusing on filtering the herd out of the pain,
soothing it. I say, imagine, treat your treat your body
as if it were your baby, your child, you know,
if your child were hurting if you were hurt, would
you get angry at him for crying and fussing? No,
they say, I'd I'd pick them up, I'd hug them,
I soothe them. So you know what, your body is
(24:37):
as innocent as your baby. You know it has to
deal with whatever happens to it. So focus on respecting
and protecting your body the way you would your child.
And that's the that's what you're for, is this respect
and protection of your body and not making it worse
by getting angry and frustrated.
Speaker 1 (24:55):
How about anxiety? How is this using it?
Speaker 2 (24:58):
Well? Anxiety disorders. Again, it's this sort of feedback between
between brain and body. And I have people, first of all,
deal with just the way what do you perceive in
your body when you're getting anxious and so imagine, you know,
feel that tension, but imagine that you can do something
(25:19):
or imagine the thing you do to keep from being anxious,
and then think about how you could approach that problem differently.
So I had a woman who was a CEO of
a company here, tough lady, but she had a terrible
dog phobia. She get awfully anxious when she got anywhere
near a dog. And I said, well, imagine. Let's imagine
(25:41):
that this guy is bringing his dog into your office.
And she said, no, I just freeze and see what
the dog is going to do. And I said, well,
if one of your employees who was performing badly walked
into your office, would you just freeze and see what
he'd do? She said, hell, no, I'd tell him off,
you know, I'd fire him. I'd do whatever I had
to do. So I said, so, why don't you instead
(26:02):
of freezing immobilizing yourself, which only amplifies the reason you
would be afraid, picture how you will handle the dog.
What will you do and decide, first of all, is
it really a physical threat to you or not? And
if it is, protect yourself. If it isn't, then decide
whether you want to just usher the dog out of
the office or call someone to get rid of it,
or whatever it is, and do it that way.
Speaker 1 (26:41):
What is the difference between that and let's say cognitive
behavioral therapy.
Speaker 2 (26:45):
Well, with cognitive behavioral therapy, you kind of think it through.
There's less about this sort of direct psychophysiological control. So
you're trying to think about it in a way that
is logical and maybe is less likely eventually to trigger
your anxiety, but we sort of go for the money.
We go for handling the way the body is reacting
first and teaching her that once she had this realization that, yeah,
(27:09):
there are times when you want to be afraid of
an animal, including a dog, but is this one of
those times? And so you're acknowledging the cause your anxiety,
but you're controlling the way your body feels. So your
body is floating and comfortable. You can picture it without
having that automatic, you know, physiological protection. And the funny
thing is about people with anxiety and phobias in particular,
they often don't have an event. It's not that they
(27:32):
were bitten by a dog a long time ago. It's
just that they have developed this. And what happens with
phobias in particular is the more you avoid it, the
worse it gets. And if you think about it, you
know what you do if you avoid it is you
reaffirm psychologically that there must be a reason for being
so scared of this, and that's why you avoid it.
(27:53):
And the other thing is you deprive yourself of success stories,
so you don't get close enough to a dog to
have a good experience. You know, he just licked your
hand and it was very nice. You just have the
fact that you got more and more anxious and more
and more avoidant, and it replicates itself. So it's not
about thinking it through or understanding what happened to you
(28:13):
early in life that led to this. It's a matter
of trying to intervene with the psychophysiological reaction that tends
to reinforce the strength of the phobia anxiety.
Speaker 1 (28:24):
I want to take at tense for one second. I
was going to ask you about your origin story. So
your father did the exact same thing that you're doing.
Speaker 2 (28:30):
Yeah, well, both of my parents were a psychiatrists psychoanalysts,
so they told me I was free to be any
kind of psychiatrist. I wanted to be here. I am.
But so the dinner table conversations were pretty interesting, and
I got to watch him make movies of patients who
had you know, had a woman who had pseudo seizures,
hysterical pseudo seizures, and he would hypnotize her and take
(28:53):
her back to the last time she had a seizure
and she would have another seizure.
Speaker 3 (28:57):
You know.
Speaker 2 (28:57):
So either way, he taught control, and I do this too.
Is not by telling them, don't make it happen, because
that's you know, don't think about purple elephants, but rather
make it happen. That's a way to have control, you know.
So she would think back to the last time she'd
have a seizure, and gradually they became milder and milder,
(29:18):
and instead of feeling frightened and angry and frustrated and
humiliated when it happened, it was kind of like, oh,
good for me. You know, I made it happen. So
you teach them a method of control. That's the opposite
of fighting it. And I had a woman from who
I lived up in Napa and was part of one
of these big wine families. She was having hysterical seizures
(29:40):
and we don't use that term anymore than's pseudo seizures now,
But it got bad when her daughter had her first
baby and the daughter said, Mom, you can't hold the
baby because I don't want you to have a seizure
and drop the baby. And that did it for her.
So it turned out that her problem was that she
(30:03):
was caught between two generations of a family that were
fighting one another. So the father was the originator of
the winery. The sons were fighting him in court over
the ownership and control of the winery, and she kept
trying to get them together for Thanksgiving and Christmas, and
both of them, both sides would be yelling at her.
And I said, she would call her father every day
(30:24):
and get yelled at again. And I said, I'll tell
you what. I'm going to teach you how to control
these seizures. But you have to do something else, and
that is, if your father starts screaming at you on
the phone, hang up, and sooner or later he will
learn that if he wants to talk to his daughter,
he better not yell at her. And after a while,
you know, there were a bunch of times where she
(30:46):
had to hang up, he stopped yelling at her. And
I said, it's not your responsibility to make these guys
stop fighting with each other. You do what you want
to do. If they come to Thanksgiving dinner, good if
they don't, okay, and learn to control this. And she's
she was holding the baby. You know she was able
and she felt good about it. So you're changing the
affective tone of the experience with the stimulus that is
(31:09):
making her anxious, and in this case, changing her ability
to manage the interactions that we're leading to this distress and.
Speaker 1 (31:17):
Just going back to the origins for me, how old
is the h How old is this field of.
Speaker 2 (31:24):
It's the oldest Western conception of a psychotherapy. It's two
hundred and fifty years old. Wow. It started with Franz
Anton Mesmer. You know the term mesmerized. He mesmerized me.
He was a Viennese physician who noticed that some of
his patients would suddenly go into one of these altered states,
like a pseudo seizure. And he thought that it may
(31:45):
have to do with badly acting magnetic fields in their bodies.
And he thought if he put his magnetic field, which
he thought was better, next to theirs, theirs would get better.
I don't know why his wouldn't get worse, but and
he then started He had these packets, these buckets full
of iron filings that were weakly magnetized, and he would
put them near that, and some would fall into a
(32:06):
trance state of some kind, and often they would get better. Actually,
so there's something about just altering your mental state that
allows you to just experience difficult things in a different way.
And he became so popular in Vienna that he left
his wife and family there and moved to Paris, where
he became like the celebrity doctor. And if you think
(32:26):
about it, two hundred and fifty years ago, what was
the major treatment in medicine. You know what? It was?
Blood letting. Yeah, let the bad humors out of your body.
So unless you happen to have polypythemia vira or congestive
heart failure, you were going to do worse. Seeing a doctor,
Voltaire wrote to his brother, We did everything we could
to save father's life. We even sent the doctors away.
(32:49):
And his office was cheerful. It was brightly lit. There
were patients hanging around, just helping other patients, talking to
them about how well they were doing. Regular doctor's officers
were great. There wasn't there. There wasn't a painting on
the wall. They were cold and dark, and you got
bad news and you got blood taken out of your body.
That was it. It wasn't much fun. So he was
(33:09):
the The other doctors complained to King Louis about him,
and he he convened a panel to investigate Mesmer, and
it included our own Benjamin Franklin, who was having a
good time in Paris. Back then, it included the famous
chemist Lauasier, who developed the principles of oxygen chemistry. Shortly
(33:32):
before he died, developed the idea of the gross national product.
Brilliant guy. He was beheaded in the revolution. And another
person on the panel was the inventor of the guilloteae,
doctor Guillotine too, and he kind of created the mind
Bobby body problem. And they concluded that hypnosis was nothing
(33:59):
but heeded imagination. Now, you know what, that's not a
terrible definition of hypnosis. It's highly focused attention. It's a
change in brain state. But that was the end of
Mesmer's career basically. And the problem is that there's been
one rejection after another. You know, a Scottish surgeon named
Isdale was traveling around India using hypnosis as general anesthesia.
(34:21):
You know what was anesthesia before ether? It was, you know,
getting people drunk and holding them down. It was terrible,
but hypnosis was actually very effective. It was. And I
gave a lecture mass general to ether Dome on tolari
Ago where ether was introduced here and a surgeon strode
(34:42):
to the front of the amphithiter efforts to say, gentlemen,
this is no humbug to distinguish hypnosis from ether. You know,
hypnosis is no humbug. It works, and you know, would
we use it all the time now, But I've used
hypnosis in surgical procedures where you don't use general anesthesia,
and it's an extremely effective analgesic.
Speaker 1 (35:04):
Still incredible, but it depends on the suggestibility of the
pain part.
Speaker 2 (35:08):
But even in randomized trials that include people of different
levels of hypnotizability, we show a significant difference. We did
one where they were injecting through arterial cutdowns in catheters,
chemo ambolizing tumors in the liver, expanding the renal artery,
and in all comers, we found if you randomized to
(35:30):
the standard care condition with able to push a button
and get opioids into your bloodstream, pain level at the
end of an hour and a half doing this was
five out of ten, if you had a supportive nurse
comforting you, three out of ten, hypnosis one out of ten. Wow,
and the hypnosis and they were all and the hypnosis
(35:52):
group was using half the amount of opioids that the
standard care group was using. And the procedures got done
seventeen minutes.
Speaker 1 (36:14):
So what do you see as the thing that gets
in the way of hypnosis or why it gets rejected.
Speaker 2 (36:19):
I don't know. I mean, we published that study in
the Lancet, you know, not yet big randomized trial. If
what we had used was a drug, everybody, every hospital
in the country would be using it now. And I think,
I think there are a couple of things, David. You know,
we're both in the psychiatry department at Stanford. We know
that psychiatry. You know, we're like the Rodney Dangerfield of
(36:41):
medical things. You know, we don't get no respect. You know.
He once said, they asked me to leave a bar
so they could start happy hour, you know. And people
have this prejudice against what goes on in the brain,
and they think if you use your brain to solve problems,
the problem started in your brain. Well that's not true.
(37:01):
You know, you have people, we have people who've had
injuries to their knees, have knee replacements, and they do
better with hypnosis plus other kinds of analgesia than those
who just have the standard analgesia, and they're less likely
to get addicted to opioids. It's teaching this brain is
this incredible instrument, as you have depicted beautifully in your writings,
(37:22):
that we don't that doesn't get the respect it deserves.
And we think that the only real interventions in medicine
are ingestion, injection or infusion, and that is not true.
You know, we do remarkable things with our brains that
can make our lives better. And so it's it's a
kind of prejudice that we have to get over, and
I'm sorry to see it, but that's what we're still
(37:43):
stuck with.
Speaker 1 (37:44):
And have you you've done brain imaging in your Yeah.
Speaker 2 (37:48):
I've done functional magnetic residence imaging. We've taken highly hypnatizable people,
put them in the scanner and compared to low hypnotizables.
Put them in the scanner, give them a bunch of
tasks and so control tasks, and then we look at
what are the things that happen only in the highly
hypotizable people and only when they're in a hypnotic state,
and we find three things happen. One is reduced activity
(38:11):
in the dorsal anterior cingulate cortex. So that's part of
the salience networks, the brain's alarm system. It does pattern matching,
and you hear a loud noise and you get distracted.
That's your dorsal anterior singular thing. There's trouble here. You
better divert what you're doing and focus on that. So
it's a it's a safety system for the body. If
you turn down activity there, you're allowing yourself to focus
(38:34):
more intently on other things. And that's what happens in hypnosis.
We found in another study that highly hypnotizable people have
more GABA menu butteric acid, the inhibitory neurotransmitter in the
brain than low hypnotizable people. So it's like having your
own little pharmacy on standby because what bendza diezepines do.
(38:56):
They increase GABA in the brain and so they can
mobilize more gabba to inhibit anxiety, inhibit pain response than
people who are less hypnotizable. So that's one thing. The
second thing that happens is more functional connectivity. So the
first thing I said was activity, How active is the area?
The second is when one area is active, is a
(39:19):
related area active or not? And we find more functional
connectivity between the prefrontal cortex, particularly on the left and
the insula, which is you know this insula means island
in Latin. This island of tissue in the middle of
the frontal cortex that is a mind body pathway. So
it's a way in which the brain controls the body,
(39:41):
and it's also a place where you have greater inter reception.
You're better able to perceive what's going on in your
body so that it makes sense in hypnosis. You can
better feel what's going on in your body and better
control what's going on in your body. We had a
group of students years ago that we brought in first
thing in the morning, no breakfast, and had them eat
(40:01):
imaginary meals for an hour. They would take we'd take
a gastronomictory of the Bay area, and Ken Klein was
a gastorineurologist worked with me, had a nasogastric tube down
and he would measure a gastrior gacid secretion. And one
woman was so caught up in this imaginary food that
she said, after about half an hour, let's stop. I'm full,
(40:22):
you know, So it seemed real. Those subjects had an
eighty nine percent increase in gastric acid secretion. So we're
narrowly David. You wouldn't think you could do that, but
you can. You can change your stomach's preparation for a meal.
We then did the opposite. We had them imagine and
hypnosis that they were on a desert island doing anything
(40:43):
but eating or drinking. Thirty nine percent decrease in gastrior
acid secretion, and then we injected them with pentagastrin, which
triggers maximal prietal cell output of gastric acid. We still
in the hypnosis condition had a nineteen percent decrease. So
the brain is much better better at controlling what's going
on in the body than we give ourselves credit for.
(41:04):
The third thing that happens in the MRI scanner, you
see inverse functional connectivity between activity and the prefrontal cortex
and activity in the posterior singulate. Now that is, you know,
as part of what we call the default mode network.
It's what your brain does when you're not working or
doing anything particular, but thinking about who you are, what
(41:24):
you are, what people think of you, what your mother
wanted you to be, all kinds of things like that,
and it's the thing that kind of keeps you on course.
Sometimes you know who you are and what you are
and what you're supposed to do. But it also can
keep you in a kind of rigid state where you
don't want to change. I should be like this, I
shouldn't be like that, And yeah, you know, I sometimes
(41:45):
call it the my fault mode network, where you just
you know, think about what's wrong with you. And so
when you're active in hypnosis, you're inhibiting activity in the
posterious singulate. Now, interestingly, that's the same thing that happens
in studies of long term meditators that they have lower
natural activity in the posterior singular cortex. And it's also
(42:07):
the major finding with psychedelics.
Speaker 1 (42:09):
I was just going to ask about that. So your
interpretation of that is when the default mode network is
running strong, people are essentially running in the same loops.
Let's take the mountain analogy. You've got a certain number
of ski runs down the mountain, and everyone's just staying
in those ski runs.
Speaker 2 (42:25):
That's exactly right.
Speaker 1 (42:26):
But when you inhibit that, people think, oh, I can
actually ski down the mountain this other way that nobody's
taking with it.
Speaker 2 (42:33):
Well, just you know, for example, you know I've been there,
you know where you think, oh god, that's steep. I
am not the kind of skier can do that. You know.
But if you're loosening up your default mode network, and
if you're getting more engaged in what you're doing, you say,
you know what if I take it this way in
that way, If I don't make this the bad skiers
mistake of leaning backwards going down the hill, which gives
(42:55):
me less control over the skis. But you allow yourself
to lean forward, the edges work better and you actually
have more control over how you're turning and how you
can stop if you need to. So I, when I
do that, I have to suppress activity in my default
mode networks is saying, are you crazy? You can't do that?
And give it a try. So that's right. And so
I actually think that hypnosis is a kind of less toxic,
(43:20):
much more controllable psychedelic experience where you just allow yourself
to try out things that are different and see what
it feels like. But you can turn it on and
you can turn it off.
Speaker 1 (43:32):
Do you suppose if you look across the population, so
some people are more hypnotizable. I'm totally speculating here, but
do you suppose that those are the people that are
more attracted to literature? Because when I go into the bookstore,
I notice that some read fiction, some only go to
the nonfiction section, right, But for the people who are
going and they want to read a story and step
into the shoes of a protagonist and be someone else,
(43:54):
do you suppose it would be a correlation there?
Speaker 2 (43:55):
I think so, I think. I mean, I haven't seen
a study like that, but I think, you know, in
role we actually it's interesting. On the every app we
call people who test out to be highly hypnotizable, the
poets that you know, they just the imagined world and
the real world can become the real world for you,
and so it's easy to go into that. Whereas we
(44:15):
call the low hypnotizables the researchers you know that, and
low hypnotizalar people that just you know, have to analyze
everything and read about it, just just what you're saying now.
They may read books, so they may be part of
who's populating the bookstores, but it's different kinds of books.
And the mid range people we call diplomats who will
try and experience and then step back and think about
(44:37):
what it's like. I had one day in the office
when it was perfect, you know, the first person was
at ten on the hypnotic in very hypnotizable. She had
some really bad neck pain and it just went away.
You know. I just had her imagine you had this
hot pack on your neck filter their head out of
the pain. Thank you doctor. She's out the door. She
(44:58):
loved it. The second patient with somebody who had had
a knee injury seven years earlier. He was carrying a
very heavy crate with a guy who dropped it and he,
you know, did real damage to his knee. And it's
seven years later and his knee still isn't working right.
But he've been going from one doctor to another who
all say, well, you know, you've got some problem there,
but it's not that bad. And he would say, no,
(45:20):
there's got to be a solution to this, you know.
And he was like a zero. He was just not hypnotizable.
And I said, you know, I don't know how much
I can help you, but I'm wondering if maybe your
doctor's are right, and it's your irritation at whatever limitation
you have that is really what's causing you more pain
than the actual pain itself. And he said, you know, Doc,
(45:43):
you're the first doctor who's ever told me that. And
I think you're right. See, I said, I think you're
just so irritated by it that even the slightest hint
and you go off the rails. And so I had,
you know, two people with opposite extreme. I was a
hypnotizability who be helped, but in rather different ways.
Speaker 1 (46:03):
In general, if you're looking at this spectrum across the population,
from the zero to ten, the not so hypnotizable to
very hypnotizable, what are the pros and cons. Let's say
we're looking at the up end of the scale. If
you're a highly hypnotizable person just walking around in daily life,
what are the pros and cons of that?
Speaker 2 (46:21):
Y you know, imaginative involvement. You can easily get into things,
and you can tune into people, and you can, you know,
see things from their point of view. They're often very intuitive,
they relate well to people, but sometimes they get kind
of taken in by it. You know, they can it's
they're so cognitively flexible that they can be talked out
(46:42):
of a position that they know is pretty good and
reasonable and affiliate with something that in the long run
may not be the right thing to affiliate with. They
tend to enjoy these sort of emotional experiences. They get
into movies in theater and things like that. The low
hypnotizables are more large, logical and rational and want to
(47:02):
think things through before they accept much of anything. And
the world needs people like that too. You know, they
don't they don't just give themselves to it, but they
can acquire it if they do it on their terms.
So it's a matter of, you know, sort of more
of the poet or more the researcher kind of approach,
but both people can do well. I had I'll tell
you I just I had a lawyer who had tenadis
(47:24):
for like five years. Was driving her nuts and she
told me, I said, what do you do that you enjoy?
I she's a scuba diver, and I said, okay, here's
what we're going to do. And I got her hypnotized,
and I said, I want you to imagine that the
tenadus is the sound of your the bubbles and your regulator,
and just picture how you feel. Because she loved diving
(47:46):
and she would go to the greatest places and just
enter that other world. And I want you to experience
it as the bubbles in your regulator. And she thanked me.
She said, this is the first time I felt comfortable
in five years.
Speaker 1 (48:00):
The thing that gets people about tenetus is they pay
attention to it and they try to make it they're
fighting against it instead of thinking it's a very pleasant
sort of thing.
Speaker 2 (48:08):
That's exactly.
Speaker 1 (48:10):
Yeah. So what advice would you give to listeners here?
Speaker 2 (48:15):
Well, you know, I've David found, you know, over fifty
years of doing work with using hypnosis and using it
with about seven thousand people, that it helps a lot
of people and it doesn't hurt anybody, and that's not
true of most of the things we do in medicine,
and so but I realized, I'm glad about that, but
(48:37):
so many more people could get help from this, you know,
and because they don't know about it, or what they
know is wrong, because of their prejudice against it, because
people think it's weird, or it's not possible that you know,
people could just do it with their head, or if
they do it was it wasn't real in the first place.
All of these misconceptions, a lot of people are missing
an opportunity to help themselves feel better and do better.
(48:59):
And so I thought, my legacy gift is going to
be making it available to anybody who wants it. So
about five years ago I was talking at a brain
Mind summit at Stanford, and Aeriel Pohlar, who's a helped
found Stravo, which is a really good, you know, cycling app,
came up to me in Stanford Business School mit and
(49:21):
he said, David, would you you want to try an app?
See if I could put it, put it on an
app and see what Amazon it is at a time
when Amazon was pushing Alexa and they were making it
easy to program your own app. So we did, and
I said, well, let's help people stop smoking. So the
approach there was focus on what you're for. So think
(49:43):
of this for my body smokings of poison. I need
my body to live. I owe my body respected protection.
You would never put hot air laced with tory nicotine
into your dog's lungs or your baby's lungs. Your body's
as innocent as they are, so protect and respect your body.
And so we had people do that, and one out
(50:07):
of four stopped after a single use of the of
the app, and the rest cut down their average cigarette
and consumption by about fifty percent. I had one social
worker who said I didn't even want to stop smoking.
I smoked for twenty five years. I signed up for
your study. I didn't like it the first time. The
second time, I looked at the cigarette and said, who
(50:29):
needs this? And I put it out and I haven't
had a cigarette since. My friends can't believe it. I
can't believe it. She said, this is some kind of
crazy as voodoo shit, and I mean that in a
good way. Said, so we figured it's working. So Ariel
and I formed a company where every stand or professor
like you has to have a startup. We do, and
(50:53):
we've had one point two million downloads. Now we have
a terrific team. We're using AI to manage my responses
that you can actually have an interaction with me as
if you were in my office. And you know, I
used to think, is it as good as being in
my office? While the smoking results were just the same.
And I want to leave this world with an opportunity
(51:17):
to manage these very common, very serious problems like pain
and anxiety and insomnia and bad habits in a way
that often helps and never hurts.
Speaker 1 (51:33):
That was doctor David Spiegel for me. A few things
really stand out from the conversation. First, I have to
confess that I was surprised when I first learned about
a decade ago that one of my departmental colleagues studies hypnosis,
because my assumption had been that that was some sort
of party trick. But after talking with David Spiegel, one
learns that what he refers to as hypnosis is built
(51:54):
from the systems our brains use every day, attention, expectation, imagination.
What changes in hypnosis is how tightly those systems are linked,
which allows people, and some people more than others, to
really dissociate and ski down different parts of the mountain. Second,
on a brain level, we heard that hypnosis involves measurable
(52:16):
changes in specific networks, for example, regions that handle focus
and executive control, regions that monitor self reflection and mind wandering,
and areas that integrate body sensations and emotion. When these
networks reconfigure, people can experience what seem to be clinically
meaningful reductions in pain and anxiety and trauma. This is
(52:40):
observable in brain imaging and in clinical outcomes. I'm linking
several papers to the show notes. The third thing I
want to point out is that hypnotizability is a trait
with a whole spectrum of individual differences, influenced by how
your brain organizes attention and control. Some people are naturally
very wonts of others are less so, and everywhere along
(53:02):
the spectrum. I'm very interested to see how our science
develops an understanding of this, Like, are some people just
better at popping out of their default mode network? And
here's my silly hypothesis, are these the people who get
more deeply pulled into works of literature? Who knows if
that's right, But it'll be great to see how this
(53:23):
science evolves. We're just at the beginning of understanding how
all these networks work together. But as you heard from
David Spiegel today, hypnosis can be used as a serious
tool in medicine and mental health to help some people
manage pain, to reduce anxiety and distress, and to work
with aspects of trauma and habit breaking. Is it a
(53:44):
cure all No, It has its limits and is probably
best positioned side by side with other evidence based approaches.
But for me, the awe inspiring part is that hypnosis
gives us a small experimental window into how the brain
constructs reality. If your arm hurts, it seems like that
should just be a raw signal, but it's not. It's
(54:05):
a signal that gets interpreted through attention, through beliefs, through context.
If you change those ingredients in the right way, the
experience can change again. I'm linking papers that demonstrate this.
This doesn't mean that we can think away every symptom
or circumstance, but it does tell us that our experience
(54:26):
is slightly more adjustable than it may first appear. The
boundary between expectation and sensation just might be more flexible
than most of us were taught. If this episode was useful,
consider sharing it with someone who's dealing with pain or anxiety,
or who's simply curious about how much influence our thoughts
can have on our experience. Go to eagleman dot com
(54:53):
slash podcast for more information and to find further reading.
Join the weekly discussions on my substack and check out
some Pbscribe to Inner Cosmos on YouTube for videos of
each episode and to leave comments until next time. I'm
David Eagleman, and this is Inner Cosmos.
Host
David Eagleman
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