Dr. David Spiegel: Using Hypnosis to Enhance Health & Performance

- Welcome to the Huberman Lab Podcast,

[upbeat music] where we discuss science,

and science based tools for everyday life.

I'm Andrew Huberman,

and I'm a professor of neurobiology and ophthalmology,

at Stanford School of Medicine.

Today, my guest is Dr. David Spiegel.

Dr. Spiegel is the associate chair of psychiatry,

and behavioral neurosciences,

at Stanford University School of Medicine.

He is also the director,

of the Stanford Center on Stress and Health.

Dr. Spiegel is both a researcher and a clinician,

meaning he runs a laboratory that studies the brain,

and the body.

And neural mechanisms of how the brain and body interact.

And he sees patients as a psychiatrist at Stanford.

His work is incredibly unique,

in that it bridges mind and body,

but it also has a particular focus

on the clinical applications of hypnosis.

As you'll learn today,

hypnosis is a unique brain state,

in which neuroplasticity,

the brain's ability to change in response to experience,

may be heightened and indeed the use of clinical hypnosis,

by Dr. Spiegel and colleagues has been shown

to improve symptoms of stress,

chronic anxiety, chronic pain and various other illnesses,

including many psychiatric illnesses

and even outcomes in cancer.

Today, we discuss hypnosis in the context of what's called,

self-hypnosis to distinguish it from stage hypnosis.

Many of you are probably familiar with stage hypnosis,

which is really about a hypnotist getting a person

to do things they would not otherwise do,

in contrast, clinical hypnosis,

and the use of hypnosis for the treatment

of various ailments of mind and body is vastly different.

It involves getting people to change their brain state

and to use that brain state as a portal

to make adjustments in their brain and body,

and other aspects of their biology and psychology

that benefit them.

And it's been shown over and over again,

in studies by Dr. Spiegel and colleagues

that those changes can occur extremely quickly.

Now, not everybody can be hypnotized as readily as the next.

And so today we also discuss a simple test,

developed by Dr. Spiegel.

The it can help you determine,

whether or not you have a high, medium or low degree,

of what we call hypnotizability.

Dr. Spiegel is truly an expert in this area.

He has published over 480 journal articles,

170 book chapters on hypnosis,

and on things like psychosocial oncology,

which is the interaction of mind and body

in the treatment of cancer and cancer outcomes,

on stress physiology, trauma

and other aspects of psychotherapy.

He's published 13 books.

So, he's truly the world expert

in hypnosis and clinical applications of hypnosis

for mind and body.

I'm certain that in listening to today's episode,

you're going to learn a tremendous amount

about how the brain and body interact,

about various treatments

for all sorts of common ailments of mind and body.

And you are going to get access to tools,

in particular, a tool that was developed by Dr. Spiegel,

which is the Reveri app, R-E-V-E-R-I,

the Reveri app is currently only available for Apple,

but will soon also be available for Android.

It does carry a nominal cost,

but there is a seven day free trial.

If you'd like to try it,

we're providing a link in the show notes.

The Reveri app is special,

in that it is based on clinical studies

and research done in the Spiegel lab at Stanford.

So, unlike a lot of hypnosis apps out there

and resources for hypnosis,

it was developed with clinical treatments in mind.

Today, we also discuss the use of breathwork

and I'm very fortunate that my research lab at Stanford,

has been collaborating very closely with Dr. Spiegel

in testing and developing specific breathwork protocols

to adjust mind and body for things like anxiety,

improving mood and improving sleep.

Based on his incredible and unique expertise,

and the clarity with which,

Dr. Spiegel communicates information.

I anticipate that you will really enjoy today's episode

and that you'll come away from it,

with a lot of actionable tools.

Some of you might be curious,

what a clinical hypnosis session looks like.

And for that reason, we had Dr. Spiegel hypnotize me.

A clip of that hypnosis session,

is going to be posted to the Huberman Lab Clips channel,

which is available on YouTube.

Before we begin, I'd like to emphasize that this podcast

is separate from my teaching and research roles at Stanford.

It is however, part of my desire and effort

to bring zero cost to consumer information about science

and science related tools to the general public,

in keeping with that theme,

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And now, for my discussion with Dr. David Spiegel,

David, thank you so much for being here.

- Andrew, my pleasure.

- Can you tell us, what is hypnosis?

- Hypnosis is a state of highly focused attention.

It's something like looking

through the telephoto lens of a camera in consciousness,

what you see, you see with great detail,

but devoid of context.

If you've had the experience

of getting so caught up in a good movie,

that you forget you're watching a movie

and a enter the imaginary world.

You're part of the movie, not part of the audience,

you're experiencing it, you're not evaluating it.

That's a hypnotic like experience

that many people have in their everyday lives.

- So, is any experience that really draws us in,

hypnotic in that sense?

Or let me give a different example.

If I'm watching a sports game

and I'm really wrapped up in the game,

but I'm also in touch with how it makes me feel in my body

kind of registering the excitement or the anticipation.

Is that a state of hypnosis also,

because you mentioned there's kind of,

a narrowing of context. - Right.

- But a kind of losing of the self,

or is it, do I have that right?

- Yes, it is true that you're-

[indistinct] to the extent that you're somatic,

your body experience is a part of the sport event

that you're engaged with.

I'd say that is a self altering hypnotic experience.

If your physical reactions are distracting you

or make you think about something else,

that's when it's less hypnotic like,

and more, just one of a series of experiences.

- Okay.

So I have to ask,

how did you get into this business of hypnosis?

Because,

I think for most people,

when they hear hypnosis or they think about hypnosis,

they think of stage hypnosis. - Right.

- They think of somebody with a pendant going back and forth

or people up on a stage,

behaving abnormally for the entertainment of others.

- Yeah.

- How did you get into hypnosis

as an interest, as a practice?

And if you would,

could you contrast the sort of hypnosis that you do

in the clinical setting with a sort of hypnosis

that a stage hypnotist does?

- Sure.

Well, it is something of a genetic illness in my family.

Both of my parents were psychiatrists and psychoanalysts

and they told me I was free

to be any kind of psychiatrist I wanted to be.

So, here I am.

My father was training to be a psychoanalyst in 1943.

And,

he ran into a Vietnamese refugee,

who couldn't serve in the army,

but who had studied hypnosis.

And actually it would interest you,

doing your ophthalmological research.

He had a smallpox scar right in the middle of his forehead,

and he did forensic examinations.

And he noticed that some of the prisoners,

would focus on that spot on his forehead

and then close their eyes and seem to go to sleep.

But they were in some altered state.

So he got interested in hypnosis.

He used it forensically

and his name was Gustav von Aschaffenburg.

And he offered to teach young psychiatrists,

how to use hypnosis when they went off into the war.

And so he trained my father

and my got off the analytic couch and asked,

the analyst mentioned it to him.

That's how he found out about it.

And my father said, did I say something wrong in analysis?

Why is he talking to me [laughs] now?

And he found it very useful in helping soldiers

who had acute pain when they were wounded

and helping people with conversion

in post-traumatic stress disorders.

And when he came back, he went back to his training,

but he still was sort of interested in it.

And he had his, one of his supervisors

was Frieda Fromm-Reichmann,

who was a very famous psychoanalyst.

And he said that he had been told to stop doing hypnosis

because it would ruin his reputation as an analyst.

And she said to him,

what are you so worried of about your reputation for?

You're going to give a course at the institute in hypnosis,

and I know you're going to do it because I'm going to take it.

So he was teaching Frieda Fromm-Reichmann hypnosis,

and he just kept doing it.

And after a while,

he discovered that he was getting better results

with a few sessions of hypnosis

than he was with daily psychoanalysis with his patients.

And so he switched his practice.

And so the dinner table conversations,

were pretty interesting.

And occasionally when he was making a movie of a patient,

I would get to watch that.

And so, when I went to medical school,

I figured I'll take a course.

[mumbles] Tom Hackett,

who was a chair of psychiatry of mass general was teaching

and it was a very interesting course.

And the day that converted me was,

I was doing my rotation at Children's Hospital in Boston.

And the nurse is telling me,

Spiegel, your next patient is an asthmatic

in room 437 or something.

And I'm just following,

the sound of the wheezes down the hall.

I go in the room, there's a 16 year old girl,

knuckles white, bolt upright in bed, struggling for breath.

You can hear the wheezing.

She twice had subcutaneous epinephrine, didn't work.

They were thinking about general anesthesia

and starting her on steroids.

And her mother's there crying.

And I said, I don't know what else to do.

So I said, you want to learn a breathing exercise?

And she nods.

And I got her hypnotized.

And then I realized we hadn't gotten to asthma

in the course yet.

So, I made up something very complex.

I said, each breath you take will be a little deeper

and a little easier.

And within five minutes, she's lying back in bed.

Her knuckles aren't white, she's not wheezing.

Her mother stopped crying.

The nurse ran out of the room,

and the intern, my intern comes to find me

and I figured he is going to pat me on the back and say,

nice job, Spiegel.

He said, the nurse has filed a complaint

with a nursing supervisor

that you violated a Massachusetts law by hypnotizing,

a minor without parental consent.

And I thought, oh, that's nice.

I doubt there is a law like this.

So, the interns says,

you're going to have to stop doing this with her.

And I said, why?

He said, it's dangerous.

I said, you're going to give her general anesthesia

and put her on steroids,

and talking to her is dangerous?

He said, well, you'll have to do it.

And I said, I'll tell you what,

take me off the case if you want,

but I'm not going to tell a patient of mine,

anything I know is not true.

So, there was a battle over the weekend about what to do,

and the intern, the chief resident, the attending,

were all arguing about it.

And on Monday they came back with a radical idea.

They said, let's ask the patient.

I don't think this has ever been done

at children's [chuckles] hospital before.

And she said, oh, I like this.

She'd been hospitalized every month

for three months in status asthmaticus,

she did a one subsequent hospitalization but after that,

went on to study to be a respiratory therapist.

And I thought that anything,

that can help a patient that much,

violate a nonexistent Massachusetts law,

frustrate the nursing supervisor,

had to be worth looking into.

So, I just kept doing it.

I discovered that there were,

all of my classmates in medical school,

had just read the new issue of the New England Journal

and had some new medication to suggest.

And I would, you know,

surgeons would say, look,

if you can help this guy with his pain or his anxiety,

anything above the neck, that's yours, do it, Spiegel.

So, I was having fun and being able

to learn how to help people

in a way that just otherwise was not being done.

And so, it got me thinking about the fact that,

we're born with this brain

but we don't have a user's manual for it.

And we don't use it nearly as well as we can.

And that's something your research is all about too.

And so, I thought,

I want to understand this better.

And I want to see what we can do.

Stage hypnotists drive me nuts.

They make fools out of people.

There was one.

This is a case my father was involved.

He got a call from, he was at Columbia, he got a call,

Spiegel, you got to come see this woman, she's in the ER.

And she's in some kind of weird upset state that happened.

And it turned out she'd been on the show

with a stage hypnotist who,

and what they do by the way is,

they cycle around, you know,

The beginning of the show,

they don't just grab somebody and say, we're doing this.

They get a bunch of people up.

They do what [indistinct] testing,

to see if people-

and they get the ones who are the most hypnotizable.

So she was the one.

And he said, there's now a little bird in your hand,

and you're going to play with the bird.

And she starts to cry and scream.

And he just gets her off the stage,

'cause it's very upsetting.

And she's wandering around New York City

in the middle of the night dissociated

and brought to Columbia.

And that's where my father saw her.

She was still in a kind of uncomfortable trance like state.

And it turned out,

that she was the trophy wife of a very wealthy guy.

And she felt like a bird in a gilded cage.

And so to her,

that image just triggered all of this sense of,

dissatisfaction and discomfort, fear about her life.

And he was able to get her reoriented and talk with her

about what she was going to of her life.

But I don't like stage hypnosis.

You're making fools out of people

and you're using the fact,

and that's what scares people about hypnosis.

They think you're losing control.

You're gaining control.

Self-hypnosis is a way of enhancing your control,

over your mind and your body.

It can work very well,

but because it gives you a kind of cognitive flexibility,

you're able to shift sets very easily.

To give up judging and evaluating the way you usually do

and see something from a different point of view.

That's a great therapeutic opportunity,

but if misused, it could be a danger too,

and that's what scares people about it.

It is that very ability to suspend critical judgment

and just have an experience and see what happens.

That can be a great therapeutic opportunity,

but if somebody's misusing it,

it can be a way to harm people.

And there are plenty of examples of people,

having fantasies imposed on them,

that they come to think are realities.

It's not unusual these days.

So,

it's an ability that,

if people learn to recognize and understand it,

can be a tremendous therapeutic tool.

- I've been stage hypnotized

and I've been clinically hypnotized many times

through a self-hypnosis app.

We'll talk about later.

And then I know we have plans for you to hypnotize me today.

You've done it once before. - Mm-hm.

- [Andrew] And I'm very hypnotizable

as we both know. - Right.

- We'll talk about,

how one can gauge their hypnotizability.

- Sure. - But the stage hypnosis,

was interesting.

This was in college,

they brought someone out to the dormitory

and,

I recall being one of the people

that was selected. - Mm-hm.

- And engaging in very bizarre behavior, right?

It wasn't thoroughly embarrassing,

but it was pretty embarrassing.

And then being sent off the stage,

and as I was exiting,

suddenly screaming something out

because he had planted a suggestion of some sort.

- Ah, mm-hm. - And then I was told

to look in my pocket and there was,

like a, I think, a torn up dollar bill.

There were a bunch of things

that I have vague recollection of.

- Mm-hm. But it raises set of questions

that really boil down to,

as a biologist, I always think that,

there's no events in the brain, there are processes.

And so hypnosis, we know has an induction.

Then one is hypnotized, I imagine.

And then it sounds like this woman

and this example of the bird

and being distraught in New York City,

is a failure to exit the hypnotic state.

Do we know what sorts of brain areas are active

during the induction,

let's call it the deep hypnosis

and then what's shutting off

or changing as people exit hypnosis.

- Yes, we do, we've studied that.

We've been very interested in that.

And so, we did a study where we selected highly

and non-hypnotizable people

so we could do the comparison.

And then hypnotize them in the functional MRI scanner.

And we found three things characterized the entry

into the hypnotic state.

The first is turning down activity

in the dorsal anterior cingulate cortex.

So the DACC is in the central front-middle part of the brain

as you well know.

And it's part of what we call the salience network.

It's a conflict detector.

So if you're engaged in work and you hear a loud noise

that you think might be a gunshot,

that's your anterior cingulate cortex saying,

hey, wait a minute,

there's some potential danger over there.

You better pay attention to it.

So, it compares what you're doing

with what else is going on

and helps you decide what to do.

And as you can imagine,

turning down activity in that region,

make it less likely that you'll be distracted

and pulled out of whatever you're in.

And in another study,

we found that highly hypnotizable people,

even without being hypnotized,

have more functional connectivity between the DACC,

the anterior cingulate cortex

and the left dorsolateral prefrontal cortex.

So, which is part of a key region

in the executive control network.

So, when you're engaging in tasks,

you're enacting a plan,

you're writing a paper, you're doing whatever you're doing.

That's the prefrontal cortex who's doing that.

And so, if that is coordinated,

we found more functional connectivity.

So, when one is up, the other's up

and one is down, the other's down.

That coordination implies that the brain is saying,

okay, go ahead, I know what you're doing.

Carry out that plan.

And don't worry about other possibilities.

So, two other things happen when people are hypnotized.

One is that that DLPFC has higher functional connectivity

with the insula.

Another part of the salience network.

It's a part of the mind-body control system,

sensitive to what's happening in the body.

It's part of the pain network as well,

but it's also a region of the brain where,

you can control things in your body

that you wouldn't have think you could.

For example, we did a study years ago,

where we took people who were highly hypnotizable,

hypnotized them and told them,

we went on a imaginary culinary tour.

So, they would eat their favorite foods and we found that,

they increased their gastric acid secretion, like by 87%.

So, their stomach was acting as though it was about to get,

I mean, there was one woman,

it was so vivid for her that halfway through, she said,

let's stop, I'm full, [laughs] eating these imaginary-

- Having never eaten- - Having never eaten anything-

- Actual food? - No.

- Incredible. - And then we got them

to relax and think of anything but food or drink.

And we got like a 40% decrease in gastric acid secretions.

And that was DLPFC through the insula,

telling the stomach you're getting food

or you're not getting food.

And even, we injected them with Pentagastrin,

which triggers gastric acid release.

And even then in the hypnosis condition,

they had a 19% reduction in gastric acid.

So, the brain has this amazing ability

to control what's going on in the body

in ways that we don't think we have ability to control.

That's just one example.

So, that's the DLPFC insula connection.

The third thing that happens,

and this relates to what you did on the stage,

is you have inverse functional connectivity

between the DLPFC and the posterior cingulate cortex.

The posterior cingulate is part of the default mode network.

It's in the back of the brain.

And it's an area whose activity goes down for example,

in meditators.

And in meditation, you're supposed to be selfless.

You're supposed to, [indistinct] self is an illusion,

you're supposed to let it dissolve

and just experience things.

And when you're doing that,

the posterior cingulate is decreasing in activity,

the inverse connection is,

I'm doing something

but I'm not thinking about what it means for me.

I may not even remember much of it.

if I do, I don't care that much about it.

And so, that is part of the dissociation

that I occur with hypnosis.

So, it's how you put things outside of conscious awareness,

and don't worry about what it means.

It also adds to cognitive flexibility.

If you're thinking,

well, people like me don't usually do this.

That may inhibit you from,

enacting a new form of psychotherapy for example,

that you've never done before.

But if you're having this decreased activity

in the part of your brain that reflects on what it means,

you're more likely to be cognitively flexible

and willing to give it a try.

And that's one of the therapeutic advantages

of hypnosis as well.

- Fascinating, and it's really,

I'm going to embarrass you here a little bit.

[David laughing] In the positive sense,

your laboratory is really the one

that's pioneered brain imaging of hypnotic states.

And, it sounds like it,

that's my understanding, is that correct?

- Yeah, I mean, there are other people,

who've done excellent research too.

- Sure. Pierre Rainville in Montreal

and several other people,

but we're one of the leading labs

in neuroimaging of hypnosis.

- I have to ask about,

attention deficit hyperactivity disorder.

I get a lot of questions about this.

And I think a lot of people just struggle

with holding attention nowadays,

because of interference with phones and devices.

And of course, there is a lot of,

clinically legitimate ADHD out there,

but the way that you describe, - Sure.

- the dorsal anterior cingulate

and the salience network and this a conflict detector of,

am I focusing on something or am I splitting my attention?

How distractable am I?

Seems to relate to some extent to activity

in the anterior cingulate cortex.

Do people with ADHD,

display disruptions in elements of these networks

and has hypnosis ever been used to,

or self-hypnosis, I should be,

to distinguish from stage hypnosis,

clinical and self-hypnosis been used

to enhance people's ability to focus

and hold attention?

Because that's such a built in component

of the hypnotic state.

- It's a great question.

There's sort of two ways to think about it,

in terms of enhancing focus, yes.

It has been very helpful in teaching people

to just prepare your mind

to narrow in and focus on something.

And when you're really engaged in reading something,

or you're writing a pa-

I mean, I'll have that,

sometimes I'm thinking,

oh God, I have to do this for another hour.

Other times an hour will go by and I'll think,

hey, great, because when you're in that,

it feels game-like to you,

you're just assembling the parts of the puzzle

and putting 'em together.

It's fun, you just get absorbed,

that for me, that's a hypnotic like experience,

when I'm having trouble, when I'm struggling,

sometimes doing things like self-hypnosis can help.

I'm not an expert on ADHD.

My impression is that you're right,

that these are people who are constantly distracted

and rather rigid.

The other part of it is they're easily distractable.

They're very upset when they get distracted

and they're rather rigid in what they want to attend to

and what they can.

I think, as a way of controlling this,

distractibility, frankly.

My guess is that many people with ADHD,

would not be that hypnotizable,

but I haven't studied it.

So, it's possible that for some people with that disorder,

training in self-hypnosis might help,

but we'd have to see how hypnotizable they were

and take it from there.

- I want to return to some of the underlying neural networks

and the clinical applications but,

what sorts of things aside from the asthma,

have you used hypnosis successfully for

or have others used clinical hypnosis for?

And are there any particular areas of,

psychiatric challenges or illnesses, I guess they're called,

that are particularly amenable to hypnotic treatment.

- Yes, there are.

Hypnosis is very good as a problem focused treatment.

It's the oldest western conception of a psychotherapy,

and it can be used for specific problems

in a way that's very helpful.

We found it very helpful for stress reduction.

For helping people deal,

we're all dealing with stress these days.

And it's helpful, that mind-body connection is very helpful

because part of the problem with stress is your perception.

You mentioned earlier in a sort of good sense,

you're at a football game or something,

and you feel the physical reaction.

That can be a reinforcing thing.

Wow, this is exciting, let's do it.

It can also be very distracting.

So, you're worried about getting COVID

or you're worried about,

some other physical problem you have.

And you notice it in your body, your body tenses up,

you start to sweat.

The sympathetic nervous system goes,

your heart rate goes up.

And when you notice that you think,

oh God, this is really bad.

And then you feel worse.

So, it's like a snowball rolling downhill.

And then you feel worse and then your body gets worse.

Hypnosis can be very helpful

in dissociating somatic reaction

from psychological reactions.

So, we teach people

to imagine their body floating somewhere safe

and comfortable like a bath, a lake,

a hot tub or floating in space,

and then picture the problem

that's stressing them on an imaginary screen,

with the rule, no matter what you see on the screen,

you keep your body comfortable.

So, at this point, you still can't control the stress,

but you can control your physical reaction to it.

And that starts you feeling more in control.

At least there's one thing I can manage.

And then you can use it to think through

or visualize through one thing you might do

about that stressor.

So, hypnosis is very helpful in controlling

mind-body interaction in relation to stress.

It's very helpful for people to get to sleep.

We're having a lot of fun with that.

I'm getting emails from people who said,

I haven't slept right in 15 years,

and now for the first time,

I'm listening to your app and I can sleep at night.

So it's very helpful and again,

if you wake up in the middle of the night,

I tell people, don't look at the clock.

That's an arousal cue.

You'll wake up more,

but picture whatever you're thinking about or worrying about

on that imaginary screen while your body is floating.

So, watch your own movie, but keep your body floating.

And many people can use that to get back to sleep.

- I've been using self-hypnosis for sleep for a long time.

And now the Reveri app,

and we'll talk about our relationship to the Reveri app

and its uses.

I find it incredibly useful for falling back asleep

in the middle of the night.

And it raises a question,

I've found and I think I understand this correctly,

that one can do self-hypnosis during the daytime.

And then if there's an issue that comes up later,

like, so for instance,

do self-hypnosis for stress reduction,

away from the stressful event to prepare one

to deal with stress better. - Right.

- Or do hypnosis for improving the return to sleep.

And that can be done when you actually want to go to sleep.

But it's kind of a training up of these networks,

right? - That's right.

- So, is there evidence that,

these brain networks actually form stronger connections,

when people do self-hypnosis over time?

- Well, there's a rule in neurobiology as you know,

that neurons that fire together wire together.

- Our friend, Carla Shatz. - Yes, Carla-

- Not Donald Hebb, by the way.

[David laughing] I keep trying to,

there's a widespread myth in the world

that is unfortunately, all over the internet,

which is that, fire together wire together was said by,

this psychologist, Donald Hebb

Donald Hebb did many important things,

but it is the neurobiologist Carla Shatz-

- That's exactly right. - Who,

Yes, is at Stanford but was also at Berkeley and Harvard.

So, also decent schools. - That's exactly right.

- But is at Stanford, who said, fire together wire together.

And so she deserves, - Right.

- the credit for that statement.

Yeah, so with repeated use of self-hypnosis,

one could imagine that these networks are getting stronger.

- I would think so.

We don't have evidence of that yet,

but long term potentiation provides a pathway

and you've described them on your program, a number of times

that allow for repeated activation of a network

to actually build new connections that work.

And at the least,

even from a learning and memory point of view,

memory is all a network of associations.

That's how we remember things.

And the example I'd like to give is,

you go back to your grade school

and you see these little tiny lockers

and the size is all wrong.

And you suddenly have a flood of memories

that were obviously stored there,

but you just didn't think of.

So, context and association is what memory's about.

If you start to acquire memories about a problem.

So, one thing we use hypnosis for

is treating phobias, for example.

And the problem with people who have phobias,

like airplane phobias

or crossing a bridge or being up high,

is that the more they avoid it the more,

the only source of associations and memories is their fear.

They don't have any good experiences with it

'cause they avoid it.

It's like get back on the horse

after you fall off kind of thing.

And with hypnosis,

if you can start people able to manage their anxiety enough

that they can have more, a wider array of experiences,

they start to have a network of associations

that isn't so negative and may even be positive.

- So it's almost like a, sorry to interrupt,

but I have to ask.

- Sure - It's almost like a,

exposure therapy done in the mind.

- Yes. - It's always in the mind.

I mean, even that exposure to, if I have a snake phobia,

which I don't, I don't like snakes,

but I don't think it qualifies as a full blown phobia.

I think I have a healthy fear of snakes.

- Yeah. - But if,

let's say I had a snake phobia,

the typical approach in, would be,

cognitive behavioral approaches, right,

would be to show a picture of a snake,

then a rubber snake, then a real snake.

Eventually the person is, - Yeah.

- holding a boa constrictor or something like that.

- [David] Right.

- That's all in the mind

because it's all translate into nervous system signals.

But with hypnosis,

sounds like you can give a number of positive experiences

without having to use any props,

without having bring any animals into the room.

- Right, I-

- Drive someone across the bridge, is that right?

- Yes, I had a woman,

who was a very successful business woman,

high level in a corporation.

I had a terrible dog phobia.

And so I had her imagine that somebody brought in the dog

to the room and I said, "what are you doing?"

And you could see her getting tense.

And she said, "Well, I'm waiting to see what the dog does."

And I said, "If somebody who works for you,

comes into your office,

would you freeze and wait to see what they did?"

And she said, "Of course not,

I tell 'em what to do."

[laughs] And I said, "Well, so you're immobilizing yourself,

the power isn't with the dog it's with you,

so, imagine what you might do to engage the dog

and help control the situation."

And she said, "Thanks."

And this reminds me of,

one of my favorite stories about hypnosis that,

my father was seeing a woman who lived in Midtown Manhattan

and had a horrible dog phobia.

She'd dropped things, she'd spill coffee if she saw a dog.

She would time her trips to the store,

when she thought it was least likely

that people would be walking dogs.

- Now that wouldn't be possible, everyone in-

- [laughs] Everyone in New York has a dog

- It's like a fleet of French Bulldogs,

- Right, exactly. - taking over New York City.

- So, he taught her to think of dog as a friend,

have a neighbor who had a dog,

bring the dog over but hold the dog by the collar

and make sure,

and gradually she was able to stroke the dog and say,

dog friend and distinguish between wild and tame animals.

There are animals, you should be afraid of [murmurs].

So, she seemed to be doing better.

He called back about three months later

and asked for her.

"Well, who's calling?" the son said.

And he said, "Dr. Spiegel."

And the boy said, "That's weird."

And my father said, "What's weird?"

He said, "Spiegel's in heat."

She had bought a dog, - I love it.

- and named it, Spiegel.

- I love it. - Talk about transference.

- I love it. [David laughing]

But it really speaks to the power of this.

And it brings me back to this issue.

So, what is different about,

what your father did in that case with this woman,

in terms of what happened in hypnosis

that allowed her to go

from being completely terrified of dogs

to owning a dog and naming it after your father?

Which I find amusing. - Yeah.

- But that's different

than just the two of them sitting down

and talking about it, right?

You know, in therapy,

narrative is a huge component. - Right.

- And in hypnosis narrative is a huge component.

- Right. - So it must be that,

the brain state is what is really different.

Because we'll talk about trauma in a few minutes.

But I think people who have trauma or phobias,

certainly could have a conversation about it.

Some of them might freeze up.

Some of them might lose their articulation and so forth.

But what is different about that state

that combines with narrative,

you think to allow these underlying neural networks

to engage her to change?

'Cause I find this so fascinating because we're a-

Every attempt at dealing with stress or phobia

in the clinical setting involves some discussion

about what it is. - Yes.

- But, here we're not talking about

any medication being introduced,

at least not in these particular circumstances.

- Right. - So,

I realize it's kind of an obvious question

like, it has to be some difference in brain activity,

but I find that to be incredible.

The control variable there is the brain state.

It's not, what's spoken.

- You're raising a couple of very important issues, Andrew.

We talked earlier about with systematic desensitization,

where you sort of lay out a hierarchy of things

and do it one at a time.

I think of this as unsystematic desensitization,

because you're changing mental states.

And I think there's more and more evidence

that mental state change itself has therapeutic potential.

We're seeing that with ketamine treating depression,

the dissociogenic drug.

We know it every morning when we wake up,

that problem, when you know,

you made the mistake of reading a nasty email at 11:00 PM.

You didn't know what to do.

You wake up in the morning thinking,

oh, that idiot, yeah, here's what I'm going to do.

So, just changing mental state,

itself has therapeutic potential.

And I think we underestimate our ability to regulate

and change responses to be cognitively,

emotionally and somatically flexible.

And so, we do things, you're right,

that follow similar principles of facing a problem,

seeing it from a different point of view.

And you've done a really,

a nice podcast on trauma and stress

and how you have to expose yourself to it,

not avoid it, as we talked about before.

And then find some way to reconnect to it,

to substitute something that can make you feel good,

rather than bad,

so that you activate other centers of the brain

like mesolimbic reward system.

And so, I that with hypnosis and you can do it much faster.

People don't think they can but they can.

If you are having, right now that physical experience,

I'm thinking about this

but I'm not feeling as bad as I used to.

That can be a powerful thing

and you can do it with hypnosis.

So, a woman came to see me,

who had suffered an attempted rape.

It was getting dark,

she was coming back from the grocery store

and this guy grabs her

and wants to get her up into her apartment.

It's outside her apartment.

And she starts fighting with him

and she winds up with a basilar skull fracture.

He runs away.

The cops come,

since she hadn't been raped, they left,

they weren't interested.

And she wanted to use hypnosis

to get a better image of what this guy looked like,

which is a painful, upsetting thing.

So, she was quite hypnotizable.

I got her floating.

I say, you're safe and comfortable, now,

nothing can happen that will harm your body.

But on the left side of the screen,

I want you to picture this guy

and his approaching and what's happening.

And she said, I really, the light,

it was getting dark.

I really can't see much of his facial features,

but I do recognize something,

I hadn't allowed myself to remember.

If he gets me upstairs,

he doesn't just want to rape me, he's going to kill me.

And so, in some ways, what she was seeing was even worse.

So, you're thinking, good, Spiegel,

you made her even more frightened than she was before.

But as you had pointed out in your PTSD stress lecture,

you've got to confront the trauma,

to restructure your understanding of it.

So, on the other side of the screen,

I had her picture,

what are you doing to protect yourself?

And everybody in a trauma situation engages in some strategy

of self protection.

That's the salience network kicking in.

And she said, "You know what?"

He's surprised that I'm fighting that hard.

He didn't think I would.

And so, she realized on the one hand

that it was even worse than she thought it was.

But on the other hand

that she actually probably saved her life.

And so, it was a way of,

helping her restructure her experience of the trauma

and make it more tolerable.

So that helped with her-

She didn't recog-

She couldn't identify the guy,

but it helped her restructure and understand her experience.

And that's something that you can do

in just talking, straight out psychotherapy.

But sometimes you can do it a hell of a lot faster

and more efficiently using hypnosis.

And there is one randomized trial out of Israel

that shows that adding hypnosis to PTSD treatment,

actually improves outcome.

So it's a way of accomplishing things that we understand

in the broader psychotherapy world, but much more quickly

and sometimes effectively.

- Yeah, it sounds like going somewhat into the state

that one is trying to deal with,

but then dissociating from that state is key.

And I could imagine,

and I've been open about this on various podcasts.

I've done a lot of an analysis over the years.

I've experienced myself that in those sessions,

depending on how I show up to them,

I might just get kind of a laundry list of what happened

as opposed to actually feeling anything,

around what happened. - Right.

- And I think people probably vary in the extent

to which they can drop into feeling states

and it can depend on the day.

It can depend on how well you slept the night before

and so on.

- There's one thing I might add, Andrew,

- Yes. - And that is,

there's a notion to late Gordon Bower,

we just had a memorial for Gordon at Stanford.

He died about a year ago.

Brilliant cognitive psychologist,

one of the founders of cognitive psychology at Stanford

and a great pitcher.

He almost became a Major League pitcher

but he decided to go to grad school instead,

and I'm glad he did.

But Gordon helped establish the concept of

state dependent memory

that when you're in a certain mental state,

you enhance your ability to remember things about it.

And sort of the bad example of that is

the drunk who hides the bottle

and can't remember where he put it

until he gets drunk again

and he's in that same mental state.

People go into dissociative states when they're traumatized.

So in a way, hypnosis is helping them remember

and deal with the memories better

because they're more in the mental state

that is more like what happened.

And most rape victims will tell you,

I was floating above my body,

feeling sorry for the woman being assaulted below.

People in traumatic episodes, they just say,

you know, I blank out, I don't know what's happening,

I'm on autopilot

and that's a kind of self hypnotic state.

So, when you use hypnosis to help them deal

with a traumatic memory,

you're making the state they're in,

right there in your office with you,

more congruent to the state they were likely in,

when the trauma happened.

And I think that is part of what helps facilitate treatment

of trauma related disorders.

- I see.

So that makes me have to ask, every question I have to ask,

'cause I really feel it as a almost like compulsion,

then if dissociation during a traumatic episode is,

it's a part of the adaptive strategy.

- Right.

- But it creates certain issues, it creates problems, right?

Why would something like ketamine,

which creates a dissociative state,

be useful for the treatment of trauma?

This is what I'm confused about these days

because our colleague, Karl Deisseroth,

who's also been on this podcast

and his coworkers have figured out,

okay, there's these layer one networks in the neocortex,

and those are involved in dissociative state.

And so we're starting to gain some understanding

of how ketamine works at a neural level.

- Right. - It does seem,

as if for certain populations it can be a useful treatment.

I don't know, I've never tried it.

I don't know what the current status of that is,

but it is legal.

It is allowed at least in,

it's FDA approved and it's in use.

Why would dissociative states be useful

if some element of dissociation

is what gave rise to the trauma memory in the first place?

- Well, yeah, and Karl had a brilliant paper

in nature where he,

it was from rats to humans in one paper.

And he showed that there's this rhythmic discharge

in the retrosplenial region,

that is triggered by ketamine.

And the rats actually showed dissociative like behavior,

in that they would a hot pad that they ordinarily wouldn't

and they didn't seem to have much pain in their paw.

And he then had a male subject who had implanted electrodes-

- Human, yeah. - A human subject, yeah.

And the electrodes had picked up this rhythmic activity.

And when they did,

he would report being in a dissociative state.

And his description was,

it's like being a pilot of an airplane.

And then I felt myself walking out of the cockpit

and the plane was still flying and-

- It sounds terrifying to me. [David laughing]

It sounds terrify terrifying. - That's the thing-

- I want to be in my body, [David laughing]

most of the time, you know.

- That's right but,

the point is, in a way the principal, Andrew,

is like, the principle you said,

that you need to re-confront a traumatic situation

before you can modulate your associations to it.

So, you have to accept it, accept the arousal,

put some boundaries around it

and then figure out how you can approach that problem

or how you did approach that problem

from a different point of view.

So, it does not surprise-

In fact, we've studied,

people who disassociated during the Loma Prieta earthquake

and the Oakland-Berkeley firestorm.

- I remember both those well. - Yeah.

- Earthquakes follow me.

Then I move south and then the Northridge quake-

- I'm going to keep away from

So, there'll be one later, this afternoon.

[David laughing]

- I'm starting to dissociating.

So, dissociation does compartmentalize experience,

but that means from the point of view of treating trauma,

it's an inhibition.

You don't engage it.

It's like it happened over there.

And I think what happens is that people,

are sometimes too good at being able

to separate themselves from their recollection.

So it's in there somewhere.

It's out of sight but it's not out of mind.

It's having effects on you, but you can't deal with it.

You can't reprocess it.

So I do think one reason ketamine might work

is that in fact, it allows you to keep,

to re-approach the dissociative experience

in a way that you can then start to think about

and do something about it.

And just the fact you can turn it on and off.

And that's also where self-hypnosis is so helpful.

It's not something that just comes over you

and happens to you.

It's something you can make happen.

You can control it, you can do something with it.

So, you feel less helpless and out of control.

The essence of trauma is helplessness.

It's not fear, it's not pain.

It's helplessness.

You become an object.

You become just your body.

You don't control what's going on.

And we're not used to that.

You and I have discussed this breathing paper

on anticipation of breathing.

And it's not whether you breathe,

inhale or exhale or hold your breath,

it's that if you think you can inhale and you can't,

that is really upsetting, understandably.

And so, the issue is control

and hypnosis, which has this terrible reputation

of taking away control is actually a superb way

of enhancing your control over mind and body.

- I love that and it reminds me that naming is so important.

You almost wonder if self-hypnosis

and clinical hypnosis had been called something else,

that it would've been separated out from stage hypnosis

in a way that would make it less scary,

weird, complicated for people to embrace.

But, - Yeah.

- part of the reason for having this discussion is,

I've had great experiences with hypnosis,

that I've seen the data,

we're talking about a lot of clinical examples.

It's incredibly powerful

and it boils right down to neural brain states.

- Right. - And,

I think in the years to come,

it's going to become more widespread along those lines.

How quickly,

you've described some examples

of people getting relief very quickly.

- Right. - How permanent,

are those changes?

Is there a need for follow up and related to that,

I'm sure a number of people are listening to this

and thinking, wonderful, I'd love to get hypnotized

for any number of different things by Dr. Spiegel

or somebody else expert in clinical hypnosis,

but they might not have access to you

or somebody with similar training.

So what is the power?

So, how quickly does it work?

How long lasting are those changes?

And then,

is it necessary to work with a clinical hypnotist?

And is it better to do that

than self-hypnosis and so on and so forth?

Maybe you could just give us a contour

of the landscape of directed and self-directed treatment.

- Well, typically,

most people start by coming to see a clinician like me.

It's better to see someone who has licensing

and training in their professional discipline,

medicine, psychology, dentistry, whatever.

- 'Cause there are a lot of hypnotists out there,

who are just hypnotist. - Right.

Just hypnotists. - Oh, okay.

- And the key issue is,

somebody who can really assess what your problem is

and make sure that you're not,

talking someone into reducing their chest pain,

rather than getting their coronary artery problem-

- 'Cause they could have a real issue there.

- They could, right. - That hypnosis might adjust

but wouldn't deal with the deeper underlying issue.

- That's right.

On the other hand.

And typically when I use it with people,

I often only see them once or twice or periodically,

but not every week.

And certainly not every day,

if they have a pain problem

and hypnosis is very helpful for pain.

And so, what I'm doing is,

identifying how hypnotizable they are.

I give them a standard brief test

of their ability to experience hypnosis,

and then going through a self-hypnosis exercise with them

to deal with the problem, seeing how they respond to it,

and then teaching them how to do it for themselves.

And in the old days,

I used to have them use their iPhone and record

that part of the session.

So they could play back the hypnosis experience.

Now we've developed an app, "Reveri,"

that can teach people and step them through,

dealing with pain, stress,

focus, insomnia and help people eat better

and stop smoking.

But we have elements that take about 15 minutes

and elements that just take one or two minutes

that people can refresh and reinforce.

- Two minute hypnosis,

[indistinct] one minute. - Yes.

- Yeah. - And it's one to two,

we're one to two minutes now,

and we're finding that two thirds of the people find

that even just the one minute refresher,

helps them feel better.

They're reporting, they feel better.

So, the nice thing is, you know right away,

whether it's likely to help you or not.

And we've found, we've done studies,

looking at hypnosis for pain relief

in acute medical procedures.

We did a randomized trial that we published in The Lancet,

three conditions, people getting arterial cutdowns

to chemoembolized tumors in the liver

or visualize renal artery stenosis.

You don't use general anesthesia for this.

It's very uncomfortable and people are anxious

and we had three conditions.

One was standard care,

they could push a button and get opioids, IV.

- This is during the surgery? - During the surgery.

The second is, they could do that,

plus they had a friendly nurse, comforting them.

So, we controlled for pleasant attention and support.

And the third was, we taught them self-hypnosis

for pain control.

So, you're feeling, you can change the temperature,

you're your body is cool, tingling, and numb,

you're floating in ice water and feeling comfortable.

Or go somewhere else,

leave your body here and go to a desert island

and enjoy yourself.

And we found that,

it's about two and a half hour procedure,

that by an hour and a half,

the hypnosis group had reduced their pain by 80%,

compared to the standard, - Wow.

care group, using half the amount of opioids,

they had fewer complications

and the procedure took 17 minutes less time

on average to get done.

Because not only was the patient more relaxed.

So was the treatment staff.

They weren't dealing with someone

who's struggling and uncomfortable.

We measured their anxiety and same thing.

They hypnosis group, I was worried they were all dead.

They had no anxiety after an hour and a half,

they were saying, I'm fine, you know,

and they were fine.

And the standard care group,

had 5 out of 10 anxiety scores at that point.

So, we published that in The Lancet,

big randomized trial.

If we had a drug that did that,

every hospital in the country would be using it now,

but there's no industry to push it.

So, that's part of what helped us decide

that we needed to help people,

do this with Reveri

and teach them how to do it

and provide interactive support for them to do it.

And does it, the question, although is,

does it work long term?

'Cause what we can do acutely doesn't necessarily carry on.

So, we did around randomized trial of women

with metastatic breast cancer.

They had advancing disease.

We met with them in a support group once a week

and taught them self-hypnosis,

for stress and anxiety and pain control at the end.

And by the end of a year,

the treatment group had half the pain the control group did,

on the same, in very low amounts of medication.

So, it lasts.

And they would say,

when I felt that pain in my chest

and thought it was a metastasis, I just did the exercise.

I got myself in a warm bath and I felt fine.

So, it works because it becomes a skill that people acquire,

but they can tell right away,

whether it's likely to help them,

working with a clinician or now using the app

or other ways of helping them learn to use it as a skill.

So, the nice thing is you will know very quickly,

whether it's likely to help you or not.

And if it is, you can learn to do it for yourself.

- That's great and we will,

again, there'll be a link to Reveri in the caption,

it's available for Apple and Android.

And I think even though there's a nominal cost there,

I think that, as you mentioned,

medications and other approaches to dealing

with these problems are quite expensive,

and have all the potential for side effects and things.

Not that some of those aren't also useful.

- Could I, before you get to that,

- Please. - just one thing.

We've worked very hard on the app.

We have an iOS app for Apple.

We decided to table for a moment, redoing the Android app.

So, it was available,

when we were working through the Alexa platform.

It's not at the moment but it will be soon.

So, I just don't want people to be disappointed

if they're looking for it for Android,

it's on our agenda but we don't have it at the moment.

- Great, thanks for that clarification.

So hopefully, in time for both,

I get asked a lot about obsessive thoughts

or intrusive thoughts.

I also get asked a lot about OCD.

Is there any evidence that hypnosis

or self-hypnosis can be used for,

dealing with obsessive thoughts?

- Sometimes, there are some very obsessional people,

who just turn out not to be that hypnotizable for,

yeah, and it's not random.

They tend to be so over controlling of thought,

they're all busy evaluating rather than experiencing, so-

- I know a few people like that.

[David laughing]

It sounds like an adaptive mindset for a lot of professions.

- That's right.

- And then we get trained up in that,

- Yeah. - during school,

how to obsess over the exam,

obsess over the, - Yeah.

- our social interactions.

I mean, it's part of becoming a functional human being.

And yet, it can take us down a different-

- We sometimes overdo it.

I mean, I'll tell you one example from extreme situations,

that, you know, you're judging, evaluating,

you're not letting yourself experience,

including emotionally.

I know somebody,

who listens to the tapes from airplanes that go down.

So, they get the black box and they listen to it.

And he said to me, you know-

- That's his profession or he does this recreational-

- No, it's his profession. - Okay.

- That's what he did.

'Cause they're trying to do accident prevention

and how to handle things.

And he said that you worry about people panicking, right?

And here these guys know that they've got 30 seconds

or some 45 seconds

and they're just going through their checklist.

He said, they don't panic enough.

They're taught that this is what you do.

And there is reason, there's good reason for it.

But sometimes they overdo it.

And it's painful to listen to this

'cause you know what's going to happen.

So, it's kind of a balance we have to hit.

And sometimes we get too emotional and too absorbed

and you're not with that enough

to sort of see other possibilities.

That can be a problem.

But on the other hand,

sometimes you're too rigid and controlled

and you don't let your emotions guide you

to what you need to do to protect yourself

or protect others.

So, I would say in general that people with OCD are,

on the less hypnotizable side of the spectrum,

they're less likely to allow themselves to engage in any,

and the typical example is the checking

with OCD for example,

they don't remember,

whether they locked the door

or turned off the gas in the oven and they keep going back

and they keep checking.

So, there the evaluative component of the brain,

kind of overrides the experiential one

and sometimes people can get some benefit,

but they're not a group that I would select

for being the most likely to respond

to self hypnotic approaches.

- Are superstitions similar?

- Superstitions, I think that's more,

there are people who are very hypnotizable,

who keep getting caught up in things like superstitions

and there, the imagination supplants the reality.

And we've seen a lot of that happening recently.

And so I think there,

it's by possible that they could be helped by learning

to sort of see it but put it in context,

see it from a different point of view.

- I developed a pretty vicious superstition,

when I was in college and it was hard to break, actually.

I always feel, when I talk to clinicians,

I have to reveal certain things

about my own pathology. - Please do.

- And so- - You'll get my bill later.

- Thank you, yes,

it's part of the reason I arranged this.

[David laughing] No, I'm just kidding.

But yeah, I did.

I had a habit of knocking on wood for things

and I noticed it started to,

I would sneak knocking on wood every once in a while

'cause I didn't want people to think I was doing too often.

And then I started to realize that,

it was becoming a little bit of a reflex.

And then I saw this incredible video

from Bence Olveczky's lab at Harvard.

He studies motor patterns.

And he has these rats that press different sequences

of levers and turn dials in order to get a pellet of food.

But as they do that,

they'll start to introduce these behaviors

that have nothing to do with the actual lever pressing,

like they'll start scratching their hind quarters

and things like that.

And their hat, their heads, excuse me,

they don't wear hats and flipping their ears.

And this is just like a pitcher before throwing a baseball.

That we do this, - Oh, yeah.

- we start to incorporate motor behaviors

that are unrelated to the outcome,

but our mind somehow starts to think

that they're necessary for the outcome.

And so then you incorporate it.

So, I decided to break it by simply forcing myself

to not do it for about a week. - Mm-hm.

And then it just seemed like a ridiculous,

- [Both] thing to do.

Yeah, well- - Knock on wood.

- We call that response prevention and it works.

What you do is,

you set up a new context in your brain,

where you get the outcome you want,

devoid of the extraneous behavior.

- Yeah, and I knew it was nuts, right.

I knew it was illogical. - Right.

- But somehow these things take on meaning.

- [David] Right.

- So, we talked about,

the utility of hypnosis for stress reduction,

phobias, pain,

possibly, we don't know but for,

things like ADHD and OCD,

it just will depend on hypnotizability.

- Right.

- You talked about this beautiful study on the,

metastatic breast cancer outcome or patients.

Hypnotizability is clearly a key variable.

- Yes. - So could you please tell us,

what hypnotizability is,

how it's evaluated

and what The Spiegel Eye-Roll Test is?

- Okay, sure.

So, hypnotizability is just a capacity

to have hypnotic experiences.

And we have a test called the hypnotic conduction profile.

Where we give a highly structured hypnotic experience.

And the old tradition in clinical hypnosis was,

that you try a bunch of different things,

talking, walking upstairs and downstairs

and other images and time what you say

to the breathing of the subject and all that.

And the more you change what you do as a clinician,

the less you can make of variation and outcome.

And it could take a long time, you know,

20 minutes, 30 minutes.

And I just view that as a kind of complex,

not very effective way

of assessing the person's hypnotic capacity.

We know that the peak period

of hypnotizability in the human life,

is the latency years in childhood.

So, every eight year old is in a trance all the time.

You call all 'em in for dinner, they don't hear ya,

they're doing their thing.

And that's why childhood is such a wonderful experience.

Work and play are all the same thing.

And we try to make them into little adults,

which I think is a terrible mistake.

Everything is fun for them.

They enjoy learning, they enjoy everything.

- So what age are they in this-

- This is like 6 to 10, 6 to 11.

And they're playful, they enjoy everything.

Everything is sort of a game and fun

and we try to make it miserable for them,

but they've got it.

And then when, what Piaget called,

a more adult cognitive framework,

where we learn abstract concepts,

we learn that even if one bottle looks bigger

than the other, they can have equal volume.

And so, we at imposing logic,

we're growing our DLPFC at that point

and imposing cognitive structure on experience.

Some people start to lose that hypnotic ability.

By the time you're in your early 20s,

your hypnotizability becomes extremely fixed.

And there was a study done at Stanford,

Ernest Hillard, Phil Zimbardo did this, looking at,

they've tracked down students who were in psych one,

had their hypnotizability measured

and retested them blindly 25 years later.

And the test, retest correlation was,

you want to guess what it was?

- I'm guessing it's, I don't know, 0.6 something.

- Yeah, very close.

It was 0.7, IQ would be 0.6,

on the 25 year interval. - Wow.

- So, it's more stable than IQ over a 25 year interval.

So, once you're at that point, that's where you are.

What are the factors that lead to that?

Well, and so what it means is that,

about a third of that adults are just not hypnotizable.

Two thirds are,

about 15% are extremely hypnotizable

and we can measure that and give it a number

from 0 to 10.

And that's very useful.

For some of my patients when I do it,

I say, look, I'm sorry, you're not hypnotizable

but we're going to do something else.

Medication, systematic desensitization,

mindfulness, other things

or if they're very hypnotizable, I just go for it.

I don't do a lot of explaining.

People who are low to moderate hypnotizable,

like explanations about what you're doing,

but then they can still get the benefits.

So, it helps me guide the nature of my treatment

with these people.

Now, the eye roll is,

my father used to use an eye fixation induction,

he used to say, look up at the ceiling

and now close your eyes while you're looking up.

You're very, yes,

you're very- - Yeah [indistinct] [laughs].

- He noticed he had two patients back to back.

And one was a woman who I'd seen him work with,

who had hysterical seizures.

She would just suddenly start shaking.

And- - Real epileptic seizures?

- No, pseudo epileptic seizures.

- I see, so hysteria.

- Hysteria, and although some people have both,

that is the,

for some people, real epilepsy becomes a framework

that gets elaborated on,

for when you're stressed, you have seizures.

She just had pseudo epilepsy,

no EEG abnormalities.

And she was really something to watch.

Her husband had to move his work bench near the door,

so that if she started to have a seizure,

he could run home and try and help her with it.

It was that bad.

And he noticed that when she did what you did,

when she looked up,

when she would have one of her seizure events,

all you see is sclera, you don't see Iris anymore.

And she would start to seize.

So he did a great thing with her.

He taught her to have seizures.

Everybody else was telling her to stop.

He made her have one.

So he hypnotized her,

[indistinct] let's go back to the last time you had one

and sure enough, she'd start to shake.

And gradually he'd make them smaller and smaller.

So, she was learning she could control,

she'd have access, it's like with PTSD,

you confront, you don't avoid it, you don't suppress it.

You confront it and figure out how to deal with it.

The next patient he had was a rigid obsessional businessman

who wanted to stop being so controlling

and all this [chuckles], it reminded me,

there was a New Yorker cartoon of a driver,

who comes to a yield sign and he yells, "Never!"

It's always [indistinct].

- That sounds about right, you're a New Yorker.

- Yeah, I'm a New Yorker.

And so, this guy, when he tried to look up,

he couldn't keep his eyes up while he closed them.

And so, my father started testing people.

And it seemed that there is a rough correlation

between the capacity to keep your eyes up,

while you closed them and measured hypnotizability.

- So that people who are listening [stutters],

and watching on video.

So, the Spiegel Eye-Roll Test,

involves looking up at the ceiling.

So, it's tilting the head back,

I'm tilting my chin back and looking up at the ceiling now.

But I'm also directing my eyes upward and my eyes are open.

And then the eye roll test involves then,

closing the eyelids while the eyes are open.

- Are open. - And whether or not,

the eyes roll back and as you said it,

then you see sclera,

the white part. - You see sclera,

the white part. - That means you're,

very hypnotizable

or moderately hypnotizable. - Right.

- Whereas if the eyes move down and you see iris,

the colored part of the eye as the eyes close,

less hypnotizable. - Right.

- So you can look this up online there,

you just put Spiegel Eye-Roll Test

and you'll find it.

And we are also going to do an actual example of hypnosis

on video later. - Right.

So, you're asking the brain to do something difficult,

to keep the eyes up while closing the eyelids.

And so that's contradictory signals

for the third, fourth and sixth cranial nerve nuclei

that control eye movement.

- You said the third- - Fourth and six,

- Yup. - cranial nerve nuclei.

And so you're suspending one activity,

while asking them to do another

and eye movements have a lot to do

with levels of consciousness.

The periaqueductal gray,

surrounds these cranial nerve nuclei.

And when we close our eyes when we sleep,

we have rapid eye movement when we dream.

Most drugs, that affect level of consciousness,

can affect eyes and eye movements,

either the dilation or contraction of the pupils,

depending on whether it's a stimulant or an opioid.

- Stimulants, make the pupils big.

- Big, right? - Yeah.

Like cocaine, amphetamine. - Right, exactly.

- Things that sort. - And opioids,

you get constricted pupils.

- This is what the parents looking

at their kids coming in the door late at night,

they're looking for substance abuse.

- That's right. - Yeah.

- So, there's something about the eyes

that has a lot to do with level of consciousness.

I mean, obviously, you close your eyes when you go to sleep,

you have rapid eye movement when you're dreaming.

So, it's not surprising.

And there's an old Zen practice called,

looking at the third eye.

And I think part of the reason that this happens is,

where you're looking up inside

it's like there's a third eye

between the other two in your forehead.

And I think it's because we are visual creatures,

we're pretty pathetic from a physical point of view.

Many animals can outrun us,

or outs smell us or eagles could read the newsprint

at a hundred yards and we can't.

So, our major defensive sensory input is vision.

And that's why animals,

predator animals have eyes in the front of their head,

so that they have very good, detailed vision of prey.

Whereas prey animals like deer,

have eyes on the side of their head.

So, they don't see things that well,

but they have a much bigger range

of potential to see threat.

And we mainly use,

and in fact, it's interesting,

there have been social anthropologists that say,

why do we gather where we do,

on coastlines and at the edge of a forest or something,

it's because you've got protection in the back.

Something can attack you from one side

and you have a big vision of what might threaten you.

And we tend to be attracted

to those kinds of physical situations, so-

- Yeah, we love vistas.

- We love vistas, that's right.

- Vistas are very calming.

They take us into that panoramic vision.

- That's right. - I didn't know this,

but it turns out that most of the scenic spots

at any location in national parks

and where people naturally aggregated it was-

which makes sense. - Sure.

- But, that those signs and locations were built up around,

people's tendency and animals tendencies.

- Oh, really [indistinct]? - To aggregate there.

Yeah, there's a interesting book

on the history of the national parks that says,

that they didn't give a research study to support it,

but there was no Google Maps, obviously.

- That's very interesting.

- Yeah, panorama

and visual boundaries are really interesting.

I think, so the eyes, as we both know,

are two pieces of the central nervous system

of the brain, outside the- - Right.

I used to say that the eyes are outside the skull

and a neuro-ophthalmologist wrote to me

and vehemently pointed out

that they are outside the cranial vault, so, you know.

They're outside the cranial vault

but they are two pieces of brain they're out there.

And so, you mentioned cranial nerves, three, four and six.

This isn't a neuroanatomy course

but maybe we could go a little deeper there.

So, you said there's contradictory activity,

looking up is controlled by the one set of cranial nerves.

And then the closing of the eyelids,

is controlled by another cranial nerve.

- No, it's the same one.

I think it's six that when you close your eyes,

you activate,

no, it's the facial, I guess it's the facial nerve.

It's 7, yeah. - 7, yeah.

- But you're looking up,

you're activating the muscles

that force your eyes to look up.

And closing your eyelids normally relaxes those,

it relaxes that upper movement,

because your eyes are closed and you don't need to do it.

So you're breaking a usual customary pattern.

- It's like the rubbing the, - Right.

- hey, I can't even do it,

see it's like the, - Right.

[Andrew and David laughing]

- That's exactly right. - Rubbing your tummy

and patting your head.

There's a bit of a conflict there,

- Right. - But clinically,

it's been a good probe for you,

- It has. - and for your father.

So, was it Spiegel senior

or Spiegel junior? - That's Spiegel senior.

- That developed The Spiegel Eye-Roll Test.

- But the key issue is this,

that normally when we close our eyes also,

we're going to sleep.

You're not worried about

what's going on in the world anymore.

Here, you're maintaining resting alertness.

So, you're focusing but you're turning inward.

That's an unusual state.

Normally we close our eyes periodically, we have to,

but when you close your eyes for some period of time,

it's normally to go to sleep

and you're not worried about detecting risk or threat.

So, it's an interesting state

because you're turning inward, basically,

you're looking up, you're shutting your eyes

and you're allowing whatever happens outside you to happen

and focusing on what's going on inward.

So, I think it's a signal to your brain to turn inward.

- Very interesting.

And meditation of course, could be done with eyes open

but almost always is done with eyes closed.

- Yes, that's right. - Very interesting.

So, you can very quickly determine

whether or not someone is highly hypnotizable.

- Right. - not at all hypnotizable.

You said about two thirds of people can be hypnotized.

- Right. - Obviously a third cannot.

But within the two thirds that can,

there's a range,

and you said 15% of people fall into this,

highly hypnotizable category. - Right, that's correct.

- That I seem to be a member of.

- Yeah. - And,

does repeated use of self-hypnosis or clinical hypnosis,

increase or change hypnotizability,

for those that can access it in the first place?

- I would say in general, it may increase a little bit,

but not a hell of a lot,

and it's not worth the effort

to increase your hypnotizability at that point.

It's worth trying to deal with the problem,

you're dealing with.

So, you can get better

at using it at the level that you have.

There was a study done in which they tried to train people

to be more hypnotizable and obviously,

there're subjective and behavioral components to the test,

you can learn to do a little better on them.

But what we found was when we reanalyze this data,

that we could account for three times the final score,

based on the initial hypnotizability measurement,

rather than whether or not they had been trained

to do better.

So, you can improve it a little

but it's not worth the trouble.

- Got it.

Along the lines of eyes and eye movements,

a lot of interest out there about EMDR,

Eye Movement Desensitization Reprocessing.

- Yeah. - Shapiro herself was working,

she wasn't at Stanford directly,

but was the local to Stanford. - Yeah.

- I think in Palo Alto. - MRI, yeah.

- So what are your thoughts on EMDR?

Where is it useful, where do you think it's less useful?

Are there things that EMDR could be combined with

to make it more useful?

The listeners of this podcast come to,

I think, come to the podcast with a range of backgrounds

and interests.

To me, it makes sense why EMDR,

lateralized eye movements might work,

given the newer data that it can suppress amygdala activity

in some animals and animal models and in humans as well.

But it really hasn't been explored much, neurally.

I've heard things like,

it coordinates the two sides of the brain,

which it, to me is just a throwaway.

I don't think there's any evidence that,

coordinating the two sides of the brain

is better than not coordinating.

I wouldn't be speaking right now

if the two sides of my brain,

were well correlated. - Yeah.

- Because language is lateralized so,

- Right, exactly. - I heard that it mimics,

rapid eye movements during sleep, but actually it doesn't.

So, - Right.

- But I have heard people talk

about their positive experiences with EMDR.

What are your thoughts about EMDR?

- Yeah, you had a good comment on that

in one of your recent podcasts.

And I'll tell you,

one way I sort of think about it

from a bemused point of view,

is the old, you mentioned it earlier,

the oldest sort of idea of a hypnotic induction,

was a dangling watch, right?

And [indistinct] watch.

And, in fact, there was enough concern about it

that when automobiles were invented,

there was a movement to prevent installing windshield wipers

because people were afraid that they would be hypnotized,

if they watched the windshield wipers go back and forth

on a car.

Now, it turns out fortunately that,

you tend not to look at the windshield wipers.

You keep looking through the windshield.

And so, we have windshield wipers today.

But that movement is,

what exactly used to be a hypnotic induction.

I think there is a lot of hypnosis in EMDR.

- Ah. - And I think,

it's a combination of that with exposure based treatments,

where you use EMDR to think about it.

You tend not to process the experience as much

and just do the physical part of it,

which I personally think is a drawback.

And, every study I've seen that was a dismantling study.

There's no question that people who go through EMDR,

many of them get better with trauma related problems

and the VA has a big program using it and so on.

But every program that has dismantled,

going through the treatment

with having the lateral eye movement,

has shown that the lateral eye movement,

doesn't add anything to it.

And toward the end of her career,

Francine was doing [indistinct] contralateral touching

or something, it wasn't eye movements anymore.

It was other things.

So, I tend to think that,

EMDR is another form of exposure based therapy for trauma,

but as you've implied

with the exception of this possible new data,

it certainly doesn't have to do with,

rapid eye movement sleep.

And I don't think moving the eyes is the issue.

I think it's a way of sitting down and confronting trauma.

And I would rather,

that the trauma itself be processed a bit more

than often happens in EMDR.

So, a lot of people have gotten therapy.

Some of them have been helped.

Francine used to originally claim

that just one session would desensitize people and do it.

And that's clearly not true.

I see a lot of people who said,

yeah, it helped for a while but I need more.

So, I think it became a kind of a,

overly simplistic approach to understanding brain physiology

and that part is wrong.

And the interesting thing,

you mentioned suppressing amygdala activity.

It's very interesting that, my late friend Allen Hobson,

who was a brilliant sleep researcher,

you know Alan- - Sleep researcher.

Well, I don't know him,

but I read his book when I was in college

about the chemistry of sleep. - Right.

And the similarities between dream states

and hallucinations. - Yes.

- And it's one of the reasons I got into this business.

- Yes, well, I worked with him

in a MacArthur mind-body network for many years.

- Wow. - He was a brilliant guy,

points out that we need to get into,

primarily a parasympathetic state to go to sleep,

that we have to shut off the sympathetic nervous system.

And that's why a loud noise wakes you up,

when your heart rate goes up and all this.

So, he was brilliant at documenting

what happens in the brain at sleep.

He pointed out something also very interesting about dreams,

which is that the stories in dreams,

and even the images in dreams can change all over the place

in crazy ways.

But usually the affect is constant,

he said, usually if it's a frustration dream,

whatever happens, you end up frustrated.

And if it's a enjoyment dream,

you enjoy whatever's going on.

So, there's an odd consistency and affect in dreams

that you don't have in other states.

And the idea of lateral eye movement,

suppressing amygdala activity would kind of fit with that,

that you don't allow intrusions

of fear and anger and upset in dreams.

It may be there all the time,

but it may not be there when you think it should be.

So, why is it that you can be falling off a building

and somehow not that scared,

you're just having this experience of flying in a dream.

So, I think there may be something going on

about regulating affect, but there are,

we have elaborated better ways to regulate affect.

- Great, so EMDR,

might incorporate some elements of hypnosis,

so the lateralized eye movements,

perhaps by way of suppressing the amygdala,

this fear associated center,

might bring people into a more parasympathetic calm state.

So, it might be pseudo hypnosis,

and then an exposure therapy

through the discussion about the issue.

- Right. - Okay.

More research needed on EMDR out there.

And obviously,

something that's come up a lot in this discussion

and in our discussions that,

have the great fortune of talking to you every week is,

and working together is,

this idea of getting close to the phobia,

getting close to the trauma,

re-experiencing it as a portal

to then adjusting the response to it and rewiring something.

So, the troubling thing

or the horrible thing is no longer as horrible to us.

but the repeating theme is we can't expect

to get over something without getting really close to it.

Maybe even experiencing it somatically.

Nowadays, we hear a lot about,

triggers and trigger warnings.

And certainly, one can understand why those exist,

but it seems like in the general population,

there's this idea that we want to move away

from anything that upsets us and yet,

- Right. - I think it's fair to say,

even though I haven't gathered the statistics that,

on the whole,

that human beings are becoming more and more anxious

and more and more stressed,

perhaps because of but certainly in parallel,

with the fact that we're trying to move away

from troubling things.

So, I've heard you say before,

that in terms of therapeutic approaches,

it's not just about the state you get into,

but whether or not you brought yourself there voluntarily.

- That's exactly right.

- So, this element of deliberate self exposure,

deciding I'm going to confront the trauma,

I'm going to confront the pain.

I'm going to confront the insomnia.

I'm going to confront the, you know,

and fill in the blank.

And then readjusting one's emotional response,

right up next to that troubling thing.

That seems to be the hallmark of this treatment.

And,

if I'm thinking about it correctly,

of pretty much all treatments for getting over stuff.

If people don't have access

to a really good clinician, like yourself,

how should they carry these thoughts and these ideas?

I mean, I think almost everybody of any reasonable age,

has memories or things that upset them,

but we learn to suppress them.

What does one do?

Obviously, the Reveri app has approaches

to dealing with some of this, inside of the app,

but how does one start to think about,

actually dealing with something like this

and avoiding the hazards

of just kind of reactivating a lot of painful experiences?

Because a lot of being a functional human being

is also going to work each day,

interacting with people and not bringing one's trauma,

and dumping it out all on the table

or being able to just function is so crucial.

So, how do you think about this as a clinician?

- Well, the image it comes to mind

is the Greek myth of Pandora's Box.

That it opened and the Furies got out

and you couldn't put 'em back in.

And we have this kind of fantasy

that once you get into these memories,

they'll take you over

and you'll never get them back in the box.

And I think that's wrong.

People who use hypnosis say that,

there are ways to present things to people

that will be helpful and ways that won't.

And one real mistake is to tell someone,

don't think about purple elephants.

What are you thinking about? - Purple elephants.

- It doesn't work.

So, you want to find a way to feel in control of the access

and to define what happened on your own terms.

And so, I'm not a big fan of trigger warnings.

I think we're going crazy over,

this could be upsetting, that could be upsetting.

Yeah, there are lots of things that are upsetting.

The average kid has watched 20,000 murders,

by the time he's 20 years old,

watching television and movies these days.

So, we see terrible things

and it's not a matter of,

are you exposed to something that's upsetting,

but how do you handle it?

What do you make of it and are you feeling in control?

It's not like,

what Putin is doing to his rival in Russia,

forcing him to watch propaganda movies 10 hours a day,

while he is in prison.

It's a matter of thinking about a problem,

in a way that leaves you feeling, you understand better.

You're in more control, you can turn it off when you want,

you can turn it on when you want.

And so we have to, in life, deal with stressful things,

there are studies,

Karen Parker at Stanford has done some wonderful studies

with primates about stress inoculation.

That if you separate a baby monkey from his mother

for two hours a day and then reunite them,

and then you stress that baby monkey later,

they actually handle stress better.

There's less cortisol arousal in the face of distress,

stress inoculation, that's been called.

So, mere exposure to trauma or stress.

It's a part of living anyway.

We can't avoid it, even if we'd like to,

and,

it's not pleasant, it's not great

but it's sometimes things you need to learn about life.

And if you can find an algorithm for facing it,

putting it into perspective, dealing with it,

you become a stronger person not a weaker person.

So, this idea that,

college students are such fragile flowers,

that if you talk about a sexual assault or something,

you're doing something terrible to them,

it's just wrong.

And I think we need to build our ability

to recognize and manage stress.

And you can't do that without doing it.

You can't ride a bicycle

without taking the risk of falling off it.

And so, I think that's the way,

I think of dealing with stress.

- Yeah, I really appreciate you saying that.

You and I were both at a gathering,

let's say where this issue was being discussed,

and around an issue of a publicized sexual trauma.

And you made an excellent case

for why this stuff can't be pushed under the rug.

And that actually, in my observation,

led to a lot of healing for the people that

and the families of people that suffered from this.

I do think people are resilient.

But we don't really teach how to think about feelings.

We're told that we need to feel our feelings,

but then again, we are also told

that feelings don't hold all the information.

And so, I think that as you mentioned,

there's no operating or users manual

for this nervous system thing.

Brings me to another issue,

which is the mind-body connection.

Something that we're very interested in

and you've done extensive work on.

We all like to think that,

getting more in touch with our body,

would be a great thing,

learning to interocept,

paying attention to our internal landscape,

would be a great thing.

But as we often discuss,

when we're feeling lousy,

then being really in touch with that lousy feeling,

may or may not be a good thing, right?

So, how should we think about mind-body?

I can see examples in hypnosis,

from your descriptions of hypnosis,

where you want to unify the mind-body connection.

Feel what you're thinking,

think what you're feeling, et cetera.

But I could also point to elements

within the hypnotic process

in which you are actively trying to uncouple those.

- That's.

- So, it sounds to me like,

this whole mind-body thing is a bit more like a car.

You can't say that 40 miles per hour is the optimal speed.

It kind of depends on the road you're on

and the turn you may or may not be taking.

- Right.

- How should we think about mind-body in terms of,

navigating daily life?

What do you think is the adaptive way,

to conceptualize the mind-body?

It's a big question. - It is.

It's a very interesting one.

I guess, I think that it's a matter or not of,

absolute control but more control,

that we need to think of our brain as a tool

and our body's signals as tools as well,

to help us understand what's going on in the world,

what we need, what matters, what's important, what isn't,

but also something that can be managed,

not simply absorbed.

And so, hypnosis I think is a kind of limiting case,

where you can push it about as far as we can push it

in terms of regulating pain.

Pain is a good example of that.

Obviously, you need to pay attention.

If you just broke your ankle,

you better pay attention to it and get help

or you're having crushing substernal chest pain.

You better do something about it.

But our brain,

is sort of programmed to treat all pain signals

as if they were novel pain signals.

If it's a sudden new problem that needs to be attended to.

I teach people to think of the pain and categorize it,

does the pain mean that if you put weight on this,

you're going to re-injure your ankle for example,

or does it simply mean that your body is healing

and the pain is a sign that,

gradually things are getting back to normal

and so, you can modify the way you process pain,

based on what your brain tells you the pain means.

And that's true for emotional pain as well.

And particularly where I think a strategy that really helps,

is if you think of an interpersonal problem

or a threat of something coming as an opportunity

to do something to ameliorate the situation.

So, it's not just it's happening to you,

but something that you can influence and do something about.

So, it's blending the receptive with the active response,

that I think can make a difference.

So, you try and process it in a way

that gives you a deeper understanding of what's happening.

You face it but you also say,

this is an opportunity for me to do something about it.

And the minute you realistically enha-

and this doesn't mean, imagine away a heart attack.

It means figure out how to rehabilitate from a heart attack

or a broken leg or something like that

in a way that you get as much control

into the situation as you can.

- I love it.

Grief.

Grief is one of those states that is very hard

to remove oneself from.

And a lot of people asked me,

how do I deal with grief?

And I'm not a clinician so I'm deferring to you.

- Mm-hm. - On the one hand,

actually someone at Stanford recently came to me and said,

my mother passed away and I had a sibling that passed away

and they were the only people that I had.

And I'm also living alone

and I'm challenged with a number of things.

And,

they looked like they were holding it together,

- Mm-hm. - very well, in fact,

given what they were describing.

And on the one hand,

well, I certainly pointed out that I'm not a clinician,

but I said on the one hand,

you could imagine that it would be necessary and useful

to go into the grief's state,

if you want to transition through it.

- Right.

- On the other hand there,

I've heard before that the cathartic model

of just really diving into an emotion,

can also be potentially hazardous.

If you don't have any anchors to grab onto.

What is view of psychiatry or your view of grief

and how to deal with grief?

Because I think grief is,

one of those all encompassing emotions for many people.

- Yeah, it is.

And it's a very important, natural, necessary stage of life.

And the reason we have all these grief rituals

from burials and memorials and headstones

and sitting shiva and other things that people do.

It's a way of making it real,

that an incomprehensible loss has to be comprehended.

You have to realize that you're now going to have to live life

without your loved one, your parent, your sibling, whoever.

And we've all gone through this at one time or another,

I certainly have.

And it's very hard to just come to terms with,

but one principle is to sort of say,

it's never all or none, it's more or less.

So yes, it's all or none that you've lost a loved one,

but I ask people as part of their grieving

to say to themselves,

and I do this in hypnosis sometimes too.

You've lost them but what have they left you with?

What have they bequeathed to you even though they're gone?

And I'll sometimes ask them to say,

if your mother could be here right now,

what would she say to you?

How would she feel about your life now?

What would she advise you to do?

So, in our support groups

for women with advanced breast cancer, we lost people.

And I got to tell you that we were warned by oncologists,

that we demoralized people that,

I mean, they were wonderful oncologists,

but there are some that were very afraid

that we would harm them in some way,

because the mortality rate is fairly high

with metastatic breast cancer.

They're going to watch people die of the same disease

and you'll demoralize them.

So, we actually measured their emotion

and the content of speech every five minutes

throughout a bunch of groups to make sure

that wasn't happening.

What we found was,

that they talked about more serious issues,

but the mood didn't actually get worse.

And we found in general that expressing negative emotion

on the long run helps people be less anxious

and depressed over time.

And we've shown this in randomized clinical trials.

So, it's not just my clinical impression.

And what we try to get them to do,

is to face a loss,

live with the emotion that comes with it

but also see that the reason it hurts so much,

is how much that person gave you.

So, we would do a self-hypnosis exercise

at the [indistinct] say,

I want you to get your body floating, safe and comfortable.

Now, picture Mary and sit with the feeling of sadness

that she's no longer with us.

And we do that for a few minutes.

And then we'd say on the other side,

picture one thing she left with you that you still have,

that you carry on in your heart,

her tradition of what she gave to you.

And so just seeing it, not as a complete loss,

but as a real loss, a painful loss

but one that helps you to reflect on,

what you gained from her and knowing her,

I think can be very helpful in the grieving process.

- That's very helpful way to conceptualize it.

Couple quick questions.

Can children be safely hypnotized or do self-hypnosis?

- It's sometimes harder for them to do self-hypnosis,

they need more structure to do it.

You've got to share your dorsolateral prefrontal cortex

with 'em a little bit,

but yes, absolutely, children can be very hypnotizable.

And I know pediatricians,

who use it wonderfully all the time.

They get them to focus on something else.

So, they're going to have to give them a shot

or draw blood or something.

And they'll say,

I'm going to press your happy button

and he presses their belly button.

And they start to giggle the way kids do.

And meanwhile, the nurse is drawing the blood

and they don't even notice it.

Dentists, good dentists can use it to help kids

with fear and pain.

So yes, it can be very effective for children.

We did a randomized trial.

I have a publication in pediatrics,

my late sister, who was a pediatrician,

and who always used to joke that,

she was the only one in our family who was a real doctor.

I said, I gotcha.

I got a paper in pediatrics [Andrew laughing]

and the paper was children having to undergo,

a voiding cystourethrogram.

So, the anatomy of the kidney,

if you'll forgive me, is sort of interesting in that,

the ureter that goes into the bladder,

normally goes into the bladder at an angle.

And so that means,

that when the bladder contracts to expel urine,

it automatically closes off the ureter

because it's sideways to the bladder.

Some kids are born with it perpendicular,

and then you'll get reflux into the kidney.

And some children outgrow it,

some need pretty complicated surgery to fix that.

And so, you image them every year or so

to see whether they're getting kidney damage or not.

And it's a pretty miserable experience.

You're a nine year old girl.

You have to go and lie on a hard cold table,

have strangers pull your legs apart

and stick a catheter into your urethra

and hold in the bladder and then expel urine.

And so, you get into these struggling fights.

And of course the more they struggle,

the more they constrict and it makes it harder to do it.

So, I was asked if we could test this.

So, we did a randomized trial at children's hospital.

They either got training in self-hypnosis.

I would meet with them and the mother the week before,

we find out from the kids where they like to be.

And I'd say, you're going to play a trick on your doctors.

Your body's there, you're somewhere else,

go visit your friend, go to Disneyland, do something else.

And the mother would work on this with me

at the head of the table.

And we found that these children were much easier to image.

One got so relaxed that, so your guy [indistinct] he's said,

normally it takes us 10 minutes to get them to pee

after they're doing this.

She was so relaxed, she started peeing

before I could even get the bed pan under her [laughs].

And I had to clean up the table.

And they also, 17 minutes shorter procedures.

And that's a long 17 minutes for a little kid.

So, it can be very effective with children.

They're less anxious, they have less pain

and get through these difficult procedures very well.

- That's great.

Has hypnosis ever been done for couples,

like couples therapy?

I'm thinking of pretty much every clinical setting here.

Both people have to be hypnotizable,

of course. - Mm-hm, yes.

- But the reason I ask about this,

is next, I'm going to ask about psychedelics

and there's a lot of interest in,

coordinating states through the use,

of drugs of different kinds. - Mm-hm.

- We actually do this when we treat depression, right?

You have a depressed person with family members

who are not depressed, and you say,

well, let's make them all not depressed [chuckles],

[David laughing] right, I mean,

but and I'm only half kidding there,

because that is kind of the underlying logic in some sense.

But are you aware of any of any coordinated hypnosis?

- That's interesting, I mean,

I've done plenty of it in groups not with couples.

- You can hypnotize large groups,

at once? - Oh yeah.

- Are we hypnotized right now?

- Yeah, you are.

And I hope you've been enjoying it.

[Andrew laughing]

But the metastatic breast cancer,

there was a group of like 10 women,

who would meet once a week

and we would all go into hypnosis together.

- I didn't realize that,

you were hypnotizing them collectively.

- Yes, right.

- Fascinating. - And that, if anything,

I think it brings out the best in people's abilities

because it's a shared social experience

and they would talk about it afterwards.

And so, yes, that's absolutely doable, yeah.

- And I don't want to focus on psychedelics specifically.

Maybe that's a topic for a future episode.

But is there any basis for combining hypnosis

with drug therapies inside of the hypnotic episode?

So, I realize that some patients of yours,

might be prescribed a antidepressant

or a medication for some purpose,

maybe same or different

than the hypnosis is being directed toward.

But is there any evidence that,

if people are relaxed through the use of a propranolol

or one of these many things in the psychiatrist's kit,

that hypnosis can be more effective?

- Well, interestingly,

one study that I haven't mentioned is,

we did spectroscopy on people who were hypnotized.

And we found that,

there was a correlation between hypnotizability

and GABA activity in the anterior cingulate cortex,

which fits with turning down activity.

To the extent that we can self-medicate

and GABA receptors basically are doing

what benzodiazepines do to the brain,

that can happen when people are hypnotized.

- So you're saying inside of the hypnosis,

you have neural evidence that,

there's a kind of a sedative effect of hypnosis

at the chemical level.

- Yeah, right. - Amazing.

- The people who are more hypnotizable,

have more of those GABA receptives

and it's related to the degree of their hypnotizability.

- Fascinating.

- In terms of, there have been studies,

where they give people medications as well.

And the interesting thing with benzodiazepines,

which activate inhibitory activity in the brain.

If you are very anxious,

it might improve your hypnotic response a bit.

If you're just so anxious

and [indistinct] you can't do it.

If you're not very anxious,

it actually inhibits hypnotic activity

because you get sort of sedated and just out of it.

And you can't focus your attention, as well.

So, by and large,

we don't use drugs as an adjuvant to hypnotic experience.

Most of the time you don't need to.

And sometimes it can make it worse rather than better.

There's some evidence that,

mild stimulants might enhance hypnotic responsiveness,

a little reliably, but too much,

Well, [indistinct] scatter attention

and you'll have less control over it.

So, they might be adjuvants,

but I frankly think hypnosis is more of a replacement

than a need of supplementation.

- Your laboratory and my laboratory have,

well, have sort of snuck into your lab

and then trying to emerge the two,

it's been a lot of fun, - It sure has,

been learning a lot about,

the power of respiration of breathing

to shift brain states, not just during breathing protocols,

but at all times.

And we will do an entire episode about those protocols.

I think we, - Cool.

- after those are published and so on.

But breathing itself is, you've described as a bridge

between conscious and unconscious states.

- Right. - So, I have to ask,

how important is the patient's breathing pattern?

How closely are you monitoring their breathing pattern?

How closely do you monitor your own breathing pattern

as you're inducing hypnosis?

Put simply, what is the role of respiration

in shifting the brain's state,

during a hypnotic protocol?

- Yeah, that's very interesting.

You had a great show with Jack-

- Yeah, Jack Feldman - Feldman.

[Andrew indistinct] And he is.

And the issue,

I watch it,

I try [stutters].

The work that we're enjoying doing together shows

that there are breathing patterns

that may increase sympathetic arousal or may decrease.

It may [indistinct] cyclic sighing seems to,

actually, where you have more time spent exhaling

than inhaling.

And there's reason to believe

that it induces parasympathetic activity,

'cause you're increasing pressure in the chest

and therefore allowing the heart to slow down

because blood is being returned to the atrium more easily.

I do use it.

I ask people to take a deep breath as part of the induction

and then slowly exhale.

And partly as a result of our research together,

I'm emphasizing this slow exhale more,

as part of [stutters],

to enhance the idea in the induction

that this is a period of relaxation,