The Science of Clinical Hypnosis
Clinical hypnosis is experiencing a resurgence in psychology, supported by decades of empirical research demonstrating its effectiveness across pain management, anxiety, depression, sleep, and behavior change. As Amanda Barnier, PhD, observed in her early research, hypnotic suggestion can shift a person’s sense of agency—participants described posthypnotic actions as “a compelling urge they had to meet,” while non‑hypnotized participants experienced their actions as voluntary compliance. This altered sense of authorship appears central to hypnosis’s therapeutic power.
What Hypnosis Is
APA Division 30 defines hypnosis as “a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion” (Elkins et al., 2015). While experts debate whether hypnosis constitutes a distinct state or a shift in attentional processes, consensus holds that hypnosis creates a unique context of focused attention that increases responsiveness to therapeutic suggestion.
Hypnotherapy typically involves:
Induction: verbal guidance to narrow attention and deepen relaxation
Suggestion: targeted therapeutic instructions aimed at modifying perception, emotion, or behavior
Unlike mindfulness—which emphasizes acceptance—hypnosis is oriented toward active change (Montgomery, 2024).
Evidence for Cognitive and Perceptual Change
Research consistently shows that hypnotic suggestion can alter automatic cognitive processes:
Stroop Effect Disruption
Highly hypnotizable individuals instructed to attend only to font color showed elimination of Stroop interference (Raz et al., 2002). EEG‑confirmed replications demonstrate that posthypnotic suggestion, rather than hypnosis alone, drives this effect (Zahedi et al., 2017).
Color Perception in Grayscale Images
Spiegel et al. (2000) found that hypnotic suggestion to “see color” activated color‑processing regions of the brain despite grayscale stimuli. These findings illustrate hypnosis’s top‑down influence on perception and cognition.
Hypnotizability
Hypnotizability follows a normal distribution: roughly 10–20% of people are low in responsiveness, 10–20% are highly responsive, and most fall in between. Measures include:
Hypnotic Induction Profile (Spiegel & Spiegel, 2004)
Elkins Hypnotizability Scale (Kekecs et al., 2021)
Neuroimaging suggests highly hypnotizable individuals show stronger connectivity between the central executive network and salience network, supporting flexible attentional control (Hoeft et al., 2012).
Clinical Applications
Menopause & Cancer‑Related Hot Flashes
Elkins’s randomized trials show:
74% reduction in hot flashes with hypnosis vs. 17% in controls
Physiological monitoring confirmed a 57% reduction vs. 10% in controls (Elkins et al., Menopause, 2013)
Sleep
A meta‑analysis found hypnosis to be a promising intervention for sleep disturbances (Chamine et al., 2018).
Depression
Hypnosis appears to be an effective treatment for depression (Milling et al., 2019).
Anxiety
Hypnosis combined with psychological interventions reduces anxiety more effectively than hypnosis alone (Valentine et al., 2019).
Pain Management
Two major meta‑analyses show:
Hypnosis significantly reduces experimentally induced pain, especially among highly suggestible individuals (Thompson et al., 2019).
Hypnosis is “very efficacious” for clinical pain, with medium effect sizes (Milling et al., 2021).
Montgomery’s oncology research continues to demonstrate hypnosis’s value for cancer‑related pain, including joint pain from breast‑cancer medications.
Neuroscience of Hypnosis
A review by Landry et al. (2017) identified three networks consistently involved:
Central executive network
Default mode network (typically reduced during hypnosis).
This reduction in default‑mode activity may reflect a temporary softening of habitual self‑referential thinking, allowing new interpretations and behaviors to emerge.
Hypnotizability also correlates with cognitive flexibility—highly hypnotizable individuals show lower perseveration and adapt more easily to new rules (Faerman & Spiegel, 2021).
Future Directions
Emerging research explores enhancing hypnotizability itself. A forthcoming Nature Mental Health study shows that targeted transcranial magnetic stimulation (TMS) can temporarily increase hypnotizability by modifying executive–salience network connectivity.
Digital tools are expanding access:
Reveri (Spiegel)
Mindset Health apps: Finito (smoking), Evia (menopause), Nerva (IBS)
Advocates argue that clinicians should integrate hypnosis into psychotherapy, noting its strong evidence base and broad applicability.
References
Barnier, A. (1998). Psychological Science, 9(4).
Chamine, I., et al. (2018). Journal of Clinical Sleep Medicine, 14(2).
Elkins, G. R., et al. (2015). International Journal of Clinical and Experimental Hypnosis, 63(1).
Elkins, G. R., et al. (2013). Menopause, 20(3).
Faerman, A., & Spiegel, D. (2021). Scientific Reports, 11, 5704.
Hoeft, F., et al. (2012). Archives of General Psychiatry, 69(10).
Kekecs, Z., et al. (2021). International Journal of Clinical and Experimental Hypnosis, 69(1).
Landry, M., et al. (2017). Neuroscience & Biobehavioral Reviews, 81(A).
Milling, L. S., et al. (2019). American Journal of Clinical Hypnosis, 61(3).
Milling, L. S., et al. (2021). International Journal of Clinical and Experimental Hypnosis, 69(3).
Montgomery, G. (2024). Icahn School of Medicine at Mount Sinai.
Raz, A., et al. (2002). Archives of General Psychiatry, 59(12).
Spiegel, D., et al. (2000). American Journal of Psychiatry, 157(8).
Spiegel, H., & Spiegel, D. (2004). Trance and Treatment. APA Publishing.
Terhune, D. (2022). Neuroscience & Biobehavioral Reviews, 139.
Thompson, T., et al. (2019). Neuroscience & Biobehavioral Reviews, 99.
Valentine, K. E., et al. (2019). International Journal of Clinical and Experimental Hypnosis, 67(3).
Zahedi, A., et al. (2017). Neuropsychologist
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