PT is at its most effective for treating pelvic pain syndromes when supplemented with other strategies. This blog post is dedicated to one such strategy: hypnotherapy.
If you’re skeptical about the prospect of using hypnosis to ease your pain, I completely understand. To someone with pelvic pain, it can be difficult to hear that your mind has the capacity to ease your pain. It smacks of the “it’s all in your head” mentality that sadly used to be the pat response to those suffering with pelvic pain. But those days are behind us (unfortunately, not completely, but that’s another blog!), and if you have pelvic pain, it’s best to be informed about every avenue available to you in your healing journey.
So, if you’re skeptical, I ask only that you read this post with an open mind. I promise that you’ll walk away with a lot to think about. If you’re someone who is open to hypnotherapy for pain and healing, this post will help you make an informed decision about whether you’d like to take the next step and give it a try. And if you’re a PT reading this blog, you’ll learn about a few strategies that you can possibly incorporate into your own practice.
Before we get into the nuts and bolts of how hypnosis works, I’d like you to read the script below and follow its instructions. I think it does a great job of showing you how your mind affects your body.
“Picture yourself on a hot beach. It’s sunny, and very hot, over 90 degrees. Feel the sun pounding down on you. Your mouth is dry, and you are sweating. You see a cooler and look inside for a cold drink, but find only a juicy lemon slice. Tentatively you bite into the lemon slice, and the sour juice squirts into your mouth.”
Did your body physically respond to the script? Mine did! When I went through the exercise at a recent course on hypnotherapy and pain control, I could feel my mouth water in response to the thought of the sour lemon juice. And when I looked around the room, I saw that my fellow classmates were swallowing because their bodies were having similar reactions.
Now, let’s get down to the business of how your mind can alter what your body feels as pain or comfort and can help promote healing.
For the first order of business, I’d like to give you an explanation of what hypnosis is. Then, I’ll briefly take on the stigma surrounding hypnotherapy. After that, we’ll take a look at how you can tell if you’re someone who is “hypnotizable.” Then, we’ll get to the most important part of the post: how hypnotherapy can help with pelvic pain/dysfunction. Lastly, I’ll let you in on how we’ve begun to use tenets of hypnotherapy at PHRC.
What is hypnosis?
Hypnosis is an altered state of mind that allows us to access our subconscious. When someone is under hypnosis, they go into what is referred to as a “trance state” where they experience heightened focus and suggestibility along with a sense of tranquility and relaxation. So they’re relaxed, yet extremely focused and open to suggestion.
A hypnotic trance is not therapeutic in and of itself; it is the suggestions and images administered to someone in a trance that can lead to the treatment of a variety of health conditions or improved behavioral habits.
Hypnosis is induced by a series of instructions and suggestions, and can be delivered by a certified hypnotist or self-administered.
We’ve actually all experienced spontaneous hypnotic-like trances. For instance, if you’ve ever experienced daydreaming or become so absorbed in reading or watching TV that you fail to notice what’s happening around you, you’ve experienced a hypnotic-like trance. Or in a dream, if you’ve ever imagined you are falling and been startled awake by the sensation of falling, you’ve triggered the same mechanisms in your brain that allows the mind to influence the body in hypnosis.
Speaking of the brain, using imaging technology, neuroscientists have taken pictures of people’s brains during hypnosis. These images show a decrease of arousal in the cortex, the brain’s manager and planner, and an increase in activity in areas involved in focusing attention.
While in the trance, a person is usually focused on imagining some vivid image, which likely accounts for the heightened attention. The drop of arousal in the cortex accompanies a drop in moment-to-moment alertness. So the thinking is that the person is conscious enough to hear and understand suggestions like “You will feel strong and healthy after surgery” or “You will not want a cigarette,” without applying his or her usual skepticism. Therefore, the suggestions are more likely to take root. The theory goes that if the suggestions do succeed in taking hold, they may become a part of the person’s subconscious memory. This takes place beneath the level of consciousness, so the suggestions are not something the person has to think about or remember.
Today, hypnotherapy is used for a variety of medical conditions, including to help women give birth without drugs, for dental pain, for helping people lose weight, to stop smoking, and even to allow for surgery without drug anesthesia. And in universities across the country, hypnosis is the subject of active research. Researchers at prestigious institutions like Harvard, Stanford, Tulane, Mount Sinai, Case Western, and Beth Israel, to name a few, are focused on the successful application of hypnosis in mainstream medicine.
Hypnosis and Pain
Relieving physical pain is one of the more common uses of hypnosis; however, it is also the hardest to understand. So far, researchers report that hypnosis doesn’t appear to act on the body’s natural pain-killing chemicals, the way drugs do. Instead, scientists believe, with hypnosis, a person can be trained to focus away from their pain. The human brain can only focus on about seven to nine things at any given time, so the person isn’t necessarily avoiding the pain, it’s more that it gets knocked off the list of things the brain is perceiving.
For example, an athlete can injure herself or himself during a game, and not even realize it because the brain has shut off awareness of that part of the body through what is known as “the power of selective focus.” In this case the selective focus is on winning the game.
Through hypnosis, we can tap into this same power of selective focus to quite literally take our minds off our pain!
Hypnotherapy techniques can also work to calm the nervous system allowing for pain relief and for the body’s own self-healing mechanisms to work better. As many of you know, when you’re in pain, your nervous system jumps into a “fight-or-flight” state, which creates tension in the body that can both perpetuate the cycle of pain, and stand in the way of healing. So, calming the nervous system is a powerful healing tool.
Dispelling the Myths
Despite the new imaging research and the fact that the medical community has begun to embrace hypnotherapy as a viable treatment option, proponents of hypnotherapy continue to spend a lot of time dispelling common myths and answering to skepticism. For starters, hypnosis, they say, doesn’t make people do or say something against their will. It’s not about someone exerting control over the mind of another. Secondly, credible hypnotists do not dangle a watch in front of clients. This only happens in the movies! Lastly, when folks go into a trance state, they are not asleep or unconscious.
“Years of scientific research shows that even in a state of deep hypnosis, a person will only accept suggestions that are pleasant to her and fit within her moral compass,” says Cai Bristol , a certified medical and clinical hypnotherapist based in California. “A hypnotherapist cannot control a client,” Cai adds. “In fact, the person’s conscious mind is still participating in the exercise. In a trance state, they have the awareness to ask or answer questions. Furthermore, they remember doing so after the session is complete.”
Can you be Hypnotized?
Most people like to think that they can’t be hypnotized. That’s because there’s a perception that it means they are weak-willed, naive, or unintelligent. But in fact, modern research shows that hypnotizability is correlated with intelligence, concentration and focus.
The truth is that most people can be hypnotized to some degree. It’s just a question of how far. Researchers have learned that both biological and environmental factors predict how deeply a person goes into a trance. For example, early experiences play a role. For instance, children who are encouraged to engage in imaginative play and creative activities will likely grow up to respond strongly to hypnosis.
How can Hypnotherapy Help Pelvic Pain?
Hospitals now use hypnotherapy to help relieve pain and speed up recovery. For instance, at the University of North Carolina, hypnotherapy is used to treat irritable bowel syndrome. At the University of Washington’s regional burn center doctors use it to help ease their patients’ pain. Hospitals affiliated with Harvard Medical School are using it to speed up post surgical recovery time. Not to mention that many health-insurance plans now pay for hypnosis if it’s part of an accepted medical treatment.
So it makes sense that pelvic pain/dysfunction patients are also tapping into hypnotherapy as treatment tool. And there are a number of hypnotherapy techniques that are useful for pelvic pain/dysfunction.
“If moms can numb their pelvic floors to give birth comfortably using hypnotherapy, then pelvic pain patients can use it to help manage their pain,” says Cai.
One technique that works for pelvic pain patients is the “selective focus,” the strategy described above. Pelvic pain patients use it to shut off awareness of their pain. Besides “selective focus,” pelvic pain patients can use “guided imagery” to help turn down the volume on their pain.
Guided imagery is a hypnotherapy technique that directs thoughts and suggestions toward a relaxed and focused state. The guided imagery technique is huge when it comes to pelvic pain because one of the most common things we see is muscles that need to relax. Using the guided imagery technique helps to relax the muscles and return blood flow, which reduces pain by giving the tissues the nutrients and oxygen that they need to heal.
While a certified hypnotist can walk you through guided imagery, you can also use tapes or a script. As a matter of fact, there is a DVD available for pelvic pain patients that walks them through the guided imagery technique. It’s called “Guided Imagery for Women with Pelvic Pain, Interstitial Cystitis or Vulvodynia.” For more information on this DVD, click here .
Another hypnotherapy technique that can help with pelvic pain/dysfunction is the repetition of “therapeutic suggestion.” With this technique the patient receives daily repetition of suggestions of healthy images and ideas while in deep relaxation or in a trance state. For instance, if you have urethral burning as part of your pelvic pain, the therapeutic suggestion might be: “My urethra feels cool today.”
One of the main purposes of therapeutic suggestion, Cai explains, is to get the brain focused on the desired outcome of a calm, comfortable and healthy body. The subconscious brain does not know the difference between fact and fantasy. What often happens with chronic pain is a repetition of “I’m in pain. I’m in pain. I’m in pain.” or “This pain isn’t going away.”
It is completely understandable that these types of thought-loops would be created, and actually it would be unusual if they were not. However, this means that this pain message is continuously sent to the nervous system, which then creates a tension in the body, which then reinforces the idea and the experience of pain. The daily repetition of therapeutic suggestion has the potential to create a different, more comforting message to be sent to the nervous system helping the nervous system to quiet the nerves and relax the body.
When it comes to hypnotherapy for pelvic pain/dysfunction, Cai cautions that everybody will respond differently. “The scale can be anywhere from a 20% to a 100% reduction of pain,” she says. “I have not yet had a client who doesn’t experience some reduction, and when a person has been experiencing chronic pain, any reduction is welcomed.”
She also points out that to give hypnotherapy a real chance to work, you must be committed to it. “The brain changes through repetition and in general I find that the more a patient repeats the hypnosis practices, the more they receive benefit.”
PHRC Incorporates Mind/Body Techniques
At the Pelvic Health and Rehabilitation Center we’re beginning to explore how we can incorporate some of the tenets of hypnotherapy for pain management in our own treatment strategy.
In fact, we’ve already begun to add a few simple techniques we’ve learned in our research of hypnotherapy. For instance, we’ve made subtle changes in our language to promote comfort. In addition, we’re focusing on educating our patients on the mind/body connection and guided imagery techniques for relaxation and pain reduction. We have some literature on this subject, and refer patients to local hypnotherapists for further treatment. If you’d like to consult with a practitioner, a good place to begin might be the American Society of Clinical Hypnosis.
Now that I’ve given you the rundown of what I know, I want to hear your thoughts.
Have you ever tried hypnotherapy with a certified hypnotist? If so, please let us know if and how it helped you.
Have you ever tried any of the strategies mentioned in this post, like guided imagery or therapeutic suggestion? If so, what was your experiences with them?
If you haven’t tried hypnosis, is it something you’d be open to trying?
Also, are there any other alternative treatments that you think are helpful for pelvic pain/dysfunction? If so, what are they?
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All the very best,
Melinda Fontaine, DPT, is a staff physical therapist at the Pelvic Health and Rehabilitation Center. Click here to learn more about Melinda.