MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

hypnotherapy

In this case study, the authors describe an adult patient who struggled with persistent warts on the plantar surface of the foot for several years. All medical therapies were exhausted, so the patient turned to medical hypnosis as a last resort.

The patient experienced complete resolution of all his warts after three sessions of medical hypnosis. The suggestions used in the treatment included:

  • strengthening the immune system,
  • increasing blood flow in the foot,
  • visualizing immune mechanisms destroying infected cells,
  • the regrowth of healthy tissue.

After 3 years, the authors are still in contact with the patient, and he reports no recurrence of the disease.

The authors concluded that this case report adds to the existing body of the literature supporting the use of medical hypnosis in the treatment of warts. It demonstrates that medical hypnosis can be a valuable complementary or alternative treatment option for patients with persistent warts who have not responded to conventional therapies. It also highlights the need for further research to better understand the mechanisms by which hypnosis influences the resolution of warts and to identify the most effective types of suggestions for treatment.

Oh, dear!

Warts are viral infections. They can persist for months and years and disappear suddenly without apparent reason. What the authors of this case report observed is exactly this phenomenon of spontaneous recovery. There is no sound evidence that hypnotherapy or any similar treatment will speed up the disappearance of warts.

Many years ago, we did a trial of ‘distant healing’ for warts. It confirmed the ineffectiveness of this approach:

Purpose: Distant healing, a treatment that is transmitted by a healer to a patient at another location, is widely used, although good scientific evidence of its efficacy is sparse. This trial was aimed at assessing the efficacy of one form of distant healing on common skin warts.

Subjects and methods: A total of 84 patients with warts were randomly assigned either to a group that received 6 weeks of distant healing by one of 10 experienced healers or to a control group that received a similar preliminary assessment but no distant healing. The primary outcomes were the number of warts and their mean size at the end of the treatment period. Secondary outcomes were the change in Hospital Anxiety and Depression Scale and patients’ subjective experiences. Both the patients and the evaluator were blinded to group assignment.

Results: The baseline characteristics of the patients were similar in the distant healing (n = 41) and control groups (n = 43). The mean number and size of warts per person did not change significantly during the study. The number of warts increased by 0.2 in the healing group and decreased by 1.1 in the control group (difference [healing to control] = -1.3; 95% confidence interval = -1.0 to 3.6, P = 0.25). Six patients in the distant healing group and 8 in the control group reported a subjective improvement (P = 0.63). There were no significant between-group differences in the depression and anxiety scores.

Conclusion: Distant healing from experienced healers had no effect on the number or size of patients’ warts.

My conclusion of the above case study is therefore very different from that of the original authors:

This case report adds nothing to the existing body of the literature on medical hypnosis or on the treatment of warts other than misleading the public.

The history of so-called alternative medicine (SCAM) is rich with ‘discoveries’ that are widely believed to be true events but that, in fact, never happened. Here are 10 examples:

  1. DD Palmer is believed to have cured the deafness of a janitor by manipulating his neck. This, many claim, was the birth of chiropractic. BUT IT NEVER HAPPENED! How can I be so sure? Because the nerve responsible for hearing does not run through the neck.
  2. Samuel Hahnemann swallowed some Cinchona officinalis, a quinine-containing treatment for malaria, and experienced the symptoms of malaria. This was the discovery of the ‘like cures like’ assumption that forms the basis of homeopathy. BUT IT NEVER HAPPENED! How can I be so sure? Because Hahnemann merely had an intolerance to quinine, and like does certainly not cure like.
  3. Edward Bach, for the discovery of each of his flower remedies, suffered from the state of mind for which a particular remedy was required; according to his companion, Nora Weeks, he suffered it “to such an intensified degree that those with him marvelled that it was possible for a human being to suffer so and retain his sanity.” This is how Bach discovered the ‘Bach Flower Remedies‘. BUT IT NEVER HAPPENED! How can I be so sure? His experience was not caused by by the remedy, which contain no active ingredients, but by his imagination.
  4. William Fitzgerald found that pressure on specific areas on the soles of a patient’s feet would positively affect a specific organ of that patient. This was the birth of reflexology. BUT IT NEVER HAPPENED! How can I be so sure? Because there are no nerve connections from the sole of our feet to our inner organs.
  5. Max Gerson observed that his special diet with added liver juice, vitamin B3, coffee enemas, etc. cures cancer. This is how Gerson found the Gerson therapy. BUT IT NEVER HAPPENED! How can I be so sure? Because he never could demonstrate this effect and others never were able to replicate his alleged finfings.
  6. George Goodheart was convinced that the strength of a muscle group provides information about the health of inner organs. This formed the basis for applied kinesiology. BUT IT NEVER HAPPENED! How can I be so sure? Because applied kinesiology has been disclosed as a simple party trick.
  7. Paul Nogier thought that the function of inner organs can be influenced by stimulating points on the outer ear. This was the discovery that became auricular therapy. BUT IT NEVER HAPPENED! How can I be so sure? Because Nogier’s assumptions fly in the face of anatomy and physiology.
  8. Antom Mesmer discovered that by moving a magnet over a patient, he would move her vital fluid and affect her health. This discovery became the basis for Mesmer’s ‘animal magnetism‘. BUT IT NEVER HAPPENED! How can I be so sure? Because there is no vital fluid and neither real nor animal magnetism have specific therapeutic effects.
  9. Reinhold Voll observed that the electric resistance over acupuncture points provides diagnostic information about the function of the corresponding organs. He thus invented his ‘electroacupuncture according to Voll‘ (EAV). BUT IT NEVER HAPPENED! How can I be so sure? Because EAV and the various methods derived from it are not valid and fail to produce reproducible results.
  10. Ignatz von Peczely discovered that discolorations on the iris provide valuable information about the health of inner organs. This was the birth of iridology. BUT IT NEVER HAPPENED! How can I be so sure? Because discolorations develop spontaneously and Peczely’s assumptions about nerval connections between the iris and the organs of the body are pure fantasy.

I hope that you can think of further SCAM discoveries that never happened. If so, please elaborate in the comments section below; you will see, it is good fun!

PS

By sating ‘IT NEVER HAPPENED’, I mean to say that it never happened as reported/imagined by the inventor of the respective SCAM and that the explanations perpetuated by the enthusiasts of the SCAM regarding cause and effect are based on misunderstandings.

Third molar extraction is a painful treatment and thus is often used to investigate the effects of analgesics on pain. Hypnotherapy is said to help to reduce pain and to decrease the intake of postoperative systemic analgesics. Therefore, it seems reasonable to study the effects of hypnotherapy on the pain caused by third molar extraction.

In this study, the effectiveness of a brief hypnotic induction for patients undergoing third molar extractions was investigated. Data were collected from 33 patients with third molar extractions on the right and left sides. Patients received two different types of interventions in this monocentric randomized crossover trial. Third molar extraction was conducted on one side with reduced preoperative local anesthetics and an additional brief hypnotic induction (Dave Elman technique). The other side was conducted with regular preoperative local anesthetics without a brief hypnotic induction (standard care). Intake of postoperative systemic analgesics was allowed in both treatments.

Patients’ expectations about hypnosis were assessed at baseline. The primary outcome was the area under the curve with respect to ground of pain intensity after the treatment. Secondary outcomes were the amount of postoperative analgesics consumed and the preferred treatment.

There was no evidence that the area under the curve with respect to ground of pain differed between the two interventions (controlling for gender). There was, however, evidence to show that the patients’ expectations affected the effectiveness of the brief hypnotic induction. This means that patients with high expectations about hypnosis benefit more from treatment with reduced preoperative local anesthetics and additional brief hypnotic induction.

The authors concluded that, in this study, additional a brief hypnotic induction with reduced preoperative local anesthetic use did not generally reduce posttreatment pain after third molar extraction more than regular local anesthetics. The expectation of the patients about the effectiveness of hypnosis affected the effectiveness of the brief hypnotic induction so that patients with high expectations had a larger benefit from a brief hypnotic induction than patients with low expectations.

The most interesting findings here are, in my view, that:

  1. Hypnotherapy is not as effective as many enthusiasts claim.
  2. Expectation influences the outcome of hypnotherapy.

Expectation is, of course, a determinant of the size of the placebo response. Thus, this finding is interesting but far from unexpected. I would go as far as postulating that similar results would be obtained with most treatments regardless of whether they are alternative or conventional. The difference is that, in the case of alternative therapies, the expectation is a major (if not the only) determinant of the outcome, while it merely somewhat improves the outcome of an effective treatment. To put it differently, so-called alternative medicine (SCAM) relies entirely/mostly on expectation, while conventional medicine does not.

Conversion therapy has been banned last week in Canada. These therapies – also known as sexual orientation change effort (SOCE), reparative therapy, reintegrative therapy, reorientation therapy, ex-gay therapy, and gay cure – rely on the assumption that sexual orientation can be changed, an idea long discredited by major medical associations in the US, the UK, France, and elsewhere. The new law makes “providing, promoting, or advertising conversion therapy” a criminal offense. It will also be an offense to profit from the provision of conversion therapy. In addition, the bill states a person cannot remove a “child from Canada with the intention that the child undergo conversion therapy outside Canada.” Prime Minister Justin Trudeau hailed the law’s Royal Assent: “It’s official: Our government’s legislation banning the despicable and degrading practice of conversion therapy has received Royal Assent — meaning it is now law.”

Conversion therapy is the attempt to change an individual’s sexual or gender identity by psychological, medical, or surgical interventions. Often, informed consent is insufficient or lacking. In conventional medicine, numerous treatments have been tried for this purpose, some of them dangerous and all of them ineffective. In alternative medicine, approaches that have been advocated include:

  • Homeopathy (see below),
  • Hypnotherapy,
  • Spiritual healing,
  • Prayer,
  • Eye Movement Desensitization,
  • Rebirthing,
  • and others.
Survey data imply that conversion therapy is still disturbingly popular, often leads to undesirable outcomes, and is most frequently practiced by:
  • Faith-based organizations or leaders
  • Licensed healthcare professionals
  • Unlicensed healthcare professionals

As previously reported, the German ‘Association of Catholic Doctors’ claimed that homeopathic remedies can cure homosexuality. Specifically, they advised that ‘…the working group ‘HOMEOPATHY’ of the Association notes homeopathic therapy options for homosexual tendencies…repertories contain special rubrics pointing to characteristic signs of homosexual behavior, including sexual peculiarities such as anal intercourse. And a homeopathic remedy called ‘Dr. Reckeweg R20 Glandular Drops for Women’ was claimed to treat “lesbian tendencies.” The product is “derived and potentised from fetal tissues.”

Several countries are now in the process of banning conversion therapy. France has already banned it and so has Germany. The UK government intends to introduce a legislative ban on the practice of conversion therapy. The consultation on how to best do this is open until 4 February 2022.

We all know, I think, that chronic low back pain (CLBP) is common and causes significant suffering in individuals as well as cost to society. Many treatments are on offer but, as we have seen repeatedly on this blog, not one is convincingly effective and some, like chiropractic, is associated with considerable risks.

Enthusiasts claim that hypnotherapy works well, but too little is known about the minimum dose needed to produce meaningful benefits, the roles of home practice and hypnotizability on outcome, or the maintenance of treatment benefits beyond 3 months. A new trial was aimed at addressing these issues.

One hundred veterans with CLBP participated in a randomized, four parallel group study. The groups were (1) an eight-session self-hypnosis training intervention without audio recordings for home practice; (2) an eight-session self-hypnosis training intervention with recordings; (3) a two-session self-hypnosis training intervention with recordings and brief weekly reminder telephone calls; and (4) an eight-session active (biofeedback) control intervention.

Participants in all four groups reported significant pre- to post-treatment improvements in pain intensity, pain interference and sleep quality. The three hypnotherapy groups combined reported significantly more pain intensity reduction than the control group. There was no significant difference among the three hypnotherapy groups. Over half of the participants who received hypnotherapy reported clinically meaningful (≥30%) reductions in pain intensity, and they maintained these benefits for at least 6 months after treatment. Neither hypnotizability nor amount of home practice was associated significantly with treatment outcome.

The authors conclude that two sessions of self-hypnosis training with audio recordings for home practice may be as effective as eight sessions of hypnosis treatment. If replicated in other patient samples, the findings have important implications for the application of hypnosis treatment for chronic pain management.

Even though this trial has several important limitations, I do agree with the authors: these results would be worth an independent replication – not least because self-hypnosis is cheap and does not carry great risks. What would be interesting, in my view, are studies that compare several alternative LBP therapies (e.g. chiropractic, osteopathy, acupuncture, massage, various form of exercise and hypnotherapy) in terms of cost, risks, long-term effectiveness and patients’ preference. I somehow feel that the results of such comparative trials might overturn the often issued recommendations for spinal manipulation, i.e. chiropractic or osteopathy.

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