Hypnosis, an extraordinary Integrative Practice

By Isabelle CELESTIN-LHOPITEAU

- Director of IFPPC, the French institute for Mind-Body Practices (www.ifppc.eu).

- Head of the University Diploma in Mind-Body Practices and Integrative Health Studies, Paris Sud University and Réunion University.

- Head of the University Diploma in Hypnosis and Anaesthesia, Paris Sud University.

- Psychologist and Psychotherapist, at the Pain Assessment and Management Center, Bicetre University Hospital, Paris.

- President of the association 'Thérapies d’Ici et d’Ailleurs' (Translatable by: 'Therapies from here and elsewhere').

KEY WORDS:

HYPNOSIS, COMPLEMENTARY PRACTICES, INTEGRATIVE MEDECINE, INTEGRATIVE HEALTH

SUMMARY:

Hypnosis is a journey towards integrativity – this contemporary turning point that brings us from notions like practicing complementary healthcare and integrative medicine to the notion of integrative health. Hypnosis, by its nature, but also through hypnotic communication and self-hypnosis, is fully integrated in this change in perspectives brought about by the integrative pratice thinking.

           More and more institutions around the world offer mind-body practices to patients in their care pathway, sometimes developing fully integrative medicine. Simultaneously, patients resort to these pratices by themselves and associate them more and more easily, particularly when a symptom becomes chronic.

           A few years ago, this very fact motivated me to create a center which would allow for the discovery of various therapeutics in an integrative perspective, based on four key areas:

1 – Various mind-body practices are presented by health professionals and passed on to patients so that they can use them independently (hypnosis, yoga, performance optimization techniques, massage),

2 – The same practices are passed on to health professionals during training courses,

3 – The practices are then assessed through scientific research,

4 – Eventually creating a real think tank around complementary practices.[1]

           In this fourfold perspective, hypnosis has found its place in the IFPPC, the French institute for Mind-Body Practices in Paris, with the aim of developing resolutely integrative hypnosis. In this article, we will draw from this experience to focus on what role hypnosis could play in this integrative movement. How to think out hypnosis in the integrative perspective? What could be the role of this experience in the frame of health care aiming at healing pain and suffering for patients? And for health professionals themselves? What value would it bring to patients and caregivers... in learning self-hypnosis?

I - A CONTEMPORARY TURNING POINT TOWRDS INTEGRATIVITY

           In order to grasp and understand all the aspects of the integrative power of hypnosis, let's focus on this ongoing integrative movement, in which hypnosis fully takes part.

           Let us bear in mind that the development of complementary and integrative practices is modifying the world's therapeutic scene – even changing our medical glossary, with more and more frequent uses of terms such as integrative health, integrative medicine, complementary medicine, complementary therapies, mind-body practices, integrativity...

           In this integrative movement, we can single out three steps that make the world of care move first from the notion of complementary medicine to integrative medicine, and then to the notion of integrative health. In these three fields, hypnosis has a great role to play.

           1 – The term 'complementary medicine' covers a broad range of health practices, usually referred to as CAM – Complementary Alternative Medicine in English; and is defined by the US National Institutes of Health and by the Cochrane Collaboration as follows: 'a large and diverse set of healing ressources that bring together all the systems, methods and health practices – including their theories and beliefs – that differ from those that are intrinsic to the politically dominant health system in a particular society or culture, at a specific period of history'.

           As it is mentioned in the 2012 APHP report on complementary medicine, complementary treatments are often grouped together as follows[2]:

   • According to the nature of the treatment (4 categories)

           o Natural biological treatments (herbs and botanicals, dietary supplements, …)

           o Mind-body treatments (hypnosis, yoga, ...)

           o Manual body treatments (osteopathy, chiropractic, massage, ...)

           o Other health practices and approches (traditional medicine, ...)

   • According to the administering process (3 categories[3])

           o Self-administered (herbs and botanicals, dietary supplements, meditation, self-hypnosis, …)

           o Administered by a practitioner (hypnosis, acupuncture, massage, osteopathy, ...)

           o Self-administered with regular supervision (yoga, biofeedback, self-hypnosis, Tai-Chi, …)

           These practices are not integrated in the academic tradition, or in the dominant system of the country, and yet they are widely used by patients, especially when a symptom becomes chronic. They are thus identified as the practices used as a complement to conventional medicine (theferore clearly different from alternative medicines that are used instead of conventional medicine).

           2 – On the other hand, the notion of integrative medicine refers to integration – in patients' care pathways – of practices from conventional medicine and practices from complementary medicine – which are scientifically assessed as far as efficiency and security are concerned.

           Intregrative medicine takes into account the person as a whole – body, mind and spirituality – and it develops a personalized approach, gathering the practices of both approaches, while focusing on the therapeutic relation. Under this approach, the various aspects concerning the patients' way of life are taken into account, and prevention is a very significant issue.

           The key word is interdisciplinarity - or how a team can bring all the necessary and adapted cares to patients – whether these cares are from medicine or from complementary practices. Facing the variety of therapeutic practices and theoretical models, the integrative approach appears to be necessary. It forces us to continuously innovate care. And above all, it is a creative process, a dynamic prespective where practitioners and patients build a moving approach together. More and more, it seems important to build links, contacts between the different disciplines, practices, theorizations...

           And hypnosis lies in this integrative perspective, be it because of the numerous teams that are trained in hypnotic communication – a relational factor which facilitates the building of multidisciplinarity and interdisciplinarity – or be it because of the nature of hypnosis itself which allows for the integration of patients' various resources, internal or external.

           3 – Passing from the notion of integrative medicine to integrative health is clearly a new way in the therapeutic field. The fact that the NCCAM (National Center for Complementary and Alternative Medicines) evolved - logically - to NCCIH (National Center for Complementary and Integrative Health) in 2015 clearly underlines this turning point, thus highlighting the significance of prevention and integrative health. Note that for WHO, health is not merely the absence of disease but a state of complete mental, physical, emotional and spiritual well-being.

           It is no longer a question of informing, of offering complementary approaches or care pathways that combine various approaches; instead it is about allowing patients to integrate them, to be more independent in a daily practice, and therefore to develop a true way of life which will bring lasting changes.

           Hypnosis also fully fits into this perspective with the pratice of self-hypnosis – which allows patients to regularly recharge or find calm, and also to face stress and pain that arise, in a different manner.

           Thus, complementarity in care appeared as the first step. Integrativity is a logical sequel to it, and now, passing to the notion of health integrativity is a necessity that emphasizes the need for prevention and the importance of using different practices to take care of one's health. The use of hypnosis, which lies in these three perspectives – complementarity, integrativity and integrative health - truly has a role to play in these new health care perspectives.

II – HOW DOES HYPNOSIS FIT INTO THIS INTEGRATIVE MOVEMENT?

      HOW TO THINK ABOUT THIS PRATICE IN AN INTEGRATIVE PERSPECTIVE?

           Hypnosis has fully found its place in this evolution of care and prevention which is brought about by the integrative perspective. The practice of hypnosis follows three main lines:

           1 - It is a complementary practice for many indications,

           2 - It is an integrative practice, and even an integrative model,

           3 - It is a precious tool in the field of integrative health – as self-hypnosis can be recommended to patients so that they integrate hypnosis in their daily life.

           Let us examine these three axes in detail.

1 – Hypnosis as a complementary practice in the care pathway

           There are many studies showing the effectiveness of hypnosis as a complementary practice for several indications such as managing pain, stress, phobias, neurological disorders ... (Vanhaudenhuyse A., Faymonville M-E., 2015; Flamand-Roze C. 2016).

           The significance of hypnosis is well underlined in these studies (Vanhaudenhuyse A., Faymonville M-E., 2015, Lindfors P 2012, Kohen D.P. 2010), and above all, in its potential in the field of integrative health, the aim of which is to accompany patients and render them more independent. Many hospital units have integrated it in their treatment offerings, as a complement to medical care and to psychological care.

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2 – Hypnosis as an integrative practice

           Hypnosis is part of the integrative movement, both as an integrative model and as an integrative practice.

           a – Hypnosis as an integrative model

                       The nature of hypnosis is integrative in itself:

           It is a practice in which connections and relationships are essential. Observing the hypnotic process reveals that healing with hypnosis is actually bringing a person to change his/her sensorality, to push aside a restricted perception for a different type of perception, and to enter a new opening phase.

           This opening phase is the moment when adjustments and changes can occur. When we suffer from pain, depression, anxiety, we are stuck in our life by these symptoms which prevent us from having a stable relation to the world and to ourself. They are a break in the permanent flow of change and in our capacity to adapt to change and to focus on it. By focusing on them, the symptom ends up influencing our whole field of perception.

           As an arousal of awareness and attention, hypnosis allows us to remove focus from the symptoms in order to relate back to all the elements of life.

           Generally speaking, the hypnotic process allows us to move from a usual perception which tends to separate and divide, to a perception that integrates whithout opposing the various elements of life. As François Roustang – a philosopher and hypnotherapist- recalls[4]:

          'I simply put the symptom back in the whole self of the person, without trying to give it a specific meaning, without trying to interpret it. I suggest that the person not take into account the symptom precisely, as it becomes what itself only because it is isolated. Put it back into your life as a whole and it will disappear...'

           As hypnosis is an ideal mind-body practice, it does not dissociate the body from the mind and allows us to experience the whole.

                       Hypnotic communication, an ideal integrative model:

           The hypnotic experience demonstrates that an integrative practice can lie at the heart of communication between practitioners and patients, at various levels.

           Hypnosis is not a mere juxtaposition of techniques but an art of communicating which invites us to integrate the patients' problems by activating their strength and ressources – whereas many therapies focus on their problems and overlook their strengths (Gassman and Grawe, 2006). This particular attitude in care represents a very interesting model for other complementary practices.

           Note that the words used in hypnosis somehow focus on links, putting aside words referring to a break in the thinking. In itself, hypnotic communication is a stimulus for fluidity where everything can be accepted and integrated at the same time.

           This communication practice is in line with the practitioner's willingness to adapting to the patient, in order to facilitate change – thus making it a model for the integrative approach which is to be dynamic and creative.

                       Hypnosis as an integrative means to link current practices and older ones:

           Many mind-body practices originate from traditional practices - the various forms of meditation, yoga, Qi Gong, hypnosis... In fact, hypnosis is our current way, our cultural way to experience transe. This opening process does exist – in other forms or under other names – in other cultures within very ancient traditional types of medicine.

           Hypnosis has grown from its roots with transe, but also from more recent neuroscientific discoveries. It is now a fully fledged tool in many hospital units – pain management centers, anaesthesia or resuscitation units, … The practice of hypnosis is now widely spread in units for a better management of pain, and it has entered many people's daily life.

           Interestingly enough, hypnosis, as many other traditional practices which are integrated into our units, can not be a mere copy of ancient or eastern techniques, but a modern synthesis of these traditions and of our current representations of care, derived from the concepts originating from various cultures and periods. This synthesis, this adaptation, this dialogue between various representations and practices, this is also what the integrative movement consists of.

           b – The practice of hypnosis as fully part of the integrative approach

           How could we define an integrative approach?

           Several integrative approaches emerge from scientific literature[5] and propose to:

1. Incorporate and absorb new tools in one's personal practice and conceptualization,

2. Juxtapose various tools or care frameworks without overlapping them, thus multiplying perspectives,

3. Develop a theoretical metamodel from the synthesis of various theories,

4. Determine the specific effectiveness of such or such technique on such or such patient, for such or such problem.

           Let us study how hypnosis fully fits within these various approaches.

                       Hypnosis allows for the integration of numerous other practices and concepts:

           Hypnosis allows the incorporation or assimilation of numerous other practices, and vice versa, to be integrated among these. It can also integrate a therpeutic model or associate different theoretical models.

           For example, Hypnosis can be induced by a breathing technique from yoga or a movement work from Qi Gong. A meditation period can also be introduced at the end of a session, if we feel the need to settle down the thinkingmind. Moreover, hypnosis can be used as an exploration tool in an analytic therapy, or even as a step for CBT.

Hypnosis allows us to juxtaposate different tools, to associate various care frames and to gather different health professionals:

           Indeed, all the tools can be proposed: paradoxes, body, metaphors... Practitioners can have patients experiment different practices to permanently adapt to the person, to have them change pain, modulate it, or go through an emotion...

           Hypnotic communication and the practice of hypnosis can be shared by various health professionals, and integrated into their own field of competence, as complementary practices. They bring a different way of being with patients, like a main thread in the care pathway, a synergy between the various health professionals.

       In its integrative perspective, hypnosis incites the development of a particular reflection on change:

           Beyond the various practices and conceptual references, common therapeutic ingredients do emerge, and their synergy promotes change. In an integrative approach, putting into perspective hypnosis and other mind-body practices (yoga or Qi gong for instance) highlights the importance of some common factors or transversal ingredients:

                                  • Paying attention to the present moment, to oneself, to the world:

           Entering a hypnosic state is to regain contact with oneself, to simply be here and now, to remove oneself from the permanent worrying about the past or future. It means coming back to the present moment. Hypnosis, meditation or yoga, ... are 'being to the world'. This is an experience that can happen everyday, at any time. These various paths show us that the genuine difficulty is understanding that 'being to the world'... does not require any effort. This attitude appears to be very useful for patients suffering from chronic pain, and more generally for everyone who feels too much pressure trying to reach an objective. Fritz Perls clearly sums up this paradox in the process of change: 'To be willing to change is the greatest obstacle to change'. Putting will aside, letting-go, seems essential in the process of change. This corresponds to a common idea in the Zen philosophy: 'tis when willing to follow the path that you go astray'.

           This self-presence is presence to the world. For all these practices, which are suggested within a therapeutic framework, far from seperating us from the world, they connect us more intensely. Facing a world where attention is fragmented (frequent intrusion of adds on TV, numerous SMS or e-mails, and often overstimulation from numerous activities at work or during leisure... all of which do not leave time to settle down or dream), taking breaks and having time with oneself seem more and more essential.

           As for most mind-body practices which focus attention back on the present time, hypnosis restores the place of the body and of sensorality in the process of change. Changing is not only a question of understanding and knowing the world via the thinking ego, but also through sensorality.

                                  • Going with the flow of life:

           When we focus on the possible impact of symptoms in a person's life – pain, depression, anxiety, ...- we note that we are stuck in our lives by these symptoms and that they take us away from a stable relationship with the world and ourselves. They are a break in the permanent movement of change. This leads us to formulate the following observation: 'what we are treating in fact is immobilization'.

           Changing is to get moving again. Doing Qi Gong movements, meditating, having a massage or massaging oneself, using hypnosis or self-hypnosis, or yoga; all these means tend to put people back into the movement of life. Just as in yoga, we experiment with the fact that a flexible body and mind will allow us to face unavoidable changes in life. A regular practice of asanas (yoga poses) develops flexibility. This notion of flexibility and fluidity is essential in hypnosis, and in the integrative approach more generally.

                                  • Being capable of going through one's emotions

           The work during hypnosis or during meditation is not about avoiding difficult feelings, but more a question of not nurturing them. Incidentally, etymologically speaking, 'emotion' comes from the latin emovere which refers to the idea of 'setting in motion, putting movement into'. Emotions are very efficient warning signs – anger for frustration, fear for danger, etc. But once the warning role is over, we should not nurture them and let them rule our lives. They are 'good servants, but poor masters'. We can learn how to welcome our emotions and go through them. This allows us to develop genuine self-confidence, a feeling of inner security, feeling one's stability when everything is fine, and maintaining it when stress appears.

           Scrutinizing one's thoughts, breaking free from mental constructs: hypnosis helps us to learn how not to let an emotion – and more generally a thought – take over. We learn how to break free from any mental construct, how to follow the movement of thoughts, without judging or justifying. Entering a hypnotic state is not a state but a process. It is about discovering the process of one's whole self.

                                  • Breathing techniques: an ideal integrative tool

           Breathing is at the heart of meditation, hypnosis, yoga, and Qi Gong: once the body is in a stable position for a certain time, a calm breathing rate can set in. 'When the breating is restless, the mind is restless too. When the breathing is still, the mind is still...' (Hatha-Yoga Pradipika). Stilling the breath allows us to still the mind efficiently. Moreover, breathing is one of the most efficient ways to connect to the present moment. Paying attention to one's breathing is being connected to the permanent movement of life – breathing is at the heart of change. This focus on breathing or the conscious modulation of breathing are used both in hypnosis and self-hypnosis as a quick starting point.                 

Identifying the specific effectiveness of such or such hypnotic technique for such or such patient and such or such problem is a key issue in hypnosis - to actually adapt to the patient

           Hypnosis is a permanent adaptation to the patient by the practitioner. The idea is not to anticipate patients but rather to accompany them. Concerning pain, when it is acute and overwhelms the whole attention of patients, we have noticed that a relaxation induction is not the most adapted, compared to an induction starting from the perception of this pain, with the aim of modifying it.

           Lao-Tzu said: 'He who thinks does not feel, he who feels does not think'. When the idea is to have a person set aside his/her mental imagination, focusing the attention on sensorality appears to be an efficient means. When pain draws the attention on the body, bringing someone to look for an image – as it is done with reification – or inother words to focus on the mind, allows for modifying the perception of this pain. Identifying what is eventually the most efficient technique is at the heart of the permanent adaptation of the practitioner concerning the patient.

3 – Hypnosis: an integrative health technique

           The integrative perspective also has a role to play in everyday life by urging us to modify what health means to us. The term 'health' here leaves aside the old definition of 'absence of disease', and expands it to a wider sense of balance or stability, of fulfillment in the various aspects of life – body , emotions, intellect and spirit.

           With self-hypnosis, hypnosis is then fully part of this integrative health perspective where the various aspect of the patients' way of life are taken into account, and where prevention prevails. When looking for common ingredients, we do find interesting food for thought when imagining a way to integrate self-hypnosis in an efficient and quick way, when pain or stressful situations appear. It is also food for thought for how to use self-hypnosis in order to be fully present to the world, and to oneself, in the present moment.. and getting in on the action.

           A variety of breathing and posture hypnosis techniques – which in fact come from yoga and meditation or Potential Optimization Techniques – will facilitate the integration of hypnosis in daily situations and also in situations of pain or stress.

           Using integrative thinking allows us to optimize the practice of hypnosis in order to relieve pain and suffering for patients and for health professionals. The latter point is essential in the integrative approach.

CONCLUSION

           The term 'integrative' – rather than 'integrated' – is interesting in the way that it refers to a movement, to a process. Integration refers to permanent creativity in health care and daily life. In this article, we have seen how hypnosis effectively fits in an integrative approach, being a complementary practice, an integrative model and an integrative health tool at the same time.

           The integrative perspective in care alters communication between patients and healers, and therefore the therapeutic relationship. The state of mind which prevails in this new attitude is based on openness, adaptation, flexibility and a real willingness to render patients independent, without being dogmatic.

           As care givers, this attitude leads us to integrate and welcome new ways of thinking. It urges us to widen our perspectives and to take a new look at our own therapeutic practices. Hence, it forces us to develop a new perspective for our own practice. This notion of integrative health puts patients back in the centre, and requires a change in attitude from practitioners. This may also be a challenge for integrative medicine: reasserting the importance of the relationship between patients and healers.

           Hypnosis, as many other mind-body and integrative health therapies, cannot be reduced to mere techniques, but should be considered as many different ways to establish communication and relations with patients.

BIBLIOGRAPHY

Célestin-Lhopiteau I., Se soigner par les pratiques psychocorporelles. Dunod, 2015.

Flamand-Roze C., Célestin-Lhopiteau I., Roze E., Hypnosis and movement disorders: State of the art and perspectives. Revue Neurologique, 2016, Volume 172, Issue 8, Pages 530-536,

Kohen D.P. (2010). Long-term follow-up of self-hypnosis training for recurrent headaches: What the children say. International Journal of Clinical Experimental and Hypnosis, 58 (4), 417-432.

Lindfors P., Unge P., Nyhlin H. et al.: Long term effects of hypnotherapy in refractory irritable bowel syndrome. Scand J Gastroenterol 2012 ; 47 : 413-20,

Vanhaudenhuyse A., Faymonville M-E. [Interest of hypnosis in healthcare].., La Revue du praticien 04/2015; 65(4):457-9. 0,

[1]Partly inspired from the teaching in the Leadership Program in Healthcare, Duke University, NC, USA.

[2]National Center for Complementary and Alternative Medicine http://nccam.nih.gov

[3]Manheimer E. , Berman B. Cochrane Complementary Medicine Field. About The Cochrane Collaboration (Fields) 2008, Issue 2.Art. No.:CE000052.

[4] Interviewed by Léon Wisznia for the website 'Conférences et débats.fr' (the agenda of knowledge and ideas, Paris and Ile-de-France),

[5] See 'Aide-mémoire – Hypnothérapie et hypnose médicale', Antoine Bioy, Isabelle Célestin-Lhopiteau and al., Dunod, 2012.