Hello, I'm Paul Evans. Welcome to Airing Pain, a programme brought to you by Pain Concern, the UK charity providing information and support for those of us living with pain and healthcare professionals. This edition's been funded by a grant from the Dorothy Howard Charitable Trust. Harnessing the power of the mind to control or manage pain is something we've explored many times on Airing Pain, be it through mindfulness, cognitive behavioural therapy, mirror therapy, or even groundbreaking research into neuroengineering, where patients have trained themselves to identify the part of the brain that controls their pain, and then reduce that pain. With such innovation, it's tempting to think that only now, in this age of discovery, are we beginning to fully understand the potential of the minds to manage pain. But go back through the millennia, even to prehistory, and we find that priests, shamans and witch doctors have attempted to bring about healing by inducing an altered state of consciousness. In effect, hypnosis. Now, you might associate hypnosis with entertainment programmes, where members of the public are induced to perform weird and wonderful acts of stupidity in front of an audience. That is stage hypnotism. Not to be confused with anything beyond the shallow realms of showbiz.
The British Society of Clinical and Academic Hypnosis promotes the safe and responsible use of hypnosis in medicine, dentistry and psychology. Its aim is to educate both professionals and the public about hypnosis and its uses. In the British Pain Society's annual scientific meeting of 2014 I met Dr Anne Williamson, a retired GP who's been involved in hypnosis since the late 1980s and who's been training health professionals for more than 20 years. So what is hypnosis? My way of thinking of hypnosis is that it's...
A meditative type state, I suppose, where you have your normal outside awareness and you have your internal awareness. And in hypnosis, you focus internally. But within a session, that can go up and down so that somebody can be more aware of what's going on outside and then less aware. It's a bit like reading a good book. You get lost in a good book and you lose awareness of what's outside. But if someone was to call your name or shout fire, you'd be off and up. So how does it differ from meditation? The aim is different. The aim in meditation is to empty your mind and to become one with.
Life falls, God, however you want to language it. In hypnosis, the aim is emotional management of some sort or experiencing a goal because hypnosis is very experiential. You kind of step into the you that you want to be and associate with it and feel it. So it's a much more experiential way of working with something. So the me that I want to be could well be a completely fit person.
It's got to be realistic. If I am 20, 30 stone and my goal is to climb Everest, that's not going to be realistic. But when I step into that imagining, I'll know it's not realistic. The intuitive part of me will understand that. For instance, a pain patient will be wanting to reduce their pain.
feel comfort, feel calm. So you can go in the hypnotic state and you can go to places and times when you have those feelings and re-access them. You can link them to things that you can bring to the front of your mind, which will then take you back into it. There's been interesting work done with phantom limb pain, one of our colleagues. I don't know if you're aware of one of the treatments for phantom limb pain is the mirror box. Well, what she does is get the person to imagine moving that hand or that arm or that leg in hypnosis. And we know from neuroscience findings that...
What you imagine in hypnosis, the same parts of the brain light up as in reality, or very similar, whereas just thinking about it, it doesn't. So there's something there that is giving us access, if you like, to these mind-body links. So hypnosis is more than just relaxation. I suppose thinking about being well, being without pain, is maybe wishful thinking. It's thinking about something that is not there, and maybe thinking about it is not a good thing to do anyway, because you're trying to imagine what will never happen.
That's why I think it's got to be tailored to the individual case. I've met people with fibromyalgia, for instance, who have had a lot of pain and have been very disabled by it, but giving them the tool of self-hypnosis, of using imagery to help them reduce their pain directly, which some people can do, and then also to look at the underlying psychological drivers of the fibromyalgia. Like anything else, it's mind and body, and they're very interlinked. That can actually reduce the pain, not just through relaxation, but it can actually reduce the pain intensity. We know people can modulate pain intensity. They can have surgery under hypnosis. Some people can, who have got that ability. It's wishful thinking, yes, but if you focus on the pain, then you're just going to focus more and more into the pain. If you focus on what you want, which would be comfort, or a greater degree of comfort, or being more able to cope.
feeling more able to take an interest in something outside of your pain then that will in itself reduce the pain. How does this differ in outcome from a talking therapy like acceptance and commitment therapy? I think that any talking therapy if you're in deep rapport with someone and you're talking they enter if you like a semi-hypnotic state anyway. So I think a lot of good therapists. are using the hypnotic state, even though they're not aware of it. When someone's in a great deal of pain or a great deal of anxiety, they're already in, working, their brain is processing, if you like, in a hypnotic type state. That's why hypnosis can be used very effectively in things like emergency medicine, when somebody is already in that frame of mind. I think hypnosis facilitates lots of different therapeutic approaches. Hypnosis on its own is just the state of mind. It's what you do with it that's important.
It's altering the person's focus of attention. And by altering their focus of attention internally in that hypnotic state, suggestions are more readily taken on board because they can experience and they can feel them. If you like, another way of looking at it would be a storyteller. I don't know if you've ever experienced a really good storyteller coming into the room and holding a whole audience entranced. And we say it's entranced. This is the same way. They're all in that kind of hypnotic state at that point. But what they're doing with it is different than in clinical hypnosis. So it's a state we go in and out of quite naturally. Sportsmen refer to the zone, don't they? Yes, being in the zone, same thing. And it's that business, I guess, of being able to shut off all the pressures, all that's going around. It's just totally focused. I'm thinking of somebody kicking a penalty in Wembley. If that were me, the fear.
of humiliation, of failure. But of course, as soon as you start thinking of that, that will put your performance off. So they learn to be completely focused. That's why hypnosis and hypnotic techniques are used in a lot of sport and athletics, a lot of Olympic athletes, because to get that edge, you need to be able to do that. And some people are more able to do it than others. So some people find it really hard to actually focus attention. But everyone has got an ability. If you use a right-left brain model, if we are functioning normally in our conscious waking state in our left brain, and going into a relaxed state or focus of attention is...
It tends to be a right brain process. I've got one brain, and I know it's got two sides. So what's going on? So if you think of the left side of the brain as our intellectual, rational, reasoning, conscious, awareness part, I mean, this is a model. It's not the truth. It's just a way of looking at things. And the right side of our brain is our emotional, creative, intuitive, memory part. Take, say, a phobia of a spider. Logically, it's totally crazy to be so terrified of that little spider down there. But telling myself that doesn't really help.
I still get that overwhelming feeling, and we know some of the brain pathways of why that happens. But to be able to work with both types of processing, you need something that links. And the one thing that links is visualisation. You can paint a word picture, and the right brain thinks in pictures, symbols, metaphor, and the left brain uses words. So we can talk, if you like, to both types of our processing, to our heart and our head, by using imagery. I mean, if you think of all the great teachers, they use parable, stories, metaphor. Why? Because it's a good way to get something across.
We tend to very much think in the cognitive side of things, but actually the bit that drives us more than anything is our emotional part. So we need something that will work at both levels. That's where I think hypnosis and that type of approach works. If I were to draw a diagram of me, I would think, and you can tell me if I'm wrong, that I'm doing all my reasoning on this, my left-hand side, but the real me, the emotion, the arts, what makes me is on my left side, and somehow you need to join those two sides together. That's the aim of all therapy, really, isn't it? To marry and make links between our intellectual understanding and our emotional understanding, to make those links and make those processes work together. If you're in great pain or if you're in great distress, you're in that emotion and you haven't got access to your adult rational cognitive processing. You're into the emotion, into the feeling, and you need both. It was rational to be afraid of spiders in our evolutionary past. Possibly. And that still stays there.
Which links in with fight and flight and pain mechanisms. So how does hypnosis come in to break some of those things? Depends on the causation of pain to some extent. I mean, the fight and flight, obviously, if you're tense and you're in an adrenaline state, your pain is going to be worse. Or your perception of pain is going to be worse. So anything that will reduce that will be helpful.
But then you've also got the psychological underpinnings of pain. Pain isn't just tissue damage or organ damage. It's all the rest. It's the whole pain uromatrix that gets involved. And hypnosis can help psychotherapeutically. Using the hypnotic snake can kind of help people to explore and resolve whatever might be underlying those problems, but giving rise to the pain. Dr Anne Williamson of the British Society of Clinical and Academic Hypnosis. Dr Jane Boissier, also of the Society, was a GP for 12 to 13 years. She was also a house practitioner in psychiatry.
When I was trying to persuade my GP patients to come and see me at my day's psychotherapeutic hospital, I would say to them that if you imagine the brain is a room and you've got a cupboard at one end, we've all got a room and a cupboard. And what we do is during the course of our life, we put all the rubbish in the cupboard, we close the door and we live in the tidy part of the room. And then one day, along comes a bit of rubbish, might not be that big a piece of rubbish, you try to fit it in the cupboard and there's no more room. The cupboard door bursts open, you have rubbish all over the room. and you are in a state of panic, anxiety, depression, whatever. And what you do is you try to put all that rubbish back in the cupboard and close the door tight. And you might manage to do that to begin with, but you're sitting on top of a volcano. And so if you've got too much rubbish in your cupboard, what you need to do is sort it out. And that's what we used to do at the day psychotherapy hospital. We would have to spring clean. Now, spring cleaning's not a good job, all right? You have to pull out all the rubbish, sort it all out, throw away or put it back tidily, because obviously you can't get rid of those things, but if you put it back tidily, then you will have...
more room in that cupboard for all the other rubbish that is bound to occur during the course of your life. And so that was how I would explain what we were going to do at the Day Psychotherapy Hospital. But spring cleaning is incredibly messy. When I stopped being a GP and doing the psychiatry, I was really missing seeing patients. And it was then that I discovered hypnosis. And what I discovered with hypnosis was that all this rubbish that was in the cupboard, you didn't have to pull it all out, sort it all out and put it back.
It was so much easier than that. So much easier. It was like having an ultrasound scan. Because all you had to do was ask the unconscious mind which bit of rubbish was causing the trouble. It would sort itself out with a few clues and tips and whatever.
and all would be well. You didn't need to pull all this rubbish out. You didn't need to cause a huge mess in the room. You could actually go straight to the point that was causing... And often it would be something very minor. You know, because my training was in psychiatry, I would do a full psychiatric history before I would do anything at all. So you do the full psychiatric history. You know, some people have had horrendous lives, a huge amount of trauma and distress, and you could come up with all kinds of theories as to what might be causing their symptoms. And very often you would be wrong.
It would be something much smaller, minor, that you'd not even considered to be important, that had caused the upset or the distress. So you can't always make assumptions. We think that our frontal lobes are in control, but actually it's your unconscious mind, often, that is in control. So if you have a behaviour or a symptom that you don't understand, that you don't know what it's about, I would say to patients who were referred to me, if you have this symptom and you don't know what's caused it, if the symptom goes away and you don't know why it's gone away, will that matter? No.
In other words, you don't need to necessarily know what it is. Sometimes the unconscious mind doesn't want your conscious mind to know what the problem is. The analogy of rubbish in the cupboard is something that we can all get hold of. But what constitutes rubbish? Traumatic events, deaths. We can go with very major things, as I say, but sometimes you would find being bullied. Events that have upset you in the past. I would say that the things that might upset me are things that I've done that are out of character. Say, when I've lost my temper with somebody in public, and I don't do that.
Those are the things that stick in my mind. And that's because you have not adhered to your own standards. You've set yourself a standard. And if you break that rule that you've set for yourself, then you beat yourself up about it. Now, you could be more forgiving. You could find ways of not being quite so angry as well. You could find out what it was that triggered you to behave in that sort of way. There are all sorts of ways that we could help with that. So you could look at what the triggers are for you losing your temper in that way. And that's fascinating. I love dealing with anger because...
Repressed anger is not good for you. In terms of somebody with persistent pain, the anger comes from everything. The doctors, the employers, life, the politicians, the health service. Absolutely. There's nothing worse. Everybody is to blame for my condition. Absolutely. Absolutely. I fully understand. If you've been through the mill with fibromyalgia, the degree of anger, of the lack of understanding, the lack of people dealing with it appropriately, not knowing, the effect of the heart sink. Are you with me? So that...
If you go to the doctor, you know, if we've got a simple diagnosis, trying to say, I know, you've got wax in your ear, and we can take the wax out, we've got a happy patient and a happy doctor. Everybody's happy. We've got a diagnosis, a treatment, and everybody knows where they are. Once you are into the realms of the medically unexplained, are you with me, once we're dealing with symptoms that don't fall neatly into that sort of category, you have got the doctor feeling miserable and the patient feeling miserable, then we're into a very negative sort of cycle here. Now, if I saw patients who had defeated other practitioners, shall we say, I was always delighted to see them.
Come on in. This is great. Because they're going to get some solutions now. Even that just, I mean, I used to say that I love doing psychiatry for two reasons. I meet the nicest people and I love watching people get better. It is a joy treating people having discovered these sorts of ways of accessing the part of the mind that can actually help you heal yourself. It's the way you deliver the message. If you go to the doctor and the doctor says, I can't find anything wrong with you, the patient thinks, if they can't find anything wrong with me, there isn't going to be a treatment. That means I'm going to suffer forever.
but there is a possibility of you being completely normal if we can just find some answers. Now, most things are multifactorial. What you have to do is get all the factors going in the right direction. When you see somebody who has been through the mill, you end up with a vicious circle with everything going in the wrong direction, all spinning in the wrong direction. What you've got to do is get in there, get all the factors right, and get it spinning in the right direction. If you get it going in the right direction, then you can start feeling good and better. But there is a part to be played. I'm not saying that...
I've got all the answers to all these, but it's a matter. We have an important part to play, and unfortunately, hypnosis is completely underutilised by the NHS. It's a complete tragedy. So how do people get to see a recognised hypnotherapist? Within the NHS, it's virtually impossible. You can't even use the word hypnosis. Some people who have even been trained in hypnosis, as I understand it, can't then practise it within the NHS. They will say that it is not, for example, for the treatment of post-traumatic stress disorder. We have got lots of evidence, but we haven't got it sufficient for it to be considered.
strong enough to be an evidence-based treatment. But if you don't have enough... people doing it you know you're in a catch-22 what you've got to be able to do is to be most of the nice guidance before pain for example and you know they say more research is required how can you do that research if you don't have enough people practicing it and you you know they can't get funding to come on the courses because it's hypnosis it's considered an alternative therapy now I don't know why we are considered an alternative therapy we've been around for 200 years Freud started with hypnosis then decided maybe not and everybody became very frightened or unconscious there is nothing to be frightened of at all really nothing at all all hypnosis is self-hypnosis and it's about you being in more control, not less control. OK, we think that the frontal lobes are the bit that's controlling everything. It's not. As we go back to what we said earlier about behaviours, that you've got behaviours that you don't like and that you can't help and you just lose your temper and you don't want to. It's only happened twice. But sadly, I can remember each one. Indeed. But forgiveness is one thing. And B, knowing how to handle that differently is another one. But it's not just that. Certainly, from the repressed anger point of view, you might be so busy trying not to explode. That won't be doing your pain any good.
Dr Jane Boissier, so what approach would a health professional practising hypnosis take with a new patient, Anne Williamson again? Well, if a patient came to me and wanted hypnosis for pain relief or pain management, we'd talk about it first and talk about what it is and what it isn't and kind of dispel misconceptions because people often think of hypnosis as a magic wand and it isn't. It's a brain state that you can utilise to help yourself develop skills and abilities to help you manage pain. Well, actually most people would think of hypnosis as a music hall act. Exactly, that's one of the difficulties. But you can make me run around naked as a chicken.
Well, only if you wanted to. I don't. No. And only if you're a good hypnotic subject, because we all have different hypnotic ability in the same way as we all have different musical ability. So this is not stage hypnosis? No.
I would be conscious. You'd be aware of whatever was going on around you. Then if you were going more focused internally, you might get less aware. If I'm doing a session with somebody and somebody opens the door and the phone rings, it disturbs me more than the person I'm working with very often. And the first stage, obviously, would be to be taking a history and find out about the person, what they like, what they dislike. Because people very often have used kind of semi-hypnotic tools already without even knowing that they've done it. I worked with one guy once who said, well, when I start to get stressed, I sing my tune in my head.
and he has this little tune that he used. He was a musician, and he did this tune in his head. So he already had a link to feeling calmer. People often have things that they do that help them already, and hypnosis can help them more. But they often don't feel any different in the hypnotic state than the wake state, except that they're more focused internally. And you see, when people kind of come out of the hypnotic state, it takes a moment or two to reorient back into the here and now.
And one uses all sorts of things with people. It's not just a question of getting them to access a calm, relaxed feeling, which you can do. You might get them to use imagery of a special place that they'd love to be, which would be calm and relaxed, which could be imaginary and could be real. You could get them to imagine what their pain or discomfort looked like, and then if they could... go in and make a change which would make it more comfortable, what would they do? And that can often help. You can have classic imagery, turning dials down or going to your pain control centre in the back of your mind and turning the lever down more towards comfort. Certainly not in the first session, but it might be the second or third session that I would work with somebody to look at whether there's anything psychological underpinning their pain that they need to address or that they want to address because they might not want to. The important thing is giving the patient tools that they can then take away and use.
So I give them the kind of metaphor of a child. Anyone who's had children knows a toddler will be clamouring for attention just at your busiest moment in the kitchen. And you say, go away, mummy's busy. And what does the toddler do? Clamours even louder until you give it attention. Well, your pain can just whisper as long as you're aware when you need to give it attention. So instead of being 7 or 8 out of 10, it can be 2 or 3 out of 10. So instead of grabbing you by the throat, you can just tap you on the shoulder? Yes, and you can pay attention to it.
and do what you need to do to keep yourself comfortable that's dr anne williamson of the british society of clinical and academic hypnosis don't forget that you can download all the previous editions of airing pain or obtain cd copies direct from pain concern if you'd like to put a question to pain concerns panel of experts or just make a comment about these programs then please do so via our blog message board email facebook twitter or pen and paper all the contact details are at our website which is And whilst we believe the information and opinions on airing pain are accurate and sound based on the best judgments available, you should always consult your health professional on any matter relating to your health and well-being. He or she is the only person who knows you and your circumstances and therefore the appropriate action to take on your behalf.
So for those wanting to find out more about hypnosis, be you a patient or a medical professional, where should you look for advice? Our society, British Society of Clinical and Academic Hypnosis, believes that you should only treat with hypnosis things that you can treat without hypnosis. And I think that is a really good safety guideline. So if someone who is looking for someone to work with using hypnosis needs to find someone who they would be going to anyway, like physio or doctor. And as you were saying, members of the British Society of Clinical and Academic Hypnosis, they are practitioners in other areas as well. They are all working health professionals, yes. So what standards should people with chronic pain look for in choosing a hypnotherapist? You need to find someone who has some knowledge of your condition, I think. You see, hypnosis is very easy. It's what you do with it.
that's more difficult. I can find any number of hypnotherapists in Yellow Pages or on the internet. And that's why I think you need someone who's either a psychologist or a doctor or certainly someone who's UKCP accredited, something like that, United Kingdom Council of Psychotherapy. For health professionals listening to this, where should they go if they're interested in using hypnotherapy? Well, if you go on our website, which is www.bscah.com, you'll find lots of information there. Find information on our training courses, which are around the country.
Usually the foundation training is three weekends, which gives kind of basic grounding in hypnosis and hypnotic techniques. And the third weekend we tailor to whoever we have participating. So if we've got a lot of dentists, we'll get a dental trainer in. If we've got a lot of anaesthetists, we'll get an anaesthetist who uses hypnosis. So it's tailored to the people that are attending.