Ep123. No More S Words! What Hypnosis Teaches Us About Talking with Patients

Make a pledge with me to try and stop using the S word! Can you guess what it might be? Who better to talk us through the evidence against using nocebo language and the power of suggestion than anaesthetist and expert in clinical hypnosis, Associate Professor Allan Cyna. A/Prof Cyna is the Director of the Advanced Training in Clinical Hypnosis run by the South Australian Society of Hypnosis. I drill down on his journey from a transformative lecture during medical school to becoming a leading expert. We discuss the evidence, delve into my failures and his successes with hypnotic suggestion and even ponder whether this is all just woo woo. I mention the overlap with psychology and refer to this episode on Ep118 on Trauma Informed Care with psychologist Brigette Berry.I specifically discuss using hypnotic suggestion for children in Ep55 with Drs Annette Webb and James Auld.Find A/Prof Allan Cyna's talk from the 2025 National Scientific Congress here (in September). You'll need to be an ASA member to gain access.Interested in learning hypnosis? Find more information here, as well as the articles we discuss. Feel free to communicate your thoughts on the podcast with me! email [email protected] AI generated notes:Episode Highlights00:02:45: Cyna's pivotal medical school experience with a senior anaesthetist demonstrating hypnotic phenomena, including arm anaesthesia and age regression, which sparked his lifelong interest in hypnosis.00:06:30: Introduction of the concept of "nocebo language"—negative perceptual suggestions like "this will sting"—and their evidence-based harmful effects on patient anxiety and pain scores.00:08:15: Discussion of the landmark 2007 Women's and Children's Hospital study showing reduced vocalizations and arm movements when avoiding the word "sting" during drip insertion.00:15:20: Explanation that 95% of anesthetic hypnosis involves conversational hypnosis rather than formal induction, with patients naturally vulnerable to suggestion when anxious.00:22:40: Cyna's PhD research demonstrating increased hypnotisability in pregnant women due to neurobiological changes that facilitate dissociation during labor.00:28:15: Case study of a postpartum woman with massive hematoma who underwent two-hour surgery using only hypnosis and fentanyl, developing lower body anesthesia through guided imagination.00:32:00: Practical recommendations for immediate implementation: listen for inadvertent negative suggestions in your own speech and focus on explaining the meaning behind procedures rather than predicting perceptual experiences.Key Takeaways1. Eliminate negative perceptual language ("sting," "sharp," "hurt") from clinical communication; five randomized trials confirm this reduces pain scores and anxiety without additional intervention. 2. Conversational hypnosis occurs naturally when patients are anxious—healthcare providers can harness this vulnerability therapeutically through positive suggestion rather than inadvertently through nocebo effects.3. Reframe procedures by explaining their purpose and meaning rather than predicting how they will feel, allowing patients to experience sensations without imposed expectations.4. Children aged 4-10 possess particular hypnotic susceptibility due to their natural imaginative and make-believe capacities; simple dissociation techniques (using "the arm" instead of "your arm") are highly effective.5. Formal hypnosis training requires 4-5 years to achieve true fluency, but meaningful clinical benefits begin within the first one or two course weekends through understanding and applying basic principles.Quotable Moments"If you can do an intervention that doesn't cost anything, but it could improve outcomes and there's no real side effects, then why not give it a go?""We actually did one of the first studies at the Women's and Children's with drip insertion...people who used the negative perceptual language had more vocalisations of pain, more movements of the arm.""In our daily lives, we're in and out of a hypnotic state maybe two or three hundred times a day...it frees the mind up to do logical things.""I don't think people could function in the world if they didn't have this ability to utilise hypnosis...about 90% of people will respond in some helpful way with standard techniques."