Using Hypnosis To Enhance Mental Health, Performance & Preventing Disease | Dr. David Spiegel

Within a few minutes, people can change. And so it's that capacity to focus intently, alter your perception, be different, see what it feels like to be different. Hypnosis is a naturally occurring state of highly focused attention. It's believed in imagination. It's a state that we have for a reason, that it allows us to concentrate intently, to put inside conscious awareness things that matter and put outside of conscious awareness things you don't want to attend to. It also puts you in a state of cognitive flexibility where you, and so the fact that, you know, the football coach will dance like a ballerina is showing you that it's a state where you can let go of your usual views of who you are and what you are, you're worried about what people think of you and act different, try out being different. Now, doing it that way is something that does not appeal to me at all, but helping my patients see themselves experience things from a different point of view is a tremendous therapeutic tool. So, you know, I had a woman yesterday with terrible lower back pain that had not responded to other kinds of interventions. And she was very worried about a past diagnosis of cancer. And her pain was six out of 10. I just tested her hypnotizability and the pain went down to two out of 10. And then we practiced using it to imagine herself being in a warm bath, filter the hurt out of the pain. It was zero at the end. So within a few minutes, people can change. And so it's that capacity to focus intently, alter your perception and be different, see what it feels like to be different. Yeah.

I mean, it's interesting, you know, it takes a long time often for medical discoveries to become implemented in healthcare. And this is not exactly who was in from the 1700s, you know, kind of developed this concept of animal magnetism. And that was later sort of termed hypnotism, right? It was a term by James Braid who was a Scottish doctor in the 1800s. So this is not new, but tell us about sort of the evolution of this in medicine. And again, it's, you know, it sounds kind of weird and kind of goofy and a little bit there with seances and, you know, speaking to the dead, but it really is a validated medical procedure that has profound effects.

Well, you know the history. It's the oldest Western conception of a psychotherapy. It's the first time that a talking interaction was thought to have therapeutic benefit. There was a Scottish surgeon named, well, Mesmer himself, you know, he was demonstrating that people could go into these altered mental states and many of them seemed to get better.

Mesmerized.

Mesmerized, that's where we get the term. That's exactly right. As soon as he started getting popular in Vienna, he left his wife and family there and moved to Paris where he became the sort of go-to upper class physician. And what people observed about most French doctors offices at the time were grim. They were bare. You got bad news from the doctor. Voltaire wrote to his brother, we did everything we could to save father's life. We even sent the doctors away.

The.

Major treatment in France, you remember what the major treatment in 18th century France was? It was bloodletting. And so unless you happened to have polycythemia vera or congestive heart failure, you were more likely to be killed than helped by going to a doctor. And Messmer's office, by contrast, was cheerful. There were other patients around. They would cheer one another on. This sense that you were entering a state of change that could help you feel better made patients feel better. And he kept them away from the bloodletting, too. He therefore aroused the enmity of this traditional French physician. against whom he was competing quite successfully. So they convinced King Louis to form a commission to investigate him. And the commission included our own Benjamin Franklin, who was having a very good time in Paris.

Oh, that's right. He was the ambassador to France, right?

Right, right. The brilliant chemist Lavoisier, who not only discovered the principles of oxygen chemistry, but a few months before he was killed in the French Revolution, he was beheaded, this brilliant chemist. He also came up with the notion of the gross national product. So he sort of founded a key element of economics. Another person who was on the committee was Dr. Guillotin. Now, he may sound familiar. He, right. The inventor of the guillotine. Right. And so he kind of created the mind-body problem, you might say. And that committee concluded about the separation.

Between mind and body.

Yeah, that's. You got it. the committee concluded that hypnosis was nothing but heated imagination. And actually, you know, that's not bad. That's kind of what it is in a way, but that was the end of Mesmer's career. And so there were, but nonetheless, others picked up and took after him and started using it. There was a brilliant Scottish surgeon named Esdaile who was using hypnosis for general anesthesia during surgery. he went to India, they were doing these horrible amputations, he would get people hypnotized, and he reported 80% surgical anesthesia with hypnosis.

And that's before they were using any anesthesia, right?

Yeah, that's right. Four burly people would hold you down and they'd get you drunk, and it was horrible. Just think about that. So about 10 years later at Mass General in what we now call the ether dome, they demonstrated ether anesthesia for the first time. And a surgeon strode to the front of the amphitheater and announced to the observers, Gentlemen, this is no humbug to distinguish what they were doing with ether from what Esdale had done with animal magnetism, with hypnosis. And it's taken us a couple hundred years to discover that the mind and the brain have something to do with pain control. But you know what? Poor Esdale actually withdrew his paper because he said, They're getting 90% surgical anesthesia. I'm only getting 80%. quit, you know. So time and again, this, we have this prejudice in medicine and you know it as well as any physician, Mark, that, that, that you, the real treatments are incision, ingestion or injection that, that actually the brain, this three pound organ that is connected to every part of the body and runs the machine has nothing much to do with physical problems. And that's just like what you've been doing in, in the way we eat and the things we put in our body.

That's nonsense, right?

So, so. It's a shame that we have, and the thing about the brain is it is a very powerful thing, but it doesn't come with a user's manual. And so there are a lot of things our brains can do that we haven't yet figured out how to use. And that's part of what hypnosis is. It's a way of intensifying the mind-body connection, enhancing your ability and willingness to control your body as well as your mind.

Yeah, it's beautiful. You mentioned Voltaire and it reminds me what you're saying of one of his famous quotes, which is, Doctors are men. they used to be men only men. The doctors are men who prescribe medicines of which they know little to cure diseases of which they know less in human beings of which they know nothing. I wish I could say that wasn't true anymore. I wish I could say that wasn't true anymore, but it's very far off from that. So let's talk about hypnosis. Let's talk about hypnosis in the current day. You're a Stanford professor, you're the chair of the psychiatry department, Department, Vice Chair of the Psychiatry Department. You're really using this as a modality to treat real problems. And, tell us about what is going on with hypnosis, how does it work, and what is the biology of this? Because it's not just suggestion. There's something else going on physiologically.

Yes, you're absolutely right. And, we've done a number of studies using functional magnetic resonance imaging and positron emission tomography. to understand what goes on in the brain when people experience hypnosis. It's a state of highly focused attention. One way that it works, we took very high and very low hypnotizable people in various conditions in the MRI scanner. What we found was three things occur when people go into a state of hypnosis. One is they turn down activity in the anterior cingulate cortex. The cingulate cortex is like the C sitting on its ends in the middle of the brain. The front part, the dorsal Anterior Cingulate Cortex is part of what we call the salience network. It's when you hear a loud noise and you suddenly turn away, the salience network does pattern matching and it says, oh, there's a problem here, you better pay attention. It's what social media use when they try and get people drag them onto their sites. They said there were 15 girls out there who were better looking than you are, you better find out what they're doing. So your salience network fires. So in hypnosis, you turn that down. you just say, I don't care that much what else is going on. I'm going to talk to Mark. You just get into it. You focus your attention. So that's number one. Number two, you increase functional connectivity between the left dorsolateral prefrontal cortex, part of our executive control network, and the insula. The insula is this little insula is Latin for island, this little island in the center of the brain that is a mind-body conduit. So when you control things in your body, when you juice up your gastric acid secretion because you just eaten a meal. The insula is the transmitter of that. It also is a center for interoception, for our ability to perceive what's going on in our body. So you're intensifying your connection between brain and body. And the third thing that happens is you have reverse functional connectivity between the dorsolateral prefrontal cortex and the back part of the cingulate cortex. We call it part of the default mode network. And that's a part of the brain that gets active when you're not doing much else, when you're not carrying out some plan or working or something. It's the part where you reflect on yourself. Who am I? What am I? What do people think of me? And so what you do is you are in a place where as you're doing something, you can disconnect from your reflections about who you have been and who you are and who you ought to be.

That's what psychedelics do is they kind of exactly default mode network.

Exactly. That they particularly affect the default mode. You kind of get over yourself. You try out being different. And that's what happens in meditation too, is that experienced meditators turn down activity in the default mode network. So the cool thing about it is, Mark, is that you can try- so-.

You- mean you don't have to take LSD or mushrooms. You can actually just do hypnosis and.

Have the same- yeah, there you go. Well, some of the- there is overlap. I mean, you don't have wild wild hallucinations and you don't sort of float away and do things you hadn't thought about for hours at a time. But yes, in some ways it's a microdose of psychedelics in a sense. Not that you're seeing colors and images, but that you can alter your relationship with your body, alter the way you think and try it out. We used to think you have to do a lengthy process of self-exploration to understand why you're doing what you're doing and do it differently, and that sometimes but you don't have to do that.

You can be on a couch five days a week for 30 years like Woody Allen.

He used to say that it took that long because he never gave his analyst any accurate information about himself. But, you know, Freud started psychoanalysis with hypnosis. He was using it to have people trace their current symptoms back to some early traumatic event in their life, and that was sometimes true. But the idea is rather than understand it first and then change, it's change and then understand it. So you can sort of short circuit that by saying, what would it feel like if I were different? And people can have that experience intensely and start to change very quickly.

It's amazing. You know, listening to your talk reminds me of that trope in medicine where you say, you know, a neurologist paid no attention to the mind and psychiatrists paid no attention to the brain. And hearing you talk about the default mode work network and the cingulate cortex, I'm like, wait a minute, this is a psychiatrist talking about the brain. Yeah, what do you know? I mean, it's quite interesting because it's actually the biology of the brain that we're having to adjust to change our physical symptoms or our mental symptoms or emotional states. And, I think hypnosis is a very underused modality in medicine, which, you know, is safe, it's effective. I mean, it doesn't necessarily work on everybody, but I think, you know, the biology of it is fascinating. You know, now it's not just, oh, this thing may work. You're actually doing brain imaging studies and looking at blood flow and looking at what's turned on and off and how it affects your overall view of yourself and your relationship to your emotional state, your physical state. And it's pretty profound. I would say that, you know, typically a guy educated at Harvard and Yale and Stanford is generally going to be pretty buttoned up academic and rigorous and not so much interested in the fluff of integrative medicine. But it actually isn't really fluff. I'm kind of tongue in cheek here. But how did you go from that to being someone who's really focused on novel and integrative ways to deal with mental health and physical health?

Well, I'll tell you, Mark, when I When I got into Yale and went there, I thought, God, I'm going to meet a whole lot of really smart people that understand really complicated things. And what I discovered was that smart people make complicated things simple, that they understand them. And so the issue I felt that I had an opportunity that I needed to honor, and that was to see if I could contribute in a way to healthcare that was different from what my colleagues were doing. and what I discovered was that I was one of the few people who was really interested in what was going on above the neck in my surgery and medicine rotations. And the surgeons were cool. They just said, Spiegel, if you can fix it, go ahead. You know, I had a guy who was afraid to go into surgery and they wanted to settle him down enough to do it. And I could do that. And it started for me with a patient, Mark, when I was a pediatric medical student. at Children's Hospital in Boston. And I'm walking down the hall and the nurse says, your patient's in room 342. She's in status asthmaticus. And I'm following the sound of the wheezing down the hall and I walk into the room and there's this pretty 15-year-old redhead bolt upright in bed, knuckles white, struggling for breath. Her mother standing there crying. There's a nurse in the room. She'd been twice unresponsive to subcutaneous epinephrine. They were thinking about giving her general anesthesia and starting around steroids. And I didn't know what the hell to do. But I had just taken a hypnosis course at Mass General. And so I thought, well, I said to her, you want to learn a breathing exercise? And she nods. And I said, I got her hypnotized. And then I realized, oh, I haven't gotten asthma in the course yet. What do I do? So I came up with something very subtle, very clever. I said, each breath you take will be a little deeper and a little easier. And within five minutes, she's lying back in bed. She's not wheezing anymore. Her mother stopped. crying. The nurse ran out of the room. I'm astounded. And just to be able to witness something working that well, that fast caught my attention. So my intern comes looking for me and he says, Spiegel, what'd you do? And I said, well, I taught her a hypnosis exercise. And he said, well, you're going to have to stop doing that. You know, I thought he was going to pat me on the back or something. He said, I said, why? He said, well, it's dangerous. I said, well, you're going to give her general anesthesia.

More than you're saying.

Exactly. And you say this is dangerous. I don't think so. Well, you have to stop doing it. You can't follow her. I said, I live in Boston. I'll follow her as long as I need to. So he said, he said, well, the nursing, the nurse filed a complaint with the nursing supervisor that you violated Massachusetts law by hypnotizing a minor without parental consent.

Oh, now.

God. Massachusetts has a lot of weird laws. That's not on the list. So I just said, well, look, God.

Forbid you would have fed him a vegetable, and that would have been against the law, too, without consent. You fed him a vegetable without consent.

Exactly. So I just said, well, you know what? Take me off the case if you want, but as long as she's my patient, I'm not telling her anything I know is not true. So he stops off, and over the weekend, the intern, the chief resident, the attending are having this council of war. And on Monday, they came back with a radical idea. They said, let's ask the patient. I don't think they'd ever done that before. What a concept. And she said, oh, I like this. I want to keep doing it. Now, she'd been hospitalized every month for three months in status as medicas. She did have one subsequent hospitalization, but went on to study to be a respiratory therapist. And I thought that anything that help a patient that much, that fast, frustrate the head nurse, violate a non-existent law in Massachusetts had to be worth looking into. So I've, I've been doing it. She was the first of about 7, 000 people I've used hypnosis. hypnosis with. And I've been studying how it works, what goes on in the brain, doing randomized clinical trials, and. And now I'm trying to spread it so that anybody that wants it can have it.

I mean, you know, most people think of hypnosis as, like, a carnival trick, right? You get some people on stage, you hypnotize them, you get to do all this crazy stuff. You know, I actually was one of those people.

I actually got on stage for the hypnotist.

Did you really? What happened? I don't think it worked on me. I don't think I'm. I don't know if I'm hypnotizable or I'm just. I was too resistant, or I wanted to be. my ties. It just, I don't know if it didn't, didn't work on me, but I did see other people do all this stuff. I'm like, wow, that's very impressive.

Well, you know, it, it drives me wild because it's just, you know, it's a misuse of the phenomenon, and it, it sort of caricatures it and makes people think that it makes you do foolish things and that it's just a parlor show, parlor trick, but it isn't. And one of the things that I'm sure that guy did, and they all do, is they, they get a bunch of people on and off the stage till they collect the few who are extremely hypnotizable and they're the ones that they do all the other stuff with.

I kind of wonder around hypnosis in the application of it, where are you seeing this be most effective? And also, when you apply it, is it universally effective or just some people are super susceptible to hypnosis and others aren't? Is there a reason for that? how do we, you know, because it sounds great, right? So, but I find myself having, you know, trouble with that. I don't think I'm easily hypnotizable.

Well, maybe I am, I don't know. That may be. Hypnotizability is a very stable trait in adult life. So, we did a study at Stanford years ago where they blindly retested a bunch of Stanford students who had been hypnotized and had their hypnotizability measured in psych one. and 25 years later, the test retest reliability was 0.6, 0.6. Now, that's amazing. IQ is just a little bit more stable than that over a 25-year interval. The deal is this, that most children are very hypnotizable. In fact, most children are entranced most of the time. You know, work and play are all the same thing. You call your eight-year-old in for dinner, he doesn't hear you, he's doing what he's doing. Imagination and their reality is sort of all the same thing. It's wonderful. I think, we've evolved to have that kind of consciousness because when you're a kid, you've got this big brain and it's relatively empty. You haven't had much experience, you haven't learned that much, and you want to be in a mode where you're just soaking up new learning and new information. And that's what children do. It's a shame we try to make them into little adults before their time because they learn much better that way. So some of us in adolescence, Mark, as we go from childhood to adulthood, is some of us lose some of that ability because we come to value reason and understanding more than experience. And so some people are kind of learned to be rational first and experiential second. Others hang on to that sense and it has to do in part there's a genetic difference. We actually have a genetic test that can help determine who's more hypnotizable, COMT, you got it. And the people who metabolize that at a moderate rate turn out to be more hypnotizable. But also, there are people who maintain this ability to focus their attention. And so we call them the poets. They're people for whom, you know, they get so caught up in movies that they forget they're watching a movie and enter the imagined world, believed in imagination. Then there are people in the mid-range who go back and forth, who have the hypnotic experience, but then stop and reflect about it. We call them diplomats. They have to negotiate the difference between one type of experience and another. And the ones who are less habitable are we call the researchers. They've got to explain everything first.

That might be me.

Yeah, that might be you. And then allow themselves to experience it. But all of them can benefit. I had a woman recently who was a 72-year-old woman who wanted to stop smoking. hypnosis can be very helpful. She had actually stopped but wanted to consolidate it. And, but she said, I need a reason for everything, you know, and she was turned out to be one of the researcher types. She was not very hypnotizable. So for her, it was a matter of using what ability she had to focus on a concept that appealed to her. And she said, I said, why are you stopping? Well, you know, I'm coughing at night now. And I didn't. I said, well, your body's giving you a message. so here's what I want you to think about. For my body, smoking's a poison. I need my body to live. I owe my body respect and protection. Your body is as dependent on you as your baby or your pet. Would you ever put tar and nicotine smoke into the lungs of your baby? Hell no. And for her in particular, she had had the misfortune of having a husband who. Who beat her one night, and she did something very wise that not everyone in that situation does. The next morning, she was in her lawyer's office getting a divorce, and she became a very high level administrator in the government and had an otherwise terrific life. And I said, you know what you need? You need a divorce from your cigarettes. They're damaging your body. And she said, that's it. She wrote it down. She said, I need to find a pendant.

I need a lawyer.

Well, that was it. I'd be a good lawyer for you. So there are people who aren't very habitable, who need to approach things from a more logical point of view, but can still benefit a great deal. But then there are others. like the woman I mentioned whose pain just disappeared, you know, and that can happen too when we understand how that happens in the brain as well.

So can you talk about, you know, from a clinical perspective, you know, where is the research showing this has the most leverage? What are the conditions or problems that people suffer from? And often they're problems, by the way, which don't have great other treatments in medicine. What are those problems and what are you seeing, you know, from the research and also clinically in your practice? What have you seen?

Well, I would have to say the top of the list is pain control, Mark. The strain and pain lies mainly in the brain and using your brain differently. I had a woman who was seven months pregnant, had terrible lower back disease, and as the baby grew, the pain got worse and worse. They couldn't put her on opioids, thank God, and so because she was pregnant, they put in a nerve stimulator. They implanted it. That didn't work. and so she's in terrible pain and it's getting worse. So I had her imagine in hypnosis that she's doing what she does physically to relieve the pain, which is take a nice warm bath. So I said, you,'re floating in the bath. She was a diplomat. She was in a mid-range of hypnotizability. Oh yeah, I can feel that. I feel the warmth, filter the hurt out of the pain. And we understand how that works now. We've done EEG studies where we take Stanford students, give them shocks on the wrist, and in normal conditions and then in hypnosis where they're filtering the hurt out of the pain, your arm is in ice water, cool, tingling and numb. And we reduced by half the electrical activity in the brain in response to the shocks. We did EEG time linked to the shot when the shocks were administered and the first component of the ERP, the P100, disappeared entirely. So within a tenth of a second, their brain is substantially reducing the signal of the same shocks that are being administered. And the rest at P300, 200P300 was half as big. So the brain literally turns down the amplitude of its response to these shocks. And we've discovered a group at the University of Montreal showed that you turn down activity in two parts of the brain. One is somatosensory cortex, which you would expect if you give that kind of instruction, cool, tingling, and filter their head out of the pain. The other hypnotic instruction was it's there, but it just won't bother you so much. There they got analgesia, but the activity reduction was in the dorsal anterior cingulate cortex. You just stop worrying about it. We know how it works. We've published randomized clinical trials. We had a paper in the Lancet in 2000, 241 patients getting arterial cutdowns to do chemoembolization of tumors in the liver, to visualize renal artery stenosis. and it's two and a half hours, it's an unpleasant procedure, you don't use general anesthesia. And we had three conditions. 80 of them just got standard care, which meant if you're in pain, press a button, you'll get opioids through your IV. The second was that plus a friendly nurse providing emotional comfort. And the third was training in self-hypnosis. By the end of an hour and a half, pain was five to six out of 10 in the standard care group, It was three out of 10 in the nursing group and it was one out of 10 in the hypnosis condition. Their anxiety was five out of 10 in standard care, three out of 10 with a comforting nurse and zero in the hypnosis group. I thought they'd all died or something. They were just so mellow. They were using half as much opioids, half as much and getting better pain control and they got done 17 minutes quicker. Now, Mark- which matters in surgery because.

It'S, you know, you never want to do it too long.

Exactly right. And it also meant, you know why it happened faster? The surgical team felt better too because they had a patient who wasn't suffering, who was mellow and just feeling comfortable. So if I published a paper like that with a randomized clinical trial, three arm, carefully controlled, demonstrating that you could cut opioids in half and reduce pain. And what I was doing was a medication, another med.

You'd be a billionaire.

Everybody in the country would be using it, right? But no. And because they just can't believe that that's what's going on. However, here's the thing, Mark. Last year, there were 75,000 opioid overdose deaths in the United States. It's been hundreds of thousands of Americans have died, and they're not suicides. because opioids have, our neurons have two receptors for opioids. One controls pain and pleasure, and it's what makes it effective as an analgesic for some time. And the other controls respiration. And you habituate to the first one, but not the second one. So that means people are taking more. It's suppressed, they just go to sleep and they don't wake up. The brilliant musician Prince, fabulous guitarist and singer. Just, he had injuries from the stunts he'd done on the stage. He had opioids in his body and he just went to sleep and didn't wake up. And now there are these hyper potent opioids, fentanyl, remifentanil, that are just killing kids. They killed the other day in New York, a one-year-old in a daycare center somehow got us into something that was contaminated with fentanyl. and died. This is horrifying. And so people say, well, hypnosis is weird, you know, I saw a stage show, but opioids and opioids are, they're, they're good at short-term analgesics. They will reduce pain short term, but they become less and less effective and they actually get you hooked because you get hypersensitivity to pain. So over time, it gets harder to get off them because your super sensitive to pain experience when you've been on opioids. So they're a lousy drug to use long term. And yet, you know, we know the story with Purdue Pharma and these other companies that have made billions of dollars trying to make opioids seem cool for upper middle class people, and they're killing people, and it's just horrible. So the contrast between what we can do with hypnosis, where the worst thing that happens is it doesn't work, okay, do something else. But we have in Reverie now, we have people getting 60% reductions in their pain in the first 10 minutes of using it. And so, you know, why not try it? Why not teach people to help themselves deal with their pain?

So pain is a huge factor, right? Is that you can treat with hypnosis. What are the other things?

Depression, anxiety, sleep, It's very effective for insomnia. And we do it from the body up, Mark. We just say to people, imagine you're floating in a bath, a lake, a hot tub, or floating in space. And picture, if you're worrying about something, picture it on an imaginary screen, but keep your body out of it. So you might picture on the screen some place you like to be, swimming in a mountain lake or lying on the beach in the sun or something. or if you have something you're preoccupied with, just put it out there as if you're watching your own movie. Don't let it stir up tension in your body. And people find that it's tremendously effective. You know, I used to worry, we built Reveri to be interactive so that I asked you from point to point, how are you doing? Is your arm floating in the air? Are you feeling comfortable? And if they say yes, we go on to the next thing. If not, I reinforce what they need to do to get to that level. I used to worry that it still wasn't as good as being in the office with me. Then it occurred to me that if people are waking up at 3:00 in the morning and need help going back to sleep, hopefully I'm not in their bedroom with them.

Yeah, psychiatrists usually don't have a call.

No, no, that's right. I'm there on the phone and anytime you can use it. It's very helpful for insomnia, stress management too. The way we deal with that is we have people get their body floating and comfortable and first deal with the somatic reaction to the stress rather than trying to solve the stress problem right away. And then once you've done that, you've already started to manage the stress by managing the way it affects your body. So you don't feel the muscle tension, the increase in heart rate, the sweating. And that's already a part of a victory over the effect of the stress. We've learned using functional imaging that there are actually more in people who are more hypnotizable, there are more GABA receptors in the anterior cingulate. GABA, gamma-aminobutyric acid, is an inhibitory neurotransmitter that is stimulated by anti-anxiety drugs. Yeah, like Valium is what it does. That's right. Valium does that. But the problem with it, like opioids, it's good acutely, but it's addictive. It's not good for your cognition. And over time, the effect wears off. You get dependent on it and you get accustomed to levels that you can't safely take anymore. And so in the same way, people who are hypnotizable can be their own little pharmacist. They have more of the inhibitory neurotransmitters in the anterior cingulate and they can mobilize them and use them. to literally reduce stress and their reaction to stress. So it's very helpful for getting people into what athletes call the zone, where you're just there, you know what you're doing, you feel it, you're alert and aroused but calm, and hypnosis is very helpful with that. You know, it's interesting as you're talking.

It makes me think about one of the things we use in our practice, particularly Cleveland Clinic and my practices, is the ACE questionnaire, the Adverse Childhood Events. which really is about childhood stress and trauma that actually causes or contributes to many significant illnesses that are not mental, like autoimmune disease or cancer or diabetes or obesity. So, it seems to me that hypnosis may be a tool to help people deal with a lot of these not just emotional psychological issues like insomnia or anxiety or depression or pain, which is obviously a physical thing. But how do you imagine it working to treat not just psychiatric issues but also inflammatory immune issues and other medical problems? You could argue 95% plus are either caused by or exacerbated by stress.

Well, you're absolutely right. And people who have histories of childhood physical and/or sexual abuse are at least twice as likely to show up in an emergency room as adults. you know, and it does all kinds of things to, you know, because your body, as you relive these events or as something even minor that stresses you, it triggers the associative network of what it means to be beaten or yelled at or sexually assaulted. So your body is in this fight or flight mode and you have high levels of cortisol, high levels of epinephrine and norepinephrine, and it can trigger inflammatory responses impair your body's ability to cope with stimulants that could cause inflammation. And to give you an example of how it can work, I had a woman who was chronically depressed. She grew up in a country that is famous for its mistreatment of women. She said, as a teenager, I realized that my body wasn't my own. Men could say anything they wanted to me on the street. and she then told me that at the age of 12 she was raped by their landlord and her parents were afraid to do anything because they were afraid they'd be thrown out of the building. And so she got to the United States, she became a healthcare professional. She did all right, but she was chronically depressed and she retired early and she came to see me and I said, you know what, let's use hypnosis. She was quite hypnotizable. I said, I want to go back to that time when you were raped by the landlord. and she starts to cry. And I said, I want you to be your own mother. I want you to picture yourself as a 12-year-old girl. And I want you to look at yourself then and tell me, answer this question. Was this your fault? Did you deserve this? Did you do something that you can blame yourself for? And she cried harder and she said, I'm stroking her hair. I'm stroking her hair. She was able to let go for the first time of the common problem that people who have been beaten and assaulted or somehow it's their fault, they deserved it. Because we'd rather feel guilty than helpless. Well, if only I did X instead of Y. It's why women stay for years with abusive husbands thinking if I just make dinner right and don't raise my voice, he won't beat me again, that kind of thing. She called me about a week later, and she said, My psychiatrist wants to know what you did to me because I am not depressed anymore. And she'd been on one med after another, it helped somewhat. And she said, My friends do not recognize me. And so she was able to try out being different and let go of this lifelong belief that somehow she was responsible for what that bastard had done to her. And I just got an email from her a couple days ago, six months later, saying, I just thank God for the doctor who referred me to you, and I'm just a different person. I feel better. So, yes, you're absolutely right. You can use this state to help people reapproach and deal with these sometimes lifelong problems that have sort of set the tone for their mind-body relationship and, and change it.

Yeah, I think, I think that's really important to understand. I also think that this is a tool that has been used clinically by people like yourself in academic centers or in clinical practice, but it hasn't really widely gotten out there that people can do this to themselves or self-hypnosis. So I'd love you to distinguish between the effectiveness of clinical hypnosis versus self-hypnosis. Then I want to talk about your app, Reverie, because I think it's a really important door for people. So how do we begin to think differently about those two approaches?

I mean, about four years ago, Mark, I was speaking at a Mind Body Summit that happened once a year out here in the Bay Area. And I met Ariel Poler, who's a serial entrepreneur, went to MIT and Stanford Business School, and he came up after my talk and he was very interested in what I was saying about hypnosis now at work. And I said, Could we, do you think, it was when Alexa had just come out, and I said, Do you think we could use that to talk to people because I said, you know, all hypnosis is really self-hypnosis and so I said, Alexa, will you help me? And so he said, well, you know, Amazon is making it very easy to, to build programs on it because they want more use of it. So let's see what we can do. So he helped me record the first app. It was for smoking control and just to see if it would work. and we did a study on it. We got some lovely people to fund a study, and we got 19% of the people who just used the app to stop smoking. Well, you know, we, we get about 23 to 25% face to face. It wasn't, it wasn't all that different. And we found that of the people who didn't quit, they reduced their average daily intake of cigarettes by half. And, and I thought, hell, you know, this thing is working just about as well as when people come to see me. It's a lot less expensive. It's accessible to so many more people. And I decided, you know, I've tried being a boy scout my entire career, you know, do the research, publish the randomized clinical trials and all this stuff. And it hasn't moved the needle at all. So I just thought, I'm going what in the.

It's in your own echo chamber, right? It's really true. It's like so much of medicine, you.

Know, it's like, it's all happening in an echo chamber. So I'm going D to C. I'm going. direct to consumers because, you know, people were worried with horrible things happen if people were hypnotized. You know, a hundred years ago when the automobile was invented, there were States passing laws against windshield wipers. You know why? Because the old hypnotic induction was a dangling watch. And they thought that if drivers are watching the windshield, but you don't watch the windshield wipers. You look, you know, so that doesn't. So people were scared of it. But, but I'll tell you what the number of problems that have come up with hundreds of thousands of people signing up on the app is like this many and none of them were serious and we took care of all of them. So I was reassured because I know that hypnosis is a benign, helpful state that people who are hypnotized will go into all the time. People who get caught up in movies, who get lost and absorbed in a sunset, who are so busy working they miss lunch, they're in hypnotic states all the time anyway. So why not teach people to identify and use use it.

Yeah. Powerful. So can you walk us through the mechanics of hypnosis? Like, what were you doing clinically and what happens on the app? Because I think, I don't, I mean, it sounds kind of airy fairy, well, I got hypnotized. What does that mean? Like, you use the watch dangling watch.

Or you're like, I just look getting.

Sleepy or getting sleepy, you know?

No, it's not that you're right. Nice try, Mark, but I just, I teach people to get comfortable. On one, do one thing, look up. On two, do two things, slowly close your eyes and take a deep breath. Three, do three things, breath out, eyes relax, let your body float, and then let one hand or the other float up in the air like a balloon. And people are amazed. I did it with Andrew Huberman after the podcast that I did. And Andrew's this brilliant neuroscientist and a tough guy, too tough minded and I said, your hand's floating in the air. If you pull it down, it'll float right back up. And his hand goes up like this, and he looks at it like, what is going on here? And that element of surprise is part of the power of hypnosis, that you can change the way you relate to your body and the way your body relates to you, and you can see it. So I teach people to do that. Now you understand what it feels like to be in a state of hypnosis. Let's now, if you have pain, imagine you're floating in a bath. the lake, the hot tub or floating in space, filter the hurt out of the pain. If you want to go to sleep, project your thoughts and feelings onto an imaginary screen, keep your body floating. If you want to stop smoking, focus on, for my body smoking is a poison, I need my body to live, I owe my body respect and protection. So I have people practice this on their own. For that, for fears like fears of, if you're flying, you can imagine floating with the plane and thinking of the plane as an extension of your body. and so people do it for themselves and anytime they want to, they can just turn on the app and get into the part of the program that helps them with the problem they've got.

Incredible. And tell us about the sort of innovation that you've created where you've sort of democratized hypnosis. You don't have to go to you or some clinical hypnotist. You can actually access yourself and you create an app and if people go to reverie.com, R-E-V-E-R-I.com, they can learn about it. But can you talk us through, you know, about the development of that and what your effectiveness is, what you're learning?

So, after Alexa worked for smoking, we thought, you know, this is still kind of clunky and people don't always want their speakers to be listening to them all the time. And so, we built an app and you can download the app, from the App Store if you have an iOS phone or from Google Play if you have an Android. And you get into the Reveri app and it asks you what's the problem you want to deal with. You can measure your own hypnotizability. We have an eight-minute hypnotizability test where you go through a series of instructions like the thing about your hand and you'll be told whether you're a poet, a diplomat, or a researcher. And that teaches you the style with which you can use the hypnotic so the approach to it is different, but anybody can potentially be helped with it. And then you can press and get into the part of the app where you learn to sleep better, where you learn to control your pain, where you learn to deal with your fears, do stress management. And we also, so people can practice them anytime they want. just go get the app, get into that state, and you can get instructions at either just a straight recording or an interactive program where I'll ask you questions periodically and you can respond. So it's there with you whenever you want it, whenever you need it to handle stress. We have one for transitioning, particularly in the pandemic days, transitioning from work to home, even if you're still in your home, but sort of getting into a different mindset than you're at when you're sitting at your desk. And so, it's like having you in their pocket. I like that. That's exactly right, having me in their pocket. That's it. So, I'm happy to be in your evening.

So, have you been able to measure the effectiveness of the app on various conditions?

We found, for example, for the stress management app, we studied about 15,000 people and their pre-post changes were like a 35% reduction in stress. self-reported stress levels within eight minutes. So they are instantly able to do it on a large scale. It's what we call a large effect size. It's a way of measuring how big the difference is between where you started and where you wound up. And it's a large one. And so you're pleased in psychological research when you get a moderate effect size. This is large. And so, and you can tell, you know, the cool thing about it is people can tell right away whether it's helping them or not. And if it is, do more of it. If it isn't, okay, do something else. So the feedback is very rapid and effective. And the same for pain control. We've got similar 35% reductions in pain level within eight minutes just doing the app with large numbers of people using it.

I mean, an aspirin doesn't even work that fast, right?

That's exactly right. That's exactly right. You can tell right away.

I mean, the story you told about the asthmatic young girl that actually was your first hypnosis patient, which was illegal and you should have gone to jail for, but... Don't get me wrong, you potentially were harming them. Yeah, so I mean, that works so fast on a condition that's, you know, a life-threatening condition in real time, right? Or someone who's undergoing surgery. So it's not like a trivial response. It's something that we haven't really deployed across medicine. And, you know, we talk about things like meditation or breath work or EMDR or other therapies. How does this compare to some of the other tools? You know, because you can get Headspace and listen to that and, you know, people have all these options now. So how do you sort of differentiate yourself?

Well, you know, first of all, we conceptualize stress as a kind of snowball effect. that you start to worry about something and then you notice your body's tensing up, you're starting to sweat, your muscles get tight, heart rate goes up, and then you think, oh my God, this must be really bad because my body is reacting to it. So you get more worried and then your body reacts to that. It's like a snowball. So what you can do very quickly is change the somatic reaction first and then start to deal with the problem. I'm asked all the time about the relationship between hypnosis and meditation. I'm very impressed at the uptake of meditation and very good websites like Headspace and Calm. People do it. There's mindfulness-based stress reduction, which is a program of half an hour twice a day that Jon Kabat-Zinn developed. But the difference is this, that meditation is Eastern and hypnosis is Western. meditation. You're not supposed to do it for a purpose to solve a problem. You're supposed to, although John Kabat-Zinn has a good new book out on meditation for pain control, so he's heading in that direction. But the idea is basically you're just supposed to be, not do. You're supposed to get over yourself. And experienced meditators do turn down activity in the default mode network in the posterior cingulate cortex. But you do three things that are related but different. In meditation, you may do a body scan, check out how different parts of your body feel. It's good to just become more aware of it, but not try to change it. You're supposed to experience open presence. So let thoughts and feelings and sensations just flow through you like a storm passing by and you're supposed to practice compassion. Those are all three good things. But I had a woman who'd meditated like that for 10 years and she had migraines. and the migraines didn't change. And so I taught her how to use self-hypnosis to imagine an ice cap on her head, cool, tingly numbness, filter her head out of pain, the migraines were gone. And she wrote me and said, thank you, Dr. Spiegel, for freeing me to use my intentionality. Because in meditation, you're not supposed to be intentional. You're supposed to be just experiential, let it happen. So hypnosis is Western. You use it to solve a problem. I'm not trying to create a bunch of people going around being hypnotized all the time. I'm trying to teach them to use it to solve a problem. And that's Western. The Eastern approach is just have the experience and see what happens. And there's value to both, and it's a lot of people are going to use it. It's helped them. That's great. But, and it also affects related but different parts of the brain. So hypnosis has this inverse connectivity between the prefrontal cortex, the executive control network, and the posterior cingulate, the default mode network. but it's sort of rapid and it happens while you're doing it and it goes back to baseline when you're not. Whereas in meditation, the idea is to chronically turn down activity in the default mode, which can happen. So they're related events, but they're different. And hypnosis has some overlap with meditation, but it's different and it's Western. EMDR, eye movement desensitization and reprogramming, is a technique that's been used a lot to help people with problems like post-traumatic stress disorder.

Yeah, trauma.

The idea is that they get you to move your eyes from one side to the other. It was thought that doing that somehow changes the impact of traumatic experience on you. But what studies have been done that dismantle the sort of general therapeutic practice from the eye movements have shown that the eye movements don't really have anything to do with whatever theory is. Oh, really? Yeah. Oh, wow. So, and so the main thing it is, it's like what we call exposure-based therapies for PTSD. So, bringing on memories of the trauma in very controlled ways and trying to deal with them has therapeutic benefit.

It's like the desensitization like with spiders. As you're afraid of spiders, right?

That's right. Yes. And it's good for phobia. I'll tell you a story. My father had a patient who was the wife of a very wealthy man who had a dog phobia. And having a dog phobia in the middle of Manhattan is not a good idea. She would try to time her walks for when people wouldn't be walking their dog. So he was having a very fancy dinner party at a hotel and this woman came in with a little white poodle and she screamed and jumped up and knocked the table over. and her husband was furious. And he said, you get fixed or we're done, you know. So she goes to my father, he gets her hypnotized. She, he teaches her to honor her fear of some animals, wild animals are things to be afraid of, but not tame animals. And he said, find a friend who you trust, who will hold his dog and you can pet the dog and desensitize, as you mentioned. So she did that. and she felt much better. And my father had called her up about six months later just to see how she was doing. And a little boy answered the phone and he said, Can I speak to your mama please? And he said, Yes, but who's calling please? And he said, Dr. Spiegel. And there was a long pause and the little boy said, that's funny. Spiegel's in heat.

She made the dog after your dad. That's so funny.

So, yes, it can work for things like that. That's amazing. That's amazing. It's very helpful in strange ways sometimes.

That's a great story. That's a great story. So it's not like a replacement, it's like for meditation or breath work, but it actually is an adjunct that can be used in medicine. And I think what we're seeing is a lot of the democratization of tools that have been held within medicine and healthcare. And, this is what I think Reveri is about. And, I think it's a really powerful tool. And, I'm very excited to use it for myself for sleep, for stress, for, you know, I have different issues with my back and this thing. I think, you know, I've kind of always thought I was never going to be able to hypnotize, but I'm re-inspired to go and try it and to see if I'm going to do the hypnotizability test to Great.

Great.

Whether I am right or not, it'd be terrific.

And we actually have some breath work as well on the app now. So we published a study last January showing that cyclic sighing actually reduces average respiratory rates and improves mood if you just do it five minutes a day for a month. And it's a very simple exercise where you inhale partway through your abdomen, diaphragmatically, stop, then fill your lungs by expanding your chest and slowly exhale through your mouth so that the exhale is at least twice as long as the inhale. And that we think triggers parasympathetic activity, but many people find that just doing that three times they feel more relaxed. And so I've been combining that with hypnosis too. It's a good thing to do if you're up in the middle of the night, can't get back to sleep, do the self-hypnosis and combine it with cyclic sighing. And so we've got that and one other breathing exercise on the app, on Reveri as well.

Now, for someone like me who thinks he's not that hypnotizable, how do you improve hypnotizability?

Well, it's more how do you improve how you use it. We have just finished a study now using transcranial magnetic stimulation to try and enhance hypnotizability. and we found that in the short term it actually works. So we triggered connectivity between the dorsal lateral prefrontal cortex and the dorsal anterior cingulate using TMS, and we found that there was an increase in hypnotizability. But I would say-- so that's where.

You have to put a big magnet on your head.

It's a magnet on your head. So, you know, we know that there's an inverse relationship between the flow of electrical current and a magnetic field. So that's what an electromagnet is, that the movement of the electrons triggers a magnetic field around that flow. And conversely, imposing a magnetic field will change the electrical flow within specific regions of the brain. It's a remarkable treatment for depression. My colleague, Nolan Williams at Stanford has pioneered the use of what we call SAINT. It's a Theta Burst very rapid, high intensity TMS. And in just a week, we've had people who have been depressed for years who say, now I feel like, and not I feel better, they say, I feel like my old self again. We're using it now to treat acute suicidal ideation as well. It's a very powerful, important new treatment in psychiatry. But it also can enhance hypnotizability. However, it's not a standard thing you would do. I would say, from our point of view, the best thing to do is to learn to use it better, whatever your degree of hypnotizability is. And again, the worst thing will happen is it won't work, but you can learn to just experience things differently and combine the therapeutic approach we use, which involves focusing on what you're for and what you're against with being in the hypnotic state. and see how well it works.

Yeah, essentially, you know, this all started with the concept of magnetism and you're using magnets to actually help the brain. I mean, it's really an exciting time in Psychiatry. We were chatting a little bit about this before, but I think this is a really a revolutionary time in Psychiatry where the old Concepts are fading out and, and we're rethinking how to actually include the brain as part of the treatment of psychiatric illness as opposed to just seeing it as a psychological problem or a chemical imbalance. There's actually a real change. Can you share as we close up, can you just sort of share a little bit about what's happening in the field, what you're excited about and what you're seeing as the big shift?

You know, Michael Pollan's book Changing youg Mind, we're using psychedelics now and the interesting thing is that just just one or two uses with psilocybin, which also works on the posterior cingulate cortex, the serotonin system, that you just try out being different. So there have been studies using psilocybin with dying cancer patients. And, you know, my first, I've worked with dying cancer patients a lot. And my first thought is you wouldn't want to take a bad trip, you know, when you're thinking about death. But people emerge from it saying I could see, I could look, I could peer at my own death. and it's profound, but I also realize what a miracle it is that I exist. And so they come out of it with a totally different perspective. So you just try out being different, and psychedelics are another way to do that. Also TMS and other kinds of brain stimulation can trigger activity in specific regions of the brain that can affect depression and anxiety. And so we're learning that there are ways to change how the brain works or how we use the brain and make it work differently that are powerful therapeutic tools. So, you're right, it is a very exciting time.

Yeah, it's like transcranial magnetic stimulation, using energy, literally energy. Using energy.

That's right.

Hypnosis, psychedelics. At Stanford, there's a department of metabolic psychiatry where they're studying the role of nutrition and particularly metabolic health and insulin resistance and depression. At Harvard, they have departments of nutritional psychiatry and looking at the microbiome. So we're really kind of rethinking it to sort of almost an enlightened age where we actually have to kind of change everything. And, you know, you're kind of towards the end of your career, but it's, you know, it's been a long slog of things that really don't work very well. I mean, I literally was on the phone for an hour with a friend of mine whose mother's, you know, got severe depression. was just hospitalized. She's on, I mean, one pile of medication after another. It's like, okay, this doesn't work. Let's add this. This doesn't work. Let's add this. It's like. And she's just like a zombie from the medication, and we don't know what's going on in there anymore. So I think having these other tools is so important. And I encourage everybody to. To sort of explore these tools. If they're challenging their own lives with any issues related to mental health or cognitive function, to definitely check out. Revere R-E-V-E-R-I.com and you can download the app and you can try it out. I'm definitely gonna try it. If you love that last video, you're gonna love the next one. Check it out here.

What they're still suggesting to the public is you're controlled by genes. And if you're controlled by genes, then that means you have no control. And that means you're a victim. And that means we must find somebody to heal us. And the relevance about all.