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What are Hypnotic deepeners?
The deepener’s job is to take someone from being in a trance to being in a deeper trance (see trance depth). There are a number of reasons why someone would want to do this;
- it is general believed that the deeper the trance the more effective the therapy. The evidence for this is not clear, particularly because lighter states of trance may allow you to work more flexibly.
- People are presenting for ‘hypnotherapy’, the emphasis here being on the ‘hypno’ part and as such may have a more convincing experience with a deeper state.
There are many different formats for deepening and below we will explore some of the most common.
Numerical hypnotic deepeners
These are deepener’s which rely on counting up or down, commonly this might be counting down from 3 or up to 10. The counting provides a defined period of time in which the deepening can occur thus allowing the mind to make the transition. Typically, suggestions such as “deeper and deeper, “deep sleep” and “relax” will be made in and around the numbers to help facilitate the deepening.
Natural phenomena hypnotic deepeners
Possibly the most common natural phenomena hypnotic deepener are those which use ideomotor response to return a limb to normalcy after having conducted induction through an Arm levitation or Limb catalepsy induction. A lesser example of a natural phenomenon deepener is delivering deepening suggestions as the subject exhales to gain the benefit of the simultaneous physical suggestion given by the act of breathing out. for more on natural Phenomena in hypnosis
Visual engagement hypnotic deepeners
These look to create deepening by encouraging the subject to focus internally on imaginary imagery, typically a journey or favourite place. This creates dissociation from the current environment and may help access resources states, such as relaxation which in themselves may further deepen the subject.
Dissociative hypnotic deepeners
These are deepeners which explicitly encourage dissociation, the separation of subject from their current time / space. Many people argue that dissociation is the basis of hypnosis so anything which encourages it is likely to be useful. A typical example of dissociation deepening is asking a subject to imagine floating out of their body, this can easily lead into a visual engagement deepener such as a journey to a favourite place.
Triggered and conditioned hypnotic deepeners
These are a little different to the other types of deepener as when initially introduced they are not intended to procedure deepening but rather are establishing a cue for deepening at a later point. The cue word may be “sleep”, “relax”, “Nowww” or something similar. The use of the cue word is to take the subject back to the state in which the cue word was installed, to this end the hypnotherapist will look to install as deep a trance as possible before installing the cue word. Such deepening words are resources to be applied by the hypnotherapist when trance depth has been disrupted by something or an extra bit of deepening is required.
The above are all elements of deepeners and may well in mixed in together to create a more effective whole.
Opinions of people with IBS towards Hypnotherapy
Recently I presented at the Society for Academic Primary Care (SAPC) Conference at Warwick University (UK). Below is a short video covering some of the main points and below that is the written out full length presentation.
Full Text – presented to clinicians
Science or Magic! … well if you were asked which one you represented I suspect you know what you would say? … not so much for me … I’m a hypnotherapist … and none of us control my own image … So what I want to know is which do people see me closer to the scientific world, with a body of knowledge which can be taught, is structured and replicable … or the magical world where the ability to heal is not explicable … not strictly learnable … but comes from something unknowable
And why does this question matter, why is this question important to primary care?
Back in 2008 Hypnotherapy was accepted into NICE guidelines as a treatment for refractory IBS, refractor IBS is IBS which hasn’t responded to primary treatment and has developed an ongoing profile of symptoms.
There was good reason for this inclusion
· IBS is a substantial problem with prevalence rates around 10% internationally, we don’t know exactly how many of those people are classified as ‘refractory’ but it could be as many as 1/3rd.
· IBS is expensive for the NHS, with approximate 0.1% spent within the NHS being on IBS, 50 million of which alone is accounted for by anti-spasmodic and laxatives, the rest being in other forms of medication to controls symptoms, but one of the biggest expenses being in GP time.
· And although it’s not life threatening it does make people’s lives a misery. Its effects their attendance at work, their ability to work (so called presentism) and they usually are paying out of their own pocket for treatments and remedies, some studies suggest the this is roughly equal to the amount the NHS spend.
So there is good reason to integrate any effective tool, particularly if it provides and actual cure, rather than just a control.
But to the best we can tell, people with IBS are not interested Hypnotherapy for their condition, they are not seeking it out either in the public or private sector and we wondered why. One of the things we considered was the image of hypnotherapy and the hypnotherapist, may present a barrier, specifically we were interested in seeing if the perception of the hypnotherapists was more medical or more magical?
I am conducting 1-2-1, semi-structured, qualitative interviews with adults with refractory IBS to find out their opinions about hypnotherapy. These will be analysed using the framework method for indications of what the Sociologist Weber characterised as the Bureaucratic and Charismatic,
· Bureaucratic meaning reliable, teachable, learnable
· Charismatic meaning having power from within
So far the main finding has been that it’s very hard to recruit for this stuff, possibly there are too many elements – IBS, refractory, hypnosis but the one interview which I have conducted has raised some interesting findings
Firstly, the phrase ‘Cluck like a chicken’ was used, a phrase I’ve heard a lot as a hypnotherapist, another one was “funfair comedy magician thing” suggesting that the musical hall associations of hypnosis are strongly present. This points to a third image which is not science nor magic but frippery, entertainment … and who’s going to consider using hypnotherapy for their IBS if they perceive it as an entertainment.
However, this should be balanced against another observation the interviewee made
“But I’ve not heard of hypnotherapy for an actual medical reason, it’s always been for phobia or … maybe depression, that what I associate hypnotherapy with”
So the connection with mental health appears established in her mind but not with physical health, and although it’s very early days on this research perhaps this is the true barrier to usage, People just don’t think of hypnotherapy for physical problems. They don’t see the connection.
Pre-induction factors which affect hypnotic induction
In this Vlog / blog we look at several factors which can effect the outcome of a hypnotic induction. let’s first define what an induction is;
A hypnotic induction is a way of getting someone to close their eyes. It generally includes some degree of deepening but ultimately it is about taking someone from having their eyes open to having their eyes closed. This means that the simplest form of hypnotic induction is the ‘simple eye closure’ where you just ask someone to close their eyes, even this cuts out a substantial amount of the information which is coming into the brain (approximately 40% I am told) allowing for greater focus on the internal world. However most inductions are more elaborate than this and start to produce hypnotic states in advance of eye closure.
Pre-induction factors which affect hypnotic induction – preparation
there are a number of basics which can make quite a difference these include;
Comfort & physical stabilisation – Are they physically comfortable? Is the chair you use strong, stable and comfy for a semi-conscious person. Is the room warm / cool enough for a semi-conscious person, and have they been to the toilet recently enough (don’t ask about this immediately before induction). In addition I always invite my patients to place their feet flat on the floor and their hands on their laps as this create more physical stability.
Understanding – Studies (by me!) suggest that most people have a balanced view of hypnosis and hypnotherapy and many of the old myths about control and domination are dying out, however they are not yet gone, so a good explanation of what hypnosis is, what it might be like and what it is not is a good idea. In addition you should offer the client the chance to aske any questions they may wish.
Consent – Although it would be possible to argue that the act of presenting to a hypnotherapists for therapy gives implied consent for hypnosis, explicit consent is much more respectful. So always stop to ask if a client is ready to enter hypnosis before you initiate induction.
Co-operative mind set – by enhancing co-operation prior to induction they are far more likely to co-operate in trance. Co-operation is enhanced by building rapport, but also by demonstrating co-operation and techniques like the ‘yes set’ which will be discussed in other videos.
The use of natural phenomenon in hypnotic induction
In this video I discuss the use of 6 natural phenomenon in hypnotic induction
Breath – deceptively simple but overlooked by many is combining your suggestions with someone breath. Usually this means you deliver deepening suggestions on the outbreath thus giving a physical suggestion in combination with the verbal suggestion.
Tiring – a hypnosis classic! you place the subject in a position where they will gradually become tired, for example the eyes focused on a elevated spot, wait for a little while and then tell them that they are becoming tired. The real trick is to tell them they are becoming tired before they are consciously aware of it. By directing their attention to the pre-existent tiredness it gives the impression that suggestion has made this happen.
Ideomotor response (IMR) – Most people are not aware that most thought, especially about actions, tend to produce small unconscious movements, these are called IMR’s. By directing a subject to have a certain thought a hypnotist may produce an IMR. As with tiring (see above) the hypnotist may be credited with producing this IMR but all the hypnotist is actually doing is focusing the subjects attention on something which is already. By repeating and enhancing the IMR through suggestion it can be taken well beyond its naturally occurring level and produce some of the more impressive hypnotic inductions such as the Arm levitation.
Dissociation – we all have the ability to mentally separate from our immediate circumstances, we call it daydreaming, this is also a form of dissociation. Dissociation means to separate from the here and now, usually by an act of engaging with the internal mental world. A hypnotist will often encourage dissociation directly by inviting someone to imagine floating out of their body and floating off to a beautify place. Dissociation can be in both space (location an bodily awareness) or time.
Fractionation – It has been observed that someone in a trance, however light, will go progressively deeper if they are asked to open their eyes and then invited to closed them again. Although often enhanced with suggestion this interesting natural phenomenon has been used by hypnotists for many years to help people go gently deeper into hypnosis.
Confusion – far from my favourite as it is rarely appropriate to the anxious patients I tend to work with it is however a powerful hypnotic technique. When in a state of confusion a person will often latch on to any single clear command or idea with far greater belief than if the were not confused. Hypnotists will often produce mild confusion in their subjects which they then break with a single clear command.
3 Innate Factors which affect hypnotisability
The socio-cognitive theorists offer up three different factors which are innate to hypnotic subjects to varying degrees and affect how easily they can be hypnotised
- Vividness & Involvement – this is a persons ability to loose themselves into or sink into a concept. Part of this is the realism with which they experience a scene, memory of concept be that visually, physically or with any other sense. Although this can be enriched through suggestion most people have a basic level of vividness and involvement which the hypnotherapists guides. With people who display a strong level of involvement I tend to use very little deep hypnosis and favour imagery and Ericksonian approaches.
- Expectancy – as you may anticipate this is a person’s belief in hypnosis. Naturally this varies from complete acceptance in the idea to utter disbelief in phenomenon of trance or hypnotic suggests. Essentially, the stronger the belief in hypnosis the more easily someone is likely to go into it, or respond to it. This is mostly because they are going to be open, co-operative and interested in the experience. With people with a high degree of belief in hypnosis I tend to use the more traditional, often more theatrical, approaches which fit more closely many peoples expectation of hypnosis. A common expectation to this is when they have prior positive hypnotic experience and then I attempt to replicate their past experience.
- Compliance – some people are naturally more cooperative than others and respond well to being given simple clear instructions. Highly cooperative people tend to be more natural hypnotic subjects, but everyone who presents to a hypnotherapist is intending to go with the process to some degree. A compliant mind set can be nurtured with a few simple, reasonable, request such as asking the person to place their feet flat on the floor and their hands upon their lap.
Ever wanted to know how many people use hypnotherapy?
A little way back I did an article for the British Society of Clinical Hypnosis (BSCH) addressing the question of how many people use hypnotherapy. This was inspired by my research into the public’s attitude towards hypnotherapy. It was a question which had been on the agenda of that project but never quite materialised, so here it is How many people use hypnotherapy
Please remember that this is not a fully peer reviewed paper just a little research project I did on the side. At some point I may revisit it for a full systematic review because no one has yet done that . I do however believe that it is the best information on this topic currently available.
Take a look – How many people use hypnotherapy? or cut and paste – http://www.bsch.org.uk/hypnotherapyusage.html
The author – Matt Krouwel is a hypnotherapist and researcher in Birmingham (UK)
What do people think of hypnotherapy ?
my latest academic paper addresses the issue of what people think of hypnotherapy. Take a look at the abstract
Refractory Irritable Bowel Syndrome (IBS) sufferer’s attitudes and opinions towards hypnotherapy as a treatment.
I am looking for people who have;
- Received a formal diagnosis of Refractory IBS. Refractory IBS means that a person has been diagnosed with IBS and received prescribed medication from their doctor but is still suffering with IBS 12 months later.
- Currently live in the UK
- And who have not seen a hypnotherapist for their IBS.
If you fit this description I would like to invite you to take part in an interview based research study. Before committing please take a few moments to read the following and consider if this is something which you feel comfortable to participate in.
What is the purpose of the study?
In 2008 the National Institute for Care Excellence (NICE), who decides on ‘best practice’ for the NHS authorized the use of hypnotherapy to treat refractory IBS. As part of my doctoral research I am interested in finding out sufferer’s attitudes and opinions towards hypnotherapy and its use within the NHS.
Do I have to take part?
Participation is entirely voluntary and much appreciated. Feel free to ask any questions at any time you like. You can withdraw at any time you like without having to explain.
What will happen to me if I take part?
If you agree to become involved;
- I will come to interview you at the location of your choice, your home or at the University of Birmingham for example.
- I will obtain your written permission to conduct the interview.
- The interview will last 45-60 minutes.
- With your permission I will record the interview.
- I will ask questions around your general experience of IBS and IBS treatment as well as attitudes towards hypnosis and hypnotherapy.
- After the interview the recording will be transcribed and any identifiable data will be removed.
- If you wish your details can be retained by me so that I can inform you of the findings of the study (this may be several months or more than a year after the initial interview)
Expenses and payments?
If as part of the study you incur any reasonable incidental expenses, such as travel, then these will be met. Please bring these to my attention prior to our meeting to enable budgeting and please retain any relevant receipts.
What are the possible disadvantages and risks of taking part?
As this research is based on an interview there are no risks to your health, however IBS can be a very personal topic and I advise you to consider how comfortable you will feel divulging personal experience to a relative stranger and in particularly to consider this when deciding where you would like me to meet you for the interview.
Is it confidential?
All information is confidential and will only be seen in full by myself and a transcriber who is bound by confidentiality. During the transcription phase identifying details will be removed to maintain your anonymity. Your details will be retained by myself for a period of 10 years in a secure locked file, after which they will be appropriately destroyed. Your data will not be used for any purpose other than those directly related with this study.
What if there is a problem?
In any study there are a number of possible problems which may arise. The most common of which is that you need to cancel or rearrange the appointment for the interview, in this eventuality please contact me (Matt) on 0739 295 7945.
In the event of a more serious problem or complaint you may contact myself (Matt 0739 295 7945) or if you would prefer to speak to someone else then please contact Professor Sheila Greenfield who is supervising this research on 0121 414 6493.
You are entitled to withdraw from the study at any point up to a month after the interview.
What will happen to the results of the research study?
The research is primarily for academic purposes and as such will be used, in an anonymised form, to help write an article for a peer reviewed journal and be used as part of my PhD thesis. Specifically, verbatim quotes may be used, these will not be identifiable.
Who is organising or sponsoring the research?
The research is being organised with the University of Birmingham and is receiving no funding from any other sources.
Further information and contact details:
Mobile 0739 295 7945
University E-mail MJK599@student.bham.ac.uk
Matt Krouwel is a Post graduate research student with University of Birmingham working towards a PhD in Health and Population Science.
What is the difference between neurosis and psychosis? Let us start by defining neurosis and psychosis.
Neurosis is a broad term rarely used by therapists and psychologists these days. However, it does have some value to hypnotherapists. Broadly, neurosis can be said to be a mental problem in which the suffer is in touch with reality. Often this appears as a logical – emotional dissonance. This means the suffer can tell you that their behaviour is inappropriate but feel it is beyond their control. Typical examples would include;
- Phobia’s – in which the sufferer knows that the trigger for the phobia is not dangerous.
- Obsessions – where the obsessed know that they are over focused but cannot break out of that.
- Extreme Habits – the sufferer may be able to identify the habit as unpleasant, but they are unable to take control of it.
- Twitches and ticks – where the afflicted cannot control the muscles involved but there is no identifiable physical problem.
With neurosis there is an implication that some life event or problem is influencing the problem. This may not always be true as a life event may have initiated the problem behaviour but it may now be a habit.
Neurosis is the most serious level of mental health issue a hypnotherapist may deal with. Psychosis (see below) are contraindicated for hypnotherapy.
is a general term used to describe any set of symptoms where the sufferer is thought to be out of touch with external reality. This may be due to any number of factors such as organic brain impairment or long term stress. Symptoms of psychosis include
- Severe lack of insight or self-awareness.
If you have any concerns that a potential patient may be out of touch with reality refer them on to a doctor.