TRANSCRIPT

This podcast is sponsored in part by Reveri.

Interested in trying hypnosis for migraine? Take 20% off yearly or lifetime with code SPOTLIGHT or visit: https://reverihealth.app.link/spotlight-on-migraine

Molly O’Brien: Hello and welcome to Spotlight on Migraine. I’m your host, Molly O’Brien. Today we’re exploring a therapy that has a long history but is quite often misunderstood. We’re talking about clinical hypnosis. Hypnosis is a well-established therapeutic technique rooted in neuroscience and psychology. In this episode, we’re going to break down some of those misconceptions surrounding hypnosis, while also talking about what it is and how it can be an effective tool to help manage migraine. I’d like to welcome our guest, the leading expert in the field, Dr. David Spiegel. Dr. Spiegel is Wilson Professor and Associate Chair of Psychiatry at Stanford School of Medicine. He has more than 45 years of clinical experience. He’s a pioneer in clinical hypnotherapy research and has authored 13 books and more than 450 research papers. Dr. Spiegel is founder of Reveri, a self-hypnosis app. Dr. Spiegel, thank you for joining us today. 

Dr. David Spiegel: You’re most welcome, Molly. I’m delighted to be with you. 

O’Brien: This is a really interesting topic, and you are the leading expert in the country, around the world, with tons of research and supporting evidence behind hypnosis, so we’re really looking forward to talking about it. So to lay the groundwork for our audience, can you tell us what hypnosis is, and with that, what it is not?

Spiegel: Hypnosis is a state of highly focused attention. Have you ever had the experience of getting so caught up in a good movie that you forget you’re watching a movie, you enter the imagined world? So you lose yourself in the event. It’s like looking through a telephoto lens of a camera. What you see, you see with great detail, but you’re less aware of the context. To do that, you dissociate. You put outside of conscious awareness things that would ordinarily be in consciousness to allow you to focus on what you want to pay attention to. And you also, in doing that, disconnect from your ordinary sense of expectations – who you are, what you are, what you can do, and what you can’t do. So it’s been called believed in imagination. Actually, I think of it as a kind of underutilized state that many of us have the ability to mobilize, but we don’t use it. Sort of like an app that’s on your phone, but you haven’t opened and used yet. Hypnosis is a highly effective means of controlling your emotion, your pain perception, your sense of physiological arousal.

O’Brien: It sounds like low risk and potential for high reward.

Spiegel: Exactly, Molly.

O’Brien: Can you tell us a little bit about what hypnosis is not?

Spiegel: The biggest misunderstanding about hypnosis, Molly, is that it’s a loss of control. You know that somebody will take you over and turn you into, you know, a robot that will go do anything you want. It is not that. It is a state of highly focused attention. Now we’re all social creatures. We all are susceptible of social influence of one kind or another. But you’re not losing control in hypnosis, you’re gaining control. You’re gaining control over how your body feels, over what you pay attention to and what you don’t, about how you approach problems, about how you can reduce the secondary anxiety and frustration that comes when you’re having a migraine attack. 

It can help you restructure your experience of even very difficult situations, learn to treat them and to prevent them from growing into a full-blown attack if you’re having it. In meditation, which I have great regard for, it’s about being. Be different. Let feelings flow through you. Don’t try to control them. Hypnosis is, in many ways, in that sense, the opposite. You use hypnosis to focus on changing something – on reducing your pain, on changing the way you manage your body, on changing the way you react to the onset of pain. If you have an aura, what do you do about it? So, it’s different in the sense that it helps you to focus attention and control the way your mind and your body respond to a stressful situation.

O’Brien: Thanks for bringing that up, because I did want to ask a little bit about the difference and maybe the overlap of hypnosis and mindfulness and meditation and CBT. So it sounds like there are some similarities, but maybe that main difference is, instead of just sitting with it and letting it be, that you can proactively work to improve. Is that kind of right?

Spiegel: That’s exactly right. That’s what you do. You use hypnosis as a way of deciding what to pay attention to and what to ignore. And in a way, rather than from the head down – which you’re doing with meditation, and to some extent with CBT too, where you have these series of cognitive steps that you take to stop pain catastrophizing and so on – with hypnosis, you start with the body up. You say, part of the problem I have, and part of the problem we see in people with pain is the reaction to it can amplify the pain. The worst thing you can tell a patient is, don’t think about purple elephants. That’s what you’re going to do. And so with hypnosis, you say, the situation is making me and my body feel terrible. And I’m going to start with the one thing I can do something about, which is how my body is reacting to the stressor. 

So you get an aura, and you think, oh, my God, I’m going to be miserable for the next three days. And the aura is there, the neuroinflammation, or whatever is going on in the brain when you have a migraine is the real deal, but the way the brain reacts to that initiation of stress can have a big effect on how bad it gets. Problem with many pain syndromes – and certainly migraine attacks are one of them – is it starts to happen. You’re having the aura, you think, oh, I know what’s coming. And you’re reacting in a way that can amplify rather than diminish the pain. We are built to react to pain stimuli because they indicate potential danger. But we all tend to react to any pain as if it were acute pain. You just broke your ankle. Something terrible happened. You better do something about it. And that’s true for some pain, but for a lot of pain, it isn’t. And so you can decide how much attention to pay to it. Hypnosis is a way of controlling what you pay attention to and what you ignore. 

And we have evidence…we took a group of Stanford undergrads who were highly hypnotizable. We’d screen them for hypnotizability. We gave them electric shocks on the wrist that were mildly painful. And in one condition, we just recorded the EEG response, the somatosensory evoked response. And you get this wave form of a little wave at a 10th of a second, a bigger wave at two tenths of a second, and a really big one at three tenths of a second. It’s the standard way the brain reacts to a series of stimuli. And we got the normal recording. And then I hypnotized them and said, your arm is in circulating ice water, cool, tingling, and numb. They get the same shocks. 

The first wave at a 10th of a second disappeared; the brain was acting like it wasn’t happening. The second and the third waves were half as big. So just by using a simple hypnotic instruction, they could filter out at least 50% of this real pain signal that they were still getting. And so, you can train the brain to react differently to the same stimuli. And it doesn’t mean the stimuli aren’t there; it just means the brain it has to decide how much attention to pay to it. And the strain and pain lies mainly in the brain, you know, that’s where it happens. And so, if you control it, it doesn’t mean there isn’t something real going on. It means your brain is reacting differently to it, and that’s what people suffering migraine attacks can learn to do.

O’Brien: I love the idea of this being a proactive approach that you are almost taking control of your pain or whatever you’re working on with clinical hypnosis. Is this something that we need to practice and get better at? Say like we’re strength training and we’re building up the strength in our muscles. With hypnosis, if you find yourself being able to be hypnotized – as you mentioned, you kind of have to have the openness and willingness – is it something that might be able to work right away? And if not, is it something that we can get better at over time?

Spiegel: So far, our data shows that – interestingly enough – people within 10 minutes, they can get 17% lower pain levels right away. Four out of five people feel better right away. And what we find is that the degree of reduction each time they do it is pretty consistent. It doesn’t necessarily get a whole lot better, but you get more confident that you can do it, and you tend to use it more. And each time you do it, you get the same relief. It’s more you learn to use it, and you learn to use it quickly, and you can interrupt that cycle of physical discomfort and mental reaction to it that can amplify pain, and instead you can diminish it. 

O’Brien: Is there a little bit of positive reinforcement, like that kind of concept behind it? I did it, I saw benefits, and now I keep going. Are we kind of training our brain in that way?

Spiegel: Exactly. That’s exactly right. That instead of being sort of thinking, oh God, you know, this thing is going to take over my head and my life for the next three days, you’re thinking, this is a situation that I don’t like, but I can deal with. And so it becomes an occasion to reinforce your sense of competence in managing the pain.

O’Brien: And now I want to get to kind of maybe your least favorite part – but I think a really fun part – is really busting the myths around hypnosis. I’m sure many people out there, as soon as they hear that word, it goes to the movies, the Hollywood perception, or the magic show, or whatever it is, an entertainment purpose. So let’s break some of those misconceptions and talk to us a little bit about maybe the stereotypes out there that are negative, and just kind of clarify for us to paint a better picture.

Spiegel: I’ll do my best, Molly. It’s one of my great frustrations – and I’ve been doing this for 50 years – despite the fact that hypnosis is the oldest Western conception of a psychotherapy, it’s been around for 250 years, it’s still viewed as either useless or dangerous or both. And it’s neither of those things. It works. It has tremendous efficacy in controlling pain, controlling anxiety, reducing phobias, getting people to stop smoking. It’s got many areas of clearly proven effectiveness in randomized clinical trials. We know a lot about the mechanism that happens, and yet people think it’s dangerous. You know, this idea that you’re just going to lose control and someone will take you over. Now, people in a hypnotic state will do remarkable things, but they can control what they’re doing. 

All hypnosis is really self-hypnosis. And what you’re learning to do is identify. When I see highly hypnotizable people, it helps them understand things that go on in their lives. That they sometimes find themselves like buying into thoughts that other people had that we’re trying to push on them, and they wondered why they were so open to it. Very hypnotizable people are open to that. Well it’s a kind of personality attribute that can be a benefit. You understand and get in sync with people, but it can be a problem if you swallow things you shouldn’t swallow. So it’s good to know if that’s the way you are. But it’s also a way of focusing very intently, of changing your…letting go of your presumptions of what you can do and what you can’t do. And we found that it is very helpful in teaching people how to better manage their bodies, their relationships with people. 

There’s this other misconception, Molly, that if you can fix it with hypnosis, it isn’t real. You know what, the brain is the organizing center for everything that goes on in the body. It connects with every part of the body. It receives information from every part of the body and controls what happens. And a big part of any disease is how the brain is reacting to whatever’s going on in the body. And that is a tremendous opportunity. So just because you can reduce or even eliminate migraine attacks doesn’t mean you don’t have migraine. It means that you’re learning to respond to it better, so that it does minimal disruption to your mind and your body. And so it’s real, but you’re just taking full advantage of the organ that orchestrates everything that’s going on in the body and using it better. 

O’Brien: Is it always with someone in person? Can it be virtual? Like what types, what opportunities are there out there?

Spiegel: Molly, all hypnosis is really self-hypnosis. If you’re not hypnotizable – and there’s about 25% of the adult population just isn’t hypnotizable – I could talk to you all day long in my office, and you would not have a hypnotic experience. You might learn a strategy to focus on what your for and be less likely to panic and let it take you over, but it would not have the same acute sensory alteration that you have with people who are moderately or highly hypnotizable. So hypnosis is not something that I impose on a patient. What I do when I see every patient – every 1 of these 7,000 patients – first thing I do is test their hypnotizability. We score it on a 0 to 10 scale. We can do it in about five minutes. And Reveri has the hypnosis test on it, so you get information about how hypnotizable you are, and then we tailor the way we instruct you to use it to your degree of hypnotizability. 

And so, it used to be that you had to go to a professional and spend time with them – like me – and learn how to use it. I would take you through the hypnotic experience and show you how to do it, and then we would evaluate how you did it and adjust it. Now what we’ve found is that we can get comparable results just teaching you to listen to the app, and the app itself is interactive. So I ask a question, you give an answer, and we’re using AI now to sort of reconfigure my responses based on what your experience is, which is really kind of cool, actually. So it’s, you know, as much like being in my office as possible. 

But we get results that are very comparable to, you know, what happens when you’re with someone with hypnosis. There are some people who benefit from it. There are some excellent psychologists, psychiatrists, physicians, pain docs, who use hypnosis. And that’s fine if you have access. The thing is it’s hard to find these people – there aren’t that many of them – and it costs money. There are two good professional societies, the Society for Clinical and Experimental Hypnosis and the American Society of Clinical Hypnosis. They have websites, and they can help you get a referral, or your doctor can refer you to somebody who practices hypnosis and is a licensed and trained professional.

O’Brien: Let’s talk a little bit about hypnosis for migraine or people with migraine using hypnosis.

Spiegel: There have been a number of randomized trials, and there are meta-analyses that have looked at the use of hypnosis. And what they find is that it is significantly effective. That at least half the people who use it get clear improvement in their migraines. And sometimes they shorten the attacks, or they reduce the symptoms that come in all stages of migraine, from the aura through the full bore migraine attack. And so there is clear evidence that it’s as effective as other treatments like, you know, reducing catastrophizing of pain, and that it can be sometimes as effective in preventing or reducing symptoms as some of the medications because it’s working on this reactive component. We have evidence that hypnosis can change activity in different parts of the brain just depending on the wording you use in hypnosis. 

So there was a very good fMRI study showing that if you tell people that you can filter the hurt out of the pain. That it’s there, but you can transform the experience, focus on cool, tingling, numbness, or comforting warmth, and you reduce activity in the somatosensory cortex in the brain. But if you just tell the same people, it’s there, but it won’t bother you so much, you won’t worry about it so much, you get reduced activity in the dorsal part of the anterior cingulate cortex, which is our salience network. It’s part of the alarm system. It’s also part of the pain processing system in the brain. And we’ve been able to show that people, when they’re hypnotized, turn down activity in the anterior cingulate cortex. So they’re literally turning off the alarm. They’re just saying, it’s there, but I’m not going to worry about it. And you can mobilize that in a minute or two just learning to do self-hypnosis. So, it’s effective, and it changes the way your brain is working.

O’Brien: It’s so cool to think about the changes that are actually happening in our brain being open, and that you really can sort of reprogram yourself and take back some of that control. Let’s talk a little bit about the app that you developed and founded, Reveri. I’ve got it right here on my phone. There are a lot of different strategies and different things to work on and practice within the app. There’s pain, there’s better sleep, there’s focus, there’s all kinds of stuff. Can you tell us a little bit about the app? What went into it, what people can experience, people can learn, and just give us an idea of what it is and what it’s all about. 

Spiegel: Sure. Reveri is a self-hypnosis app that we built to help people learn to do this for themselves. You know, I’ve used hypnosis, Molly, with about 7,000 people in my career, and I’m glad I did. It was delightful to interact with people and help them person to person. But I realized that there are so many more people who could benefit from hypnosis for pain control and people with migraine and other kinds of pain, fibromyalgia, that it’s a shame that more people don’t get access to it. Hypnosis is a highly effective means of controlling your emotion, your pain perception, your sense of physiological arousal. And so far, it hasn’t succeeded in killing anybody, and it’s safe and effective. 

So I wanted to make it available to as many people as possible to give it a try. And the worst thing that happens is it doesn’t work. But you know what, with a whole lot of people, it does. And I think, you know, a big part of the way hypnosis works with migraine attacks and other things is helps you change your attitude towards your body. So if you can just flip into that mindset of, oh yeah, I know what this is. It’s a problem. We’ve been there before. I want to try and comfort and soothe my brain and my body and help it handle this differently.

O’Brien: Can you walk us through what a session looks like, feels like, sounds like? How long they are – is it a few minutes a day, is it an hour a day? Just kind of walk us through.

Spiegel: Well we welcome you to Reveri, explain a little about what hypnosis is and what it isn’t. And if you like, a good way to start is to take the hypno test, and you do a hypnotic experience that I instruct you to do, making your hand feel light, floating up in the air. If you pull it down, it wants to float back up. And then I give you a cutoff signal to end it, so we see how well your body is able to respond to the hypnotic instructions. And then we tell you you’re in one of three categories. Either you’re a poet, you’re in there all the time. You’re easily absorbed and things, your body reacts very quickly and profoundly. Or you’re what we call the diplomat. You have the experience, but then you step back, and you think, well what is this? Is it real or not? And you kind of negotiate your way into having a hypnotic experience. And then there are people who we call the researchers, who just are very skeptical. 

And so then that helps us then to decide what kinds of instructions to give you in dealing with the problem. For the highs, it’s just change it. You know, there’s an ice pack on your head, cool tingling and numb, (inaudible) of the pain, and very quickly they can do it. For mid-range people, it’s more a negotiation of try out some different approaches, and let’s see how it works. And for the lows, it’s more focusing on your attitude and less on your ability to change perception about how you’re reacting to your body. And so then there are a series of exercises you can do for pain control, as you mentioned, for stress management. Because sometimes one of the common triggers for a full-blown migraine attack is just stress, you know, or insomnia, that’s another one. So we have components in Reveri that will teach you how to better manage stress, to get your body comfortable first, and then use an imaginary screen to problem solve. To picture the problem on one side and the possible solution on the other. But you start out by managing your body’s reaction to whatever the stressor is. 

That’s the one thing about a stressor anybody can control – it’s how their body’s reacting to it. And then once you’ve calmed that down, you’re better at figuring out what’s the thing you do about the stressor itself. Or we teach people how to get a better night’s sleep. We teach you to manage the various stressors that can either trigger a migraine attack or make it worse if it’s happening and to control pain. There are a number of pain control techniques that include just learning to imagine that that part of your body is warmer or cooler or tingling or numb. Imagine dissociating – I’m going to leave my body here, and I’m going to Tahiti, you know, I’m just going to sit on a beach in my imagination. 

And sometimes that ability to detach from it. A third thing is to move it around a little bit. Sometimes people find it useful to just change where it feels it’s happening, or change what the pain symptom is, so you’re feeling some degree of control over it. And another one is to just think about having compassion for your body. You know, my poor brain’s been through a lot, and it may have this inflammatory problem, and I just want to help it deal with it better. Ten minutes twice a day is usually plenty, and people, each time they do it, get consistent pain relief.

O’Brien: You mentioned a little bit people have…there are different categories of people. If they are very hypnotizable, if they’re sort of, they can get there, can we change categories?

Spiegel: We’ve studied that, and we actually have done research with transcranial magnetic stimulation, which is a very exciting new treatment for depression and impulsiveness and other things. Works extremely well and very fast. And we use TMS to stimulate one part of the brain that would inhibit activity in the dorsal anterior cingulate. And we found that there was a transient increase in hypnotizability. Didn’t last that long, but it was a sort of proof of principle, and we’re hoping to study that more if we can affect those specific brain regions that are involved in hypnosis. So it’s possible. 

But I would say the best thing from a practical point of view now is identify your style and make the best use of the style that you have. But even in our studies, we’ve studied thousands of our users in Reveri, and we find that hypnotizability makes a difference, but it’s not the whole story. Because part of what we do with Reveri is teach you not just how do you mobilize hypnosis, but how to approach the problem, how to avoid making it worse, and not fighting your body, but instead helping it the way you would help a child who is troubled. And even non-hypnotizable people can do that. 

O’Brien: I’m curious if you have any advice for listeners/followers out there who are really curious about self-hypnosis, but still, even after listening to this whole podcast, they’re still a little skeptical. 

Spiegel: Just try it. The worst thing that happens is it doesn’t work. And the best thing that happens is you get a grip on how to address your problems from a new point of view. You can try out being different for free. Just see what it’s like and see if you can’t discover things about yourself and your brain and how it can help you better manage your body. You know, the brain doesn’t come with a user’s manual. We’ve got to learn how to use it better, and hypnosis is a good way to do that.

O’Brien: We’ll leave it at that. Dr. David Spiegel, thank you so much for your time and sharing all of your knowledge, leading expert in this topic. We really appreciate you chatting with our audience today.

Spiegel: My pleasure, Molly. Thank you for having me. 

O’Brien: And for all of our followers, if you want more information on self-hypnosis or the Reveri app, you can visit the website at www.reveri.com. And that wraps up this episode of Spotlight on Migraine. To all of our followers out there, thank you for listening. This podcast is made possible by supporters like you. You can make a tax-deductible donation today at www.migrainedisorders.org. I’m Molly O’Brien with Spotlight on Migraine, we’ll see you next time.

Interested in trying hypnosis? Take 20% off yearly or lifetime with code SPOTLIGHT or visit: https://reverihealth.app.link/spotlight-on-migraine