Dr. David Spiegel: Using Hypnosis to Enhance Health & Performance

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.280 | where we discuss science and science-based tools

00:00:04.880 | for everyday life.

00:00:05.900 | I'm Andrew Huberman,

00:00:10.520 | and I'm a professor of neurobiology and ophthalmology

00:00:13.300 | at Stanford School of Medicine.

00:00:15.160 | Today, my guest is Dr. David Spiegel.

00:00:17.640 | Dr. Spiegel is the Associate Chair

00:00:19.400 | of Psychiatry and Behavioral Sciences

00:00:21.260 | at Stanford University School of Medicine.

00:00:23.440 | He is also the Director of the Stanford Center

00:00:25.840 | on Stress and Health.

00:00:27.620 | Dr. Spiegel is both a researcher

00:00:29.540 | and a clinician, meaning he runs a laboratory

00:00:32.160 | that studies the brain and the body

00:00:34.680 | and neural mechanisms of how the brain and body interact.

00:00:37.880 | And he sees patients as a psychiatrist at Stanford.

00:00:41.640 | His work is incredibly unique

00:00:43.480 | in that it bridges mind and body,

00:00:45.320 | but it also has a particular focus

00:00:47.360 | on the clinical applications of hypnosis.

00:00:50.080 | As you'll learn today, hypnosis is a unique brain state

00:00:53.280 | in which neuroplasticity, the brain's ability to change

00:00:56.200 | in response to experience, may be heightened.

00:00:58.880 | And indeed, the use of clinical hypnosis

00:01:01.540 | by Dr. Spiegel and colleagues has been shown

00:01:03.800 | to improve symptoms of stress, chronic anxiety,

00:01:07.240 | chronic pain, and various other illnesses,

00:01:09.740 | including many psychiatric illnesses

00:01:11.480 | and even outcomes in cancer.

00:01:13.440 | Today, we discuss hypnosis in the context

00:01:15.560 | of what's called self-hypnosis

00:01:17.540 | to distinguish it from stage hypnosis.

00:01:20.180 | Many of you are probably familiar with stage hypnosis,

00:01:22.580 | which is really about a hypnotist getting a person

00:01:25.260 | to do things they would not otherwise do.

00:01:28.440 | In contrast, clinical hypnosis and the use of hypnosis

00:01:32.360 | for the treatment of various ailments of mind and body

00:01:35.020 | is vastly different.

00:01:36.420 | It involves getting people to change their brain state

00:01:39.680 | and to use that brain state as a portal

00:01:42.080 | to make adjustments in their brain and body

00:01:44.920 | and other aspects of their biology and psychology

00:01:47.080 | that benefit them.

00:01:48.360 | And it's been shown over and over again

00:01:50.320 | in studies by Dr. Spiegel and colleagues

00:01:52.540 | that those changes can occur extremely quickly.

00:01:55.560 | Now, not everybody can be hypnotized as readily as the next.

00:01:58.700 | And so today we also discuss a simple test developed

00:02:01.760 | by Dr. Spiegel that can help you determine

00:02:03.920 | whether or not you have a high, medium or low degree

00:02:06.760 | of what we call hypnotizability.

00:02:08.600 | Dr. Spiegel is truly an expert in this area.

00:02:11.640 | He has published over 480 journal articles,

00:02:14.720 | 170 book chapters on hypnosis

00:02:17.920 | and on things like psychosocial oncology,

00:02:20.860 | which is the interaction of mind and body

00:02:22.600 | in the treatment of cancer and cancer outcomes,

00:02:25.040 | on stress physiology, trauma

00:02:27.040 | and other aspects of psychotherapy.

00:02:28.800 | He's published 13 books.

00:02:30.680 | So he's truly the world expert in hypnosis

00:02:33.680 | and clinical applications of hypnosis for mind and body.

00:02:36.680 | I'm certain that in listening to today's episode,

00:02:38.800 | you're going to learn a tremendous amount

00:02:40.880 | about how the brain and body interact,

00:02:43.080 | about various treatments for all sorts of common ailments

00:02:46.380 | of mind and body.

00:02:47.640 | And you're going to get access to tools,

00:02:49.500 | in particular, a tool that was developed by Dr. Spiegel,

00:02:52.560 | which is the Reveri app, R-E-V-E-R-I.

00:02:56.060 | The Reveri app is currently only available for Apple,

00:02:58.700 | but will soon also be available for Android.

00:03:01.600 | It does carry a nominal cost,

00:03:03.960 | but there is a seven day free trial.

00:03:05.980 | If you'd like to try it,

00:03:06.820 | we're providing a link in the show notes.

00:03:08.920 | The Reveri app is special in that it is based

00:03:11.320 | on clinical studies and research done

00:03:13.660 | in the Spiegel lab at Stanford.

00:03:15.800 | So unlike a lot of hypnosis apps out there

00:03:18.120 | and resources for hypnosis,

00:03:19.640 | it was developed with clinical treatments in mind.

00:03:21.940 | Today, we also discussed the use of breath work.

00:03:24.420 | And I'm very fortunate that my research lab at Stanford

00:03:27.060 | has been collaborating very closely with Dr. Spiegel

00:03:29.600 | in testing and developing specific breath work protocols

00:03:32.920 | to adjust mind and body for things like anxiety,

00:03:35.560 | improving mood and improving sleep.

00:03:37.660 | Based on his incredible and unique expertise

00:03:40.320 | and the clarity with which Dr. Spiegel

00:03:42.080 | communicates information,

00:03:43.580 | I anticipate that you will really enjoy today's episode

00:03:46.240 | and that you'll come away from it

00:03:47.680 | with a lot of actionable tools.

00:03:49.960 | Some of you might be curious what a clinical hypnosis

00:03:52.420 | session looks like.

00:03:54.080 | And for that reason, we had Dr. Spiegel hypnotize me.

00:03:57.660 | A clip of that hypnosis session is going to be posted

00:04:00.160 | to the Huberman Lab Clips channel,

00:04:01.580 | which is available on YouTube.

00:04:03.340 | Before we begin, I'd like to emphasize that this podcast

00:04:06.020 | is separate from my teaching and research roles at Stanford.

00:04:08.860 | It is however, part of my desire and effort

00:04:10.880 | to bring zero cost to consumer information about science

00:04:13.480 | and science related tools to the general public.

00:04:16.300 | In keeping with that theme,

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00:09:06.260 | And now for my discussion with Dr. David Spiegel.

00:09:09.240 | David, thank you so much for being here.

00:09:11.160 | - Andrew, my pleasure.

00:09:12.360 | - Can you tell us what is hypnosis?

00:09:17.300 | - Hypnosis is a state of highly focused attention.

00:09:21.880 | It's something like looking through the telephoto lens

00:09:24.160 | of a camera in consciousness.

00:09:26.080 | What you see, you see with great detail,

00:09:27.880 | but devoid of context.

00:09:30.300 | If you've had the experience of getting so caught up

00:09:33.080 | in a good movie that you forget you're watching a movie

00:09:35.380 | and enter the imagined world, you're part of the movie,

00:09:37.520 | you're not part of the audience, you're experiencing it,

00:09:40.080 | you're not evaluating it, that's a hypnotic like experience

00:09:43.520 | that many people have in their everyday lives.

00:09:46.240 | - So is any experience that really draws us in hypnotic

00:09:51.000 | in that sense, or let me give a different example.

00:09:55.840 | If I'm watching a sports game

00:09:58.640 | and I'm really wrapped up in the game,

00:10:00.720 | but I'm also in touch with how it makes me feel in my body,

00:10:03.760 | kind of registering the excitement or the anticipation,

00:10:07.920 | is that a state of hypnosis also?

00:10:10.080 | Because you mentioned there's kind of a narrowing

00:10:12.640 | of context, but a kind of losing of the self.

00:10:16.000 | Or do I have that right?

00:10:17.880 | - Yes, it is true that to the extent that your somatic,

00:10:22.800 | your body experience is a part of the sport event

00:10:27.100 | that you're engaged with,

00:10:28.680 | I'd say that is a self-altering hypnotic experience.

00:10:32.660 | If your physical reactions are distracting you

00:10:35.580 | or make you think about something else,

00:10:38.820 | that's when it's less hypnotic like

00:10:41.700 | and more just one of a series of experiences.

00:10:44.360 | - Okay, so I have to ask,

00:10:47.180 | how did you get into this business of hypnosis?

00:10:50.300 | Because I think for most people,

00:10:52.980 | when they hear hypnosis or they think about hypnosis,

00:10:55.780 | they think of stage hypnosis.

00:10:57.660 | I think of somebody with a pendant going back and forth

00:11:00.140 | or people up on a stage,

00:11:02.500 | behaving abnormally for the entertainment of others.

00:11:07.640 | How did you get into hypnosis as an interest, as a practice?

00:11:14.120 | And if you would, could you contrast the sort of hypnosis

00:11:18.140 | that you do in the clinical setting

00:11:20.020 | with the sort of hypnosis that a stage hypnotist does?

00:11:22.940 | - Sure.

00:11:24.060 | Well, it is something of a genetic illness in my family.

00:11:28.780 | Both of my parents were psychiatrists and psychoanalysts.

00:11:32.460 | And they told me I was free to be any kind of psychiatrist

00:11:35.140 | I wanted to be, so here I am.

00:11:37.580 | My father was training to be a psychoanalyst in 1943.

00:11:42.900 | And he ran into a Viennese refugee

00:11:49.900 | who couldn't serve in the army,

00:11:51.960 | but who had studied hypnosis.

00:11:54.420 | And actually, it would interest you

00:11:56.420 | in doing your ophthalmological research.

00:11:58.500 | He had a smallpox scar right in the middle of his forehead,

00:12:02.020 | and he did forensic examinations.

00:12:03.820 | And he noticed that some of the prisoners

00:12:06.000 | would focus on that spot on his forehead

00:12:08.740 | and then close their eyes and seem to go to sleep,

00:12:12.000 | but they were in some altered state.

00:12:14.020 | So he got interested in hypnosis.

00:12:15.740 | He used it forensically.

00:12:18.660 | His name was Gustav von Aschaffenburg.

00:12:21.520 | And he offered to teach young psychiatrists

00:12:25.260 | how to use hypnosis when they went off into the war.

00:12:29.620 | And so he trained my father.

00:12:31.940 | And my father got off the analytic couch

00:12:34.660 | and asked, the analyst mentioned it to him.

00:12:37.680 | That's how he found out about it.

00:12:39.200 | And my father said, "Did I say something wrong in analysis?

00:12:41.400 | "Why is he talking to me now?"

00:12:43.760 | And he found it very useful in helping soldiers

00:12:47.040 | who had acute pain when they were wounded

00:12:49.240 | and helping people with conversion

00:12:50.860 | post-traumatic stress disorders.

00:12:52.980 | And when he came back, he went back to his training,

00:12:56.500 | but he still was sort of interested in it.

00:12:59.460 | And one of his supervisors was Frieda Fromreichmann,

00:13:02.920 | who was a very famous psychoanalyst.

00:13:05.560 | And he said that he had been told to stop doing hypnosis

00:13:09.360 | because it would ruin his reputation as an analyst.

00:13:12.180 | And she said to him, "What are you so worried

00:13:13.900 | "about your reputation for?

00:13:15.580 | "You're gonna give a course at the Institute in hypnosis,

00:13:18.340 | "and I know you're gonna do it because I'm gonna take it."

00:13:20.560 | So he was teaching Frieda Fromreichmann hypnosis.

00:13:23.680 | And he just kept doing it.

00:13:24.960 | And after a while, he discovered that he was getting

00:13:27.400 | better results with a few sessions of hypnosis

00:13:30.200 | than he was with daily psychoanalysis with his patients.

00:13:34.200 | And so he switched his practice.

00:13:36.540 | And so the dinner table conversations

00:13:38.200 | were pretty interesting.

00:13:39.360 | And occasionally when he was making a movie of a patient,

00:13:42.400 | I would get to watch that.

00:13:44.240 | And so when I went to medical school,

00:13:47.920 | I figured I'll take a course.

00:13:49.160 | There was Tom Hackett, who was the chair of psychiatry

00:13:51.360 | at Mass General was teaching,

00:13:52.520 | and it was a very interesting course.

00:13:54.760 | And the day that converted me was I was doing my rotation

00:13:59.680 | at Children's Hospital in Boston.

00:14:01.240 | And the nurse is telling me, "Spiegel, your next patient

00:14:04.000 | "is an asthmatic in room 437," or something.

00:14:06.880 | And I'm just following the sound

00:14:08.000 | of the wheezes down the hall.

00:14:09.680 | I go in the room.

00:14:10.520 | This is 16-year-old girl, knuckles white,

00:14:12.640 | bolt upright in bed, struggling for breath.

00:14:14.700 | You can hear the wheezing.

00:14:16.080 | She twice had subcutaneous epinephrine, didn't work.

00:14:18.700 | They were thinking about general anesthesia

00:14:20.480 | and starting her on steroids.

00:14:22.480 | And her mother's there crying.

00:14:25.220 | And I said, "I don't know what else to do."

00:14:28.060 | So I said, "You want to learn a breathing exercise?"

00:14:30.200 | And she nods.

00:14:31.600 | And I got her hypnotized, and then I realized

00:14:34.240 | we hadn't gotten to asthma in the course yet.

00:14:36.000 | So I made up something very complex.

00:14:37.880 | I said, "Each breath you take will be a little deeper

00:14:40.520 | "and a little easier."

00:14:42.080 | And within five minutes, she's lying back in bed.

00:14:44.140 | Her knuckles aren't white.

00:14:45.080 | She's not wheezing.

00:14:45.920 | Her mother stopped crying.

00:14:47.600 | The nurse ran out of the room.

00:14:49.440 | And the intern, my intern, comes to find me.

00:14:51.540 | And I figure he's going to pat me on the back

00:14:53.140 | and say, "Nice job, Spiegel."

00:14:54.920 | He said, "The nurse has filed a complaint

00:14:56.500 | "with the nursing supervisor that you violated

00:14:58.820 | "a Massachusetts law by hypnotizing a minor

00:15:01.280 | "without parental consent."

00:15:03.800 | And I thought, "Oh, that's nice.

00:15:07.320 | "I doubt there is a law like this."

00:15:09.660 | So the intern says, "You're going to have to stop

00:15:11.480 | "doing this with her."

00:15:12.360 | And I said, "Why?"

00:15:13.200 | He said, "It's dangerous."

00:15:14.180 | I said, "You're going to give her generalized anesthesia

00:15:16.440 | "and put her on steroids and talking to her is dangerous?"

00:15:19.820 | He said, "Well, you'll have to do it."

00:15:21.000 | And I said, "I'll tell you what.

00:15:22.060 | "Take me off the case if you want,

00:15:23.680 | "but I'm not going to tell a patient of mine

00:15:25.280 | "anything I know is not true."

00:15:27.320 | So there was a battle over the weekend

00:15:29.620 | about what to do.

00:15:30.460 | And the intern, the chief resident attending,

00:15:33.440 | we're all arguing about it.

00:15:35.000 | And on Monday, they came back with a radical idea.

00:15:37.960 | They said, "Let's ask the patient."

00:15:40.300 | I don't think this has ever been done

00:15:41.740 | at Children's Hospital before.

00:15:43.240 | And she said, "Oh, I like this."

00:15:45.020 | She'd been hospitalized every month for three months

00:15:47.080 | in status asthmaticus.

00:15:48.640 | She did have one subsequent hospitalization,

00:15:50.620 | but after that, went on to study

00:15:52.200 | to be a respiratory therapist.

00:15:54.200 | And I thought that anything that can help a patient

00:15:56.520 | that much violate a non-existent Massachusetts law,

00:15:59.840 | frustrate the nursing supervisor,

00:16:01.440 | had to be worth looking into.

00:16:02.860 | So I just kept doing it.

00:16:04.840 | I discovered that there were, you know,

00:16:06.680 | all of my classmates in medical school

00:16:08.880 | had just read the new issue of the New England Journal

00:16:10.760 | and had some new medication to suggest.

00:16:13.240 | And I would, you know, surgeons would say,

00:16:14.920 | "Look, if you can help this guy with his pain

00:16:17.460 | or his anxiety, anything above the neck,

00:16:19.880 | that's yours, do it Spiegel."

00:16:21.140 | So, you know, I was having fun

00:16:23.700 | and being able to learn how to help people

00:16:26.540 | in a way that just otherwise was not being done.

00:16:28.940 | And so it got me thinking about the fact that, you know,

00:16:32.500 | we're born with this brain,

00:16:33.540 | but we don't have a user's manual for it.

00:16:35.340 | And we don't use it nearly as well as we can.

00:16:37.680 | And that's something your research is all about too.

00:16:40.500 | And so I thought, "I want to understand this better

00:16:44.120 | and I want to see what we can do."

00:16:45.800 | Stage hypnotists drive me nuts, you know.

00:16:47.840 | They make fools out of people.

00:16:49.860 | There was one, this is a case my father was involved.

00:16:55.240 | He got a call from, he was at Columbia.

00:16:57.060 | He got a call, "Spiegel, you got to come see this woman.

00:16:59.460 | She's in the ER and she's in some kind of weird upset state

00:17:04.040 | that happened."

00:17:05.600 | And it turned out she'd been on the show

00:17:07.400 | with a stage hypnotist who,

00:17:09.960 | and what they do, by the way, is they cycle around.

00:17:12.880 | You know, they have, at the beginning of the show,

00:17:14.620 | they don't just grab somebody and say, "We're doing this."

00:17:17.040 | They get a bunch of people up.

00:17:18.420 | They do what amounts to hypnotizability testing

00:17:20.820 | to see if people, and they get the ones

00:17:22.960 | who are the most hypnotizable.

00:17:24.560 | So she was the one.

00:17:26.400 | And he said, "There's now a little bird in your hand

00:17:30.480 | and you're going to play with a bird."

00:17:32.520 | And she starts to cry and scream.

00:17:35.600 | And he just gets her off the stage

00:17:37.640 | 'cause it's very upsetting.

00:17:39.220 | And she's wandering around New York City

00:17:40.920 | in the middle of the night, dissociated,

00:17:43.600 | and brought to Columbia, and that's where my father saw her.

00:17:46.220 | She was still in a kind of uncomfortable trance-like state.

00:17:48.840 | And it turned out that she was the trophy wife

00:17:51.520 | of a very wealthy guy,

00:17:53.120 | and she felt like a bird in a gilded cage.

00:17:55.920 | And so to her, that image just triggered

00:17:59.400 | all of this sense of dissatisfaction,

00:18:02.500 | discomfort, fear about her life.

00:18:04.740 | And he was able to get her reoriented

00:18:06.780 | and talk with her about what she was going to do

00:18:08.440 | with her life.

00:18:09.480 | But I don't like stage hypnosis.

00:18:11.340 | You're making fools out of people,

00:18:13.000 | and you're using the fact,

00:18:14.580 | and that's what scares people about hypnosis.

00:18:16.360 | They think you're losing control.

00:18:18.200 | You're gaining control.

00:18:19.160 | Self-hypnosis is a way of enhancing your control

00:18:22.000 | over your mind and your body.

00:18:24.120 | It can work very well.

00:18:25.640 | But because it gives you a kind of cognitive flexibility,

00:18:29.280 | you're able to shift sets very easily,

00:18:32.600 | to give up judging and evaluating the way you usually do

00:18:36.280 | and see something from a different point of view.

00:18:38.760 | That's a great therapeutic opportunity,

00:18:41.000 | but if misused, it could be a danger too.

00:18:43.380 | And that's what scares people about it.

00:18:45.000 | It is that very ability to suspend critical judgment

00:18:48.820 | and just have an experience and see what happens.

00:18:51.320 | That can be a great therapeutic opportunity,

00:18:53.860 | but if somebody is misusing it,

00:18:55.280 | it can be a way to harm people.

00:18:56.540 | And there are plenty of examples

00:18:59.040 | of people having fantasies imposed on them

00:19:02.000 | that they come to think are realities.

00:19:03.580 | It's not unusual these days.

00:19:05.240 | So it's an ability that if people learn to recognize

00:19:10.080 | and understand it, it can be a tremendous therapeutic tool.

00:19:13.320 | - I've been stage hypnotized

00:19:16.760 | and I've been clinically hypnotized many times

00:19:22.300 | through a self-hypnosis app we'll talk about later.

00:19:25.840 | And then I know we have plans for you

00:19:28.640 | to hypnotize me today.

00:19:30.040 | You've done it once before

00:19:31.920 | and I'm very hypnotizable as we both know.

00:19:34.480 | - Right.

00:19:35.520 | - We'll talk about how one can engage

00:19:37.200 | their hypnotizability.

00:19:38.800 | - Sure.

00:19:39.640 | - But the stage hypnosis was interesting.

00:19:42.760 | This was in college, you know,

00:19:43.880 | they brought someone out to the dormitory

00:19:45.620 | and I recall being one of the people that was selected

00:19:50.620 | and engaging in very bizarre behavior, right?

00:19:57.800 | It wasn't thoroughly embarrassing,

00:19:59.320 | but it was pretty embarrassing.

00:20:00.900 | And then being sent off the stage

00:20:03.320 | and as I was exiting, suddenly screaming something out

00:20:06.960 | because he had planted a suggestion of some sort.

00:20:10.300 | And then I was told to look in my pocket

00:20:12.420 | and there was like a, I think a torn up dollar bill.

00:20:14.900 | There were a bunch of things

00:20:15.840 | that I have vague recollection of,

00:20:17.920 | but it raises a set of questions

00:20:21.280 | that really boiled down to, you know,

00:20:26.300 | as a biologist, I always think that, you know,

00:20:28.060 | there's no events in the brain, there are processes.

00:20:32.040 | And so hypnosis, we know has an induction.

00:20:35.160 | Then one is hypnotized, I imagine.

00:20:37.200 | And then it sounds like this woman

00:20:38.700 | and this example of the bird and being in,

00:20:42.920 | being distraught in New York City

00:20:44.520 | is a failure to exit the hypnotic state.

00:20:47.760 | Do we know what sorts of brain areas are active

00:20:51.440 | during the induction, the let's call it the deep hypnosis,

00:20:55.440 | and then what's shutting off or changing

00:20:57.720 | as people exit hypnosis?

00:20:59.680 | - Yes, yes, we do.

00:21:00.840 | We've studied that, we've been very interested in that.

00:21:02.780 | And so we did a study where we selected highly

00:21:07.480 | and non-hypnotizable people so we could do the comparison

00:21:11.640 | and then hypnotize them in the functional MRI scanner.

00:21:15.000 | And we found three things characterize the entry

00:21:18.640 | into the hypnotic state.

00:21:20.200 | The first is turning down activity

00:21:22.120 | in the dorsal anterior cingulate cortex.

00:21:24.200 | So the DACC is in the central front middle part

00:21:26.840 | of the brain, as you well know.

00:21:28.840 | And it's part of what we call the salience network.

00:21:32.400 | It's a conflict detector.

00:21:35.220 | So if you're engaged in work and you hear a loud noise

00:21:40.080 | that you think might be a gunshot,

00:21:41.540 | that's your anterior cingulate cortex saying,

00:21:43.640 | hey, wait a minute, there's a potential danger over there,

00:21:46.020 | you better pay attention to it.

00:21:47.260 | So it's a, it compares what you're doing

00:21:50.280 | with what else is going on and helps you decide what to do.

00:21:53.760 | And as you can imagine, turning down activity in that region,

00:21:58.640 | make it less likely that you'll be distracted

00:22:00.600 | and pulled out of whatever you're in.

00:22:02.840 | And in another study, we found that highly hypnotizable

00:22:05.720 | people, even without being hypnotized,

00:22:07.960 | have more functional connectivity between the DACC,

00:22:12.120 | the anterior cingulate cortex,

00:22:13.480 | and the left dorsolateral prefrontal cortex.

00:22:17.080 | So, which is part of the, a key region

00:22:19.320 | in the executive control network.

00:22:20.840 | So when you're engaging in tasks, you're enacting a plan,

00:22:24.680 | you're writing a paper, you're doing whatever you're doing,

00:22:26.480 | that's the prefrontal cortex is doing that.

00:22:29.920 | And so if that is coordinated,

00:22:31.960 | we found more functional connectivity.

00:22:34.680 | So when one is up, the other's up,

00:22:37.080 | when one is down, the other's down.

00:22:38.520 | That coordination implies that the brain is saying,

00:22:41.880 | okay, go ahead, I know what you're doing,

00:22:44.240 | carry out that plan and don't worry

00:22:45.760 | about other possibilities.

00:22:47.640 | So two other things happen when people are hypnotized.

00:22:50.540 | One is that that DLPFC has higher functional connectivity

00:22:54.120 | with the insula, another part of the salience network.

00:22:57.060 | It's a part of the mind-body control system,

00:22:59.920 | sensitive to what's happening in the body.

00:23:01.840 | It's part of the pain network as well.

00:23:04.160 | But it's also a region of the brain

00:23:05.880 | where you can control things in your body

00:23:09.080 | that you wouldn't think you could.

00:23:10.280 | For example, we did a study years ago

00:23:12.680 | where we took people who were highly hypnotizable,

00:23:15.840 | hypnotized them, and told them to,

00:23:18.500 | we went on an imaginary culinary tour.

00:23:21.080 | So they would eat their favorite foods.

00:23:24.360 | And we found that they increased

00:23:25.900 | their gastric acid secretion by 87%.

00:23:29.420 | So their stomach was acting as though it was about to get.

00:23:32.520 | I mean, there was one woman, it was so vivid for her

00:23:34.760 | that halfway through she said, let's stop, I'm full.

00:23:37.400 | You know, eating these imaginary--

00:23:38.920 | - Having never eaten anything.

00:23:39.760 | - Having never eaten anything.

00:23:40.600 | - Actual food. - No.

00:23:41.600 | - Incredible.

00:23:42.440 | - And then we got them to relax

00:23:44.580 | and think of anything but food or drink.

00:23:46.760 | And we got like a 40% decrease in gastric acid secretion.

00:23:51.280 | So they could, and that was DLPFC through the insula

00:23:55.220 | telling the stomach you're getting food

00:23:56.800 | or you're not getting food.

00:23:57.840 | And even, we injected them with pentagastrin

00:24:00.480 | which triggers gastric acid release.

00:24:03.000 | And even then in the hypnosis condition

00:24:04.880 | they had a 19% reduction in gastric acid.

00:24:07.780 | So the brain has this amazing ability

00:24:10.160 | to control what's going on in the body

00:24:11.620 | in ways that we don't think we have ability to control.

00:24:14.400 | That's just one example.

00:24:15.880 | So that's the DLPFC insula connection.

00:24:18.480 | The third thing that happens,

00:24:19.920 | and this relates to what you did on the stage,

00:24:23.000 | is you have inverse functional connectivity

00:24:26.560 | between the DLPFC and the posterior cingulate cortex.

00:24:31.000 | The posterior cingulate is part of the default mode network.

00:24:34.440 | It's in the back of the brain.

00:24:36.320 | And it's an area whose activity goes down,

00:24:39.400 | for example, in meditators.

00:24:41.440 | And in meditation you're supposed to be selfless.

00:24:43.720 | You're supposed to, the self is an illusion.

00:24:45.320 | You're supposed to let it dissolve

00:24:46.440 | and just experience things.

00:24:47.880 | And when you're doing that,

00:24:49.160 | the posterior cingulate is decreasing in activity.

00:24:52.200 | The inverse connection is I'm doing something

00:24:55.420 | but I'm not thinking about what it means for me.

00:24:57.960 | I may not even remember much of it.

00:25:00.000 | If I do, I don't care that much about it.

00:25:02.460 | And so that is part of the dissociation

00:25:05.680 | that occurs with hypnosis.

00:25:06.920 | So it's how you put things outside of conscious awareness

00:25:09.880 | and don't worry about what it means.

00:25:11.520 | It also adds to cognitive flexibility.

00:25:14.360 | If you're thinking,

00:25:15.600 | well, people like me don't usually do this,

00:25:18.320 | that may inhibit you from enacting

00:25:21.240 | a new form of psychotherapy, for example,

00:25:23.080 | that you've never done before.

00:25:25.120 | But if you're having this decreased activity

00:25:28.060 | in the part of your brain that reflects on what it means,

00:25:31.160 | you're more likely to be cognitively flexible

00:25:33.440 | and willing to give it a try.

00:25:34.640 | And that's one of the therapeutic advantages

00:25:36.640 | of hypnosis as well.

00:25:38.600 | - Fascinating.

00:25:39.440 | And it's really,

00:25:41.240 | I'm gonna put, I'm gonna embarrass you here a little bit.

00:25:43.640 | But in the positive sense,

00:25:45.040 | your laboratory is really the one that's pioneered

00:25:47.800 | brain imaging of hypnotic states.

00:25:49.740 | And it sounds like it, that's my understanding.

00:25:52.600 | Is that correct?

00:25:53.560 | - Yeah, I mean, there are other people

00:25:54.840 | who've done excellent research too,

00:25:56.680 | but Pierre Rainville in Montreal and several other people,

00:25:59.900 | but we're one of the leading lamps

00:26:01.680 | in neuroimaging of hypnosis.

00:26:04.280 | - I have to ask about attention deficit

00:26:07.160 | hyperactivity disorder.

00:26:08.640 | I get a lot of questions about this.

00:26:11.120 | And I think a lot of people just struggle

00:26:12.760 | with holding attention nowadays

00:26:15.000 | because of interference with phones and devices.

00:26:18.980 | And of course there is a lot of clinically legitimate

00:26:22.160 | ADHD out there, but the way that you describe

00:26:24.580 | the dorsal and the anterior cingulate

00:26:26.880 | and the salience network and this conflict detector of,

00:26:30.540 | am I focusing on something or am I splitting my attention?

00:26:33.520 | How distractible am I seems to relate to some extent

00:26:36.440 | to activity in the anterior cingulate cortex.

00:26:40.740 | Do people with ADHD display disruptions

00:26:44.820 | in elements of these networks?

00:26:46.500 | And has hypnosis ever been used to, or self-hypnosis,

00:26:51.500 | I should be, to distinguish from stage hypnosis,

00:26:54.980 | clinical and self-hypnosis has been used

00:26:56.960 | to enhance people's ability to focus and hold attention

00:27:00.740 | because that's such a built-in component

00:27:02.780 | of the hypnotic state.

00:27:03.980 | - It's a great question.

00:27:06.360 | There are, there's sort of two ways to think about it.

00:27:08.880 | In terms of enhancing focus, yes, it has been very helpful

00:27:13.440 | in teaching people to just prepare your mind

00:27:16.120 | to narrow in and focus on something.

00:27:18.200 | And when you're really engaged in reading something

00:27:20.540 | or you're writing a, I mean, I'll have that,

00:27:22.400 | sometimes I'm thinking, oh God,

00:27:24.200 | I have to do this for another hour.

00:27:25.560 | Other times, an hour will go by and I'll think,

00:27:27.880 | hey, great, because when you're in the,

00:27:30.040 | it feels game-like to you, you're just assembling

00:27:32.800 | the parts of the puzzle and putting them together.

00:27:35.680 | It's fun, you just get absorbed.

00:27:37.280 | But for me, that's a hypnotic-like experience.

00:27:39.480 | When I'm having trouble, when I'm struggling,

00:27:41.780 | sometimes doing things like self-hypnosis can help.

00:27:45.080 | I'm not an expert on ADHD.

00:27:47.680 | My impression is that you're right that these are people

00:27:50.640 | who are constantly distracted and rather rigid.

00:27:53.720 | The other part of it is they're easily distractable.

00:27:55.800 | They're very upset when they get distracted.

00:27:58.360 | And they're rather rigid in what they want to attend to

00:28:00.560 | and what they can't, I think as a way

00:28:01.960 | of controlling this distractability, frankly.

00:28:05.880 | My guess is that many people with ADHD

00:28:08.420 | would not be that hypnotizable, but I haven't studied it.

00:28:11.480 | So it's possible that for some people with that disorder,

00:28:16.480 | training in self-hypnosis might help,

00:28:18.880 | but we'd have to see how hypnotizable they were

00:28:21.160 | and take it from there.

00:28:23.120 | - I want to return to some of the underlying neural networks

00:28:26.120 | and the clinical applications.

00:28:28.200 | But what sorts of things, aside from the asthma,

00:28:34.900 | have you used hypnosis successfully for?

00:28:39.320 | Or have others used clinical hypnosis for?

00:28:43.180 | And are there any particular areas of psychiatric challenges

00:28:48.180 | or illnesses, I guess they're called,

00:28:51.000 | that are particularly amenable to hypnotic treatment?

00:28:56.000 | - Yes, there are.

00:28:57.360 | Hypnosis is very good as a problem-focused treatment.

00:29:03.240 | It's really, it's the oldest Western conception

00:29:05.360 | of a psychotherapy, and it can be used for specific problems

00:29:09.060 | in a way that's very helpful.

00:29:10.860 | We found it very helpful for stress reduction,

00:29:13.420 | for helping people deal,

00:29:14.500 | we're all dealing with stress these days.

00:29:17.200 | And it's helpful, that mind-body connection is very helpful

00:29:20.600 | because part of the problem with stress is your perception,

00:29:25.540 | you mentioned it earlier in a sort of good sense,

00:29:27.520 | you're at a football game or something

00:29:29.400 | and you feel the physical reaction.

00:29:32.020 | That can be a reinforcing thing.

00:29:33.960 | Wow, this is exciting, let's do it.

00:29:35.820 | It can also be very distracting.

00:29:37.540 | So you're worried about getting COVID

00:29:40.400 | or you're worried about some other physical problem you have

00:29:45.160 | and you notice it in your body, your body tenses up,

00:29:48.500 | you start to sweat, the sympathetic nervous system goes,

00:29:51.600 | your heart rate goes up.

00:29:53.140 | And when you notice that, you think,

00:29:55.020 | oh God, this is really bad.

00:29:57.060 | And then you feel worse.

00:29:58.140 | So it's like a snowball rolling downhill.

00:30:00.760 | And then you feel worse and then your body gets worse.

00:30:03.840 | Hypnosis can be very helpful

00:30:05.500 | in dissociating somatic reaction

00:30:07.980 | from psychological reactions.

00:30:09.320 | So we teach people to imagine their body floating somewhere

00:30:12.800 | safe and comfortable, like a bath, a lake, a hot tub

00:30:15.320 | or floating in space, and then picture the problem

00:30:18.400 | that they're stressing them on an imaginary screen

00:30:21.320 | with a rule that no matter what you see on the screen,

00:30:23.220 | you keep your body comfortable.

00:30:24.800 | So at this point, you still can't control the stress,

00:30:27.860 | but you can control your physical reaction to it.

00:30:30.660 | And that starts you feeling more in control.

00:30:33.060 | At least there's one thing I can manage.

00:30:34.620 | And then you can use it to think through

00:30:36.380 | or visualize through one thing you might do

00:30:38.780 | about that stressor.

00:30:39.740 | So hypnosis is very helpful in controlling mind body

00:30:43.340 | interaction in relation to stress.

00:30:45.480 | It's very helpful for people to get to sleep.

00:30:49.560 | We're having a lot of fun with that.

00:30:50.820 | I'm getting emails from people who said,

00:30:54.220 | I haven't slept right in 15 years

00:30:56.020 | and now for the first time, I'm listening to your app

00:30:59.700 | and I can sleep at night.

00:31:01.540 | So it's very helpful.

00:31:02.680 | And again, if you wake up in the middle of the night,

00:31:05.840 | I tell people don't look at the clock,

00:31:09.060 | that's an arousal cue, you just wake up more.

00:31:13.060 | But picture whatever you're thinking about

00:31:16.180 | or worrying about on that imaginary screen

00:31:18.120 | while your body's floating.

00:31:19.060 | So watch your own movie, but keep your body floating.

00:31:21.980 | And many people can use that to get back to sleep.

00:31:24.660 | - I've been using the self-hypnosis for sleep

00:31:27.660 | for a long time.

00:31:29.400 | And now the Reverie app, and we'll talk about

00:31:31.540 | our relationship to the Reverie app and its uses.

00:31:33.620 | I find it incredibly useful for falling back asleep

00:31:36.620 | in the middle of the night.

00:31:38.600 | And it raises a question I've found,

00:31:43.340 | and I think I understand this correctly,

00:31:45.060 | that one can do self-hypnosis during the daytime.

00:31:49.940 | And then if there's an issue that comes up later,

00:31:52.180 | like, so for instance, do self-hypnosis for stress reduction

00:31:55.460 | away from the stressful event to prepare one

00:31:58.120 | to deal with stress better,

00:31:59.460 | or do a hypnosis for improving the return to sleep.

00:32:03.860 | And that can be done when you actually want to go to sleep,

00:32:06.260 | but it's kind of a training up of these networks, right?

00:32:09.900 | - That's right.

00:32:10.740 | - So is there evidence that these brain networks

00:32:14.220 | actually form stronger connections

00:32:17.400 | when people do self-hypnosis over time?

00:32:20.940 | - Well, there's a rule in neurobiology, as you know,

00:32:23.340 | that neurons that fire together, wire together.

00:32:25.500 | - Our friend, Carla Schatz, not Donald Hebb, by the way.

00:32:28.580 | I keep trying to, there's a widespread myth in the world

00:32:32.520 | that is unfortunately all over the internet,

00:32:34.900 | which is that the fire together, wire together

00:32:36.860 | was said by the psychologist, Donald Hebb.

00:32:39.060 | Donald had many important things,

00:32:40.940 | but it is the neurobiologist, Carla Schatz.

00:32:44.300 | - That's exactly right.

00:32:45.380 | - Yes, is at Stanford, but was also at Berkeley and Harvard.

00:32:48.100 | So also decent schools.

00:32:50.860 | But is at Stanford who said fire together, wire together.

00:32:55.260 | And so she deserves the credit for that statement.

00:32:58.500 | Yeah, so with repeated use of self-hypnosis,

00:33:02.160 | one could imagine that these networks are getting stronger.

00:33:06.200 | - I would think so.

00:33:07.700 | We don't have evidence of that yet,

00:33:10.060 | but long-term potentiation provides a pathway,

00:33:14.580 | and you've described them on your program a number of times,

00:33:18.860 | that allow for repeated activation of a network

00:33:22.060 | to actually build new connections that work.

00:33:25.260 | And at the least, even from a learning

00:33:27.480 | and memory point of view,

00:33:28.740 | memory is all a network of associations.

00:33:32.660 | That's how we remember things.

00:33:34.740 | And the example I like to give is you go back

00:33:37.580 | to your grade school, and you see these little tiny lockers,

00:33:41.500 | and the size is all wrong, and you suddenly have a flood

00:33:44.660 | of memories that were obviously stored there,

00:33:47.520 | but you just didn't think of.

00:33:48.540 | So context and association is what memory is about.

00:33:52.360 | If you start to acquire memories about a problem,

00:33:55.340 | so one thing we use hypnosis for

00:33:57.340 | is treating phobias, for example.

00:33:59.020 | And the problem with people who have phobias,

00:34:01.100 | like airplane phobias, or crossing a bridge,

00:34:04.660 | or being up high, is that the more they avoid it,

00:34:08.260 | the more the only source of associations

00:34:10.600 | and memories is their fear.

00:34:12.940 | They don't have any good experiences with it

00:34:14.840 | 'cause they avoid it.

00:34:16.260 | It's like get back on the horse

00:34:17.380 | after you fall off kind of thing.

00:34:19.220 | And with hypnosis, if you can start people able

00:34:24.220 | to manage their anxiety enough

00:34:26.360 | that they can have more, a wider array of experiences,

00:34:29.760 | they start to have a network of associations

00:34:32.380 | that isn't so negative and may even be positive.

00:34:34.820 | - So it's almost like a, sorry to interrupt,

00:34:36.860 | but I have to ask, it's almost like a exposure therapy

00:34:40.900 | done in the mind.

00:34:43.020 | - Yes. - I mean,

00:34:43.860 | it's always in the mind.

00:34:44.680 | I mean, even exposure to, if I have a snake phobia,

00:34:46.860 | which I don't, I don't like snakes,

00:34:48.860 | but I don't think it qualifies as a full-blown phobia.

00:34:51.220 | I think I have a healthy fear of snakes.

00:34:53.940 | But if, let's say I had a snake phobia,

00:34:57.740 | the typical approach would be,

00:35:01.740 | cognitive behavioral approaches, right,

00:35:03.220 | would be to show a picture of a snake,

00:35:04.920 | or then a rubber snake, then a real snake,

00:35:06.380 | and eventually the person is holding a boa constrictor

00:35:09.260 | or something like that.

00:35:11.080 | That's all in the mind because it's all translated

00:35:13.640 | into nervous system signals.

00:35:14.820 | But with hypnosis, it sounds like you can give

00:35:17.400 | a number of positive experiences

00:35:19.380 | without having to use any props,

00:35:21.580 | without having to bring any animals into the room,

00:35:24.380 | drive someone across the bridge, is that right?

00:35:26.040 | - Yes, I had a woman who was a very successful

00:35:29.260 | businesswoman, high level in a corporation.

00:35:32.020 | I had a terrible dog phobia.

00:35:33.660 | And so I had her imagine that somebody brought in

00:35:37.320 | a dog to the room and I said, "What are you doing?"

00:35:39.420 | And you could see her getting tense.

00:35:41.420 | And she said, "I'm waiting to see what the dog does."

00:35:44.460 | And I said, "If somebody who works for you

00:35:46.660 | comes into your office, would you freeze

00:35:48.560 | and wait to see what they did?"

00:35:50.580 | And she said, "Of course not."

00:35:51.820 | And I tell them what to do, you know.

00:35:54.240 | And I said, "Well, so you're immobilizing yourself.

00:35:56.700 | The power isn't with the dog, it's with you.

00:35:59.100 | So imagine what you might do to engage the dog

00:36:01.840 | and help control the situation."

00:36:04.500 | And she said, "Thanks."

00:36:05.500 | And this reminds me of one of my favorite stories

00:36:08.460 | about hypnosis, that my father was seeing a woman

00:36:12.120 | who lived in midtown Manhattan

00:36:13.360 | and had a horrible dog phobia.

00:36:14.860 | You know, she'd drop things, she'd spill coffee.

00:36:17.360 | You know, she saw a dog.

00:36:18.560 | She would time her trips to the store

00:36:20.640 | when she thought it was least likely

00:36:22.080 | that people would be walking dogs.

00:36:23.320 | - Now that wouldn't be possible.

00:36:24.400 | Everyone, it's like a fleet of French bulldogs

00:36:28.560 | taking over New York City.

00:36:30.920 | - So he taught her to think of dog as a friend,

00:36:35.160 | have a neighbor who had a dog, bring the dog over,

00:36:38.980 | but hold the dog by the collar and make sure.

00:36:41.540 | And gradually she was able to stroke the dog

00:36:44.320 | and say, "Dog friend,"

00:36:45.160 | and, "Distinguish between wild and tame animals.

00:36:47.240 | There are animals you should be afraid of."

00:36:49.400 | So she seemed to be doing better.

00:36:50.640 | He called back about three months later

00:36:53.180 | and asked for her and said,

00:36:55.620 | "Well, who's calling?"

00:36:56.480 | The son said, and he said, "Dr. Spiegel."

00:36:58.880 | And the boy said, "That's weird."

00:37:01.140 | And my father said, "What's weird?"

00:37:02.520 | He said, "Spiegel's in heat."

00:37:04.440 | She had bought a dog and named it Spiegel.

00:37:08.620 | Talk about transference.

00:37:09.860 | - I love it.

00:37:11.280 | - But it really speaks to the power of this.

00:37:13.600 | And it brings me back to this issue.

00:37:16.720 | So what is different about what your father did

00:37:22.340 | in that case with this woman

00:37:25.680 | in terms of what happened in hypnosis

00:37:29.200 | that allowed her to go from being completely terrified

00:37:31.560 | of dogs to owning a dog and naming it after your father,

00:37:35.820 | which I find amusing.

00:37:36.920 | But that's different than just the two of them

00:37:40.700 | sitting down and talking about it, right?

00:37:43.620 | In therapy, the narrative is a huge component

00:37:47.500 | and in hypnosis, narrative is a huge component.

00:37:50.240 | So it must be that the brain state

00:37:53.380 | is what is really different

00:37:54.620 | because we'll talk about trauma in a few minutes,

00:37:57.380 | but I think people who have trauma or phobias

00:38:01.680 | certainly could have a conversation about it.

00:38:06.160 | Some of them might freeze up.

00:38:07.380 | Some of them might lose their articulation and so forth.

00:38:09.980 | But what is different about that state

00:38:13.180 | that combines with narrative,

00:38:15.260 | you think to allow these underlying neural networks

00:38:18.180 | to engage her to change?

00:38:20.140 | 'Cause I find this so fascinating

00:38:21.620 | because every attempt at dealing with stress or phobia

00:38:26.620 | in the clinical setting

00:38:27.980 | involves some discussion about what it is.

00:38:30.380 | But here we're not talking about

00:38:32.380 | any medication being introduced,

00:38:33.840 | at least not in these particular circumstances.

00:38:36.180 | So I just, I realized it's kind of an obvious question.

00:38:39.900 | Like it has to be some difference in brain activity,

00:38:42.620 | but I find that to be incredible.

00:38:44.420 | The control variable there is the brain state.

00:38:48.140 | It's not what's spoken.

00:38:50.500 | - You're raising a couple of very important issues, Andrew.

00:38:54.480 | We talked earlier about systematic desensitization

00:38:59.140 | where you sort of lay out a hierarchy of things

00:39:02.700 | and do it one at a time.

00:39:04.220 | I think of this as unsystematic desensitization

00:39:07.400 | because you're changing mental states.

00:39:10.360 | And I think there's more and more evidence

00:39:12.380 | that mental state change itself has therapeutic potential.

00:39:15.340 | We're seeing that with ketamine,

00:39:16.960 | treating depression as a sociogenic drug.

00:39:19.440 | We see it, we know it every morning

00:39:22.680 | when we wake up, that problem.

00:39:24.360 | You made the mistake of reading a nasty email at 11 p.m.

00:39:27.320 | You didn't know what to do.

00:39:28.400 | You wake up in the morning, you think, oh, that idiot.

00:39:30.200 | Yeah, here's what I'm gonna do.

00:39:31.740 | So just changing mental state itself

00:39:34.580 | has therapeutic potential.

00:39:36.000 | And I think we underestimate our ability

00:39:38.860 | to regulate and change responses,

00:39:41.340 | to be cognitively, emotionally, and somatically flexible.

00:39:46.340 | And so we do things, you're right,

00:39:48.500 | that follow similar principles of facing a problem,

00:39:51.420 | seeing it from a different point of view.

00:39:53.420 | And you've done a really nice podcast on trauma and stress

00:39:56.940 | and how you have to expose yourself to it,

00:39:59.900 | not avoid it, as we talked about before,

00:40:02.340 | and then find some way to reconnect to it,

00:40:06.240 | to substitute something that can make you feel good

00:40:08.640 | rather than bad so that you activate other centers

00:40:12.520 | of the brain, like mesolimbic reward system.

00:40:15.120 | And so I do that with hypnosis,

00:40:17.520 | and you can do it much faster.

00:40:19.960 | People don't think they can, but they can.

00:40:21.900 | If you're having, right now, that physical experience,

00:40:24.660 | I'm thinking about this,

00:40:25.520 | but I'm not feeling as bad as I used to,

00:40:28.960 | that can be a powerful thing,

00:40:30.520 | and you can do it with hypnosis.

00:40:32.040 | So I had a woman came to see me

00:40:34.860 | who had suffered an attempted rape.

00:40:36.860 | It was getting dark.

00:40:38.460 | She was coming back from the grocery store,

00:40:40.200 | and this guy grabs her and wants to get her up

00:40:42.820 | into her apartment.

00:40:43.660 | It's outside her apartment.

00:40:44.700 | And she starts fighting with him,

00:40:47.080 | and she winds up with a basilar skull fracture.

00:40:49.680 | He runs away.

00:40:51.300 | The cops come.

00:40:52.600 | Since she hadn't been raped, they left.

00:40:54.140 | They weren't interested.

00:40:54.980 | And she wanted to use hypnosis to get a better image

00:40:57.920 | of what this guy looked like,

00:40:59.400 | which is a painful, upsetting thing.

00:41:01.160 | So she was quite hypnotizable.

00:41:03.460 | I got her floating.

00:41:04.680 | I say, "You're safe and comfortable now.

00:41:06.040 | "Nothing can happen that will harm your body,

00:41:08.340 | "but on the left side of the screen,

00:41:10.260 | "I want you to picture this guy

00:41:12.360 | "and his approaching and what's happening."

00:41:14.600 | And she said, "I really, the light, it was getting dark.

00:41:17.360 | "I really can't see much of his facial features,

00:41:20.140 | "but I do recognize something

00:41:21.680 | "I hadn't allowed myself to remember.

00:41:23.900 | "If he gets me upstairs, he doesn't just want to rape me.

00:41:26.520 | "He's gonna kill me."

00:41:28.160 | And so, in some ways, what she was seeing

00:41:31.080 | was even worse.

00:41:31.920 | So you're thinking, good Spiegel,

00:41:34.160 | you made her even more frightened than she was before.

00:41:37.000 | But as you had pointed out in your PTSD stress lecture,

00:41:40.600 | you've got to confront the trauma

00:41:42.240 | to restructure your understanding of it.

00:41:45.460 | So on the other side of the screen, I had her picture.

00:41:48.380 | What are you doing to protect yourself?

00:41:53.040 | And everybody in a trauma situation

00:41:54.860 | engages in some strategy of self-protection.

00:41:57.560 | That's the Salience Network kicking in.

00:41:59.880 | And she said, "You know what?

00:42:02.520 | "He's surprised and I'm fighting that hard.

00:42:04.940 | "He didn't think I would."

00:42:06.760 | And so she realized, on the one hand,

00:42:08.680 | that it was even worse than she thought it was,

00:42:10.580 | but on the other hand,

00:42:11.480 | that she actually probably saved her life.

00:42:13.800 | And so it was a way of helping her restructure

00:42:17.520 | her experience of the trauma and make it more tolerable.

00:42:20.680 | So that helped with her.

00:42:22.280 | She didn't, she couldn't identify the guy,

00:42:25.240 | but it helped her restructure and understand her experience.

00:42:29.120 | And that's something that you can do

00:42:31.120 | in just talking straight out psychotherapy,

00:42:33.880 | but sometimes you can do a hell of a lot faster

00:42:36.640 | and more efficiently using hypnosis.

00:42:39.200 | And there is one randomized trial out of Israel

00:42:41.680 | that shows that adding hypnosis to PTSD treatment

00:42:44.160 | actually improves outcome.

00:42:46.160 | So it's a way of accomplishing things that we understand

00:42:51.160 | in the broader psychotherapy world,

00:42:54.160 | but much more quickly and sometimes effectively.

00:42:58.400 | - Yeah, it sounds like going into,

00:42:59.560 | somewhat into the state that one is trying to deal with,

00:43:03.160 | but then dissociating from that state is key.

00:43:05.600 | And I could imagine, and I've been open about this

00:43:08.480 | on various podcasts.

00:43:09.380 | I've done a lot of analysis over the years.

00:43:13.200 | So in, but I've experienced myself that in those sessions,

00:43:17.440 | depending on how I show up to them,

00:43:19.160 | I might just get in kind of a laundry list of what happened

00:43:22.320 | as opposed to actually feeling anything

00:43:24.120 | around what happened.

00:43:25.160 | And I think people probably vary

00:43:27.640 | in the extent to which they can drop into feeling states

00:43:30.760 | and it can depend on the day.

00:43:33.240 | It can be dependent on how well you slept the night before

00:43:36.080 | and so on.

00:43:37.360 | - There's one thing I might add, Andrew,

00:43:38.840 | and that is, you know, there's a notion

00:43:40.640 | of the late Gordon Bauer.

00:43:41.640 | He did, we just had a memorial for Gordon at Stanford.

00:43:45.240 | He died about a year ago.

00:43:47.120 | Brilliant cognitive psychologist,

00:43:48.960 | sort of one of the founders of cognitive psychology

00:43:51.480 | at Stanford and a great pitcher.

00:43:53.280 | He almost became a major league pitcher,

00:43:55.400 | but he decided to go to grad school instead.

00:43:57.420 | And I'm glad he did.

00:43:58.720 | But Gordon helped establish the concept

00:44:03.080 | of state-dependent memory,

00:44:04.440 | that when you're in a certain mental state,

00:44:07.140 | you enhance your ability to remember things about it.

00:44:09.200 | And the sort of the bad example of that

00:44:11.120 | is the drunk who hides the bottle

00:44:12.800 | and can't remember where he put it

00:44:14.160 | until he gets drunk again,

00:44:15.240 | that he's in that same mental state.

00:44:18.220 | People go into dissociative states when they're traumatized.

00:44:22.480 | So in a way, hypnosis is helping them remember

00:44:26.080 | and deal with the memories better

00:44:27.360 | because they're more in the mental state

00:44:29.400 | that is more like what happened.

00:44:30.560 | And most rape victims will tell you,

00:44:32.800 | "I was floating above my body feeling sorry

00:44:35.160 | "for the woman being assaulted below."

00:44:37.500 | People in traumatic episodes, they just say,

00:44:42.140 | "You know, I blank out.

00:44:43.040 | "I don't know what's happening.

00:44:43.880 | "I'm on autopilot."

00:44:44.940 | And that's a kind of self-hypnotic state.

00:44:47.320 | So when you use hypnosis to help them deal

00:44:50.520 | with the traumatic memory,

00:44:51.960 | you're making the state they're in

00:44:53.500 | right there in your office with you

00:44:55.600 | more congruent to the state they were likely in

00:44:58.040 | when the trauma happened.

00:44:59.200 | And I think that is part of what helps facilitate

00:45:01.840 | treatment of trauma-related disorders.

00:45:04.600 | - I see.

00:45:05.840 | So that makes me have to ask every question I have to ask

00:45:09.360 | 'cause I really feel it as almost a compulsion.

00:45:11.860 | Then if dissociation during a traumatic episode

00:45:15.680 | is part of the adaptive strategy,

00:45:20.060 | but it creates certain issues.

00:45:21.440 | It creates problems, right?

00:45:24.560 | Why would something like ketamine,

00:45:27.240 | which creates a dissociative state,

00:45:29.800 | be useful for the treatment of trauma?

00:45:32.300 | This is what I'm confused about these days

00:45:34.560 | because our colleague, Carl Deisseroth,

00:45:36.680 | who's also been on this podcast

00:45:38.040 | and his coworkers have figured out,

00:45:40.460 | okay, there's these layer one networks in the neocortex

00:45:43.760 | and those are involved in dissociative state.

00:45:45.360 | And so we're starting to gain some understanding

00:45:46.680 | of how ketamine works at a neural level.

00:45:49.400 | It does seem as if for certain populations

00:45:52.760 | it can be a useful treatment.

00:45:54.840 | I don't know, I've never tried it.

00:45:55.880 | I don't know what the current status of that is,

00:45:57.420 | but it is legal.

00:45:58.740 | It is allowed, at least it's FDA approved, and it's in use.

00:46:03.280 | Why would dissociative states be useful

00:46:06.840 | if some element of dissociation is what gave rise

00:46:10.880 | to the trauma memory in the first place?

00:46:13.600 | - Well, yeah, Carl had a brilliant paper in Nature

00:46:16.660 | where it was from rats to humans in one paper.

00:46:20.200 | And he showed that there's this rhythmic discharge

00:46:22.840 | in the retrosplenial region that is associated,

00:46:26.280 | that is triggered by ketamine.

00:46:28.040 | And the rats actually showed dissociative-like behavior

00:46:31.960 | in that they would touch a hot pad

00:46:34.100 | that they ordinarily wouldn't

00:46:35.280 | and they didn't seem to have much pain in their paw.

00:46:37.320 | And he then had a male subject

00:46:40.520 | who had implanted electrodes.

00:46:43.120 | - Human. - A human subject, yeah.

00:46:44.860 | Human subject.

00:46:45.700 | And the electrodes had picked up this rhythmic activity,

00:46:50.700 | and when they did,

00:46:51.860 | he would report being in a dissociative state.

00:46:54.100 | And his description was,

00:46:55.660 | "It's like being a pilot of an airplane."

00:46:57.740 | And then I felt myself walking out of the cockpit

00:47:00.560 | and the plane was still flying.

00:47:01.820 | - That sounds terrifying to me.

00:47:03.220 | (laughing)

00:47:04.060 | That sounds terrifying.

00:47:05.140 | I want to be in my body most of the time, you know.

00:47:08.620 | - That's right.

00:47:09.460 | But the point is, in a way, the principle, Andrew,

00:47:13.040 | is like the principle you said,

00:47:14.500 | that you need to re-confront a traumatic situation

00:47:17.900 | before you can modulate your associations to it.

00:47:21.280 | So you have to accept it,

00:47:22.340 | accept the arousal, put some boundaries around it,

00:47:25.860 | and then figure out how you can approach that problem

00:47:28.300 | or how you did approach that problem

00:47:29.820 | from a different point of view.

00:47:31.300 | So it does not surprise,

00:47:32.980 | in fact, we've studied people who dissociated

00:47:36.020 | during the Loma Prieta earthquake

00:47:38.100 | and the Oakland-Berkeley firestorm.

00:47:40.380 | - I remember both of those well.

00:47:41.580 | - Yeah, yeah.

00:47:42.420 | - Earthquakes follow me.

00:47:43.240 | - So there's the south and then the northridge.

00:47:45.000 | - I'm going to keep--

00:47:45.840 | - So there'll be one layer of this after me.

00:47:47.120 | (laughing)

00:47:48.420 | - I'm starting to dissociate, Andrew.

00:47:50.380 | So dissociation does compartmentalize experience,

00:47:55.320 | but that means from the point of view of treating trauma,

00:47:58.100 | it's an inhibition.

00:48:00.380 | You don't engage it.

00:48:01.500 | It's like it happened over there.

00:48:02.980 | And I think what happens is that people

00:48:05.740 | are sometimes too good at being able to separate themselves

00:48:08.740 | from the recollection, so it's in there somewhere.

00:48:11.540 | It's out of sight, but it's not out of mind.

00:48:13.320 | It's having effects on you, but you can't deal with it.

00:48:15.660 | You can't reprocess it.

00:48:17.300 | So I do think one reason ketamine might work

00:48:20.820 | is that, in fact, it allows you to keep,

00:48:25.520 | to re-approach the dissociative experience

00:48:29.040 | in a way that you can then start to think about

00:48:31.000 | and do something about it.

00:48:32.080 | And just the fact you can turn it on and off,

00:48:34.360 | and that's also where self-hypnosis is so helpful.

00:48:37.540 | It's not something that just comes over you

00:48:39.360 | and happens to you, it's something you can make happen.

00:48:41.580 | You can control it, you can do something with it.

00:48:43.860 | So you feel less helpless and out of control.

00:48:46.520 | The essence of trauma is helplessness.

00:48:48.420 | It's not fear, it's not pain, it's helplessness.

00:48:50.980 | You become an object.

00:48:52.620 | You become just your body.

00:48:54.180 | You don't control what's going on,

00:48:55.500 | and we're not used to that.

00:48:57.240 | You and I have discussed this brilliant paper

00:49:00.380 | on anticipation of breathing,

00:49:02.500 | and it's not whether you breathe,

00:49:04.340 | inhale, or exhale, or hold your breath.

00:49:06.820 | It's that if you think you can inhale and you can't,

00:49:10.280 | that is really upsetting, understandably.

00:49:12.680 | And so the issue is control.

00:49:15.060 | And hypnosis, which has this terrible reputation

00:49:18.120 | of taking away control, is actually a superb way

00:49:21.880 | of enhancing your control over mind and body.

00:49:24.500 | - I love that.

00:49:26.600 | And it reminds me that naming is so important.

00:49:29.120 | You almost wonder if self-hypnosis and clinical hypnosis

00:49:32.640 | had been called something else,

00:49:34.600 | that it would have been separated out from stage hypnosis

00:49:38.220 | in a way that would make it less scary, weird,

00:49:43.220 | complicated for people to embrace.

00:49:46.680 | But part of the reason for having this discussion

00:49:49.420 | is I've had great experiences with hypnosis.

00:49:52.380 | I've seen the data.

00:49:54.180 | We're talking about a lot of clinical examples.

00:49:55.700 | It's incredibly powerful,

00:49:57.240 | and it boils right down to neural brain states.

00:50:01.340 | And I think in the years to come,

00:50:03.760 | it's going to become more widespread.

00:50:06.720 | Along those lines, how quickly,

00:50:09.280 | you've described some examples of people

00:50:12.440 | getting relief very quickly.

00:50:14.720 | How permanent are those changes?

00:50:17.500 | Is there a need for follow-up?

00:50:20.160 | And related to that,

00:50:21.520 | I'm sure a number of people are listening to this

00:50:23.140 | and thinking, "Wonderful, I'd love to get hypnotized

00:50:26.200 | for any number of different things by Dr. Spiegel

00:50:29.640 | or somebody else expert in clinical hypnosis."

00:50:32.320 | But they might not have access to you

00:50:35.120 | or somebody with similar training.

00:50:37.400 | So what is the power?

00:50:39.200 | So how quickly does it work?

00:50:40.900 | How long lasting are those changes?

00:50:42.960 | And then is it necessary to work with a clinical hypnotist?

00:50:46.940 | And is it better to do that than self-hypnosis

00:50:49.720 | and so on and so forth?

00:50:50.660 | Maybe you could just give us a contour of the landscape

00:50:53.560 | of directed and self-directed treatment.

00:50:56.200 | - Well, typically most people start

00:51:01.000 | by coming to see a clinician like me.

00:51:03.200 | It's better to see someone who has licensing and training

00:51:06.540 | in their professional discipline,

00:51:08.640 | medicine, psychology, dentistry, whatever.

00:51:11.800 | - 'Cause there are a lot of hypnotists out there

00:51:13.200 | who are just hypnotists.

00:51:14.240 | - Just hypnotists.

00:51:15.080 | - Oh, okay.

00:51:15.920 | - And the key issue is somebody who can really assess

00:51:18.880 | what your problem is and make sure

00:51:20.380 | that you're not talking someone

00:51:21.680 | into reducing their chest pain

00:51:22.920 | rather than getting their coronary artery problem.

00:51:26.200 | - 'Cause they could have a real issue there.

00:51:27.560 | - They could, right.

00:51:28.400 | Hypnosis might adjust, but wouldn't deal

00:51:31.400 | with the deeper underlying issue.

00:51:33.160 | - That's right.

00:51:34.000 | On the other hand, and typically when I use it with people,

00:51:37.080 | I often only see them once or twice or periodically,

00:51:39.720 | but not every week, and certainly not every day

00:51:42.300 | if they have a pain problem.

00:51:43.380 | And hypnosis is very helpful for pain.

00:51:45.840 | And so what I'm doing is identifying

00:51:51.080 | how hypnotizable they are.

00:51:52.280 | I give them a standard brief test

00:51:53.940 | of their ability to experience hypnosis.

00:51:55.880 | And then going through a self-hypnosis exercise with them

00:51:59.440 | to deal with the problem, seeing how they respond to it,

00:52:02.200 | and then teaching them how to do it for themselves.

00:52:04.940 | And in the old days, I used to have them use their iPhone

00:52:07.880 | and record that part of the session

00:52:12.040 | so they could play back the hypnosis experience.

00:52:15.020 | Now we've developed an app, Reverie,

00:52:18.100 | that can teach people and step them through

00:52:22.740 | dealing with pain, stress, focus, insomnia,

00:52:27.440 | and help people eat better and stop smoking.

00:52:31.520 | And we have elements that take about 15 minutes

00:52:35.240 | and elements that just take one or two minutes

00:52:37.120 | that people can refresh and reinforce.

00:52:39.220 | - Two-minute hypnosis.

00:52:40.420 | - Yes, yes.

00:52:41.500 | And it's one to two minutes now.

00:52:44.620 | And we're finding that two-thirds of the people

00:52:46.620 | find that even just the one-minute refresher

00:52:49.680 | helps them feel better.

00:52:50.820 | They're reporting they feel better.

00:52:52.080 | So the nice thing is you know right away

00:52:53.920 | whether it's likely to help you or not.

00:52:56.760 | And we've found, we've done studies looking at hypnosis

00:53:00.480 | for pain relief in acute medical procedures.

00:53:03.320 | We did a randomized trial that we published in The Lancet.

00:53:06.540 | Three conditions, people getting arterial cut-downs

00:53:09.960 | to chemoembolized tumors in the liver

00:53:12.380 | or visualized renal artery stenosis.

00:53:14.700 | You don't use general anesthesia for this.

00:53:16.300 | It's very uncomfortable and people are anxious.

00:53:18.360 | And we had three conditions.

00:53:19.660 | One was standard care, they could push a button

00:53:22.300 | and get opioids, IV.

00:53:24.920 | - Is during the surgery.

00:53:25.900 | - During the surgery.

00:53:26.740 | The second is they could do that

00:53:28.200 | plus they had a friendly nurse comforting them.

00:53:30.640 | So we controlled for pleasant attention and support.

00:53:33.460 | And the third was we taught them self-hypnosis

00:53:35.720 | for pain control.

00:53:36.560 | So you're feeling, you can change the temperature.

00:53:39.460 | Your body is cool, tingling and numb.

00:53:41.580 | You're floating in ice water and feeling comfortable.

00:53:44.540 | Or go somewhere else, leave your body here

00:53:47.900 | and go to a desert island and enjoy yourself.

00:53:51.740 | And we found that it's about two and a half hour procedure

00:53:55.860 | that by an hour and a half,

00:53:58.380 | the hypnosis group had reduced their pain by 80%

00:54:02.920 | compared to the standard care group

00:54:04.740 | using half the amount of opioids.

00:54:07.100 | They had fewer complications

00:54:09.020 | and the procedure took 17 minutes less time on average

00:54:12.340 | to get done because not only was the patient more relaxed,

00:54:14.620 | so was the treatment staff.

00:54:15.860 | They weren't dealing with someone who's struggling

00:54:18.380 | and uncomfortable.

00:54:19.540 | We measured their anxiety.

00:54:21.220 | And same thing, the hypnosis group,

00:54:22.740 | I was worried they were all dead.

00:54:23.940 | They had no anxiety after an hour and a half.

00:54:25.980 | They were saying I'm fine, you know.

00:54:27.660 | And they were fine.

00:54:28.980 | And the standard care group had five out of 10

00:54:32.100 | anxiety scores at that point.

00:54:33.860 | So we published that in The Lancet.

00:54:36.280 | Big randomized trial.

00:54:38.460 | If we had a drug that did that,

00:54:40.860 | every hospital in the country would be using it now.

00:54:44.300 | But there's no industry to push it.

00:54:46.300 | So that's part of what helped us decide

00:54:48.880 | that we needed to help people do this with Reverie

00:54:52.720 | and teach them how to do it

00:54:54.060 | and provide interactive support for them to do it.

00:54:57.820 | And the question, although, is does it work long term?

00:55:01.980 | 'Cause what we can do acutely doesn't necessarily carry on.

00:55:05.080 | So we did a randomized trial of women

00:55:07.700 | with metastatic breast cancer.

00:55:09.000 | They had advancing disease.

00:55:10.940 | We met with them in a support group once a week

00:55:13.000 | and taught them self-hypnosis for stress and anxiety

00:55:16.660 | and pain control at the end.

00:55:18.100 | And by the end of a year, the treatment group

00:55:21.400 | had half the pain the control group did

00:55:23.120 | on the same and very low amounts of medication.

00:55:25.580 | So it lasts.

00:55:26.500 | And they would say when I felt that pain in my chest

00:55:29.820 | and thought it was a metastasis, I just did the exercise.

00:55:32.980 | I got myself in a warm bath and I felt fine.

00:55:35.640 | So it works because it becomes a skill that people acquire.

00:55:40.640 | But they can tell right away

00:55:42.040 | whether it's likely to help them working with a clinician

00:55:44.660 | or now using the app or other ways of helping them learn

00:55:48.920 | to use it as a skill.

00:55:50.100 | So the nice thing is you will know very quickly

00:55:52.960 | whether it's likely to help you or not.

00:55:54.420 | And if it is, you can learn to do it for yourself.

00:55:57.100 | - That's great.

00:55:57.940 | And we will, again, there'll be a link

00:56:00.180 | to Reverie in the caption.

00:56:01.740 | It's available for Apple and Android.

00:56:04.100 | And I think even though there's a nominal cost there,

00:56:07.400 | I think that, as you mentioned, medications

00:56:12.340 | and other approaches to dealing with these problems

00:56:14.900 | are quite expensive and have all the potential

00:56:18.960 | for side effects and things.

00:56:20.220 | Not that some of those aren't also useful.

00:56:22.120 | - Could I, before you get to that, just one thing.

00:56:24.320 | We've worked very hard on the app.

00:56:27.080 | We have an iOS app for Apple.

00:56:29.620 | We decided to table for a moment redoing the Android app.

00:56:33.500 | So it's not, it was available when we were working

00:56:37.880 | through the Alexa platform.

00:56:39.680 | It's not at the moment, but it will be soon.

00:56:41.800 | So I just don't want people to be disappointed

00:56:44.020 | if they're looking for it for Android.

00:56:45.640 | It's on our agenda, but we don't have it at the moment.

00:56:48.720 | - Great, thanks for that clarification.

00:56:50.300 | So hopefully in time for both.

00:56:52.440 | I get asked a lot about obsessive thoughts

00:56:56.680 | or intrusive thoughts.

00:56:58.720 | I also get asked a lot about OCD.

00:57:01.300 | Is there any evidence that hypnosis or self-hypnosis

00:57:04.320 | can be used for dealing with obsessive thoughts?

00:57:07.080 | - Sometimes.

00:57:10.480 | There are some very obsessional people who just turn out

00:57:13.200 | not to be that hypnotizable and it's not random.

00:57:16.320 | They tend to be so over controlling of thought.

00:57:19.440 | They're all busy evaluating rather than experiencing.

00:57:23.000 | So in some ways-- - I know a few people

00:57:24.040 | like that. (laughing)

00:57:26.040 | Sounds like, it sounds like an adaptive mindset

00:57:28.920 | for a lot of professions and that we get trained up in that

00:57:33.500 | during school, how to obsess over the exam,

00:57:36.620 | obsess over our social interactions.

00:57:40.280 | I mean, it's part of becoming a functional human being

00:57:42.560 | and yet you can take us down a different--

00:57:45.260 | - We sometimes overdo it.

00:57:46.420 | I mean, I'll tell you one example from extreme situations.

00:57:50.100 | 'Cause you're judging, evaluating,

00:57:52.820 | you're not letting yourself experience,

00:57:54.180 | including emotionally.

00:57:55.700 | I know somebody who listens to the tapes

00:57:59.140 | from airplanes that go down.

00:58:00.760 | So they get the black box and they listen to it.

00:58:03.360 | And he said to me, you know--

00:58:04.760 | - That's his profession or he does this recreationally?

00:58:06.260 | - No, it's his profession, that's what he did.

00:58:08.980 | And 'cause they're trying to do accident prevention

00:58:11.220 | and how to handle things.

00:58:12.400 | And he said that you worry about people panicking, right?

00:58:17.400 | And here these guys know that they've got 30 seconds

00:58:20.740 | or some 45 seconds and they're just going

00:58:23.260 | through their checklist.

00:58:24.500 | He said they don't panic enough.

00:58:26.980 | They're taught that this is what you do

00:58:28.840 | and there is reason, there's good reason for it.

00:58:31.360 | But sometimes they overdo it.

00:58:33.580 | And it's painful to listen to this

00:58:36.340 | 'cause you know what's gonna happen.

00:58:37.500 | So it's kind of a balance we have to hit.

00:58:40.260 | And sometimes we get too emotional and too absorbed

00:58:43.540 | and you're not with it enough

00:58:46.140 | to sort of see other possibilities.

00:58:48.260 | That can be a problem.

00:58:49.100 | But on the other hand, sometimes you're too rigid

00:58:51.380 | and controlled and you don't let your emotions guide you

00:58:54.460 | to what you need to do to protect yourself

00:58:56.820 | or protect others.

00:58:57.660 | So I would say in general that people with OCD

00:59:01.860 | are on the less hypnotizable side of the spectrum.

00:59:05.840 | They're less likely to allow themselves to engage in any.

00:59:08.460 | And the typical example is the checking with OCD,

00:59:11.260 | for example.

00:59:12.180 | They don't remember whether they locked the door

00:59:17.020 | or turned off the gas in the oven

00:59:18.380 | and they keep going back and they keep checking.

00:59:20.100 | So there the evaluative component of the brain

00:59:23.560 | kind of overrides the experiential one.

00:59:26.140 | And sometimes people can get some benefit

00:59:29.340 | but they're not a group that I would select

00:59:32.440 | for being the most likely to respond

00:59:35.120 | to self-hypnotic approaches.

00:59:37.140 | - Are superstitions similar?

00:59:39.080 | - Superstitions, I think that's more.

00:59:44.240 | There are people who are very hypnotizable

00:59:47.740 | who keep getting caught up in things like superstitions.

00:59:51.060 | And there the imagination supplants the reality.

00:59:55.220 | And we've seen a lot of that happening recently.

00:59:58.120 | And so I think there it's possible

01:00:02.200 | that they could be helped by learning to sort of see it

01:00:05.260 | but put it in context, see it from a different point of view.

01:00:09.040 | - I developed a pretty vicious superstition

01:00:11.080 | when I was in college and it was hard to break, actually.

01:00:13.920 | I always feel that when I talk to clinicians

01:00:16.920 | I have to reveal certain things about my own pathology.

01:00:19.880 | - You'll get my bill later. - Thank you, yes.

01:00:22.200 | It's part of the reason I arranged this, I'm just kidding.

01:00:24.440 | But yeah, I did.

01:00:25.280 | I had a habit of knocking on wood for things

01:00:28.160 | and I noticed it started to,

01:00:29.720 | I would sneak knocking on wood every once in a while

01:00:35.480 | 'cause I didn't want people to think I was doing too often.

01:00:37.360 | And then I started to realize

01:00:38.200 | that it was becoming a little bit of a reflex.

01:00:41.400 | And then I saw this incredible video

01:00:43.800 | from Ben Solevsky's lab at Harvard.

01:00:45.840 | He studies motor patterns.

01:00:47.320 | He has these rats that press different sequences

01:00:49.760 | of levers and turn dials in order to get a pellet of food.

01:00:54.400 | But that as they do that,

01:00:55.440 | they'll start to introduce these behaviors

01:00:56.960 | that have nothing to do with the actual lever pressing.

01:00:59.720 | Like they'll start scratching their hindquarters

01:01:02.180 | and things like that and their head,

01:01:04.600 | excuse me, they don't wear hats, and flipping their ears.

01:01:06.720 | And this is just like a pitcher before throwing a baseball.

01:01:11.320 | That we do this, we start to incorporate motor behaviors

01:01:15.160 | that are unrelated to the outcome,

01:01:17.200 | but our mind somehow starts to think

01:01:19.720 | that they're necessary for the outcome.

01:01:21.620 | And so then you incorporate it.

01:01:22.680 | So I decided to break it by simply forcing myself

01:01:25.040 | to not do it for about a week.

01:01:26.880 | And then it just seemed like a ridiculous thing to do.

01:01:29.800 | Knock on wood.

01:01:30.880 | - We call that response prevention and it works.

01:01:33.460 | 'Cause what you do is you set up a new context in your brain

01:01:37.800 | where you get the outcome you want

01:01:39.600 | devoid of the extraneous behavior.

01:01:43.080 | - And I knew it was nuts, right?

01:01:44.840 | I knew it was illogical,

01:01:46.320 | but somehow these things take on meaning.

01:01:48.620 | So we talked about stress reduction,

01:01:51.440 | the utility of hypnosis for stress reduction,

01:01:55.220 | phobias, pain, possibly, we don't know,

01:01:58.880 | but for things like ADHD and OCD,

01:02:01.580 | it just will depend on hypnotizability.

01:02:03.980 | You talked about this beautiful study

01:02:06.640 | on the metastatic breast cancer outcome or patients.

01:02:11.640 | Hypnotizability is clearly a key variable.

01:02:16.040 | So could you please tell us what hypnotizability is,

01:02:20.720 | how it's evaluated, and what the Spiegel eye roll test is?

01:02:25.040 | - Okay, sure.

01:02:25.880 | So hypnotizability is just a capacity

01:02:30.880 | to have hypnotic experiences.

01:02:33.240 | And we have a test called the hypnotic induction profile.

01:02:35.920 | We give a highly structured hypnotic experience.

01:02:39.520 | And you know, the old tradition in clinical hypnosis

01:02:42.640 | was that you try a bunch of different things,

01:02:45.040 | walking upstairs and downstairs and other images,

01:02:48.480 | and time what you say to the breathing

01:02:50.880 | of the subject and all that.

01:02:52.200 | And the more you change what you do as a clinician,

01:02:55.900 | the less you can make a variation in outcome.

01:02:59.040 | And it could take a long time, you know,

01:03:00.880 | 20 minutes, 30 minutes.

01:03:02.840 | And I just view that as a kind of complex,

01:03:05.940 | not very effective way of assessing

01:03:07.660 | the person's hypnotic capacity.

01:03:09.720 | We know that the peak period of hypnotizability

01:03:13.160 | in the human life is the latency years in childhood.

01:03:16.200 | So every eight-year-old is in a trance all the time.

01:03:19.080 | You know, you call them in for dinner, they don't hear you.

01:03:20.900 | They're doing their thing.

01:03:21.960 | And that's why childhood is such a wonderful experience.

01:03:24.520 | Work and play are all the same thing, you know.

01:03:26.840 | And we try to make them into little adults,

01:03:29.080 | which I think is a terrible mistake.

01:03:31.320 | Everything is fun for them.

01:03:32.560 | They enjoy learning, they enjoy everything.

01:03:34.680 | - So what age are they in this?

01:03:36.800 | - This is like six to 10, six to 11.

01:03:40.240 | They're playful, they enjoy everything.

01:03:42.440 | Everything is sort of a game and fun.

01:03:44.640 | And we try to make it miserable for them,

01:03:46.440 | but they've got it.

01:03:47.960 | And then when what Piaget called, you know,

01:03:51.520 | a more adult cognitive framework,

01:03:53.680 | where we learn abstract concepts,

01:03:56.320 | we learn that even if one bottle looks bigger

01:03:58.280 | than the other, they can have equal volume.

01:04:00.040 | And so we start imposing logic.

01:04:02.080 | We're growing our DLPFC at that point

01:04:04.800 | and imposing cognitive structure on experience.

01:04:08.920 | Some people start to lose that hypnotic ability.

01:04:12.440 | By the time you're in your early 20s,

01:04:14.840 | your hypnotizability becomes extremely fixed.

01:04:19.960 | And there was a study done at Stanford,

01:04:22.640 | Ernest Hilgard, Phil Zimbardo did this,

01:04:25.000 | looking at, they've tracked down students

01:04:29.760 | who were in psych one, had their hypnotizability measured,

01:04:32.960 | and retested them blindly 25 years later.

01:04:35.800 | And the test-retest correlation was,

01:04:38.240 | you wanna guess what it was?

01:04:40.240 | - I'm guessing it's, I don't know, 0.6 something.

01:04:44.880 | - Yeah, very close.

01:04:46.160 | It was 0.7, IQ would be 0.6 on a 25 year interval.

01:04:50.240 | So it's more stable than IQ over a 25 year interval.

01:04:53.160 | So once you're at that point, that's where you are.

01:04:57.080 | What are the factors that lead to that?

01:04:59.560 | Well, and so what it means is that about a third of adults

01:05:02.520 | are just not hypnotizable.

01:05:04.280 | Two thirds are, about 15% are extremely hypnotizable.

01:05:07.760 | And we can measure that and give it a number from zero to 10.

01:05:11.080 | And that's very useful.

01:05:12.360 | For some of my patients when I do it,

01:05:14.360 | I say, look, I'm sorry, you're not hypnotizable,

01:05:16.160 | we're gonna do something else.

01:05:17.800 | Medication, systematic desensitization,

01:05:20.560 | mindfulness, other things.

01:05:22.760 | Or if they're very hypnotizable, I just go for it.

01:05:25.920 | I don't do a lot of explaining.

01:05:27.560 | People who are low to moderate hypnotizable

01:05:30.120 | like explanations about what you're doing,

01:05:31.960 | but then they can still get the benefits.

01:05:34.160 | So it helps me guide the nature of my treatment

01:05:38.280 | with these people.

01:05:39.120 | Now, the eye roll is, my father used to use

01:05:43.760 | an eye fixation induction.

01:05:45.320 | He used to say, look up at the ceiling

01:05:47.960 | and now close your eyes while you're looking up.

01:05:50.960 | You're very, yes, you're very hypnotizable.

01:05:53.640 | So he noticed he had two patients back to back.

01:05:57.560 | And one was a woman who I'd seen him work with

01:05:59.600 | who had hysterical seizures.

01:06:01.960 | She would just suddenly start shaking and--

01:06:05.040 | - Real epileptic seizures.

01:06:06.400 | - No, pseudo epileptics.

01:06:07.560 | - I see, so hysteria.

01:06:09.000 | - Hysteria, and although some people have both,

01:06:11.360 | that is for some people, real epilepsy

01:06:14.440 | becomes a framework that gets elaborated on

01:06:17.560 | for when you're stressed, you have seizures.

01:06:19.560 | She just had pseudo epilepsy, no EEG abnormalities.

01:06:23.080 | And she, it was really something to watch.

01:06:25.280 | Her husband had to move his workbench near the door

01:06:29.040 | so that if she started to have a seizure,

01:06:30.460 | he could run home and try and help her with it.

01:06:32.560 | It was that bad.

01:06:34.000 | And he noticed that when she, she did what you did.

01:06:38.000 | When she looked up, when she would have

01:06:39.560 | one of her seizure events, all you see is sclera.

01:06:42.360 | You don't see iris anymore.

01:06:44.280 | And she would start to see.

01:06:45.440 | So he did a great thing with her.

01:06:47.600 | He taught her to have seizures.

01:06:49.040 | Everybody else was telling her to stop.

01:06:51.160 | He made her have one.

01:06:52.040 | So he hypnotized her, let's go back

01:06:53.600 | to the last time you had one.

01:06:54.760 | And sure enough, she'd start to shake.

01:06:56.360 | And gradually, he'd make them smaller and smaller.

01:06:59.480 | So she was learning, she could control, she'd have access.

01:07:02.260 | It's like with PTSD, you know, you confront,

01:07:04.800 | you don't avoid it, you don't suppress it.

01:07:06.780 | You confront it and figure out how to deal with it.

01:07:09.520 | The next patient he had was a rigid,

01:07:12.680 | obsessional businessman who wanted to stop, you know,

01:07:16.020 | being so controlling and all this.

01:07:19.540 | Remind me, there was a New Yorker cartoon of a driver

01:07:22.060 | who comes to a yield sign and he yells, "Never!"

01:07:24.620 | You know, it's always being in control.

01:07:26.420 | - That sounds about right.

01:07:27.260 | You're a New Yorker.

01:07:28.080 | - I'm a New Yorker, right.

01:07:30.320 | And so this guy, when he tried to look up,

01:07:34.080 | he couldn't keep his eyes up while he closed them.

01:07:36.260 | And so my father started testing people,

01:07:40.520 | and it seemed that there is a rough correlation

01:07:43.440 | between the capacity to keep your eyes up

01:07:45.440 | while you close them and measured hypnotizability.

01:07:48.400 | - So that people who are listening

01:07:50.000 | and watching on video.

01:07:53.120 | So the Spiegler eye roll test involves looking up

01:07:55.920 | at the ceiling, so it's tilting the head back.

01:07:57.640 | I'm tilting my chin back and looking up at the ceiling now,

01:07:59.780 | but I'm also directing my eyes upward and my eyes are open.

01:08:04.080 | And then the eye roll test involves then closing the eyelids

01:08:08.680 | while the eyes are open and whether or not

01:08:11.300 | the eyes roll back.

01:08:13.200 | And as you said, then you see sclera, the white part.

01:08:16.000 | - You see sclera, the white part.

01:08:16.840 | - That means you're very hypnotizable

01:08:18.720 | or moderately hypnotizable.

01:08:20.440 | Whereas if the eyes move down and you see iris,

01:08:22.840 | the colored part of the eye, as the eyes close,

01:08:25.320 | less hypnotizable.

01:08:26.720 | - Correct, and you can look this up online.

01:08:28.520 | You just put Spiegler eye roll test and you'll find it.

01:08:32.880 | And we are also going to do an actual example of hypnosis

01:08:37.400 | on video later.

01:08:38.560 | - Right, so you're asking the brain to do something difficult

01:08:42.600 | to keep the eyes up while closing the eyelids.

01:08:46.840 | And so that's contradictory signals for the third, fourth,

01:08:50.200 | and sixth cranial nerve nuclei that control eye movement.

01:08:53.620 | - You said the third?

01:08:54.460 | - Fourth and sixth cranial nerve nuclei.

01:08:57.420 | And so you're suspending one activity

01:09:00.820 | while asking them to do another.

01:09:04.020 | And eye movements have a lot to do

01:09:05.820 | with levels of consciousness.

01:09:07.420 | The periaqueductal gray surrounds

01:09:09.780 | these cranial nerve nuclei.

01:09:11.700 | And when we close our eyes when we sleep,

01:09:15.420 | we have rapid eye movement when we dream.

01:09:17.480 | Most drugs that affect level of consciousness

01:09:19.480 | can affect eyes and eye movements,

01:09:21.340 | either the dilation or contraction of the pupils,

01:09:24.220 | depending on whether it's a stimulant or an opioid.

01:09:27.200 | - Stimulants make the pupils big.

01:09:29.380 | Yeah, like cocaine, amphetamine, things of that sort.

01:09:33.240 | - And opioids, you get constricted pupils.

01:09:36.720 | - This is what parents, you know,

01:09:37.880 | the parents looking at their kids

01:09:39.080 | coming in the door late at night.

01:09:40.440 | They're looking for substance abuse.

01:09:44.040 | - That's right.

01:09:45.240 | So there's something about the eyes

01:09:47.480 | that has a lot to do with level of consciousness.

01:09:49.440 | I mean, obviously you close your eyes when you go to sleep,

01:09:52.180 | you have rapid eye movement when you're dreaming.

01:09:54.460 | So it's not surprising.

01:09:56.020 | And there's an old zen practice

01:09:57.760 | called looking at the third eye.

01:09:59.820 | And I think part of the reason that this happens

01:10:02.840 | is where you're looking up inside.

01:10:05.420 | It's like there's a third eye

01:10:06.480 | between the other two in your forehead.

01:10:08.660 | And I think it's because we're visual creatures.

01:10:12.260 | You know, we're pretty pathetic

01:10:14.460 | from a physical point of view.

01:10:15.620 | You know, many animals can outrun us, you know,

01:10:19.180 | and or out smell us or see, you know, eagles can read,

01:10:22.560 | could read the newsprint at a hundred yards

01:10:24.880 | and we can't, you know, it's.

01:10:26.440 | So our major defensive sensory input is vision.

01:10:31.440 | And that's why, you know, animals,

01:10:35.140 | predator animals have eyes in the front of their head

01:10:38.280 | so that they have very good detailed vision of prey.

01:10:42.200 | Whereas prey animals like deer

01:10:44.520 | have eyes on the side of their head.

01:10:45.900 | So they don't see things that well,

01:10:47.140 | but they have a much bigger range of potential to see threat.

01:10:52.140 | And we mainly use, in fact, it's interesting.

01:10:55.660 | There've been social anthropologists that say,

01:10:57.500 | why do we gather where we do, you know, on coastlines

01:11:01.180 | and, you know, at the edge of a forest or something?

01:11:03.940 | It's because you've got protection in the back.

01:11:06.500 | Something can't attack you from one side

01:11:08.540 | and you have a big vision of what might threaten you.

01:11:11.340 | And we tend to like be attracted

01:11:13.380 | to those kinds of physical situations.

01:11:16.460 | - And we love vistas.

01:11:17.700 | - We love vistas.

01:11:18.540 | - Vistas are very calming.

01:11:19.540 | They take us into that panoramic vision.

01:11:21.460 | - That's right.

01:11:22.280 | - I didn't know this, but it turns out

01:11:23.500 | that most of the scenic spots at any location

01:11:26.860 | in national parks and were where people naturally aggregated.

01:11:30.260 | It wasn't, which makes sense, you know,

01:11:32.820 | but that those signs and locations were built up

01:11:36.360 | around people's tendency and animals tendencies

01:11:40.100 | to aggregate there.

01:11:41.700 | Yeah, there's an interesting book on the history

01:11:44.060 | of the national parks that says

01:11:45.940 | that they didn't give a research study to support it,

01:11:48.660 | but there was no Google maps, obviously.

01:11:50.540 | - That's very interesting.

01:11:51.580 | - Yeah, panorama and visual boundaries

01:11:54.340 | are really interesting.

01:11:55.340 | I think, so the eyes, as we both know,

01:11:57.860 | are two pieces of the central nervous system

01:11:59.980 | of the brain outside the,

01:12:02.300 | I used to say that the eyes are outside the skull

01:12:04.300 | and a neuro-ophthalmologist said,

01:12:07.620 | there wrote to me and vehemently pointed out

01:12:11.300 | that they are outside the cranial vault.

01:12:13.340 | So, you know, they're outside the cranial vault,

01:12:15.780 | but they are two pieces of brain, they're out there.

01:12:17.820 | And so you mentioned cranial nerves, three, four, and six.

01:12:20.980 | This isn't a neuroanatomy course,

01:12:22.340 | but maybe we could go a little deeper there.

01:12:24.540 | So there's, you said there's contradictory activity.

01:12:26.620 | Looking up is controlled by the one set of cranial nerves

01:12:31.460 | and then the closing of the eyelids

01:12:32.780 | is controlled by another cranial nerve.

01:12:35.740 | - No, it's the same one.

01:12:36.900 | I think it's six that when you close your eyes,

01:12:42.220 | you activate, no, it's the facial,

01:12:46.500 | I guess it's the facial nerve, it's a seven.

01:12:48.940 | - Seven, yeah. - Seven, yeah.

01:12:50.180 | - But you're looking up, you're activating the muscles

01:12:54.460 | that force your eyes to look up

01:12:58.060 | and the closing your eyelids normally relaxes those,

01:13:02.620 | relaxes that upper movement because your eyes are closed

01:13:05.300 | and you don't need to do it.

01:13:06.680 | So you're breaking a usual customary pattern.

01:13:09.700 | - It's like the rubbery, the, hey, I can't even do it.

01:13:12.140 | See, it's like, rubbing your tummy and patting your head,

01:13:16.100 | it's a bit, there's a bit of a conflict there,

01:13:19.100 | but clinically it's been a good probe for you

01:13:22.020 | and for your father.

01:13:23.300 | So was it Spiegel Senior or Spiegel Junior?

01:13:25.340 | - That's Spiegel Senior.

01:13:26.300 | - That developed the Spiegel Eye Roll Test.

01:13:28.700 | - But the key issue is this,

01:13:30.080 | that normally when we close our eyes also,

01:13:32.940 | we're going to sleep.

01:13:34.260 | You're not worried about what's going on

01:13:36.020 | in the world anymore.

01:13:36.940 | Here, you're maintaining resting alertness.

01:13:40.140 | So you're focusing, but you're turning inward.

01:13:42.940 | That's an unusual state.

01:13:44.260 | Normally we don't, we close our eyes periodically.

01:13:46.580 | We have to, but when you close your eyes

01:13:49.340 | for some period of time, it's normally to go to sleep

01:13:51.780 | and you're not worried about detecting risk or threat.

01:13:56.700 | So it's an interesting state

01:13:58.620 | because you're turning inward basically.

01:14:01.140 | You're looking up, you're shutting your eyes

01:14:03.260 | and you're allowing whatever happens outside you to happen

01:14:05.780 | and focusing on what's going on inward.

01:14:08.180 | So I think it's a signal to your brain to turn inward.

01:14:11.980 | - Very interesting.

01:14:13.340 | And meditation of course could be done with eyes open,

01:14:16.420 | but almost always is done with eyes closed.

01:14:18.560 | - Yes, that's right.

01:14:20.100 | - Very interesting.

01:14:21.340 | So you can very quickly determine

01:14:24.020 | whether or not someone is highly hypnotizable,

01:14:27.220 | not at all hypnotized.

01:14:28.180 | When you say about two thirds of people can be hypnotized,

01:14:31.560 | obviously a third cannot,

01:14:32.820 | but within the two thirds that can, there's a range.

01:14:35.980 | And you said 15% of people fall into this

01:14:38.660 | highly hypnotizable category

01:14:40.740 | that I seem to be a member of.

01:14:42.780 | And does repeated use of self-hypnosis or clinical hypnosis

01:14:48.240 | increase or change hypnotizability

01:14:50.100 | for those that can access it in the first place?

01:14:52.300 | - I would say in general, it may increase a little bit,

01:14:54.800 | but not a hell of a lot.

01:14:55.980 | And it's not worth the effort

01:14:57.880 | to increase your hypnotizability at that point.

01:15:00.220 | It's worth trying to deal with the problem

01:15:02.000 | you're dealing with.

01:15:03.020 | So you can get better at using it at the level that you have.

01:15:07.780 | There was a study done in which they tried to train people

01:15:10.780 | to be more hypnotizable.

01:15:11.960 | And obviously there are subjective

01:15:15.180 | and behavioral components to the test.

01:15:17.580 | You can learn to do a little better on them.

01:15:19.680 | But what we found was when we reanalyzed this data

01:15:23.300 | that we could account for three times the final score

01:15:26.420 | based on the initial hypnotizability measurement

01:15:29.400 | rather than whether or not

01:15:30.660 | they had been trained to do better.

01:15:32.060 | So you can improve it a little,

01:15:33.940 | but it's not worth the trouble.

01:15:35.300 | - Got it.

01:15:36.260 | Along the lines of eyes and eye movements,

01:15:38.940 | a lot of interest out there about EMDR,

01:15:40.900 | eye movement desensitization reprocessing.

01:15:43.060 | Shapiro herself was working,

01:15:46.900 | she wasn't at Stanford directly,

01:15:48.140 | but was the local to Stanford, I think in Palo Alto.

01:15:51.380 | So what are your thoughts on EMDR?

01:15:55.220 | Where is it useful?

01:15:56.260 | Where do you think it's less useful?

01:15:58.500 | Are there things that EMDR could be combined with

01:16:00.780 | to make it more useful?

01:16:03.140 | The listeners of this podcast come to,

01:16:08.460 | I think come to the podcast

01:16:10.100 | with a range of backgrounds and interests.

01:16:13.060 | To me, it makes sense why EMDR,

01:16:16.220 | lateralized eye movements might work given the newer data

01:16:19.940 | that it can suppress amygdala activity in some animals

01:16:22.740 | and animal models and in humans as well.

01:16:25.580 | But it really hasn't been explored much neurally.

01:16:27.920 | I've heard things like it coordinates

01:16:29.500 | the two sides of the brain,

01:16:30.500 | which to me is just a throwaway.

01:16:33.300 | I don't think there's any evidence

01:16:34.580 | that coordinating the two sides of the brain

01:16:36.480 | is better than not coordinating.

01:16:38.320 | I wouldn't be speaking right now

01:16:39.380 | if the two sides of my brain were well-correlated

01:16:42.220 | because language is lateralized.

01:16:43.820 | So I've heard that it mimics rapid eye movements

01:16:46.680 | during sleep, but actually it doesn't.

01:16:48.520 | So, but I have heard people talk about

01:16:52.620 | their positive experiences with EMDR.

01:16:55.220 | What are your thoughts about EMDR?

01:16:56.740 | - Yeah, you had a good comment on that

01:16:58.420 | in one of your recent podcasts.

01:16:59.800 | And I'll tell you, one way I sort of think about it

01:17:04.800 | from a bemused point of view is the old,

01:17:07.840 | you mentioned it earlier,

01:17:08.840 | the oldest sort of idea of a hypnotic induction

01:17:12.100 | was a dangling watch, right, and a watch.

01:17:15.340 | And in fact, there was enough concern about it

01:17:19.600 | that when automobiles were invented,

01:17:21.660 | there was a movement to prevent installing windshield wipers

01:17:25.940 | because people were afraid that they would be hypnotized

01:17:29.580 | if they watched the windshield wipers

01:17:31.380 | go back and forth on a car.

01:17:33.580 | Now, it turns out, fortunately,

01:17:35.120 | that you tend not to look at the windshield wipers.

01:17:37.500 | You keep looking through the windshield.

01:17:39.900 | And so we have windshield wipers today.

01:17:42.720 | But that movement is what exactly

01:17:45.280 | used to be a hypnotic induction.

01:17:46.740 | I think there is a lot of hypnosis in EMDR.

01:17:50.800 | And I think it's a combination of that

01:17:52.920 | with exposure-based treatments

01:17:55.740 | where you use EMDR to think about it.

01:17:57.760 | You tend not to process the experience as much

01:18:01.000 | and just do the physical part of it,

01:18:03.100 | which I personally think is a drawback.

01:18:05.340 | And every study I've seen that was a dismantling study,

01:18:09.400 | there's no question that people who go through EMDR,

01:18:11.760 | many of them get better with trauma-related problems,

01:18:14.640 | and the VA has a big program using it and so on.

01:18:17.440 | But every program that has dismantled

01:18:20.580 | going through the treatment

01:18:21.800 | with having the lateral eye movement

01:18:23.760 | has shown that the lateral eye movement

01:18:26.360 | doesn't add anything to it.

01:18:27.840 | And toward the end of her career,

01:18:29.860 | Francine was doing now contralateral touching or something.

01:18:34.440 | It wasn't eye movements anymore.

01:18:35.880 | It was other things.

01:18:36.720 | So I tend to think that EMDR

01:18:41.400 | is another form of exposure-based therapy for trauma.

01:18:45.660 | But as you've implied,

01:18:47.940 | with the exception of this possible new data,

01:18:50.480 | it certainly doesn't have to do

01:18:51.920 | with rapid eye movement, sleep.

01:18:53.760 | And I don't think moving the eyes is the issue.

01:18:56.400 | I think it's a way of sitting down and confronting trauma.

01:18:59.520 | And I would rather that the trauma itself

01:19:01.600 | be processed a bit more than often happens in the EMDR.

01:19:05.120 | So a lot of people have gotten therapy.

01:19:07.200 | Some of them have been helped.

01:19:08.520 | Francine used to originally claim

01:19:10.480 | that just one session would desensitize people and do it.

01:19:13.360 | And that's clearly not true.

01:19:14.960 | I see a lot of people who said,

01:19:16.400 | "Yeah, it helped for a while, but I need more."

01:19:18.800 | So I think it became a kind of overly simplistic approach

01:19:23.800 | to understanding brain physiology, and that part is wrong.

01:19:30.400 | And the interesting thing,

01:19:33.040 | you mentioned suppressing amygdala activity.

01:19:35.680 | It's very interesting that my late friend, Alan Hobson,

01:19:39.480 | who was a brilliant sleep researcher, you know Alan.

01:19:42.140 | - Well, I don't know him, but I read his book

01:19:44.160 | when I was in college about the chemistry of sleep

01:19:46.840 | and the similarities between dream states and hallucinations.

01:19:51.840 | And it's one of the reasons I got into this business.

01:19:54.520 | - Yes, well, I worked with him

01:19:55.920 | in a MacArthur mind-body network for many years.

01:19:58.280 | And a brilliant guy points out that we need to get

01:20:01.840 | into primarily a parasympathetic state to go to sleep,

01:20:05.960 | that we have to shut off the sympathetic nervous system.

01:20:09.700 | And that's why a loud noise wakes you up

01:20:11.560 | when your heart rate goes up and all this.

01:20:13.520 | So he was brilliant at documenting what happens

01:20:17.000 | in the brain of sleep.

01:20:17.840 | He pointed out something also very interesting about dreams,

01:20:20.820 | which is that the stories in dreams and even the images

01:20:24.560 | in dreams can change all over the place in crazy ways,

01:20:27.440 | but usually the affect is constant.

01:20:30.380 | So usually if it's a frustration dream,

01:20:32.680 | whatever happens, you wind up frustrated.

01:20:34.600 | And if it's a enjoyment dream,

01:20:36.840 | you enjoy whatever's going on.

01:20:38.680 | So there's an odd consistency and affect in dreams

01:20:42.220 | that you don't have in other states.

01:20:44.960 | And the idea of lateral eye movement

01:20:47.880 | suppressing amygdala activity would kind of fit with that,

01:20:50.340 | that you don't allow intrusions of fear and anger

01:20:54.360 | and upset in dreams.

01:20:55.600 | It may be there all the time,

01:20:56.980 | but it may not be there when you think it should be.

01:20:59.660 | So why is it that you can be falling off a building

01:21:02.080 | and somehow not that scared?

01:21:03.780 | You're just having this experience of flying in a dream.

01:21:06.840 | So I think there may be something going on

01:21:10.980 | about regulating affect,

01:21:12.200 | but we have elaborate and better ways to regulate affect.

01:21:16.700 | - Great, so EMDR might incorporate some elements

01:21:20.240 | of hypnosis by, so the lateral eye movements,

01:21:22.920 | perhaps by way of suppressing the amygdala,

01:21:24.800 | this fear associated center might bring people

01:21:27.080 | into a more parasympathetic calm state.

01:21:29.240 | So it might be pseudo hypnosis and then exposure therapy

01:21:32.160 | through the discussion about the issue.

01:21:34.080 | - Right. - Okay.

01:21:35.680 | More research needed on EMDR out there.

01:21:38.400 | And obviously something that's come up a lot

01:21:42.700 | in this discussion and in our discussions

01:21:45.540 | that I have the great fortune of talking to you every week

01:21:48.660 | is, and working together,

01:21:50.540 | is this idea of getting close to the phobia,

01:21:55.540 | getting close to the trauma,

01:21:57.740 | re-experiencing it as a portal

01:22:00.100 | to then adjusting the response to it

01:22:02.420 | and rewiring something.

01:22:03.920 | So the troubling thing or the horrible thing

01:22:06.540 | is no longer as horrible to us.

01:22:09.720 | But the repeating theme is we can't expect

01:22:14.600 | to get over something without getting really close to it,

01:22:17.160 | maybe even experiencing it somatically.

01:22:20.420 | Nowadays, we hear a lot about triggers and trigger warnings,

01:22:24.760 | and certainly one can understand why those exist.

01:22:29.760 | But it seems like there's a, in the general population,

01:22:32.700 | there's this idea that we want to move away

01:22:35.120 | from anything that upsets us.

01:22:36.480 | And yet I think it's fair to say,

01:22:38.240 | even though having gathered the statistics that on the whole,

01:22:41.660 | that the human beings are becoming more and more anxious

01:22:44.480 | and more and more stressed, perhaps because of,

01:22:48.900 | but certainly in parallel with the fact

01:22:51.680 | that we're trying to move away from troubling things,

01:22:53.640 | troubling things.

01:22:54.520 | So I've heard you say before that it's,

01:22:59.520 | in terms of therapeutic approaches,

01:23:01.200 | it's not just about the state you get into,

01:23:03.400 | but whether or not you brought yourself there voluntarily.

01:23:06.960 | - That's exactly right.

01:23:07.800 | - So this element of deliberate self-exposure,

01:23:11.440 | deciding I'm going to confront the trauma,

01:23:14.320 | I'm going to confront the pain,

01:23:16.000 | I'm going to confront the insomnia,

01:23:18.040 | I'm going to confront the, you know, and fill in the blank.

01:23:20.800 | And then readjusting one's emotional response

01:23:24.560 | right up next to that troubling thing.

01:23:28.060 | That seems to be the hallmark of this treatment.

01:23:31.240 | And if I'm thinking about it correctly,

01:23:34.560 | of pretty much all treatments for getting over stuff,

01:23:37.560 | if people don't have access to a really good clinician

01:23:41.320 | like yourself,

01:23:42.600 | how should they carry these thoughts and these ideas?

01:23:45.900 | I mean, I think almost everybody of any reasonable age

01:23:49.240 | has memories or things that upset them,

01:23:52.260 | but we learn to suppress them.

01:23:53.880 | What does one do?

01:23:56.820 | Obviously the Reverie app has approaches to dealing

01:23:59.120 | with some of this inside of the app,

01:24:02.440 | but how does one start to think about actually dealing

01:24:05.260 | with something like this and avoiding the hazards

01:24:08.040 | of just kind of reactivating a lot of painful experiences?

01:24:10.860 | Because a lot of being a functional human being

01:24:12.760 | is also going to work each day, interacting with people

01:24:15.400 | and not bringing one's trauma, you know,

01:24:17.200 | and dumping it out all on the table

01:24:19.120 | or being able to just function is so crucial.

01:24:22.760 | So how do you think about this as a clinician?

01:24:25.420 | - Well, you know,

01:24:26.260 | the image that comes to mind is the Greek myth of Pandora's

01:24:28.860 | box, you know, that it opened and the furies got out

01:24:31.360 | and you couldn't put them back in.

01:24:33.300 | And we have this kind of fantasy that once you get

01:24:35.980 | into these memories, they'll take you over

01:24:38.460 | and you'll never get them back in the box.

01:24:40.580 | And I think that's wrong.

01:24:41.980 | You know, people who use hypnosis say that there are ways

01:24:46.060 | to present things to people that will be helpful

01:24:48.380 | in ways that won't.

01:24:49.700 | And one real mistake is to tell someone,

01:24:51.800 | don't think about purple elephants.

01:24:53.620 | You know, what are you thinking about?

01:24:55.220 | You know, it doesn't work.

01:24:56.600 | So you want to find a way to feel in control of the access

01:25:01.100 | and to define what happened on your own terms.

01:25:04.460 | And so I'm not a big fan of trigger warnings.

01:25:06.860 | I think we're going crazy over, you know,

01:25:09.040 | this could be upsetting, that could be upsetting.

01:25:10.780 | Yeah, there are lots of things that are upsetting.

01:25:12.360 | You know, the average kid has watched 20,000 murders

01:25:16.220 | by the time he's 20 years old watching television

01:25:18.700 | and movies these days.

01:25:20.260 | So, you know, we see terrible things

01:25:22.260 | and it's not a matter of are you exposed to something

01:25:25.540 | that's upsetting, but how do you handle it?

01:25:28.100 | What do you make of it?

01:25:28.960 | And are you feeling in control?

01:25:30.360 | It's not like, you know, what Putin is doing

01:25:34.300 | to his rival in Russia, you know,

01:25:36.660 | forcing him to watch propaganda movies 10 hours a day

01:25:39.340 | while he's in prison.

01:25:40.780 | It's a matter of thinking about a problem

01:25:45.780 | in a way that leaves you feeling you understand it better,

01:25:49.180 | you're in more control, you can turn it off

01:25:50.980 | when you want, you can turn it on when you want.

01:25:54.260 | And so we have to, in life, deal with stressful things.

01:25:57.280 | There are studies, Karen Parker at Stanford

01:25:59.800 | has done some wonderful studies with primates

01:26:02.660 | about stress inoculation, that if you separate

01:26:05.640 | a baby monkey from his mother for two hours a day

01:26:08.920 | and then reunite them, and then you stress

01:26:11.460 | that baby monkey later, they actually handle stress better.

01:26:14.880 | There's less cortisol arousal in the face of the stress.

01:26:17.600 | Stress inoculation, it's been called.

01:26:19.360 | So mere exposure to trauma or stress,

01:26:23.280 | it's a part of living anyway.

01:26:24.860 | We can't avoid it even if we'd like to.

01:26:27.160 | And it's not pleasant, it's not great,

01:26:30.200 | but it's sometimes things you need to learn about life.

01:26:32.680 | And if you can find an algorithm for facing it,

01:26:36.400 | putting it into perspective, dealing with it,

01:26:38.440 | you become a stronger person, not a weaker person.

01:26:40.820 | So this idea that college students are such fragile flowers

01:26:44.680 | that if you talk about a sexual assault or something,

01:26:47.060 | you know, you're doing something terrible to them,

01:26:49.320 | it's just wrong.

01:26:50.360 | And I think we need to build our ability

01:26:54.440 | to recognize and manage stress.

01:26:56.260 | And you can't do that without doing it.

01:26:58.040 | You can't learn, or you can't ride a bicycle

01:27:00.400 | without taking the risk of falling off it, you know?

01:27:02.760 | And so I think that's the way I think

01:27:05.440 | of dealing with stress.

01:27:07.320 | - Yeah, I really appreciate you saying that.

01:27:09.080 | I was, you and I were both at a gathering,

01:27:12.160 | let's say where this issue was being discussed

01:27:14.920 | and around an issue of a publicized sexual trauma

01:27:18.680 | and you made an excellent case for why

01:27:21.920 | this stuff can't be pushed under the rug.

01:27:23.980 | And that actually, in my observation,

01:27:27.520 | led to a lot of healing for the people that,

01:27:29.400 | and the families of people that suffered from this.

01:27:32.620 | I do think people are resilient,

01:27:35.280 | but we don't really teach how to think about feelings.

01:27:40.160 | You know, we don't, you know,

01:27:41.200 | we're told that we need to feel our feelings,

01:27:43.060 | but then again, we are also told

01:27:45.160 | that feelings don't hold all the information.

01:27:47.080 | And so I think that, as you mentioned,

01:27:48.560 | there's no operating or user's manual

01:27:51.200 | for this nervous system thing.

01:27:53.320 | Brings me to another issue,

01:27:54.560 | which is the mind-body connection,

01:27:56.000 | something that we're very interested in

01:27:57.800 | and you've done extensive work on.

01:27:59.880 | We all like to think that getting more in touch

01:28:03.720 | with our body would be a great thing.

01:28:05.560 | Learning to intercept,

01:28:06.680 | paying attention to our internal landscape

01:28:08.400 | would be a great thing.

01:28:09.220 | But as we often discuss, when we're feeling lousy,

01:28:13.200 | then being really in touch with that lousy feeling

01:28:15.880 | may or may not be a good thing, right?

01:28:18.720 | So how should we think about mind-body?

01:28:21.400 | I can see examples in hypnosis,

01:28:23.880 | from your descriptions of hypnosis,

01:28:25.460 | where you want to unify the mind-body connection,

01:28:29.920 | feel what you're thinking,

01:28:31.760 | think what you're feeling, et cetera.

01:28:33.320 | But I could also point to elements

01:28:36.120 | within the hypnotic process

01:28:37.520 | in which you are actively trying to uncouple those.

01:28:41.360 | So it sounds to me like this whole mind-body thing

01:28:44.400 | is a bit more like a car.

01:28:46.140 | You can't say that 40 miles per hour is the optimal speed.

01:28:49.760 | It kind of depends on the road you're on

01:28:51.640 | and the turn you may or may not be taking.

01:28:53.740 | How should we think about mind-body

01:28:57.400 | in terms of navigating daily life?

01:29:00.060 | What do you think is the adaptive way

01:29:01.960 | to conceptualize the mind-body?

01:29:05.020 | It's a big question.

01:29:07.300 | - It is, it's a very interesting one.

01:29:10.720 | I guess I think that it's a matter not of,

01:29:16.260 | absolute control, but more control,

01:29:18.540 | that we need to think of our brain as a tool,

01:29:23.460 | and our body signals as tools as well,

01:29:26.660 | to help us understand what's going on in the world,

01:29:29.940 | what we need, what matters, what's important, what isn't.

01:29:33.380 | But also something that can be managed,

01:29:36.220 | not simply absorbed.

01:29:39.240 | And so hypnosis, I think, is a kind of limiting case

01:29:43.520 | where you can push it about as far as we can push it

01:29:46.780 | in terms of regulating pain.

01:29:48.680 | Pain is a good example of that.

01:29:51.680 | Obviously, you need to pay attention.

01:29:53.600 | If you just broke your ankle,

01:29:54.680 | you better pay attention to it and get help,

01:29:56.780 | or you're having crushing substernal chest pain.

01:29:59.340 | You better do something about it.

01:30:00.840 | But our brain is sort of programmed

01:30:03.180 | to treat all pain signals as if they were novel pain signals

01:30:06.260 | if it's a sudden new problem that needs to be attended to.

01:30:09.580 | I teach people to think of the pain and categorize it.

01:30:13.140 | Does the pain mean that if you put weight on this,

01:30:17.860 | you're gonna re-injure your ankle, for example?

01:30:20.940 | Or does it simply mean that your body is healing

01:30:23.040 | and the pain is a sign that gradually

01:30:25.420 | things are getting back to normal?

01:30:27.200 | And so you can modify the way you process pain

01:30:31.720 | based on what your brain tells you the pain means.

01:30:35.480 | And that's true for emotional pain as well.

01:30:37.740 | And particularly where I think a strategy that really helps

01:30:42.060 | is if you think of an interpersonal problem

01:30:45.880 | or a threat of something coming as an opportunity

01:30:50.880 | to do something to ameliorate the situation.

01:30:53.580 | So it's not just it's happening to you,

01:30:56.120 | but something that you can influence and do something about.

01:30:59.480 | So it's blending the receptive with the active response

01:31:04.100 | that I think can make a difference.

01:31:05.340 | So you try and process it in a way

01:31:06.940 | that gives you a deeper understanding of what's happening.

01:31:09.460 | You face it, but you also say this is an opportunity

01:31:12.940 | for me to do something about it.

01:31:14.620 | And the minute you realistically enhance,

01:31:17.340 | and this doesn't mean imagine a way, a heart attack,

01:31:19.900 | it means figure out how to rehabilitate from a heart attack

01:31:24.540 | or a broken leg or something like that

01:31:27.300 | in a way that you get as much control

01:31:30.100 | into the situation as you can.

01:31:32.640 | - I love it.

01:31:33.480 | Grief.

01:31:36.780 | Grief is one of those states that is very hard

01:31:39.700 | to remove oneself from, you know?

01:31:42.800 | And a lot of people ask me, how do I deal with grief?

01:31:46.240 | And I'm not a clinician, so I'm deferring to you.

01:31:49.500 | On the one hand, actually someone at Stanford recently

01:31:52.660 | came to me and said, you know, my mother passed away

01:31:54.740 | and I had a sibling that passed away

01:31:56.100 | and they were the only people that I had.

01:31:57.540 | And I'm also living alone and I'm challenged

01:32:00.300 | with a number of things.

01:32:01.180 | And they looked like they were holding it together

01:32:05.340 | very well, in fact, given what they were describing.

01:32:08.420 | And on the one hand, well, I certainly pointed out

01:32:12.740 | that I'm not a clinician, but I said on the one hand,

01:32:14.820 | you could imagine that it would be necessary and useful

01:32:17.580 | to go into the grief state

01:32:19.020 | if you want to transition through it.

01:32:20.860 | On the other hand, I've heard before

01:32:25.580 | that the cathartic model of just really diving

01:32:29.380 | into an emotion can also be potentially hazardous

01:32:32.780 | if you don't have any anchors to grab onto.

01:32:37.780 | What is the view of psychiatry or your view of grief

01:32:41.700 | and how to deal with grief?

01:32:43.000 | Because I think grief is one of those all-encompassing

01:32:46.620 | emotions for many people.

01:32:48.500 | - It is, and it's a very important, natural,

01:32:51.260 | necessary stage of life.

01:32:52.580 | And the reason we have all these grief rituals

01:32:55.080 | from burials and memorials and headstones

01:32:59.340 | and sitting Shiva and other things that people do,

01:33:02.140 | it's a way of making it real that an incomprehensible loss

01:33:06.420 | has to be comprehended.

01:33:08.100 | You have to realize that you're now gonna have to live life

01:33:10.820 | without your loved one, your parent, your sibling, whoever.

01:33:14.500 | And we've all gone through this at one time or another.

01:33:18.260 | I certainly have.

01:33:19.680 | And it's very hard to just come to terms with,

01:33:22.860 | but one principle is to sort of say,

01:33:26.200 | it's never all or none, it's more or less.

01:33:29.500 | So yes, it's all or none that you've lost a loved one.

01:33:32.980 | But I ask people as part of their grieving

01:33:35.820 | to say to themselves, and I do this in hypnosis sometimes

01:33:39.060 | too, you've lost them, but what have they left you with?

01:33:44.060 | What have they bequeathed to you even though they're gone?

01:33:47.220 | And I'll sometimes ask them to say,

01:33:49.260 | if your mother could be here right now,

01:33:51.500 | what would she say to you?

01:33:53.260 | How would she feel about your life now?

01:33:55.020 | What would she advise you to do?

01:33:56.960 | So in our support groups for women with advanced breast

01:34:00.000 | cancer, we lost people.

01:34:02.200 | And I gotta tell you that we were warned by oncologists

01:34:04.780 | that we demoralize people that,

01:34:06.880 | I mean, they were wonderful oncologists,

01:34:08.320 | but there were some that were very afraid

01:34:09.960 | that we would harm them in some way,

01:34:13.000 | because the mortality rate is fairly high

01:34:16.540 | with metastatic breast cancer.

01:34:18.240 | They're gonna watch people die of the same disease

01:34:21.100 | and you'll demoralize them.

01:34:23.060 | So we actually measured their emotion

01:34:25.880 | and the content of speech every five minutes

01:34:28.180 | throughout a bunch of groups to make sure

01:34:29.820 | that wasn't happening.

01:34:30.660 | What we found was that they talked about more serious issues

01:34:33.740 | but the mood didn't actually get worse.

01:34:35.820 | And we found in general that expressing negative emotion

01:34:38.960 | on the long run helps people be less anxious

01:34:41.140 | and depressed over time.

01:34:42.100 | And we've shown this in randomized clinical trials,

01:34:44.300 | so it's not just my clinical impression.

01:34:47.180 | And what we try to get them to do is to face a loss,

01:34:54.620 | live with the emotion that comes with it,

01:34:56.200 | but also see that the reason it hurts so much

01:34:58.780 | is how much that person gave you.

01:35:00.500 | So we would do a self-hypnosis exercise at the end of the group

01:35:03.580 | and say, I want you to get your body floating

01:35:05.660 | safe and comfortable.

01:35:06.940 | Now picture Mary and sit with the feeling of sadness

01:35:11.480 | that she's no longer with us.

01:35:13.420 | And we do that for a few minutes.

01:35:14.920 | And then we'd say on the other side,

01:35:16.700 | picture one thing she left with you that you still have,

01:35:19.620 | that you carry on in your heart her tradition

01:35:22.500 | of what she gave to you.

01:35:24.500 | And so just seeing it not as a complete loss,

01:35:28.080 | but as a real loss, a painful loss,

01:35:30.740 | but one that helps you to reflect on what you gained

01:35:33.540 | from her and knowing her,

01:35:35.680 | I think can be very helpful in the grieving process.

01:35:38.540 | - That's very helpful, the way to conceptualize it.

01:35:42.060 | Couple quick questions.

01:35:43.540 | Can children be safely hypnotized or do self-hypnosis?

01:35:48.800 | - It's sometimes harder for them to do self-hypnosis.

01:35:52.840 | They need more structure to do it.

01:35:54.560 | You've got to share your dorsolateral prefrontal cortex

01:35:58.340 | with them a little bit.

01:35:59.660 | But yes, absolutely.

01:36:00.820 | Children can be very hypnotizable.

01:36:02.980 | And I know pediatricians who use it wonderfully all the time.

01:36:07.980 | They get them to focus on something else.

01:36:10.780 | So they're going to have to give them a shot

01:36:12.560 | or draw blood or something.

01:36:14.180 | And they'll say, I'm going to press your happy button

01:36:18.360 | and presses their belly button.

01:36:20.000 | And they start to giggle the way kids do.

01:36:21.800 | And meanwhile, the nurse is drawing the blood

01:36:24.400 | and they don't even notice it.

01:36:26.180 | Dentists, good dentists can use it to help kids

01:36:28.900 | with fear and pain.

01:36:30.340 | So yes, it can be very effective for children.

01:36:32.700 | We did a randomized trial.

01:36:34.000 | I have a publication in pediatrics.

01:36:35.940 | My late sister who was a pediatrician

01:36:37.900 | and who always used to joke that she was the only one

01:36:41.620 | in our family who was a real doctor.

01:36:43.420 | I said, I got you, I got a paper in pediatrics.

01:36:47.900 | And the paper was children having to undergo avoiding

01:36:52.000 | cystourethrograms.

01:36:53.140 | So the anatomy of the kidney, if you'll forgive me,

01:36:56.880 | is sort of interesting in that the ureter

01:37:00.000 | that goes into the bladder normally goes into the bladder

01:37:03.200 | at an angle.

01:37:04.120 | And so that means that when the bladder contracts

01:37:06.800 | to expel urine, it automatically closes off the ureter

01:37:10.800 | because it's sideways to the bladder.

01:37:12.820 | Some kids are born with it perpendicular

01:37:14.880 | and then you'll get reflux into the kidney.

01:37:17.160 | And some children outgrow it.

01:37:19.220 | Some need pretty complicated surgery to fix that.

01:37:22.620 | And so you image them every year or so

01:37:25.980 | to see whether they're getting kidney damage or not.

01:37:28.640 | And it's a pretty miserable experience.

01:37:30.440 | You're a nine-year-old girl.

01:37:32.000 | You have to go and lie on a hard, cold table,

01:37:33.880 | have strangers pull your legs apart and stick a catheter

01:37:36.400 | into your urethra and hold in the bladder

01:37:40.040 | and then expel urine.

01:37:41.680 | And so you get into these struggling fights.

01:37:43.800 | And of course, the more they struggle,

01:37:45.120 | the more they constrict and it makes it harder to do it.

01:37:47.540 | So I was asked if we could test it.

01:37:51.000 | So we did a randomized trial at Children's Hospital.

01:37:54.080 | They either got training in self-hypnosis.

01:37:56.240 | I would meet with them and the mother the week before.

01:37:59.200 | We find out from the kids where they like to be.

01:38:01.440 | And I'd say, "You're gonna play a trick on your doctors.

01:38:03.660 | "Your body's there.

01:38:04.500 | "You're somewhere else.

01:38:05.500 | "Go visit your friend.

01:38:06.600 | "Go to Disneyland.

01:38:07.440 | "Do something else."

01:38:08.280 | And the mother would work on this with me

01:38:10.060 | at the head of the table.

01:38:11.600 | And we found that these children were much easier to image.

01:38:15.280 | One got so relaxed.

01:38:17.400 | He said, "Normally, it takes us 10 minutes

01:38:18.840 | "to get them to pee after they're doing this."

01:38:21.160 | She was so relaxed, she started peeing

01:38:22.780 | before I could even get the bedpan under her

01:38:25.100 | and I had to clean up the table.

01:38:27.200 | And they also, 17 minutes shorter procedures.

01:38:30.400 | And that's a long 17 minutes for a little kid.

01:38:33.800 | So it can be very effective with children.

01:38:36.560 | They're less anxious.

01:38:37.440 | They have less pain and get through

01:38:40.160 | these difficult procedures very well.

01:38:42.360 | - That's great.

01:38:43.600 | Has hypnosis ever been done for couples,

01:38:46.480 | like couples therapy?

01:38:47.560 | I'm thinking of pretty much every clinical setting here.

01:38:49.860 | Both people have to be hypnotizable, of course.

01:38:52.480 | But the reason I ask about this is next,

01:38:54.680 | I'm gonna ask about psychedelics.

01:38:56.480 | And there's a lot of interest in coordinating states

01:38:59.620 | through the use of drugs of different kinds.

01:39:04.040 | We actually do this when we treat depression, right?

01:39:05.840 | You have a depressed person with a family members

01:39:08.360 | who are not depressed and you say,

01:39:09.260 | "Well, let's make them all not depressed," right?

01:39:13.080 | I mean, but in all, and I'm only half kidding there

01:39:15.960 | because that is kind of the underlying logic in some sense.

01:39:18.480 | But are you aware of any coordinated hypnosis?

01:39:23.480 | - That's interesting.

01:39:24.560 | I mean, I've done plenty of it in groups, not with couples.

01:39:27.880 | - You can hypnotize large groups at once?

01:39:29.880 | - Yeah, yeah.

01:39:30.720 | - Are we hypnotized right now?

01:39:31.540 | - Yeah, you are.

01:39:32.480 | I hope you've been enjoying it.

01:39:36.680 | But the metastatic breast cancer, there was a group

01:39:39.700 | of like 10 women who would meet once a week

01:39:41.680 | and we would all go into hypnosis together.

01:39:44.500 | - I didn't realize that you were hypnotizing them

01:39:46.600 | collectively.

01:39:47.440 | - Yes, yes, right.

01:39:48.860 | - Fascinating.

01:39:49.700 | - And that, if anything, I think it brings out the best

01:39:52.600 | in people's abilities because it's a shared

01:39:54.620 | social experience and they would talk about it afterwards.

01:39:59.280 | And so yes, that's absolutely doable, yeah.

01:40:02.540 | - And I don't wanna focus on psychedelics specifically.

01:40:05.180 | Maybe that's a topic for a future episode,

01:40:06.920 | but is there any basis for combining hypnosis

01:40:10.720 | with drug therapies inside of the hypnotic episode?

01:40:15.500 | So I realize that some patients of yours might be prescribed

01:40:18.560 | a antidepressant or a medication for some purpose,

01:40:23.380 | maybe same or different than the hypnosis

01:40:25.080 | is being directed toward.

01:40:26.540 | But is there any evidence that if people are relaxed

01:40:30.900 | through the use of a propranolol or some, you know,

01:40:34.220 | one of these many things in the psychiatrist's kit,

01:40:37.260 | that hypnosis can be more effective?

01:40:40.180 | - Well, interestingly, one study that I haven't mentioned

01:40:44.020 | is we did spectroscopy on people who were hypnotized.

01:40:49.020 | And we found that there was a correlation

01:40:53.380 | between hypnotizability and GABA activity

01:40:57.620 | in the anterior cingulate cortex,

01:40:59.980 | which fits with turning down activity.

01:41:02.460 | So to the extent that we can self-medicate

01:41:05.040 | and GABA receptors basically are doing

01:41:07.500 | what benzodiazepines do to the brain,

01:41:10.500 | that can happen when people are hypnotized.

01:41:13.020 | - So you're saying inside of the hypnosis,

01:41:15.500 | you have neural evidence that there's a kind of

01:41:18.140 | a sedative effect of hypnosis at the chemical level?

01:41:22.060 | - Yeah, right, right.

01:41:23.340 | The people who are more hypnotizable

01:41:24.700 | have more of those GABA receptors

01:41:26.520 | and it's related to the degree of their hypnotizability.

01:41:29.260 | In terms of, there have been studies

01:41:32.380 | where they try to give people medications as well.

01:41:35.220 | And the interesting thing with benzodiazepines,

01:41:37.740 | which activate inhibitory activity in the brain,

01:41:41.320 | if you're very anxious,

01:41:44.380 | it might improve your hypnotic response a bit.

01:41:46.380 | If you're just so anxious and you can't do it.

01:41:48.620 | If you're not very anxious,

01:41:49.740 | it actually inhibits hypnotic activity

01:41:52.100 | because you get sort of sedated and just out of it

01:41:54.400 | and you can't focus your attention as well.

01:41:56.740 | So by and large, we don't use drugs as an adjuvant

01:42:02.340 | to hypnotic experience.

01:42:04.040 | Most of the time you don't need to

01:42:05.340 | and sometimes it can make it worse rather than better.

01:42:08.300 | There's some evidence that mild stimulants

01:42:12.380 | might enhance hypnotic responsiveness a little reliably,

01:42:15.360 | but too much will again scatter attention

01:42:17.860 | and you'll have less control over it.

01:42:19.540 | So they might be adjuvants,

01:42:22.600 | but I frankly think hypnosis is more of a replacement

01:42:25.740 | than a need of supplementation.

01:42:28.660 | - Your laboratory, my laboratory have, well,

01:42:32.780 | sort of snuck into your lab

01:42:34.460 | and then trying to kind of merge the two.

01:42:36.300 | It's been a lot of fun

01:42:37.780 | and learning a lot about the power of respiration

01:42:41.200 | of breathing to shift brain states,

01:42:43.240 | not just during breathing protocols, but at all times.

01:42:47.060 | And we will do an entire episode about those protocols.

01:42:49.660 | I think after those are published and so on.

01:42:54.560 | But breathing itself is, you've described as a bridge

01:42:59.120 | between conscious and unconscious states.

01:43:01.440 | And so I have to ask how important

01:43:05.560 | is the patient's breathing pattern?

01:43:08.000 | How closely are you monitoring their breathing pattern?

01:43:11.220 | How closely do you monitor your own breathing pattern

01:43:13.600 | as you're inducing hypnosis?

01:43:15.460 | Put simply, what is the role of respiration

01:43:17.840 | in shifting the brain's state during a hypnotic protocol?

01:43:23.580 | - Yeah, that's very interesting.

01:43:24.620 | You had a great show with Jack Feldman, and he is.

01:43:29.620 | And the issue, I watch it, I try,

01:43:35.200 | the work that we're enjoying doing together

01:43:40.320 | shows that there are breathing patterns

01:43:41.900 | that may increase sympathetic arousal or may decrease.

01:43:46.460 | It may help in cyclic sighing seems to actually

01:43:50.020 | where you have more time spent exhaling than inhaling.

01:43:53.500 | And there's reason to believe

01:43:55.620 | that it induces parasympathetic activity

01:43:58.220 | 'cause you're increasing pressure in the chest.

01:44:00.720 | And therefore, allowing the heart to slow down

01:44:04.440 | because blood is being returned to the atrium more easily.

01:44:08.700 | I do use it, I ask people to take a deep breath

01:44:12.620 | as part of the induction and then slowly exhale.

01:44:15.080 | And partly as a result of our research together,

01:44:17.240 | I'm emphasizing this slow exhale more

01:44:21.960 | to enhance the idea in the induction

01:44:23.860 | that this is a period of relaxation

01:44:25.620 | 'cause I think they are inducing that

01:44:28.260 | and perhaps perceiving it as well.

01:44:30.940 | So there's no, you're absolutely right

01:44:34.220 | that breathing is very interesting

01:44:36.660 | 'cause it's right at the edge of conscious,

01:44:38.300 | and Jack talked about that too,

01:44:39.700 | of conscious and unconscious control,

01:44:41.340 | that it will go on automatically, but we can control it.

01:44:44.900 | And so it's a kind of way for us to demonstrate to ourselves

01:44:50.380 | greater ways of modulating our internal state.

01:44:54.280 | So you can either do it thinking about it

01:44:56.340 | the way we do with pain control and hypnosis,

01:44:58.940 | or you can do it to some extent

01:45:00.460 | by taking charge of your breathing

01:45:03.660 | and doing things that will produce a change

01:45:05.960 | that you wanna see happen in your body.

01:45:08.060 | So I like it because it's right at that margin

01:45:11.020 | where you can enhance.

01:45:13.360 | For me, I like that as a way of augmenting hypnosis

01:45:16.540 | more than medication.

01:45:17.760 | I think this is a powerful way of doing that.

01:45:20.720 | - Great, I'm really excited to see where all of this goes.

01:45:23.600 | Breathing, vision, bodily states,

01:45:26.420 | clearly the directed mental focus

01:45:31.420 | seem to be the key elements of hypnosis.

01:45:34.960 | Am I missing any other ingredients?

01:45:38.160 | - Yeah, I think that's right.

01:45:39.880 | - Breathing, vision?

01:45:40.920 | - Breathing, vision, how you change your vision.

01:45:46.440 | Typically, you're in a physically relaxed state,

01:45:49.520 | but frankly, there are people at the peak of performance,

01:45:52.840 | including physical athletic performance

01:45:55.000 | or musical performance,

01:45:56.640 | when they're in hypnotic states too.

01:45:58.560 | I've talked to classical pianists who say,

01:46:01.560 | if I start thinking about what my fingers are doing,

01:46:03.560 | now I screw up.

01:46:04.760 | I'm floating above the piano thinking about the tone

01:46:08.300 | that I want to feel exuding from the instrument.

01:46:11.520 | So that's a hypnotic-like state too.

01:46:13.520 | And many athletes who are in peak performance

01:46:18.200 | are just flowing with it.

01:46:20.080 | They're not thinking step by step, what am I doing?

01:46:24.280 | And that's when you're doing your best.

01:46:26.000 | Or when we're working or giving a talk and doing it well,

01:46:31.000 | we're in a hypnotic-like state.

01:46:34.720 | So it usually requires,

01:46:39.680 | but doesn't necessarily require physical comfort

01:46:42.200 | or quietness, it can sometimes be intense activity.

01:46:46.000 | - Incredible.

01:46:47.280 | Well, this has been an amazing discussion.

01:46:50.640 | I've learned so much that I always do from you.

01:46:54.040 | Where can people learn more about

01:46:56.400 | how they can get hypnotized?

01:46:58.840 | We mentioned Reverie, we will put a link to it.

01:47:00.680 | It's R-E-V-E-R-I.com is the way to access that.

01:47:05.280 | - Or it's the Reverie app from the app store

01:47:07.280 | is the other way.

01:47:08.120 | Reverie.com is the website.

01:47:09.420 | You can get to it through that

01:47:10.560 | or download the Reverie app from the app store.

01:47:13.840 | - Great.

01:47:14.680 | So currently on Apple, hopefully soon, also on Android.

01:47:18.840 | But in the meantime,

01:47:20.320 | what if people are interested in exploring clinical hypnosis

01:47:24.280 | working with you or somebody similar?

01:47:27.240 | Is there a centralized resource that people can go to

01:47:29.760 | to find really well-trained hypnotists?

01:47:34.200 | - There are two good professional organizations

01:47:37.840 | that will help you with that.

01:47:38.740 | One is the Society for Clinical and Experimental Hypnosis.

01:47:42.560 | And I think that's S-C-E-H dot U-S is their website.

01:47:46.980 | - We'll look it up and provide a link.

01:47:48.160 | - And the American Society for Clinical Hypnosis.

01:47:50.380 | And they both provide referral services for professionals.

01:47:55.380 | You can look it up.

01:47:56.600 | I would just say in general,

01:47:58.100 | look for someone who is licensed and trained

01:48:00.840 | in their primary professional discipline,

01:48:02.780 | psychiatry, psychology, medicine, dentistry,

01:48:06.520 | and who has training and interest in using hypnosis

01:48:09.680 | is a way to do it.

01:48:11.180 | - Great.

01:48:12.020 | And then one more question and then a comment.

01:48:15.180 | The question is, will you be my psychiatrist?

01:48:17.320 | (laughing)

01:48:18.580 | - I'm honored, I'm honored.

01:48:20.420 | - It's a tall task.

01:48:22.200 | I might be the most stubborn patient.

01:48:24.500 | - I think the hardest work's already been done, Andrew.

01:48:26.600 | - Thank you.

01:48:27.440 | - You're fine now.

01:48:28.280 | - Appreciate that.

01:48:29.120 | Well, and the final thing is a comment.

01:48:31.860 | First of all, thank you so much for being here today,

01:48:35.180 | for sharing your knowledge.

01:48:36.400 | I hope we can do it again and again.

01:48:38.880 | - I hope so.

01:48:39.720 | - I love working with your laboratory and with you.

01:48:41.920 | - Likewise.

01:48:42.760 | - Because when you speak, I learn,

01:48:44.640 | and I know others do as well.

01:48:47.900 | We will put resources to get to you.

01:48:49.980 | But I also just want to say thank you

01:48:52.000 | for doing the work that you do.

01:48:54.620 | It's an incredible thing that in this world

01:48:57.600 | where we are discovering so much about how the body works,

01:49:00.520 | the mind is still rather mysterious

01:49:02.760 | and people are struggling with a lot of things.

01:49:04.520 | But also I think people are really excited about

01:49:06.920 | applying tools like hypnosis to perform better,

01:49:10.240 | feel better mentally and physically.

01:49:11.700 | And so you've pointed us to a tremendous amount of resources

01:49:15.080 | and how these tools work

01:49:17.600 | and where they've already been demonstrated to work.

01:49:19.520 | So just thank you.

01:49:21.000 | I know this is your life's professional commitment in life

01:49:25.080 | and we all benefit.

01:49:26.500 | So thank you so much. - Well, thank you.

01:49:27.340 | But it's been a real joy for me

01:49:28.740 | to be collaborating with you

01:49:30.340 | and for you to be using your precision and knowledge

01:49:33.120 | about neuroanatomy, neurobiology to address problems

01:49:37.360 | that often people who are that disciplined

01:49:39.320 | in the primary neurobiological end

01:49:42.200 | aren't as interested in as you are.

01:49:43.900 | And so it's really been a pleasure

01:49:45.360 | to try and bring together what we both know

01:49:48.780 | from these different perspectives

01:49:50.320 | to build something that neither of us could do alone.

01:49:53.520 | And so it's been a real joy for me to do it.

01:49:56.120 | - Thank you, I'm honored.

01:49:57.320 | - Thank you.

01:49:58.160 | - Thank you very much, David.

01:49:58.980 | - You're welcome.

01:50:00.580 | - Thank you for joining me today

01:50:01.720 | for my discussion with Dr. David Spiegel.

01:50:04.000 | I hope you found it as fascinating as I did.

01:50:06.860 | And if you'd like to see the video

01:50:08.280 | of Dr. Spiegel hypnotizing me

01:50:10.500 | in what constitutes a abbreviated clinical hypnosis session,

01:50:14.120 | you can go to the Huberman Lab Clips channel on YouTube.

01:50:17.600 | Also, if you'd like to check out the Reverie app

01:50:19.540 | for self-hypnosis designed by Dr. Spiegel and colleagues,

01:50:22.620 | you can go to Reverie, that's R-E-V-E-R-I.com

01:50:26.440 | to see the Reverie app.

01:50:27.620 | There's also other information there

01:50:28.980 | about the scientific studies that support the Reverie app.

01:50:31.780 | If you're enjoying and/or learning from this podcast,

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01:50:55.180 | Please also check out the sponsors

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01:51:06.900 | at any level that you like.

01:51:08.500 | On many previous episodes of the Huberman Lab podcast,

01:51:10.820 | we discussed supplements.

01:51:12.140 | While supplements aren't necessary for everybody,

01:51:13.960 | many people derive tremendous benefit from them

01:51:16.220 | for things like enhancing sleep and focus

01:51:18.460 | and various other aspects

01:51:19.780 | of brain and body health and performance.

01:51:22.000 | One issue with supplements, however,

01:51:23.380 | is that many of the supplements out there

01:51:25.400 | simply do not contain what's listed on the bottle

01:51:28.140 | and/or the quality of the ingredients is not very high.

01:51:31.900 | That's why we partnered with Thorne supplements.

01:51:34.140 | Thorne supplements are used by all the major sports teams

01:51:36.740 | and they partnered with the Mayo Clinic.

01:51:38.860 | The reason they have so many high-level partners

01:51:41.060 | is that Thorne supplements

01:51:42.340 | are of the very highest quality ingredients.

01:51:44.740 | They also are extremely precise

01:51:46.820 | in terms of what's listed on the bottle

01:51:48.780 | is always what's in the bottle.

01:51:50.540 | If you'd like to see the Thorne supplements that I take,

01:51:52.640 | you can go to Thorne, that's t-h-o-r-n-e.com/u/huberman,

01:51:57.820 | and there you can see the Thorne supplements that I take

01:52:00.140 | and get 20% off any of those supplements.

01:52:02.620 | Also, if you navigate deeper into the Thorne site

01:52:04.860 | through that portal, t-h-o-r-i-n-e.com/u/huberman,

01:52:09.860 | you can also get 20% off any of the other supplements

01:52:12.580 | that Thorne makes.

01:52:13.940 | If you're not already following us on Instagram and Twitter,

01:52:16.480 | please do so.

01:52:17.320 | It's Huberman Lab on both Instagram and Twitter,

01:52:19.340 | and at those channels,

01:52:20.820 | I cover science and science-related tools,

01:52:22.700 | some of which overlap with the content of this podcast,

01:52:26.020 | other of which does not and is unique content.

01:52:28.680 | So once again, thank you for joining me

01:52:30.220 | for my discussion with Dr. David Spiegel,

01:52:32.260 | and last, but certainly not least,

01:52:34.460 | thank you for your interest in science.

01:52:36.340 | [upbeat music]

01:52:38.920 | (upbeat music)

Dr. David Spiegel: Using Hypnosis to Enhance Health & Performance | Huberman Lab Podcast #60

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