2023-05-31 16:57:09
- Laura Plitt
- BBC News World
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In some less complex procedures, hypnosis can be used with a combination of medication and local anesthesia.
“Find a nice, calm and safe place and make yourself comfortable”, says a melodious female voice in a tone that invites calm.
“Now, inhale very slowly and exhale very slowly, gently,” she continues, giving instructions with the same serenity as at the beginning.
This voice is part of a series of audios uploaded to the UK’s Royal College of Anaesthetists (RCoA) website, which recently called for greater use of these recordings on the eve of surgery .
The idea is to bring the patient, through self-hypnosis, to a state of relaxation in order to reduce their level of anxiety before they enter the operating room.
The purpose of these recordings is also to have “a resource to offer patients (which has been developed, tested and modified with their feedback in mind), rather than recommending that they seek this information on the Internet”, explains at BBC Mundo Dr Samantha Black, pediatrician and anesthetist who helped develop the RCoA audios.
According to the available data, she adds, this preliminary psychological preparation (along with the consumption of nutritious foods and physical exercise) improves the results of the surgical intervention.
Other European countries, as well as the United States, have gone further: in some hospitals, this technique is used not only before, but also during the operation.
Several studies and randomized clinical trials – including some conducted in the United States, Belgium and France – show that the use of hypnosis (also called hypnosedation or hypnotherapy) can reduce the dose of anesthetics during the operation, as well as the time and need for painkillers during the recovery period.
As absorbed by a film
Hypnosis is a state in which attention is highly focused, with limited awareness of what is happening at the periphery.
It is usually obtained with the help of another person who guides us with their words until the hypnotic trance is induced, although it is also possible to practice self-hypnosis. In this state, the person is neither asleep nor unconscious, but relaxed.
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Spiegel compares the hypnotic state to when we are totally absorbed in watching a movie that fascinates us.
“You tune out, dissociate yourself from what’s happening on the periphery of your consciousness, and enter a state of cognitive flexibility: you’re more open to trying new ideas and experiences and letting go of your usual way of doing things. “, explains to BBC Mundo David Spiegel, professor in the department of psychiatry and behavioral sciences at Stanford University, in the United States.
In the context of surgery, where the patient’s attention is diverted from their body, this technique is used “to restructure the experience of the surgical procedure,” he adds.
In other words, you’re telling your brain “to filter out the pain, literally ignoring the sensation and focusing on being somewhere else.”
The eminent researcher in clinical hypnosis compares this state to watching a movie that completely absorbs us, so much so that we sometimes forget that we are part of the audience, so absorbed are we in the drama unfolding on the screen.
It’s a bit like taking the car to go somewhere, explains Elizabeth Rebello, professor in the department of anesthesiology and perioperative medicine at the MD Anderson Cancer Center in Texas (USA), to BBC Mundo.
“As you’re driving, you think regarding what you have to do for the day, or regarding your family, and all of a sudden you realize you’ve arrived. That’s kind of what hypnosis does,” says -She.
Effect on the brain
In more technical terms, hypnosis has three effects on the brain, says Spiegel, who observed these changes in functional magnetic resonance imaging (fMRI) studies as part of his research:
- 1 There is reduced activity in the dorsal area of the anterior cingulate cortex, an area of the brain that helps you be aware of your surroundings.
- 2 Connectivity between two regions of the brain (the dorsolateral prefrontal cortex and the insula) is increased. This “brain-body” connection helps the brain process and control what is happening in the body.
- 3 The reduction in connections between the dorsolateral prefrontal cortex and the default neural network likely represents a disconnect between a person’s actions and awareness of their actions (such as when we do something without really thinking regarding what we are doing). This dissociation allows the person to respond to instructions during hypnotherapy without devoting mental resources to consciousness.
Complement
The goal of proponents of using hypnosis in the operating theater is not to replace general anesthesia with hypnosedation in very complex surgeries, but to use it as a complement in simpler and more short, in addition to local anesthesia.
This is precisely what a team of doctors and researchers at the MD Anderson Cancer Center at the University of Texas has been doing for several years.
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Surgery under hypnosis in a hospital in Belgium in 2004.
Dr. Rebello and his team use hypnosis for some patients undergoing lumpectomy (surgery to remove a cancerous or abnormal lump from the breast), a procedure usually performed under general anesthesia.
Patients who are open to the idea, in addition to receiving hypnosis during the operation, have previous sessions with the same professional.
Once in the operating room, an interdisciplinary team in constant communication monitors the patient’s comfort level and increases medication or local anesthesia as needed.
“It’s a very safe environment, because we’re in an operating room. And if you have to switch to general anesthesia, you have everything you need to do it,” says Rebello, who points out that this option is only viable for certain procedures and for a certain group of patients.
Benefits
The benefits are manifold, say the doctors consulted by BBC Mundo.
In addition to reducing anxiety before and during the procedure, it reduces the dose of anesthetics and sedatives, and therefore the nausea, vomiting and other discomforts that many patients suffer following the procedure.
Patients also don’t feel dazed or groggy, as they do following general anesthesia, and are almost ready to go home at the end of the procedure.
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Although hypnosis has been used in the medical field for years, it is still shrouded in an aura of pseudo-science.
Rebello also points out that its use can potentially reduce opioid use, since fewer opioids are needed during and following surgery.
Lorenzo Cohen, director of the integrative medicine program at the University of Texas MD Anderson Cancer Center, notes that it’s also beneficial to avoid general anesthesia whenever possible because it “can lead to cognitive deficits at short and long term”.
“Also, it’s been shown to cause immune suppression, which we don’t want when trying to control cancer growth,” he says of the lumpectomies performed at his facility.
Disadvantages
Considering the benefits of hypnosis, it is interesting to wonder why hypnosis remains a minority clinical practice, despite gaining ground in recent years.
One of the obstacles is that not everyone can be hypnotized.
“It’s a stable trait, like IQ. To some degree, most people are susceptible to hypnosis. But 25% of adults aren’t,” says Spiegel, who estimates that this variability is possibly due to genetic causes.
On the other hand, this technique requires more training time for the patient to prepare for the operation, as well as more careful monitoring during the operation.
Other reviews point out that it is not useful for major and long-lasting internal organ surgeries, as the pain would then be intolerable.
It should not be forgotten that, although many studies published in prestigious scientific circles support its effectiveness in certain contexts, hypnosis retains an aura of pseudoscience closer to the world of Victorian entertainment than to the field of medicine.
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Many people associate hypnosis with the typical image of a clock or pendulum moving before our eyes. Nothing might be further from the truth.
“Hypnosis is still stigmatized and associated with TV shows of the past rather than the medical world,” says Black, although he thinks that view is slowly changing as access and training courses to hypnosis for doctors and anesthesiologists are developing.
However, Spiegel believes hypnosis isn’t more widely used in the medical environment because there aren’t big pharmaceutical companies making money from it.
“Part of the problem is that we don’t have a good business model to spread this practice,” he concludes.
Photo credit, Getty Images
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