Mind-body therapies, hypnosis and other relaxation techniques

Mind–body medicine recognises the profound connection between the mind and the body, the body’s natural healing ability and the role of self-responsibility in the healing process. A wide range of tech­niques comes under this umbrella, including hypnotherapy, biofeed­back, guided imagery, meditation, Qigong, yoga and autogenic training.

The power of suggestion has played a major role in healing for thousands of years. Healing trances have been used by cultures to implant suggestions for self-cure, including the various types of exorcism that were frequently recorded in mediaeval Europe. Over the past 300 years, however, the importance of psychological influences in health and disease has often been neglected.

Franz Anton Mesmer, a Viennese physician, introduced modern hypnotherapy as a method of healing in the late eighteenth century. Mesmer successfully treated a large number of people by inducing deep trances, and explained the healing process with the aid of concepts such as ‘stored cosmic fluid’ and ‘animal mag­netism’. However, Mesmer’s wild theories and his use of magico­theatrical settings alienated the medical profession, and he was banned from France. The Lancet poured scorn on mesmerism: ‘We regard its abettors as quacks and imposters.’

James Braid, a Scottish surgeon, in the nineteenth century coined the term ‘hypnosis’ from hypnos, the Greek word for sleep. Despite therapeutically successful demon­strations and Braid’s new neuro­physiological theories, conventional medical opinion remained hostile until recently to hypnosis, and insisted that the mind could not influence organic disease.

Mind–body techniques encom­pass a holistic healing philosophy that recognises the remarkable extent to which the mind and nervous system play a role in governing physical and psycho­logical well-being. Chronic stress and unhappiness may contribute to disease, whereas relaxation, positive ways of coping with stress and restoring a more balanced way of life can be used to regain health.

Although mind–body therapies often begin by promoting mental and physical relaxation, they make use of the body’s self-healing ability and the person is actively involved in their own treatment. By taking responsibility for their healing, a person’s sense of control replaces feelings of helplessness and hopelessness. Mind–body medicine regards illness as a message to the body and looks beyond the immediate problem to review the entire system.

HYPNOTHERAPY

Hypnosis can be defined as a relaxed state of heightened suggestibility. The state is usually obtained by first relaxing the body, then distracting the conscious mind and heightening the focus of attention on ideas suggested by the therapist or oneself (self-hypnosis). This does not usually involve swinging a pocket watch. It’s more like a quiet meditation session.

Modern hypnotherapy does not always involve the stereotypical ‘hypnotic trance’. There are various trance states:

• Light trance (superficial hypnotic state): The eyes are closed, the person is deeply relaxed and accepts suggestions.

• Medium trance (fully hypnotised state): Physiological processes slow down, the person is partially insensible to pain, allergic reactions stop – it is in this state that most therapy is performed.

• Deep trance (somnambulistic state): The eyes may be open but total anaesthesia is possible – it is in this state that post-hypnotic suggestions are most successful.

The session usually ends with a few words from the hypnotherapist which bring the patient out of the trance.

Ninety per cent of the population can be hypnotised, with 20 to 30 per cent having enough suggestibility to enter a deep trance, making them highly receptive to treatment.
Conditions essential to successful hypnotherapy include:

• rapport between the therapist and subject

• a comfortable environment, free from distraction

• willingness and cooperation of the subject to participate in the process.

The hypnotic state is used to implant a post-hypnotic suggestion, for example, the desire to stop smoking. The effectiveness of hypnotherapy depends on the extent to which the patient retains the suggestion in their waking state. Suggestions have to be reinforced and maintained by the patient as well as the therapist so self-hypnosis or relaxation is often an important part of the treatment.

A hypnotherapy session may last about one hour. The average number of sessions required to produce results are between 6 and 12, usually once a week. Hypno­therapy can be used for any condition that will benefit from a relaxation technique.

BIOFEEDBACK

Biofeedback training is a process of learning self-regulating abilities. An appropriate monitoring device is used, which enables the person to know when they are controlling a previously ‘unconscious’ response (such as blood pressure).

The degree to which a person can learn to regulate, consciously, normally unconscious vital functions is quite remarkable. Research has shown that some people can even learn to control brainwave activity, heart rate, skin temperature and gut contraction.

The person is instructed in the use of simple relaxation. This should produce the desired response (for example, lower the blood pressure or body temp­erature or relax the muscles), and an electronic device is used to provide feedback to see whether the relaxation is achieving the desired effect. The feedback used in the technique should be designed to suit the individual and help him or her to relax.

The courses of treatment vary in length, with most being 10 to 15 half-hour weekly sessions. Biofeedback skills appear to improve with daily practice.

GUIDED IMAGERY OR VISUALISATION

Guided imagery is a process that involves using the conscious mind to create mental images to evoke physical changes, promote natural healing and provide insight and self-awareness. Imagery in a relaxed state of mind is a component of most of the mind–body techniques and can be achieved through use of images suggested by the therapist.

The first reported visualisation techniques in the mid-1970s used aggressive images such as sharks attacking and killing cancer cells. However, while these may be helpful to some people, they may induce negative feelings in others. Nowa­days, more positive images are used
– relaxation, cancer cells being carried out of the body, pain being con­trolled with calmness and serenity.

MEDITATION

Meditation can be broadly defined as any activity that keeps the mind calm and pleasantly focused in the present moment, so that it is neither reacting to memories from the past, nor being preoccupied with plans for the future.

Although meditation covers a wide range of techniques, these can be grouped into two basic approaches:

• Concentrative meditation involves focusing the attention on breathing, an image or a sound (‘mantra’), so that the mind becomes more tranquil and aware.

• Mindfulness meditation involves opening the attention to whatever goes through the mind, without thoughts or worries, so that the mind becomes calm and clear.

A number of studies have shown that the state of deep relaxation produced by meditation is accompanied by various physio­logical and biochemical changes, including decreased heart rate, blood pressure, respiratory rate, muscle tone and electrical skin conduction, and increased brain­waves. Mindfulness meditation has been thoroughly researched as an effective way of treating anxiety, chronic pain and panic disorder.

QIGONG

Qigong is the practice of activating, refining and circulating the human ‘energy field’. Qigong literally means ‘energy cultivation’ and is a cornerstone of traditional Chinese medicine. It is perhaps the oldest known method of physical, mental, emotional and spiritual healing, and combines slow graceful movements with imagery, mental concentration, sounds that affect body organs and breathing control to increase a person’s ‘life force’. The three key elements of Qigong are:

• regulating the body through postures and movements

• regulating breathing using breathing control exercises

• regulating the mind through mental focusing and visual­isation methods.

YOGA

Yoga originated in India and provides a complete system of physical, mental and spiritual health. Yoga means ‘union’, and physical postures, breathing exercises and meditation practices are used to achieve mind–body– spirit unity.
Classical yoga is organised into eight ‘limbs’, which include life­style, hygiene and detoxification regimens, together with physical and psychological practices. The first four limbs consist of postures from breathing exercises that serve to bring the mind and body into harmony. The remaining four limbs involve meditative practices. Yoga postures are designed to create a condition of ease in the body to facilitate meditation, or may be applied therapeutically for specific physical disorders.

Breathing control, or ‘prana­yama’, exercises are designed to promote the free and even flow of prana (‘life force’) throughout the body. Pranayama can help to regulate the previously unconscious bodily function, and to promote a calm and focused state of mind in preparation for meditation.
Samadhi (‘spiritual realisation’) is the final stage of yoga and can be achieved only through long-disciplined and dedicated practice. A person is said to enter a fourth state of consciousness, separate from and beyond the ordinary states of waking, dreaming and sleep.

AUTOGENIC THERAPY

Autogenic therapy is a self-help method that produces profound relaxation and relief from the negative effects of stress. ‘Autogenic’ means ‘generated from within’.

The standard autogenic formu­lae were originated by Dr Johannes Schultz in the 1920s in Berlin. Autogenic therapy (often known as autogenic training) was further developed in Canada by his colleague Dr Wolfgang Luthe. It is taught in many countries, especially in continental Europe and Canada. It was introduced to Britain in the 1970s and the British Association for Autogenic Training and Therapy (BAFATT) was formed in 1984. BAFATT is a registered charity founded for the purpose of training therapists and maintaining pro­fessional standards.

The technique mobilises our natural systems for healing and recuperation. It consists of a series of simple, easily learned mental exercises that link mind and body together in association with deep relaxation. These exercises enable the mind to calm itself by switching off the body’s stress responses.
The standard autogenic exercises can be adapted to include personal motivational formulae, affirmations or healing formulae. In addition, various additional mental exercises can be introduced – some to help deal with the lingering effects of past experience and others to allow calming in a stressful situation.

WHAT CAN MIND–BODY THERAPIES BE USED FOR?

Beyond simple relaxation, mind–body therapies have a wide range of uses. Because these methods treat the whole person rather than symptoms or diseases, they can be applied to almost any health problem. In addition, in healthy people, mind–body techniques (particularly Qigong, yoga and meditation) may be useful in health maintenance, disease prevention, the enhancement of well-being and spiritual growth.
Scientific studies have evaluated a number of these mind–body therapies.

Hypnotherapy has been used to treat pain, irritable bowel syndrome and asthma effectively, and appears to be as good as any other approaches to smoking cessation.

Biofeedback has been shown to be of value in migraine, tension headaches, raised blood pressure and urinary incontinence.

Guided imagery is certainly an easy way to relax and, although there are few clinical trials, it has been used in a wide range of conditions including pain, asthma, raised blood pressure and irritable bowel syndrome as well as in the treatment of AIDS and cancer.

Meditation has been used to treat anxiety and depression in cancer patients as well as stress and pain.
There are very few good quality clinical trials evaluating Qigong, but a wide range of studies have been used to evaluate and understand autogenic therapy and do show that it is beneficial for many people.

HOW DO THESE THERAPIES WORK?

Mind–body therapies support and encourage the body’s internal healing mechanism. Our under­standing of healing and how the mind can affect the immune system (psychoneuroimmunology) has increased dramatically over the last two decades. We now understand that various chemicals released during relaxed emotional states enhance healing and relax the automatic or unconscious part of the nervous system so that it becomes less ‘stressed and tense’. These psychoneuroimmunological effects do have a direct positive effect on our immune status and the activity of our white blood cells.

IS IT SAFE?

These methods are generally very safe, and there are few precautions or side effects provided that they are competently taught and appropriately applied. As with any form of treatment it is, of course, essential that a proper diagnosis is made first, and the limitations of the method recognised. Hypnosis should not be performed on patients with psychosis, organic psychiatric conditions or antisocial personality disorders because the hypnotic process may strengthen their condition.

WHO SHOULD I CONSULT?

There are various different organisations for each of the therapies. In the case of doctors practising any of these techniques, the General Medical Council regulates the ethical and pro­fessional standards of medical behaviour. Psychologists practising these therapies are certified and registered by the British Psycho­logical Society. Practitioners who are neither doctors nor psycho­logists are regulated mainly by their professional training and therapy organisations.