#731: Dr. David Spiegel, Stanford U. — Practical Hypnosis, Meditation vs. Hypnosis, Pain Management Without Drugs, The Neurobiology of Trance, and More

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At this altitude I can run flat out for a half mile before my hands start shaking. Hello boys and girls ladies and germs. This is Tim Ferris. Welcome to another episode of the Tim Ferris show. I'm very excited about this episode. It is incredibly practical, very, very tactical.

And we answer some questions I've had for a very, very long time. What is hypnosis is it credible if it is how do you apply it? What is the latest and greatest science for what indications is the best applied? How can you use it? How can I use it? And to separate fact from fiction.

I went to one of the world's foremost experts. His name is Dr David Spiegel. Dr David Spiegel is Wilson professor and associate chair of psychiatry and behavioral sciences director of the center on stress and health and medical director of the center for integrative medicine at Stanford University School of Medicine, where he's been a member of the academic faculty since 1975.

Dr Spiegel has more than 40 years of clinical and research experience has published 13 books, 104 scientific journal articles and his work has been supported by the National Institute of Mental Health National Cancer Institute and more. He is also the founder of Revri Spelled REVRI, the world's first interactive self hypnosis app.

He has some amazing stories, some incredible case studies and actually hypnotizes me in the middle of this conversation and we do a little demo, which was the first for me. The website for Revri is Revri.com, REVRI.com. You can find it on Instagram, stram.com slash Revri. And we will add more links to everything we discuss in the show notes as always at Tim. Blog slash podcast with all that said, please enjoy a very wide ranging conversation with. The one and only doctor David Spiegel.

David, so nice to have you here. Thank you for making the time. Thank you so much for having me Tim. And I want to say up front that you are a man of many talents in addition to hypnosis and the other things that people will get from your bio, you are an expert in word play. You came up with ostentatious as an ostent city before start recording and I had to write down I was like if there's not a retail shop with that name, there must be.

I'm going to will that into existence and put it out there. Somebody feel free to grab it. And we'll start with a question, which is not how you were exposed to hypnosis, but how your father was exposed to hypnosis. Would you mind winding back the clock? I'd be glad to. It's a good psych one, let it think to do. I'm the child of not one, but two psychiatrists and psychoanalysts. Both of my parents were and they told me that I was free to be any kind of psychiatrist I wanted to be. So here I am.

My father was finishing his analytic training just at the beginning of World War two. And so he enlisted in the army, he was a battalion surgeon. And as he was getting off the couch, his analyst actually said something to him. He said, Herb, would you like to get a course in hypnosis? And my father was thinking what was wrong with my free associations?

You know, does he trying to fix me some other way or something? And his analyst said no, there's a V&E's refuge and Gustav Fana Schaffenberg, who was a forensic psychiatrist in Austria. He had a smallpox scar right smack in the middle of his forehead. And he noticed that as he's interviewing these prisoners, suddenly their heads would sort of nod, they'd close their eyes and go into some kind of altered state.

So he got interested in hypnosis and was using it to help his prisoners. And so he offered to teach army docs how to use it. So my father took this course from Dr. Fana Schaffenberg and he used it to help soldiers deal with combat stress reactions to deal with pain. The dinner table conversations were really interesting. He told me a story of one guy who developed a historical conversion paralysis. He couldn't use his legs.

He said, I don't know what happened. So my father asked him about the context and he said, well, we were ordered to retreat. And I saw my best friend lying on the ground and I had to make a choice. So I try and save him or do I follow orders. So I follow orders. I feel terrible. And maybe I could have saved him. And so my father in hypnosis said, I want you to look at your friend right now. And I want you to notice something. His boots are facing down. And that means he's already gone.

And the guy said, thank you, doctor. And he got up and walked that he was telling himself physiologically, I should not have moved. I should not have left him. And when my father helped relieve him of the guilt. And you know, most people who have been traumatized would rather feel guilty than helpless. They'd rather find a way to blame themselves as though they could replay the movie and it would come out differently. And he was helping him face the fact that his body was gone.

And there was likely nothing he could do to stop it. So I'd hear those kind of conversations at the dinner table. And they were pretty interesting. I got invited once to watch him treat a woman who had non epileptic seizures. So she's your father, my father. So he's making him a teaching movie and he invited me to come and watch. And he had her go back in hypnosis to the last time she had a seizure. And her head starts to twist and shake and she's starting to have these convulsive movements.

And you know, he said to me, it's a lot easier to get people to start these symptoms and to stop them. You know, they've already tried to stop them. It didn't work. So the way you teach them how to control it is you teach them how to bring it on. And then he had her practice making them milder and milder and milder. And he threw her of her hysterical seizure.

How does she make them milder if you're triggering these events? How do you ratchet down the intensity of say the convulsions? How does your father coach someone through doing that? He was kind of an inference. He's basically non verbally communicating that I'm not just going to put you through the same misery over and over again. I'm going to show you how to manage it better.

And so he taught her that if you can make it happen, you can make it happen differently. You can change the way it happens. And you're not going to get all the hysterical reactions around it. At his workbench at his factory, put near the door. So when she had another seizure, he could rush out the door and go to a department and help her. That's how much panic it elicited.

So he taught her that you can have this for whatever reason, but it doesn't have to be as bad. And over time, the more she did it, the more she kind of deconditions the intensity of the seizures. So we're going to get to definitions pretty quickly, just in terms of what hypnosis is, what it is not. But first, a few follow-up questions. Forensic psychiatrist. I've seen these words separately, but what is a forensic psychiatrist?

Well, I do that in my copious spare time. It's basically in those situations, you work for an attorney, not for the patient. So you may assess the patient, trying to decide what's wrong with them.

But it's for the purposes of preparing a report. For example, some kind of emotional damage that was someone I was evaluating a woman who terrible situation, one of the recent forest fires where she's on the phone with her mother as the mother's home was burning down in one of these fires. And it turned out that the community had not been adequately warned how bad this was going to be and even worse.

Her boyfriend didn't want to be bothered to go pick up her mother. So it was a very complicated emotional situation. So I was evaluating what the emotional consequences were for her of the mom. You're being brought in as a subject matter expert to determine the meritorious nature or life of this particular case.

One of my favorite moments doing that I kind of have, you know, I like testifying a court because and I was being grilled by some attorney one day and I'm thinking, I'm enjoying this and then I thought, you're crazy. You go, what are you when he's going after you? And I said, you know what compared to academic life, this is simple. Your friend is the guy at that table and your enemy is the guy at that day. And in academia, you never know where it's coming from.

So this lawyer is going after it was a case that the United Parcel Service where a gunman, you know, a ploy gun, gone off, came in with a bunch of guns in his pack, got through a metal detector, the guard was looking at his phone and not paying any attention. And he started shooting nine minutes later. And I just said, this is a horrible breach of protocol. If he's going to be checking people, you ought to do something about it.

And even if he didn't want to confront the guy directly, he could have called the police. The police got there in three minutes when they were called it took the guy nine minutes to get ready to start shooting. It was a terrible thing. The lawyer, the defense lawyer did not like what I was saying. And he said, well, Dr. Spiegel, you're not a security expert. Are you?

And I said, no sir, I'm more of an insecurity expert. And I could hear the judge on the jury laughing and that cost him a lot of money. Cost him a lot of cost him. So I enjoyed doing that on the side. Was it, I think it was Kissinger who said, I left academia because I couldn't stand the politics. Yeah, no, he said the reason academics fight so bitterly is the stakes are so low. Right. Right. There we go. Thank you. Okay.

And the other question I had was you mentioned this, Gent, I can't remember the there was a Vaughn in there. I can't remember the full name. Vaughn, a Schoffenberg. Who had the smallpox scar in the loose forehead. And I think it was he who when he spoke with his patients, notice they were nodding off or transitioning into this altered state.

Why were they entering that altered state? Was he doing it deliberately or was there some manner in which he was conducting these sessions that he ended up just correlating with that and he figured out it was causal. What was actually I always more the latter was more at first. I mean later on he was doing formal inductions, but what hypnosis is Tim is just a heightened focus of attention.

It's like looking through a telephoto lens with a camera. You get fully absorbed in the center of your awareness and things that ordinarily you'd be conscious of noises on the outside. Other things you dissociate you put outside of conscious awareness. So it's a kind of self altering highly focused attention and it was happening at first by chance just because instead of looking at him, looking at his eyes and listening to his words, they just tended to focus on the spot in his forehead.

Many hypnotic inductions involve some kind of visual focus to narrow the focus of attention when Andrew Huberman, my friend and colleague was on your program, he was talking about that the narrowing of attention just as the lens of the eye changes and limits the amount of information you get this kind of heightened focus on the center of attention. So it changes your state of consciousness as well.

How would you for people who are listening and for me, I'm listening glad to hear that different he a hypnosis from say meditation concentration practice meditation and also from what people might consider say a flow state and maybe they're the same one when people have this focus to the exclusion of much else in these say sports contacts or other types of contacts.

If you could just delineate those three that would be very sure so hypnosis has three main components I've already mentioned to highly focused attention or absorption dissociation putting outside conscious awareness things that are in consciousness right now for example, hopefully you're so interested in what I'm saying that you're not aware of the sensations of your feet touching the floor right now if you were we could just stop now but the more intensely focused you are the more things you got to put outside of awareness to keep from distracting you.

The third component and in some ways the most interesting and hypnosis is what used to be called suggestibility you know you'll do anything I say if I tell you to do which is not exactly true. But the truth in it is that you are more cognitively flexible we've done some research a feet ferment my postdoc and I did a study looking at the continuous performance task and people who are high and low hypnotizable the task has subtle changes in these way you solve the problems you're solving.

But they don't tell you what it is so people who are more cognitively flexible will figure out quicker that the rules have changed and how you do it and that highly hypnotizable people are very good at that they're good at letting go of the old premise and hooking into the new one. So that's a kind of cognitive flexibility that is very valuable and I think a key aspect of why hypnosis is so helpful and treatment and helps people just manage problems better.

So a question there just in terms of the reason that it helps people in a clinical context with various issues is it because the in a sense the errors of causality point both ways in the sense that someone with this higher cognitive flexibility are better at letting go of say one premise and then taking on another but at the same time you can use hypnosis to make someone put someone into a state where they are more cognitively flexible and can kind of overwrite. The previous premise.

Yes, you're right and it's because you know all hypnosis is frankly self hypnosis that is you don't need to watch somebody dangle watch or have a develop a small box car in their forehead. People can shift into the state of highly focused attention and when they do and one of the coolest things about the state is you tend to let go of your ordinary premises not just about what's going on at that moment but who you are what kind of a person you are.

And that's what scares people you know it's the state show thing of the football coach dancing like a ballerina but there's a message there not that hypnosis is good to make people look silly. It's that people can try out being different and see what it feels like they can let go of their usual premises and that's where hypnosis is something like flow state.

Chicks and may high I knew him and his point you know he calls flow and auto telek experience is one that itself rewarding it feels good just to do it and hypnosis is like that when you get really absorbed in experience like you ever get so caught up in a good movie that you forget you're watching a movie or drawing especially all going just yeah time just kind of vanishes when I'm in that state exactly that's a self hypnotic state and I'm sure you're good at that.

And one of the ways in which I help athletes for example I was asked to consult with the Stanford women swimming team their terrific team a lot of the women went up in the Olympics but the coach noticed that they were doing better in practice than they were in meets their time was better and thinking what the hell is going on here.

Well swimming is not a context work and so the only person you really competing with is yourself and what the women were doing was distracting themselves by paying attention to the women in the lane on either side instead of being in touch with their own bodies getting into a flow state by saying how do I move through the water how do I connect with my muscles how do I coordinate them we were being distracted from that and so I got them in hypnosis to get into more of a flow state to focus not on the outcome but the process.

And that's a key thing for athletes in you know in golf and basketball you know tiger trained with hypnosis yet a caddy was helping him with hypnosis I've helped golfers do that you know their number major basketball players who do it as well and it's a way of not worrying about whether you're going to hit the basket or not but what you need to do in your body to make the connection to do what you want to do.

And so hypnosis is like a flow state it's something that you just get in it to enjoy the feeling of doing it and how you relate to your body and by the way good things can happen when you do it. If you were using let's just say a concentration practice and meditation whether that be something like transcendental meditation with a mantra or thinking of a candle flame or film the blank. Would that qualify as a subset of self hypnosis or are there differences that you'd want to highlight.

They're different because in mindfulness you're engaged in a somewhat different practice it's open presence you're not judging you're not evaluating you're just letting feelings and thoughts flow through you.

And people learn to do it with great discipline over time but it doesn't come naturally you don't lose yourself in it the way you lose yourself in a movie now eventually some people do but as you know from having considerable experience with it it takes training and it's a struggle where is the funny thing about hypnosis is boy if people are hypnotizable they're in it just like that even if they've never formally done it before if you're hypnotizable you just do it.

So it's a kind of natural shift in attention narrowing the focus that leads you along and gets you engaged in a flow like experience whereas with meditation you have open presence you do a body scan you cultivate compassion they're all important things but it's about being rather than doing.

Where is hypnosis is more doing than being in hypnosis you do it for a purpose you do it to control pain to manage stress you get to sleep to stop smoking to eat more sensibly so it's more intense it's briefer and it does emphasize the development of absorption and flow if someone is highly hypnotizable how do you determine hypnotizability and I do have the I roll test in my notes I would have never done yeah.

So it's curious if that is just one of a portfolio of techniques that you use or if that is a dominant test how do you determine if someone to what degree someone is hypnotizable. Well, hypnosis is a very stable trait most eight year olds are in transit most of the time as you know if you're call your A-Rolling for dinner you doesn't hear you you know he's doing his thing work and play all the same thing for kids I don't know why we try to train to be little adults because they have so much fun.

But as you we go through adolescence psa talked about developing formal operations in adolescence where you begin to privilege reason over experience some of us lose some of that hypnotizability you don't get as easily absorbed in things you have to think them through logically first by the time you're about 21 your hypnotizability becomes a stable of trade is IQ and there was a study done at Stanford they did a 25 year blind follow up to former psych one students who'd been either hypnotizability measured and the next time you're going to be able to do it.

And the test retest correlation was 0.7. Okay now that's that's better than IQ I mean that's really something and in general what happens is they get divided into one of three groups the people we call the poets highly hypnotizable they still get totally absorbed in movies and caught up in things that's about 20% about 60% we call them the diplomats they'll have the experience and then they'll think about it and negotiate it and then go back and try it a little more and go back and forth.

And there's 20% we call the researchers you just aren't very hypnotized researchers yeah but they can benefit from techniques employing hypnosis because you learn to focus on what you're for not what you're against you don't fight a problem you find a way to master it by joining it and focusing on a positive resolution a self reinforcing resolution of it so

hypnotizability we know what's going on in the brain we've taken high and low hypnotizable put them in the functional MRI scanner and there's an interesting thing that happens only in the highly hypnotizable people that is functional connectivity that is when one reason is active the other region is active between the left doorcelletto or prefrontal cortex which is part of the executive control network the one I'm hopefully using now talking to you.

And the doorcell anterior singulate now the singulate cortex is like to see on its ends in the middle of the brain and the doorcell front part is part of our salience network the alarm system it's the thing that if you hear a loud noise you know it distracts you it so the salience network is coordinated in highly hypnotizable people with the executive control network and that makes sense if they're working together it's easy to lose yourself in an activity and not worry about whether you should be doing something else we've actually found

also there's a genetic component to that there's a particular polymorphism of the gene that metabolizes dopamine cataclyclo omethyl transferase and if you happen to have the methanine valine version of it you have moderate metabolic rate which keeps pretty high unstable levels of dopamine in the brain and those people are more hypnotizable than those who are homozygous for either methanine or valine I had a brilliant young graduate student Dana Cortad who actually developed the brain and I'm going to talk about the brain.

I actually developed a point of care genetic test for hypnotizability so you can take a drop of blood and in a couple of minutes we can tell how hypnotizable you're likely to be but we also have a test called the hypnotic induction profile that my late father and I developed that gives you like a six minute hypnotic experience have your hand float up in the air if you pull it down will it flow right back up do you experience a loss of control in that hand do you respond to the signal ending that experience do you have a sense of floating lightness or something like that.

So you get a score from zero to 10 and that is likewise a very stable trade it's something I have used with every one of the 7000 people I've used hypnosis within my career and it helps me have a sort of common experience that is not initially connected to treatment but just we both can see how much they can respond and a it gives me useful information be it gives them useful information and see we're not blaming the victim here if somebody is not him at the end of the day.

So the reality is not hypnotizable it's not because they're resisting because most people aren't there paying good money to see me and get help and it's not because I'm not good at what I'm doing because I've learned something about it although my first psychoanilic supervisor said yes she didn't go into a trans to spite having had 200 shock treatments because you're a lousy hypnotist and I said I don't think so but it's nice because it makes it a neutral experience.

So I'm going to ask you to try and see what it's like and they learned from it and I learned from it. Where does the eye roll test stand in terms of a reliable indicator? Well the eye roll test is like a good initial guest it's moderately correlated with formally measured the possibility and my father discovered this he was using eye fixation on a light on the ceiling of his office.

The woman I mentioned who you know had the historical procedures he noticed that when he asked you to look up at that light and then close your eyes all he saw was the white's a race they stayed up after he made that movie that day the following Monday he had one of the most obsessional men he'd ever seen and he had the guy look up and he could not keep his eyes up as he was closing the eyelids.

They came down and all he saw is his iris is there they close the eyes so he began measuring and it turned out you can score people from zero to four and how much they're able to dissociate lowering the eyelid with lowering the eye and that is an initial interesting indication of hypnotizability so if you want a quick five second test to it here is a five second time.

So look up past your eyebrows all the way up high way way up and as you keep looking up slowly close your eyes look up close. Oh yeah. Oh yeah. You're a three to four you're on the upper end because you keep your eyes way up and I can barely see your iris as you start to close your eyes. Great. Well another optional many of them. Yeah you bet and give any hypothesis for why those are correlated.

Eye movements are very much related to level of consciousness the obvious thing is you close your eyes when you go to sleep. Drugs that affect the eye and eye movements are related to autonomic arousal your truples get big when you're you know your sympathetic nervous system is going on small when you're on opioids for example and the third fourth and sixth cranial nerve nuclei are surrounded in the brain stand by the particular activating system which is part of our arousal network.

So things that affect eye movements tend to affect arousal as well and so we think it's an ability to shift gears inhibit peripheral awareness and intensify your focus and that this is just it's no accident that it's the same parts of the brain that regulate arousal and eye movement that are associated with this I roll.

And this is a side alley question we're going to come back to the mainstream in a second but I'm very curious do you have an opinion of EMDR I do and you just explain for folks what that is I'm from New York I'm not the void of opinions. Fellow New Yorker here. Alright here we go. Here we go. It's a step in folks.

EMDR's eye movement desensitization and reprocessing Francine Shapiro developed this and it's a widely used technique the VA uses it a lot to help people with trauma and hypnotic like techniques are very helpful with trauma and I'll be glad to talk about that but her idea was that somehow you facilitated communication between the hemispheres.

If you had people move their eyes back and forth while they were discussing a traumatic experience now the certainly good idea in this is that we know no more and more that re exposure under controlled conditions to traumatic memories is in itself therapeutic so exposure therapy and cognitive restructuring are too very prominent ways of helping people deal with trauma and EMDR has components of that but.

And you know if you think about it is anything like hypnosis well what was the oldest way of inducing hypnosis remember the dangling watches you know what your eyes doing when you know you're moving back and forth so I think there's a lot that's hypnotic in EMDR but to tell you the truth every study that has deconvaluted I movements from everything else that goes on in the MDR has shown that the I movements don't have much to do with it and toward the end of her career Francine Shapiro stopped.

She ended tapping rather than I movements and other things but it's not at all clear to me that the actual I movements have anything much to do with the outcome so it's another therapeutic technique but.

I have to say that my overall impression is of what's good about it isn't new and what's new about it isn't good so what are the ingredients in EMDR aside from discussing the traumatic event are there other characteristics or elements that contribute to outcomes when they are good yes this has been studied in any.

Yes it is been used I mean the B.A. is used it extensively in helping combat that's with post traumatic stress disorder and the fact that you summon up a traumatic event and then you picture it become aware of the emotions that come along with it can be a component of effective psychotherapy I think the two things that matter the most and what I do when I use hypnosis and treating PTSD is number one the control with which you summon it I've always wondered if I'm going to do it.

I've always wondered if exposure therapy works so well why don't flashbacks cure PTSD and flashbacks are symptoms of PTSD you're reliving the event is over happening again and the difference I think is that there's no control you feel reattached by the memory the way you did the trauma and so I think with the MDR like other psychotherapies like exposures therapies cognitive reframing therapies you.

In a controlled situation bring up a traumatic memory so it's not hitting you again for out of nowhere you're saying I'm going to spend some time thinking about this now so you're doing it in an element of control that was completely absent when the trauma happened that was just done to you this is something you're doing to yourself in a controlled way with the prospect of a direct benefit the second thing is cognitive restructuring is helping you to see an old problem from a new point of view to understand it differently so.

I was treating a California road worker who was in a construction zone when some idiot went the wrong way and hit him with a car he was taking a rest on the break it was two days before his wedding he had bad ankle fracture he had just pushed himself out of the way as the car was coming and he was miserable you know and see on say was miserable and he just how why didn't I see this coming in time and again if I had a nickel for every traumatized person either sexual assault or physical assault.

The blame themselves for events they didn't control you know what's that guilt versus helplessness guilt versus helplessness that's exactly right and I had him relive it in hypnosis I said let's go through this and he said I'm sitting on the thing having my lunch and suddenly I realized that he's not going the way all the other cars were going he's coming at me and I just pushed myself away from a barrier next to me and fell forward and that's when he hit my leg and I said I want you to look at this what would have happened if you hadn't done that.

He said well he would have hit me dead on and I said so you saved your life so it's tragic it's a terrible thing that happened but it could have been so much worse so think about this not just from what went wrong but from what went right what you did to help yourself and he felt entirely different about the trauma after that he was still unhappy about his leg being injured but it's a way of restructuring your point of view about the problem and that's where techniques including hypnosis for trauma.

And help people really change their perspective. The other thing that happens in hypnosis is the more you concentrate use your prefrontal cortex the less activity in the default mode network.

Now that's the part of the brain the posterior singlet that's involved with self reflection and self understanding and when you're not doing much but thinking about yourself and who you are you've got a lot of activity going on in the default mode and if you can in hypnosis turn that down you can try out being different.

Instead of seeing this as just a total failure and disaster that messed up your wedding and all kinds of things you can see it as evidence that you had the wherewithal in a matter of a split second to do something that saved your life so it changes your view of yourself and who you are and that's one of the terrific things about hypnosis is it allows you to try out being different see what it feels like.

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So learn more check it out go to drink AG one dot com slash Tim that's drink AG one the number one drink AG one dot com slash Tim last time drink AG one dot com slash Tim check it out. Feel free to fact check this but I've had a lot of involvement with say MDMA system psychotherapy for PTSD and all the way through the face three trials and so on.

And have also through my foundation funded a lot of basic science and some clinical work related different psychedelic assisted therapies for say true versus depression or major depressive disorder in the case of psilocybin. And the default mode network in this type of not quite deactivation but sort of down regulation a measure of the proper technical term would be is something that Robin car Harris talks a lot about predominantly out of imperial college London and then later at UCSF.

And it's striking because the subjective reports in a lot of these experiences whether it be in the MDMA assisted psychotherapy although I don't really consider MDMA psychedelic for various reasons but let's just use psilocybin or even LSD the ability to take a impartial observer status on yourself and to assume new perspectives.

The description that you know paraphrasing here that you just share it is very similar to the subjective reports of people who get who have good therapeutic outcomes with these other modalities so it's exciting to me to hear you describe it in that way because psychedelics are contraindicated for so many people they're quite a few people who should not take sex in any form.

I do want to talk about some of the applications but in terms of risk profile usually the kind of magnitude of potential impact is correlated to some type of risk profile are there adverse events there are but before I get to that let me just backtrack a little bit on MDMA and psilocybin for PTSD because a lot of the things that the psychedelics have in common although some are more hallucinogenic than others like psilocybin is what's been called ego dissolution.

And that you seem to just suppress activity in the default mode number and so it becomes a kind of non-judgmental awareness where you see it happens but you're sort of disconnected from it so breast cancer patients dying of breast cancer have done very well with psilocybin trips now I've for years work with women who are dying of breast cancer I know what it's like and what struck me as similar and interesting is one of my group therapy patients said that looking at death in the group

is like looking into the grand canyon when you're afraid of heights you know if you fell down it would be a disaster but you feel better about yourself because you're able to look at it I can't say I feel serene but I can look at it so it's this odd kind of detachment where you can see it and what they think about their death now is I still don't like the idea of dying but what I can see now is what a miracle it is that I ever got to live it all and so they see the same thing from two different perspectives so this ability to sort of disconnect your self-wood and in hypnosis

it's a rapid suspension of your usual self-wood in psychedelic work it's more this ego dissolution it kind of dissolves so it's a quicker reversible form of something similar which is playing with who you are and what you are and that has tremendous therapeutic possibilities now I think one reason MDMA works so well with PTSD is because it's the sort of human connection drug you know and these waves and everything people see it and I think

waves and everything people suddenly feel connected with people they never even know or feel very different about their loved ones and how they connect with them people who have been traumatized where PTSD feel deep shame and it's not because they've done anything wrong but just to be treated like an object like a thing is humiliating and so to be able to relive it in a state where you're feeling different about who you are is a way of

reprocessing and disconnecting from the sense of shame just saying yes I had happened I don't like it but it's not the bottom line about me and that's where depression with post-traumatic stress disorder are so harmful to people because it tarnishes their feeling about who they are as people and if you can understand the experience but disconnected in some ways from this default mode conclusion about what sort of a person you are that can be powerfully therapeutic

absolutely the commonalities are really worth highlighting here because certain treatments are not accessible to some folks which is also part of the reason why I'm so interested in the work that is being pioneered in part by our mutual friend Nolan Williams yes that's a good no less terrific and people will probably come back to Nolan and accelerate TMS in a second but sure what are the risks if any there are very few I'll tell you when we started

reverie about three years ago I was kind of worried because you know 30 years ago I would not have dared to put an interactive digital hypnosis app out there on the web and just see what happened to people I worry that people would have all kinds of reactions and dissociative reactions and terrible things could happen but I thought what the hell I want people to have access to this and be able to try it

and we've had like three quarters of a million downloads and the number of potential problems we've have is less than 10 and none of them are serious you know some of the ecstatic positive experiences kind of like you know psychedelic ones most of them are you know periods of anxiety or stress that are easily reversible and so the good thing about hypnosis is you can turn it on real fast you can turn it off real fast so the worst

thing that happens most of the time is sometimes it doesn't work so what so you do something else so compared to the side effects of drugs like let's take opioids for example where last year 88,000 Americans died of opioid overdoses and almost all of them were not suicides they were just inadvertent overdoses of opioids hypnosis has not yet succeeded in killing anyone hits just not dangerous and the reason you're using that as an example is because of the intersection

with pain management you bet okay so what will also we'll go back to that got it more her noted so adverse risk profile pretty low adverse event profile pretty manageable I want to come back to Nolan for a second because I'm wondering if someone is in the researcher 20% so a low responder is there because I do believe that Nolan mentioned this to me the possibility of using something like accelerated TMS which is transcranial magnetic stimulation is the type of brain

stimulation to improve trait hypnotizability I don't know what trait as a modifier means but is it possible that one could use a tool like accelerate TMS to improve their response to hypnosis the answer is absolutely yes and Nolan and I and a fake fireman and a number of other members of Nolan's team just published a paper in nature mental health in which we took him a ties with people who were less than highly hypnotizable and we administered to them either accelerated TMS to the left

doorcellular prefrontal cortex with the idea of regulating activity in the door slantary singulate using real versus sham TMS so we could tell whether they actually got the TMS or not they couldn't tell the paddle made the same noise but they didn't know and we were able to

significantly increase hypnotizability in the ones who got the real TMS and not in the ones who got the sham what was the dosing on that was it one day was it five sessions yeah no it was it was one day it was just one session and then we measure

the single session oh yeah it was not repeated like the treatment of depression or suicide ideation single session okay so we're hoping that's right that I can see your face lighting up I feel the same way that we may be able for people we were studying people with

fibromyalgia people with chronic pain to enhance their hypnotizability and then use it to treat pain which it is very effective for okay I'm going to get to pain quickly folks I promise the segway is different tools show their best results in different

contexts and so you might have something like PRP play later rich plasma for certain types of injury repair surgical recovery better for some types of surgeries and joints than others you might have fill in the blank MDMA assist it's like a therapy for

instance better for certain indications like complex PTSD than others for instance other things might be better suited to say I'll call use disorder what is hypnosis best for where have you seen the most outstanding results compared to other options we've seen excellent results in helping people to manage stress we're finding with every that about 80% of people within 10 minutes feel a significant reduction in their stress levels it helps people focus intensify their focus of attention plan

what they want to do and then do it it's a skill that they can learn to use very quickly it's very effective with pain it's one of the oldest uses of hypnosis with pain in fact there was a British surgeon named Ezdale who went to India and was using hypnosis this was pre ether anesthesia now they would just you get people drunk have them bite on a block of wood hold them down and cut on them frontier medicine frontier medicine right and he went to

India and he reported 80% surgical anesthesia with hypnosis and when 10 years later at mass general he just don't want to be in the 20% no you don't it's better than it's better than zero better than what was happening before than bourbon and a wallet right exactly and when ether was first introduced at mass general 10 years later the surgeon strode to the front of the amphitheater say gentlemen this is no humbug to distinguish ether from hypnosis well they were getting 90% anesthesia and so

Ezdale withdrew his paper he said well they're saying ether is getting 90 and hypnosis is getting 80 yeah I got to say he withdrew his paper he withdrew his paper and you know it's taken us like a century and a half to figure out that the brain actually has something to do with pain processing

yeah and there are studies now showing which part of the brain just changing the words of use in hypnosis which part of the brain is involved in the analgesia so you significantly reduce pain in the somatosensory cortex if you say the hand that's receiving the shocks is cool

tingling and numb filter they're heard out of the pain you get the same reduction in pain response if you say well the pain is there but it won't bother you so much sort of like opioids then you return down activity in the dorsal anterior singulet so you can see different parts of the brain

involved in pain processing and in hypnodic allergies and the language you use depending on the language so if you think what doctor say to patients right it is spell casting that's right but no point he had for anything yeah those come to the more advanced life he's got a pair association to get the hats right so how does that affect the treatment if you're looking at say the example that you just gave where different wording is affecting different neuroanatomical structures and activity

does that then determine your neuro targeting for lack of a better term and you're like okay we saw a instead of b light up we really want to go after a based on what we know it may be for certain kinds of pain or certain kinds of problems you want to emphasize one of the other

but frankly we have four different sets of instructions that involve either just going somewhere else leaving your body here and going to a desert island and enjoying things we're imagining a physical remedy that actually reduces pain a warm bath or an ice bath

or something like that or move the pain around see what it feels like to do that and one other technique that's very helpful is teach people to have compassion for their bodies this is like mindfulness in some ways but you know if your body were a three-year-old child

who'd been hurt would you get frustrated and angry with it hell no what would you do that everybody says I give him a hug and I stroke him and I try and make him feel better so there are different language techniques we can use to get the same effect which is to significantly reduce pain we have randomized clinical trials that prove that hypnotic analgesia works at much lower levels of medication too and so it's an underutilized resource hypnosis is like an under appreciated company

that hasn't been managed well and has a lot more positive resources and that's what it's like we just don't take advantage of it so let's use me as a hypothetical intrepid user of self hypnosis so I have some low back pain we were chatting about this before we started recording

is there a particular approach that you might recommend one or in this case I start with in a case like this sure we can try it if you want yeah I'm a dumb game your game I'm an absolutely game all right how would you rate your pain right now on a zero intense kill

I'd say it's a two out of ten it's more of a bothersome and annoying and yeah and is there a physical remedy that helps you with it warm bath there are foam rolling say the like pure form is includes and so on does help using so as release tends to help just laying on my stomach

honestly with my hands under my pelvis to take all the activity out of the spinal directors helps those are few things like laying down on my stomach and breathing into the back to relax the spinal directors I would say is one thing that seems to help well that seems like a vivid image and temperature things don't make much difference thing temperature if I do say a cold bath and then a hot bath just contrast therapy like that that seems to help so that feeling of cold tissue

vasodilating when I get into the hot bath that type of like prickly sensation of being sort of perfused with blood that's something I associate I would say with feeling better feeling better so part of what you're doing is reinterpreting the signals you're getting in a different way so

let's try it if you want to see so get as comfortable as you can on one please do one thing look up all the way up high you can two do two things slowly close your eyes and take a deep breath and three do three things let the breath out let your eyes relax to keep them

closed and let your body float imagine you're floating somewhere safe and comfortable like a bath a lake hot tub or floating in space and then take your right hand and stroke the back of your left hand starting with a tip of your left middle finger or you can put it on the table that might be better

a stroke the back of your left middle finger down long the back of your left hand past your wrist to your elbow and as you do that develop a sense of tingling and numbness and lightness and let your left hand float up in the air like a balloon feel the tingling that's good and let it float up you bend your elbow and you can rest your arm lightly on the table and please describe what physical sensations are aware of now in your left hand and arm feel my heart beating my palm

a little bit of I can feel the hair on the back of my arm touching the sleeve that I rolled up and I'm going to give you this instruction if you pull your hand back down to the table with your right hand and then let go it will float right back up to the upright position to see what happens

that's good so you're putting it down now let go I see you smiling what's happening there's I mean it feels like it's floating number one I'm also the kind of second guessing myself so I wonder if I'm doing this to conform to the exercise that makes sense it feels like it's floating

okay and as you do that let your left hand bring it up right later when I ask you to touch your left elbow with your right hand and let go your usual sensation and control will return but right now when I ask you to touch your left elbow with your right hand and then let go your usual sensation and control will return right now I want you to notice sensations in your back what does your back feel like right now the part that's usually painful it feels relaxed right now good more relaxed good

good how would you rate the discomfort level right now and that's your authentic scale 0.5, 1 out of 10 1 out of 10, 0.5 to 1 okay good so already notice how you've been able to change sensation not just in a neutral part of your body or left hand and arm but in a part it has been problematic

now I want you to imagine now that you're lying on your belly maybe with a roll under you and feel a pleasant tingling numbness in your lower back is this if it were cooler or warmer or you were changing it from warmer to cooler

feel a pleasant tingling numbness and let it filter the hurt out of the pain each breath deeper and easier now again with your eyes closed and remaining in the state of concentration please describe how your body is feeling right now it does feel cooler what feels little dissociated makes sense like

can you describe that a little more feel like it's very similar to to QS or or low dose of ketamine which I don't recommend but as a dissociative I've always struggled to put words to the dissociative experience there's a lightness and there's a conscious awareness of the body without being as identified with the body exactly so you can observe it but it feels different and would it be fair to say that it's not as annoying as it usually is?

it's not as annoying so notice how you're able to filter a lot of the discomfort and displeasure out of the usual pain situation by detaching from it by experiencing it differently sentence you have to endure it's a sensation your body is giving you that you can interpret in different ways now for people who might wonder if this is compartmentalizing in a way that is long term harmful I'm not saying that's what it is but is this just taking a different vantage point?

how would you encourage them to think about this? yes I would say it's reinterpreting and you're getting from that part of your body and you're uncopling them from the usual sense of annoyance and limitation that tends to actually make it worse oh 100% makes it worse yeah and instead you're saying okay it's there I don't like it but it's not bad

and that capacity to reframe, to reprocess the signal is a powerful way of better managing pain filtering the hurt out of the pain now please take your right hand and touch your left elbow and then let go and see what happens to your left hand and arm yeah just more movement is more forthcoming

uh-huh good that's surprising and then yeah I was noticing how like my fingers got kind of got frozen in this position I thought that was interesting not making too much out of it but I was saying hmm all right you can let it float back down now and how's your left hand and arm feeling now? normal normal good so you were able to change sensation in both directions and how's your lower back feeling now?

feels really good action terrific that's remarkable I'm very glad that's great so thank you for that you're welcome where do you get my bill? you have my email I'm really glad I'm really glad first books $6,000 what happened to the first one's always free?

oh wait no that's dog dealing not hypnosis and if someone's inducing that from a self hypnosis perspective let's just talk about it could be in the context of reverie could be in a different context steps that they take or how do they self induce

for something like that let's just say if I want to do that five minutes a day I wanted to do it five minutes a day you could remember what I told you or you could queue up the pain control app on reverie and you get to hear my Malifluis voice teaching you in exercise this is the stress this dulcet

dulcet don't there you are to teach you how to do this and you could follow along and it's interactive so I'll ask you as your hand floating if it is I'll tell you one thing if not it's something else so it's a branch chain kind of response that I tried to make as much like being across the table or in my office is I could and not to beat the dead horse of neurobiology but just to reinforce my understanding from a neurobiological or neuroanatomical bush-effective what is happening?

so what's happening is and we've got EEG studies, we've got FMRI studies, we've got PED studies showing that what's happening if you think about it the pain is a always a combination of peripheral input through the lateral spinal thalamic track through the thalamus

through the periacriductal gray end up to the somatosensory cortex with input from the salience network so if you just broke your arm the salience network is gone, God you're in trouble, you better do something but the problem is because we're fairly pathetic physical creatures

we have to take very good care of our fragile bodies and so we have a brain that is designed to help you recognize when you're hurt and get help and manage the pain but for example freeze not necessarily move sore predator could detect you more easily

so pain is a combination of those peripheral signals coming in and what your brain decides is wrong and what to do about it and so very often chronic pain is really not anything you need to do but you're brain often treats it as if it were acute pain

here I am and so it derails you and it annoys you and it keeps you from doing what you want to do and the more annoying it is the more attention you pay to it, it's like the noisy kid in the classroom and so you can learn to modulate that so we showed in one experiment with Stanford students

we gave them electric shocks, we measured somatosensory of oaps responses so you can see wave forms coming out up to a second after the shocks are administered and in the hypnosis condition we were able to stop the P100, the first response cold or with no response of the brain when they were in hypnosis in the first tenth of a second and the P200 and P300 were half as big as ordinarily so within a fraction of a second the brain is processing the signals differently

and as I mentioned there are studies that show you can turn out activity and somatosensory cortex so the brain is saying this is not as bad as I initially thought it was and I don't have to pay as much attention to it it doesn't have to hurt me as much

because very often we amplify pain rather than diminish it by being so annoyed that it's happening and another thing that we know is going on in the brain is the anterior is singulate is rich in GABA receptors, GABA immunobuturic acid, they're inhibitory neurotransmitter

highly immunotisable people have more binding of GABA in the anterior is singulate than low immunotisable people so they can use it to be their own little drug dispensaries to inhibit the anxiety reaction in the dorsal anterior is singulate cortex so there are many understandable neurophysiological ways by which the brain can literally take the strain out of pain also wondering I mean you'd have to test this of course but if hypnotizability as assessed by various means

whether it's the eye roll test or a drop of blood and looking at the genetic profile if there might be some correlation to high response baseline response, low response for psychedelic assisted treatments as well because as it stands currently there's a lot of shooting in the dark

assessment that determines if someone is likely to be a high response to psychedelic but as we're talking about it there seem to be a lot of parallels I think there are, it wouldn't be that hard to test, somebody has to fund it of course but there are lots of assessments for

determining the strength of a mystical experience and how that's correlated to therapeutic outcomes highly correlated, it turns out at least to psilocybin and so on and so forth might have for depression and a handy and so on or the GID or whatever all of these various things but in terms of determining in the process of patient recruitment who might be a high responder that's a huge deficit in the system right now I agree with you, I'd be a terrific thing to do and maybe in Nolan's next day

he just published a paper on my museum I would gain with astounding results I mean just astonishing not just improving PTSD which I kind of expected TBI, traumatic brain injuries and it stays down, goes down to the stays down

yeah it's very durable and that's one of the things about a lot of these psychedelic studies is that it breaks the whole the whole model of keep occupying that receptor and you know blocking serotonin and uptake and all this stuff and it's just once or twice and the brain is like

reset it's rebooted and that's where I think this interaction with the default mode network activity is very interesting because I think people reset their expectations of who they are, what they are and what their symptoms mean in a way that lasts and there's now a lot of it, of course there's often psychotherapeutic assistance with the psychedelic research which is important but some of that could be hypnotic construction too and I don't think much of that has been done

but it would be very interesting to do, I agree with you to be super interesting, yeah there's a broad canvas still remaining for all sorts of research I'm glad to hear that so let me ask about a few things first used wording that was along the lines of I heard you mentioned at least twice filtering the hurt from the pain am I getting this right?

could you elaborate on that and then the second piece is much earlier you were referring to the say I don't want to call them below hypnotizable people who fall into this category and name the researcher who could still use it and I thought I heard you say something like framing issues is for us not against us, something like so could you first talk about filtering the hurt from the pain and then this for us versus against us?

well the filter that hurt from the pain is you know it sounds kind of paradoxical what are you talking about pain hurts you know but the degree to which it hurts has to do with more than just a signal traveling through the lateral spinal thoracal amic tract it has to do with how you interpret that signal we have all kinds of somatic signals some of which could be on the verge of discomfort some of which aren't and our brain's job is to interpret them and decide what to do about them

and so you can have a signal that doesn't necessarily automatically convey that something is wrong with the body it may be just an intense silly you know it's like the difference between and enthusiastic hug and a squeeze that hurts and there's a line in there somewhere where that you cross and it's pretty obvious but there's also an area of interpretation or the ostentatious long hug there are a lot of guys here who do long hugs they say I'm a hugger when you try to shake hands

there's a point where it gets uncomfortable it gets uncomfortable that's right and it's usually after the first second or two but that's right and so the brain is doing its interpretive job making meaning out of the sensory experience one of the other things that we know happens in the brain with hypnosis is higher functional connectivity between the dorsalato prefrontal cortex and the insula inses this little island that means island and then the mid front part of the brain

that has a mind body conduit so it's a place where the brain controls what's happening on the body how much gastric acid you should treat your autonomic arousal for example and also it receives information into reception from the body

how is the body reacting to things and hypnosis intensifies this connection and intensifies coordinated activity between the executive control network and the insula and so it's a way in which the brain can intensify it's reading and understanding and interpretation of what's happening in the body

and so you know athletes who are pushing their bodies to do things that most of the rest of us would say how I can't do this are interpreting that as I'm pushing my body as hard and as far as I can to get what I want and so they will interpret things that everyday people would interpret as putting yourself through pain as training doing what you need to do and you know that runner's high is in part composed of signals that many of us would just consider painful

and so that's part of what the brain does and that's part of what hypnosis helps us to regulating control how much of it is pain and how much it is not and so the interpretation of pain the meaning of it has a lot to do with how much it hurts and what about the for us versus against us?

people who are experienced with hypnosis that is people who know that people actually listen and respond to what you say let's say the dumbest thing you can say to somebody is don't think about purple elephants what are you going to think about and the best way to change behavior is intermittent positive reinforcement so you want the process of change to be what chicks and may I call auto-tell like you want to feel good about doing it

so an example where we do that in hypnosis and where even non-hypnotizable people can respond is when I try to teach someone how to stop smoking which was the first experiment we did with Revery I don't say you know cigarettes will taste terrible

my professor at medical school did that he you know your cigarettes will taste like horseshit and the guy lit up the cigarettes oh thank you doctor it's and he got a frantic hold two hours later he said doc my house smells terrible my house smells like horses

right and then the heck it said while you're smoking he said no but I forgot to tell you that my wife is a smoker so he had to hypnotize him and say only your cigarette you know it doesn't work you focus on what you're for respect and protect your body for my body

smoking is a poison I need my body to live I owe my body respect and protection you would never put tar and nicotine filled smoke in your baby's lungs your body is as dependent on you as your baby was so treat your body with the same respect you give a child and so you're focusing on whether you have an urge to smoke or not whether you feel better or with on nicotine or not but whether you are going to commit to respect and protect your body and that way you can feel good and you can feel good

and that way you can feel good from the moment you make the commitment to do it I'm being a good parent to my own body so even people who aren't hypnotizable can get that concept and say I'm not going to worry about my urge I have lots of urges I don't act on I don't have to act on this one just because I have it so I had one alcoholic who I was trying to use that to help him stop his drinking and he said oh you mean sort of like the body is the temple of the soul

and I said yes you got it that's it and he stopped drinking so it's a matter of finding a way to formulate the resolution of a problem so that you start feeling good from the moment you commit to doing it before you know that you're going to stop smoking

and we're getting one out of five people stop just like that and they surprise themselves that's one of the things I love about working with hypnosis is people are surprised at what they can do because they're trying out being different and seeing what it feels like

what do you think is happening with the addiction specifically whether it's nicotine alcohol or other what does this work where other things fail and I should ask actually just so you can set the table for this how does hypnosis compare and I'm sure it depends on the practitioner and so on

which kind of gets into a whole separate question I wanted to ask about just schools of hypnosis I don't know how standardized things are like CBT for instance but not that that's hypnosis I'm just saying they try to standardize so they can track things how does hypnosis compare to other types of interventions for addiction well the results we get with it does is about one in four one out of five people just flat out stop and the rest cut down by about 50% and how much they're smoking

that's roughly comparable to the use of verenacleaner but you probably on or nicorette patches it's not very different depends on the population but it's about as good as the same people I don't know for sure because they're done in different contexts but it's not bad and I have people who are

surprised by how easy they said like a lever was pulled and I just don't worry about it anymore I just don't think about it now does it have with everyone no but every time we feel good any time we get anybody to stop the most

reversible cause of cancer in the world this is cigarette smoking so anybody you get that's a good thing and even people where it is correlated with hypnotizability so more hypnotizable people are more likely to stop using this approach but there are some non-hematizable people who do too

because they get the concept even if they don't get the feeling that comes along with it and the other thing that keeps in mind in addiction medicine is that the odd thing is that it's not actually the high from the drug that hooks

people it's the chase is better than the catch so you get more mesolimbic dopamine secreted when you're going through a scenario of scoring a drug then when you're actually taking the drug so it's the anticipation of pleasure that really gets to people and from my point of view using hypnosis

that's fertile ground for intervention where you just say I can make you feel good without chasing after the drug I can make you feel good the way you felt when you hugged your six-month-old child because you're doing the same thing with your body now and that's a good thing so helping people to focus on what they're for is a crucial part of the therapeutic strategy and makes it work what is the oldest that you're aware of documentation of hypnosis or

something resembling hypnosis you know I was in Bali watching trans healers and the difference in Bali and this has gone on for a thousand of years they go into a trans and their patients watch them so they kind of go into this altered state and start chanting and singing and the idea is if you

watch it as kind of hypnotic and you'll kind of go along with them but from a Western point of view it started in the late 18th century with friends Anton Mesmer who was a V&E physician and Mesmerized that's right and he called it

animal magnetism and he thought he actually had to do with changing the magnetic field in a patient's body and he had to look at tubs filled with iron filings and he had a magnet in fact the magic wand and magic shows comes originally from a magnetic rod that was used to him that's 1.0

Yeah that's right from animal magnetism to trans cranial magnetic stimulation that's right and he was very popular he left his wife and family in Vienna he moved to Paris he was out competing the leading French physicians of the day Voltaire wrote to his brother we did everything we could

just say father's life we even sent the doctors away and if you think about the major treatment at the time in France it was bloodletting France was the world's leading exporter of leeches and unless you happen to have congestive heart failure the world's leading exporter of leeches leeches

because that's how they didn't and they still in some like hand damage things they use leeches to suck blood out of certain regions in the hand and all that but at the time that was the major treatment and he was so popular and the cool thing if you read about what his office was like he was cheerful it was brightly lit patients would hang around all day boasting about what they'd done with animal magnetism and the typical French physicians office was truly grim

it was dark no decorations on the walls patients were getting bad news from doctors I once had the opportunity to visit anafroyd when I was a medical student in London and she asked me if I was going to become an analyst and I tried to be diplomatic and say well I'm not sure she said so you're not going to be you know she wasn't messing around you know why and I said well I don't like the passivity I don't like not offering something trying to help fix things with

people and she said you need to understand something when my father was training as a doctor it was considered a waste of time for a doctor to listen to a patient patients were there to listen to doctors and I was humbled by that I thought you know it was a very it was a very good point and she said

it's hard to be analyzed because analysis is a liberation from your parents and that's difficult if your parents are analysts and she knew better than anyone because her father was her analyst actually oh boy but so that's not that there yeah there was a lot in the doctor patient

relationship in that time there was pretty grim and so the fact that mesmer was talking to patients and listening to them made him very popular so they got King Louis to convene a panel of to investigate mesmer the panel was very

interesting our own Benjamin Franklin was on it he was having a lot of fun and I was just being investigated because he was competing so successful in the doctor's they don't like the doctor the French doctor lobby the French doctor love that they know that the stops they said that his

theory was all wrong that he wasn't really changing magnetic fields which is correct it's true they they concluded and another member of the panel was Lavoisier the brilliant French chemist to develop oxygen chemistry and who six months before he was beheaded in the French Revolution discovered

the idea of the gross national product he was a genius and one of the third other panel members was a doctor named Dr. Guietan the inventor of the Guietan he kind of created the mind body problem yeah what a panel so this set up for a joke yeah it is but it wasn't unfortunately they concluded

that hypnosis was nothing but heated imagination and you know what I've heard worse definitions but that was it for mesmer yeah and so you know it's set in motion a pattern of why hypnosis is just an underdeveloped resource is that people think it's either dangerous or it's ridiculous

and it's neither it's a valuable effective treatment that we have underutilized for decades for centuries what is if you had to pick one or two anything that comes to mind some of the more surprising patient outcomes or changes that you've seen so there are cases where I'm sure

you could have predicted the outcomes I have 50% chance this person has a three percent reduction in the A B and C symptoms but were there any that really stand out to you as surprising the first one was the one that got me to decide that yes this happens to remember my father's interest but I'm

not going to let that determine from something I'm interested in and it was the first patient I reused hypnosis with it was on my pediatrics rotation the children's hospital in Boston the nurse says speak all your patient is room 342 she's in status as Maddicas she's been

hospitalized every month for three months and she's back again and she hasn't responded toepinephrine twice and we're going to maybe give her general anesthesia and put her on steroids so I walked in the room following the sound of the weasel down the hall pretty 15 year old girl bolt upright in bed

struggling for breath knuckles white mother standing there crying I didn't know what to do but I had taken hypnosis course so I said well would you like to learn a breathing exercise she nods so I get her hypnotized and then I break into a sweat and I think wait a minute we haven't gotten the hazmat in the course so I said something very subtle and clever I said each breath you take will be a little deeper and a little easier and within five minutes she's lying back

in bed she's not weasing anymore her mother stopped crying nurse runs out of the room and if you think about the dynamic of that I mean it was stunning to me I couldn't believe it but each time she tried to breathe in her trouble she got more and more anxious because she thinks I'm going to not be able to breathe frightening so you have her anxiety building like a snowball rolling down hill on top of the physical sensations so in comes my intern I thought he's

going to pat me on the back and say good for you you know he said the nurse has filed a complaint with the nursing supervisor that you violated Massachusetts law by hypnotizing a minor without parental consent could you not and Massachusetts has a lot of dumb laws but that is not on the list and furthermore her mother was standing next to me when I did it he said well you're going to have to stop doing this and they said oh really why he said because it could be

dangerous and I said you're going to give her general anesthesia put her on steroids and my talking to her is dangerous I don't think so so I said tell you what as long as she's my patient I'm not telling her something I know isn't true so take me off the case if you want so he storms out of the room he finds the chief resident in the attending and they have a council of war and they came back with a radical solution they said let's ask the patient you know I don't

think they'd ever thought of that you have breakthrough and she said oh I like this I want to keep doing this and she was hospitalized one month after that a month later and went on to study to be a respiratory therapist and I thought that anything that could help patients that much that fast

frustrate the head nurse violated non-existent Massachusetts law had to be worth looking into and I've been doing it ever since but you know the nice thing is you can see it in front of your eyes you see whether it's going to help you know just like you with your pain you know it's the same thing if

it's going to happen your brain is wired to every part of the body to make it happen quickly and it doesn't always happen but it often does I'd say the next major patient that really struck me when I first got to Stanford I was assigned to the Palo Alto VA Medical Center and there was an army cook who had been mustard out of the army because after 19 years of good service something happened during the Ted Offensive and he just grabbed an ambulance and

some guns and more ran out in the jungle and started shooting at what he thought were be at con and he seemed psychotic they couldn't contain to me was agitated he was emotionally uncontrolled he wasn't responding to meds and he wound up being discharged from the army and spending 11 months in a state mental hospital in California and a social worker there interviewed him and said he's not a drug user he's you know he doesn't seem psychotic to me there's

something wrong but I think it's post traumatic so I saw him at the VA and he told me that something happened during the Ted Offensive and it had something to do with a Vietnamese child that he had informally adopted he was like the youngest of 13 children he identified with young kids this

kid had been badly burned was on a crutch nobody seemed to claim him and so he just kind of took over and they became buddies and during the Ted Offensive I find out in hypnosis he comes upon boy's body and he realized he's been killed and in reliving this in hypnosis and he was very immatisable he says oh my god they hit you when oh my god they ain't got to kill kids they ain't got to kill kids so he's screaming and crying and then he's going into setting

up defenses on a water tower because he thinks they're going to be overrun by the at-gang and he's going through all of that and I move him then the remarkable thing was he was very intensely involved in all this but very malleable so I say okay we're going to change times now and we're going to

go to the time when you collected his body and buried him and so he does that and he says ashes and ashes and dust to dust I guess that's it and then he starts banging on the arm of his chair and he says if I'd only taken you over to G Wing Man you wouldn't be there it's all my fault and I said tell

me something with this boy blame you for what happened and he starts to smile he says no no he said your number one cook you're my number one cook number one cook he knew he was going to die that he was crippled he looked like he

had arthritis and so I said okay we're going to go to his funeral now and no we're going to go to a different time we're going to go to the time before the funeral when you had a party for him a happy memory because you know often with grief the reason it hurts so much is that you loved and cared

about each other so much so there's something positive behind the grief right and so he says oh you look so happy the donut dollies brought a cake my sister sent an electric train for a present for you you never seen electric came before have you you know via nom didn't got no air roads and and it turned out later that the train was actually from Spiegel Brothers department store in Chicago and he said he's so happy you're nine number one cook so I said okay

we're going to put as much of this as you don't want to think about now behind a filter to be there if you needed but you're going to remember two things about this you're going to remember bearing him and you're going to remember birthday party and so he's you know he's sweating he's here's going down his cheeks and I brought him out of the hypnosis and he looked a little sort of days they look a little confused and I said what do you remember and he said

doc I remember a grave and a cake that was a great one a cake so it was a way of helping him acknowledge his grief begin to go through a process of grieving but see it from two points of view if he had this time with this kid he made the boy happy the boy made him happy and that can't be taken away

even though he died and he was in the hospital for a while longer he practiced it every day sitting in the Lord he was doing the self hypnosis and he was discharged he was upset he couldn't get back in the army he wanted to but he'd been discharged his brother who was a police officer in Chicago was killed in the line of duty and he'd decompensated again but we processed it we compensated me it just got symptoms all over again I started to look like he was hearing voices

although he wasn't but discontrolive emotion and so I had him grieve his brother's death in the same way and he got discharged he was spending his time training teenagers how to do long distance cycling and he was out of the hospital and doing fine so you know I thought that anything that can help

people in these rather extreme situations come to a new point of view and a hurry about that was worth pursuing and I've been doing it ever since and we've had people in and remember a guy who was in his home for three years he had the social phobia you know where he just couldn't stand to leave his house he was there for three years and we taught him to use self hypnosis to deal with his anxiety and he's out in the world again he's living a normal life so it is

surprising how much it can help people in our what a remarkable story I want to ask you to just describe where every for folks in a minute but first I want to ask in that circumstance where you have this veteran who some think psychotic who is getting really animated heated sweating to maintain your

composure and direct that environment that person in that state what does it take to get to that point where you're comfortable doing that that's a very stupid question because it I'm the intensity of it is remarkable we actually have a grainy old video of it but I sometimes get surprised myself I was actually holding on to his arm the whole time I didn't even realize it at the time but I was like trying to connect with him so that whatever else was going on he knew I was

there with him and I guess two things him one was it's a characteristic of highly hypnotizable people that they can be having intense experiences and yet be connected and contained that is they're absorbed in it but they're not just out of control they're not just wild you know they're expressing their emotion but they're also able to modulating control it and focus on this sort of narrow container of being intense in reliving what happened but also somehow aware

that it is a reliving of the event it isn't actually happening and so I figured you got to have the reins of the horse when you're riding fast but it was clear to me that he was listening to me and what struck me the most and what reassured me frankly was that he could change times very easily he could change mood so literally transition from screaming I should have taken you over the Hoochman it's all my fault to ashes to ashes and dust to dust was a

few seconds you know but he was following me and you know if I saw that he wasn't I'd spend more time on the control issue but it's also because the intensity had to do with something we were meaningfully working on that is I wasn't doing it just to have him show off how emotionally he could be I was doing it to help him to up into perspective the thing that was upsetting him so much and help him to process it in a way that made him feel better about it so I knew I was

doing something that I thought could help him and I'll tell you that in some of these intense kinds of hypnotic therapies I'm a little dissociated to you know just saying it's a smart hypnotist that knows who was hypnotizing whom but I'm kind of listening to my own mind saying what's the next step what do we need to do and I'm thinking about it for a second and saying is this really the right thing well let's try it out and see and so I'm also testing his response and

if I see that we're not getting anywhere then I'll change course and it takes some time and training to just sort of know the direction you want to go in and why you're doing this and is it really going to help him or is it just but not a show and it was clear to me that's what he needed to do and you get this sort of deep connection with somebody that they can feel you and you can feel them you know that he knows what I'm trying to do and I know what he needs to do I think

there might be something to the correspondence of trait hypnotizability and good candidacy for psychedelic assisted therapies I really do because that what you just described also I think would be mirrored in many patient reports

who exhibit strong durable outcomes they're able to switch from one thing to the next very quickly from one maybe very positive emotional valence to one very negative emotional valence and then back and forth while still maintaining some semblance of observer awareness of that makes sense so it's very very curious who is reverie designed for?

reverie is designed for anybody who's curious about dealing with their problems if you just want to learn something about your ability to explore and change your mental states it's useful it's a tool it's more like an antibiotic than a vitamin it's if you've got a problem you can try and see if it'll help so people with pain stress insomnia that's our most popular use people getting to sleep or getting back to sleep I used to worry that reverie wasn't quite as

good as being in my office with me and then I thought if you wake up at three in the morning and need to get back to sleep you probably don't want me in your bedroom helping you do you probably don't want to be I don't eat in the morning that's exactly right it's very useful for dealing with

phobias like airplane phobias claustrophobia had a lovely woman who had an obsessive compulsive disorder or like and claustrophobia is diagnosed recently with cancer and had to have a scan in an enclosed tube and just was freaked out about doing it and I had her picture doing two things that

made her feel better one is just floating somewhere she felt comfortable and she said I remember floating in the Dead Sea and I thought for a cancer patient it might not be the ideal image but the intense salinity of the Dead Sea makes you float like a cork and so she liked it so I said okay

we'll do that and she had a very loving sister in New York who would come out to visit her and I said and I want you to imagine that your sister is standing next to that scanner giving you a hug and reassuring you and she came out of it and she started a cry and she said for the first time I think

I can do this you know I can actually do this I mean she was afraid to go on an elevator by herself who was too scared she'd waited I know multiple people who have this issue with elevators airplanes and with airplanes I have people imagine they're floating with the plane the way you take a roller

coaster I don't fight the plane float with it and see the plane is an extension of your body like a bicycle when I get somewhere faster you're using the plane is an extension of your body the pilot is an extension of your mind you chose an airline that has good pilots and he's or she is an extension

of your mind so concepts like that can help people do self-ignosis and get from it play point A to point B so that's good and then for habit problems like smoking or drinking or eating badly you know you can learn to eat like a gourmet you can enjoy eating more while you eat healthier food by using the self-ignosis to do that what have you used if anything self hypnosis for on yourself I had recurrent dislocation of my shoulder and I realized I needed surgery done it's

a three hour operation it's a big deal my left shoulder reconstructed it's a lot of fun isn't it so I use general anesthesia for the surgery itself but afterwards I just itself of no sense for the pain control you know and it was a mass general and I wasn't supposed to read my record but I worked there so the nurse kind of looks at me like and the resident wrote in my record patient using very little pain medication we mustn't have cut many nerves now you know I've

got a scar from here to here I can tell you they cut nerves but it's this misunderstanding that you know the body is just like a broken car you just got a you know incision ingestion or injection you know you got to do something to the body rather than teach the person to use the control system that roll born with this three pound object the top of our shoulders that is connected every part of the body and helps to control it and why on earth shouldn't we be

able to use that better you know it doesn't come with the users manual you know so you got to figure out how to do it but it makes a huge difference and so you know diagnosis is not a commodity it's a skill to be shared and that's one reason actually it's under utilized is you know I don't have a bunch of x cheerleaders going to doctors offices telling them use hypnosis but drug companies do and you know I'm a doctor I prescribe meds but there are many times when doing

something like this is much better and safer and more effective could also be the given the very favorable risk profile something that you at least attempt before moving on to more severe interventions it's exactly right you know why not try this first I had a young woman seven months pregnant very

bad lower back disease and of course as the baby grew you know it got worse they put in a nerve stimulator didn't help and they couldn't give her opioids because she was you know had a pregnant and so I have her imagines she's floating in a nice warm bath filter the her out of the pain her pain went

from seven to three in a couple of minutes but she looked angry and I said what's the matter she said why in the hell are you the last doctor I got sent to instead of the first and that's exactly right Tim I don't get it you know it's inexpensive it's effective why not try that first and then if that doesn't work do something else it's really a shame it's a disservice to people who can help themselves it's excessively expensive to do use medications or procedures when some

people may not need some do but a lot don't and so I would like to see wherever used as a kind of placeholder while people are getting evaluated and getting appointments with people who can help them deal with whatever their pain or other problem is take forever to find a good specialist meaning

outside of hypnosis I have a friend is dealing with a very unpredictable onset of what he describes as overwhelm that seemed to begin after he had a pretty bad neck injury he was constantly in this flexed position while he was working at his laptop and then he went to play tennis one day went into a

serve bent his head back and had some type of structural event that then precipitated this onset of what he would call sort of overwhelm where he goes into fight or flight and really can't focus or work and it's taken many many many many months to find specialist to work with just to begin the trial

and error so in the meantime I could see something like this being incredibly valuable aside from reverie and people can find reverie at reverie dot com great name by the way r-e-v-e-r-i dot com and on all the socials will link to them the show notes as well but reverie dot com and I would

imagine that can be found in the app stores well but are you yes are are you are in addition to that are there any resources because I'm sure there's the good the bad and the ugly when it comes to hypnosis resources whether those are books documentaries or otherwise are there any particular resources for those who would like to try to educate themselves more explore this more you know there are a number of good professional hypnosis societies that have

members who are professionally trained in use of no system society for clinical experimental hypnosis s-c-e-h dot u-s the American society of clinical hypnosis a s-c-h dot n-e-t is an international society of hypnosis for you listeners who are elsewhere there are good textbooks on hypnosis we've

written one of them called transcend treatment my light father and that's available there are other good apps there's one leaf which is a French app that the French government has invested in that has excellent recordings to help people use hypnosis there's one called nirva out of

Australia that helps people irritable bowel syndrome and hypnosis can be very effective for that as well so there are more and more of those apps coming as well that seem to help people manage with hypnosis so it's growing the

list is growing so like dollars and transcend treatment I must ask since you mentioned Bali and I've seen various types of yeah I think what you would consider trans whether that's Sufis spinning or various types of repetitive singing droning do you have any particular longstanding type of

trance that you find most interesting or appealing there's a sociologist book called boiling energy about the use of drumming actually as I kind of trans inducing experience in Africa and there's no question that people use that kind of rhythmic activity as a way of socially connecting and soothing

themselves you know and there's something about being in that rhythm of rate that is usually roughly the rate of heartbeat you know about one a second that helps people and that's why people like to dance and sing and things

like that I think we coordinated social activity that gets the body involved can be very soothing actually and so I think a lot of our healing rituals involve repetitive movement that people find soothing David thank you for what a what a fantastic wide range in conversation this became and is there

anything else you'd like to mention of course people can find reverie at reverie.com or a V R I dot com is there anything else you'd like to mention or point people to it's from the app store and Google play as well as if people have Android phones I would say I think we've talked about the major

uses of it I would love it if people give it a try see it as a first recourse not a last recourse and I'd love to see it integrated better with people's overall health and wellness care I think it's been sort of the Rodney Dangerfield of psychotherapies get no respect yeah he said they asked me to

leave a bar so they could start happy hour you know after having done this my entire career this is a legacy project for me I you know a time will come when I'm not available to keep doing this for people it warms my heart that while we've been talking I've held more people than I used to in

months of person to person clinical activity and I want people to have it as a resource for helping themselves feel better and function better and I think it can so thank you for helping me do that because that's the same kind of thing you're doing with your show and I'm honored to be a part of it my pleasure entirely what fun this is this job on earth as far as I'm concerned and everybody listening we will have links to all things discussed in the

show notes as pre usual at Tim. Blog slash podcast speak all SPI EG EL you can search it there and it'll pop right up and until next time as always just be a little kinder than is necessary to others and to yourself thank you for tuning in hey guys this is Tim again just one more thing before you take off and that is five bullet Friday with you enjoy getting a short email from me every Friday that provides a little fun before the weekend between one and

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