S5 E3: Migraine and hypnotherapy

Migraine and hypnotherapy

Series 5, episode 3

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Transcript

00:00:00 Speaker 1
Welcome to the Heads Up podcast, brought to you by the National Migraine Centre, the only UK charity treating headache and migraine. Visit our website to book your appointment with a world-class headache doctor, wherever you are in the UK. There is no need for a referral. You can refer yourself. Our headache specialist doctors are looking forward to helping you soon.
00:00:34 Dr Katy Munro
Welcome to this episode of Heads Up podcast and we are delighted today to be talking about a kind of therapy that some people may not have tried or may have questions about as to whether it can be helpful. So today we’re talking about migraine and hypnosis and hypnotherapy and I’m delighted to be sharing the podcast with my colleague, Dr Nazeli Manukyan, and Dr Ann Williamson. So welcome to both of you. Ann, would you like to just tell us a little bit about your background and how you got involved in hypnotherapy?
00:01:09 Dr Ann Williamson
Right, yes. I was a GP for 32 years and way back in the late 80s I was getting very frustrated by having large numbers of emotionally distressed patients and nothing to offer them. All they had was Valium in those days and no counselling input at all. It just wasn’t available. If you’re psychotic or suicidally depressed, then you can access help, but otherwise nothing. So, I decided I’d go and my interest was piqued by a series of three lectures on hypnosis at a local hospital. So, I went along to that and started to use simple techniques with my patients and they really appreciated it. So, I went and trained properly with The British Society of Medical and Dental Hypnosis as it was then. That’s how it started. I then went and did various other trainings in NLP and brief solution-focused therapy, in metaphor and patterns and various approaches. And now that I’ve retired from general practice, I tend to train others and do the odd paper and talk and see the occasional patient.
00:02:34 Dr Katy Munro
So it’s turned into your passion.
00:02:37 Dr Ann Williamson
Certainly did.
00:02:39 Dr Katy Munro
NLP for people who are listening is neuro-linguistic programming, isn’t it?
00:02:44 Dr Ann Williamson
It is. It’s an approach that looked at why certain therapists were being effective and tried to break down actually what was happening in the interaction. I think the thing with hypnosis is that it seems to be… We don’t really know what’s going on in our brains a lot of the time and hypnosis seems to be an altered state that one can enter by focusing attention on where your outer awareness lessens and you become more deeply focused internally and the usefulness about this is that you can teach someone to get this into this state and then they can go away and do it for themselves. So as a GP, it appealed to me tremendously that I wasn’t creating dependency, I was giving people a tool that they could go away and use.
00:03:52 Dr Katy Munro
So, it really is a form of self-management.
00:03:57 Dr Ann Williamson
Definitely.
00:03:58 Dr Katy Munro
For all sorts of situations, and I think there’s been a lot of misunderstanding about hypnosis and hypnotherapy, hasn’t there, with the sort of circus trick types, stage hypnotherapy and people quite often scared about it?
00:04:14 Dr Ann Williamson
Yeah, control issues are always the biggest issue and really, it’s a question of the person taking control because you as the hypnotist or the hypnotherapist are merely directing them, they have to follow the directions. It’s a bit like I’m the satnav and they’re the driver. Or I’m the piano teacher and I can show them what to play on the piano, but they have to actually do it to play the tune. And people have a varying amount of ability to go in. It’s a being stage rather than a doing state. There’s certain kind of parallels with meditation and meditative states. But it’s very much to do with focus of attention and imagination. And I think the person doing is going to be much more in control. If you think of someone who’s highly anxious or having a panic attack, they’re very far from being in control, whereas if they have the tool of self-hypnosis and various hypnotic techniques that you can use, they actually can take that control. It gives them emotional regulation, which is really useful.
00:05:37 Dr Katy Munro
So, there’s no way that this is a mind control thing from somebody outside of the person making them do things. So going back to your satnav image, you couldn’t make somebody drive the wrong way down a one-way street or do anything dangerous.
00:05:54 Dr Ann Williamson
No, but bear in mind that our minds are the most powerful tool that we have and things that can be used for good can also be used for ill. So, there’s parallels with brainwashing techniques as well. Because when you’re in a hypnotic state, you’re much more open to suggestion and you’re much more likely to act on the suggestions that you make internally to yourself as well as from external sources. So that’s one of the main reasons for using hypnosis. It is the ability to actually take on board helpful suggestions that can move you forward. The other thing is that it gives you greater access to things that we normally think of as unconscious processes, things like inflammatory response or immune functioning.
There’s been quite a lot of work done with hypnosis. Well, the imagery that you use in hypnosis can alter these things. Because the thing with hypnosis is it isn’t a therapy in itself. It’s what you do with it. It’s the vehicle, if you like. It’s a bit like the syringe that delivers the medicine. What you use with it, it could be cognitive behavioural approaches, it could be guided imagery, it could be all sorts of different things that you can use, and it seems to facilitate them. It means that therapy is often a lot quicker than you might expect so it’s a really useful tool. I think everyone should be taught how to do self-hypnosis and how to be able to utilise imagery to kind of get rid if you like or put to one side things that emotions and thoughts that they don’t want, and to be able to focus on things that they do want.
00:08:03 Dr Katy Munro
Naz?
00:08:06 Dr Nazeli Manukyan
Maybe it will help to understand better the actual process, what it involves, whether it’s self-hypnosis or it’s conducted by a specialist, what is actually involved in the process?
00:08:20 Dr Ann Williamson
I mean, all hypnosis is self-hypnosis, from what I was saying. But it’s usually easier with someone directing you. Normally If I’m seeing a patient for hypnosis, I’ll explain about hypnosis to the patient. I’ll talk about how that you can be in your normal doing state. You’re working on that kind of intellectual reasoning side of your brain, and you can tell yourself not to be afraid or not to be anxious. And it really has very little effect on the emotions because that’s a different form of processing, that’s more right brain processing, if you like. And the way to talk to both parts of the brain, both are kinds of processing, is by using imagery, which is why imagery is so effective. By telling a story, you’re painting a word picture, which is why metaphor and parable have been used by all the greatest teachers in the world throughout time. And recently, the fascinating thing for me, we’ve always known from our experience that using imagery in the hypnotic state really has an effect. But now we’ve got these fMRI scans which are showing that very similar bits of brain light up when you’re imagining doing something as if you were actually doing it. If you’re imagining doing it in hypnosis, whereas if you just think about doing it doesn’t react in the same way. So, there’s increasing evidence that there is a different way of processing when you go into hypnosis, it’s effective.
00:10:15 Dr Katy Munro
We are, aren’t we? We’re learning more about the brain because we have such amazing scans now to be looking at people while they’re undergoing things like hypnosis or acupuncture or when they’re in the middle of a migraine attack. We can see which parts of the brain light up. That’s really useful. But if you’re seeing a patient in your clinic, can you look at them and know that they will be somebody who is willing or able to be hypnotised or is it only once that process and that kind of interaction between you and the subject happens that you get the feeling that they will be?
00:10:51 Dr Ann Williamson
If in a normal clinic situation or a surgery situation, I would need to have good rapport with my patient and know my patient before. There’s got to be trust in any interaction. I think that when patients come along, they have an expectation. They’re hoping that they’re going to be able to do something, or you’re going to be able to help them to do something which will allow them to get better. And of course, some people are not prepared to put the work in. It’s not a magic wand. It’s not a spell that you can say over a patient and then they’ll magically get better. I really wish it were, but no magic wands here, unfortunately. But there is a spread of ability in the population. About 10% are highly hypnotizable and 10% are very poorly hypnotizable. The bulk of us are in the middle. And one of the key things is motivation. If a person is really motivated to get better or to help themselves, then they will very often do it. One of the biggest problems I find with patients doing hypnosis is sometimes they’re so motivated to get better that they try too hard. And it’s the trying and the doing that gets in the way. It’s more a question of allowing and getting into that being. So, I try to get the patient to be curious, to explore and to notice what happens when they do certain things and that kind of approach seems to work.
00:12:39 Dr Katy Munro
So, people may have tried mindfulness meditation, and that’s very much about being in the moment, isn’t it? And not fretting about the past or thinking about the future but being present. Is that similar to hypnosis, or is there an overlap?
00:12:58 Dr Ann Williamson
I’ve done mindfulness training as well, and from a subjective viewpoint, the kind of space I go into if I do a mindfulness breathing meditation is very similar, or the same, but it does seem that there are key differences between mindfulness and hypnosis in that they do activate different parts of our brain function. And that some people who are very good at being in the present moment and being very aware and being very observant without judgement, may find it difficult to switch off to going inside and working with imagery. It is a different thing if you like.
00:13:51 Dr Katy Munro
Yeah, yeah.
00:13:52 Dr Ann Williamson
Subjectively, the states seem similar.
00:13:57 Dr Nazeli Manukyan
Well, there are probably wide therapeutic applications of hypnosis, can be used not only for anxious patients but also certain habits like smoking or nail-biting, treatments of phobias. When I did the course with the British Society of Clinical and Academic Hypnosis, there were lots of dentists who were training to deal with dental phobia as well as a local anaesthesia effect and numbing effect of it.
00:14:36 Dr Ann Williamson
Yeah, anxiety is up there in the uses of hypnosis. Although you don’t have to be relaxed to be in hypnosis, of course. If you think of Olympic athletes, they’re far from relaxed. In the dental field, yes, dental fear is very common, and its extreme end is phobia. You can use hypnosis to help people with fears and phobias, not just by getting them to rehearse doing whatever, you know, having a tooth out or going to the dentist, feeling calm, but who can actually use hypnosis to resolve fears from the past, from previous episodes where they’ve had difficulties, by looking at it in a dissociated way so you’re not actually in it, you’re not re-experiencing it, but you’re seeing it from a distance and you can then work with them in various ways to resolve the fear and then they can help, they can go forward into doing it easily and calmly.
00:15:43 Dr Katy Munro
Were there any conditions where you would not use hypnotherapy? I was exploring it a few years ago when I was a partner and did a short course to understand about it more and I seem to remember that they said it would be not so advisable for people with depression.
00:16:02 Dr Ann Williamson
I think as a general rule, if you’re not used to working with a particular type of patient without hypnosis, you shouldn’t be working with them with hypnosis. If you’re used to working with suicidal depressives, then yes, you can use hypnosis. It’s no different than any other approach with depression. Whereas the suicidal depression starts to lift, they start to get more energy, and they may then actually fulfil some of their suicidal ideation, but it’s no more with hypnosis than it is with any other therapy. So, it’s very much if you’re used to working with that group of patients.
00:16:47 Dr Katy Munro
So, it’s about your own experience as a therapist.
00:16:49 Dr Ann Williamson
Yes, for instance, I certainly wouldn’t work with anyone who is psychotic or had a recent history of active psychosis. But I know that there are certain psychiatrists who are used to working in that field who have used hypnosis in that experience, so it very much depends on the context.
00:17:12 Dr Katy Munro
And are there any age groups that you would avoid? Can you use hypnotherapy in children as well as in adults?
00:17:20 Dr Ann Williamson
Children are rarely out of hypnosis, in their imaginative play. Children are very easy to work with. You just have to have a slightly different, more flexible approach, I think. It’s harder with certain conditions such as autism and dementia and deafness, they all have their own problems that make it more difficult to use hypnosis with. But the great majority of people, you can use hypnosis with.
00:18:02 Dr Nazeli Manukyan
And when do you see the role of hypnosis in migraine patients? We have a variety of patients who have very rare episodic, infrequent migraines. But they still consult us because they want a complete cure, and this anxiety between the attacks is very overwhelming and there are patients who have chronic headaches nearly daily and have lots of other physical co-morbid conditions like fibromyalgia, depression. PTSD, and where would be the role of hypnosis?
00:18:40 Dr Ann Williamson
I think hypnosis can be used in all those situations, but in different ways. I’ve certainly used hypnosis with migraine patients when I was working as a GP. The first thing with any patient that I would work with, with hypnosis, is to teach them self-hypnosis and use of imagery. And I bring them in. We talk about hypnosis. I’d make sure that they weren’t labouring under misconceptions about what it was and what it could do. And then we would explore together different ways of inducing hypnosis, different ways of focusing attention, because the induction of hypnosis, the ritual that you use, whether it’s a progressive muscular relaxation, whether it’s using your breathing, all those kinds of things. It doesn’t really matter what the person uses, one can look at different ways and we all function in different ways. So, one way will suit one person and not another. So, it’s useful to be flexible. What I do like is also to get the patients to make for themselves a calm, safe, relaxing place internally that they can go to recharge their batteries. It could be real, could be imaginary, could be a mixture. Some people have very clear visual imagery, others have less, so some people just have an awareness. It doesn’t really seem to matter. But I do like them to get into their mind, to the back of their minds, some place that they can go to, and they tend to use the same place every time, but they don’t always. And in that place, they can give themselves suggestions. So there are ways you can use imagery to throw away things, such as throwing things down rubbish chutes, throwing a pebble into the sea, putting something on a balloon and sending it into the sky, and then you want to get hold of more positive feelings and those could be another pebble that you squeeze and get a good feeling out of it. It could be writing messages to yourself in the sand. The imagination is there to be used, and people come up with the most amazing imageries. For pain, for migraine, I will sometimes get them to actually go into the headache or headache sufferers anyway. Concentrating, if you like, all that discomfort into a coloured crystal. And I’ll ask them what colour it is and say, you know, when you’re a child, did you have a play with crystals where you poured liquid over them and they gradually dissolved? What I’d like you to do is to imagine pouring a warm healing fluid over that crystal and just watch it dissolve. And of course, by doing that, they’re externalising their pain because they’re imagining it as a crystal, and then they’re seeing it dissolve, and people can use their own imagery as well. I might use that as an example.
Then I’ll say we go into where the difficulty is, the pain is, the discomfort is in your head. What kind of image comes to your mind? If you were to paint me a picture or make me a model of it, what would it look like? Would it be a colour? Would it have a temperature? Would it be moving? Would it be a shape? And, you know, people can talk in hypnosis so they can tell you and then I say, OK, if there was one thing you could start to do that might make it feel easier, what would that be? And you just let them start to make it easier internally. And then of course you’ve got the suggestion that if, as you feel more comfortable now in hypnosis, you can keep that comfort when you come out of hypnosis. And that’s called a post-hypnotic suggestion, which is a suggestion given in hypnosis that is active afterwards.
So, I’ll use that with pretty much all my kind of migraine-type patients. Those who are complex. you will often need a lot longer. Because you may have past trauma, PTSD, you may have to get them stable before you can even start to be looking at those kinds of issues. I remember one lady I saw who had really bad migraine and she was on lots of medications. She had been for a long while, really wasn’t helping terribly well. And she was very good at doing her self-hypnosis and she used an imagined, cool helmet that she put on her head, and she found that that was really useful. And one of the things that we did with her was get her to look back at the time when her first migraine was triggered or to whatever was relevant in her past to the development of her migraines. And it was when she was coming back from the baby clinic having been told that her child was profoundly deaf. And she was absolutely devastated and that was when she started with the migraine. So, we kind of did some work around the feelings of loss and feelings of anger. Her daughter by the time I was working with her was grown up and a lovely woman, you know, so she didn’t need those awful feelings that she had back then, that she’d suppressed and held and were kind of responsible for a large amount of the migraine problem. She didn’t get rid of the migraines completely, but they certainly reduced both in intensity and in frequency. So yeah, that was really quite good.
00:25:11 Dr Katy Munro
So, when you say you might need longer with somebody who’s more complex, do you mean that you might need a longer session, or you might need more sessions?
00:25:19 Dr Ann Williamson
More sessions, yeah.
00:25:20 Dr Katy Munro
Is there kind of an average, for the listeners of the podcast, if they were deciding to try hypnotherapy? I’m guessing that most people would need to go more than once.
00:25:32 Dr Ann Williamson
Yeah, my normal pattern I suppose would be to have three sessions. First session I would be teaching self-hypnosis and use of imagery. Second session, see how they were getting on with that and then maybe if there was something else that needed to be addressed. And have a third session in case something came up. But sometimes people who’ve had really difficult backgrounds, really difficult pasts, need a lot, lot longer. I mean, I very rarely in my work as a GP saw people for more than six sessions. But I had one or two patients that I saw for years on end, more in a supportive psychotherapy role, so you can’t generalise too much. It’s very much dependent on the person. But I think with my general practice patients, I probably spent less time because I already knew them as their doctor. Whereas a private patient, I might need a full session to really catch up and get to know them.
00:26:48 Dr Katy Munro
To get to know the background. Yeah. So before we started recording, I was saying that I’d done a short course and found that it was difficult to get that into a GP normal surgery, but you were saying that it doesn’t need to be a long session sometimes and I think that’s more about the way we phrase things, isn’t it? An average session where you’re seeing people now would be what about an hour or hour and a half?
00:27:15 Dr Ann Williamson
An hour. When I was working as a GP I had five to ten minute appointments with my patients, so it was quite difficult. It’s very amenable to groups, so I used to have a group session, and I would teach maybe half a dozen patients self-hypnosis and use of imagery. And then I would bring them back individually. for a ten minute or maybe a double appointment, a whole twenty minutes, to see what we could do. And not so much with migraine, but certainly with anxiety and depression I have used what I’d call drip feed psychotherapy where we’ve made a contract, I’ll see them every week or every two weeks for so long and they come in for their five or ten minutes and we’re very targeted in what we’re doing and they go home with some homework to do.
And the patient has got to be motivated, but it can work very well. Mostly I think it’s more seeing them for half an hour at the end of surgery as a one to one after you’ve done the groups. That’s how I would have done it.
00:28:37 Dr Katy Munro
Yeah, that’s how I managed to do it a little bit.
00:28:41 Dr Nazeli Manukyan
And can we talk about the concept of hypnotic language? And we’ve had on NLP and use of metaphors and analogies, I hear you use lots of musical analogies, like a pianist or the cadences at the end of sentences. Can we talk a bit more about it?
00:29:02 Dr Ann Williamson
Of the people that we train in hypnosis, I think the majority do not use formal sessional hypnosis, they use it informally in how they approach people. Initially people tend to use a lot of negative language. I’ve had various blood tests recently and a number of nurses who say just a sharp scratch instead of, you know, hold still or squeeze my other hand really tight while I take some blood. You know, you don’t notice it. Using words like pain, really, something like painkillers. Take that as an example. Why do we say painkillers? Because we’re focusing on pain. Why not medicine that’ll keep you comfortable? You know, migraine is quite an emotive word in itself rather than headache, but these labels give validity to the symptoms sometimes, which is a shame because a symptom is a symptom and has to be worked with but using metaphors and metaphorical language is a really useful way of getting someone to understand things that you want to get through to them.
00:30:33 Dr Katy Munro
Do you want to give us an example of a metaphor that might be helpful?
00:30:39 Dr Ann Williamson
You put me on the spot. My mind’s gone blank.
00:30:44 Dr Katy Munro
I was going to say, while you’re thinking about that, I had a real example recently about the use of language and how unhelpful it can be and how we’re sometimes programmed ourselves to say unhelpful things to ourselves. So, I have a friend who had some really bad back pain. He had a scan, I think it was a scan rather than X-ray and was told that it was about the kind of appearance that they would expect for somebody of his age. But he interpreted that as his back is crumbling and he told his wife that his back was crumbling. Now, to me that was shocking, because that means that he’s going to likely stop moving, which is the worst thing he could do.
00:31:26 Dr Ann Williamson
Absolutely.
00:31:27 Dr Katy Munro
I’m really interested in this concept of how we phrase things because I think as doctors, we’re very guilty sometimes of giving that kind of negative “Well, you know, it only helps a few people.” I mean, it probably would, if he’s telling people things won’t work, they’re not going to work, so.
00:31:42 Dr Ann Williamson
I think putting side effect leaflets in tablets was one of the worst moves we’ve ever made. Because people will take on and people who are very anxious and who are in shock are much more suggestible. They’re in a hypnotic-type state already. So, you know the language that people use is really key.
I’m just thinking, metaphors. One of the ones I do like is that pain is a message sometimes. But it doesn’t need to shout unless you’re not paying attention. It can whisper. The things that we say to ourselves can be really powerful. I had a chap who had a head and neck pain following a road traffic accident and this was some years after he’d had it. And he’d been investigated and there was nothing, no particular reason why he should be getting this kind of continual pain, and we looked at it in hypnosis and he looked down at himself in the car crash, where he was trapped in the car for some considerable time. And he realised that he’d said to himself, well, my head’s hurting, I must be alive. As soon as he realised that ,“So I don’t need to have a headache, do I? I know I’m alive.” But our unconscious parts of our minds don’t always take on board time, and what happened in the past can be very present.
00:33:29 Dr Katy Munro
We’ve had a couple of other examples in migraine clinic. I’m certainly aware of a couple of patients who said to me, “Well, I was given this medication, but the doctor said, oh, it’s really, really strong. Don’t take it unless it’s absolutely necessary.” And then they’re just either too fearful to take it or take it and then have side effects because they’re programmed to think that it’s incredibly strong. Normally this is something that we use as standard. And the other thing which I think is a message that has been given to a number of my patients is, “Oh, well, you’ve tried everything. There’s nothing more we can do.” And so, we really do have to be careful about the messages we give as doctors, all the messages we give ourselves. “I’m never going to get better and there’s nothing I can do. I’m just going to be like this all the time.”
00:34:18 Dr Ann Williamson
Yes.
00:34:20 Dr Nazeli Manukyan
Another message is when they have an MRI scan and then consultant reports us, it’s all normal. So, you have just migraine. When they have a quite disabling lifelong condition and they won’t just resolve.
00:34:37 Dr Katy Munro
Yeah, that almost feels dismissive, doesn’t it? Oh, it’s normal. It’s just migraine. It’s nothing. There’s nothing much wrong with you. And. And of course, people are still in a lot of pain. Sometimes on a number of days.
00:34:51 Dr Ann Williamson
Yeah, I mean this is the problem with functional disorders. It’s a software rather than a hardware problem.
00:34:58 Dr Katy Munro
Yeah.
00:34:59 Dr Ann Williamson
I like computer metaphors, actually. When people, especially if people are, say, highly anxious and they’re running their anxiety programme on their desktop and I’ll ask them to minimise that and to click on this, their self-hypnosis calm programme. And then, you know, they can choose which one they want to run.
00:35:26 Dr Katy Munro
Again, that’s putting the person back in control and what feels right to them at that time, if somebody’s going into self-hypnosis themselves at home, if they’ve learned the techniques, what sort of time are they going to set aside to be in that sort of state?
00:35:44 Dr Ann Williamson
I would ask my patients if they’re wanting hypnosis to work for them, for the first three or four weeks they probably need to do it every day or every other day, for five-ten minutes. OK, ten minutes, fifteen minutes. I mean, there’s no set time. But it’s like any other thing that you do. If you’re wanting to be good at something, you have to practise, and it’s training. Once someone has trained in self-hypnosis, they don’t really need to do any lengthy induction, they’ll just set the intention, take a deep breath, close their eyes and go.
This is why it’s actually quite quick in. When I used to work in general practice with patients and use hypnosis. I’d teach them self-hypnosis; they’d come in and they put themselves into hypnosis within seconds. And then we could work and then so it can be very quick. It’s nice to do a nice, gentle ten–fifteen-minute relaxation and guided imagery, but it’s not absolutely essential.
00:37:03 Dr Nazeli Manukyan
And you also talked about how calming and relaxing for the practitioner when they are with patients.
00:37:10 Dr Ann Williamson
Yes, because you go into an altered state as well when you’re leading someone into hypnosis. People used to think I was crazy because I’d used to commonly do my kind of half-hour hypnosis session at the end of a busy Wednesday evening, having worked all day. “Oh, why are you doing it then?” But actually, it’s the best time because I’ll be teaching someone. And as I’m talking, I’m doing it as well. You don’t go internal into the imagery, but yeah, you get the physical relaxation. And we do as clinicians, we tend to go and focus on the clinical relaxation because most of our patients are anxious and tense. So, we want to give them something to calm them down.
00:37:59 Dr Nazeli Manukyan
It’s also quite creative when you come up with certain script or deal with them, work with some image and just describe various things to the clients.
00:38:13 Dr Katy Munro
So, quite restorative for the person leading the hypnosis session as well as the person having it, actually.
00:38:19 Dr Ann Williamson
It can be and I think scripts have a part when you’re learning, when you’re training in hypnosis, and they can give you a bit of confidence. But I think that the sooner a practitioner can move away from a script to more free-flowing and it’s very much determined by the feedback you’re getting all the time from your patient. If you’re reading a script, it’s very difficult to actually really observe your patient at the same time. And it’s important that you notice if the patient’s getting a bit tense rather than relaxed or is really going with it or swallowing. And then you can emphasise that and help them on their way to being in that state.
00:39:19 Dr Katy Munro
With most of the things that we do with patients, we have to tell them about the benefits, but also the possible side effects or harms. Are there any things that you have to say to patients or clients that might be something to watch out for?
00:39:35 Dr Ann Williamson
I will usually suggest that if someone is trained in self-hypnosis, they don’t go to stage shows because stage hypnotists are very good at getting on board on the stage those people who are good at doing hypnosis, and for whatever reason are wanting to take part, but also the people in the audience may well be affected. So, I think that is a downside, if you like. One of the downsides of being a good hypnotic subject is that you are more likely to get chronic pain. It’s the problem and the solution, if you like.
00:40:13 Dr Katy Munro
Oh, why is that then?
00:40:15 Dr Ann Williamson
Because you’re more able to attend to it, I think.
00:40:20 Dr Ann Williamson
It’s probably not something that’s important here, but when you do cold pressor tests and you put a hand into really icy cold water, if you’re a good hypnotic subject, it’s absolutely excruciating. You can’t keep it in for more than a few seconds. But you’re then able to use imagery and say, numb your hand, and then you can keep it in as long as you, you know, any time. And people with PTSD tend to be good hypnotic subjects as well. So, it’s just the way that our brains are and I think hypnosis doesn’t have any side effects. I think the side effects are maybe inexpert practitioners giving incorrect suggestions and the person acting on them. Which is why I think it’s really important that you know the type of patient that you’re working with.
00:41:30 Dr Katy Munro
So, going on from that, how does somebody who wants to explore hypnotherapy for themselves go about finding a reputable or experienced practitioner? Are there governing bodies?
00:41:44 Dr Ann Williamson
No, there’s no statutory regulation in this country at all. The British Society that Nazeli mentioned, The British Society of Clinical and Academic Hypnosis, is the only hypnosis society in the UK or in England that is exclusively for health professionals. But of course, most of our members are busy health professionals and don’t have time to see private patients, so there’s not a huge number of people on our referral list. But for the general public, what you really need to get is someone who has got some psychological background. So, some counselling diplomas, some counselling training, some kind of background that indicates that they have something more than just hypnosis training.
00:42:45 Dr Katy Munro
But most people who are hypnotherapists also have done NLP training. Would that be something that they often do, or would it be worth looking to see if they’ve had that training too?
00:42:57 Dr Ann Williamson
Well, NLP was borne out of hypnosis and family therapy, Gestalt, but I think it’s more important that the practitioners have had some counselling background.
00:43:11 Dr Katy Munro
That’s very interesting.
00:43:14 Dr Nazeli Manukyan
We have lots of not only migraine patients, but clinicians listening to our podcast. So, what are the training opportunities for healthcare professionals?
00:43:25 Dr Ann Williamson
Well, at the moment we’re running training online since the pandemic started. And we didn’t think it was going to work, but actually it does. Surprisingly. So, there is online training and there’s also training in various places around the country such as York, London, Edinburgh, where they do six-days training in three weekends. They can be done online as well. So the thing to do is to go on the website, which I think you’ll probably post that – www.bscah.com – and look at the training and events. There’s two modules run each year, so then three I think can run around the country, so four or five a year opportunities to train. And the anaesthetists are actually putting on a training course, I think, from either the Royal College of Anaesthetists or the AAGBI. There’s a lot of training that isn’t specific for health professionals and I’m not in a position to say whether that’s good or bad. I haven’t experienced their trainings. Come and train with us if you’re passionate – trained by health professionals for health professionals.
00:45:08 Dr Nazeli Manukyan
Yeah, it should be good for also self-development and self-hypnosis.
00:45:13 Dr Ann Williamson
Oh, definitely.
00:45:14 Dr Nazeli Manukyan
Communication skills and using some NLP tips.
00:45:23 Dr Ann Williamson
There’s a lot of NLP in the training because it partly developed from hypnosis anyway, so there are a lot of crossovers. And there are a lot of crossovers between different approaches between brief therapy and active therapy and all sorts of different approaches, so this is just a way in. Remember that hypnosis isn’t a therapy in itself. It’s what you do with hypnosis that’s the therapy. But it does give the patient a tool that they can actually utilise and that gives them more access to their unconscious processing. It’s very useful in that respect.
00:46:05 Dr Katy Munro
So, Ann and Naz, are there any other things that we haven’t mentioned that you’d like to flag up before we leave this episode?
00:46:15 Dr Nazeli Manukyan
Maybe use of hypnosis in some other physical conditions or functional disorders like fibromyalgia, IBS, chronic pain.
00:46:24 Dr Ann Williamson
Yeah. And certainly, it’s been used a lot with IBS. Peter Whorwell in Manchester’s done a huge amount of work there. Again, I’ve used it with IBS. Three sessions and it’s usually pretty well effective. Not with everybody, but nothing’s effective with everybody. The same kind of idea, you can teach hypnosis, use imagery, and look at if there are any underlying drivers, any things from the past that are pushing it forward. And especially with fibromyalgia, I found that in my experience that a lot of people with fibromyalgia find it difficult to express emotion of various sorts. They’re holding the emotions from maybe all sorts of difficult life situations that they’ve experienced. They hold things within their body rather than letting it out. And I think one of the first things one has to do there is let them realise that actually the dam isn’t going to burst, and they won’t get overwhelmed because that’s one of their biggest fears that you can find the sluice gates. And some of the sluice gates are in using hypnosis and in using hypnotic imagery. And then you need to work on the grief or the loss or the trauma that they did experience in the past, and to resolve it.
00:47:59 Dr Katy Munro
That’s really interesting. I was going to say I’ve read a book recently called The Painful Truth by Monty Lyman and he talks a bit about the use of hypnosis and hypnotherapy in IBS and that I’d recommend that to anybody who’s interested in pain in general and how our brain is kind of a predictive organ that tells us what we’re going to feel. And how I was saying to patients, you know, the brain is all joined up. There isn’t a section that’s pain, a section that’s anxiety and a section that’s depression. It’s all one thing and the interaction I think is really fascinating.
00:48:42 Dr Ann Williamson
Yeah, I think we’ve moved on from the idea of the pain is an on/off switch. One thing I was going to say, I think Nazeli mentioned smoking and nail-biting. Weight loss is the other one people talk about with hypnosis and all those things I think hypnosis can play a part but you’ve got to have it as part of the whole package, so it’s a kind of behavioural package with hypnosis added in if you like. And I think that quite often these kinds of ideas that with smoking and nail biting and weight loss you can have hypnosis and then it’ll suddenly, magically disappear. It doesn’t. You’ve got to help with the habit. It’s a question of using hypnosis to focus on the goal that you want, which helps to motivate you to break the habit and breaking the patterns because all our behaviour is patterned.
00:50:02 Dr Katy Munro
So not the magic wand, we discourage people from that, but a very useful tool in in a range of strategies to dealing with all these conditions that we’ve talked about.
00:50:19
You’ve been listening to the Heads Up podcast. If you want more information or have any comments, e-mail us on info@nationalmigrainecentre.org.uk . Till next time.