I offer you three operating definitions for this series as we begin the second article into understanding hypnotherapy and the placebo effect and response.

1. Hypnotherapy is a relationship between two people where one person focuses all of their attention toward making actual and lasting shifts and changes within another person toward or away from various experiences at the request of the person needing help.

2. Hypnosis can be defined as an event whereby one person bypassing the critical factor of the mind of another creating a sense of trust and expectancy.

3. The placebo effect is the expectation of improvement actually changing outcome. The placebo effect is the therapeutic effect of hope aroused by partaking in a specific therapy, process or treatment. Hope has been defined in psychological literature as the perceived possibility of achieving a goal. (Stotland 1969) The placebo effect is measurable by comparing bogus therapy with actual therapy, bogus drugs (inert pills) compared to real drugs.

Someone who suffers from chronic fatigue who undergoes therapy that might reasonably be expected to help the person will have a built in placebo effect as the person watches an occasional improvement and then the body responds favorably to the improvement which could be both a combination of therapy and placebo effect.

The placebo effect, hopefully, is an important part of hypnotherapy, much like the response of various drugs by people is partially the placebo response. However, the placebo effect is not equal to hypnotherapy though it is sometimes the same as hypnosis.

"Physicians have always known that their ability to inspire expectant trust in a patient partially determines the success of treatment." (Persuasion and Healing, Frank, 1993)

We see the doctor as a healer and therefore when he prescribes a medication or course of action we expect that course to work. As we improve the placebo response helps most people improve toward the goal whether a placebo is involved or not. Until the mid-twentieth century, most drugs prescribed by medical doctors were actually toxic and so the entire history of medicine until the last half century is really the study of the power of the placebo effect and response.

Hypnotic procedures favorably affect those bodily systems that are most reactive to psychological inputs- notably, the cardiovascular, gastrointestinal, and respiratory systems and the skin (Crasilneck and Hall 1985). The well-authenticated hypnotic cure of warts is particularly noteworthy because warts are caused by identifiable viruses. Apparently hypnotic suggestion can induce immunological changes in the skin that combat these viruses. More remarkable is the finding that this procedure can cause warts to disappear on one side of the body only (Sinclair-Gieben and Chalmers 1959). (Persuasion and Healng, Frank, 1993)

Hypnosis is just as effective in removing warts as surgical procedures whether the person has experienced failure in previous treatments or not. Interestingly, you can paint inert dye on warts and tell people that the ingredients in the dye will make the warts go away and that works just as well as hypnosis and surgery also! In these three procedures is an apparently powerful placebo response at work.

The placebo effect can also be seen in it’s reciprocal "nocebo" responses. One kind of nocebo is seen in the patient (who dislikes doctors and traditional helping professionals) who is prescribed medicine to and actually has many side effects to the "medicine" when in fact the person is experiencing side effects to the traditional helper. Many people simply don’t like medicine and do not trust the traditional doctor. There responses are in line with their expectations in many instances. Researchers have found that typical "side effects" to doctors and traditional professionals include nausea, diarrhea, and skin eruptions (Wolf and Pinsky 1954) How powerful is the nocebo response?

In 1992, Dr. Clifford Meadord of the Department of Medicine at Vanderbilt Medical School read an article called Voodoo Death describing how it is possible for people to die a hex or voodoo-like death. I will explain Meadord’s significance to this in a moment. The article was by a physiologist Walter Cannon. There are three components in such a hexing death.

1. The victim and all family and friends must believe that the ability and power of the hexer is genuine and will indeed cause death.

2. All previously known victims of the hexing must have died, unless the hex was removed.

3. Every person known to the victim, including family and friends, must behave toward him as if he will die. This involves leaving him alone and isolated, even by his closest relatives.

Meador published this article and the case of an older white man who was dying from what he believed to be esophageal cancer. Meador was an internist and consulted on the case. The entire story is detailed in Larry Dossey’s (MD) book, Be Careful What You Ask For. What I want to share with you was through this man’s tragic first bout with his life ending, he asked Meador if he could just lived til Christmas. It was summer and his condition was grim. The entire staff, friends and family did everything they could to help the man and he amazingly improved. Dramatically so. He was healthy and you wouldn’t know he had cancer. In January he was re-admitted to the hospital and died within 24 hours. The cancer turned out to be one and only one nodule. It had not spread as had been suspected. A previous liver scan showing cancer was a false positive. The only thing that could be determined was that "...he died thinking he was dying of cancer, a belief shared by his wife, family, his surgeons and me, his internist."

This kind of nocebo response is very powerful indeed. Although you cannot tell someone with metastatic cancer that they can safely go on with their life and ignore treatment, never offer a negative review for a person’s prognosis as a hypnotherapist. Why? Consider the following sampling of studies and papers.

Research in patients being treated for stomach cancer showed that 1/3 of patients who received placebos developed nausea, 1/5 developed vomiting and 1/3 lost hair. Certainly the cancer played a confounding role in nausea and vomiting but in hair loss? (Fielding 1983)

Cases have been reported where patients become addicted to placebos. One extreme in this research showed a patient who took 10,000 placebo’s in one year. (Rhein 1980)

In another study, two thirds of patients receiving a placebo developed evidence of streptomycin toxicity-streptomycin being the antibiotic they believed they were taking- including high and low frequency hearing loss, a known side effect of using aminoglycosides. (Wolf and Pinsky)

Finally, in the Framingham Heart Study, in which thousands of residents of Framingham, Massachusetts have been followed over decades, women aged 45-60 who believed they were likely to suffer a heart attack were 3.7 times more likely to die from coronary conditions than women who didn’t consider themselves particularly coronary prone. (Voelker 1996)

Personality and The Placebo Response

What personality traits of people seem to be threaded to responding well to the placebo effect? Research shows that it is often individuals displaying anxiety, people who can be fddependent on others for help, people who are emotionally reactive, people who are conventional, and people who can accept others in their lives. Some studies have shown that people who tend to be less responsive tend to be isolated and mistrustful. (Lasagna 1954)

In our next article about Hypnotherapy and The placebo and nocebo responses we will look at how to utilize belief and expectancy in the healing process.

• Crasilneck, H.B., and Hall, J.A. 1985. Clinical Hypnosis: Principles and Applications. New York: Grune and Stratton.
• Dossey, Larry. Be Careful What You Pray For..., San Francisco, Harper. 1998
• Fielding, J.W.L. "An Interim Report of a Prospective, Randomized, Controlled Study of Adjuvant Chemotherapy in Operable Gatric Cancer: British Stomach Cancer Group." World Journal of Surgery 7 (1983): 390-99
• Frank, Jerome. Persuasion and Healing. Baltimore, Johns Hopkins, 1993.
• Meador, C.K. "Hex Death: Voodoo Magic or Persuasion?" Southern Medical Journal 85, no. 3 (1992): 244-47
• Rhein, R.W., Jr. "Placebo: Deception or Potent Thearpy?" Medical World News (February 4, 1980), 39-47.
• Sinclair-Gieben, A.H.C. 1959. Treatment of Warts by Hypnosis. Lancet 2:480-82.
• Stotland, E. 1969. The Psychology of Hope. San Francisco: Jossey-Bass
• Voelker, Rebecca. "Nocebos Contribute to a Host of Ills." Journal of the American Medical Association 275 no. 5 (1996): 345-47.
• Wolf, S. and R.H. Pinsky. "Effects of Placebo Administration and Occurrence of Toxic Reactions." Journal of American Medical Association 155, no. 4 (1954) 339-41.