Image: ABC. By Bianca Nogrady.

Hypnosis may well conjure images of black-clad, eyeliner-embossed performers convincing seemingly innocent people to perform cringe-worthy acts.

But there’s more to hypnosis — or more specifically, medical hypnotherapy — than mere showmanship.

Clinical hypnotherapy is a combination of hypnosis and a psychological treatment. It involves getting you into a relaxed state where the therapist can communicate with the subconscious part of your mind and make suggestions relevant to your symptoms, says clinical hypnotherapist Simone Peters.

“For example, if somebody has diarrhoea-predominant irritable bowel syndrome, you might get them to imagine that their gastrointestinal tract is being represented by the flow of a river, and that they need to slow the flow of the river down in order to control the bowel movements,” said Ms Peters, PhD candidate at Monash University and therapist at Melbourne’s Shepherd Works clinic, which focuses on the treatment of people with gastro-intestinal conditions.

“Or with bloating, it’s this idea of blowing up a balloon and letting the pressure from the balloon go, or getting them to put their hands on their abdomen and imagine that soothing the gut.”

Online, there is no shortage of people who say it has helped them quit smoking or lose weight, or helped them manage medical conditions such as depression.

So is there any evidence to support these anecdotes and which conditions, if any, is hypnotherapy most effective in treating?

Irritable bowel syndrome

Perhaps the clearest evidence for a benefit from hypnotherapy is for irritable bowel syndrome (IBS), a condition that affects as many as one in five Australians.

People with IBS experience some pretty unpleasant digestive symptoms — abdominal pain, bloating, diarrhoea and constipation — that can have a significant impact on their quality of life.

Sometimes these symptoms go away by themselves, without treatment, but for some people, the symptoms are severe and no treatment — including the gold standard approach of the FODMAP diet — brings relief.

Several studies, including one from Australia, now point to hypnotherapy as a way to bring significant and lasting relief from symptoms, especially for those people who haven’t responded to other treatments.

Another Dutch study in children with abdominal pain and irritable bowel syndrome showed that 68 per cent of those treated with six sessions of medical hypnotherapy over three months were still in remission after at least four years, compared to 20 per cent of the group treated with standard medical treatment.

Ms Peters said a study at The Alfred hospital in Melbourne had shown similar results.

“They don’t just walk out of the first session and find that they’re completely symptom free; it usually takes a number of sessions, but after about four to six sessions they start to show improvement.”

Adolescent health specialist Professor Susan Sawyer says we do not quite understand how hypnotherapy works in irritable bowel syndrome, but the evidence shows it works better than any other form of conventional therapy for severe, intractable symptoms.

“If we think firstly about what is hypnotherapy, how does it work, it is defined as the ability to focus narrowly, intensify ones’ concentration and perception, while, if you like, you’re reciprocally diminishing awareness of all other stimuli,” Professor Sawyer said.

“During that focused state, therapeutic suggestions can be more readily accepted and incorporated into the subconscious mind with the individual being able to then modulate some of their physiological processes.”

Professor Sawyer said the process could be changing how people’s minds respond to and process pain, or could even be influencing gut function. It could also help by reducing stress.

If people are considering this hypnotherapy for IBS, they should ask their doctor for a referral to a clinical hypnotherapist with experience in treating IBS, and who is registered with organisations such as the Australian Society of Hypnotherapists.

Other studies have found that medical hypnotherapy can help relieve the nausea and vomiting associated with chemotherapy treatment, particularly in children.

Pain

There is also growing evidence that hypnotherapy can help you manage pain both chronic and acute.

Studies suggest that it may be more effective than other psychological treatments, such as supportive counselling, cognitive behavioural therapy alone, physical therapy or educational programs for cancer pain, low-back pain, arthritis pain and other chronic pain conditions.

There is some suggestion that hypnosis can reduce pain and distress when used in conjunction with sedation (hypnosedation), or before a general anaesthetic is given.

At this stage there are relatively few studies on this.

Quitting smoking

Many people quitting smoking turn to hypnotherapy to help them beat their addiction. But unfortunately, here the evidence isn’t quite as strong.

A 2010 Cochrane review of studies of hypnotherapy for smoking cessation failed to show that hypnotherapy was any better than any other quit smoking interventions, or even no treatments at all.

So it’s difficult to make a blanket statement for or against hypnotherapy as a quit smoking aid because the programs are all so different, says QUIT Victoria director Dr Sarah White.

“All programs are not created equal, and it could be some of those programs contain elements of motivational interviewing or coaching, so it could be that which has an effect,” says White.

Some people also struggle to break the routines associated with smoking, White says.

“For some people, hypnotherapy might help them change that routine because it’s making them more aware that they get up and have a cigarette, but there’s no solid evidence of this.”

Weight loss

The few studies that have looked at the use of hypnosis for weight loss show that it only achieves a slight weight loss.

The advice from US-based Mayo Clinic is that hypnosis alone is unlikely to achieve significant weight loss.

Childbirth

Another area where hypnotherapy may show benefit is in helping women during childbirth.

A 2012 Cochrane review of seven studies of hypnotherapy in childbirth concluded that while the results across these studies were mixed, there was suggestion of benefits.

For example, some studies showed women who underwent hypnosis had a lower intensity of pain, shorter labour and shorter hospital stays compared to women who did not undergo hypnosis.

But on the question of whether hypnosis led to less pain medication being used, or a greater likelihood of a vaginal birth, the studies were too mixed to deliver a clear answer.

Depression

What about psychological problems? After all, if hypnotherapy is a psychological process, shouldn’t it be effective for the treatment of conditions such as depression?

According to Beyond Blue, there is not a whole lot of good clinical trial evidence examining the effectiveness of hypnotherapy for depression.

One study that combined hypnotherapy with another well-known therapeutic approach called cognitive behavioural therapy (CBT) suggested that the combination might be more effective than CBT by itself, but the size of the effect was not huge.