Hypnosis in Academia: Contemporary Challenges in Research, Healthcare and Education 303122874X, 9783031228742

Table of contents :
Preface
Contents
Chapter 1: Hypnosis, Science, and Contemporary Universities: An Introduction
References
Chapter 2: When Hypnosis Becomes a “First-Line” Teaching, the University Wins
2.1 Hypnosis in Healthcare: Four Centuries of Recognition in France
2.1.1 What’s Next?
2.2 Hypnosis in Medical School: A Recent Advance in France
2.3 Hypnosis in the Faculty of Humanities
2.4 Teaching the Therapeutic Relationship at the University: Contributions of Hypnosis
2.5 Conclusions
References
Chapter 3: Hypnosis, University, and Democracy: An Emancipatory Proposal
3.1 Introduction
3.2 Foundations
3.2.1 The CHYS Project
3.2.2 Semiotics and Hypnosis
3.3 Education, Inquiry, and Service
3.3.1 Education, Belonging, and Becoming
3.3.2 Inquiry from the Inside Out
3.3.3 Hypnotherapy and Partnership
3.4 Far Beyond Technique
References
Chapter 4: Liège School of Hypnosis
4.1 Introduction
4.2 Dawn of a University Course
References
Chapter 5: Hypnosis at the Medical Sciences Universities
5.1 Introduction: Historical Accounts
5.2 Hypnosis Groups and Partnerships
5.2.1 Agreements Established Between the UCMSC and Other Universities for the Teaching of Hypnosis and Other Subjects
5.2.2 Foreign Universities in Which UCM-SC Professors Have Taught Basic and Advanced Hypnosis Courses
5.2.3 Cuban Universities in Which UCM-SC Professors Have Taught
5.2.4 Research and Thesis
5.3 The Intramural Work
5.4 Evidence of the Work of Clinical Hypnosis from Our University, Given in the Realization of Events, Publications, and Journalistic Articles
5.5 A Seed Is Sown
5.6 Certainties of Hypnotherapists
5.7 Science and Sensibility
5.8 Of Debts and Adhesions
References
Chapter 6: University and Hypnosis: Some Aspects of a “Win-Win” Situation
6.1 Introduction
6.2 National Expansion and the Development of Hypnotherapy
6.3 The Emergence of Hypnosis at Various University Training Levels
6.3.1 Bachelor
6.3.2 Masters
6.3.3 PhD
6.4 Conferences
6.5 The Relationship Between Hypnosis and the University
6.5.1 How the University Supports: What Does “Hypnosis” Get from the University?
6.5.2 What Does the University Get from Hypnosis?
6.6 The Current Situation
6.7 Conclusion: General Recommendation and Possible Path for Further Development
Appendix
References
Chapter 7: Hypnosis: A Boundary Object on the Edges of Science in Swiss Universities
7.1 Introduction: Placing Hypnosis in a University Context
7.1.1 Into Which Category of Knowledge Should Hypnosis Be Placed?
7.1.2 Delimiting the Concept of Hypnosis in Order to Practise Science
7.1.3 Which Interpretive Framework Should Be Used When Placing Hypnosis in the Context of a University?
7.1.4 What Do We Know About the Influence at Play in a Hypnotic Interaction and Its Effects?
7.1.5 Hypnosis: A Ritual Technique That Produces the Illusion of Power
7.1.6 An Ambiguous, Vague Concept Used by Each Individual According to His Own Expectations
7.1.7 Hypnosis: A Form of Experimental Interaction
7.1.8 Is Hypnosis a Natural Phenomenon or a Codified Experimentation Technique?
7.1.9 Hypnosis: A Boundary Object on the Borders of Science in Swiss Universities
7.2 Circulation of the Boundary Object “Hypnosis” in Swiss Universities
7.2.1 From the Ritual of Exorcism to a Technique for Demonstrating Magnetism
7.2.2 Magnetism and Hypnotism: Instruments of Power and of Professional Identity
7.2.3 Hypnosis: A Boundary Object that Stimulates the Exploration of Non-voluntary Behaviours on the Border Between Neurology and Psychiatry
7.2.4 Hypnosis: A Boundary Object That Stimulates the Exploration of Mental Illnesses on the Borders of Neurology, Psychiatry and Psychotherapy
7.2.5 Hypnosis as a Boundary Object Stimulating the Exploration of the Unconscious Mind on the Borders of Psychology, Parapsychology and Linguistics
7.2.6 Hypnosis as a Boundary Object Stimulating an Exploration of the Human Experience on the Borders of Philosophy of Mind and Religious Science
7.2.7 Hypnosis as a Boundary Object Stimulating the Exploration of Therapeutic Interaction on the Borders of Different Forms of Therapy
7.2.8 Hypnosis as a Boundary Object Stimulating the Exploration of Alternative Practices on the Borders of Academic, Alternative and Popular Medicine
7.2.9 Hypnosis as a Boundary Object Stimulating the Exploration of Pain Therapy
7.2.10 Hypnosis: A Boundary Object Stimulating the Exploration of the Attention Span and Cognitive and Perceptual Performances of Human Subjects
7.3 Hypnosis: A Boundary Object Stimulating the Development of Science at Universities and Institutes of Further Education
References
Chapter 8: Hypnosis and Academia from an Iberian Perspective
8.1 Introduction
8.2 Hypnosis, Psychology, and Academia
8.3 Hypnosis Research During the World Wars
8.4 Hypnosis and Measurement
8.5 The Evolution of State and Non-state Theories
8.6 Hypnosis, Academia, and the Portuguese Reality
8.7 A Future of Hypnosis in Portugal
References
Chapter 9: Clinical Hypnosis in Russia: From Historical Tradition to Modern Education, Research, and Practice
9.1 Introduction: Prehistory
9.2 Two Independent Theories of Hypnosis
9.2.1 Pavlovian Theory of Hypnosis
9.2.2 The Theory of Hypnosis by Vladimir Bekhterev
9.3 Hypnosis and Hypnotherapy in Russia in the Soviet and Post-Soviet Periods: Education, Research, and Practice
9.3.1 Hypnotherapy of the First Soviet Period: Education, Research, and Practice (1920–1965)
9.3.2 Hypnotherapy of the Second Soviet Period: Education, Research, and Practice (1966–1991)
9.4 Hypnotherapy of the Third Period: Education, Research, and Practice (1991 to Present)
9.4.1 Education
9.4.2 Researches
9.4.3 Organization of Hypnotherapy Practice
9.5 Conclusion
References
Chapter 10: A Roadmap to Evidence-Based Medical Hypnosis Training in Academia
10.1 Introduction
10.2 The Role of Academia in the Complex Landscape of Hypnosis Training
10.3 Integrating the Basic Science of Hypnosis
10.4 Domains of Application
10.4.1 Designing the Program
10.4.2 Target Populations
10.4.3 Identifying Teachers and Supervisors
10.5 Partnerships
10.6 Conclusion
References
Chapter 11: Professional Practices, University Education, and Research in Hypnosis
11.1 Introduction
11.2 Professional Practices and Organizations
11.2.1 Professional Boards
11.2.2 Professional Associations
11.2.3 Professionalization and Dissemination of Hypnosis/Hypnotherapy Activity
11.2.4 Hypnosis in the National Policy of Integrative and Complementary Practices (PNPIC)
11.3 University Education and Research in Hypnosis: The University of São Paulo Case
11.4 Final Remarks
References
Chapter 12: A Law Regularizing Hypnosis and the Role of Academia in Teaching and Promoting Hypnosis
12.1 Introduction
12.2 The Israeli Law of Hypnosis (Law No. 1120)
12.2.1 Hypnosis Studies and Licensing
12.2.2 Receiving a License to Practice Hypnosis
12.3 The Role of the Israeli Academia in the Research, Teaching, and Promoting of Hypnosis
12.3.1 Hypnosis Teaching During Medical and Dental Studies: The Case of Tel Aviv University
12.3.2 Demonstrative Cases Treated at the Clinic of Oral Psychophysiology (Including Student Participation)
Unidentified Trauma
Father’s Teeth
Needle Phobia
Extreme Gag Reflex
12.3.3 Selected Research in Hypnosis Performed by the Israeli Academia
12.4 Conclusion
References
Index

Citation preview

Maurício S. Neubern Antoine Bioy   Editors

Hypnosis in Academia Contemporary Challenges in Research, Healthcare and Education Preface by Dr. Roxanna Erickson-Klein

Hypnosis in Academia

Maurício S. Neubern  •  Antoine Bioy Editors

Hypnosis in Academia Contemporary Challenges in Research, Healthcare and Education

Editors Maurício S. Neubern Institute of Psychology University of Brasília Brasília, Brazil

Antoine Bioy Laboratory of Psychopathology and Process of Change University Paris 8 Paris, France

ISBN 978-3-031-22874-2    ISBN 978-3-031-22875-9 (eBook) https://doi.org/10.1007/978-3-031-22875-9 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface

I am honored to offer opening words for this timely work: Hypnosis in Academia. The theme that unites this volume is appreciation for the centrality of academia in the investigations of hypnosis. Drawn from university programs in ten countries on three continents, this collection illustrates that individual paths of academic development are as varied as individual subjects who present in clinicians’ offices—each having a unique history and particular perspective. It is through our own efforts to learn more about the endeavors of these differing programs that we receive the gifts of wisdom that come through experiences. This collection embraces narratives that entice readers with cultural flavors: history, climate, politics, and key players who have been profoundly impactful. The chapters represent a diverse group of approaches brought together by a common intent to provide a resource to explain and extend uses of therapeutic hypnosis. We encounter the growth edge of learning more about hypnosis—how to study it, how to apply, and how to teach it. Academia—the stewards of higher learning, provides a felt sense commitment to students of today, the leaders of tomorrow. With advancements in technology, we find ourselves on a new platform of study. This work actualizes an opportunity for communication that has evolved in past decades. Geographical distances and language differences now represent much more manageable barriers than they once did. Now we begin the integration of knowledge with the benefit of many voices, a cooperative expression unavailable just a lifetime ago. This international compilation of current academic perspectives was beyond reach even in my own academic studies but offers now a multitude of new ways to bring what is known to the forefront. Milton Erickson, a key individual who impacted the trajectory of modern studies, is a name that serious students of hypnosis will readily recognize. What a momentous opportunity to study with others we now enjoy that was not available during Erickson’s lifetime (1901–1980) possibly even beyond the imagination of those in earlier times. As a daughter of Milton Erickson, I was raised in an exceptional learning environment. My siblings and I were brought up with a clear understanding that higher education was to be a definitive element of each of our futures. While we were given vast freedom to study any field that interested us, investigations and practice of v

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hypnosis was the focus of our parents’ professional undertakings. Their passionate interests were part of our daily lives. Each one of the eight children in our family appreciated, studied, and practiced hypnosis as we chose. Four of us focused our careers in health care within which hypnotic suggestion can and does make its great impact on quality of life. Fascination with trance states occurs in virtually every culture. Paradoxically we know little about the nature of the hypnotic state. While few question that ceremonial elements of hypnotic trancework engender powerful responses, the fundamental definition and process of documentation of trance remains open to debate and speculation. Individually, professionally, and in our communities, we are affected by expectations and biases that we may not even fully recognize. It is now possible to explore ideas with a much broader reach than ever in history. The context of Erickson’s first exposure to hypnosis was stage entertainment; he was so impressed with the power of what he saw that he committed himself to carrying forward this methodology into the hands of healing professionals where it could be further developed to promote health and rehabilitation. Health professionals who integrate hypnosis into their arts typically have learned through experiences with other clinicians. As their skills grow, they learn from the patients they seek to help. Like each one of us, Erickson had strengths and vulnerabilities. Perhaps the most salient of all his attributes was an insatiable curiosity, a deep burning desire to learn. No matter what circumstance, stroke of misfortune or paucity of resources, he consistently turned inward and let the fire of curiosity light the way to healthy adaptation and growth. His own life began in humble circumstances without access to the tremendous reservoir of resources available today. He was born at the start of the twentieth century in a two-room dirt-floor log cabin high on a mountainside that overlooked an arid valley. The remote circumstances was home to a community of miners who used burlap sacks to lug silver ore out of candle-lit tunnels where they chipped away at rock with pick axes. Labor was hard, and day-to-day resources were incredibly sparce; working together was an essential element of survival. His parents, Albert and Clara, were united in their core values of a commitment to hard work and cooperative community bonds. Erickson’s own journey from a remote mountain camp to the University of Wisconsin is fascinating and inspiring. In many ways Erickson found himself challenged, isolated, poorly understood, and unappreciated—so is the journey of many who are driven in their commitment to discover what is not yet known. Individual contributions are influenced by our own experiences and the elements of our own personalities, physical attributes, and circumstances of life. Erickson’s dedication to education and his ambition to contribute to elevate hypnosis from its status as poorly understood entertainment theatrics to a legitimate scientific medical tool reflects his family core values of hard work and participation within the larger community. On an individual level, as well as within society, we all must accept our own limits of knowledge, and the collective limitations. As healing professionals we seek a community from which to continue expansion of our practice skills: colleagues, peers, and other who successfully apply techniques that seem useful. Other professionals provide an identity group from whom one can seek role models or

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trial subjects for learning elusive techniques. Organizations have evolved to link professionals who are committed to advancing their own abilities to tap into hypnotic resources. Local, national, and international organizations seek to share what is known and what is being studied. Even now, at this time, the International Society of Hypnosis is in the process of creating a substantial publication that will serve as a resource for professionals worldwide. That compilation, still in development, like this one, will bring diverse perspectives for readers to read, ponder, and learn from the experiences of others. In his years of study at the university, Erickson became strongly committed to the concept of the central role that academia—higher education and scientific research— must play in the advancement of knowledge. Academia, the network of institutes of higher learning, provides a forum that can now reach around the world to integrate energy, ideas, and efforts from an ever-broadening arena. Science provides a common language and methodology to advance what is known. Among the commitments of which Erickson expressed certainty is a commitment to transparency—to share findings, whether expected or unexpected, whether desired or problematic. The information gleaned from experiential wisdom becomes part of the literature to advance science. Step by step, case by case, information comes together. Each story, each unique experience, ushers along a growing awareness of professional wealth. Learning from individual experiences, from organizational experiences, from cultural experiences all contribute to the foundation for all students. Bolstered by the balance of fascination for human behavior and his own experiences in the application of the unconscious mind to enhance healing, Erickson found his own position in the history of hypnosis. How many more bright, motivated individuals are working to bring forward their own ideas, perspectives, and discoveries? One of my father’s favorite teaching mantras was “Practice, Practice, Practice.” Here, now, and in response to this great contribution to current literature, I propose a related bit of advice: “Communicate, Communicate, Communicate.” As we advance professional knowledge to specialized fields of study, we learn how much more remains to integrated into the sea of knowledge. Amassing of wisdom is not a linear continuum, but rather an infinitely complex constellation of experiences that involve exceptional strengths and troublesome limitations. This exploration of a diversity of approaches and the foundations of research to support what is now known about the topic of hypnosis will help all who seek both basic and advanced written information. This volume expresses strong messages. With the telecommunication resources we now have—reach beyond what is familiar. Appreciate and learn from those in similar and dissimilar circumstances—broaden the understanding of possibilities, to teach, to study, to discover. As we extend our efforts, far and wide, to unite what is known—we do inspire our future directions. Dallas, TX, USA 2022

Roxanna Erickson-Klein https://www.erickson-rossi.com/

Contents

 1 Hypnosis,  Science, and Contemporary Universities: An Introduction����������������������������������������������������������������������������������������    1 Maurício S. Neubern and Antoine Bioy  2 When  Hypnosis Becomes a “First-Line” Teaching, the University Wins����������������������������������������������������������������������������������    7 Antoine Bioy, Pierre Castelnau, and Julien Nizard  3 Hypnosis,  University, and Democracy: An Emancipatory Proposal����������������������������������������������������������������������������������������������������   27 Maurício S. Neubern  4 Liège  School of Hypnosis������������������������������������������������������������������������   53 Marie-Elisabeth Faymonville and Anne-Sophie Nyssen  5 Hypnosis  at the Medical Sciences Universities��������������������������������������   59 Alberto Erconvaldo Cobián Mena, Adolfo Rafael Lambert Delgado, and Frank David Alcalá Ciria  6 University  and Hypnosis: Some Aspects of a “Win-Win” Situation����������������������������������������������������������������������������������������������������   83 Katalin Varga, Éva Bányai, Zoltan Kekecs, and Eniko Kasos  7 Hypnosis:  A Boundary Object on the Edges of Science in Swiss Universities��������������������������������������������������������������������������������  107 Eric Bonvin  8 Hypnosis  and Academia from an Iberian Perspective��������������������������  125 Pedro Rodrigues Ribeiro  9 Clinical  Hypnosis in Russia: From Historical Tradition to Modern Education, Research, and Practice��������������������������������������  143 Rashit Tukaev

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10 A  Roadmap to Evidence-Based Medical Hypnosis Training in Academia����������������������������������������������������������������������������������������������  153 David Ogez and Pierre Rainville 11 Professional  Practices, University Education, and Research in Hypnosis ����������������������������������������������������������������������������������������������  165 Wellington Zangari, Guilherme Rodrigues Raggi Pereira, and Fatima Regina Machado 12 A  Law Regularizing Hypnosis and the Role of Academia in Teaching and Promoting Hypnosis����������������������������������������������������  181 Nir Uziel and Ilana Eli Index������������������������������������������������������������������������������������������������������������������  197

Chapter 1

Hypnosis, Science, and Contemporary Universities: An Introduction Maurício S. Neubern

and Antoine Bioy

Hypnosis, at present, seems to live a moment of great relevance in the international scientific scene. There is a constant interest in research, as can be easily seen in important scientific journals (BMC Anesthesiology, Frontiers, PLOS One, Brain Science, Pain, etc.), in which it is studied on topics such as different types of pain, anxiety, trauma, and depression, not to mention the reflections it promotes in terms of its explanatory models. Medicine, psychology, dentistry, and nursing are the disciplines most directly linked to this, especially in Universities and research centers. The interest about hypnosis in the therapeutic field has also been growing, both in terms of providing more punctual services, such as in university hospitals and health centers, and in the contexts of private practices, such as psychotherapy. Although it is possible to highlight that there are still considerable resistances on the part of professionals and institutions, hypnosis is gaining more and more recognition in scientific and professional communities of different countries, which qualify it as a possible technical resource of its members. This moment of growth seems to have a special character, mainly because of its historical course. After a long period of ostracism, between the beginning and the middle of the twentieth century, in Europe, as well as in North America, important reflections on its historical, clinical, and epistemological levels occurred. Part of these authors (Chertok & Stengers, 1989; Laurence & Perry, 1988; Stengers, 2001) highlighted the difficult path of hypnosis in the face of scientific institutions, recognizing its value as a fundamental theme of reflection on the ways of modern sciences, especially in elusive fields, and difficult to conceptualize, such as human subjectivity. Another group of authors (Erickson & Rossi, 1979; Roustang, 2015; Zeig, 1994) emphasized its applicability in methodological and clinical terms, M. S. Neubern (*) Institute of Psychology, University of Brasília, Brasília, Brazil A. Bioy Laboratory of Psychopathology and Process of Change, University Paris 8, Paris, France © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_1

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M. S. Neubern and A. Bioy

considering it as a relevant therapeutic device and stripped of myths and prejudices that until now were often attributed to it. Both trends, which occurred more than 30  years ago, presented proposals to recognize its relevance, conceiving it with hopes for the future, which placed it in the debate against old resistances, which positioned themselves against its scientific and therapeutic validity. A third group of these authors – that of experimental research – can be highlighted as another trend of great relevance. Above all, due to the evidence-based studies (Jay Lynn et al., 2019), numerous researches on hypnosis currently occupy important scientific journals and make it a topic of interest for researchers from different countries. Although the field is characterized by the absence of consensus on a number of issues (Facco, 2021), the work of such researchers (Hilgard, 1978; Kirsch, 1994; Orne & O’connell, 1967; Spanos et  al., 1983; Spiegel & Spiegel, 2004) has been fundamental to demonstrate the effectiveness of hypnosis, so that hardly, at present, any research can oppose it. Nevertheless, the current scenario allows one to question whether a different future has arrived, whether it is still far from a fuller recognition or, at least, on its way. It is in this sense that the proposal of this book is inserted, highlighting how hypnosis has entered a commonly conservative space such as universities and contributed to raise it to a broader condition of acceptance, in the scientific community, among students and also among researchers and users of services. Therefore, different axes of analysis are developed from articles by researchers from universities in different countries, on at least four continents. A first axis highlights a historical aspect of hypnosis in its institutions, pointing to a progressive character of space achievements and elements of innovation, as highlighted in the experience of Liège, Moscow, and Lisbon. In these chapters, there is a resumption of their historical influences, with narratives that justify certain trends and contextualize current interests, such as research with virtual reality, highlighted by Faymonville and Nyssen; the interest in hypnotherapy in Russia, raised by Tukaev; and the experimental research, discussed by Ribeiro. In such works, it is possible to conceive how hypnosis, over time, comes to occupy spaces with university hospitals, different research groups, graduate programs, and, as raised by Faymonville and Nyssen, even higher councils of their university, concerned with the publication, with the Belgian Society, of relevant information on the subject. Pedro Ribeiro, in Lisbon, highlights the historical dispute between trends between state and non-state and how the support of experimental sciences favored more solid conceptions about hypnosis in the Iberian Peninsula. Another axis of reflection brought by the articles is the dialogue of hypnosis linked to other knowledge of society, as highlighted by the Universities of Brasilia, with Neubern, and Lausanne, with Bonvin. In both chapters, there is the theme of other knowledge, which refers to an ancient and controversial problem linked to hypnosis: freedom. From the quarrels involving Mesmer (Chertok & Stengers, 1989) to more recent situations, the question constantly arises about the possibility that someone may or may not use hypnosis so that another person commits acts contrary to his will. This discussion can also extend to other issues such as the life

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sciences, especially at a time when neuroscience is in the focus of the public and scientific interest, as Bonvin proposes, and democracy itself, as Neubern proposes. Eric Bonvin, conceiving hypnosis as a boundary object, places it at the intersection of different disciplines, such as psychology, psychiatry, philosophy, history, spirituality, medicine, and popular knowledge. Unlike his Portuguese colleague, Pedro Ribeiro, whose idea is to search for clearer concepts for hypnosis, based on experimental sciences, Bonvin situates it as a boundary object between different disciplines, conceiving it as an essentially complex field. In this sense, although hypnosis can place itself as the target of pseudo-science criticism (Gordin, 2021), it already currently presents a robust body of results on its effectiveness that allows it to be recognized in different sectors of academia. In the proposal of this book, it is understood that if, on the one hand, experimental research has the great contribution of demonstrating reliable data for the acceptance of hypnosis, on the other, the reflections from the humanities and philosophy are fundamental for a conceptual and logical refinement on this complex field of studies. Nevertheless, there is also the concern with religious and spiritual themes, which appears strongly in the ethnopsychological proposal, which bases research and interventions in Brasilia, of Neubern. In this work, hypnosis is placed as a mediation device with the spiritual knowledge present in the users of the university services, in order to facilitate communication between such universes, placing them, as far as possible, in a horizontal relationship and in frank criticism of a colonialist perspective of research, education, and therapy. Both Neubern and Bonvin conceive that the interface of hypnosis with spirituality is not in itself a problem, mainly because of the cultural relations between such fields and the demands of many users in clinical contexts. Research shows itself as a constant axis in virtually all articles, which is a point of convergence of the fact that such works are developed in universities. Zangari, Pereira, and Machado highlight the incipient content of research in Brazil, while Cobián, Lambert, and Alcalá refer to a history of three decades in Cuba. While in Israel, according to Uziel, there seems to be a prevalence of the biomedical model, of research related to dentistry and medicine, in Brasilia, Neubern’s research is closer to the humanities, in qualitative methods and sciences such as psychology. In a way, it is possible to conceive that there is a cognitivist hegemony in this field, although there are also relevant alternatives such as qualitative research inspired by semiotics and symbolic interactionism. Zangary, Pereira, and Machado also highlight the interest in issues related to the explanation of altered states of consciousness, a theme very present in the research agenda of their study center at the University of São Paulo. Like its Cuban colleagues, Varga, Bányai, Kekecs, and Kasos present a solid list of research and training in hypnosis that runs through the bachelor’s, master’s, and PhD degrees. Commonly focused on the field of health, such research reveals a strong resumption of hypnosis at the Eötvös Lorand University in Budapest, sustained by different generations of researchers. According to Uziel, hypnosis has strong integration with medicine and dentistry courses at the universities of his country, Israel. Bioy, Castelnau, and Nizard, from French universities, propose a chapter highlighting that if hypnosis is a priority in

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academic world, the University only has to gain in terms of vocational training, research, and the provision of services. The authors cite important examples in medicine and psychology courses in their country, especially regarding empathy, communication, understanding, and care with service users. Therefore, while Uziel’s chapter highlights the strong integration with the academic courses, his French colleagues do not fail to recognize the great resistances that still exist in the academic environment. This difference deserves attention, especially if one considers the relevance of France in the production of so many researchers, therapists, and relevant works on the subject. In this sense, Ogez and Rainville, from the University of Montréal, emphasize the importance of evidence-based studies as a basis for the implementation of hypnosis training in universities. Even pointing out some obstacles, the authors consider that such forms of studies are fundamental for the creation of a critical and conscious community about hypnosis within the Academy. While their Hungarian colleagues associate the research with applications in health, Ogez and Rainville consider that the research should serve as the main foundation for the training of hypnotherapists. Many of the research also bring relevant questions when developing from the provision of services to people who turn to universities for help. The demands are quite variable, but the issues related to chronic pain seem to be the most common, as Faymonville, Uziel, Cobián, and Varga highlight. However, themes such as depression, unemployment, memory, self-image, performance, violence, conjugality, family, spirituality, enuresis, surgeries, and adherence to treatments are also recurrent in the curricula of these authors, as is the case with Tukaev, Neubern, and Bioy. Another important point is that a good part of these authors are also practitioners of hypnosis, in order to actively integrate themselves into the services provided to the public. Regardless of the theoretical affiliation of the researchers, this factor seems to be of great relevance to the research, because it places them in a deep connection with the reality of such people who, as such experiences suggest, have a good evaluation of the use of hypnosis in the services in which it is used. If, as Varga and colleagues affirm, hypnosis favors the increase of empathy with users, in addition to the important ethical and clinical implications, this statement places this process at the heart of the research, constituting itself as an important epistemological assumption to be considered. The fourth and last axis concerns the training present in universities around hypnosis. Although there are striking differences between them, it is found that hypnosis has become present in undergraduate, specializations, and graduate courses, according to the course, as can be noted in the texts of researchers from different countries. Faymonville and Nyssen, as well as Uziel, highlight the affective aspect of hypnosis in student training, which leads them to consider its importance for learning in the relationship with service users. This point perhaps brings the reflection in which a historically marginalized praxis seems to have many resources to assist university courses in one of its weakest points – the distance regarding users due to a logic of professional life increasingly specialized and fragmented. If hypnosis is based exactly on a certain rupture of otherness (Melchior, 1998; Neubern, 2016), characterized by an interpenetration of the selves of the protagonists, it is,

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par excellence, a practice that mobilizes the emotional of people, be they the practitioners, be they the users. Therefore, it is of great importance that such educational work takes place in a context of continence, because of the ethical and theoretical implications that result from such a phenomenon, as discussed by Bonvin. Not without reasons, some authors listed here, such as Uziel, Zangary, and colleagues, Ogez and Rainville, highlight legal aspects of the use of hypnosis and also the importance of its teaching in professional training to be integrated into different research projects, in which methodological rigor is an important technical reference. At the same time, works such as that of Bioy, Castelnau, and Nizard are of great importance in that they give voice to students, whose contributions are essential to understand how hypnosis is conceived in their university courses. This scenario seems to bring a single relatively clear point, if one considers the emergence and diffusion of hypnosis in universities: there are an increasing number of spaces occupied by hypnosis in relation to what occurred in recent decades in universities of different countries. Nevertheless, what this means, at various levels, is still far from being deciphered, even because of the absence of more detailed research and surveys involving a larger number of institutions, students, faculty, and research groups. It is believed that, even if it is possible that hypnosis is constituted as a typical collective theme of the return of the repressed (Eliade, 1969/2006), in which those topics that are not properly treated in today return to haunt men and women in tomorrow, it also seems to adapt to important contemporary demands, as seems to be the logic of performance and effectiveness, represented in numerous articles published in scientific journals. Moreover, it is difficult to say whether and how the production of knowledge in universities is really changing due to the growing interest in hypnosis, since there are still no elements that allow security on these points. Perhaps hypnosis is both a sign of the interest of liberal societies in quick and efficient resolutions to everyday problems, or perhaps it also points to changes in paradigms and the very vision of universities that are announced for the future, so that, at least in utopia, they are more integrated into their societies and more emancipatory in terms of the construction of knowledge (Santos & Meneses, 2009), which implies the resumption of epistemological and social themes commonly problematic for scientific thought, such as subjectivity (Gonzalez Rey, 2019; O’Donohue, 2013). However, this book positions itself optimistically with regard to this future, without wanting to associate hypnosis with some kind of hegemony. Hypnosis, as a praxis, is closely associated with imaginary dimensions of human subjectivity, individual and collective, which link it to fantasy, imaginary and spiritual, as shown by various current artistic expressions in literature, TV and cinema (Bioy, 2018). This central constituent of its identity does not consist in something to be opposed and eradicated by scientific rigor, but in a condition to be taken into account so that new theoretical, methodological, and ethical alternatives are created in the face of the numerous challenges that already occur and will still occur soon on the planet. In addition to pandemics, as tragically shown by Covid-19, there are considerable risks of war, economic and political conflicts, as well as serious ecological consequences that are already beginning to present themselves in different latitudes. More than ever, human

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beings will need to understand who they are, in order to access and reintegrate into the humanity they carry with them, in order to be able to feel part of the universe with which they are willing to know and interact in a responsible and respectful way. And hypnosis, bringing this dimension of the magical, the imaginary, and the elusive (Neubern, 2018), can be, without a doubt, an important praxis in this sense.

References Bioy, A. (2018). “O pequeno teatro da hipnose”: uma leitura clínica do funcionamento hipnótico. In M. Neubern (org). Clínicas do transe: etnopsicologia, hipnose e espiritualidade no Brasil (pp. 49–68). Juruá. Chertok, L., & Stengers, I. (1989). Le coeur et la raison. L’hypnose em question. De Lavoisier à Lacan. Payot. Eliade, M. (2006). Le mythe de l’éternel retour. Folio. (Originel publié en 1969). Erickson, M., & Rossi, E. (1979). Hypnotherapy: An exploratory casebook. Irvington. Facco, E. (2021). Hypnosis and hypnotic ability between old beliefs and new evidences: An epistemological reflection. American Journal of Clinical Hypnosis, 64(1), 20–35. https://doi.org/1 0.1080/00029157.2020.1863181 Gonzalez Rey, F. (2019). Subjectivity in debate: Some reconstructed philosophical premises to advance its debates in psychology. Journal of Theory and Social Behavior, 49, 1–23. Gordin, M. (2021). On the fringe. Where science meets pseudoscience. Oxford University Press. Hilgard, E. R. (1978). The Stanford Hypnotic Susceptibility Scales as related to other measures of hypnotic responsiveness. American Journal of Clinical Hypnosis, 21(2–3), 68–83. https://doi. org/10.1080/00029157.1978.10403965 Jay Lynn, S., Green, J., Pollizzi, C., Ellenberg, S., et  al. (2019). Hypnosis, hypnotic phenomena and hypnotic responsiveness: Clinical and research foundations – A 40 years perspective. International Journal of Clinical and Experimental Hypnosis, 67(4), 475–511. https://doi.org/1 0.1080/00207144.2019.1649541 Kirsch, I. (1994). Defining hypnosis for the public. Contemporary Hypnosis, 11(3), 142–143. Laurence, J., & Perry, C. (1988). Hypnosis: Will and memory. Guilford Press. Melchior, T. (1998). Créer le Réel. Seuil. Neubern, M. (2016). Iconicity and complexity in hypnotic communication. Psicologia: Teoria e Pesquisa, 32, 1–9. https://doi.org/10.1590/0102-­3772e32ne217 Neubern, M. (2018). Clínicas do transe. In Etnopsicologia, hipnose e espiritualidade no Brasil. Juruá. O’Donohue, W. (2013). Clinical psychology and the philosophy of science. Springer. Orne, M.  T., & O’connell, D.  N. (1967). Diagnostic ratings of hypnotizability. International Journal of Clinical and Experimental Hypnosis, 15(3), 125–133. https://doi. org/10.1080/00207146708407518 Roustang, F. (2015). Jamais contre, d’abord. La presence d’un corps. Odile Jacob. Santos, B., & Meneses, M. (2009). Epistemologias do sul. Cortez. Spanos, N. P., Radtke, H. L., Hodgins, D. C., Bertrand, L. D., Stam, H. J., & Dubreuil, D. L. (1983). The Carleton University responsiveness to suggestion scale: Stability, reliability, and relationships with expectancy and “hypnotic experiences”. Psychological Reports, 53(2), 555–563. https://doi.org/10.2466/pr0.1983.53.2.555 Spiegel, H., & Spiegel, D. (2004). Trance and treatment: Clinical uses of hypnosis (2nd ed.). American Psychiatric Pub. Stengers, I. (2001). Qu’est-ce que l’hypnose nous oblige à penser? Ethnopsy, 3, 13–68. Zeig, J. (1994). Ericksonian methods. The essence of the story. Bruner & Mazel.

Chapter 2

When Hypnosis Becomes a “First-Line” Teaching, the University Wins Antoine Bioy

, Pierre Castelnau

, and Julien Nizard

2.1 Hypnosis in Healthcare: Four Centuries of Recognition in France The emergence of hypnosis in healthcare has had a chequered history, interspersed with long periods of silence and sometimes even ostracism. A brief historical overview allows us to discern certain reasons for this laborious recognition. And then, we will better understand why the university can and must, today, play a leading role in the dissemination of knowledge concerning hypnosis. France appears, in fact, as one of the main cradles of hypnosis from the magnetizers of the end of the eighteenth century to the glorious names of the nineteenth century. Beyond the ancestral ritual and/or shamanic practices, it is usual to consider that modern hypnosis, as a care practice, has its roots in “animal magnetism,” proposed at the end of the eighteenth century by Franz Anton Mesmer, a Viennese doctor. Driven out of Austria for charlatanism, Mesmer went into exile in France. For him, the understanding of illnesses is a disturbance of the good order of nature, and the restoration of health was achieved by a return to harmony through the intervention of the animal fluid, its passage causing the crisis which itself signaled the cure or relief. Mesmer claimed to have a secret for capturing and distributing this cosmic energy. In 1784, King Louis XVI appointed two commissions to examine this famous animal fluid. These commissions were composed of eminent scientists such as Lavoisier, Jussieu, Bailly, and Guillotin. These commissions came to the A. Bioy (*) Laboratory of Psychopathology and Processes of Change, University of Paris 8, Paris, France P. Castelnau University of Tours, Tours, France J. Nizard University of Nantes, Nantes, France © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_2

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conclusion that there was no such thing as animal fluid and considered that the cures were only due to the imagination of the patients. Once again forced into exile, Mesmer died ruined without having obtained the recognition as a benefactor of humanity that he so much aspired to. In the provinces, a pupil of Mesmer, Amand-Marie-Jacques de Chastenet, Marquis of Puységur, treated the peasants of his estates. He used other supports than the tub of his master, in particular an elm whose branches were equipped with cords to form the chain of circulation of the famous fluid. He also practiced like his master, and during a session conducted in this way, an important phenomenon occurred with his patient Victor Race: instead of presenting a crisis as usual, Victor calmed down and fell asleep with a particular sleep during which he seemed to be able to speak and answer questions. Puységur called this state “somnambulism,” and it is an important discovery. In this situation, the patient is autonomous; he acts by himself and seems to be endowed with knowledge that his usual state of consciousness does not allow him to appreciate. He can diagnose his illness, prescribe treatment, and predict its evolution. Thus, the action originates in the patient, which Puységur allowed to happen as he was not a doctor and therefore did not have the posture of his master Mesmer. The therapist, who is only there to create the conditions favorable to its implementation, is thus placed in a position of accompaniment and helps the subject to reach this privileged state in which new possibilities appear. Gradually, the observations of these pioneers indicated that the subject possesses his own resources that can be put to good use. At the beginning of the nineteenth century, the complementary and fundamental notion of suggestion took shape in France, under the influence of de Faria, a Luso-­ Goan Catholic monk who moved to Paris in 1788. José Custódio de Faria did not believe in the theory of an external, circulating animal fluid but thought, on the contrary, that the results came from what the patient really wanted. After having chosen the subjects who seemed favorable to him, he instructed them to close their eyes and concentrate their attention on the idea of sleep. He considers that magnetic sleep is nothing other than a particular state of concentration. He added that the patient’s abilities developed with the repetition of the sessions. Faria described the first post-hypnotic suggestions, extended the foundations of what would become the placebo effect, and described the first effects of hypnotic anesthesia. His major contribution is now universally accepted, like that of his two predecessors. Bringing together the abilities of the subject (commonly referred to today as “trance”) and those of the caregiver (through different modalities of therapeutic suggestion), Faria introduced this key encounter, this therapeutic relationship conducive to the co-­ construction of care. In 1826, the Royal Academy of Medicine took a new interest in animal magnetism and appointed a commission to examine the new facts brought to its attention. After 5  years of work, a rather favorable report was made public, but it did not convince the Academy. Another commission was appointed in 1837, and its members included the surgeon Cloquet who had performed a painless mammectomy on a patient with breast cancer in 1829. Once again, animal magnetism did not succeed

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in establishing itself. Little by little, the initial intolerance seems to give way to a certain form of tolerance mixed with indifference. While animal magnetism was in relative disrepute in France, the show hypnotist Lafontaine began a lecture tour abroad. When he arrived in England in 1841, he gave many demonstrations, one of which was attended by James Braid, a surgeon from Manchester. For Braid, everything came down to the ocular fixation of a shining object a few centimeters from the face and to monoidism focused on sleep. Following in Faria’s footsteps, as we know, Braid rejects the existence of the fluid and the notion of the magnetizer’s magical will. He describes this technique as essentially physical and cognitive-behavioral and gives it an apparently new name: hypnotism. But history is misleading because in 1820, Henin de Cuvilliers, a French author who created neologisms from Greek roots, coined the words hypnotism and hypnotist, terms taken up by Braid 20 years later (although it is doubtful whether Braid was aware of the French author’s writings). In 1859, the surgeon Broca operated on a new patient at the Necker Hospital with a painful breast cancer without the patient being aware of it. The illustrious Velpeau, convinced, made a communication to the Academy of Medicine the next day which had a major impact. Unfortunately, the lack of practice to renew their experiments contributed to lowering the enthusiasm. Broca preferred to give up hypnosis in favor of a more secure career at the Faculty. Meanwhile, a country doctor from Lorraine (East of France), Dr. Auguste Liebault, began to practice with success. He wanted to make his colleagues at the faculty aware of his work and went to Nancy. They treat him as a charlatan. However, his cures attract Professor Hippolyte Bernheim (Bernheim, 2011) who introduces him to the hospital. A decisive turning point in the history of therapeutic hypnosis, “the Nancy School,” as it is called today, was to defend the idea that hypnosis is a physiological manifestation, a normal state of the human body. But this conception is the opposite of the one of Jean-Martin Charcot, eminent professor of the Salpêtrière, in Paris. The most famous neurologist in the world, his communication on “The various nervous states determined by hypnotization in hysterics” will allow hypnosis to be recognized by the official authorities. However, Charcot was convinced of the organic nature of hypnotic phenomena and never hypnotized his patients, leaving this to his assistants Gilles de la Tourette and Babinski. The “Tuesday Lessons” will be immortalized in the famous painting by André Brouillet: “A Clinical Lesson at La Salpêtrière” (1887). At the same time, Emile Coué de la Chataigneraie, a pharmacist initiated by Liebault, invented a method of conscious autosuggestion in which the will must take precedence over the imagination. This process can be summed up by repeating, without even having to believe it, the following sentence: “Every day, in every way, I am getting better and better.” The disconcerting simplicity of this theory contributed to all the mockery, so that today in France, the famous COUE Method is most often, and unjustly, negatively connoted in the common language. It will experience a more important development abroad, particularly in the United States. In 1889, the 1st International Congress of Experimental and Therapeutic Hypnotism established the validity of the theses of the Nancy School: hypnosis is a

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normal state useful for the relief of patients. Once again, the influence of this school was felt more abroad than in France, where criticism and sarcasm were often rife. Initially welcomed as a trainee at Charcot’s, a certain Sigmund Freud will translate Bernheim’s book and will be trained by this method. He even brought to Bernheim one of his patients, whom he considered too resistant to hypnosis. Freud learned and practiced hypnosis, but had an ambiguous relationship between love and loathing for it. In the end, and contrary to a persistent rumor, he studied it all his life, practiced it even after his invention of psychoanalysis, and the study of his correspondence shows that he recommended its practice to some of his colleagues. Moreover, Freud’s contribution to a better understanding of the psychic processes that contribute to the unconscious circuits of the human brain is quite certain. Moreover, other great names in psychoanalysis, such as Jung, Ferenczi, and Bettelheim, also made contributions to the understanding of the mechanisms at work during hypnotic trance and to the “rapport hypnotique (hypnotic relationship)” (the relational dimension of the practice of hypnosis). Opposing hypnosis to psychoanalysis is a common mistake, but, on the contrary, it is clear that the rise of the different currents of psychoanalysis will contribute to obscure the virtues of hypnosis for more than 50 years in France. The 2nd International Congress of Experimental and Therapeutic Hypnotism was held in Paris in 1900. It confirmed the conclusions of the first congress, but, except for Pierre Janet who started to work on hypnosis, this discipline gradually entered a new and long phase of silence in France. During the first half of the twentieth century, hypnosis continued to develop abroad, notably in the USSR with Pavlov and in Germany with Schultz. Hypnosis reappeared in France in 1965 with the 3rd International Hypnosis Congress inaugurated by the Lithuanian-born psychiatrist Léon Chertok in Paris. In the middle of the Cold War and in the United States, a professor of psychiatry became a rising figure in hypnosis. Milton Erickson began to apply the procedures of the nineteenth century but noted its limits and inconsistencies. Operating a synthesis and without seeking to theorize in particular or to mark the history of his name, Erickson is in the footsteps of Mesmer, Puységur, de Faria, Braid, Liebault, and Bernheim. As everyone knows, he is considered today as the father of modern hypnosis, a hypnosis that is useful for care, as natural as it is powerful, and free from its spectacular ornaments or from an anxiogenic and guilt-inducing pathos. During the twentieth century, the wise man from Arizona, as he is sometimes called, trained many doctors throughout the world. From then on, hypnosis was no longer in search of recognition but of knowledge. Doctors Jean Godin and Jacques-Antoine Malarewicz introduced his thought and practice in France, training a whole generation of practitioners and researchers. Still in France, François Roustang (1923–2016) crossed the world of hypnosis like a comet. A former Jesuit and then a former psychoanalyst, he brought to hypnosis a conceptual bareness that bordered on poetry and metaphysics. Stressing the importance of the body and the senses, of attention, of relationship, of posture and gesture, Roustang considers that the therapist is a go-between who “puts himself in a position where things can circulate, for him and in the relationship with the

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patient.” Thus, in a way, Roustang revives Mesmer’s circulation of a fluid and leads the subject to accept, through action, his finitude within the cosmos. With Roustang, hypnosis is no longer a magical power but an access to a form of maturity and wisdom, an operative lucidity. In 1994, he proposed the term “paradoxical awakening” to rename hypnosis, a French terminology that is difficult to export internationally. However, we can consider that Roustang’s contribution will mark the history of hypnosis and remains to be explored and discovered. Didier Michaux is also the author of the first thesis in the humanities on hypnosis (on suggestion, studied experimentally after an internship at Stanford University). A psychologist and for a time an associate professor at the University of Paris X-Nanterre (at the invitation of Professor Jean-Michel Petot, who was an important supporter of hypnosis at the university), Michaux explored the first research position on the subject of hypnosis at the CNRS (one of the two main public research organizations in France). Author of numerous works, he was for a time president of the Group for the Study of Medical Applications of Hypnosis (GEAMH, created by Chertok1) and then founded the training center Institut Français d’Hypnose (IFH), of which he has remained the honorary president since his retirement. He worked a lot with Léon Chertok, who directed the psychosomatic department of the association L’Élan retrouvé, which was then located on rue du Rocher in Paris. Chertok had begun to set up a research team when Michaux contacted him in 1971 to learn more about hypnosis and Chertok offered him to join the team. The research work was intense during the 1970s and 1980s. Today, the French Confederation of Hypnosis and Brief Therapies (CFHTB) represents the historical structure of clinical and therapeutic hypnosis in France and in the French-speaking world.2 The CFHTB was created in 1996 in Vaison-la-Romaine, by the presidents of the training institutes in the wake of the very first Milton H. Erickson Institute in Paris created in 1983 by Doctors Jean Godin and Jacques-­ Antoine Malarewicz. These founders shared a common base of knowledge, practices, and theoretical references. This common spirit remains very present within the Confederation today with two axes: –– To train health professionals and psychologists in hypnosis in a spirit of medical deontology and ethics and to place the patient at the center of the therapeutic alliance within the framework of the competencies of each discipline –– To federate, in order to promote the dissemination of knowledge, the development of research, to harmonize the teaching of hypnosis and brief therapies, and to transmit a common spirit of hypnosis in care for the benefit of patients The CFHTB has become a learned society and now includes more than 30 hypnosis training institutes for healthcare professionals. In this dynamic, the CFHTB  The GEAMH has awarded two research prizes over the years: the Pierre Janet Prize and the Léon Chertok Prize. 2  A “white book” on hypnosis in France was published by the CFHTB in 2018: https://cutt. ly/RLxmMlC 1

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has also created in 2021 a Hypnosis Research Award to allow students to complete a university training (Master 2) in a French-speaking research team. This initiative is intended to promote research in hypnosis, the networking of research teams, and the involvement of young talent in these rapidly expanding fields. In addition, various French-speaking journals have allowed for the dissemination of knowledge, including the journal Phoenix and now Hypnose et Thérapies brèves or La Revue de l’hypnose et de la santé which also turn to the use of digital technologies by regularly organizing webinars for health professionals and psychologists.

2.1.1 What’s Next? After this quick overview of four centuries of history of hypnosis for the benefit of healthcare, we can discern the reasons for this recognition which may seem laborious. Let’s face it; hypnosis touches what is most precious to man, his health, and challenges established knowledge and orders: –– It shows that the human brain is not as predictable, rational, and aware of its objectives and capacities as it has been believed and asserted to be. It prefigures the extent to which “the body is the sounding board of the mind” according to the formula of A. Damasio (1999) and thus weakens the dogmatic supremacy of the brain and even of the human species within the living world. It also calls into question the prerogatives of the caregivers, modern variants of our ancestral shamans with a religious touch. Would the person being cared for thus have his or her own under-exploited resources in the care process? Would the doctor thus lose his dearly acquired omnipotence, so well singled out, from Molière to Jules Renard? Presumably, this sharing of honors, this co-construction of care, is disturbing and provokes resistance to change, etc. From the reoriented cosmic animal fluid to the psychic and dynamic resources of a patient who has become competent, it is possibly the sharing of power that is the subject of debate. In this so particular relation that is the singular colloquy of the care, which refers as powerfully as symbolically to our anguish of finitude (that the American Dan Short calls The Fear of Death), the stake is perhaps the one of the self-determination and the free will. In the care as in other domains, history is unfortunately rich in examples where the freedom of the men to decide of themselves was obstructed. But the University is freedom. It is the cradle of universalism. It is the opening of human thought, the crossing of cultures and the questioning of dogmas, the permanent updating of theories and concepts. It is knowledge above all. Thus, the University is probably, in this respect, the privileged place of recognition and teaching of hypnosis. In this reminder of important facts, we can see how much the individual initiatives of certain academics have contributed to the recognition of hypnosis. In prestigious universities and reputable establishments, the great hours

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of hypnosis have been played out, and it is now experiencing an unprecedented popular infatuation. In a singular way, we notice that patients are not afraid of hypnosis. Some ask for it in the vain hope of a miraculous, quick, and effortless cure. But for most of them, the understanding of the powers of the psyche to requalify the perception of a symptom or an affection is acquired. What remains to be done is to channel energies and creativity, to structure relevant teaching and fertile research, to reframe illuminated and/or mercantile deviances, and to promote the skills of trained professionals. These experienced actors are ready and waiting for the impetus of the supervisory authorities who have the Universities at their disposal to animate this official recognition of hypnosis in the professions oriented toward health and care. The stakes are high: not only concede the interest of hypnosis, not only accept that professionals train late and at the end of their initial academic career, but introduce the teaching of these approaches from the first years of training. Today in France, a large number of universities contribute to the teaching of hypnosis through university diplomas (DU-DIU): University Courses Medical hypnosis – University of Aix-Marseille Medical hypnosis – University of Bordeaux Medical and clinical hypnosis – University of Burgundy Hypnotherapy – University of Burgundy Medical hypnosis – University of Montpellier-Nîmes Medical hypnosis and techniques of activation and orientation of attention and consciousness – University of Paris 11 Medical and clinical hypnosis – Rennes University of Western Brittany and Burgundy Hypnosis – University of Clermont Auvergne Clermont-Ferrand Therapeutic and medical hypnosis for health professionals  – University of Grenoble Clinical hypnosis – University of Lille Medical hypnosis – University of Lyon Medical hypnosis – University of Tours Study of trances and altered states of consciousness, creative self-hypnosis – University of Paris 8 Hypnosis and strategic and solution-oriented brief therapies  – University of Limoges Hypnosis and therapeutic communications – University of Nantes Medical hypnosis and training in the practice of therapeutic hypnosis  – University of Nice Sophia Antipolis Medical hypnosis – University of Paris 6 Hypnosis in anesthesia – University of Paris 11 (continued)

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Medical and clinical hypnosis – University of Reunion Island Medical hypnosis – University of Toulouse Hypnosis and pain management – University of Strasbourg Hypnosis and anesthesia – University of Paris XI Clinical hypnosis – University of Paris XI, Bicêtre – Orsay Hypnoanalgesia and the use of non-pharmacological techniques in the treatment of pain – University of Versailles Saint-Quentin-en-Yvelines On the other hand, only a few universities have teams involved in hypnosis research (University of West Paris, Paris 5, Paris 8, Tours, Lorraine, etc.). This must be developed in conjunction with a comparable effort in the EPST (INSERM, CNRS, etc.). We will now look at two recent developments in the French academic world. We will use the experience of the faculties of Medicine and Psychology.

2.2 Hypnosis in Medical School: A Recent Advance in France Until 2022, medical students had little or no instruction in non-medicinal interventions (NMIs) and complementary therapies, to which hypnosis is often linked, as part of their initial training. These rare courses could be integrated in a very heterogeneous way within the various faculties, in particular in teaching units relating to pain, physical medicine, and rehabilitation and psychiatry. Some French faculties had already set up a free or complementary teaching unit, which could meet with some success, but which generally only concerned about 20 students per year for each of the faculties concerned and on an optional basis. In 2018, a University College of Integrative Medicine and Complementary Therapies, the CUMIC, was created, bringing together about 60 academics from various disciplines, from medicine to pharmacy, dentistry, midwives, psychologists, health economists, or public health specialists. The missions of the CUMIC are to: –– Promote and supervise university education and training on the integrative and personalized approach to patients and on complementary therapies. –– Promote research and innovation in the field of health, in terms of care and prevention, on integrative medicine and complementary therapies. In particular, it will encourage innovation in methodological research on these themes, and develop medico-economic studies that take into account the efficiency of such treatments, and contribute to limiting iatrogeny and the resulting unnecessary hospitalizations. –– Be the interlocutor of academic bodies, public authorities, organizations representing health professions, and user and patient associations on these issues.

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–– Set up the basis for an observatory of practices and undesirable events. –– Promote the sharing of experiences and methodological resources. –– Promote studies at the national and international level on these topics and promote their European harmonization. In 2019, this college was recognized by the National Coordination of Colleges of French Medicine Teachers (CNCEM), a decisive step in the recognition of this dynamic by the university physician peers. On the occasion of the current reform of the second cycle of medical studies, CUMIC proposed and obtained, from the CNCEM, then from the Conference of Deans of Medicine, and finally from the Ministry of Higher Education and Research, the addition of a new compulsory item, item 327: “Principles of integrative medicine. Usefulness and risks of drug interventions and complementary therapies.” This compulsory item therefore concerns all medical students in France since the beginning of the 2022/2023 academic year. It is broken down into four complementary dimensions: 1. A national e-learning course comprising two parts: a module concerning the definitions and general principles relating to the evaluation of non-drug interventions and non-drug therapies in their quantitative and qualitative aspects 2. Chapter 29 of the College of Therapeutics and Medical Pharmacology book This chapter addresses: (a) Definitions, concepts, and general principles of evaluating NMIs and complementary therapies (b) Classification of NMIs (c) Principles of action, utility, and risks of the major complementary therapies: –– Acupuncture and traditional Chinese medicine. –– Manual medicine and osteopathy. –– Medical hypnosis and hypnoanalgesia. This last paragraph was written by three professionals experienced in the practice of hypnosis in different environments: hypnosis and psychological care, hypnoanalgesia, and hypnosis and general medicine (see box below). –– Mindfulness meditation. 3. A summary sheet, also available on the national e-learning platform, within the Learning Follow-up Booklet (LiSA), a solution designed to accompany the implementation of the competency-based approach in the second cycle of medical studies 4. Faculty courses, generally in the fourth and fifth years of medicine, focused on the integration of a complementary therapy, and in particular hypnosis, in the life of a patient with a chronic pathology, with a suggested hourly volume of 6–8 h of teaching In 2022, the CUMIC opened its doors to French-speaking colleagues interested in the dynamics of teaching and research on non-drug interventions and

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complementary therapies: Belgian, Swiss, and Canadian French-speaking university colleagues. At the same time, the CUMIC is currently working on integrating such teaching in initial training in the short and medium term into the studies of pharmacy, dentistry, and maieutics, but also in the curriculum of psychologists and in the training schools for paramedical professions.

Contents of Chapter 29 of the College of Therapeutics and Medical Pharmacology Book Here are the elements presented to medical students concerning hypnosis. They are supplemented by a bibliography to consult. 1. Definition and Principles –– Hypnosis is defined as “a state of psychological functioning in which a subject, in relationship with a practitioner, experiences an expanded field of consciousness.” –– Hypnoanalgesia is used for the management of acute pain and must be performed by healthcare professionals within their scope of practice. –– Therapeutic hypnosis: a care practice of a psychological nature, it requires more advanced training. It can be used alone (with chronic patients, during psychotherapy, etc.) or as a complement to other practices (hypnotic communication during care with premedication, as a complement to locoregional anesthesia, etc.). It allows to obtain a state of consciousness that is said to be modified or enlarged (“hypnotic state” or “hypnotic trance”), because the patient no longer focuses his attention and emotions only on one part of his body (pain, anxiety support, etc.) but acquires a greater psychological flexibility that allows him to modify the way he perceives his bodily sensations and thus his reality. In a state of hypnosis, the patient can, for example, imagine putting a modulator on the painful part of his or her body and thus lowering its intensity. This “creative imagination” produced by the trance is really felt by the body, and the patient’s relationship to his pain is modified. –– These data are objectified by neurophysiology and cerebral imaging, which show a signature of cerebral activity characteristic of the hypnotic state (a state of awakening and relaxation at the same time). 2. Indications and Results –– Hypnosis, which must be performed by health professionals in their field of expertise, can be useful for: –– The management of pain (acute, chronic, procedural). –– The management of anxiety. –– The management of so-called “functional” disorders and all psychotherapeutic indications.

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–– Hypnosis has a level of scientific evidence that allows it to be included in medical practices with confidence, as long as practitioners are trained. The practice of hypnosis can begin as early as 4 years of age. 3. Hypnosis and Pain, Hypnoanalgesia –– The International Association for the Study of Pain (IASP) revised in 2020 the definition of pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” This definition highlights the two main components of pain: the sensory component, which makes it possible to describe this pain, and the emotional component, which corresponds to the impact of this pain on affect. There are also a behavioral component and finally a cognitive component (through his personal history, what meaning the patient gives to his pain). There are close relations between the emotional and sensory components: negative emotions (anxiety, depression) increase the feeling of pain. Anticipatory anxiety prior to care, surgery, or childbirth modifies and increases the sensation of pain. –– Many studies have confirmed the interest of hypnosis in the management of pain. –– In acute pain, hypnosis allows to modulate the sensory component (pain intensity) and emotional component (associated anxiety), in many situations where hypnosis can be used alone or in addition to other analgesic treatments: pain induced by care (dressings, sutures, punctures, reduction of dislocation, etc.), in dentistry, in obstetrics, and in the operating room within the framework of a hypnosedation where hypnosis allows to significantly reduce the doses of sedative and analgesic agents. In practice, several hypnotic techniques can be used: conversational hypnosis associating positive communication, detour of attention, confusion for short gestures, or formal hypnosis for longer procedures by maintaining the hypnotic trance (allowing the patient to live, e.g., a pleasant situation, etc.) during the care or the intervention. Hypnosis is also interesting to prepare the patient before an intervention by reducing preoperative anxiety. –– In the case of chronic pain, the management of patients is more complex and relies on a multidisciplinary approach where hypnosis can have its place among other treatments. Several sessions are necessary in order to give the patient new resources to face his pain, to teach him to modify his relationship with his pain, to manage it differently. –– In all cases, it is necessary to be able to mobilize the placebo effect (which explains a large part of the effectiveness of analgesic treatments, both medicinal and non-medicinal), which underlines the importance of the caregiver-patient relationship with an empathetic professional attitude, information given to the patient, and positive communication tools. (continued)

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4. Hypnosis in General Practice –– The general practitioner’s global approach and the relationship of trust established with his patients of all ages are privileged conditions for using hypnosis. If the patient feels sufficiently secure and available, he/ she can engage in hypnosis and thus become an actor in his/her treatment. –– The general practitioner can thus use hypnosedation for minor technical procedures, hypnoanalgesia for chronic or acute pain, and hypnotherapy for psychological or physical trauma. –– Conversational hypnosis is adapted for short procedures (vaccinations, peri-articular infiltrations) and formal hypnosis for procedures requiring more time (insertion and removal of hormonal contraceptive implants, insertion of IUDs, sutures, cryotherapy, complex dressings, etc.). –– Formal hypnosis contributes to the management of chronic pathologies: irritable bowel syndrome, migraines and chronic headaches, dysmenorrhea, fibromyalgia, sleep disorders, anxiety, depression, bereavement, post-traumatic stress disorder, asthma, etc. 5. Contraindications and Risks –– The practice of hypnosis by a health professional or a psychologist can concern all patients without contraindication, within the framework of the practitioner’s skills. However, in the case of patients with a psychotic profile, the delirium in the active phase does not allow the relationship, and the work from the internal world of the patient is prevented. 6. Self-Hypnosis –– Teaching self-hypnosis to the patient from the beginning of the treatment teaches him/her to become autonomous and an actor of his/her health. A few minutes of self-hypnosis each day is enough to maintain the therapeutic work set up by the practitioner and allows the patient to participate in the healing process. 7. Diploma Courses –– In France, there are many university diplomas in medical or therapeutic hypnosis, generally of 1  year, open to health professionals and psychologists.

2.3 Hypnosis in the Faculty of Humanities In the field of health, hypnotic practice is of course a therapy designed to improve the daily lives of those who use it. But hypnosis is more than that; it is also a philosophy in the sense that it proposes a very particular vision of the human being,

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enriched by the way practitioners and researchers have nourished it. Also, the relational and psychological factors that guide its practice are at the forefront of the effects produced. They have even been rapidly identified as essential, from the Marquis of Puységur to the present day. All these data place hypnosis in a filiation with the human sciences and the humanities. Psychology, art, philosophy, anthropology, and even history since animal magnetism, which gave birth to hypnosis, had a significant influence on the period of the French Revolution (1789) and the ideas it brought to power. In France, the historical place of Hypnosis in modern psychology and the appearance of psychotherapies (with H. Bernheim) are underlined. But often, hypnosis is seen as a rather outdated practice. Many prefer to teach other practices that use trance states, such as mindfulness meditation, EMDR (Eye Movement Desensitization and Reprocessing), or Lifespan Integration. Some untruths are even still taught, such as the fact that Freud turned away from hypnosis (Bioy, 2008, 2021) or that psychosis is an absolute contraindication to hypnosis. In other words, the culture of teachers about hypnosis remains fragmented. However, this is not true for universities that are also places of research in hypnosis, such as the University of Paris 8, Paris Ouest, Burgundy, Nantes, and others. This underlines the importance of the university maintaining important links between teaching and research. Even if the teachers are not all practitioners, this nevertheless guarantees a certain level of initial knowledge. In initial training in Human Sciences, the practice of hypnosis as a specific discipline is taught only in a French university (Paris 8 – Vincennes-Saint-Denis), in the last year of Psychology. In continuing education, most of the diplomas are taught in medical schools. However, two are offered in the Human Sciences: the hypnotherapy diploma and the inter-university diploma in medical and clinical hypnosis (University of Burgundy, Dijon). Both are at the bachelor’s level. We (Antoine Bioy) set up the first one in 2011, for psychologists and psychiatrists. It is very focused on the practice of hypnosis in relation to psychopathological disorders, in addition to more common applications. We set up the second one in 2013, for medical and paramedical professions, focusing on practices during care and accompaniment of patients with chronic somatic disorders. In 2022, we created two other diplomas, this time at the University of Paris 8 where we now practice, at the master’s level on the study of trances and altered states of consciousness. The teachings are centered on the trance process and the way in which a modified state of consciousness has an action on people. We find hypnosis of course as the “core” of research in this field, but also other practices such as shamanism, virtual reality devices, forms of meditation, psychotherapies using hallucinogenic substances, flow, etc. The wish is to create a platform for meetings and exchanges between practitioners and researchers in Psychology, Sociology, Anthropology, Neuroscience, Medicine, Classical and Contemporary Arts, etc. It seems to us that the university must also have this function, that of dialogue between different horizons around the processes that underlie clinical practices. These spaces do not really exist outside of the university or only ephemerally during conferences.

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2.4 Teaching the Therapeutic Relationship at the University: Contributions of Hypnosis The relationship is at the heart of any therapist’s profession. It is also at the heart of the history of hypnosis, as we have indicated. In clinical psychology, the last 2 years are devoted to learning professional methods that will allow for concrete professional practice. And of course, the question arises of how to train in the therapeutic relationship. The students obviously have theoretical training in this regard. The practice is done in the field, with practical internships of between 500 and 800 h depending on the university. How to complete this, on the university campus itself? The question is complex because the relationship is not a simple meeting, or a simple communication, even if well conducted (Malet et al., 2022). The deontology of teachers pushes us to question how to learn it correctly and to work on its posture in a conscious way before it is internalized and “simply there” in the interview. If this is not learned correctly, the relationship will be limited to its technical aspects, to communication, to the “race of scripts” to do well, and the follow-up will be subject to the practitioner’s blindness as to his principle of influence. In fact, any therapeutic approach has both specific factors and common factors such as the impact of the personality characteristics of both the patient and the therapist on the course of the follow-ups. Among these common factors, the one that has the highest influence on the effects obtained is the notion of therapeutic alliance. It can be defined as the cooperation, the partnership, between the patient and the therapist in order to achieve the objectives set during a temporary meeting. It is not decided; it is in fact the consequence of an adequate therapeutic work (Despland et al., 2006). It is through this concept that we can best understand the dynamics of follow-up and the way in which effects are organized. Until recently, the notion of therapeutic alliance was present in hypnosis textbooks as an important notion, but had not been studied scientifically. We have initiated a line of research on this subject which shows, among other things, that the dynamics of the alliance in the first sessions of hypnotherapy are more related to the adjustment factors of the practitioner toward the patient than to the evolution of the patient during the first sessions. It is because the practitioner sets himself in motion (adapts) that the patient will set himself in motion, which is in line with the conclusions of previous research, notably in humanistic psychology (Bioy & Servillat, 2017; Santarpia, 2016) and also in psychodynamic psychology (de Roten et al., 2006). This dynamic is not a function of the use of hypnosis (classical or conversational), but its use in session accentuates the sense of working toward the goal in congruence with the “expected” form of work. The feeling of being understood and appreciated is greater when hypnosis is employed. The evocation or prescription of self-hypnosis does not affect the alliance dynamic. It was Elisabeth Zetzel who was the first to truly affirm that the therapeutic alliance is essential to the effectiveness of any therapeutic intervention. She showed that the alliance is dependent on the fundamental ability to form a stable trusting relationship: an ability rooted in the early relationships between the baby and

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mother and in part also between the baby and father. If the necessary climate for the therapeutic relationship is not present because of developmental deficiencies, then Zetzel proposes that, first and foremost, the therapist work with the patient in a supportive relationship whose goal is the development of an alliance (in the same way that the mother provides an appropriate maternal environment to facilitate the development of a basic sense of trust). Here again, we have opened a line of research to extend this work into the field of hypnosis which confirms in the first results the links between early attachments and engagement both in the hypnotic situation and in the relationship with the practitioner. As a result, in our hypnosis psychotherapy practice, we always have an eye for this attachment quality and the impact it can have on the patient’s therapeutic engagement. When the quality of attachment needs to be worked on, we devote the first few appointments to it, both to encourage the deployment of hypnosis in a safe setting and of course because this work is already therapeutic in nature, since it works on the patient’s relationship to the world. This particular work is done according to a perceptive approach close to that of François Roustang, integrating an assumed directivity to “frame” the patient’s experience as closely as possible, before offering a space for more autonomous investment of the sensations and feelings attached to the different percepts. Thus, whether we are talking about the field of therapy or psychotherapy, the therapeutic alliance has a central place. It has a major effect on the prospects of change and even almost predicts the success of the work undertaken when the initial alliance is of good quality. In clinical practice, it is therefore important to pay particular attention to this notion, even if biases may obviously be present, notably the tendency of practitioners to underestimate the initial quality of the alliance as perceived by the patient. The practitioner has to find a good adjustment between exploration (of the request, of the anamnesis, etc.) and restraint and to know how to adjust to the dynamic characteristics of his patient (capacity of adjustments, resources, defensive modalities, etc.). Particularly at the very beginning of the follow-up, it is often useful to pay particular attention to the patient’s level of commitment, even if it means working on his motivation and the way he perceives the follow-up, its framework, and the objectives worked on jointly. Studies show that these are the elements integrated into the notion of therapeutic alliance which make this notion almost predictive of the effectiveness of the follow-up. How can these known elements be transmitted to future colleagues or to colleagues already working who wish to improve their skills? How to teach “a good alliance”? Henry and his team (1993) were pioneers in this field and set about this task. They offered psychotherapists with at least 2  years’ experience a 50-week training course, spread over 1  year, on the therapeutic alliance, its identification, etc., with role-playing and analysis. The training consisted of 2 h of seminars per week, with supervision, on interpersonal exchanges and the therapeutic relationship. The results showed that the practitioners had a better adherence to the method than initially, but also that there was a deterioration in the therapeutic relationship, with practitioners being more authoritarian, more active, and more pessimistic than initially about the follow-up. What had happened? Too much focus on the “technical” aspects of the alliance and more globally on the relationship hinders a natural

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fit and an authentic involvement of the practitioner. A kind of “tension” finally on the performative aspects of the alliance and the relationship to be set up, which put aside sensoriality, affectivity, and clinical sense. The two aspects are of course necessary and complementary, and favoring one over the other weakens the whole clinical edifice. So, how to proceed? In Practice Currently in France, the vast majority of hypnosis teaching in universities takes place within the framework of continuing education (university diplomas, private training), in other words, at the stage of the third university cycle and/or post-graduate education (EPU), with rare occasional sensitizations during initial courses. This means that the principles of hypnosis are “condemned” to follow the initial learning, to inflect them as best as possible, and then to impregnate the practice. It is necessary to adapt and sometimes undo the existing to transmit something else. So much effort could be avoided by integrating hypnosis or at least its principles from the initial training! The idea is not so much to turn everyone into a hypnotherapist as to rely on the experiential advantages of the method so that learning can be intelligently and effectively transmitted. Hypnosis is not the only method to promote this: the use of role-playing and simulation in healthcare is part of the same movement. However, hypnosis also constitutes a “language,” a particular way of approaching the human being that integrates the psyche and the body from the outset; this language can be a basis for practice that can be shared by all in a health team (Bioy, 2007). The question that arose for us as academics and particularly in the training cycle of students in clinical psychology was therefore how to transmit a relational approach differently from what is usually done in teaching (essentially theory and case studies)? The question was of great importance since the therapeutic effects are lodged in the relationship as much in the question of follow-ups as in psychological evaluations. Indeed, if psychological accompaniment remains a known practice, it is not the basis of the teaching of clinical psychology in France: the heart of this profession is clinical evaluation. It is because students learn psychopathology and the evaluation of normal and pathological processes that they can then put this knowledge into practice in the context of psychological and psychotherapeutic follow-up. The master’s degree is really the moment of professionalization of the students, with teachings thought in the continuity of the 2 years. It is therefore at this level that the relationship is taught. We have focused our efforts on the subject of “clinical interviewing” in Master 1 (for its core practice, as certain aspects are seen in other teaching units) and in Master 2. In Master 1, the acquisitions are made in the traditional way: the lecture is centered on humanistic psychology and also psychodynamic psychology, and the tutorials propose the study of fundamental texts, analyses of interviews from filmed

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sessions, and role-playing. A separate course allows for the supervision of fieldwork (professional internship) and a review of the analysis of relational dynamics with patients. But it is in Master 2 that we really changed the form and content of the teaching, to integrate hypnosis on an experiential side, and not to fall into the “pitfalls” that Henry showed by his study in 1993. This allows us to give “body” to what has been seen “academically” until now and to mobilize the senses to make the relationship live in a full and complete involvement of oneself. Thus, we begin the first class by teaching the students an exercise of play between body and consciousness: they move the finger of one hand on the palm of the other hand, in a concentric movement. After having found the rhythm with which they are currently most comfortable, they first focus their attention on the surface of the hand and feel as much as possible the trace that the finger makes, the perceptive trace that is drawn on it, the sensations that are present, etc. Then, while prolonging this exercise, the students will be able to feel the rhythm of the hand. Then, while prolonging this movement, they put their attention in the sole pulp of the finger which sweeps the palm of the hand and go to meet the relief of this “ground,” its (more or less) fine irregularities, the way in which the discovery is carried out sensorially. They then return to the palm of the hand, etc. This experience is rich in contribution: the students experience a “corporalized consciousness,” of restricted and enlarged perception, of the way they can learn to play with it. Of course, they are instructed to do this exercise every day for 2 weeks (they integrate the movement of self-hypnosis). This brings them to the next class and a first debriefing about these self-hypnoses. Once these aspects have been acquired, the following lessons will be on different themes related to what is called “the relationship.” For each one, an exercise is proposed (in groups but most often in pairs), and then the link between what has been experienced and clinical practice is discussed, both in the context of “lambda” follow-up and with patients with decompensated psychopathological disorders. Let’s take the example of an exercise around attachment and its expression in the relationship. The students stand back to back, and after a period of empathic discovery of the other (which has been worked on in the exercise beforehand: to feel the presence of the Living in the other, of his or her “animal” presence in the sense of what animates him or her), one of the two takes a step forward to detach from the other. The students are instructed at this moment to continue their work of perception and to see what remains of the imprint of the other in themselves. Then, a conscientious and respectful debriefing is proposed in a round table, pair by pair. Obviously, everyone experiences their own attachment modalities, and we discuss the implications this may have relationally, in the way we practice. Once this is (continued)

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over, we present a variation of this exercise that we propose in mourning problems or even to work with abandoned personalities. In this way, the main themes are worked on: empathy, congruence, the place of emotions, affectivity, temporality, intuition, relational creativity, movement, body metaphors, etc. Thus, if the relationship cannot be learned, it can be discovered as early as university studies. In a professional setting, the way to work with it is not innate and needs to be explored in a guided and intelligent way. Studies on the alliance show the subtlety of the relational process, which has not yet been fully uncovered, even if research is opening up to continue its exploration directly in the field of hypnosis. Introducing the question of the relationship from the initial training is for us a fundamental step, which can be helped by the hypnotic method so that it is at the same time knowledge and experience. As for the evaluation of the teaching, it joins the canons of the discipline and the university: a written file that each student returns presenting a case study where the body, the percept, and the posture will have been particularly worked in clinical relation.

2.5 Conclusions In France, hypnosis is still mostly learned at the end of the university curriculum and during the later stages of the care and health professions, at the stage of updating knowledge commonly called continuing education. But the university can allow the learning of hypnosis from the initial training. We have mentioned the case of future doctors and psychologists. There are sufficiently numerous and reproducible experiences to be able to count on a very favorable reception from students. Hypnosis can also enrich transversal teachings such as those on relationships and professional posture, which are absolutely central to care practices. The constant and even exponential progress of health technologies over the last 20 years (genomics, imaging, AI) tends to favor a purely technical approach to care to the detriment of relational and human components. Because it brings together the skills of the caregiver and the resources of the patient, hypnosis favors, on the contrary, a co-construction of the care and the healing process in terms of well-being, quality of life, and capacity for autonomy and participation of the subject. Finally, it seems important to us that the university should be the privileged place for researchers and practitioners to meet. Hypnosis allows us to open up to transversal processes such as states of consciousness and trance phenomena which never cease to intrigue science and researchers. It is not excluded that hypnosis could even constitute a privileged way to participate in the understanding of the brain and human psychic mechanisms.

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References Bernheim, C. (2011). Hippolyte Bernheim: Un destin sous hypnose. Eds JBz & Cie. Bioy, A. (2007). La pratique de l’hypnose en Psychologie Clinique. Psychologues et Psychologies, 193, 6–8. Bioy, A. (2008). Sigmund Freud et l’hypnose: une histoire complexe. Perspectives Psy, 47(2), 171–184. Bioy, A. (2021). Freud, défenseur de l’hypnose. La Revue de l’hypnose et de la santé, 14(1), 86–91. Bioy, A., & Servillat, T. (2017). Construire la communication thérapeutique grâce à l’hypnose. Dunod. Damasio, A. (1999). Le sentiment même de soi. Odile Jacob. de Roten, Y., Michel, L., Despland, J.-N., Beretta, V., & Kramer, U. (2006). Alliance and technique in psychodynamic psychotherapy: What therapists should do to strengthen the alliance. European Psychiatry, 21(1), 235. Despland, J.-N., Zimmermann, G., & De Roten, Y. (2006). L’évaluation empirique des psychothérapies. Psychothérapies, 2(26), 91–95. Henry, W. P., Strupph, H., Butlers, F., Schachtt, E., & Binderj, L. (1993). Effects of training in time-limited dynamic psychotherapy: Changes in therapist behavior. Journal of Consulting and Clinical Psychology, 61(3), 434–440. Malet, P., Bioy, A., & Santarpia, A. (2022). Clinical perspectives on the notion of presence. Frontiers in Psychology, 13, 783417. https://doi.org/10.3389/fpsyg.2022.783417 Santarpia, A. (2016). Introduction aux psychothérapies humanistes. Dunod.

Chapter 3

Hypnosis, University, and Democracy: An Emancipatory Proposal Maurício S. Neubern

3.1 Introduction Hypnosis appears, throughout its history, largely associated with the notion of control, which assumes varied meanings according to context (Stengers, 2001). A few years before the French Revolution, Jean Sylvain Bailly warned the king of France and the authorities, in his famous secret report on mesmerism that eventually became the ancestor of hypnosis, about the risks of sexual exploitation of women by unscrupulous doctors (Bertrand, 1813/2004). In extreme cases, the use of hypnosis for improper goals is highlighted as a massive persuasion of people to perform unlawful acts (Dimsdale, 2021; O’Neill & Piepenbring, 2019). In terms of recent scientific research, that same notion, related to the modern paradigm of science (Stengers, 1995), appears linked to themes such as pain control and other symptoms (Jensen & Patterson, 2014). Practices of control via hypnosis expose the theme of freedom, considering that a practice that aims to produce certain responses in a person leads to the question of whether they have their choices, deliberations, and will respected. In contemporary societies, as individual rights become the central foundation of democracy, that paradox is problematic, because a therapist, at least in theory, should not impose anything on another person without their knowledge and Acknowledgments to Professor Farouk Seif, PhD; Ann Blake, PhD; and Randy Morris, PhD, from Antioch University, Seattle, Washington, USA, and Amanda Pavani, PhD, for language review. The author thanks the Graduate Program in Clinical Psychology and Culture, University of Brasília, for the financial support for the publication of this chapter. The author declares that there are no conflicts of interest in this chapter and that all ethical measures regarding research with human subjects have been strictly complied with, obeying the Ethics Committees of the University of Brasilia. M. S. Neubern (*) Institute of Psychology, University of Brasília, Brasília, Brazil © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_3

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consent. The problem also arises when training these therapists, because the possibility of controlling others is strongly opposed to the ethics code of their profession and their university education, whose principles are usually bound by human rights. As for research, even if the idea of control is central in addition to its ethical facet, as illustrated in Milgram’s experiments (1963), this paradox also appears in conceptual terms. The extent to which control is compatible with contemporary notions of agency (Sharov & Thonnessen, 2022) is an essential question as much as the extent to which the authorial role of a person might be possible if one is under a therapist’s control. In terms of university, the theme of control also warrants attention. Despite its emancipatory content related to various human rights fronts, such as racial and gender equality, social inclusion, the fight against poverty, and the environment, universities often perform a regulatory role (Santos & Meneses, 2010), as in the different forms of colonialism (Nathan, 2014). The scientific knowledge promoted by the institution easily acts as a disqualifier of other cultural knowledges and traditions, situating them as mere beliefs to be undermined in the name of reason. The conflicts generated by such confrontations often cause many problems to individuals and communities, especially in societies in which other worldviews are culturally accepted and represent important references to the world. Another noteworthy point is that the neoliberal influence itself on contemporary universities (Mota Jr, 2019; Newfield, 2018) fabricates its dependence on funding agencies, whose policies distort their purposes, rendering it a production machine rather than a promoter of free thought. These policies, essentially devoted to the market, favor a logic of productivism for articles and other items under arbitrary amounts of evaluation, excessive bureaucratization, prioritization of certain themes and areas of research, and student indebtedness on account of student financing. Control at the macrosocial level of universities constitutes a problem for hypnosis, since it further reinforces the myth around an alleged dominance of one over the other and restricts result-oriented techniques. However, their emancipatory aspect can also be a source of interest on a subject, rebellious in itself to attempts to control modern science (Stengers, 2001). As for democracy, the idea of control also introduces issues of foremost importance. Despite democracy’s status as an important achievement by contemporary societies, references to its fragility are not uncommon, either due to its surrender to powerful economic groups (MacLean, 2017) or for extremist threats that haunt many countries (Santos & Meneses, 2010). As it deteriorates, individual freedom is restricted, minorities become vulnerable to ultraconservative attacks, authoritarian threats become concrete, and citizen exercise is poorly restricted to voting. At the individual level, largely influenced by media manipulation, a kind of alienation of the person occurs, drastically detaching the subject from their collective belonging niches (ethos). They may themselves even favor dominant groups and attack their origins. In such cases, there is an abandonment of citizenship, as they renounce acting as social representatives of their own groups. In terms of collective knowledge, the authoritarian impetus favors a real persecution of traditional knowledges from minority groups and the emergence of negationist and violent theories, self-evident in the authority of their leaders, regardless of rational and scientific criteria. In this

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scenario, it bears to question the extent to which hypnosis might not be a vehicle for individual and collective manipulation (Dimsdale, 2021) or whether it itself can constitute a way of opposing such a mentality. Both self-reconciliation at the individual level (Binswanger, 2008) and establishing dialogue with other knowledges (Neubern, 2018a) are interesting paths promoted by hypnosis that are in tune with democratic principles. The oscillation between regulatory and emancipatory forces highlighted here acquires a content of hope when one touches on the dimension of utopia, as introduced by Darcy Ribeiro (2015). The Brazilian thinker proposed projects of great relevance on different fronts, such as the creation of the University of Brasília, marked by interdisciplinarity and free thought, the construction of full-time schools for children, and the support for Indigenous causes. Although he recognized his failure on all these fronts himself, he also regarded his defeats as victories, never longing for the place of those who overcame him. In this work, the proposal is that it is exactly at this point that utopia fulfills its role not as an unattainable ideal but as something beautiful in itself (Peirce, 1997) and that, as a result, can always gain new breath with people who can admire it and incorporate it into their lives. Utopia, as an aesthetic ideal, can be irresistible in its appeal and leave lasting marks on those who get carried away by it. Thus, this chapter aims to highlight possible paths for the relationship between hypnosis and emancipation in the university context. This objective is developed in three ways, based on the experience of the CHYS (Complexity, Hypnosis, and Subjectivity) project conducted at the Institute of Psychology (IP) in the University of Brasília (UnB), Brazil. In the first stage, the way hypnosis can favor a broader educational process among students is emphasized, highlighting reconciliation with the respective ethos and the construction of each person’s being. A legitimate educational process promoted with the student fosters citizenship, as the person becomes aware of their origins, which groups they represent, and how they can position themselves before others in different processes of social exchanges. The basic premise of that point is that offering services to the community, while focused on hypnotherapy, might lead to important reflections and searches on their own ethos, mainly through self-hypnosis. The second moment refers to the notion of inquiry, which goes far beyond the scope of research to encompass a broader attitude of reflection on a topic (Liszka, 1996; Seif, 2019). Hypnosis, according to the proposal in this chapter, shows great potential to highlight central aspects of a true inquiry, as the deep integration between the subject and the studied field, the fundamental eidetic content to that process (Ibri, 2015), the different modes of thought construction, and the principle for the needs inherent to such a process are not precluded by a priori criteria. This inquiry is conceived as an inside-out process, that is, something born from a fragile and fallible relationship involving the researcher and the field, going through different modes of reflection until submission to public control through scientific communities. That moment highlights the strong relationship between the elusive and fluid field of hypnosis and the notion of a self in which individual and social

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interpenetrate (Petrilli, 2017), favoring an understanding of hypnogenesis1 (Stengers, 2001). Individual and collective protagonisms by subjects shape a good inquiry process, as knowledge is not made about the other, but from a relationship with them (Neubern, 2018a; Seif, 2019). In that sense, this inquiry maintains the link between clinical practice and research; by evading scholarly hegemonies, common in psychology, some ways can be highlighted for different theoretical proposals to contribute to its construction. In the third section, this chapter highlights the offer of hypnotherapy services under an ethnopsychological perspective (Neubern & Nogueira, 2019), in order to create a context for the subject and the collective knowledge they represent to be shown from their own references of legitimation. By opposing colonialism, a context was construed, based on Erickson’s utilization approach (Erickson & Rossi, 1979), for a care plan developed as a team in the home of a person with psychiatric problems and fibromyalgia. That context sought to approach her most important clinical needs so she could feel recognized as a person and as belonging to a spiritual ethos. There is important emphasis on her integration with herself as a condition for citizenship and the recognition of her spirituality as collective knowledge, potentially belonging to a democracy of knowledges (Stengers, 1997).

3.2 Foundations 3.2.1 The CHYS Project The CHYS project, instituted in 2011, consists of a proposal for advanced studies on hypnosis, in tandem with IP/UnB. In broad terms, it seeks to construe complex references for an in-depth understanding of hypnosis in its different expressions. It is deeply inspired by the ideas of Edgar Morin (2015), Charles Peirce (1985), and Milton Erickson (Erickson & Rossi, 1980) while also maintaining conversation with ethnopsychology (Nathan, 2014; Neubern, 2018a) and various other branches of knowledge. Ethnopsychology has a special role in that project because, opposed to the typical colonialism in modern science (Nathan, 2014), it seeks to understand other knowledges from their own references and legitimacy. Its main principle is that nothing is known about the other but from the dialogue with them, which occurs in individual and collective terms (Neubern, 2018a). In the graduate level, the project promotes research in master’s degrees and doctorates; in the undergraduate level, it offers courses, research, and internships aimed at hypnotherapy being offered to the community. In these two levels of training, research and service provision are very articulated, aiming to give students a broad spectrum about hypnosis. All research participation by subjects is submitted to UnB’s Ethics Committees,

 Phenomenon in which the therapeutic or research relationship tends to reproduce the therapist’s or researcher’s theories, along with their interlocutor (Stengers, 2001; Tukaev, 2020). 1

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which requires procedures such as consent and secrecy forms on user identity, with the creation of names and fictitious information for them. The cases mentioned here have strictly complied with these measures. The population that commonly uses CHYS services is basically people suffering from chronic pain. These aims aim to promote a broad understanding of the person in the world, covering different dimensions that may be, according to the case, linked to chronic pain, like culture, finance, ethnicity, social class, sexuality, family, social circle, spirituality, work, and politics, among others (Breton, 2012). The proposal of hypnotherapy does not fit the logic of pain control because it spans a broader process about that person in their world with their different semiotic records. The proposal involves partnership and protagonism by patients, in order to facilitate connections with deeper agency systems, capable of reconfiguring chronic pain. In addition to individual and weekly hypnotherapy, group, couple, and family sessions may also be proposed, following individual needs. In some situations, there are visits and follow-ups in users’ social environment, such as a hospital, a recreational context, and, especially, their homes. The team, whose members all offer hypnotherapy services, is usually composed of the coordinating professor, graduate students, volunteer psychologists, and undergraduate students (trainees). Because of a shift in semesters, trainees and volunteer psychologists usually spend only 1 year in the service, though some choose to remain longer. Users’ demands are often linked to problems like fibromyalgia, autoimmune diseases, oncology, orthopedic problems, surgical injuries, and situations of undefined etiology. This is a public that often finds considerable difficulties in adhering to conventional treatments, whose services are usually not prepared to deal with chronicity. It is not uncommon for these people to undergo an uncontrolled search for treatments: they subject themselves to invasive and costly situations, losing most of their savings. As chronic pain is often viewed with suspicion (because objective tests not always confirm them), affective and social isolation is quite frequent, favoring psychic vulnerability in such people. Moreover, the reduction in physical and work capacity prevents these users from performing social functions and roles they previously did, further stimulating their sense of fragility. That scenario, associated with the absence of a definitive answer to their problems, often favors cases of depression, anxiety, and suicidal ideations (Neubern, 2018b).

3.2.2 Semiotics and Hypnosis Peirce (1985) conceived that the universe is perfused, that is, permeated, crossed, and, in a way, composed of signs. The sign is that which replaces something (an object) and produces an effect on the mind of the interlocutor (interpretant), whether they are human or not. Thought, necessarily, in its triadic aspect (in recursive relations involving object and interpretant), has many classifications (Liszka, 1996), the most famous being about its relations with the object: the icon refers to the object through similarity or quality (such as a drawing, hieroglyphs, or emoticons), while

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indexes are signs which refer through cause (such as footprints in the sand or a scar on the body) or functionality (such as marks on a mercury thermometer). Symbols, the most developed signs, do so through law, habit, or convention (such as words and speeches). Peirce’s semiotics is not limited to a classificatory effort; instead, it takes shape in a broader science – logic – that constitutes an important normative science, with the others being aesthetics and ethics (Liszka, 1996). These sciences depend specially on phenomenology, also developed by that philosopher and characterized by the study of the ways experience is seized. The first main phenomenological category is firstness, characterized by feeling, quality, and potentiality and essentially as linked to the present. Icons, quali-signs, and rema are examples of firstness signs. Secondness, in turn, is connected to indexes, sin-signs, and dicents, referring to the experience of reaction, the dyad, and existing; it also puts forth a historical aspect. Thirdness, in turn, already focuses on thought, law, habit, convention, and signs such as the symbol, legi-signs, and the arguments. That is the category which allows perspectives on the future. A classification derived from the previous categories, important to the study of hypnosis and bound to icons, is called iconicity (Jappy, 2013). Images (such as visions during trance) are signs of first-firstness; diagrams (signs referring to relationships between two or more objects, as in a descriptive narrative) are signs of second-firstness; and metaphors (signs that unite two distinct fields of knowledge in one expression, as in “love is blind”) are signs of third-­ firstness. Iconicity is revealed as an important field of study in hypnosis mainly because of the strong suggestive content in icons, which evokes unconscious processes and feelings that are fundamental for hypnotherapy (Neubern, 2016). Another issue regarding semiotic terms is the very attitude by the hypnotherapist toward a subject. Closer to firstness, the therapist’s attitude is like an icon, so it tends to evoke, along with the other, via hypnogenesis, a relationship based on welcoming, sharing the present with the other, “here and now”; thus, they evoke feelings and potentialities of change. Approaching humanist and existential therapies (Binswanger, 2008; Buber, 1971), that attitude is the foundation of the bond and initiates a process of accessing the other through the subtle trance provoked; the therapist seems to enter the world of the other and also to receive this other in their world. An attitude based on secondness already focuses on a perspective of reactivity, leading the protagonists to develop a relational choreography, including cognitive, behavioral, and systemic therapies, characterized by an emphasis on technique. The third attitude is highly marked by thought and symbolism, in terms of both narrative and theoretical construction and the reflexivity required for the course of therapy. Its proximity relates to psychodynamic and narrative therapies, although it is present in all approaches. In hypnotherapy, it occupies a fundamental role in terms of producing a favorable context for the construction of new meanings for the patient for important themes in their life. Semiotics also has relevant contributions to the understanding of the relations between ego and self (Colapietro, 1989; Petrilli, 2017), casting important reflections on hypnotic trance (Neubern, 2018a). In summary, the ego is a complex system of signs, capable of reflexivity (self-control, self-interpretation, and self-criticism) and

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different modes of rationalization regarding relevant issues of knowledge. It also constitutes important identity references, added to situating the subject before the social conventions connected to one’s own movement in the world (such as time, space, body, and matter) and to ethical and aesthetic values (good/evil, masculine/ feminine, beautiful/ugly, real/illusory, sacred/profane, human/animal). Although the ego carries an identity with the individual, it is socially constructed, so that it carries within itself the semiotic marks of its encounters, even though the limits of otherness change according to the context (Raposa, 2020). The self, in turn, refers to a broader dimension of subjectivity, marked by processes beyond deliberation and control by the ego (unconscious), which is traversed by social and collective records. Hypnosis is thus conceived as a set of communication processes that lead the subject to a state called trance, characterized by changes in the ego’s references to the world and by the emergence of a range of processes in the self (Neubern, 2016): a person can be on an armchair in a trance and see themselves in a childhood scene, in another time and place; a human figure can present themselves fused to an animal in the same way that a real-world person might present themselves in dialogue with a folkloric being (Clément, 2011). Another central aspect is the polyphony that trance usually enables (Morin, 2015; Neubern & Nogueira, 2019). The ego experiences a kind of decentralization somewhat heightened, that is, its perspective of control and identity center are changed, and other semiotic forms arise in the hypnotic scenario, with relative autonomy to it (Morin, 2015). An important and dear person from the past (a “you”) appears to resolve an affective impasse; an angel or divine being appears to summon that person to a spiritual mission (a “we”); an anesthetic process is triggered, evoking phylogenetic features and temporarily eliminating a terrible pain (an “it”). These processes evoke unconscious resources, favoring modifications on the agency of systems related to clinical demands. Therefore, important processes from semiosis (Liszka, 1996) can take place, that is, the capacity of a sign to be translated into other signs. A pain whose object is the incessant transmission of information to the brain, even after physical treatment, can alter that circuit when other suggestions link it to distinct sensory and perceptual processes, providing it with other meanings in teleonomic terms, that is, in the body’s own animal language. If that same pain is configured as a paralyzing fear of the family future in case of death, it can be modified in trance if the new object becomes a future with plausible reasons of security for that person’s family – that would be a modification in teleological terms or of conventional signs. Therefore, changes in ego-self relations occupy a vital role in hypnotherapy. As they reconcile and reconnect, the ego appropriates even more the richness of its ethos to feel more integrated into its own universe. Their active role is important for learning to connect and to evoke such processes without the pretense of controlling them. Instead, they seek to access them and allow them to act in their social world or in their own body. That way, a person can become the subject of their own process. On the other hand, they can also realize they are a sign that represents the collectivities encountered in trance, which also gives them the feasibility of being a citizen. That perspective allows for the conception of somebody that represents their origins in diverse ways.

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3.3 Education, Inquiry, and Service 3.3.1 Education, Belonging, and Becoming In the perspective adopted here (Neubern, 2018a), the human being as integrated with their ethos is a basic condition for citizen formation. It is from the dialogue with different influences inhabiting their self that they can discover themselves and develop a trajectory of existence with meaning. Hypnosis is shown as a valuable resource, since it favors dialogue with different semiotic systems shown through voices, beings, images, memories, and scenes intensely promoted by sociocultural processes in which the students insert themselves throughout their life trajectory – of which they are not always aware. Moreover, that process usually occurs in an unpretentious way, starting from the first sessions. The student is often amazed at the severity people’s demands as they come to the service in search of hypnotherapy. The vast majority is composed of people with various chronic diseases and pains, who often bring symbolic themes of relevance that transcend the simple question of chronic pain as an index, though they maintain strong articulations with them: a history of family mistreatment, depression, isolation, sexual violence, proximity to death, spirituality, conjugality, changes in family and social roles, pilgrimage for health services and increasingly invasive procedures, lack of money, loss of employment, problems at work, or the difficult search for certificates of leave with healthcare institutions. Faced with contexts of similar complexity, it is natural for the student to ask about the kind of technique to be applied, perhaps because they assume the power of hypnotic techniques could bring them some security and help solve problems. Therefore, the educational process begins with an appeal to their relationship, as demonstrated in the fictional dialogue below, inspired by dozens of previous real conversations: Student: “Sir, What technique should I apply with Dona Francisca? She has fibromyalgia, she’s at risk of being fired, she’s depressed, her husband’s an alcoholic … what do I do?” Professor: “Nothing.” Student: “What do you mean, nothing? I need to apply a technique…” Professor: “No, you don’t. What you should ask yourself is: how would you like your mother to be received in a service like this? Or your father or your girlfriend or any important person in your life. What would they need to receive if they were in need of this service?” Student: “But then what do I do? Nothing?” Professor: “Offer her a cup of coffee.” Student: “But there is no coffee here.” Professor: “I know. But there is the attitude to be interested in her. When you welcome somebody into your home and want her to feel good, offer her a coffee. So, if there is no coffee, maintain the same social situation, so that she feels good about you and can talk about herself to you. She is not a diagnosis or a medical record number, but a person. And you always need to try to answer this question: who is this person? Who is Dona Francisca? And that question you will never be able to fully answer in therapy, because people always change. It’s up to you to stay receptive, available, and present with her. That way you will learn about her and about hypnosis as well.”

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The previous excerpt may seem contradictory, considering that the internship experience has a strong emphasis on technical learning. However, the metaphor of coffee and its striking iconicity has a significant appeal to the development of a relational and affective process. In Brazil, a coffee offered to a visitor is a symbol of affection and cordiality, a sign that people feel comfortable to get together and talk. In that stage, the metaphor refers to the creation of a relational context, including some important characteristics. Firstly, it displays sincere way to grow interested in the person, in their ethos and social relations, something that goes far beyond the mere inclusion of typical indexes for a diagnosis or patterns of behavior. Secondly, it constitutes an initial training to set a first attitude, that is, a receptive one in which the semiotic processes coming from the other touch the student in their own body and begin to provide them with distinct elements to enter that relationship. This leads one to consider that this attitude is much closer to a presence (as they make themselves available to the other and receive different types of signs) than a “listening” stance, in which the verbal aspect of the conversation is prioritized. In presence, icons (images, sensations, feelings), indexes (tone of voice, pauses, movements), and symbols (words, ideas) of diverse types are important signs that gradually lead the student to build their role in the relationship. On the other hand, the first attitude is also a way of getting the student to contact a natural trance (Erickson & Rossi, 1979), one they initially do not always seem to realize. The receptivity of this attitude, especially when aided by self-hypnosis training, leads the student to alterations of typical trance references that sharpen their sensitivity to the other and allow them to feel, in a vivid and protected way, a little more than what is happening in their own world. These are moments when the porosity of the self (Petrilli, 2017) is accentuated, allowing for sharper interpenetration between the protagonists of the relationship: one enters the world of the other and provokes new processes of semiosis. In a welcoming and protected context, they learn, little by little, to establish the important balance between showing empathy and feeling the other’s experience, establishing the necessary distance so that the therapeutic role can be constituted and promote legitimate hypnotherapy. Thus, the attitude breaks with the idea of conceiving hypnosis as a grotesque form of manipulation, as the therapist seeks to place themselves in a unilateral relationship, within a completely distant role, from where they observe indexes and propose supposedly effective interventions. Here, on the contrary, the student is invited to encounter their own subjective universe and, from there, establish a respectful relationship with the other, while the latter realizes that they are, in fact, recognized as a person and as the protagonist of that process. Even if, occasionally, there is a need for action apparently contrary to such a connection (in the case of confrontations and provocations), the logic of the context remains the same, and the established bond sustains these interventions. Before learning techniques and theories, the student is formed from their humanity and that it crosses, necessarily, their semiotic interpenetration with the other. This often leads the student to a fundamental question for the democratic exercise: the issue of their own roots. By being available to be with the other in a relationship of genuine interest, they realize that, to learn to recognize the other, they

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end up feeling the need to recognize themselves. At this level of reflection, the student is faced with a very poignant problem in university education as practiced in several countries  – colonialism (Nathan, 2014). In countries like Brazil, significantly marked by great ethnic diversity (Carvalho, 1994) and permeated by important worldviews to understand the world, such as spiritual, folkloric, and popular, it is common for university education to lead students to great existential conflicts that favor alienation from their origins, related to that disqualified knowledges by scientific knowledge (Neubern, 2018a). Thus, the spiritual experiences and popular beliefs of their relatives are reduced to beliefs, ignorance, or psychopathology, leading the student to reject their own ethos to become a psychologist. To insert oneself into the academic universe, one must pay the price of mutilating themselves and leaving behind a good part of the self. The way one deals with such a problem in CHYS includes a significant process of deconstruction of colonialist optics; basically, that happens through two paths, widely supported by ethnopsychology (Nathan, 2014; Neubern, 2018a). The readings and discussions in group aim to highlight that scientific knowledge, despite its importance, is not the only knowledge that should serve as a reference for people, especially because it has specific roles and limits the scope of study. Themes such as death, transcendence, the Spiritual, beauty, art, love, and even everyday issues related to common sense require specific knowledges that have been developed for generations, with their own criteria of legitimacy; these are quite powerful to generate meaning in people’s lives. In more specific terms, the moments of hypnosis and self-hypnosis are commonly permeated by pervasive practices from Brazilian culture, involving songs, folklore, habits, parties, and storytelling that aim to lead them to a form of reconciliation with their own ethos. In these processes, it is not uncommon for students to report encounters during trance with familiar, spiritual, and ancestral figures and themes signified in their experiences, so passage through that stage often triggers new searches in their process toward their origins and the way they affect or promote their destinies. If an educational process cannot be reduced to psychotherapy, it is also right to say that this process has very significant therapeutic implications, as it refers the student to an encounter with various facets integrated into historical group processes and knowledges. It is the awareness of this ego-self integration, constantly in process, that enables the start of citizenship, because the student begins to know their positions in the great social arena. Nevertheless, the internship proposal is only to begin that trajectory of becoming and placing oneself between the voices that precede them, with their destiny being construed in the social transactions of daily life.

3.3.2 Inquiry from the Inside Out One of the central aspects of democracy is freedom of thought for its citizens, who can influence the most simple and broad decisions of their society (Santos & Meneses, 2010). In addition to the application of the electoral vote, a citizen can

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manifest themselves regarding sensitive issues of their society and actively participate in different modes of social control. Similarly, the scientist has freedom of thought to conduct their research and reflections as long as they obey the scientific rigor of that method and submit their work to public control by their peers. Universities, combining democratic and scientific ideals, become, at least in theory, institutions that promote intellectual freedom about the production of knowledge with an emancipatory character. Research, therefore, should be a creative act of thought generation (Gonzalez Rey, 2019) that, while obeying the rigor of the method, also becomes an adventure toward the new, challenging previously established beliefs and habits. Milton Erickson, throughout his work (Erickson & Rossi, 1980), achieved prominence through his conception of hypnosis as a field of inquiry. While he united clinical practice and knowledge construction, he refused to create a systematic theory about hypnosis and human subjectivity, as many of his contemporaries did. Such a stance relates to Erickson’s deeper perception of an elusive and diaphanous reality of hypnosis that could not be grasped by the common modes of theoretical construction available. Considering the complex architecture of knowledge as proposed by Peirce (Liszka, 1996), Erickson’s perception of subjectivity and hypnosis is linked to a field of knowledge prior to common scientific logic: a philosophical field marked by phenomenology and metaphysics. Without claiming that hypnosis should be irretrievably linked to that field and forgotten by science, inquiry is conceived in that interstice (Liszka, 1996; Seif, 2019) as a way of enabling access to promote a scientific construction about it, as illustrated in the example that follows: Antônio Nobre, 40 years old, came to the CHYS service in search of help for severe chronic pain resulting from subsequent surgical accidents. Apparently, the surgeries had injured some nerves in the dorsal spine and lower abdomen, causing inappropriate stiches in that area and leading him to paralyze his social and work activities and seriously consider suicide. He reported feeling like he was tied up inside, which made his mobility difficult. Divorced, father of two daughters, he had distanced himself from the family and lived under the help of few friends, through whom he had access to an Umbanda2 group. According to him, that group helped him significantly in terms of his pain, during the short period he participated in their activities. In the first session after Umbanda, the therapist induced him into a long and deep trance, with many pauses so that he could explore each moment of the experience. For Antônio it was important, because he had the habit of occasionally focusing his attention on the pain areas (imagining lights and sensations), sometimes trying to immerse himself in sleep. It is curious to note that, during his induction, the therapist was also in a receptive process and was surprised by the sight of a woman, by the sea, with very brown skin, black hair, white clothes, and white flowers on her hair and hands. Such a vision, however, disappeared like smoke that simply falls apart in front of someone’s eyes. Without the therapist telling him anything, Antônio reported that, while trying to immerse himself in deep trance, he visualized a group of people in white clothes and flowers performing a ritual by the sea and that, upon returning from the trance, he felt as if the internal systems ties connected to his pain were loosened, which brought him great relief.

 Umbanda is a typically Brazilian religion that integrates African influences, European spiritism, and Indigenous religions. He works intensively with trances and communications with the spiritual world. 2

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This report refers to a need for access via inquiry, a more complex practice than research, given the ontological content of that reality. This attitude of inquiry, therefore, should initially be that of navigation (Seif, 2019), as the researcher-therapist travels through the field and lets themselves be touched by it, in multiple impressions, without stagnating themselves on any of them. As this process of navigation advances, its movement allows a new connection with its own self, to evoke an intentionality regarding the experience and, from there, the start of its first processes of constructing hypotheses and impressions (abduction) which, in turn, have nothing definitive but constitute an initial milestone for investigation (Fann, 2010). The inquiry led to a semiotic process of constructing images that seems accessible to the protagonists only through meticulous trance construction. The field of hypnotic experience, in no way corresponding to the consensual reality of care, has its own logic, focused on the theme of Antônio’s healing. The presence of images in scenic motion seems influenced by his Umbanda session, which highlights his receptivity for collective construction of knowledge with those who sought help. This knowledge, permeated by the Sacred (Otto, 1917/2017), has significant impacts on him, introducing a power that is capable of providing effective aid for his pain. Even in front of a protagonist with a tendency to seek control of his experiences, these images displayed autonomy in actions. They were diaphanous and disappeared in an evanescent manner, suggesting that they have a fluid and elusive constitution. The role of the researcher should not be restricted to a distant posture focused on the binomial index collection  – on intervention. Quite the contrary: this type of immersion, even if fragile, leads to an abductive process through which the first approaches toward signs of primordiality are initiated; they are also a way of linking the researcher with the field. In addition to its therapeutic value, this causes the important consequence of introducing experiences into their own self. The idea of a natural trance as discussed by Erickson (Erickson & Rossi, 1979) is coherent with this concept, since it refers to a familiar situation and is experienced daily by researchers. Inspired by Peirce (Santaella, 2004), this chapter shows that knowledge should not start from artificial questions, as in Cartesian doubt, but from the field experienced within the researcher’s own visceral senses. That attitude usually seems fragile in the face of assessment by positivist researchers and instrumentalists who would see it as an irredeemable source of error. Nevertheless, it refers to a central principle of inquiry: the eidetic principle of knowledge (Ibri, 2015), according to which knowledge is legitimized because of its similarity in relation to its field. It is only through that similarity between the experience of knowing and the studied field that the construction of knowledge becomes possible, turning the experience into the subject of the process (Peirce, 1997). That shift does not cease to demand an active role by the researcher, who must stay agile and flexible enough to generate intelligibility from their complex relations with the field. Despite the importance of discussion and consensus at the community level (Liszka, 1996), this relationship with hypnosis is born and present from multiple actions by the subject, who dialogues with various facets of that experience to generate knowledge. Following Morin’s (2015) perspective, if science demands scientific communities for legitimacy and continuity, it does not dispense with the

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subject’s participation. The inquiry’s eidetic content (Ibri, 2015), therefore, is what should prevail as a condition for the process, requiring a subject to accompany and dialogue with that complexity. In the case discussed here, the attitude of first approach seeks to inventory semiotic processes from hypnotic reality, marked by diaphanous and elusive signs. This is a field of the present, qualitative, and potential (Peirce, 1997) without concrete existence but playing a fundamental role in the constitution of other fields of reality, which seem to be linked to important processes of change and subjective reorganization (Neubern, 2018b). Therefore, the next step of inquiry refers to a second attitude, characterized both by deduction, as hypotheses are chosen and improved (Fann, 2010), and by a more technical and choreographic mode of interaction in the hypnotic relationship. It is a moment that comes out of the “may be” of abduction, to set the scene for what “should be” in deduction (Peirce, 1997). In Antônio’s case, hypotheses must revolve around the central theme of the inquiry: the relationship between the hypnotic context and process of reorganization around systems of chronic pain. Furthermore, even if an appearance of spiritual beings during trance to the researcher and the patient represents an interesting trait in parapsychological terms (Maraldi, 2021), for example, that hypothesis has become irrelevant either because it does not have a direct relationship with the purpose of the investigation or because it has not lasted throughout the therapeutic process. The absence of continuity and adherence by Antônio to the spiritual treatment also did not allow the treatment to go further in ethnopsychological terms, as it often happens in other cases (Neubern, 2013). However, further investigations on the influence of that collective knowledge are possible. The hypothesis, then, began to focus on building a hypnotic context that favors both the fulfillment of an ego as required to deliberately use its focus on the affected regions and the possibility of surrendering and diluting oneself into a broader experience – something fundamental to affect deeper levels of agency in the organization of pain systems. This dual movement would allow access to a vast field of primordial signs, potentially initiating new processes of semiosis along these systems and promoting significant changes. The excerpt that follows illustrates that process: Researcher: So, Antônio, as a part of your focus on what they want, the other part is preparing to switch off and take a vacation… And you’ve already tried some of the streets, protected and smooth, so you can focus on places in your body as you want it. Your mind seems to possess the medicine that influences them so much… The lights, sounds, and colors, all of it in your mind, you may want to use it… Or just talk to that part of your body… As long as it does that, I wonder about the ways life … is like a drop of water .. When it comes loose from a leaf and falls into a river. Does it disappear and dissolve in the Great River? Or is it that it’s still there and it just gets carried away by the running water… And gets some fruition from it all… Or maybe it should be the life of a feather, released from a bird… It’s dancing to the tune of the wind, it will go from one side to the other. […] It holds on to a vine for a while until it leaves again… And the wind hits it a bit harder so it dances with stunning beauty… With incredible lightness…

This moment illustrates an attitude that refers to a technical application and a real interactive game (rapport) between the researcher and the patient, characterized by a choreography of many poses and slowness in their expressions and behaviors.

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Both seemed to sleep even though they were engaged in the procedure. In a certain part of the induction, there was a deliberate conversation directed at the ego, offering it freedom of action, as it is typical for Antônio. It was an attempt to meet an important characteristic about his way of being – the control of his life – that had been brutally affected by surgical accidents. The other part of the induction had a metaphorical character, creating an implicit relationship between his being and some small body (like a drop of water or a plume) letting itself go along something bigger, like a river or the wind. This suggestion, permeated by different icons and integrated with a diversity of signs, was fundamentally important for evoking the potential and feeling dimensions of the experience in order to generate new processes of semiosis.3 This hypothesis was gradually improved during the sessions, leading to a significant possibility of making meanings. As deemed pertinent, the next stage of the inquiry turned toward an induction process to verify its legitimacy. The relationship between the hypnotic context and the possible interpretants generated from the clinical process remaining over time had been established. Now, there is a central aspect for the inquiry proposal defended here: contrary to what a lot of the scientific literature supports, it is not that hypnosis should be an instrument for pain control, but a way to facilitate the reconfiguration of these systems with new modes of agency (Liszka, 1996). The idea of control refers to deliberate actions by the ego over systems it cannot modify. However, that the ego should have an active role in connecting with other systems of the self, which can be evoked to work on pain experiences from their respective modes of agency. After 2 years of work, when Antônio reported that his pains had decreased from 8 or 9 to 3 or 4, these statements were important indexes of improvement due to that ability to access the self, whether through hypnosis sessions or in moments of self-hypnosis at home. This allowed him relative autonomy in his daily life, favoring him with certain resumption of social circles and activities. In terms of inquiry, the process would conceive the extent to which the interpretants generated in hypnosis had a teleological character, that is, aimed at proposing meanings and purposes for the future (Liszka, 1996). This would refer to a new symbolic construction on pertinent elements of pain systems, implying the involvement of the triadic dimension of signs in their ability to generate conventional signs. The process should also cover, though on a secondary level, a teleonomic dimension of semiosis, considering the biology of pain. These axes of analysis would be important to highlight the ways hypnosis could help in reorganizing pain experience. Considering Antônio’s, hypnosis could satisfactorily achieve its purposes for the following reasons:

 It is not stated here that icons act through a brute and direct force on agency systems. My hypothesis, on the contrary, is that their presence, by the force of change, can promote new processes of semiosis that might lead to broader changes at the level of agency. Surely, hypnotic suggestions are also not restricted to icons, even if they play an important role in them. There are also signs of secondness and thirdness, as notable from the clinical illustration analyzed here. 3

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• The hypnotic context contemplated the uniqueness of semiotic production, seeking to build a compatible language with its subjective universe and modes of communication, verbal or nonverbal. • Antônio’s particular needs, such as reception, exercise of control, and immersion in trance, were relatively met. • Antônio was involved as the protagonist of the process, performing a key role in his own therapy. • The dissociative process, while allowing him to exercise deliberate actions, promoted access to important systems that, once activated, helped him to promote semiosis processes that led him to new modes of agency, with relative durability over time and autonomy for the therapist. Sentences such as these, corroborated by several similar clinical situations, encourage reflections of terrific value. It is true that they must be subjected to public debate, as criticism and reflection can exercise community control that might reject, legitimize, or improve them. However, instead of a simple production of sentences for subsequent communication, the moment of induction is logically connected to a broader reflexivity, in which the researcher can evaluate the process and their participation in it using pragmatic terms (Seif, 2019). That attitude, marked by externality, offers the possibility of constant corrections in the face of the fallible condition of knowledge – Peirce’s fallibilism – generated in the process of science (Ibri, 2015). That is also an attitude which must be pursued in scientific exchanges with the community; their reflections are fundamental in this self-correcting path. Nevertheless, from the researcher’s point of view, this process is highly relevant, leading them to identify and understand the new habits bequeathed to them by such a process and whether they have remained consistent with their ethical ideals and knowledge-building aesthetics. These phases of inquiry, as well as the attitudes linked to them, are not closed within themselves, and they may recursively feed on each other throughout the construction process. At the same time, this proposal is based on a deep relationship between the researcher’s experience and the field of reality studied, as evident in hypnosis. That content, from the inside out of the inquiry, highlights the importance that such a mode of relationship with reality should be above external criteria, as deemed desirable by instrumentalist cognitivism (Psillos & Zorzato, 2021) and some contemporary financing policies. The democratic context of science and the university must require researchers who feel integrated into their fields and who are committed aesthetically and ethically to them, given the eidetic content of that relationship (Ibri, 2015). On the contrary, far from presenting themselves to the arenas of community negotiations as citizens of knowledge, they tend to be alienated from the purposes of their knowledge, becoming mere puppets of other subjects whose interests do not always coincide with the needs of the inquiry.

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3.3.3 Hypnotherapy and Partnership The recognition of the other is one of the most central themes of human existence (Buber, 1971), through which different social records intersect. It is the founding condition for citizenship, so that each person, under a common symbolic ground of values, rights, and duties, goes through polis and interacts with their fellow people. It is also an important clinical problem, as it is from this otherness that the other is situated in the condition of subject (Morin, 2015) and remains co-protagonist of their therapy. Moreover, that acknowledgement comes from modern clinical and health practices, which are sometimes contradictory, because they proclaim the autonomy of the subject, but imposes on them very different worldviews from those of their ethos, promoting a colonialist logic of interaction (Nathan, 2014). The person, as a sign, is read under individualistic concepts, detached from the multiple relations of the collective knowledge that it represents; these are disqualified and reduced to beliefs, imagination, or madness. It is precisely at this point that hypnotherapy, under ethnopsychological inspiration (Neubern & Nogueira, 2019), assumes a significant role. In a radical way, trance illustrates the porous contents of the self, which is largely permeated by social exchanges, and there they present themselves more vividly than in a simple memory. At the same time, the autonomy in the signs emerging from trance commonly surprise the ego, which places these experiences in a distant condition from the passivity through which so many people are seen by therapists. The person who searches a service is an active being and sign of collectivities, so they must be recognized through those conditions. The question of who is this other, therefore  – who goes to hypnotherapy service – must be thought of through two major axes. On the one hand, there is a broad self that transcends the ego and points to multiple forms of relationships and semiosis. The monolithic and hegemonic modern view is focused on an individual closed in itself and is almost totally identified with the ego, so it loses its reason for being given the semiotic heterogeneity from processes of self that always brings in itself the semiotic marks of the social sphere (Colapietro, 1989; Petrilli, 2017). Moreover, trance highlights a key issue regarding the relationships between ego and self that need to seek new ways for integrating in the face of the flow of life and the challenges that this brings them. The ego is not an all-powerful instance, capable of settling the multiple levels of determination that impose upon it, but, since it establishes new modes of integration with the self, it can trigger decisive resources and potentialities for the reconfiguration of experiences. It is precisely because trance acknowledges and learns to deal with influences and determinations that it can create important alternatives to the demands that afflict the self (Raposa, 2020). This is what allows one to situate the person as the subject of the process, a sign linked to their intentionality and transformative action which can involve teleologic and teleonomic modes of pain management configured by it. On the other hand, the other is also constituted as a representative for the collectivity, that is, a sign of collective knowledge in a society. A person who has spiritual manifestations is a sign of a

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universe that goes beyond their individuality, a universe of collective knowledge and machinery, with its own logic and notions of reality (Nathan, 2014). It is essential that therapists and researchers get to know this other collective and establish with it the necessary negotiations for the course of therapy. This may result in more formalized situations, involving practices and conscious actors, such as rituals and experts for more subtle moments, for example, in common conversations that occur during trance. The technical power of that knowledge (Nuñez, 2013) and the potential of their worldviews to generate meaning should become essential for dealing with complex situations of chronic pain (Neubern, 2018b). In short, for this other, individually and collectively, to show itself from that own union, it is essential to build an adequate and emancipatory context. In that sense, it is possible to conceive the principles for building that therapeutic context, as illustrated in the case that follows: When Isadora Ribeiro, 57, a university professor, came to the service in search of help, her situation was too serious. It came from a traumatic divorce, with betrayals and violence and a highly precarious financial condition. She had intense mental disorganization, unable to finish sentences and reasoning, nor could she walk down the street without getting lost in time and space. The strong bouts of anguish were accompanied by suicidal thoughts, fueled by a violent family past that excluded her, condemned her, and accused her of being mad or lying because of her “spiritual things.” For her family of origin, Isadora would have no way to work out in life. She was already away from work, and her social circle was highly restricted, with few neighbors helping her with basic matters. After 2 years of internal reorganization work, she began to experience severe body pain, diagnosed as fibromyalgia. However, at that same time, during trance, her body and voice were taken, and she manifested spiritual beings – Chinese masters – who would belong to a spiritual collectivity, named as White Fraternity, well known in esoteric circles in Brazil. Much of the treatment turned to a new form of connection between Isadora and this universe, mainly in the sense that, from the negotiation with such a machinery, her therapeutic demands were met. Their sessions were developed with a care team composed of students, psychologists, and the coordinating researcher.

One of the first principles applied to build Isadora’s care was the relational contract, according to which spiritual beings could express themselves through her freely, provided that the expression did not compromise their integrity and that of others present. The goal there was twofold: On the one hand, the context created worked so that Isadora could exercise that form of trance protectively, in order to establish new connections between ego and self. On the other hand, it was a way to realize the principle that nothing is known about others and their versions (Neubern, 2018a). Other can be known only through a relationship with them, as they express their knowledge and world references. As Masters expressed themselves through it, their appearances and interventions were discussed, appreciated, and debated with the care team. This was a way of establishing a dialogue so that this great collective knowledge showed itself and assumed a leading role in Isadora’s treatment. Another important aspect of the treatment concerned the home visitations. If there was a need to prevent accidents (she had already fallen on the street and in public transport), the team also sought to meet a request from spiritual beings, for whom her home would be a spiritually more balanced place than the university. In

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ethnopsychological terms (Neubern, 2018a), that idea is often present in different religions, as they prepare sacred environments to protect them from negative influences through rituals composed of prayers, fasts, oracles, and different technical objects such as incense, herbs, crystals, images, and water. It should be noted that this context has been largely driven and influenced by the principle of utilization (Erickson & Rossi, 1979), according to which different expressions of the subject’s ideas, behaviors, opposition, symptoms, and modes of relationship are used in favor of their healing process, in order to become a tool for their needs. With the acceptance of the other as a precondition, this principle was taken primarily in terms of the relational needs presented by Isadora and her Masters in order to facilitate the expressions of that universe. When the Masters exposed their intention to the team – to bring spirituality and science closer – they did not seek to put themselves in the position of an object to be studied, but to promote specific modes of relationship. The performance of these roles (Schechner, 2013) gave the team members a kind of passport to deepen this collective knowledge in its richness of expression. Under the influence of the Masters, Isadora placed herself as a sign of the Sacred (Otto, 1917/2017), implying an unspeakable but deeply meaning-generating sphere, focused in the present, with strong emotional involvement situated in a sphere of power beyond human limits (death, life, matter) and linked to a field of action by spiritual beings. Occasionally, during trance, Isadora performed a vast repertoire of paranormal abilities: predictions, telepathy, health diagnoses, distant vision, and healing that seemed to constitute technical dispositives (Nathan, 2014) to challenge their interlocutors. However, that approach was not limited to a cognitive exercise and could include a strong presence of the Sacred, capable of deeply mobilizing the team members and touching on important themes of their lives, without having them feel exposed. The Masters incorporated in Isadora were signs of the Sacred, whose influence was not something fixed and delimited, but an elusive instance, capable of producing new feelings and experiences each time it was visited (Raposa, 2020). Their manifestations involved a considerable range of signs, far beyond the expression of words – especially because it was common for team members to accept being put into a trance, as in experiments proposed by the Masters. At certain times, they introduced lessons of spiritual wisdom on life themes, situating team members as disciples. In others, they exercised prophecies that, more focused on individual themes or on the collective, placed them in the role of witnesses. In others still, healing powers were used for diseases of the body and soul, and team members acted as patients. The emotional implication of these interventions seemed to be given sparingly, since the Masters themselves stated that an experience would not be proposed beyond a person’s reach. Such a performative scenario presented semiotic principles of great relevance, beginning with the protagonists of the relationship who positioned themselves as participants in a theater – as signs of specific symbolic scripts (Elam, 2010) who could be actors in the context, that is, in the scene with Isadora and her Masters and in the auditorium, where they felt the resonance of these performances.

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There was always the opportunity for questioning and contestation on the part of the team, mainly if they understood that certain interventions were inappropriate, which required new negotiations. The relational contract stated that the context should not propose a religious conversion or the foundation of a sect, but the possibility of living spirituality as a human experience worthy of the scientific interest. The contract also included the provisional construction of an alternative network for Isadora, as team members assisted her in basic matters such as buying groceries, bank visits, and hospital appointments, when necessary. In addition to promoting an important network of support that facilitated bonding, this proposal also had pedagogical content with the students in the sense of putting them in contact with different modes of the social reality for a person with chronic pain. The context, which lasted another 3 years after the initial 2, had important therapeutic consequences. Isadora became increasingly autonomous to enter trance, which allowed her to explore and integrate important dimensions of herself, such as her paranormal abilities. The capacity to revisit her history under spiritual assistance did not exempt her from suffering but placed her in a diverse condition: she could conceive karmic motives for a difficult family history and understand that her life had a mission of bringing spirituality to people. Her social network grew, and Isadora became someone who could help and guide others spiritually, helping them in various matters. From a troubled, lying, and crazy person, who would have no way to function in life, she became a positive reference for the lives of other people; she became capable of guiding them, taking care of them, and teaching them spirituality, that is, she became a sign of the spiritual world. Her psychic disorganization ceased, as did her strong bouts of anguish and suicidal ideation. Even though the pains remained, there was a reported improvement in her quality of life, either through a new social network and the practice of meaningful activities or because of the daily habit of exercising trance, which gave her strong pain relief. Most cases in the service do not resemble Isadora’s, either by the abundance of spiritual phenomena or by the characteristics of the hypnotic context that was developed. Usually, the issues related to ethos and collective knowledge remain in the setting of the care room and are treated on a symbolic and imaginary plane, as in common scenarios of hypnotherapy. Nevertheless, it is quite telling of the proposal of hypnotherapy, mainly concerning the idea of acceptance and utilization by Erickson (Erickson & Rossi, 1979), here taken as the basis for recognizing the other. That idea assumed a radical content in the sense of taking seriously her reality that her Masters were concrete, beings of a great collective machinery (Nathan, 2014) and important characters of their own world. This is how hypnosis, for Isadora, became a powerful vehicle for recognition. Through adopted principles (Erickson & Rossi, 1979), the therapeutic team favored a context of hypnogenesis in which she and her Masters could express themselves according to the legitimacy of the collective knowledge they represented. The beneficial therapeutic consequences coincided with a strong emancipatory attitude; despite her limitations, Isadora became better at managing her own universe, integrating with it in healthier ways. Moreover, from a marginalized condition in many ways, Isadora began to integrate her social circle as a person capable of

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negotiation – a sign of the spiritual world – offering and receiving meanings from others, capable of taking her place in the citizen world of polis. Her hypnotherapeutic process was a way of integrating Isadora into a democratic condition in the social world that undoubtedly needs diversity to exist. Regarding the esoteric knowledge that Isadora represented, her acknowledgement, in a university context, was important in the sense of selecting a hypnotherapy averse to colonialism. That great scenario of knowledge, where everyone can take their seat, assumes that, in addition to modern science, other ways of understanding and investigating the world can take part. This does not mean a dispute over the truth or even over the acceptance of any idea, but that there is traditional knowledge that is a source of meaning and inspiration for people and groups dealing with issues that science cannot access. They have their own ontologies whose beings do not respond to scientific devices, but to their own technologies generated from their machinery (Nathan, 2014). Recognizing them is important based on the very idea of a democracy of knowledge (Stengers, 1997); if science is the only voice in the social scene, democracy will give way to tyranny, and science itself will lose its raison d’être.

3.4 Far Beyond Technique Kahlil Gibran (1923/1973), a Lebanese poet, once wrote that working with love meant that man should put a breath of his own soul into everything he did. In the perspective presented here, love or agape (Peirce, 1985) fulfills the role of the ideal, as introduced by Darcy Ribeiro: what is beautiful and admirable in itself cannot modify macrosocial systems, but it should guide people toward a life that would not be corrupted by those same macrosystems. To do that, the person is the one who should seek his ideal so they, in some way, inhabit their self through habits and senses, involving others who are available to experience it, as well. For the educational process to go beyond the theoretical and physical walls of the university, the student must develop, from their own world, a bond with the field of their training, so they can serve as a guide, as a professional, citizen, and human being. Hypnogenesis is, in itself, a powerful vehicle for the construction of experiences, because of the transgressions upon otherness it provides, either through formal trance or through the relationship itself. Therefore, it is necessary to be guided by that ideal – agape – so that it extends to the other through general empathy, as if the other were one of theirs, so they can feel touched by the universe that inhabits them and is inhabited by that person. Experience, here, is to realize that they are and that they see themselves semiotically in this other, just as this other is also in their world, contributing to new processes of semiosis. Hypnosis, supported by the notion of self (Colapietro, 1989; Petrilli, 2017), thus contributes to an important ethical commitment; despite learning to take a reflexive distance, the student begins to realize that commitment to the other is a philosophical, technical, and ethical condition. Agape becomes a central aspect to position itself in the face of the complexity of universes

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of people with chronic pain in Brazil, such as failures in problem-solving, issues with domestic violence, racism, spirituality, financial losses, solidarity, work upheavals, social isolation, artistic expression, support figures, depression, and fear of death (Neubern, 2018b). It is that ideal that allows the student to learn to connect to the contradictions in such universes, to be supportive of them and to work, along with their protagonists, toward building the paths pointed out by the possible. It is through that profound exchange that agape leads the student to ask themselves about their own ethos, seeking to connect with their origins, ancestry, voices, and knowledge. In dialoguing with such a universe, the student can connect past and future to themselves through a present attitude and establish meanings for life (Frankl, 1978). These modes of connection between ego and self oppose alienation, so present in contemporary societies, and set themselves as a central topic of citizenship, as they perceive themselves as subject and representative of the universes inhabiting them. To forge oneself as a therapist is to walk the path of dialogue and integration, which requires many instances of trance. This is how the technique, far from a tool of manipulation and distance, becomes an extension of their subjectivity, as the guitar is for the musician. Agape, while ideal, has similar influences in inquiry through its principles and practical moments, inspiring a love of knowledge. The essence of the inquiry is not in the application of instruments and protocols, but in the eidetic character of that experience (Ibri, 2015) that situates it as the main north for research and implies the researcher as a subject (Morin, 2015), especially in their participation as an agent trying to generate intelligibility about the field. Inquiry thus becomes a praxis of soul because it is constituted from an experience generated from within the researcher’s subjectivity based on a fruitful relationship with the field, which in turn generates thought. Regarding hypnosis, Erickson’s a-theoretical character (Erickson & Rossi, 1979) is one of the first points to be considered in the inquiry, because it refers to an elusive and diaphanous dimension of experience, exemplified in Antônio’s case, when theorization becomes practically impossible. This does not situate Erickson as a metaphysician but suggests that his persistence avoiding theory refers to a need to seek resources from metaphysics and philosophy to initiate new possibilities of understanding about what hypnosis would be, as recently proposed by some authors (Neubern, 2016; Short, 2020). Another noteworthy aspect relates to the researcher’s own role in this process. Because these are phenomena whose semiosis seems to flow rapidly, as if the self becomes another at every moment (Erickson & Rossi, 1980), inquiry must be based not on the establishment of external criteria for regularity, as in the experiment that is repeated in a laboratory, but upon logic principles based on the semiotic construction of these highly complex, singular, and irregular systems in many of their moments. Agape acts in the sense of engaging researcher in knowledge as an adventure (Ribeiro, 2015), which occurs in terms of feeling and thinking, given the scientific requirements of a field that, through hypnogenesis, invades and creates habits in their subjectivity. As a true philosopher, consistent with the term PhD, the researcher understands that doing science is a particular mode of their philosophical praxis (Martins, 2005). More importantly, they understand that inquiry is a process

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that has its own needs: from the bowels of subjectivity, as in abduction, to discussions with the scientific community, the researcher takes their own position, acts, and reflects upon contradictions, failures, and any coherences presented to them by that field – this practice becomes a challenge for them, set between pleasure and anguish, from which they cannot deviate. The eidetic character of this relationship with the real impels them to a more refined attempt of approximation between their constructions and what reality presents to them. In hypnosis, this challenge is even more forceful, mainly due to being a field which escapes attempts by modern science (Stengers, 2001) to break with the differences between fact and art-fact. For these reasons, if one conceives the importance of hypnogenesis as a semiotic constituent of the process rather than a problem to be avoided, new perspectives for understanding this field’s needs and its relations with the researcher become possible. Therefore, the needs inherent to inquiry should not be disregarded in relation to external criteria resulting from methodological imperialism, as if the scientific method were the only option (Gordin, 2021) to adopt goals and modes of production alien to the investigators. Devotion to the market as a philosophy of drastic consequences should not outweigh the needs inherent to inquiry and research in general. The researcher’s role as a citizen is exactly to remain faithful to their relationship with the field, promoting conscious opposition to such influences. Moreover, one of the fundamental characteristics of the researcher as a citizen is the practice of reflexivity by observing that which is left by the inquiry as a habit in their universe, because it also grows and develops from that same inquiry. Inspired once again by Erickson’s proposal, the clinic in hypnosis is essentially a way of inquiring, either through the eidetic content of one’s relationship with the field or because of the role of the therapist as a subject. Agape adds the dimension of care as a philosophical, technical, and ethical condition, because the request for help on the part of the person is, at first, the reason for seeing a therapist. If the inquiry inspires the researcher to love knowledge, the clinic leads them toward the knowledge of love. Regarding the recognition of the other, even if the authority of the therapist has an important role to include them as a protagonist in that context, the first attitude requires a posture of profound humility, in the sense that the therapist knows nothing about that other. That attitude immerses the therapist in a subtle trance, characterized by great availability to the other, as agape extends toward them in a movement that merges care and knowledge. As the person captures, consciously or not, that set of loving suggestions, when they realize they can express themselves in their own ways in front of the therapist, their protagonism becomes concrete in the therapeutic scenario. The term protagonism also requires further consideration because it involves a dimension of authority – a term usually restricted to the role of the therapist. Even if a person occupies a submissive or marginal role, socially speaking, as in Isadora’s case, hypnotherapy should lead her not only to a recognition of authorship, as the person faces their role in the plots they are involved, but also in relation to the recognition of authority – enabling them to appropriate their universe over other perspectives, to reposition oneself in the world. This authority, which grants it the possibility of citizenship, is also shared and preserved

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by the collective knowledge and by the influences that permeate that universe. A relationship based on partnership requires the presence of both authorities, that is, therapists and people (or someone from their networks) who are experts on their own worlds. On the other hand, the problem of meaning is central to the relationship of hypnotherapy, when collective knowledges such as the spiritual one are involved. Commonly, a somewhat veiled colonialist impetus in therapeutic relationships provides an acknowledgement of these senses but only halfway, which tends to mischaracterize them (Neubern, 2013). In addition to restricting these feelings to the individual and, eventually, to their social exchanges, a strong colonialist mechanism is also used to translate other components of knowledge (such as beings, technologies, extrasensory phenomena) into typically psychological or psychiatric categories. When this occurs, the attitude of recognition falls to the ground, and the therapeutic relationship is at risk, because people are better at perceiving rejection than therapists usually realize. Meaning, therefore, must spring from an entire ecology of individual and collective processes that cross experiences, such as those of trance, which refer to a worldview marked by invisible beings, perspectives of spiritual laws of the universe, and intentionality regarding men, objects, relationship with nature, and diverse technologies; those include cures, spells, divinations, oracles, and negotiations with the spiritual world (Nathan, 2014). In short, rather than seeking to apprehend the senses through categories alien to their knowledge, the researcher should favor these entities to show themselves from the ecology of their own universes. Certainly, many would wonder if that attitude would not be a way to support deniers and pseudoscience doctrines (so in vogue currently), a point that deserves further study for several reasons. As a general principle, no movement or knowledge that puts the integrity of people at risk deserves acceptance in the arena of negotiations in a great polis of knowledge. A lot of destruction has been caused by fascist, anti-vaccine, and sect movements (Nathan & Swertvaegher, 2003) in contemporary societies, and accepting such proposals would be a risk to democracy itself because of the violation of citizens’ integrity. On the other hand, the term pseudoscience should also be revised, since not everything outside the reach of modern science (Stengers, 1995) should be thought of based on its criteria. Knowledges such as yoga, acupuncture, qui-gong, homeopathy, blessing, prescriptions, and spiritual healing techniques not only have a long ancestral tradition but are also sources of powerful meanings for many people in the world (Nathan, 2014). Even more recent therapeutic techniques should receive special attention, particularly because of the therapeutic effect they have (Bergé, 2005). The proposal to study that which is outside the scientific scope is undoubtedly valid, but the risk of conducting a process of disqualification is not insignificant, since many of these forms of knowledge have specific dispositives and ontologies that do not respond to modern laboratories (Stengers, 1995). Agape, then, can be constituted as a link of solidarity among knowledges, and criticism and rivalry would not prevail to determine the genuine interest of understanding and recognition of the other. After all, it would not be an exaggeration to conceive that paradigm shifts lead science to think and rethink, not

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in terms of a distinct and fragmented knowledge about others but connected to them by historical and epistemological continuities that must be considered, as hypnosis suggests under different optics (Neubern, 2018a). Pseudoscience also raises another important question: would the humanities, philosophy, and arts also be in its scope? What about hypnosis, which remains at the edge of modern science (Stengers, 2001) and still claims multiple views from different disciplines? A possible answer to such questions can be thus: perhaps science cannot evolve and even exist without these frontier fields, since it is exactly what has not yet been explained and is marginal in the face of a constituted knowledge that motivates science to progress (Gordin, 2021). In the case of hypnosis, that problem is even more interesting, as the researcher is irreversibly entwined with the other whom they are willing to study.

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Morin, E. (2015). La méthode V. Seuil. Mota, W., Jr. (2019). O Banco Mundial e a contrarreforma da educação brasileira no governo Lula da Silva (2003–2010). Avaliação, 24(1), 213–233. Nathan, T. (2014). Nous ne sommes pas seuls au monde. Seuil. Nathan, T., & Swertvaegher, J. (2003). Sortir d’une secte. Seuil. Neubern, M. (2013). Psicoterapia e espiritualidade. Diamante. Neubern, M. (2016). Iconicity and complexity in hypnotic communication. Psicologia: Teoria e Pesquisa, 32, 1–9. https://doi.org/10.1590/0102-­3772e32ne217 Neubern, M. (2018a). Clínicas do transe. Etnopsicologia, hipnose e espiritualidade no Brasil. Juruá. Neubern, M. (2018b). Hipnose, dores crônicas e complexidade. Técnicas avançadas. Ed. UnB. Neubern, M., & Nogueira, H. (2019). Complex hypnosis contributions to clinical psychology. In C.  Antloga, K.  Brasil, S.  Lordello, M.  Neubern, & B.  Queiroz (Eds.), Psicologia Clínica e Cultura 4 (pp. 71–90). Technopolitik. Newfield, C. (2018). The great mistake. How we wrecked public universities and how we can fix them. John Hopkins University Press. Nuñez, S. (2013). Brazil’s soulful medicine. Infinity. O’Neill, T., & Piepenbring, D. (2019). Chaos. Charles Manson, the CIA, and the secret history of the sixties. Little, Brown and Company. Otto, R. (2017). The idea of the Holy. Pantianos Classics. Original work published in 1917. Peirce, C. (1985). The collected papers of Charles S. Peirce. Harvard University Press. Peirce, C. (1997). Pragmatism as a principle and method of right thinking. State University of New York Press. Petrilli, S. (2017). The self as a sign, the world, and the other. Sage. Psillos, S., & Zorzato, L. (2021). Against cognitive instrumentalism. International Studies in the Philosophy of Science, 33(4), 1–11. https://doi.org/10.1080/02698595.2021.1961420 Raposa, M. (2020). Theosemiotic. Religion, reading and the gift of the meaning. Fordham University Press. Ribeiro, D. (2015). O povo brasileiro. Global. Santaella, L. (2004). O método anticartesiano de C. S. Peirce. Unifesp. Santos, B., & Meneses, P. (2010). Epistemologias do sul. Cortez. Schechner, R. (2013). Performance studies. An introduction. Routledge. Seif, F. (2019). De-sign in the transmodern world. Envisioning reality beyond absoluteness. Perter Lang. Sharov, A., & Thonnessen, M. (2022). Semiotics agency. Springer. Short, D. (2020). From William James to Milton Erickson. The care of human consciousness. Archway Publishing. Stengers, I. (1995). L’invention des sciences modernes. Flammarion. Stengers, I. (1997). Cosmopolitiques. Pour en finir avec la tolerance. Synthelabo. Stengers, I. (2001). Qu’est-ce que l’hypnose nous oblige à penser? Ethnopsy, 3, 13–68. Tukaev, R. (2020). The integrative theory of hypnosis in the light of clinical hypnotherapy. In C. Mordeniz (Ed.), Hypnosis and hypnotherapy (pp. 234–249). Namik Kemal University.

Chapter 4

Liège School of Hypnosis Marie-Elisabeth Faymonville

and Anne-Sophie Nyssen

4.1 Introduction The University of Liège, at a very early stage, has recognized that hypnosis is a field for fundamental and therapeutic research and saw the importance of letting its researchers, professors, and students venture into the study of the phenomenon of hypnosis and its therapeutic practice. It was in 1855 that Liège-born Joseph Delboeuf obtained his first doctorate in philosophy and literature and in 1859 his doctorate in physical and mathematical sciences. In 1866, he was appointed professor in charge of philological exercises, and in 1883, the University created a course in philosophy, taught by him, which was opened to students from all faculties (Delboeuf, 1890). Delboeuf himself tells us that his interest in hypnosis dates back to the chance discovery of a book about magnetism, Lettres, by Ricard, a hypnotist who, in 1843, was convinced of curing an epileptic patient with the help of two doctors. Delboeuf had his doubts, and he looked for other evidence that could convince him of the existence of a hypnotic phenomenon. In 1869, he published his first article on this This work was carried out with the support of the University and University Hospital of Liège, the Action de Recherches Concertées de la Communauté Française (ARC - 06/11–340), the Belgian National Fund for Scientific Research (FRS-FNRS), the Human Brain Project (EU-H2020-­ fetflagship-hbp-sga1-ga720270), the Luminous project (EU-H2020-fetopen-ga686764), Wallonie-­ Bruxelles International, the James McDonnell Foundation, the Mind Science Foundation, the IAP research network P7/06 of the Belgian government, the European Commission, the European Labour University, Fondazione Europea di Ricerca Biomedica, Bial Foundation, and Belgian National Cancer Plan number 139. M.-E. Faymonville · A.-S. Nyssen (*) University of Liège, Liège, Belgium e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_4

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subject, in which he denounced the religious explanation which was given for the stigmata presented by a young Belgian Christian woman and he proposed self-­ suggestion as an explanation. In 1885, his visit to Charcot, at the Pitié-Salpêtrière University Hospital in Paris, convinced him of the existence of a hypnotic phenomenon. Nevertheless, Delboeuf remained skeptical about some elements of experimental protocols, and he questioned the particular virtues of the magnets used in magnetic transfer experiments. He questioned also the Salpêtrière dogma about post-hypnotic amnesia by suggesting a change in the protocol. When he returned to Liège, he decided to embark on the practice of hypnosis and to experiment with it himself, scrupulously noting what he observed in his subjects and varying the protocols he used and the instruction he gave. As a result of his rigorous work and publications, Delboeuf quickly gained international recognition. His opinions on artificial somnambulism and his theory of memory were taken into consideration by Freud, Binet, and many other scientists. What we owe to Delboeuf is the seriousness of his scientific approach; the rigor he showed to psychological facts enabled us to move away from erroneous beliefs and “magical” ideas around hypnosis. He made hypnosis an object of study. According to Delboeuf, what is at play in hypnotism is not so much the power of one human being over another as the power that each person’s mind can have over their own body. Power lies not with the hypnotist but with the hypnotized subject. All demonstrations of hypnotism are due to the subject and only the subject. The hypnotist can only intervene to persuade the subject that they can do what they thought they could not or that they cannot do what they thought they could. In this practice, he demonstrated surprising insights and innovations for the time, which were developed by others in the second half of the twentieth century. In June 1887, the Royal Belgian Academic of Sciences invited him to present a lecture on the origin of the curative effects of hypnotism. His lecture triggered a heated debate, and Dr. Thiriar, Professor of Surgery at the University of Brussels, called for doctors to be exclusively allowed to practice hypnotism and for a ban on public hypnosis sessions. History went on to show that the annexation of hypnosis by doctors did not contribute to its development, neither in Belgium nor elsewhere. After the death of Delboeuf in 1896, interest in hypnosis declined considerably. After the First World War, there was a renewed interest in hypnosis, particularly in Germany and Austria, in response to the harmful effects of medical anesthesia. However, improvements in the drugs used for general anesthesia led to hypnosis being definitively abandoned. It was only after the Second World War that interest in hypnosis spread again, particularly in the United States. In Liège, however, it was until 1990 that hypnosis, and more specifically hypnosedation, was reintroduced into the University Hospital (CHU Liège) by an anesthetist, Marie-Elisabeth Faymonville, as part of surgical procedures (Faymonville et al., 1999). Since 1992, nearly more than 10,000 surgical procedures have been performed using hypnosedation. Hypnosedation combines hypnosis, conscious intravenous sedation, and local anesthesia. This anesthetic technique is used in

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different surgical situations such as thyroid and parathyroid surgery, vascular procedures, prostate biopsies, plastic surgery, sterilization implant, vaginal hysterectomy, skin tumor removal, childbirth, glioma surgery, maxillofacial surgery, etc. Retrospective and prospective randomized studies confirmed the interest of this technique (Colombani et  al. 2008; Defechereux et  al., 2000; Faymonville et  al., 1997, 1999; Meurisse et al., 1996, 1999; Tefikow et al., 2013). A funding request was submitted to the FNRS (Belgian National Fund for Scientific Research) to investigate the brain activity associated with the hypnotic process. This was the beginning of a series of experimental pieces of research carried out using neuroimaging tools. These studies provided results relating to knowledge about consciousness and its modified states, including hypnosis, as well as the impacts of hypnosis on sensory perception (Faymonville et al., 2000, 2003; Maquet et al., 1999; Vanhaudenhuyse et al., 2009). Although the neural mechanisms involved in the hypnotic process are far from being fully understood, our neuroimaging studies reveal that hypnosis results form a decrease in the activity of the external awareness network, involved in environmental and sensory perception (Demertzi & Faymonville, 2011; Demertzi et  al., 2015; Vanhaudenhuyse et al., 2017). In addition, studies focusing on the perception of pain reinforce the idea that the analgesic effect of hypnosis is explained by a global modulation of a network of brain zones involved in the sensory and affective perception of stimulation, but also of neural networks involved in self-awareness and environmental awareness. This leads to changes in the cognitive and behavioral mechanisms involved in information processing. It is in this context that our medical approach to the treatment of acute and chronic pain has evolved into both pharmacological and psychological strategies that can relieve pain and improve patient well-being. We developed and studied the use of hypnosis in healthcare contexts: algology (Vanhaudenhuyse et al., 2015, 2018) and maternity and oncology (Bragard & Faymonville, 2017; Gregoire et al., 2017). These different clinical applications of hypnosis and the outcomes of the resulting clinical studies demonstrate the value of hypnosis in the field of care. Hypnosis allows the patient to regain an active role in treatment, using his own resources, encourages caregivers to share control, and suggests being more attentive to the patient’s needs. But, above all, it trains clinicians in therapeutic communication based on observation, use, and encouragement of patient progress, training that is all too often absent from university courses. The hypnosis of the future may also include technologies that uses computers to immerse the patient in a three-dimensional multisensory virtual environment. We believe that it is now necessary to evaluate and compare non-pharmacological techniques in the context of rigorous research projects in order to better guide and frame their use in the context of care, avoid the pitfalls of the fascination with new technologies, and keep at the heart of our concerns the enhancement of scientific and clinical knowledge and well-being of patients and healthcare staff (Rousseaux et al., 2020a, b). We explore the effect of another non-pharmacological technique that combines self-hypnosis/self-care learning on cognitive complaints, well-being, and

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return to work within a population of cancer patients. These promising initial results encourage the development of research on hypnosis in the field of aging and altered consciousness.

4.2 Dawn of a University Course The 1889 Congress on Hypnotism was the apogee of the recognition of hypnosis. Dr. Ladame’s report recognized the therapeutic effectiveness of hypnosis and suggested that all medical students be trained in hypnosis. However, at our University of Liège, it wasn’t until the clinical routine use of hypnosis as an anesthetic technique and results of studies that had previously taken place had been published that a cycle of free continuing education classes were organized in 1994 on “Hypnosis, acute and chronic pain” at the University Hospital of Liège. These were initially presented in collaboration with Dr. Paul-Henri Mambourg, child psychiatrist, and, since 2000, with Dr. Anne-Sophie Nyssen, Professor of Psychology at the Faculty of Psychology, Logopedics, and Educational Sciences. In 2015, a 15-h open course entitled “Awareness of the hypnotic process and therapeutic communication” was created in the university curriculum, open to students of medicine and psychology. Hypnosis, acute and chronic pain continuing education course that we have been offering at the University Hospital of Liège since 1994 is open to all psychologists, dentists, and doctors who work with acute or chronic or palliative care patients. Our objective is to teach healthcare professionals to take the patient’s contribution as a starting point and to abandon the dominant attitude that naturally leads the patient to adopt a position of passivity and resistance. It is about the caregiver taking an interest in the patient’s resources and creating the dialogue and context that allows the patient to move toward a process of change and well-being (Faymonville & Nyssen, 2014; Nyssen et al., 2018). Non-verbal communication plays a critical role in establishing a relationship context: it may or may not promote the transmission of information. Effective communication requires an ecology between content, relationship, and context. In a 1991 report, the Royal College of Physicians and Surgeons of Canada defined communication skills as one of the seven essential skills that medical profession must master (Simpson et al., 1991). Learning communication skills raises awareness of listening and empathy. People who are trained are able to recognize the defensive mechanisms used by other people to handle their own stress and/or suffering, which allows them to adjust their own communication to the needs of the other. Patient dissatisfaction is often linked to a lack of information, explanation, and feedback from the caregiver. Physicians do not always understand the type of information patients need, and many complaints are not directly related to clinical skills, but the communication skills. The obligation to warn the patient of the risks associated with treatment only increases the physician’s difficulty in finding a communication adapted to the patient’s specific needs.

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A question arises: should hypnotic communication training be offered to all medical and psychological students or to practitioners already practicing? Some believe that students lack the maturity to control the emotional dialogue he or she engages in with the patient. Others believe, on the contrary, that practitioners have already acquired professional habits that they will hardly change. Hypnosis training enables people to learn about patient-centered communication. It gives us the tools to adapt a caring therapeutic attitude, not only toward the patient but also toward ourselves. This seems essential at a time when the increasing specialization and technical development of medicine sometimes lead to a tendency to neglect both the patient and the care professional.

References Bragard, E., & Faymonville, M. E. (2017). A non-randomized comparison study of self-hypnosis, yoga, and cognitive-behavioral therapy to reduce emotional distress in breast cancer patients. The International Journal of Clinical and Experimental Hypnosis, 65, 189–209. https://doi. org/10.1080/00207144.2017.1276363 Colombani, C., Evrard, S., et al. (2008). Right colectomy with regional anaesthesia and hypnosedation in ASA 3 patient. Annales Françaises d’Anesthèsie et de Rèanimation, 27, 341–344. Defechereux, T., Degauque, C., Fumal, I., et al. (2000). Hypnosedation, a new method of anesthesia for cervical endocrine surgery. Prospective randomized study. Annales de Chirurgie, 125, 539–546. Delboeuf, J. (1890). Magnétiseurs et médecins (F. Alcan, Ed.). Demertzi, S., & Faymonville, M. E. (2011). Hypnotic modulation of resting state fMRI default mode and extrinsic network connectivity. Progress in Brain Research, 193, 309–322. Demertzi, A., Vanhaudenhuyse, A., Noirhomme, Q., et  al. (2015). Hypnosis modulates behavioural measures and subjective ratings about external and internal awareness. The Journal of Physiology, 109, 173–179. https://doi.org/10.1016/j.jphysparis.2015.11.002 Faymonville, M.  E., & Nyssen, A.  S. (2014). Communication soignant-soigné. Douleur et Analgésie, 27, 210–214. Faymonville, M.  E., Mambourg, P.  H., Joris, J., et  al. (1997). Psychological approaches during conscious sedation. Hypnosis versus stress reducing strategies. A prospective randomized study. Pain, 73, 361–367. Faymonville, M. E., Meurisse, M., Fissette, J., et al. (1999). Hypnosedation: A valuable alternative to traditional anaesthetic techniques. Acta Chirurgica Belgica, 99, 1141–1146. Faymonville, M. E., Laureys, S., Degueldre, C., et al. (2000). Neural mechanisms of antinociceptive effects of hypnosis. Anesthesiology, 92, 1257–1267. Faymonville, M. E., Roediger, L., Del Fiore, G., et al. (2003). Increased cerebral functional connectivity underlying the antinociceptive effects of hypnosis. Cognitive Brain Research, 17, 255–262. Gregoire, C., Bragard, I., Jerusalem, G., et al. (2017). Group interventions to reduce emotional distress and fatigue in breast cancer patients: A nine-month follow-up pragmatic trial. British Journal of Cancer, 117, 1442–1449. https://doi.org/10.1038/bjc.2017.326 Maquet, P., Faymonville, M. E., Degueldre, C., et al. (1999). Functional neuroanatomy of hypnotic state. Biological Psychiatry, 45, 327–333. Meurisse, M., Faymonville, M. E., Joris, J., et al. (1996). Chirurgie endocrinienne sous hypnose. De la fiction à l’application clinique quotidienne…. Annales d’Endocrinologie, 57, 494–501. Meurisse, M., Defechereux, T., Hamoir, E., et al. (1999). Hypnosis with conscious sedation instead of general anaesthesia? Applications in cervical endocrine surgery. Acta Chirurgica Belgica, 99, 151–158.

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Nyssen, A.  S., Lamy, M., Blavier, A., et  al. (2018). Impact of adverse events on anesthetists’ health: A Belgian case study. Acta Anaesthesiologica Belgica, 68, 25–30. Rousseaux, F., Bicego, A., Ledoux, D., et  al. (2020a). Hypnosis associated with 3D immersive virtual reality technology in the management of pain: A review of the literature. Journal of Pain Research, 3, 1129–1138. https://doi.org/10.2147/JPR.S231737 Rousseaux, F., Faymonville, M. E., Nyssen, A. S., et al. (2020b). Can hypnosis and virtual reality reduce anxiety, pain and fatigue among patients who undergo cardiac surgery: a randomised controlled trial. Trials, 21, 330. https://doi.org/10.1186/s13063-­020-­4222-­6 Simpson, M., Buckman, R., Stewart, M., et al. (1991). Doctor-patient communication: The Toronto consensus. British Medical Journal, 303, 1385–1387. Tefikow, S., Barth, J., Maichrowitz, S., et al. (2013). Efficacy of hypnosis in adults undergoing surgery or medical procedures: A meta-analysis of randomized controlled trials. Clinical Psychology Review, 33, 623–636. Vanhaudenhuyse, A., Boly, M., Balteau, E., et  al. (2009). Pain and non-pain processing during hypnosis: A thulium-YAG event-related fMRI study. NeuroImage, 47, 1047–1054. Vanhaudenhuyse, A., Gillet, A., Malaise, N., et  al. (2015). Efficacy and cost-effectiveness: A study of different treatment approaches in a tertiary pain centre. European Journal of Pain, 19, 1437–1446. https://doi.org/10.1002/ejp.674 Vanhaudenhuyse, A., Staquet, C., Rousseaux, F., et al. (2017). Hypnose: Un outil de modulation cérébrale. In L. Froger, P. Dupeyron, & E. Julia (Eds.), La plasticité cérébrale (pp. 73–84). Sauramps Medical. Vanhaudenhuyse, A., Gillet, A., Malaise, N., et  al. (2018). Psychological interventions influence patients’ attitudes and beliefs about their chronic pain. Journal of Traditional and Complementary Medicine, 8, 296–302. https://doi.org/10.1016/j.jtcme.2016.09.001

Chapter 5

Hypnosis at the Medical Sciences Universities Alberto Erconvaldo Cobián Mena and Frank David Alcalá Ciria

, Adolfo Rafael Lambert Delgado

,

5.1 Introduction: Historical Accounts The first thing that the authors want to express is that we start from a staunch belief about the value of hypnosis, invariably supported and reinforced, in and by our clinical practice for more than 20 years. Since we began to study and use hypnosis – each one at different and specific times – we have been observing its potentialities and in this way, we have convinced ourselves of why, in the last century it had been so successful in the treatment of psychic disorders and of the possibilities within it of current therapeutics, constantly asking ourselves why neither psychologists and psychiatrists nor other medical specialists have used hypnosis as a therapeutic resource in Cuba. Even knowing the answer, there was tremendous resistance to accepting that truth, given the absence of the topic in the curricula of these specialties. As expressed in the book, I do believe in hypnosis The first work of one of the authors of this chapter (Cobián Mena, 1997, 2010), by a stroke of luck, paved the way for hypnosis to begin to travel through the then Higher Institute of Medical Sciences of Santiago de Cuba, today the University of Medical Sciences. The new study plan for the medical degree established in the mid-1980s included hypnosis as a therapeutic model of useful value for the general practitioner in unit 3, corresponding to the subject Medical Psychology II. This fact was incredible, as it denoted a radical change in the perception of the contents of Psychotherapy and specifically of suggestive-type psychotherapies, Our thanks to MSc Rosa María Cobas Salazar for the language revision, a process that required a great effort given the little time she had to do it. To both our eternal gratitude and our appreciation. A. E. Cobián Mena (*) · A. R. Lambert Delgado · F. D. Alcalá Ciria Medical Sciences, University of Santiago de Cuba, Santiago de Cuba, Cuba © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_5

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endowing this new curriculum put into operation since 1986 and in force to this day, with an extraordinary tool that would transcend the role of hypnosis within university medical education in Cuba, a phenomenon that would later spread to other types of universities. When the contents concerning hypnosis were taught in the Medical Psychology II classes of the third year of medicine, there was a total change in terms of the perception that this technique existed in the student audience and in the teaching body, denoting that it was a natural process, given in man and caused by him in his own brain based on neurophysiological premises, the latter element postulated by Pavlov. This would serve as a methodological guide for the understanding, study, and implementation of hypnosis. So then the spectrum of the followers was expanded, those who, seeing with their own eyes the effects of a hypnotic act in the middle of a trance, were leaning in a definitive way, toward acceptance of the fact and to foment the interest in its knowledge, study, and practice. In an interesting historical research work entitled “Hypnosis Group. Its history and community projection,” carried out by Isis Blanco Tamayo et  al. (2015), expresses the following: “Our historical investigation shows that in 1992, coexisting with the collapse of the socialist camp and the entry of Cuba into the so-called special period” characterized by the fact that the Cuban economy was bottoming out, a group of medical students proposed to the Department of Psychology to create a group of scientific discussions around hypnosis and its manifestations. The idea was to get involved in doing science and unravel the mysteries of the referred discipline. The idea had a happy outcome and what has been known since then as the Hypnosis Group was created, which had and has the purpose of discussing and analyzing epistemological, theoretical, and practical problems, and delving into the explanation of a whole range of phenomena associated with the hypnotic event. From this moment on, a period of reflections and theoretical discussions begins on a weekly basis, every Wednesday and lasts 3 h, which involved students from the advanced years of medicine and dentistry, who would later join others from the University of Oriente accompanied by professors of mainly psychology, internal medicine, psychiatry, dentistry, physiology, and immunology. This moment of theoretical discussions was complemented by practical activities that allowed doubts to be cleared up, conclusions to be reached, and/or new questions to arise, but the most significant thing is that knowing the benefits of hypnosis, treatment began – a year later. Some clinical manifestations that students and workers of the medical school showed affected both their work productivity and social life, such as lack of concentration, anxiety, depression, and phobias. In October of that year (1993) the Hypnosis Clinic was founded, which together with the homonymous group, have been the genesis and driving forces of all the work carried out, the successes obtained, and the development achieved. Proof of this are the courses, training, and diploma courses given, the congresses held, the only ones of their kind in the country, and one of the most important in Latin America, the large number of patients treated by extending care services to the population, and the results in terms of recognition  from national and foreign institutions.

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5.2 Hypnosis Groups and Partnerships In making this historical account, we consider it fair to recognize those students who have led the Hypnosis Group throughout its fruitful existence. These are professionals today: Jorge Sánchez Tamayo (1992–1995), Juan Carlos Vaillant Vila (1995–1997), Wilvian Ernesto Cobas Contreras (1998–2001), Adolfo Rafael Lambert Delgado (2002–2006), Andrés Rosell Oliva (2006–2009), Marcos Enrique Zaldívar Hernández (2009–2014), and those who are still students Alejandro Cervera Ferrera (2015–2019) and Daniel Casamayor Rivero (2021 to the present). In the same way, the hypnosis clinic has remained under the direction of Professor Cobián Mena, and its deputy directors have been doctors Juan Carlos Vaillant Vila (1996–2000), Wilvian Ernesto Cobas Contreras (2002–2012, 2014–2017), and 2022, and Adolfo Rafael Lambert Delgado (2013–2014 and 2017 to the present). Currently, Dr. Lambert deals with academic matters and Dr. Cobas with care (Blanco Tamayo et al., 2015). As an expression of development and clinical and therapeutic experience, the group initially defined the main lines of research as follows: the treatment of enuresis, bronchial asthma, arterial hypertension, dermatological disorders, smoking, anxiety, deforming oral habits, and pain treatment. Later incorporating other lines increased the spectrum of research topics. This allowed a period of investigative splendor to begin, characterized by broad participation in student scientific conferences, science- and technology-based forums, and international conferences (Saavedra Caballero et al., 2017). From this proliferating scientific production, the need arose to promote a space that had clinical hypnosis as its central theme, so the group convened the first International Workshop on Therapeutic Hypnosis and Related Techniques, Hipnosantiago 99, held in March of that year (1999). Thus, the leadership of the group in relation to the approach to hypnosis was revealed and its projection began toward other provinces of the country, Central America, and the Caribbean. These international events have been held uninterrupted, on a biennial basis, as we can see in Table 5.1, for more than 20 years and have become a space for socializing work experiences, exchanging techniques and knowledge, giving prestige to the Medical University of Santiago, and opening agreements of exchange with foreign and national universities. From then on, some professionals from the hypnosis group began an arduous training process on the subject, promoting postgraduate courses, teaching the behavioral medicine module in the master’s degree in natural and traditional medicine, diplomas and training, benefiting an enormous number of health professionals. During all these years, the work of hypnosis in our university has grown so much that its results have made it possible to open paths, weave dreams, build bridges and, above all, continue to play a growing role in terms of results and the impact of its work at a social, scientific, academic, and investigative level.

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Table 5.1  Hipnosantiago events Year 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 Total

Participants 87 179 188 168 189 122 161 148 183 170 206 1801

Papers presented 48 82 100 64 76 68 76 61 60 71 111 817

Courses taught 6 8 9 7 9 12 13 15 10 16 20 125

Papers presented 17 12 4 12 14 11 70

Courses taught 1 1 1 6 2 5 16

Source: Hipnosantiago event reports Table 5.2  Psychohealth events Year 2000 2004 2008 2011 2014 2017 Total

Participants 18 15 32 170 42 54 331

Source: Psychohealth event reports

Table 5.3  Asociación Latinoamericana de Psicologia de la Salud (ALAPSA) events Year 2005 2018 Total

Participants 37 69 106

Papers presented 10 6 16

Courses taught 1 4 5

Source: Reports of ALAPSA events

It should be said that the results of Hipnosantiago have served to trigger an important demand about the presence of research works with hypnotherapy, courses, and workshops on this subject in different international congresses, such as the events Psychohealth, PSICOCIMEQ, and ALAPSA, as shown in Tables 5.2, 5.3, and 5.4, which are celebrated periodically in Cuba and have a very high scientific level and announcement respectively.

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Table 5.4  Psicocimeq events Year 2000 2002 2004 2008 2010 Total

Participants 23 34 12 32 8 109

Papers presented 1 3 3 4 2 13

Courses taught 0 0 1 1 1 3

Source: Reports of Psicocimeq events

5.2.1 Agreements Established Between the UCMSC and Other Universities for the Teaching of Hypnosis and Other Subjects 1. University of Panama was signed in 2002 to promote the teaching of the Diploma in Therapeutic Hypnosis in the Isthmian campus with a coordinating group made up of Dr. Alberto E. Cobián Mena on the Cuban side, and on the Panamanian side, Drs. Adriana Shaik de Sandoval and Judith Garibaldo de Chié. 2. San Juan Bautista School of Medicine, Caguas, Puerto Rico, was signed by Dr. Nayra Irene Pujals Victoria, rector of the then Higher Institute of Medical Sciences of Santiago de Cuba and Dr. Juan José Rodríguez del Valle, Dean-­ President of the EMSJB. The agreement allowed the teaching of advanced hypnosis courses and the clinical supervision of the practical activities of the graduate in that brother country, by specialists from our institution, extended to the teaching of basic and behavioral sciences. 3. Universidad Católica de la Santísima Concepción, Republic of Chile, signed in 2017. It has made it easier for Chilean health science professionals to undergo training and receive courses. In a special way, reference is made to the University of Panama in which several editions of the Therapeutic Hypnosis diploma have materialized as well as more than 100 hypnotherapists, whose professions are doctor, psychologist, dentist, and nurse. In her book “Therapeutic Hypnosis in Panama”, Dr. Adriana Shaik de Sandoval (Shaik de Sandoval, 2011), mentions that in 2001, the Panamanian Association of Therapeutic Hypnosis decided to organize the First International Seminar on Therapeutic Hypnosis, developing it in the Hospital del Niño during the first days of August, with a successful result, given the participation of numerous specialists that included a total of 60 delegates, reason enough to agree to turn it into a diploma course entitled “Hypnosis and its therapeutic applications,” entrusting Dr. Alberto Cobián with the preparation of an analytical program for the diploma, which would be submitted for the consideration of the academic authorities of the University of Panama for approval.

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The legal framework served as the scientific/technical/cultural cooperation agreement and the specific collaboration agreement between the University of Panama and the Higher Institute of Medical Sciences of Santiago de Cuba, signed by the then rectors of both institutions, Julio Vallarino Rangel and Dr. Nayra Irene Pujals Victoria. After a long process, the diploma project was approved by the Academic Council No. 36-02 on 28 August 2002, entrusting its execution and control to the Vice Chancellor of Extension Professor Elva de los Ríos and the Dean of the Faculty of Humanities Dr. Carlos Castro. (This agreement is still in force as neither party has denounced it.) Strategically, before its approval, the modules were taught, starting in January 2002, culminating in the first edition in December of the same year, with the participation of a large group of Cuban professors who were joined by colleagues from the Panamanian university environment. There was a total 41 graduates from the first promotion, including 34 psychologists, 5 doctors, and 2 dentists. For several years different versions were happening. Adriana de Sandoval continues by expressing that between 2001 and 2005 four diploma courses were developed in Panama City and one in Chiriquí, the latter under the auspices of the Santamaría la Antigua Catholic University, all under the academic protection of the University of Panama, the number of graduates for each version being the following: Second Promotion: 8 Third Promotion: 26 Fourth Promotion (Chiriquí): 7 Owing to necessary and beneficial adjustments, given that the School of Psychology became a faculty in 2005, updated courses were taught and in 2010 the fifth version of these courses returned to the diploma course. There was a total of 24 graduates, among these, four Costa Rican psychologists. A distinctive note is the development of Hipnocaribe Panama 2006, an international scientific event that brought together many scholars on the subject and was organized by the Panamanian Association of Therapeutic Hypnosis, the Caribbean Association of Therapeutic Hypnosis and the University of Panama (Shaik de Sandoval, 2011). This successful congress attracted professionals from Panama, Puerto Rico, Brazil, Cuba, Colombia, Costa Rica, Chile, Mexico, and Peru. Just 3 months after completing Hipnosantiago 99, the first course that was structured from the Santiago medical university, was aimed at colleagues from Puerto Rico and the Dominican Republic, with the participation of six colleagues from both countries, with a duration of 20 h, a high satisfaction index, and an excellent evaluation by the students: this gave rise to the organization, in April 2000, between the Puerto Rican Societies of Psychiatry, Therapeutic Hypnosis Inc., and the Central University of the Caribbean (Bayamón), of the first courses on basic and advanced therapeutic hypnosis. The initial enrollment was of more than 60 students and both versions had to be repeated because of this success, already with a lower enrollment in the office of Dr. Jaime Ramos Couvertier, psychiatrist and one of the course coordinators together with the Dr. Jesús Saavedra Caballero, Director of the Psychiatric

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Unit for Children and Adolescents (UPA), a government entity of the Free State Associate of Puerto Rico, attached to the Bayamón Hospital. In the 2003 and 2006, Cuban professors were present once again, to participate in the delivery of a 20-h course that took place out between 21 and 23 August 2003. In 2006 it took place under the clinical supervision of the practices of the classical hypnosis diploma, which was attached to the San Juan Bautista School of Medicine (EMSJB), throughout the month of April. The academic exchanges that started in 2002 between the Higher Institute of Medical Sciences of Santiago de Cuba (ISCM-SC) and the EMSJB, with the visit of a delegation from the latter headed by the Dean President Dr. Juan José Rodríguez del Valle and composed of Dr. Ramonita Correa Ortiz, Academic Dean, Dr. Jesús Maria Saavedra y Caballero, Head of the Department of Psychiatry and Behavioral Sciences, Professor of Immunology and Biochemistry Enith Rivera, and Dr. Ramón Scharbai, Head of Microbiology, resulted in the subsequent signing of the Scientific-­ Technical and Cultural Academic Cooperation Agreement, with emphasis on Therapeutic Hypnosis, by doctors Nayra Pujals and Ramonita Correa, in the city of Santiago of Cuba during the first quarter of 2003, promoting a fluid exchange of visits in both directions and the proliferation of scientific meetings whose central theme was hypnotherapy. Thus, in August 2003, the visit of a delegation from the medical university of Santiago de Cuba to Puerto Rico, headed by the aforementioned rector, and made up of the dean of faculty 1, Dr. Cecilia Melián, the Department Head of Medical Psychology, Dr. Alberto Cobián, the Head of the Department of Genetics, Dr. Dulce Estenos, and three medical students, prominent members of the Hypnosis Group and hypnotherapists of the clinic, who presented the results of their research in the fields of dermatopathies, monosymptomatic nocturnal enuresis, and learning disorders. They are today doctors Yosmel Toirac Fernández, specialist in family medicine and gynecology & obstetrics, Adolfo Rafael Lambert Delgado, specialist in family medicine and child and adolescent psychiatry, and Alexander Guerrero Lavado, specialist in family medicine. These exchanges took place annually until 2006, when the US policy toward Cuba deteriorated. Despite this, the agreement remains in force. In recent years, the signing of the agreement between our medical university and the Catholic University of Our Lady of the Most Holy Conception took place, which has allowed students who have obtained solid results in their training to be sent to Cuba.

5.2.2 Foreign Universities in Which UCM-SC Professors Have Taught Basic and Advanced Hypnosis Courses • Central Caribbean University (UCC), Puerto Rico, 2000 • National Autonomous University of Mexico (UNAM), Mexico, May 2001 • Center of Higher Studies of Monterrey, Mexico, October 2001

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Federal University of Rio de Janeiro, Brazil, October, 2002 San Juan Bautista School of Medicine (EMSJB), Puerto Rico, 2003, 2006 Catholic University of Santo Domingo, Dominican Republic, 2002, 2004, 2005 Rafael Landívar University, Guatemala, 2006 Mexican Institute of Psycho-oncology (IMPO), 2009, 2010, 2011, 2012, 2014 University Foundation of the Andean Area, Colombia, 2010, 2011, 2016 Federal University of Sao Paulo, Brazil, Hypnosis Studies Group, 2010 Clinical Hypnosis Center of Chile, 2018

5.2.3 Cuban Universities in Which UCM-SC Professors Have Taught • • • • •

University of Medical Sciences of Holguín University of Medical Sciences of Guantanamo University of Medical Sciences of Santiago de Cuba University of Medical Sciences of Matanzas University of Oriente

5.2.4 Research and Thesis Below we present some tables with data of interest showing the academic, scientific, and health care impact. As we can see in Table 5.5, we have had students from dissimilar specialties of human health, from the Americas mainly, although also from Europe, training or receiving courses. Table 5.5  Number of students who have received courses or training in Therapeutic Hypnosis at the Medical University of Santiago de Cuba, by country and specialty Countries Puerto Rico Dominican Republic Spain Panama Mexico Uruguay Colombia Luxembourg Chile Totals

Physicians 6 2 1 1 1 1 1 5 18

Psychologists 4 2 1 3 1

Psychiatrists 5a 2a 1a 1a

2

1a 1a 2a 13a

2 15

Nurses

2 2

Total trainees 10 4 2 4 1 1 3 1 9 35

Legend: aPhysicians who are psychiatrists, they are not added, they are already considered in the total numbers of doctors by country

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Tables 5.6, 5.7, and 5.8 show us the relationship between the main lines of research and the thesis work carried out to complete PhDs and Master’s degrees, medical specialties, and psychology studies. Psychology Thesis (5) 1 . Maikel Cuza and Raúl Boubaire Bell/Sexual Dysfunctions/UO-UCMSC 2. Carlos Ferrera Garrido and Alexei Paneque Preval/Rheumatoid Arthritis/ UO-UCMSC 3. José Luis Reyes Escalona/Phobias/UCMSC 4. Marcos Zaldívar Hernández/UCMSC Depression 5. Yunier Montalván Figueredo/Phobias/UCMSC 6. Olivia Sandoval Shake/Bronchial asthma/UCMSC-University of Panama Master’s thesis defended with the use of hypnosis (19) 1. Ramón Sánchez Cuza/Sexual Dysfunction/UCMSC 2. Arnaldo Castillo Ferrer/Sexual Dysfunction/UCMSC Table 5.6 Research lines of the Therapeutic Hypnosis Group of Santiago de Cuba and various outputs Research lines Enuresis Dermatopathies Learning disorders High blood pressure Bronchial asthma Phobias Depression Fundamental theoretical basic research Hypnoanesthesia Sexual dysfunction Pain Pernicious habits Prevention of suicide attempt Psychoimmunology Other anxiety disorders Diabetes mellitus Attention deficit hyperactivity disorder Peptic ulcer Hypnopedia Total lines: 20

PhD 1

Master’s degree 1

1

2

1 1 4

2

2 3 2 1 1

Specialty 1 1 1 3 3 2

Completion of Psychology studies –

1 2 1

2

1

1

2 1

1 1 1 1 C2 IC 3 Total 5

Legend: IC in course, C completed

1 Total 19

Total 17 Total 8

Totals 3 1 1 4 4 5 2 8 2 5 2 1 3 2 2 1 1 1 1 49

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Table 5.7  Lines of research of the Therapeutic Hypnosis Group of Santiago de Cuba and its relationship with Master’s degrees Bioenergetic medicine 1 1 1

Research lines Enuresis High blood pressure Phobias Depression Fundamental Theoretical basic investigation Hypnoanesthesia Sexual dysfunction Pain Deforming oral habits Suicide Attempt Prevention Other Anxiety Disorders Hypnopedia Total lines: 12

Community psychiatry

1 4 2a 3 2 1 1 1 1 Total 17

Total 2

Totals 1 1 1 1 4 2 3 2 1 1 1 1 19

Source: Master’s degree thesis repository a In maxillofacial and pediatric surgeries Table 5.8  Research lines of the Therapeutic Hypnosis Group of Santiago de Cuba and its relationship with medical specialties Family Pediatrics medicine 1 1 1 3

Research lines Enuresis Dermatopathies Learning disorders High blood pressure Phobias Fundamental theoretical basic investigational Sexual dysfunction Diabetes mellitus Attention deficit hyperactivity disorder Peptic ulcers Total lines: 10 Total 1

Children and adolescent psychiatry

Normal and Pathological Psychiatry physiology

2 2

1 1

Total 2

Total 1

2 2

1 1 1

1

1 Total 8

Totals 1 1 1 3

Total 2

1 14

Source: Medical specialties thesis repository Legend: UO Universidad de Oriente, UCLV Universidad Central de Las Villas, UMSC Universidad Médica de Santiago de Cuba, UCMG Universidad de Ciencias Médicas de Granma, UH Universidad de La Habana, UCMHG Universidad de Ciencias Médicas de Holguín

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3. Geramer La Rosa Vaillant/Sexual Dysfunction/UCMSC 4. Orlando Rodríguez García/Vertebral Pain/UCMSC 5. Claribel Suarez López/Cancer Pain/UCMSC 6. Migdia Pérez Pérez/Enuresis/UCMSC 7. Adolfo Lambert Delgado/Arterial Hypertension/UCMSC 8. José Luis Reyes Escalona/Phobias/UCMSC 9. Emilio Silega López/Behavior Physiological Variables/UCMSC 10. Gabriel Pérez Almoza/Prevention of Suicidal Behavior/UCMHG 11. Pedro Manuel Rodríguez Sánchez/Study of Cognitive Functions/UCMG 12. María Rodríguez/Ethics Code of Hypnosis/UCMG 13. Ernesto Ross/Reducing Anxiety in Hitters to Improve Their Performance/UCMSC 14. Josué Freire Soler/English Language Learning/UCMSC 15. Ivette Contreras Callejas/Hypnoanesthesia in Extractions/UCMSC 16. Marelis Delisle Prior/Hypnoanesthesia in Pediatric Surgery/UCMSC 17. Néstor Salas Bell/Hypnoanesthesia in Cancer Pain/UCMSC 18. Daniel Águila Castillo/Hypnosis in Depression/UCLV 19. Ada María Bueno Roig/Anxiety/UH Thesis specialty in Family Medicine (11) 1. Juan Carlos Vaillant Vila/Bronchial Asthma/UCMSC 2. Wilvian E. Cobas Contreras/Arterial Hypertension/UCMSC 3. Juliette Ruiz Vara/Diabetes/UCMSC 4. Adrián Balart Cuevas/Peptic Ulcer Control/UCMSC 5. Alexander Guerrero Lavado/Dyslexia/UCMSC 6. Yosmel Toirac Fernández/Dermatopathy/UCMSC 7. Adolfo Lambert Delgado/High Blood Pressure/UCMSC 8. Yaimarelis Pico Carela/Bronchial Asthma/UCMSC 9. Dianelys Gonzáles Lara/Bronchial Asthma/UCMSC 10. Jorge Javier Bergues Mustelier/Sexual Dysfunctions/UCMSC 11. Lissette Arévalo Quesada/Arterial Hypertension/UCMSC Children and adolescent psychiatry and Adult Psychiatry Thesis (5) 1 . Adolfo Lambert Delgado/Phobias in Children and Adolescents/UCMSC 2. Wilvian Ernesto Cobas Contreras/Children’s Enuresis/UCMSC 3. Ramón Sánchez Cuza/Addictions/UCMSC 4. Francisco Cela Mora/Tobacco Addiction/UCMSC 5. New Resident/Attention Deficit Hyperactivity Disorder/UCM-SC Pediatrics Thesis 1. Teurys Bernardo Vinent Bonne/Enuresis (1)/UCMSC Because of its importance, we refer to published articles, which collect or show the importance of the work of the Group and the Hypnosis Clinic of the Faculty of Medicine 1 of the UCM-SC, of which these authors are professors.

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5.3 The Intramural Work Since 2001, the UCMSC has structured a diploma course that already exhibits 10 completed editions and whose scope is national. More than 270 health professionals from various provinces of the country have graduated from the diploma course. Santiago de Cuba, Holguín, Granma, Camagüey and Havana stand out. The XI edition is still waiting to be resumed. The course has a faculty and an academic committee of excellence, made up mostly of Full Professors and Assistant Professors, Masters in Sciences, and Doctors in Sciences. Among the projections and challenges of our university are: 1. To materialize the creation of the International Center for the Development of Clinical and Therapeutic Hypnosis, its execution delayed by the COVID 19 pandemic 2. To officialize the opening of the Master of Clinical Hypnosis The Center for the Development of Clinical Hypnosis will have three aspects: • Care work: given by the operation of the clinic and the services offered in clinics and hospitals. • Academic work: given by/and in the courses, training, the diploma, and the Master’s degree • Scientific-investigative work: it will have output in the theses of the diploma, thesis of the completion of the career, specialty, master’s and doctorate, publications, and celebration of scientific events It is currently working in three directions: 1 . Making necessary adjustments to the master’s study program project 2. Complete the file 3. Submit it for approval to the Ministry of Higher Education. The project to which we have referred is an enormous challenge; its materialization would make us the first university institution to have an international center for the development of clinical hypnosis, shielded by having an advanced and comprehensive study program, adjusted to the high demands that postgraduate education and science and technological innovation pose to the National Accreditation Board of the Ministry of Higher Education, the Department of Science and Technological Innovation of the Ministry of Public Health, and the Ministry of Science, Technology, and Environment of the Republic of Cuba. This is, from the conception of the project, an obligatory reference and an enormous challenge when integrating three essential components, the academy, health assistance, and the scientific-investigative, and all based on hypnotherapy, where the university plays and will play a role. Central, nuclear, as it will serve as a technology production center in terms of hypnosis, and in this sense we are already working on several doctoral topics that are aimed at validating the content of various

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therapeutic algorithms with the use of hypnosis, in the treatment of monosymptomatic nocturnal enuresis and phobias in children and adolescents, and in adults, respectively, as well as in the continuity of fundamental research that will lead to specialization theses, especially in the field of physiology. In an interview with the authors of this article (Diario Juventud Rebelde, 2019) they express the following, “the passion and love with which they have worked in all these years and the sense of ethics, have made the group gain followers, both among students and among professionals in our region. There is a continuous and permanent interest in hypnosis. It is a challenge that we have to take on and we are ready to do so, but for this the preparation of all of us must be permanent. It is the only way to face them and satisfy the requests and demands of those who have imposed such a high and gratifying exigencies on us.” This is our biggest challenge, our highest challenge and we make it our own, aware that materializing it will be an extraordinary contribution to study, knowledge, and its use as a therapeutic modality.

5.4 Evidence of the Work of Clinical Hypnosis from Our University, Given in the Realization of Events, Publications, and Journalistic Articles

▷ Alberto Cobian 【 HABLA DE HIPNOSIS 】 Hipnosis Mindfulness Meditación Yoga Psicología (hipnosisclinica.org) • Update on Hypnotherapy International quoted in Cuba • www.acn.cu/salud/42474-­puesta-­al-­dia-­sobre-­hipnoterapia-­en-­cita-­intern... • 3/3/2019 · Cuba will show the advances of Hypnotherapy in the XI International Workshop of Therapeutic Hypnosis and Related Techniques (Hipnosantiago 2019), which will take place from March 18 to 22

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• Adolfo Rafael Lambert Delgado (0000-­0001-­9977-­6033) – ORCID • https://orcid.org/0000-­0001-­9977-­6033 ORCID record for Adolfo Rafael Lambert Delgado. ORCID provides an identifier for individuals to use with their name as they engage in research, scholarship, and innovation activities. • Lambert Delgado, Adolfo Rafael – autoressalud.sld.cu • autoressalud.sld.cu/index.php?P=FullRecord&ID=2297 • Lambert Delgado AR, Cobián Mena AE, Silva Albear Y, Torres Leyva M.  Hypnotherapy in pregnant adolescents with psychic symptoms due to the pandemic of COVID-19. MEDISAN [online]. 2021 [cited 4 Abr 2022]; 25 (1): [approximately 14 p.]. • Adolfo Rafael Lambert Delgado’s Research works • https://www.researchgate.net/.../Adolfo-­Rafael-­Lambert-­Delgado-­2181016320 • Adolfo Rafael Lambert Delgado’s 3 research works with 111 reads, including: Hypnotherapy in pregnant adolescents with psychic symptoms due to the pandemic of COVID-19 • Hypnotherapy for the achievement of adequate indicators … • www.medisan.sld.cu/index.php/san/article/view/4078 • 30/3/2022 · Adolfo Rafael Lambert Delgado Dean of the Faculty of the UCM-­SC. Medical. First Degree Specialist in Child and Adolescent Psychiatry and Second Degree in Family Medicine, Assistant Professor, Master in Bioenergetic and Naturalistic Medicine. President of the Pan American Association of Therapeutic Hypnosis. • MSc. Adolfo Rafael Lambert Delgado – Promoción de Eventos • https://promociondeeventos.sld.cu/.../msc-­adolfo-­rafael-­lambert-­delgado MSc. Adolfo Rafael Lambert Delgado. Minicurriculum • Authors: “Adolfo Rafael Lambert Delgado” – Search | Paperity • https://paperity.org/search/?q=authors:"Adolfo+Rafael+Lambert+Delgado Search: authors: “Adolfo Rafael Lambert Delgado” 8 papers found. Use AND, OR, NOT, +word, -word, “long phrase”, (parentheses) to fine-tune your search. Hypnotherapy in pregnant adolescents with psychic symptoms due to the pandemic of COVID-19 • Effectiveness of hypnotherapy in the approach of … revzoilomarinello.sld.cu/index.php/zmv/article/view/273425/5/2021 · Adolfo Rafael Lambert-Delgado, Alberto Erconvaldo Cobián-Mena, Gabriel Pérez-­ Almoza, Julio Armando Sánchez-Delgado, Nailé Edita Sánchez-Lara. Complete text: PDF. Summary. Bases: The attention deficit disorder is inconsistent with the individual development and frequently in childhood. • Effectiveness of hypnotherapy in the approach of … • www.revzoilomarinello.sld.cu/index.php/zmv/article/view/2734/pdf_793 • 25/5/2021 · Adolfo Rafael Lambert-Delgado First Degree Specialist in Child and Adolescent Psychiatry and Second Degree in Family Medicine, Assistant

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Professor, Master in Bioenergetic and Naturalistic Medicine. President of the Pan American Association of Therapeutic Hypnosis. • Hypnotherapy in adolescent pregnant with symptoms … • www.medisan.sld.cu/index.php/san/article/view/3360 • 10/2/2021 · Adolfo Rafael Lambert Delgado Hospital Infantil Docente Norte Dr. Juan de la Cruz Martínez Maceira, First Degree Specialist in Child and Adolescent Psychiatry and Second Degree in Family Medicine, Assistant Professor, Master in Bioenergetic and Naturalistic Medicine. President of the Pan American Association of Therapeutic Hypnosis. Therapeutic Hypnosis Diploma. • Clinic of Therapeutic Hypnosis of Santiago of Cuba: 25 years of science and health. –– (Science) –– On Wednesdays at 4:30 p.m in the teaching area of Faculty 1 of Medical Sciences a group of psychologists take the rooms available to perform hypnosis by heart. None of the doors say “Clinic…” –– Created on 5 April 2019 • Therapeutic Hypnosis: its health and medical procedures –– (Science) –– Hypnosis is an ancient science used for the benefits of human health, currently in Cuba and globally it advances as a way of performing psychological therapies that bring about diverse benefits … –– Created on 4 April 2019. • Hypnosis: science, ethic, and love for human beings –– (Science) –– Today finished the XI edition of the International Workshop of the Therapeutic Hypnosis and Related Techniques Hipnosantiago 2019, that was for 5 years put together in this city for health professionals of 17 countries, … –– Created on 22 March 2019 • Hipnosantiago 2019 begins –– (Headlines) –– Specialists of America, Africa, and Europe will show their experiences and advances in clinical hypnosis during the sessions of the XI International Workshop of Hypnotherapy and Related Techniques “Hipnosantiago…” –– The first medical American doctor: more precisely from Santiago… –– (Science) –– … today 410 years later, Mariana “starred” in one of the emotive moments in the opening of the XI International Workshop of Hypnotherapy and Related Techniques. “Hipnosantiago 2019,” when the delegation…

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• Assessing possibilities of hypnosis as a model… • https://www.radiosantacruz.icrt.cu/3199-­valoran-­posibilidades-­hipnosis... • 22/3/2009 · The IV International Workshop Hipnosantiago 2009 finished in Santiago, Cuba, as an important scenario for assessing the advances and… • Update on Hypnotherapy in an internationally quoted … • https://www.solvision.cu/puesta-­al-­dia-­sobre-­hipnoterapia-­en-­cit… • 4/3/2019 · Cuba will show their experiences and advances in clinical hypnosis during the sessions of the XI International Workshop of Hypnotherapy and Related Techniques (Hipnosantiago 2019), which will take place from 18 to 22 March in the Convention Center. • Welfare and Health. Hipnosantiago 2016 • https://www.facebook.com/groups/bienestarmentalyfisico/posts/... • Hipnosantiago 2016 • [:es] X International Workshop of Therapeutic Hypnosis and … • cubacoopera.uccm.sld.cu/el-x-taller-internacional-de-hipnosis-terape… • 15/3/2017 · Therapeutic Hypnosis Cuban Society, Cuban Society of Health Psychology and The University of Medical Sciences of Santiago de Cuba, convene to the hypnotherapists of Cuba, Latin American, The Caribbean, North America, Europe, Asia, Africa and the rest of the world to participate in the X International Workshop of Therapeutic Hypnosis and… • Dr. Elmer A. Masís Olivas– CLINIC OF PSYCHOLOGY … • https://www.psicologoscrprocoape.com/quienes-­somos/elmer-­masis-­olivas • Attended as a Congress delegate and Exhibitor to the International Congress Hipnosantiago in Santiago, Cuba (2013). He participated in the workshop formation in charge of the international congress from Mexico, Cuba, and Colombia on themes of therapeutic hypnosis, Neurophysiology, and Ericksonian and Clinical Hypnosis • Hypnoclinic, Hypnosis in Uruguay, Hypnosis Course… • https://hipnoclinica.org • Organizer and Speaker of multiple events for the diffusion of Therapeutic Hypnosis and Science such as: Psychohavana 98, Psychohealth 2000, 2004, ALAPSA 2005, Regional Congress of the APAL 2006, I and II Caribbean Congress of Psychology organized by University of Oriente in 1997 and 1999… • Hypnotherapists of the world attend the workshop in Cuba… • https://www.cubaplusmagazine.com/es/noticias/hipnoterapeutas-­mundo... • Hypnotherapists of America, Europe, Asia, and Africa will participate in Cuba in the XI International Workshop of Therapeutic Hypnosis and Related Techniques (Taller Internacional de Hipnosis Terapéutica y Técnicas Afines), from 18 to 22 March, the organizing committee of the event informed. Covering Cuba Tourism & Travel, Food & Cuisine, Culture, Health, Business, Events • © 2022 Microsoft Some Articles: 1. Saved by hypnosis – Juventud Rebelde – Journal of Cuban Youth

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Saved by hypnosis The experiences during 25  years of the Therapeutic Hypnosis Clinic of the University of Medical Sciences of Santiago, Cuba show that this ancient technique, handled with rigor, commitment, and humanism, has much to contribute to the solution of health problems. Published: Saturday 4 May 2019/ 10:48:05 pm. Author: Odalis Riquenes Cutiño [email protected] Saved by hypnosis. Author: Odalis Riquenes Cutiño. Published: 4 May 2019 10:26 pm Santiago, Cuba: For a little over a year, little Anderson has not needed any medication to combat the attention deficit hyperactivity disorder (ADHD) that was diagnosed in his health attention area and that worried his family so much. During all that time, every Wednesday afternoon, he, Dr. Glenda Ramírez, and his imaginary friend play together from the spacious classrooms of Faculty No. 1 of the University of Medical Sciences in Santiago, which is the headquarters of the Therapeutic Hypnosis Clinic. Thus, the infant supplies the need that he declared to his therapist when he arrived at the first consultation: “I just want someone to play with me…”, and, with the help of hypnosis, he extracts from his unconscious the tools that allow him to improve his social interaction and transform his behavior at home. The progress is noticeable, to the satisfaction of the grateful mother, her hypnotherapist, and the child, who, despite being discharged 6 months ago, insists on being first on the young psychologist’s list every Wednesday.

5.5 A Seed Is Sown Raciel entrusts psychologist Glenda Ramírez and hypnosis with the solution to her night terrors. The rejoicing of the Anderson boy and his family is not unique. There are many stories that have had a different ending, of self-confidence, and resilience, since in December 1993 the full professor and emeritus of the University of Medical Sciences (UCM), Doctor Alberto Cobián Mena, at the head of a multidisciplinary group of psychologists, psychiatrists, immunologists, neurophysiologists, and advanced students, founded the Clinic and sowed the seed of therapeutic applications of hypnosis in Cuba. The first patients were students and professors from the same UCM. “Alopecia, emotional disorders and phobias of our colleagues were successfully treated.” (Dr. Cobián Mena, founding president of the Pan-American and Caribbean Association of Therapeutic Hypnosis, and today still leader of that group, with the same enthusiasm and rigor). In the absence of a campus, the classrooms of the Faculty of Medicine No.1 give up their space to the Hypnosis Clinic.

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From then on, that project would begin to grow and unravel myths, always sheltered by the commitment and dedication of the professionals who directed it, the combination of investigative work with assistance work and the voluntary and enthusiastic contribution of many young people who were linked with the technique from their college career. The opening at the UCM of a Master’s Degree in Natural and Traditional Medicine in 1996, which included a Hypnosis module, recalls Alberto Cobián, also president of the Cuban Society of Health Psychology, gave them the opportunity to teach how to have the clinic as a reference for the management of health problems with this therapeutic modality. The success was such, explains the professor, that almost a third of the theses to obtain the Master’s degree on that occasion chose hypnosis as the theme, thus beginning to characterize and endorse its use in fields such as dentistry, sexual dysfunction, management of pain and vertebral pain. In 1999 they already felt capable of summoning and organizing the 1st International Workshop on Therapeutic Hypnosis and Related Techniques, which since then has been a space to update knowledge, discover common principles and approaches, and to showcase the advances in the use of this ancient technique in the treatment of patients with different pathological conditions. Names such as Wilvian Ernesto Cobas Contreras, Adrián Balart Cuevas, Carlos, Roberto Puentes Campos, Jorge J.  Bergues Mustelier, Yosmel Toirac Fernández, Emilio Silega López, Frank D.  Alcalá Ciria or the teacher Betania Castellanos, essential in the application of hypnosis in the battle against deforming oral habits, make a mark to this day.

5.6 Certainties of Hypnotherapists We perform hypnotherapy to help people who need it, from maxims such as respect for their dignity, ethics, professionalism, and, above all, humanism. That is the motto of our work, Professor Alberto Cobián Mena has said. The young doctor Adolfo Rafael Lambert Delgado, to all “Adolfito,” deputy director of the clinic, ratifies this. He emphatically adds that his academic life, his successes, and professional growth are the result of hypnosis. Like almost everyone, he has been linked to the clinic since his student days, in the second year of his medicine degree. From there he took his first steps as a research student, winning the Ministry of Science, Technology, and Environment (CITMA) Award and the Forgers of the Future Seal, which is awarded by the National Bureau of the Union at the proposal of the Youth Technical Brigades (BTJ) of Young Communists, among other recognitions, and immersed himself fully and inexorably in topics such as the use of this naturalistic procedure in the treatment of arterial hypertension or childhood enuresis. Thanks to the benefits of hypnosis, he became a Second Degree Specialist in Comprehensive General Medicine and Master in child and adolescent psychiatry. At

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only 38 years of age he has been elected president of the Pan American Association and Caribbean Therapeutic Hypnosis. “Hypnosis saved me professionally, it saved my patients,” he comments excitedly, as he evokes how he was able to relieve pain when he worked as part of his social service in the mountains of II Frente and did not have the right medicine to hand: “Thanks to hypnosis I was able to do wonders,” he insists, from the account of the miracles of science that he achieved in the name of Cuban medicine under the difficult conditions of the Venezuelan Amazon or in Brazilian communities reached by the Mais Medicos Program. Hypnosis can be useful in the treatment of almost all diseases; combined with conventional therapies and other techniques; it enhances their action, it is an innocuous procedure that has advantages even from an economic point of view, because being fast and effective it allows to the costs of the use of medicines to be reduced, he explains. For health professionals, according to Lambert Delgado, knowing and using hypnosis gives them a more comprehensive training. For this reason, it regrets that this procedure is still not given the importance in the country that it should among the techniques of natural and traditional medicine, nor is it included in greater depth in the curricular training programs for medical professionals, which could contribute to reducing the myths and prejudices that exist around it. “Although it is part of the programs of the subject of Psychology II, it is given only informatively; hypnosis is not taught, except in certain places where teachers have the knowledge. Hypnosis is one more tool that the doctor has; a valuable tool that should be part of the subjects learned in the degree,” insists Lambert Delgado. His certainty is also that of other young people who make up the new batch of hypnotherapists in Santiago, Cuba, such as Wilvian Cobas Contreras, Marcos Enrique Zaldívar, José Luis Reyes, Javier Singüenza, Tatiana Hierrezuelo, and Glenda Ramírez, in love with hypnosis, who each week challenge obstacles such as residing in municipalities and towns far from the provincial capital, or the vicissitudes of being divided between the clinic and responsibility in their jobs in other health institutions, to be with their patients (Diario Juventud Rebelde, 2019).

5.7 Science and Sensibility Hypnosis can be useful in the treatment of almost all diseases. From the sitting or lying position, this technique is practiced in Santiago, Cuba. At this time, the Therapeutic Hypnosis Clinic is a science and technology service certified by CITMA, which combines care for patients of all ages and the most diverse health problems (every Wednesday from 4 pm), with the performance of basic and applied research, together with institutions in the territory such as the Saturnino Lora and Infantil Sur hospitals, which contribute with the assistance of renowned specialists such as doctors Arquímedes Montoya, Emilio Silega, and Jorge Guillarte. “We do hypnosis very seriously, our practice is backed by research,” emphasizes Dr. Lambert Delgado.

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Experimental studies that offer methods for the treatment of entities such as phobias, depression, anxiety, anger; sexual dysfunction; dermatopathies such as psoriasis and vitiligo; enuresis and chronic noncommunicable diseases such as high blood pressure and diabetes mellitus; asthma, pain management, and sleep disorders; the use of hypnosis as an method of anesthesia in surgical interventions and in the correction of deforming oral habits, among many others, have been developed in the Santiago Hypnosis Clinic. Likewise, explains Dr. Alberto Cobián, and with the contribution of the Department of Physiological Sciences of the Faculty of Medicine No. 1, they carry out basic research: measurements of different variables or physiological components, case studies, quantitative and qualitative research, aimed at describing the neurophysiological foundations of hypnosis, which have been contributions of Cuba in this field. Publications such as the books Hypnosis and its therapeutic applications and I do believe in hypnosis, which have had a great reception among those interested in the subject, are evidence of what has been achieved. But one of the outstanding aspects of the work in the Santiago clinic is its decisive contribution to the training of hypnotherapists not only in Santiago, but also in Cuba and the Latin American, Caribbean, and European regions, from the constant completion of basic and advanced courses and graduates who prepare their students in theoretical and practical aspects and train them from knowledge and ethics for competent performance. This was confirmed during the 11th International Workshop on Therapeutic Hypnosis and Related Techniques (Hipnosantiago 2019), which, with the participation of professionals from 17 countries, became a platform for the forceful and unanimous recognition of the Cuban contribution, from Santiago, to the training of hypnotherapists in countries such as Spain, Puerto Rico, Mexico, Panama, Chile, Colombia, Brazil, and Uruguay. “What we are doing in therapeutic hypnosis in other countries is a product of Cuba; you have to feel very proud,” the president of the Panamanian Association of Therapeutic Hypnosis, Dr. Adriana Shaik de Sandoval, said during the sessions of the event – held recently – summarizing the general feeling. His opinion was seconded by prestigious personalities linked to the subject in the region, and also in Cuba, as the clinic in the indomitable city has also been a benchmark for the training of hypnotherapists in provinces such as Havana, Camagüey, Holguín, Granma, and Guantánamo.

5.8 Of Debts and Adhesions After 25  years of intense and fruitful work, not without misunderstandings and obstacles, the Therapeutic Hypnosis Clinic of the UCM in Santiago knows of “therapeutic adherences” and debts; rewards and challenges. So much dedication and commitment has earned them recognition such as the 2004 HipnoCaribe Prize, awarded in Puerto Rico in 2004, the Forjadores del Futuro Seal, which they received as a team in 1995 and 2000, and individually by many of its members on several occasions.

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Likewise, on more than one occasion they managed to lead the MNT rooms of the Student Scientific Forum of Medical Sciences and were included by the CITMA in the province among the 50 and 55 most relevant scientific-technical results in the revolutionary history of Santiago, Cuba respectively. However, sometimes ignorance and undervaluation of this way of doing science still lacerates it,  which perhaps has its most forceful expression in the fact that despite half a century of contributions and demonstrations they still do not have a headquarters, their own place, stable, with the necessary conditions, that frees them from waiting for classes to conclude in the Faculty of Medicine, or from the constant negotiation of spaces with other professors to be able to work. Also, as doctors Cobián Mena and Lambert Delgado confirm, “they are encouraged and gratified by the satisfaction of being able to help people who need it, who come to them seeking to transform their lives, and that is the best incentive to continue willing to dream and take risks.” For now, they see high hope: create the International Center for the Development of Clinical and Therapeutic Hypnosis, which, with headquarters in Santiago and replicas in other countries, would be capable of guaranteeing doctoral training in this subject. They already have the scientific knowledge to fulfill that dream. They know that this also implies cooperation and effort, but 25 years of dedication after the miracles of this special dream that is hypnosis have prepared them to achieve it.

Dr. Adolfo Lambert Delgado

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Dr. Frank D. Alcalá Ciria

Doctor Alberto Cobián

Dr. Alberto Cobián talks about definitions and findings in the investigations carried out. From the talkativeness and didactics that characterize him, Dr. Alberto Cobián explains that hypnosis is defined as the creation of a special state of brain functioning, always conditioned by the word, which makes the subject function under special conditions and allows the achievement of change processes: restructuring of thought, ideas, and behaviors (Cobián Mena, 2004).

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It is a procedure that operates from the mind–body relationship and also makes repressed elements emerge in personal stories that are producers or genesis of alterations. Therefore, it can be of great value in treating psychological disorders, but also other conditions of a psychosomatic nature. Neurophysiological studies have shown that through hypnosis it is possible to modify the activity of some areas of the brain, favoring the full expression of potentialities that, owing to defensive neurophysiological mechanisms, do not actively manifest in a waking state (Cobián Mena, 2004). It has also been discovered that cognitive processing under a hypnotic state is faster than under a normal state, as the brain synthesizes fewer neurons to have an equal or superior result, which makes hypnosis a highly effective technique. This is endorsed by the work of half a century of the Santiago clinic, where science and sensitivity together allow the patient to take out of himself what he does not know he has, where people are given new knowledge about their own abilities, they discover new lifestyles, and are taught to reflect. NEWS International Center of Clinical Hypnosis will be created in Cuba JUNE 13, 2018 Facebook, Twitter, YouTube Share Havana, 13 (ACN) The University of Medical Sciences of Santiago de Cuba is working on a joint project with the Hypnosis Clinic, to found an International Center for the Development of Clinical Hypnosis, an expert from that province announced. In a dialogue with the Cuban News Agency, Alberto Cobián Mena, Full Professor and Emeritus of that house of higher studies, said that the research-academy project would have a Master’s degree, a Diploma, and fundamental research, through the laboratories, in coordination with hospitals and the aforementioned clinic. The also president of the Cuban Society of Health Psychology announced that it is in the preparation phase and it is the purpose for the coming year to present it as a Master’s project to the Ministry of Higher Education and the Pan American Health Organization …

ACN: Cuban News Agency NEWS: Economic Cuba: 01-11-2005 Cuban doctors use hypnosis successfully in their treatments According to studies carried out by the health institutions of the island, the application of hypnosis in order to facilitate the work in various surgical treatments, especially in hypertensive people, allergic to anesthetics, or with fear of medical interventions, have been a success during the last years. The local press details that of a total of 108 patients chosen for the practice of hypnosis, 48 resorted to this alternative for fear of medical intervention, 16 were hypertensive, and the rest had allergies to anesthetics. Only three patients did not resolve their ailment, while the rest registered hypnotic depth indices that facilitated operations. The report also adds that these results motivate a more complete statistical study, as well as research work to discover other applications of hypnosis.

ACN: Cuban News Agency ULTIMAS NOTICIAS

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References1 Agencia Cubana de Noticias. (2018, June 13). Crearán en Cuba Centro Internacional de Hipnosis Clínica. Agencia Cubana de Noticias. Blanco Tamayo, I., Vázquez Nold, L., & Téllez Veranes, T. (2015). Grupo de Hipnosis. Su historia y proyección comunitaria. Trabajo presentado en Hipnosantiago, Santiago de Cuba, Cuba. Cobián Mena, A. (1997). Yo sí creo en la hipnosis. Editorial Oriente. Cobián Mena, A. (2004). Hipnosis y sus aplicaciones terapéuticas. Morales i Torres Editores. Cobián Mena, A. (2010). Yo sí creo en la hipnosis (2nd ed.). Editorial Oriente. Cuba Económica. (2005, 1 January). Los médicos cubanos aplican la hipnosis con éxitos en sus tratamientos. Cuba Económica. Diario Juventud Rebelde. (2019, 4 May). Salvados por la Hipnosis, Artículo periodístico. Diario Juventud Rebelde. Saavedra Caballero, J., Shaik de Sandoval, A, Pereira Garzón, A., & Lambert Delgado, A. (2017). La Hipnosis terapéutica en América Latina. Inicios, desarrollo y perspectivas actuales. Panel presentado en Hipnosantiago. Santiago de Cuba, Cuba. Shaik de Sandoval, A. (2011). La Hipnosis terapéutica en Panamá. Su historia reciente. Imprenta Universitaria.

 The thesis papers and reports presented here can be found in the following university repositories: Programas Científicos y relatorías de los eventos Hipnosantiago 1999, 2001. 2003, 2005, 2007, 2009, 2011, 2013, 2015, 2017, and 2019. Universidad Santiago de Cuba. Programas Científicos y relatorías de los eventos Psicosalud 2000, 2004, 2008, 2011, 2014, and 2017. Programas Científicos y relatorías de los eventos ALAPSA 2005 and 2018. Programas Científicos y relatorías de los eventos Psicocimeq 2000, 2002, 2004, 2008, and 2010. Repositorio de Tesis de Maestrías defendidas en la UCMSC. Dirección de Posgrado UCMSC. Repositorio de Tesis de Especialidad defendidas en la UCMSC.  Dirección de Posgrado UCMSC.  Repositorio de Tesis de Terminación de Carrera de Psicología dirigidas y defendidas por y en la UCMSC.  Departamento de Psicología Médica, Facultad de Medicina 1, UCMSC.  Repositorio de Tesis de Maestrías defendidas en la UCMG.  Dirección de Posgrado UCMG.  Repositorio de Tesis de Maestrías defendidas en la UCMHG. Dirección de Posgrado UCMHG. Repositorio de Tesis de Maestrías defendidas en la UCLV.  Dirección de Posgrado UCLV.  Repositorio de Tesis de Maestrías defendidas en la UH. Facultad de Psicología, UH. 1

Chapter 6

University and Hypnosis: Some Aspects of a “Win-Win” Situation Katalin Varga

, Éva Bányai

, Zoltan Kekecs

, and Eniko Kasos

6.1 Introduction Although Hungarian universities have been in operation for hundreds of years, they have only been in a position to enjoy real autonomy for a few decades, free from the dominant influence of the Church, the Crown, or even the Soviet power. While – unfortunately  – this autonomy seems to be on the decline nowadays (Kovats & Rónay, 2021; Rónay, 2019a), after a long period of prohibition, “hypnosis” as a subject is flourishing at our university: the first permanent university – founded in 1635  – nowadays one of the biggest universities in Hungary, Eötvös Loránd University (ELTE). However, it may come as a surprise that research into hypnosis was already well underway when the Hungarian Republic was proclaimed in 1989, when the Constitution guaranteed the autonomy of universities. The subject was therefore already within the university walls, even before the university had acquired the autonomy to decide what it could and could not deal with. The story of this turn of events is fascinating to follow and is summarized below briefly (Box 6.1).

K. Varga · É. Bányai · Z. Kekecs ELTE Eötvös Loránd University, Faculty of Education and Psychology, Budapest, Hungary e-mail: [email protected]; [email protected]; [email protected] E. Kasos (*) ELTE Eötvös Loránd University, Faculty of Education and Psychology, Budapest, Hungary Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_6

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Box 6.1 The Roots of the Development of Modern Hypnosis Research in Hungary Although there were internationally recognized Hungarian contributions to the field of hypnosis in the first part of the twentieth century (like Sándor Ferenczi’s notion of “maternal” and “paternal” hypnosis and András Völgyesi’s book on animal hypnosis), hypnosis, like psychology in general, was considered “suspicious bourgeois pseudo-science” after World War II, during the communist era. Even worse: because of Thomas Mann’s metaphorical description of Cipolla in the book Mario and the Magician, hypnosis was connected to fascism. No wonder that practicing hypnosis was “undesirable” and practically forbidden. There were only two exceptions in the 1960s, allowed to use hypnosis in Hungary: Dr. András Völgyesi (1895–1967) and Dr. István Mészáros (1931–2002). In the 1930s, Völgyesi had a personal relationship with Ivan Petrovich Pavlov, the great Russian physiologist, whose interest in and theory of hypnosis were accepted in Hungary even during those years. That is why Völgyesi was allowed to use hypnosis in his medical practice. István Mészáros, on the other hand, graduated from Leningrad Medical School, where hypnosis was part of the curriculum, so after his return to Hungary, he was allowed to study the effect of hypnosis on renal functions and on conditioned evoked potentials at the Department of Physiology of the Budapest Medical School. Both Völgyesi and Mészáros used Pavlov’s name as a “safe conduct” for using hypnosis. However, both Völgyesi’s therapeutical use of hypnosis and Mészáros’s hypnosis research remained isolated until the “Laboratory of Human Electrophysiology” at the Department of Comparative Physiology of ELTE was founded with the hidden goal of conducting hypnosis research in 1970. An important factor in the establishment of the laboratory was that György Ádám, Professor of the Department of Comparative Physiology, had just become Director of the Institute for Psychology of the Hungarian Academy of Sciences, and he set up a research group there, to which he invited Éva Bányai, a young psychologist with an excellent background in physiology, who was also invited to work as a research associate in several other departments of the Institute of Psychology. Éva Bányai had been interested in hypnosis since childhood and wanted to do research on it, so she responded to the invitations by signing up for the department where she could do hypnosis research. At first, Professor György Ádám frowned at the premise and asked the young psychologist if she knew that hypnosis was not promoted in Hungary after World War II. Éva Bányai knew this, of course, but she also knew that Dr. István Mészáros was already working in Professor Ádám’s department and hoped that with his Pavlovian “safe conduct,” more people might be able to do research on hypnosis. (continued)

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Box 6.1  (continued) Professor György Ádám, who was an excellent science politician, had indeed found the solution. He allowed István Mészáros and Éva Bányai to form a research group to study learning and memory “in different states of higher nervous activity.” With this Pavlovian terminology, hypnosis research was successfully covered up for a while. To ensure the scientific validity of their tests, the research team almost immediately translated the standard Hypnotic Susceptibility Scales developed at Stanford University. They managed to involve students with an excellent command of English in the translation, who became so interested in this work that they chose it as their thesis topic, and several of them joined the team of the ELTE Hypnosis Lab later. Among them, Anna Csilla Greguss (later Gősi-Greguss), who joined the laboratory in 1972, became a regular member of the team and continued her scientific career in hypnosis research after obtaining her university degree. When the first results on learning and memory (Mészáros et al., 1971a, b) and on the electrophysiological correlates of hypnosis (Mészáros & Bányai, 1973a, b) were obtained in the laboratory, and these results were received positively by the scientific community in serious scientific forums, such as the conferences of the Hungarian Physiological Society and the International EEG Society, it became an open secret that the Department of Comparative Physiology’s “Laboratory of Human Electrophysiology” was in fact a laboratory for hypnosis research. The title of Éva Bányai’s doctoral dissertation (“The effect of hypnosis on learning”) in 1973 reflected this change, as it openly claimed to be about hypnosis. The dissertation had won a prize in a competition announced by the Hungarian Academy of Sciences for “original research and theories.” As a result, Éva Bányai was awarded an 8-month study trip to Stanford University in the United States under an exchange agreement between the two academies in 1973–1974, where, in the creative atmosphere of the hypnosis laboratory of Professor Ernest R.  Hilgard, she developed active-alert hypnosis (Bányai & Hilgard, 1974, 1976). As a result of this study trip, Hungarian hypnosis research re-entered the international bloodstream on the one hand, and it also awakened the desire of the Hungarian hypnosis researchers to bring the therapeutical application of hypnosis back into practice on the other hand. It was a fortunate coincidence that by 1974, suspicion of psychotherapies in Hungary had eased, and the so-called “Psychotherapy Weekends” series was already started. István Mészáros, Éva Bányai, and later Anna Csilla GősiGreguss demonstrated the method of hypnosis at these professional meetings, which attracted the interest of clinicians, and some of them came to the Department of Comparative Physiology for internal study tour to learn the methods of inducing and applying hypnosis. As a result of this process, the ELTE Hypnosis Lab of the Department of Comparative Physiology of ELTE became a center of the revival of hypnosis in Hungary.

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6.2 National Expansion and the Development of Hypnotherapy Later, other universities joined the study and application of hypnosis. First, two highly qualified colleagues of the Department of Psychiatry of the Medical University of Szeged (Dr. Zoltán Janka and Dr. István Boncz), who were on an internal study trip with the Budapest research group, started to apply hypnotherapy at the Psychiatric Clinic in Szeged. In 1978, Professor Pál Juhász, Head of the Department of Psychiatry at the Budapest Medical University, invited members of the Budapest research team to give a formal hypnosis training course to the staff of the Clinic and to the GPs who regularly held Bálint Groups there. The Hypnosis Working Group of the Psychotherapy Section of the Hungarian Psychiatric Society was founded in 1980, led by István Mészáros, from the participants of this training. The first formal training was followed by more, and the number of clinicians using hypnosis grew so rapidly that the Hypnosis Working Group became an independent Hypnosis Section of the Hungarian Psychiatric Society in 1988 (chaired by Éva Bányai). Meanwhile, the results of the ELTE Hypnosis Research Laboratory – summarized in István Mészáros’ monograph on hypnosis (1984) and in his DSc dissertation (1981) and published by the researchers in neuroscientific journals (Mészáros, 1981, 1984; Mészáros et al., 1980, 1981, 1982; Mészáros & Bányai, 1978) – and Éva Bányai’s work on active-alert hypnosis (Bányai, 1980; Bányai et  al., 1980, 1981) were so well received that István Mészáros was invited to head the Institute of Psychology at the Kossuth Lajos University (KLTE) of Debrecen and Éva Bányai was invited to become a founding associate professor at the then-forming Department of Experimental Psychology at the ELTE Faculty of Humanities in 1985. So, the working group that revived hypnosis in Hungary was split. Hypnosis research was initiated at the Institute of Psychology of the KLTE under the leadership of Prof. István Mészáros, while Dr. Éva Bányai, Anna Csilla Gősi-Greguss, and several graduate students (e.g., Katalin Varga, Péter Vágó, and Róbert Horváth) continued their hypnosis research in the interactional paradigm at the Department of Experimental Psychology of the ELTE. Since 1985, intensive hypnosis research has been conducted at three universities in Hungary: the Eötvös Loránd University of Budapest, the Institute of Psychology of the Kossuth Lajos University of Debrecen, and the Institute of Psychiatry of the University of Medical Sciences in Szeged. The use of hypnosis in psychotherapy has also been widely supported and promoted by the Departments of Psychiatry of the Medical Universities of Budapest and Pécs. István Mészáros and his research group in Debrecen mainly conducted research on the neurobiological background of hypnosis and hypnotic susceptibility, often in international cooperation (Mészáros et al., 1989). Unfortunately, after the sudden death of István Mészáros in 2002, only Csaba Szabó continued his hypnosis research in Debrecen: In his studies, he compared the experience of altered states of consciousness under hypnosis with the effect of shamanistic drumming on trance (Szabó, 1993, 2004, 2012).

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In Szeged, István Boncz and his colleagues’ research on the hypnotic susceptibility of suicide attempters attracted much international interest (Boncz et al., 1985), and the research of Ambrus Zoltán Kovács, István Szendi, and their colleagues has brought us closer to the exploration of hypnosis-induced cognitive changes (Nemeth et al., 2013). After the death of István Boncz in 2019 and the retirement of Ambrus Zoltán Kovács, the hypnosis work in Szeged is unfortunately suspended for the time being.

6.3 The Emergence of Hypnosis at Various University Training Levels So, although at first the subject of hypnosis had to be sneaked into the research topics, it became more and more independent. Nowadays, there are no restrictions on what we teach about hypnosis, we are free to choose our research topics in this field, and there is less university oversight of the publication of our results. Recent years have shown that the government in power does not hesitate when it does not like a subject: with the stroke of a pen, it can stop it from being thought or researched, even without justification, despite the fact that the constitution does not authorize it to do so (Rónay, 2019b). Let us hope that the government in power will see that the subject of hypnosis has special potential, in terms of both teaching and research, and that it belongs within the walls of the university.

6.3.1 Bachelor BA Psychology students can learn about hypnosis and, more broadly, about suggestive communication in the context of elective courses. They have the opportunity to listen to theoretical lectures (e.g., Interactional Approach to Hypnosis; Hypnosis from an Evolutionary Perspective; Practical Applications of Hypnosis) or to develop their skills in practical courses. For example, in the Hypnosis Research Methods course, they can learn about the importance and details of observation. In this course, of course, they will comprehend the concept of susceptibility and its scoring system based on behavioral responses. They learn the protocol for hypnotizability assessment and can participate in group hypnotizability assessments as participants or assistants. This knowledge and experience provide a very good basis for later professional performance. In addition to direct observation (e.g., hypnotizability scoring the task), they can also learn how to handle unexpected events (e.g., if someone is unwell or wants to join late). In complex situations, they can put into practice their ethical knowledge, such as confidentiality or “do no harm.” A unique opportunity for future hypnosis practitioners is that during these courses, they will encounter dozens of “responses” to the same suggestion. They

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will thus be exposed to the different types, latencies, and perhaps quirks of hypnosis responses. On the other hand, they can directly experience the amazing richness of human responses. By the time they start to perform hypnosis themselves, they have already seen hundreds of hypnoses as an observer. Thus, in their own practice, they are no longer surprised by how slow some people organize certain movements and by what happens when someone does not respond to the disengagement of a certain suggestion, and they already have seen multiple unique or unexpected reactions. These experimental data were used to create the Hungarian norm of the Harvard scale, and the results benefited both the national and international hypnosis community (Költő et al., 2015). As an innovation on the commonly used group hypnotizability scale protocols, in our studies, we use observer as well as subjective scoring of the test suggestion performance. Observer and subjective scores of hypnotizability show a high correlation (Bentler and Hilgard 1963 found the same correlation value between these two scores, 0.83) (Bentler & Hilgard, 1963). However, during the data entry, we discovered that even though the self-scoring and the observer-scoring resulted in very close total scores – for example, if both the self- and the observer-scoring were 6 – this was not necessarily due to exact matches on the scoring of the individual test suggestions. This very interesting phenomenon was discussed in detail on several occasions in the department, involving external experts, and a separate statistical test was developed for the problem. The phenomenon and our thoughts on it have been shared with the international hypnosis community (Varga et al., 2012). It is no exaggeration to say that hypnosis is showing its amazing, “mystical” face here, although it is of a completely different nature from what the general public thinks. For students studying at the BA level, we provide several courses where they study together with students from other disciplines or professions. • We run a joint course with law students, and each semester, there is an invited lecture on the “Forensic use of hypnosis” by Tamás Agárdi (clinical psychologist and lawyer): both psychology and law student can hear a reliable summary of the application of hypnosis in various legal actions. For most, this is the first time they hear about hypnosis, getting acquainted with a non-medical application. • The “Psychological Support Based on Positive Suggestions” training is mainly aimed at health professionals. However, we also offer places for some of our BA students. In this way, they will be exposed to the questions and perspectives of doctors, nurses, physiotherapists, and dentists from the very beginning of their studies. Again: beyond the immediate curriculum, they gain experience that can provide an important background for their future professional life. In some cases, our students may know something better than an older professional, or vice versa: they may be confronted with considerations that guide the somatically oriented professionals during their work, which the students may not have thought of at all when relying on their own training. This brings the real world into what has been a mainly book-based curriculum for years: the BA student is exposed to the real perspectives of real professionals.

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• Students can also take courses on the applications of hypnosis. They will get an overview of the very wide range of uses of hypnosis, from pain relief to sleep problems or treating skin conditions. In some courses, students are asked to write short – 1–2-sentence-long – summaries of hypnosis, based on appropriately challenging articles. These will then be published on the blog of the International Society of Hypnosis (ISH). During these courses, students learn about much more than just hypnosis. The knowledge and experience gained during such courses can be linked back to theoretical studies. For example, they can tie what they learned about the reliability of testimony to memory, about leading questions to state-dependent learning, about the alteration of consciousness to the role of emotional arousal, etc. It can crystallize the students’ concept of “normality.” They regularly encounter that even serious clinical symptoms – such as amnesia, catalepsy, and hallucinations – can be deliberately elicited and reversed in an organized way under appropriate circumstances. It is easy to see that these experiences can provide a sense of security when they encounter similar phenomena as a novice practitioner in a clinical setting.

6.3.2 Masters Students studying at the MA level can take an elective course in hypnosis, where they can explore a particular area more comprehensively. An original course is focused on the application of hypnosis in oncology, including the results of a major national research project led by Prof. Éva Bányai. Another option is the Medical Aspects of Suggestions course, where you can delve into the applications of suggestive or hypnotic methods in a variety of areas, from anesthesia to dentistry and intensive care. A special solution has emerged during the Covid pandemic. Forced into the online space, the class took an unprecedented form: each occasion, a leading researcher presented one of his or her key research projects, followed by students being able to have a direct conversation with the researcher. Video recordings of these sessions, as well as the students’ summaries of the articles discussed, written in plain language, were made available on the ISH website. In this way, eminent members of the international professional community will enrich the course, and the product will be returned into the international arena available for all (Table 6.1).

6.3.3 PhD Our university also offers the possibility to obtain a PhD degree in psychology with the thesis topic focused on hypnosis. It is usually chosen by those who have learned about hypnosis during a previous course or lecture and have become more familiar

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Table 6.1  Non-exhaustive list of the presentations Name of presenter Magdolna Bene Putri Sibron, Methavee Chaloeyjitr Guilad Tchelet Noémi Eszter Németh Alexandra Pájer, Mónika Tolnai Bianka Gönye Csenge Szabadhegyi, Zsófia Buris Yeganeh Farahzadi Zsuzsanna Nagy, István Farkas Noémi Balázs, Anna Leszovszki Márton Tönkő, Csilla Ördögh, István Farkas Irmelin Hovland-Hegg Katerina Hatzigianni Domonkos File Fanni Sára Pusztai Joakim Døving Raechel Drew Enikő Rózsa Katonai Boglárka Erdélyi-Belle Eniko Kasos Zoltán Kondé, Gergely Szabó Anna C. Gősi-Greguss Dr. Katalin S. Varga, Prof. Katalin Varga Giuseppe De Benedittis Lilla Benczur M. Elena Mendoza András Költő Zoltán Kekecs

Title The use of hypnosis in the rehabilitation of patients with stroke Hypnosis and the immune system: A literature review 2020 Hypnodelic therapy: The appropriation of cognitive-behavioural therapy as a therapeutic approach Psycho-oncology: Hypnosis as a pathway between mind and the immune system The role of hypnosis in back pain and spine surgery Hypnosis in medical treatment of children Intellectual property Hypnotic induction modulates functional networks of the brain The methodology of mediation and hypnosis Is hypnosis an effective intervention for burnout? The suggestive aspects of using tales and anecdotes as narratives in therapy Can hypnotherapy be useful for parents and preterm infants in a neonatal intensive care unit? Understanding how oxytocin is related to hypnotizability Unconscious perception during hypnosis Hypnosis styles and their clinical relevance Visual Suggestions of Magazine Covers Plants in hospital settings: the role of nature in patient well-being Hypnosis and genetics An overview of genetic terms in psychogenetic association studies Active-alert hypnosis: Phenomenological, Physiological and Hormonal Analysis Hypnosis and executive control Studying the affective prosody of hypnotists Visual imaginative synchrony How the Hypnotic Brain Can Link Neuroscience to Psychotherapy When and What? On the Scope of Positive Suggestions by Efficacy of Hypnosis for Pain Management On the Importance of Assessing Hypnotizability in Clinical Practice Statistical Significance and Effect Size in Hypnosis Research: What Clinicians Should Know

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with it or even written their MA thesis on the subject. Another special direction is when an external specialist – typically a doctor or biologist – can be linked to our university through the subject of hypnosis in the context of doctoral training. This means that a formal link is established between other institutions, such as hospitals, and the university. The PhD research serves as a kind of “protected framework” for introducing hypnosis or suggestive techniques into institutions that are otherwise apprehensive of using such methods. Since the research results speak for themselves and are generated on site, it is hard to deny the effectiveness of the method: reduced need for medication, shorter hospital stays, less blood loss, increased patient satisfaction, and better cooperation are the recurrent results (Kekecs & Varga, 2013). It is also fascinating to explore the personal interaction itself in the context of the social psychobiological model of hypnosis described by Prof. Éva Bányai: looking for the essence of the phenomenon not only in the hypnotized person but in the dyadic interaction between the subject and hypnotist. This has led to the development of methods that can be applied independent of hypnosis (Varga et al., 2006) to the description of patterns of experience of hypnosis that can be compared with other states (Józsa et al., 2019; Varga, 2013), with theoretical and practical examples of interactional synchrony research (Varga, 2013). The opponents, committee members, and audience for these PhD defenses include several people who know nothing at all about hypnosis, in some cases encountering it for the first time in an academic setting. This is a unique opportunity to dispel misconceptions and develop a more realistic view of hypnosis. Several doctoral students supervised by Prof. Éva Bányai became leading hypnosis researchers and experts themselves. Prof. Katalin Varga’s research on the experience of the hypnotized subjects and the hypnotists and her MA thesis and PhD and DSc dissertations (Varga et al., 1994, 2008, 2013) provide a unique insight into the phenomenology of hypnotic interaction. Anna Csilla Gősi-Greguss’s analysis of changes in the affective prosody of hypnotists during hypnosis interactions (2002, 2003) is also unique in the international literature (Gősi-Greguss, 2002, 2003). Not surprisingly, they were both elected to the board of directors of the International Society of Hypnosis. András Költő’s studies on the relationship between hypnotizability, gender, and childhood parenting style (Költő et al., 2014, 2019) also attracted such international interest that he was elected as a board member of the European Society of Hypnosis at a young age (Table 6.2).

6.4 Conferences When Prof. Éva Bányai was elected President of the European Society of Hypnosis in 1993, and the 7th European Congress of Hypnosis was subsequently held in Budapest in 1996, 70 university students were directly involved in the organization and running of the conference, which was also very inspiring for them. When Prof. Éva Bányai was elected President-Elect of the International Society of Hypnosis in

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Table 6.2 Successfully defended PhD dissertations on hypnosis at ELTE Eötvös Loránd University, Budapest Year 1997

Author Katalin Varga

2003

Anna Gősiné Greguss Noémi Császár

2003

2007 2009 2012

2012 2013 2014

Eszter Biró Györgyi Katona Lilla Benczúr

Katalin Varga S. Emese Józsa Edit Jakubovits

2014

Zoltán Kekecs

2015

András Költő

2015

Katalin Melinda Kissné Gombos Orsolya Zsigmond Adrienn Vargay

2019 2019

2021

Csenge Márta Szeverényi

Title Comparing the subjective and behavioural effects of hypnosis Affective prosody in hypnosis

Supervisor Prof. Éva Bányai

A projective principle-based study of the role of prior expectations of hypnosis in an experimental situation of induced pain Interactional synchrony during hypnosis Self-control during hypnosis

Prof. Éva Bányai

The role of positive suggestion in the management of ventilated patients in an intensive care unit Visual imaginative synchrony

Prof. Katalin Varga

The experience pattern of dyadic interactions The impact of suggestive communication on patients’ physical well-being in critical medical situations: Reduction of side effects during chemotherapy for breast cancer patients with adjuvant hypnotherapy The effectiveness of suggestive techniques as adjunct to medical procedures, and particularly applied in surgical settings Hypnotic susceptibility and mentalization skills in the context of parental behaviour Determining the characteristics of the suggestive teacher based on a relational approach

Prof. Katalin Varga Prof. Katalin Varga

Posttraumatic growth of childhood and adult survivors of cancer Coping with breast cancer and patient’s experience of psychological interventions: a longitudinal study Possibilities of applying psychotherapeutic methods during orthopaedic and traumatological operations

Prof. Éva Bányai

Prof. Éva Bányai

Prof. Éva Bányai Prof. Éva Bányai

Prof. Katalin Varga

Prof. Katalin Varga

Prof. Éva Bányai Prof. Katalin Varga

Prof. Éva Bányai

Prof. Katalin Varga

1997, many of her undergraduate students decided to write their MA theses on hypnosis research. It was becoming increasingly clear that conferences were essential for the “revival,” even the revitalization, of the hypnosis life. The annual summits of the Hungarian Association of Hypnosis, co-organized by the Department of Affective Psychology at ELTE, are regularly attended by

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students. Here, in addition to the professional content (lectures, round tables, workshops), they also have the opportunity to develop their event management skills. They have a special – and rare – opportunity to meet members of the association at informal social events. In short, our students are full participants of the conference. Our aim is to bring them closer to the association itself and its values, traditions, and community, in addition to their direct professional knowledge. Our experience is that in this way hypnosis becomes part of the forming professional identity of young students and the association itself can provide a real experience of “belonging.” The Researchers’ Night is an annual event where the public is invited to the universities to get a glimpse into the life of research laboratories and subjects that they study. This event always includes hypnosis research as a topic, including a major lecture and group hypnosis. Our students who participate in these events are thus involved in the possibilities of disseminating knowledge and learn about the views and questions of the lay public. In this way, when they start to work independently, they will not be surprised to find that the “man in the street” often has a different way of thinking about hypnosis than they encountered during their studies. Likewise, hypnosis is a recurring theme at the Memorial Day of Sándor Illyés, the founder professor of our department. Here, the format bringing hypnosis closer to participants may be research posters of students, lectures, and workshop discussions of our written or planned publications. The annual events are sometimes complemented by truly large-scale events. We have organized several international conferences over the past decades, for which ELTE has not only provided logistical support but also served as an official co-organizer. It is an undeniable message that the opening ceremonies of these events have been honored by the presence of the university’s administration. This is a public declaration that the subject of “hypnosis” is not a subject that has been ignored or “forgotten,” but a proudly embraced part of the rich intellectual palette of our institution. Eurohypnosis ‘96 was one of the European Hypnosis Society’s highest-quality conferences. A few years after the regime change, it was an intoxicating feeling to welcome the leading international representatives of the field in our country. The 1st International Conference on Hypnosis in Medicine (ICHM) was held in Budapest in 2013. The meeting was co-organized by ELTE, the Hungarian Association of Hypnosis, the Department of Anaesthesiology and Intensive Therapy, the Semmelweis University, and the nominal sponsorship of the European as well as the International Society of Hypnosis. It was a very special meeting from many reasons, as it was the first scientific international conference where experts in hypnosis presented their findings on the application of this method specifically in the context of biomedicine: it was a historic moment. The program of the conference served everyone from beginners of this special field to the experienced colleagues. It represented an astonishing variety, as hypnosis can be used in a wide range of settings in medicine: from preparation for childbirth to the alleviation of pain in palliative care; from dentistry to emergency medicine; and from dermatology to brain surgery – just to mention a few examples.

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The program of the meeting was exceptionally rich: leading experts in the field presented 7 keynote addresses altogether, 41 paper presentations, and 65 workshops and shared their opinions in 3 panels. There were two film programs and four self-­ awareness sessions also available. The explicit aim of the Hypnosis: New Generation Conference (H:NG, 2019) was to provide space for young colleagues, even students, to present and meet, since they do not have this opportunity at the big international conferences where the main presentations are usually given by established “big names.” These conferences have given many psychology students the opportunity to attend these programs locally. Bringing the event itself “home” therefore allows more people to get close to leading experts than if we had to attend these meetings abroad, which usually only two to four colleagues get the opportunity to do, with the help of different grants. International conferences organized at home, on the other hand, give up to 50 students or young colleagues the opportunity. This gives a new and inspiring impetus to the subject of hypnosis.

6.5 The Relationship Between Hypnosis and the University 6.5.1 How the University Supports: What Does “Hypnosis” Get from the University? The university supports hypnosis on many levels. One of the most important is that it “embraces” hypnosis, making it a formally teachable, researchable subject. It is also essential that the university gives hypnosis a direct and literal place: research space, experimental rooms, and equipment for data management (video recordings, computers, lockable containers, etc.). Hypnosis research is conducted in a demanding and reliable context: this is likely to increase people’s confidence in the subject. The university environment itself is a kind of assurance that hypnosis can be experienced here, with a real scientific purpose, led by knowledgeable professionals. The university also supports hypnosis research through its own “internal” grants, which gives young, novice professionals in particular a starting opportunity to publish their first results, enabling them to be considered for independent grants. The “external” grants are also backed by the university budget, which often provides the “co-payment” for the grant itself. The university provides access to literature, the opportunity for the acquisition and storage of textbooks. It also supports the actual publication (e.g., through obtaining contracts for open access between the university and the publishers). In addition, the university is an intellectual environment where one can find a highly experienced colleague to turn to in almost any issue: from language proofreading to clarifying statistical issues to discussing physiological details. Our department specifically has the tradition of discussing emerging research ideas or identified problems in need to be solved. During these discussions, a colleague, not

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directly familiar with hypnosis, but who knows its main features as a phenomenon, can directly tune in to the issues that need to be resolved. In this way, there is no need to deal with external experts’ misconceptions or even the amazement regarding hypnosis instead of a meaningful professional consultation. The university’s community provides a large number of students who often volunteer to be experimental subjects. This is also open to non-psychology students through various course placement opportunities. The university is an important guarantee of professionalism and security here as well. At the same time, it is important to see the drawbacks of research at the university (see Box 6.2).

Box 6.2 Disadvantages of Academic Hypnosis Research As we have seen, there are several advantages to the presence of hypnosis in a university setting. Nevertheless, it is also important to realize the potential downsides. Several hypnosis research laboratories worldwide have been and still are based at universities, in departments related to social sciences. Consequently, the participant pools of most studies consist of healthy university students. However, this sample is not representative of hypnotherapy clients. This issue of drawing conclusions about humans in general from samples of college students is not unique to hypnosis research in the United States at all; it is typical of the field of psychology at large (Henrich et  al., 2010). Nevertheless, it is important for us to realize this and how it might affect our current understanding of how hypnosis works. For example, it is established in laboratory research conducted with samples including thousands of people (mainly university students) that hypnotizability plays a major role in determining people’s responsiveness to suggestions under hypnosis and that there is a large interpersonal variation in this trait (Költő et al., 2014). Since hypnosis is often thought of as an effective delivery agent for suggestions, and suggestions are thought to be the main effective ingredients in hypnotherapy, it is natural to conclude that high hypnotic suggestibility is a prerequisite for effective clinical treatments as well. However, this is not true according to practical clinical experience. According to the Efficacy Standards for Clinical Hypnosis Task Force’s big hypnosis survey, most clinicians (about 80%) do not measure hypnotizability in their practice, and hypnotizability was rated overall as the least important of ten proposed factors of effectiveness of hypnotherapy in this survey (Palsson et al., n.d.). Empirical evidence also suggests that hypnotizability, although playing a significant role statistically, only accounts for 6% of the variance of clinical effectiveness of hypnotherapy (Montgomery et al., 2011). Thus, just like the science of psychology in general, our field needs to move away from conducting research with university students in order to make our findings more generalizable.

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Students can also contribute to the synthesis and publication of knowledge on hypnosis at various levels. BA students summarize articles in Hungarian for the newsletter of the Hungarian Association of Hypnosis. In this way, they help inform colleagues who are less familiar with the international literature. The MA students do the same in English or write summaries of hypnosis-related topics. The best of these will be made publicly available, for example, on the ISH website. More recently, very concise, attention-grabbing descriptions have been produced for social media platforms, giving interested people the opportunity to study the topic in more depth with a link to a journal article or study. In this way, an increasingly rich pool of knowledge is “flowing” continuously from the world of academia to professionals and the wider public. This should improve attitudes toward hypnosis and dispel misconceptions.

6.5.2 What Does the University Get from Hypnosis? In particular, the university receives researchers and academics, committed to the subject, and who may join up, for example, to a research question, in some cases literally by the hundreds. Students thus gain not only direct knowledge but also role models that can shape their professional identity. Students can literally follow how science is created. How a brand new form of hypnosis can unfold and have an impact: they can listen directly to lectures on active-alert hypnosis from the author (Bányai, 2018; Bányai & Hilgard, 1976). The ELTE Hypnosis Lab’s framework, the so-called interactional approach, can provide a foundation and background in many other areas, where students now see interpersonal interactions rather than individual approaches. Indeed, during their studies, they have been able to follow the research paradigms of this hypnosis model, the stages of theorization, and, of course, the results themselves (Bányai, 1998). Through hypnosis research, they can also be linked to seemingly completely different fields, such as psychogenetics, clinical neuroscience, parenting styles, or even oxytocin research (Jensen et al., 2017; Kasos et al., 2018; Költő et al., 2019; Szekely et al., 2010; Varga & Kekecs, 2014). During education, the university also “gets” “hypnosis” as a subject – a topic to which a number of topics can be tied: methodology, ethics, measurements, individual differences, traits, state-dependent phenomena, interaction model, and so on. Students get practical experience working in an academic setting, and hypnosis research topics can bring grant money to the university. In return, students get access to an important career opportunity: after getting acquainted with hypnosis during the larger BA courses, students who want to gain a more in-depth knowledge may continue to explore the hypnosis phenomena during their MA studies. At both levels, they can complete their thesis on the topic. Following larger BA courses, those with a more in-depth interest can continue to explore hypnosis phenomena in their MA studies. At both levels, they can complete a thesis on this. The most advanced

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students can progress to the PhD level. At the same time, colleagues who have graduated at other universities, for example medical doctors or biologists, enrich the ranks of the university’s specialists, broadening the university’s perspective and increasing the making the university’s “brand recognition” “circulate” in with the partner institutions.

6.6 The Current Situation Hypnosis research has been conducted with uninterrupted momentum only at the Department of Experimental Psychology (later named Department of Affective Psychology) of the ELTE Eötvös Loránd University, Faculty of Humanities, and, since 2003, at the Faculty of Education and Psychology. The “secret” of this success is that the ELTE Eötvös Loránd University has been able to involve many students in research from the very beginning and many of them entered hypnosis training after writing their thesis and then wrote their doctoral thesis on hypnosis. It was also inspiring that the independent Hungarian Association of Hypnosis (HAH) has been based at the Department of Experimental Psychology (later Affective Psychology) at ELTE Eötvös Loránd University since its foundation in 1991. So, students can observe the life of HAH closely. The interactionist research approach to hypnosis, initiated by Prof. Éva Bányai at ELTE (Bányai, 1985, 1991, 1998, 2019; Bányai et  al., 1985, 1990), has many therapeutic implications, so it may bridge the gap between basic research and the clinical application of hypnosis, which may also be attractive to students. Hypnosis research is still active at the Department of Affective Psychology at ELTE. Prof. Éva Bányai and her students are currently investigating the effects of hypnosis on cancer patients in a randomized clinical trial. The study has resulted in 3 PhD dissertations, 11 MA theses, and 3 BA theses so far. The literal transcription of patients’ experiences is being carried out by students of several BA courses, while students from other MA courses are involved in the content analysis of the end-of-treatment and end-of-research interviews. Prof. Katalin Varga and her PhD students also conduct intensive hypnosis research at the Department. Zoltán Kekecs has already gained international reputation and is currently studying the difference between the effects of hypnosis induction and “sham hypnosis.” One PhD student and several MA and BA students are participating in this research. Eniko Kasos, who has already obtained interesting results on oxytocin changes induced by activealert hypnosis interactions (Kasos et  al., 2018, 2019), is just preparing her PhD thesis for defense. The ongoing intensive research in the Department of Affective Psychology at ELTE is very promising: experience has made it evident so far that if students are actively involved in research, it will lead to more of them choosing hypnosis as their field of specialization after graduation, either to investigate the background of hypnosis further or to apply it therapeutically in practice.

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6.7 Conclusion: General Recommendation and Possible Path for Further Development Reflecting on the relationship between hypnosis and university, we can be really proud of how the subject of “hypnosis” is flourishing at our Institute. The recipe is simple: seize the moment, choose the right medium, and link hypnosis to a topic that is accepted and presentable. Once the subject is “in” on campus, get charismatic teaching-research personalities to charm a few hundred students, so that they can turn out those who are more deeply committed. Cultivate international contacts, and accept positions in international hypnosis organizations, so that your colleagues who have become your friends will come to meetings you organize at home. At the same time, possible opportunities for further development emerge at several points: It is especially important to take care of the international involvement: building up research partnerships, applying for scholarships, and hosting and sending visiting lecturers. Through our university’s contacts and partners, every opportunity is available to do this. It is important to nurture the next generation. Unfortunately, the last decades have shown that if colleagues who have been active in the field of hypnosis disappear from a platform, even from a university platform (e.g., if they retire), the subject itself can disappear or be significantly relegated to the background. Therefore, even during this period of booming enthusiasm, it is essential to pay attention to the education of the next generation. It is essential to publish on the subject of “hypnosis” in non-hypnosis journals: we need to gain better exposure toward the wider academic public. Clinicians who have experienced the effectiveness of hypnosis should report their findings in prestigious journals. This requires the right quality research and publishing skills, what academics are best known for. This process is facilitated by the guidelines for evaluating the effectiveness of clinical hypnosis applications (see Box 6.3). Box 6.3 Guidelines for the Assessment of Efficacy of Clinical Hypnosis Applications Hypnosis is rooted in Western medicine (Hammond, 2013). Thanks to its origins, it has been the subject of Western scientific scrutiny for much longer than most other types of mind-body medicine interventions. So, hypnosis arguably had a head start at becoming an evidence-based mind-body medicine intervention, as it being studied has started at universities and research laboratories very early. Consequently, considerable amount of research has been conducted on the efficacy of hypnosis on various clinical applications ranging from pain management (Moss & Willmarth, 2019) through the treatment of irritable bowel syndrome (Palsson & Ballou, 2020) to the treatment of mood disorders (Milling et al., 2019). (continued)

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Box 6.3  (continued) Nevertheless, hypnosis is still not widely used in either medicine or psychotherapy. There are multiple reasons for this, for example, its continuing misrepresentation in popular media. But another important reason is the lack of standards in the field regarding conducting and reporting clinical research and in assessing the efficacy based on multiple studies. The lack of widely accepted methodological standards leads to a wide variation in the quality of evidence produced by the individual studies conducted in the field, reduced reproducibility of both the studies and the interventions themselves, and a lack of consensus on which applications can be considered already established evidence-based application. The Efficacy Standards for Clinical Hypnosis Task Force (Kekecs et al., 2022) has been established to address these issues and provide explicit standards for research and evaluation of efficacy of clinical hypnosis applications. The Task Force undertook three main projects so far: As a first step, it formulated guidelines for efficacy assessment, which help evaluate the state of the evidence about efficacy of a given application accumulated over multiple studies (Kekecs et al., 2022). Second, it issued best practice recommendations for conducting research on efficacy of clinical hypnosis applications and a checklist for reporting the findings of these clinical trials. Finally, the Task Force also conducted the largest survey so far among clinicians and researchers, gathering information about their practices and experiences in using hypnosis and their views on the effectiveness and safety of different hypnosis applications and on what are the most important research areas to focus on for the future (Kekecs et al., 2022).

“Building bridges of understanding” – the ISH slogan by Peter Bloom and Per-­ Olof Wikström – is now part of the ISH logo (see the 2015/3 newsletter at the ISH website) (Linden, 2015). If you are looking for a solid and reliable foundation for this bridge, the university environment is the best choice.

Appendix Below are the testimonials of some of the “stakeholders” who were asked to describe how they see the relationship between hypnosis and the university. Bálint Dömök, BA student  Hypnosis, being an often-debated topic of psychology, is an important element of our studies as psychology students from many aspects. First, the concept of scientifically proving a phenomenon or method – that is considered a hoax in the public opinion – is really inspiring. As a university stu-

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dent, it is even more important to learn about how hypnosis became accepted, because it makes us realise that everything is not what it seems and that there is still a huge part of the human mind left undiscovered and maybe waiting for us to do so. Moreover, I think the many ways of using or applying hypnosis is important because suggestions and self-suggestions are crucial for our performance. We frequently experience anxiety and stress as students and adolescents. It’s important to use these events to our advantage and giving ourselves suggestions can increase successful outcomes. Evelin Pató, demonstrator  Thanks to hypnosis research at the University, I absorbed the knowledge of hypnosis as naturally as I absorbed the Rogerian approach. However, I find that my former classmates, working on their masters at a different University, view the method with a great deal of scepticism or fear, mainly influenced by movies and therefore tend to shy away from it. At ELTE, on the other hand, there is a general openness and interest in the subject, which is strongly supported by the research, as it is possible to join in, both as subject and as a research assisstant. For students, it is a great opportunity to experience hypnosis first-hand, and I am sure that there are very few places where this is possible free of charge. This is facilitated by a shared experience where everyone can understand what was going on in them at that time and place and understand the scientific basis and applications of the method from excellent instructors. And as a demonstrator (role similar to a TA), I get to see the excited faces of students before and after hypnosis and answer their questions myself. I get more insight into the research than ever before, and in a safe teaching atmosphere I can learn the practices and knowledge that you can’t learn anywhere else unless you are very lucky, or only later on, through your own mistakes. All in all, I am very happy that I am doing my studies here and that I have been able to develop such a close, active relationship with the method. Boglárka Csapó, demonstrator  As a student, I am very grateful to the researchers and lecturers at ELTE for the opportunity to learn about hypnosis and its many applications during my undergraduate studies. This was not only possible in a theoretical framework, but I also had the opportunity to experience hypnosis, in group and individual situations, after which I was able to discuss my experiences. I also had the opportunity to be involved in research on hypnosis as a demonstrator. All this helped me a lot to integrate my knowledge and experience of hypnosis. There is no other method that I could have gained such insight into during my undergraduate training, despite the fact that one of the fundamental issues of a psychologist identity is the method one uses. This experience, together with the fact that the University has a very high quality and active hypnosis life even by international standards, is very motivating. So much so that I would like to master this method in the future. Although initially I did not want to be a researcher, I have become so interested in hypnosis that I am seriously considering research in this field as a future.

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Krisztina Hunyadi, MA student  During my BA studies I enrolled in a course about hypno-suggestive methods. I already had effective strategies for studying from my years at law school, but I thought there was always room for improvement. Since I have always been interested in hypnosis and related topics, I was keen on learning what the course could offer. To be honest I haven’t really changed my study methods, but the course and some other personal experiences (hypnobirthing, sensory deprivation tank) motivated me to learn more about hypnosis at other university courses. The topics covered during the course further widened my perspective on hypnosis and made me realize, that altered states of consciousness are part of our lives and the sheer knowledge of this can be a tool to understand more of our everyday experiences. János Gelleri, MA student  During my studies at the Eötvös Loránd University (BA and MA), I only had 3 courses about hypnosis and 2 of them were elective. In my opinion, hypnosis is not getting the attention it deserves and should receive a bigger role in the study of psychology. The courses about suggestive communication and altered states of consciousness helped me better understand the human psyche, including my own. Suggestive communication and hypnosis could be vital tools in any psychologist’s toolbox; therefore, I am pretty sure I’d like to expand my expertise in these areas, even after finishing my university studies. Bogi Barta, MA student  Before university I was never really interested in altered states of consciousness, and hypnosis seemed like a magician’s trick. At university my first encounter was during the affective psychology lectures, given by Prof. Éva Bányai. My whole point of view changed and made me realize just how interesting and full of potential this subject is. This realization motivated me to write my BA thesis on mindfulness techniques, and to take other courses. These experiences helped me realize just how present altered states are in our everyday life, and how easy it can be to slip into them without us realizing it. Knowing this, I have used mindfulness techniques almost every day, and my change in attitude has been drastic. I am glad that I have a chance to deepen my knowledge about myself and what these practices can unearth in others. Balázs Nyíri, PhD student  I think it’s a very special experience to study at an institute and department where you can learn directly from internationally renowned experts in hypnosis. Not only to learn, but also “spend every day with them.” This means being able to hear up close and personal accounts of what is new in hypnosis, or to look into research that is shaping the discipline. It also means being able to ask a question in the kitchenette or in the corridor from professionals whose decades of knowledge is only available for others during lectures and conferences. Studying hypnosis at ELTE is something that replaces any reference letter: in an international setting, you just have to say ELTE Hungary/Budapest and everyone knows “Ah! Éva Bányai and Katalin Varga.” It also means that there are many different areas of research and experience are covered by the curriculum, the focus is not only on one

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area. It is also great in my opinion, that, in addition to research, you can also learn a lot about practical applications. In addition to all this, hypnosis professionals here, almost without exception, are increasingly involved in the international hypnosis scene, whether in international projects or as journal or book editors, or board members of different organisation. This means that there are many opportunities available that may not be at other universities. I would be hard put to name a disadvantage. Perhaps some disadvantages are that it is harder to stand out among such “big players” or that it takes a bit more courage to come up with a new idea or theory – but that was not my experience so far. Prof. György Hunyady, former dean of the faculty  During the multi-stage development of the Institute of Psychology at ELTE, Éva Bányai, who was working on hypnosis at the Department of Comparative Physiology at the Faculty of Sciences and had produced original results, joined the activities of the emerging educational and research organisation, and became increasingly important within its framework. Through her, the scientific and educational topic of hypnosis became established in the Institute from the second half of the 1980s. It became one of the subject areas that attracted external interest and the attention of students, that produced excellent domestic research record and first-class international contacts through a sophisticated theory that exploited the many facets of the subject, a quest for integrity and a wealth of applications. This multi-faceted approach is inherently represented and inspired by Professor Bányai, who has played an active, effective and distinctive role at the University and the institutional life, and who has selected excellent collaborators who themselves have developed a multi-generational thematic focus, with prolific research and valuable pedagogical work. For many decades, this has been a well-known centre of the field of psychology, an integral part of the appeal of “ELTE Psychology,” and its contributors regularly appear and create forums in the field. In my view, the outstanding professional value of the practitioners in this field lies in the precise and effective application of the subject matter, which has traditionally captured attention, and in the specific pedagogical ethos that has developed and continues to be derived from this field. Katalin Varga S, PhD, Head of the Hungarian Association of Hypnosis  I first heard a lecture on Hypnosis at the University as a first-year student. I remember being intellectually impressed by the history of the method, its effectiveness, and the wide range of its uses, but what really caught me was the passion the instructor talked about hypnosis with. I felt that I wanted this magic too! I want to learn it! I want to feel it! I started attending all hypnosis-related programs that were held at the University, and when I read that they were looking for a student to help transcribe hypnosis texts on the computer at the ELTE Hypnosis Lab, I almost ran into their office to get the position that for me represented a window to the world of Hypnosis. It will be 25 years that I fell in love with the method as a young mind open to science and a heart full of enthusiasm. During my university years, I participated in different studies and attended several conferences.

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As I graduated, I started a method-specific training, right there, in the same conference room where I had heard that bright-eyed speaker four years before. I also wrote my doctoral dissertation on Hypnosis, of course there, at the University, and as a doctoral student, I spoke to students about hypnosis with the same bright-eyes. I gradually got into life at the Hungarian Association of Hypnosis while still at the University. Even the often-monotonous administrative work seemed exciting with the ELTE Hypnosis Lab just next door, where the most recent research was running, and where I could escape to, when my time allowed. The University provided space for working with colleagues and it was not just a space for a physical presence. We shared more in that space within the walls of the University: an exchange with students, youngsters who were there with us, so that we could be there with them too. The passion spread organically. I decided to share my personal story to show the points of connection where and when the world of University and Hypnosis became one in my life, both on a professional and a personal level. I am currently holding the position of President of the Association. What does the University give the Association now, and me at the same time? A nest. Socialization. A constantly revitalising community. Fresh, professional, scientific thinking. Physical space. Possibility. Freedom. A framework it is good to belong to, which I have proudly voiced on every forum. I know that as President I should be more nuanced, yet many times the two symbolic spaces, the University and the Hungarian Association of Hypnosis, become One to me.

References Bányai, É. I. (1980). A new way to induce a hypnotic-like altered state of consciousness: Active-alert induction. In L. Kardos & C. Pléh (Eds.), Problems of the regulation of activity (pp. 261–273). Akadémiai Kiadó. Bányai, É. I. (1985). A social psychophysiological approach to the understanding of hypnosis: The interaction between hypnotist and subject. Hypnos. Swedish Journal of Hypnosis in Psychotherapy and Psychosomatic Medicine, 12, 186–210. Bányai, É. I. (1991). Toward a social-psychobiological model of hypnosis. In J.  W. Rhue & S.  J. Lynn (Eds.), Theories of hypnosis: Current models and perspectives (pp.  564–598). Guilford Press. Bányai, É. I. (1998). The interactive nature of hypnosis: Research evidence for a social-­ psychobiological model. Contemporary Hypnosis, 15(1), 52–63. https://doi.org/10.1002/ch.116 Bányai, É. I. (2018). Active-alert hypnosis: History, research, and applications. American Journal of Clinical Hypnosis, 61(2), 88–107. https://doi.org/10.1080/00029157.2018.1496318 Bányai, É. I. (2019). Interakciós szemléletű hipnóziskutatás: A hipnózis szociál-pszichobiológiai modelljének kísérleti háttere [Interactional approach to hypnosis research: Experimental background of the social-pszichobiological model of hypnosis]. Magyar Pszichológiai Szemle, 74(1), 7–27. https://doi.org/10.1556/0016.2019.74.1.2 Bányai, É. I., & Hilgard, E. R. (1974). A comparison of active-alert hypnotic induction with traditional relaxation induction. Paper presented at the 26th annual scientific meeting of the society for clinical and experimental hypnosis.

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Bányai, É. I., & Hilgard, E. R. (1976). A comparison of active-alert hypnotic induction with traditional relaxation induction. Journal of Abnormal Psychology, 85(2), 218–224. https://doi.org/1 0.1037/0021-­843X.85.2.218 Bányai, É. I., Mészáros, I., & Greguss, A.  C. (1980). Active-alert hypnosis: Psychological and physiological characteristics. In M. Pajntar, E. Roskar, & M. Lavric (Eds.), Hypnosis in psychotherapy and psychosomatic medicine (pp. 39–43). University Press. Bányai, É. I., Mészáros, I., & Greguss, A.  C. (1981). Alteration of activity level: The essence of hypnosis or a byproduct of the type of induction? In Brain and behaviour (pp. 457–465). Elsevier. https://doi.org/10.1016/b978-­0-­08-­027338-­9.50068-­2 Bányai, É. I., Mészáros, I., & Csókay, L. (1985). Interaction between hypnotist and subject: A social psychophysiological approach (preliminary report). In Modern trends in hypnosis (pp. 97–108). https://doi.org/10.1007/978-­1-­4684-­4913-­6_7 Bányai, É. I., Gősi-Greguss, A. C., Vágó, P., Varga, K., & Horváth, R. (1990). Interactional approach to the understanding of hypnosis: Theoretical background and main findings. In R. Van Dyck, P. Spinhoven, A. J. W. Van der Does, Y. R. Van Rood, & W. De Moor (Eds.), Hypnosis: Current theory, research and practice (Issue 1, pp. 53–69). Free University Press. Bentler, P. M., & Hilgard, E. R. (1963). A comparison of group and individual induction of hypnosis with selfscoring and observer-scoring. International Journal of Clinical and Experimental Hypnosis, 11(1), 49–54. https://doi.org/10.1080/00207146308409227 Boncz, I., Pallag, L. P., & Fodor, J. (1985). A study on the hypnotic susceptibility of persons attempting suicide: Some therapeutic considerations. In Modern trends in hypnosis (pp.  131–136). https://doi.org/10.1007/978-­1-­4684-­4913-­6_10 Gősi-Greguss, A. C. (2002). Acoustic analysis of the hypnotist’s voice – A preliminary study. In B. Peter, W. Bongratz, D. Revenstorf, & W. Butollo (Eds.), Hypnosis international monographs number 6 (pp. 129–136). MEG Stiftunk. Gősi-Greguss, A. C. (2003). Hipnotizőrök affektív prozódiájának vizsgálata [Examining the affective prosody of hypnotists] (PhD dissertation). ELTE, Eötvös Loránd University, Budapest. Hammond, D.  C. (2013). A review of the history of hypnosis through the late 19th century. American Journal of Clinical Hypnosis, 56(2), 174–191. https://doi.org/10.1080/0002915 7.2013.826172 Henrich, J., Heine, S.  J., & Norenzayan, A. (2010). Beyond WEIRD: Towards a broad-based behavioral science. Behavioral and Brain Sciences, 33(2–3), 111–135. https://doi.org/10.1017/ S0140525X10000725 Jensen, M.  P., Jamieson, G.  A., Lutz, A., Mazzoni, G., McGeown, W.  J., Santarcangelo, E.  L., Demertzi, A., De Pascalis, V., Bányai, É. I., Rominger, C., Vuilleumier, P., Faymonville, M.-E., & Terhune, D. B. (2017). New directions in hypnosis research: Strategies for advancing the cognitive and clinical neuroscience of hypnosis. Neuroscience of Consciousness, 2017(1). https://doi.org/10.1093/nc/nix004 Józsa, E., Költő, A., Bányai, É. I., & Varga, K. (2019). A tudat fenomenológiája kérdőív magyar változatával szerzett tapasztalatok [Experiences with the Hungarian version of the phenomenology of consciousness inventory]. Magyar Pszichológiai Szemle, 74(1), 29–45. https://doi. org/10.1556/0016.2019.74.1.3 Kasos, E., Kasos, K., Pusztai, F., Polyák, Á., Kovács, K. J., & Varga, K. (2018). Changes in oxytocin and cortisol in active-alert hypnosis: Hormonal changes benefiting low hypnotizable participants. International Journal of Clinical and Experimental Hypnosis, 66(4), 404–427. https://doi.org/10.1080/00207144.2018.1495009 Kasos, E., Kasos, K., Józsa, E., Költő, A., Bányai, É. I., & Varga, K. (2019). Új kutatási eredmények aktív-éber hipnózisban: fenomenológiai, fiziológiai és endokrin elemzések [New results in active-alert hypnosis research: Phenomenological, physiological and endocrine analysis]. Magyar Pszichológiai Szemle, 74(1), 81–95. https://doi.org/10.1556/0016.2019.74.1.6 Kekecs, Z., & Varga, K. (2013). Positive suggestion techniques in somatic medicine: A review of the empirical studies. Interventional Medicine and Applied Science, 5(3), 101–111. https://doi. org/10.1556/IMAS.5.2013.3.2

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Kekecs, Z., Moss, D., Elkins, G., De Benedittis, G., Palsson, O.  S., Shenefelt, P.  D., Terhune, D. B., Varga, K., & Whorwell, P. J. (2022). Guidelines for the assessment of efficacy of clinical hypnosis applications. International Journal of Clinical and Experimental Hypnosis, 70(2), 104–122. https://doi.org/10.1080/00207144.2022.2049446 Költő, A., Gősi-Greguss, A. C., Varga, K., & Bányai, É. I. (2014). The influence of time and gender on Hungarian hypnotizability scores. International Journal of Clinical and Experimental Hypnosis, 62(1), 84–110. https://doi.org/10.1080/00207144.2013.841487 Költő, A., Gősi-Greguss, A.  C., Varga, K., & Bányai, É. I. (2015). Hungarian norms for the Harvard Group Scale of Hypnotic Susceptibility, Form A. International Journal of Clinical and Experimental Hypnosis, 63(3), 309–334. Költő, A., Józsa, E., & Bányai, É. I. (2019). Recalled parental rearing style and dimensions of hypnotic response. International Journal of Clinical and Experimental Hypnosis, 67(2), 157–191. https://doi.org/10.1080/00207144.2019.1580968 Kovats, G., & Rónay, Z. (2021). Academic freedom in Hungary. Linden, J.  H. (2015). Building bridges of understanding. The International Society of Hypnosis Newsletter. https://www.ishhypnosis.org/wp-­content/uploads/2015/03/ISH_NL_ March_2015.pdf Mészáros, I. (1981). A hipnózis és a hipnotikus fogékonyság pszichoziziológiája [The psychophysiology of hypnosis and hypnotic susceptibility]. DSc dissertation. Mészáros, I. (1984). Hipnózis [Hypnosis]. Medicina Könyvkiadó. Mészáros, I., & Bányai, É. I. (1973a). Kiváltott potenciálok változása hipnózisban [Changes in evoked potentials during hypnosis]. Presentation at the MÉT 39. Vándorgyűlésén. Mészáros, I., & Bányai, É. I. (1973b). Modification of human evoked potentials during hypnosis. Paper presented at the 8th international congress of electroencephalography and clinical neurophysiology. Mészáros, I., & Bányai, É. I. (1978). Electrophysiological characteristics of hypnosis. In K. Lissák (Ed.), Neural and neurohumoral organization of motivated behaviour. Proceedings of the 4th conference of interbrain. Pécs, Hungary May 19–23, 1975 (pp. 19–23). Akadémiai Kiadó. Mészáros, I., Osmánné Sági, J., & Bányai, É. I. (1971a). Az emberi tanulás egyes tényezőinek változása hipnózisban [Changes in factors of human learning under hypnosis]. Presentation at the Magyar Élettani Társaság (MÉT) 37. Vándorgyülésén. Mészáros, I., Osmánné Sági, J., & Bányai, É. I. (1971b). Effect of hypnosis on some factors of human learning. Paper Presented at the I.  Mezsdunaroden Szimpozium Po Problemi Na Szugesztologiata. Mészáros, I., Bányai, É. I., & Greguss, A.  C. (1980). Psychophysiological correlates of hypnosis. Wiessenschaftliche Zeitschrift Der Karl-Marx-Universität Leipzig, Mathematisch-­ Naturwissenschaftliche Reihe, 29, 235–240. Mészáros, I., Bányai, É. I., & Greguss, A.  C. (1981). Evoked potential, reflecting hypnotically altered state of consciousness. In G. Ádám, I.  Mészáros, & É. I.  Bányai (Eds.), Advances in physiological sciences. Proceedings of the 28th international congress of physiological sciences, Budapest, 1980. Vol. 17. Brain and behaviour (pp.  467–475). Pergamon Press  – Akadémiai Kiadó. Mészáros, I., Bányai, É. I., & Greguss, A. C. (1982). Evoked potential correlates of task-specific motivation in hypnosis. In K. Lissák & P. Molnár (Eds.), Recent developments of neurobiology in Hungary. X. Motivation – The neural and neurohumoral factors in regulation and behaviour (pp. 177–183). Akadémiai Kiadó. Mészáros, I., Crawford, H. J., Szabó, C., Nagy-Kovács, A., & Révész, Z. (1989). Hypnotic susceptibility and cerebral hemisphere preponderance: Verbal-imaginal discrimination task. In V. A. Gheorghiu, P. Netter, H. J. Eysenck, & R. Rosenthal (Eds.), Suggestion and suggestibility (pp. 191–203). Springer. https://doi.org/10.1007/978-­3-­642-­73875-­3_15 Milling, L. S., Valentine, K. E., McCarley, H. S., & LoStimolo, L. M. (2019). A meta-analysis of hypnotic interventions for depression symptoms: High hopes for hypnosis? American Journal of Clinical Hypnosis, 61(3), 227–243. https://doi.org/10.1080/00029157.2018.1489777

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Montgomery, G.  H., Schnur, J.  B., & David, D. (2011). The impact of hypnotic suggestibility in clinical care settings. International Journal of Clinical and Experimental Hypnosis, 59(3), 294–309. https://doi.org/10.1080/00207144.2011.570656 Moss, D., & Willmarth, E. (2019). Hypnosis, anesthesia, pain management, and preparation for medical procedures. Annals of Palliative Medicine, 8(4), 498–503. https://doi.org/10.21037/ APM.2019.07.01 Nemeth, D., Janacsek, K., Polner, B., & Kovacs, Z. A. (2013). Boosting human learning by hypnosis. Cerebral Cortex, 23(4), 801–805. https://doi.org/10.1093/cercor/bhs068 Palsson, O.  S., & Ballou, S. (2020). Hypnosis and cognitive behavioral therapies for the management of gastrointestinal disorders. Current Gastroenterology Reports, 22(7). https://doi. org/10.1007/s11894-­020-­00769-­z Palsson, O.  S., Kekecs, Z., DeBenedittis, G., Moss, D., Elkins, G., Terhune, D.  B., Varga, K., Shenefelt, P. D., & Whorwell, P. J. (n.d.). Current practices, experiences, and views in clinical hypnosis: Findings of an international survey (In Preparation). Rónay, Z. (2019a). Academic freedom and strong state control: Two samples to illustrate the consequences. Paper presented at the annual international conference of the Bulgarian Comparative Education Society (BCES), 17, 175–180. Rónay, Z. (2019b). The rise and fall of autonomy. The last thirty years of Hungarian higher education. In N. Popov, C. Wolhuter, L. de Beer, G. Hilton, J. Ogunleye, E. Achinewhu-Nworgu, & E. Niemczyk (Eds.), Global education in practice: Teaching, researching, and citizenship BCES conference book (pp. 238–243). Bulgarian Comparative Education Society. Szabó, C. (1993). The phenomenology of the experiences and the depth of hypnosis: Comparison of direct and indirect induction techniques. International Journal of Clinical and Experimental Hypnosis, 41(3), 225–233. https://doi.org/10.1080/00207149308414552 Szabó, C. (2004). The effect of monotonous drumming on subjective experiences. Music Therapy Today, 1, 1–9. Szabó, C. (2012). Alternatív transzállapotok, avagy hipnózis másként [Alternative trance states or hypnosis in another way]. In K.  Varga & A.  C. Gősi-Greguss (Eds.), Tudatállapotok, hipnózis, egymásra hangolódás/States of consciousness, hypnosis, attunement (pp. 107–123). L’Harmattan Kiadó. Szekely, A., Kovacs-Nagy, R., Bányai, É. I., Gösi-Greguss, A. C., Varga, K., Halmai, Z., Rónai, Z., & Sasvári-Székely, M. (2010). Association between hypnotizability and the catechol-O-­ methyltransferase (COMT) polymorphism. International Journal of Clinical and Experimental Hypnosis, 58(3), 301–315. https://doi.org/10.1080/00207141003760827 Varga, K. (2013). The phenomenology of hypnotic interactions. Nova Science Publishers. Varga, K., & Kekecs, Z. (2014). Oxytocin and cortisol in the hypnotic interaction. The International Journal of Clinical and Experimental Hypnosis, 62(1), 111–128. https://doi.org/10.108 0/00207144.2013.841494 Varga, K., Bányai, É. I., & Gősi-Greguss, A. C. (1994). Parallel application of the Experiential Analysis Technique with subject and hypnotist: A new possibility for measuring interactional synchrony. International Journal of Clinical and Experimental Hypnosis, 42(2), 130–139. https://doi.org/10.1080/00207149408409346 Varga, K., Józsa, E., Bányai, É. I., & Gősi-Greguss, A.  C. (2006). A new way of characterizing hypnotic interactions: Dyadic Interactional Harmony (DIH) questionnaire. Contemporary Hypnosis, 23(4), 151–166. https://doi.org/10.1002/ch.320 Varga, K., Bányai, É. I., Józsa, E., & Goysi-Greguss, A. C. (2008). Interaction phenomenology of maternal and paternal hypnosis styles. Contemporary Hypnosis, 25(1), 14–28. https://doi. org/10.1002/ch.347 Varga, K., Farkas, L., & Mérő, L. (2012). On the objectivity of the scoring of Harvard Group Scale of Hypnotic Susceptibility. The International Journal of Clinical and Experimental Hypnosis, 60(4), 458–479. https://doi.org/10.1080/00207144.2012.675298 Varga, K., Bányai, É. I., Gősi-Greguss, A. C., & Tauszik, K. (2013). Phenomenological aspects of hypnotic interactions: The effect of kinship. International Journal of Clinical and Experimental Hypnosis, 61(4), 401–415. https://doi.org/10.1080/00207144.2013.810476

Chapter 7

Hypnosis: A Boundary Object on the Edges of Science in Swiss Universities Eric Bonvin

7.1 Introduction: Placing Hypnosis in a University Context 7.1.1 Into Which Category of Knowledge Should Hypnosis Be Placed? The context for this consideration is that of the university: an institution whose mission is to gather, test, develop and transmit collective knowledge and expertise as well as the resulting techniques. The question we address in this chapter is how to position Hypnosis in this context. Is hypnosis a specific phenomenon in itself or does it designate a cause, an agent, an effect or all three at the same time? Is it a natural phenomenon that simply needs to be discovered or a conceptual construct developed for specific purposes? Is it an active force that requires expert mastery or a vital, natural and spontaneous activity? All these questions, which have no clear and unequivocal answer, make it difficult to position such a polysemous, nebulous concept as hypnosis within the rational, orderly universe of a university. In the absence of a clear, unequivocal definition of what hypnosis actually is, we will nevertheless attempt to consider this question globally in order to position it within an academic context, both from a conceptual and a practical viewpoint. In order to be considered in a university context, the concept of hypnosis either has to be predominantly an object that can be studied by science as a phenomenon or a scientific tool to allow the study of other phenomena or the construction of specific knowledge.

E. Bonvin (*) University of Lausanne, Lausanne, Switzerland e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_7

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7.1.2 Delimiting the Concept of Hypnosis in Order to Practise Science The ambition of hypnosis has been, since its outset, to demonstrate and actuate a specific form of influence that takes place during the hypnotic ritual. At the present time, after two centuries of exploration, there are still no data able to credibly objectify a phenomenon, agent or specific effect that could characterise hypnosis. Its only characteristic is situational in nature. In effect, whatever its usage, the term hypnosis necessarily forms part of an interaction that takes place in a given context (treatment, a show, a scientific laboratory, the street and so on), in other words, which unites different actors by their respective intentions, which may or may not be the same (to find relief, for self-delusion, for study or entertainment purposes and so on). However, what we can observe is that whatever the context, the hypnotic interaction is always based around a person who is impelled (the subject) under the effect of an influencing agent (the hypnotist, the hypnotic power) in the function of a given context (Oughourlian, 1984).

7.1.3 Which Interpretive Framework Should Be Used When Placing Hypnosis in the Context of a University? Hypnosis is a form of interaction that has been codified and ritualised over almost two centuries, in various contexts of our culture such as medicine, psychotherapy, experimental psychology, communication sciences, the performing arts, spiritual or cultural rituals and judicial or military interrogation. The academic approach that appears to best apprehend this singular form of interaction is without a doubt microsociology, through the theory of symbolic interactionism (Le Breton, 2004). This is a theoretical approach that favours explanation by means of the dynamics of interaction observable between individuals while refusing to confine those dynamics within sociological or biological determinisms (Mead, 1963). This approach underlines the fact that the meaning of phenomena results from the interpretations made by the actors in the situation (Strauss, 1992). These interpretations are based on interpretive frameworks that derive from the symbolic verbal and non-verbal interactions between the actors (Goffman, 1974).

7.1.4 What Do We Know About the Influence at Play in a Hypnotic Interaction and Its Effects? Human behaviours around hypnosis depend entirely on the social context, which means the expectations of the subject and the intentions of the hypnotist (Goffman, 1974, 1991). Thus it is these expectations that influence and modulate the exercise

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of our perceptions and the effects perceived in a given context, not a particular “state” such as the one implied by hypnosis (Kirsch, 1990, 1999). Nicholas Spanos, with over 250 experimental investigations to his credit, has also demonstrated that hypnosis is in fact a form of social ritual in which the dynamics are based entirely on the expectations of the subject, which the hypnotist appropriates by acting as a kind of simulated agent (Spanos, 1986; Spanos & Barber, 1976; Spanos et al., 1988). For Spanos, as for Erving Goffman (1991), every human relational context is actuated and motivated by a goal, an intention and an expectation. This is also true and operative for the context in which the hypnosis ritual plays out, independently of the hypnosis itself (Spanos & Barber, 1974; Spanos et  al., 1974). These authors follow on from White (1941) and Sarbin and Coe (1972), who believed that the subject would voluntarily enter into hypnosis with very clear expectations, conform to the hypnotist’s suggestions and endeavour to enter into a conscious and supposedly special activity.

7.1.5 Hypnosis: A Ritual Technique That Produces the Illusion of Power Although the observed effect is present regardless of the type of ritual influence being used (exorcism, magnetism or psychotherapy), practitioners are often tempted to attribute its origin to the technique itself rather than to the context of the ritual. By concealing the contextual origin of the observed effect in order to attribute it to the technique of hypnosis, the hypnotist implicitly subjects the hypnotised person to his fabrication, without the subject realising this. This is how one must understand the definition of hypnosis given by Goffman (1991), in other words, as a framework of social interaction fabricated from start to finish, in which the subject is influenced in order to “appear under hypnosis”. Through the techniques imposed upon him, the subject is led through an interaction in which he feels obligated to accept the idea that it is indeed the hypnotist who had led him to that state, in other words, that there is something called “hypnosis” and that he must conform to it (Cangas et al., 2015).

7.1.6 An Ambiguous, Vague Concept Used by Each Individual According to His Own Expectations Hypnosis is ultimately a fabricated and ambiguous concept that brings together the notions of situation, agent and effect of the influence, with no need to enunciate each of these terms and their linkage. It designates – by assimilating the terms with each other but without defining them – the situation, agent and effect of the interactional influence exerted during a ritual interaction (a treatment, a show, a laboratory test,

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judicial interrogation or communication). Joseph Delbœuf (1893) was already aware of this ambiguity and its impact on the therapeutic interaction, because according to him the term “sleep” could generate resistance to patients who, in hypnosis, did not feel asleep, hence his preference for the term “psychotherapy” or “psychodynamics”. According to Goffman (1991), White (1941) and Sarbin and Coe (1972), the fact that the subject accepts this scenario under the guise of a concept of hypnosis that is as vague as it is ambiguous is certainly linked to the subject’s expectations. He expects what he assumes that the “hypnosis” or the “power” of the hypnotist can give him. Yet primarily, it appears that the agent producing the effects of the hypnosis is nothing other than the context in which the hypnosis takes place, which is primarily made up of the expectation that the subject has of that context. The validation  – through implicit confirmation  – of the subject’s supposition, whereby the realisation of his expectations is due to the power of the hypnosis or of the hypnotist, appears to be an attempt at fabrication of a relational framework whose purpose serves the professional interests of the hypnotist, unbeknown to the subject.

7.1.7 Hypnosis: A Form of Experimental Interaction In the field of science, theory and practice, the concept of hypnosis is the legacy of thoughts and experiments conducted during the eighteenth and nineteenth centuries in relation to exorcism and animal magnetism. Both these practices attempted to identify, in the context of a ritual, the cause and agent of the effects observed in a person impelled by another person exercising a function of influence, whether religious, medical, scientific or charismatic (Bonvin & Salem, 2023). In the medical domain, from exorcism to modern psychotherapy treatments, including magnetism, hypnotism and suggestion, ritual situations have all been studied and tested with particular regard to their curative and therapeutic effects (Goffman, 1974). There have been numerous attempts to explain and demonstrate the effects of these different interactive rituals, each one following the other like a kind of distillation or logical purification: while the technique of magnetism shows that it can produce the effects of exorcism without exorcism (Ellenberger, 1974), hypnosis shows that it is possible to produce the effects of magnetism without magnetism (Rapport, 1784; Braid 1843/2004), verbal suggestion shows that it can induce the effects of hypnosis without hypnosis (Delbœuf, 1891–1892), and psychotherapy shows that it can produce the effects of suggestion without explicit suggestion. Finally, comparative studies between the different techniques of psychotherapy have shown that psychotherapy can operate without technique and that its effect is determined by worldly, non-specific relational and contextual factors (Luborsky, 1975; Roustang, 2002; Lambert, 2013). Ultimately, this scientific distillation indicates that the effect produced during the ritual interaction of the therapy, including by hypnosis, is essentially determined by

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soft skills and only to a very small extent by professional knowledge or abilities (Bonvin, 2006). These various observations demonstrate that hypnosis does not exist, either as a field of knowledge (Chertok & Stengers, 1999) or as a specific phenomenon, and that the behaviours manifested by subjects under hypnosis are in fact due to their “great motivation” or, in other words, their “expectations”. In regard to his therapeutic practice of hypnotism and suggestion, Joseph Delbœuf (1893) had already noted that “without a doubt, there is nothing in this treatment that deviates from the normal laws of psychology. My role was that of support, and my power was the confidence, the faith that the subject had in me”.

7.1.8 Is Hypnosis a Natural Phenomenon or a Codified Experimentation Technique? Ever since its advent at the beginning of the nineteenth century, hypnosis has attempted to designate and demonstrate a ritual interaction, its effects on the subject and the agent of the influence which the master of ceremonies had the skill to exert. However, as we have seen, hypnosis is the framework of a fabricated interaction, rather than the influence, or its agent, that impels the actors. How, then, can we understand the fact that the concept of hypnosis has remained part of our culture over the past two centuries, even in university, scientific and therapeutic contexts? While hypnosis is neither the influence at play within the interaction nor its agent nor its effect, it is, however, a ritual scenario that allows the exploration and experimentation of the interaction. In other words, hypnosis is not the phenomenon in itself, but the technique that allows the inducement and study of this phenomenon. It is an epistemological and technical approach that creates a ritual situation in which it is possible to observe the effects produced by the influence exercised by one person over another in a given context. The technique of hypnosis in essence fulfils two functions that allow the experimentation and demonstration of the influence operating during a ritual interaction (Bonvin & Salem, 2023): • An epistemological function based on a semantic matrix that attempts to designate an interactional situation (the hypnosis “session”), the effect produced by that situation (being in a trance, being impelled by hypnosis), a mechanism of action (the influence or the suggestion) and the agent (the hypnotist, the hypnosis procedure). The articulation of the various aspects of this semantic matrix serves as a basis of reasoning in an attempt to elaborate, by induction, a general rule (syllogism) of relational influence. • The technical function serves to fabricate a situation of relational ritual influence characterised by a protocol (the hypnosis technique), performed by an operator, the hypnotist, on a client,1 the subject, who is assumed to be impelled (the  In this context, the term client refers to a person placed under the protection of another.

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h­ ypnotic trance) by the hypnotist. The technique of hypnosis consists of fabricating a segment of ritualised interaction delimited by the manifestation of the effects produced spontaneously under the influence of the context. The epistemological and technical device of hypnosis is useful for exploring the various aspects of relational influence in various contexts in which it is used, with different intentions and applications: treatment, medicine, experimental psychology, philosophy, religious rituals, shows or entertainment, communication sciences, political propaganda, advertising, judicial or military interrogations and so on. It is also a kind of epistemological alembic, distilling various theories about the nature and effects of the influence at play in the ritual interactions, with the new theories still being judged more rational than the ancient ones they are superseding (exorcism, magnetism, somnambulism, hypnotism, suggestion and psychotherapy).

7.1.9 Hypnosis: A Boundary Object on the Borders of Science in Swiss Universities It is thus as a technique for epistemological and technical experimentation and demonstration that hypnosis finds a place in a university context, where the purpose is to experiment, develop and transmit knowledge, science and techniques. This pairing of an ambiguous, blurred semantic matrix with a well-codified ritual protocol makes hypnosis an epistemological and technical device for experimentation and demonstration that has persisted over the past two centuries. In this regard, and from the perspective of symbolic interactionism, the technique of hypnosis can be considered a boundary object which is “sufficiently plastic to adapt to the local needs and constraints of the different groups using it, while being sufficiently robust to maintain a common identity from one area to the other (…) while maintaining the informational requirements of each area” (Star & Griesemer, 1989). In this sense, hypnosis as a boundary object does not designate the reality of what would be the phenomenon of hypnosis but instead allows the exploration and experimentation of the situation, the presumed agent and the effects of the influence of one person over another. The utility and purpose of a boundary object such as the technique of hypnosis does not consist of demonstrating its reality but of stimulating and facilitating cooperation and interactions between actors and diverse scientific and technical domains without imposing a single, narrow meaning of the object. By making sure to preserve both the stability of the perimeter of its epistemological structure and its flexibility of interpretation, hypnosis as a boundary object thus becomes an academic tool which is particularly useful in exploring – through different scientific disciplines – the ecology of ritual interactions in different contexts. In the domain of treatment – whether medical or therapy-based – the main benefit of hypnosis as a boundary object is to delineate a relational space and time during which the therapist’s attention is exclusively dedicated to the perceptions

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experienced by the patient receiving the treatment. Hypnosis thus constitutes an excellent pretext for creating a space and time for interpersonal relations between two human beings, of which the therapeutic action is proven (Bonvin & Salem, 2023).

7.2 Circulation of the Boundary Object “Hypnosis” in Swiss Universities 7.2.1 From the Ritual of Exorcism to a Technique for Demonstrating Magnetism The advent of hypnosis in Switzerland was preceded by different events pertaining to the phenomenon of animal magnetism. In fact, the doctor behind the method and theory of animal magnetism, Franz Anton Mesmer (1734–1815) was largely inspired by the Swiss doctor, philosopher, alchemist and theologian Philippus Aureolus Theophrastus Bombastus von Hohenheim, also known as Paracelsus (1493–1541), who famously taught at two Swiss universities, in Basel and St. Gallen. Paracelsus was the founder of magnetic therapy, a medical theory that spread during the seventeenth century. Paracelsus thought of the human being as a microcosm closely bound to the celestial macrocosm by influential forces that were magic, magnetic and astral in nature (Braun, 1994). Franz Anton Mesmer was a firm believer in science, inspired by the philosophy of the Lumières. He dedicated himself to attempting to demonstrate a universal law of magnetic influence over living things. Starting with a study of the practice of exorcism, he set himself the goal of giving a rational interpretation to the phenomena of relational influence and their effects arising in this context. He elaborated a theory of a universal fluid and its effect, “the magnetic state” (Mesmer, 1766/2002), as well as a tool (a tub of magnetised water), which was used both to demonstrate his theories and to perform a therapeutic ritual using magnetism (Mesmer, 1779/2004). However, in 1784, Franz Anton Mesmer was disavowed and discredited by the Royal Society of Medicine in Paris, which relegated his demonstration of animal magnetism to the level of mere illusion. A favourite of King Louis XVI, he was later forced to flee to Switzerland during the French Revolution. Mesmer became a Swiss citizen and lived for many years in Frauenfeld, not far from Zürich. Mesmer remained active in the teaching of magnetism and was finally awarded a chair in magnetism at Berlin University, in 1815. In 2022, the University of Fribourg held an international symposium2 on the European and global diffusion of the theories and practices of animal magnetism. The discussions presented during the symposium are an exemplary illustration of the circulation, transfer and hybridisation of the knowledge and practices deriving  https://www.sgeaj.ch/aktualitaet/magnetisme-animal-en-mouvement/

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from the concept of animal magnetism between the end of the eighteenth century and the mid-nineteenth century. It was the precursor to hypnosis, which followed a few decades later.

7.2.2 Magnetism and Hypnotism: Instruments of Power and of Professional Identity Exorcism attempts to demonstrate the power of the metaphysical influence of the divine over living beings. For its part, the theory of animal magnetism attempts to demonstrate that this power of influence is the effect of natural universal forces. Hypnosis, which followed on from animal magnetism, attempts to attribute this power to the individual (Bonvin & Salem, 2023). Thus, between each of these representations, there are at play issues of appropriation and use of the power of influence in different interactive contexts. Numerous disputes about the legitimacy of exercising this power have divided the proponents of these different representations. In Switzerland, during the nineteenth century, two disputes illustrated these issues concerning the power of influence. The first dispute arose in Lausanne, home of the French writer, jurist, criminalist and philosopher Joseph Michel Antoine Servan (1737–1807), a fervent defender of Mesmer, in which he challenged the famous Lausanne physician Auguste Tissot (1728–1797). The public dispute between the two men related to the fact that Servan organised magnetic seances in people’s homes; these were strongly disapproved of by Tissot, who considered them dangerous. The second dispute, which arose in the late 1880s, involved the doctor Paul-­ Louis Ladame (1842–1919), a lecturer at the University of Geneva where he taught neurology, psychiatry and criminal anthropology. Ladame was particularly interested in the medical applications of hypnosis and agreed with Jean-Martin Charcot (1825–1893) on the idea that it was a pathological manifestation of hysteria. Both of them deduced that the use of the technique of hypnosis was potentially pathogenic and that it should only be reserved for certified doctors. During the First International Congress on Hypnotism, held in Paris in 1889, Charcot and Ladame obtained, by a vote, a prohibition on the medical use of magnetism, arguing that the magnetisers’ practices led to effects that were very dangerous for health and social order. Ladame (1889) demanded that the police impose measures to ban public magnetic seances and that the practice of hypnosis should be regulated and reserved strictly for doctors who had been trained in faculties of psychiatry. He was challenged by the mathematician and philosopher Joseph Delbœuf (1889) who retorted that, under the guise of ethics, the doctors who followed Ladame were in fact trying to monopolise the practice of hypnotism, which was a substantial source of revenue and power, and that the emphasis on the dangers of hypnotism was dictated by an erroneous theoretical assumption (Duyckaerts, 1990). During the International Congress, also held in Paris in 1889 (Rapport, 1890), the magnetisers were not

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cowed by the attacks of the hypnotist physicians. They came out strongly against Charcot and Ladame and the alienists, saying that they had no respect for their patients and calling them “creators of experiments (…) who have transformed hospitals into laboratories and reduced patients to the condition of dogs, rabbits and guinea pigs” (Rouxel, 1892). They considered the practices of doctors to be much more harmful than those of the magnetisers, citing the extreme dependence of patients on doctors to whom the Institution attributed quasi-discretionary powers. In 1889, when hypnotism was at its zenith, the debate around magnetism was still raging and along with it the question of the rationality of such practices with regard to the art of medicine, neurology, alienist psychiatry or philosophy. This debate was mostly played out around corporate issues rather than scientific ones, in connection with the definition of the various experimental and therapeutic techniques used in magnetism and hypnosis.

7.2.3 Hypnosis: A Boundary Object that Stimulates the Exploration of Non-voluntary Behaviours on the Border Between Neurology and Psychiatry During the second half of the nineteenth century, hypnotism was used as a testing ground for reflexive, automatic and non-voluntary behaviours, which mobilised disciplines as diverse as neuroanatomy, neurology, psychiatry and entomology (Despret, 2001). Under the aegis of Auguste Forel (1848–1931), another Swiss doctor who had attended the First International Congress on Hypnotism in 1889, the University of Zürich became the setting for an intensive collaboration between these disciplines using hypnosis. Forel was an entomologist, neuroanatomist and psychiatrist. He was a professor of psychiatry at the University of Zürich and director of the university’s Burghölzli psychiatric clinic. Forel practised and taught hypnosis. He initiated two of his eminent colleagues, the Swiss psychiatrist and neurologist Otto Ludwig Binswanger (1852–1929), doctor to the philosopher Friedrich Nietzsche, and the German Oskar Vogt (1870–1959), also a psychiatrist, neuroanatomist and entomologist, best known for having conducted an autopsy on the brain of Lenin. After having trained in hypnosis under Auguste Forel, Oskar Vogt, together with Sigmund Freud, founded a publication, the “Zeitschrift für Hypnotismus”, on which other close collaborators included Forel and Binswanger. Oskar Vogt was also known for his self-hypnosis method, which inspired Johannes Heinrich Schultz (1884–1970) to conceive his well-known autogenic training. These academic physicians believed that they could make particular use of hypnosis in treating and converting behaviours considered deviant found among certain categories of people, particularly those of other races, afflicted by mental troubles (homosexuality was at the time considered one such complaint). A study has highlighted that in Switzerland, Auguste Forel and Eugen Bleuler practised conversion treatments and forced sterilisations, as well as interning people considered to be

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“socially deviant” (Wottreng, 1999). Between 2003 and 2007, the University of Zürich was the setting for a dispute that ended with the removal of the bust of Auguste Forel from the university’s hall of fellows. The practice of eugenics had spread to a number of countries under the guise of “social hygiene”, and the technique of hypnosis was part of its “therapeutic” arsenal. This included Germany, where Johannes Heinrich Schultz (1932) published his work on autogenic therapy shortly before being appointed deputy director of the Göring Institute in Berlin (Cocks, 1985). This institute for research into psychology and psychopathology is known in particular for being actively engaged in the extermination of the mentally handicapped and for imposing conversion therapy on homosexual men. However, this did not prevent Schultz’s autogenic training from inspiring a number of relaxation techniques, as with Caycedian sophrology (Bonvin, 2012a, b).

7.2.4 Hypnosis: A Boundary Object That Stimulates the Exploration of Mental Illnesses on the Borders of Neurology, Psychiatry and Psychotherapy Auguste Forel’s successor as chair of psychiatry and director of the Burghölzli centre at the University of Zürich was Eugen Bleuler (1857–1939), who is particularly known for having introduced and developed the notions of schizophrenia and autism into psychiatric nosography (Bleuler, 1911). He was interested in the permanent forms of disconnection or dissociation (die Spaltung) of the conscience which afflicted some of his patients (Hulak, 2000). Bleuler (1889) made use of the technique of hypnosis not merely from a therapeutic perspective but also for the purposes of introspective self-observation, particularly in order to explore, by analogy, the forms of perception that may be experienced by people suffering from schizophrenia and autism (Hacking, 1998). However, Bleuler (1916) imposed a limit on the possibilities of using hypnosis, stating that with hypnosis, “we are working with the patient’s brain, which in the case of mental illness is a deficient instrument”. Bleuler left valuable indications about the relationship between hypnosis and schizophrenia, thus allowing them to be combined, as we propose, in the treatment of the forms of suffering that such a complaint may induce (Bonvin & Salem, 2023). Carl Gustav Jung (1875–1961) was first the assistant and then the close collaborator of Bleuler. He later became an associate professor at the University of Zürich, where he also practised and taught hypnosis at the Faculty of Medicine. Jung (1991) finally abandoned this practice as it was impossible to clearly define or understand it and, ultimately, out of fear of triggering latent dissociative psychoses in hypnotised patients.

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7.2.5 Hypnosis as a Boundary Object Stimulating the Exploration of the Unconscious Mind on the Borders of Psychology, Parapsychology and Linguistics While Carl Gustav Jung distanced himself from the therapeutic use of hypnosis, he remained interested in the experiences of hypnotic trances during a ritual. He thus showed a great interest in the work on somnambulistic and mediumistic trances, performed by the person he referred to as his mentor on the subject, Théodore Flournoy. “Miss Miller”, a case which Jung (1944) elaborated at length in his work “Metamorphoses of the soul and its symbols”, was none other than a patient of Flournoy. Théodore Flournoy was a doctor who trained in experimental psychology in Germany under Wilhelm Wundt before becoming a professor of psychophysiology at the University of Geneva, where he founded his own experimental psychology laboratory (Flournoy, 1896). Flournoy (1911a) focused his work on spiritism and somnambulistic and mediumistic trances, which he discussed extensively with the American philosopher William James and Carl Gustav Jung. His best-known study is the one devoted to a description of a case of glossolalia in a patient of his who was a medium, Denise Müller alias Hélène Smith. Flournoy (1900/2006) showed that most of Hélène Smith’s visions were not the manifestation of a mystical force but derived from real events related to the reading of a book, childhood memories or other testimonies that had remained in Hélène Smith’s subconscious mind. Flournoy also submitted the writings of Hélène Smith for consideration by his colleague from Geneva, Professor Ferdinand de Saussure, none other than the founder of modern linguistics and the person who inspired structuralism. In the end, by drawing on the opinion of Ferdinand de Saussure, Flournoy concluded that the Hindi spoken by the medium was in fact an Indo-European language, skilfully disguised. Flournoy’s exploration triggered the study of memories brought up during a trance state; this would become the object of intensive research during the astonishing epidemic of false memories during the last quarter of the twentieth century (Bonvin & Salem, 2023).

7.2.6 Hypnosis as a Boundary Object Stimulating an Exploration of the Human Experience on the Borders of Philosophy of Mind and Religious Science Flournoy (1911b) was one of those rare researchers of his time to have explored, along with the philosopher William James (2007), the activity of pure experience and a form of primary, non-dual reality of conscience, which he termed “sciousness”. A few decades later, Jean François Billeter (2016), Professor of Chinese Studies at the University of Geneva, in his “Studies on Zhuang Zhou”, began an

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in-depth reflection on the question of collective human experience and of the different routines of the living body. He devoted a section of the work (pages 229–244) to the critical study of hypnosis and of the world of hypnosis experts, particularly through his discussions with two famous hypnotherapists, Gérard Salem and François Roustang. Billeter noted the difficulties involved in entering the world of hypnotists, which he found inaccessible, mainly because of the technical jargon used to evoke experiences that are in fact natural and ordinary. The different forms of ritual human experiences, including the hypnotic trance, have also been of interest to religious science at the University of Lausanne. Professors Jean-Daniel Kaestli and Claire Clivaz (2008) have taken a particular interest in passages from certain apocryphal gospels, which describe the debates that could have ensued from trance experiences in nascent Christianity and which attempt to distinguish the different forms of thinking and feeling in their physical manifestation. For her part, Professor Silvia Mancini (2006, 2008a, b) has conducted multiple studies on the limit-experiences of trance and the efficacy of magical-religious or psychotherapeutic ritual techniques, including hypnosis.

7.2.7 Hypnosis as a Boundary Object Stimulating the Exploration of Therapeutic Interaction on the Borders of Different Forms of Therapy In the field of psychotherapy, Nicolas Duruz (2002), Professor of Psychology at the University of Lausanne, and his colleague Michèle Gennart have integrated hypnosis into their comparative approach to different models of psychotherapy. The presentation of hypnosis was penned by Gérard Salem (2002), private lecturer at the University of Lausanne, while the afterword was written by François Roustang (2002), who elaborated on the importance of the efficacy of non-specific relational factors in therapy. For our part, we have studied in particular the position occupied by hypnosis in the field of psychotherapy (Bonvin, 2012b; Bonvin & Salem, 2023).

7.2.8 Hypnosis as a Boundary Object Stimulating the Exploration of Alternative Practices on the Borders of Academic, Alternative and Popular Medicine Also at the University of Lausanne, my colleague Gérard Salem and I have extended the spectrum of comparison of therapeutic practices in the field of popular and alternative medicine. For this purpose, we have set up the Ling Foundation for Medicine, Psychology and Culture in Lausanne, which has served as a bridge between the worlds of these different practices and the University (Bonvin, 2000). In 1995, this

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partnership enabled the introduction of a course on alternative medicines, which I led for several years at the Faculty of Biology and Medicine, also incorporating a presentation on hypnosis. Together with Gérard Salem, we also created the Ling Foundation Hypnosis Unit, which over a decade has provided practical teachings, particularly for various departments of the Vaud University Hospital Centre (CHUV) (Bonvin & Salem, 2023), including the Centre for Psychiatric Rehabilitation (Bonvin, 2003) and the Burns Centre (Bonvin, 1997a). At my instigation and, until 2006, under my presidency, the Ling Foundation finally became the Romand Foundation Institute of Swiss Hypnosis (IRHyS) and is still active today.

7.2.9 Hypnosis as a Boundary Object Stimulating the Exploration of Pain Therapy Our work on the different relational aspects involved in the treatment and support provided to victims of serious burns has highlighted the possibilities offered by the technique of hypnosis to support patients with pain management (Bonvin, 1997b; Bonvin & Cochand, 1998a, b). The VUHC later incorporated hypnosis as a fully-­ fledged medical treatment, particularly at the Burns Centre, thanks to the work of Professor Mette Berger (2010) and her colleague Maryse Davadant (Bertholet et al., 2013). Hypnosis treatments at the CHUV are now finally under the responsibility of the Centre for Integrative and Complementary Medicine (CEMIC) led by Professor Chantal Berna-Renella (Zaccarini et al., 2020). The Centre also uses the technique of hypnosis to explore phenomena such as the placebo effect (Berna-Renella et al., 2016; Boussageon et al., 2011) or antalgia. This is a field of study shared with colleagues from the Geneva University Hospitals (HUG), in particular under the guidance of Professor Jules Desmeules and the Multidisciplinary Pain Centre and its Clinical Pharmacology and Toxicology Unit with Dr Valérie Piguet et  al. (2021; Cedraschi et al., 2011).

7.2.10 Hypnosis: A Boundary Object Stimulating the Exploration of the Attention Span and Cognitive and Perceptual Performances of Human Subjects In most Swiss universities, neuroscience researchers now have access to the experimental technique of hypnosis for their work on cognition, attention and perception. Professor Patrik Vuilleumier, who leads the Neurology and Imagery Research Group at the Department of Neuroscience of the Faculty of Medicine at the University of Geneva, works closely with colleagues at HUG, VUHC and other global research centres in order to promote and develop the use of hypnosis as a

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technique in basic neuroscience research and to better understand the mechanisms of cognition, attention and perception (Jensen et al. 2017; Cojan et al., 2009). In collaboration with the Swiss Federal Institute of Technology in Zürich (ETHZ), Professor Bigna Lenggenhager (2011), who leads the Centre for Cognitive Psychology, Neuropsychology and Neuroscience at the Department of Psychology of the University of Zürich, is affiliated with a research group that uses hypnosis to explore the neuronal mechanisms involved in the perception of illusion and virtual reality. In a similar domain, the team led by Professor Björn Rasch of the Department of Psychology at the University of Fribourg is exploring the effect of hypnotic suggestion on sleep (Beck et al., 2021; Cordi et al., 2014). Also in the field of neuroscience, the Institute of Psychology at the Faculty of Philosophy and Human Sciences at the University of Bern, under the guidance of Professor Achim Elfering, is pursuing studies on attention span, by attempting to explore alterations in performance that hypnosis may induce during competitive air rifle shooting (Mattle et al., 2020). Together with the Swiss Federal Institutes of Technology of Lausanne (EPFL) and the University of Lausanne,3 we offer a practical course on “Therapeutic hypnosis and cognitive neuroscience” which favours a transferable, interdisciplinary and experiential approach to the mechanisms of attention (Bonvin 2012c; Bonvin & Salem, 2023). The course is taught by Dr Olivier Jorand, private lecturer at the Department of Philosophy, Modern and Contemporary Philosophy at the University of Fribourg, with his colleague Marlyse Schweitzer, and is under my responsibility in the context of my professorship at the Faculty of Biology and Medicine at the University of Lausanne.

7.3  Hypnosis: A Boundary Object Stimulating the Development of Science at Universities and Institutes of Further Education There are numerous definitions, theories and techniques of the concept of hypnosis. However, none of these definitions can claim to demonstrate a specific reality and effect. We propose to address the ambiguous question of hypnosis in the academic context of exploring, developing and transmitting knowledge, starting from its fundamental characteristic which is the relational influence operating in a codified ritual interaction (such as a treatment, a performance, experimental psychology or judicial interrogation). As a theoretical perspective in microsociology, symbolic interactionism seems to us appropriate for such an analysis. By using the microsociological interpretation offered by symbolic interactionism, we show that the specificity of hypnosis is essentially based on the fact that it is an epistemological and technical approach aimed at exploring – based on the noted effects – the relational  https://www.formation-continue-unil-epfl.ch/formation/hypnose-therapeutique/

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influence operating during certain ritual interactions. From this viewpoint, hypnosis is not merely a phenomenon in itself or an object of science, but instead a scientific technique that can be used to explore influence in the context of a ritual interaction. From the standpoint of symbolic interactionism, the “hypnosis technique” has all the characteristics of a “boundary object”, which is flexible enough to adapt to the needs of the different fields of knowledge or practice that use such a technique while being robust enough to maintain a certain semiological identity. A boundary object that, as with its circulation in Swiss universities, allows fruitful exploration and interdisciplinary collaboration within the confines of the various academic disciplines. Aside from the illusions fabricated by certain hypnotists and the proselytism of other groups of therapists who attempt to use it for profit, hypnosis can be considered a boundary object that is particularly suitable for scientific creativity and serendipity. On the edges of the different fields of knowledge, where the boundaries are porous and blurred, hypnosis as a boundary object allows interesting exploratory collaborations into the phenomenon, as natural as it is complex, of the influence between beings and its perceived effects. It is a potentiality that, mirroring its development in Swiss universities, promises positive scientific prospects for the future growth of hypnosis in an academic context.

References Beck, J., Cordi, M., Jasmin, R., & Rasch, B. (2021). Hypnotic suggestions increase slow-wave parameters but decrease slow-wave spindle coupling. Nature and Science of Sleep, 13, 1383. Berger, M. M., Davadant, M., et al. (2010). Impact of a pain protocol including hypnosis in major burns. Burns, 36(5), 639–646. Berna-Renella, C., et  al. (2016). The placebo effect in the clinical setting: Considerations for the pain practitioner. In Z.  Bajwa et  al. (Eds.), Principles and practice of pain medicine. McGraw Hill. Bertholet, O., Davadant, M., Cromec, I., & Berger, M.  M. (2013). Hypnosis integrated in burn care: Impact on the healthcare team’s stress. Revue Médicale Suisse, 9(397), 1646–1649. Billeter, J.-F. (2016). Études sur Tchouang-Tseu. Allia. Bleuler, E. (1889). Auto-observation par Eugen Bleuler de l’état hypnotique. Medizinische Wochenschrift, 5. Bleuler, E. (1911). Dementia praecox oder Gruppe des Schizophrenien. Springer-Verlag. Bleuler, E. (1916). Lehrbuch des Psychiatrie. Springer-Verlag. Bonvin, E. (1997a). La Fondation Ling  – Passerelle entre pratiques, savoirs et traditions des soins. Bulletin des Hypnose chez les grands brûlés. In G. Salem (Ed.), L’hypnose au pluriel (pp. 57–68). Editions Ling. Bonvin, E. (1997b). Hypnose chez les grands brûlés. In G.  Salem (Ed.), L’hypnose au pluriel. Editions Ling. Bonvin, E. (2000). La Fondation Ling – Passerelle entre pratiques, savoirs et traditions des soins. Bulletin des Médecins Suisses, 81(46), 2611–2612. Bonvin, E. (2003). Hat Hypnose in einem komplexen Pflegesystem einen Wert? Beispiele aus der psychosozialen Rehabilitation. Hypnose und Kognition, 20, 75–90. Bonvin, E. (2006). Pour une initiation propédeutique à la relation thérapeutique. Transmettre l’art de l’influence. Psychothérapies, 26(4), 187–196.

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Jensen, M.  P., Jamieson, G.  A., Lutz, A., Mazzoni, G., McGeown, W.  J., Santarcangelo, E.  L., Demertzi, A., de Pascalis, V., Bányai, É. I., Rominger, C., Vuilleumier, P., Faymonville, M.-E., & Terhune, D. B. (2017). New directions in hypnosis research: Strategies for advancing the cognitive and clinical neuroscience of hypnosis. Neuroscience of consciousness, 3, nix004. Jung, C.  G. (1944). Métamorphoses de l’âme et ses symboles. Analyse des prodromes d’une schizophrénie. LGF. Jung, C. G. (1991). “Ma vie”. Souvenirs, rêves et pensées. Gallimard Folio. Kaestli, J.-D., & Clivaz, C. (2008). Le corps, lieu de l’expérience des limites? Réflexions à partir de la littérature chrétienne antique. In P.  Gisel (Ed.), Le corps, lieu de ce qui nous arrive. Approches anthropologiques, philosophiques, théologiques. Labor et Fides. Kirsch, I. (1990). Changing expectations: A key to effective psychotherapy. Brooks/Cole. Kirsch, I. (1999). How expectancies shape experience. American Psychological Association. Ladame, P.-L. (1889). La nécessité d’interdire les séances publiques d’hypnotisme. In E. Bérillon (Ed.), Premier Congrès international d’hypnotisme à Paris (p. 30). Lambert, M.  J. (2013). The efficacy and effectiveness of psychotherapy. In M.  Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (pp. 169–217). Wiley. Le Breton, D. (2004). L’interactionnisme symbolique. PUF. Lenggenhager, B., Halje, P., & Blanke, O. (2011). Alpha band oscillations correlate with illusory self-location induced by virtual reality. European Journal of Neuroscience, 33(10), 1935–1943. Luborsky, L. (1975). Comparative studies of psychotherapies: Is true ‘everyone has won and all must have prizes’? Archives of General Psychiatry, 32, 995–1008. Mancini, S. (2006). Histoire des religions et constructivisme. La religion comme « technique ». In S. Mancini (Ed.), La fabrication du psychisme. Pratiques rituelles au carrefour des sciences humaines et des sciences de la vie (pp. 15–41). La Découverte. Mancini, S. (2008a). Le dispositif mythico-rituel comme opérateur efficace. Techniques magico-­ religieuses d’arrêt, figuration et résolution des états critiques. In P. Gisel (Ed.), Le corps, lieu de ce qui nous arrive. Approches anthropologiques, philosophiques, théologiques (pp. 41–59). Labor et Fides. Mancini, S. (2008b). Par delà magie et psychothérapie. L’efficacité de la « dés-historisation » mythico-rituelle. In E. Collot (Ed.), Hypnose et pensée magique (pp. 51–72). Imago. Mattle, S., Birrer, D., & Elfering, A. (2020). Feasibility of hypnosis on performance in air rifle shooting competition. International Journal of Clinical and Experimental Hypnosis, 68(4), 521–529. Mead, G. H. (1963). L’esprit, le soi et la société. PUF. Mesmer, F. A. (2002). De l’influence des planètes sur le corps humain. Harmattan. (original work published in 1766). Mesmer, F. A. (2004). Mémoire sur la découverte du magnétisme animal. Harmattan. (original work published in 1779). Oughourlian, J.-M. (1984). L’hypnose, révélation du rapport interindividuel. In L. Chertok (Ed.), Résurgence de l’hypnose. Desclée de Brouwer. Piguet, V., Zoutter, G., Cuddy, N., Forster, A., & Coen, M. (2021). Utilisation de l’hypnose lors de douleurs chroniques: une mise en mouvement. Revue Médicale Suisse, 7(744), 1210–1213. Rapport des commissaires de la Société Royale de Médecine nommés par le roi pour faire l’examen du magnétisme animal (1784). Paris. Rapport général. (1890). Congrès international de 1889. Le magnétisme humain appliqué au soulagement et à la guérison des malades. Georges Carré. Roustang, F. (2002). Non-specific therapeutic factor. In N. Duruz & M. Gennart (Eds.), Traité de psychothérapie comparée (pp. 405–413). Médecine & Hygiène RMS Editions. Rouxel, J. (1892). Rapports du magnétisme et du spiritisme. Librairie des Sciences Psychologiques. Salem, G. (2002). L’hypnose. In N. Duruz & M. Gennart (Eds.), Traité de psychothérapie comparée (pp. 345–373). Médecine & Hygiène RMS Edition. Sarbin, T. R., & Coe, W. (1972). Hypnotic behavior: The social psychology of influence communication. Holt, Reinhart & Winston.

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Chapter 8

Hypnosis and Academia from an Iberian Perspective Pedro Rodrigues Ribeiro

8.1 Introduction What is hypnosis? How can we definite it? And what is the connection between hypnosis and academia? These are important questions for students, researchers, and future professionals in the field of hypnosis. However, as you will see, not all countries have the same relationship with hypnosis, in particular my home country of Portugal. Hypnosis is a social construction with various connotations that evolved. The term “hypnosis” is used to describe a range of social interactions, that which the participants activate roles based on social influence. In this perspective, there is an implicit or explicit agreement between different persons that believe that the situation is hypnotic, using a specific induction ritual. This induction establishes the scenario and is a part of the hypnotic process. Inside this process, the hypnotic subject activates roles and processes associated with his conceptions of hypnosis, as the therapist suggests that the subject focuses his attention on ideas and images that can evoke changes in his thoughts, emotions, and behaviors. These hypnotic suggestions differ from everyday life instructions, in the sense that they are experienced automatically, nonvoluntary, and without effort. Also, these hypnotic procedures can be learned and used by the subject, which is called “self-hypnosis.” This definition, proposed by the Association for the Advance of Experimental and Applied Hypnosis, is based on previous definitions from the British Society of Psychology (The Nature of Hypnosis(netdna-­cdn.com)), Kihlstrom (1985), Kirsch P. R. Ribeiro (*) Applied Psychology Research Center Capabilities & Inclusion, Ispa-Instituto Universitário de Ciências Psicológicas, Sociais e da Vida, Lisbon, Portugal e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_8

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(1994), and Montgomery and colleagues (Montgomery et al., 2010), among many others. What differentiates this definition of hypnosis from others is the fact that these results were obtained by years of empirical and academic research, as well as clinical applications. It’s safe to say that without academic support and research, the state and validation of hypnosis as a scientific procedure would be seriously compromised and hypnosis would remain in the entertainment domain. Historically, various theories and definitions of hypnosis began to appear in the age of scientific experimentation especially those based on non-state hypotheses, meaning that hypnosis is not and doesn’t require an altered state of consciousness or trance needed to hypnotize someone and achieve a certain depth. Also, these theories view hypnosis as a social construct and not related to psychopathology, like hysteria (Chaves, 2000). Also, we must recognize the important work of Ambroise-Auguste Liébeault and Hippolyte Bernheim as the true precursors of non-trait and sociocognitive perspectives of hypnosis. In opposition to the trance and altered state of consciousness perspective of Nancy, pioneered by Charcot and Janet, Liébeault and Bernheim believed that suggestion was responsible for hypnotic effects and not dissociation processes. It’s not my intention or goal to revise the history of hypnosis, but rather to summarize and show the different perspectives and theories of hypnosis and how they link themselves to the field of psychology, the research of hypnosis, and the academia’s role in this journey.

8.2 Hypnosis, Psychology, and Academia One of the major influences on hypnosis research and applications was the development of Psychology, as a science. Usually, we consider the beginning of experimental psychology in the year 1879, with the creation of the first laboratory dedicated to psychological research, by Wilhelm Wundt (1832–1920). Along with his colleagues and students, Wundt’s research helped Psychology to become a scientific field where scientific methods could be used to measure psychological, behavioral, and cognitive variables. Psychology gained its own identity and differentiated itself from Philosophy. At the same time, in America, William James (1842–1910) publishes one of the most influential essays, The Principles of Psychology, a book that helped the revolution of American psychology. Along with G.  Stanley Hall (1844–1924), James M. Cattell (1860–1944), and Edward B. Titchener (1867–1927), by the end of the nineteenth century, there were more than 40 psychology laboratories between the United States and Canada. Because of this period and enthusiasm for research and development, in 1982, the American Psychological Association was born with the main goal of contributing to the advance of psychology, as a science (Benjamin, 2007). As you may notice, some of the most important names in the history of hypnosis are somewhat missing. The reason for that is while experimental psychology and

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academic research are important, the developments in the medical community helped to establish hypnosis as an important field. Names like James Braid, James Esdaile, Jean-Martin Charcot, Pierre Janet, August Liébeault, and Hippolyte Bernheim truly are responsible for the emergence of hypnosis and his detachment from mesmerism. It wasn’t until Freud that hypnosis had a more therapeutic part. Well, sort of! Sigmund Freud (1856–1939) was an Austrian neurologist and one of the fathers of Psychoanalysis. After completing his medical degree, Freud gains the opportunity to do an internship, in Paris at the Salpêtrière Hospital, under the guidance of Charcot. Influenced by Charcot and his work with hysteria and susceptibility to hypnosis, Freud used those methods to treat hysteria and other conditions, alongside Josef Breuer. It was Anna O., one of Breuer’s patients, that made Freud reform his ideas in what we now know as Psychoanalysis. However, in the process, Freud abandoned the use of hypnosis for other approaches, like free association, and the perception of the importance of hypnosis started to diminish. While hypnosis fell from the mainstream, academic research was started to produce results showing how hypnosis could be a valuable approach to psychology. One such case is the work of Joseph Jastrow. Joseph Jastrow (1863–1944) was a psychologist and founder of the Department of Psychology of the University of Wisconsin. Besides being a close friend of William James, Jastrow was a doctoral student under G.  Stanley Hall, who later became the American Psychological Association’s first president. Jastrow dedicated his research to hypnosis, especially mechanisms of voluntary and involuntary behavior, and the processes of self-deception and self-control. Later, his interests continued to expand to everyday dissociations of mental processes, such as daydreaming, slips in attention, and perceptions of involuntariness for behaviors under conscious control (Pintar & Lynn, 2009). Alongside running the Department of Psychology, Jastrow was also responsible for a course on the medical uses of hypnosis. That course would be later taken over by one of his best students and arguably one of the most important academic researchers in the history of hypnosis, Clark L. Hull (1884–1952). There were criticisms among Jastrow and Hull, not only for their personal styles but also for their professional choices, because Hull always identified himself with his role as a laboratory scientist. The gap between them increased after Hull completed his doctoral work and became a full behaviorist, focusing more on observed behaviors and not on mental internal processes. Eventually, a rupture emerged between them, which brought repercussions for future supporters from both sides, future investigations, and even future relationships with William James (Pintar & Lynn, 2009). Clark Hull’s book Hypnosis and Suggestibility is considered to be one of the most important pieces of hypnosis history and relevance, not only as the first book detailing the application of experimental methods in researching hypnotic phenomena but also as a departure from the state and trance theories. In his own words, Hull (2002) stated:

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Moreover, the rapid development of psychology as an experimental science within recent years has given to the hypnotic investigator a large number of experimental methods and devices (6,7) particularly of a quantitative nature, which were not available to early workers. These may be utilized at once with little or no modification. Indeed, the following pages will be occupied mainly with elaborating in the concrete a variety of examples of the ­application of the methods of modern experimental psychology to the solution of the elusive problems of hypnosis and suggestibility. (p. 22)

Eventually, a second-year undergraduate Medicine student would dispute some of the claims and demonstrations of Hull’s seminars about suggestibility, saying that every person could be hypnotized. That student later became who many consider being the father of modern hypnosis, Milton H. Erickson. During his time at the University of Wisconsin, Erickson would experiment with hypnosis, greatly in opposition to some of Hull’s methods. History credits Erickson with having been Hull’s student, when in fact it was Jastrow that consider Erickson to have a promising career with hypnosis, supporting Erickson’s initial formal experimental research. Although Erickson would collaborate with Hull on his research, his objections were quite immediate. Erickson said that Hull preferred to induce hypnosis using a phonograph recording that would ensure that the same instructions with the same inflections were used with every single experimental subject. This is standard practice for creating a standardized method, in this case, a standardized induction. From Erickson’s point of view, this method disregards the subjects as people and turned them into nothing more than inanimate laboratory devices (Pintar & Lynn, 2009). Erickson would use a personalized induction method for every subject that he encountered and would conduct investigations on those procedures, something that would be a cornerstone for the Ericksonian approaches to hypnosis. Those experiments and Erickson’s style of doing hypnosis create a very disturbing feeling in Hull, considering that Erickson was disregarding the importance of suggestion and suggestibility and also the role of the operator in doing the induction. Eventually, Erickson’s approach was abandoned in the University of Wisconsin’s seminars (Pintar & Lynn, 2009). Despite that, Erickson would continue to produce papers on hypnosis, the use of hypnosis in medicine and therapy, as well as case studies where he demonstrated his views on therapy and hypnosis. After Erickson established himself in Phoenix, because of health issues, his popularity grew after a collaboration with Gregory Bateson, Jay Haley, and John Weakland. Erickson would be a consultant for many of those cases and would train and show many of his approaches to hypnosis and therapy. Haley was very impressed with Erickson, so impressed in fact that Haley wanted to write a book on Erickson and his views. That project became “Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D.” Haley’s book would give Erickson international fame and recognition, motivating psychologists, psychiatrists, nurses, social workers, and other medical professionals to seek out Erickson for therapy, seminars, and training. Names like Jeffrey Zeig, Brent Geary, Ernest Rossi, William O’Hanlon, Stephen Lankton, and others are associated with Ericksonian hypnosis and therapy. As far as publications, Erickson founded the

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American Society of Clinical Hypnosis in 1957, which is responsible for the American Journal of Clinical Hypnosis. Erickson’s influence would extend to the fields of Strategic Therapy, Family and Systemic Therapy, Solution-Focused Therapy, Ordeal Therapy, Rossi’s Psychobiological Therapy, and Bandler and Grinder’s Neuro-linguistic Programming. Nowadays, the Milton H.  Erickson Foundation is responsible for the preservation and divulging of Erickson’s teachings and views on therapy and hypnosis.

8.3 Hypnosis Research During the World Wars During the World Wars, hypnosis continued to be researched in academic settings and clinically applied in stressful conditions, such as pain management, trauma, “war neuroses,” and post-traumatic stress disorder. Names such as William McDougall (1871–1938), William Halse Rivers (1864–1922), Hans Eysenck (1916–1997), Hamilton Gibson (1914–2001), and George Estabrooks (1885–1973) had a tremendous impact on the teaching, research, and clinical application of hypnosis. Gibson, in 1978, was largely responsible for the founding of the British Society of Experimental and Clinical Hypnosis. Hypnosis started to gain attention from professionals and the general public, thanks to the growing interest in mental health disorders and treatments. According to Pintar and Lynn (2009), the American Psychological Association had an increase in members, from 3,000  in 1940 to 16,000  in 1950. Also, various psychological journals appear, like the American Journal of Clinical Hypnosis, the Annual Review of Hypnosis Literature, the Journal of Clinical and Experimental Hypnosis, and the Journal of Hypnosis and Psychology in Dentistry.

8.4 Hypnosis and Measurement Another great mark for hypnosis and academia happened to be in the development of the standardized measures for hypnosis, by Hilgard. Ernest Ropiequet Hilgard (1904–2001) was an American psychologist and one of the most influential names in hypnosis. His career began at Stanford University, in 1933, after he completed his doctoral work on conditional responses in learning, at Yale University. Alongside his wife, Josephine Rohrs Hilgard (1906–1989), and with the support of André Muller Weitzenhoffer (1921–2005), Hilgard set up the Laboratory of Hypnosis Research at Stanford, where he served as the director from 1957 until 1979. In 1959, Hilgard and Weitzenhoffer published what was to become the gold standard measures for hypnotic suggestibility, the Stanford Hypnotic Suggestibility Scale, Forms A and B. The purpose of these scales is to measure and quantify a

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subject’s hypnotic ability, something that is called hypnotizability, the capacity to produce those effects generally considered to be “hypnotic” (Weitzenhoffer, 1997). According to Hilgard (1965), the best way to measure the subject’s capacity to produce hypnotic effects is to take a sample of hypnotic performance under standard conditions of induction and testing. Simply put, you have a standard hypnotic induction procedure and then a series of hypnotic experiences. If the subject objectively and subjectively experiences the suggested phenomena, he gets a score. The total score brings the subject into one of the three categories: low, medium, or highly hypnotizable. For more information on hypnotizability measurement, see Barnier and Council (2010) and Barnier and McConkey (2004). By 1957, Hilgard, Weitzenhoffer, and colleagues began a study involving hypnotic responsivity that elevated Stanford University to the most important hypnosis research center in the world. They began with a modified version of the Friedlander-­ Sarbin Scale, becoming apparent that they need a new measure because of a bimodal distribution and too many extremely low scores (Hilgard et al., 1961). Using the Friedlander-Sarbin Scale as a base, Hilgard and Weitzenhoffer added easier items to spread the distribution of scores and simplified the scoring, resulting in the Stanford Hypnotic Susceptibility Scale, Forms A and B (SHSS: A and B; Weitzenhoffer & Hilgard, 1959). No longer in current use, these scales provided two others that are still used in research and considered to be standards: the Stanford Hypnotic Suggestibility Scale, Form C (SHSS: C; Weitzenhoffer & Hilgard, 1962) and the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS: A; Shor & Orne, 1962). These forms, A and B, have only slight changes in wording and procedure, allowing repeated measurement without contamination from practice effects (Barnier & Council, 2010). The administration of the scales begins with a test for waking suggestibility, a suggested experience of the subject’s body swaying and falling, with the propose of responding to suggestions. Then a hypnotic induction is administered, consisting of repeated suggestions for relaxation, drowsiness, and eye closure. The induction is read verbatim, and the experimenter can’t deviate from the scripted procedure (Barnier & Council, 2010). After the induction, the experiment administers ten additional suggestions which are divided into three categories: ideomotor suggestions (ideas becoming actions), challenge suggestions (challenge a suggested state of affairs), and cognitive-­ delusory suggestions (alterations in perception, emotion, action, or memory). These suggestions are: . Hand lowering (ideomotor) A B. Arm immobilization (challenge) C. Finger lock (challenge) D. Arm rigidity (challenge) E. Moving hands (ideomotor) F. Verbal inhibition (challenge) G. Hallucination (cognitive-delusory)

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. Eye catalepsy (challenge) H I. Posthypnotic suggestion (ideomotor/cognitive-delusory) J. Posthypnotic amnesia (cognitive-delusory) The categories are consistent with factor analyses of hypnotizability measures (Balthazard & Woody, 1985; Woody et al., 2005), while these suggestions are interspersed between easy and difficult to respond so that participants can be tested on a wide range of responses without experiencing too many consecutive failures (Barnier & Council, 2010). Each suggestion is scored as pass (1 point) or fail (0 points), generating a total score that can range between 0 and 12. According to Hilgard (1965), the predominant ideomotor and challenge suggestions on Forms A and B made the scales not especially sensitive to differences among the most responsive participants. Form C was created to answer this shortcoming, retaining the same format and number of items as the previous versions, adding new and more difficult cognitive-delusory suggestions to better assess the participant’s ability to experience distortions of perception and memory. Also, these suggestions were presented in approximate order of increasing difficulty. Retaining the hand lowering, moving hands apart, mosquito hallucination, arm rigidity, arm immobilization, and posthypnotic amnesia suggestions, Form C introduced the following new items: . Taste hallucination (cognitive-delusory) A B. Dream (cognitive-delusory) C. Age regression (cognitive-delusory) D. Anosmia to ammonia (cognitive-delusory) E. Hallucinated voice (cognitive-delusory) F. Negative visual hallucination (cognitive-delusory) Form C correlates well with Form A while being more difficult is a particularly good scale for identifying and/or confirming high hypnotic ability (Balthazard & Woody, 1992; Hilgard, 1978). Weitzenhoffer and Hilgard’s work sparked years of research in the development of new measures for hypnosis and hypnotic susceptibility. Some of the more research scales are: • • • • • • • • •

Harvard Group Scale of Hypnotic Susceptibility, Form A (Shor & Orne, 1962) Waterloo-Stanford Group C (Bowers, 1993, 1998) Stanford Hypnotic Clinical Scale for Adults (Morgan & Hilgard, 1978a–1979) Stanford Hypnotic Arm Levitation Induction and Test (Hilgard et al., 1979) Stanford Profile Scales of Hypnotic Susceptibility (Weitzenhoffer & Hilgard, 1963, 1967) Children’s Hypnotic Susceptibility Scale (Cooper & London, 1978) Stanford Hypnotic Clinical Scale for Children, Forms A and B (Morgan & Hilgard, 1978b–1979) Barber Suggestibility Scale (Barber, 1965) Carleton University Responsiveness to Suggestion Scale (Spanos et al., 1983)

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• Creative Imagination Scale (Barber & Wilson, 1978–1979) • Diagnostic Rating Scale (Orne & O’Connell, 1967) • Hypnotic Induction Profile (Spiegel & Spiegel, 2004) For more details, see Barnier and Council (2010).

8.5 The Evolution of State and Non-state Theories While academia was contributing to the creation of standardized measures for hypnotic susceptibility, hypnotizability, and hypnotic suggestibility, theories of hypnosis were also evolving. Hilgard would develop what we named as “neodissociation theory,” in which he would explore the possibility that the human mind is composed of multiple cognitive systems, which would be organized in a hierarchical structure and controlled by an “executive ego” (Pintar & Lynn, 2009). These cognitive subsystems carry out normal actions that are activated by that central control system; however, once activated, the subsystems operate without little interference from the executive ego. Hypnotic suggestions, according to Hilgard, are accompanied by a separation of the executive ego into two parts divided by an amnesic barrier, creating a subjective feeling that hypnotic responses are not volitional. Take an arm levitation, for example. In response to the suggestion that the arm is feeling lighter and rising, the executive ego intentionally activates it for the arm to move. Because the central control system is dissociated, the amnesic barrier prevents the executive ego to be aware of its command (Pintar & Lynn, 2009). According to Hilgard’s theory, dissociation is not unique to hypnosis, describing a series of routine experiences as well, like unintentionally driving home, for example. That’s why it’s not perceived as an altered state theory. The “hidden observer,” a self-aware part of consciousness that remains immune to suggestion during hypnotic induction, has been a source to present empirical evidence for Hilgard’s theory. Hilgard demonstrated the “hidden observer” phenomenon, for the first time, on a subject who managed to respond to the suggestion of being completely deaf. Although not having any startling response to loud noises, the subject responded when Hilgard said: “Although you are hypnotically deaf, perhaps there is some part of you that is hearing my voice and processing the information. If there is I should like the index finger to rise as a sign that it is the case.” The rising finger of the subject showed Hilgard the presence of some dissociated “hidden” part of the subject that remained aware during the hypnotic intervention. This “hidden observer” phenomenon became important to the neodissociation theory, not only supporting it but also criticizing it (Pintar & Lynn, 2009). Kenneth S. Bowers (1937–1996), another proponent name in hypnosis research and academia, as well as Hilgard’s colleague, had a different view on dissociation, particularly the amnesic barrier in the neodissociation model. According to Bowers, the approach attempts to explain commonplace phenomena through a rare one, the

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spontaneous creation of an amnesic barrier. However, research indicates that amnesia is only successful in about 25% of hypnotized subjects (Pintar & Lynn, 2009). For Bowers, dissociation doesn’t refer to a divided executive ego, but a disengagement of subsystems from conscious control, meaning that those subsystems can be directly and automatically activated, instead of being controlled by high-­ level executive control. Another person who extended the neodissociation theory was John F. Kihlstrom, who made the differentiation between types of dissociation that can occur in the hypnotic context: dissociations between experience and memory or pain and the experience of pain. Not only that, but he also incorporated new models of cognitive psychology, such as memory models, and the difference between procedural and declarative knowledge (Pintar & Lynn, 2009). Kihlstrom’s preference for the “state” tradition most likely appeared by the influence and the identification with the collegial relationship that he had with his mentor, Martin Orne. However, it is important to reflect that Kihlstrom always tried to be tolerant and inclusive in the state/non-state debate. Martin T. Orne (1927–2000) began his investigation into the subjective experiences of hypnotic subjects in 1950, 32 years after developing his phenomenological model of hypnosis, at the University of Pennsylvania. Orne’s model deliberately incorporates aspects from the state and non-state theories while focusing on the differences between hypnotic and waking cognitive activities (Pintar & Lynn, 2009). Other contributors included Peter W.  Sheehan and Kevin M.  McConkey, two important figures in the Australian hypnosis research field. The contextual model of Sheehan focuses on the interactive and reciprocal relations at work in the hypnotic context and the subtle variation in responsiveness to suggestions among very highly suggestible subjects. Like Sheehan, McConkey also studied the variables in hypnotic responses, by examining the meaning that subjects placed on the hypnotist’s communications, and the idiosyncratic ways in which they cognitively process suggestions (Pintar & Lynn, 2009). Psychoanalysis would also influence the altered state theories, considering hypnosis as a way to increase the availability of imagination, fantasy, and other primary process thinking. Erika Fromm (1909–2003), Professor of Psychology at the University of Chicago, was responsible for introducing hypnosis to another generation of psychodynamic therapists, including Michael Nash. Nash, who completed his doctoral work with Steven Jay Lynn and established an active laboratory at the University of Tennessee, contended that hypnosis creates a special state of psychological regression with specific properties which include an increase in primary process material, spontaneous and intense emotion, unusual body sensations, experience of non-volition, and the tendency to establish a special rapport with the hypnotist (Pintar & Lynn, 2009). To describe the non-state or sociocognitive perspectives, it’s important to say that these theorists challenge the association of hypnosis with a hypnotic trance state and the assumption that that particular state is responsible for the experience of hypnotic suggestibility. They may accept dissociation as a descriptive not as an explanatory phenomenon and the subject’s beliefs, expectations, and imaginings about

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hypnosis, and the interpretations of the hypnotist’s suggestions are sufficient to explain the hypnotic response. We must start with the work of Theodore R. Sarbin (1911–2005). Sarbin became known and recognized for his “role theory,” which had various applications in the field of psychology. By analyzing hypnosis as a social-­ psychological behavior and applying role theory, Sarbin studied the relationship between hypnotist and subject, identifying the implicit and explicit roles that each would follow. According to this perspective, it’s not the hypnotic induction that produces a response in the subject, but the belief that the response is appropriate for the hypnotic subject to produce. For example, a subject will likely demonstrate eye catalepsy if he knows that this is classic hypnotic behavior. Sarbin used the term role-taking, explaining that subjects may be completely unconscious of the role that they are taking on. Alongside his colleague William C. Coe (1930–2004), they identified a group of variables that can affect hypnotic responsiveness, like knowledge, expectations, and imagination. The term “believe­in imaginings” was used to describe spontaneous distortions of reality that can occur in the hypnotic context and in ordinary life. Role theory analyzes the experiences of a hypnotic subject as a performance within an active, collaborative, and imaginative relationship, not so different from non-hypnotic relations. Sarbin’s theory was criticized and expanded by Theodore X. Barber (1927–2005), after concluding a series of extensive studies between 1960 and 1970. Barber concluded that hypnotic responses were strongly correlated with much greater amplitude of factors, such as attitudes, expectancies, wording, and tone of the suggestion, motivation, defining the situation as “hypnosis,” suggestions for relaxation, the wording of the questions to which the response is solicited, and the behavior adopted by the hypnotist (Pintar & Lynn, 2009). Barber emphasized individual differences in imaginative ability as one of the key aspects of hypnotic responses. More important, Barber believed that hypnosis could have positive therapy outcomes regardless of the innate hypnotic ability of the subject and if he experienced a dissociative state. Barber also suggested that different subjects may respond to hypnotic suggestions according to their personal style, which implied that some responded in a more dissociated state and others didn’t. By the end of the twentieth century, another theorist’s work became influential in experimental and clinical hypnosis. Beginning his career with Barber, Nicholas P. Spanos (1942–1994) and other colleagues such as John Chaves structured their research on social psychological processes, especially on the dynamics of communication that made subjects understand their role as hypnotic subjects and interpreters of hypnotic suggestions in a specific way. “Special process” was the term used by Spanos as an alternative to altered state theory, because the main purpose of social psychological theories is to explain hypnotic behavior using the same variables and processes that account for non-­ hypnotic behavior. Influenced by Barber, Sarbin, and Orne, Graham Wagstaff offers the possibility that the term hypnosis refers to a collection of phenomena that we can’t account for by a single explanation (Pintar & Lynn, 2009). Focusing on the influence of

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compliance in hypnotic suggestibility, Wagstaff is a founding member of the British Society of Experimental and Clinical Hypnosis. More recently, the work of Irving Kirsch and Steven Jay Lynn helped defined research on hypnosis and its clinical applications. Kirsch’s theory centers around the role of expectancy and how it generates specific responses. According to Kirsch, people’s expectations of their hypnotic response produce hypnotic experiences. For example, if my response expectation of an arm levitation suggestion is that my arm will feel lighter and starts to lift easily and automatically, the hypnotic experience is generated according to that expectation. The response expectancy theory predicts that a subject’s expectancy can increase the subjective sense of non-volition during their hypnotic experience (Pintar & Lynn, 2009). In sum, people tend to respond expectantly, and so the role of the hypnotic induction is simply to increase that expectancy. Conditions can be manipulated to increase response expectancy, and it can increase hypnotic susceptibility or suggestibility (Wickless & Kirsch, 1989). Steven Lynn’s approach, an “integrative model,” places its emphasis on unconscious determinants of hypnotic responsiveness and also rapport and relationship factors. Lynn and colleagues have stated that some features of the hypnotic context discourage awareness and analysis of the personal and situational factors that influence hypnotic responses (Pintar & Lynn, 2009). Kirsch and Lynn developed in collaboration a “response set theory” in which most actions, hypnotic or non-hypnotic, ordinary or unusual, planned or spontaneous, are initiated automatically at the moment of activation, rather than resulting from conscious intention, implying that the real illusion is not the subjective experience of involuntary or automatic action that occurs in the hypnotic context, but the experience of volition that we assume characterizes our everyday behavior (Pintar & Lynn, 2009). The state vs. non-state debate is still ongoing and a recurrent topic among the hypnosis community. While academic research and neurosciences have provided empirically validated support for most sociocognitive theories, there’s still a strong adherence to altered state perspectives, the most common being hypnoanalysis (psychodynamic psychotherapies with hypnosis) and the Ericksonian approach. These perspectives, hypnoanalysis and the Ericksonian approach, are mostly used in clinical settings with therapeutic benefits with claims of superiority against sociocognitive perspectives. However, we know that indirect suggestions, the main tool of the Ericksonian style, are not more effective than direct suggestions (Lynn et al., 1993) and that hypnotic age regression, a main tool of hypnoanalysis, can elicit memories, namely, childhood memories, that in a substantial number of cases are not corroborated by parents. Many researchers and clinicians have adopted an integrative approach, joining sociocognitive perspectives with the flexibility and tailoring of suggestions to fit the different subject’s unique characteristics. In one study by Arreed Barabasz and colleagues, patients with irritable bowel syndrome were provided either tailored or manualized inductions prior to hypnotic suggestions for symptom management. The results show that all study participants responded to the hypnotic suggestions to

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some degree. However, only the participants in the tailored condition reported no incapacitating pain at posttreatment. Moreover, the tailored group continued to improve and evidenced better outcomes than the manualized participants at 10 months posttreatment (Barabasz & Barabasz, 2006).

8.6 Hypnosis, Academia, and the Portuguese Reality By the description of some important moments in hypnosis, hypnosis research, the connection with research, and academic settings, you probably notice a tendency for an evolution particularly in the United States. That’s not to say that in the rest of the world, hypnosis had no impact. Historically speaking, European countries like France, Germany, and Austria were very influential in hypnosis and still are. Spain has a presence in hypnosis research and clinical applications with the creation of a workgroup for psychological hypnosis, within the Official College of Psychologists for the Valencian Community, supported by such names as Antonio Capafons Bonet, Etzel Cardeña, and Elena Mendoza. From a sociocognitive perspective and inspired by the concept of “waking hypnosis” by Wells (1924) and Bányai’s active-alert hypnosis (1993), Capafons and colleagues developed the Waking Hypnosis Valencia Model, in which hypnosis is presented to the subject in a way that avoids trance explanations and hypnosis is contextualized as a general coping skill for self-control that uses self-regulatory functions of the brain and takes into account the beliefs of the subject in regard to hypnosis (Alarcón & Capafons, 2006). The subject has an active role in the hypnotic context and in any part of the process is requested to close the eyes or suggestions for relaxation are delivered; on the contrary, the subject is encouraged to do routine tasks. The model can be viewed as the following: 1 . Presentation of hypnosis 2. Clinical assessment of hypnotic suggestibility 3. Rapid self-hypnosis 4. Didactic metaphor 5. Suggestions for practice and training 6. Hetero-hypnosis (active-alert) 7. Therapeutic suggestions (Capafons, 2012) While some Spanish workgroups are trying to establish hypnosis as an empirical and valid approach to various health contexts, the Portuguese reality of hypnosis is bittersweet, to say the least. It’s not that hypnosis research doesn’t exist, because it does, as you will see. It’s safe to say that hypnosis started to have a place in Portugal by the influence of the Spanish work on hypnosis and by Portuguese clinical psychologists and researchers that went to various countries to get some formal training, like the United States. Hypnosis training and research were mostly centered around three areas: Porto, Coimbra, and Lisbon.

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In Porto, we could see more of a focus on training professionals on how to use hypnosis. A great influence was the work of Peter J. Hawkins, a psychologist with a special interest in integrative approaches to psychotherapy using hypnosis. Hawkins founded the European School of Psychotherapy and for more than 30 years was a visiting professor at ISMAI (now the University of Maia), where he taught courses on Brief Therapy and Hypnosis. By the 1990s, Hawkins was one of the responsible for Milton H.  Erickson of Portugal, with the support of the Milton H.  Erickson Foundation’s director, Jeffrey K. Zeig. It’s safe to say that hypnosis in Porto has a more Ericksonian approach, which is more used in clinical practices. In November of 2018, the University Fernando Pessoa in Porto attributes the degree of Doctor Honoris Causa to Jeff Zeig, for his contributions to the fields of Hypnosis and Psychotherapy, which he received alongside Camillo Loriedo. In Coimbra, hypnosis is taught and researched by the Research Group for the Study of Psychological Processes Related to Suggestion, Placebo, Hypnosis, and Psychopharmacs, directed by Carlos Pires. Carlos Pires is a psychologist and a professor at the University of Coimbra. His main interests are hypnosis and psychopharmacology. Pires had a longtime association with the Valencia colleagues, creating opportunities for workshops and courses by Antonio Capafons and himself. In 2007, Pires and colleagues of the University of Coimbra organized the I Iberic Symposium of Experimental and Clinical Hypnosis, with the participation of Professor Juan Lamas from the University of Coruna and Professor Antonio Capafons from the University of Valencia. In 2008, the curricular unit “Fundaments and Applications of Hypnosis” was inserted into the master’s degree program of the Psychology Course and also the release of a book co-edited by Pires Clinical Hypnosis: Fundaments and Applications in Health and Psychology, which featured research articles from Portuguese and Spanish psychologists and therapists. In Lisbon, it’s fair to say that hypnosis research and clinical applications have been mainly done by the effort of Dra. Cláudia Carvalho, from Ispa Institute for Psychological, Biological, and Social Sciences. Cláudia Carvalho is a clinical psychologist, professor, and researcher. Licensed in Psychology by the University of Porto, she received her Ph.D. from the University of Lisbon and Ispa. Her doctoral work “Adherence to health-related behaviors: Effectiveness of implementation intentions and posthypnotic suggestion in college students” (Carvalho, 2008) combined Gollwitzer’s implementation intentions concept and Kirsch’s and Lynn’s response set theory to test the effectiveness of a combined intervention of implementation intentions with posthypnotic suggestions in enhancing the adherence to health tasks, such as a mood report and a physical activity exercise. An international sample was used, composed of students from one university in the United States and students from two universities in Portugal. Groups were organized and randomized, where it was requested to send a mood report and went for a run. Half of the group had only the task prescription, and the other half received a posthypnotic suggestion to reinforce the intention to do the tasks. Suggestibility was previously evaluated with the Waterloo-Stanford Group C scale of hypnotic suggestibility, having results being favorable to the ones that were highly suggestible. Because the Portuguese population didn’t have a standard

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suggestibility measure, Carvalho did a translation and adaptation of the WSGC to the Portuguese, with a sample of college students. Also, to understand participants’ attitudes toward hypnosis, a translation and adaptation of the Escala de Valencia de Actitudes y Creencias Hacia la Hipnosis, Versión Cliente was also done in these studies. From Carvalho’s many articles, I would point out Portuguese norms for the Harvard Group Scale of Hypnotic Susceptibility, Form A (Carvalho, 2013), Revised Valencia Scale of Attitudes and Beliefs Toward Hypnosis-Client Version (Carvalho et al., 2007), placebo and nocebo effects (Evers et al., 2018), open-label placebo research (Carvalho et al., 2016, 2021), and the book The Essential About Hypnosis: Theories, Myths, Clinical Applications and Research (Carvalho, 2012). She’s also responsible for the curricular class Introduction to Clinical and Experimental Hypnosis, in Ispa’s Health Psychology master’s degree, and coordinated an Introductory Course to Clinical and Experimental Hypnosis, taught by Antonio Capafons. Last, but not least, Carvalho is the founder and director of the Milton H. Erickson Institute of Lisbon established in 2002. Currently, Alexandra Ferreira-Valente, clinical psychologist, professor, and researcher, is responsible for a study financed by BIAL Foundation titled “COPAHS – COping with PAin through Hypnosis, mindfulness and Spirituality” (Ferreira-Valente et al., 2021). The purpose of this study is to evaluate and compare the immediate effects of self-hypnosis, mindfulness meditation, and a spiritual intervention relative to a control condition for increasing pain tolerance and reducing pain intensity. By experimental design, the participants will be submitted to a Cold Pressor Arm Wrap, and there will be no instruction on the use of specific strategies. After the experience of pain, an audio recording will be played providing a guided practice of either self-hypnosis, mindfulness meditation, or Christian prayer. This study also counts with the participation of Mark Jensen, a clinical psychologist and researcher, who has developed and studied the efficacy of psychosocial pain treatments, such as cognitive-behavioral, hypnotic, and motivational approaches. Dr. Jensen is the current president of the International Society of Hypnosis and editor-in-chief of The Journal of Pain.

8.7 A Future of Hypnosis in Portugal For a small country, it’s amazing how Portuguese clinicians and researchers have been able to produce such an amount of quality research in the field of hypnosis. It’s no small feat to publish in reference journals, such as the International Journal of Clinical and Experimental Hypnosis and the American Journal of Clinical Hypnosis. Not only that, but those who have an academic career constantly stimulate students to focus on hypnosis for their academic papers, such as dissertations. However, academic and some experimental research in hypnosis have substantially decreased,

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and nowadays, it is quite rare to see a good article or research project in academic settings. Why is that? The answer relies on the general perception of hypnosis among professionals and the lack of professional regulation for the use of hypnosis. First, it’s important to clarify that the term “hypnotherapy” is terribly misleading because hypnosis is not a therapy. Clinical hypnosis, as Kirsch (1995) defines it, is a procedure in which a therapist suggests that a client experience changes in sensation, perception, thought, and behavior. What that means is that hypnosis is an adjunct that increases the effects of specific interventions. To quote Martin Orne: “If a professional is not qualified to treat a certain clinic condition without hypnosis, then he’s not qualified to treat that clinical condition.” In 2014, the Portuguese Psychologists Association stated that hypnosis is one of the techniques and interventions that psychologists can use to work on emotions, internal conflicts, and the client’s unconscious. Hypnosis is a part of a psychologist’s professional competencies and the actions that psychologists can do, in their professional capacity (parecer_sobre_hipnose.pdf (ordemdospsicologos.pt)). In the same year, the Portuguese National Health System recommends that hypnosis could and should be used as one of the psychosocial interventions for neuropathic pain in adults and elders, with biofeedback, relaxation, meditation, and cognitive-behavioral therapy (NÚMERO: (aped-­dor.org)). Although professional and official organizations say that hypnosis is a part of their procedures, there is no official Portuguese organization that regulates and professionally certifies hypnosis as a legal profession. People who are not trained health professionals can take hypnosis courses (most of them administered by laymen with some training on hypnosis and NLP), courses that supposedly teach them how to intervene with psychopathologies like depression or anxiety, directly or indirectly persuading those people to establish themselves as “therapists,” under the umbrella of alternative therapies. Hypnosis has also been presented as a “lie detection” procedure and past-life regressions as has been also presented on primetime television. With all these factors, health professionals started to associate hypnosis with those practices, as if hypnosis was an obscure or esoteric tool. Also, it is important to say that most professionals don’t spend time to search empirically validated research on hypnosis, because they don’t have the time or interest or because they don’t know where to get the best references in academic research. In conclusion, while I believe there are more factors associated with current beliefs on hypnosis by health professionals, these are the most impacting. And if professionals and those who are in a position to make decisions on academic curriculums and funding for research projects have these beliefs, I’m afraid that the road to increasing the quality of hypnosis in academia is more difficult. Not impossible, but certainly more difficult!

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Spanos, N. P., Radtke, H. L., Hodgins, D. C., Bertrand, L. D., Stam, H. J., & Dubreuil, D. L. (1983). The Carleton University responsiveness to suggestion scale: Stability, reliability, and relationships with expectancy and “hypnotic experiences”. Psychological Reports, 53(2), 555–563. https://doi.org/10.2466/pr0.1983.53.2.555 Spiegel, H., & Spiegel, D. (2004). Trance and treatment: Clinical uses of hypnosis (2nd ed.). American Psychiatric Publishing. Weitzenhoffer, A.  M. (1997). Hypnotic susceptibility: A personal and historical note regarding the development and naming of the Stanford Scales. International Journal of Clinical and Experimental Hypnosis, 45(2), 126–143. https://doi.org/10.1080/00207149708416114 Weitzenhoffer, A. M., & Hilgard, E. R. (1959). Stanford Hypnotic Susceptibility Scales, Forms A and B. Consulting Psychologists Press. Weitzenhoffer, A. M., & Hilgard, E. R. (1962). Stanford Hypnotic Susceptibility Scale, Form C (Vol. 27). Consulting Psychologists Press. Weitzenhoffer, A. M., & Hilgard, E. R. (1963). Stanford Profile Scales of Hypnotic Susceptibility: Forms 1 and 2: To provide measures of differential susceptibility to a variety of suggestions within the induced hypnotic state. Consulting Psychologist Press. Weitzenhoffer, A.  M., & Hilgard, E.  R. (1967). Revised Stanford Profile Scales of Hypnotic Susceptibility: Forms I and II. Consulting Psychologists Press. Wells, W.  R. (1924). Experiments in waking hypnosis for instructional purposes. The Journal of Abnormal Psychology and Social Psychology, 18(4), 389–404. https://doi.org/10.1037/ h0074476 Wickless, C., & Kirsch, I. (1989). Effects of verbal and experiential expectancy manipulations on hypnotic susceptibility. Journal of Personality and Social Psychology, 57(5), 762–768. https:// doi.org/10.1037/0022-­3514.57.5.762 Woody, E. Z., Barnier, A. J., & McConkey, K. M. (2005). Multiple hypnotizabilities: Differentiating the building blocks of hypnotic response. Psychological Assessment, 17(2), 200–211. https:// doi.org/10.1037/1040-­3590.17.2.200

Chapter 9

Clinical Hypnosis in Russia: From Historical Tradition to Modern Education, Research, and Practice Rashit Tukaev

9.1 Introduction: Prehistory The dramatic Franco-European history of hypnosis of the eighteenth–nineteenth centuries, that incorporated the birth of mesmerism and its transformation into hypnotism, determined the later formation and exhaustive development of the Nancy and Salpêtrière schools of hypnosis, terminated at the turn of the nineteenth–twentieth centuries with a double transit of the totality of hypnotic knowledge and practices to Russia and the USA. The history of American hypnology in the twentieth and twenty-first centuries is well known, while the development of Russian hypnology and hypnotherapy, due to geopolitical reasons, remained out of sight of the rest of the world. The first factor of interest in hypnosis and the development of hypnotherapy in Russia in the nineteenth century was the practice of scientific trips for young talented Russian doctors in leading European medical centers of that time, where hypnosis was quite popular. So, Vladimir Bekhterev, due to a training in Europe, France, in the 1880s, not only mastered the body of knowledge and practices of contemporary hypnology, but, having returned to Russia, he started original studies of hypnotic suggestions and hypnotherapy. The second factor was the development by Ivan Sechenov in the 1860s  of the doctrine of brain reflexes (Sechenov, 1965), which became the basis of the worldview of several generations of Russian doctors, physiologists, and biologists and the foundation for the development of reflexological theories by Ivan Pavlov and Vladimir Bekhterev. The accent on reflexology has become an unconditional and productive component in research, theories of hypnosis, and the practice of hypnotherapy. And the third additional factor that influenced hypnosis research and hypnotherapy was the practice of usage of researches in R. Tukaev (*) Russian Medical Academy of Continuous Professional Education, Moscow, Russia e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_9

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animal behavior and physiology for understanding of the physiological and psychological processes in humans, including the common mechanisms of the hypnotic state development.

9.2 Two Independent Theories of Hypnosis At the beginning of the twentieth century, two independent theories of hypnosis were developed in the reflexological doctrines of Ivan Pavlov and Vladimir Bekhterev.

9.2.1 Pavlovian Theory of Hypnosis Pavlov’s theory of hypnosis and suggestion presents the derivative of his theory of higher nervous activity, which not only legalized practice and methodological and scientific research in the field of hypnosis and psychotherapy but also defined the boundaries and directions of their practical application and scientific research for the next 60–70 years (Pavlov, 1928). Ivan Pavlov studied sleep and hypnosis in the context of inhibition processes in the cerebral cortex. He came to the conclusion that hypnosis is a partial sleep, a transitional state between wakefulness and sleep, when, against the background of inhibition with varying degrees of intensity of the brain regions, there is a waking watchpoint in the cerebral cortex, which provides rapport of the hypnotist and hypnotized. It was believed that in hypnosis, the cells of the cerebral cortex are in different phases of the inhibitory process, and the paradoxical and ultra-paradoxical phases of it provide the greatest efficiency of verbal suggestions. The word in hypnosis is a signal of signals, and suggestion becomes a simplified typical conditioned reflex of a human being. Pavlov believed that hypnosis, like natural sleep, is a state in which the protective-restorative function of inhibition is carried out most fully. The effectiveness of hypnotic protective inhibition was shown in the experiments on the treatment of experimental neuroses in dogs (Pavlov, 1921, 1928, 1932). I.P. Pavlov discussed the therapeutic use of hypnosis in two aspects: (1) hypnosis increases the patient’s suggestibility and susceptibility to therapeutic suggestion and (2) the hypnotic state, representing a partial sleep, actualizes the mechanism of protective inhibition. In general, Pavlov’s theory of hypnosis retains the definition of hypnosis as a state, traditional for Russian hypnology, filling it with its own characteristic, conceptual content of a state process (Pavlov, 1921, 1928, 1932). Pavlov’s theory of hypnosis formed two main directions in the research of hypnosis: (1) the search for signs of hypnotic protective inhibition and (2) the study of the influence of hypnotic suggestions on physiological and mental functions. Such studies were carried out mainly in the 1920s–1950s. The study of suggestions in hypnosis included pain reception, reflexes, respiration, pulse, blood pressure,

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trophic functions, digestive system, states of hunger and satiety, water metabolism, gas exchange, carbohydrate metabolism, heat exchange, sweating, and mental functions (including visual and auditory perception, muscle strength, perverted perceptions, positive or negative hallucinations, age-related regression and progression, emotional states, attention, memory (including hypermnesia), volitional processes, thinking, and speech) (Slobodyanik, 1977). The reflexology of I.P. Pavlov was historically the first to create a holistic system of concepts, which made it possible to distinctively describe the mechanisms of hypnotic state development and hypnotherapy, the field of its application. This description was partly interpretive and speculative, which, however, did not prevent the development of effective clinical practice. In this respect, Pavlov’s theory of hypnosis fundamentally is not inferior to the later Western cognitive theories of hypnosis, which also include interpretive and speculative components and are also supported by effective practice.

9.2.2 The Theory of Hypnosis by Vladimir Bekhterev At the turn of the nineteenth–twentieth centuries, Bekhterev (1888) came to the understanding of human hypnosis as an analogue of animal hypnosis. In fact, the hypnosis of animals – a state of stupor – represents, according to Russian physiologists V. Danilevsky and V. Bekhterev, a protective inhibitory reflex to danger, a prototype of the hypnotic state of a man. Human hypnosis is based on the artificial reproduction of a natural protective inhibitory animal reflex. Therefore, hypnosis is neither a morbid nervous state nor a suggested sleep but is a special biological reflex inhibitory state common to animals and humans. According to Bekhterev (1888, 1903, 1910, 1911), suggestion is working better in a hypnotic state, due to the emerging of special state of consciousness. The study of mental epidemics, compared with psychotherapeutic practice, allowed the scientist to formulate a conclusion about an increase in personal suggestibility in the group according to the mechanisms of mutual suggestion. Thus, the combination of a group format with hypnosis should further increase the suggestive effect of psychotherapy (Bekhterev, 1911). Bekhterev did not confine himself to the European tradition of hypnotherapy for hysterical disorders. Back in the 1880s and 1890s, he began to successfully use hypnotherapy in the treatment of obsessive-compulsive disorder – later in the treatment of alcoholism (Bekhterev, 1910, 1911). Follow-up research and psychotherapeutic application of suggestion, self-­ suggestion, persuasion, hypnosis, researches of mass mental phenomena, and mental epidemics were subsequently used by V.M. Bekhterev at the beginning of the twentieth century in creating method of collective psychotherapy (Bekhterev, 1954) (50 years later named Bekhterev psychotherapeutic triad). The method of collective psychotherapy of alcoholism included persuasion, hypnotherapy, and self-­ suggestion (self-affirmation).

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By the 1930s, Pavlov’s reflexology (which included Pavlov’s theory of hypnosis and an approach to the hypnotherapy of neuroses) became the ideological basis of Soviet medicine, while V. Bekhterev’s psychological reflexology was criticized and ceased to be relevant, which made both his theory of hypnosis and psychotherapeutic approach irrelevant for 40 years.

9.3 Hypnosis and Hypnotherapy in Russia in the Soviet and Post-Soviet Periods: Education, Research, and Practice Due to the ideologically conditioned delay in the development of psychology (psychological faculties at universities appeared only after 1955) and the presence of a developed, physiologically oriented (Pavlovian) hypnotherapy became and remains the leading method of psychotherapy in Soviet medicine (Platonov, 1957; Slobodyanik, 1977; Vel’vovskiy et al., 1954). Hypnotherapy, as a method based on protective inhibition, was utilized as the main method of psychotherapy of neurosis in psychiatry and was widely used in the system of restorative sanatorium treatment (Rozhnov, 1985; Slobodyanik, 1977). Hypnotherapy found its application in the treatment of mental trauma during the Second World War (Slobodyanik, 1977). Hypnotherapy was also used for the treatment of somatic, neurological, and dermatological diseases (Rozhnov, 1985; Slobodyanik, 1977). Three periods in Russian Soviet and post-Soviet education on hypnosis and hypnotherapy can be distinguished: the first, “education in the referent workplace”; the second, education at the departments of psychotherapy of the state institutes for the doctor’s improvement; and, the third, multifactorial education (at state departments of psychotherapy and research institutes of psychiatry and faculties of psychology and in private educational psychological and medical organizations).

9.3.1 Hypnotherapy of the First Soviet Period: Education, Research, and Practice (1920–1965) The development of hypnosis research and the practice of hypnotherapy in the first period was realized in medical model and based on Pavlov’s theory of hypnosis, which after the 1930s was perceived as a scientific absolute, verified, in particular, by neurophysiological studies (Tukaev, 2002a, b). During this period, hypnotherapy training took place during the work of doctors in medical hospitals and polyclinics, in the workplace, when knowledge was transferred from experienced specialists practicing hypnotherapy to interested beginners. In Russia, there were well-known clinical centers that used hypnotherapy (e.g., the Clinic of Neurosis in Leningrad).

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By the 1930s, Pavlov’s theory of hypnosis was perceived as axiomatic, so hypnosis research was directed to studying the potential of suggestive influences on the psyche, the function of organs and systems (Tukaev, 2002a, b). The range of hypnotic suggestions studied in the 1930s was used in the 1930s–1940s–1950s in hypnotherapy for neurosis; somatic, neurological, and dermatological disorders; and combat trauma. Russian hypnotherapy has made extensive use of the group format. Thus, in the 1930s, Ilya Vel’vovskiy (Vel’vovskiy et al., 1954) developed an effective method of labor pain relief, which included psychoeducation and training in self-hypnotic pain relief for pregnant women, which the French obstetrician Fernand Lamaze successfully reproduced in France in the 1950s (Lamaze, 1956). The Russian psychiatrist and psychotherapist Vladimir Rozhnov in the 1950s (Rozhnov, 1985) developed group methods: (1) emotional-stress (hypno-aversive) hypnotherapy for alcoholism and (2) long-term hypnosis-rest for the treatment of neuroses. A limited number of researchers and practitioners of hypnosis and hypnotherapy were concentrated in the leading scientific centers of the country (mainly in Moscow and Leningrad and partly in Kharkov) (Tukaev, 2002a, b). During the first period on the subjects of hypnosis and hypnotherapy, 17 scientific dissertations were successfully completed, and 12 monographs and 387 research and clinical articles were published in scientific journals.

9.3.2 Hypnotherapy of the Second Soviet Period: Education, Research, and Practice (1966–1991) The second period in the development of hypnosis and hypnotherapy in Russia started with the founding of the Department of Psychotherapy at the Central Institute for the Improvement of Physicians in Moscow in 1966 (Rozhnov, 1985). By the end of the 1960s, two new departments of psychotherapy in Institutes for the Improvement of Physicians were organized in the USSR: in Leningrad (now St. Petersburg) and Kharkov (Rozhnov, 1985; Tukaev, 2002a, b). The Moscow Department of Psychotherapy was headed by V.  Rozhnov, a well-known researcher of hypnosis and hypnotherapist. The teaching of psychotherapy at Moscow department of psychotherapy included hypnotherapy, rational psychotherapy, and autogenic training. Later, a comparable program was applied at the Department of Psychotherapy in Kharkov. Education included primary specialization (about 360 academic hours) and repeated improvement (about 144 academic hours). Educational activities were supplemented by scientific researches and the development of methods of psychotherapy. Training in hypnotherapy was put on stream, and a certain number of professional psychotherapists, who widely used hypnotherapy in their practice, appeared in the country (from 200 to 300 in different years). In the second period, the themes of hypnosis and hypnotherapy were reflected in 11 scientific dissertations, 12 monographs, and 377 research and clinical articles in scientific journals.

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9.4 Hypnotherapy of the Third Period: Education, Research, and Practice (1991 to Present) 9.4.1 Education The third educational period was for hypnosis and hypnotherapy a time of great expectation, hope, and certain limitations and difficulties. In the 1990s, emissaries of Western psychotechnologies and psychotherapy (neurolinguistic programming, transpersonal therapy, psychoanalysis, Ericksonian hypnosis, cognitive-behavioral therapy, etc.) flooded into Russia. Hopes and expectations for something new, superior to own, were clearly manifested in Russian psychotherapy and hypnotherapy of that time. Soon, after studying with Western trainers, Russia had its own trainers, and over time, educational programs on Western modalities of psychotherapy, private educational institutions. Psychotherapy has moved from a medical model to a mixed medical-psychological one, which has also affected hypnosis and hypnotherapy. Ericksonian hypnosis has become relatively widely used in medical and psychological models, although the legitimate institution of Milton Erickson appeared only in the 2010s. The traditions of Russian hypnosis and hypnotherapy are preserved only in some state research centers of psychiatry and state departments of psychotherapy of Medical Academies of Continuous Professional Education. Hypnosis is practically not taught or studied at the departments of psychology of the leading Russian universities (in Moscow, St. Petersburg); it is remembered only in a historical context. The peculiar “idiosyncrasy” of Russian psychology toward Russian hypnosis undoubtedly has historical roots, due to the “trauma” of the 1930s–1940s, when psychology as a science and practice was seriously limited for ideological reasons, while Pavlovian reflexology and hypnotherapy were supported. Modern departments of psychotherapy of the state system of medical postgraduate education provide a broad overview of modern methods of clinical psychotherapy, including the themes of directive and non-directive hypnosis and hypnotherapy, but relatively little time is devoted to the leaning of hypnosis and hypnotherapy. The part of professionals in the field of hypnotherapy receive education at private seminars, workshops, and long-term programs, in private educational institutions of additional psychotherapeutic education. Aspects of the hypnosis and hypnotherapy research in such education are not affected. Russian hypnotherapy in the 1980s–1990s ceased to be the leading method of psychotherapy but remained a method of psychotherapy and psychologic correction, which significantly distinguishes it from dominant Western traditions of using hypnosis to relieve and control acute and chronic pain. The total number of practicing hypnotherapy in Russia in clinical and psychological formats does not exceed 250–300 professionals, while the total number of psychotherapists and consultants in various psychotherapeutic modalities is about 7000–8000 specialists.

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9.4.2 Researches Current scientific research on hypnotherapy is predominantly clinically, methodically directed. Russian “New Wave” Erickson therapists mainly ignore traditional Russian hypnology. The traditions of Russian hypnology and hypnotherapy usually are supported and developed by some psychotherapists-psychiatrists who have received education in the departments of psychotherapy. The author of this chapter, based on the phenomenological, biological, neurophysiological, and socio-psychological analysis of hypnosis in the traditions of Russian hypnology, developed an integrative theory of hypnosis and hypnotherapy. The integrative theory of hypnosis and hypnotherapy contains neurophysiological, biological, and communicative components (Tukaev, 2006, 2020). 1. Hypnosis, being the ultimate defensive reaction of higher vertebrates, is triggered in humans by symbolical hypnogenic situations of inability of decision-­ making and/or its behavioral realization. Hypnosis development results in qualitative reorganization of the brain activation system functioning from distribution to generation of neuronal activity by default mode network structure. Hypnosis deepening is based on the increase of brain activation. Hypnosis development in right-handers is associated with a regressive reorganization of the left hemisphere to the right hemisphere functioning mode, with whole brain functioning on right hemispheric principle. 2. Hypnotization generates hypnogenic stress. Hypnotherapy activates a readaptation process, including neurohormonal and neurotransmitter secretions, activation of the immunological and biochemical responses, and spontaneous change of pain sensation. 3. Hypnotic communication styles (directive, non-directive) are (i) changing due to historical evolution of social communication styles and (ii) indirectly using the representations about hypnosis. The developed theory generally corresponds to modern data on hypnosis nature; in particular, its biological component is confirmed by experimental studies of heart rate variability. On the base of the integrative theory of hypnosis and hypnotherapy, the author has developed methods of universal hypnotherapy and projective hypnotherapy (Tukaev, 2006, 2020). The Universal Hypnotherapy method (Tukaev, 2020) (1) is based on systemic feedback from the patient and client, (2) uses the therapeutic protocol, (3) presents a component of the author’s positive-dialogue psychotherapy for anxiety disorders, (4) is effective in a controlled trial, and (5) allows to determine predictors of the effectiveness of positive-dialogue psychotherapy. The method of Projective Hypnotherapy (Tukaev, 2006) is based on: (1) prescribed by the Integrative Theory of Hypnosis and Hypnotherapy the strengthening in hypnotic state of the mechanism of infantile attributive projectivity; (2) the production by the patient, client of spontaneous (mainly visual) imagery and its

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interactive therapeutic transformation; (3) applies the rules for working with imagery phenomenology formed on the basis of the author’s research; (4) intended for therapeutic work with a wide range of clinical disorders and psychological conditions. It should be noted that in recent years, Russian university psychology has begun (in an international format) the studies of hypnotizability traditional for cognitive hypnology.

9.4.3 Organization of Hypnotherapy Practice Hypnotherapy of the second period relied on a practically unified medical educational standard, based on a set of theoretical knowledge and practical, methodological skills, job descriptions, and relevant legislation. Therefore, hypnotherapists were part of a formalized society of neurologists and psychiatrists, as a psychotherapy section where enthusiasts could exchange experiences. Currently, the utilization of hypnosis and hypnotherapy in Russia has gone beyond the medical specialty. Specialists who use hypnotherapy differ in their basic education profiles (medical, psychological) and training in different models of understanding and applying hypnosis and hypnotherapy. In Russia, there is a developed system of regulation of medical psychotherapy, while the regulation of psychological psychotherapy is in the process of long formation. In such circumstances, the importance of legal professional associations, with the appropriate charter and ethical code, compensating for such social and legal gaps, is growing. The absence of an obligatory tradition to rely on the professional community in their practical activities made several attempts to organize hypnosis and hypnotherapy societies unsuccessful. In 2017, according to the mechanisms of self-organization, the Association of Specialists in the Field of Clinical Hypnosis was created in Russia, the Coordinating Council of which, on the basis of a collegial decision taken by the Association, developed an educational standard and an educational program on hypnosis and hypnotherapy for practitioners and researchers of hypnosis.

9.5 Conclusion Russian hypnology and hypnotherapy have gone through a long historical path of formation and development, retaining its unique features. For a century, Russian hypnosis and hypnotherapy have been successfully developed within the framework of medical science, practice, and education, apart from the traditional Western, predominantly psychological, university education. It is characterized by undoubted achievements in theoretical, methodological, and practical terms. In the last 30 years, Russian hypnology has actively and critically assimilated and taken into account the experience of Western studies and practices of hypnosis.

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The current tasks of Russian hypnology and hypnotherapy are (1) the preservation of the medical model of research and practice of hypnosis, supplemented by the (2) introduction of hypnology and hypnotherapy into the system of university psychological education and research. The success of solving these problems is possible under the condition of the development of professional communities of hypnologists and hypnotherapists, capable of consolidating and integrating the further development of medical and psychological hypnosis in Russia.

References Bekhterev, V. M. (1888). Soznaniye i yego granitsy [Consciousness and its limits]. Kazan. Bekhterev, V. M. (1903). Osnovy ucheniya o funktsiyakh mozga. Vyp. 1–7 [Fundamentals of the doctrine of the functions of the brain. Issue. 1–7]. SPb. Bekhterev, W. M. (1910). La suggestion et son rôle dans la vie sociale (P. Kéraval, Trans., 1st ed.). Boulangé. Bekhterev, V. M. (1911). Gipnoz, vnusheniye i psikhoterapiya [Hypnosis, suggestion and psychotherapy]. SPb. Bekhterev, V. M. (1954). Izbrannyye proizvedeniya s sistematicheskim ukazatelem trudov i vystupleniy avtora i yego blizhayshikh uchenikov [Selected works with a systematic index of the works and speeches of the author and his closest students]. Moscow. Lamaze, F. (1956). Painless childbirth: psychoprophylactic method. H. Regnery Company. Pavlov, I. P. (1921, November 9). O tak nazyvayemom gipnoze zhivotnykh [About the so-called animal hypnosis]. [Conference session]. Division of Physical and Mathematical Sciences of the Russian Academy of Sciences. Pavlov, I. P. (1928). Lectures on conditioned reflexes. Twenty five years of objective study of the higher nervous activity (W. H. Gantt, Trans., 1st ed.). Intern. Publ. Pavlov, I. P. (1932). Proba fiziologicheskogo ponimaniya simptomologii isterii [A test of the physiological understanding of the symptomology of hysteria]. L.: Izd-vo AN SSSR, 36. Platonov, K.  I. (1957). Slovo kak fiziologicheskiy i lechebnyy faktor (Voprosy teorii i praktiki psikhoterapii na osnove ucheniya I. P. Pavlova) [The word as a physiological and therapeutic factor (Questions of the theory and practice of psychotherapy based on the teachings of IP Pavlov)] M., 432 s. Rozhnov, V.  E. (1985). Gipnoterapiya. Rukovodstvo po psikhoterapii. 3-ye izd.  – Tashkent [Hypnotherapy. In Guide of psychotherapy. 3rd ed. – Tashkent] (pp. 176–177). Sechenov, I. (1965). Reflexes of the brain. The MIT Press. Slobodyanik, A. P. (1977). Psikhoterapiya, vnusheniye, gipnoz [Psychotherapy, suggestion, hypnosis] (p. 480). Zdorov’ya. Tukaev, R. (2002a). The history of hypnosis and hypnotherapy in Russia. Against the odds. Part 1. Psychological hypnosis. Bulletin of American Society of Psychological Hypnosis, 11(1), 10–11. Tukaev, R. (2002b). The history of hypnosis and hypnotherapy in Russia. Against the odds. Part 2. Psychological hypnosis. Bulletin of American Society of Psychological Hypnosis, 11(2), 4–5. Tukaev, R. (2006). (Rus) Gipnoz; Fenomen i klinicheskoye primeneniye [Hypnosis: Phenomenon and clinical application]. MIA. Tukaev, R. (2020). The integrative theory of hypnosis in the light of clinical hypnotherapy. In C.  Mordeniz (Ed.), Hypnosis and hypnotherapy (pp.  234–249). Namik Kemal University. https://doi.org/10.5772/intechopen.83045 Vel’vovskiy, I. Z., Platonov, K. I., Ploticher, V. A., & Shugom, E. A. (1954). Psikhoprofilaktika boley v rodakh [Psychoprophylaxis of labor pains]. Medgiz.

Chapter 10

A Roadmap to Evidence-Based Medical Hypnosis Training in Academia David Ogez

and Pierre Rainville

10.1 Introduction The challenge of integrating hypnosis to the training of health-care professionals may reflect the relative conservatism of academia, health-care professional organizations, and regulatory bodies, regarding complementary approaches that are often considered marginal in Western medical practice. This resistance is often maintained despite incentives from international and some national health organizations to develop an open mind, yet a rigorous critical judgment, on integrative approaches to health care. The World Health Organization has emphasized the importance of considering traditional medicine with strong historical and cultural roots and to acknowledge the shortcomings of modern medicine (WHO, 2015). Hypnosis may claim with confidence that some underlying principles guiding its modern practice can be traced back to traditional rituals and find some echo in modern examples of shamanism and the induction of trance (Célestin-Lhopiteau, 2011; Gregoire et al., 2022). However, modern medical hypnosis has abandoned the more spectacular

In developing this project, many people were involved and supported us. We would like to thank Pierre Beaulieu, director of the Department of Anesthesiology and Pain Medicine at the University of Montreal, who assisted with the process of developing this program, and Julie Gosselin and François Robichaud, who supported the process of recognition of this program within the biomedical sciences of the University of Montreal. We would also like to thank Jean-Marc Benhaiem, physician hypnotherapist and director of the University of Paris hypnosis program. His advice and experience in the development of this type of program have been invaluable. Finally, we thank our clinical and research colleagues in hypnosis for their help in developing this program and its content. Thanks to Clarisse Defer, Mathieu Landry, and Michel Landry. D. Ogez (*) · P. Rainville Université de Montréal, Montréal, QC, Canada e-mail: [email protected]; [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_10

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display of trance expression to develop a variety of induction and suggestion techniques readily amenable to its integration to modern health-care settings. In the USA, the National Institute of Health has created a National Center for Complementary and Integrative Medicine (NCCIH, 2022) with the mission to “determine, through rigorous scientific investigation, the fundamental science, usefulness, and safety of complementary and integrative health approaches and their roles in improving health and health care” (NCCIH, 2022). In a survey conducted in 2002, 2007, and 2012 (Clarke et al., 2015), the use of progressive relaxation, guided imagery, or hypnosis over the past 12 months was reported in more than 5% of the participants. Yet this percentage decreased slightly from 2002 to 2012, and the specific report of hypnosis usage accounted for only 0.1–0.2%. In contrast, other mind-­ body approaches such as yoga, tai chi, qigong, and meditation increased significantly to reach about 18% in 2012. We did not find similar studies in Canada, and one may expect similar trends that might discourage the development of a training agenda in our home country. However, there may be cultural facilitators through the close links developed with French European communities in Belgium and France where medical hypnosis has been implemented successfully in several clinical settings. However, the popular representation of hypnosis may remain a serious obstacle that needs to be addressed to ensure a smooth integration of hypnosis to academic settings. The academic field continues to manifest ambivalent feelings about hypnosis practices. The reasons are diverse and complex. First, hypnosis is still widely perceived by the public as an act related to the entertainment sector. In this context, the popular belief holds that the hypnotized person loses control, and the practitioner has power over them. This belief is maintained by the media and especially by the entertainment industry, which offers programs on hypnosis shows (stage hypnosis). By showing participants in an apparent total loss of control, the media creates fear and does not show the public the benefits of hypnosis, the one that cures. Also, these shows and performances overshadow the dissemination of research results, while science has been proposing a large body of fundamental and clinical research on hypnosis, and scientific journals are even dedicated to this research (APA, 2011). Second, the central position of pharmacology in physical and mental health care also contributes to this lack of knowledge about the effects of hypnosis. Historically, the discovery of ether downgraded the use of hypnosis in anesthesia (Bouchet, 1998). Nowadays, in a society that advocates rapid care, instituting a medication seems more practical than conducting a procedure that might take longer. This is often not true. Studies show that hypnosis does not take longer than medication in anesthesia contexts, for example (Lang et al., 2000; Tefikow et al., 2013). In psychotherapy, hypnosis was also developed in the field of brief therapies, as underlined by the popularity of the approach developed in California by Bateson and Mead. Consequently, we believe that hypnotherapy should continue to have a place in academia, which will increase its scientific and clinical legitimacy in the eyes of both professionals and the public. For that reason, we have developed a university training program. In this chapter, we propose a roadmap to the development of

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hypnosis training in academic settings. Building on evidence-based principles, we argue in favor of a strong integration to biopsychosocial models of behavioral intervention to improve health and reduce suffering. This integration should provide scientifically based mechanistic conceptualizations and guide the development of innovative applications.

10.2 The Role of Academia in the Complex Landscape of Hypnosis Training Obviously, universities do not have the exclusivity on hypnosis training, and excellent programs may be developed outside of academia. A distinction between academic and non-academic training settings is also useful. The academic setting has a triple function: education, research, and clinical activity. Academic curriculum development is focused on science and intervention, both through research and clinical training, which are conducted by laboratories and clinics affiliated with the academic community. The academic richness is therefore the combination of research and clinical professors who can provide complementary expertise to students in their teaching. As previously stressed, hypnosis suffers from a lack of legitimacy that could be brought by the scientist, as much research are widely conducted on its subject. The advantage of a university education consists in the possibility of teaching research and clinical studies. Moreover, a diploma in hypnosis recognized by the academic community provides legitimacy and, above all, a reassuring message for the public, both for professionals who wish to train and for patients who wish to be treated. Evidence-based practice (EBP) is a core feature of academic training and can be defined as the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health-care decisions (Titler, 2008). Academia is adequately prepared to train health-care practitioners in EBP of hypnosis by allowing for an integrated training building on the specific expertise of health-care professionals and a strong scientific background on the clinical conditions addressed within the fields of competency of each discipline (medicine, psychology, nursing, rehabilitation, etc.). Methodological expertise is a fundamental aspect of university training and a major strength allowing to assess the quality of the best available scientific evidence. The Task Force on EBP of Psychological Treatments of the Canadian Psychological Association has summarized their recommendations as follows (Canadien Psychological Association (CPA) Taskforce, 2012): Evidence for recommending or providing treatment should stem from treatment outcome research, treatment process research, and basic psychological research. Before providing treatment, psychologists should first consider the hierarchy of evidence available for the treatment options under consideration.

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Psychologists should utilize the best available evidence (evidence which is highest on the hierarchy) which includes findings that are replicated across studies and that have used methodologies that address threats to validity (e.g., randomized controlled trials to address threats to internal validity; naturalistic studies to address threats to external validity). In cases where there may be little or no relevant treatment research, practice guidelines may be available that are based on a consensus among experts and have been determined by formalized methods. Psychologists should frequently and systematically monitor clients’ reactions, symptoms and functioning during treatment. Psychologists should be prepared to alter the treatment based on data from ongoing treatment monitoring, discussions with the client, and reconsideration of the relevant hierarchy of evidence.

These principles highlight the importance of scientific training to assess the quality of the evidence available in support of an application. They also underscore reliance on consensus of recognized experts within their field of competency when scientific evidence is insufficient. Systematic methods can be applied to minimize biases in surveying experts (e.g., Delphi). While academic settings are not completely immune to pseudoscientific theories and misguided practices, questioning and revising one’s view based on independent evidence is valued as the norm rather than the exception in academia. Recommendations from experts and clinical guidelines are revised periodically to integrate new evidence. This ongoing questioning of the efficacy of any intervention is also crucial at the dyadic level where the clinician-­ patient interaction involves monitoring key outcomes and allows ongoing adjustment or redirection of treatments. This obviously applies to all health-care practice and is directly relevant to clinical hypnosis.

10.3 Integrating the Basic Science of Hypnosis A strong scientific background is integral to any academic training of health-care professionals. The implementation of new interventions, or of existing interventions to a new clinical setting, must obviously rely on the demonstration of their clinical efficacy. However, this is rarely sufficient for the adoption of the new practice in a modern clinical context. Interventions must be integrated into a meaningful explanatory framework that is largely shared between the multiple partners involved in care. The required evolution of biomedical approaches toward a biopsychosocial model was affirmed strongly 45 years ago (Engel, 1977) and has provided fertile grounds for this integration of psychological and psychosocial intervention to medical care. Explanatory theories of the effects on health and well-being can now be developed in the context of mind-body medicine where the brain acts as a key interface. Hypnosis research was engaged very early on in this integrative effort through experimental studies documenting the effects of hypnosis, mainly hypnotic

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analgesia, on pain-evoked physiological responses. As summarized by Hilgard (1975) in the Annual Review of Psychology, evidence supporting clinical hypnosis at that time was largely based on expert reports and single- or multiple-case studies, but several experimental studies had been conducted on hypno-analgesia using controlled nociceptive stimuli applied to groups of healthy participants. These studies showed that hypnosis could be used to reduce pain perception, as reported by the participants, but also cardiovascular responses induced by the painful stimuli. Theoretical debates have emphasized the role of dissociation (Hilgard, 1974), contextual/psychosocial factors (Coe & Sarbin, 1977), and cognitive process (e.g., attention and expectations (Kirsch, 2001)), but the field gradually converged toward an integrative psychosocial and neurobiological framework that provided new grounds to study the mechanisms underlying hypnosis phenomenology (Jensen et al., 2017; Lynn et al., 2015). The development of advanced functional brain imaging methods, including electroencephalography and magnetoencephalography, positron emission tomography, and functional magnetic resonance imaging, has provided extraordinary means to study the brain as the mediator of hypnosis-related effects (Landry et al., 2017). Reciprocally, hypnosis is also considered an important tool to study basic brain mechanisms underlying mental function and subjective experience in normal and pathological conditions (Landry et al., 2014; Oakley & Halligan, 2013). Although many questions remain unanswered, solid scientific methods are now available to test more directly specific hypotheses about neurobiological processes involved in hypnosis and responses to hypnotic interventions. This rich scientific literature provides a strong pillar to the foundation of modern academic training in clinical hypnosis.

10.4 Domains of Application In all universities, the first step will always be to clarify how new programs are created and to identify the mechanisms involved in the submission, evaluation, and approval. In this process, it will be essential to know the assessment criteria and to identify stakeholders and key partners that will help advocate for the program. Support usually needs to be strong at the department level before the proposal can be submitted at the level of a faculty. The proposal often needs to be approved by a centralized university office responsible for all study programs. Professional regulation organizations may overlook the content of the program when their formal accreditation is required. Medical university programs may need to be approved at the governmental level, typically by the Ministry of Education or Health. In this section, we describe important considerations that need to be addressed explicitly to create a new training program in medical hypnosis. We refer to a new program that we are currently developing to highlight some key steps of the creation and implementation process.

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Fundamentals Course:

Applied Hypnosis Course:

Fundamentals of clinical hypnosis Hypnosis protocol in clinical settings

Clinical Hypnosis, Anesthesiology and Pain Clinical hypnosis, oncology, and palliative care Clinical hypnosis, anxiety, and trauma

Practical course: Internship in clinical hypnosis Integration project in clinical hypnosis

Fig. 10.1  Design of the university hypnosis training program

10.4.1 Designing the Program In the design of a new university hypnosis training program (Fig. 10.1), it is useful to refer to existing models, while adding new specificities, related to the culture of the country in which the program will be developed and the university environment in which it will be taught. Among the programs that currently exist, we find the first university diploma in hypnosis developed in France by Dr. Benhaiem in the Department of Anesthesia and Intensive Care at the University of Paris VI.  This program is offered at the Pitié-Salpêtrière Hospital and has served as a model for other French universities (DU, 2022). This program’s strengths reside in the clinical teaching of hypnosis techniques through the variability of the trainers and their expertise. This program allows participants to be quickly exposed to hypnosis techniques and therefore facilitates the integration of these techniques into their practice environment. In order to integrate this program into a North American culture, it is useful to add additional research dimensions. Evidence at both the basic and clinical levels is essential for the academic community to embrace such a program. The ability to include a research section to the program also fits the academic culture. In this case, we have integrated hypnosis clinicians and researchers into the development team, allowing for the co-construction of a program that will involve both the research and clinical cultures. This program is defined in terms of courses that address the theoretical and practical aspects of various clinical and medical hypnosis techniques. Two courses are first articulated around the basics of hypnosis, detailing the historical and scientific foundations of hypnosis in medical and clinical settings, through basic research in neuroscience, and proven protocols in health-care settings (clinical studies). Three courses then focus on the application of these techniques in the medical setting: (1) in the management of procedural and chronic pain, (2) in the management of symptoms associated with chronic diseases and cancer, and (3) in the management of anxiety and trauma associated with the hospital environment and diseases.

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Additionally, a practical component is also integrated into this training to promote rapid clinical integration of the techniques taught and to consolidate the students’ skills. After the basic courses, an intervention internship under the supervision of a hypnosis specialist will be offered. The internship environment is selected according to the student’s field of practice. Finally, in order to promote the integration of theoretical and practical content, a final assignment is required as part of this university program. In connection with his or her learning and practice, the student will be invited to write a theoretical-­ clinical paper that will allow him or her to revisit the notions acquired throughout the program. A research project could also be considered, depending on the student’s interest, which would also allow for the integration and evaluation of skills.

10.4.2 Target Populations The university hypnosis program is intended for a public of caregivers registered with a professional order who work in a psycho-medico-social practice with patients. This is essential because the value of hypnosis training is based on learning techniques that are complementary to clinical expertise. By training in hypnosis techniques, we intend to offer a complementary non-pharmacological technique that could be used as an adjunct to techniques/procedures already well acquired and used by a health professional. In this case, the program integrates students who wish to have knowledge of clinical and medical hypnosis to acquire techniques complementary to their initial clinical skills. Overall, the program aims to integrate students from the health-care field who wish to integrate hypnosis techniques in the management of pain and distress associated with illness and medical treatment procedures. This audience includes physicians, nurses, psychologists, dentists, physiotherapists, occupational therapists, and kinesiologists. The relational, para-verbal, and verbal techniques of hypnotic communication constitute a valuable contribution to the practice of each of these professionals. They will allow them to address on the one hand a different mode of relationship with their client and, on the other hand, a discourse oriented toward positive and constructive suggestions which will aim to facilitate and considerably improve the adherence and quality of the proposed care. For example, when a nurse performs a painful procedure, the patient is the main focus of her attention. With a relationship centered on the patient and a discourse devoid of pain suggestions, we could expect a less anxiety-inducing and less uncomfortable procedure. Regarding specific techniques, hypnosis analgesia procedures can be proposed by each of these professionals, to accompany a painful medical or rehabilitation treatment or to reduce pain perception in a patient suffering from chronic pain, carried out among others by psychologists or occupational therapists. Techniques focusing on the side effects of chronic illnesses follow the same direction. For example, an oncology nurse who accompanies a patient during chemotherapy

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treatment can use direct or indirect suggestions to reduce nausea. Finally, about the accompaniment of the anxious and traumatic aspects, we can also believe that training for this large audience of caregivers could be beneficial. For instance, an accident patient who is experiencing traumatic anxiety, could obviously be accompanied by a psychologist who would focus on the psychological trauma but also by a physiotherapist who would help with the physical trauma through hypnotic techniques. In this sense, each of the techniques in the program has a role to play for each eligible professional, with the intention of complementing his or her skills with an appropriate technique.

10.4.3 Identifying Teachers and Supervisors The program incorporates teachers from each of the admitted disciplines, given the target student audience. This fact is essential because each of these professionals has acquired experience in the application of hypnotic techniques within their own activity, in accordance with their clinical expertise. As part of a program development, it is important to train professionals in the application of medical hypnosis by training them in the appropriate teaching techniques and by accompanying them in the realization of their courses. For this reason, we propose to develop a training pilot group that includes hypnosis trainers and university professors who will prepare the training of future teachers on the one hand and who will provide this training and supervise the teachers in the proposed courses on the other. The piloting group includes complementary expertise essential to the development of this program. On the one hand, the clinical and research dimensions are represented by the inclusion of three experienced hypnosis trainers in hypnosis (clinician and researcher) who are responsible for the quality of the program’s content and the teachers who will be recruited. On the other hand, two biomedical science professors and a pedagogical manager from the university are included to allow the integration of this program at the university level. Their expertise in pedagogy and in the development of university training programs will greatly facilitate the creation of this program and especially its integration with the professional orders. The teachers who will be included represent the health professionals who will be accepted into the university program. They are physician, psychologist, dentist, nurse, and physiotherapist. Each of those professionals is already trained in hypnosis and has acquired several years of experience in clinical practice. They are a guarantee to their professional order of the recognition of these interventions in each of their fields of expertise. They will be involved in the selection of the clinical supervisors involved in the training course.

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10.5 Partnerships The training program is administered by the University’s Academic Programs Department and more specifically by a university department, which assumes responsibility on multiple levels. On the one hand, the department is responsible for the financing of the training program and for the administrative procedures with multiple academic and professional bodies. On the other hand, it oversees the definition of the teaching program and evaluations, the selection of teachers and internship settings, and the inclusion of participants. In order to have this training recognized, an essential step consists of partnering with professional organizations, which have a legal responsibility regarding the health professionals’ field of expertise (order of physicians, dentists, psychologists, nurses, physiotherapists, etc.). These organizations’ support also allows for the implementation of hypnosis practice beyond training and facilitates the evaluation of subsequent practices. Clinical settings are also involved. They allow for the integration of participants into intervention practicums under the supervision of hypnosis practitioners. These settings include both university centers and private practice settings that involve different health-care professionals. All these professionals are recognized by the professional hypnosis associations affiliated with the International Society of Hypnosis. Additional support may be obtained from patient partners or association of patients. In some clinical settings, such as multidisciplinary pain clinics, patient advocacy is welcome, and the diversity of approaches offered is highly valued by both clinicians and patients.

10.6 Conclusion The development of clinical hypnosis training programs in academic settings is important but can be challenging. In this chapter, we argue that academia must engage in such training to ensure that the practice of hypnosis in clinical settings is evidence-based. Basic scientific knowledge has built over the past decades that allows for a meaningful integration of hypnosis into a valid biopsychosocial model. Human physiology and brain imaging methods provide valuable insight into mediators of hypnosis-related phenomena that support plausible mechanistic models of clinical hypnosis. Specific practical steps are identified for the creation of a new program. In this process, we must underscore the determinant importance of developing strong partnerships with university officials, clinical milieu, and international consultants. Target fields of applications need to be determined where sufficient scientific evidence is available and for which clinical resources and interest are present. Identifying competent teachers and clinical supervisors may be difficult in the beginning. The selection of the first cohorts of students should be well-advised,

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cover multiple disciplines, and aim at building a community of practice sharing a common view on the importance of strong clinical expertise and evidence-based practice. This community will strengthen the clinical opportunities for advanced training and will help improve access to hypnosis interventions for patients.

References APA. (2011). Hypnosis today. https://www.apa.org/monitor/2011/01/hypnosis. Accessed 2022. Bouchet, H. (1998). The beginnings of anesthesia. Annales de Chirurgie, 52(9), 935–939. Canadien Psychological Association (CPA) Taskforce. (2012). Evidence-based practice of psychological treatments: A Canadian perspective. https://cpa.ca/docs/File/Practice/Report_of_the_ EBP_Task_Force_FINAL_Board_Approved_2012.pdf Célestin-Lhopiteau, I. (2011). Changer par la thérapie. Dunod. Clarke, T. C., Black, L. I., Stussman, B. J., Barnes, P. M., & Nahin, R. L. (2015). Trends in the use of complementary health approaches among adults: United States, 2002–2012. National Health Statistics Reports, 79, 1–16. Coe, W. C., & Sarbin, T. R. (1977). Hypnosis from the standpoint of a contextualist. Annals of the New York Academy of Sciences, 296, 2–13. DU. (2022). Hypnose et anethésie. https://www.medecine.universite-­paris-­saclay.fr/formations/formation-­c ontinue/les-­d iplomes-­d universite-­d u-­e t-­d iu/du-­hypnose-­e t-­a nesthesie. Accessed 2022. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. Gregoire, C., Marie, N., Sombrun, C., et al. (2022). Hypnosis, meditation, and self-induced cognitive trance to improve post-treatment oncological Patients' quality of life: Study protocol. Frontiers in Psychology, 13, 807741. Hilgard, E.  R. (1974). Toward a neo-dissociation theory: Multiple cognitive controls in human functioning. Perspectives in Biology and Medicine, 17(3), 301–316. Hilgard, E. R. (1975). Hypnosis. Annual Review of Psychology, 26, 19–44. Jensen, M.  P., Jamieson, G.  A., Lutz, A., et  al. (2017). New directions in hypnosis research: Strategies for advancing the cognitive and clinical neuroscience of hypnosis. Neuroscience of Consciousness, 3(1), nix004. Kirsch, I. (2001). The response set theory of hypnosis: Expectancy and physiology. The American Journal of Clinical Hypnosis, 44(1), 69–73. Landry, M., Appourchaux, K., & Raz, A. (2014). Elucidating unconscious processing with instrumental hypnosis. Frontiers in Psychology, 5, 785. Landry, M., Lifshitz, M., & Raz, A. (2017). Brain correlates of hypnosis: A systematic review and meta-analytic exploration. Neuroscience and Biobehavioral Reviews, 81(Pt A), 75–98. Lang, E. V., Benotsch, E. G., Fick, L. J., et al. (2000). Adjunctive non-pharmacological analgesia for invasive medical procedures: A randomised trial. Lancet (London, England), 355(9214), 1486–1490. Lynn, S. J., Laurence, J. R., & Kirsch, I. (2015). Hypnosis, suggestion, and suggestibility: An integrative model. The American Journal of Clinical Hypnosis, 57(3), 314–329. NCCIH. (2022). Complementary, alternative, or integrative health: What’s in a name? https:// www.nccih.nih.gov/health/complementary-­alternative-­or-­integrative-­health-­whats-­in-­a-­name. Accessed 2022. Oakley, D. A., & Halligan, P. W. (2013). Hypnotic suggestion: opportunities for cognitive neuroscience. Nature Reviews Neuroscience, 14(8), 565–576.

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Tefikow, S., Barth, J., Maichrowitz, S., Beelmann, A., Strauss, B., & Rosendahl, J. (2013). Efficacy of hypnosis in adults undergoing surgery or medical procedures: A meta-analysis of randomized controlled trials. Clinical Psychology Review, 33(5), 623–636. Titler, M.  G. (2008). Chapter 7: The evidence for evidence-based practice implementation. In R.  G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US). NIH: https://www.ncbi.nlm.nih.gov/books/ NBK2659/ WHO. (2015). WHO Director-General addresses traditional medicine forum. https://www.who. int/director-­general/speeches/detail/who-­director-­general-­addresses-­traditional-­medicine-­ forum. Accessed 2022.

Chapter 11

Professional Practices, University Education, and Research in Hypnosis Wellington Zangari , Guilherme Rodrigues Raggi Pereira and Fatima Regina Machado

,

11.1 Introduction Brazil is a country of continental dimensions with enormous regional diversity in terms of cultural and economic aspects. Because of this, describing any of its aspects is a daunting challenge. This is especially difficult when the task itself deals with the relative lack of publicly available information on some themes as hypnosis research studies and practices. Despite that, without the intention of exhausting the topic in this chapter, we describe the current situation/regulation of the use of hypnosis in Brazil and, later, present the developments in terms of dissemination and studies of hypnosis carried out at the University of São Paulo. Firstly, we discuss the specific role of regulated professions in providing some grounds on how hypnosis can be done, how professional and scientific associations have promoted activities in the field, and how the diversity of practices is presented and affects the field. The role of the Sistema Único de Saúde (SUS) (Brazilian Unified Health System) is intertwined with this story, but since its principles and the objective of providing free health care throughout the national territory would require its own chapter, we will focus on the adoption (Ministério da Saúde, 2006) and expansion (Ministério da Saúde, 2018) of the Política Nacional de Práticas Integrativas e Complementares (PNPIC) (National Policy on Integrative and Complementary Practices), which modifies the professional scenario of hypnosis and whose effects have yet to be measured.

W. Zangari (*) · G. R. R. Pereira · F. R. Machado Instituto de Psicologia – Universidade de São Paulo, São Paulo, Brazil e-mail: [email protected]; [email protected]; [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_11

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11.2 Professional Practices and Organizations 11.2.1 Professional Boards To discuss the role of professional boards in Brazil, it is first necessary to undertake the challenge of distinguishing the notions of occupation from profession, whose notions may vary between countries and cultures. In this chapter, we consider a profession to be a class of work activities organized and recognized for its historical and social importance, bound to certain standards of educational qualifications and ethics. This class is given the relative monopoly of certain activities by federal law, which can only be exercised when the worker holds a professional license issued by a competent government-related professional board (Franzoi, 2009). In turn, occupation is a broader term used to describe work activities that encompass regulated professions along with other work activities that are not regulated. The definition used by the Ministry of Labor itself is the following: “Occupation is the aggregation of jobs or similar work situations in terms of the activities performed”1 (Ministério do Trabalho e Emprego, 2002). Given the grouping by activities, the Ministry organized the Classificação Brasileira de Ocupações (CBO) (Brazilian Classification of Occupations) with the purpose of categorizing occupations and of aiming to plan government actions, by coding and describing them, recognizing their existence without regulatory power: CBO recognizes the existence of a certain occupation in the classificatory sense and not of its regulation. The profession, unlike CBO, is governed by law, whose appreciation is made by the National Congress, through its Deputies and Senators and submitted to the sanction of the President of the Republic. CBO has no power to Regulate Professions.2 (Ministério do Trabalho e Emprego, 2002)

In Brazil, when a profession is first recognized by law, a professional board system must be established, with a federal office responsible for the publishing of regulations and regional offices responsible for administrative work regarding the professionals of this occupation. The professional boards aim to regulate, inspect, guide, and ethically discipline its class’s work. For example, to work as a doctor, a psychologist, or a nutritionist, it is necessary to complete the academic training stages and to present the diploma to a regional professional board, which will evaluate the documentation and issue the professional’s registration number. From that moment on, the professional can identify himself or herself as belonging to that profession,

 Authors’ translation for “Ocupação é a agregação de empregos ou situações de trabalho similares quanto às atividades realizadas” 2  Authors’ translation for “A CBO tem o reconhecimento no sentido classificatório da existência de determinada ocupação e não da sua regulamentação. A regulamentação da profissão diferentemente da CBO, é realizada por Lei cuja apreciação é feita pelo Congresso Nacional, por meio de seus Deputados e Senadores e submetida à sanção do Presidente da República. A CBO não tem poder de Regulamentar Profissões” 1

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perform professional activities, and, thus, be ethically responsible for his or her conduct. There are certain professions, like pedagogy, that are entered into after undergoing higher education but are not yet regulated professions by law in Brazil. Other activities are associated with many professions and families of occupations, as is the case of “therapies” in general and psychotherapy specifically, which are not regulated by law and can be performed by different kinds of professionals, including those with no university degree or technical training in the health field. Hypnotherapy, as the name suggests, is part of this group of unregulated activities in the country. CBO is typically updated annually. While writing this chapter in 2022, we checked the classification, and the keywords “hypnosis” and “hypnotherapy” were not found in either occupations, professions, or activities associated with any jobs. Activities not considered exclusive/private to a particular profession can be performed by any professional if they are not explicitly prohibited by law or subject to specific regulations from their professional class. For example, in Brazil, a holistic therapist could, within their professional attributions, use hypnosis to treat clients, as there is no specific legislation that prohibits the use of the technique; a psychologist, on the other hand, could not carry out a “past life regression” activity, even if it is similar to hypnosis, as the concept of “past lives” is religious in nature and therefore outside the legal scope of the psychologist’s work. Therefore, any health professional can use hypnosis as a tool within their activities. Despite this freedom, some boards have published, throughout their history, specific legislation regarding the technique, recognizing its importance and contextualizing its use. Some of the boards of regulated professions that have legislated about the use/practice of hypnosis are the following: • Psychology: The Conselho Federal de Psicologia (CFP) (Federal Board of Psychology) explicitly regulates the practice of hypnosis through CFP Resolution No. 13/2000 (Conselho Federal de Psicologia, 2000). Recognizing its historical importance, the practical value in the professional activity of the psychologist and other workers in the health field in general, the use of the technique is approved if the professional can prove adequate technical training. Hypnosis can be used when the psychologist’s evaluation concludes it to be necessary, as long as ethical standards are observed and the safety and well-being of the person served are guaranteed. In addition, the resolution prohibits the use of hypnosis for futile, sensationalist demonstrations or ones that create embarrassing situations for the people involved. • Medicine: The Conselho Federal de Medicina (CFM) (Federal Board of Medicine) recognizes the use of hypnosis (Conselho Federal de Medicina, 1999). As this recognition was issued through a technical opinion document, the legal text is more flexible than regulations found in other professional boards. The document comments briefly about scientific literature available at the time and the physician’s daily professional practice. In general, the draftsmen of the opinion consider hypnosis a “valuable practice” that supports diagnoses and treatments; they point out that other professions such as psychology and dentistry

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also use it, and other medical specialties can collaborate on patient care. The latter claim is made as the authors suggest naming hypnotic practices performed by physicians as “hypniatry.” They list some scientific productions available at the time to corroborate the opinion and conclude by emphasizing the need for technical, legal, and ethical qualifications to exercise the practice; therefore, the lay use could be characterized as quackery, which is a crime punishable by penal law. • Dentistry: Among the health professions in Brazil, dentistry has always shown particular interest in the practice of hypnosis, historically appearing in societies and health associations in defense of the technique. The law that regulates dentistry professional practice mentions hypnosis: “Art. 6 It is incumbent upon the dental surgeon: VI - to use analgesia and hypnosis, provided that they are proven to be qualified, when they constitute effective means of treatment” (Presidência da República, 1966). In 2008, when regulation of integrative and complementary practices in oral health was needed, the Conselho Federal de Odontologia (CFO) (Federal Board of Dentistry) approved a resolution to recognize the exercise of acupuncture, phytotherapy, floral therapy, hypnosis, homeopathy, and laser therapy activities within the dental surgeon’s work (Conselho Federal de Odontologia, 2008). As in the legislation of other boards, the appropriate qualification/certification in reputable institutions is necessary for the exercise of these activities, and in the case of this specific legislation, it expressly includes the need to have a theoretical-practical assessment at the end of each course (not present in other consulted legislation). • Physical Therapy: In Brazil, physical therapy and occupational therapy activities are governed by the same federal board (the Conselho Federal de Fisioterapia e Terapia Ocupacional  – COFFITO), even if they are characterized as distinct professions, with equally distinct codes of ethics. In the case of physical therapy, the regulation of the practice of hypnosis (along with others) appears expressly in resolution form (Conselho Federal de Fisioterapia e Terapia Ocupacional, 2010), which decided on the professional use of integrative and complementary practices and specifies the need for proof of mastery on the part of the professional in regard to the techniques they may employ. The aforementioned resolution authorizes a set of practices that include phytotherapy; body, manual, and meditative practices; floral therapy; magnetotherapy; anthroposophic physical therapy; thermalism/crenotherapy/balneotherapy; and hypnosis. In order to prepare for later amendments to law, the board indicates that any additions to the list of integrative practices by the Ministry of Health involving acts complementary to human health will be added to the activities executed by the physical therapist. • Occupational Therapy: Occupational therapy, despite having been established as a profession in the same law that regulates physical therapy (Poder Executivo, 1969), remains a distinct profession with its own practices. This also implies differences in specific legislation. Such is the case with integrative and complementary practices, which include hypnosis. The resolution that authorizes the use of such practices in the work of the occupational therapist adds a greater number of professional activities, given the update of the list of practices made by the

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Ministry of Health (Conselho Federal de Fisioterapia e Terapia Ocupacional, 2017). From the complete list, art therapy, meditation, and yoga are additions thematically similar to hypnosis, and we point out that the resolution also establishes the update of the list in accordance with the determinations of the Ministry of Health and the need for adequate qualification, as the physical therapy resolution presented above. • Nursing: In Brazil, the Conselho Federal de Enfermagem (COFEN) (Federal Board of Nursing), along with its regional boards, governs the work of professionals with various levels of education, ranging from nurses (higher education course required) to nursing technicians (high school with a technical level required), nursing assistants and attendants (high school and specialized courses required). As in other boards, the implementation of Integrative and Complementary Practices by the Ministry of Health in SUS implied the publication of specific legislation regulating the work of nurses. COFEN updates its recognition of nursing specialties, with Nursing in Integrative and Complementary Practices falling into the said specialties (Conselho Federal de Enfermagem, 2018). The latter may include hypnosis knowledge and practices, in addition to other practices already described in relation to other boards, including traditional Chinese medicine practices. After the publication of this resolution, which deals exclusively with the granting of specialist titles, a consultation was made to COFEN on the nursing professional use of hypnosis, which results in the production of a technical opinion (Conselho Federal de Enfermagem, 2021). In this document, the use of hypnosis in nursing is highlighted, with main indications in “disorders, preparation for invasive exams and during their performance, preoperative preparation, assistance in the treatment of acute and chronic pain relief, control and elimination of anxiety and fears, post-traumatic stress management, bleeding control, use of hypoesthesia and hypo-analgesia.”3 (We suppose that “hypo-analgesia” is probably a typo in the original document and was supposed to be written as “hypo-analgesia.”) The technical opinion is concluded by stressing the need for training and that the practice must be carried out in the context of nursing work. • Speech Therapy: The Conselho Federal de Fonoaudiologia (Federal Board of Speech Therapy) issued an opinion (Conselho Federal de Fonoaudiologia, 2020) in which it reiterates the determination of the Ministry of Health that the speech therapist is qualified to use integrative practices, including hypnosis/hypnotherapy, if they are properly trained to do so. In this opinion, there is no other specific recommendation in addition to the instructions received from the Ministry of Health.

 Authors’ translation for “distúrbios, preparo para exames invasivos e durante suas realizações, preparo pré-operatório, auxílio no tratamento de alívio de dores agudas e crônicas, controle e eliminação da ansiedade e de medos, controle de stress pós-traumático, controle de sangramento, uso de hiponestesia e hipoanalgesia” 3

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Oddly, among the health professions consulted, the Conselho Federal de Nutrição (CFN) (Federal Nutrition Board) recognizes the entry of integrative practices in SUS (Conselho Federal de Nutrição, 2021), but for reasons not documented in the resolution, it leaves out the activity of hypnosis/hypnotherapy while maintaining meditative practices and yoga. The original regulation of hypnosis practices in Psychology, Medicine, and Dentistry predates the most recent legislations from the Ministry of Health that deals with Integrative and Complementary Practices. This points to the tradition that those professions already had in relation to the subject. Also, as a common point, health professions are generally forbidden to make sensationalist claims of efficacy for any sort of practice; this contrasts with how unregulated/unlicensed professionals tend to advertise their hypnotherapy activities and creates a tension with health professionals because the boards only have legal power to regulate its own class. Therefore, unregulated hypnotherapists are not ethically accountable, and in the event of complication, they must be judged in the general law system, often by consumer law only.

11.2.2 Professional Associations An important organizational aspect for any field is the creation and maintenance of professional associations, whose role is to bring together professionals with similar interests, foster scientific production, promote meetings for debates and professional update, and carry out political and consultancy activities in their field of expertise. Brazil has relatively little organized written production regarding the history of hypnosis in the country and its professional associations. Much of this production is already old, relating to the first half of the twentieth century. Few professional associations have publicly available documentation, which greatly hinders research into their histories. Sometimes getting information is only possible in conversation with its members, and, considering that little is written, elements of recent history have been and are continuously lost. In addition, there is currently no federation or a general Brazilian society that centralizes updated information on regional associations, which further hampers mapping the field. Currently, the institutions that call themselves hypnosis societies or associations are mainly private clinics of professionals who teach courses and provide clinical care and not institutions of scientific and political organization. Professional associations with websites and public data available over the Internet that we could find and that are active in 2022 were the Associação de Hipnose do Estado de São Paulo (AHIESP) (São Paulo State Hypnosis Association), the Sociedade de Hipnose Médica do Rio de Janeiro (SOHIMERJ) (Rio de Janeiro Medical Hypnosis Society), and the Sociedade de Hipnoterapia do Estado de Pernambuco (SHEPE) (Pernambuco State Hypnotherapy Society). Little can also be found regarding the concrete participation of associations in the political life of their regions, as it is more common to find individual

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contributions in certain areas. Specifically, it is possible to find people linked to the associations for the institution of September 25 as the “Hypnologist’s Day” in the states of São Paulo and Rio de Janeiro by state laws (and, in the case of São Paulo, also municipal law). Despite this scenario, a few scientific congresses were held in Brazil over the last decade, but the lack of publication about the proceedings of these events makes it impossible to carry out a more detailed evaluation of the activities. Just like the “associations” that are actually course sales businesses, many events named “conferences” are just courses with dubious certification or a set of lectures without specific scientific direction. Those events often give rise to scientifically dubious practices such as past life regression, the use of memory regression to treat trauma, proposals for psychosomatic treatments for infectious diseases, and other picturesque presentations of hypnosis treatments.

11.2.3 Professionalization and Dissemination of Hypnosis/ Hypnotherapy Activity Given the context already presented in relation to the professional boards and the scarcity of information from professional associations/societies, it isn’t surprising that there is little concrete information about the individuals who work in this field. With the popularization of the Internet and the increasing presence of digital influencers, it is possible to visit online profiles of professionals that advertise hypnosis and hypnotherapy. Unlike what is seen on professional association websites, it is common to find better organized websites, which make clearer mention of their leaders, hypnotherapy practices, and courses sold. It has also been common to find websites that propose franchise models for opening hypnotherapy clinics, with brand manuals and other marketing tips and tricks. It seems that the field of hypnosis/hypnotherapy is easily co-opted by the world of coaches, especially prone to talk about “mental reprogramming” or even “DNA reprogramming” to address issues related to professional/career success or even health issues. It is possible to speculate that the moment of economic crisis strengthens activities that are seen as professional training and that promise swift financial returns. Also, the promise of swift and easy “cures” for a plethora of health and mental health issues seems to attract a great deal of attention, which directly clashes with how regulated professions are bound to advertise treatments. While regulated professions maintain a stricter advertisement of their practices and their efficacy, unregulated professionals can promote instant resolution to depression, anxiety, and fears. The rise of swift hypnosis inductions by digital influencers and “street hypnosis” also seems to corroborate these positions. It is still unclear how this changes popular and professional perceptions of hypnosis in Brazil.

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11.2.4 Hypnosis in the National Policy of Integrative and Complementary Practices (PNPIC) The National Policy on Integrative and Complementary Practices (PNPIC) was established by the Ministry of Health (2006), providing 19 integrative practices in SUS: Ayurveda, homeopathy, traditional Chinese medicine, anthroposophical medicine, medicinal plants/phytotherapy, art therapy, biodance, circular dance, meditation, music therapy, naturopathy, osteopathy, chiropractic, reflex therapy, Reiki, Shantala, integrative community therapy, social thermalism/crenotherapy, and yoga. In 2018, ten additional practices were added to the SUS list, including hypnotherapy (Ministério da Saúde, 2018). The other practices added were apitherapy, aromatherapy, bioenergetics, family constellation, chromotherapy, geotherapy, laying on hands, ozone therapy, and floral therapy. In the legal document, there is a short definition of each practice, and the hypnotherapy one is as follows: Hypnotherapy is a set of techniques that, through intense relaxation, concentration and/or focus, induce the person to reach a heightened state of consciousness that allows them to change a wide range of conditions or unwanted behaviors such as fears, phobias, insomnia, depression, anguish, stress, chronic pain. It can promote self-knowledge and, in combination with other forms of therapy, it helps to manage a series of problems. In 1993, hypnotherapy was defined by the American Psychological Association (APA) as a procedure through which a health professional leads the individual to experience sensations, changes, perceptions, thoughts or behaviors, with its use indicated to various conditions such as depressive disorders, anxiety, depressive neurosis, depression, based on previous studies. Current studies indicate hypnosis therapy as an effective and relevant treatment for depression. Some literature reviews carried out identified articles, covering different populations, which mainly believe that hypnotherapy is beneficial, can improve skills, especially memory, and who would consider its use in appropriate circumstances. Some health sectors regularly adopt this practice in their care protocols, such as dentistry, psychology, physical therapy, nursing, among others.4 (Ministério da Saúde, 2018)

 Authors’ translation for “A hipnoterapia é um conjunto de técnicas que, por meio de intenso relaxamento, concentração e/ou foco, induz a pessoa a alcançar um estado de consciência aumentado que permita alterar uma ampla gama de condições ou comportamentos indesejados como medos, fobias, insônia, depressão, angústia, estresse, dores crônicas. Pode favorecer o autoconhecimento e, em combinação com outras formas de terapia, auxilia na condução de uma série de problemas. Em 1993, a hipnoterapia foi definida pela American Psychological Association (APA) como procedimento através do qual um profissional de saúde conduz o indivíduo a experimentar sensações, mudanças, percepções, pensamentos ou comportamentos, com o seu uso indicado em diversas condições como transtornos depressivos, ansiedade, neurose depressiva, depressão, baseado em estudos anteriores. Estudos atuais indicam a terapia por hipnose como um tratamento eficaz e relevante na depressão. Algumas revisões de literatura realizadas identificaram artigos, abrangendo populações distintas, nas quais a maioria das pessoas acredita que a hipnoterapia é benéfica, pode melhorar habilidades, especialmente a memória, e consideraria seu uso em circunstâncias adequadas. Alguns setores de saúde adotam regularmente esta prática em seus protocolos de atendimento, como a odontologia, a psicologia, a fisioterapia, a enfermagem, dentre outras” 4

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Among the many things that could be pointed out in the definition, and considering its contextual vagueness, we stress the necessity for a good implementation of these practices so as not to maintain prevalent misconceptions about hypnosis. Yapko (1994) found a high prevalence of psychotherapists/hypnotherapists who believed that hypnosis could be used to retrieve memories of trauma from the past as far as the birth (54%) and even past lives (28%), so the inclusion of a highly controversial topic such as retrieval of memory through hypnosis in the definition is troubling. The insertion of these practices has been greater (about 79%) in primary health care (Ministério da Saúde, 2020), that is, in the stages of prevention and health promotion, but there is still no information available on which practices are being effectively implemented and in which regions of Brazil. There is a lot of uncertainty about how this policy will affect the field of public health as a whole in the long term and even more uncertainty about what it will look like for the field of hypnosis in particular.

11.3 University Education and Research in Hypnosis: The University of São Paulo Case The scenario presented clearly indicates that the development of hypnosis in Brazil depends primarily on the accomplishment of some concrete actions toward education and high qualification of researchers and professionals in the area. For that, it is desirable that those actions are accomplished in an environment that promotes continuing training, development of studies/research, and university extension activities. Considering that the academic environment is privileged in those terms, from 2010 onward, we decided to promote a series of activities more specifically – but not exclusively  – at the Institute of Psychology of the University of São Paulo (IPUSP). Our initial objective was to reach the training of health professionals directly and then gradually also professionals of other areas of the human sciences. The University of São Paulo (USP) is the largest and best evaluated university in the country, is one of the most important universities in terms of scientific production in Latin America, and is known for training leading professionals in their areas for the excellence in training, due to the impact of its production and the fact that a good number of its students are hired by other academic institutions as professors. For these reasons, our first activity was to propose and teach a semester course titled “Hypnosis, Altered States of Consciousness and Culture” to introduce hypnosis to graduate students in Social Psychology. Such course has been taught about once a year since 2013, and at this moment, about 150 graduate students (regular, special, or academic audit ones) have attended the classes. The objectives of the course were to (1) present the main researches and psychological theories of hypnosis, placebo, suggestion, and alterations of consciousness, with emphasis on psychosocial research and theories; (2) discuss the relationship between hypnosis, placebo, suggestion, and alterations of consciousness and their

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possible common psychological basis; and (3) reflect on the importance of the psychosocial study of hypnosis, placebo, and alterations of consciousness for the understanding of cultural phenomena. To justify the proposition of the course, we argued that (a) the study and the use of hypnosis are historically linked and are a cornerstone of the establishment of Psychology as an independent field of study; (b) the interest in hypnosis remains strong in important research and training centers (e.g., in the United States, 25% of clinical psychology Ph.D. programs offer full training courses in hypnosis; in the United Kingdom, approximately 45% of psychology departments maintain similar courses; and in Australia, it rises to 75%); and (c) in the United States and Europe, important psychology associations offer continuing education and training in hypnosis to professionals. Besides, we also pointed out that (d) the Division 30 of the American Psychological Association is composed by the Society of Psychological Hypnosis and (e) the report titled The Nature of Hypnosis was produced at the request of the Professional Affairs Board of the British Psychological Society to offer British psychologists specialized information about hypnosis practices. Nevertheless, in Brazil, although the Federal Council of Psychology has issued a resolution that approves and regulates the use of hypnosis “as an auxiliary resource for the work of Psychology professionals” (CFP No. 013/00 of December 20, 2000), since 2000, very little is discussed about hypnosis in academia, and the subject is barely discussed/studied in psychology undergraduate courses. In short, the course was justified by, firstly, seeking to fill the gap between professional training in psychology and theoretical and practical scientific knowledge of hypnosis and, secondly, by the need to train in graduate level qualified personnel for research in the area. Thirdly, it was justified by the need for instrumentalization of professionals for the academic dissemination of the theme, which would contribute to the reduction of misinformation and misuse of hypnosis by psychology professionals. And finally, the course would bring a relevant psychosocial reading of cultural phenomena from concepts derived from research in the field of hypnosis and altered states of consciousness, proposing an expansion of the use of this knowledge to other fields. The course consists of 12 classes with the following content: (1) definition of the field of study; (2) history of hypnosis; (3) the cultural construction of hypnotic theories and the altered states of consciousness; (4) current definitions of hypnosis mechanisms (suggestion, suggestibility, and expectation); (5) efficacy of clinical hypnosis (recent meta-analyses); (6) the placebo issue (meta-analyses of comparative studies and methodological and clinical problems); (7) expectation as a mediator of hypnosis and placebo; (8) hypnotic phenomena and altered states of consciousness, the “state theories and non-state theories” debate; (9) cultural factors in hypnosis and suggestion, an examination of ethnological research data; (10) hypnotic-­type procedures in health practices among indigenous peoples, a psychological assessment; (11) methodological aspects of the research and use of hypnosis; and (12) ethical aspects of research and use of hypnosis. After the end of the course taught to the first graduate class, we started our second strategic activity: the establishment of a study group, initially formed by students from the first class of the course who wanted to continue studying the topic.

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Then, in 2014, we started the GEHIP (Grupo de Estudos de Hipnose e Estados Alterados de Consciência) (Study Group on Hypnosis and Altered States of Consciousness), an activity linked to our laboratory currently named InterPsi (Laboratório de Estudos Psicossociais: “Crença, Subjetividade, Cultura e Saúde”) (Laboratory for Psychosocial Studies: “Belief, Subjectivity, Culture and Health”) at the IPUSP (www.interpsi.org). GEHIP remains active, and despite the predominance of psychology students, researchers, and professionals, the group has always maintained a multidisciplinary setting, congregating people with training in areas of health like Medicine, Physiotherapy, and Speech Therapy, among others, and in areas such as Engineering, Physics, and Biology. We maintain a maximum number of 15 participants in the group to allow for in-­ depth study of the themes, despite receiving hundreds of requests for participation. The group used to meet fortnightly and, since 2020, on a monthly basis, with scheduled readings every semester. The texts chosen are usually studied by pairs or trios who present their content at the meeting when it is discussed by all participants. Just as an illustration, in the first half of 2022, the study group will read/study four chapters of the Handbook of Clinical Hypnosis (Lynn et al., 2010). In addition to the studies carried out, an important mission of the study group is to promote the technical development of the participants. Although the group started by exclusively focusing on theoretical improvement by reading articles and books on the historical and epistemological foundation of hypnosis, since 2020, the studies have been more directed toward the clinical area and toward the development of participants’ practical skills. Several of the members are health-care professionals and use hypnosis as a clinical tool in therapeutic contexts. In addition, some of the participants also maintain both theoretical and clinical research activities in their master’s and doctoral research projects, as we will detail later. After carrying out the first two activities, the graduate-level course and the creation of GEHIP, we thought that it would be important to turn our attention to undergraduate students, since basic training would have a strong impact on young professionals’ perspectives on hypnosis. So, we planned as a third action a 60-hour introductory course offered at the Institute of Psychology to undergraduate students, as an open elective subject. At USP, open elective courses can be taken by students from all university units, enabling students from other majors to attend the course. Thus, the undergraduate-level course Hypnosis and Altered States of Consciousness: Psychosocial and Cultural Aspects was offered in 2015. There were originally 50 spots for enrollment, half of them for Psychology students and the other half for students of any undergraduate majors at the university. However, surprisingly, we had more than 200 applications from students from practically all USP units. We increased the number of spots to 80 and mainly admitted students from the health areas. Since 2015, the course has been regularly offered every year and a half, reaching approximately 300 undergraduate students. Although the content of the undergraduate course offered was similar to the graduate course mentioned before, undergraduate course syllabus mainly focused on psychological, neurological, and cultural basic processes linked to hypnosis. Thus, although the graduate course emphasis centered on empirical studies of

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experimental and clinical hypnosis, the undergraduate course was focused on phenomena such as the ideomotor effect, absorption, dissociation, memory construction, suggestion, placebo, expectation, and hypnotic susceptibility and ethical aspects in research and clinical practice. Classes focused mainly on studies of these themes along with classroom dynamics that reproduced some of those phenomena, such as the use of the Chevreul pendulum to demonstrate the ideomotor effect and the reproduction of memory construction experiments inspired by Elizabeth Loftus’s studies (ex. Loftus & Pickrell, 1995). A fourth set of activities on hypnosis, also worthy of note, was carried out at USP linked to the area of university extension, which aimed to take the discussion of hypnosis beyond the university. Firstly, we held a conference to discuss the history of hypnosis in Brazil, during the second Jornada do InterPsi (InterPsi Symposium), held in June 2017 at IPUSP, an activity with guest lecturers and open to the public. Secondly, we highlight a 40-hour extension course titled “Hypnosis, Altered States of Consciousness and Psychosocial Aspects,” certified by the USP Pro-Rector of Culture and Extension, which was open to the USP’s students and to the general public, with a total of 50 attendees. That extension course was held during the second half of 2018 and had four thematic modules: 1. The field of hypnosis – history and general theories, in which we covered concepts/topics as suggestibility, hypnosis, hypnotism, the birth of psychotherapy, stage hypnosis, hypnotic phenomena, and the subject of culture 2. Hypnosis and consciousness, in which we covered the topics neuroscience, mechanisms, hypnotizability, explanatory hypotheses of some phenomena, the problem of conscience, individual differences in hypnotic response, sociocultural factors in the difference to the hypnotic response, and the question of hypnotic “induction” and its effects 3. Contemporary research, which covered hypnotizability and its consequences, clinical efficacy, hypnosis as a research methodology in neurosciences, mind-­ body interactions, and memory 4. Technology and applications, which covered health and clinical use, sport, and performance The fifth area of hypnosis development falls strategically within the scope of research. Some young researchers  – some of them attended the activities mentioned – started to develop postgraduate research on hypnosis at IPUSP. We briefly present three of them as prominent examples in the next paragraphs. As a student of the Social Psychology Graduate Program and having Prof. Wellington Zangari as advisor, Guilherme Rodrigues Raggi Pereira developed a master thesis titled “Translation and adaptation of two hypnotizability assessment scales.” His research aimed to assess two scales, namely, the Harvard Group Scale of Hypnotic Susceptibility, Form A and the Stanford Scale of Hypnotic Susceptibility, Form C, to make them available in Brazilian Portuguese to be used in Brazil. In addition to translating and culturally adapting the scales to Brazilian Portuguese in his thesis, Pereira also discussed translation procedures of instruments such as these

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and pointed out as future developments validation and standardization studies of those scales to be used with the Brazilian population (Pereira, 2017). Another research titled “Effects of meditation and blood of hypnotic suggestion on telomerase activity in peripheral mononuclear cells” was carried out by Anderson Josué Corrêa de Paula Santos for his Ph.D. in Experimental Psychology with Prof. Marcelo Fernandes da Costa as his advisor and Prof. Wellington Zangari as co-­ advisor. In a longitudinal experimental study, Santos aimed to compare the effects of meditation and hypnosis on the health of volunteers who underwent those practices, using telomerase activity (TA) of peripheral blood mononuclear cells (PBMCs) as a biomarker. Participants (N = 14) were randomly assigned to four groups named according to the intervention used: (1) hypnosis, (2) meditation, (3) relaxation (a positive control for the expectations toward meditation), and (4) control group (no intervention). Each volunteer underwent 4 months of daily interventions by means of previously recorded instructions. They also answered questionnaires on health and psychophysical aspects to assess expectations and well-being whose data analysis deepens general results discussion. Analysis of TA viable cells was done with the TRAPeze XL commercial kit’s protocol. As a result, no significant differences were found among groups in terms of TA after interventions. However, participants reported health improvement and other positive effects understood as resulting from interventions (meditation, hypnosis, and relaxation techniques). Findings are not conclusive but raise new questions to be investigated (Santos, 2019). The third research we would like to mention is still in progress, developed as doctoral research in Social Psychology by Vitor Villar Scattone, with Dr. Leonardo Breno Martins as advisor. Scattone and Martins are GEHIP members. Scattone’s experimental research project titled “Hypnotizability and psychological reactance: possible predictors of placebo response in pain?” is composed of two studies. The first study consists of measuring participants’ level of hypnotizability and reactance and also of assessing their opinions about hypnosis. Participants who score at the extremes of the hypnotizability and reactance scales will be invited to a second study. In the second study, they will be exposed to painful stimuli while the experimenter gives different information to modulate their expectations of the next stimulus. Pain perception and cardiac variability will be measured throughout the procedure. The objective is to test the hypothesis that levels of hypnotizability or reactance may predict the degree of placebo, nocebo, and open-label placebo responses the participant presents when the information about the painful stimuli to which they will be exposed is manipulated (Scattone, In Progress). Bibliographic studies and activities carried out by GEHIP are moving toward clinical interventions, as mentioned. Such clinical activities must start with research to support the interventions to be offered at the clinic of the Institute of Psychology at USP.  At this point, the idea is to evaluate the effectiveness of hypnosis as an adjunct in the treatment of fibromyalgia cases with pain resistant to conventional treatments. If results indicate significant effectiveness of hypnosis in such cases, it will be possible to offer care for patients with this profile at the IPUSP clinic.

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11.4 Final Remarks In conclusion, considering the information and the situation described, we present some reflections about the challenges to hypnosis as a study area in Brazil and some actions we consider necessary to overcome them. Firstly, it would be advisable to have an entity that could bring together professionals of hypnosis who are engaged in the academy. This would facilitate networking among researchers, which would make research activity less regionalized and more organized around broader themes and needs. Although research activity seems to be on the rise, usually researchers do not communicate with each other. However, this does not mean there is a lack of research. Despite still being low in numbers compared to other fields, the gradual increase of publications (articles and books) on hypnosis research in recent years is remarkable. But those efforts are often made by individuals working separately. As in other fields, collective research work would be an important tool for the development of the field especially for the possibility of having data collections from different contexts. Furthermore, the analysis of those data would benefit from the possibility of employing distinct regional perspectives. Secondly, it is important that hypnosis training be part of the health professional’s university training. As pointed out, hypnosis training programs offered are usually taught by people with no academic background, which consequently leads to poor student training. Our experience at the Institute of Psychology – University of São Paulo demonstrates that there is a repressed demand from professionals and students interested in hypnosis and that there is still an open field to be explored academically. Academic training in hypnosis would likely result in a gradual improvement of courses offered by private institutions, since there would be a greater number of competent teachers and a greater demand for quality on the part of those interested in hypnosis training. Lastly, Brazil still lacks a journal dedicated to hypnosis studies. Despite some meritorious efforts in the past, none of the hypnosis journals published achieved scientific and academic relevant status in Brazil. Hypnosis researchers usually publish their papers in journals with general interests in Psychology, Psychiatry, or Physiotherapy, for example. Disseminating information about hypnosis studies in generalist journals is important, but that makes hypnosis researchers work often dependent on the interest of the journal’s editorial line – what commonly represents the editor’s interest, knowledge, and openness (or not) regarding hypnosis  – to define whether something about hypnosis will be published. Paradoxically, whereas there is great interest in hypnosis on the part of health professionals in Brazil, universities in general do not offer the necessary support for development of teaching and research in that field of study. The scenario is even more paradoxical because, as mentioned, several professional boards consider hypnosis a therapeutic tool. There is a dangerous mismatch between training and using hypnosis that makes room for a plethora of low-quality training programs that offer quick and uncritical, yet expensive, training. However, with rare exceptions, there

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are no consistent and persistent efforts by individuals and/or groups to establish teaching and research programs at prestigious universities in Brazil. This could be explained by the lack of previous good academic training in hypnosis on the part of the hypnosis teachers – a kind of vicious circle difficult to be broken by initiatives of a few individuals. Considering that, it would be desirable that at least some scholars from prestigious national universities created a joint work aiming to overcome the problem of training in hypnosis, in other words a working group that could plan the basic/common syllabus of the hypnosis training program and that could work toward the development of the field in an integrated way. In Brazil, there is a wide variety of perspectives and applications of hypnosis. It is common, for example, that a research group maintains a primary interest in clinical uses of hypnosis, while another is focused on experimental studies with hypnosis. Furthermore, there is a wide variety of theoretical perspectives underlying the use of hypnosis. This multiplicity can be seen as something very rich that allows the emergence of equally significant ways for the development of hypnosis so that such differences must be respected in collaborative works among groups. On the other hand, we know that those differences also represent a great challenge to be overcome because for collaborative actions to occur, it is necessary to find common points of interest and, sometimes, to give up what is particularly important to a group or person. Variety of perspectives should not prevent collaboration, should not make each group be closed at its own interests and perspectives. For the collaborative work proposed, it may be necessary to give up some private interests in order to privilege common central themes and common challenges that must be overcome by all and to plan necessary actions to be carried out collectively pro-development of the study and use of hypnosis in a coordinated way in Brazil. Therefore, besides the recognition of the rich diversity of perspectives and the potential for creativity inherent to it, it is essential to consider what is necessary for developing the field as a whole in the Brazilian scenario.

References Conselho Federal de Enfermagem. (2018). Resolução COFEN n° 581/2018  – Alterada pela Resolução COFEN no 625/2020 e Decisões COFEN N°s 065/2021 e 120/2021. Retrieved from http://www.cofen.gov.br/resolucao-­cofen-­no-­581-­2018_64383.html Conselho Federal de Enfermagem. (2021). Parecer de Câmara Técnica no 0054/2021/CTLN/ DGEP/COFEN. Retrieved from http://www.cofen.gov.br/parecer-­de-­camara-­tecnica-­ no-­0054-­2021-­ctln-­dgep-­cofen_98095.html Conselho Federal de Fisioterapia e Terapia Ocupacional. (2010). Resolução N°. 380/2010  – Regulamenta o uso pelo Fisioterapeuta das Práticas Integrativas e Complementares de Saúde e dá outras providências [Regulates the use by physiotherapist of integrative and complementary health practices and other provisions]. Retrieved from https://www.coffito.gov.br/ nsite/?p=3143 Conselho Federal de Fisioterapia e Terapia Ocupacional. (2017). Resolução n° 491, de 20 de outubro de 2017. Retrieved from https://www.coffito.gov.br/nsite/?p=8749

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Conselho Federal de Fonoaudiologia. (2020). Parecer CFFa no 45, de 15 de fevereiro de 2020. Retrieved from https://cffa-­br.implanta.net.br/PortalTransparencia/Publico/ArquivosAnexos/ Download?idArquivoAnexo=fd9435fd-­af7a-­49d6-­a757-­a726dc06c0ce Conselho Federal de Medicina. (1999). Processo-Consulta CFM no 2.172/97. Retrieved from https://sistemas.cfm.org.br/normas/visualizar/pareceres/BR/1999/42 Conselho Federal de Nutrição. (2021). Resolução CFN no 679, de 19 de janeiro de 2021. Retrieved from https://www.cfn.org.br/wp-­content/uploads/resolucoes/Res_679_2021.html Conselho Federal de Odontologia. (2008). Resolução CFO-82, de 25 de setembro de 2008. Retrieved from https://www.ufpb.br/nephf/contents/documentos/resolucoes/homeopatia/ resolucao-­cfo-­2008 Conselho Federal de Psicologia. (2000). Resolução CFP no 013/00 de 20 de dezembro de 2000. Brasília. Retrieved from http://site.cfp.org.br/wp-­content/uploads/2000/12/resolucao2000_13.pdf Franzoi, N.  L. (2009). Profissão [Profession]. In Fundação Oswaldo Cruz (Ed.), Dicionário da Educação Profissional em Saúde [Dictionary of professional education in health]. Loftus, E.  F., & Pickrell, J.  E. (1995). The formation of false memories. Psychiatric Annals, 25(12), 720–725. Lynn, S.  J. E., Rhue, J.  W., & Kirsch, I.  E. (2010). Handbook of clinical hypnosis. American Psychological Association. Ministério da Saúde. (2006). Política Nacional de Práticas Integrativas e Complementares [National Policy on Integrative and Complementary Practices]. Brasília. Retrieved from https:// bvsms.saude.gov.br/bvs/publicacoes/pnpic.pdf Ministério da Saúde. (2018). Portaria No 702, de 21 de Março de 2018. Retrieved from https:// www.in.gov.br/web/guest/materia/-­/asset_publisher/Kujrw0TZC2Mb/content/id/7526450/ do1-­2018-­03-­22-­portaria-­n-­702-­de-­21-­de-­marco-­de-­2018-­7526446 Ministério da Saúde. (2020). Práticas Integrativas e Complementares (PICS) [Integrative and complementary practices]. Retrieved from https://www.gov.br/saude/pt-­br/assuntos/ saude-­de-­a-­a-­z/p/praticas-­integrativas-­e-­complementares-­pics-­1 Ministério do Trabalho e Emprego. (2002). Classificação Brasileira de Ocupações [Brazilian classification of occupations]. Retrieved from http://www.mtecbo.gov.br/cbosite/pages/informacoesGerais.jsf;jsessionid=HeQEs1qqNJBJw2XePyeuKKlU.slave23:mte-­cbo#2 Pereira, G. R. R. (2017). Tradução e adaptação de duas escalas de avaliação da hipnotizabilidade [Translation and adaptation of two hypnotizability assessment scales] [Master’s thesis, Universidade de São Paulo]. Biblioteca Digital de Teses e Dissertações da USP. https://doi. org/10.11606/D.47.2017.tde-­24072017-­174315 Poder Executivo. (1969). Decreto-Lei no 938, de 13 de outubro de 1969. Retrieved from https:// www2.camara.leg.br/legin/fed/declei/1960-­1969/decreto-­lei-­938-­13-­outubro-­1969-­375357-­ publicacaooriginal-­1-­pe.html Presidência da República. (1966). Lei n° 5.081, de 24 de agosto de 1966. Retrieved from http:// www.planalto.gov.br/ccivil_03/leis/l5081.htm Santos, A. J. C. de P. (2019). Efeitos da meditação e da sugestão hipnótica na atividade da telomerase nas células mononucleadas do sangue periférico [Effects of meditation and blood of hypnotic suggestion on telomerase activity in peripheral mononuclear cells] [Doctoral dissertation, Universidade de São Paulo]. Biblioteca Digital de Teses e Dissertações da USP. https:// doi.org/10.11606/T.47.2020.tde-­21012021-­003640 Scattone, V.  V. (In Progress). Hipnotizabilidade e reatâncioa psicológica: possíveis preditores da resposta polacebo à dor? [Hypnotizability and psychological reactance: Possible predictors of placebo response in pain?] [Doctoral project, Universidade de São Paulo] Projeto de Doutorado. Programa de Pós-Graduação em Psicologia Social do Instituto de Psicologia da Universidade de São Paulo. Yapko, M. D. (1994). Suggestibility and repressed memories of abuse: A survey of psychotherapists’ beliefs. American Journal of Clinical Hypnosis, 36(3), 163–171. https://doi.org/10.108 0/00029157.1994.10403066

Chapter 12

A Law Regularizing Hypnosis and the Role of Academia in Teaching and Promoting Hypnosis Nir Uziel

and Ilana Eli

12.1 Introduction With its ancient roots, hypnosis has been accepted as a scientific and medical tool in modern medicine. Even though there is a diversity of theories as to the nature of hypnotic phenomena, there is no doubt that hypnosis is a powerful therapeutic tool for medicine and dentistry. Erickson and Rossi viewed hypnotherapy as “a process whereby we help people utilize their own mental associations, memories and life potential to achieve their own therapeutic goals.” While this definition was initially meant to cover the utilization of hypnosis in hypnotherapy, this definition successfully conveys the principles of hypnotherapy in the medical and dental setting (Eli, 2020). Hypnosis has long moved away from the myths and mystery that have been surrounding it for decades. The constantly increasing number of reports on hypnosis appearing in the scientific literature indicates an enduring willingness on the part of the scientific and clinical communities to use it as therapeutic mode in various clinical settings (Eli, 2016). Israel is one of the unique countries which has regularized the practice of hypnosis under a designated country law.

N. Uziel (*) · I. Eli School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel e-mail: [email protected]; [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9_12

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12.2 The Israeli Law of Hypnosis (Law No. 1120) Until the year 1983, there were no limitations on the practice of hypnosis in Israel. It was practiced both by popular entertainers and by members of the medical professions. In 1975, an unfortunate major mishap occurred during one of the entertaining sessions which resulted in a hospitalization in coma of a 16-year-old girl. The girl eventually returned to consciousness with the help of a psychiatric hypnotherapist (Kleinhauz & Beran, 1981). The case initiated a law regularizing the various aspects of hypnosis which was approved by the Israeli Knesset in 1984. The law regularizes the use and the teaching of hypnosis as a treatment mode in medicine, dentistry, and psychology (https://www.health.gov.il/LegislationLibrary/Nefesh34.pdf). According to the law, only licensed physicians, dentists, and/or psychologists can study and practice hypnosis, each of the professions limited to their area of expertise. The law defines several sub-degrees of licensing: license to practice hypnosis, license to teach hypnosis, license for hypnosis research, and license for using hypnosis during police investigation. In order to implement the law, the Minister of Health appoints a statutory committee (the Minister’s Advisory Committee on Hypnosis – ACH). Members of the ACH are senior hypnosis practitioners and teachers representing the three professions allowed to practice hypnosis by the law (physicians, dentists, psychologists), as well as representatives of the Ministry of Health. The following issues are strictly regulated by the Ministry of Health and the ACH:

12.2.1 Hypnosis Studies and Licensing In order to receive a license to practice hypnosis, the relevant professionals have to complete a course which has previously been confirmed by the ACH.  The basic requirements are as follows: (a) The course is organized and taught by a professional licensed to teach hypnosis, and its curriculum has been approved by the ACH. (b) The course should include a minimum of 35 hours of theoretical studies on the following subjects: history of hypnosis, basic theoretical concepts, preparing a patient for hypnosis, techniques of hypnosis, hypnotherapist-patient relationships, hypnotic-related reactions, indications and contraindications, ways of applying and using hypnosis, law and ethics, and knowledge of the professional literature. (c) Additional minimum of 20  hours should be dedicated to individual or group instruction of clinical cases treated by the candidate (under supervision). Each participant has to treat and present at least three cases. (d) Dentists and physicians other than psychiatrists have to complete an additional 20-hour-long course in basic psychology. Subjects include principles of clinical interview, principles in psychopathology, normal and abnormal behavior, stages

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of psychological development through life span, learning and motivation, classical and operant conditioning, psychosocial aspects of pain, coping skills, anxiety, stress, and burnout. Psychologists and psychiatrists are exempt from this part.

12.2.2 Receiving a License to Practice Hypnosis After completing the required studies, the applicant has to pass an oral examination organized by the Ministry of Health. The requirements are as follows: (a) The applicant has to submit a written recommendation from his/her senior instructors. (b) The applicant has to submit a written case report of a patient treated with hypnotic tools performed under the supervision of his/her instructor or another licensed hypnotist. (c) Finally, the applicant has to appear in front of three members of an examining committee (which comprises at least one member belonging to the discipline of the candidate). Having successfully completed the abovementioned requirements, the candidate receives a license to practice hypnosis from the Ministry of Health. The license is restricted to the practitioner’s field of clinical practice – physicians in medical care, dentists in dental care, and psychologists in psychological treatment. In order to receive a license to teach hypnosis, further studies are required. The candidate must actively practice hypnosis and has to participate in additional four courses in hypnosis (during a period not exceeding 5 years). As a candidate teacher, the candidate is required to teach 35 hours of theory and 20 hours of individual or group instructions on clinical cases, all under the supervision of the course organizer. A recommendation must be sent to the ACH by at least two persons licensed to teach hypnosis with at least one of them in the field of the applicant. Scientific study of hypnosis necessitates an additional specific license to conduct research that uses hypnosis  and an approval from the ACH for each project. A license for use of hypnosis in police investigations can be obtained only by clinical psychologists or psychiatrists. 

12.3 The Role of the Israeli Academia in the Research, Teaching, and Promoting of Hypnosis The making of the law of hypnosis in 1984 was a turning point in the status of hypnosis in Israel. Hypnosis was officially recognized as a potent treatment tool where its use should be regulated and supervised. This in turn led the Israeli universities to

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incorporate the subject in the curricula of the medical and dental studies. Although some private hypnosis courses do exist, most of the teaching moved to the academic institutions. As specified above, the general outline of the courses is defined and controlled by the ACH. While courses outside the universities need to receive an accreditation from the ACH, courses organized by state universities are exempt from this requirement. Nevertheless, most of the official academic institutions expand on the basic demands set by the ACH. Israel has ten official state universities: Tel Aviv University, the Hebrew University of Jerusalem, Bar-Ilan University, Haifa University, Weizmann Institute of Science, Ariel University, Reichman University, Technion – the Israeli Institute of Technology, Ben-Gurion University of the Negev, and the Open University of Israel. Within these institutions act six schools of medicine, two schools of dentistry, and eight programs of psychology. During the clinical years of their studies, most medical students are exposed to integrative clinics within the hospitals, where physicians and psychologists are using hypnotic tools to treat patients (e.g., Multidisciplinary Pain Clinic, Neurological Clinic, Hemato-oncology Clinic). To our best knowledge, hypnosis is usually not part of the official curriculum for the students in psychology but is mentioned sporadically by the lecturers. Bar-Ilan University has a medical school, as well as undergraduate and graduate studies in psychology. The University runs a 2-year postgraduate program for psychologists in hypnotic psychotherapy. Papers on brain mechanisms have been published (Zeev-Wolf et al., 2016, 2017). The Hebrew University of Jerusalem runs a 6-year program in medicine (toward an MD degree) and a 6-year program in dental medicine (toward a DMD degree) as well as undergraduate and graduate studies in psychology. During their studies, within courses of pathophysiology and medical psychology, medical and dental students are exposed to lectures on hypnosis by physicians and dentists who are trained in practicing and teaching hypnosis. Studies on the use of hypnosis in the dental setting, and on its effects on brain mechanisms and pain perception, have been published by faculty members (Sharav & Tal, 1989, 2004; Tal & Sharav, 2005; Zeev-­ Wolf et al., 2016). In the Faculty of Medicine at the Technion, several studies on hypnosis have been conducted, such as the effectiveness of hypnosis in reducing pain and improving secretion of saliva after head and neck radiation and the effectiveness of hypnosis as an adjuvant to medical surgeries (Schiff et  al., 2009; Sroka et  al., 2015). Ben-Gurion University of the Negev has a medical school and a school of psychology. All medical students receive an introduction course in hypnosis. Studies on the effectiveness of hypnosis for alleviating headache and in  vitro fertilization have been conducted (Ezra et al., 2012; Levitas et al., 2006). The largest university in Israel is Tel Aviv University with about 30,000 students. The University has a Faculty of Medicine which includes both a medical and a dental school and a Faculty of Social Sciences which includes a school of psychology. Teaching of hypnosis in the medical and dental schools is described in more detail below.

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12.3.1 Hypnosis Teaching During Medical and Dental Studies: The Case of Tel Aviv University Tel Aviv University runs a 6-year program in medicine (toward an MD degree) and a 6-year program in dental medicine (toward a DMD degree). A big proportion of the first 3-year studies (preclinical studies) are held together for both groups of students. During the last 3 years (clinical studies), the students separate, with medical students acquiring their practical clinical training in hospital wards affiliated with the University and dental students start treating patients, under supervision, at the premises of the dental school. From its early years the dental school at Tel Aviv University acknowledged the importance of hypnosis in dental and medical care. Establishing a special clinic, designated for the treatment of patients suffering from diverse oro-related behavioral dysfunctions, played a major role in integrating hypnosis in the curriculum for graduate and postgraduate dental students. From the very beginning until today the clinic is operated by professionals licensed to practice and teach hypnosis and concentrates on the use of hypnotic tools to treat patients referred from throughout the country. Incorporating hypnosis in the dental studies: 1. During the preclinical years, both medical and dental students are studying courses in medical and dental education, including issues relevant to professionalism and ethics. Besides frontal lectures, some of the teaching is held in small groups which include discussions of personal and ethical issues, practicing interviewing skills, and skills interpersonal communication. The groups are mentored by senior physicians and/or dentists, many of whom are trained and licensed in hypnosis. Thus, the importance of hypnosis and of hypnotic communication tools is prominent in most of the discussions. During the clinical years, the dental curriculum includes an additional 2-year-­ long course in behavioral sciences which is enrolled by psychologists and dentists trained and licensed in hypnosis. During the whole period of studies the role of hypnosis is presented as a tool to enhance personal resources to overcome the challenge of acquiring professional skills, promoting communication skills, reducing the risk of burnout, and treating patients with behavioral and/or emotional difficulties. Interviewing and anamnesis taking exercises are performed and analyzed in front of the class. Students are asked to present clinical cases (including admission, diagnosis, patient management, and treatment) from a behavioral point of view. Notions from hypnosis are incorporated in the discussions. Students are asked to pay attention to patient’s appearance and the way he/she is dressed and communicates and pay attention to his/her body language. One of the aspects is to point out that behind every tooth (or abdomen, leg, etc.) exists a person whose judgment of the treatment is based mostly on the doctor’s behavior. The ability to create good rapport with patients is crucial for both treatment outcome and patient satisfaction.

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One of the goals is to broaden and explain the concept of hypnosis and of hypnotic tools to the students. During clinical instructions, hypnotic tools (such as the use of hypnotic tone and use of proper words and suggestions) are implemented when an anxious and/or a difficult to manage patient(s) is encountered. The advantage of the clinical setting lies in the fact that students can appreciate the way a short hypnotic intervention can elicit positive outcomes. Interventions vary from systematic desensitization (relaxation, gradual exposure) to more profound hypnotic procedures performed by a licensed instructor. Cases range from overcoming exaggerated gag reflex that unable dental care to achieving local analgesia using hypnosis as a sole tool (Eli & Kleinhauz, 1985; Kleinhauz & Eli 1993). On other instances, an instructor demonstrated to a stressed student how hypnosis can be effective in reducing patient’s salivary flow (by imagining a trip in the desert) that prevented taking of an adequate impression. Demonstrations like that serve as a powerful tool to have students (and instructors) understand the potential of hypnosis and get interested in further exploring the subject. 2. Patients who pose exceptionally difficult behavioral problems, which exceed the treatment skills of undergraduate students, are referred to the Clinic of Oral Psychophysiology, designated to treat such cases. In the clinic, an integrative medico-­psychological approach is applied, including more progressive hypnotic techniques, to treat patients suffering from oro-related behavioral dysfunctions, such as extreme dental anxiety and gagging. The clinic is activated by dentists and a medical psychologist, all licensed to practice hypnosis and trained in cognitive behavioral approaches. This multidisciplinary professional team is responsible for the management of patients that arrive to the clinic from all over the country. The medico-psychological approach applied during diagnosis and management of patients is pivotal and unique and in most of the cases includes the use of hypnosis (Kleinhauz et al., 1985; Kleinhauz & Eli, 1991). Most of the cases are focused in reducing the patient’s anxiety and are based on relaxation, positive reinforcement, systematic desensitization, hypnosis, post-­ hypnotic suggestions, and ego-strengthening. In severe cases, hypno-dissociative strategies are used. In some cases, hypnosis is used as sole anesthetic for different treatments (obturation, root canal filling and extraction). In some cases, hypnosis is used as an adjuvant to nitrous oxide sedation. For example, the team uses hypnosis to alleviate gagging in dental patients through deep relaxation and incorporated process of systematic desensitization carried out in vivo, at the dental chair. Eli and Kleinhauz (1985) presented cases where the gag was identified as a learned avoidance reaction originating from former aversive encounters with treatment. When symptomatic gagging is defined as a defense mechanism, hypnosis is used to achieve relaxation together with suggestive procedures aimed to separate the psychodynamic conflict from the gagging symptom. In one case, the conflict was of a sexual nature in which intrusion of dental instruments into the mouth had a symbolic oral sexual meaning, and in another case, the patient suffered from a dependence-­ independence conflict. Some of the other successfully treated cases include tardive

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dyskinesia, excessive preoccupation with the tongue, bruxism with inability to support night guard, fear of injection, fear of the clinic sounds, continuous feeling of numbness after mandibular block, and many others. Some of the patients who are suffering from severe dental phobia along with actual or assumed traumatic background may present symptoms resembling those of post-trauma. Upon our experience, the use of temporal hypnotically induced dissociation can help dentists to treat such patients by suspending their post-trauma-­ like symptomatic behaviors during dental treatment (Meyerson & Uziel, 2014). As part of the clinical curriculum at the clinical years, students attend the clinic and later present their experiences in front of the whole class. 3. Additional use of hypnosis at the dental school is aimed to reduce student’ personal stress, experienced mostly during the clinical years (Levartovsky et  al., 2021). Students often share their distress during the small group meetings. Certified instructors show students ways to use their own resources and to improve their clinical performance by imagining the procedures and enhancing their feeling of success. These are accompanied with stress reduction techniques. During the first stage of the COVID-19 pandemic, when students were isolated, meetings were performed digitally. Guided imaginary hypnotic training and ego-­ strengthening methods were used to ease students’ coping with the difficult period. The fact that hypnotic relaxation techniques are commonly used and students experience positive experiences increase their interest in hypnosis and their perception of hypnotic tools as useful both in clinical practice and for personal use. This motivates many of them to study further, get a license, and/or refer patients to treatments that involve hypnosis. It is our belief that once students are exposed to the benefit of hypnosis at an early stage of their professional lives, they will use the tools also after graduation. Students who wish can continue their studies toward an MSc degree which includes additional courses on the biological and behavioral aspects of the dental patient, including the advantages of hypnosis in clinical settings. A designated course in hypnosis, according to the recommendation of the law and the AHC, is available for those interested in getting a license to practice hypnosis independently. 4. Designated hypnosis courses: Both the dental and medical schools run designated courses of hypnosis on a yearly basis. The courses are aimed to physicians, dentists, and psychologists. The fact that participants belong to different disciplines enables them an exposure to different aspects of hypnotic clinical treatment. Participants present various cases in front of the whole group which not only enrich their knowledge but also enable various points of view.

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12.3.2 Demonstrative Cases Treated at the Clinic of Oral Psychophysiology (Including Student Participation) Unidentified Trauma A 27-year-old single female suffering from extreme fear of injections (Meyerson & Uziel, 2014) reported that she is afraid of dental treatment in general (not only injections). The fear has prevented her from receiving adequate dental care since she was a child. Initial oral examination indicated an urgent need of a root canal treatment. During the first appointment, she started to cry on the dental chair, curled up into a fetal position, and refused to continue treatment. Hypnotically enhanced desensitization, relaxation, and cognitive restructuring techniques were attempted with no success. A comprehensive interview with a clinical psychologist did not yield a significant advancement. The traumatic-like reaction of crying, curling up, and avoiding dental treatment persisted for few sessions without progress. At this point a hypnotically induced dissociative technique was suggested in order to temporarily alleviate the symptomatic behavior and facilitate dental treatment. Hypnotic trance was initiated using pleasant memories of a trip to the desert of Australia and her love of horses. The patient was encouraged to imagine herself horseback riding in Australia. After being sufficiently immersed in the experience, the patient was instructed to “…put all (her) old worries, unpleasant feelings, anxieties that arise in association with dental treatment into an old crate, lock it and to keep the key until it is needed.” At the end of the session, the patient was given post-­ hypnotic suggestions to “…leave the unpleasant past experiences in the crate, thus allowing an opportunity to experience healing of the teeth and mouth.” During the next visit, the patient was very task-oriented. During the hypnotic trance, she insisted on receiving an injection and commencing treatment. The temporary hypnotically induced dissociation (THID) of the “old crate” was again initiated. Dental treatment was enabled with no further behavioral manifestations of fear or anxiety. Two additional appointments were carried out, using the THID technique to reinforce the behavioral change. Further treatment was enabled with no further complications. In that case, the hypnotically induced metaphor was used to dissociate supposedly post-traumatic emotional reactions from dental situational cues. This made the dental treatment feasible and positively cued to a familiar and calming experience. Father’s Teeth A 40-year-old single female reported a high fear of dental treatment since childhood (Meyerson & Uziel, 2014). Oral clinical inspection revealed general periodontitis including oral malodor and a need for multiple restorations, extractions, and root canal treatments. The patient described that during childhood, her father underwent several surgeries due to suspected cleft palate and gingival problems. She recalled that the father was “dripping blood from his mouth.”

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During her first appointment, she refused to leave the waiting room. A systematic desensitization combining hypnosis was carried out, along with the use of nitrous oxide. Following 20 sessions (!), only a minor progress was evident. At this point, a THID technique was used to temporarily alleviate the symptomatic behavior. Hypnosis was induced, and the patient was given a suggestion to imagine her father sitting in an adjacent dental chair. She was asked to see that “…the sick father from childhood is sitting on the chair from her childhood. Slowly the chair and everything connected to it is drawn away…blurred…and eventually she finds herself treated in the present on the ‘grown-up’ dental chair….” At the end of the session, the patient was given post-hypnotic suggestions that “…from now on when you need dental management you can find yourself sitting in an appropriate ‘grown up’ dental chair in an appropriate dental clinic, without any distractions from your past experiences and memories. And if, in the future, you need to deal with these or other matters from your past, you can do so at an appropriate time and appropriate place.” The dissociative technique was used during two more consecutive appointments to strengthen the change in behavior. In subsequent treatments, the patient successfully underwent extractions and fillings with no signs of phobic reaction. In this case, the child’s identification with her father’s suffering, amplified by visual memories of his bleeding teeth, transformed the patient’s dental experience into a harsh and fearful event. Hypno-dissociative intervention to separate the actual grown-up dental treatment from the traumatic childhood memories paved the way for her to receive appropriate dental care. Needle Phobia A 30-year-old man was referred to the clinic by a family physician with complaints of needle phobia. He expressed his distress through sentences such as “I feel dizziness even before getting the injection, already when I smell the odor of the alcohol”; “even thinking, talking or seeing a medical procedure make me feel dizzy”; “I am not able to receive vaccines, dental treatments or undergo blood tests”; and “I am afraid to die.” During the last 12 years, he has not received any dental treatments nor blood tests or vaccines. He arrived to the clinic with an urgent need for several fillings and an extraction of a wisdom tooth. At first, he was very nervous and agitated, holding the dental chair with his two hands. In the first appointment, he was looking for the exit in case he faints. Following his demand, the distraction technique that was used was music. Then, a gradual exposure to pictures of needles was performed in the clinical setting, and he was instructed to further exercise it at home. In order to avoid fainting, he was instructed to pay attention to signs preceding fainting. We used techniques that aim to prevent fainting by augmenting blood pressure with hand and leg muscle contraction. In addition, he was told to hold and press special balls that agitate the palms. He was motivated to repeat those exercises at home. Following three appointments, he was able to receive vaccines and undergo blood test while exercising the

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techniques he had learned. Later, a filling of a lower molar tooth which included a mandibular block was performed. This successful treatment was achieved through a carefully planned and applied medico-psychological intervention. Hypnotically submitted desensitization which included healing metaphors was presented and adapted by the patient in the newly acquired atmosphere of trust and mutual respect. Extreme Gag Reflex A 36-year-old man was referred to our clinic with complaints of extreme fear and a severe gag reflex. During the years he has not accepted any dental management and was in an urgent need of restorations and a root canal treatment. “I can’t brush my teeth,” “I can’t even chew the food,” “I feel immediately like vomiting…” he proclaimed before he climbed a dental chair. At examination, the gag reflex appeared when touching with a dental mirror the outside part of his upper incisor. The patient recalled being taken for dental treatment at the age of 6 years old where the dentist behaved aggressively and did not put attention to his complaints. When he refused to go to the dentist again, his fear was ridiculed by his father and family. Carefully planned and applied medico-psychological intervention included a hypnotic induced age regression technique in which the father was now supportive and the dentist was empathic and attentive. At the end of the session, no gagging was observed, and a week later, the patient reported being able to chew his food and to brush his teeth with no complaints of gagging whatsoever.

12.3.3 Selected Research in Hypnosis Performed by the Israeli Academia Many of the Israeli academic institutions give attention to the integration of hypnosis in their curriculums. Concomitantly, research in the field is carried out which results in a significant body of knowledge (Abramowitz & Lichtenberg 2009, 2010; Arnon et  al., 2017; Bonshtein et  al. 2005; Lotan et  al. 2015; Lichtenberg et  al. 2008a, b, 2009; Navon 2014; Shaoul et al. 2009; Sroka et al. 2015; Zalsman et al, 2001; Zeev-Wolf et  al., 2016). Some of the papers present theoretical models of interventions or relevant case reports. Others scientifically compare the effectiveness of hypnosis to other interventions. The third group tries to reveal the brain mechanisms involved with hypnosis. Abramowitz and Lichtenberg (2010) show that many combat veterans with post-­ traumatic stress disorder (PTSD) have an olfactory component to their traumatic memories that might be utilized by a technique called hypnotherapeutic olfactory conditioning (HOC). In the study, 36 outpatients with chronic PTSD, featuring

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resistant olfactory-induced flashbacks, were treated with six 1.5-hour sessions using hypnosis. The authors used the revised Impact of Event Scale (IES-R), Beck Depression Inventory (BDI), and Dissociative Experiences Scale (DES) as outcome measures. Significant reductions in symptomatology were recorded by the end of the 6-week treatment period for the IES-R, as well as for the BDI and the DES. Improvement was maintained at 6-month and 1-year follow-ups. Use of medication was curtailed. HOC shows potential for providing benefit to individuals suffering from PTSD with olfactory components. Galili et  al. (2009) present that functional chronic recurrent abdominal pain (FCRAP) is a long-lasting, intermittent, or constant pain which affects 15–30% of children aged 4–18 years and presents a diagnostic and treatment challenge to the physician. In the study, 17 patients who met the criteria for FCRAP patients underwent a one single session of hypnosis. In 14 of the adolescents, all clinical symptoms resolved. Hypnosis was not effective in three cases, in whom secondary gain was probably responsible for their symptoms. No side effects have been noted during and after the study. Ezra et al. (2012) present a study in which patients presenting to the headache clinic with a diagnosis of tension-type headache that justified prophylactic therapy (frequent episodic or chronic) were given the choice of amitriptyline (AMT) treatment or hypnotic relaxation (HR) and were treated accordingly. Patients were given the option to cross over to the other treatment group at each visit. HR was performed during standard length neurology clinic appointments. Seventy-four percent of the patients in the HR group and 58% of patients in the AMT group had a 50% reduction in the frequency of headaches. Long-term adherence to treatment with HR exceeded that of AMT. HR treatment was a more popular choice among patients, they reported greater symptom relief than those choosing AMT and were found to have greater treatment compliance. Patients receiving HR were less likely to change treatments. The study of Levitas et al. (2006) aimed to investigate whether hypnosis during embryo transfer (ET) contributes to successful IVF (in vitro fertilization)/ET outcome. Ninety-eight IVF/ET cycles with hypnosis during the ET procedure were matched with 96 regular IVF/ET cycles. Results showed 52 clinical pregnancies out of 98  cycles (53.1%) with an implantation rate of 28% among hypnosis IVF/ET cycles and 29 out of 96 (30.2%) clinical pregnancies and an implantation rate of 14.4% in the control cycles. The overall IVF program pregnancy rate for the same period was 32.1%. Logistic regression analysis emphasized the positive contribution of hypnosis to the IVF/ET conception rates. Sharav and Tal (1989), studied Masseter inhibitory periods and sensations evoked by electrical tooth-pulp stimulation in subjects under hypnotic anesthesia. Sensation and masseter inhibitory periods (MIP) to electrical tooth-pulp stimulation were recorded under hypnotic anesthesia and placebo to local anesthesia. In the first experiment, eight subjects were tested for the effect of hypnotic anesthesia on sensory detection and MIP at non-painful stimulus levels and painful levels. Hypnotic anesthesia blocked sensation without interrupting the initiation of the early component of the MIP but did suppress its late component. In the

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second experiment, eight subjects were tested for the perceived intensity of five levels of electrical tooth-pulp stimulation under hypnotic anesthesia and placebo. Sensory intensity was measured by the visual analog scale (VAS). Hypnotic anesthesia was significantly more effective than placebo in reducing sensation. The differential effect of hypnotic anesthesia on the early and late component of the MIP lent further support to the hypothesis that hypnotic anesthesia operates primarily at supra-­segmental, higher levels in the brain. Sharav and Tal (2004) presented a study in which generalized relaxation and focused analgesia were induced in high-hypnotizable (HH) and low-hypnotizable (LH) subjects. Pain intensity and unpleasantness were rated on visual analog scales in response to painful electrical stimuli. The authors found that both focused analgesia and generalized relaxation significantly decreased pain intensity. However, stimulus intensity response curves differed under the two hypnotic conditions. As stimulus intensity became higher, pain reduction was enhanced under focused analgesia, while a constant reduction occurred under generalized relaxation. The interaction between hypnotic state and stimulus intensity was significant for focused analgesia but not for generalized relaxation, and the difference became more pronounced for HH subjects. Pain reduction was significantly higher in HH than in LH subjects under focused analgesia. The authors concluded that by utilizing two modes of hypnotic suggestions in response to ascending stimuli, there are two components of hypnotic analgesia. One shows a parallel shift in the stimulus-response function, has features similar to placebo, and bears no clear relationship to hypnotic susceptibility. The other shows a slope change in the stimulus-response curve and has a positive relationship to hypnotic susceptibility. Schiff et al. (2009) showed that 12 patients with xerostomia after radiotherapy for head and neck cancer received a single hypnosis session with specific suggestions to increase salivation (preparation of favorite food, waterfall, juicy lemon). The session was recorded, and the participants were instructed to listen to it twice a day for 1 month. Results showed that saliva flow increased and the symptomatic improvement significantly correlated with the number of times the patients listened to the hypnosis. Winocur et al. (2002) performed a study to evaluate the effectiveness of hypnorelaxation in the treatment of myofascial pain disorder (MPD) compared with the use of occlusal appliance and/or to minimal treatment. The study population consisted of 40 female patients with myofascial pain who were allocated to 1 of 3 possible treatment groups: hypnorelaxation, occlusal appliance, and minimal treatment group. Both active treatment modes (hypnorelaxation and occlusal appliance) were more effective than minimal treatment regarding alleviating muscular sensitivity to palpation. However, only hypnorelaxation (but not occlusal appliance) was significantly more effective than minimal treatment with regard to the patient’s subjective report of pain. Zeev-Wolf et al. (2016) used magnetoencephalography (MEG) to investigate and localize brain responses during sensory processing under hypnotic anesthesia. Participants received vibrotactile stimuli to the right and left index fingers in a random sequence. Thereafter, a hypnotic state was induced, in which anesthetic

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suggestion was applied to the left hand only. Once anesthetic suggestion was achieved, a second, identical, session of vibrotactile stimuli was commenced. The authors found greater brain activity in response to the stimuli delivered to the left (attenuated) hand before hypnotic anesthesia, than under hypnotic anesthesia, in both the beta- and alpha-bands. The findings suggest that the brain mechanism underlying hypnotic anesthesia involves top-down somatosensory inhibition and, therefore, a reduction of somatosensory awareness. The result of this mechanism is a mental state in which individuals lose bodily sensation. Zeev-Wolf et al. (2017) used hypnotic suggestion to manipulate the subjective experience of self-location. The brain activity of 18 right-handed participants was recorded using MEG, while their subjective experience of self-location was hypnotically manipulated. Spectral analyses were conducted on the spontaneous MEG data before and during an induction of an out-of-body experience by a trained psychiatrist. The results indicate high correlations between power at alpha- and high-­ gamma-­ frequency bands and the degree of perceived change in self-location. Regions exhibiting such correlations include temporal-occipital regions, the rTPJ, as well as frontal and midline regions. The findings are in line with an oscillatory-­ based predictive coding framework.

12.4 Conclusion Hypnosis is defined as an altered state of consciousness characterized by markedly increased receptivity to suggestion (Barber, 1996) or a procedure during which a health professional or researcher suggests that a patient or subject experience changes in sensations, perceptions, thoughts, or behavior (APA, 1994). Hypnosis enables muscle relaxation which inevitably leads to a decrease in the subject’s stress response. It affects also involuntary muscles, controlling the respiratory, alimentary, and cardiovascular systems. During hypnosis, one can achieve alterations in physical senses (e.g., sight, smell, hearing, pain) and achieve alterations in mental activity, reduction in critical thinking, and higher susceptibility to persuasive communication from others or from self. All these make hypnosis a potent treatment tool in various aspects of the medical, dental, and psychological professions. For example, the ability of hypnosis to manage pain has a relatively solid evidence base. A meta-analysis of 18 studies revealed a moderate to large hypno-analgesic effect, supporting the efficacy of hypnotic techniques for pain management (Montgomery et al., 2000). Hypnosis reduces burnout, enhances empathy toward patients, and plays a major part in the patient-­ centered approach (Ruysschaert, 2009; Wickramasekera & Szlyk, 2003). The idea that the use of such a potent tool should be regularized is of great importance. Distancing hypnosis from popular and potentially deleterious use for entertainment is an important step toward securing it as a professional therapeutic modality. The law in Israel limits the practice of hypnosis to physicians, dentists, and psychologists. During the writing of this chapter, discussions are held to expand

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the law to additional caretaking professions such as nurses and clinical social workers. The synergy between major medical centers and clinical wards and the academic institutions benefits both fields. The mutual synergism enables more options to the patient, promotes a healthier outcome, and facilitates academic research. The importance of hypnosis in medical and dental education is acknowledged by most universities in Israel. It should be acknowledged by all academic institutions involved with training of future physicians, dentists, psychologists, and other caretakers such as pain nurses.

References Abramowitz, E. G., & Lichtenberg, P. (2009). Hypnotherapeutic olfactory conditioning (HOC): Case studies of needle phobia, panic disorder, and combat-induced PTSD. International Journal of Clinical and Experimental Hypnosis, 57(2), 184–197. Abramowitz, E.  G., & Lichtenberg, P. (2010). A new hypnotic technique for treating combat-­ related posttraumatic stress disorder: A prospective open study. International Journal of Clinical and Experimental Hypnosis, 58(3), 316–328. Arnon, Z., Attias, S., & Schiff, E. (2017). The role of hypnosis in multidisciplinary teams in a medical center. Contemporary Hypnosis & Integrative Therapy, 1(1), 32. APA. (1994). The executive committee of the American psychological association–Division of Psychological Hypnosis. https://www.apa.org/topics/psychotherapy/hypnosis. last accessed 12.14.22 Barber, J.  E. (1996). Hypnosis and suggestion in the treatment of pain: A clinical guide. WW Norton & Company. Bonshtein, U., Shaar, I., & Golan, G. (2005). Who wants to control the habit? A multi‐dimensional hypnotic model of smoking cessation. Contemporary Hypnosis, 22(4), 193–201. Eli, I. (2016). Hypnosis as a treatment modality for chronic pain management: Level of evidence. Journal of Oral & Facial Pain and Headache., 30(2), 85–86. Eli, I. (2020). Oral psychophysiology: Stress, pain, and behavior in dental care. CRC Press. Eli, I., & Kleinhauz, M. (1985). Hypnosis: A tool for an integrative approach in the treatment of the gagging reflex. International Journal of Clinical and Experimental Hypnosis, 33(2), 99–108. Ezra, Y., Gotkine, M., Goldman, S., Adahan, H. M., & Ben-Hur, T. (2012). Hypnotic relaxation vs amitriptyline for tension-type headache: Let the patient choose. Headache: The Journal of Head and Face Pain, 52(5), 785–791. Galili, O., Shaoul, R., & Mogilner, J. (2009). Treatment of chronic recurrent abdominal pain: Laparoscopy or hypnosis? Journal of Laparoendoscopic & Advanced Surgical Techniques, 19(1), 93–96. Kleinhauz, M., & Beran, B. (1981). Misuses of hypnosis: A medical emergency and its treatment. International Journal of Clinical and Experimental Hypnosis, 29(2), 148–161. Kleinhauz, M., & Eli, I. (1991). Hypnotic induction in dentistry–coping with the fear of losing control (autonomy). International Journal of Clinical and Experimental Hypnosis, 39(3), 125–128. Kleinhauz, M., & Eli, I. (1993). When pharmacologic anesthesia is precluded: the value of hypnosis as a sole anesthetic agent in dentistry. Special Care in Dentistry, 13(1), 15–18. Kleinhauz, M., Eli, I., & Rubinstein, Z. (1985). Treatment of dental and dental-related behavioral dysfunctions in a consultative outpatient clinic: A preliminary report. American Journal of Clinical Hypnosis, 28(1), 4–9. Levartovsky, S., Msarwa, S., Reiter, S., Eli, I., Winocur, E., & Sarig, R. (2021). The association between emotional stress, sleep, and awake bruxism among dental students: A sex comparison. Journal of Clinical Medicine, 11(1), 10.

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Levitas, E., Parmet, A., Lunenfeld, E., Bentov, Y., Burstein, E., Friger, M., & Potashnik, G. (2006). Impact of hypnosis during embryo transfer on the outcome of in  vitro fertilization–embryo transfer: A case-control study. Fertility and Sterility, 85(5), 1404–1408. Lichtenberg, P., Even-Or, E., Bachner-Melman, R., Levin, R., Brin, A., & Heresco-Levy, U. (2008a). Hypnotizability and blink rate: A test of the dopamine hypothesis. International Journal of Clinical and Experimental Hypnosis, 56(3), 243–254. Lichtenberg, P., Even-Or, E., Bar, G., Levin, R., Brin, A., & Heresco-Levy, U. (2008b). Reduced prepulse inhibition is associated with increased hypnotizability. International Journal of Neuropsychopharmacology, 11(4), 541–545. Lichtenberg, P., Shapira, H., Kalish, Y., & Abramowitz, E. G. (2009). Israeli norms for the Stanford hypnotic susceptibility scale, Form C. International Journal of Clinical and Experimental Hypnosis, 57(2), 227–237. Lotan, A., Bonne, O, & Abramowitz, E.  G. (2015). Methylphenidate facilitates hypnotizability in adults with ADHD: a naturalistic cohort study. International Journal of Clinical and Experimental Hypnosis, 63(3), 294–308. Meyerson, J., & Uziel, N. (2014). Application of hypno-dissociative strategies during dental treatment of patients with severe dental phobia. International Journal of Clinical and Experimental Hypnosis, 62(2), 179–187. Montgomery, G.  H., Du Hamel, K.  N., & Redd, W.  H. (2000). A meta-analysis of hypnotically induced analgesia: how effective is hypnosis? International Journal of Clinical and Experimental Hypnosis, 48(2), 138–153. Navon, S. (2014). The illness/non-illness model: Hypnotherapy for Physically Ill Patients. American Journal of Clinical Hypnosis, 57(1), 68–79. Ruysschaert, N. (2009). (Self) hypnosis in the prevention of burnout and compassion fatigue for caregivers: Theory and induction. Contemporary Hypnosis, 26(3), 159–172. Schiff, E., Mogilner, J. G., Sella, E., Doweck, I., Hershko, O., Ben-Arye, E., & Yarom, N. (2009). Hypnosis for postradiation xerostomia in head and neck cancer patients: A pilot study. Journal of Pain and Symptom Management, 37(6), 1086–1092. Shaoul, R., Sukhotnik, I., & Mogilner, J. (2009). Hypnosis as an adjuvant treatment for children with inflammatory bowel disease. Journal of Developmental & Behavioral Pediatrics, 30(3), 268. Sharav, Y., & Tal, M. (1989). Masseter inhibitory periods and sensations evoked by electrical tooth-­pulp stimulation in subjects under hypnotic anesthesia. Brain Research, 479(2), 247–254. Sharav, Y., & Tal, M. (2004). Focused analgesia and generalized relaxation produce differential hypnotic analgesia in response to ascending stimulus intensity. International Journal of Psychophysiology, 52(2), 187–196. Sroka, G., Arnon, Z., Laniado, M., Schiff, E., & Matter, I. (2015). Hypnosis-induced mental training improves performance on the Fundamentals of Laparoscopic Surgery (FLS) simulator. Surgical Endoscopy, 29(5), 1024–1029. Tal, M., & Sharav, Y. (2005). Jaw clenching modulates sensory perception in high-but not in low-­ hypnotizable subjects. Journal of Orofacial Pain, 1, 19. Wickramasekera, I. E., & Szlyk, J. P. (2003). Could empathy be a predictor of hypnotic ability? International Journal of Clinical and Experimental Hypnosis, 51(4), 390–399. Winocur, E., Gavish, A., Emodi-Perlman, A., Halachmi, M., & Eli, I. (2002). Hypnorelaxation as treatment for myofascial pain disorder: A comparative study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 3(4), 429–434. Zalsman, G., Hermesh, H., & Sever, J. (2001). Hypnotherapy in adolescents with trichotillomania: Three cases. American Journal of Clinical Hypnosis, 44(1), 63–68. Zeev-Wolf, M., Goldstein, A., Bonne, O., & Abramowitz, E.  G. (2016). Hypnotically induced somatosensory alterations: Toward a neurophysiological understanding of hypnotic anesthesia. Neuropsychologia, 87, 182–191. Zeev-Wolf, M., Dor-Ziderman, Y., Goldstein, A., Bonne, O., & Abramowitz, E.  G. (2017). Oscillatory brain mechanisms of the hypnotically-induced out-of-body experience. Cortex, 96, 19–30.

Index

A Academia, 3, 96, 126–129, 132, 136–138, 153–156, 161, 174 Hypnosis in Academy, 4 Ancestor, 27–50 B Boundary object, 3, 107–121 C Centuries, 143–151 Communication, 56 Connection, 125–139 Consideration, 107–121 Contemporary universities, 1–6, 28 D Democracy, 3, 27–50 Discover, 34–46 E Education, 3, 14, 15, 19, 22, 24, 28, 34–46, 56, 60, 70, 81, 96–98, 120–121, 146–151, 155, 165–179, 185, 194 Emancipation, 29 Evidence-based, 2, 4, 98, 99, 155, 161, 162

F Formation, 74 Future, 121 H Healthcare, 7 History, 3, 7, 9–12, 17, 19, 20, 27, 34, 45, 54, 60, 79, 102, 126–128, 143, 167, 170, 174, 176, 182 Hypnosis, 1, 7, 27, 53, 59, 83, 87–91, 125, 143, 153, 165, 181 Hypnosis history, 127 Hypnosis in Academy, 12, 174 Hypnosis in Brazil, 165, 171, 173, 176 I Incorporated, 143–151 Institutions, 181–194 Israel, 3, 181–184, 193, 194 Israeli, 184 L Law, 32, 88, 101, 113, 166–168, 170, 171, 181–194 Liège, 56 M Medical Sciences, 59–81, 86 Model, 59, 96, 133, 146, 150, 151

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. S. Neubern, A. Bioy (eds.), Hypnosis in Academia, https://doi.org/10.1007/978-3-031-22875-9

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198 O Oriente, 60 P Palliative, 56 Paulo, 165, 171, 173–177 Philosophy, 3, 18, 19, 47, 48, 53, 112, 113, 115, 117–118, 120, 126 Practice, 165–177 Professionals, 153–161 Psychology, 3, 4, 14, 19, 20, 22, 29, 56, 59, 60, 64, 65, 67, 74, 76, 77, 81, 84, 86–89, 92, 94, 95, 97, 99, 101, 102, 108, 111, 112, 116–118, 120, 125–129, 133, 134, 137, 138, 146, 148, 150, 155, 157, 167, 170, 172–178, 182, 184 Q Qualification, 165–179 R Research, 1–5, 11–15, 19–21, 24, 27–30, 37, 38, 47, 48, 53, 55, 60–62, 65–69, 71, 72, 76–78, 81, 83–87, 89–103, 116, 117, 119, 120, 126–139, 143–151, 154–156, 158, 159, 165–179, 182, 183, 190, 194

Index Research on hypnosis, 56, 84, 100, 135, 139, 154, 176 Russian hypnosis, 148, 150 S Schizophrenia, 116 Sciences, 150 Service, 1–4, 29–31, 34–46, 60, 70, 77 T Theories, 8, 9, 12, 22, 27, 28, 30, 35, 37, 47, 54, 84, 85, 102, 108, 110, 112–114, 120, 126, 127, 132–138, 143–147, 149, 156, 173, 174, 176, 181, 183 Training, 3–5, 10–14, 16, 19–22, 24, 28, 30, 35, 46, 55, 57, 60, 61, 63, 65, 66, 77–79, 86–91, 97, 100, 103, 128, 136, 137, 139, 143, 146, 147, 150, 153–162, 166, 167, 169, 171, 173–175, 178, 179, 185, 187, 194 U Universities, 2–5, 7–24, 28, 29, 36, 37, 41, 43, 46, 53–57, 59–81, 83, 85–103, 107–121, 127–131, 133, 137, 146, 148, 150, 151, 154, 155, 157–161, 165–179, 184, 185, 194