Authors: Brian Wu, MD Candidate, Keck School of Medicine, California, USA; Dr Ebtisam Elghblawi, Dermatologist, Tripoli, Libya. DermNet NZ Editor-in-Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. July 2018.
Hypnosis, or hypnotherapy, induces someone to enter into a 'trance state' using deep breathing and relaxation, meditation and guided imagery. It mandates proper training to deepen the trance state, to psychosomatically lessen pain, and to support healing. Marmer (1959) described hypnosis as a psychophysiological tetrad of altered consciousness, consisting of:
Hypnosis is performed by a trained therapist who uses verbal repetition to create mental images, whereby a state of calm and relaxation is induced to help the patient to cope better with anxiety or pain.
Mental and emotional stress operates along two major pathways in the body:
In dermatology patients, hypnosis can reduce sleep disturbance and the compulsion to itch, and lessen the anxiety, distress and pain due to skin conditions.
The skin develops during embryonic development in utero. Both the central nervous system (CNS) and the epidermis originate from the ectoderm (the outermost layer of cells) and thus the CNS and the skin are strongly connected. Extreme stress can create vulnerability in the CNS, whereby it affects the epidermis. The greater the escalation of the stress, the worse the skin condition may become. Hypnosis can be a remedy to this cycle, by alleviating the stress and distracting the patient from exacerbating the skin condition by scratching.
Hypnosis induction techniques are done for a specific reason; for example, for relaxation, to reduce pain or pruritus, or to modify a habit to assist healing. Hypnosis can aid in three distinct ways: addressing the core of the issue, examining the remission of symptoms, and changing the conditioned response. By visualising vivid and meaningful mental images (such as accomplishing goals or pleasant memories), hypnosis has proven useful in the psychological treatment of several dermatological disorders, particularly those associated with severe itching, pain, or psychological stress.
However, hypnosis continues to be controversial and has limited scientific evidence to support it.
Examples of dermatological conditions that may benefit from hypnosis include:
Patients should be carefully selected for medical hypnotherapy. Hypnosis is not recommended for patients with schizophrenia, an addiction to alcohol, or other severe mental health condition that requires antipsychotic medication.
Hypnosis is reported to:
Hypnosis is an adjunctive therapy to aid symptom control and should not be the primary method of treating skin diseases. Medical hypnotists with appropriate training are not widely available. Informed consent is crucial before proceeding with medical hypnotherapy.
Side effects from hypnosis are uncommon. They can include:
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