Exploring the Underutilized Potential of Clinical Hypnosis: A Scoping Review of Healthcare Professionals’ Perceptions, Knowledge, and Attitudes

ABSTRACT

The perceptions, knowledge, and attitudes of healthcare professionals (GPs, oncologists, nurses, midwives and obstetricians, anesthetists, mental health professionals, and other professionals) toward hypnosis are explored in this scoping review. Despite proven effectiveness in various health conditions, the use of hypnosis in healthcare has stagnated, emphasizing a gap between research and practice. Data from 35 studies (1995–2023) were analyzed, revealing predominantly positive attitudes and interest in training. Professionals with more knowledge and experience had favorable attitudes toward hypnosis compared to those with limited exposure or understanding of the practice. The main obstacles were insufficient time and inadequate training. Considering the growing interest in complementary therapies, the need for education in hypnosis for healthcare professionals is highlighted. Barriers to integration require exploration for a focused research agenda supporting knowledge translation and implementation.

Erforschung des unzureichend genutzten Potenzials der klinischen Hypnose : Eine Übersichtsarbeit über die Wahrnehmungen, Kenntnisse und Einstellungen von Angehörigen der Gesundheitsberufe.

Malwina Szmaglinska, Lesley Andrew, Debbie Massey und Deborah Kirk

Zusammenfssung: In dieser Übersichtsarbeit werden die Wahrnehmung, das Wissen und die Einstellung von Angehörigen der Gesundheitsberufe (Allgemeinmediziner, Onkologen, Krankenschwestern und -pfleger, Hebammen und Geburtshelfer, Anästhesisten, psychiatrische Fachkräfte und andere Berufsgruppen) zur Hypnose untersucht. Trotz nachgewiesener Wirksamkeit bei verschiedenen Gesundheitszuständen stagniert der Einsatz von Hypnose im Gesundheitswesen, was die Kluft zwischen Forschung und Praxis verdeutlicht. Es wurden Daten aus 35 Studien (1995-2023) analysiert, die eine überwiegend positive Einstellung und Interesse an einer Ausbildung erkennen lassen. Fachkräfte mit mehr Wissen und Erfahrung hatten eine positive Einstellung zur Hypnose im Vergleich zu denjenigen, die nur wenig mit der Praxis in Berührung gekommen waren oder sie nur wenig verstanden. Die größten Hindernisse waren Zeitmangel und unzureichende Ausbildung. In Anbetracht des wachsenden Interesses an komplementären Therapien wird die Notwendigkeit einer Hypnoseausbildung für Fachkräfte im Gesundheitswesen hervorgehoben. Die Hindernisse, die der Integration entgegenstehen, müssen im Hinblick auf eine gezielte Forschungsagenda zur Unterstützung der Wissensübertragung und -umsetzung untersucht werden.

Explorer le potentiel sous-utilisé de l’hypnose clinique : Un examen approfondi des perceptions, des connaissances et des attitudes des professionnels de la santé.

Malwina Szmaglinska, Lesley Andrew, Debbie Massey, et Deborah Kirk

Résumé: Les perceptions, les connaissances et les attitudes des professionnels de la santé (médecins généralistes, oncologues, infirmières, sages-femmes et obstétriciens, anesthésistes, professionnels de la santé mentale et autres professionnels) à l’égard de l’hypnose sont explorées dans cette étude exploratoire. Malgré une efficacité prouvée dans diverses conditions de santé, l’utilisation de l’hypnose dans les soins de santé a stagné, soulignant un fossé entre la recherche et la pratique. Les données de 35 études (1995-2023) ont été analysées, révélant des attitudes majoritairement positives et un intérêt pour la formation. Les professionnels ayant plus de connaissances et d’expérience avaient des attitudes favorables à l’égard de l’hypnose par rapport à ceux qui n’avaient qu’une exposition ou une compréhension limitée de cette pratique. Les principaux obstacles étaient le manque de temps et une formation inadéquate. Compte tenu de l’intérêt croissant pour les thérapies complémentaires, la nécessité d’une formation à l’hypnose pour les professionnels de la santé est mise en évidence. Les obstacles à l’intégration requièrent l’exploration d’un programme de recherche ciblé soutenant l’application et la mise en œuvre des connaissances.

Explorando el potencial infrautilizado de la hipnosis clínica : Una revisión exhaustiva de las percepciones, los conocimientos y las actitudes de los profesionales sanitarios.

Malwina Szmaglinska, Lesley Andrew, Debbie Massey y Deborah Kirk

Resumen: En esta revisión se exploran las percepciones, conocimientos y actitudes de los profesionales sanitarios (médicos de cabecera, oncólogos, enfermeras, matronas y obstetras, anestesistas, profesionales de la salud mental y otros profesionales) hacia la hipnosis. A pesar de su eficacia demostrada en diversas condiciones de salud, el uso de la hipnosis en la asistencia sanitaria se ha estancado, lo que subraya una brecha entre la investigación y la práctica. Se analizaron los datos de 35 estudios (1995-2023), que revelaron actitudes predominantemente positivas e interés en la formación. Los profesionales con más conocimientos y experiencia tenían actitudes favorables hacia la hipnosis en comparación con los que tenían una exposición o comprensión limitada de la práctica. Los principales obstáculos fueron la falta de tiempo y la formación inadecuada. Teniendo en cuenta el creciente interés por las terapias complementarias, se destaca la necesidad de formación en hipnosis para los profesionales sanitarios. Los obstáculos a la integración requieren la exploración de una agenda de investigación centrada en el apoyo a la traslación e implementación del conocimiento.

Translation acknowledgements: The Spanish, French and German translations were conducted using DeepL Translator (www.deepl.com/translator).

KEYWORDS:

• Attitudes
• hypnosis
• hypnotherapy
• knowledge
• perception
• views

Introduction

Hypnosis has been researched for its efficacy in various health disorders, including pain (Facco et al., 2018), smoking cessation (Andrean & Makful, 2022), irritable bowel syndrome (IBS) (Palsson, 2015), sleep (Chamine et al., 2018), dentistry (Holden, 2012), colonoscopy (Miller et al., 2011), childbirth (Catsaros & Wendland, 2020), dermatology (Delaitre et al., 2020), cancer care (Elkins et al., 2012; Kravits, 2015; Sohl et al., 2010), hypertension (Jakubovits & Kekecs, 2017), obesity (Milling et al., 2018), hot flashes (Elkins et al., 2008) and migraine headaches (Flynn, 2018). However, despite its effectiveness for many clinical conditions, hypnosis is underutilized for medical purposes, compared to other complementary and alternative medicine (CAM) therapies. For instance, in recent years, cancer centers in the US have begun to offer CAM therapies. Furthermore, there has been a statistically significant increase in the number of cancer center websites that provide information on hypnosis (from 30% in 2009 to 60% in 2016) (Yun et al., 2017). However, this increase is modest compared to the information now available on other CAM modalities. Significantly, despite increasing interest, there has been no rise in the application of clinical hypnosis in healthcare for more than two decades (Clarke et al., 2015; Emslie et al., 2002; Wang et al., 2003). The terms hypnosis and hypnotherapy, often considered synonymous (Abramowitz et al., 2008; PoSA, 2009), are used interchangeably in this review, reflecting this synonymous usage in the literature.

Research reveals that the public generally holds neutral to positive attitudes toward hypnosis, as well as a high level of acceptance for its use in healthcare (Lind et al., 2021; Montgomery et al., 2018; Palsson et al., 2019). Among patients in various healthcare settings, acceptance of clinical hypnosis is also high (Glaesmer et al., 2015; Hollingworth, 2012). However, patients have voiced a lack of support for hypnosis from healthcare professionals and expressed concerns about limited communication about the use of complementary therapies in general (King et al., 2015). In the absence of a standardized approach to these modalities, it would be unreasonable to expect patients to discern which sources are reliable and suitable for their needs (Kittle & Spiegel, 2021).

Despite the proven effectiveness of hypnotherapy for a variety of conditions and its general positive perception among patients, hypnosis has not gained popularity in healthcare (Montgomery et al., 2013). Reluctance may be due to a lack of comprehensive knowledge and understanding of hypnotherapy and its potential applications, or mistrust resulting from the primarily negative portrayal of hypnosis in popular culture (Barrett, 2006; Conn, 1981; Heap, 2000; Wagstaff, 2000). It may also be influenced by the lack of clarity among healthcare professionals on how hypnotherapy fits into the healthcare system. It is difficult to have any certainty, however as the reasons behind this discrepancy have not been thoroughly examined through empirical research.

As healthcare professionals’ knowledge, perceptions, and attitudes toward interventions significantly impact their use in clinical practice, understanding these factors in relation to hypnosis is essential (Snow et al., 2013). While there is existing research exploring the attitudes of healthcare professionals toward hypnotherapy, conducted in various international contexts and across different professions, these disparate findings have yet to be systematically collated and analyzed to provide a comprehensive overview of the field. A significant gap remains in understanding, as individual studies have not been synthesized to draw a more holistic and informed picture of attitudes, knowledge, and perceptions of healthcare professionals toward hypnotherapy. This scoping review aims to address this gap by mapping out current evidence, shedding light on potential facilitators and barriers to its broader adoption in clinical practice.

Materials and Methods

This scoping review, adhering to the JBI guidelines (Peters et al., 2020) and following the PRISMA extension for scoping reviews (PRISMA-ScR) (Tricco et al., 2018), sought to map and analyze research evidence on healthcare professionals’ perceptions and attitudes toward clinical hypnosis. The scoping review was chosen for its ability to capture various aspects of hypnotherapy, including changes over time and differences across locations and professions while identifying knowledge gaps in this broad field (Crilly et al., 2010). Using the scoping review method, key themes on the attitudes of healthcare professionals toward clinical hypnosis were derived inductively from diverse sources of evidence. These themes were then deductively organized into predetermined categories based on distinct healthcare professional groups. This approach, ensuring rigor and consistency, enabled a structured analysis guided by pre-established themes (Pollock et al., 2023).

Search Strategy

A systematic search was undertaken using the following search terms to capture all relevant articles, with TI being “title search”: (TI hypnosis OR TI hypnotherap*) AND (TI view* OR TI perception* OR TI attitude* OR TI opinion* OR TI experience* OR TI belief* OR TI knowledge OR TI interest OR TI misconception*). A separate search was conducted to locate articles on CAM therapies that included information on hypnosis, which contained the terms: (TI complementary OR TI alternative OR TI integrative) with the terms hypnosis/hypnotherapy searched in the abstracts. The articles were searched using controlled vocabulary and medical subject headings (MeSH) descriptors. The relevant literature was identified primarily by searching EBSCOhost (including APA PsycArticles, APA PsycInfo, CINAHL Ultimate, MEDLINE), PMC and ProQuest. Moreover, a Google Scholar search was carried out using identical keyword combinations in the “title only.” The reference lists of eligible articles were examined to identify additional articles that might fit the criteria.

Eligibility Criteria

Studies employing qualitative, quantitative, and mixed-method research approaches were included in this scoping review. All studies assessing healthcare professionals’ attitudes, beliefs, experiences, interests, knowledge, misconceptions, perceptions, opinions, and views of hypnosis or hypnotherapy were selected for subsequent filtering. Studies on CAM therapies that assess hypnotherapy/hypnosis were included, but articles presenting a meta-analysis or literature review were not. In adherence with JBI Scoping Reviews Guidelines (Peters et al., 2020), a rigorous focus was maintained on peer-reviewed literature, chosen for its high-quality standard and reliability in exploring healthcare professionals’ attitudes and perceptions, however, this approach diverged from their recommendation to include gray literature, such as unpublished or non-peer-reviewed works like reports, theses, and white papers. This decision ensured the presentation of the most credible research evidence (Snyder, 2019) relevant to the objective of this exploratory review. The professions selected for this review were not initially predetermined but instead emerged organically from the search and analysis process. The review began with an open search encompassing all healthcare professions, yet the results pointed to specific disciplines as primary groups showing their involvement in clinical hypnosis.

Studies focusing solely on hypnosis as a phenomenon, those dedicated to scale development and validation with minimal relevant information, and those solely reporting on the use of hypnosis without addressing perceptions or attitudes were excluded. Only studies of professionals were included and studies that focused on students (i.e., medical, pharmacy, or psychology) were excluded. Only articles in English and peer-reviewed were included in the results, encompassing all international publications. The date range of 1995–2023 was selected for the search, as this date range represents a period of significant growth in research on perceptions and attitudes toward hypnosis among healthcare professionals.

Study Selection

A multistep filtering process (Table 1: PRISMA ScR) was implemented for the studies. The main database search returned 565 articles, of which, after eliminating duplicates and irrelevant studies, 98 were selected. An additional seven articles were identified from a manual search. The first phase involved screening records by title, and title with abstract, for relevance to the search criteria. Unsuitable articles were excluded at each step, leaving 39 articles from the main databases and 5 from the manual search. In the second phase, full-text articles were closely examined to identify studies that accurately investigated perceptions and attitudes toward hypnosis/hypnotherapy throughout the spectrum of healthcare professions. A total of 35 articles met the set criteria and were incorporated into this review.

Table 1. PRISMA ScR Flow Diagram Illustrating the Literature Filtering and Selection Process.

Results

Perceptions and attitudes toward hypnosis have been researched in various healthcare professionals, including general practitioners (GPs) (Berman et al., 1995; Boutin et al., 2000; Cohen et al., 2005; Easthope et al., 2000; Elkins & Wall, 1996; Goldszmidt et al., 1995; Hall & Giles-Corti, 2000; Pirotta et al., 2000; Verhoef & Sutherland, 1995), oncologists (Haddad et al., 2020; Newell & Sanson‐Fisher, 2000; Pirson et al., 2023), mental health professionals such as psychologists, psychiatrists, and counselors (Desai et al., 2011; Madan & Pelling, 2015; Mendoza et al., 2009; Montgomery et al., 2019; Stein & McCann, 2022), nurses (Brolinson et al., 2001; Carvello et al., 2021; Desai et al., 2011; Görücü & Sayılan, 2021; Hjeij et al., 2022; Stein & McCann, 2022; Thomson, 2003), midwives (Eng & Cyna, 2006; Gaffney & Smith, 2004; McAllister et al., 2017; Mollart et al., 2018), anesthetists (Coldrey & Cyna, 2004; McAllister et al., 2017; Stone et al., 2016), and pediatricians (Sikand & Laken, 1998). How participants perceive hypnosis, including as a part of the overall CAM picture, was the most common objective of these articles (Aveni et al., 2016; Berman et al., 1995; Boutin et al., 2000; Brolinson et al., 2001; Cohen et al., 2005; Easthope et al., 2000; Furlow et al., 2008; Gaffney & Smith, 2004; Goldszmidt et al., 1995; Görücü & Sayılan, 2021; Jafari et al., 2021; Mollart et al., 2018; Newell & Sanson‐Fisher, 2000; Pirotta et al., 2000; Pirson et al., 2023; Sikand & Laken, 1998; Sohn & Loveland Cook, 2002; Verhoef & Sutherland, 1995).

Study Characteristics

The 35 selected articles explored a range of health professions: GPs (n = 9), oncologists (n = 3), nurses (n = 5), midwives and obstetricians (n = 5), anesthetists (n = 2), mental health professionals (n = 2), and pediatricians (n = 1). The remaining 8 studies studied a range of healthcare professionals (n = 8). In addition, studies that examined professionals’ perspectives on a variety of CAM approaches, inclusive of data on hypnosis/hypnotherapy, were also incorporated (n = 21). All studies, except one, used quantitative methodologies. A notable bias was observed toward general practitioners, who were the most researched group, and toward English-speaking countries, primarily the United States (n = 11), Australia (n = 10), and to a lesser extent Canada (n = 3). However, a diverse range of nationalities was also identified with samples from Switzerland, India, Italy, Turkey, Lebanon, Iran, Cuba, Spain, and China.

The average mean number of participants across the 35 studies is approximately 248, suggesting a moderate-to-large sample size in the majority of the studies examined. There is a wide range of participants across the studies, with the smallest study including just 6 participants (in a qualitative study, while 29 participants being the smallest number among quantitative studies) and the largest comprising 1,286, resulting in a range of 1,280. Lastly, it is important to note that there are 8 studies in the review that can be classified as “low N,” meaning they have fewer than 100 participants, suggesting these studies may lack the statistical power to detect small effect sizes (Brysbaert, 2019). Detailed characteristics of the studies can be found in Table 2.

Table 2. Summary.

#	Author & Country	Sample	Methods, Type & Aim	Key Relevant Findings
1	Aveni et al., 2016 Switzerland	Healthcare professionals (n=1247) (physicians, nurses, physical therapists & midwives)	Cross-sectional survey that assessed the attitudes of physicians, nurses, physical therapists, and midwives toward CM and toward its use for treating chronic pain.	Favourability of CM: 96.9% of respondents are in favour of offering CM at the hospital, hypnosis being the most accepted (89.8%). CM Training: 15.8% (196 respondents) have undergone CM modality training. Hypnosis Training: Of those trained in CM, 11.7% specifically received hypnosis training.
2	Berman et al., 1995 United States	Family Physicians (n = 176)	An exploratory survey assessing attitudes toward CAM.	Perception of Hypnotherapy: 73.7% view hypnotherapy as legitimate medical practice, and 30.6% as alternative medicine. Hypnotherapy Usage: 30.8% have used hypnotherapy in practice. Training in Hypnotherapy: 39.8% received hypnotherapy training. Knowledge and Interest in Hypnotherapy: 59.9% have hypnotherapy knowledge; 79.2% are interested in training. Referrals: 20.9% referred patients to physicians; 26.1% to nonphysicians.
3	Boutin et al., 2000 United States	Physicians (n = 85)	Self-administered survey inquiring about physicians’ specialities, patients’ usage of alternative therapies, and their opinions on incorporating these therapies into care plans.	Patient Usage of Hypnotherapy: 5% of respondents have patients who use hypnotherapy. Provision of Hypnotherapy: Only 1% provide hypnotherapy themselves. Recommendation of Hypnotherapy: 15% recommend it, but 21% don’t, and 34% lack enough information to recommend it. Desire for Hypnotherapy Provision: 19% of respondents want hypnotherapy to be provided.
4	Brolinson et al., 2001 United States	Nurses (n = 515)	Cross-sectional survey consisted of 100 items covering 22 CAM therapies designed to ascertain the familiarity, perceptions and knowledge of CAM.	Familiarity with Hypnotherapy: Among CAM therapies, 17% of nurses are unfamiliar with hypnotherapy. Evidence for Hypnotherapy: 17% find no evidence, 27% see growing evidence, 30% see a preponderance of evidence, and 9% find the evidence conclusive. Perceived Safety of Hypnotherapy: 10% believe safety isn’t established, 8% view it as not safe, 5% see it as probably safe, 54% believe it’s definitely safe (highest among all assessed therapies), and 23% are unsure.
5	Carvello et al., 2021 Italy	Nurses (n = 78) (85.7% of all participants)	Descriptive cross-sectional survey evaluating nurse knowledge and perceptions of hypnotic communication and reasons for its infrequent use before and after a 4h formative event The Hypnotic Communication available only to nurses.	Uses of Communicative Hypnosis: Post-event, 93.6% of nurses see a wide range of uses for communicative hypnosis. Obstacles to Hypnosis in Practice: 82.5% identify stereotypes and prejudices, not technique complexity, usefulness, or interprofessional conflict, as the main barrier to using hypnosis in clinical practice.
6	Cohen et al., 2005 Australia	GPs (n = 636)	A survey investigating attitudes toward complementary therapies and GPs responses to the increase in community demand for these therapies.	Acceptance and Effectiveness of Hypnosis: 81% view hypnosis as safe, and 65% consider it moderately to highly effective. Interest in Hypnosis Education: 22% show interest in an introductory workshop, while 14% are interested in obtaining a certificate or diploma.
7	Coldrey & Cyna, 2004 Australia	Anaesthetists (n = 218)	Survey to assess the current knowledge, previous experiences, and attitudes of anaesthetists towards hypnotherapy and suggestion within anaesthesia practice.	Knowledge Level: 63% rate their knowledge as below average. Role in Clinical Anesthesia: 48% see a role for hypnotherapy in clinical anaesthesia. Support for Hypnotherapy Use: 48% back the use of hypnotherapy and positive suggestions in clinical anaesthesia.
8	Desai et al., 2011 India	Healthcare professionals (n = 21) participating in the workshop: 57% psychiatry, 14% psychology & 29% nursing	Semi-qualitative survey conducted to understand the myths and misconceptions of healthcare professionals about hypnotherapy + a feedback form to collect qualitative information and views about hypnotherapy and the workshop.	Correct Hypnosis Perceptions: Two-thirds correctly responded about the dangerousness of hypnosis (90%), the relationship between a weak mind and hypnosis (86%), and hypnosis as therapy (81%). Incorrect Hypnosis Perceptions: Incorrect responses were seen on losing control in hypnosis (57%), hypnosis being akin to sleep (62%), and dependency on the hypnotist (62%). Professional Background: Mainly mental health professionals participated, potentially having a better hypnotherapy understanding, while other health professionals might have more inadequate knowledge.
9	Easthope et al., 2000 Tasmania	GPs (n = 290)	Survey assessing the extent to which GPs accept complementary therapies as a normal medical practice.	Approval Predictors: Personal experience and patient endorsement are key predictors of GPs approving complementary therapies. Referral and Perception: Hypnotherapy is the second most referred modality (33%), ranked third in safety (67%), and therapeutic value (91%).
10	Elkins & Wall, 1996 United States	Physicians (n = 56) Staff physicians (n = 37) Resident physicians (n = 19)	Survey assessing experience, knowledge, and opinions regarding hypnosis and its use in medical practice.	Lack of Training: The majority of physicians (79%) have had no prior hypnosis training, and only 5% use it personally in practice. Awareness and Interest: There’s limited awareness about hypnosis applications, but 85% expressed interest in hypnosis education. Referrals: Less than 30% make hypnosis referrals; however, 39% would accept a hypnosis referral for their personal care if recommended.
11	Eng & Cyna, 2006 Australia	Midwives (n = 118)	Cross-sectional survey to assess midwives’ knowledge, attitudes, and experience of hypnosis in 2 hospitals: with a clinical hypnosis service (CH) and without (NCH).	Positive Effects of Hypnosis: 94% of CH respondents and 54% of NCH reported hypnosis to be positive. Knowledge Source: Midwives from both CH (76%) and NCH (39%) units acquired their hypnosis knowledge from the clinical setting. Interest in Hypnosis Training: The reason behind midwives’ interest or disinterest in hypnotic training wasn’t explored. Training Recommendations: 83% agreed that positive suggestion techniques should be included in midwifery training.
12	Furlow et al., 2008 United States	Obstetricians & gynaecologists (n=396)	Survey conducted to determine general attitudes and approaches to 17 CAM modalities.	Attitudes towards CAM: Physicians demonstrated a more positive attitude towards CAM compared to patients. Effectiveness Perception: 46.2% of the respondents found hypnosis to be moderately to highly effective. Endorsement, Provision, and Referrals: 70.1% of the surveyed physicians either endorse, provide, or refer to hypnosis as a treatment option. Unwilling to Recommend: 25.2% of the physicians would not recommend hypnosis as a treatment option.
13	Gaffney and Smith, 2004 Australia	Obstetricians & gynaecologists (n = 75), Midwives (n = 145)	Two surveys to examine attitudes towards the use of CAM during pregnancy, referral patterns and views on the usefulness and safety of these therapies during pregnancy.	Usage Among Pregnant Women: Hypnosis is one of the most frequently referred or advised therapies. Perception Among Obstetricians: 64.7% find hypnosis useful, 14.7% not useful, and 20.6% would refer. 77.9% consider it safe. Perception Among Midwives: 62.2% deem it useful, 5.25% not useful, and 43.7% refer to it. 68.1% believe it’s safe.
14	Goldszmidt et al., 1995 Canada	GPs (n = 121)	Cross-sectional survey to determine the referral practices, perceived usefulness, knowledge, prior training, and desire for the training.	Self-Reported Knowledge: 11% of GPs report significant knowledge about hypnosis, with only 3% having received hypnosis training. Age-Based Perception: Older GPs tend to be more knowledgeable about hypnosis and are more likely to perceive it as useful compared to younger ones.
15	Görücü & Sayılan, 2021 Turkey	Nurses (n=300)	Cross-sectional and descriptive interview survey to examine nurses’ levels of knowledge of CAM methods.	Knowledge and Usage of Hypnotherapy: 50.7% of respondents are knowledgeable about hypnotherapy, yet none reported using it.
16	Haddad et al., 2020 Lebanon	Medical oncologists (n = 103)	Cross-sectional survey to assess knowledge, opinion and understanding of hypnosis, its use and the obstacles facing its application in oncology.	Knowledge and Interest: 67% of oncologists have poor to no hypnosis knowledge, but 40% are interested in hypnosis training. Perceived Benefits of Hypnosis: 75.7% consider it beneficial for chronic pain, 58.3% for anxiety, 56.3% for sleep disorders, 49.5% during invasive procedures, 45.6% for chemotherapy-induced nausea, 43.7% for depressive disorders, 40.8% for smoking cessation, and 29.1% for fatigue reduction.
17	Hall & Giles-Corti, 2000 Australia	GPs (n=282)	Descriptive cross-sectional survey to identify the knowledge, attitudes, and referral patterns of GPs.	Training: 10% of men and 8.2% of women report having received hypnosis training. Perceived Benefit: 75.63% of participants find hypnosis to be of some or great benefit. Hypnosis Practice: 2.0% of GPs practice hypnosis. Referrals: 24.53% have formally referred to hypnosis.
18	Hjeij et al, 2022 Canada	Nurses (n = 6) 4 women 2 men	Qualitative descriptive study - Individual interviews to describe how nurses perceive the integration of CH into chemotherapy-related care.	Holistic Oncology Care: Almost all participants (5/6) found CH helpful in providing holistic oncology care, finding it gratifying and effective in achieving specific objectives. Planning and Organization: All participants (6/6) stressed the importance of good planning and organization for successful CH integration. Patient Experience: All participants (6/6) felt CH enhanced patient experience, especially in pain management (3/6), and improved the patient-nurse relationship. Reduced Stress: Most respondents (4/6) reported that CH helped reduce their job stress due to the calm environment it creates. Outpatient Clinic Setting: All participants (6/6) identified the outpatient clinic as a saturated care setting, which could potentially hinder CH integration into cancer care. Overall Value: Findings highlight the added value of CH in outpatient oncology care.
19	Jafari et al., 2021 Iran	Healthcare professionals (n=209): physicians (n=8), nurses (n=93), midwives (n=32), health workers (n=76)	Cross-sectional study to assess perceived knowledge, usefulness, previous training, referrals, and practice of 17 CAM modalities.	Usage and Recommendation: Hypnosis is one of the least commonly used therapies (4.8%) and is only recommended by 2.4%. Knowledge of Hypnosis: The majority rate their hypnosis knowledge as none (25%) to low (48.6%), with only 7.6% rating it as good to very good. Personal Use: 95.2% of respondents have not used hypnosis themselves.
20	Madan & Pelling, 2015 Australia	Health professionals (n = 121): psychologists (n = 58), counsellors (n = 18), and physiotherapists (n = 45)	Two-part questionnaire (one being VSABH-T) exploring the current use of hypnosis, experience, knowledge, interest, and attitudes and beliefs toward hypnosis.	Hypnosis Experience: 58.7% of respondents have experienced hypnosis, with the main information source being courses and workshops. Ability to Practice: 39.7% report knowing how to practice hypnosis, with psychologists making up 75.4% of this group. Hypnosis Usage: 30.6% use hypnosis in therapy. Interest in Information: 47.9% express interest in receiving more practical information about hypnosis. Reason for Lack of Use: Lack of comprehensive understanding, skill, and knowledge of hypnosis application contributes to its underutilization.
21	Martín et al., 2010 Cuba	Health professionals (n = 97) Group 1 (n = 46): 90% physicians of different specialities; Group 2 (n = 51): 100% physicians	Health professionals from different institutions divided into two groups: G1 invited to receive a lecture about scientific hypnosis & G2 (control) about urology. A questionnaire using VSABH-T applied before and after the lecture to examine whether a lecture on hypnosis can modify attitudes and misconceptions about hypnosis.	Impact of Lecture: The hypnosis lecture significantly corrected participants’ misconceptions about memory and hypnosis. Group 1 Characteristics: This group had a higher academic level, more individuals knowledgeable about hypnosis, and more professionals using hypnosis in practice. Interest in Hypnosis Information: Interest in further information about hypnosis was high in both groups, with 90% of Group 2 and 100% of Group 1 showing interest.
22	McAllister et al., 2017 United Kingdom	Healthcare professionals (n = 129) involved in the care of childbearing women: anaesthetists (n = 13), midwives (n = 101) & obstetricians (n =15)	Prospective survey to examine healthcare professionals’ attitudes, knowledge and levels of self-efficacy regarding the use of self-hypnosis in childbirth.	Knowledge and Self-Efficacy: Higher levels of knowledge about hypnosis are associated with higher self-efficacy levels. Knowledge Gap: Despite positive attitudes, 56% reported minimal or no knowledge of hypnosis. Comparison between Midwives and Doctors: Midwives reported significantly higher levels of knowledge, self-efficacy, more positive attitudes, and greater exposure to hypnosis than doctors.
23	Mendoza et al., 2009 Spain	Psychologists (n = 2434)	VSABH-T to examine the influence of receiving scientific information about hypnosis over psychologists’ beliefs and attitudes toward hypnosis.	Misconceptions: Even with prior hypnosis experience, some misconceptions remained before the intervention. Knowledge and Experience Impact: Professionals with more knowledge, experience, and interest in hypnosis displayed more accurate beliefs before and after the intervention. Prior Training: Over 50% of subjects had scientific training in hypnosis before the intervention.
24	Mollart et al., 2018 Australia	Registered midwives (n = 571)	Self-administered survey to investigate if midwives’ personal CAM use impacts discussions and recommendations of CAM/Self-help strategies.	Hypnosis Recommendation: 35.7% of respondents recommended Hypnosis/Calmbirthing/Hypnobirthing. Referrals to CAM Practitioner: 55.2% of respondents would refer a woman experiencing a post-date pregnancy to a CAM practitioner, with Calmbirthing/Hypnotherapist being one of the top choices (54%). Personal Use: 22.9% of respondents used hypnosis for personal reasons, and 22.5% would use it in their own pregnancy.
25	Montgomery et al., 2019 United States	Trainees (psychosocial cancer care providers) (n = 340): 36.1% psychologists, 28.9% social workers, 7.2% psychotherapists, 6.5% counsellors; 6.5% nurses & 14.8% other	ATH questionnaire utilised to evaluate the impact of a 12-minute online hypnosis lecture on providers’ attitudes, anticipating that it would enhance attitudes towards hypnosis.	Impact of Online Video Lecture: A brief online video lecture significantly enhanced healthcare providers’ attitudes towards hypnosis. Age Factor: Older participants showed more positive attitudes towards hypnosis and exhibited less fear. Pre-Lecture Attitudes: Participants’ attitudes towards hypnosis were generally positive before the lecture. Trainee Experience: Trainees without previous hypnosis experience demonstrated a greater change in attitudes post-lecture compared to those with prior experience.
26	Newell & Sanson-Fisher, 2000 Australia	Oncologists (n = 161): radiation (n = 60), medical (n = 64), unclassified (n = 37)	Survey to assess self-reported knowledge about and attitudes towards a range of non-traditional therapies used by people with cancer.	Perceived Helpfulness of Hypnotherapy: Considered highly beneficial by 31% of curative patients and 46% in palliative care (ranked second to Meditation/Relaxation/Visual Imagery). Perceived Harmfulness: 4% of curative patients and 3% of palliative care patients considered hypnotherapy harmful. Knowledge of Hypnotherapy: 3% of respondents were unfamiliar with it, 46% had some knowledge, and 12% had extensive knowledge.
27	Pirotta et al., 2000 Australia	GPs (n = 488)	Self-administered postal survey to describe attitudes towards and use of a range of CAM.	Acceptance & Referrals: Hypnosis is well accepted with over 80% of GPs referring patients to it and nearly 50% considering its use. Training in Hypnosis: 20% have received training in hypnosis. Patient Interest: 62% would support a patient’s suggestion to try hypnosis. Perceived Harmfulness: 29% see hypnosis as occasionally harmful, while 63% consider it seldom harmful. Effectiveness: Hypnosis is considered highly effective by 18% of GPs, moderately effective by 60%, and seldom effective by 14%. Practicing & Funding: Over 90% believe trained GPs should practice hypnosis and that it should qualify for Medicare rebates.
28	Pirson et al., 2023 Switzerland	Paediatric oncologists (POs) (n = 29)	Cross-sectional survey of paediatric oncologists’ (POs) personal experiences, qualifications, perceptions, interactions with patients concerning CM, the availability of resources and experts, the potential benefits and risks of CM therapies, and the need for further information and training on CM.	Referrals: 31% don’t refer patients interested in hypnosis. Access to Specialists: 52-83% of POs have access to in-house or external CM specialists, including hypnotherapists. Patient Conversations: 38% discuss mind-body therapies like hypnosis with more than half of their patients. Comfort Level & Knowledge Gap: 52% feel unprepared to discuss CM due to insufficient knowledge, but 76% want to learn more about hypnosis. Perceived Effectiveness: 79% believe hypnosis can improve the quality of life or specific symptoms. Referred Specialists: Hypnotherapists receive 69% of CM referrals from POs. Qualification in Hypnosis: 3% have hypnosis qualifications. Perceived Harm: Most POs don’t see hypnosis as harmful.
29	Sikand and Laken, 1998 United States	Paediatricians (n = 348)	Survey assessing the attitudes toward and practice of CAM, knowledge, experience, and referral patterns, and the desire for continuing medical education courses on CAM therapies.	Referral: 13.8% of pediatricians would refer patients for hypnosis. Safety Perception: 50.3% consider hypnosis safe. Effectiveness: Hypnosis is the fourth most recommended CAM therapy with 13.8% of pediatricians advocating for it. Hypnosis Learning Interest: 31.4% are interested in learning more about hypnosis. Safety Rating: 24.4% find it safe and 5% view it as potentially harmful.
30	Sohn & Loveland-Cook, 2002 United States	Nurses (n = 151)	A cross-sectional descriptive research design investigating the knowledge, referral practices, and interest in future education of complementary and alternative health care.	Referral: Hypnotherapy was the third least referred therapy, with only 11.2% of nurses making such referrals. Knowledge Rating: On average nurses reported having limited knowledge about hypnotherapy. Sources of knowledge: Only 5.1% received hypnotherapy education from their nursing program, 7.4% obtained it outside of their nursing education, and 14.5% expressed an interest in further education on the subject.
31	Stein & McCann, 2022 United States	Health care professionals (n = 37): physicians (32.4%), nurses (21.6%), counsellors (13.5%), social workers (10.8%), psychologists (8.1%) and others	Cross-sectional survey to examine experiences, attitudes, and interests in hypnosis among health care professionals from a variety of disciplines.	Patient Interest: Most participants rarely or never encounter patient inquiries about hypnosis. Lack of Training: 70.3% haven’t received any hypnosis training. Certification Belief: 83.8% believe that hypnosis providers should be both trained and certified. Healthcare Context Acceptance: 78.3% support the use of hypnosis in a healthcare setting. Prior Experience: Among those with prior hypnosis experience, 78% found it positive. Learning Interest: 16% of those with and 20% of those without prior hypnosis experience are interested in learning more about it.
32	Stone et al., 2016 United States	Anaesthesia providers (n = 126): anaesthesiologists (43%), trainees in anaesthesia (33%), and nurse anaesthetists (24%)	Survey to measure current attitudes toward hypnosis.	Clinical Practice: 42% of participants agreed or strongly agreed that hypnotherapy has a place in anesthesia. Positive Suggestion: 83% considered positive suggestion useful. Usage Concerns: 41% are against its use due to time constraints, and 34% due to the need for special training. Knowledge Rating: Over 70% of providers, regardless of their level of training, rated their hypnosis knowledge as below average or non-existent.
33	Thomson, 2003 United States	Healthcare professionals: nurses (70%), physicians, faculty members; Pre-test (n = 196) Post-test (n = 202) 3 month follow up (n = 126)	Pre-intervention, post-intervention and a three-month follow-up questionnaire to assess the change in beliefs, attitudes and practices of health care professionals concerning hypnosis and hypnotherapy after a lecture.	Perception Change: The educational intervention influenced views on hypnosis: 77% believed hypnosis belonged in traditional medicine before the intervention, 96% immediately after, and 91% three months later. Practice Change: There was a significant increase in recommending hypnotherapy to patients and in plans to pursue hypnosis training, reaching 83% after three months. Self-Regulatory Strategies: There was a significant difference in plans for suggesting self-regulatory strategies before the intervention and for the future, but no significant difference in actual practice during the follow-up period. Training Interest: Interest in hypnosis training increased from 30% to 78% post-intervention, with 83% planning to pursue it after three months. 24% had already begun enhancing their knowledge.
34	Verhoef and Sutherland, 1995 Canada	GPs (n = 200)	Pilot study: Cross-sectional survey to assess the opinions and behaviour regarding alternative medicine.	Knowledge & Usefulness: 23% of participants claimed to have considerable to significant knowledge about hypnosis, and 55% viewed it as useful or very useful. Recognition: Hypnosis was among the best-known and most useful alternative approaches. Training: 20% had training in alternative medicine, primarily hypnosis and acupuncture. Among those without training, 50% expressed a desire for training, particularly in hypnosis or acupuncture.
35	Yu, 2004 China	Healthcare professionals (n = 75): psychiatric nurses (n = 37) and social workers (n = 16); Others include occupational therapists, counsellors etc.	Survey measuring beliefs and opinions regarding hypnosis and its applications among healthcare professionals in medical settings in comparison to students.	Beliefs and Misconceptions about Hypnosis: Clinicians, although to a lesser extent, were found to harbour the same misconceptions and beliefs about hypnosis as university students.

Abbreviations: AMA = Australian Medical Association; ATH = Attitudes Toward Hypnosis; CAM = Complementary & Alternative Medicine; CH = Conversational Hypnosis; CM = Complementary Medicine; COSA = The Clinical Oncological Society of Australasia; FMOQ = The Fédération des Médecins Omnipraticiens du Québec (Eng: Federation of General Practitioners of Quebec); GP = General Practitioner; HIC = The Health Insurance Commission; LSMO = Lebanese Society of Medical Oncology; VSABH-T = The Valencia Scale of Attitudes and Beliefs toward Hypnosis –Therapist;

General Practitioners (GP)

The attitudes of general practitioners toward hypnotherapy among other CAM therapies were explored in eight studies, and toward hypnosis specifically identified in one study (Elkins & Wall, 1996), with all studies conducted in English-speaking countries: Australia (Cohen et al., 2005; Easthope et al., 2000; Hall & Giles-Corti, 2000; Pirotta et al., 2000), United States (Berman et al., 1995; Boutin et al., 2000), and Canada (Goldszmidt et al., 1995; Verhoef & Sutherland, 1995).

The perception of hypnosis as a legitimate medical practice was held by 73.7% of GPs, and 30.6% viewed it as an alternative medicine (Berman et al., 1995). Cohen et al. (2005) found hypnosis to be accepted as safe by the majority (81%), with 65% perceiving it as moderately to highly effective. Easthope found that 91% of GPs saw hypnosis as having significant therapeutic value (Easthope et al., 2000) with older GPs more likely than their younger counterparts to perceive it as useful (Goldszmidt et al., 1995). There seemed to be a majority consensus on the safety of hypnosis, with 67% to 81% of physicians considering it safe (Cohen et al., 2005; Easthope et al., 2000). Furthermore, 92% believed that trained physicians should practice hypnosis (Pirotta et al., 2000). The desire for hypnotherapy to be provided to patients is highlighted by 19% of GPs (Boutin et al., 2000). However, in terms of usage, only a minority of GPs reported having applied it in their practice (Berman et al., 1995; Boutin et al., 2000; Hall & Giles-Corti, 2000).

Berman et al. (1995) found that almost 40% of GPs had training in hypnotherapy and 60% had knowledge of it. However, another study found that a significant majority (79%) reported not receiving prior training (Elkins & Wall, 1996), which is supported by findings of Verhoef and Sutherland (1995) indicating that 23% claimed to know a lot about hypnosis and 20% had training in alternative medicine, primarily hypnosis. Despite frequently encountering patients who inquire about complementary therapies, including hypnosis, many GPs lack formal education on these modalities. Less than half have pursued formal studies on such therapies, and 60% have expressed interest in further training (Hall & Giles-Corti, 2000). This finding is supported by two other studies that report the majority (approximately 80%) of GPs were interested in hypnosis training (Berman et al., 1995; Elkins & Wall, 1996), with a third finding that 22% showed interest in an introductory workshop (Cohen et al., 2005).

This knowledge gap is mirrored in referral patterns. While a large proportion of healthcare professionals have referred patients for CAM therapies like acupuncture, hypnosis, and meditation, only a small fraction received training in hypnosis themselves, indicating a discrepancy between practice and knowledge (Pirotta et al., 2000). Another study found hypnotherapy was the second most referred-to complementary medicine (CM) modality at 33% (Easthope et al., 2000). Yet, Boutin et al. (2000) found that 21% of GPs did not recommend hypnosis, which may be related to their finding that 34% of the GPs surveyed reported having inadequate information about the subject. This supposition is supported by Elkins and Wall’s (1996) study, which found limited awareness of the appropriate applications of hypnosis among GPs.

Oncologists

In this review of the literature, it was found that hypnosis knowledge among oncologists varied, with a study conducted in Australia showing that 46% of oncologists had some knowledge (Newell & Sanson‐Fisher, 2000), and a study in Lebanon indicating that 67% of oncologists had little to no knowledge (Haddad et al., 2020). However, the review did identify an interest in hypnosis among oncologists. Approximately 40% of Lebanon’s oncologists showed interest in receiving this training (Haddad et al., 2020), and 76% of Swiss pediatric oncologists indicated interest in further learning (Pirson et al., 2023).

Hypnosis among oncologists was generally perceived as beneficial for numerous health conditions, including chronic pain and anxiety, sleep disorders, chemotherapy-induced nausea, and depressive disorders (Haddad et al., 2020). It was also found to be particularly useful in palliative care (Newell & Sanson‐Fisher, 2000). Pirson et al. (2023) found that in Switzerland 79% of the oncologists sampled believed that hypnosis improved the quality of life or specific symptoms in cancer patients. There was a mixture of practices concerning the referral of patients to hypnosis practitioners, with 31% of oncologists not doing so, despite between 52% and 83% of the oncologists surveyed having access to hypnosis specialists (Pirson et al., 2023). Lack of training (almost 80%), perceptions of hypnosis as “quackery” (70%), and limited financial resources (50%) were identified as the primary deterrents to using or referring to hypnosis services (Haddad et al., 2020).

Nurses

In the existing literature, the knowledge of hypnotherapy among nurses was found to vary widely. In the US, one study found that approximately 17% of nurses reported unfamiliarity with hypnotherapy (Brolinson et al., 2001), while another study reported that nurses had on average limited knowledge about hypnotherapy, with only 11.2% making referrals to hypnotherapy and only a small fraction received their knowledge from their nursing program (5.1%) or outside of it (7.4%) (Sohn & Loveland Cook, 2002). Furthermore, 14.5% of these nurses expressed an interest in further education on hypnotherapy. Meanwhile, in a study conducted in Turkey two decades later, almost half of the nurses (49.3%) were unfamiliar with the therapy (Görücü & Sayılan, 2021).

In contrast, in a study conducted in Italy, after an educational intervention on hypnosis, a majority (93.6%) of nurses recognized the wide range of applications of hypnotic communication. Interest in the use of hypnosis also increased, with more than 90% of nurses agreeing that hypnosis had a wide range of uses in healthcare (Carvello et al., 2021). In another study, in the US, most nurses planned to pursue hypnosis training (Thomson, 2003).

Another study conducted in the US found nurses perceived hypnotherapy to be one of the safest therapies, with 54%, a view held more strongly for hypnotherapy than for any other CAM therapy evaluated (Brolinson et al., 2001). More recently, a study conducted in Canada (Hjeij et al., 2022) revealed a positive attitude toward the effectiveness of hypnotherapy among nurses, with participants reporting that communicative hypnosis improved patient experience (particularly pain management) and patient-nurse relationship.

Most nurses identified that the primary barrier to the use of hypnosis in clinical practice was the prevalence of stereotypes and prejudices, rather than the technique’s usefulness, complexity, or risk of interprofessional conflict (Carvello et al., 2021). Another barrier, highlighted by Hjeij et al. (2022), was the environment, characterized by constant noise from medical devices, continuous care delivery, and continuous movement of patients and staff. Such an environment was perceived to have a detrimental effect on the integration of hypnotic communication into cancer care.

Midwives and Obstetricians

Most studies investigating the attitudes and knowledge of midwives and obstetricians toward hypnosis have been conducted in Australia. A study by Eng and Cyna (2006) reported a high percentage of respondents, comprising 94% of participants in hospitals with hypnotherapy service (CH) and 54% of those without it (NCH), acknowledged its positive impact. In this study, midwives from both CH (76%) and NCH (39%) units reported they acquired their knowledge of hypnosis predominantly from the clinical setting. However, in a study conducted a decade later in the UK, more than half of perinatal healthcare professionals reported having little or no knowledge of hypnosis (McAllister et al., 2017). Despite this, the literature reveals midwives, similarly to nurses, demonstrated significantly higher levels of knowledge, self-efficacy, exposure, and more positive attitudes toward hypnosis than doctors (Aveni et al., 2016; McAllister et al., 2017).

Regarding the usefulness of hypnosis, Gaffney and Smith (2004) reported that in Australia more than 60% of both obstetricians and midwives deemed it beneficial and approximately 70% considered it safe. Interestingly, 30% of midwives admitted using hypnosis for personal reasons, including during their own pregnancy (Mollart et al., 2018). In the US, almost 50% of obstetricians and gynecologists found hypnosis to be moderately to highly effective and even exhibited a more positive attitude toward CAM, including hypnosis, as compared to patients.

In Australia hypnosis was found to be one of the most frequently recommended or referred therapies among pregnant women, with 43.7% of midwives and 20.6% of obstetricians making referrals (Gaffney & Smith, 2004). Furthermore, 35.7% of midwives recommended hypnosis/hypnobirthing, and 54% expressed a willingness to refer a postdate pregnant woman to a hypnotherapist (Mollart et al., 2018). In the US, the obstetricians and gynecologists surveyed also exhibited high levels of endorsing, providing, or referring to hypnosis as a treatment option (70%). However, a notable proportion (25%) would not recommend it. The findings did not provide a reason for this (Furlow et al., 2008).

Anesthetists

More than 60% of anesthetists rated their knowledge of hypnosis as below average (Stone et al., 2016), despite 40–50% acknowledging the potential role of hypnotherapy in the clinical practice of anesthesia (Coldrey & Cyna, 2004; Stone et al., 2016). A significant majority, (83%) believed in the usefulness of positive suggestion (Stone et al., 2016). A study in Australia reported that anesthetists who had the opportunity to witness clinical hypnosis had more positive attitudes toward this intervention (Coldrey & Cyna, 2004). Stone et al. (2016) identified time constraints (41%) and lack of adequate training (34%) as the primary obstacles to implementing hypnosis in clinical practice.

Mental Health Professionals

A study by Montgomery et al. (2019) involving various mental health professionals from the US, such as psychologists, counselors, psychotherapists, and social workers, reported a consistent positive perception of hypnosis. Similar to the research conducted with GPs (Goldszmidt et al., 1995), the study revealed that older participants had more positive attitudes about hypnosis and fewer fears about it (Montgomery et al., 2019). Another study showed that older practitioners tended to draw on a wider variety of information sources about hypnosis compared to students (Yu, 2004). Mental health professionals expressed a belief in the appropriateness of hypnosis usage in healthcare settings. However, in another study conducted in the US, the majority of professionals indicated that their patients have rarely or never asked about hypnosis (Stein & McCann, 2022). A study focusing on South Australian psychologists and counselors reported positive attitudes to hypnosis, with significant exposure to it (over 50%), and the ability to practice hypnosis (40%). In another Australian study, half of the participants expressed a desire for more practical information on the subject (Madan & Pelling, 2015).

Nevertheless, certain misconceptions about hypnosis persist even among mental health professionals. This trend appears to correlate with the level of experience and interest in the subject. A survey of Spanish psychologists on their beliefs and attitudes toward hypnosis, revealed accurate views on some aspects (dangers of hypnosis, the therapeutic potential of hypnosis), but even with prior experience of hypnosis, some misconceptions remained (Mendoza et al., 2009). In India, substantial misconceptions about losing control during trance (57%), the mistaken belief that hypnosis is a state of sleep (62%), and the development of dependence on the hypnotist (62%) were identified among mental health professionals (Desai et al., 2011). A study conducted in Australia identified that the main limitations to the use of hypnosis in clinical practice were the lack of skill, comprehensive understanding and knowledge of its application (Madan & Pelling, 2015).

Other Healthcare Professionals

Studies that encompass other types of healthcare professionals or a diverse range of professions within healthcare settings highlight both interest and existing gaps in the understanding of hypnotherapy. The majority (96.9%) of Swiss healthcare professionals sampled in a study by Aveni et al. (2016) were in favor of offering complementary medicine (CM) in hospitals, the most supported modality being hypnosis (89.8%). As a study of pediatric medicine in the US reported, 13.8% of pediatricians would refer patients for hypnosis, ranking it fourth on the list of most used CAM therapies (Sikand & Laken, 1998). However, in Iran, hypnosis remained one of the least used therapies (4.8%), recommended by only 2.4% of healthcare professionals. A significant majority rated their knowledge of hypnosis as minimal or non-existent, which seems to reflect the fact that 95.2% had not personally used hypnosis (Jafari et al., 2021).

Discussion

The aim of this scoping review was a comprehensive exploration of perceptions, knowledge, and attitudes of healthcare professionals toward hypnosis across various professions. Although hypnosis demonstrates proven efficacy in the management of various health conditions, its application within the healthcare sector remains stagnant, indicating a gap between research findings and actual practice. Key insights were uncovered that highlight the primary barriers to the integration of hypnotherapy into standard healthcare procedures.

The review reveals predominantly positive attitudes toward hypnosis across different professional groups, with an associated interest in additional training. Furthermore, there is global consistency in the attitudes of healthcare professionals toward hypnosis, indicating these attitudes are not significantly influenced by the country of origin. This insight underscores the need for universal interventions to address these shared perceptions. It also highlights the need for future research to uncover the specific factors that shape these globally consistent attitudes.

A particular point of interest that emerged from the review relates to the safety and effectiveness of hypnosis. There appears to be a consensus among healthcare professionals on the safety and utility of hypnosis, with particularly strong positive views among midwives and physicians. However, the strength of this belief varies across professions. An optimistic stance is adopted by a substantial proportion of healthcare professionals, albeit cautiously, which is consistent with research conducted on CAM therapies, revealing that most healthcare professionals believed that CAM would be safe when practiced by trained professionals and were in favor of incorporating CAM (Liu et al., 2021; Wong et al., 2010).

The findings indicate that hypnosis represents an underutilized resource, largely due to the prevalent knowledge deficits among various healthcare professionals (Brolinson et al., 2001; Eng & Cyna, 2006; McAllister et al., 2017; Stone et al., 2016). Despite recognizing the potential benefits of hypnosis, most healthcare professionals report minimal personal exposure to or use of hypnotherapy (Aveni et al., 2016; Gaffney & Smith, 2004; Hjeij et al., 2022). Clinicians also reported minimal understanding of hypnosis, often acquiring knowledge through personal experience or non-academic literature (Sohn & Loveland Cook, 2002).

The finding in this scoping review that significant gaps persist in these professionals’ understanding and perceptions of hypnotherapy is also found in other CAM therapies (Liu et al., 2021; Wong et al., 2010). Wong et al. noted that most healthcare professionals perceived their knowledge of CAM to be limited and these professionals had little personal experience with these therapies. However, in stark contrast to this perceived knowledge deficit, more than 80% of the respondents expressed a positive disposition toward CAM and indicated an interest in attending CAM seminars (Wong et al., 2010). Collectively, these findings highlight the need for expanded education and training in hypnosis for healthcare professionals to foster its integration into practice.

The subject of hypnosis presents a unique challenge, as even professionals holding advanced knowledge and understanding of the mind are not exempt from misconceptions about hypnosis. Encouragingly, the effectiveness of educational interventions in enriching knowledge and interest, as well as improving perceptions of the utility of hypnosis in healthcare have been demonstrated by other researchers (Martín et al., 2010; Montgomery et al., 2019). In fact, higher levels of exposure and understanding have been associated with more favorable attitudes, increased self-efficacy, and a broader application of hypnosis in clinical practice (McAllister et al., 2017). Reflecting the widespread interest in additional training observed across diverse professions (Elkins & Wall, 1996; Haddad et al., 2020; Pirson et al., 2023), it is evident that there is a substantial need and desire for practical information and further education on hypnosis (Madan & Pelling, 2015; Martín et al., 2010).

The last finding from this scoping review concerns referrals for hypnosis. Our findings suggest that referral is heavily influenced by the perceived usefulness and safety of hypnosis, as well as the level of knowledge of professionals. Psychologists, for example, showed a higher level of knowledge, which was correlated with their exposure and practical competence (Madan & Pelling, 2015). Similarly, midwives, compared to obstetricians, were found to be more inclined to refer patients to hypnosis (Gaffney & Smith, 2004; Mollart et al., 2018). This trend aligns with their reported higher levels of knowledge about and positive attitudes toward hypnosis (Eng & Cyna, 2006; McAllister et al., 2017). It echoes Wong et al. (2010) observation that patients’ preferences and the perceived efficacy of CAM for specific conditions were the primary drivers for healthcare professionals to refer patients to these therapies. Yet, more than 50% of respondents who refrained from referring patients for CAM cited a lack of personal knowledge of the subject as the reason. This hesitation in referral not only highlights the need for professional training and education but also the potential impact it has on patient outcomes and satisfaction.

When healthcare professionals are well informed about hypnosis, they are better equipped to meet patient needs using the most appropriate therapeutic interventions. This understanding facilitates a better dialogue with well-informed patients who have a broad understanding of alternative therapies (Snow et al., 2013). An improved referral process can lead to more effective patient care, greater compliance with treatment, and ultimately improved health outcomes. Furthermore, when patient preferences are considered in therapeutic decisions, patient satisfaction and active participation in their own care often increase. It is crucial to bridge the knowledge gap and promote a positive attitude toward hypnosis among healthcare professionals as an effective patient-practitioner relationship, nurtured through this mutual understanding and respect for patient preferences, can have considerable positive effects on patients’ health status (Riedl & Schüßler, 2017).

Considering that many of the studies analyzed were conducted over 20 years ago, there is clearly an important need to revisit perceptions of hypnotherapy from a more contemporary lens. Furthermore, limited research and information are available on how to implement the findings on perceptions and views on hypnosis in a practical sense and how to leverage the reported attitudes effectively (Montgomery et al., 2013). Furthermore, the exploration of the obstacles that prevent healthcare professionals from using or referring to hypnosis has been minimal, which is why the next logical step would be to further explore and address the barriers that prevent hypnosis from being incorporated more widely into healthcare practices.

The review findings demonstrate a disconnect between the efficacy, comprehension, and actual use of hypnosis in healthcare (be it use or referral), highlighting the need for research on the dissemination and implementation of hypnosis. Addressing the understanding and attitudes of healthcare professionals toward hypnosis is also imperative, as patients increasingly show interest in alternative therapies (Montgomery et al., 2013; Wong et al., 2010). Properly equipping professionals with knowledge of hypnosis can facilitate realistic patient expectations and improve patient-professional communication about such therapies (Bourgeault, 1996; Riedl & Schüßler, 2017). Moving forward, it is essential to go beyond establishing the efficacy of hypnosis and consider its practical implementation in healthcare settings (Bowen et al., 2009; McHugh & Barlow, 2010; Proctor et al., 2009). First, educational curricula in medical and nursing schools should incorporate introductory courses on hypnosis and its potential utility in various clinical settings (Martín et al., 2010). Second, professional development programs should offer modules on hypnosis as part of their continuing education courses. This could be complemented by hands-on workshops led by experts in the field, allowing for experiential learning. Additionally, interdisciplinary seminars involving psychologists, physicians, and other healthcare providers could foster a shared understanding and facilitate referrals for hypnotherapy. Lastly, establishing a central online repository of evidence-based practices, case studies, and patient testimonials could serve as a comprehensive resource for healthcare professionals seeking to expand their competence in this therapeutic intervention.

Study Limitations

Although published research indicates a considerable number of studies demonstrating interest and positive attitudes toward hypnosis and its therapeutic prospects, this review acknowledges some limitations that may have impacted the findings. The exclusion of non-English language journals may have influenced the international representation of the findings. Furthermore, the issue of small and heterogeneous sample sizes in certain studies compromises the generalizability of the findings. Certain professional groups have received considerably more research attention compared to others. Furthermore, several studies evaluated hypnosis in conjunction with other CAM therapies. This approach not only limits specific insights about hypnosis, but may also have inadvertently skewed the data. Studies on various professionals also show uneven numbers of participants among various professionals, making the evaluation of the results difficult. The primarily quantitative design of the studies included further limits the findings, providing minimal insight into the reasons behind the opinions. Another issue is that the studies included in this scoping review predominantly utilized self-selected samples, which introduces a potential source of bias. It is well-established in research methodology that self-selected samples may not be fully representative of the broader population and can skew results. In the context of this review, the self-selected nature of the participants may particularly bias the findings in a favorable direction, as it is likely that only those healthcare professionals already interested in or open to the concept of clinical hypnosis would volunteer to participate. Consequently, the generally positive attitudes and perceptions captured in these studies may overestimate the level of interest or acceptance among all healthcare professionals. Therefore, the findings should be interpreted with caution.

Conclusion

This review was conducted to address the gap between the established clinical efficacy of hypnosis and its limited use in practice. With this important knowledge gap identified, this review aimed to describe the state of perceptions, knowledge, and attitudes of healthcare professionals, highlighting several factors influencing the adoption of hypnosis in clinical settings. The review demonstrates a generally positive perception of hypnosis among various healthcare professionals, highlighting its perceived efficacy, safety, and overall usefulness, which remained consistent across different countries. However, it also reveals significant knowledge gaps, existing misconceptions, and a varying degree of interest and self-efficacy related to hypnosis among different professions. This review clearly indicates the need for comprehensive education and targeted training to improve the understanding and application of hypnosis among healthcare professionals. Future research should build on these findings, focusing on overcoming identified barriers and encouraging strategies to improve the integration of hypnosis into healthcare. It would also be valuable for future studies to evaluate the assessment of clinicians’ perceptions, attitudes, utilization of, interest in, and referrals for other alternative medicine interventions, such as mindfulness and acupuncture, in comparison to clinical hypnosis. Furthermore, the prevalence of quantitative research in this area emphasizes the need for more qualitative research. These can provide a deeper understanding of the underlying reasons for healthcare professionals’ attitudes toward hypnosis, their practical experiences, and the contextual factors influencing its use.

Acknowledgments

We would like to acknowledge Dr. Davina Porock for her valuable input and contributions to this article through the course of its development. We would also like to note that this review forms part of a larger PhD research project, supported by the ECU RTP-Stipend Scholarship.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Data Availability Statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study. This work is based on existing literature rather than original data collection, so there is no specific dataset to share.

Additional information

Funding

The work was supported by the Edith Cowan University.