Clinical Hypnosis Intervention for Improving Sleep Quality: Emerging Research and Future Directions

ABSTRACT

Research into clinical hypnosis for sleep disturbances is an expanding area with important implications for clinical practice and future research. This issue of the International Journal of Clinical and Experimental Hypnosis includes emerging research on clinical hypnosis to improve sleep quality and disturbances. While clinical hypnosis for sleep is very promising, the underlying mechanisms are largely unknown. To address this is an article that examines pre-sleep arousal and worry reduction as potential variables associated with the effects of clinical hypnosis in improving sleep quality. Related to this topic is an article entitled, “Aging adults’ willingness, preferences, and access to self-hypnosis for sleep: A cross-sectional study,” which identifies aging adults’ preferences and access to self-hypnosis for sleep. This issue of the IJCEH also includes an important article on health care professionals’ perceptions, knowledge and attitudes toward clinical hypnosis which considers the need for more training and education in clinical hypnosis among health care providers. Further, a scoping review of hypnotherapy for treatment of depression is presented, followed by an exploration of implicit rapport in hypnotherapy, and a case report on hypnotherapy in oral surgery with a highly hypnotizable patient.

Introduction

Sleep disturbances are a significant concern for many adults. Sleep problems increase with age, and individuals ages 45 and older are particularly at risk for experiencing poor sleep quality and sleep duration (Roth, 2007). In addition, certain health problems are associated with poor sleep; sleep disturbances in adults have been linked to depression, anxiety, fatigue, day-time sleepiness, and decreased quality of life (Morin & Benca, 2012). Currently, many individuals with poor sleep use prescription sleep medication on a chronic basis; which increases risk of dependency, addiction, and decreased effectiveness during prolonged use (Hossain & Shapiro, 2002). Nonpharmacological approaches are limited and primarily consist of cognitive-behavioral therapy for insomnia (CBT-I). However, CBT-I is a highly involved and burdensome intervention with low adherence and negative side effects (Morin & Benca, 2012). Therefore, there is a critical public health need for alternatives such as an optimized clinical hypnosis intervention.

The article entitled, “Aging adults’ willingness, preferences, and access to self-hypnosis: A cross-sectional survey” (Wofford et al., 2024) provides some insights into the perceptions and preferences of adults age 45 and older. In this study, 244 adults completed survey questionnaires that assessed sleep, sleep related problems, perceptions of self-hypnosis, preferences, and access. The findings showed generally positive perceptions of self-hypnosis for sleep and willingness to use it if available. Interestingly, there was found to be a general preference for telehealth or mHealth delivery. This may represent a shift in how health care is delivered post-COVID pandemic and a greater acceptance of remotely delivered health care services including clinical hypnosis for certain health problems.

While research into clinical hypnosis for sleep problems, such as insomnia, is still in the early stages, it is of considerable interest to determine the underlying mechanisms by which clinical hypnosis may improve sleep. Questions that have yet to be answered include: “Does hypnotizability moderate the efficacy?;” “Do psychological factors account for the beneficial impact of clinical hypnosis on sleep?;” “What are the biological or physiological mechanisms that may be affected by clinical hypnosis suggestions and interventions for sleep disturbances?” These questions are partly answered in a thought-provoking article exploring the psychological mechanisms associated with self-hypnosis for sleep improvement (Alldredge et al., 2024). This study involved 22 college students who achieved significant improvements in sleep quality and decreased insomnia symptoms following a clinical hypnosis intervention (Snyder et al., 2023). Significant improvements were observed in pre-sleep arousal following self-hypnosis; participants reported decreased worry. Given these are potential mechanisms that may also serve as targets for clinical hypnosis interventions for sleep, further research is needed to explore potential biological and physiological mechanisms as well as the role of hypnotizability in a more diverse sample of individuals with sleep problems.

In addition to sleep disturbances, depression is another medical and psychological problem to which clinical hypnosis has been applied in both research and clinical settings. This issue of the IJCEH includes a comprehensive scoping review in which 14 studies ranging from clinical case studies to randomized clinical trials were identified (Wan Vun et al., 2024). In treatment of depression, hypnotherapy may be provided as an adjunct to other types of psychotherapy or antidepressant medication, and the number of sessions may vary depending on individual needs and protocols. This scoping review provides strong support for the integration of hypnotherapy in treatment of depression. Results show that, in the majority of studies, hypnotherapy can be an effective treatment equal to or superior to antidepressant medications in reducing depressive symptoms and in creating overall well-being. Limitations include that more well-controlled randomized clinical trials are needed to fully know how hypnotherapy can be most effective in helping individuals with depression. Clinical hypnosis encompasses a large “tool kit” including ego strengthening suggestions, positive expectancies, cognitive restructuring, stress management, and teaching self-hypnosis. Further research is needed to establish efficacy, inform clinicians on the effective components, and to fully establish how hypnotherapy can be most integrated into treatment of depression in a diverse range of patients in regard to age, race, culture, and gender.

In order for clinical hypnosis to be more widely used, it is essential that health care providers be well informed on the research regarding hypnosis and its applications. This issue of the IJCEH also includes a scoping review of health care professionals’ perceptions, knowledge, and attitudes toward clinical hypnosis (Szmaglinska et al., 2024). Data from 35 studies (including insights of physicians, nurses, midwives, and mental health practitioners) reveals there are, in fact, predominantly positive attitudes and interest in clinical hypnosis. Most professionals have limited exposure to training in clinical hypnosis in their academic programs, but most express interest in gaining more educational opportunities and training. This is a very encouraging finding that suggests health care providers are receptive and interested in clinical hypnosis. To address this need, it may be that training offerings could better target these health care providers. Also, given the gap in knowledge, efforts to better disseminate research evidence on clinical hypnosis would help providers be better informed. Further, this points to a need for increasing opportunities for high-quality training in evidence-based clinical hypnosis.

An example of an innovative use of clinical hypnosis in medical/dental care is a case report on nocebo response and changes associated with hypnotherapy in oral surgery (Queirolo et al., 2024). In this case study, a highly hypnotizable patient presented for oral surgery removal of the third molar. The effective use of hypnosis is reported as well as illustrating effective (and ineffective) communication in the context of using hypnosis in dental care.

This issue of the IJCEH also provides further guidance on the hypnotherapeutic relationship and the concept of implicit rapport (Staffin, 2024). Implicit rapport refers to the subtle and often unconscious interactions between therapist and client that can enhance rapport and a positive therapeutic relationship. It is recognized that a positive and trusting therapeutic relationship is very important in psychological interventions, including clinical hypnosis. In this article, several clinical vignettes that illustrate implicit rapport are presented and insight on how it can affect treatment outcomes are provided.