Last year, I had the worst cold and flu bug of my life and the cough that followed seemed to hang around forever. it just would not go away. I was so miserable as a result. I kept coughing in the middle of talking, which is not ideal if you are a hypnotherapist, right? it woke me up at night and so my sleep was affected. I tried every single cough medicine available, even the super power plus, guaranteed to beat any chesty cough linctus stuff from Benylin and every other brand known to man. Wondering whether it would ever desist, I called my GP’s office and arranged an appointment.
Upon arriving at his daytime surgery office, in his usual authoritative, informed and dynamic manner, he enquired about my symptoms and proceeded to tell me that a persistent cough was common following this recent flu strain and that in most cases it gradually cleared within a few weeks. He prescribed another medicine which I picked up at the neighbouring chemist, he told me I should notice some improvements within a week, and to get back in touch with him if my symptoms persisted.
That week my cough dissipated, bothered me far less and the following week, was just about gone. As soon as I had left his office, I had felt in control of it and it got better.
I really have no idea how much the medicine helped or if my illness would have disappeared eventually anyway. However, as an evidence based practitioner, I do know that the mere fact of seeking and receiving medical care, contributed to me feeling better; more in control, more at ease and gave me optimism.
The benefit I received from this scenario is called, a placebo effect. Many people know a bit about it, though I believe hypnotherapists should know much more about it than they often do… Especially when you consider that the man who has contributed the most research to the field of hypnotherapy, Professor Irving Kirsch, refers to hypnosis as a non-deceptive mega-placebo!
On many occasions, when subjected to scientific scrutiny, many, many treatments, are proven to derive their benefits from the placebo effect.
Of course when we look back to the practices of Mesmer and his animal magnetism theories, or at doctors of old prescribing leaches and blood letting, along with a variety of potions and brews and other incantations, it is easier to accept the placebo effect in relation to them. However, people seem to find it much more difficult to believe in it in relation to much of todays health care treatments.
Much of our modern treatments and interventions do actually undergo rigorous testing to prove their effectiveness. There is certainly a movement demanding that treatments be based on evidence; I am one such person making those kinds of demands in the field of hypnotherapy.
With that said though, there are many academics and experts who estimate that as little as 20% of the treatments routinely used by our doctors today have actually been proven effective in careful studies. Doctors and their patients continue to ascribe healing powers to certain medications, psychotherapies, and medical procedures that may well be impotent. As hypnotherapists, how many of us actually know how many of the interventions we employ with our clients are supported by evidence (beyond anecdotal) or are powered by placebo? How many believe that the hypnotherapy treatment is working because of it being so effective? What is the relationship between hypnotherapy and the placebo effect? It may simply be the hypnotherapists belief in it that results in the treatment being so effective!
Of course clients benefit from those hypnotherapy interventions, but is it really the intervention that is creating the benefit, or is it the placebo effect in some cases? Placebos are all too often ignored by hypnotherapists as well as other psychotherapeutic schools.
Most people think of a placebo as an inert tablet or capsule. Though as us hypnotherapists do not deal out tablets or prescribe medication, a placebo can also be thought of as those elements of the therapy we offer that actually don’t have any real therapeutic value for the condition being treated but that still makes people feel better.
This could include simply turning up for hypnotherapy and expecting results, especially if referred by a friend who got great results. It can also include feeling euphoric after a hypnotherapy session and leaving the office expecting to feel better just because they have been into hypnosis during the session. it could also include a wide array of techniques and strategies employed by hypnotherapists, delivered with such belief that the client firmly believes they are going to do them some good.
Depending on a hypnotherapist’s personal style, the placebo effect may be enhanced as a result of the hypnotherapist’s enthusiasm, motivation and commitment, or just as a result of the client having had an opportunity to talk about their issue. It may even be enhanced as a response to encouragement and attention received by the hypnotherapist.
In conventional medical trials, there is research piece upon research piece that demonstrates the healing power of placebo – in most areas of medical treatment. Some results are more impressive than others, but it tends to leave even the most hardened sceptic with the sense that it is an incredible force that is often amazingly effective.
More relevant to psychological and psychiatric fields, thousands of depressed patients have been given placebos in double-blind clinical trials (Double blind means that the patient and the doctor administering it are unaware of it being a placebo medication). The interest for hypnotherapists, is that the severe depressive individuals, those traditionally considered to be contraindicated for hypnotherapy, respond less well to placebo than the standard treatments of antidepressant drugs, for example.
However, in the most common type of depression, the milder version that might possibly be considered viable clients for hypnotherapy, especially if you follow the work of Michael Yapko, that effects approximately one fifth of the UK population at some stage in their lives — placebo pills are almost as effective as antidepressants. In fact, much research suggests that the less severe the depression, the more likely it is to improve with placebo treatment. Which may enhance the viability of hypnotherapy for treating mild depression among those who traditionally consider it to be a contraindication.
Placebos do compare favourably to a variety of psychotherapies in relation to depression. Comparisons between treatments such as behavioural, cognitive and analytical therapies and placebo pills have consistently shown that placebos tend to be as effective as any of the psychotherapies, at least in the short term.
Study after study does indicate that expectation undoubtedly makes an important contribution to the healing power of placebos. Across a wide range of issues and ailments, clients who expect to improve are more likely to improve.
Perhaps now is the time for hypnotherapists to become more aware of the studies and the evidence for placebo and its effect upon our work. And rather than letting our egos drive our thoughts to defend us being excellent therapists that wield our therapy for the good of mankind, maybe we can accept placebo and use it to enhance our work, rather than dismiss it out of hand.
Research offers some guidance as to how to enhance the power of placebo in our hypnotherapy work with clients:
– Help to boost your hypnotherapy client’s expectations of getting better. Without being dishonest or making false or inaccurate claims. Help the client to have confidence in you and the hypnotherapy you offer.
– Be congruent, optimistic and upbeat.
– Treat the hypnotherapy sessions as a collaborative process, not something you dictate to the client. Seek out the opinion, feedback and thoughts of the client and allow them to become involved in the treatment plan you jointly put together.
– If you have a client citing an issue for which there are several intervention options, suggest that the method you are choosing is the most effective in your opinion and explain why it is being used here.
– If a hypnotherapy client has responded well to a certain therapeutic intervention in the past, use the same or similar intervention again unless there is a very good reason not to. Their belief in the process will fuel the placebo effect.
– Ensure you encourage good communication with the client. Let them feel comfortable enough to express concerns. Suffering in silence or having hidden worries is likely to undermine the effectiveness of the hypnotherapy and dissipate any placebo effect.
Brilliant post Adam!
There is not enough clever and well intentioned use of the Placebo effect – be that in mainstream medicine or through other therapeutic interventions.
There is a great clip of Ben Goldacre talking about the NHS and the Placebo effect here http://www.youtube.com/watch?v=wsFTgirKXHk
Your post is full of learning. Thank you
Thank you Richard, and thanks for the link too. Lets hope more people wake up to ways of utilising the placebo effect, eh?
I thoroughly enjoyed the above post as the placebo effect is something that fascinates me. It has been around as long as pretty much everything and probably has the longest track record in all clinical trials.
I do not envy those carrying out research trying to find out if the efficacy is down to intervention or placebo.
The placebo effect is well known in the golf business. One very famous American teaching professional told me that the majority of his lessons involved no real teaching in the classical sense.
He just gave occasional words of encouragement such as “Slow down” or “That’s it” and he said almost all golfers who see him are hitting it better simply due to the fact that they have had a chance to warm up and hit more shots than they usually do.
This however would not be effective if he didn’t charge so much and be a “famous teacher”. People expected to perform better, and did!
I see now he was a placebo himself!!!!
I suppose the question is when a placebo is unethical. I know homeopaths think they actually give effective treatments, but double blind clinical trials have shown time and time again to prove it’s no more than a placebo BUT……
If the treatment proves to be more effective with the belief and TLC of the homeopath and combining/enhancing the belief of the client does this then create a “mega placebo”?
Would it be right to outlaw such a treatment even if it doesn’t work in the way it’s thought to?
(And before any homeopaths put a price on my head, read Bad Science by Ben Goldacre. It’s a placebo enhanced by belief, end of story 😉 )
I suppose what I am trying to say if when do we know if something does not work? If a double or even triple blind trial is done, I am guessing it rules out the placebo effect but in some cases maybe we need to compare the intervention compared to nothing at all?
I have now given myself a headache so will stop rambling…..plenty of food for thought from todays blog though Adam.
Having watched the Ben Goldacre clip it opens the ethical can of worms on lying about treatments that technically don’t work.
Grrrr….. how can a blog and a comment stir up so many questions and ideas?
I think my personal view would be to use the placebo enhancing effects in combination that something that is scientifically proven to work.
But I’m a bit like the Fast Show character down the pub so this may change 😉
Hey Gareth… Offering up prescribed placebo effect interventions is of course a huge moral and ethical issue… And us hypnotherapists have to bear in mind our duty of care and issues around informed consent. You are quite right.
However, for now, we can harness some of its power in the way we communicate and develop the notion within what we do for the good of the client.