Hypnosis in Dentistry
- The dental appointment is an ideal situation for hypnosis.
- Myths and misunderstandings prevent dentists, hygienists, and assistants from using hypnotic methods.
- There are several useful forms of hypnosis which include trance and nontrance experiences, hypnotic language, distraction, metaphor, and indirect suggestion.
- Many hypnotic techniques are easy to learn and use in everyday dental practice. Dental practitioners owe it to their patients to utilize them.
If M. Mesmer had no other secret than how to put the imagination into motion effectively, for health purposes, would not that still be a marvelous blessing? If the medicine of imagination is best, should we not practice the medicine of imagination?
—From the original scientific investigation of animal magnetism commissioned by King Louis XVI of France (Franklin et al., 1784)
Hypnosis has been available to dentistry for centuries, yet it is underutilized and widely misunderstood. This chapter describes the essential nature of hypnosis and recommends applications that should be learned and used by every competent modern dental practitioner. The subject is too vast and complex to be covered in a short chapter such as this; consequently, the goal of this chapter is to introduce hypnosis, dispel inhibiting myths, and provide a map along with encouragement for exploration. Recommended readings are provided at the end of this chapter.
A proper understanding of hypnosis can enhance the experience of both provider and patient, and dental personnel who fail to apply basic hypnotic principles are letting their patients down.
A Brief History of Clinical Hypnosis
Hypnosis has a storied past, filled with mystery and misunderstanding. Hypnotic practice has suffered by being caught between implausibly exaggerated claims and overwrought skepticism. The literature on hypnosis is littered with reports such as Ewin’s (1992) study titled “Hypnotherapy for Warts (Verruca Vulgaris): 41 Consecutive Cases with 33 Cures” and Willard’s (1977) purportedly successful research on “Breast Enlargement through Visual Imagery and Hypnosis.” Nonetheless, it has survived over the centuries while many other nonphysical forms of healing have not. The American Medical Association officially endorsed hypnosis as a treatment modality in 1958, recommending its inclusion in mainstream medical training (Wester, 1987).
While trance was exploited by ancient healers, the modern history of clinical hypnosis begins with the Viennese physician, Anton Mesmer. Mesmer studied gypsy and religious healing practices and became intrigued with the “laying on of hands” which seemed to produce medical results. His work in “animal magnetism” was eventually discredited when a distinguished panel of investigators, including Benjamin Franklin, Antoine Lavoisier, and Dr. Joseph Guillotin, acknowledged that Mesmer had achieved positive physical outcomes. They found, however, that his “cures” (including “crises” and convulsions) were not the result of animal magnetism or the influence of heavenly bodies, as Mesmer had claimed, but “that this new agent may be only the imagination itself, the power of which is so great that it is little understood.” (Franklin et al., 1784).
The “father” of clinical hypnosis was a Scottish physician named James Braid (Kroger, 1977). He replaced the concept of animal magnetism with his term “hypnosis,” derived from the Greek word for sleep, hypnos. This turned out to be an unfortunate naming, as comparisons of hypnosis to sleep are inaccurate and misleading. Interest in medical applications of hypnosis was great in nineteenth-century Europe, where Bernheim, Charcot, Janet, and Freud all conducted extensive explorations into its usefulness. Unfortunately, Freud discarded hypnosis, partly because it bypassed the very resistance and defenses that his approach was designed to explore. Hypnosis did not fit his theoretical view, and Freud’s powerful influence dampened collegial interest. Janet was prophetic at the time, however, when he said, “If my work is not accepted today, it will be tomorrow when there will be a new turn in fashion’s wheel which will bring back hypnotism as surely as our grandmother’s styles” (Kroger, 1977, p. 4).
The physical and psychological trauma of two world wars accelerated interest in hypnosis, and military doctors returned home from battlefields motivated to continue their study of trance and healing.
The next wave of interest in hypnosis was generated in the second half of the twentieth century by the charismatic and somewhat eccentric psychiatrist, Milton Erickson. His innovations and publications excited a generation of physicians, psychologists, and dentists, and his views shaped the way that modern clinical hypnosis is understood. Erickson understood hypnosis more broadly than his predecessors, and he eventually focused on the ways that humans influence each other subconsciously, both in and out of formal trance states. Zeig (1987) observed, “To Erickson, hypnosis was not merely a trance state within a person; it was a special context for communication …” (p. 394). Erickson actually caused a paradigm shift in the ways that hypnosis is understood and practiced, and those changes are described later in this chapter.
The Nature of Hypnosis
Hypnotic interventions can add to clinical practice in the following ways (Holroyd, 1987):
- enhanced rapport
- increased suggestibility
- positive use of attention and awareness
- utilization of dissociation
- access to the mind–body relationship
- use of imagery
- responsiveness to the doctor’s messages.
Since patients and doctors typically fail to avail themselves of the benefits of hypnosis due to misconceptions, it is wise to begin with those. A multitude of myths and misunderstandings blur our ability to take advantage of something that is inexpensive (or free), generally harmless, relatively easy to do, and filled with potential benefit. Here are four important problematic myths.
Myth #1: Hypnosis Is a Trance State
This is the most pervasive misconception. While hypnosis has historical roots in formal trance induction, trance is only one aspect of the hypnotic continuum. This myth is problematic for dentistry because deep trances can be time-consuming, because relatively small numbers of people are capable of the kind of trance states that yield reliable dental anesthesia or analgesia, because most people are frightened by the prospect of entering a deep trance at the suggestion of a hypnotist, and because stage hypnotists have made fools of volunteers in public. Most of the value of dental hypnosis lies in qualities of hypnosis that do not involve deep trance states or lengthy inductions.
Similarly, people think that hypnosis must involve relaxation, and dental patients are not typically relaxed in the chair. But hypnosis, in all of its forms, does not require physical relaxation. People who are extremely tense or even terrified sometimes slide into a defensive trance state in emergencies. Their brain locks up, and they cannot think of anything, especially not the present-moment consequences. One of the most prominent teachers in the history of clinical hypnosis, Kay Thompson, was a dentist. She wrote that, “I have increasingly turned away from the relaxation-sleep model …” and that hypnosis will work for a patient “whether or not he looks as though he is relaxed.” (Kane & Olness, 2004, p. 139).
Myth #2: Hypnosis Involves Loss of Control
Most people do not cherish the idea of losing control, especially in a dental office. Much of the difficulty that patients have with visits to the dentist involve a real or perceived loss of control, and the thought of giving over more control to a dentist is not attractive to most patients. However, properly conducted hypnotic interventions actually help people gain control and manage themselves more autonomously and effectively.
Myth #3: Hypnosis Is Dangerous
People (doctors and patients) are concerned that odd or bizarre things might happen when a dentist hypnotizes a patient, especially if the dentist is inexperienced in hypnosis. The procedures and skills described in this chapter have little or no chance of harming patients, especially if the dentist does not attempt to coerce patients. The only formal prohibition involves patients who are Christian Scientists or Seventh Day Adventists, as these faiths do not condone the use of hypnosis (Kane & Olness, 2004).
Myth #4: The Doctor Must Possess an Elaborate Set of Skills and Must Exercise Them Charismatically
Some hypnotic skills are complex, and the learning curve for a hypnotic practitioner can be long (and interesting—even thrilling), but the basic skills required to hypnotically enhance a dental practice can be taught to doctors, hygienists, assistants, and front-office staff in a relatively short period of time. They do require diligence and focus, but they’re worth it, both in terms of patient experience and practitioner satisfaction. Humans possess a natural capacity for trance (Kane & Olness, 2004).
Defining Hypnosis and Using It
Novices think exclusively about trance when they think of hypnosis, but there are other ways to define hypnosis that open the door to widespread and efficient application in dental care. There exists no single, well-accepted definition of hypnosis. Carol Erickson reported (personal communication) that her father, Milton, once said, “I’ve been doing hypnosis for fifty years, thinking about it for fifty years, and I still don’t really know what it is.” In fact, as Lynn and Rhue (1991) observe in their book on theories of hypnosis, “There is no question that hypnosis has eluded a single, simple definition.”
What follows is a description of a “map” of hypnosis. An outline of this map can be found in Table 6.1. This description is quite basic in nature, and the map is not the territory.
It is useful to divide hypnosis into two forms: trance and nontrance.
Trance is a “state” of consciousness that allows special focus. Trance is not exclusive to hypnosis or meditation, and there are countless variations of natural trance states in everyday life. In fact, it is best to think of consciousness as variegated. When people think of hypnosis, they usually have heavy trance states in mind. Deep trances represent an unfortunate stereotype of hypnosis. Heavy trance states can be interesting to be sure, and they can even be useful in the hands of a skilled hypnotherapist or dentist. But a relatively small number of people are capable of easily or conveniently entering deep trance states. The majority is not (American Society of Clinical Hypnosis, 1973, p. 6; Moss, 1977, p. 323). Most people can learn to enter a moderately deep state, given time, practice, and concentration, but this can prove inefficient or impractical in a real-life dental practice. When Milton Erickson used deep trance, he often spent hours preparing his patient for the experience (Hammond, 1990, p. 21), and he spent a lifetime preparing himself.
There are many varieties of consciousness that we all experience every moment of every day. These variations can harm us (the flashback of the person with posttraumatic stress disorder, for example) or help us (when we imagine accomplishing something difficult). We drift in and out of various trance-like states all the time. We stare out a window. We gaze at an attractive person who happens to walk by (and lose our previous train of thought!). We absorb ourselves in a good novel or video game. These are common examples of natural trances.
It is useful to (somewhat artificially) divide trance into “heavy” states and “light” trance states. It is the variety of trance that interests the modern clinical hypnotist, along with the way that focus-of-attention works in trance. For example, most people have experienced the inconvenience of a cracked car windshield. It’s an annoyance at first, but we rather quickly learn to stare right through the crack to focus on the highway. It isn’t long before we don’t even notice the crack at all. Many people talk on cell phones while they drive cars, and they persist in spite of laws prohibiting that behavior. Pedestrians stroll in/>