Clinical hypnosis is focused attention, not mind control

The Short Version

Clinical hypnosis is not the stage trick where a performer makes volunteers cluck like chickens. Stanford psychiatrist David Spiegel defines it plainly: "Hypnosis is a state of highly focused attention," and he argues that it gives people more control over their minds and bodies, not less [1]. His brain-imaging work shows three measurable network changes during hypnosis. In randomized trials, self-hypnosis cut procedural pain by 80% with half the opioids, halved pain in women with metastatic breast cancer, and made medical procedures shorter and calmer for adults and children [1]. Andrew Huberman, who says he is very hypnotizable and practices self-hypnosis regularly, describes it as an unusual mix of alertness and relaxation that suits fast neuroplasticity, and he says self-hypnosis for pain is now well supported [2][3]. It doesn't work equally for everyone: about a third of adults aren't hypnotizable. But a simple eye-roll test and free guided tools let anyone find out whether it works for them [1][3].

Table of contents

What They Said

David Spiegel: the myth, and what hypnosis actually is

Spiegel is associate chair of psychiatry and behavioral sciences at Stanford, directs the Stanford Center on Stress and Health, and is one of the leading researchers on clinical hypnosis [1]. He starts by taking apart the popular image.

Focus, like a telephoto lens. "Hypnosis is a state of highly focused attention," he says, and compares it to looking through a camera's telephoto lens: great detail, little context [1]. The experience is common. Getting so absorbed in a movie that you forget you're in the audience is hypnotic-like, and many people have that kind of experience every day [1]. Being wrapped up in a sports game while feeling it in your body can count too, as long as the body sensations are part of the experience rather than a distraction [1].

Stage hypnosis is the problem, not hypnosis. Spiegel dislikes stage hypnosis: "You're making fools out of people" [1]. He explains how it works. Stage hypnotists quietly screen audiences for the most hypnotizable people, so the dramatic results come from choosing the right volunteers, not from any power over the mind [1]. He also gives a cautionary story. His father treated a woman after a stage hypnotist told her a bird was in her hand. She had felt trapped in her marriage like a bird in a gilded cage, and afterward she wandered New York City in a dissociated state until his father helped her [1]. The ability to suspend critical judgment and see things from a new angle is a great therapeutic opportunity, Spiegel says, but it can be misused [1].

You gain control rather than lose it. People fear hypnosis because they assume they'll be controlled. Spiegel turns this around: "They think you're losing control. You're gaining control" [1]. The point comes back in his view of trauma. Self-hypnosis is something you make happen and can switch on and off, so it restores a sense of control to people whose suffering comes from feeling helpless [1]. Huberman suggests hypnosis might be less feared if it had a different name [1].

A family trade and a teenager's asthma attack. Both of Spiegel's parents were psychiatrists. His father learned hypnosis in 1943 from Gustave Aschaffenburg, a refugee who had noticed prisoners going into a trance while staring at a smallpox scar on his forehead [1]. His father used it with wounded soldiers during the war, taught it to the psychoanalyst Frieda Fromm-Reichmann, and found that a few hypnosis sessions often worked better than daily psychoanalysis [1].

Spiegel's own turning point came as a medical student at Boston Children's Hospital. A 16-year-old girl was struggling to breathe in a severe asthma attack despite two shots of epinephrine, and doctors were considering general anesthesia. He hypnotized her and suggested that each breath would be a little deeper and a little easier. Within five minutes she was breathing comfortably [1]. A nurse filed a complaint claiming he'd broken a law against hypnotizing minors, which he doubted existed. After a weekend of arguing, the team asked the patient, who wanted to continue. She had only one more hospitalization and later trained as a respiratory therapist [1]. The case convinced him that we have a brain without a user's manual and don't use it nearly as well as we could [1].

Spiegel: what the brain does in hypnosis

To answer the charge that hypnosis is just theater, Spiegel points to brain scans. His lab put highly and poorly hypnotizable people in an fMRI machine and found three changes [1].

1. The alarm system quiets. Activity drops in the dorsal anterior cingulate cortex, part of the salience network that detects conflict and potential danger, so you're less likely to be pulled out of your focus [1]. Highly hypnotizable people also show stronger coordination between this area and the left dorsolateral prefrontal cortex (DLPFC), part of the executive control network, even when they aren't hypnotized [1]. Using spectroscopy, Spiegel also found that more hypnotizable people have more GABA activity in the anterior cingulate, a natural calming effect [1].

2. The executive region links up with the body. The DLPFC becomes more connected to the insula, a mind-body control area involved in sensing the body and pain [1]. Spiegel offers a striking demonstration. Hypnotized people took an imaginary tour eating their favorite foods and raised their stomach acid secretion by 87%. One woman asked to stop because she felt full [1]. When they relaxed and thought about anything but food, secretion dropped by about 40%. Even after an injection of a drug that triggers stomach acid, hypnosis lowered it by 19% [1]. A focused mental state changed a measurable organ function in both directions.

3. Self-monitoring steps back. The DLPFC becomes inversely connected with the posterior cingulate cortex, part of the default mode network tied to self-reflection [1]. This dissociation lets people act without worrying about what it means for them, which increases cognitive flexibility and makes them more willing to try something new [1].

Together, the three changes explain why hypnosis works as therapy. The brain stops scanning for threats, links deliberate control to the body, and gets out of its own way long enough to try a new response.

Spiegel: what it treats

Spiegel calls hypnosis a problem-focused treatment and the oldest Western conception of psychotherapy [1].

Stress. Stress often snowballs. You notice your body tensing and sweating, decide it's really bad, and feel worse [1]. His technique separates the physical reaction from the psychological one. People imagine their body floating somewhere safe and comfortable, like a bath, a lake or space. They picture the problem on an imaginary screen, with the rule that whatever they see, their body stays comfortable. Then they use the screen to think through one thing they could do about it [1].

Sleep. If you wake at night, don't look at the clock, which is an arousal cue. Instead, watch your worries on the screen while your body keeps floating [1]. Spiegel says he gets emails from people who hadn't slept well in 15 years and now can [1].

Phobias. Avoidance means the only associations a phobic person has with the feared thing are fearful ones. Hypnosis helps them manage anxiety long enough to build new, even positive, associations [1]. Spiegel helped a businesswoman afraid of dogs realize she could take charge of the situation, as she would with an employee [1]. His father taught another dog-phobic woman to see a dog as a friend. Months later, when his father phoned her, the person who answered said Spiegel was in heat: she had bought a dog and named it after him [1].

Trauma. Spiegel describes a woman who survived an attempted rape that left her with a skull fracture. Under hypnosis, with her body floating safely, she pictured the attacker on one side of a screen and realized something she hadn't let herself remember: he meant to kill her. On the other side, she pictured what she did to protect herself and realized that by fighting so hard she had probably saved her life [1]. The truth was worse than she'd thought, but she could now see her own strength [1]. Spiegel cites a randomized trial from Israel showing that adding hypnosis to PTSD treatment improved outcomes [1]. He also draws on the late Stanford psychologist Gordon Bower's work on state-dependent memory: we recall best in the mental state we were in. Many trauma survivors dissociate during the event, so hypnosis can bring the therapy state closer to the one they were in [1]. His core claim: "the essence of trauma is helplessness it's not fear it's not pain it's helplessness" [1].

Surgical and procedural pain. This is where the evidence is strongest. In a randomized trial published in The Lancet, patients having uncomfortable procedures without general anesthesia, such as treatment of liver tumors or imaging of the kidney arteries, got one of three things: standard care with on-demand IV opioids, standard care plus a supportive nurse, or self-hypnosis training [1]. The hypnosis group imagined their body cool, tingling and numb, or floating to a desert island. About an hour and a half into the roughly two-and-a-half-hour procedure, they had cut their pain by 80% compared with standard care while using half the opioids [1]. They also had fewer complications, no anxiety, and procedures that finished 17 minutes sooner [1]. Spiegel's reaction: "if we had a drug that did that every hospital in the country would be using it now" [1]. He notes that no industry exists to push it [1].

Cancer pain. The benefits can last. In a randomized trial of women with metastatic breast cancer who met weekly in support groups and learned self-hypnosis, the treatment group had half the pain of the control group by the end of a year, while using very little medication [1]. In his cancer groups, expressing negative emotion made people less anxious and depressed over time [1].

Children. Children are very hypnotizable but need more structure. Pediatricians press a child's belly button as a "happy button" during shots [1]. In Spiegel's trial published in Pediatrics, children having a difficult bladder imaging procedure who learned self-hypnosis were less anxious, felt less pain and finished 17 minutes faster [1]. Hypnosis also works well in groups [1].

Grief and the meaning of pain. For grief, Spiegel asks people to sit with the sadness but also picture what their loved one left them [1]. For pain, he teaches people to ask what it means, for instance whether it signals re-injury or simply healing, and to treat problems as a chance to act [1]. He adds, "I'm not a big fan of trigger warnings," arguing that what matters is feeling in control of how we approach upsetting material, and he cites Karen Parker's stress inoculation studies in young monkeys [1].

Spiegel: who can be hypnotized

Part of the myth is that hypnosis either works on everyone or is fake. Spiegel's answer is that it is a measurable trait.

Childhood peak, adult stability. "every eight-year-old is in a trance all the time," he says. Ages six to eleven are the peak, when work and play are the same thing [1]. As abstract logic develops, some people lose the ability, and by the early twenties it is largely fixed [1]. A Stanford study that retested people 25 years later found a test-retest correlation of about 0.7, making hypnotizability more stable than IQ [1].

The numbers. About a third of adults aren't hypnotizable, and about 15% are extremely hypnotizable [1]. Training raises scores only a little, and Spiegel says it isn't worth the effort. He uses the score to guide treatment: for low scorers he turns to other approaches, such as medication or mindfulness [1].

Who tends to be less hypnotizable. People with OCD tend to be less hypnotizable because they're so busy evaluating rather than experiencing, as in repeatedly checking whether the stove is off [1]. Spiegel suspects many people with ADHD aren't very hypnotizable either, though he hasn't studied it [1]. Self-hypnosis can still help people narrow and prepare their focus [1].

The eye-roll test. His father noticed that a patient with pseudo-seizures rolled her eyes up so only the whites showed, while a rigid, controlling businessman couldn't keep his eyes up while closing them [1]. To try it: tilt your head back, look up toward the ceiling, and slowly close your eyelids. If mostly the whites of your eyes show, you are likely more hypnotizable. If the colored iris shows as the lids come down, less so [1]. The test asks the brain to do something contradictory, and eye movements are closely tied to levels of consciousness, changing in sleep, dreaming and on drugs. Looking up and closing the eyes while staying alert signals the brain to turn inward [1].

Spiegel on EMDR, drugs, breathing and performance

EMDR. Spiegel thinks EMDR contains a lot of hypnosis, since a swinging watch was once the classic hypnotic induction [1]. Many people with trauma improve with EMDR, but he says studies that remove the eye movements find they add nothing, making it essentially exposure therapy [1]. Huberman mentions newer data suggesting eye movements may calm the amygdala [1].

Drugs. Spiegel rarely combines hypnosis with drugs. Benzodiazepines may help very anxious people but otherwise sedate them and blunt focus, and mild stimulants may help a little. He sees hypnosis more as a replacement than something that needs a supplement [1]. He does see a parallel with ketamine for depression, which may help people approach dissociated experiences in a way they can then work with [1].

Breathing. Breathing sits at the edge of conscious and unconscious control. From his research with Huberman on cyclic sighing, which emphasizes long exhales, Spiegel now stresses a slow exhale in his inductions to promote relaxation [1].

Performance, not just relaxation. Hypnotic states aren't only for calming down. Classical pianists describe floating above the piano thinking about tone rather than their fingers, and athletes at their peak are flowing rather than thinking step by step [1]. The same can happen during good work or a well-delivered talk [1].

Brief treatment, lasting skill. Spiegel usually sees patients only once or twice. He tests their hypnotizability, guides them through an exercise for their problem, and teaches them to do it on their own [1]. Hypnosis works because it becomes a skill, and people can tell quickly whether it helps [1].

Huberman: hypnosis as a tool for plasticity

At a live event in New York, Huberman described hypnosis as uniquely combining alertness (focus) with relaxation, a combination he considers ideal for fast neuroplasticity [2]. He said he practices self-directed hypnosis regularly to manage emotions, increase mental flexibility and reduce stress, and explained that it helps reframe emotional responses to stressors, enabling significant cognitive and emotional shifts [2].

Huberman's interest links to a question he put to Spiegel: whether repeated self-hypnosis strengthens the relevant brain networks. Spiegel invokes the rule that "neurons that fire together wire together" (the two credit the phrasing to neurobiologist Carla Shatz rather than Donald Hebb) and says there isn't evidence yet but it's plausible [1]. So Huberman's claim about plasticity is his own view from his practice and his reading of the mechanism. Spiegel is more cautious about whether repetition strengthens the networks themselves.

Huberman: self-hypnosis for pain

In an episode on pain and pleasure, Huberman lists self-hypnosis among the tools for changing pain. It was developed at Stanford by his collaborator Spiegel and, he says, is now well supported [3]. It works by changing activity in the prefrontal cortex and insula, which alters how we interpret sensations [3]. That matches Spiegel's finding that the DLPFC links up with the insula [1].

Huberman adds a useful point about the mechanism. The brain's chemical currencies, such as dopamine, serotonin and GABA, haven't changed. What changes is what triggers them [3]. His dose: brief sessions of 10 to 15 minutes a few times a week, sometimes followed by one minute a day, can bring significant relief from chronic pain [3]. He points listeners to Reveri, a zero-cost app with Spiegel's self-hypnosis scripts [3].

The episode also explains why a focused mental state can change pain at all. "Pain is a subjective emotional experience," Huberman says. Nociceptors carry information about stimuli, and the brain assigns the label of pain [3]. He pushes back on dismissing psychosomatic symptoms, noting that "everything is neural" [3]. If pain is an interpretation, a technique that changes how the brain interprets is working on the pain itself.

Where They Agree, and Where They Don't

They agree on what hypnosis is. Both describe it as a state of intense focus, not surrender. Spiegel's "state of highly focused attention" [1] and Huberman's combination of alertness and relaxation [2] describe the same thing. Both treat it as a skill people use on themselves: Spiegel teaches self-hypnosis after one or two sessions [1], and Huberman practices it himself [2].

They agree on the brain mechanism. Spiegel's scans show the DLPFC coupling with the insula [1]. Huberman explains self-hypnosis's pain relief through the prefrontal cortex and insula [3]. Both regard it as a physical brain state, not suggestion or theater.

They agree on pain as the strongest use. Spiegel's Lancet trial, breast cancer trial and pediatric trial [1] and Huberman's statement that self-hypnosis is well supported for chronic pain [3] line up.

They differ in emphasis on plasticity. Huberman frames hypnosis as ideal for inducing rapid neuroplasticity [2]. Spiegel, asked directly whether repeated practice strengthens the networks, says it's plausible but not yet shown [1]. Spiegel does suggest that changing mental state itself has therapeutic power, which he calls unsystematic desensitization [1]. The difference is about how much evidence exists, not about direction.

They differ on who it's for. Huberman's framing, and the app he recommends, invite anyone to try [3]. Spiegel stresses that about a third of adults won't respond and that training barely changes this [1]. He tests hypnotizability first and uses other treatments for low scorers [1]. The two views fit together: try it, but expect some people not to benefit.

Spiegel pushes back on neighboring therapies. Spiegel's view that EMDR's eye movements add nothing [1] differs from the newer data Huberman mentions suggesting eye movements may calm the amygdala [1]. That disagreement is about EMDR, not hypnosis, but it shows that Spiegel reads the evidence critically even in his own area.

Why It Works

The threat detector goes quiet. Reduced activity in the dorsal anterior cingulate, part of the salience network, means fewer interruptions from conflict and danger signals [1]. More GABA activity in that area in hypnotizable people adds a natural calming effect [1].

Deliberate control links to the body. Stronger coupling between the DLPFC and the insula gives focused attention more influence over body sensation and function [1]. The stomach acid experiments show this: an 87% increase imagining food, about a 40% decrease while relaxing, and a 19% decrease even after a drug that stimulates acid [1]. For pain, changing prefrontal and insula activity changes how signals are interpreted [3].

Self-judgment steps aside. Decoupling the DLPFC from the posterior cingulate, part of the self-reflective default mode network, allows action without self-conscious worry, which increases flexibility and willingness to try something new [1]. That flexibility is what lets a phobic person form a new association or a trauma survivor see a memory from a new angle [1].

Body and worry can be separated. Spiegel's screen technique keeps the body comfortable while the mind looks at the problem, breaking the loop in which bodily stress signals feed psychological alarm [1].

Matching memory states. Because memory is state-dependent, a dissociated-like hypnotic state can help people reach traumatic memories that were encoded while they were dissociated [1].

Control replaces helplessness. If "the essence of trauma is helplessness" [1], then a state you enter and leave at will helps restore a sense of agency [1].

Pain is interpreted, so interpretation can change it. Pain is a subjective experience built by the brain from sensory data [3]. Hypnosis doesn't block the signals. It changes what the brain makes of them [3].

Slow exhales help. Long exhales promote relaxation, which is why Spiegel now builds a slow exhale into his inductions [1].

Where It Applies, and Where It Doesn't

Strong fit: Procedural and surgical pain, where the Lancet trial showed 80% less pain with half the opioids [1]. Chronic cancer pain, with half the pain at a year [1]. Chronic pain generally, according to Huberman [3]. Children's procedures [1]. Stress and insomnia [1]. Phobias [1]. PTSD as an addition to treatment [1]. Emotional regulation and flexibility, in Huberman's personal practice [2]. Peak performance and flow states [1].

Weaker fit: About a third of adults aren't hypnotizable, and training doesn't change that much [1]. People with OCD tend to be less hypnotizable, and Spiegel suspects the same for many people with ADHD [1]. For low scorers, he uses medication, mindfulness or other approaches [1].

Not a substitute for diagnosis. Spiegel recommends working with someone licensed in their primary discipline, because a symptom like chest pain needs a proper diagnosis before anyone treats it with hypnosis [1]. For trauma, serious pain or any medical condition, see a qualified clinician, and treat self-hypnosis as a complement to care.

Not without risk when misused. The woman who wandered New York after a stage show shows that the capacity to suspend critical judgment can be exploited [1]. That's an argument for clinical, self-directed use, not for performance.

Not proven for everything Huberman hopes. The idea that repeated self-hypnosis rewires the brain faster is plausible and consistent with how neurons strengthen connections, but Spiegel says the evidence isn't in yet [1].

What To Do With It

1. Take the eye-roll test. Tilt your head back, look up toward the ceiling and slowly close your eyelids. If mostly the whites show, you are likely more hypnotizable. If the iris shows as the lids close, less so [1]. It's a rough guide to whether hypnosis is worth your time.

2. Try a guided session. The Reveri app, which Spiegel helped develop, offers 15-minute sessions and one- to two-minute refreshers for pain, stress, focus, insomnia, eating and smoking. Spiegel says two-thirds of users find it helpful even at one minute [1]. Huberman describes it as zero-cost [3].

3. Follow Huberman's schedule for chronic pain. Do 10 to 15 minutes of self-hypnosis a few times a week, then drop to about one minute a day [3].

4. Use the floating body and the screen for stress. Imagine your body floating somewhere safe, like a bath, a lake or space. Put the problem on an imaginary screen, keep your body comfortable whatever appears, and use the screen to plan one thing you could do about it [1].

5. Don't check the clock when you wake at night. It's an arousal cue. Watch your worries on the screen while your body keeps floating [1].

6. Prepare for procedures. Before a scan, an injection or a procedure without general anesthesia, practice picturing the area cool, tingling and numb, or picture yourself floating somewhere pleasant, as the Lancet trial participants did [1]. For children, use structured cues like pressing a "happy button" during shots [1].

7. Add a slow exhale. Build a long, slow exhale into your induction to deepen relaxation, as Spiegel now does [1].

8. Ask what the pain means. Ask whether a pain signals re-injury or simply healing, and treat the problem as a chance to act [1].

9. Find a qualified clinician for serious problems. For trauma, phobias or significant pain, the Society for Clinical and Experimental Hypnosis and the American Society of Clinical Hypnosis offer referrals. Spiegel advises choosing someone licensed in their primary discipline [1].

10. Don't fight a low score. If you're among the third of adults who aren't hypnotizable, don't spend effort trying to raise your score. Spiegel says it isn't worth it, and other tools like mindfulness or medication may suit you better [1].

Sources

1. Dr. David Spiegel: Using Hypnosis to Enhance Health & Performance · Huberman Lab
2. LIVE EVENT Q&A: Dr. Andrew Huberman Question & Answer in New York, NY · Huberman Lab
3. How to Control Your Sense of Pain & Pleasure · Huberman Lab