#731: Dr. David Spiegel, Stanford U. — Practical Hypnosis, Meditation vs. Hypnosis, Pain Management Without Drugs, The Neurobiology of Trance, and More

25:22That is, when one region is active, the other region is active between the left dorsolateral prefrontal cortex, which is part of the executive control network, the one I'm hopefully using now, talking to you, and the dorsal anterior cingulate. Now, the cingulate cortex is like the C on its ends in the middle of the brain. And the dorsal front part is part of our salience network, the alarm system. It's the thing that if you hear a loud noise, you know, it distracts you. So the salience network is coordinated in highly hypnotizable people with the executive control network. And that makes sense.

25:54If they're working together, it's easier to lose yourself in an activity and not worry about whether you should be doing something else. We've actually found also there's a genetic component to that. There's a particular polymorphism of the gene that metabolizes dopamine, catechol-O-methyltransferase. And if you happen to have the methionine-valine version of it, you have moderate metabolic rate, which keeps pretty high and stable levels of dopamine in the brain. And those people are more hypnotizable than those who are homozygous for euthomethion intervaline. I had a brilliant young graduate student, Dana Cortad, who actually developed a point of care genetic test for hypnotizability.

26:34So you can take a drop of blood and in a couple of minutes, we can tell how hypnotizable you're likely to be. But we also have a test called the hypnotic induction profile that my late father and I developed that gives you like a six-minute hypnotic experience? Have your hand float up in the air? If you pull it down, will it float right back up? Do you experience a loss of control in that hand? Do you respond to the signal ending that experience? Do you have a sense of floating lightness or buoyancy? So you get a score from zero to 10. And that is likewise a very stable trait. It's something I have used with every one of the 7 ,000 people I've used hypnosis with in my career.

27:11And it helps me have a sort of common experience that is not initially connected to treatment, but just we both can see how much they can respond. And A, it gives me useful information. B, it gives them useful information. And C, we're not blaming the victim here. If somebody is not hypnotizable, it's not because they're resisting, because most people aren't, they're paying good money to see me and get help. And it's not because I'm not good at what I'm doing, because I've learn something about it. Although my first psychoanalytic supervisor said, yes, she didn't go into a trance despite having had 200 shock treatments because you're a lousy hypnotist.

27:48And I said, I don't think so. But it's nice because it makes it a neutral experience. It's one in which you try out and see what it's like. And they learned from it and I learned from it. Where does the eye roll test stand in terms of a reliable indicator? Well, the eye roll test is like a good initial guess. It's moderately correlated with formally measured hypnotizability. And my father discovered this. He was using eye fixation on a light on the ceiling of his office. And he noticed that the woman I mentioned who had the hysterical pseudo seizures, he noticed that when he asked her to look up at that light and then close her eyes, all he saw was the whites of her eyes.

28:24They stayed up. After he made that movie that day, the following Monday, he had one of the most obsessional men he'd ever seen. And he had the guy look up and he could not keep his eyes up as he was closing the eyelids. They came down and all he saw was his iris as they closed their eyes. So he began measuring that. And it turned out you can score people from zero to four on how much they're able to dissociate lowering the eyelid with lowering the eye. And that is an initial interesting indication of hypnotizability. So if you want a quick five-second test. Let's do it. Here it is. Love five-second tests.

28:57All right. So look up past your eyebrows all the way up. Way, way up. And as you keep looking up, slowly close your eyes. Look up. Close. Oh, yeah. Oh, yeah, yeah. You're at a three to four. You're on the upper end because you keep your eyes way up and I can barely see your iris as you start to close your eyes. Great. Well, another option on the menu then. Yeah, you bet. And do you have any hypothesis for why those are correlated? Eye movements are very much related to level of consciousness. The obvious thing is you close your eyes when you go to sleep. Drugs that affect the eye and eye movements are related to autonomic arousal.

29:32Your pupils get big when your sympathetic nervous system is going on. small when you're on opioids, for example. And the third, fourth, and sixth cranial nerve nuclei are surrounded in the brainstem by the reticular activating system, which is part of our arousal network. And so things that affect eye movements tend to affect arousal as well. And so we think it's an ability to shift gears, inhibit peripheral awareness, and intensify your focus. And that this is just, it's no accident that it's the same parts of the brain that regulate arousal and eye movement that are associated with this eye roll.

30:11And this is a side alley question. We're going to come back to the mainstream in a second, but I'm very curious. Do you have an opinion of EMDR? I do. And if you could just explain for folks what that is. I'm from New York. I'm not devoid of opinions. Fellow New Yorker here. All right. Here we go. Here we go. So strap in, folks. EMDR's Eye Movement Desensitization and Reprocessing, Francine Shapiro developed this, and it's a widely used technique. The VA uses it a lot to help people with trauma, and hypnotic-like techniques are very helpful with trauma, and I'll be glad to talk about that. But her idea was that somehow you facilitated communication between the hemispheres if you had people move their eyes back and forth while they were discussing a traumatic experience.

31:00Now, the certainly good idea in this is that we now know more and more that re-exposure under controlled conditions to traumatic memories is in itself therapeutic. So exposure therapy and cognitive restructuring are two very prominent ways of helping people deal with trauma, and EMDR has components of that. But, and you know, if you think about it, is it anything like hypnosis? Well, what was the oldest way of inducing hypnosis? Remember the dangling watches? You know, what are your eyes doing when, you know, you're moving back and forth? So I think there's a lot that's hypnotic in EMDR. But to tell you the truth, every study that has deconvoluted eye movements from everything else that goes on in EMDR has shown that the eye movements don't have much to do with it.

31:45And toward the end of her career, Francine Shapiro stopped. She then did tapping rather than eye movements and other things. But it's not at all clear to me that the actual eye movements have anything much to do with the outcome. So it's another therapeutic technique, but I have to say that my overall impression is that what's good about it isn't new and what's new about it isn't good. So what are the ingredients in EMDR, aside from discussing the traumatic event, are there other characteristics or elements that contribute to outcomes when they are good? I don't know if this has been studied in any structured way.

32:18It has been used, I mean, the VA has used it extensively in helping combat vets with post-traumatic stress disorder. And the fact that you summon up a traumatic event and then you picture it, become aware of the emotions that come along with it, can be a component of effective psychotherapy. I think the two things that matter the most, and what I do when I use hypnosis in treating PTSD, is number one, the control with which you summon it. I've always wondered if exposure therapy works so well, why don't flashbacks cure PTSD? I mean, flashbacks are symptoms of PTSD. You're reliving the event as though we're happening again.

32:56And the difference, I think, is that there's no control. You feel reattacked by the memory the way you did the trauma. And so I think with EMDR, like other psychotherapies, like exposure therapies, cognitive reframing therapies, you, in a controlled situation, bring up a traumatic memory. So it's not hitting you again from out of nowhere. You're saying, I'm going to spend some time thinking about this now. So you're doing it in an element of control that was completely absent when the trauma happened. That was just done to you. This is something you're doing to yourself in a controlled way with the prospect of a direct benefit.

33:32The second thing is cognitive restructuring is helping you to see an old problem from a new point of view, to understand it differently. So, you know, I was treating a California road worker who was in a construction zone when some idiot went the wrong way and hit him with a car. He was taking a rest on his brake. It was two days before his wedding. He had bad ankle fracture. He had just pushed himself out of the way as the car was coming, and he was miserable, you know, and his fiance was miserable. And he just thought, why didn't I see this coming? And time and again, if I had a nickel for every traumatized person, either sexual assault or physical assault that blame themselves for events they didn't control.

34:13What's that? Guilt versus helplessness. Guilt versus helplessness. That's exactly right. And I had him relive it in hypnosis. I said, let's go through this. And he said, I'm sitting on the thing having my lunch. And suddenly I realized that he's not going the way all the other cars were going. He's coming at me. And I just pushed myself away from a barrier next to me and fell forward. And that's when he hit my leg. And I said, I want you to look at this. What would have happened if you hadn't done that? He said, well, he would have had me dead on. And I said, so you saved your life. So it's tragic.

34:45It's a terrible thing that happened, but it could have been so much worse. So think about this, not just from what went wrong, but from what went right, what you did to help yourself. And he felt entirely different about the trauma after that. He was still unhappy about his leg being injured. But it's a way of restructuring your point of view about the problem. And that's where techniques, including hypnosis for trauma, can help people really change their perspective. The other thing that happens in hypnosis is the more you concentrate, use your prefrontal cortex, the less activity in the default mode network.

35:18Now, that's the part of the brain, the posterior cingulate, that's involved with self-reflection and self-understanding. And when you're not doing much but thinking about yourself and who you are, you've got a lot of activity going on in the default mode. And if you can, in hypnosis, turn that down, you can try out being different. Instead of seeing this as just a total failure and disaster that messed up your wedding and all kinds of things, you can see it as evidence that you had the wherewithal in a matter of a split second to do something that saved your life. So it changes your view of yourself and who you are.

35:52And that's one of the terrific things about hypnosis is it allows you to try out being different, see what it feels like.

36:02Just a quick thanks to one of our sponsors, and we'll be right back to the show. This episode is brought to you by AG1, the daily foundational nutritional supplement that supports whole body health. I do get asked a lot what I would take if I could only take one supplement, and the true answer is invariably AG1. It simply covers a ton of bases. I usually drink it in the mornings and frequently take their travel packs with me on the road. So what is AG1? AG1 is a science-driven formulation of vitamins, probiotics, and whole food sourced nutrients. In a single scoop, AG1 gives you support for the brain, gut, and immune system.

36:37So take ownership of your health and try AG1 today. You will get a free one-year supply of vitamin D and five free AG1 travel packs with your first subscription purchase. So learn more, check it out, go to drinkag1.com slash Tim. That's drinkag1, the number one, drinkag1.com slash Tim. Last time, drinkag1.com slash Tim. Check it out.

37:06Feel free to fact check this, but I've had a lot of involvement with say MDMA-assisted psychotherapy for PTSD and all the way through the phase three trials and so on. And I've also through my foundation funded a lot of basic science and some clinical work related to different psychedelic assisted therapies for say treatment resistant depression or major depressive disorder in the case of psilocybin and the default mode network in this type of not quite deactivation but sort of down regulation i'm not sure what the proper technical term would be is something that robin carhart harris talks a lot about predominantly out of imperial college london and then later at UCSF.

37:44And it's striking because the subjective reports in a lot of these experiences, whether it be in the MDMA-assisted psychotherapy, although I don't really consider MDMA a psychedelic for various reasons, but let's just use psilocybin or even LSD, the ability to take an impartial observer status on yourself and to assume new perspectives. The description that I'm paraphrasing here that you just shared is very similar to the subjective reports of people who have good therapeutic outcomes with these other modalities. So it's exciting to me to hear you describe it in that way because psychedelics are contraindicated for so many people.

38:22There are quite a few people who should not take psychedelics in any form. I do want to talk about some of the applications, but in terms of risk profile, usually the kind of magnitude of potential impact is correlated to some type of risk profile. Are there adverse events? There are, but before I get to that, let me just backtrack a little bit on MDMA and psilocybin for PTSD. Because a lot of the things that the psychedelics have in common, although some are more hallucinogenic than others like psilocybin, is what's been called ego dissolution. And that you seem to just suppress activity in the default mode network.

38:58And so it becomes a kind of non-judgmental awareness where you see it happens, but you're sort of disconnected from it. So breast cancer patients dying of breast cancer have done very well with psilocybin trips. Now, I've for years worked with women who are dying of breast cancer. I know what it's like. And what struck me as similar and interesting is one of my group therapy patients said that looking at death in the group is like looking into the Grand Canyon when you're afraid of heights. You know, if you fell down, it would be a disaster, but you feel better about yourself because you're able to look at it.

39:31I can't say I feel serene, but I can look at it. so it's this odd kind of detachment where you can see it and what they think about their death now is i still don't like the idea of dying but what i can see now is what a miracle it is that i ever got to live at all and so they see the same thing from two different perspectives so this ability to sort of disconnect your selfhood and in hypnosis it's a rapid suspension of your usual selfhood in psychedelic work it's more this ego dissolution it kind of dissolves so it's a quicker, reversible form of something similar, which is playing with who you are and what you are.

40:09And that has tremendous therapeutic possibilities. Now, I think one reason MDMA works so well with PTSD is because it's the sort of human connection drug. In these raves and everything, people suddenly feel connected with people they never even know or feel very different about their loved ones and how they connect with them. People who have been traumatized, throughout PTSD feel deep shame. And it's not because they've done anything wrong, but just to be treated like an object, like a thing is humiliating. And so to be able to relive it in a state where you're feeling different about who you are is a way of reprocessing and disconnecting from the sense of shame.

40:53Just saying, yes, it happened. I don't like it, but it's not the bottom line about me. And that's where depression with post-traumatic stress disorder are so harmful to people because it tarnishes their feeling about who they are as people. And if you can understand the experience, but disconnected in some ways from this default mode conclusion about what sort of a person you are, that can be powerfully therapeutic. Absolutely. The commonalities are really worth highlighting here because certain treatments are not accessible to some folks, which is also part of the reason why I'm so interested in the work that is being pioneered in part by our mutual friend, Nolan Williams.

41:36Yes. At Stanford. Nolan's terrific. And we'll probably come back to Nolan and Accelerate TMS in a second. Sure. But what are the risks, if any? There are very few. I'll tell you, when we started Reverie about three years ago, I was kind of worried because, 30 years ago, I would not have dared to put an interactive digital hypnosis app out there on the web and just see what happened to people. I worry that people would have all kinds of ab reactions and dissociative reactions and terrible things could happen. But I thought, what the hell? I want people to have access to this and be able to try it.

42:10And we've had like three quarters of a million downloads and the number of potential problems we've had is less than 10 and none of them are serious. You know, some of them are ecstatic, positive experiences, kind of like, you know, psychedelic ones. Most of them are, you know, periods of anxiety or stress that are easily reversible. And so the good thing about hypnosis is you can turn it on real fast. You can turn it off real fast. So the worst thing that happens most of the time is sometimes it doesn't work. So what? So you do something else. So compared to the side effects of drugs, like let's take opioids for example, where last year 88 ,000 Americans died of opioid overdoses and almost all of them were not suicides.

42:52They were just inadvertent overdoses of opioids. Hypnosis has not yet succeeded in killing anyone. It's just not dangerous. And the reason you're using that as an example is because of the intersection with pain management? You bet. Okay, so we'll also So we'll come back to that. Got it. Marker noted. So adverse risk profile, pretty low. Adverse event profile, pretty manageable. I want to come back to Nolan for a second because I'm wondering if someone is in the researcher 20%, so a low responder. Is there, because I do believe that Nolan mentioned this to me, the possibility of using something like accelerated TMS, which is transcranial magnetic stimulation, this is a type of brain stimulation to improve trait hypnotizability?

43:41I don't know what the trait as a modifier means, but is it possible that one could use a tool like accelerated TMS to improve their response to hypnosis? The answer is absolutely yes. And Nolan and I and Afik Fireman and a number of other members of Nolan's team just published a paper in Nature Mental Health in which we took hypnotized people who were less than highly hypnotizable and we administered to them either accelerated TMS to the left dorsolateral prefrontal cortex with the idea of regulating activity in the dorsal anterior cingulate using real versus sham TMS. So we could tell whether they actually got the TMS or not.

44:17They couldn't tell. The paddle made the same noise, but they didn't know. And we were able to transiently significantly increase hypnotizability in the ones who got the real TMS and not in the ones who got the sham. What was the dosing on that? Was it one day? Was it five sessions yeah no it was one day it was just one session and then we measure that through a single session oh yeah it was not repeated like the treatment of depression or suicidal ideation single session okay so that seems like so we're hoping that's right i can see your face lighting up i feel the same way that we may be able for people we were studying people with fibromyalgia people with chronic pain to enhance derythmetizability and then use it to treat pain which it is very effective for.

45:02Okay, I'm going to get to ping quickly, folks, I promise. The segue is different tools show their best results in different contexts. And so you might have something like PRP, platelet-rich plasma for certain types of injury repair, surgical recovery, better for some types of surgeries and joints than others. You might have fill in the blank, MDMA-assisted psychotherapy, for instance, better for certain indications like complex PTSD than others, for instance. Other things might be better suited to say alcohol use disorder. What is hypnosis best for? Where have you seen the most outstanding results compared to other options?

45:39We've seen excellent results in helping people to manage stress. We're finding with Reverie that about 80 % of people within 10 minutes feel a significant reduction in their stress levels. It helps people focus, intensify their focus of attention, plan what they want to do, and then do it. It's a skill that they can learn to use very quickly. It's very effective with pain. It's one of the oldest uses of hypnosis with pain. In fact, there was a British surgeon named Hesdale who went to India and was using hypnosis. This was pre-ether anesthesia. Now they would just get people drunk, have them bite on a block of wood, hold them down and cut on them.

46:18Frontier medicine. Frontier medicine, right. And he went to India and he reported 80 % surgical anesthesia with hypnosis. And when 10 years later at Mass General - You just don't want to be in the 20%. No, you don't, but it's better than - It's better than zero. Better than what was happening before. Better than bourbon in a wallet. Right, exactly. And when ether was first introduced at Mass General 10 years later, the surgeon strode to the front of the amphitheater to say, gentlemen, this is no humbug to distinguish ether from hypnosis. Well, they were getting 90 % anesthesia. And so Esdell withdrew his paper.

46:53He said, well, they're 10 % better. Are you saying ether is getting 90 and hypnosis is getting 80? Yeah. I got to say he withdrew his paper. He withdrew his paper. And you know, it's taken us like a century and a half to figure out that the brain actually has something to do with pain processing. And there are studies now showing which part of the brain, just changing the words you use in hypnosis, which part of the brain is involved in the analgesia. So you significantly reduce pain in the somatosensory cortex. If you say the hand that's receiving the shocks as cool, tingling, and numb filter the hurt out of the pain.

47:25You get the same reduction in pain response if you say, well, the pain is there, but it won't bother you so much, sort of like opioids. Then you turn down activity in the dorsal anterior cingulate. So you can see different parts of the brain involved in pain processing and in hypnotic analgesia. Depending on the language you're using. Depending on the language. So if you think that what doctors say to patients, right, It is spellcasting, that's right, but no pointy hats or anything. Those come at the more advanced levels. You've got to pay your association dues to get the hats. So how does that affect the treatment?

48:01If you're looking at, say, the example that you just gave, where different wording is affecting different neuroanatomical structures and activity, does that then determine your neurotargeting, for lack of a better term? and you're like, okay, we saw A instead of B light up. We really want to go after A based on what we know. It may be for certain kinds of pain or certain kinds of problems, you want to emphasize one or the other. But frankly, we have four different sets of instructions that involve either just going somewhere else, leaving your body here and going to a desert island and enjoying things.

48:37We're imagining a physical remedy that actually reduces pain, a warm bath or an ice bath or something like that, or move the pain around. See what it feels like to do that. And one other technique that's very helpful is teach people to have compassion for their bodies. This is like mindfulness in some ways. But, you know, if your body were a three-year-old child who'd been hurt, would you get frustrated and angry with it? Hell no. What would you do? Everybody says, I'd give him a hug and I'd stroke him and I'd try and make him feel better. So there are different language techniques we can use to get the same effect, which is to significantly reduce pain.

49:11We have randomized clinical trials that prove that hypnotic analgesia works at much lower levels of medication too. And so it's an underutilized resource. Hypnosis is like an underappreciated company that hasn't been managed well and has a lot more positive resources. And that's what it's like. We just don't take advantage of it. So let's use me as a hypothetical, intrepid user of self-hypnosis. So I have some low back pain. we were chatting about this before we started recording. Is there a particular approach that you might recommend one, or in this case, I start with in a case like this? Sure.

49:51We can try it if you want. Yeah, I'm game. You're game? I'm absolutely game. All right. How would you rate your pain right now on a zero to ten scale? I'd say it's a two out of ten. It's more of a bothersome stiffness. And annoyance. Yeah. And is there a physical remedy that helps you with it? A warm bath? There are foam rolling, say the piriformis and glutes and so on does help. Using psoas release tends to help. Just laying on my stomach, honestly, with my hands under my pelvis to take all the activity out of the spinal erectors helps. Those are a few things. Like laying down on my stomach and breathing into the back to relax the spinal erectors, I would say, is one thing that seems to help.

50:33Well, that seems like a vivid image. And temperature things don't make much difference. say temperature if i do say a cold bath and then a hot bath just contrast therapy like that that seems to help okay so that feeling of cold tissue vasodilating when i get into the hot bath that type of like prickly sensation of being sort of perfused with blood that's something i associate i would say with feeling better feeling better so part of what you're doing is reinterpreting the signals you're getting in a different way. So let's try it if you want. So get as comfortable as you can. On one, please do one thing.

51:12Look up all the way up high as you can. Two, do two things. Slowly close your eyes and take a deep breath. And three, do three things. Let the breath out. Let your eyes relax, but keep them closed and let your body float. Imagine you're floating somewhere safe and comfortable like a bath, a lake, a hot tub, or floating in space. And then take your right hand and stroke the back of your left hand, starting with the tip of your left middle finger. Or you can put it on the table. That might be better. Now stroke the back of your left middle finger down along the back of your left hand, past your wrist to your elbow.

51:56And as you do that, develop a sense of tingling and numbness and lightness. and let your left hand float up in the air like a balloon. Feel the tingling. That's good. And let it float up. You bend your elbow and you can rest your arm lightly on the table. And please describe what physical sensations you're aware of now in your left hand and arm. Feel my heartbeat in my palm. A little bit. I can feel the hair on the back of my arm touching the sleeve that I rolled up. And I'm going to give you this instruction. If you pull your hand back down to the table with your right hand and then let go, it will float right back up to the upright position to see what happens.

52:45That's good. So you're putting it down. Now let go. I see you smiling. What's happening? There's, I mean, it feels like it's floating. Number one, I'm also kind of second guessing myself because I wonder if I'm doing this to conform to the exercise, if that makes sense. But it feels like it's floating. Okay. Yeah. And as you do that, let your left hand remain upright. Later, when I ask you to touch your left elbow with your right hand and let go, your usual sensation and control will return. Can you say that last part again? When I ask you to touch your left elbow with your right hand and then let go, your usual sensation and control will return.

53:26Okay. Right now, I want you to notice sensations in your back. What does your back feel like right now? The part that's usually painful? Yeah. It feels relaxed right now. Good. More relaxed, yeah. Good. How would you rate the discomfort level right now on that 0 to 10 scale? 0.5, 1 out of 10. 1 out of 10. 0.5 to 1. Okay, good. But so already, notice how you've been able to change sensation, not just in a neutral part of your body, your left hand and arm, but in a part that has been problematic. I want you to imagine now that you're lying on your belly, maybe with a roll under you, and feel a pleasant tingling numbness in your lower back, as if it were cooler or warmer, or you were changing it from warmer to cooler.

54:21Feel a pleasant tingling numbness and let it filter the hurt out of the pain. Each breath deeper and easier. Now again with your eyes closed and remaining in this state of concentration, please describe how your body is feeling right now. It does feel cooler. Good.

54:43Feels a little dissociated. Uh-huh. Makes sense. Can you describe that a little more? I feel like it's very similar to two tequilas. There you go. Or a low dose of ketamine, which I don't recommend, but as a dissociative anesthetic, I've always struggled to put words to the dissociative experience. There's a lightness and there's a conscious awareness of the body without being as identified with the body. Exactly. So you can observe it, but it feels different. And would it be fair to say that it's not as annoying as it usually is? It's not as annoying. Good. So notice how you're able to filter a lot of the discomfort and displeasure out of the usual pain situation by detaching from it, by experiencing it differently.

55:39It's not a sentence you have to endure. It's a sensation your body is giving you that you can interpret in different ways. now for people who might wonder if this is compartmentalizing in a way that is long-term harmful i'm not saying that's what it is but is this just taking a different vantage point how would you encourage them to think about this yes i would say it's reinterpreting the sensations and signals that you're getting from that part of your body and you're uncoupling them from the usual sense of annoyance and limitation that tends to actually make it worse oh it 100 makes it worse Yeah, and instead you're saying, okay, it's there.

56:20I don't like it, but it's not bad. And that capacity to reframe, to reprocess the signal is a powerful way of better managing pain, filtering the hurt out of the pain. Now, please take your right hand and touch your left elbow and then let go and see what happens to your left hand and arm. Yeah, just more movement is more forthcoming. Uh-huh. Good. That's surprising, isn't it? Yeah. I was noticing how my fingers kind of got frozen in this position. I thought that was interesting. I'm not making too much out of it, but I was like... All right, you can let it float back down now. and how's your left hand and arm feeling now?

57:09normal normal good so you were able to change sensation in both directions and how's your how's your lower back feeling now feels really good actually yeah so terrific that's remarkable i'm very glad uh that's great so thank you for that you're welcome where do you get my bill you have my email i'm really glad fresh books six thousand dollars what happened to the first one's always free oh wait no that's drug dealing not hypnosis yeah exactly and if someone's inducing that from a self-hypnosis perspective well let's just talk about it could be in the context of reverie it could be in a different context what are the steps that they take or how do they self-induce for something like that let's just say if i want to do that five minutes a day if i wanted to do it five minutes a day you could remember what i told you, or you could cue up the pain control app on Reverie and you get to hear my mellifluous voice teaching you an exercise.

58:14Good use of mellifluous. Right. This dulcet tone. Dulcet tone. There you are. To teach you how to do this and you could follow along and it's interactive. So I'll ask you, is your hand floating? If it is, I'll tell you one thing. If not, it's something else. So it's a branch chain kind of response that I tried to make as much like being across the table or in my office as I could. And not to beat the dead horse of neurobiology, but just to reinforce my understanding, from a neurobiological or neuroanatomical perspective, what is happening? So what's happening is, and we've got EEG studies, we've got fMRI studies, we've got PET studies showing that what's happening, if you think about it, that pain is always a combination of peripheral input through the lateral spinothalamic tract, through the thalamus, through the periaqueductal gray, and up to the somatosensory cortex with input from the salience network.

59:07So if you just broke your arm, the salience network is going, God, you're in trouble, you better do something. But the problem is because we're fairly pathetic physical creatures, we have to take very good care of our fragile bodies. And so we have a brain that is designed to help you recognize when you're hurt and get help and manage the pain. But, for example, freeze, not necessarily move so a predator could detect you more easily. So pain is a combination of those peripheral signals coming in and what your brain decides is wrong and what to do about it. And so very often chronic pain is really not anything you need to do anything about, but your brain often treats it as if it were acute pain.

59:50Here I am. And so it derails you and it annoys you and it keeps you from doing what you want to do. And the more annoying it is, the more attention you pay to it. It's like the noisy kid in the classroom, you know. And so you can learn to modulate that. So we showed in one experiment with Stanford students, we gave them electric shocks. We measured somatosensory evoked responses. So you can see waveforms coming out up to a second after the shocks are administered. And in the hypnosis condition, we were able to stop the P100, the first response, cold. There was no response of the brain when they were in hypnosis in the first tenth of a second.

1:00:26And the P200 and P300 were half as big as ordinarily. So within a fraction of a second, the brain is processing the signals differently. And as I mentioned, there are studies that show you can turn out activity in the anterior cingulate, you can turn out activity in somatosensory cortex. So the brain is saying, this is not as bad as I initially thought it was, and I don't have to pay as much attention to it. It doesn't have to hurt me as much. Because very often, we amplify pain rather than diminish it by being so annoyed that it's happening. And another thing that we know is going on in the brain is the anterior cingulate is rich in GABA receptors, gamma immunobutyric acid, their inhibitory neurotransmitter.

1:01:09Highly hypnotizable people have more binding of GABA in the anterior cingulate than low hypnotizable people. So they can use it to be their own little drug dispensaries to inhibit the anxiety reaction in the dorsal anterior cingulate cortex. So there are many understandable neurophysiological ways by which the brain can literally take the strain out of pain. I'm also wondering, I mean, you'd have to test this, of course, but if hypnotizability as assessed by various means, whether it's the eye roll test or a drop of blood and looking at the genetic profile, if there might be some correlation to high response, baseline response, low response for psychedelic assisted treatments as well.

1:01:57Because as it stands currently, there's a lot of shooting in the dark. I'm not aware of any assessment that determines if someone is likely to be a high responder to psychedelic. But as we're talking about it, there seem to be a lot of parallels. Oh, I think there are. It wouldn't be that hard to test. I mean, somebody has to fund it, of course, but science takes money. But I mean, there are lots of assessments for, let's just say, determining the strength of a mystical experience and how that's correlated to therapeutic outcomes, highly correlated, it turns out, at least with psilocybin and so on and so forth.

1:02:28They're all the standard assessments that you might have for depression and HAMD and so on, or GAD or whatever, all of these various things. But in terms of determining in the process of patient recruitment who might be a high responder, that's a huge deficit in the system right now. I agree with you. I'm going to be a terrific thing to do. And maybe in Nolan's next study, he just published a paper on Ibogaine with astounding results. I mean, just astonishing, not just improving PTSD, which I kind of expected, but TBI, traumatic brain injuries, and it stays down, goes down and it stays down. Yeah, it's very durable.

1:03:03And that's one of the things about a lot of these psychedelic studies is that it breaks the whole model of keep occupying that receptor and, you know, blocking serotonin uptake and all this stuff. And it's just once or twice and the brain is like reset, it's rebooted. And that's where I think this interaction with the default mode network activity is very interesting because I think people reset their expectations of who they are, what they are, and what their symptoms mean in a way that lasts. And there's now a lot of of course, there's often psychotherapeutic assistance with the psychedelic treatments, which is important, but some of that could be hypnotic instruction too.

1:03:42And I don't think much of that has been done, but it would be very interesting to do. I agree with you. It'll be super interesting. Yeah, there's a broad canvas still remaining for all sorts of research. I'm glad to hear that. So let me ask about a few things. First, you used wording that was along the lines of, I heard you mentioned at least twice, filtering the hurt from the pain. Am I getting this right? Right. Could you elaborate on that? And then the second piece is much earlier. You were referring to the, say, I don't want to call them below hypnotizable people who fall into this category, nicknamed the researcher, who could still use it.

1:04:24And I thought I heard you say something like framing issues as for us, not against us, something like that. So could you first talk about filtering the hurt from the pain and then this for us versus against us? Well, the filter the hurt from the pain is, you know, it sounds kind of paradoxical. What are you talking about? Pain hurts, you know, But the degree to which it hurts has to do with more than just the signal traveling through the lateral spinothalamic tract. It has to do with how you interpret that signal. We have all kinds of somatic signals, some of which could be on the verge of discomfort, some of which aren't.

1:04:59And our brain's job is to interpret them and decide what to do about them. And so you can have a signal that doesn't necessarily automatically convey that something is wrong with the body. It may be just an intense ceiling. You know, it's like the difference between, you know, an enthusiastic hug and a squeeze that hurts. And there's a line in there somewhere that you cross and it's pretty obvious, but there's also an area of interpretation. Or the ostentatious long hug. There are a lot of guys here who do long hugs. They say, I'm a hugger when you try shake hands. Yeah. It's like a 20 second hug.

1:05:32There's a point where it gets uncomfortable. It gets uncomfortable. That's right. And it's usually after the first second or two, but that's right. And so the brain is doing its interpretive job of making meaning out of the sensory experience. One of the other things that we know happens in the brain with hypnosis is higher functional connectivity between the dorsolateral prefrontal cortex and the insula. Insula is this little island that means island in Latin in the mid front part of the brain that is a mind-body conduit. So it's a place where the brain controls what's happening in the body, how much gastric acid you secrete, your autonomic arousal, for example.

1:06:06and also it receives information interoception from the body. How is the body reacting to things? And hypnosis intensifies this connection and intensifies coordinated activity between the executive control network and the insula. And so it's a way in which the brain can intensify its reading and understanding and interpretation of what's happening in the body. And so, you know, athletes who are pushing their bodies to do things that most of the rest of us would say, ouch, I can't do this, are interpreting that as I'm pushing my body as hard and as far as I can to get what I want. And so they will interpret things that everyday people would interpret as putting yourself through pain as training, doing what you need to do.

1:06:52And that runner's high is in part composed of signals that many of us would just consider painful. And so that's part of what the brain does. And that's part of what hypnosis helps us to regulate and control. How much of it is pain and how much it is not. And so the interpretation of pain, the meaning of it, has a lot to do with how much it hurts. And what about the for us versus against us? People who are experienced with hypnosis, that is people who know that people actually listen and respond to what you say, will say the dumbest thing you can say to somebody is don't think about purple elephants.

1:07:27What are you going to think about? And the best way to change behavior is intermittent positive reinforcement. So you want the process of change to be what Csikszentmihalyi called autotelic. You want to feel good about doing it. So an example where we do that in hypnosis, and where even non-hypnotizable people can respond is, when I try to teach someone how to stop smoking, which was the first experiment we did with reverie, I don't say, you know, cigarettes will taste terrible. My professor at medical school did that. He said, your cigarettes will taste like horseshit. And the guy lit up the cigarette and said, oh, thank you, doctor.

1:08:03And he got a frantic call two hours later. He said, doc, my house smells terrible. My house smells like horseshit. Right. And Hackett said, well, are you smoking? He said, no, but I forgot to tell you that my wife is a smoker. So he had to hypnotize him and say, only your cigarette. It doesn't work. You focus on what you're for. Respect and protect your body. For my body, smoking is a poison. I need my body to live. I owe my body respect and protection. You would never put tar and nicotine-filled smoke in your baby's lungs. Your body is as dependent on you as your baby was. So treat your body with the same respect you'd give a child.

1:08:41And so you're focusing not on whether you have an urge to smoke or not, whether you feel better on nicotine or not, but whether you are going to commit to respect and protect your body. And that way you can feel good from the moment you make the commitment to do it. I'm being a good parent to my own body. So even people who aren't hypnotizable can get that concept and say, I'm not going to worry about my urge. I have lots of urges I don't act on. I don't have to act on this one just because I have it. So I had one alcoholic who I was trying to use that to help him stop his drinking. He said, oh, you mean sort of like the body is the temple of the soul?

1:09:18And I said, yes, you got it. That's it. And he stopped drinking. So it's a matter of finding a way to formulate the resolution of a problem so that you start feeling good from the moment you commit to doing it before you know that you're going to stop smoking. And we're getting one out of five people stopped just like that and they surprise themselves that's one of the things i love about working with hypnosis is people are surprised at what they can do because they're trying out being different and seeing what it feels like what do you think is happening with the addiction specifically whether it's nicotine alcohol or other why does this work where other things fail and i should ask actually just so you can set the table for this how does How hypnosis compare, and I'm sure it depends on the practitioner and so on, which kind of gets into a whole separate question I wanted to ask about just schools of hypnosis.

1:10:13I don't know how standardized things are, like CBT, for instance. But not that that's hypnosis, I'm just saying they've tried to standardize so they can track things. How does hypnosis compare to other types of interventions for addiction? Well, the results we get with hypnosis is about one in four, one out of five people just flat out stop. And the rest cut down by about 50 % in how much they're smoking. That's roughly comparable to the use of Varenicline or Bupropion or Nicorette patches. It's not very different. Depends on the population. But it's about as good. Is it the same people? I don't know for sure because they're done in different contexts.

1:10:47But it's not bad. And I have people who are surprised by how easy it is. They said like a lever was pulled. And I just don't worry about it anymore. I just don't think about it. Now, does it happen with everyone? No. But every time, we feel good any time we get anybody to stop the most reversible cause of cancer in the world is cigarette smoking. So anybody you get, that's a good thing. And even people who are, it is correlated with hypnotizability. So more hypnotizable people are more likely to stop using this approach. But there are some non-hypnotizable people who do too because they get the concept even if they don't get the feeling that comes along with it.

1:11:28And the other thing that keeps in mind in addiction medicine is that the odd thing is that it's not actually the high from the drug that hooks people. The chase is better than the catch. So you get more mesolimbic dopamine secreted when you're going through a scenario of scoring a drug than when you're actually taking the drug. So it's the anticipation of pleasure that really gets to people. And from my point of view, using hypnosis, that's fertile ground for intervention. where you just say, I can make you feel good without chasing after the drug. I can make you feel good the way you felt when you hugged your six-month-old child because you're doing the same thing with your body now.

1:12:08And that's a good thing. So helping people to focus on what they're for is a crucial part of the therapeutic strategy and makes it work. What is the oldest that you're aware of documentation of hypnosis or something resembling hypnosis? You know, I was in Bali watching trance healers and the difference in Bali, and this has gone on for thousands of years, they go into a trance and their patients watch them. So they kind of go into this altered state and start chanting and singing. And the idea is, if you watch it, it's kind of hypnotic and you'll kind of go along with them. But from a Western point of view, it started in the late 18th century with Franz Anton Mesmer, who was a Viennese physician hence mesmerized that's right and he called it animal magnetism and he thought it actually had to do with changing the magnetic field in a patient's body and he had to look at tubs filled with iron filings and he had a magnet in fact the magic wand in magic shows comes originally from a magnetic rod that was used tms 1.0 yeah that's right that's right from from animal magnetism to transcranial magnetic stimulation.

1:13:19That's right. And he was very popular. He left his wife and family in Vienna. He moved to Paris. He was out competing the leading French physicians of the day. Voltaire wrote to his brother, we did everything we could to save father's life. We even sent the doctors away. And if you think about the major treatment at the time in France, it was bloodletting. France was the world's leading exporter of leeches. And unless you happen to have congestive heart failure. France was the world's leading exporter of leeches. Leeches, because that's how they didn't. And they still, in some like hand damage things, they use leeches to suck blood out of certain regions in the hand and all that.

1:13:55But at the time, that was the major treatment. And he was so popular. And the cool thing, if you read about what his office was like, he was cheerful. It was brightly lit. Patients would hang around all day boasting about what they'd done with animal magnetism. And the typical French physician's office was truly grim. It was dark, no decorations on the walls. Patients were getting bad news from doctors. I once had the opportunity to visit Anna Freud when I was a medical student in London. And she asked me if I was going to become an analyst. And I tried to be diplomatic and say, well, I'm not sure.

1:14:30She said, so you're not going to be an analyst. She wasn't messing around, you know. Why? And I said, well, I don't like the passivity. I don't like not offering something, trying to help fix things with people. And she said, you need to understand something. When my father was training as a doctor, it was considered a waste of time for a doctor to listen to a patient. Patients were there to listen to doctors. And I was humbled by that. I thought, you know, it was a very good point. And she said, it's hard to be analyzed because analysis is a liberation from your parents. And that's difficult if your parents are analysts.

1:15:03And she knew better than anyone because her father was her analyst, actually. Oh, boy. Lots to unpack there. Yeah, there was a lot in the doctor-patient relationship in that time that was pretty grim. And so the fact that Mesmer was talking to patients and listening to them made him very popular. So they got King Louis to convene a panel to investigate Mesmer. The panel was very interesting. Our own Benjamin Franklin was on it. He was having a lot of fun in Paris. Why was Mesmer being investigated? Because he was competing so successfully with French doctors. They didn't like the competition. The French doctor lobby.

1:15:38The French doctor lobby. That was it. Pulled out the stops. They said that his theory was all wrong, that he wasn't really changing magnetic fields, which is correct. It's true. They concluded. And another member of the panel was Lavoisier, the brilliant French chemist who developed oxygen chemistry, and who, six months before he was beheaded in the French Revolution, discovered the idea of the gross national product. He was a genius. and one of the third other panel members was a doctor named dr guillotine the inventor of the guillotine he kind of created the mind body problem what a panel yeah what a panel it's like the setup for a joke yeah it is but it wasn't unfortunately they concluded that hypnosis was nothing but heated imagination and you know what i've heard worse definitions than hypnosis but But that was it for Mesmer.

1:16:29And so it's set in motion a pattern of why hypnosis is just an underdeveloped resource, is that people think it's either dangerous or it's ridiculous, and it's neither. It's a valuable, effective treatment that we have underutilized for decades, for centuries. What is, if you had to pick one or two, anything that comes to mind, some of the more surprising patient outcomes or changes that you've seen? Is there cases where I'm sure you could have predicted the outcomes? I have a 50 % chance this person has a 30 % reduction in A, B, and C symptoms. But were there any that really stand out to you as surprising?

1:17:09The first one was the one that got me to decide that, yes, this happens to me. I'm in my father's interest, but I'm not going to let that deter me from something I'm interested in. And it was the first patient I ever used hypnosis with. It was on my pediatrics rotation at Children's Hospital in Boston. And the nurse says, Spiegel, your patient is in room 342. She's in status asthmaticus. She's been hospitalized every month for three months, and she's back again. And she hasn't responded to epinephrine twice, and we're going to maybe give her general anesthesia and put her on steroids. So I walk in the room, following the sound of the wheezes down the hall.

1:17:46Pretty 15-year-old girl, bolt upright in bed, struggling for breath, knuckles white, mother standing there crying. I didn't know what to do, but I had taken a hypnosis course. So I said, well, would you like to learn a breathing exercise? And she nods. So I get her hypnotized and then I break into a sweat and I think, wait a minute, we haven't gotten the hazma in the course. So I said something very subtle and clever. I said, each breath you take will be a little deeper and a little easier. And within five minutes, she's lying back in bed. She's not wheezing anymore. Her mother stopped crying.

1:18:17Nurse runs out of the room. And if you think about the dynamic of that, I mean, it was stunning to me. I couldn't believe it. But each time she tried to breathe and had trouble, she got more and more anxious because she thinks, I'm going to not be able to breathe. It's very frightening. So you have her anxiety building like a snowball rolling downhill on top of the physical sensations. So in comes my intern. I thought he was going to pat me on the back and say, good for you. He said, the nurse has filed a complaint with a nursing supervisor that you violated Massachusetts law by hypnotizing a minor without parental consent.

1:18:52Kid you not. And Massachusetts has a lot of dumb laws, but that is not on the list. And furthermore, her mother was standing next to me when I did it. He said, well, you're going to have to stop doing this. And I said, oh, really? Why? He said, because it could be dangerous. And I said, you're going to give her general anesthesia and put her on steroids. Am I talking to her as dangerous? I don't think so. So I said, tell you what, as long as she's my patient, I'm not telling her something I know isn't true. So take me off the case if you want. So he storms out of the room. He finds the chief resident and the attending, and they have a council of war.

1:19:22And they came back with a radical solution. They said, let's ask the patient. You know, I don't think they'd ever thought of that. Breakthrough. Yeah, breakthrough. And she said, oh, I like this. I want to keep doing this. And she was hospitalized one month after that, a month later, and went on to study to be a respiratory therapist. And I thought that anything that could help a patient that much, that fast, frustrate the head nurse violated non-existent Massachusetts law had to be worth looking into. And I've been doing it ever since. But, you know, the nice thing is you can see it in front of your eyes.

1:19:56You see whether it's going to help, you know, just like you with your pain. You know, it's the same thing. If it's going to happen, your brain is wired to every part of the body to make it happen quickly. And it doesn't always happen, but it often does. I'd say the next major patient that really struck me when I first got to Stanford, I was assigned to the Palo Alto VA Medical Center. And there was an army cook who had been mustered out of the army because after 19 years of good service, something happened during the Tet Offensive. And he just grabbed an ambulance and some guns and ran out in the jungle and started shooting at what he thought were Viet Cong.

1:20:32And he seemed psychotic. They couldn't contain him. He was agitated. He was emotionally uncontrolled. He wasn't responding to meds. And he wound up being discharged from the army and spending 11 months in a state mental hospital in California. And a social worker there interviewed him and said, he's not a drug user. He doesn't seem psychotic to me. There's something wrong, but I think it's post-traumatic. So I saw him at the VA, and he told me that something happened during the Tet Offensive, and it had something to do with a Vietnamese child that he had informally adopted. He was like the youngest of 13 children.

1:21:10He identified with young kids. This kid had been badly burned, was on a crutch. Nobody seemed to claim him, and so he just kind of took over, and they became buddies. And during the Tet Offensive, I find out in hypnosis, he comes upon the boy's body, and he realized he's been killed. and in reliving this in hypnosis, and he was very hypnotizable. He says, oh my God, they hit G-Wing. Oh my God, they ain't got to kill kids. They ain't got to kill kids. So he's screaming and crying. And then he's going into setting up defenses on a water tower because he thinks we're going to be overrun by Viet Cong.

1:21:49And he's going through all of that. And I move him then. The remarkable thing was he was very intensely involved in all this, but very malleable. So I'd say, okay, we're going to change times now. and we're going to go to the time when you collected his body and buried him. And so he does that and he says ashes to ashes and dust to dust, I guess that's it. And then he starts banging on the arm of his chair and he says, if I'd only taken you over to G-Wing, man, you wouldn't be there. It's all my fault. And I said, tell me something. Would this boy blame you for what happened? And he starts to smile.

1:22:23He says, no, no. He said, you're number one cook. You're my number one cook. Number one cook. he knew he was going to die. He was crippled. He looked like he had arthritis. And so I said, okay, we're going to go to his funeral now. And no, we're going to go to a different time. We're going to go to a time before the funeral when you had a party for him, a happy memory. Because, you know, often with grief, the reason it hurts so much is that you loved and cared about each other so much. So there's something positive behind the grief. And so he says, oh, you look so happy. The donut dollies brought a cake.

1:23:01My sister sent an electric train for a present for you. You've never seen an electric train before, have you? Vietnam ain't got no railroads. And it turned out later that the train was actually from Spiegel Brothers department store in Chicago. And he said, he's so happy. You're my number one cook. So I said, okay, we're going to put as much of this as you don't want to think about now behind a filter to be there if you need it but you're going to remember two things about this you're going to remember burying him and you're going to remember that birthday party and so he's you know he's sweating his tears going down his cheeks and i brought him out of the hypnosis and he looked a little sort of dazed he looked a little confused and i said what do you remember and he said doc i remember a grave and a cake that was it so it was a way of helping him acknowledge his grief begin to go through a process of grieving but see it from two points of view that he had this time with this kid he made the boy happy the boy made him happy and that can't be taken away even though he died and he was in the hospital for a while longer he practiced it every day sitting in the ward he was doing his self-hypnosis and he was discharged he was upset he couldn't get back in the army.

1:24:22He wanted to, but he'd been discharged. His brother, who was a police officer in Chicago, was killed in the line of duty, and he decompensated again. But we processed the grief. What does decompensated mean? It just got symptoms all over again. He started to look like he was hearing voices, although he wasn't, but discontrol of emotion. And so I had him grieve his brother's death in the same way. And he got discharged. He was spending his time training teenagers how to do long distance cycling and he was out of the hospital and doing fine. So, you know, I thought that anything that can help people in these rather extreme situations come to a new point of view in a hurry about that was worth pursuing.

1:25:04And I've been doing it ever since. And we've had people in a guy who was in his home for three years. He had the social phobia, you know, where he just couldn't stand to leave his house. He was there for three years and we taught him to use self hypnosis to deal with his anxiety. And he's out in the world again. He's living a normal life. So it is surprising how much it can help people in R.E. What a remarkable story. I want to ask you to just describe reverie for folks in a minute. But first I want to ask, in that circumstance where you have this veteran who some think psychotic, who is getting really animated, heated, sweating, to maintain your composure and direct that environment, that person in that state, what does it take to get to that point where you're comfortable doing that?

1:25:59That's a very astute question because the intensity of it is remarkable. We actually have a grainy old video of it, but I sometimes get surprised myself. I was actually holding onto his arm the whole time. I didn't even realize it at the time, but I was like trying to connect with him so that whatever else was going on, he knew I was there with him. And I guess two things, Tim, one was it's a characteristic of highly empathizable people that they can be having intense experiences and yet be connected and contained. That is, they're absorbed in it, but they're not just out of control. They're not just wild.

1:26:38They're expressing their emotion, but they're also able to modulate and control it and focus on this sort of narrow container of being intense in reliving what happened, but also somehow aware that it is a reliving of the event. It isn't actually happening. And so I figured you got to have the reins of the horse when you're riding fast. But it was clear to me that he was listening to me. And what struck me the most and what reassured me, frankly, was that he could change times very easily. He could change mood. So literally transition from screaming, I should have taken you over the hooch, man.

1:27:15It's all my fault. To ashes to ashes and dust to dust was a few seconds, you know, but he was following me. And, you know, if I saw that he wasn't, I'd spend more time on the control issue. But it's also because the intensity had to do with something we were meaningfully working on. That is, I wasn't doing it just to have him show off how emotional he could be. I was doing it to help him queue up into perspective the thing that was upsetting him so much and help him to process it in a way that made him feel better about it. So I knew I was doing something that I thought could help him. And I'll tell you that in some of these intense kinds of hypnotic therapies, I'm a little dissociated, too.

1:27:55You know, they're just saying it's a smart hypnotist that knows who is hypnotizing whom. But I'm kind of listening to my own mind saying, what's the next step? What do we need to do here? And I'm thinking about it for a second and saying, is this really the right thing? Well, let's try it out and see. And so I'm also testing his response. And if I see that we're not getting anywhere, then I'll change course. And it takes some time and training to just sort of know the direction you want to go in and why you're doing this. And is it really going to help him or is it just putting on a show? And it was clear to me that's what he needed to do.

1:28:28And you get this sort of deep connection with somebody that they can feel you and you can feel them. you know that he knows what i'm trying to do and i know what he's needs to do i think there might be something to the correspondence of trait hypnotizability and good candidacy for psychedelic assisted therapies i really do because that what you just described also i think would be mirrored in many patient reports who exhibit strong durable outcomes they're able to switch from one thing to the next very quickly from one maybe very positive emotional valence to one very negative emotional valence and then back and forth while still maintaining some semblance of observer awareness if that makes sense so it's very very curious who is reverie designed for reverie is designed for anybody who's curious about dealing with their problems if you just want to learn something about your ability to explore and change your mental states, it's useful.

1:29:31It's a tool. It's more like an antibiotic than a vitamin. If you've got a problem, you can try it and see if it'll help. So people with pain, stress, insomnia, that's our most popular use, people getting to sleep or getting back to sleep. I used to worry that reverie wasn't quite as good as being in my office with me. And then I thought, if you wake up at three in the morning and need to get back to sleep, you probably don't want me in your bedroom helping you do it. You probably don't want to be in. I don't either. Someone's in the bedroom at 3 in the morning. That's exactly right. It's very useful for dealing with phobias like airplane phobias, claustrophobia.

1:30:06I had a lovely woman who had an obsessive compulsive disorder, oral life, and claustrophobia, and was diagnosed recently with cancer and had to have a scan in an enclosed tube and just was freaked out about doing it. And I had her picture doing two things that made her feel better. One is just floating somewhere she felt comfortable. And she said, I remember floating in the Dead Sea. And I thought for a cancer patient, it might not be the ideal image, but the intense salinity of the Dead Sea makes you float like a cork. And so she liked it. So I said, okay, we'll do that. And she had a very loving sister in New York who would come out to visit her.

1:30:45And I said, and I want you to imagine that your sister is standing next to that scanner, giving you a hug and reassuring you. And she came out of it and she started to cry. And she said, for the first time, I think I can do this. You know, I can actually do this. I mean, she was afraid to go in an elevator by herself. It was too scary. She'd wait in the hospital. I know multiple people who have this issue with elevators, airplanes. And with airplanes, I have people, imagine they're floating with the plane. The way you take a roller coaster ride, don't fight the plane, float with it. And see, the plane is an extension of your body like a bicycle.

1:31:18If you want to get somewhere faster, you're using the plane as an extension of your body. The pilot is an extension of your mind. You chose an airline that has good pilots, and he or she is an extension of your mind. So concepts like that can help people do self-hypnosis and get from point A to point B. So that's good. And then for habit problems like smoking or drinking or eating badly, you can learn to eat like a gourmet. You can enjoy eating more while you eat healthier food by using self-hypnosis to do that. What have you used, if anything, self-hypnosis for on yourself? I had recurrent dislocation on my shoulder, and I realized I needed surgery done.

1:32:03It's a three-hour operation. It's a big deal. I've had my left shoulder reconstructed. It's a lot of fun, isn't it? Very fun. I used general anesthesia for the surgery itself, but afterwards, I just did self-hypnosis for the pain control. And it was a mass general, and I wasn't supposed to read my record, but I worked there. So the nurse kind of looks at me like, and the resident wrote in my record, patient using very little pain medication, we mustn't have cut many nerves. Now, you know, I've got a scar from here to here. I can tell you they cut nerves. But it's this misunderstanding that, you know, the body is just like a broken car.

1:32:40You just got to, you know, incision, ingestion or injection. You know, you got to do something to the body. rather than teach the person to use the control system that we're all born with, this three-pound object at the top of our shoulders that is connected to every part of the body and helps to control it. And why on earth shouldn't we be able to use that better? It doesn't come with a user's manual. So you've got to figure out how to do it, but it makes a huge difference. And so hypnosis is not a commodity. It's a skill to be shared. And that's one reason, actually, it's underutilized. is, you know, I don't have a bunch of ex-cheerleaders going to doctor's offices telling them use hypnosis, but drug companies do.

1:33:22And, you know, I'm a doctor, I prescribe meds, but there are many times when doing something like this is much better and safer and more effective. Could also be the, given the very favorable risk profile, something that you at least attempt before moving on to more severe interventions. That's exactly right. You know, why not try this first? I had a young woman, seven months pregnant, very bad lower back disease. And of course, as the baby grew, you know, it got worse. They put in a nerve stimulator, it didn't help. And they couldn't give her opioids because she was, you know, had it pregnant.

1:33:59And so I have her imagine she's floating in a nice warm bath, filtered the hurt out of the pain. Her pain went from seven to three in a couple of minutes. But she looked angry. And I said, what's the matter? She said, why in the hell are you the last doctor I got sent to instead of the first? And that's exactly right, Tim. I don't get it. You know, it's inexpensive. It's effective. Why not try that first? And then if that doesn't work, do something else. It's really a shame. It's a disservice to people who can help themselves. It's excessively expensive to do use medications or procedures when some people may not need it.

1:34:36Some do, but a lot don't. and so I would like to see wherever used as a kind of placeholder while people are getting evaluated and getting appointments with people who can help them deal with whatever their pain or other problem is. It could take forever to find a good specialist meaning outside of hypnosis. I have a friend who's dealing with a very unpredictable onset of what he describes as overwhelm that seemed to begin after he had a pretty bad neck injury. He was constantly in this flexed position while he was working on his laptop. And then he went to play tennis one day, went into a serve, bent his head back and had some type of structural event that then precipitated this onset of what he would call sort of overwhelm where he goes into fight or flight and really can't focus or work and it's taken many many many many months to find specialists to work with just to begin the trial and error so in the meantime i could see something like this being incredibly valuable aside from reverie and people can find reverie at reverie.com great name by the way reverie.com and on all the socials we'll link to that in the show notes as well but reverie.com and I would imagine that can be found in the app store as well but R-E-V-E-R-I.

1:35:56R-E-V-E-R-I. In addition to that are there any resources because I'm sure there's the good the bad and the ugly when it comes to hypnosis resources whether those are books documentaries or otherwise are there any particular resources for those who would like to try to educate themselves more explore this more? You know there are a number of good professional hypnosis societies that have members who are Professionally Trained and Use Hypnosis, the Society for Clinical and Experimental Hypnosis, SCEH.US, the American Society of Clinical Hypnosis, ASCH.NET. There's an International Society of Hypnosis for your listeners who are elsewhere.

1:36:32There are good textbooks on hypnosis. We've written one of them called Transcend Treatment, my late father and I read, treatment that's available. There are other good apps. There's OneLeaf, which is a French app that the French government has invested in that has excellent recordings to help people use hypnosis. There's one called Nerva out of Australia that helps people with irritable bowel syndrome, and hypnosis can be very effective for that as well. So there are more and more of those apps coming as well that seem to help people manage with hypnosis. So it's growing. The list is growing. So we'll link to all those.

1:37:13And trance and treatment, I must ask, since you mentioned Bali, and I've seen various types of, I think what we would consider trance, whether that's Sufis spinning or various types of repetitive singing, droning. Do you have any particular long-standing type of trance that you find most interesting or appealing? There's a sociologist book called Boiling Energy about the use of drumming, actually, as a kind of trance-inducing experience in Africa. And there's no question that people use that kind of rhythmic activity as a way of socially connecting and soothing themselves. And there's something about being in that rhythm of rate that is usually roughly the rate of heartbeat, you know, about one a second that helps people.

1:38:03And that's why people like to dance and sing and things like that. I think we coordinated social activity that gets the body involved, but can be very soothing actually. And so I think a lot of our healing rituals involve repetitive movement that people find soothing. David, thank you for what a fantastic wide ranging conversation this became. And is there anything else you'd like to mention? Of course, people can find Reverie at Reverie.com, R-E-V-E-R-I.com. Is there anything else you'd like to mention or point people to? It's from the App Store and Google Play as well has it for people who have Android phones.

1:38:42I would say, I think we've talked about the major uses of it. I would love it if people give it a try, see it as a first recourse, not a last recourse. And I'd love to see it integrated better with people's overall health and wellness care. I think it's been sort of the Rodney Dangerfield of psychotherapies. Can't get no respect. Yeah. He said, they asked me to leave a bar so they could start happy hour. After having done this my entire career, this is a legacy project for me. A time will come when I'm not available to keep doing this for people. It warms my heart that while we've been talking, I've helped more people than I used to in months of person-to-person clinical activity.

1:39:28And I want people to have it as a resource for helping themselves feel better and function better. And I think it can. So thank you for helping me do that because that's the same kind of thing you're doing with your show. And I'm honored to be a part of it. My pleasure entirely. What fun. This is the best job on earth as far as I'm concerned. and to everybody listening we will have links to all things discussed in the show notes as per usual at tim.blog slash podcast spiegel s-p-i-e-g-e-l you can just search it there and it'll pop right up and until next time as always just be a little kinder than is necessary to others and to yourself thank you for tuning in hey guys this is tim again just one more thing before you take off and that is five bullet friday would you enjoy getting a short email from me every Friday that provides a little fun before the weekend.

1:40:21Between one and a half and two million people subscribe to my free newsletter, my super short newsletter called Five Bullet Friday. Easy to sign up, easy to cancel. It is basically a half page that I send out every Friday to share the coolest things I've found or discovered or have started exploring over that week. It's kind of like my diary of cool things. It often includes articles I'm reading, books I'm reading, albums perhaps gadgets, gizmos, all sorts of tech tricks and so on that get sent to me by my friends, including a lot of podcast guests. And these strange esoteric things end up in my field, and then I test them, and then I share them with you.

1:41:00So if that sounds fun, again, it's very short, a little tiny bite of goodness before you head off for the weekend, something to think about. If you'd like to try it out, just go to tim.blog slash Friday, type that into your browser, tim.blog slash Friday. Drop in your email and you'll get the very next one. Thanks for listening. This episode is brought to you by Helix Sleep. Helix Sleep is a premium mattress brand that provides tailored mattresses based on your sleep preferences. Their lineup includes 14 unique mattresses, including a collection of luxury models, a mattress for big and tall sleepers, that's not me, and even a mattress made specifically for kids.

1:41:36They have models with memory foam layers to provide optimal pressure relief if you sleep on your side, as I often do, and did last night on one of their beds. Models with more responsive foam to cradle your body for essential support in stomach and back sleeping positions and on and on. They have you covered. So how will you know which Helix mattress works best for you and your body? Take the Helix sleep quiz at helixsleep.com slash Tim and find your perfect mattress in less than two minutes. Personally, for the last few years, I've been sleeping on a Helix Midnight Luxe mattress. I also have one of those in the guest bedroom and feedback from friends has always been fantastic.

1:42:12They frequently say it's the best night of sleep they've had in ages. It's something they comment on without any prompting from me whatsoever. Helix mattresses are American made and come with a 10 or 15 year warranty, depending on the model. Your mattress will be shipped straight to your door free of charge. And there's no better way to test out a new mattress than by sleeping on it in your own home. That's why they offer a 100 night risk-free trial. If you decide it's not the best fit, you're welcome to return it for a full refund. Helix has been awarded number one mattress by both GQ and Wired magazines.

1:42:42And now Helix has harnessed years of extensive mattress expertise to bring you a truly elevated sleep experience. Their newest collection of mattresses, called Helix Elite, includes six different mattress models, each tailored for specific sleep positions and firmness preferences, so you can get exactly what your body needs. Each Helix Elite mattress comes with an extra layer of foam for pressure relief and thousands of extra microcoils for best-in-class support and durability. Every Helix Elite mattress also comes with a 15-year manufacturer's warranty and the same 100-night trial as the rest of Helix's mattresses.

1:43:17And you, my dear listeners, can get 20 % off of all mattress orders plus two free pillows. So go to helixsleep.com slash tim to learn more. That's HelixSleep, H-E-L-I-X, HelixSleep.com slash Tim. This is their best offer to date, and it will not last long. So take a look. With Helix, better sleep starts now. This episode is brought to you by Momentus. Momentus offers high-quality supplements and products across a broad spectrum of categories, including sports performance, sleep, cognitive health, hormone support, and more. I've been testing their products for months now and I have a few that I use constantly.

1:44:01One of the things I love about Momentus is that they offer many single ingredient and third-party tested formulations. I'll come back to the latter part of that a little bit later. Personally, I've been using Momentus Mag3n8, L-theanine, and Apigenin, all of which have helped me to improve the onset quality and duration of my sleep. Now, the Momentous Sleep Pack conveniently delivers single servings of all three of these ingredients. I've also been using Momentous Creatine, which doesn't just help for physical performance, but also for cognitive performance. In fact, I've been taking it daily, typically before podcast recording, as there are various studies and reviews and meta-analyses pointing to improvements in short-term memory and performance under stress.

1:44:42So those are some of the products that I've been using very consistently. And to give you an idea, I'm packing right now for an international trip. I tend to be very minimalist, and I'm taking these with me nonetheless. Now back to the bigger picture. Olympians, Tour de France winners, Tour de France winners, the U.S. military and more than 175 college and professional sports teams rely on Momentus and their products. Momentus also partners with some of the best minds in human performance to bring world-class products to market, including a few you will recognize from this podcast, like Dr. Andrew Huberman and Dr.

1:45:16Kelly Starrett. They also work with Dr. Stacey Sims to assist Momentus in developing products specifically for women. Their products contain high-quality ingredients that are third-party tested, which in this case means informed sport and or NSF certified, so you can trust that what is on the label is in the bottle and nothing else. And trust me, as someone who knows the sports nutrition and supplement world very well, that is a differentiator that you want in anything that you consume in this entire sector. So, good news. For my non-U.S. listeners, more good news, not to worry. Momentous ships internationally, so you have the same access that I do.

1:45:50So, check it out. Visit livemomentous.com slash Tim and use code Tim at checkout for 20 % off. That's livemomentous, L-I-V-E-M-O-M-E-N-T-O-U-S dot com slash Tim and code Tim for 20 % off.