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Ep. 149 - LiveWell Talk On...Clinical Hypnosis (Dr. Benjamin Tallman)

episode 149

Ep. 149 - LiveWell Talk On...Clinical Hypnosis

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guests: Dr. Benjamin Tallmanpsychologist, St. Luke's Physical Medicine and Rehab

Dr. Arnold:
This is LiveWell Talk On...clinical hypnosis. I'm Dr. Dustin Arnold, chief medical officer at St. Luke's Hospital. Returning to the podcast today, is Dr. Benjamin Tallman, psychologist with St. Luke's Physical Medicine and Rehabilitation, to discuss clinical hypnosis and how it can be used as an innovative approach to pain management. I think the title of this lecture, and also the one that we're going to do on virtual reality should just be titled: Mind Over Matter, and kind of go along those things. But can you start, I mean, I think we all know what hypnosis is or have some sort of layman impression of that. You know, when I count to three, you'll cluck like a chicken or something like that. But give us an overview of how this is integrated in your practice of pain management.

Dr. Tallman:
Yeah, absolutely. Thanks. Again, thanks for having me on and being able to chat about hypnosis. You're right, I think we all have lots of ideas about what hypnosis is, and a lot of that is part of the media. You know, we've seen the television programs. We probably have seen stage hypnosis, where there's a perception that controlling people on stage to do all kinds of crazy things: clucking like a chicken, ripping their clothes off, and doing lots of things. That's all really for entertainment value, and while certainly entertaining, it's not in line with what happens during clinical hypnosis. Clinical hypnosis is really the application of hypnosis to address, you know, a specific medical issue or mental health concern. There's a lot of research to suggest that hypnosis is effective to address stress related concerns, anxiety, post-traumatic stress, help people make changes regarding difficult behaviors like smoking tobacco or quitting. And even, you know, research to suggest actually quite a bit of research and kind of what I use hypnosis for mostly in my practice, is for acute and chronic pain management. And really using it as a technique to help people manage symptoms of chronic pain or symptoms of acute pain, if that's on the inpatient side. But it's been around for a long time, it's a medical treatment that's recognized by the American Psychological Association, the American Medical Association. But yeah, when I'm first talking about it with patients, I have to make the distinction that: you're not going to cluck like a chicken, unless you want to. Really, we're going to use it as a way to help you manage your symptoms.

Dr. Arnold:
Does the patient have to be receptive to it? Is there a buy-in from the patient? I mean, if a patient's skeptical to begin with, is there a difference there? Is there a placebo effect to this, if that's the right descriptor?

Dr. Tallman:
Yeah, great question. So I think almost every, I wouldn't say every, but I think the majority of my patients that I talk about hypnosis with, are skeptical. And I have to help them understand what we're trying to accomplish and really the goals of using the hypnosis. Again, a lot of it in my work with patients is for acute or chronic pain management. So I'm addressing some of those myths and yes, getting buy-in. If somebody doesn't think it's going to work, then it's probably is not going to work as well as somebody who is open to the suggestions and open to the possibility that they could experience change.

Dr. Tallman:
When we look at the literature and when we look at the impact, we know that 20% of people really have a very strong response. What's a strong response? You know, I can be working with somebody with chronic pain concerns and they've had it for 25 years. And during the session and after the session, they might not have any pain. And I'll say, when was the last time you didn't have pain? And they'll say, I don't remember the last time I've had pain. That happens for a subset of people. And then we have about 50-60% of people who have what I would consider, kind of an average response, where they still have good benefit from the hypnosis. They might have symptom reduction and it's a positive experience. And then 20% of people who just kind of feel a little relaxed and they might not have as strong or as powerful of an experience as some of those other folks. And some of that is based on—you know, there's research, there's hypotheses about the mechanism of action and why this works. Some of it could be social desirability. There's certainly an interaction between myself as the therapist and hypnotist and the patient. You mentioned placebo. Placebo is one of the most powerful tools that we have, I think, in medicine. Whether that's for mental health issues or for medical issues. But we also have some good science to suggest that when we're offering specific suggestions, for example, pain. You know, people feel pain in their legs or their arms or their back or their butt, but it's processed, you know, in our brain and our spinal cord. So when people experience pain in the emotional centers of the brain or the sensory centers of the brain, and we're scanning those people's brains when they're in a trance, we can actually see some of those areas of the brain that quiet down in response to some of those suggestions.

Dr. Tallman:
So we see—you know, again, some of those areas actually change. I also explain to patients: when you're in a trance, and I'm offering suggestions about, you know, feeling calm or relaxed or comfortable, it's kind of like we can control the dial on experience. You know, some of the old radios still have dials on them, now they're mostly all digital. But it's like tuning down pain, or anxiety, or stress. So it might be there, but it's really in the background in our mind. And our brain has the ability to tune down some of those sensations. So again, a lot of people have experienced a lot of benefit from these techniques. But yeah, I have to do a fair amount of discussion ahead of time. The setup of the hypnosis and talking about it, I think is probably equally as important as the actual hypnosis session itself.

Dr. Arnold:
Well, it's interesting you say that because like, if I get an injury, I simply say to myself: Okay, Dustin, this is simply an exchange of sodium and potassium ions that are traveling to my brain. This is not, the pain is not real. And, you know, you just kind of take a deep breath and for me, it works. You know, I'm just like this is just sodium and potassium being exchanged. This is not real. So I can believe that, that there is a huge influence to this, the mentality. And upbeat people do better than people that aren't upbeat. You know, I mean, I think attitude means a lot. Let's just go through it. I have chronic pain, I'm at your office Dr. Tallman, and I want to do hypnosis. Kind of walk us through, what would that look like?

Dr. Tallman:
Yeah absolutely. Well, one of the exciting things that we're doing in our clinic that I've just started, is a hypnosis group. So this is an eight session evidence-based treatment. I'm using a manualized protocol from a gentleman named Mark Jensen, who's done a tremendous amount of work out the west coast. So it's a manualized protocol, meaning that we have specific scripts that are used and each session has a particular theme. And then we practice a hypnosis within the session. So, I'll back up a little bit before that. Even before patients get to hypnosis, when they enter my program, they come to a 90 minute class that tells all about pain psychology, pain management. And if they like what they hear, they can enroll in an eight session, cognitive behavioral treatment, for patients with pain. It's a gold standard treatment for chronic pain concerns. In that cognitive behavioral therapy, they really learn the foundational skills of all these different bio-psychosocial factors influencing pain, and how their mind and their body work. You know, you kind of mentioned mind over matter, and how your perspective, how thinking patterns really influence the perception of pain.

Dr. Tallman:
So if patients, kind of graduate from that cognitive behavioral therapy group, they're then eligible for the next set of hypnosis or the next set of treatments, and that's hypnosis. We designed the protocol to do hypnosis after cognitive behavioral therapy because there's research to support. We look at the meta-analyses, all these studies of randomized controlled trials that have been done. When we add hypnosis to cognitive behavioral, we get a better treatment bump. We get a nice treatment effect to suggest that hypnosis and CBT is better than hypnosis alone, or CBT alone. So that's kind of the progression.

When people come to the hypnosis group, the first group session we're going to talk a lot about what hypnosis is, what it isn't, where to de-mystify hypnosis, things like the hypnotist doesn't have control over you. You know, I don't have control over somebody and that they have to be open to the suggestions. You can't get stuck in a trance. Some people are like, well, what if I never come out? I say, well, a trance is kind of similar to a daydream. You can't get stuck in a daydream, but you know, hypnosis is very similar. We all go into a trance-like state many different times during the day, I do, you do, we all do. A trance is kind of like our mind taking a little break. We've been driving down the road and you've gone 15, 20 miles, you thought, boy, I just missed my turn. I don't even remember what I was thinking about. Right? Our mind takes us to these trances. Or watching a really good show on Netflix and it seems like 10 minutes has gone by and holy smokes, an hour's gone by. So our mind automatically goes into trance. Hypnosis is just the process of teaching people to have more control over that. So we would talk to people about some of those misconceptions and then we would practice the hypnosis session in the group. So the groups have, five to seven people, sometimes up to eight, and we do a 20-25 minute hypnosis session. And then the cool thing that we've implemented just this year, I had a wonderful student intern from Coe College who worked in our maker space downstairs at St. Luke's.

Dr. Arnold:
Can I, can I interrupt? You can simply say the Harvard of the Midwest and everybody will know that you're talking about Coe College.

Dr. Tallman:
You got it Dustin. As both Coe alumni.

Dr. Arnold:
You can just say: the Harvard of the Midwest, and people will go, yeah right, Coe College.

Dr. Tallman:
Absolutely. So the Harvard of the Midwest, wonderful student in collaboration, she created a website that essentially people can bring it up from their phone, or they can bring it up from a computer. And we have all of the hypnosis sessions in a password-protected web format, that patients can then listen to. So you learn the hypnosis in the group, and then they have access to all the hypnosis sessions after the group. They get a password, it's password protected. So the key with hypnosis is, certainly some people can practice or they can benefit from just one session. But just like anything, you have to practice the skill to get good at it. You know, if you were going to run a race, you wouldn't just show up at the race and run and run your best time. You're going to put the time and you're going to practice ahead of time. And that's very similar with hypnosis.

Dr. Tallman:
So eight sessions, each session has a different theme. Some of that we turn back to some of the cognitive behavioral work, we integrate that into the hypnosis sessions. And then patients are practicing, listening to the recordings. And then we've also practiced them and do self-hypnosis, which is to do the hypnosis on their own without the recordings. And the goal is, you know, the goal is symptom reduction, for patients to have a decreased physiological response to pain. We've had one particular person in our group this past session, that has discontinued use of pain medications and is only using hypnosis, which I think is absolutely fantastic. Amazing. the goal is not to get off pain meds, but if some people want to do that, they like that option. But yeah, we we've had a lot of success with our group. And people are very interested in it because they haven't heard a lot about it, but once they hear about the research, once they hear about the effectiveness, they're interested and they want to give it a try.

Dr. Arnold:
I think the whole mental aspect of healthcare, or just living our lives in general, is just yet to be explored. Because when you meet, I'll go off to a related subject. When you meet someone that has chronic pain, chronic opioid dependency, there's a huge emotional-mental component to that. You know, it's not all physiologic. I'm not saying they're faking it. Don't take that wrong or out of context. And I think if you can unlock that, I think there's a lot of potential there. And that's what I'm hearing from you today, that there is potential there. A couple of questions. Are there certain patients like, you know, you're allergic to penicillin, are you allergic to hypnosis? Where you might say no, we're not even going to try it.

Dr. Tallman:
Yeah. You know, somebody has to have the cognitive capacity to participate.

Dr. Arnold:
Okay.

Dr. Tallman:
So somebody with advanced dementia or has cognitive difficulty, where they can't attend to stimuli for sustained time, they're probably not going to be a great fit. And then sometimes people with active psychosis, you know, that are having active hallucinations, delusions, things like that, may not be the best fit. Besides that, anybody's a good candidate. And there aren't really any major side effects. Once in a while, people can become emotional during hypnosis and sometimes it can bring up difficult memories. Typically, when that happens, you know, people can get a little bit emotional and concerned about that. But I'm a believer that if those things are coming up, you know, we've kind of opened up this opportunity for us to be more tuned to what's happening in our unconscious awareness. That gives us a pretty good indicator, that if there are difficult memories that are coming up, that they probably need to be addressed. So that's good clinical information for us to have to say, you know what, maybe we need to refer you for some individual treatment to address some of those things. But yeah, the big two would be the cognitive difficulties and then if somebody is having any type of active psychosis.

Dr. Arnold:
I have the saying out on the floor I'm taking care of: the patient's kidneys are smarter than me. Meaning if I can just get the body in balance, the kidneys will do their job. You know, I think this kind of opens up that phrase of: the patient's brain is smarter than me. And if I could just put things in balance, the brain will take care of that. It will get rid of what it doesn't need and it'll take in what it wants. Is this something that's ongoing? Or if I respond great to it, do I have to do it every X-amount of days in between? How does that work?

Dr. Tallman:
Yeah. Each person is very different. So again, depending on level of suggestibility and commitment, practice. You know, some patients I can do a one session hypnosis with and the treatment effect is incredible and they might have sustained symptom relief. I think for most people it's a skill to learn and there needs to be practice, right? If it was so good and helped everybody with one session, you know, we'd be doing it for everybody. But just like anything, I think sometimes in medicine, you know, we have kind of a reactionary type system, right? Where we're fixing things after they're kind of already broken. And I think hypnosis gives patients the opportunity to take control over what's happening in their body and to enhance the connection between their mind and their body. Just like any muscle that we're trying to get stronger, if I'm going to build my biceps, I gotta lift weights. If I'm going to build my cardiovascular endurance, I have to run, I have to bike. If I want to enhance the connection between how my mind and body communicate with one another, and have more control over that process, then I need to practice techniques like hypnosis, or meditation, or other things.

So to answer your question again, some people can have immediate lasting benefit with just a session or two, but a lot of people do need sustained attention in practicing the exercises and really being intentional to work it into their daily routine. The patients that do the best across time, who have chronic pain or anxiety, are patients who are implementing these types of interventions and techniques into their lifestyle. And they're the ones that have sustained change. Just like if I was going to diet or exercise, if I'm doing those things on a consistent basis, the outcomes are probably going to be positive. If I'm not doing them, I'm probably going to gain weight, I might be more stressed, I might have sleep difficulty, etc. So just like any positive lifestyle change that we would want to make, we want to try to sustain it and continue it.

Dr. Arnold:
How do patients get more information or arrange a session?

Dr. Tallman:
Absolutely. So patients can self-refer to our program and they can call our outpatient therapies at 319-369-7331, and they can request interest. The entry point to our program is our pain class. Again as I mentioned, that's a 90 minute to two hour class, depending on how many people we have. And we provide all the information about our services, about cognitive behavioral therapy, about hypnosis. We have some other treatments that we have within our program, and it's a one-time deal. Insurance covers it for the vast majority of people. Our wonderful administrative support staff will be able to help sort through any insurance things. But coming to that class is kind of a no risk way to test out, Hey, is this for me? And then if they like the class, we'll do some screening based on their symptoms, provide information at the end of the class. If they like what they hear, then we can get them hooked up and into our eight session CBT group. And then if they like that, we can get them into our hypnosis group.

Dr. Arnold:
Cognitive behavioral therapy, CBT. Correct?

Dr. Tallman:
You got it. You got it.

Dr. Arnold:
Well, this is interesting. I think any time that we can make a patient better without a pill and without a scalpel, that's a win.

Dr. Tallman:
Absolutely.

Dr. Arnold:
Well Dr. Tallman, Ben, thanks for joining me today. This has been a wonderful session. Once again, this is Dr. Benjamin Tallman, psychologist at St. Luke's Physical Medicine and Rehabilitation. For more information, visit UnityPoint.org.

Dr. Arnold:
Thank you for listening to LiveWell Talk On. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcast. We're available on Apple Podcast, Spotify, Pandora, or wherever you get your podcasts. Until next time, be well.