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There are currently few laws in the UK which control the practice of hypnosis. It is advisable that if you are seeking to use hypnosis as an adjunct to your treatment or therapy, you should check that your hypnotist has had some form of formal training. Dr Mike Gow advises that you seek help from a professional who is trained in medicine, dentistry of psychology. Dr Mike recommends that when searching for a hypnotist that you do so via the British Society of Clinical and Academic Hypnosis (BSCAH) or the British Society of Medical and Dental Hypnosis (Scotland) (BSMDH Scotland). As a member of both the BSCAH, BSMDH (Scotland), and also the European Society of Hypnosis (ESH), Mike has attended many approved post graduate courses and lectures, attended overseas hypnosis conferences, received training to an advanced level. Dr Mike Gow is Accredited by the BSCAH. Mike also has a Masters (MSc) in Hypnosis Applied to Dentistry from University College London (for more information please go to Hypnosis Unit UK.) From 30th March 2008- Dr Mike Gow is the President of The British Society of Medical and Dental Hypnosis (Scotland). For more information about the BSMDH Scotland email - mail@bsmdh-scot.com)
Having just undertaken the BSMDH training courses in hypnosis a number of years ago, I was keen to try out my new skills. One of my first cases was a very anxious man who required multiple extractions and the provision of immediate dentures. He was reluctant to have sedation, but asked if there was anything else which could help him relax during the procedure. Following the usual initial case history, investigations and discussions he showed an interest in hypnosis. I asked him if there was a ‘Relaxing’ or ‘Special Place’ he could create in his mind, where he would prefer to imagine being during the procedure. After discussion it transpired that his ‘Special Place’ was Ibrox Stadium, watching Rangers beating Celtic. (An experience, sadly in current times, that one could probably only have in a fantasy world of make believe!) On the day of the surgery, after a basic induction technique, I commentated on a fictitious football game, using occasional simple ego-strengthening techniques, while carrying out the injections and subsequent extractions. Being a Rangers supporter myself aided in the conviction and enthusiasm of my match report, and of course the home team scored several goals and won the game! My patient gleefully sang “Oh the Bluebells are Blue!” while undergoing the multiple extractions. I knew from that moment that hypnosis would always be a useful tool which I would integrate into dental practice. I now have a MSc in Hypnosis Applied to Dentistry from University College London.
Possible reasons for the under-use of medical and dental hypnosis. (See Hart 1984 and Heap and Dryden 1991 p88)
The belief that it is too time consuming. The disbelief in its effectiveness. Misconceptions about the nature of hypnosis. Early clinical failures. Fear of ridicule. The development of chemical anaesthetics/analgesics. Paucity of hypnotic training in medical and dental schools in spite of the BMA’s approval of it in 1955.
Hypnotic intervention certainly need not be time consuming and indeed one should consider any additional time spent when determining the cost of the treatment to the patient. Many dentists are unaware that there is a actually a discretionary NHS fee for hypnosis. In most cases you will find that a small amount of time invested in hypnosis will actually lead to a swifter completion of treatment than could otherwise have been expected.
In 1836 Oudet, a Parisian physician extracted a tooth from a hypnotised patient (the hypnosis was the only method of pain control). In the same year Harwood is reported to have extracted a 12 year old girl’s decayed molar ten minutes after she had been hypnotised by Bugard. (Chaves 1997, Oakley 2001). By the 1890s interest had increased and Carter & Turner (Leeds) demonstrated (mainly) extractions to various medical gatherings. WW1 & WW2 provided opportunities for a wide range of application of hypnosis in situations where analgesics/anaesthetics were not available. In the last 60 years dental hypnosis has grown in reputation with increasing evidence based documentation supporting its uses as an adjunct to dental practice (Heap and Aravind 2002). 170 years after Oudet performing his extraction, dental hypnosis continues to be misunderstood and undervalued by many dentists.
Since the Poswillo Report in 1990 and the subsequent changes in the General Dental Council (1998) guidelines regarding the provision of General Anaesthesia, there has been a growing demand for alternative methods of dental anxiety management. Certainly, dental anxiety and phobia affects a significant proportion of the population. The Adult Dental Health Survey UK 1998 (Walker & Cooper 2000) revealed that 24% of dentate adults reported “always feeling anxious about going to the dentist”. This concurred with the statistic made by the British Dental Association (1995) that one adult in three has moderate to severe fear of dental procedures. It is true that one of the main applications of hypnosis in dentistry is its use in anxiety and phobia management; however the spectrum of applications is wide and the evidence based literature in these applications is growing. (Chaves 1997, Oakley 2001)
The Uses of Hypnosis in Dentistry include:
“Hypnosis” is defined in the Oxford English Dictionary as:
A hypnotic subject is said to be in trance. Trance is a particular frame of mind characterised by focused attention, dis-attention to extraneous stimuli, and absorption in some activity, image, thought or feeling (Oakley 2001). People can and do enter this state spontaneously everyday, for example being lost in thought or day dreaming, absorption in sport, reading, listening to music etc, driving for long distances and not recalling the route taken, being absorbed in meditation/relaxation procedures. Often in these examples there will be time distortion in that the passage of time is underestimated. Hypnotic procedures formalise this process of ‘entrancement’ and intensify it. Potential hypnotic subjects are given a series of instructions which, if they follow them, are intended to assist them in achieving a ‘trance’. Many people who are hypnotised are in fact not aware of anything out of the ordinary. This is because they expect to feel very different in hypnosis. They expect to feel ‘out, under, or zonked out’, which does not occur in hypnosis. Hypnosis is certainly not suitable or preferable for everyone and each case is individually assessed. Patients should not agree to use hypnosis unless they are fully aware of what it is and how it could be of benefit to them. Extra care has to be taken if the subject has a history of mental illness, and in some cases hypnosis should be avoided. Most people are hypnotisable to some degree. There tends to be a peak in hypnotic susceptibility in 10-12 year olds, with a gradual descent thereafter (Heap and Dryden 2001). It is thought that most people can experience a light trance, many can experience a medium trance and some can experience a deep trance. Most research papers agree that the depth of trance experienced by the subject does not affect the outcome of the intervention (with the exception of acute pain control). Some people do not respond to hypnosis with one hypnotist but the chances are that another hypnotist, with whom they have a better rapport, may succeed. Obviously, it is deep trance subjects who a stage hypnotist would target. It is my view that hypnosis should not be used as a form of entertainment, or for fun. Stage hypnosis is damaging to the reputation of medical, dental and clinical hypnosis as it conveys an inaccurate image. Although hypnosis is very safe, without a full medical and psychological assessment by a trained individual there are concerns regarding the safety of the participant. Stage hypnotists need not (and mainly do not) have any formal qualifications in hypnosis. Of course, it is up to each individual to make up their own mind if the want to participate, however, one must be aware of all the facts. Common myths and misconceptions about hypnosis addressed: Not remembering anything afterwards – There is not necessarily amnesia following a hypnosis session. Usually patients will have full recollection, unless you have chosen, or it has been deemed beneficial to block specific memories. Losing control – During hypnosis patients are fully aware, and fully in control. Like the everyday trance experiences described previously, control is never lost. For example, if during a hypnosis session the subject became aware that the building was on fire, the subject would open their eyes and return to ‘normal’ without any prompting. Not ‘waking up’ afterwards – If someone is tired, they may fall asleep, however, no-one has ever been ‘stuck’ in trance. You would wake up naturally if unprompted. Hypnosis may be dangerous – As discussed earlier, hypnotic trance can be compared to natural, everyday trance. So long as hypnosis is used by a responsible professional there should be no concerns regarding safety. Being hypnotised against your will – It is impossible to trick someone into hypnosis or hypnotise someone who does not wish it to happen. The subject is in complete control at all times. Being made to do something you would not normally do when hypnotised – A subject would never do anything which is against their morals or beliefs while hypnotised. A hypnotist can not make someone rob a bank, unless they wanted to rob a bank anyway! I often compare hypnosis to like watching a film, or reading a book. If the morals of the story are acceptable to your belief system, then that story may change the way you feel about certain things. However if the story was unacceptable to your belief system, then naturally you would reject the morals and it would not change the way you felt about that subject at all. Hypnosis might lead to unwilling disclosures – A subject will never disclose any information unless they are entirely comfortable to do so. Often it is not necessary for the hypnotist to know the exact details of the problem, so long as the subject is aware of them and the significance they may play to their treatment. There is often a very good rapport between the hypnotist and patient, and occasionally people are surprised that they are happy to discuss issues which they may have never discussed before with anyone. Hypnosis is ‘magic’ and produce an effortless cure – Although therapy conveyed using hypnosis can be very dramatic and seem to require very little effort on the subject’s behalf, hypnosis is certainly not magical or supernatural. Hypnosis can unlock ‘lost’ memories – Hypnosis can help to enhance memories, however once a memory is lost, it is lost forever. Care has to be taken not to elicit ‘false memories’. Hypnosis requires complete immobility - It is important for patients to know that they can move during hypnosis. If a patient has an itch, it may cause more distraction for them not to move their hand to scratch it! Long distance runners can experience trance while running!
Clinicians new to hypnosis should select simple cases initially, gradually building their skills and confidence. As with any intervention, hypnosis is not a panacea, and clinicians should not be disheartened if they find a hypnotic intervention to be of limited use in a particular case (especially if this happens with one of their early cases.)
As the evidence base for hypnosis applied to dentistry grows, as does its reputation. It is important to remember that the hypnosis does not constitute a form of treatment or therapy in its own right (Oakley 2001). Hypnosis is an adjunct, providing a context for the delivery of the treatment or therapy. Therapy incorporating hypnosis can only be as effective as the underlying therapeutic approach permits. Hypnosis is most effective when used in combination with other techniques (for example using hypnosis for acute pain control, in combination with pharmacological techniques).
Interestingly the results of my elective study, undertaken in 4th Year at the Glasgow Dental School, ‘Anxiety and its management in Vancouver B.C. Canada.’
Management of certain dental problems has long been a case of T.E.E.T.H. (Tried Everything Else? Try Hypnosis!) Hypnosis is often thought of as a last resort when all else has failed. It is our duty as dentists however to at least know about and consider hypnosis as a first line intervention in suitable patients, whether undertaking this intervention personally or referring to an appropriately trained colleague. This article has addressed many of the possible reasons why hypnosis continues to be under-used in medicine and dentistry.
Indeed, many dentists reading this article may have undergone BSMDH (Scotland) training at one time, often many years (or decades) ago! I am certain that most would agree that, even if they did not end up using hypnosis frequently in practice, it was valuable training and many of the skills transferable to everyday practice. If you have previously trained with BSMDH (Scotland) many years ago, you will be welcomed back to our courses to refresh your skills and learn some of the newer approaches and techniques. Anyone with previous training can either repeat all three weekends, or attend the ‘Advanced’ course.
Most dentists experience very little regarding hypnosis training as undergraduates. Perhaps historically hypnosis has seemed to be something shrouded in mystery with the ‘secrets’ were only shared by a select few. Today the BSMDH-Scotland has over 300 members.
TRAINING COURSES BSMDH (Scotland) Basic, Intermediate and Advanced courses are recommended for newcomers to hypnosis and also those wishing to refresh and update their current skills. Those who trained on the courses many years ago are also encouraged to attend the courses. Drs who wish to register, please contact mail@bsmdh-scot.com Also see the society website www.bsmdh-scot.com which has details of the society calendar of regular lectures and meetings in Glasgow and Edinburgh.
REFERENCES BRITISH DENTAL ASSOCIATION (1995) Dental Phobia. Fact file, June. British Dental Association, 64 Wimpole Street, London W1M 8AL. CHAVES JF (1997) Hypnosis in dentistry: historical overview and current appraisal. In: Mehrstedt M, Wikstrom PO, eds. Hypnosis in Dentistry: Hypnosis International Monographs 3, MEG Stiftung, Munich: 5-23 DAILEY YM, HUMPHRIES GM, & LENNON MA (2001) The use of dental anxiety questionnaires: a survey of a group of UK dental practitioners. Brit Dent Jour. 2001, 190, No.8, 450-453 FREEMAN R (2000) The Psychology of Dental Patient Care. British Dental Association. GENERAL DENTAL COUNCIL (1998) Maintaining Standards: Guidance to Dentists on Professional and Personal Conduct. London: General Dental Council. GOW MA & CANNING G (1998) Anxiety and its management in Vancouver B.C. Canada. Elective Project; Behavioural Science 27: 1998, Glasgow Dental Hospital & School Library. GOW MA., (2002) Treating Dental Needle Phobia Using Hypnosis, Australian Journal of Clinical and Experimental Hypnosis, Vol 30, No.2, 198-202. GOW MA.,(2003) Management of Dental Needle Phobia Using Hypnosis, Relaxation, and Desensitisation Techniques: A Clinical Case Report. Journal of the Society for the Advancement of Anaesthesia in Dentistry. SAAD Digest. Vol. 20 No.2 Autumn 2003, p14 S12.3 GOW MA (2005) ‘Book Review: Secrets of Hypnotherapy by John Butler and Janet Fricker’ Contemporary Hypnosis Vol 22, No 2. GOW MA (2006a) (In press) Hypnosis with a 31 year old female with dental phobia requiring an emergency extraction. Contemporary Hypnosis. GOW MA (2006b) (In press) Hypnosis with a blind 55 year old female with dental phobia requiring periodontal treatment and extraction. Contemporary Hypnosis. HART B. (1984) Hypnosis for pain control, in A. Broome (ed.) Proceedings of the first International Conference of the Pain Interest Group, Liverpool. HEAP M & ARAVIND (2002) HEAP M & DRYDEN W (1991) Hypnotherapy: A Handbook, Open University Press HEAP M., ALDEN P., BROWN R., NAISH P., OAKLEY D., WAGSTAFF G., & WALKER L. (2001). The Nature of Hypnosis. A Report prepared by a Working Party at the request of the Professional Affairs Board of The British Psychological Society. The British Psychological Society. March 2001. HEAP M. & ARAVIND K. (2002) Hartland’s Medical and Dental Hypnosis. 4th Ed., Churchill Livingstone. MILGROM P., WEINSTEIN P.,& GETZ T. (1995) Treating Fearful Dental Patients. 2nd Ed. Continuing Dental Education. University of Washington, Seattle, Washington 98195. OAKLEY D, (2001) The use of hypnosis in dentistry, Dentistry, 6th Sep 2001, p14-15. POSWILLO D. (1990) General anaesthesia, sedation and resuscitation in dentistry. Report of the Working Party for the Standard Advisory Committee. London: Department of Health. WALKER A, & COOPER I (eds). (2000) Adult Dental Health 1998 Survey. London: HMSO.
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