Dr. Lynn Johnson. Altered States: Why Hypnosis Helps Depression. Original video:

Transcription

1 Dr. Lynn Johnson Altered States: Why Hypnosis Helps Depression Original video: I'm Dr. Lynn Johnson. I had some training in graduate school in hypnosis. Maybe my best training was spending time with Milton Erikson in Phoenix and that started me on a path of using hypnosis in my practice. I went and I came back from Phoenix, and started to Utah Society of Clinical Hypnosis and I kept that going for quite a few years. Cory Hammond took it over and ran it for a while. And I taught for the American Society of Clinical Hypnosis. I taught a lot of workshops. OK, Well big deal right? It's interesting that in those days I didn't think of using hypnosis with depression. I was kind of like, why would you do hypnosis for depression? It just didn't seem to make any sense. Let's go through a few things here and I'm going to use my white board. If you don't mind. The first thing I want to talk about is the effective treatments. So everybody will say CBT is like the effective treatment. Well not so fast. The problem is that there's no solid evidence that CBT is better than other forms of treatment. What CBT is better than is no treatment. So, when you get randomized clinical trials to randomly put people into a placebo group and into an active treatment group and CBT sure enough - sure enough. Much better - much better - than no form of therapy. It's not better than other forms of therapy. So if I say to you well, is CBT better than interpersonal therapy? which is a kind of a psychoanalytic approach you say, well they're the same. Yes you're correct. What about if it's better than behavioral therapy, which mostly focuses on behavior activation - getting people do things? Well, they're the same. Well, what about psychoanalysis? Frankly, they're the same. In other words CBT is perfectly good. Is it better than? No! It's absolutely not better than. It's just a very good, effective 1

2 treatment. We're going to say today that hypnosis is a very effective treatment. And I can't prove it. Because nobody's done a really good trial of hypnosis. But frankly all the treatments work. They all are helpful. And nothing is any better than anything else. And then, by the way that is what is called the dodo bird verdict and look up dodo bird verdict in your Wikipedia you can find out more about that. So what is the better treatment for depression? is totally a trick question. Inflammation and Depression Here's something that I did not know back in the 1970 s, when we were learning hypnosis from Dr. Erickson. Well, I know we're out there for inflammation should be in on the N of this on and off on you know I'm just about out of this picture. OK So inflammation turns out plays a big big big role in treatment of depression. The evidence is pretty clear that had within twenty-four hours of giving somebody an SSRI the serotonin levels that the synaptic cleft are up in the normal range. There are high high high. In fact they're up in the normal range. So why aren't people feeling better in twenty-four hours? Well the best evidence right now is serotonin is vastly overrated as a factor in depression. There are some psychiatrists say serotonin plays no role in depression. I don't know if I'm going to go that far. But I would definitely say it plays a vastly overrated role. In other words, serotonin is kind of a mediocre predictor of depression. Inflammation is a pretty darn good predictor of depression. What do we mean by inflammation? Well, to inflame means what? Here's a fire. It means to set on fire. OK well how can you set your own body on fire? Pretty easy, actually. Have you ever had a nasty sprain? Well, did your ankle or knee or whatever you sprain, did it get hot and throbbing and swollen? Oh yeah. And that's inflammation. Ever had a nasty flu feverish hot all over? You're cold, you wrap yourself in blankets. Inflammation OK? Inflammation can take a couple of qualities acute and all that's should be you there. OK when I'm writing and talking it's a terrible risk. Acute - is something that happens like when you have a bad sickness or a bad injury or chronic inflammation that's the danger. Why would people be chronically inflamed? Their immune system is over reacting to things, that they've got a lot of white blood cells floating around ready to get in trouble, you know looking for a fight. Got a lot of high level of c reactive protein (CRP) a good measure maybe the best measure of chronic inflammation is C. reactive protein the C.R.P. score. And if it's greater than five you've got real trouble. And if it's less than one you've got a really high quality high functioning immune system and that's good that's good. Why don't you want a chronically inflamed state? Because it causes all kinds of problems, including including depression. Several big studies now by people like what's his name Vladimir Multik from South Carolina and Chuck Raison at the University of Arizona ( There are a lot of people who have done these studies. And what they find is if you measure the C. reactive protein in people and you get high levels and they don't have depression as defined by the Beck Depression Inventory or 2

3 the CSD, the Center for Epidemiological Studies Depression Inventory (CSD ) any of the depression inventories - they all give about the same measurement. And the CSD. and the, let's say your Beck Inventory is less than 10. OK. Less than 10 on the Beck or the CSD. means no depression no depression no depression. Could somebody be less than ten and have depression? Well, of course of course. None of this stuff came down carved on tablets or granite from some wisdom on high. Rather they're pretty good, pretty good measures off depression, OK? And that's all we're shooting for, is a pretty good measure. Now people's high C.R.P. (c. reactive protein) but they're in the normal range in terms of depression and you follow those people for the next year. And the higher the C.R.P. the more likely they are to convert into a major depression. Did You Know That? Well, if you did good for you that's great because a lot of clinicians don't know about that check Charles Raison. By the way looking up our R A I S O N and he's a very fine writer pretty accessible articles and one of things he did was he took a group of what they call treatment resistant - T.X. means treatment resistant. Well, I've always kind of disliked that term because that implies that they're fighting back or you know these are not people that fight back - they'd love to feel better. What they mean is you give them antidepressants and they don't feel any better. Now what can we do for treatment resistant depression? Well obviously and this doesn't occur to some psychiatrists, unfortunately --- refer them to psychotherapy. The highest and best outcomes are always with severely depressed or with severely depressed are always a combination. You've got your psychotherapy and your medication in those two come together and they really work nicely - they work synergistically. However Chuck Raison found that if you take these treatment resistant patients and give them a powerful anti-inflammatory Infliximab this what they used. Let's see if I can spell that. I N F L I X I M A B should be in there in Flex amid. That's a powerful anti-inflammatory you people with I suppose rheumatoid arthritis. And the people that were high in C.R.P. In other words people that were very inflamed chronic level - they got better. Well what does all that mean about treating people with depression using hypnosis? Well. Oh and I should mention to you CELEBREX has now been shown at least one large study and celecoxib, really improves people's reaction to taking a standard anti-depressant. What do you think about that? 3

4 So, inflammation turns out to play a big role, it's predictive of depression. Also if you give people an anti-depressant, in about eight weeks, the inflammation rate comes down. So it may be that one of the things that helps people get better is just lowering the inflammation rate. You can give them an anti-depressant long enough you know the depression starts to work as an anti-inflammatory agent. Not always, not always it's not mainly designed that way so this is a good thing to bear in mind. Well so what triggers? OK Now new topic here triggers Triggers I think trigger was Roy Rogers horse. I remember right. Dates me from the Stone Age. Triggers of inflammation. Now remember we're not worried about acute inflammation, stuff that happens when you sprain your ankle and you get the flu and things like that. We're worried about chronic inflammation where the level of inflammation is high and you feel like crap. One of the reasons you feel like crap is inflammation will cross the blood brain barrier so when your body gets inflamed your brain gets inflamed. Your brain gets inflamed. OK I'll get to triggers in a minute. Stick with me here. Brain derived neurotropic factor (BDNF) goes down, down, down. But what good is brain derived neurotropic factor is that your brain is always fixing itself. You know your cell dies and the B.D.N.F. says, grow a new cell. And then dendrites shrink a little bit. And the B.D.N.F. says grow those dendrites reach out to the other to the other nerve cells And it s good stuff. It keeps your brain young. It's like it. I don't know what would it be like S.T.P. for the brain. I don't know what good STP does, does but you know they say it does some good for your engine. Well brain derived neurotropic factor does you a lot of good and when you get high inflammation then that drops that the inflammation goes right across the blood brain barrier brain gets all inflamed. It shrinks your brain. You don t like brain shrinkage. I don't, if my brain shrinks any more I'm in deep trouble. Abuse and Neglect OK So what are the triggers? Early trauma, early abuse. OK or neglect. Ok, what's going on here? What's going on? It's a message from the environment to the body saying you're in a really crummy life here; you're facing a lot of danger. You better get your immune system up so you can fight off all the many dangers because when the body thinks that it's in danger it's going to raise the inflammation rate to be able to deal with injuries and infections and things like that. So early abuse and neglect a lifelong impact blood mirrored Mufti s (Dr. Shawana Mufti ) that's the guy from South Carolina Medical School. What else? Bad diet. No exercise. In other words you take a thirty year old who never exercises 4

5 and you take some old geezer like me and even I'm old and kind of chubby and it's hard for me to exercise. I go out and exercise really. I do a lot of bike riding, kind of disenchanted with bike riding because I did these really really hard rides for a long time before a five K run and then I run my five run. What four days ago and I was three minutes slower than I was the year before when I was doing interval training. So I'm going to go back to do interval training. To heck with the bikes right. Well my brain, because I do the exercise is going to look a lot healthier than a thirty year old brain who doesn't exercise. When you when you scan my brain you think, oh looks pretty young pretty healthy pretty good pretty good So what else? Now this is interesting watch this. Let's erase this stuff. (Erases the board). OK. We said, Inflammation will lead to depression." Depression leads to more inflammation. And I get it. So this is a kind of a circular thing here. If you there is a woman University Ohio Athens who did this study. I cannot remember her name right now and she. She gave these women a stressful event and then she encouraged half of them to ruminate. And the way you get people to ruminate is to ask them think about how you could have done better. Well that makes you ruminate and then women that were ruminating and their C. reactive protein went up over the next hour. Whereas to the people that were distracted they said, OK that stressful event is over. Now think about something else and they try to get him think about neutral things. I think what would be really fun would be if you got people to think about positive things. That would be good. Remember, depression leads inflammation, inflammation leads to depression it sort of cycles right around like that. Treatments All right so what are some treatments? Well we talked about Eat Better, Sleep More. I didn't say sleep more but it was in my mind. Good psychotherapy will reduce inflammation. And what else? What else? Well guess what? Hypnosis will reduce inflammation. You get it now get it. Why does hypnosis reduce inflammation? Most of us when we're doing hypnosis we're looking for a peaceful feeling. Are we not, relaxed, warm and comfortable? That's not necessarily true. I mean you can hypnotize somebody and have them ride on a stationary bike or fight an imaginary foe. You can you can get people do all kinds, all kinds of things in the state of hypnosis. But we clinicians, how do we use it? Peace, relaxation comfort. What about rumination during 5

6 hypnosis? Well, it absolutely stops it. Hypnosis puts a halt to that rumination. You're responsive to the lead the therapist is carrying you through and you're focused on maybe some imagery, some ideas some well for example age regression too very pleasant experiences. I'm not so hot on age regression to bad experiences. It's got to be done somewhat carefully but age regression to a pleasant experience is going to definitely stop that Rumination, is it not? So we create peace and comfort. We stop the rumination. And then we work on post hypnotic suggestion. Do more all of this kind of stuff (points to peace and comfort on the board) and less of this kind of stuff stuff (points to rumination) and helping the person to be in a peaceful comfortable quiet experience. Hypnosis and Meditation Now there's not enough studies on this but there are some really good studies on meditation. Now, in my opinion meditation and hypnosis are very very very similar. They are like first cousins. And so I look at these studies on meditation and one of the reliable things that go on is that meditation will drop your rumination, and your C. reactive protein goes down and your sense of peace comes up. And so these are good things. Self-Hypnosis Now, what I want to do today is talk about a type of self-hypnosis that I found very very easy comfortable. I mean I get nine out of ten people responding very well to this approach. That's pretty darn good. Frankly I mean that's very good. That's very good nine out of ten is an awfully good hit rate in our business. I do it in groups. And I'll say OK how many of you felt such and such how many of you felt such and such. Nine out of ten. Eight out of ten sometimes more than nine out of ten say twenty people. One person saying, Well I didn't get very much out of it. So it's kind of what I would call a Self-Hypnosis for Dummies, Meditation for Dummies. I say look, I'm a very simple person. I'm not terribly smart and I like very simple things, very simple things. And so let's talk about my form of self-hypnosis now. Erickson is passed on now. I used to write him letters and he had write me back and it was a great you know and I you know I learned a lot from being with him I learned a lot from these letters we exchanged. And he never answers my letters anymore. You know can't get him on the phone. It is terrible. And what I need is somebody can talk to dead people and we can find out what's up with him. So I've never discussed this with Erikson but I liked it quite well. There were some German MDs. Schultz (Johannes Heinrich Schultz) and Lutha (Wolfgang Luthe) and they came up with this rather systematic approach to self-hypnosis called Autogenic training. What does Autogenic mean? Self-guided, self-created training. The genesis of something is the start of something so self-guided self-created training and there was a gal at the University of Utah by the name of (sound unclear) and so she was well she was not at the University of Utah. She was in private practice. She was an adjunct up at the University of Utah and she would teach some workshops and things like that occasionally. And so a lot of us that 6

7 went to the University of Utah got some exposure to some of Autogenic training. I'm going to give you some training in it today. And frankly it's like no brainer stuff, old Luther you got that OK. I will be on the final. (Lynn erases the board). Well pleased that they were German M.D.'s of the on the final. Well we'll go through two of the phenomena of autogenic training let's go through several of them here. Now this is my version. [Lynn writes on board: Heavy Heart, Warm Face, Bright Face, Cool Forehead] I focus on heaviness, warmth, breathing, heart. I do the face smooth and calm and smooth warm and you can do cool forehead. There we go. Cool forehead. I'm going to show you pretty close to what the original German folks came up with. I'll have you go through it. I ll have you download a script. It is your script to use a I had a woman contact me. I teach this in a lot of my workshops. I'll leave that up (points to the board.) I had a woman contact me the other day. She said, OK I've been practicing you're autogenic training for the last six or eight weeks and I'm getting really pleased with it. My patients are happy with it. I like it they like it everything's going well, "What do I need to do to be certified in autogenic training? Well, the bottom line is I said I'll write you a letter saying you're certified I've been doing it for forty. And I guess I'm as good as anybody in the country at certifying people at autogenic training. I know of no central authority on this and just between you and me I'm not that hot on central authority anyway. I mean yeah I was in the army but then after I got out of the army I hung out with a lot of hippies and they ruined my attitude about authority and so I've always said. You don't need to be certified. And frankly and this is kind of no brainer stuff. If Schultz and Luther were still alive to be saying no no no you must be playing the lottery carefully baloney but I have had very good success with this I've never had bad effects. You know people are always saying well what if somebody didn't wake up or what if this or that. You know what? It never happens unless the therapist is afraid it is going to happen. Now let's talk about that. And to tell you kind of an embarrassing thing, when people are in hypnosis they're in explicitly tuned into experience with you. They may not show it, you may not know it, but I can assure you they are explicitly well tuned in to you. And if you have a fear of the what if this happens or what if that happens, guess what? It will happen. You know what that's called. 7

8 It's called iatrogenic. There s no place to write here. See how high up this goes, well I won't write it. Well let's write it iatrogenic. So it means, doctor caused I after genic damage her genic problems and so. So hypnosis is full of times when a lot of people get all freaked out and excited and they say oh goodness what of that. And I know it comes true. Look I went through the 1980 s and people were discovering all these victims of satanic ritual abuse and it seemed like more and more people were popping up with satanic ritual abuse. And I got a number of these cases. And usually they were started by another therapist and people came to me. And I looked at it as totally symbolic and I didn't think look the thing is the ideas they go up in the mountains and they sacrifice dogs and cats and children to Satan and all that stuff. I've spent many thousands of hours in the mountains never run into anything like that. I don't think it exists you know. Besides that I would say and where was that and you know and I know the mountains and they were describing stuff that just wasn't there. There's no road there there's nothing of that sort. You go up there and nothing is ever happened. So I thought it was all nonsense and I was able to help a lot of people by shifting it to it's just a symbolic representation of some very upset feelings you have. And of course you're upset feelings are completely natural and anyone would be upset. Now what am I getting at here? When you believe something is going to happen in hypnosis you'll tend to get what you believe. And so I think you need to go into it with a couple of concepts, which is number one: you have to feel pretty darn good pretty happy pretty grateful. Kind of humble. It's a very it's a very great privilege for us to work with people. Have you ever thought about that huge privilege, huge privilege? And so you ought to approach that you know like Moses on the mountain you take off your shoes when you approach the burning bush with the greatest reverence, because only a fool will tamper with the emotional health of the people that we see. You have two approaches the greatest respect and when you're when you feel like it's a wonderful privilege and your calling is to be a healer. It leaks out in hypnosis. You get better results over and over again. So in other words it's really great. I have this friend that said Lynn what's the scariest verse in the Bible. I don't know, What's the scariest verse in the bible? He said, In the last days the secrets will be shouted from the rooftops. Roll eyes, right? I think. I don't think that scares me. I mean I think that's great you know because why. Well because if secrets are shouted on the rooftops I probably won't be in any worse shape than any of us. We're all kind of in the same boat. I think we're all; we all have these weird useless secrets we pack around. So you know we're all in the same boat. So why should I care if my secrets are shouted from the rooftops? So I want you to have a clean heart when you go into this. The Experience All right so I'm going to get in a seated position now and we will do this oh maybe 10 minutes of autogenic training and I'll stop and talk to you about it for a bit. 8

9 Welcome back. In the next few minutes I'm going to take you through autogenic training I want you to try this for yourself. You can watch me if you want but you're not going to see very much. I'd like you to really focus in on the sound of my voice. Consistent with what I told you earlier. I think it's a great privilege. It's a great privilege for me to be able to teach other people things that I have heard out on the anvil of my own experience. And if it can save you some struggles, some wondering in the trackless wilderness, if it can give you insight and tools. My life is made meaningful, because I've been able to help you. Thank you. All right feet flat on the floor. Hands on your lap, no touching or crossing. Erickson believe that if you crossed your hands it was a bad thing. It symbolized somebody trying to hold on to his or her conscious mind and well, who knows, maybe maybe not. It's just something that he told me. But one thing I do know is if your hands are on your lap it's going to be very useful for you in a few moments. Close your eyes, breathe in and out, just focusing in on the feelings in your body. Your breath flows in your breath flow out, any time you're going to do either hypnosis or meditation it's awfully good to just take a minute and turn your attention inward. Breathing is something that is easy; it's always something we can focus on. I like to focus on the bottom lobes of my lungs breathing in from the bottom of my lungs. Stomach comes out, the stomach goes back in. Focus your attention now on your right arm and say three times in your mind it's three times silently to yourself: My right arm feels heavy And when I'm teaching this to you, I will say the same phrase in my mind three times. Well actually, I say it about five times, gives you plenty of time, we're not in a rush. We have all the time in the world here. And know if your right arm feels heavy, that's very fine it's very good. And if it doesn't feel any different that's perfectly fine too. It'll catch up with you soon enough. Shifting your attention to your left arm. Say three times in your mind. My left arm feels heavy. My arms feel heavy and relaxed. My right leg feels heavy. My left leg feels heavy. My arms feel heavy and relaxed. My arms and legs feel heavy. 9

10 My hips and stomach are quiet and comfortable. My breathing is calling and regular. My heart to beat is calm and regular. My shoulders feel heavy. My face feels smooth. My right hand feels warm. My left hand feels warm. Warmth flows into my hands. And if you're good at visualizing you can imagine a comfortable stream of energy moving down your arms and all out your fingertips all the way out to your fingertips. Warmth flows into my hands. My right foot feels warm. My left foot feels warm. Warmth flows into my hands and feet. I am beginning to feel quite relaxed. Imagine warm energy flowing into your eyes and say in your mind my eyes feel warm. Warmth flows into my eyes As you breathe in, say in your mind, My forehead feels cool Now just combine those two. As you breathe in say, forehead cool and as your breathe out say eyes warm. Something else you may want to experiment with is the feeling of warmth in the center of your chest right around the area of the heart right around the solar plexus. The center of my chest feels warm. Just run that through your mind at least three times. If you can do that as long as you like chest warm it's a little ten-minute activity. 10

11 We could do longer, we can do fifteen minutes for twenty manage, but ten minutes is enough for a good experience of deeper breath. Ending: Stretch a little. Open your eyes wake up wide-awake refreshed and rested all over. Waking up waking up waking up OK when you think if you'll do this once away day twice a day three times a day you're going to get a lot of improvement your mind will calm down you won't be so reactive your emotions will be more measured and calm. It is going to help you in about everything you do at least once a day. Now I try to do it every day at lunch time. You can do it whenever it's convenient for you. I had a patient who had a chronic G.I. problem irritable bowel syndrome colitis whatever they want to call it these days. I taught her this and I didn't see her for a couple weeks she came back, she'd had zero zero symptoms for the last two weeks I was astonished. I said, How did you do that? Well she's said, I practice five times a day. How on earth do you practice five times a day? Well, once in the morning before I go to work every day, at ten o'clock we have a fifteen-minute break. I do ten minutes of I don't connect right. Lunchtime. Finish my lunch. Sorry girls can't talk to you today. Got to do my autogenic training it's the doctor's orders. She did ten minutes once at afternoon break ten minutes, got home from work another ten minutes, Now she was doing fifty minutes of the work a day - about ten minutes each time. She stopped the symptoms in the tracks. You sleep better, you feel better, there are lots of advantages. It is self-hypnosis for Dummies. I am a very simple minded person myself. I really enjoy things that are simple. Try it and see, try it and see. Be glad to hear from you. I will put up a script with autogenic training. In fact, I'll give you a second page for pain management, no charge. Frankly you could modify that pain management thing and try to deal with any feeling or emotion that you wanted to. It s privilege for me to work with you. I'm very touched. Thank you for letting me try to give you some tools. 11