Using Hypnosis to Enhance Health & Performance | Dr. David Spiegel

1. 0:00 – 4:16

   Dr. David Spiegel MD, Hypnosis

   1. AHAndrew Huberman0:00

      (uptempo music) Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today, my guest is Dr. David Spiegel. Dr. Spiegel is the Associate Chair of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. He is also the Director of the Stanford Center on Stress and Health. Dr. Spiegel is both a researcher and a clinician, meaning he runs a laboratory that studies the brain and the body and neural mechanisms of how the brain and body interact, and he sees patients as a psychiatrist at Stanford. His work is incredibly unique in that it bridges mind and body, but it also has a particular focus on the clinical applications of hypnosis. As you'll learn today, hypnosis is a unique brain state in which neuroplasticity, the brain's ability to change in response to experience, may be heightened, and indeed, the use of clinical hypnosis by Dr. Spiegel and colleagues has been shown to improve symptoms of stress, chronic anxiety, chronic pain, and various other illnesses, including many psychiatric illnesses and even outcomes in cancer. Today, we discuss hypnosis in the context of what's called self-hypnosis to distinguish it from stage hypnosis. Many of you are probably familiar with stage hypnosis, which is really about a hypnotist getting a person to do things they would not otherwise do. In contrast, clinical hypnosis and the use of hypnosis for the treatment of various ailments of mind and body is vastly different. It involves getting people to change their brain state and to use that brain state as a portal to make adjustments in their brain and body and other aspects of their biology and psychology that benefit them. And it's been shown over and over again in studies by Dr. Spiegel and colleagues that those changes can occur extremely quickly. Now, not everybody can be hypnotized as readily as the next, and so today, we also discuss a simple test developed by Dr. Spiegel that can help you determine whether or not you have a high, medium, or low degree of what we call hypnotizability. Dr. Spiegel is truly an expert in this area. He has published over 480 journal articles, 170 book chapters on hypnosis, and on things like psychosocial oncology, which is the interaction of mind and body in the treatment of cancer and cancer outcomes, on stress physiology, trauma, and other aspects of psychotherapy. He's published 13 books, so he's truly the world expert in hypnosis and clinical applications of hypnosis for mind and body. I'm certain that in listening to today's episode, you're going to learn a tremendous amount about how the brain and body interact, about various treatments for all sorts of common ailments of mind and body, and you're going to get access to tools, in particular, a tool that was developed by Dr. Spiegel, which is the Reveri app, R-E-V-E-R-I. The Reveri app is currently only available for Apple, but will soon also be available for Android. It does carry a nominal cost, but there is a seven-day free trial. If you'd like to try it, we're providing a link in the show notes. The Reveri app is special in that it is based on clinical studies and research done in the Spiegel lab at Stanford. So, unlike a lot of hypnosis apps out there and resources for hypnosis, it was developed with clinical treatments in mind. Today, we also discuss the use of breathwork, and I'm very fortunate that my research lab at Stanford has been collaborating very closely with Dr. Spiegel in testing and developing specific breathwork protocols to adjust mind and body for things like anxiety, improving mood, and improving sleep. Based on his incredible and unique expertise and the clarity with which Dr. Spiegel communicates information, I anticipate that you will really enjoy today's episode and that you'll come away from it with a lot of actionable tools. Some of you might be curious what a clinical hypnosis session looks like, and for that reason, we had Dr. Spiegel hypnotize me. A clip of that hypnosis session is going to be posted to the Huberman Lab Clips channel, which is available on YouTube. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public.

2. 4:16 – 9:09

   AG1 (Athletic Greens), Thesis, ROKA

   1. AHAndrew Huberman4:16

      In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Athletic Greens. Athletic Greens is an all-in-one vitamin mineral probiotic drink. I've been taking Athletic Greens since 2012, so I'm delighted that they're sponsoring the podcast. The reason I started taking Athletic Greens and the reason I still take Athletic Greens once or twice a day is that it covers all of my foundational vitamin mineral probiotic needs. There is now ample evidence that probiotics can be very helpful for supporting what is called the gut microbiome. The gut microbiome is an aspect of our biology in which little gut microbiota live all along our digestive pathway and help support various aspects of our biology, including our immune system, our metabolic system, our hormones or endocrine system, as well as what's called the gut-brain axis, which is literally communication between the gut and the brain to support things like mood, motivation, and various other aspects of brain health. With Athletic Greens, I get the probiotics that I need to support a healthy gut microbiome and the vitamins and minerals tap off any deficiencies I might have based on lack of certain foods and lack of certain nutrients in my diet. If you'd like to try Athletic Greens, you can go to athleticgreens.com/huberman to claim a special offer. They'll give you five free travel packs plus a year's supply of vitamin D3 K2. There's a lot of evidence now that vitamin D3 is critically important for various aspects of immediate and long-term health. And while many people get enough vitamin D3, many people do not. So, the year's supply of vitamin D3 ought to be very useful for many people, and K2 has been shown to be important for calcium regulation, various aspects of metabolic health, and so forth. So again, if you'd like to try Athletic Greens and get that special offer of the five free travel packs and year's supply of vitamin D3 K2, go to athleticgreens.com/huberman. Today's episode is also brought to us by Thesis. Thesis makes custom nootropics.Now, nootropic is a smart drug and personally, I'm not a big fan of the concept of a smart drug, at least not the way that most people talk about smart drugs or nootropics, for the following reason: Being smart involves various things. There is creativity, there's focus, there's task switching, and so on, and each one of those involves different operations in the brain, different neural circuits, different neurochemicals have to be deployed in order for us to, for instance, be very focused, or for us to be very creative, or for us to be able to switch tasks easily. Thesis understands this and for that reason, they've developed custom nootropics that are aimed at getting your brain and body into particular states for particular types of work or physical activity. In order to accomplish that, they've created unique blends of high-quality ingredients and each of those blends is designed to get your brain and body into a particular mode, such as focus, clarity, or motivation. I've been using Thesis nootropics for over six months now and I have to say, it's been a total game changer and very unique from the experience of using sort of what I call catchall nootropics so with Thesis, it's really directed toward particular brain/body states. I should also mention that they tailor those custom blends to you, so by taking a quiz on their site, they will tailor the blend to you and your specific needs and the things you don't want. So if you want to try your own personalized nootropic starter kit, you can go online to takethesis.com/huberman. You'll take a three-minute quiz and Thesis will send you four different formulas to try in your first month and then based on the outcomes with those, they can update your formulations for you. That's takethesis.com/huberman and use the code Huberman at checkout to get 10% off your first box. Today's episode is also brought to us by ROKA. ROKA makes eyeglasses and sunglasses that I believe are of the utmost quality. The company was founded by two all-American swimmers from Stanford and everything about the design of ROKA eyeglasses and sunglasses was created with performance in mind. There are a number of things about ROKA sunglasses and eyeglasses that I particularly like. First of all, they're extremely lightweight. You basically forget that you're wearing them. Second of all, you can wear them for work, for going out to dinner, et cetera, they have great aesthetics so you can wear them anywhere, but also for exercise. You can wear them when running or cycling and even if you get sweaty, they're designed so that they don't slip off your face. Another terrific feature of ROKA eyeglasses and sunglasses is that they were designed with the biology of the visual system in mind. We all have the experience of being in a shaded area and then going to a bright area, it takes some time for your eyes to adjust or to adapt. Many sunglasses make it hard to see as you move from one environment to the next and therefore you have to take on and off your sunglasses. With ROKA sunglasses you don't have to do that. You don't even notice the transitions between those bright areas and those dimmer areas so you can wear them anywhere, anytime and again, most of the time you don't even realize that they're on your face. If you'd like to try ROKA eyeglasses and sunglasses go to roka.com, that's roka.com, and enter the code Huberman to save 20% off your first order. Again, that's ROKA, roka.com and enter the code Huberman at checkout. And now for my discussion with Dr. David Spiegel.

3. 9:09 – 16:45

   Clinical Hypnosis

   1. AHAndrew Huberman9:09

      David, thank you so much for being here.

   2. DSDr. David Spiegel9:11

      Andrew, my pleasure.

   3. AHAndrew Huberman9:13

      Can you tell us what is hypnosis?

   4. DSDr. David Spiegel9:17

      Uh (sighs) , hypnosis is a state of highly focused attention. Uh, it's something like looking through the telephoto lens of a camera in consciousness, which you see, you see with great detail but devoid of context. Um, if you've had the experience of getting so caught up in a good movie that you forget you're watching a movie and enter the imagined world, you're part of the movie, not part of the audience, you're experiencing it, you're not evaluating it, that's a hypnotic-like experience that many people have in their everyday lives.

   5. AHAndrew Huberman9:46

      So is any experience that really draws us in hypnotic in that sense or, um, let me give a different, uh, example. If I'm watching a sports game and I'm really wrapped up in the game but I'm also in touch with how it makes me feel in my body, kind of registering, you know, the excitement or the anticipation, is that a state of hypnosis also? Because you mentioned there's kind of an, um, a narrowing of context-

   6. DSDr. David Spiegel10:13

      Right.

   7. AHAndrew Huberman10:14

      ... but a kind of losing of the self, or is it, is, do I have that right?

   8. DSDr. David Spiegel10:18

      Yes, it is true that your, e- e- e- it, to the extent that your somatic, your body experience is a part of the, the sport event that you're engaged with, I'd say that is a self-altering hypnotic experience. If your physical reactions are distracting you or, uh, make you think about something else, that's when, uh, it's, it's less hypnotic-like and more just one of a series of experiences.

   9. AHAndrew Huberman10:44

      Okay. So I have to ask, how did you get into this business of hypnosis? Because, um, I think for most people when they hear hypnosis or they think about hypnosis, they think of stage hypnosis.

   10. DSDr. David Spiegel10:57

       Right.

   11. AHAndrew Huberman10:57

       They think of somebody with a pendant going back and forth or people up on a stage, um, behaving abnormally for the entertainment of others.

   12. DSDr. David Spiegel11:07

       Yeah.

   13. AHAndrew Huberman11:08

       Um, how did you get into hypnosis, uh, as an interest, as a practice, um, and if you would, could you contrast the sort of hypnosis that you do in the clinical setting with the sort of hypnosis that a stage hypnotist does?

   14. DSDr. David Spiegel11:23

       Sure. Well, um, it is something of a genetic illness in my family. Uh, both of my parents were psychiatrists and psychoanalysts and they told me I was free to be any kind of psychiatrist I wanted to be so (knock sound) here I am. Um, my father, uh, was training to be a psychoanalyst in 1943 and, um, he, uh, ran into a Viennese refugee who couldn't serve in the army but who had studied hypnosis and actually, it would interest you doing your ophthalmological research, he had a, uh, smallpox scar right in the middle of his forehead and he did forensic examinations and he noticed that some of the prisoners would focus on that spot on his forehead and then close their eyes and f-... seemed to go to sleep, but they were in some altered state. So, he got interested in hypnosis. He used it forensically a- his name was Gustav von Aschoffenburg. And, um, he offered to teach young psychiatrists how to use hypnosis when they went off, uh, in- into the war. And so, he trained my father, um, and he- my father got off the analytic couch and asked, you know, m- eh, th- the analyst mentioned it to him. That's how he found out about it. And my father said, "Did I say something wrong in analysis? Why is he talking to me (laughs) now?" And, um, he found it very useful in helping soldiers who had acute pain when they were wounded, in helping people with conversion post-traumatic stress disorders. And when he came back, he went back to his training, um, but, um, he still was sort of interested in it. And he ha- he had his- one of his supervisors was Frieda Fromm-Reichmann, who was a very famous psychoanalyst. And he, he said that he had been told to stop doing hypnosis because it would ruin his reputation as an analyst. And she said to him, "What are you so worried about your reputation for? You're gonna give a course at the Institute in hypnosis, and I know you're gonna do it because I'm going to take it." So, he was teaching Frieda Fromm-Reichmann hypnosis. And he just kept doing it, and after a while, he discovered that he was getting better results with a few sessions of hypnosis than he was with daily psychoanalysis with his patients, and so he switched his, his practice. And so the dinner table conversations were pretty interesting, and occasionally when he was making a movie of a patient, I would get to watch that. And so, when I, uh, I went to medical school, I figured I'll take a course. There wa- Tom Hackett, who was the chair of psychiatry at Mass General was teaching it. It was a very interesting course. And the day that converted me was, um, I was doing my rotation at Children's Hospital in Boston, and the nurse is telling me, uh, "Spiegel, your next patient is an asthmatic in room 437," or something, and I'm just following the sound of the wheezes down the hall. I go in the room. There's this 16-year-old girl, knuckles white, bolt upright in bed, struggling for breath. You can hear the wheezing. She twice had subcutaneous epinephrine, didn't work. They were thinking about general anesthesia and starting her on steroids, and her mother's there, uh, crying. And, um, I said, I didn't know what else to do, so I said, "You wanna learn a breathing exercise?" And she nods, and, um, I got her hypnotized, and then I realized we hadn't gotten to asthma in the course yet, so I made up something very complex. 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. Her knuckles aren't white. She's not wheezing. Her mother stopped crying. The nurse ran out of the room, and the intern, my intern comes to find me, and I figure he's gonna pat me on the back and say, "Nice job, Spiegel." He said, "The nurse has filed a complaint with the nursing supervisor that you violated a Massachusetts law by hypnotizing a minor without parental consent." And I thought, you know, "Oh, that's nice." You know, I doubt there is a law like this. So, the intern says, "You're gonna have to stop doing this with her." And I said, "Why?" He said, "It's dangerous." I said, "You're gonna give her general anesthesia and put her on steroids, and talking to her is dangerous?" You know. He said, "Well, you'll have to do it." And I said, "I'll tell you what. Take me off the case if you want, but I'm not gonna tell a patient of mine anything I know is not true." So, there was a battle over the weekend about what to do, and the, the intern, the chief resident, the attending were all arguing about it. And on Monday, they came back with a radical idea. They said, "Let's ask the patient." I don't think this had ever been done at Children's Hospital (laughs) before, and she said, "Oh, I like this," you know? She'd been hospitalized every month for three months in status asthmaticus. She did have one subsequent hospitalization, but after that, went on to study to be a respiratory therapist. And I thought that anything that can help a patient that much violate a nonexistent Massachusetts law, frustrate the nursing supervisor, had to be worth looking into, so I just kept doing it. I discovered that there were, you know, ev- all of my classmates in medical school had just read the new issue of The New England Journal and had some new medication to suggest. And I would, you know, surgeons would say, "Look, if you can help this guy with his pain or his anxiety, anything above the neck, that's yours. Do it, Spiegel." So, you know, I was having fun and being able to learn how to help people in a way that just otherwise was not being done. And so, it got me thinking about the fact that, you know, we're born with this brain, but we don't have a user's manual for it, and we don't use it nearly as well as we can, and that's something your research is all about too. And, and so, I thought, "I wanna, I wanna understand this better, and I wanna see what we

4. 16:45 – 20:25

   Stage Hypnosis

   1. DSDr. David Spiegel16:45

      can do." Stage hypnotists drive me nuts, you know? They, they make fools out of people. Um, there was one, um, my, my, this is a case my father was involved. He got a call from, he was at Columbia. He got a call, "Spiegel, you gotta come see this woman. She's in the ER, and she's, uh, in some kinda weird, upset state that," um, happened, and it turned out, she'd been on the show with a stage hypnotist, um, who, and what they do, by the way, is they, they cycle around, you know? They have a, the beginning of the show, they don't just grab somebody and say, "We're doing this." They get a bunch of people up. They do what amounts to hypnotizability testing to see if people, and they s- they get the ones who are the most hypnotizable. So, she was the one, and he said, "There's now, uh, a little bird in your hand, and you're gonna play with the bird." And she starts to cry and scream, and, uh, he just gets her off the stage 'cause it's very upsetting. And she's wandering around New York City in the middle of the night, dissociated, and brought to Columbia, and that's where my father saw her. She was still in a kind of uncomfortable trancelike state, and it turned out that she was the trophy wife of a very wealthy guy, and she felt like a bird in a gilded cage. And so to her, that image just triggered all of this sense of, uh...... dissatisfaction, discomfort, fear about her life. And he was able to get her reoriented and talk with her about what she was gonna do with her life. But I don't like stage hypnosis. You're making fools out of people, um, and you're using the fact that, and that's what scares people about hypnosis. They think you're losing control. You're gaining control. Self-hypnosis is a way of enhancing your control over your mind and your body. It can work very well, but because it gives you a kind of cognitive flexibility, you're able to shift sets very easily, y- to give up judging and evaluating the way you usually do, and see something from a dif- diff- different point of view. That's a great therapeutic opportunity, but if misused, it could be a danger too, and that's what scares people about it. It's, it is that very ability to suspend critical judgment and just have an experience and see what happens. That can be a great therapeutic opportunity, but if somebody's misusing it, it can be a way to harm people, and, you know, there are plenty of examples of people having fantasies imposed on them that they come to think are realities. It's not unusual these days. So, um, it's, it's an ability that if people learn to recognize and understand it, can be a tremendous therapeutic tool.

   2. AHAndrew Huberman19:14

      I've been stage hypnotized, um, a- and I've been clinically hypnotized many times, um, through a self-hypnosis app, uh, we'll talk about later, and, um, and then I know we have plans for you to hypnotize me today. Ah, you've done it once before.

   3. DSDr. David Spiegel19:31

      (laughs) Mm-hmm. Mm-hmm.

   4. AHAndrew Huberman19:32

      Um, and I'm very hypnotizable as we both know.

   5. DSDr. David Spiegel19:34

      Right.

   6. AHAndrew Huberman19:35

      Um, we'll talk about how one can gauge their hypnotizability.

   7. DSDr. David Spiegel19:38

      Sure.

   8. AHAndrew Huberman19:39

      But the stage hypnosis, um, was interesting. This was in college, you know, they brought someone out to the dormitory, and, uh, I recall being w- one of the people that was selected.

   9. DSDr. David Spiegel19:51

      Mm-hmm.

   10. AHAndrew Huberman19:51

       ... Um, and, uh, and engaging in very bizarre behavior, right? It wasn't thoroughly embarrassing, but it was pretty embarrassing, and then being sent off the stage, and as I was exiting, suddenly screaming something out because he had planted a suggestion of some sort.

   11. DSDr. David Spiegel20:10

       Ah. Mm-hmm.

   12. AHAndrew Huberman20:10

       Um, and then I was told to look in my pocket, and there was like a, I think a torn up dollar bill. There were a bunch of things that I have vague recollection of.

   13. DSDr. David Spiegel20:17

       Mm-hmm.

   14. AHAndrew Huberman20:18

       But it raises, a, um, a set of questions, uh, that really boil down to,

5. 20:25 – 26:04

   Neurobiology of Hypnosis

   1. AHAndrew Huberman20:25

      you know, as a biologist, I always think that, you know, there's no, there's no events in the brain. There are pro- there are processes. And so hypnosis we know has an induction. Then one is hypnotized, I imagine, and then it sounds like this woman in this example of the, the bird, um, and being in, being distraught in New York City, is a failure to exit the hyp- hypnotic state. Do we know what sorts of brain areas are active during the induction, the, let's call it the deep hypnosis, and then what's shutting off or changing as people exit hypnosis?

   2. DSDr. David Spiegel20:59

      Yes. Yes, we do. We've studied that. We've been very interested in that. And so, we, ah, did a study where we selected highly and non-hypnotizable people so we could do the comparison and then hypnotize them in the functional MRI scanner, and we found three things characterize the entry into the hypnotic state. The first is turning down activity in the dorsal anterior cingulate cortex. So the DACC is in the central front middle part of the brain, as you, you well know, and it's, it's part of what we call the salience network. Uh, it's a conflict detector. So if you're, you know, uh, engaged in work and you hear a loud noise that you think might be a gunshot, that's your anterior cingulate cortex saying, "Hey wait a minute, there's some potential danger over there. You better pay attention to it." So, it's a, it compares what you're doing with what else is going on and helps you decide what to do. And, as you can imagine, uh, turning down activity in that region make it less likely that you'll be distracted and pulled out of whatever you're in. And in another study, we found that highly hypnotizable people, even without biling- being hypnotized, have more functional connectivity between the DACC, the anterior cingulate cortex, and the left dorsolateral prefrontal cortex. Um, so, which is part of the, a key region in the executive control network. So when you're engaging in tasks, you're enacting a plan, you're writing a paper, you're doing whatever you're doing, that's the, the prefrontal cortex is doing that. And so if that is coordinated, we found more functional corne- uh, connectivity. So when one is up, the other's up, when one is down, the other's down. That coordination implies that the brain is saying, "Okay, go ahead. I know what you're doing. Carry out that plan and don't worry about other possibilities." So, two other things happen when people are hypnotized. One is that that DLPFC has higher functional connectivity with the insula, another part of the salience network. It's a part of the mind body control system sensitive to what's happening in the body. It's part of the pain network as well. But it's also a region of the brain where you can control things in your body that you wouldn't think you could. For example, we did a study years ago where we took people, uh, who were highly hypnotizable, hypnotized them, and told them to ima- we went on an imaginary culinary tour. So, um, we would, they would eat their favorite foods, and we found that they increased their gastric acid secretion like by 87%. So their stomach was acting as though it was about to get... I mean, there was one woman, it was so vivid for her that halfway through she said, "Let's stop. I'm full." You know, (laughs) eating these imaginary-

   3. AHAndrew Huberman23:38

      Having never eaten any-

   4. DSDr. David Spiegel23:39

      Having never eaten anything.

   5. AHAndrew Huberman23:40

      ... actual food?

   6. DSDr. David Spiegel23:41

      No.

   7. AHAndrew Huberman23:41

      Incredible.

   8. DSDr. David Spiegel23:42

      And then we got them to relax and think of anything but food or drink, and we got like a 40% decrease in gastric acid secretion. So they could... And that was DLPFC through the insula, uh...... telling the stomach you're getting food or you're not getting food, and even we injected them with pentagastrin, which triggers gastric acid release, and even then in the hypnosis condition, they had a 19% reduction in gastric acid. So, the brain has this amazing ability to control what's going on in the body in ways that we don't think we have ability to control. That's just one example. So, that's the DLPFC-insula connection. The third thing that happens, and this relates to what you did on the stage, is you (smacks lips) have inverse functional connectivity between the DLPFC and the posterior cingulate cortex. The posterior cingulate, uh, is part of the default mode network. It's in the back of the brain, um, and it's, it's an, an area whose activity goes down, for example, in meditators. And in meditation, you're supposed to be selfless. You're supposed to, the self is an illusion. You're supposed to let it dissolve and just experience things. And when you're doing that, the posterior cingulate is decreasing in activity. The inverse connection is, I'm doing something, but I'm not thinking about what it means for me. I may not even remember much of it. If I do, I don't care that much about it. And so that is part of the dissociation that occurs with hypnosis. So, it's how you put things outside of conscious awareness, and don't worry about what it means. It also adds to cognitive flexibility. You know, if you're thinking, well, people like me don't usually do this, that may inhibit you from enacting a new form of psychotherapy, for example, that you've never done before. Um, but if you're ha- having this decreased activity in the part of your brain that reflects on what it means, um, you're more likely to be cognitively flexible and willing to give it a try. And that's one of the therapeutic advantages of hypnosis as well.

   9. AHAndrew Huberman25:38

      Fascinating. And it's really, uh, I'm going to put, um, I'm going to embarrass you here a little bit, um, in a positive sense. It's, uh, your laboratory is really the, the one that's pioneered brain imaging of hypnotic states, and, um, it, it sounds like it. That's my understanding. Is that, is that correct?

   10. DSDr. David Spiegel25:53

       Yeah. I mean, there are other people who've done excellent research too-

   11. AHAndrew Huberman25:56

       Sure.

   12. DSDr. David Spiegel25:56

       ... but, Pierre Rainville in Montreal and several other people, but we're one of the leading labs in, in neuroimaging of hypnosis.

6. 26:04 – 28:22

   ADHD

   1. DSDr. David Spiegel26:04

   2. AHAndrew Huberman26:04

      I have to ask about attention deficit hyperactivity disorder. I get a lot of, um, questions about this, and I think a lot of people just struggle with holding attention nowadays because of, um, e- you know, interference with phones and devices, and, and I, of course, there is a lot of, uh, clinically legitimate ADHD out there, but the way-

   3. DSDr. David Spiegel26:23

      Sure.

   4. AHAndrew Huberman26:23

      ... that you describe the dorsal anterior cingulate and the salience network and this co- uh, conflict detector of, you know, c- am I focusing on something or am I splitting my attention? How distractible am I seems to relate to some extent to activity in the dorsal, um, anterior cingulate cortex. Uh, do people with ADHD, um, display disruptions in elements of these networks, and, uh, has hypnosis ever been used to, uh, or self-hypnosis I should be, uh-

   5. DSDr. David Spiegel26:52

      Mm-hmm.

   6. AHAndrew Huberman26:53

      ... to distinguish from, uh, stage hypnosis, clinical and self-hypnosis been used to enhance people's ability to focus and hold attention, um, because that's such a built-in component of the hypnotic state?

   7. DSDr. David Spiegel27:04

      Uh, it, it, it's a great question. There are, there's sort of two ways to think about it. In terms of enhancing focus, yes, it has been very helpful, um, in teaching people to just prepare your mind to narrow in and focus on something, and when, you know, when you're really engaged in reading something or you're writing a pa- I mean, I'll have that, sometimes I'm thinking, oh God, I, I have to do this for another hour. Other times, an hour will go by and I'll think, hey great, because when you're in the, it feels game-like to y- you know, you're just assembling the parts of the puzzle and putting them together. It's fun. You just get absorbed there. For me, that's a hypnotic-like experience. When I'm having trouble, when I'm struggling, sometimes doing things like self-hypnosis can help. I'm not an expert on ADHD. Um, my impression is that you're right, that these are people who are constantly distracted and, and rather rigid. The other part of it is, they're easily distractible, they're very upset when they get distracted, and they're rather rigid in what they want to attend to and what they can't, I think as a way of controlling this distractibility, frankly. Uh, I, my guess is that many people with ADHD would not be that hypnotizable, but I haven't, I haven't studied it. So, uh, it, it, it's possible that for some people with that disorder, training in self-hypnosis might help, but we'd have to see how hypnotizable they were and take it from there.

7. 28:22 – 32:12

   Hypnosis for Stress & Sleep

   1. DSDr. David Spiegel28:23

   2. AHAndrew Huberman28:23

      I want to return to some of the underlying neural networks and the, uh, clinical applications, but, uh, what sorts of, um, things aside from the asthma, um, have you used hypnosis successfully for, or have others used clinical hypnosis, um, for, and are there any particular areas of, of psychiatric challenges or illnesses, I guess they're called, um, that are particularly, um, amenable to hypnotic treatment?

   3. DSDr. David Spiegel28:56

      Yes, there are. Hypnosis is very good as a problem-focused, uh, treatment. Um, it's really, it's the oldest Western conception of a psychotherapy, and it can be used for specific problems in a way that's very helpful. Uh, we found it very helpful for stress reduction, um, for helping people deal. We're all dealing with stress these days, um, and it's helpful, that mind-body connection is very helpful because, um, part of the problem with stress is your perception, you mentioned it earlier in a sort of good sense, you're at a f- you know, a football game or something and you feel the physical reaction. That can be a reinforcing thing. Wow, this is exciting. Let's do it. It can also be very distracting. So, you're worried about getting COVID or you're worried about, um, some other physical problem you have and you, you notice it in your body. Your body tenses up. Uh, you start to sweat. The sympathetic nervous system goes, your heart rate goes up, and when you notice that you think, oh God, this is really bad.... and then you feel worse. So, it's like a snowball rolling downhill, uh, and- and then you feel worse, and then your body gets worse. Hypnosis can be very helpful in s- dissociating somatic reaction from psychological reaction. So, we teach people to imagine their body floating somewhere safe and comfortable, like a bath, a lake, a hot tub, or floating in space, and then picture the problem that they're, that's stressing them on an imaginary screen with the rule that no matter what you see on the screen, you keep your body comfortable. So, at this point, you can't, you still can't control the stress, but you can control your physical reaction to it, and that starts you feeling more in control. "At least there's one thing I can manage." And then you can use it to think through or visualize through one thing you might do about that stressor. So, hypnosis is very helpful in controlling mind/body interaction in relation to stress. Um, it's very helpful for people to get to sleep. Uh, we're having a lot of fun with that. I- I've, um, I'm getting emails from people who said, you know, "I haven't slept right in 15 years, and now, for the first time, um, you know, I'm listening to your app and I can sleep at night." You know? So, it's very helpful. And again, s- you know, if you wake up in the middle of the night, you know, I- I- I tell people, "Don't look at the clock. That's an arousal cue. You know, you'll just, you'll wake up more." Um, but ima- picture whatever you're thinking about or worrying about on that imaginary screen while your body's floating. So, watch your own movie, but keep your body floating. And many people can use that to get back to sleep.

   4. AHAndrew Huberman31:24

      I've been using the, uh, self-hypnosis for sleep for a long time, um, and now the Reveri app, and we'll talk about our relationship to the Reveri app and its uses. I find it incredibly useful for falling back asleep, uh, in the middle of the night, uh, and it raises a- a question, um, I've found, and I think I understand this correctly, that one can l- do self-hypnosis during the daytime, and then if there's an issue that comes up later, like so, for instance, uh, do self-hypnosis for stress reduction away from the stressful event to prepare one-

   5. DSDr. David Spiegel31:58

      Mm-hmm.

   6. AHAndrew Huberman31:58

      ... to deal with stress better-

   7. DSDr. David Spiegel31:59

      Right.

   8. AHAndrew Huberman31:59

      ... or do, uh, hypnosis for improving the return to sleep, and that can be done when you actually want to go to sleep, but it's-

   9. DSDr. David Spiegel32:06

      Right.

   10. AHAndrew Huberman32:06

       ... it's a kind of a training up of these networks, right?

   11. DSDr. David Spiegel32:09

       That's right.

   12. AHAndrew Huberman32:10

       Um, is, so is there evidence

8. 32:12 – 37:19

   Hypnosis to Strengthen Neural Connections

   1. AHAndrew Huberman32:12

      that these brain networks actually form stronger, um, connections when people do self-hypnosis over time?

   2. DSDr. David Spiegel32:20

      Um, yeah. Well, there's a rule in neurobiology, as you know, that neurons that fire together, wire together, and s-

   3. AHAndrew Huberman32:25

      Yeah. Our friend, Carla Shatz.

   4. DSDr. David Spiegel32:26

      Yes, Carla-

   5. AHAndrew Huberman32:27

      Not Donald Hebb, by the way.

   6. DSDr. David Spiegel32:28

      (laughs)

   7. AHAndrew Huberman32:28

      I keep trying to ... There's a, there's a, there's a widespread myth in the world that, uh, is unfortunately all over the internet, which is that-

   8. DSDr. David Spiegel32:35

      Mm-hmm.

   9. AHAndrew Huberman32:35

      ... the r- fire together, wire together was said by the psychologist Donald Hebb. Donald Hebb did many important things, but it is the neurobiologist Carla Shatz-

   10. DSDr. David Spiegel32:44

       Carla Shatz. That's exactly right.

   11. AHAndrew Huberman32:45

       ... who, yes, is at Stanford-

   12. DSDr. David Spiegel32:46

       Yeah.

   13. AHAndrew Huberman32:46

       ... but was also at Berkeley and Harvard, so-

   14. DSDr. David Spiegel32:48

       That's right.

   15. AHAndrew Huberman32:48

       ... also decent schools. Um-

   16. DSDr. David Spiegel32:50

       (laughs)

   17. AHAndrew Huberman32:50

       ... that, but is at, uh, Stanford, um-

   18. DSDr. David Spiegel32:53

       Yeah, yeah.

   19. AHAndrew Huberman32:53

       ... who said fire together, wire together-

   20. DSDr. David Spiegel32:55

       Right.

   21. AHAndrew Huberman32:55

       ... and so she deserves the-

   22. DSDr. David Spiegel32:56

       Right.

   23. AHAndrew Huberman32:56

       ... the credit for that statement. Yeah, so with repeated, uh, use of self-hypnosis, um, one could imagine that these networks are getting stronger.

   24. DSDr. David Spiegel33:06

       I would, I would, I would think so. We don't have evidence of that yet. Um, but, um, you know, long-term potentiation, uh, uh, provides a pathway, and you've described them on your program a number of times, that allow for repeated activation of a network to actually build new connections that, that work. And at the least, even from a learning and memory point of view, you know, our, you know, memory is all a network of associations. That's how we remember things. Um, and, you know, the- the example I like to give is, you go back to your grade school, and s- and you see these little tiny lockers, and- and, you know, the size is all wrong, and you suddenly have a flood of memories that you, you know, were obviously stored there, but you just didn't think of. So, context and association is what memory is about. If you start to acquire memories about a problem, so one thing we use hypnosis for is treating phobias, for example. And the problem with people who have phobias, like airplane phobias, or, uh, you know, crossing a bridge or being up high, is that the more they avoid it, the more the only source of associations and memories is their fear. They don't have any good experiences with it 'cause they avoid it. You know, it's like, get back on the horse after you fall off, kind of thing. And- and with hypnosis, if you can start people able to manage their anxiety enough that they can have more, a wider array of experiences, they start to have a network of associations that isn't so negative, and may even be positive.

   25. AHAndrew Huberman34:34

       So, it's almost like a, uh, sorry to interrupt, but I have to ask, it's-

   26. DSDr. David Spiegel34:37

       Sure.

   27. AHAndrew Huberman34:37

       ... it's almost like a, um, exposure therapy done in the mind.

   28. DSDr. David Spiegel34:43

       Yeah.

   29. AHAndrew Huberman34:43

       I mean, it's always in the mind. I mean, even exposure to-

   30. DSDr. David Spiegel34:45

       Well-
9. 37:19 – 45:14

   Restructuring Trauma Narratives

   1. AHAndrew Huberman37:19

      what is different about what your father did in that case, uh, with this, uh, with this woman, in terms of what happened in hypnosis that allowed her to go from being completely terrified of dogs to owning a dog and naming it-

   2. DSDr. David Spiegel37:35

      (clears throat) .

   3. AHAndrew Huberman37:35

      ... after your father, which I find amusing.

   4. DSDr. David Spiegel37:36

      Yeah (laughs) .

   5. AHAndrew Huberman37:37

      Um, but that's different than just the two of them sitting down and talking about it, right? I-

   6. DSDr. David Spiegel37:43

      Yeah.

   7. AHAndrew Huberman37:43

      You know, in therapy their narrative is a huge component.

   8. DSDr. David Spiegel37:47

      Right.

   9. AHAndrew Huberman37:47

      And in hypnosis, narrative is a huge component.

   10. DSDr. David Spiegel37:49

       Right.

   11. AHAndrew Huberman37:50

       So, it must be that the brain state is what is really different, because, um, we'll talk about trauma in a, in a few minutes, but, you know, I think people who have trauma or phobias certainly, um, could have a conversation about it. They, some of them might freeze up, some of them might lose their articulation, and so forth. But what is different about that state, that combines with narrative, you think to allow these underlying neural networks to, to engage or to change? 'Cause I find this so fascinating because we're all, every attempt at, at, uh, dealing with stress or phobia, i- in the clinical setting involves some discussion about what it is.

   12. DSDr. David Spiegel38:30

       Yes.

   13. AHAndrew Huberman38:30

       But here we're not talking about any medication being introduced, at least not in these particular circumstances.

   14. DSDr. David Spiegel38:35

       Right.

   15. AHAndrew Huberman38:36

       So, (stutters) I realize it's kind of an obvious question, like, it has to be some difference in brain activity, but-

   16. DSDr. David Spiegel38:43

       Mm-hmm.

   17. AHAndrew Huberman38:43

       ... I find that to be incredible, the c- the control variable there is the brain state. It's not what's spoken.

   18. DSDr. David Spiegel38:51

       Y- you're raising a couple of very important issues, Andrew. Um, I, you know, we, we talked earlier about s- systematic desensitization, where you, you know, sort of lay out a hierarchy of things and do it one at a time. I think of this as unsystematic desensitization, because you're changing mental states and if, and I think there's more and more evidence that mental state change itself has therapeutic potential. We're seeing that with ketamine, treating depression, a dissociogenic drug. Um, uh, we see it, we know it every morning when we wake up, that problem, you know, you made the mistake of reading a nasty email at 11:00 PM. You don't know what to do. You wake up in the morning and you think, "Oh, that idiot. Yeah, here's what I'm going to do." You know? So, just changing mental state itself has therapeutic potential, and I think we underestimate our ability to regulate and, and change responses, to be cognitively, emotionally, and somatically flexible. And so, we do things, you're right, that follow similar principles of facing a problem, seeing it from a different point of view, and you've done a really, a nice podcast on trauma and stress and how you have to expose yourself to it, not avoid it, as we talked about before, and then find some way to reconnect to it, to substitute something that can make you feel good rather than bad, um, so that you activate other centers of the brain, like mesolimbic reward system. And so I do that with hypnosis, and you can do it much faster. People don't think they can, but they can. If you're having, right now, that physical experience, "I'm thinking about this but I'm not feeling as bad as I used to," um, that can be a powerful thing, and you can do it with hypnosis. So, I had a, a woman came to see me who had suffered an attempted rape. It was getting dark. She was coming back from the grocery store, and this guy grabs her and wants to get her up into her apartment. It's outside her apartment, and she starts fighting with him, and she winds up with a basilar skull fracture. He runs away. Um, the cops come. Since she hadn't been raped, they left, they weren't interested, and she wanted to use hypnosis to get a better image of what this guy looked like, which is a painful, upsetting thing. So, she was quite hypnotizable. I got her floating. I say, "You're safe and comfortable now. Nothing can happen that will harm your body, but on, on the left side of the screen, I want you to picture this guy and his approaching and what's happening." And she said, "I really, uh, the light was, it was getting dark, I really can't see much of his facial features, but I do recognize something I hadn't allowed myself to remember. If he gets me upstairs, he doesn't just want to rape me, he's going to kill me." And so, in some ways what she was seeing was even worse. So, you know, you're thinking, "Good, Spiegel, you made her even more frightened than she was before," but as you had pointed out in your PTSD stress lecture, you've got to confront the trauma to, to restructure your understanding of it. So, on the other side of the screen I had her picture, um, uh, "What, what are you doing to protect yourself?" And everybody in a trauma situation engages in some strategy of pr- self-protection. You know, that's the salience network kicking in. And, um, she said, "You know what? He's surprised that I'm fighting that hard."... he didn't think I would. And so she realized, on the one hand, that it was even worse than she thought it was, but on the other hand, that she actually probably saved her life. And so, it was a way of helping her restructure her experience of the trauma and make it more tolerable. So, that helped with her... She didn't recogni- she, she couldn't identify the guy, but it helped her re- restructure and understand her experience. And that's something that you can do in just talking straight out psychotherapy, but sometimes you can do it a hell of a lot faster and more efficiently using hypnosis. And there is one randomized trial out of Israel that shows that adding hypnosis to PTSD treatment actually improves outcome. So, uh, it's, it's a way of accomplishing things that we understand in the broader psychotherapy world, but much more quickly and, and sometimes effectively.

   19. AHAndrew Huberman42:58

       Yeah, it sounds like going into, somewhat into the state that one is trying to deal with, but then dissociating from that state is key, and I can imagine, all right, and, you know, I've been open about this on various podcasts. I've, I've, um, done a lot of, uh, an- analysis over the years. So, in, but in, I've experienced myself that in, in those sessions, depending on how I show up to them, I might just get in kind of a laundry list of what happened, as opposed to actually feeling anything around what happened.

   20. DSDr. David Spiegel43:25

       Right.

   21. AHAndrew Huberman43:25

       Um, and I think people probably vary in the extent to which they can drop into feeling states, and it can depend on the day. It can be, depend on how well s- uh, you slept the night before, and so on.

   22. DSDr. David Spiegel43:37

       There's, there's one thing I might add, Andrew-

   23. AHAndrew Huberman43:38

       Please.

   24. DSDr. David Spiegel43:38

       ... and that is, you know, there's a notion, the late Gordon Bauer. He d- we just had a memorial for Gordon, um, uh, at Stanford. He died about a year ago. Brilliant cognitive psychologist and one of the founders of cognitive psychology, uh, at Stanford, and a, and a great pitcher. He almost, he almost became a Major League pitcher, but he decided to go to grad school instead, and I'm, I'm glad he did. Um, but Gordon, uh, helped establish the concept of state-dependent memory, that when you're in a certain mental state, you enhance your ability to remember things about it. And the sort of the bad example of that is the drunk who hides the bottle and can't remember where he put it until he gets drunk again, that he's in that same mental state. People go into dissociative states, uh, when they're traumatized. So, in a way, hypnosis is helping them remember and deal with the memories better because they're more in the mental state that is more like what happened, and most rape victims will tell you, "I was floating above my body, feeling sorry for the woman being assaulted below." Um, uh, people in traumatic episodes, they just say, you know, "I blank out. I don't know what's happening. I'm on autopilot." And that's a kind of self-hypnotic state. So, when you use hypnosis to help them deal with a traumatic memory, you're making the state they're in right there in your office with you more congruent to the state they were likely in when the trauma happened, and I think that is part of what helps facilitate treatment of trauma-related disorders.

   25. AHAndrew Huberman45:04

       I see. So, that makes me have to ask every question I have to ask 'cause I really feel it as almost a compulsion. Then if dissociation

10. 45:14 – 50:07

    Ketamine Therapy

    1. AHAndrew Huberman45:14

       during a traumatic episode is pa- it's, uh, part of the adaptive strategy-

    2. DSDr. David Spiegel45:19

       Right.

    3. AHAndrew Huberman45:19

       ... um, but it creates certain issues. It creates problems, right? Um, why would something like ketamine, which creates a dissociative state, be useful for the treatment of trauma? This is what I'm, I'm confused about these days because, um, our colleague, Karl Deisseroth, who's also been on this podcast, and, and, and his coworkers have figured out, okay, there's these layer one networks in cort-, in the neocortex and those are involved in dissociative state. And so we're starting to gain some understanding of how ketamine works at a neural level.

    4. DSDr. David Spiegel45:48

       Right.

    5. AHAndrew Huberman45:49

       It does seem, um, as if for certain populations, it's a, can be a useful treatment. I don't know. I've never tried it. I don't know what the current status of that is, but it is legal. It is allowed, at least, and it's-

    6. DSDr. David Spiegel46:00

       Right.

    7. AHAndrew Huberman46:00

       ... FDA approved and it's in use. Why would dissociate, dissociative states be useful if dis- if some element of dissociation is what, um, gave rise to the trauma, trauma memory in the first place?

    8. DSDr. David Spiegel46:13

       Well, uh, yeah, Carl had a brilliant paper in Nature where he, h- it was from, from rats to humans in one paper, and he showed that there's this rhythmic discharge in the retrosplenial region that is associated w- that is triggered by ketamine and, and the rats actually showed dissociative-like behavior in that they would touch a hot pad that they ordinarily wouldn't, and they didn't seem to have much pain in their paw! And he then had a, a male subject who had, uh, implanted electrodes-

    9. AHAndrew Huberman46:43

       Human?

    10. DSDr. David Spiegel46:43

        A human subject, yeah.

    11. AHAndrew Huberman46:44

        Yeah.

    12. DSDr. David Spiegel46:44

        Human subject, and, and, um, the electrodes had picked up this rhythmic activity and when they did, he would report being in a dissociative state, and his description was, "It's like being a pilot of an airplane, and then I felt myself walking out of the cockpit and the plane was still flying." And it-

    13. AHAndrew Huberman47:02

        That sounds terrifying to me.

    14. DSDr. David Spiegel47:03

        (laughs)

    15. AHAndrew Huberman47:03

        It sounds terrifying.

    16. DSDr. David Spiegel47:04

        But that's the thing about-

    17. AHAndrew Huberman47:05

        I want to be in my body-

    18. DSDr. David Spiegel47:06

        (laughs)

    19. AHAndrew Huberman47:06

        ... most of the time, you know? Uh-

    20. DSDr. David Spiegel47:08

        That's right, but the, the point is, in a way, the principle, Andrew, is like the principle you said, that you need to re-confront a traumatic situation before you can modulate your associations to it. So, you have to accept it, accept the arousal, put some boundaries around it, and then figure out how you can approach that problem or how you did approach that problem from a different point of view. So, it does not surprise... In fact, we've studied, uh, people who dissociated during the Loma Prieta earthquake and the Oakland-Berkeley firestorm.

    21. AHAndrew Huberman47:40

        I remember both those well.

    22. DSDr. David Spiegel47:41

        Yeah, yeah.

    23. AHAndrew Huberman47:41

        Earthquakes follow me. Uh, then I moved South-

    24. DSDr. David Spiegel47:43

        (laughs) .

    25. AHAndrew Huberman47:43

        ... and then the Northridge quake hit.

    26. DSDr. David Spiegel47:45

        I'm going to keep away from you.

    27. AHAndrew Huberman47:45

        So, there'll be one later this afternoon. (laughs)

    28. DSDr. David Spiegel47:48

        (laughs) I'm starting to dissociate, Andrew. So, um, dissociation does compartmentalize experience, but that means from the point of view of treating trauma, it, it's an, it's an inhibition. You don't engage it. It's like it happened over there. And I think what happens is that people...... are sometimes too good at being able to separate themselves from the recollection, so it's in there somewhere. It doesn't... It's out of sight but it's not out of mind. It's having effects on you but you can't deal with it. You can't reprocess it. So, I do think one reason ketamine might work, um, i- is, uh, that in fact it allows you to keep... to re-a- approach the dissociative experience in a way that you can then start to think about and do something about it. And just the fact you can turn it on and off, and that's also where hip- self-hypnosis is so helpful. It's not something that just comes over you and happens to you, it's something you can make happen. You can control it. You can do something with it, so you feel less helpless and out of control. The essence of trauma is helplessness. It's not fear. It's not pain. It's helplessness. You become an object. You become just your body. You don't control what's going on, and we're not used to that, you know. You and I have discussed this, uh, this in- th- this brilliant paper on anticipation of breathing, and it's not whether you breathe, inhale or exhale or hold your breath. It's that if you think you can inhale and you can't, um, that is really upsetting, understandably. And so it's the... The issue is control, and hypnosis, which has this terrible reputation of taking away control, is actually a superb way of enhancing your control over mind and body.

    29. AHAndrew Huberman49:25

        I love that, and it reminds me that naming is so important. You almost wonder if, um, self-hypnosis and clinical hypnosis had been called something else-

    30. DSDr. David Spiegel49:34

        Yeah.
11. 50:07 – 56:53

    Self-directed Hypnosis, Reveri

    1. AHAndrew Huberman50:07

       those lines, ho- how quickly... Uh, you've described some, um, examples of people getting relief very quickly.

    2. DSDr. David Spiegel50:14

       Right.

    3. AHAndrew Huberman50:14

       How permanent are those changes? Um, is there a need for followup? And related to that, I'm sure a number of people are listening to this and thinking, "Wonderful, I'd love to get hypnotized for any number of different things by Dr. Spiegel or somebody else, expert in clinical hypnosis," but they might not have access to you or somebody, um, with similar training. So, what is the power... So, how, how quickly does it work? How long-lasting are those changes? And then, is it necessary to work with a clinical hypnotist, and is it better to do that than self-hypnosis and so on and so forth? Maybe you could just give us a, a contour of the, of the landscape of directed and, and self-directed treatment.

    4. DSDr. David Spiegel50:56

       Well, typically, um, most people start by coming to see a clinician like me. It's better to see someone who's li- has licensing and training in their professional discipline, medicine, psychology, dentistry, whatever it is (overlapping) .

    5. AHAndrew Huberman51:11

       'Cause there are a lot of hypnotists out there-

    6. DSDr. David Spiegel51:13

       Right.

    7. AHAndrew Huberman51:13

       ... who are just hypnotists.

    8. DSDr. David Spiegel51:14

       Just hypnotists.

    9. AHAndrew Huberman51:15

       Oh, okay.

    10. DSDr. David Spiegel51:15

        And, and the key issue is, somebody who can really assess what your problem is and make sure that you're not talking someone into reducing their chest pain rather than getting their coronary artery problem, like (overlapping) .

    11. AHAndrew Huberman51:26

        'Cause they could have a real issue there-

    12. DSDr. David Spiegel51:27

        They could, right.

    13. AHAndrew Huberman51:28

        ... that hypnosis might-

    14. DSDr. David Spiegel51:29

        Right.

    15. AHAndrew Huberman51:30

        ... adjust but wouldn't deal with the deeper underlying issue.

    16. DSDr. David Spiegel51:33

        That's right. Uh, on the other hand, and typically when I use it with people, I often only see them once or twice or periodically but not every week, and certainly not every day if they have a pain problem, and hypnosis is very helpful for pain. Um, and, and so what I'm doing is identifying how hypnotizable they are. I give them a standard brief test of their ability to experience hypnosis and then going through a self-hypnosis exercise with them to deal with the problem, seeing how they respond to it, and then teaching them how to do it for themselves. And in the old days, I used to have them use their iPhone and, and record, you know, uh, the... that part of the session, so they could play back the hypnosis experience. Now we've developed, uh, an app, uh, Reveri, that, that, uh, can teach people and step them through dealing with pain, stress, uh, focus, uh, in- insomnia, and help people eat better and, and stop smoking. Um, and but we have, uh, elements that take about 15 minutes and elements that just take one or two minutes that people can r- refresh and reinforce. So, the idea-

    17. AHAndrew Huberman52:39

        Two-minute hypnosis? Or even one minute?

    18. DSDr. David Spiegel52:41

        Yes, yes.

    19. AHAndrew Huberman52:41

        Yeah.

    20. DSDr. David Spiegel52:41

        And it... Uh, it's one to two. We're one to two minutes now. And we're finding that two-thirds of the people find that even just the one-minute refresher, uh, helps them feel better. They're reporting they feel better. So, the nice thing is you know right away whether it's likely to help you or not. And we found... We've done studies looking at hypnosis for pain relief in acute medical procedures. We did a randomized trial that we published in The Lancet, three conditions, people getting arterial cutdowns to, uh, chemoembolized tumors in the liver or visualized renal artery stenosis. You don't use general anesthesia for this. It's very uncomfortable, and people are anxious. And we had three conditions. One was standard care. They could push a button and get opioids, uh, IV.

    21. AHAndrew Huberman53:24

        It's during the surgery?

    22. DSDr. David Spiegel53:25

        During the surgery.

    23. AHAndrew Huberman53:26

        Okay.

    24. DSDr. David Spiegel53:26

        The second is they could do that plus they had a friendly nurse comforting them, so we controlled for pleasant attention and support. And the third was, we taught them self-hypnosis for pain control. So, you're, you're feeling... You can change the temperature. Your, your body is cool, tingling and numb. You're floating in ice water and feeling comfortable. Um, or go somewhere else. Leave your body here and go to a desert island and enjoy yourself. Um, and we found that it... Uh, it's about two-and-a-half-hour procedure, that af- by the en- by an hour and a half, the hypnosis group had reduced their pain by 80%, uh, compared to the standard-

    25. AHAndrew Huberman54:04

        Wow.

    26. DSDr. David Spiegel54:04

        ... care group using half the amount of opioids.... they had fewer complications, and the procedure took 17 minutes less time, on average, to get done. Because not only was the patient more relaxed, so was the treatment staff. They could, they weren't dealing with someone who was struggling and uncomfortable. We measured their anxiety, and same thing, the hypnosis group. I was worried they were all dead. They had no anxiety after an hour and a half. They were saying, "I'm fine," you know, and they were fine, and the, and the standard care group had 5 out of 10 anxiety scores at that point. So, we published that in The Lancet, big randomized trial. Um, if we had a drug that did that, every hospital in the country would be using it now, you know, but there's no industry to push it. So, that's part of what helped us decide that we needed to help people, you know, do this with, with Reveri and teach them how to do it and provide interactive support for them to do it, and does it... You know, the question, although, is, does it work long term? 'Cause what we can do acutely doesn't necessarily carry on. So, we did a randomized trial of women with metastatic breast cancer. They had advancing disease. We met with them in a support group once a week and taught them self-hypnosis for, uh, for stress and anxiety and pain control at the end. And by the end of a year, uh, the treatment group had half the pain the control group did on the same and very low amounts of medication. So, it lasts, and they would say, "When I felt that pain in my chest and thought it was a metastasis, I just did the exercise. I got myself in a warm bath, and I felt fine." So, uh, it, it works because it becomes a skill that people acquire, but they can tell right away whether it's likely to help them, working with a clinician or now using the app or your, uh, other ways of helping them learn to use it as a skill. So, the nice thing is, you will know very quickly whether it's likely to help you or not, and if it is, you can learn to do it for yourself.

    27. AHAndrew Huberman55:57

        That's great, and we will, um, again, there'll be a link to Reveri in the caption. Uh, it's available for Apple and Android, and I think, um, even though there's a nominal cost there, I think that, uh, you know, the, as you mentioned, medications and other approaches to dealing with these problems are quite expensive and, and potential, have, hold the potential for side effects and things. Not that some of those aren't also useful.

    28. DSDr. David Spiegel56:22

        Could I, before you get to that-

    29. AHAndrew Huberman56:23

        Please.

    30. DSDr. David Spiegel56:23

        ... just one thing. We, we've worked very hard on the app. We have an iOS app for Apple. We decided to, to table for a moment redoing the Android app.
12. 56:53 – 1:01:50

    Eliminating Obsessive Thoughts, Superstitions

    1. AHAndrew Huberman56:53

       I get asked a lot about, um, obsessive thoughts or intrusive thoughts.

    2. DSDr. David Spiegel56:58

       Mm-hmm.

    3. AHAndrew Huberman56:58

       I also get asked a lot about OCD. Um, is there any evidence that hypnosis or self-hypnosis can be used for dealing with obsessive thoughts?

    4. DSDr. David Spiegel57:08

       Um, it, sometimes. There are some very obsessional people who just turn out not to be that hypnotizable for, yeah, and it's not random. They, you know, they tend to be so over-controlling of thou- they're all busy evaluating rather than experiencing. So, in some ways-

    5. AHAndrew Huberman57:23

       I know a few people like that. (laughs)

    6. DSDr. David Spiegel57:25

       (laughs) Me too. Me too.

    7. AHAndrew Huberman57:26

       It sounds li- it sounds like a, it sounds like an adaptive, uh, mindset for a lot of professions-

    8. DSDr. David Spiegel57:30

       That's right.

    9. AHAndrew Huberman57:30

       ... and areas, uh, uh, and that we get trained up in that-

    10. DSDr. David Spiegel57:33

        Yeah.

    11. AHAndrew Huberman57:33

        ... during school, you know, how to obsess over the exam, obsess over the-

    12. DSDr. David Spiegel57:38

        Yeah.

    13. AHAndrew Huberman57:38

        ... our social interactions. I mean, it's part of becoming a functional human being, and yet you can take us down a, a different pathway.

    14. DSDr. David Spiegel57:45

        We, we sometimes overdo it.

    15. AHAndrew Huberman57:46

        Mm-hmm.

    16. DSDr. David Spiegel57:46

        I mean, I'll tell you one example from extreme situations, uh, 'cause it, the, y- you know, you're judging, evaluating, you're not letting yourself experience, including emotionally. I know somebody, um, who listens to the tapes from airplanes that, that go down. So, they get the black box, and they listen to it, and he said to me, you know-

    17. AHAndrew Huberman58:04

        That's his profession, or he does this recreationally?

    18. DSDr. David Spiegel58:06

        No, it's a, no, it's his profession.

    19. AHAndrew Huberman58:07

        Okay, it's his profession.

    20. DSDr. David Spiegel58:07

        That's what he did, and 'cause they're trying to do accident prevention and how to handle things, and he said that, um, you worry about people panicking, right? You know, and here these guys know that, you know, they've got 30 seconds or some 45 seconds, and they're just going through their checklist. He said they're n- they don't panic enough. They're, they're taught that this is what you do, and then there is reason, there's good reason for it. But sometimes, they overdo it, and, uh, you know, it's, it's painful to listen to this 'cause you know what's going to happen. So, it's kind of a balance we have to hit, and some, you know, we, sometimes we get too emotional and too absorbed, and you don't, you're not with it enough to, sort of see other possibilities. That can be a problem, but on the other hand, sometimes you're too rigid and controlled, and you don't let your emotions guide you to what you need to do to protect yourself or protect others. So, um, I would say in general that people with OCD are in the less, on the less hypnotizable side of the spectrum. They're less likely to allow themselves to engage in any, and you know, the typical example is the checking with OCD, for example. They don't remember, you know, whether they, you know, locked the door or turned off the gas in the oven, and they keep going back, and they keep checking. So, there, the evaluative component of the brain kind of overrides the experiential one, and, um, sometimes people can get some benefit, but, but they're not a group that I would select for being the most likely to respond to self-hypnotic approaches.

    21. AHAndrew Huberman59:37

        Are pe- are superstitions similar?

    22. DSDr. David Spiegel59:40

        Superstitions, (sighs) there, I think that's more, there are people, um, who are very hypnotizable, who keep getting caught up in things like superstitions, and there, the imagination supplants the reality, and, um, we've seen a lot of that happening recently, and so I, I think there, um, it's possible that they could be helped by learning to, sort of see it but put it in context, you know, see it from a, from a different point of view.

    23. AHAndrew Huberman1:00:09

        I developed a pretty vicious superstition when I was in college, and it was hard to break.... actually. Um, I always feel th- uh, when I talk to clinicians, I have to reveal certain things about-

    24. DSDr. David Spiegel1:00:18

        Yeah, please do.

    25. AHAndrew Huberman1:00:18

        ... my own pathology, and so, um-

    26. DSDr. David Spiegel1:00:19

        And you'll get my bill later (laughs)

    27. AHAndrew Huberman1:00:20

        Thank you. Yes. Uh, it's part of the reason I arranged this job.

    28. DSDr. David Spiegel1:00:23

        (laughs)

    29. AHAndrew Huberman1:00:23

        I'm just kidding. But yeah, I did. I, I had a, a habit of knocking on wood for things-

    30. DSDr. David Spiegel1:00:28

        Mm-hmm.
13. 1:01:50 – 1:15:36

    ‘Hypnotizability’, the Spiegel Eye-roll Test

    1. AHAndrew Huberman1:01:50

       talked about stress reduct- the u- the utility of hypnosis, uh, for stress reduction, phobias, pain, um, possibly, we don't know, but for, uh, things like ADHD and OCD, it just will depend on hypnotizability.

    2. DSDr. David Spiegel1:02:04

       Right.

    3. AHAndrew Huberman1:02:04

       Um, you talked about this, a beautiful study on the, um, a metastatic, uh, breast cancer, um, outcome or patients.

    4. DSDr. David Spiegel1:02:12

       Mm-hmm.

    5. AHAndrew Huberman1:02:13

       Hypnotizability is clearly a key variable.

    6. DSDr. David Spiegel1:02:15

       Yes.

    7. AHAndrew Huberman1:02:16

       So, could you please tell us, um, w- what hypnotizability is, how it's evaluated, and what the Spiegel eye roll test is?

    8. DSDr. David Spiegel1:02:25

       Okay, sure. So, um, hypnotizability is just a, a capacity to have hypnotic experiences, and we have a test called the hypnotic induction profile where we give a highly structured hypnotic experience. And, you know, the, the old tradition in clinical hypnosis was that you try a bunch of different things, talking, walking upstairs and downstairs and other images, and time what you say to the breathing of the subject and all that. And the more you change what you do as a clinician, the less you can make a variation in outcome. So, and it could take a long time, you know, 20 minutes, 30 minutes. And I just view that as a kind of complex, not very effective way of assessing the person's hypnotic capacity. We know that the peak period of h- of hypnotizability in the human life, is the latency years in childhood. So, every eight-year-old is in a trance all the time. You know, you call them in for dinner, they don't hear you, they're doing their thing. And that's why childhood is such a wonderful experience. Work and play are all the same thing, you know, and we try to make them into little adults, which I think is a terrible mistake. They, and everything is fun for them. They enjoy learning. They enjoy everything.

    9. AHAndrew Huberman1:03:34

       So, what age are, are they in this hypnotic state?

    10. DSDr. David Spiegel1:03:36

        Thei- this is like 6 to 10, 6 to 11. They-

    11. AHAndrew Huberman1:03:40

        Yeah.

    12. DSDr. David Spiegel1:03:40

        They're playful. They enjoy everything. Everything is sort of a game and fun, and we try to make it miserable for them, but they, they've got it. And then, when what Piaget called, um, uh, you know, a more adult cognitive framework, where we learn abstract concepts, we learn that even if one bottle looks bigger than the other, they can have equal volume. And so we start imposing logic. We're growing our DLPFC at that point, and imposing cognitive structure on experience. Um, some people start to lose that hypnotic ability. By the time you're in your early 20s, um, uh, your hypnotizability becomes extremely fixed. And there was a study done at, at Stanford, uh, Ernest Hilgard, f- Phil Zimbardo did this, looking at, um, uh, they, they've tracked down students who were in Psych 1, had their hypnotizability measured, and retested them blindly 25 years later. And the test-retest correlation was, you want to guess what it was?

    13. AHAndrew Huberman1:04:39

        Uh, I'm guessing it's, I don't know, 0.6 something.

    14. DSDr. David Spiegel1:04:44

        Yeah, very close. It was 0.7. IQ would be 0.6 on a 25-year interval.

    15. AHAndrew Huberman1:04:50

        Wow.

    16. DSDr. David Spiegel1:04:50

        So, it's more stable than IQ over a 25-year interval. So, once you're at that point, that's where you are. What are the factors that, that lead to that? Well, and, and so what it means is, that about a third of adults are just not hypnotizable, two thirds are, about 15% are extremely hypnotizable. And we can measure that and give it a number from 0 to 10. Um, and that's very useful. For some of my patients when I do it, I say, "Look, I'm sorry, you're not hypnotizable. We're gonna do something else," you know, medication, systematic desensitization, mindfulness, other things. Um, or if they're very hypnotizable, I just go for it, you know? I don't do a lot of explaining. People who are m- low to moderate hypnotizable, like explanations about what you're doing, but then they can still get the benefit. So, it helps me guide my, the nature of my treatment with these people. Now, the, the, the eye roll is, uh, my father, um, used to use an eye fixation induction. He used to say, "Look up at the ceiling and, and now close your eyes while you're looking up." Oh, you're very, yes-

    17. AHAndrew Huberman1:05:52

        Yeah.

    18. DSDr. David Spiegel1:05:53

        ... you're very (laughs)

    19. AHAndrew Huberman1:05:53

        (laughs)

    20. DSDr. David Spiegel1:05:53

        So, he noticed, he had two patients back to back...And one was a woman who I'd seen him work with, who had hysterical seizures. She would just suddenly start shaking, and it-

    21. AHAndrew Huberman1:06:05

        R- real epileptic seizures.

    22. DSDr. David Spiegel1:06:06

        ... p- psu- No, pseudo-epileptic seizures.

    23. AHAndrew Huberman1:06:07

        I see, so hysteria.

    24. DSDr. David Spiegel1:06:09

        Hysteria. And although some people have both, that is the, for some people, real epilepsy becomes a framework that gets elaborated on for when you're stressed, you have seizures. She just had pseudo-epilepsy, no e- EEG abnormalities. And she was really something to watch. Her husband had to move his workbench near the door so that if she started to have a seizure, he could run home and, and try and help her with it. It was that bad. And he noticed that when she win, she di- he, she did what you did. When she looked up, when she would have one of her seizure events, all you see is sclera. You don't see iris anymore, and she would start to seiz- So, he, he did a great thing with her. He taught her to have seizures. Everybody else was telling her to stop. He made her have one. So, he hypnotized her, "Let's go back to the last time you had one." And sure enough, she'd start to shake, and gradually, he'd make them smaller and smaller. So, she was learning she could control it. She'd have access. It's like with PTSD, you know, you confront. You don't avoid it. You don't suppress it. You confront it and figure out how to deal with it. Um, the next patient he had was a rigid, obsessional businessman who wanted to stop, you know, being so controlling and, and, and all this (laughs) . It reminded me, there was a New Yorker cartoon of a driver who comes to a yield sign and he yells, "Never." You know (laughs) , it's always being in control.

    25. AHAndrew Huberman1:07:26

        That sounds about right.

    26. DSDr. David Spiegel1:07:27

        (laughs)

    27. AHAndrew Huberman1:07:27

        You're a New Yorker.

    28. DSDr. David Spiegel1:07:28

        I'm a New Yorker, right. Um, and so, this guy, when he tried to look up, he couldn't keep his eyes up while he closed them. And so, my, uh, father started testing people, and it seemed that there is a rough correlation between the capacity to keep your eyes up while you close them, and measured hypnotizability.

    29. AHAndrew Huberman1:07:48

        So, that people who are listening, what, um, might, uh, and, uh, and watching on video, so the Spiegel eye roll test involves looking up at the ceiling. So, it's tilting the head back. I'm tilting my chin back and looking up at the ceiling now but I'm also directing my eyes upward, and my eyes are open, and then-

    30. DSDr. David Spiegel1:08:05

        Right.
14. 1:15:36 – 1:21:43

    EMDR (Eye Movement Desensitization Reprocessing)

    1. AHAndrew Huberman1:15:36

       Along the lines of eyes and eye movements, um, a lot of interest out there about EMDR, eye movement desensitization reprocessing.

    2. DSDr. David Spiegel1:15:42

       Mm-hmm. Yeah.

    3. AHAndrew Huberman1:15:43

       Um, uh, Shapiro herself was, uh, working, not, she wasn't at Stanford directly, but was the local to, to Stanford-

    4. DSDr. David Spiegel1:15:50

       Yeah.

    5. AHAndrew Huberman1:15:50

       ... I think in Palo Alto.

    6. DSDr. David Spiegel1:15:51

       Yeah, yeah, MRI, yeah.

    7. AHAndrew Huberman1:15:51

       Um, so, what are your thoughts on EMDR? Where is it useful? Where do you think it's less useful? Um, are there things that EMDR could be combined with to make it more useful? Um, you know, we get, you know, the listeners of this podcast come to, uh, I think, come to the podcast with a range of backgrounds and interests. Um, to me, it makes sense, uh, why EMDR, eye- lateralized eye movements, um, might work given the newer data that it can suppress amygdala activity in some animals and animal models and, um, in humans as well, but it really hasn't been explored much neurally. I've heard things like it coordinates the two sides of the brain, which it, to me is a, is just a throwaway. I, I don't think there's any-

    8. DSDr. David Spiegel1:16:34

       Yeah.

    9. AHAndrew Huberman1:16:34

       ... evidence that coordinating the two sides of the brain is better than not coordinating. I wouldn't be speaking right now if the two sides of my brain were, were well correlated-

    10. DSDr. David Spiegel1:16:42

        Yeah.

    11. AHAndrew Huberman1:16:42

        ... because language is lateralized. So-

    12. DSDr. David Spiegel1:16:44

        Right. Exactly.

    13. AHAndrew Huberman1:16:44

        ... um, I've heard that it mimics rapid eye movements during sleep, but actually it doesn't. So, um-

    14. DSDr. David Spiegel1:16:49

        Right, right.

    15. AHAndrew Huberman1:16:50

        ... but I have heard, um, people talk about their positive experiences with EMDR.

    16. DSDr. David Spiegel1:16:55

        Yeah.

    17. AHAndrew Huberman1:16:55

        What are your thoughts about EMDR?

    18. DSDr. David Spiegel1:16:56

        Yeah, yeah. Uh, yeah, you had a good comment on that in one of your recent podcasts, and I, I'll tell you, you know, th- (laughs) one way I sort of think about it, uh, from a bemused point of view, is the old, you mentioned it earlier, the oldest sort of idea of a hypnotic induction was a dangling watch, right? You know? And the watch ... um, and, um, in fact, there was enough concern about it that when automobiles were invented, there was a movement to prevent installing windshield wipers, because people were afraid that they would be hypnotized if they watched the windshield wipers go back and forth on a car. Now, it turns out, fortunately, that you tend not to look at the windshield wipers. You keep looking through the windshield, uh, and so we have windshield wipers today. But that movement is what exactly used to be a hypnotic induction. I think there is a lot of hypnosis in, in EMDR.

Episode duration: 1:52:40