This Huberman Lab Essentials episode features Dr. David Spiegel, a leading expert in clinical hypnosis and professor at Stanford School of Medicine, discussing the neuroscience and therapeutic applications of hypnosis with host Dr. Andrew Huberman, professor of neurobiology and ophthalmology at Stanford.

The conversation explores what hypnosis actually is, how it differs from stage hypnosis, and the specific brain regions and networks involved in hypnotic states, including the dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, insula, and posterior cingulate cortex.

Dr. Spiegel shares clinical examples of using hypnosis to treat trauma, phobias, pain, and stress, explaining how the technique enables rapid therapeutic change by altering mental states and creating cognitive flexibility.

The discussion covers practical aspects including hypnotizability testing, the Spiegel Eye Roll test, self-hypnosis techniques, and resources like the Reverie app for accessing clinical hypnosis tools.

Defining Hypnosis and Distinguishing Clinical from Stage Hypnosis

"Hypnosis is a state of highly focused attention - something like looking through the telephoto lens of a camera in consciousness. What you see, you see with great detail, but devoid of context" - David Spiegel

Hypnotic-like experiences occur naturally when people get absorbed in movies or sports, forgetting they're watching and entering the imagined world as participants rather than observers

"I don't like stage hypnosis. You're making fools out of people. And that's what scares people about hypnosis - they think you're losing control. You're gaining control" - David Spiegel

Clinical hypnosis provides cognitive flexibility, enabling people to suspend critical judgment and see situations from different perspectives, creating tremendous therapeutic opportunities

Brain Networks Active During Hypnosis

Three primary brain changes occur during hypnosis: decreased activity in the dorsal anterior cingulate cortex (DACC), which normally detects conflicts and potential dangers in the environment

Increased functional connectivity between the dorsolateral prefrontal cortex (DLPFC) and the insula enables powerful mind-body control, allowing conscious regulation of typically automatic bodily functions

Hypnosis study demonstrated subjects could increase gastric acid secretion by 87% through mental imagery of eating favorite foods, with one woman reporting feeling full despite eating nothing. Relaxation imagery produced 40% decrease in gastric acid

Even when injected with pentagastrin (which triggers gastric acid release), hypnotized subjects achieved 19% reduction in gastric acid through mental control alone

Inverse functional connectivity between DLPFC and posterior cingulate cortex creates dissociation - "I'm doing something, but I'm not thinking about what it means for me" - enabling cognitive flexibility

The posterior cingulate cortex, part of the default mode network, decreases activity during hypnosis similarly to meditation, allowing selfless experience without self-referential thinking

Clinical Applications: Stress, Sleep, and Focus

Hypnosis proves highly effective for stress reduction by dissociating somatic reactions from psychological reactions, teaching people to keep their body comfortable while visualizing stressors on an imaginary screen

"I'm getting emails from people who said, I haven't slept right in 15 years, and now for the first time, I'm listening to your app and I can sleep at night" - David Spiegel on sleep applications

Hypnosis enhances focus by training people to narrow attention and enter absorbed states, similar to when an hour passes unnoticed while writing or reading because the activity feels game-like

For ADHD, self-hypnosis training might help enhance focus, though effectiveness depends on individual hypnotizability levels and requires proper assessment

Treating Trauma and PTSD with Hypnosis

State-dependent memory principle: people enter dissociative states during trauma, so hypnosis helps by making the therapeutic state more congruent with the traumatic memory state

"Most rape victims will tell you: I was floating above my body, feeling sorry for the woman being assaulted below" - David Spiegel on dissociative states during trauma

Case study: Woman with attempted rape and skull fracture used hypnosis to recall details. While visualizing the attack on an imaginary screen, she realized "if he gets me upstairs, he doesn't just want to rape me, he's going to kill me"

By having the patient visualize her self-protection strategies on another screen, she recognized the attacker was surprised by her resistance, helping her understand she likely saved her own life

One randomized trial from Israel demonstrates that adding hypnosis to PTSD treatment actually improves outcomes compared to standard treatment alone

"You need to reconfront a traumatic situation before you can modulate your associations to it and figure out how you can approach that problem from a different point of view" - David Spiegel

Hypnosis for Pain Management and Phobias

Pain treatment with hypnosis teaches people to categorize pain: does it signal re-injury risk or simply indicate healing? This cognitive reframing modifies pain processing based on meaning

Phobia treatment uses "unsystematic desensitization" - changing mental states itself has therapeutic potential, allowing wider array of experiences beyond avoidance patterns

"The more they avoid it, the more the only memories they have are negative because they don't have any good experiences with it. It's like get back on the horse after you fall off" - David Spiegel

Pediatric study on voiding cystourethograms children taught to mentally visit friends or Disneyland during procedures experienced 17-minute shorter procedures, less anxiety, and less pain

Measuring Hypnotizability and the Eye Roll Test

Hypnotizability distribution: approximately one-third of adults are not hypnotizable, two-thirds are hypnotizable, and about 15% are extremely hypnotizable, measurable on 0-10 scale

The Spiegel Eye Roll test procedure: tilt head back, look up at ceiling with eyes open, then close eyelids while maintaining upward eye gaze

Test interpretation: seeing sclera (white part of eye) as lids close indicates moderate to high hypnotizability; seeing iris (colored part) as eyes move down indicates lower hypnotizability

"You're asking the brain to do something difficult, to keep the eyes up while closing the eyelid" - David Spiegel on why the test works as a measure

Eye movements relate to consciousness levels: we close eyes when sleeping, have rapid eye movement when dreaming, and most consciousness-affecting drugs impact eye movements or pupil dilation

The eye roll creates unusual state of "resting alertness" - maintaining focus while turning inward, unlike normal eye closure which signals sleep and reduced environmental vigilance

People with OCD tend to score lower on hypnotizability because they're "too rigid in control" and "all busy evaluating rather than experiencing," making it harder to enter hypnotic states

Practical Implementation and the Reverie App

Most patients see a clinician only once or twice to assess hypnotizability, learn self-hypnosis techniques, and then practice independently for ongoing issues like pain management

The Reverie app (reveri.com or Reverie app from app store) provides structured hypnosis sessions for pain, stress, focus, insomnia, eating better, and smoking cessation

App offers both 15-minute full sessions and one-minute refresher exercises, with two-thirds of users reporting the one-minute refreshers help them feel better

"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" - David Spiegel on rapid assessment

Children can be effectively hypnotized but need more structure than adults - "you've got to share your dorsolateral prefrontal cortex with them a little bit" - David Spiegel

Group hypnosis is highly effective, including weekly sessions with 10 women with metastatic breast cancer, where shared social experience may enhance individual abilities

Role of Breathing and Physical State in Hypnosis

"Breathing itself is a bridge between conscious and unconscious states" - Andrew Huberman on respiration's role in shifting brain states

Cyclic sighing (more time spent exhaling than inhaling) appears to decrease sympathetic arousal and enhance relaxation during hypnotic induction

Standard induction includes asking people to take a deep breath and slowly exhale, with increasing emphasis on the slow exhale to enhance relaxation signals

"Breathing is very interesting because it's right at the edge of conscious and unconscious control - it will go on automatically, but we can control it" - David Spiegel

Physical relaxation is typical but not required: peak athletic performance and classical pianists in flow states represent hypnotic-like states during intense activity

"I'm not thinking, if I start thinking about what my fingers are doing now, I screw up. I'm floating above the piano thinking about the tone" - classical pianist example of performance hypnosis

Finding Qualified Practitioners and Resources

Two primary professional organizations provide referral services: Society for Clinical and Experimental Hypnosis (SCEH.us) and American Society for Clinical Hypnosis

"Look for someone who is licensed and trained in their primary professional discipline - psychiatry, psychology, medicine, dentistry - and who has training and interest in using hypnosis" - David Spiegel

Hypnosis changes are often permanent or long-lasting after brief treatment, with many patients requiring only one or two clinical sessions before continuing self-practice