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BBC News Online
23-12-2003
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Hypnosis for the people

All doctors should know how to perform hypnotherapy on their patients, according to a US expert.
Professor David Spiegel, of the Department of Psychiatry and Behavioural Sciences at Stanford University, said the therapy had been shown to help patients deal with pain, and could potentially be used in many other situations, such as helping people cope with long-term illnesses.

Professor Spiegel told BBC News Online: “We have more and more people living with these illnesses who need help coping with them, and hypnosis is a safe and effective way to teach people how to manage their own response, how to take the edge off their pain, how to think through their anxiety and not let it overwhelm them.”

The Stanford scientist made his comments at the annual meeting of the American Association for the Advancement of Science in Boston.

He teaches self-hypnosis to help people manage their symptoms themselves.

Different colours

“If they have pain, I’ll have them imagine they’re doing to the part of their body that hurts what they actually do in the real world when it hurts, whether it’s using a bag of ice cubes or applying heat.”

Professor Spiegel said studies had shown hypnosis did help patients. In a study of women with breast cancer his team is due to publish later this year, those given support plus self-hypnosis had half the pain of those not given that combination.

His team has also found evidence that the brain’s reaction can be changed under hypnosis.

A study of people classed as highly receptive to hypnosis looked at how colour was processed in their brains.

Real view

They were shown patterns, either in colour, or in shades of grey. But if they were hypnotised to see colour, when in fact they were looking at the grey pattern, they believed they were seeing colour and their brain reacted as if that were true.

Professor Spiegel said that studies showed hypnosis was a distinct psychological state, and it was not simply that the person under hypnosis was adopting a role suggested to them.

He added: “People who are hypnotised see what they believe. They don’t just tell you that’s what it is – it actually looks that way to them.”

He is still looking for a “brain signature” which will show what happens in the brain when people are hypnotised.

Frontiers in Psychology
12-12-2023
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Meta-analytic evidence on the efficacy of hypnosis for mental and somatic health issues: a 20-year perspective

Summary: Hypnosis has been documented and investigated for centuries, and its therapeutic use is endorsed by multiple medical associations. In this comprehensive overview, the authors conducted a systematic review of meta-analyses to examine the efficacy of hypnosis in evidence-based healthcare. They focused on patients with mental or somatic health problems and compared hypnosis interventions to control conditions. Here are the key findings:

1. Robust Evidence:

• Hypnosis is most effective in patients undergoing medical procedures and those experiencing pain.
• The largest effects were observed in populations of children and adolescents.
• Reported effect sizes ranged from small to large, indicating positive impacts on treatment outcomes.

2. Safety and Efficacy:

• Hypnosis reduces pain, emotional distress, duration of medical interventions, medication use, and symptoms related to irritable bowel syndrome.
• Future research should explore moderators of efficacy and compare hypnosis to established interventions.
• For more details, you can read the full article here.

This study highlights the potential of hypnosis as a psychological tool for treating various health issues, emphasizing its safety and positive impact on patient outcomes.

Forbes
22-5-2023
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What Is Hypnotherapy?

If you’re familiar with the terms “hypnotherapy” or “hypnosis,” much of what you know may come from its stereotypical portrayal in movies and television as a tool used to control someone, often for malicious intent. However, much of this portrayal is grounded in myths—in fact, experts have been using hypnosis to help treat medical conditions since the late 1700s.

Hypnotherapy is a mind-body therapy that uses hypnosis—a mental state of heightened attention, reduced awareness of the immediate environment and enhanced willingness to accept suggestions—to manage health issues like chronic pain, obesity, bedwetting and side effects of cancer treatments.

Here’s what you need to know about hypnotherapy.
Hypnotherapy Definition
Hypnotherapy is a therapy that uses hypnosis to help treat and manage psychological and physical health issues.

According to the American Psychological Association (APA), hypnosis is “a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion.”

Another way to think of hypnosis is “nothing more than a naturally focused state you may find yourself in several times a day,” explains Michael Pulman, a U.K.-based clinical hypnotherapist. “If you have found yourself daydreaming while driving or so engrossed in a book so that you can vividly see and almost hear the characters,” you’ve experienced hypnosis, continues Pulman.

Hypnotherapy can help certain people overcome mind and body-related issues, claims Pulman. While the mechanisms of action around hypnotherapy are still being studied, recent research points to a combination of biological, psychological and social factors that work together to create a helpful hypnotherapy session. A few variables that might facilitate a successful session include higher levels of theta bandwidth activity in the brain for the client (which are brain waves that experts think are important for learning, and which occur when we are sleeping, dreaming or in a very relaxed state), motivation of the client, rapport between the client and the hypnotherapist and the client’s expectations of the session[1].

During hypnotherapy, a hypnotherapist—a trained professional who is qualified to practice hypnosis—helps a person get into a state where they can focus, ignore distractions, listen and hopefully accept suggestions such as feeling comfort, relaxation, or numbness rather than pain. According to experts, these suggestions can help treat physical and mental health issues like stress, addiction, chronic pain and anxiety disorders.

People can also learn to put themselves under hypnosis with the guidance of their hypnotherapist.

What Can Hypnotherapy Help With?
A non-exhaustive list of health issues hypnotherapy may help, according to the World Health Organization (WHO), includes:

Obesity
Bedwetting
Side effects of cancer treatments
Irritable bowel syndrome
Skin conditions like warts and psoriasis
High blood pressure
Migraine headache
Pain
Insomnia
Depression
Eating disorders
Posttraumatic stress disorder
Unhealthy habits like smoking
While research is still ongoing around the benefits of hypnosis, a few recent studies do add credibility to the WHO’s list.

When it comes to anxiety, a 2019 abstract of a meta-analysis found that while a majority of individuals treated with hypnotherapy did seem to feel improvements around their anxiety, the method was more effective in reducing anxiety when used in combination with other psychological treatments than when used alone[2].

A 2018 review analyzing how helpful hypnotherapy might be when it comes to sleep outcomes found that 58% of the studies available indicated that hypnosis provided benefits to individuals dealing with sleep disturbances[3].

Studies around obesity and hypnotherapy remain scarce, but according to a review from 2021, there is evidence that hypnotherapy may be useful in promoting weight reduction, improving eating habits and even increasing physical activity—although researchers caution that further research needs to be done before any conclusions can be made.

Can Anyone Be Hypnotized?
Anyone can be hypnotized, according to Keylee Miracle, a double-board certified hypnotherapist based in New York City and creator of the NeuroIntuitive Method. “We all have a parasympathetic nervous system and when we sleep deeply, we access this part of ourselves. Any good hypnotherapist or hypnotist relies on consent, so willingness matters, but mechanics-wise, absolutely. Treatment resistance can happen but has always been overcome in my experience,” she explains.

However, research shows that the idea of universal susceptibility may be less accurate, according to Daryl Appleton, M.Ed., a psychotherapist, executive coach and host of the Feelings & Other F Words podcast. based in New York and New England. In fact, some studies suggest only about 10% to 15% percent of the population is highly hypnotizable[5], which means they respond easily to hypnotic suggestion, she adds.

Generally, “the efficacy of hypnotherapy depends on the participant, with some people being more prone or open to suggestion than others,” says Alex Dimitriu, M.D., double board-certified physician in psychiatry and sleep medicine, and founder of Menlo Park Psychiatry and Sleep Medicine and BrainfoodMD. Around 80% of people, Dr. Dimitriu explains, are ‘medium’ for hypnotizability—meaning they’re somewhere between highly hypnotizable and not hypnotizable at all—and this tends to remain constant over their lifetime.

Does Hypnotherapy Work?
Hypnotherapy is a powerful and effective method to help people overcome mind and body-related issues, says Pulman. And it does have a long history, as it was utilized as early as the 1700s to assist in the treatment of various medical conditions.

One of the main reasons for its success is that unlike other forms of therapy such as counseling and psychotherapy, hypnotherapy works directly with the subconscious part of the mind,” claims Pulman.

However, “like most therapies, hypnotherapy is not a one size fits all approach,” Pulman continues, explaining that in his practice, clients who find hypnotherapy useful tend to:

Display an open mind towards each session
Shows a belief in their ability to be successful at hypnosis
Commit and take action to change
While the successfulness of hypnotherapy seems to be at least partially connected to how open a participant is to its benefits, a 2022 study on pediatric patients in a children’s hospital found that hypnotherapy appeared to help create “an overall improvement in symptoms” in 76% of more than 200 individuals with complex symptom disorders[6]. However, as authors of the study point out, hypnotherapy was “an add-on treatment” in addition to other clinical treatments, which means that the results may not be due solely or primarily to the effects of hypnotherapy.

How to Find a Hypnotherapist
If you’re interested in trying hypnotherapy for yourself, there are a few things experts say you should keep in mind when seeking out a hypnotherapist, who could charge anywhere from $50 to more than $200 depending on location and practitioner.

Check Their Qualifications
It’s important to look for trained professionals with qualifications from respected educational institutions, says Pulman. Two examples of education institutions include the American Society of Clinical Hypnosis and The American College of Hypnotherapy. Also, find out if hypnotherapist candidates have regular, continuing professional development and are a member of a reputable regulating body, such as the The National Hypnotherapy Society.

Because hypnosis and hypnotherapy are not heavily regulated, when an individual has accreditations from respected institutions, “you know that they’ve been through a fairly rigorous process; they’ve taken courses and submitted a certain number of testimonials and client case studies to get accredited by these institutions,” explains U.K. based hypnotherapist Robert Brennan.

Consider Trusted Testimonials
Reviews and testimonials from people you know and trust are a big deal because of the popularity of hypnotherapy, says Miracle. Asking around your social circle is one way to find out if anyone has worked with a trusted practitioner.

Interview Possible Hypnotherapists
It’s always a good idea to talk to a hypnotherapist candidate to see if you feel good about them and can have a positive rapport, says Pulman.

Having conversations about pricing and refund policies are also a good idea, explains Brennan. What happens if you don’t like the services provided or feel like it’s not helping you?

“As with all working relationships, do not be afraid to interview several therapists before settling on the right one,” advises Dr. Dimitriu. “It’s essential to feel comfortable and understood and to have faith in the relationship.”

Stacey Litam, Ph.D. also contributed to this article.

AIM Code of Ethics for Youth Mental Health Ambassadors and Advocates

Youth Mental Health Ambassadors and Advocates (hereafter referred to as “ambassadors”) play a vital role in promoting mental well-being and peer support in their communities. While not professional mental health practitioners, ambassadors are expected to uphold the highest standards of respect, responsibility, and integrity in all of their interactions. The following Code of Ethics outlines the principles guiding their conduct.

1. Confidentiality and Privacy
Ambassadors shall respect the privacy of their peers and maintain confidentiality regarding any personal information shared with them, unless there is a concern of harm to the individual or others. In such cases, they shall seek support from a responsible adult (such as a teacher, counselor, or social worker).

2. Informed and Voluntary Participation
Ambassadors shall engage with their peers in a voluntary, non-coercive manner. They shall respect their peers’ right to choose whether or not to share, participate, or accept support.

3. Respect and Non-Judgment
Ambassadors shall listen with empathy and without judgment. They shall refrain from making assumptions, labeling others, or imposing personal beliefs.

4. Clear Role Boundaries
Ambassadors shall acknowledge that they are not therapists or counselors. They shall not attempt to diagnose, give medical advice, or intervene in family matters. Their role is to offer peer support and to refer to professionals when needed.

5. Referral and Help-Seeking
Ambassadors shall recognize the limits of their role and refer peers to qualified adults or mental health professionals when facing issues such as self-harm, abuse, suicidal thoughts, or severe emotional distress.

6. Cultural Sensitivity and Inclusion
Ambassadors shall respect diversity and refrain from discrimination based on gender, ethnicity, religion, family background, sexual orientation, or ability.

7. Honesty and Integrity
Ambassadors shall be truthful and transparent in their communication. They shall not spread rumors, fabricate information, or misrepresent their role or knowledge.

8. Collaboration and Teamwork
Ambassadors shall work in cooperation with fellow ambassadors, school staff, and relevant professionals to foster a supportive mental health culture.

9. Adherence to Scientific and Evidence-Based Practices
Ambassadors shall rely solely on knowledge, strategies, and resources grounded in psychological science and mental health education. They shall avoid promoting methods or beliefs that lack scientific validation or may cause harm.

10. Compliance with Local Laws and School Policies
Ambassadors shall act in accordance with the laws of their jurisdiction and comply with all school rules, codes of conduct, and safeguarding procedures. They shall report any unlawful, unethical, or dangerous behavior to responsible authorities.

Market Reports World
06-07-2002
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Hypnotherapy Market 2022 Size, Share, Growth, Key Players, Type & Application, Market Dynamics, Challenges, Opportunities, Revenue, Price and Gross Margin, Development Trends, Cost Analysis and Forecast 2029

Summary: The global Hypnotherapy Market 2022 research report provides an in-depth analysis of market size, share, growth, trends, and forecast. The Hypnotherapy Market includes a detailed description of market sizing and growth, value, and the key opportunities in the Hypnotherapy Market. It outlines the factors that are and will be driving the growth of the industry, considering previous growth patterns within the forecast period 2022-2028. The report also provides insight into the main drivers, challenges, opportunities, and risks of the market. Key players are profiled, and their market shares in the global Hypnotherapy Market are discussed. Overall, this report covers the historical situation, present status, and future prospects. The report encompasses research methodologies, porter’s five forces analysis, product scope, and CAGR status. Additionally, it offers a quantitative analysis of key countries according to their revenue share and the latest technological advancements in each region.

BBC
20-05-2022
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The medical power of hypnosis

Summary: Hypnosis, once regarded as a stage magician’s trick, is now emerging as a potent medical treatment. Dr. David Spiegel, a pioneer in clinical hypnosis, recounts an early encounter with a wheezing asthma patient. Through hypnosis, he eased her symptoms, sparking his lifelong interest in this field. Hypnotic suggestions can lead to profound experiences, such as being unable to recognize one’s own reflection. Research shows that hypnosis is effective for pain, anxiety, PTSD, irritable bowel syndrome, and more. It works by altering brain activity, increasing the neurotransmitter GABA, and inducing a trance-like state. Despite its eccentric history, hypnosis is gaining credibility as a valuable therapeutic tool1.

Key Points:

1. Spiegel’s Encounter: Dr. Spiegel successfully treated an asthma patient using hypnosis, calming her wheezing and improving her breathing.
2. Hypnotic Suggestions: Simple suggestions during hypnosis can lead to remarkable outcomes, such as involuntary arm movement or fused interlaced fingers.
3. Effective Therapeutic Tool: Evidence supports hypnosis for pain management, anxiety, PTSD, and other conditions.
4. Brain Changes: Hypnosis alters brain activity and increases GABA levels.
5. Trance-Like State: Hypnotizable individuals enter a focused, receptive state during sessions.

In summary, hypnosis transcends its magical reputation, offering real benefits in modern medicine

BJPsych
07-09-2021
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Update on hypnotherapy for psychiatrists

Summary: Although hypnosis has played a part in psychotherapy for a long time, it is not yet seen as an evidence-based therapy and is absent from many practice guidelines when it comes to the treatment of psychiatric disorders. At present, the applications and methods of hypnotherapy are poorly understood and other methods of psychotherapy tend to be favoured. This review article aims to introduce the role of hypnotherapy and its application for certain common psychiatric presentations, as well as examine its efficacy by summarising recent evidence from high-quality outcome studies and meta-analyses.

PubMed Central
29-07-2021
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Nurse’s knowledge and perceptions on communicative hypnosis: an observational study

Abstract
Background and aim of the study.
Much evidence shows that hypnotic communication can have a pain-relieving effect and reduce complications such as anxiety, insomnia and depression. Whenever this technique was applied, the use of pharmaceuticals was reduced, there were fewer side effects, shorter hospitalization times frames and lower treatment costs. The aim of this study is to evaluate the knowledge and perceptions of nurses about hypnotic communication and the causes for which this technique is not frequently used. A secondary objective pointed to measuring the effectiveness of an educational event on hypnosis.

Method.
The evaluation was done by directly administering an anonymous and voluntary survey created ad hoc, in a pre-test and post-test modality, to nurses subscribed to a four-hour formative event on hypnotic communication organized in 2019 by the Nursing Order, Province of Ravenna.

Results.
78 nurses (85.7%) participated in the study. The analysis of the pre-test results shows a gap of knowledge regarding hypnotic communication. The variation of answers between the pre-test and post-test (T-Student) has shown a radical difference in knowledge (95%-100% correct answers). The main causes were found regarding the lack of use for hypnotic communication: stereotypes and prejudices related to this technique and insufficient university education.

Conclusions.
The implementation of this technique, effective and efficient under various aspects, requires a preliminary creation of culture regarding this theme, capable of surpassing the stereotypes and resistances brought by a lack of theoretical elements.

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Introduction
Neurophysiological studies have demonstrated that hypnosis is different from the effects brought by placebo and sleep (1). The use of Positron Emission Tomography (PET) demonstrated that during hypnosis there is an activation of the anterior cingulate cortex in the brain, capable of modifying the perceptions of a person as to reduce painful stimuli (2, 3). Computerized MRI scan has demonstrated that during a hypnotic state there is a substantial amount of activity in cortex region called DMN or Default Mode Network of the resting-state, present in awake subjects that lack awareness of their surrounding environment (4).

These studies have rekindled the interest towards various uses of this technique in clinical contexts and have allowed the acceptance and possible viability of this type of treatment by the medical-scientific community (5, 6).

Hypnotic communication uses persuasion and suggestions to surpass rational analysis and affects the subconscious, bypassing defenses and stimulating emotions. Hypnotic communication uses the strength that words have on a neurophysiological level and the bonds between operator and patient. Every experience in the world creates constraints that are in origin neurological (length of sound waves, visual chromatic spectrum), social (rules, language), individual (life experiences) and as such there is no objective reality (7).

This technique is used by doctors, psychiatrists and health workers all of which are specifically trained (8). As for indications regarding the use of these techniques in a medical field, hypnosis might be effective in:

– In reduction of pain for gastrointestinal disorders such as ulcers, irritable colon, colitis, crohn’s disease (9);
– In reduction for pain for dermatological disorders like eczema, herpes, neurodermatitis, itchiness, psoriasis, warts (10);
– In reduction of acute and chronic pain back aches, oncological pain, head aches and migraines, arthritis, rheumatism (11-15);
– In reduction of nausea and vomiting as symptoms caused by chemotherapy (16-20);
– In stabilizing hematic flow (21, 22);
– In handling anxiety in cases of acute respiratory events connected to allergies, in particular asthma (23);
– In reduction of hypertension and in invasive vascular procedures (24, 25);
– In reduction of pain connected to the replacement of medication on second degree burns and above (26,28);
– In surgery as an analgesic, especially in cases of allergic or hypersensitive patients or in cases of awake surgery (5, 18, 29,30);
– During childbirth as to reduce nausea caused by pregnancy (gestational hypermisis) (31);
– As an alternative to pharmaceutical anesthesia in dental contexts (32-34);
– In reduction of anxiety and pain connected to invasive procedures in ambulatory regimes (29-38);
– In reduction of anxiety, through the blocking of the sympathetic reactions caused by stress (16; 39-41);
– In reduction of anxiety and pain in a pediatric patient (42-48).
There are patients that are less effected by hypnosis. The results obtained are differentiated by suggestibility of the subject and the capability of the therapist. This means that 2 patients with different suggestibility and two therapists, with different levels of technique and communicative-relational skills, might produce very different results (49).

Even though there are various prejudices towards hypnotic communication, some Italian contexts have had for some time health care professionals-such as doctors and nurses- taught in the proper use of this technique, producing positive results. For example, at the Hospital “Città della Salute e della Scienza di Torino” there have been specific courses regarding hypnotic communication and this technique has been used in thousands of procedures, from cardiac ablations to gastrointestinal endoscopy. The use of hypnotic communication in this case has provided positive results in clinical outcomes (such as the reduction of collateral effects connected to pharmaceuticals) and in economical outcome (lower waiting times and use of medicines) (50).

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Methods
Aim of the study
The purpose of this study is that of evaluate perspectives and knowledges of nurses regarding the theme of hypnotic communication as to ascertain the main gaps of awareness and the more usual stereotypes that limit the use of this technique within healthcare practices.

A secondary objective of this study is to evaluate the effectiveness of a formative event on hypnotic communication with the purpose of changing preconceptions and gaps of knowledge for professionals.

Design
A descriptive cross-sectional survey was carried out.

Setting
To recruit registered nurses (RNs), we asked the participation of the Nursing Order (OPI) of Ravenna, because it had planned a four-hour training event about hypnotic communication. Data collection was done during the formative event “The Hypnotic Communication” available only to nurses and organized by the Nursing Order on the 9th march 2019.

Instrument
The survey was divided into a pre-test and a post-test. The questionnaire was made ad hoc by the researchers, in collaboration with the speaker of the training course, based on the topics covered during the formative event.

In the module pre-test there were 4 personal data variables (age, gender, work place, years of experience), 8 questions on the theme of hypnotic communication, the questions are multiple choice directed to evaluate theoretical know-how and two last items done to ascertain stereotypes and prejudices from the participants. Questions about prejudice were only asked in the pre-test because the formative event could influence responses. The module of the post-test had the same 8 theoretical questions and a new question regarding the dimension of preconceptions. The questions about perceptions were placed only in the post-test because the educational event was functional to the response.

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The questionnaire’s areas are indicated here below.
Stereotypes questions (pre-test only)

In your opinion, is a person in a state of hypnosis free to come out of it voluntarily?

In your opinion, from 0 to 10, how much of hypnosis is manipulation?

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Theoretical questions (pre and post-test)
Item 1 – What is hypnosis?

Item 2 – In what percentage of individuals can hypnotic analgesia be obtained for surgery?

Item 3 – What should a hypnotist do during a diagnostic-therapeutic procedure?

Item 4 – How quickly can a hypnotic induction be obtained?

Item 5 – Which subject is easiest to hypnotize?

Item 6 – What are the objective signs of an effective hypnotic trance?

Item 7 – What percentage of subjects are capable of all hypnotic abilities (e.g., analgesia, catalepsy)?

Item 8 – According to the legislation, who can practice hypnotic communication?

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Perception questions (post-test only)
Possible causes for lack of hypnosis communication in clinical practice (indicate three options):
Insufficient university education
Insufficient post-degree formation
Presence of stereotypes and prejudices
Risk of interprofessional conflicts
Complexity of the technique
Not much time during work
Few application contexts
Procedure
The pre-test was distributed before the start of the formative event, after a brief explanation on participation modalities and the compilation of informed consent. During the course, the technical, normative and formative characteristics of hypnotic communication the participants were given.

At the end, the post-test containing the same questions of the pre-test has been administered for evaluating the effectiveness of the formative event. The formative course was held a professional highly qualified on the subject, the President of A.S.I.E.C.I (Italian Scientific Association of Experienced Nurses in Hypnotic Communication). The 8 theoretical questions of the pre-test and post-test were agreed upon with the lecturer of the formative course

Sampling
The questionnaire was administered to all nurses enrolled in the educational event (n. 91); the non-probabilistic sample is composed from all the nurses that voluntarily agreed to participate (n.78).

Data analysis
Data was analyzed with the demo version of SPSS statistical software. Descriptive statistical analysies (frequency, percentage, mean, standard deviation, median) were performed with a 95% confidence interval. A Chi-square test was used for analyzing the nominal variables and an ANOVA test for the cardinal variables.

Ethical considerations
The study was approved by the Bioethics Committee of the University of Bologna (Prot.71554 del 29/3/2019). The instrument was completely anonymous and before releasing it an informative consent was signed by all the participants.

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Results
The sample size is of 78 nurses (85.7% of total participants at the formative event).71 were women (91%) and were 7 men (9%). the average age of the sample is 46 years old (±10.5) with an average workplace experience of 23 years (±12.2). Another variable included in the test is the specific area filled in the workplace by the subjects. From the results it’s shown that 16.7 % of the participants (n. 13) works in contexts of surgery or hospitalization, the 8.9% in the operating room and equal value in outpatient contexts. Few nurses worked within their territory (5.2%) or contexts like emergency, psychiatry and pediatric (3.8%). A smaller amount (2.6%) of participants worked in intensive care (Tab 1).

Analysis of competencies
Analysis of the results taken from the section regarding theoretical knowledge showed a marked difference between participants’ responses before and after the training event (pre-test and post-test). This trend is clear in all 8 items of the survey (Tab. 2).

For instance, in item 1, where the knowledge of nurses was polled regarding the physiology and in particular if it might be attributable to a state of physiological consciousness (right answer) or in some way altered, the variation of knowledge seems to be clear: from 40.3% in the pre-test to 100% in the post-test.

The variation of answers between the pre-test and post-test has shown a radical difference in knowledge (95%-100% correct answers) non only for item 1 but also the other 4 answers (Fig. 1).

At the moment when the necessary time of induction of the state of hypnosis was asked (item 4) only 6.5% answered correctly in the pre-test phase; namely that it happens in a few minutes. This changed in the post-test, where 67.1% answered correctly.

The connection between patient and a specialized operator in hypnotic communication was analyzed (item 3) and even in the pre-test a correct amount of sensibility was shown among operators which answered correctly 74% of the time, even before the formative event. Even though the type of connection analyzed takes into consideration not only verbal communication but also a type of connection that spans on multiple levels.

As shown by the results the informative event was shown being effective in all the topics taken in consideration, modifying the answers of the participants in a statistically significant manner- even though it’s an evaluation relative only to the short term.

Analysis of the perceptions
For the analysis of the perceptions some questions were administered between the pre-test and post-test. The first query asked to the participants what was their opinion regarding the capacity of a subject of freely getting out of the hypnosis; more then halve of the nurses answered negatively-since a subject under hypnosis can be free of it whenever the patient wishes.

The question that analyzed the perceptions of the nurses in the post-test and looked in to the reason why hypnotic communication in nursing practices. Nurses were given 3 choices out of seven alternatives to choose from. The presence of stereotypes and prejudices was shared among most participants (82.5%) and was considered as the main reason as to why hypnotic communication wasn’t used. Another important reason, according to the participants, was the lack of a proper formation regarding the subject. Also, the lack of a proper university formation was identified as an element as to why hypnotic communication wasn’t used (Fig. 2).

Discussion
The analysis of results in this study allows us to draw important information on which to reflect. The difference of correct answers between pre-test and post-test variations was statistically significant in all of analyzed items, highlighting the effectiveness of the formative event.

The initial analysis of the expertise brought to light by the pre-test is clear: theoretical knowledge on the theme of hypnotic communication is lacking among nursing professionals. From their perceptions it emerges that these gaps are mainly caused by university education and follow up formative experiences.

However, nurses appeared to be sensitive to relational and communicative dynamics tied to hypnotic communication: in the question regarding the relationship between operator and patient (item 3), indeed in the pre-test most nurses already gave a correct answer, recognizing that at the basis of the hypnotic technique there is an intense and constant relational link: such a thing could be reflected that hypnotic communication is partially and unknowingly applied daily in their field of work.

Experiences seem to be influenced by the forms of spectacle of hypnotism, that has nothing to do with the clinical prospective of this technique. The fact that 6 nurses out of 10 consider hypnosis as a state of “altered” consciousness or even “astral”, and believe that it is impossible for the assisted to voluntarily exit the hypnotic state or that in most cases a manner of manipulation, these factors seem to support this hypothesis. But contrary to popular belief no matter the level of hypnosis, it is the person to maintain total control of their conscience and not the hypnotist making it possible to interrupt the hypnosis in any moment. As expressed by Milton Erickson (51) in obtaining the hypnotic state no form of manipulative influence is done by the hypnotist, but this is derived exclusively by conscious and voluntary activity of the assisted.

Analysis of the causes at the root lack use of hypnotic communication within clinical practices opens up certain points of thought. The fact that 8 out of 10 nurses (82.5%) states that the main obstacle is the presence of stereotypes and prejudices shows an elevated level of self-awareness of participants. It is possible that this realization emerged during the training event, in which several misconceptions about hypnotic communication were refuted. Other determining factor is the training done by the participants, and that because of this nursers state that practicing hypnotic communication isn’t possible given the lack of experience and absence of practice. In such a way there is a “gap” of competences, origin of which-according to the nurses participating in the study – is to be found in a continuous education(65.0%) and in university education (38.8%).

Minor but not negligible is the percentage of those that fear possible inter-professional conflicts (28.8%) manifesting perplexity on the effective levels of autonomy for the nurse in the use of this technique. This result suggests that the best strategy for a correct knowledge translation namely a true transfer of these techniques into practice has to start from a proper education and involvement not aimed only for a professional profile but also pointed to develop the competencies of the whole interprofessional team.

The same percentage of participants (28.8%) considers that there is a possibility that there isn’t enough time. It’s important to reflect on this data, since from the start of the hypnotic suggestion it takes at least 3 to 5 minutes before it’s executed: such an element could be caused by preconceptions of the operators.

Lastly, the formative event seems to have contributed in changing perceptions regarding the possible use of hypnotic communication in clinical practices: only 5% of the participants believe that the complexity of these procedures might represent an obstacle, while, for the 6.4% of the sample, it may not have a wide range of uses.

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Conclusions
Hypnotic communication represents a form of intense relation between assisted and operator, based on the creation of a report of trust, respect and empathy.

The results of this descriptive investigation allow some conclusive reflections regarding the sample of nurses that participated in the study.

Three main elements emerge in the study: the gap of theoretical knowledge among nurses regarding the theme of hypnotic communication; effectiveness of the formative event upon the expertise and the sharing of elements that hinder the implementation of this technique in daily clinical practices. These elements according to the participants are made out of stereotypes and prejudices on the subject and lack of a proper base and post-base education.

Considering the numerous scientific evidences supporting hypnotic communication in a clinical setting and in how it could be implemented (reduction of side effects, reduction of costs and hospitalization time), it is necessary to reflect on the most appropriate strategies to introduce these techniques in care settings. Starting from the consideration of the participants, the first thing to take into consideration is that of generating a culture, acknowledgment and clarity on the theme, with the end of dissolving uncertainty tied to radical prejudices and mistrust regarding hypnosis. Such an action must engage on all systems and levels: from professionals to the sanitary directives given to citizens\patients.

Such a direction could be taken through the activation of formative events, for citizens and operators, including specific formative courses for operators on all levels (university and continuous formation) with the objective of giving the right tools and know-how as to utilize and apply this knowledge to everyday healthcare.

“Relationship time is care time” says the recent Italian Deontological Nurses’s Code (2019) and hypnotic communication can answer this request, since it’s a real and proper helpful communicative tool, pointed to optimizing the potential of the person. This technique allows nurses to “lead hand in hand” the assisted and helping the person in deal with situations that are more complex than the medical issue: pain, fear and the feeling of powerlessness.