“As a clinical psychologist, working in a medical setting, the application of hypnosis has been the most fascinating and most interesting aspect of my career.
“One of my early, early experiences was an individual who underwent extensive surgery with hypnosis as the anesthesia. And it just grabbed my attention; it set my career in motion.
“From that point on, I’ve been fascinated by ways that individuals can learn self-hypnosis, how easy it is to practice, and that if the hypnotics suggestions are appropriate and targeted toward a particular symptom, that it can have a tremendous effect.”
It was while Dr Elkins was researching hypnotherapy for cancer pain management that the hypnotherapy for hot flashes seed was planted.
“I was working with several oncologists, and one of them literally said, ‘Your work in regard to pain management is helpful, it’s interesting, but if you could do something for hot flashes, now that would really be great!’.
“Our initial studies were all with breast cancer survivors that were experiencing moderate to severe hot flashes. It came as a surprise to me, and to many others, that hot flashes decreased by 70% on average. For some women, they went away completely!
“I just thought, ‘Well, this is just the most exciting, interesting new application of hypnosis!”
“Since that time, I’ve been pursuing that line of research, seeking to learn how we can make hypnosis intervention most effective, most useful for women who are experiencing hot flashes.
The impact of hot flashes
“Most women, at some point in their life, will experience menopausal symptoms, and hot flashes are among the most distressing of symptoms. Hot flashes cause sweating, and the sweating can be severe; it’s more than just an embarrassment; it can have a greatly impactful effect on both quality of life and being able to do everyday tasks.
“Hormones or drugs often have side effects that may not be desirable. And many alternatives, such as herbal treatments, aren’t that effective.
“And so, if you think about a hypnosis program reducing hot flashes by 70-80%, and is safe, that’s really almost as good as a hormone treatment for hot flashes.
“Hypnotherapy has become, in my personal opinion, other than estrogen and progestin replacement therapy, the most effective hot flash treatment currently available.”
The science of hot flash hypnotherapy
Hot flashes occur when the hypothalamus⸺the part of the brain that regulates your body temperature⸺becomes overly sensitive to small temperature changes. Your hypothalamus wrongly assumes your body is overheating. It triggers your body’s cooling response: a racing heart, flushed skin, and sweating. In menopause, this happens because of the fluctuating levels of estrogen. Eventually, post-menopause, the body adjusts to the changed hormone levels, but it can be a five to 10-year process.
Hot flashes can be triggered by the smallest of internal or external temperature changes, such as consuming spicy foods, drinking a hot drink, or a slight change in the ambient room temperature. They can also be triggered by stress and anxiety. But, Dr. Elkins says, it is important to differentiate between triggers of hot flashes and the cause of hot flashes.
“Stress and anxiety do not cause hot flashes. If they did, we would all have hot flashes. Rather, they can serve as a trigger. So the cause of hot flashes is the decline in estrogen, and then a dysregulation in the brain’s ability to regulate body temperature correctly. As that dysregulation occurs, very minor changes can trigger hot flashes.
“Anxiety can trigger a hot flash, a cup of hot coffee can trigger a hot flash, stress can trigger a hot flash, so lots of different things can trigger a hot flash. But the trigger is not the cause.”
Hypnotherapy for hot flashes works by targeting both the cause, as well as stress, as a trigger.
By bringing the patient into a state of relaxed focus, similar to being in a vivid dream. In this state they are given imagery and suggestions for coolness, and improved temperature regulation.
In this way hypnotherapy is thought to help the brain recalibrate its temperature responses. It also engages the parasympathetic nervous system (responsible for relaxation) and calms your sympathetic nervous systems (responsible for stress response).
Dr Elkins explains, “Hypnotic relaxation brings about a reduction in anxiety, removing some of those triggers. And so immediately, hot flashes begin to decrease.
“Then, with practice, we get beyond just simply relaxation or stress reduction, to managing the cause of the hot flashes and body temperature being regulated normally.
“In our studies of hypnosis intervention for hot flashes, we have found that hot flashes begin to decrease after the first week. We see a significant decrease in hot flashes after seven days of practice. And that decline continues over the following month of practice.”
While other mind-body interventions, such as meditation and yoga, can assist people in engaging the parasympathetic nervous system, research has shown that hypnotherapy is the most effective, non-hormonal technique for reducing hot flashes.
Dr. Elkins believes the difference in effectiveness is due to the specific suggestions used during a hypnotherapy session. Rather than just guiding people through cooling imagery, they are given the freedom to experience the visualizations with all their senses. And in that hypnotic space, their minds are more open to suggestions for regulating their body temperature.
‘“Guided imagery, hypnosis, mindfulness meditation, relaxation, autogenic training; almost all mind-body interventions involve a focus of attention.
“But hypnosis is characterized by an increased capacity for response to suggestions. The suggestions that we give in hypnosis may be for alteration in perception, behavior, feelings, and so on.
“It’s very important to first go through the process of hypnotic induction and then deepening the hypnotic state so that once the therapeutic suggestions for coolness are given, the person actually experiences the change and sensation of heat or coolness. Thereby, hot flashes simply do not occur. Because as long as the brain is perceiving coolness, there are no hot flashes.”
“Imagining something is different than actually feeling it or experiencing it.
“And so simply imagining, for example, a mountain lake, would not likely be effective, any more than watching a television program and seeing snow coming down. Because although you can watch it, you don’t feel it.
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“In one study that was done comparing mindfulness meditation and hypnosis, half of the individuals received mindfulness meditation and experienced no reduction in hot flashes beyond placebo effect!”
Making hypnotherapy accessible
“I’ve been involved in a number of different clinical trials with different populations of patients, individuals experiencing hot flashes, and we just found very consistently that hot flashes decreased between 70-80%. And as individuals continued to practice with the hypnosis intervention, hot flashes continued to decline.
“However, there was a big problem. And that was how can women get hypnosis for hot flashes?
“Many clinicians are not trained in hypnosis intervention for hot flashes. And so, we wanted to find a way that more people could get the intervention. When I became aware of Mindset Health and this incredible work in developing apps utilizing hypnosis for hot flashes and improving sleep, I was just so interested in this. I felt like, okay, this is the answer! This is how women can access this very effective and very useful intervention!
“In my research, we had shown that meeting one to one with a therapist isn’t necessary for this intervention. We found that it could be done through one's own practice as long as there was guidance and instruction, using an audio recording and that women understood exactly how to use it and how to make it most effective.
“For it to be so easily accessible through the Evia app is just amazing. That something so effective and safe is easy to use!
“A hypnosis session is usually very pleasant; people look forward to it because it’s so pleasant. And the sessions aren’t that long; they’re not that time consuming, so finding the time in the day to practice, it’s pretty minimal for this big benefit that can be obtained.”
Dr. Elkins is a Professor of Psychology and Neuroscience at Baylor University, Director of the Mind-Body Medicine Research Laboratory, and Editor-in-Chief of the International Journal of Clinical and Experimental Hypnosis. He is the expert behind the hypnotherapy for hot flashes program, Evia.