Mendelsohn et al.’s study is important because it demonstrates that hypnotic suggestions influence brain activity, not just behavior and experience. Hypnotic effects are real! This fact has been demonstrated clearly in earlier work, for instance, by psychologist David Oakley (University College London) and colleagues, who compared brain activation of genuinely hypnotized people given suggestions for leg paralysis with brain activation of people simply asked to fake hypnosis and paralysis.
For several decades Braid's work became more influential abroad than in his own country, except for a handful of followers, most notably Dr. John Milne Bramwell. The eminent neurologist Dr. George Miller Beard took Braid's theories to America. Meanwhile, his works were translated into German by William Thierry Preyer, Professor of Physiology at Jena University. The psychiatrist Albert Moll subsequently continued German research, publishing Hypnotism in 1889. France became the focal point for the study of Braid's ideas after the eminent neurologist Dr. Étienne Eugène Azam translated Braid's last manuscript (On Hypnotism, 1860) into French and presented Braid's research to the French Academy of Sciences. At the request of Azam, Paul Broca, and others, the French Academy of Science, which had investigated Mesmerism in 1784, examined Braid's writings shortly after his death.
Contemporary hypnotism uses a variety of suggestion forms including direct verbal suggestions, "indirect" verbal suggestions such as requests or insinuations, metaphors and other rhetorical figures of speech, and non-verbal suggestion in the form of mental imagery, voice tonality, and physical manipulation. A distinction is commonly made between suggestions delivered "permissively" and those delivered in a more "authoritarian" manner. Harvard hypnotherapist Deirdre Barrett writes that most modern research suggestions are designed to bring about immediate responses, whereas hypnotherapeutic suggestions are usually post-hypnotic ones that are intended to trigger responses affecting behaviour for periods ranging from days to a lifetime in duration. The hypnotherapeutic ones are often repeated in multiple sessions before they achieve peak effectiveness.
The American Psychological Association published a study comparing the effects of hypnosis, ordinary suggestion, and placebo in reducing pain. The study found that highly suggestible individuals experienced a greater reduction in pain from hypnosis compared with placebo, whereas less suggestible subjects experienced no pain reduction from hypnosis when compared with placebo. Ordinary non-hypnotic suggestion also caused reduction in pain compared to placebo, but was able to reduce pain in a wider range of subjects (both high and low suggestible) than hypnosis. The results showed that it is primarily the subject's responsiveness to suggestion, whether within the context of hypnosis or not, that is the main determinant of causing reduction in pain.
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Systems theory, in this context, may be regarded as an extension of Braid's original conceptualization of hypnosis as involving "the brain and nervous system generally".(p31) Systems theory considers the nervous system's organization into interacting subsystems. Hypnotic phenomena thus involve not only increased or decreased activity of particular subsystems, but also their interaction. A central phenomenon in this regard is that of feedback loops, which suggest a mechanism for creating hypnotic phenomena.
In the brain, this state looks stranger still. A landmark study in the prestigious journal Science in the late 1990s, led by Pierre Rainville of the University of Montreal, described a study in which hypnotized people briefly placed their left hand in either painfully hot water, heated to 116 degrees Fahrenheit, or room-temperature water. Some of them had been told that they would be experiencing pain, but that they wouldn’t be very bothered by it — if, on a scale of one to ten, the hurt would normally register at an eight, they’d feel it as if it were a four. As all the participants placed their hands in the 116-degree water, their brains were scanned. The results were clear: Those who had been told that the pain would be less intense showed less activity in their brains — specifically, in the anterior cingulate cortex, which is associated with pain processing.
A typical hypnotherapy session has the patient seated comfortably with their feet on the floor and palms on their lap. Of course, the patient could choose to lie down if that option is available and if that will meet the patient's expectation of hypnosis. The therapist can even set the stage for a favorable outcome by asking questions like, "Would you prefer to undergo hypnosis in this chair or on the sofa?" Once patients make the choice, they are in effect agreeing to undergo hypnosis. Depending on the approach used by the therapist, the next events can vary, but generally will involve some form of relaxing the patient. Suggestions will lead the patient to an increasingly relaxed state. The therapist may wish to confirm the depth of trance by performing tests with the patient. For example, the therapist may suggest that when the eyes close that they will become locked and cannot be opened. The therapist then checks for this by having patients try to open their eyes. Following a successful trial showing the patient's inability to open the eyes, the therapist might then further relax them by using deepening techniques. Deepening techniques will vary for each patient and depend largely on whether the patient represents information through auditory, visual, or kinesthetic means. If the patient is more affected by auditory suggestions, the therapist would use comments such as "You hear the gentle patter of rain on the roof;" or, "The sound of the ocean waves allow you to relax more and more." For the visual person, the therapist might use statements such as, "You see the beautiful placid lake, with trees bending slightly with the breeze." Finally, with the kinesthetic person phrases such as, "You feel the warm sun and gentle breeze on your skin," could be used. It is important for the therapist to know if the patient has difficulty with the idea of floating or descending because these are sometimes used to enhance the experience for the patient. However, if the patient has a fear of heights or develops a feeling of oppression with the thought of traveling downward and going deeper and deeper, suggestions implying the unwanted or feared phenomenon will not be taken and can thwart the attempt.
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Most relaxation techniques require daily practice to be effective. A variety of formats for teaching relaxation and meditation exist, including classes as well as individual sessions. Relaxation can be taught in 1 session by conducting and audio taping a relaxation session. Using the audio tape, patients can then practice the techniques daily at home. Methods such as progressive muscle relaxation are easy to learn; yoga, tai chi, and meditation can take years to master completely.
In 2007, a meta-analysis from the Cochrane Collaboration found that the therapeutic effect of hypnotherapy was "superior to that of a waiting list control or usual medical management, for abdominal pain and composite primary IBS symptoms, in the short term in patients who fail standard medical therapy", with no harmful side-effects. However the authors noted that the quality of data available was inadequate to draw any firm conclusions.