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Dr.
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David Spiegel: Right now, I want you to notice sensations in your back.
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What does your back feel like right now?
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Tim Ferriss: The part that's usually painful? Dr. David Spiegel: Yeah.
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Tim Ferriss: It feels relaxed right now. Dr. David Spiegel: Good.
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Tim Ferriss: More relaxed. Yeah. Dr. David Spiegel: Good. Good.
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How would you rate the discomfort level right now on that zero to 10 scale?
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Tim Ferriss: David, so nice to have you here.
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Thank you for making the time. Dr.
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David Spiegel: Thank you so much for having me, Tim.
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Tim Ferriss: And I want to say up front that you're a man of many talents.
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In addition to hypnosis and the other things that people will get from your bio, you are an expert in wordplay.
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You came up with "Austintatious," as in Austin City, before we start recording, and I had to write it down.
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I was like, "If there's not a retail shop with that name, there must be."
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So I'm going to will that into existence. Let put it out there.
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Somebody, feel free to grab it. Dr. David Spiegel: Okay.
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Tim Ferriss: And we'll start with a question, which is not how you were exposed to hypnosis, but how your father was exposed to hypnosis?
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Would you mind winding back the clock? Dr.
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David Spiegel: I'd be glad to.
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It's a good psychoanalytic thing to do.
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I'm the child of not one, but two psychiatrists and psychoanalysts.
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Both of my parents were, and they told me that I was free to be any kind of psychiatrist I wanted to be, so here I am.
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My father was finishing his analytic training just at the beginning of World War II.
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And so he enlisted in the Army, he was a battalion surgeon, and as he was getting off the couch, his analyst actually said something to him.
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He said, "Herb, would you like to get a course in hypnosis?"
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And my father was thinking, "What was wrong with my free associations?
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Is he trying to fix me some other way or something?"
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And his analyst said, "No, there's a Viennese refugee, Gustav von Aschaffenburg," who was a forensic psychiatrist in Austria.
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He had a smallpox scar right smack in the middle of his forehead.
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And he noticed that as he's interviewing these prisoners, suddenly, their heads would sort of nod.
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They'd close their eyes and go into some kind of altered state.
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So he got interested in hypnosis and was using it to help his prisoners.
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And so he offered to teach Army docs how to use it.
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So my father took this course from Dr.
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von Aschaffenburg, and he used it to help soldiers deal with combat stress reactions, to deal with pain.
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The dinner table conversations were really interesting.
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He told me a story of one guy who developed a hysterical conversion paralysis.
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He couldn't use his legs.
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And so the guy said, "They just don't work, I don't know what happened."
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So my father asked him about the context, and he said, "Well, we were ordered to retreat, and I saw my best friend lying on the ground, and I had to make a choice.
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Do I try and save him or do I follow orders?" So I followed orders.
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I feel terrible, and maybe I could have saved him.
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And so my father in hypnosis said, "I want you to look at your friend right now, and I want you to notice something.
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His boots are facing down, and that means he's already gone."
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And the guy said, "Thank you, doctor."
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And he got up and walked.
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He was telling himself physiologically, "I should not have moved, I should not have left him."
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And when my father helped relieve him of the guilt — and most people who have been traumatized would rather feel guilty than helpless.
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They'd rather find a way to blame themselves, as though they could replay the movie and it would come out differently.
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And he was helping him face the fact that his buddy was gone, and there was likely nothing he could do to stop it.
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So I'd hear those kind of conversations at the dinner table, and they were pretty interesting.
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I got invited once to watch him treat a woman who had non-epileptic seizures.
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Tim Ferriss: This is your father? Dr.
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David Spiegel: My father.
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So he's making a teaching movie, and he invited me to come and watch.
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And he had her go back in hypnosis to the last time she had a seizure.
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And her head starts to twist and shake, and she's starting to have these convulsive movements.
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And he said to me, "It's a lot easier to get people to start these symptoms than to stop them.
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They've already tried to stop them, it didn't work.
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So the way you teach them how to control it is you teach them how to bring it on."
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And then he had her practice making them milder, and milder, and milder, and he cured her of her hysterical seizures.
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Tim Ferriss: How does she make them milder?
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If you're triggering these events, how do you ratchet down the intensity of, say, the convulsions?
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How does your father coach someone through doing that? Dr.
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David Spiegel: It was kind of an inference.
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He's basically non-verbally communicating that, "I'm not just going to put you through the same misery over and over again.
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I'm going to try and show you how to manage it better."
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And so he taught her that if you can make it happen, you can make it happen differently.
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You can change the way it happens, and you're not going to get all the hysterical reactions around it.
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Her husband had his workbench at his factory put near the door, so when she had another seizure, he could rush out the door, and go to her apartment, and help her.
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That's how much panic it elicited.
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So he taught her that you can have this for whatever reason, but it doesn't have to be as bad.
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And over time, the more she did it, she kind of de-conditioned the intensity of the seizures.
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Tim Ferriss: So we're going to get to definitions pretty quickly, just in terms of what hypnosis is, what it is not.
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But first, a few follow-up questions.
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Forensic psychiatrist, I've seen these words separately, but what is a forensic psychiatrist? Dr.
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David Spiegel: Well, I do that in my copious spare time.
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It's basically, in those situations, you work for an attorney, not for the patient.
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So you may assess the patient, try and decide what's wrong with them, but it's for the purposes of preparing a report, for example, some kind of emotional damage.
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There was someone I was evaluating, a woman who, a terrible situation, one of the recent forest fires where she's on the phone with her mother, as the mother's home was burning down in one of these fires.
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And it turned out that the community had not been adequately warned how bad this was going to be.
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And even worse, her boyfriend didn't want to be bothered to go pick up her mother.
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So it was a very complicated emotional situation.
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So I was evaluating what the emotional consequences were for her of losing her mom. Tim Ferriss: I got it.
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You're being brought in as a subject matter expert to determine the meritorious nature, or lack thereof of, this particular case? Okay. Dr.
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David Spiegel: One of my favorite moments doing that, I like testifying in court, because — and I was being grilled by some attorney one day, and I'm thinking, "I'm enjoying this."
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And then I thought, "You're crazy, Spiegel.
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What are you — he's going after you."
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And I said, "You know what?
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Compared to academic life, this is simple.
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Your friend is the guy at that table, and your enemy is the guy at that table."
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And in academia, you never know where it's coming from.
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So this lawyer's going after — it was a case at the United Parcel Service, where a gunman who was an employee, gun gone off, came in with a bunch of guns in his pack, got through a metal detector.
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The guard was looking at his phone and not paying any attention. Tim Ferriss: Oh, wow. Dr.
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David Spiegel: And he started shooting nine minutes later.
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And I just said, "This is a horrible breach of protocol.
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If he's going to be checking people, you ought to do something about it."
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And even if he didn't want to confront the guy directly, he could have called the police.
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The police got there in three minutes, when they were called.
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It took the guy nine minutes to get ready to start shooting. It was a terrible thing.
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So the lawyer, the defense lawyer, did not like what I was saying. And he said, "Well, Dr.
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Spiegel, you're not a security expert, are you?"
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And I said, "No, sir, I'm more of an insecurity expert."
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And I could hear the judge and the jury laughing, and that cost him a lot of — Tim Ferriss: That cost him a lot. Dr.
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David Spiegel: It cost him.
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So I enjoy doing that on the side.
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Tim Ferriss: Was it, I think it was Kissinger said, "I left academia because I couldn't stand the politics," something like that? Dr.
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David Spiegel: Yeah, no, he said, "The reason academics fight so bitterly is that the stakes are so low."
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Tim Ferriss: Oh, it's that the stakes are so low. Right, right. There we go. Thank you, okay.
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And the other question I had was, you mentioned this gent, I can't remember, there was a "von" in there, I can't remember the full name. Dr.
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David Spiegel: Von Aschaffenburg.
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Tim Ferriss: Von Aschaffenburg, who had the smallpox scar in the middle of his forehead.
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And I think it was he who, when he spoke with his patients, noticed they were nodding off or transitioning into this altered state.
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Why were they entering that altered state?
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Was he doing it deliberately or was there some manner in which he was conducting these sessions, that he ended up just correlating with that, and he figured out it was causal?
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What was actually happening? Dr.
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David Spiegel: It was more the latter, it was more at first.
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I mean, later on he was doing formal inductions.
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But what hypnosis is, Tim, it's just a heightened focus of attention.
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It's like looking through a telephoto lens with a camera.
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You get fully absorbed in the center of your awareness, and things that ordinarily you'd be conscious of, noises on the outside, other things, you dissociate, you put outside of conscious awareness.
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So it's a kind of self-altering, highly focused attention.
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And it was happening at first by chance, just because instead of looking at him, looking at his eyes, and listening to his words, they just tended to focus on the spot in his forehead.
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And many hypnotic inductions involve some kind of visual focus to narrow the focus of attention.
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When Andrew Huberman, my friend and colleague, was on your program, he was talking about that, the narrowing of attention, just as the lens of the eye changes and limits the amount of information, you get this kind of heightened focus on the center of attention.
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So it changes your state of consciousness as well.
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Tim Ferriss: How would you, for people who are listening, and for me, I'm listening — Dr.
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David Spiegel: Glad to hear that Tim Ferriss: — differentiate hypnosis from say, meditation, concentration practice, meditation, and also from what people might consider, say, a flow state.
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And maybe they're the same, but when people have this focus to the exclusion of much else in these, say, sports contexts or other types of contexts, if you could just delineate those three, that would be very helpful. Dr. David Spiegel: Sure.
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So hypnosis has three main components.
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I've already mentioned two, highly focused attention or absorption, dissociation, putting outside conscious awareness, things that are in consciousness — right now, for example, hopefully you're so interested in what I'm saying, that you're not aware of the sensations of your feet touching the floor right now.
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And if you were, we could just stop now.
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So the more intensely focused you are, the more things you got to put outside of awareness, to keep from distracting you.
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The third component, and in some ways the most interesting in hypnosis is what used to be called suggestibility.
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You know, "You'll do anything I say if I tell you to do it," which is not exactly true, but the truth in it is that you are more cognitively flexible.
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So we've done some research, Afik Faerman, my post-doc, and I did a study looking at the continuous performance task in people who are high and low hypnotizable.
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And the task has subtle changes in the way you solve the problems you're solving, but they don't tell you what it is.
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So people who are more cognitively flexible will figure out quicker that the rules have changed and how you do it.
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And highly hypnotizable people are very good at that.
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They're good at letting go of the old premise and hooking into the new one.
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So that's a kind of cognitive flexibility that is very valuable, and I think a key aspect of why hypnosis is so helpful in treatment, and helps people just manage problems better.
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Tim Ferriss: So the question there, just in terms of the reason that it helps people in a clinical context with various issues, is it because, in a sense, the errors of causality point both ways, in the sense that someone with this higher cognitive flexibility are better at letting go of, say, one premise, and then taking on another.
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But at the same time, you can use hypnosis to put someone into a state where they're more cognitively flexible and can kind of overwrite the previous premise? Dr.
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David Spiegel: Yes, you're right.
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And it's because all hypnosis is, frankly, self-hypnosis.
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That is, you don't need to watch somebody dangle a watch or develop a smallpox scar on their forehead.
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People can shift into this state of highly focused attention.
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And when they do — and one of the coolest things about the state is — you tend to let go of your ordinary premises, not just about what's going on at that moment, but who you are, what kind of a person you are.
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And that's what scares people.
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It's the stage show thing of the football coach dancing like a ballerina.
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But there's a message there, not that hypnosis is good to make people look silly.
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It's that people can try out being different and see what it feels like.
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They can let go of their usual premises.
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And that's where hypnosis is something like a flow state.
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Csíkszentmihályi, I knew him. Tim Ferriss: No kidding? Dr.
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David Spiegel: And his point, he calls flow an autotelic experience.
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It's one that is self-rewarding, it feels good just to do it.
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And hypnosis is like that.
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When you get really absorbed in experience, do you ever get so caught up in a good movie that you forget you're watching a movie?
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Tim Ferriss: Sure, or drawing, especially, I'll — Dr. David Spiegel: Drawing? Yeah.
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Tim Ferriss: Yeah, time just kind of vanishes when I'm in that state. Dr. David Spiegel: Exactly.
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That's a self-hypnotic state, and I'm sure you're good at that.
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And one of the ways in which I help athletes, for example, I was asked to consult with the Stanford Women's Swimming Team, they're a terrific team, a lot of the women wind up in the Olympics, but the coach noticed that they were doing better in practice than they were in meets.
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Their time was better, and thinking, "What the hell's going on here?"
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Well, swimming is not a contact sport.
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And so the only person you're really competing with is yourself.
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And what the women were doing was distracting themselves by paying attention to the women in the lane on either side, instead of being in touch with their own bodies, getting into a flow state, by saying, "How do I move through the water?
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How do I connect with my muscles?
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How do I coordinate them?"
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They were being distracted from that.
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And so I got them, in hypnosis, to get into more of a flow state, to focus not on the outcome but the process.
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And that's a key thing for athletes, in golf, in basketball.
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Tiger trained with hypnosis.
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He had a caddie who was helping him with hypnosis.
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I've helped golfers do that.
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There are a number of major basketball players who do it as well.
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And it's a way of not worrying about whether you're going to hit the basket or not, but what you need to do in your body to make the connection, to do what you want to do.
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And so hypnosis is like a flow state.
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It's something that you just get in it to enjoy the feeling of doing it and how you relate to your body.
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And by the way, good things can happen when you do it.
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Tim Ferriss: If you were using, let's just say, a concentration practice in meditation, whether that be something like transcendental meditation with a mantra, or thing with a candle flame, or fill in the blank, would that qualify as a subset of self-hypnosis, or are there differences that you'd want to highlight? Dr.
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David Spiegel: They're different, Tim, because in mindfulness, you're engaged in a somewhat different practice. It's open presence.
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You're not judging, you're not evaluating, you're just letting feelings and thoughts flow through you.
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And people learn to do it with great discipline over time, but it doesn't come naturally.
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You don't lose yourself in it the way you lose yourself in a movie.
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Now, eventually, some people do, but as you know from having considerable experience with it, it takes training and it's a struggle.
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Whereas, the funny thing about hypnosis is, boy, if people are hypnotizable, they're in it just like that, even if they've never formally done it before.
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If you're hypnotizable, you just do it.
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So it's a kind of natural shift in attention, narrowing the focus that leads you along and gets you engaged in a flow-like experience.
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Whereas, with meditation, you have open presence, you do a body scan, you cultivate compassion.
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They're all important things, but it's about being rather than doing.
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Whereas, hypnosis is more doing than being.
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In hypnosis, you do it for a purpose, you do it to control pain, to manage stress, to get to sleep, to stop smoking, to eat more sensibly.
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So it's more intense, it's briefer, and it does emphasize the development of absorption and flow.
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Tim Ferriss: If someone is highly hypnotizable, how do you determine hypnotizability?
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And I do have the eye-roll test in my notes, which I've never done.
16:59
So I was curious if that is just one of a portfolio of techniques that you use, or if that is a dominant test.
17:05
How do you determine to what degree someone is hypnotizable? Dr.
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David Spiegel: Hypnotizable?
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Well, hypnotizable is a very stable trait.
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Most eight-year-olds are in trances most of the time.
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As you know, if you call your eight-year-old in for dinner, he doesn't hear you.
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He's doing his thing, work and play are all the same thing for kids.
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I don't know why we try to train them to be little adults, because they have so much fun.
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But as we go through adolescence, Piaget talked about developing formal operations in adolescence, where you begin to privilege reason over experience.
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Some of us lose some of that hypnotizability.
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You don't get as easily absorbed in things.
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You have to think them through logically first.
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By the time you're about 21, your hypnotizability becomes as stable a trait as IQ.
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And there was a study done at Stanford, they did a 25-year blind follow-up to former psych one students who'd had their hypnotizability measured.
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And the test-retest correlation was 0. 7.
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Now that's better than IQ.
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I mean, that's really something.
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And in general, what happens is they get divided into one of three groups.
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The people we call the poets, highly hypnotizable, they still get totally absorbed in movies and caught up in things. That's about 20 percent.
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About 60 percent are — we call them the diplomats.
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They'll have the experience and then they'll think about it, and negotiate it, and then go back, and try it a little more, and go back and forth.
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And there's 20 percent we call the researchers, who just aren't very hypnotizable.
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Tim Ferriss: The researchers? Dr.
18:34
David Spiegel: Yeah, but they can benefit from techniques employing hypnosis, because you learn to focus on what you're for and not what you're against.
18:40
You don't fight a problem, you find a way to master it by joining it and focusing on a positive resolution, a self-reinforcing resolution of it.
18:52
So hypnotizability, we know what's going on in the brain.
18:52
We've taken high and low hypnotizables, put them in the functional MRI scanner, and there's an interesting thing that happens only in the highly hypnotizable people, and that is functional connectivity.
19:07
That is when one reason is active, the other region is active between the left dorsal, lateral, prefrontal cortex, which is part of the executive control network, the one I'm hopefully using now, talking to you, and the dorsal anterior cingulate.
19:16
Now, the cingulate cortex is like the C on its ends in the middle of the brain, and the dorsal front part is part of our salience network, the alarm system.
19:28
It's the thing that if you hear a loud noise, it distracts you, it turns — so the salience network is coordinated in highly hypnotizable people with the executive control network. And that makes sense.
19:38
If they're working together, it's easier to lose yourself in an activity and not worry about whether you should be doing something else.
19:47
We've actually found also that there's a genetic component to that, that there's a particular polymorphism of the gene that metabolizes dopamine, catechol-O-methyltransferase.
20:00
And if you happen to have the methionine-valine version of it, you have moderate metabolic rate, which keeps pretty high and stable levels of dopamine in the brain.
20:06
And those people are more hypnotizable than those who are homozygous for either methionine or valine.
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I had a brilliant young graduate student, Dana Cortade, who actually developed a point-of-care genetic test for hypnotizability.
20:21
So you can take a drop of blood, and in a couple of minutes, we can tell how hypnotizable you're likely to be.
20:26
But we also have a test called the hypnotic induction profile, that my late father and I developed, that gives you a six-minute hypnotic experience.
20:37
Have your hand float up in the air.
20:37
If you pull it down, will it float right back up?
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Do you experience a loss of control in that hand?
20:42
Do you respond to the signal ending that experience?
20:47
Do you have a sense of floating lightness or buoyancy?
20:51
So you get a score from zero to 10, and that is, likewise, a very stable trait.
20:51
It's something I have used with every one of the 7,000 people I've used hypnosis with in my career.
20:57
And it helps me have a sort of common experience that is not initially connected to treatment, but just we both can see how much they can respond, and, A, it gives me useful information, B, it gives them useful information, and, C, we're not blaming the victim here.
21:18
If somebody is not hypnotizable, it's not because they're resisting, because most people aren't.
21:23
They're paying good money to see me and get help.
21:23
And it's not because I'm not good at what I'm doing, because I've learned something about it.
21:29
Although my first psychoanalytic supervisor said, "Yes, you didn't go into a trance despite having had 200 shock treatments because you're a lousy hypnotist."
21:38
And I said, "I don't think so."
21:38
But it's nice, because it makes it a neutral experience.
21:44
It's one in which you try out and see what it's like, and they learn from it, and I learn from it.
21:49
Tim Ferriss: Where does the eye-roll test stand in terms of a reliable indicator? Dr.
21:53
David Spiegel: Well, the eye-roll test is like a good initial guess.
21:57
It's moderately correlated with formally measured hypnotizability.
22:01
And my father discovered this.
22:01
He was using eye fixation on a light, on the ceiling of his office, and he noticed that the woman I mentioned who had the historical pseudo seizures, he noticed that when he asked her to look up at that light and then close her eyes, all he saw was the whites of her eyes. They stayed up.
22:19
And after he made that movie that day, the following Monday, he had one of the most obsessional men he'd ever seen.
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And he had the guy look up and he could not keep his eyes up as he was closing the eyelids.
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They came down, and all he saw was his iris as they close their eyes.
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So he began measuring that, and it turned out you can score people from zero to four on how much they're able to dissociate lowering the eyelid with lowering the eye.
22:46
And that is an initial interesting indication of hypnotizability.
22:46
So if you want a quick five-second test — Tim Ferriss: Let's do it. Dr.
22:53
David Spiegel: Here it is.
22:53
Tim Ferriss: Love five-second tests. Dr.
22:55
David Spiegel: All right, so look up past your eyebrows, all the way up high. Way, way up.
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And as you keep looking up, slowly close your eyes, look up, close. Oh, yeah. Oh, yeah, yeah. You're a three to four.
23:04
You're on the upper end, because you keep your eyes way up.
23:04
And I can barely see your iris as you start to close your eyes. Tim Ferriss: Great.
23:09
Well, another option on the menu, then. Dr.
23:13
David Spiegel: Yeah, you bet.
23:15
Tim Ferriss: And why do you think those are — do you have any hypothesis for why those are correlated? Dr.
23:16
David Spiegel: Yes, eye movements are very much related to level of consciousness.
23:21
I mean, the obvious thing is you close your eyes when you go to sleep.
23:25
Drugs that affect the eye and eye movements are related to autonomic arousal.
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Your pupils get big when your sympathetic nervous system is going on, small when you're on opioids, for example.
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And the third, fourth, and sixth cranial nerve nuclei is surrounded in the brainstem by the reticular activating system, which is part of our arousal network.
23:49
And so things that affect eye movements tend to affect arousal as well.
23:49
And so we think it's an ability to shift gears, inhibit peripheral awareness, and intensify your focus, and that this is just — it's no accident that it's the same parts of the brain that regulate arousal and eye movement that are associated with this eye roll.
24:08
Tim Ferriss: And this is a side alley question, we're going to come back to the mainstream in a second, but I'm very curious, do you have an opinion of EMDR? Dr. David Spiegel: I do.
24:22
Tim Ferriss: And if you could just explain for folks what that is? Dr.
24:25
David Spiegel: Sure, I'm from New York.
24:25
I'm not devoid of opinions.
24:28
Tim Ferriss: Fellow New Yorker here. All right, here we go. Dr.
24:32
David Spiegel: Here we go.
24:32
Tim Ferriss: Strap in, folks. Dr.
24:36
David Spiegel: The EMDR is eye movement, desensitization, and reprocessing.
24:36
Francine Shapiro developed this, and it's a widely used technique.
24:40
The VA uses it a lot to help people with trauma, and hypnotic-like techniques are very helpful with trauma, and I'll be glad to talk about that.
24:50
But her idea was that somehow you facilitated communication between the hemispheres if you had people their eyes back and forth while they were discussing a traumatic experience.
24:58
Now, the certainly good idea in this is that we now know more and more that re-exposure under controlled conditions to traumatic memories is in itself therapeutic.
25:09
So exposure therapy and cognitive restructuring are two very prominent ways of helping people deal with trauma.
25:16
And EMDR has components of that.
25:21
And if you think about it, is anything like hypnosis?
25:21
Well, what was the oldest way of inducing hypnosis, right?
25:27
Remember the dangling watches?
25:27
What are your eyes doing when you're — Tim Ferriss: Moving back and forth. Dr.
25:35
David Spiegel: Moving back and forth.
25:35
So I think there's a lot that's hypnotic in EMDR, but to tell you the truth, every study that has deconvoluted eye movements from everything else that goes on in EMDR has shown that the eye movements don't have much to do with it.
25:46
And toward the end of her career, Francine Shapiro stopped doing — she then did tapping rather than eye movements and other things.
25:55
But it's not at all clear to me that the actual eye movements have anything much to do with the outcome.
26:00
So it's another therapeutic technique, but I have to say that my overall impression is that what's good about it isn't new, and what's new about it isn't good.
26:08
Tim Ferriss: So what are the ingredients in EMDR, aside from discussing the traumatic event, are there other characteristics or elements that contribute to outcomes when they are good?
26:19
I don't know if this has been studied in any structured way. Dr.
26:25
David Spiegel: Yes, it has been used.
26:29
The VA has used it extensively in helping combat vets with post-traumatic stress disorder.
26:29
And the fact that you summon up a traumatic event and then you picture it, you become aware of the emotions that come along with it, can be a component of effective psychotherapy.
26:44
I think the two things that matter the most and what I do when I use hypnosis in treating PTSD is number one, the control with which you summon it.
26:56
I've always wondered if exposure therapy works so well, why don't flashbacks cure PTSD?
27:02
Flashbacks are symptoms of PTSD.
27:02
You're reliving the event as though it were happening again.
27:07
And the difference I think is that there's no control.
27:12
You feel re-attacked by the memory the way you did the trauma.
27:17
And so I think with EMDR, like other psychotherapies, like therapies, cognitive reframing therapies, you in a controlled situation bring up a traumatic memory.
27:30
So it's not hitting you again from out of nowhere.
27:30
You're saying, "I'm going to spend some time thinking about this now."
27:34
So you're doing it in element of control that was completely absent when the trauma happened.
27:39
That was just done to you.
27:39
This is something you're doing to yourself in a controlled way with the prospect of a direct benefit.
27:48
The second thing is cognitive restructuring is helping you to see an old problem from a new point of view.
27:54
To understand it differently.
27:54
I was treating a California road worker who was in a construction zone when some idiot went the wrong way and hit him with a car.
28:00
He was taking a rest on his break.
28:06
It was two days before his wedding.
28:06
He had a bad ankle fracture.
28:06
He had just pushed himself out of the way as the car was coming and he was miserable and his fiance was miserable, and he just thought, why didn't I see this coming?
28:18
And time and again, if I had a nickel for every traumatized person, either sexual assault or physical assault, that blamed themselves for events they didn't control.
28:28
Tim Ferriss: That's like guilt versus helplessness, right? Dr.
28:31
David Spiegel: Guilt versus helplessness. That's exactly right.
28:32
And I had him relive it in hypnosis.
28:32
I said, "Let's go through this."
28:36
And he said, "I'm sitting on the thing having my lunch.
28:36
And suddenly I realized that he's not going the way all the other cars were going. He's coming at me.
28:41
And I just pushed myself away from a barrier next to me and fell forward.
28:47
And that's when he hit my leg."
28:47
And I said, "I want you to look at this.
28:52
What would've happened if you hadn't done that?"
28:52
He said, "Well, he would've hit me dead on."
28:57
And I said, "So you saved your life."
28:57
So it's tragic, it's a terrible thing that happened, but it could have been so much worse.
29:03
So think about this, not just from what went wrong, but from what went right.
29:07
What you did to help yourself.
29:07
And he felt entirely different about the trauma after that.
29:13
He was still unhappy about his leg being injured.
29:18
But it's a way of restructuring your point of view about the problem.
29:18
And that's where techniques, including hypnosis for trauma, can help people really change their perspective.
29:24
And the other thing that happens in hypnosis is the more you concentrate, use your prefrontal cortex, the less activity in the default mode network.
29:35
Now that's the part of the brain, the posterior cingulate that's involved with self-reflection and self understanding.
29:39
And when you're not doing much, but thinking about yourself and who you are, you've got a lot of activity going on in default mode.
29:48
And if you can, in hypnosis, turn that down, you can try out being different.
29:55
Instead of seeing this as just a total failure and disaster that messed up your wedding and all kinds of things, you can see it as evidence that you had the wherewithal in a matter of a split second to do something that saved your life.
30:06
So it changes your view of yourself and who you are.
30:11
And that's one of the terrific things about hypnosis, is it allows you to try out being different, see what it feels like.
30:16
Tim Ferriss: So feel free to fact check this, but I've had a lot of involvement with say, MDMA-assisted psychotherapy for PTSD and all the way through phase three trials and so on.
30:29
And have also, through my foundation, funded a lot of basic science and some clinical work related to different psychedelic-assisted therapies for say, treatment-resistant depression or major depressive disorder in the case of psilocybin.
30:48
And the default mode network in this type of, not quite deactivation, but downregulation, I'm not sure what the proper technical term would be, is something that Robin Carhart-Harris talks a lot about initially, I shouldn't say initially, but predominantly out of Imperial College London and then later at UCSF.
31:01
And so it's striking because the subjective reports in a lot of these experiences, whether it be in the MDMA-assisted psychotherapy, although I don't really consider MDMA a psychedelic for various reasons, but let's just use psilocybin or even LSD, the ability to take an impartial observer status on yourself and to assume new perspectives.
31:28
The description, I'm paraphrasing here, but that you just shared is very similar to the subjective reports of people who have good therapeutic outcomes with these other modalities.
31:33
So it's exciting to me to hear you describe it in that way because psychedelics are contraindicated for so many people.
31:42
There are quite a few people who should not take psychedelics in any form.
31:42
I do want to talk about some of the applications, but in terms of risk profile, usually the magnitude of potential impact is correlated to some type of risk profile.
31:54
Are there adverse events? Dr.
32:01
David Spiegel: There are, but before I get to that, let me just backtrack a little bit on MDMA and psilocybin for PTSD, because a lot of the things that the psychedelics have in common, although some are more hallucinogenic than others, like psilocybin, is what's been called ego dissolution.
32:17
And that you seem to just suppress activity in the default mode network.
32:17
And so it becomes a non-judgmental awareness, where you see it happens, but you're disconnected from it.
32:24
So breast cancer patients dying of breast cancer have done very well with psilocybin trips.
32:31
Now, I've for years worked with women who are dying of breast cancer. I know what it's like.
32:36
And what struck me as similar and interesting is that they can — one of my group therapy patients said that looking at death in the group is looking into the Grand Canyon when you're afraid of heights.
32:52
You know if you fell down, it would be a disaster, but you feel better about yourself because you're able to look at it.
32:56
I can't say I feel serene, but I can look at it.
33:01
So it's this odd detachment where you can see it.
33:01
And what they think about their death now is, I still don't like the idea of dying, but what I can see now is what a miracle it is that I ever got to live at all.
33:10
And so they see the same thing from two different perspectives.
33:10
So this ability to disconnect your selfhood and in hypnosis, it's a rapid suspension of your usual selfhood.
33:24
In psychedelic work, it's more this ego dissolution, it dissolves.
33:24
So it's a quicker, reversible form of something similar, which is playing with who you are and what you are.
33:31
And that has tremendous therapeutic possibilities.
33:37
Now, I think one reason MDMA works so well with PTSD is because it's the human connection drug in these raves and everything.
33:44
People suddenly feel connected with people they never even know or feel very different about their loved ones and how they connect with them.
33:56
People who have been traumatized, who have PTSD feel deep shame.
34:03
And it's not because they've done anything wrong, but just to be treated like an object, like a thing is humiliating.
34:07
And so to be able to relive it in a state where you're feeling different about who you are is a way of reprocessing and disconnecting from the sense of shame.
34:22
Just saying, "Yes, it happened, I don't like it, but it's not the bottom line about me."
34:28
And that's where depression with post-traumatic stress disorder is so harmful to people because it tarnishes their feelings about who they are as people.
34:34
And if you can understand the experience, but disconnect it in some ways from this default mode conclusion about what sort of a person you are, that can be powerfully therapeutic. Tim Ferriss: Absolutely. Yeah.
34:46
The commonalities are really worth highlighting here because certain treatments are not accessible to some folks, which is also part of the reason why I'm so interested in the work that is being pioneered in part by our mutual friend Nolan Williams at Stanford. Dr.
35:09
David Spiegel: Nolan's terrific.
35:12
Tim Ferriss: And I think we'll probably come back to Nolan and accelerate TMS in a second.
35:16
But what are the risks, if any, with hypnosis? Dr.
35:16
David Spiegel: There are very few.
35:16
I'll tell you, when we started Reveri about three years ago, I was worried because 30 years ago I would not have dared to put an interactive digital hypnosis app out there on the web and just see what happened to people.
35:34
I worry that people would have all kinds of abreactions and dissociative reactions and terrible things could happen.
35:39
But I thought, what the hell?
35:39
I want people to have access to this and be able to try it.
35:44
And we've had three quarters of a million downloads and the number of potential problems we've had is less than 10.
35:50
And none of them are serious.
35:54
Some of them are ecstatic, positive experiences, like psychedelic ones.
35:54
Most of them are periods of anxiety or stress that are easily reversible.
36:01
And so the good thing about hypnosis is you can turn it on real fast, you can turn it off real fast.
36:07
So the worst thing that happens most of the time is, sometimes it doesn't work, so what?
36:12
So you do something else.
36:12
So compared to the side effects of drugs, like let's take opioids for example, where last year, 88,000 Americans died of opioid overdoses, and almost all of them were not suicides.
36:25
They were just inadvertent overdoses of opioids.
36:31
Hypnosis has not yet succeeded in killing anyone. It's just not dangerous.
36:38
Tim Ferriss: And the reason you're using that as an example is because of the intersection with pain management? Dr. David Spiegel: You bet. Tim Ferriss: Okay. So we'll also — Dr.
36:45
David Spiegel: We'll come back to that.
36:46
Tim Ferriss: Come back to that. Dr. David Spiegel: Got it. Marker noted.
36:49
Tim Ferriss: So adverse risk profile, pretty low.
36:49
Adverse event profile, pretty manageable.
36:49
I want to come back to Nolan for a second because I'm wondering if someone is in the researcher 20 percent, so a low responder.
37:03
Is there — because I do believe that Nolan mentioned this to me, the possibility of using something like accelerated TMS, which is transcranial magnetic stimulation, this a type of brain stimulation to improve trait hypnotizability.
37:15
I don't know what the trait as a modifier means, but is it possible that one could use a tool like accelerated TMS to improve their response to hypnosis? Dr. David Spiegel: Yes.
37:28
The answer is absolutely yes.
37:31
And Nolan and I and Afik Faerman and a number of other members of Nolan's team just published a paper in Nature Mental Health in which we took high and low hypnotizable — we took people who were less than highly hypnotizable, and we administered to them either accelerated TMS to the left dorsal lateral prefrontal cortex with the idea of regulating activity in the dorsal anterior cingulate using real versus sham TMS.
37:54
So we could tell whether they actually got the TMS or not. They couldn't tell.
38:00
The paddle made the same noise, but they didn't know, and we were able to transiently significantly increase hypnotizability in the ones who got the real TMS and not in the ones who got the sham.
38:12
Tim Ferriss: What was the dosing on that? Was it one day? Was it five sessions? Dr. David Spiegel: Yeah. No, it was one day.
38:21
It was just one session and then we — Tim Ferriss: Single session? Dr.
38:23
David Spiegel: Single session. Oh, yeah.
38:23
It was not repeated like the treatment of depression or suicidal ideation.
38:27
Tim Ferriss: Single session. Dr. David Spiegel: Yeah. Tim Ferriss: Okay.
38:30
Well that seems like — Dr.
38:31
David Spiegel: So we're hoping, that's right — Tim Ferriss: There's something there. Dr.
38:33
David Spiegel: I can see your face lighting up. I feel the same way.
38:33
That we may be able to, for people, we were studying people with fibromyalgia, people with chronic pain to enhance their hypnotizability and then use it to treat pain, which it is very effective for. Tim Ferriss: Okay.
38:49
I'm going to get to pain quickly, folks. I promise.
38:49
The segue is, different tools show their best results in different contexts.
38:55
So you might have something like PRP, platelet rich plasma for certain types of injury repair, surgical recovery, better for some types of surgeries and joints than others.
39:06
You might have fill-in-the-blank MDMA-assisted psychotherapy, for instance, better for certain indications like complex PTSD than others, for instance.
39:17
Other things might be better suited to, say, alcohol use disorder.
39:17
What is hypnosis best for?
39:22
Where have you seen the most outstanding results compared to other options? Dr.
39:30
David Spiegel: We've seen excellent results in helping people to manage stress.
39:30
We're finding with Reveri that about 80 percent of people within 10 minutes feel a significant reduction in their stress levels.
39:42
It helps people focus, intensify their focus of attention, plan what they want to do and then do it.
39:48
It's a skill that they can learn to use very quickly.
39:48
It's very effective with pain.
39:54
It's one of the oldest uses of hypnosis with pain.
39:54
In fact, there was a British surgeon named Esdaile who went to India and was using hypnosis.
40:01
This was pre-ether anesthesia.
40:01
They would just get people drunk, have them bite on a block of wood, hold them down, and cut on them.
40:12
Tim Ferriss: Frontier medicine. Dr.
40:12
David Spiegel: Frontier medicine, right?
40:14
And he went to India and he reported 80 percent surgical anesthesia with hypnosis.
40:14
And when 10 years later at Mass General — Tim Ferriss: You just don't want to be in the 20 percent. Dr.
40:25
David Spiegel: No, you don't.
40:26
But it's better than being — Tim Ferriss: It's better than zero. Dr.
40:28
David Spiegel: Better than what was happening before.
40:29
Tim Ferriss: It's better than bourbon and a wallet. Dr. David Spiegel: Right? Exactly.
40:31
And when ether was first introduced at Mass General, 10 years later, the surgeon strode to the front of the amphitheater to say, "Gentlemen, this is no humbug to distinguish ether from hypnosis."
40:40
Well, they were getting 90 percent anesthesia.
40:40
And so Esdaile withdrew his paper.
40:47
He said, "Well there…" Tim Ferriss: So, you're saying ether is getting 90 and hypnosis was getting 80? Dr. David Spiegel: Yeah. Tim Ferriss: I got it.
40:54
So he withdrew his paper? Dr.
40:54
David Spiegel: He withdrew his paper.
40:56
Tim Ferriss: That's too bad. Dr.
40:56
David Spiegel: It's taken us like a century and a half to figure out that the brain actually has something to do with pain processing.
41:04
And there are studies now showing which part of the brain, just changing the words you use in hypnosis, which part of the brain is involved in the analgesia.
41:09
So you significantly reduce pain in the somatosensory cortex.
41:14
If you say, "The hand that's receiving the shocks is cool, tingling, and numb; filter the hurt out of the pain," you get the same reduction in pain response if you say, "Well, the pain is there, but it won't bother you so much." Like opioids.
41:25
Then you turn down activity in the dorsal anterior cingulate.
41:30
So you can see different parts of the brain involved in pain processing and then hypnotic analgesia.
41:35
Tim Ferriss: Depending on the language you're using. Dr.
41:37
David Spiegel: Depending on the language.
41:40
So if you think what doctors say to patients — Tim Ferriss: It's like spellcasting. Dr.
41:43
David Spiegel: Right, it is spellcasting. That's right.
41:45
But no pointy hats or anything like that.
41:45
Tim Ferriss: Those come at the more advanced levels.
41:49
You've got to pay your association dues to get the hats.
41:49
So how does that affect the treatment?
41:56
If you're looking at, say, the example that you just gave, where different wording is affecting different neuroanatomical structures and activity, does that then determine your neuro-targeting for lack of a better term?
42:08
And you're like, "Okay, we saw A instead of B light up.
42:15
We really want to go after A based on what we know." Dr.
42:21
David Spiegel: Well, it may be for certain kinds of pain or certain kinds of problems you want to emphasize one or the other.
42:24
But frankly, we have four different sets of instructions that involve either just going somewhere else, leaving your body here and going to a desert island and enjoying things or imagining a physical remedy that actually reduces pain, a warm bath or an ice bath or something like that.
42:43
Or move the pain around, see what it feels like to do that.
42:48
And one other technique that's very helpful is to teach people to have compassion for their bodies.
42:53
This is mindfulness in some ways, but if your body were a three-year-old child who'd been hurt, would you get frustrated and angry with it? Hell, no. What would you do?
42:59
Everybody says, "I'd give them a hug and I'd stroke them and I'd try and make them feel better."
43:03
So there are different language techniques we can use to get the same effect, which is to significantly reduce pain.
43:13
And we have randomized clinical trials that prove that hypnotic analgesia works at much lower levels of medication too.
43:20
And so it's an underutilized resource.
43:20
Hypnosis is like an underappreciated company that hasn't been managed well and has a lot more positive resources, and that's what it's like.
43:33
We just don't take advantage of it.
43:33
Tim Ferriss: So let's use me as a hypothetical intrepid user of self-hypnosis.
43:40
So I have some low back pain.
43:40
We were chatting about this before we started recording.
43:46
Is there a particular approach that you might recommend one or, in this case, I, start with in a case like this? Dr. David Spiegel: Sure.
43:53
Yeah, we can try it if you want.
43:56
Tim Ferriss: Yeah, I'm game. Dr.
43:59
David Spiegel: You're game?
43:59
Tim Ferriss: I'm absolutely game. Dr.
44:00
David Spiegel: All right.
44:00
How would you rate your pain right now on a zero to 10 scale?
44:03
Tim Ferriss: I'd say two out of 10.
44:03
It's more of a bothersome stiffness. Dr.
44:07
David Spiegel: An annoyance, then? Tim Ferriss: Yeah. Dr.
44:09
David Spiegel: And is there a physical remedy that helps you with it? A warm bath.
44:13
Tim Ferriss: There are foam rolling, say the piriformis and glutes and so on does help.
44:20
Using psoas release tends to help.
44:20
Just laying on my stomach honestly, with my hands under my pelvis to take all the activity out of the spinal erectors helps.
44:26
Those are a few things like laying down on my stomach and breathing into the back to relax the spinal rectors, I would say is one thing that seems to help. Dr.
44:39
David Spiegel: Okay, well that seems like a vivid image.
44:41
And temperature things don't make much difference?
44:45
Tim Ferriss: Temperature, if I do say a cold, cold bath and then a hot bath, just contrast therapy like that, that seems to help. Dr. David Spiegel: Okay.
44:54
Tim Ferriss: So that feeling of cold tissue, vasodilating, when I get into the hot bath, that type of prickly sensation of being perfused with blood, that's something I associate, I would say with feeling better. Dr.
45:07
David Spiegel: Feeling better.
45:07
So part of what you're doing is reinterpreting the signals you're getting in a different way.
45:17
So let's try it if you want and see.
45:17
So get as comfortable as you can.
45:17
On one, please do one thing.
45:23
Look up all the way up high as you can.
45:23
Two, do two things slowly.
45:23
Close your eyes and take a deep breath.
45:28
And three, do three things. Let the breath out.
45:28
Let your eyes relax, but keep them closed and let your body float.
45:36
Imagine you're floating somewhere safe and comfortable, like a bath, a lake, a hot tub, or floating in space.
45:42
And then take your right hand and stroke the back of your left hand, starting with the tip of your left middle finger — Tim Ferriss: In my lap? Dr.
45:55
David Spiegel: Or you can put it on the table. That might be better.
45:56
Now stroke the back of your left middle finger down along the back of your left hand, past your wrist to your elbow.
46:03
And as you do that, develop a sense of tingling and numbness and lightness, and let your left hand float up in the air like a balloon. Feel the tingling. That's good. And let it float up.
46:20
You bend your elbow and you can rest your arm lightly on the table.
46:27
And please describe what physical sensations you're aware of now in your left hand and arm.
46:35
Tim Ferriss: I feel my heartbeat in my palm. Dr. David Spiegel: Okay.
46:40
Tim Ferriss: A little bit of, I can feel the hair on the back of my arm touching the sleeve that I rolled up. Dr.
46:50
David Spiegel: And I'm going to give you this instruction.
46:50
If you pull your hand back down to the table with your right hand and then let go, it will float right back up to the upright position to see what happens. That's good.
46:59
So you're putting it down, now, let go. I see you smiling. What's happening?
47:05
Tim Ferriss: Well, it feels like it's floating. Number one.
47:12
I'm also second-guessing myself because I wonder if I'm doing this to conform to the exercise, if that makes sense.
47:15
But it feels like it's floating. Dr. David Spiegel: Okay. Tim Ferriss: Yeah. Dr.
47:24
David Spiegel: And as you do that, let your left hand remain upright.
47:27
Later, when I ask you to touch your left elbow with your right hand and let go, your usual sensation and control will return.
47:27
But right now — Tim Ferriss: Could you say that last part again? Dr.
47:27
David Spiegel: When I ask you to touch your left elbow with your right hand and then let go, your usual sensation and control will return. Tim Ferriss: Okay. Dr.
47:36
David Spiegel: Right now, I want you to notice sensations in your back.
47:40
What does your back feel like right now?
47:40
Tim Ferriss: The part that's usually painful? Dr. David Spiegel: Yeah.
47:44
Tim Ferriss: It feels relaxed right now. Dr. David Spiegel: Good.
47:47
Tim Ferriss: More relaxed. Yeah. Dr. David Spiegel: Good. Good.
47:49
How would you rate the discomfort level right now on that zero to 10 scale? Tim Ferriss: 0. 5, one out of 10. Dr.
47:56
David Spiegel: One out of 10? 0. 5 to one. Okay, good.
47:56
So already notice how you've been able to change sensation, not just in a neutral part of your body, your left hand and arm, but in a part that has been problematic.
48:07
Now I want you to imagine now that you're lying on your belly, maybe with a roll under you and feel a pleasant, tingling numbness in your lower back as if it were cooler or warmer, or you were changing it from warmer to cooler.
48:27
Feel a pleasant, tingling numbness and let it filter the hurt out of the pain.
48:33
Each breath deeper and easier.
48:42
Now again, with your eyes closed and remaining in the state of concentration, please describe how your body's feeling right now.
48:47
Tim Ferriss: It does feel cooler. Dr. David Spiegel: Good.
48:58
Tim Ferriss: It feels a little dissociated, if that makes sense? Dr.
49:05
David Spiegel: Can you describe that a little more?
49:10
Tim Ferriss: Feels like it's very similar to two tequilas. Dr.
49:18
David Spiegel: There you go.
49:24
Tim Ferriss: Or a low dose of ketamine, which I don't recommend, but I mean, as a dissociative anesthetic, I've always struggled to put words to the dissociative experience.
49:28
There's a lightness and there's a conscious awareness of the body without being as identified with the body. Dr. David Spiegel: Exactly.
49:41
So you can observe it, but it feels different.
49:41
And would it be fair to say that it's not as annoying as it usually is?
49:50
Tim Ferriss: It's not as annoying. Dr. David Spiegel: Good.
49:54
So notice how you're able to filter a lot of the discomfort and displeasure out of the usual pain situation by detaching from it, by experiencing it differently.
50:06
It's not a sentence you have to endure, it's a sensation your body is giving you that you can interpret in different ways.
50:14
Tim Ferriss: Now, for people who might wonder if this is compartmentalizing in a way that is long-term harmful, I'm not saying that's what it is, but is this just taking a different vantage point?
50:24
How would you encourage them to think about this? Dr.
50:29
David Spiegel: Yes, I would say it's reinterpreting the sensations and signals that you're getting from that part of your body and you're uncoupling them from the usual sense of annoyance and limitation that tends to actually make it worse.
50:43
Tim Ferriss: Oh, it a hundred percent makes it worse. Dr. David Spiegel: Yeah.
50:45
And instead you're saying, "Okay, it's there.
50:47
I don't like it, but it's not bad."
50:47
And that capacity to reframe, to reprocess the signal is a powerful way of better managing pain.
50:54
You're filtering the hurt out of the pain.
51:02
Now please take your right hand and touch your left elbow and then let go and see what happens to your left hand and arm.
51:11
Tim Ferriss: Yeah, just movement is more forthcoming. Dr. David Spiegel: Good. Tim Ferriss: That's it. Dr.
51:22
David Spiegel: That's surprising, isn't it? Tim Ferriss: Yeah.
51:22
I was noticing how my fingers kind of got frozen in this position, I thought that was interesting.
51:27
Not making too much out of it, but I was like — Dr.
51:33
David Spiegel: All right, you can let it float back down now.
51:37
And how's your left hand and arm feeling now? Tim Ferriss: Normal. Dr. David Spiegel: Normal? Good.
51:46
Tim Ferriss: Back to normal. Dr.
51:46
David Spiegel: So you were able to change sensation in both directions.
51:47
And how's your lower back feeling now?
51:52
Tim Ferriss: It feels really good, actually, yeah. Dr. David Spiegel: Terrific.
51:55
Tim Ferriss: That's remarkable. Dr.
51:55
David Spiegel: I'm very glad. That's great.
51:59
Tim Ferriss: So thank you for that. Dr.
51:59
David Spiegel: You're welcome.
51:59
Wait till you get my bill.
52:01
Tim Ferriss: Right, you have my email. "What is this?" Dr.
52:06
David Spiegel: I'm really glad.
52:09
Tim Ferriss: "FreshBooks $6,000?
52:09
What happened to the first one's always free?"
52:09
Oh, wait, no, that's drug dealing, not hypnosis. Dr.
52:17
David Spiegel: Yeah, exactly.
52:21
Tim Ferriss: And if someone's inducing that from a self-hypnosis perspective — well, let's just talk about, it could be in the context of Reveri, it could be in a different context.
52:31
What are the steps that they take or how do they self-induce for something like that?
52:31
Let's just say if I wanted to do that five minutes a day. Dr.
52:37
David Spiegel: If you wanted to do it five minutes a day, you could remember what I told you or you could queue up the pain control app on Reveri and you get to hear my mellifluous voice teaching you an exercise — Tim Ferriss: Mellifluous, this dulcet tones. Dr.
52:52
David Spiegel: Dulcet tones, there you are.
52:57
To teach you how to do this.
52:57
And you could follow along and it's interactive.
52:57
So I'll ask you, "Is your hand floating?"
53:01
If it is, I'll tell you one thing.
53:01
If not, it's something else.
53:05
So it's a branch chain kind of response that I tried to make as much like being across the table or in my office as I could.
53:09
Tim Ferriss: And not to beat the dead horse of neurobiology, but just to reinforce my understanding, from a neurobiological or neuroanatomical perspective, what is happening? Dr.
53:22
David Spiegel: What's happening is, and we've got EEG studies, we've got FMRI studies, we've got PET studies showing that what's happening, if you think about it, pain is always a combination of peripheral input through the lateral spinothalamic tract, through the thalamus, through the periaqueductal gray and up to the somatosensory cortex with input from the salience network.
53:45
So if you just broke your arm, the salience network's going, "God, you're in trouble, you better do something."
53:52
But the problem is, because we're fairly pathetic physical creatures, we have to take very good care of our fragile bodies.
53:56
And so we have a brain that is designed to help you recognize when you're hurt and get help and manage the pain, but for example, freeze, not necessarily move so a predator could detect you more easily.
54:14
So pain is a combination of those peripheral signals coming in and what your brain decides is wrong and what to do about it.
54:20
And so very often chronic pain is really not anything you need to do anything about, but your brain often treats it as if it were acute pain.
54:26
Here I am, and so it derails you and it annoys you and it keeps you from doing what you want to do.
54:31
And the more annoying it is, the more attention you pay to it.
54:35
It's like the noisy kid in the classroom.
54:39
And so you can learn to modulate that.
54:39
So we showed in one experiment with Stanford students, we gave them electric shocks, we measured somatosensory evoked responses so you can see waveforms coming out up to a second after the shocks are administered.
54:56
And in the hypnosis condition, we were able to stop the P100, the first response cold, there was no response of the brain when they were in hypnosis in the first 10th of a second.
55:08
And the P200 and P300 were half as big as ordinarily.
55:08
So within a fraction of a second, the brain is processing the signals differently.
55:14
And as I mentioned, there are studies that show you can turn down activity in the anterior cingulate, you can turn down activity in somatosensory cortex.
55:24
So the brain is saying, "This is not as bad as I initially thought it was, and I don't have to pay as much attention to it.
55:30
It doesn't have to hurt me as much."
55:30
Because very often we amplify pain rather than diminish it by being so annoyed that it's happening.
55:41
And another thing that we know is going on in the brain is the anterior cingulate is rich in GABA receptors, gamma-aminobutyric acid, they're an inhibitory neurotransmitter.
55:45
Highly hypnotizable people have more binding of GABA in the anterior cingulate than low hypnotizable people.
55:57
So they can use it to be their own little drug dispensaries to inhibit the anxiety reaction in the dorsal anterior cingulate cortex.
56:04
So there are many understandable neurophysiological ways by which the brain can literally take the strain out of pain.
56:15
Tim Ferriss: Also wondering, I mean you'd have to test this of course, but if hypnotizability as assessed by various means, whether it's the eye-roll test or a drop of blood and looking at the genetic profile, if there might be some correlation to high response, sort of baseline response, low response for psychedelic-assisted treatments as well?
56:37
I mean, because as it stands currently, there's a lot of shooting in the dark.
56:43
I'm not aware of any assessment that determines if someone is likely to be a high responder to psychedelics.
56:48
But as we're talking about it, there seem to be a lot of parallels. Dr.
56:53
David Spiegel: Oh, I think there are.
56:58
Tim Ferriss: It wouldn't be that hard to test.
56:58
I mean, somebody has to fund it, of course, science takes money.
57:02
But I mean, there are lots of assessments for, let's just say, determining the strength of a mystical experience and how that's correlated to therapeutic outcomes, highly correlated, it turns out, at least with psilocybin and so on and so forth.
57:13
There are all the standard assessments that you might have for depression, HAMD and so on, or JD or whatever, all of these various things.
57:23
But in terms of determining in the process of patient recruitment who might be a high responder, that's a huge deficit in the system right now. Dr.
57:34
David Spiegel: I agree with you.
57:34
I think it'd be a terrific thing to do.
57:34
And maybe in Nolan's next, he just published a paper on using — Tim Ferriss: Ibogaine. Dr.
57:42
David Spiegel: Ibogaine with astounding results.
57:44
Tim Ferriss: Astonishing. Dr.
57:44
David Spiegel: Not just improving PTSD, which I kind of expected but — Tim Ferriss: TBI. Dr.
57:49
David Spiegel: TBI, traumatic brain injuries.
57:49
And it stays down, it goes down and it stays down.
57:54
Tim Ferriss: Yeah, it's very durable. Dr.
57:54
David Spiegel: And that's one of the things about a lot of these psychedelic studies is that it breaks the whole model of keep occupying that receptor and blocking serotonin and uptake and all this stuff.
58:03
And it's just once or twice and the brain is reset, it's rebooted.
58:09
And that's where I think this interaction with the default mode network activity is very interesting because I think people reset their expectations of who they are, what they are and what their symptoms mean in a way that lasts.
58:21
And of course, there's often psychotherapeutic assistance with the psychedelic treatments, which is important.
58:27
But some of that could be hypnotic instruction too.
58:33
And I don't think much of that has been done, but it would be very interesting to do, I agree with you.
58:37
Tim Ferriss: It would be super interesting.
58:41
Yeah, there's a broad canvas still remaining for all sorts of research. Dr.
58:47
David Spiegel: I'm glad to hear that.
58:47
Tim Ferriss: So let me ask about a few things.
58:49
First, you used wording that was along the lines of, I heard you mentioned at least twice, "Filtering the hurt from the pain," am I getting this right? Dr. David Spiegel: Right.
58:59
Tim Ferriss: Could you elaborate on that?
59:02
And then the second piece is, much earlier you were referring to the say, I don't want to call them the low-hypnotizable people who fall into this category nicknamed the researcher who could still use it.
59:16
And I thought I heard you say something like "Framing issues as for us, not against us," something like that.
59:22
So could you first talk about filtering the hurt from the pain and then this for us versus against us? Dr. David Spiegel: Sure.
59:26
Well, the filter the hurt from the pain, it sounds kind of paradoxical, "What are you talking about? Pain hurts."
59:32
But the degree to which it hurts has to do with more than just the signal traveling through the lateral spinothalamic tract, it has to do with how you interpret that signal.
59:42
We have all kinds of somatic signals, some of which could be on the verge of discomfort, some of which aren't and our brain's job is to interpret them and decide what to do about them.
59:52
And so you can have a signal that doesn't necessarily automatically convey that something is wrong with the body.
1:00:05
It may be just an intense feeling.
1:00:05
It's like the difference between an enthusiastic hug and a squeeze that hurts, and there's a line in there somewhere that you cross and it's pretty obvious.
1:00:16
But there's also an area of interpretation.
1:00:16
Tim Ferriss: Or the ostentatious long hug.
1:00:21
There are a lot of guys here who do long hugs.
1:00:21
They say, "I'm a hugger," when you try to shake hands and it's like a 20-second hug, there's a point where it gets uncomfortable. Dr.
1:00:28
David Spiegel: It gets uncomfortable, that's right.
1:00:28
And it's usually after the first second or two. That's right.
1:00:31
And so the brain is doing its interpretive job of making meaning out of the sensory experience.
1:00:37
One of the other things that we know happens in the brain with hypnosis is higher functional connectivity between the dorsolateral prefrontal cortex and the insula.
1:00:46
Insula is this little island, that means island in Latin, in the mid-front part of the brain that is a mind-body conduit.
1:00:51
So it's a place where the brain controls what's happening in the body, how much gastric acid you secrete, your autonomic arousal, for example.
1:00:56
And also it receives information interoception from the body.
1:01:03
How is the body reacting to things?
1:01:08
And hypnosis intensifies this connection and intensifies coordinated activity between the executive control network and the insula.
1:01:14
And so it's a way in which the brain can intensify its reading and understanding and interpretation of what's happening in the body.
1:01:21
And so athletes who are pushing their bodies to do things that most of the rest of us would say, "Ouch, I can't do this," are interpreting that as, "I'm pushing my body as hard and as far as I can to get what I want."
1:01:38
And so they will interpret things that everyday people would interpret as putting yourself through pain as training, doing what you need to do.
1:01:43
And that runner's high is in part composed of signals than many of us would just consider painful.
1:01:50
And so that's part of what the brain does, and that's part of what hypnosis helps us to regulate and control, how much of it is pain and how much of it is not.
1:02:02
And so the interpretation of pain, the meaning of it has a lot to do with how much it hurts.
1:02:08
Tim Ferriss: And what about the for us versus against us? Dr. David Spiegel: Yes.
1:02:13
So the idea there is that people who are experienced with hypnosis, that is people who know that people actually listen and respond to what you say, let's say the dumbest thing you can say to somebody is, "Don't think about purple elephants."
1:02:27
What are you going to think about?
1:02:27
And the best way to change behavior is intermittent positive reinforcement.
1:02:31
So you want the process of change to be what Csíkszentmihályi called autotelic.
1:02:36
You want to feel good about doing it.
1:02:43
So an example where we do that in hypnosis and where even non-hypnotizable people can respond is when I try to teach someone how to stop smoking, which was the first experiment we did with Reveri, I don't say, "Ugh, cigarettes taste terrible."
1:02:56
My professor at medical school did that, "Your cigarettes will taste like horse shit," and the guy lit up the cigarette and said, "Oh, thank you, doctor, ugh."
1:03:06
And he got a frantic call two hours later, he says, "Doc, my house smells terrible."
1:03:13
Tim Ferriss: "My house smells like horse shit." Dr. David Spiegel: Right?
1:03:13
And Hackett said, "Well, are you smoking?"
1:03:16
He said, "No, but I forgot to tell you that my wife is a smoker."
1:03:16
So he had to hypnotize him and say, "Only your cigarette..." It doesn't work.
1:03:20
You focus on what you're for, respect and protect your body.
1:03:26
"For my body, smoking is a poison. I need my body to live.
1:03:32
I owe my body respect and protection."
1:03:32
You would never put tar and nicotine filled smoke in your baby's lungs.
1:03:37
Your body is as dependent on you as your baby was.
1:03:37
So treat your body with the same respect you'd give a child.
1:03:44
And so you're focusing not on whether you have an urge to smoke or not, whether you feel better or on nicotine or not, but whether you are going to commit to respect and protect your body.
1:03:54
And that way you can feel good from the moment you make the commitment to do it, "I'm being a good parent to my own body."
1:03:59
So even people who aren't hypnotizable can get that concept and say, "I'm not going to worry about my urge.
1:04:04
I have lots of urges I don't act on, I don't have to act on this one just because I have it."
1:04:09
So I had one alcoholic who I was trying to use that to help him stop his drinking, he said, "Oh, you mean sort of like the body is the temple of the soul?"
1:04:22
And I said, "Yes, you got it. That's it." And he stopped drinking.
1:04:28
So it's a matter of finding a way to formulate the resolution of a problem so that you start feeling good from the moment you commit to doing it before you know that you're going to stop smoking.
1:04:38
And we're getting one out of five people stop just like that, and they surprise themselves.
1:04:45
That's one of the things I love about working with hypnosis is people are surprised at what they can do because they're trying out being different and seeing what it feels like.
1:04:55
Tim Ferriss: What do you think is happening with the addiction specifically, whether it's nicotine, alcohol, or other?
1:05:02
Why does this work where other things fail?
1:05:02
And I should ask actually, just so you can set the table for this, how does hypnosis compare, and I'm sure it depends on the practitioner and so on — which kind of gets into a whole separate question I wanted to ask about just schools of hypnosis, I don't know how standardized things are, like CBT for instance, but not that that's hypnosis, I'm just saying they've tried to standardize so they can track things.
1:05:27
How does hypnosis compare to other types of interventions for addiction? Dr.
1:05:32
David Spiegel: Well, the results we get with hypnosis is about one in four, one out of five people just flat out stop and the rest cut down by about 50 percent in how much they're smoking.
1:05:41
That's roughly comparable to the use of varenicline, bupropion, or Nicorette patches.
1:05:48
It's not very different, depends on the population, but it's about as good. Is it the same people?
1:05:54
I don't know for sure because they're done in different contexts, but it's not bad.
1:05:58
And I have people who are surprised by how easy — they said like a lever was pulled and "I just don't worry about it anymore, I just don't think about it."
1:06:13
Now, does it happen with everyone?
1:06:13
No, but every time we feel good, anytime we get anybody to stop, the most reversible cause of cancer in the world is cigarette smoking, so anybody you get, that's a good thing.
1:06:26
And it is correlated with hypnotizability, so more hypnotizable people are more likely to stop using this approach.
1:06:30
But there are some non-hypnotizable people who do too, because they get the concept, even if they don't get the feeling that comes along with it.
1:06:42
And the other thing that keeps in mind in addiction medicine is that the odd thing is that it's not actually the high from the drug that hooks people, the chase is better than the catch.
1:06:52
So you get more mesolimbic dopamine secreted when you're going through a scenario of scoring a drug than when you're actually taking the drug.
1:06:59
So it's the anticipation of pleasure that really gets to people.
1:07:05
And from my point of view, using hypnosis, that's fertile ground for intervention where you just say, "I can make you feel good without chasing after the drug.
1:07:15
I can make you feel good the way you felt when you hugged your six-month-old child, because you're doing the same thing with your body now, and that's a good thing."
1:07:20
So helping people to focus on what they're for is a crucial part of the therapeutic strategy and makes it work.
1:07:34
Tim Ferriss: What is the oldest, that you're aware of, documentation of hypnosis or something resembling hypnosis? Dr.
1:07:38
David Spiegel: Well, officially, I mean, I was in Bali watching trance healers and the difference in Bali, and this has gone on for thousands of years, they go into a trance and their patients watch them.
1:07:46
So they kind of go into this altered state and start chanting and singing, and the idea is if you watch it, it's kind of hypnotic and you'll kind of go along with them.
1:07:57
But from a Western point of view, it started in the late 18th century with Franz Anton Mesmer, who was a Viennese physician.
1:08:08
Tim Ferriss: Hence mesmerized. Dr.
1:08:08
David Spiegel: Mesmerized, that's right.
1:08:10
And he called it animal magnetism.
1:08:10
And he thought it actually had to do with changing the magnetic field in a patient's body.
1:08:17
And he had them look at tubs filled with iron filings, and he had a magnet.
1:08:22
In fact, the magic wand in magic shows comes originally from a magnetic rod that was used — Tim Ferriss: TMS 1. 0. Dr.
1:08:31
David Spiegel: That's right, that's right.
1:08:31
From animal magnetism to transcranial magnetic stimulation, that's right.
1:08:36
And he was very popular.
1:08:36
He left his wife and family in Vienna, he moved to Paris, he was outcompeting the leading French physicians of the day.
1:08:45
Voltaire wrote to his brother, "We did everything we could to save Father's life, we even sent the doctors away."
1:08:50
And if you think about the major treatment at the time in France, it was bloodletting.
1:08:55
France was the world's leading exporter of leeches.
1:08:55
And unless you happen to have congestive heart failure — Tim Ferriss: France was the world's leading exporter of leeches? Dr.
1:09:02
David Spiegel: Leeches, because that's how they did it.
1:09:04
And they still in some hand damage things, they use leeches to suck blood out of certain regions in the hand and all that.
1:09:11
But at the time, that was the major treatment, and he was so popular.
1:09:15
And the cool thing, if you read about what his office was like, it was cheerful, it was brightly lit, patients would hang around all day boasting about what they'd done with animal magnetism.
1:09:27
And the typical French physician's office was truly grim.
1:09:32
It was dark, no decorations on the walls, patients were getting bad news from doctors.
1:09:38
I once had the opportunity to visit Anna Freud when I was a medical student in London, and she asked me if I was going to become an analyst, and I tried to be diplomatic and say, "Well, I'm not sure."
1:09:50
She said, "So you're not going to be an analyst?"
1:09:50
She wasn't messing around. "Why?"
1:09:53
And I said, "Well, I don't like the passivity.
1:09:53
I don't like not offering something, trying to help fix things with people."
1:09:59
And she said, "You need to understand something.
1:10:03
When my father was training as a doctor, it was considered a waste of time for a doctor to listen to a patient.
1:10:10
Patients were there to listen to doctors."
1:10:10
And I was humbled by that.
1:10:10
I thought it was a very good point.
1:10:16
And she said, "It's hard to be analyzed because analysis is a liberation from your parents, and that's difficult if your parents are analysts."
1:10:23
And she knew better than anyone because her father was her analyst, actually.
1:10:29
Tim Ferriss: Oh, boy, there's lots to unpack there. Dr.
1:10:32
David Spiegel: Yeah, there was a lot in the doctor-patient relationship in that time that was pretty grim.
1:10:34
And so the fact that Mesmer was talking to patients and listening to them made him very popular.
1:10:42
So they got King Louis to convene a panel to investigate Mesmer.
1:10:47
And the panel was very interesting, our own Benjamin Franklin was on it, he was having a lot of fun — Tim Ferriss: Why was Mesmer being investigated? Dr.
1:10:58
David Spiegel: Because he was competing so successfully with French doctors, they didn't like the — Tim Ferriss: So the French doctor lobby. Dr.
1:11:02
David Spiegel: The French doctor lobby, that was it.
1:11:04
Tim Ferriss: Pulled out the stops. Dr.
1:11:04
David Spiegel: They said that his theory was all wrong, that he wasn't really changing magnetic fields, which is correct, it's true, they concluded.
1:11:14
And another member of the panel was Lavoisier, the brilliant French chemist who developed oxygen chemistry and who six months before he was beheaded in the French Revolution, discovered the idea of the gross national product, he was a genius.
1:11:26
And one of the third other panel members was a doctor named Dr.
1:11:31
Guillotin, the inventor of the guillotine.
1:11:31
He kind of created the mind-body problem.
1:11:38
Tim Ferriss: What a panel. Dr.
1:11:41
David Spiegel: Yeah, what a panel.
1:11:41
Tim Ferriss: It's like the set-up for a joke. Dr.
1:11:44
David Spiegel: Yeah, but it wasn't, unfortunately.
1:11:44
They concluded that hypnosis was nothing but heated imagination. And you know what?
1:11:48
I've heard worse definitions for hypnosis, but that was it for Mesmer.
1:11:54
And so it set in motion a pattern of why hypnosis is just an underdeveloped resource is that people think it's either dangerous or it's ridiculous, and it's neither.
1:12:07
It's a valuable, effective treatment that we have underutilized for decades, for centuries.
1:12:14
Tim Ferriss: What is, if you had to pick one or two, anything that comes to mind, some of the more surprising patient outcomes or changes that you've seen?
1:12:17
Because there are cases where I'm sure you could have predicted the outcomes, "I have a 50 percent chance this person has a three percent reduction in A, B, and C symptoms," but were there any that really stand out to you as surprising? Dr.
1:12:31
David Spiegel: The first one was the one that got me to decide that, yes, this happens to be my father's interest, but I'm not going to let that deter me from something I'm interested in, and it was the first patient I reused hypnosis with, and it was on my pediatrics rotation at Children's Hospital in Boston.
1:12:47
The nurse says, "Spiegel, your patient is in room 342, she's in status asthmaticus, she's been hospitalized every month for three months, and she's back again, and she hasn't responded to epinephrine twice, and we're going to maybe give her general anesthesia and put her on steroids."
1:13:09
So I walk in the room following the sound of the wheezes down the hall, pretty 15-year-old girl bolt upright in bed struggling for breath, knuckles white, mother standing there crying.
1:13:19
I didn't know what to do, but I had taken a hypnosis course.
1:13:19
So I said, "Well, would you like to learn a breathing exercise?" She nods.
1:13:26
So I get her hypnotized and then I break into a sweat and I think, "Wait a minute, we haven't gotten to asthma in the course."
1:13:30
So I said something very subtle and clever.
1:13:35
I said, "Each breath you take will be a little deeper and a little easier."
1:13:40
And within five minutes, she's lying back in bed.
1:13:40
She's not wheezing anymore, her mother stopped crying, nurse runs out of the room.
1:13:45
And if you think about the dynamic of that, I mean, it was stunning to me, I couldn't believe it.
1:13:51
But each time she tried to breathe and had trouble, she got more and more anxious, she thinks, "I'm going to not be able to breathe," it's very frightening.
1:14:02
So you have her anxiety building like a snowball rolling downhill on top of the physical sensations.
1:14:08
So in comes my intern, and I thought he was going to pat me on the back and say, "Good for you."
1:14:14
He said, "The nurse has filed a complaint with a nursing supervisor that you violated Massachusetts Law by hypnotizing a minor without parental consent." Kid you not.
1:14:26
And Massachusetts has a lot of dumb laws, but that is not on the list.
1:14:26
Furthermore, her mother was standing next to me when I did it.
1:14:31
He said, "Well, you're going to have to stop doing this." And I said, "Oh, really? Why?"
1:14:35
He said, "Because it could be dangerous."
1:14:35
And I said, "You're going to give her general anesthesia and put her on steroids and my talking to her is dangerous?" I don't think so.
1:14:43
So I said, "Tell you what, as long as she's my patient, I'm not telling her something I know isn't true.
1:14:48
So take me off the case if you want."
1:14:48
So, he storms out of the room, he finds the chief resident and the attending and they have a council of war.
1:14:53
And they came back with a radical solution.
1:14:58
They said, "Let's ask the patient."
1:14:58
I don't think they'd ever thought of that before.
1:15:04
Tim Ferriss: Breakthrough. Dr.
1:15:04
David Spiegel: Yeah, breakthrough.
1:15:05
And she said, "Oh, I like this.
1:15:05
I want to keep doing this."
1:15:05
And she was hospitalized one month after that, a month later, and went on to study to be a respiratory therapist.
1:15:10
And I thought that anything that could help a patient that much, that fast, frustrate the head nurse, violated non-existent Massachusetts Law, had to be worth looking into.
1:15:21
And I've been doing it ever since.
1:15:26
But the nice thing is you can see it in front of your eyes.
1:15:26
You see whether it's going to help.
1:15:31
Just like you with your pain, it's the same thing.
1:15:31
If it's going to happen, your brain is wired to every part of the body to make it happen quickly.
1:15:37
And it doesn't always happen, but it often does.
1:15:42
I'd say the next major patient that really struck me.
1:15:42
When I first got to Stanford, I was assigned to the Palo Alto, VA Medical Center.
1:15:48
And there was an army cook who had been mustered out of the army because after 19 years of good service, something happened during the Tet Offensive and he just grabbed an ambulance and some guns and ran out in the jungle and started shooting at what he thought were Viet Cong.
1:16:06
And he seemed psychotic, they couldn't contain him, he was agitated, he was emotionally uncontrolled, he wasn't responding to meds.
1:16:12
And he wound up being discharged from the Army and spending 11 months in a state mental hospital in California and a social worker there interviewed him and said, "He's not a drug user.
1:16:25
He doesn't seem psychotic to me.
1:16:33
There's something wrong, but I think it's post-traumatic."
1:16:33
So I saw him at the VA and he told me that something happened during the Tet Offensive and it had something to do with a Vietnamese child that he had informally adopted.
1:16:44
He was like the youngest of 13 children.
1:16:44
He identified with young kids.
1:16:49
This kid had been badly burned, was on a crutch.
1:16:49
Nobody seemed to claim him and so, he just kind of took over and they became buddies.
1:16:56
And during the Tet Offensive, I find out in hypnosis, he comes upon the boy's body and he realized he's been killed.
1:17:03
And in reliving this in hypnosis, and he was very hypnotizable, he says, "Oh, my God, they hit G-wing.
1:17:15
Oh, my God, they ain't got to kill kids.
1:17:15
They ain't got to kill kids."
1:17:15
So, he's screaming and crying and then he's going into setting up defenses on a water tower because he thinks we're going to be overrun by Viet Cong and he's going through all of that.
1:17:26
And I move him then, and the remarkable thing was, he was very intensely involved in all this, but very malleable.
1:17:36
So I'd say, "Okay, we're going to change times now and we're going to go to the time when you collected his body and buried him."
1:17:40
And so he does that and he says, "Ashes to ashes and dust to dust. I guess that's it."
1:17:46
And then he starts banging on the arm of his chair and he says, "If I'd only taken you over to G-wing, man, you wouldn't be there. It's all my fault."
1:17:51
And I said, "Tell me something.
1:17:58
Would this boy blame you for what happened?" And he starts to smile. He says, "No, no.
1:18:04
He said, 'You're number one cook.
1:18:04
You're my number one cook, number one cook.'
1:18:04
He knew he was going to die. He was crippled.
1:18:10
He looked like he had arthritis."
1:18:10
And so I said, "Okay, we're going to go to his funeral now and now, we're going to go to a different time.
1:18:17
We're going to go to a time before the funeral when you had a party for him, a happy memory."
1:18:22
Because often with grief, the reason it hurts so much is that you loved and cared about each other so much.
1:18:29
So, there's something positive behind the grief.
1:18:29
And so he says, "Oh, you look so happy.
1:18:29
The donut dollies brought a cake and my sister sent an electric train for a present for you.
1:18:38
You've never seen electric train before, have you?
1:18:48
Vietnam didn't got no railroads."
1:18:48
And it turned out later that the train was actually from Spiegel Brothers department store in Chicago.
1:18:55
And he said, "He's so happy.
1:19:03
You're my number one cook." So I said, "Okay.
1:19:03
We're going to put as much of this as you don't want to think about now behind a filter, it will be there if you need it, but you're going to remember two things about this.
1:19:15
You're going to remember burying him and you're going to remember that birthday party.
1:19:20
And so, he's sweating, his tears going down his cheeks, and I brought him out of the hypnosis and he looked a little sort of dazed.
1:19:27
He looked a little confused.
1:19:31
And I said, "What do you remember?"
1:19:31
And he said, "Doc, I remember a grave and a cake." That was it. Grave and a cake.
1:19:38
So, it was a way of helping him acknowledge his grief, begin to go through a process of grieving, but see it from two points of view.
1:19:46
That he had this time with this kid.
1:19:51
He made the boy happy, the boy made him happy, and that can't be taken away even though he died.
1:19:56
And he was in the hospital for a while longer.
1:19:56
He practiced it every day, sitting in the ward he was doing his self-hypnosis and he was discharged.
1:20:02
He was upset he couldn't get back in the army.
1:20:10
He wanted to, but he'd been discharged.
1:20:10
His brother, who was a police officer in Chicago, was killed in the line of duty and he decompensated again.
1:20:17
But we processed — Tim Ferriss: What does decompensated mean? Dr.
1:20:23
David Spiegel: Mean he just got symptoms all over again. Tim Ferriss: I see. Dr.
1:20:25
David Spiegel: He started to look like he was hearing voices, although he wasn't.
1:20:30
But he had this control of emotion.
1:20:30
And so I had him grieve his brother's death in the same way. And he got discharged.
1:20:37
He was spending his time training teenagers how to do long-distance cycling and he was out of the hospital and doing fine.
1:20:43
So I thought that anything that can help people in these rather extreme situations come to a new point of view in a hurry about that, was worth pursuing.
1:20:58
And I've been doing it ever since.
1:20:58
And we've had people in Reveri, a guy who was in his home for three years.
1:21:05
He had the social phobia where he just couldn't stand to leave his house.
1:21:13
He was there for three years and we taught him to use self-hypnosis to deal with his anxiety.
1:21:18
And he's out in the world again.
1:21:18
He's living a normal life.
1:21:18
So it is surprising how much it can help people in a hurry.
1:21:25
Tim Ferriss: No, you're good. What a remarkable story. Really.
1:21:30
I want to ask you to just describe Reveri for folks in a minute.
1:21:30
But first I want to ask, in that circumstance where you have this veteran, who some think is psychotic, who is getting really animated, heated, sweating, to maintain your composure and direct that environment, that person in that state, what does it take to get to that point where you're comfortable doing that? Dr.
1:21:58
David Spiegel: It is a very astute question because the intensity of it is remarkable.
1:22:03
We actually have a grainy old video of it.
1:22:03
But I sometimes get surprised myself.
1:22:10
I was actually holding onto his arm the whole time.
1:22:10
I didn't even realize it at the time, but I was trying to connect with him so that whatever else was going on, he knew I was there with him.
1:22:19
And I guess there are two things, Tim.
1:22:19
One was, it's a characteristic of highly hypnotizable people that they can be having intense experiences and yet be connected and contained.
1:22:37
That is, they're absorbed in it, but they're not just out of control. They're not just wild.
1:22:41
And because they're modulating, they're expressing their emotion, but they're also able to modulate and control it and focus on this sort of narrow container of being intense in reliving what happened, but also somehow aware that it is a reliving of the event, it isn't actually happening.
1:22:59
And so I figured it's like you've got to have the reins of the horse when you're riding fast, but it was clear to me that he was listening to me.
1:23:11
And what struck me the most and what reassured me, frankly, was that he could change times very easily, he could change mood.
1:23:17
So literally, transition from screaming, "I should have taken you over the hooch, man.
1:23:23
It's all my fault," to, "Ashes to ashes and dust to dust," was a few seconds, but he was following me.
1:23:28
And if I saw that he wasn't, I'd spend more time on the control issue.
1:23:34
But it's also because the intensity had to do with something we were meaningfully working on.
1:23:41
That is, I wasn't doing it just to have him show off how emotional he could be.
1:23:46
I was doing it to help him cue up into perspective the thing that was upsetting him so much and help him to process it in a way that made him feel better about it.
1:23:52
So I knew I was doing something that I thought could help him.
1:23:58
And I'll tell you that, in some of these intense kinds of hypnotic therapies, I'm a little dissociated too.
1:24:02
There's the saying, "It's a smart hypnotist that knows who is hypnotizing whom," but I'm kind of listening to my own mind saying, "What's the next step?
1:24:15
What do we need to do here?"
1:24:15
And I'm thinking about it for a second and saying, "Is this really the right thing?
1:24:18
Well, let's try it out and see."
1:24:18
And so I'm also testing his response and if I see that we're not getting anywhere, then I'll change course.
1:24:28
And it takes some time and training to just sort of know the direction you want to go in and why you're doing this and is it really going to help him or is it just putting on a show?
1:24:37
And it was clear to me that's what he needed to do.
1:24:37
And you get this sort of deep connection with somebody that you can feel that they can feel you and you can feel them.
1:24:45
He knows what I'm trying to do and I know what he needs to do.
1:24:49
Tim Ferriss: I think there might be something to the correspondence of trait-hypnotizability and good candidacy for psychedelic-assisted therapies.
1:25:00
I really do, because that, what you just described also, I think would be mirrored in many patient reports who exhibit strong, durable outcomes.
1:25:05
They're able to switch from one thing to the next very quickly, from one maybe very positive emotional valence to one very negative emotional valence and then back and forth while still maintaining some semblance of observer awareness, if that makes sense? Dr. David Spiegel: Mm-hmm.
1:25:27
Tim Ferriss: So very, very curious.
1:25:27
Who is Reveri designed for? Dr.
1:25:35
David Spiegel: Reveri is designed for anybody who's curious about dealing with their problems.
1:25:40
If you just want to learn something about your ability to explore and change your mental states, it's useful. It's a tool.
1:25:45
It's more like an antibiotic than a vitamin.
1:25:45
If you've got a problem, you can try and see if it'll help.
1:25:52
So people with pain, stress, insomnia, that's our most popular use, people getting to sleep or getting back to sleep.
1:25:57
I used to worry that Reveri wasn't quite as good as being in my office with me.
1:26:03
And then I thought, if you wake up at 3:00 in the morning and need to get back to sleep, you probably don't want me in your bedroom helping you do it.
1:26:10
Tim Ferriss: You probably don't want to be in someone's bedroom at 3:00 in the morning. Dr.
1:26:13
David Spiegel: I don't either. That's exactly right.
1:26:16
It's very useful for dealing with phobias like airplane phobias, claustrophobia.
1:26:16
I had a lovely woman who had obsessive-compulsive disorder all her life and claustrophobia, was diagnosed recently with cancer and had to have a scan in an enclosed tube and just was freaked out about doing it.
1:26:39
And I had her picture doing two things that made her feel better.
1:26:39
One, is just floating somewhere she felt comfortable.
1:26:47
And she said, "I remember floating in the Dead Sea," and I thought for a cancer patient, it might not be the ideal image, but the intense salinity of the Dead Sea makes you float like a cork. And so she liked it.
1:26:58
So I said, "Okay, we'll do that."
1:27:03
And she had a very loving sister in New York who would come out to visit her.
1:27:03
And I said, "And I want you to imagine that your sister is standing next to that scanner giving you a hug and reassuring you."
1:27:11
And she came out of it and she started to cry.
1:27:11
And she said, "For the first time, I think I can do this. I can actually do this."
1:27:17
I mean, she was afraid to go in an elevator by herself, it was too scary, she'd wait in the hospital.
1:27:24
Tim Ferriss: I know multiple people who have this issue with elevators, airplanes. Dr.
1:27:27
David Spiegel: Right, right.
1:27:27
And with airplanes, I have people imagine they're floating with the plane.
1:27:30
The way you take a roller coaster ride, don't fight the plane, float with it and see the plane is an extension of your body like a bicycle.
1:27:40
If you want to get somewhere faster, you're using the plane as an extension of your body.
1:27:45
The pilot is an extension of your mind.
1:27:45
You chose an airline that has good pilots and he's, or she, is an extension of your mind.
1:27:51
So concepts like that can help people do self-hypnosis and get from point A to point B. That's good.
1:27:58
And then for habit problems like smoking or drinking or eating badly, you can learn to eat like a gourmet.
1:28:07
You can enjoy eating more while you eat healthier food by using the self-hypnosis to do that.
1:28:14
Tim Ferriss: What have you used, if anything, self-hypnosis for on yourself? Dr.
1:28:18
David Spiegel: I had recurrent dislocation of my shoulder and I realized I needed surgery done and it's a three-hour operation. It's a big deal.
1:28:31
Tim Ferriss: I've had my left shoulder reconstructed. Dr.
1:28:33
David Spiegel: It's a lot of fun, isn't it?
1:28:33
Yeah, so — Tim Ferriss: Great fun. Dr.
1:28:35
David Spiegel: I used general anesthesia for the surgery itself, but afterwards I just did self-hypnosis for the pain control.
1:28:42
And I went, it was a Mass General, and I wasn't supposed to read my record, but I worked there, so, you know.
1:28:46
The nurse kind of looks at me like — and the resident wrote in my record, "Patient using very little pain medication, we mustn't have cut many nerves."
1:28:52
Now, I've got a scar from here to here, I can tell you they cut nerves.
1:28:59
But it's this misunderstanding that the body is just like a broken car, you've just got to incision, ingestion, or injection, you've got to do something to the body rather than teach the person to use the control system that we're all born with, this three-pound object at the top of our shoulders that is connected to every part of the body and helps to control it.
1:29:22
And why on Earth shouldn't we be able to use that better?
1:29:28
It doesn't come with a user's manual, so you've got to figure out how to do it, but it makes a huge difference.
1:29:32
And so hypnosis is not a commodity.
1:29:32
It's a skill to be shared.
1:29:32
And that's one reason, actually, it's underutilized.
1:29:41
I don't have a bunch of ex-cheerleaders going to doctors' offices telling them "Use hypnosis," but drug companies do.
1:29:47
And I'm a doctor, I prescribe meds, but there are many times when doing something like this is much better and safer and more effective.
1:30:01
Tim Ferriss: Could also be the, given the very favorable risk profile, something that you at least attempt before moving on to more severe interventions. Dr.
1:30:12
David Spiegel: That's exactly right. Why not try this first?
1:30:12
I had a young woman, seven months pregnant, very bad lower back disease.
1:30:16
And of course as the baby grew, it got worse.
1:30:21
They put in a nerve stimulator, it didn't help, and they couldn't give her opioids because she was, had it pregnant.
1:30:26
And so I have her imagine she's floating in an nice warm bath, filter the hurt out of the pain.
1:30:32
Her pain went from seven to three in a couple of minutes, but she looked angry.
1:30:38
And I said, "What's the matter?"
1:30:38
She said, "Why in the hell are you the last doctor I got sent to instead of the first?"
1:30:43
And that's exactly right, Tim. I don't get it.
1:30:50
It's inexpensive, it's effective, why not try that first?
1:30:50
And then, if that doesn't work, do something else. And it's really a shame.
1:30:57
It's a disservice to people who can help themselves.
1:31:04
It's excessively expensive to use medications or procedures when some people may not need it.
1:31:11
Some do, but a lot don't.
1:31:11
And so I would like to see Reveri used as a kind of placeholder while people are getting evaluated and getting appointments with people who can help them deal with whatever their pain or other problem is.
1:31:23
Tim Ferriss: It can take forever to find a good specialist, meaning outside of hypnosis.
1:31:27
I have a friend who's dealing with a very unpredictable onset of, what he describes as, overwhelm that seemed to begin after he had a pretty bad neck injury.
1:31:41
He was constantly in this flexed position while he was working on his laptop.
1:31:41
And then he went to play tennis one day, went into a serve, bent his head back and had some type of structural event that then precipitated this onset of, what he would call, overwhelm where he goes into fight or flight and really can't focus or work.
1:32:00
And it's taken many, many, many, many months to find specialists to work with just to begin the trial and error.
1:32:07
So in the meantime, I could see something like this being incredibly valuable.
1:32:13
Aside from Reveri, and people can find Reveri at Reveri.
1:32:18
com — great name, by the way — R-E-V-E-R-I.
1:32:18
com and on all the socials, we'll link to that in the show notes as well, but Reveri. com. Dr.
1:32:26
David Spiegel: Thank you.
1:32:29
Tim Ferriss: And I would imagine that can be found in the App Store as well, but R-E-V-E-R-I. Dr.
1:32:32
David Spiegel: Yes, it can. R-E-V-E-R-I.
1:32:32
Tim Ferriss: In addition to that, are there any resources, because I'm sure there's the good, the bad, and the ugly when it comes to hypnosis resources, whether those are books, documentaries or otherwise.
1:32:40
Are there any particular resources for those who would like to try to educate themselves more, explore this more? Dr.
1:32:51
David Spiegel: Well, there are a number of good professional hypnosis societies that have members who are professionally trained in use hypnosis: The Society for Clinical and Experimental Hypnosis, SCEH.
1:32:58
us, The American Society of Clinical Hypnosis, ASCH.
1:33:04
net, there's an International Society of Hypnosis for your listeners who are elsewhere.
1:33:11
There are good textbooks on hypnosis.
1:33:11
We've written one of them called Trance and Treatment, my late father and I wrote — Tim Ferriss: Trance and Treatment. Dr.
1:33:18
David Spiegel: That's available.
1:33:18
There are other good apps.
1:33:18
There's Oneleaf, which is a French app that the French government has invested in that has excellent recordings to help people use hypnosis.
1:33:30
There's one called Nerva, out of Australia, that helps people with Irritable Bowel Syndrome and hypnosis can be very effective for that as well.
1:33:35
So there are more and more of those apps coming as well that seem to help people manage hypnosis and manage with hypnosis.
1:33:46
So it's growing, the list is growing.
1:33:46
Tim Ferriss: So we'll link to all those.
1:33:46
And Trance and Treatment, I must ask, since you mentioned Bali and I've seen various types of, I think what we would consider trance, whether that's Sufis spinning or various types of repetitive singing, droning, do you have any particular long-standing type of trance that you find most interesting or appealing? Dr.
1:34:14
David Spiegel: Well, there's a sociologist book called Boiling Energy about the use of drumming actually as a kind of trance-inducing experience in Africa.
1:34:25
And there's no question that people use that kind of rhythmic activity as a way of socially connecting and soothing themselves.
1:34:33
And there's something about being in that rhythm of rate that is usually roughly the rate of heartbeat, about one a second, that helps people.
1:34:46
And that's why people like to dance and sing and things like that.
1:34:46
I think we coordinated social activity that gets the body involved — it can be very soothing, actually.
1:34:50
And so I think a lot of our healing rituals involve repetitive movement that people find soothing.
1:35:06
Tim Ferriss: David, thank you for what a fantastic, wide-ranging conversation this became.
1:35:12
And is there anything else you'd like to mention?
1:35:12
Of course, people can find Reveri at Reveri. com, R-E-V-E-R-I. com.
1:35:17
Is there anything else you'd like to mention or point people to? Dr.
1:35:23
David Spiegel: Thank you.
1:35:23
It is from the App Store and Google Play as well has it, if people have Android phones.
1:35:28
I would say, I think we've talked about the major uses of it.
1:35:28
I think I would love it if people give it a try.
1:35:36
See it as a first recourse, not a last recourse.
1:35:36
And I'd love to see it integrated better with people's overall health and wellness care.
1:35:45
I think it's been sort of the Rodney Dangerfield of psychotherapies.
1:35:52
Tim Ferriss: Can't get no respect. Dr. David Spiegel: Yeah.
1:35:57
He said, "They asked me to leave a bar so they could start happy hour."
1:36:01
And after having done this my entire career, this is a legacy project for me.
1:36:01
A time will come when I'm not available to keep doing this for people.
1:36:11
It warms my heart that while we've been talking, I've helped more people than I used to in months of person-to-person clinical activity.
1:36:21
And I want people to have it as a resource for helping themselves to feel better and function better, and I think it can.
1:36:27
So, thank you for helping me do that, because that's the same kind of thing you're doing with your show and I'm honored to be a part of it.
1:36:37
Tim Ferriss: My pleasure entirely. What fun.
1:36:37
This is the best job on Earth as far as I'm concerned.
1:36:42
And to everybody listening, we will have links to all things discussed in the show notes, as per usual, at tim.
1:36:48
blog/podcast, Spiegel, S-P-I-E-G-E-L.
1:36:48
You can just search it there and it'll pop right up.
1:36:53
And until next time, as always, just be a little kinder than is necessary to others and to yourself. Thank you for tuning in.