Can You Quit Smoking Through Hypnosis?
Researchers can't agree on whether hypnotherapy actually works. I tried it when I wanted to leave cigarettes behind, but I'm still not sure, either.
“It's all about choice,” said the man with the soothing voice. “If you're here to please someone else, you can stick around and have some fun, but more than likely you're going to go out and smoke after.”
I was sitting in the basement of the public library in Arlington, Massachusetts, with a motley group of about 20, all of us desperate and skeptical, with one big thing in common: We smelled like an ashtray.
In theory we'd come together because we didn't want to smoke cigarettes anymore. “I'm here for health reasons,” one woman said. “Cigarettes are too expensive,” said an elderly man. “When thinking of my children, sometimes I feel as if I'm taking from them,” offered a middle-aged mother.
“I'm going to school for dental hygiene,” added another attendee. “We're supposed to promote health, but how can I tell someone else to stop smoking if I am myself?”
These are all good reasons why people might want to quit smoking. For me, it’s the same, plus vanity. And, fine, the grim specter of an earlier grave. (You can't look good when you're dead.) But if I really wanted to quit, then why was the only thing I could think about how much I wanted to walk out of there and go smoke a cigarette?
Mark Hall, a professional hypnotherapist and licensed social worker, was well aware of that, of course. He quit smoking many years ago himself—he says he still remembers reaching for a phantom lighter that wasn't in his pocket—and he has been holding sessions like these for more than 20 years, aimed at convincing others that they can do it themselves. Typically his hypnotherapy sessions cost around $150, or $95 with insurance coverage, but this event, sponsored by the Sanborn Foundation for the Treatment and Cure of Cancer, was near my home, and open and free to the public. In other words, there was no reason not to go, except, perhaps, a question that had been frightening me all week as the meeting approached: What if it doesn't work? Or, maybe even worse: What if it actually does? Then what the hell am I going to do? As crazy as it sounds, smoking is such a major part of my daily routine, the prospect of losing it is scary.
“Does anyone here feel like cigarettes are their best friend?” Hall asked, telling us to clap our hands, then to clap them again, this time leading with the opposite hand of what we were used to. It felt weird. The sound in the room changed noticeably as well. The point, Hall said, was that smoking is a habit we all perform as involuntarily, through muscle memory, as the way we choose to clap our hands.
People may undergo hypnosis in order to address all manner of problems—from addictions, like mine, to emotional trauma. There’s some evidence that it could be an effective tool in dentistry, treating eating disorders and post-traumatic stress disorder, and helping with pain during childbirth. But despite its prevalence, there's still ample confusion about what it actually is, sometimes even among those who've already committed to it. I certainly had no idea what I was in for as I relaxed into my superlatively uncomfortable chair, ready for, well, something. Or maybe nothing.
Hypnotism is such an amorphous concept, that when I asked a couple practitioners what it is, they spent a good portion of the discussion telling me what it is not. Many of us are familiar with the process of hypnosis from the popular brand of hypnotist entertainers, where guests are plucked from nightclub audiences to go embarrass themselves on stage. Or, if not that, then from fictional depictions of a Freudian type smugly waving a stopwatch in front of a patient's face. Those are both big misconceptions, Hall explained while prepping his crowd for the descent into a state of enhanced relaxation.
“My hypnosis is a therapeutical tool, not entertainment,” he said, beginning to put us at ease. But, he joked, “If you told someone you'll be here tonight I encourage you to go home and start clucking like a chicken.”
The practice as it's followed today generally traces its origins back to the 1840s, when Scottish surgeon James Braid built upon the idea of what he called “nervous sleep,” or, more specifically, “the induction of a habit of abstraction or mental concentration, in which, as in reverie or spontaneous abstraction, the powers of the mind are so much engrossed with a single idea or train of thought, as, for the nonce, to render the individual unconscious of, or indifferently conscious to, all other ideas, impressions, or trains of thought.”
But conflating hypnosis with sleep (the word is derived from the Greek for sleep), is inaccurate, according to the hypnotist and author Charles Tebbetts, as relayed by his student C. Roy Hunter in his book The Art of Hypnosis: Mastering Basic Techniques. Hypnotism “is actually a natural state of mind and induced normally in everyday living much more often than it is induced artificially. Every time we become engrossed in a novel or a motion picture, we are in a natural hypnotic trance,” Tebetts wrote. Hunter writes that it's more accurate to say that all hypnosis is actually self-hypnosis. The hypnotherapist, much like a physical trainer then, is merely helping the subject convince themselves to do something they were already capable of doing, nudging them in the right direction.
While there are a wide variety of approaches and styles of hypnotism employed today—something that further confounds our ability to understand it objectively, or to study it scientifically—one thing that they tend to have in common is an emphasis on relaxation, focus, harnessing a desire to change within the individual, and building linguistic and visual relationships between emotions. As the American Association of Professional Hypnotherapists explains: “Hypnosis is simply a state of relaxed focus. It is a natural state. In fact, each of us enters such a state—sometimes called a trance state—at least twice a day: once when we are falling asleep, and once when we are waking up.”
Hypnotherapists say they facilitate this process, just without the sleep part. More or less. Again, for every positive study you read about hypnosis, there are be numerous, often conflicting other accounts. In a 2000 study for the International Journal of Clinical and Experimental Hypnosis, Joseph P. Green and Steven Jay Lynn reviewed 56 studies on the results of hypnosis on smoking cessation. While it was shown to generally be a better option than no treatment at all, many of the studies combined hypnosis with other therapeutic methods, making it difficult to isolate its effects.
Likely few people try to quit smoking through hypnosis alone, and no two practices are exactly the same, which is part of what makes it so difficult to know if it works.
Moshe Torem, a professor of psychiatry at Northeast Ohio Medical University and the president of the American Society of Clinical Hypnosis, one of many such professional groups around the country, explained to me the components of typical hypnotherapist's process.
“Hypnosis is a different state of mind associated with four major characteristics,” he said. First is a “highly focused attention on something.” It could be an issue you're having, or a problem you want to address. Second is disassociating oneself from the immediate physical environment. “You focus on the beach in Florida in the middle of a Boston winter,” he said, anticipating my particular winter-addled frame of mind perfectly. “Instead of traveling there, you go there with your mind, and you're fully focused on the beach.”
Probably a nice place to smoke a cigarette.
The third element is suggestibility. The person becomes more responsive to suggestions given to him or her. Fourth is what he calls “involuntariness.” That means when you come out of hypnosis, you feel subjectively like you haven't done anything, but that something has been done to you. You may recognize that you're being told to lift you arm, for example, but you feel as if it is being lifted by some external force. Which makes sense, since when I reach for a cigarette, especially when I know I don't need it, I’m being governed by similar subconscious impulses.
The end result, ideally, finds the concepts suggested by the hypnotist—either positive reinforcement for resisting smoking or negative associations with cigarettes—taking root in the subconscious as a sort of bulwark against the impulse to smoke.
This might be a pretty good time to pause and call bullshit, particularly since, during the demonstration in the library, that's exactly what I was thinking myself. Hall himself tried a little of both techniques, telling us that we were ready to stop smoking, that this was something we wanted, but also told us horror stories about smoking. Not of cancer, which can be easy to ignore until it's too late, but of his trips to tobacco farms, where he'd seen all manner of disgusting things—rats and tree frogs and pesticides and pigeon shit falling into a tobacco shredder and so on. You're smoking tree frogs and pesticide, he said. To be honest, that didn't sound much worse than what I always sort of assumed I was smoking.
No way any of this is going to work on me, I thought, as I prepped myself to lilt off into my own special place on the beach, my compatriots drifting away into their own safe places.
“Don't try to be hypnotized,” Hall said. “Trying to be hypnotized is like trying to go to sleep.”
It's a concept that Torem echoed when we spoke.
“The worst thing you can say is ‘Today is the day that I don't want to smoke,’” he explained, likening it to what he called the Rhinoceros Principle, otherwise known as ironic-process theory. Ask someone not to think about a rhinoceros, and what's the first thing he thinks of? The same holds true for saying “don't smoke,” according to Torem.
“People don't like to be told 'don't,'” he said. “If you say ‘don't smoke,’ it's the same thing as saying ‘smoke.’” The unconscious mind doesn't understand the word ‘don't,’ he said, echoing a common, albeit undocumented, claim from hypnotists.
And yet, every day, posters, commercials, and cigarette labels tell people not to smoke. I tell myself not to smoke. It doesn't seem to be working fast enough. Although the number of smoking adults in the U.S. dropped from 20.9 percent to 17.8 percent from 2005 to 2013, smoking is still responsible for 480,000 deaths per year in the United States, and 6 million worldwide, the Centers for Disease Control and Prevention reports. Most of them have been told: Don't.
The numbers on the success rates of hypnotherapy for quitting smoking are fuzzy, which makes sense, since the practice itself is questionably scientific. Hall says it's 50/50 for his clients.
“Hypnosis is not magic for most of us,” he says. “Hypnosis is just a tool that helps in making what you're trying to do easier.”
It is but one of the tools in a crowded supply closet that those who try to quit might reach for. The U.S. Department of Health and Human Services released a series of Clinical Practice Guidelines in 2008 that outlined a number of effective practices for smoking cessation. Among them, they found, were individual counseling and the use of medications like the nicotine patch and nicotine gum. Even better was combining the two. The HHS doesn’t explicitly endorse or condemn hypnotherapy.
That's in part because there isn't enough data. While some studies have shown positive results, they differ too much for anyone to draw a solid conclusion. Few studies that have been done over the years met HHS’s inclusion criteria, owing in part to the vast array of methodologies used. “There was no common or standard intervention technique to analyze,” the guidelines read. “Moreover, an independent review of nine hypnotherapy trials by the Cochrane Group found insufficient evidence to support hypnosis as a treatment for smoking cessation.”
A later meta-study in 2010 from the Cochrane Group also forestalled a judgment on hypnotism's efficacy. “Although it is possible that hypnotherapy could be as effective as counseling treatment there is not enough good evidence to be certain of this.”
While his organization hasn’t done its own study, Lee Westmaas director of tobacco control research at the American Cancer Society told me, “At this time there's not enough evidence to say that hypnosis works definitively.”
“Perhaps for some people it might work,” he said and, indeed, I have friends who swear by it. “Possibly there might be a minority of people for whom it works, but if that's the case we don't know who.”
“You seem like exactly the type of person hypnosis would not work on,” a friend told me when I mentioned I was going to try it, implying I'm too skeptical and set in my ways to be open to something like this. Still, there I was, ready to see what would happen. Hall's voice worked a strange alchemy on me in the library, and I drifted off into what seemed like a state of intense relaxation. I could've fallen asleep easily. I didn't even pull out my phone and refresh Twitter for a whole half hour.
And then, something strange happened. I could feel some deep recess of my subconscious fighting against Hall's words. I thought of scenes from exorcist movies, of demons recoiling from a priest’s incantations. “No, no, don't abandon me,” it seemed to scream. “I'll be good. I'll be good.”
When we came out of the session, he asked us how we each had felt. Some reported feeling a sense of heaviness, others said they felt as if they were floating away. One woman couldn't remember a word he had said the entire time. An older man in a Red Sox jersey said he could hear him but couldn't make out the words. “Me relaxing to that degree made me realize how much my body is fighting to breathe cleanly,” the elderly man said. Another woman said she felt as if she wanted to cry. I shared her emotion. It felt as if something was being taken from me.
So did it work? As it is for hypnosis in general, the jury is still out. I left the session feeling noticeably different. I sat in my car outside for a half hour and did not smoke. I went to dinner nearby and sat, and had a drink, and did not smoke. Eventually I caved in to the craving, but I didn't like it. I'm still smoking, I just don't enjoy them anywhere near as much as I used to anymore.
A common idea among hypnotists is that you have to truly want it to work, or it won’t. They can't do it for you. At the very least, I can say I'm willing to try again. I don't entirely want to stop smoking just yet. But I want myself to want to.