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Enough exercise

Are you getting enough exercise?

Stress is probably the most common problem in modern life. And yet, how to deal with stress is well-known and easily achieved. You avoid stress by getting enough sleep, keeping your attitude positive, and working towards your long-term goals. 

The question of course, is how to achieve those three things? It has been proven over and over that the answer is exercise. Regular consistent exercise is possibly the single most important thing in keeping your mind and body healthy.

Benefits of enough exercise

Exercise does not only benefit the body. It also has a direct effect on the mind. Regular exercise lift your mood, and leaves you feeling relaxed and calm afterwards. When you feel relaxed and calm, you are better able to deal with stressors as they arrive.

A healthy body actually leads to a healthy mind. Exercise releases any emotional tensions held in your muscles. Releasing muscular tension releases anxiety. Relaxed muscles help you sleep better. Relaxed muscles prevent you generating the hormones associated with stress. Serotonin, dopamine, noradrenalin and other hormones all affect our perceptions of stress.

Those hormones enter the bloodstream, are taken to the brain, and make you feel worse. They maintain the primitive fight or flight responses in your brain, and keep you keyed up, ready to take on any threat. Constant anxiety tends to fill your mind with negative thoughts. These feed on themselves, make you more anxious, because more stress hormones, which then makes you feel even worse.

The way out of this vicious cycle is to get regular strenuous exercise. Exercise creates a different set of hormones that tend to make you feel good. Feeling good, makes you think positive thoughts. Positive thoughts lead to positive attitudes. And your positive attitude makes you immune to the things that normally trigger stress in you.

Most people just do not get enough exercise.

Do you?

As well as telling your clients how to improve their mental balance, perhaps you should be prescribing a healthy dose for yourself as well?

 

 

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put myself into trance

How does an experienced hypnotist do self hypnosis?

I was recently asked what I thought was the best way of going into trance, and how I put myself into trance.

I find that my preferred method is simple bio-feedback.

I sit in a quiet place and focus on my breathing. Then I imagine relaxing my arms, my legs, etc. I very quickly (not more than ten seconds) go into a deeply relaxed state.

Then I just allow my mind to ‘open’. If nothing comes, then I focus on enabling a finger life. This usually opens things up as well making me even more relaxed.

I tried it just a moment ago so that I could check what I do do. Initially it was like a whole jumble of things came into my mind. After a few seconds, one or two of them in particular began to emerge and fade. While this was happening I felt my body relaxing more and more, my head began to fall back. Then I got an image, something like a roiling cloud, with something like an elephant’s trunk coming out of it. This then turned into something more like an atomic mushroom cloud. Then the important part became the two areas on each side of the “trunk”. And then I became aware of a feeling. I realized I was worried about money. (I have recently retired from my university lecturing post and my university income will stop at the end of next month. Clearly this has been weighing on my mind unconsciously.) I waited a few moments to see what would develop from that, I got the feeling that this would take a long time, but several solutions began to suggest themselves to me.
Because I was writing this blog post I chose to come out of trance. I still feel a bit spacey. But I have no doubt that I was in trance and beginning to go into my unconscious mind. The whole process probably took less than a minute.

I’m sure that everyone has their own way of going into trance, and mine is not necessarily the best, but that’s how I do it.

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smoker

Good news for hypnotists – fewer smokers around

The war against the smoker

All round the world, public health authorities are moving towards stamping out cigarette smoking. In Britain, and many other European countries, smoking and enclosed spaces is totally banned. Some communities have banned smoking in public places outdoors as well. Smokers are increasingly taxed, vilified, and held up as per examples. There has been relentless pressure to stop teenagers starting, advertising has been banned. In Australia, government regulations decree that all cigarette packets have to be printed in a muddy brown colour, covered in horrific pictures of smoking related diseases, and almost indistinguishable from other brands. All of this has had a definite effect.

The anti-smokers are winning

Recent statistics from Britain have shown that the number of smokers in the population has fallen dramatically. The chart below, from the Office of National Statistics, shows a long-term decline in smoking. This is probably irreversible. Social and cultural attitudes have changed. Smoking will probably be extinct by the end of the century.

 

Chart showing proportion of smokers

On the face of it this might seem like very bad news for hypnotists. However, what the chart shows can be looked at differently. 

Actually, it is the hypnotists who are winning

There is a spectrum of smoking behaviour. Some people find it easy to stop smoking. Other people find it impossible. As more and more smokers stop smoking, the smokers who are left in the population are actually the people who cannot give up without help. Although there are fewer smokers, the smokers who remain are different.

And that is why this is good news for hypnotists. Although there are fewer smokers, these are the ones who most need hypnotherapy to get them off the habit. And as the number goes down, those who are left will be more and more cigarette dependent. Eventually we will be left with only those people who are psychologically dependent.

There will be plenty of business for hypnotists in the years to come.

 

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Trance

Does every trance change you?

There are essentially four ways that I judge whether or not I am hypnotised:

1. Have I achieved Effortless Selective Thinking? I.e. Can I easily focus on one specific idea to the exclusion of all others, or does my mind wander when I don't want it to?
2. Do I completely lose awareness of my immediate environment, and the noises and distractions it generates?
3. Do my limbs feel so heavy that they are almost impossible to move?
4. Do I visualise moving patterns under my eyelids? This is very much a feature of hypnosis for me.

I know that I do not necessarily need to go very deep to do useful work on myself, but if my mind wanders I do not feel that I am deep enough.

The very first time I tried the Dave Elman technique on myself I went so deep it took me 90 minutes to get out of it, despite the fact that I had slumped forward into a very uncomfortable position! I have never got that deep with it since.

Twice, using a different technique, but on consecutive days, I went so deep that I had the sensation of leaving my body, everything going white, and feeling a Nirvana-like state where I had a direct line to God. I really thought I had cracked it, but have never achieved it since!

What you say is very interesting, because despite having sometimes gone very deep, there are plenty of times when I fail to even get close to Effortless Selective Thinking.

I am hoping to find something in your collection that will assist me to achieve a reasonable trance state more reliably.

Thank you again for your help.

I replied:

I am not sure that I agree with your measures of how to know when you're in hypnosis or not. I am certainly not a world expert on these things but it does seem to me that
some of the indicators you are using are contradictory. Others are not good predictors of the presence of trance.
 
You listed:
1. Have I achieved Effortless Selective Thinking? I.e. Can I easily focus on one specific idea to the exclusion of all others, or does my mind wander when I don't want it to?
2. Do I completely lose awareness of my immediate environment, and the noises and distractions it generates?
3. Do my limbs feel so heavy that they are almost impossible to move?
4. Do I visualise moving patterns under my eyelids? This is very much a feature of hypnosis for me.
 
Number one is not something I would associate with being in trance. Does the "Effortless Selective Thinking" refer to some specific thing, or something you picked from a  training course? I have never come across this before. 
Almost by definition, if you can focus on something, then you are not in trance. Focusing on something is certainly a very good way to get into trance, but is not itself trance. Once you enter trance, you have no idea whether you're focusing or not, because you have lost conscious control. For me, the essence of the unconscious is that it does go off in random directions. When I enter my unconscious I enjoy the unpredictability of it. I love the images that morph from one into another. It is rather like a dream. I would actually feel cheated if my mind did not wander. It is the wandering away into the realms of the subconscious which lets me know that I am actually in trance.
 
Number two does seem to me to be a legitimate indicator of trance in some instances, but not in others. If you are totally lost in a TV show you may very well be unaware of your surroundings, and in trance, but you are completely aware of what's going on in the plot and hearing the actors speak, etc.
 
Number three is definitely not an indicator of trance. You can be totally relaxed, and not be in trance. You can be totally in trance, and not relaxed. Relaxation is used to help to get into trance, but it is not itself trance. 
I personally often find I'm lying in bed, every muscle relaxed, feeling the weight of my body, not wanting to move, hearing myself snoring, but still being aware that I am aware of my body and that I am actively thinking. The opposite is also true. Bandler reports that people have been hypnotised while pedalling on an exercycle. 
So relaxation is not a necessary part of trance. The same is true of highway hypnosis where a driver loses all consciousness of driving. Definitely in trance, but is still guiding the car through a changing landscape. The Benson Relaxation Response will put most people into trance, and leave them totally relaxed. But the trance is the result of the repetition, not of the relaxation.
 
Number four, the patterns under the eyelids, is not trance either. When you close your eyes in a quiet place you are depriving your mind of external sensory stimulation. Your mind is still very active. And it searches for things to work on. What it finds is random firings of the optical nerves and interprets these as external stimulus, and tries to make sense of them. These are often mapped onto images of parts of faces, or other familiar things. This is close to trance, and often experience on the way into trance, but again, this is not itself trance. It is a purely physical phenomenon.  It can be used as an induction. After a while, the conscious mind gets bored with it, and allows the subconscious mind to wander off to wherever it wants to go, which is the definition of "being in trance".
 
You mentioned several times the importance of being in a deep trance. It might be useful to remind yourself that there is no such thing as a "deep" trance. Trance does not have levels. "Deep" is a metaphor, an attempt to explain something that we do not understand in terms of something else that we do understand. There are no gradations of "deep". No one has ever successfully measured trance, in any meaningful way. There is no dipstick to the unconscious. There are certainly many different trance phenomena, but they are not connected to any sense of "deep". They are what they are, independent of each other, and no one has so far found any way of explaining and predicting when and how they arise in the mind.
 
I think you should try to suspend judgement. I admire the successes you have had so far. Well done.
However, you might want to consider that every time you go into your own unconscious mind you are inevitably causing changes to happen. After you come out of a vivid trance, you have caused or encouraged changes in your own psyche, and you will no longer be the same person. That is the essence of what we as hypnotherapists do in our therapy. That is why we lead our clients into trance.
 
So perhaps the person who had the "deep" trance with the Elman induction can not repeat it because they are not the same person?

 

 

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Problems with self hypnosis

Problems with self hypnosis

A reader wrote to me...

As a therapist of the Resolute Organisational personality type, I do not find it easy to hypnotise myself. I have used various techniques with mixed success - sometimes going deep, but often not. Strangely, I find Dave Elman's technique has worked quite well at times.

I replied...

I find your comments about putting yourself into trance quite interesting. My experience of hypnotising people is that people are only resistant until they have been successfully hypnotised. Once their subconscious mind realises that they can give up control and nothing terrible happens, then they are as susceptible to hypnosis as anyone else. A resistant person does not stay resistant.
 
If you have been successfully hypnotised to a deep state, then your mind should have no problems with allowing you to go back to that deep state easily and quickly. After a bit of practice, the very simplest induction should put you back into that state.
 
 I know that when I was in training many years ago, the instructor said that I was the hardest person he had ever come across to get into a trance. If he used an instant induction, I would drop into trance just like everyone else, but immediately come out of it again. My mind totally did not want to give up control and in fact would not. It took quite a few sessions, and many different approaches, before I finally slid into trance and experienced the magic of accessing my unconscious mind.
 
When I have a resistant client, I usually fall back on the My Friend John technique. That usually succeeds in slipping past the person's self-preservation control mechanisms and drops them into trance quite nicely. Because I am a working hypnotherapist I do not usually see people more than twice, three times. So I have very little experience of inducing other people over and over again. I do have 20 years experience of inducing myself.
 
I notice in myself that after the initial period when hypnosis was mysterious and deeply satisfying, the quality of my trances changed. I spent many years experimenting on myself. In one of those sessions I was trying to give myself a finger lift instruction while in trance. What I ended doing was accidentally anchoring my hand on being in trance. Now, every time I go into trance, I hand twitches. For example, whenever I start to lead a client into trance, I start going into trance myself, and I notice that my fingers are twitching and my hand is lifting. This tells me that I am entering trance, even though I am fully alert and talking to a client.
 
I also notice that, distressingly often, when I think I'm working on my computer, I find my fingers moving. This tells me that part of my mind has actually gone into trance and I am not nearly as focussed as I think I am. Even as I write this, thinking about what to say next, and remembering  the experiences, the process of visualising or accessing those memories is putting me into a trance because my fingers are twitching.
 
Perhaps you are expecting too much from self hypnosis? I believe that once you are adept at going from fully conscious into your subconscious that you slip in and out of it constantly.
My theory is that when you first start playing around with hypnosis there is a very clear difference between being in trance and not being in trance. But once you are skilled at it then you get additional abilities. One of them is the ability to "work" in trance. You can be in trance and still be conscious of what is happening.
On the other hand, a beginner trance takes up all your attention and you are quite clear that you're in that state. It's clear because it's so different. But once your mind is happy about slipping in and out, it becomes standard. Nobody notices at what point they slip into a daydream. A daydream is simply being in your unconscious mind and allowing it to wander where it will. It is a form of hypnosis.
 
So what I'm thinking is, that you are actually succeeding and going into trance with these various inductions. I suspect you are getting a more noticeable result from the Elman induction because it is long and repetitive and emphasises bodily responses. Trying to open your eyes, trying to lift your fingers, and so on gives you immediate feedback on how you are feeling, and emphasises that the feeling is in fact different from your normal control of your muscles. I wonder if it is the case that when doing the Elman you are not just in trance, but noticing that you are in trance. It is quite possible that you are going into trance with those other inductions very quickly and easily, and just not being aware that you are in trance because being in trance has become such a normal experience.
 
I find that after years and years of being comfortable with being in my unconscious mind, I have literally become unconscious of it. It does not seem strange or in any way odd, and therefore I cannot tell when I'm in trance and when not. My only indicator is that when I am going into trance my fingers twitch. Otherwise I would have no idea it was happening. I can in fact put myself into trance simply by willing it. I can slide my attention down to my left hand side... and even as I think about telling you how I do it I find my fingers curling up. The whole process takes less than three seconds.
 
If I deliberately want to put myself into a deep trance, I lie down in my favourite chair and do a quick count down. Sometimes I am so worked up about whatever problem I'm working on that I just can't let go. But most of the time I feel myself relaxing, going into trance, my mind wanders off somewhere random, then I suddenly find myself back in the present after some long period of being unaware of where I am and what's been happening. I'm not really sure whether I remember what I was thinking about or not. I might have been asleep. I might have been daydreaming. But I certainly feel a great deal more refreshed but I do have the feeling that I get on my lips after I have been hypnotised by someone else. So my best guess is that I was in deep trance.
 
I can only speak from my own experience, but I do think that the personal experience of going into trance changes over time and becomes much less noticeable.
 
Perhaps that is what you are experiencing? Perhaps there is nothing wrong with the way you are going into trance?
 
Have you read the book  Trances People Live by Stephen H. Wolinsky
 
It has some very interesting things to say about when we are, and are not, in trance in our daily lives, and how to tell the difference.
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Hypnosis Sexual Health Scripts

Hypnotherapy suggested research topics

Hypnotherapy suggested research topics could include a wide range of possible targets. The hypnotherapy business is a strange one. It has almost no barriers to entry. You can go on a weekend certification course and happily set yourself up as hypnotherapist on Monday. You can then set up your website. Nobody will be able to tell that you have no experience. Does it make a difference?

Does your advertising determine your success?

You can decide your style is New Age, or Spiritual, or Clinical or DNA-reprogramming, or anything else. On social media you can tell everyone that you are the most successful hypnotist of all time. To an extent, this might not be a bad thing. Belief in the process is a major part of success in hypnotherapy. So building yourself up in the client's mind may be exactly what is wanted. Does your advertising attract a particular type of client? Or are clients only interested in hypnotherapy, and really don't care what type of therapist they will see?

Does what the therapist looks like make a difference?

However, at some point, reality has to meet the hype. I know of several hypnotists who offer weight loss treatments while being themselves grossly overweight.  And hypnotists who smoke but offer stop smoking therapy. You have to wonder what effect this obvious contradiction between "what I say and what I do" has on the client. It would be interesting to see some research on how clients react to actually meeting the therapist. Does the difference between what is advertised and what you get make a difference?

Do client expectations make a difference?

Another interesting research topic to investigate: exactly what is it that clients expect when they go to a hypnotherapist? If a client strongly expects some particular approach, and doesn't get it, what effect does that have on the success rate? Should the therapist have a standard approach to everyone? Or should the therapist attempt to match the client's expectations, no matter how strange they are?

Does the venue make a difference?

We have to meet the client somewhere (Skype excluded of course). I have a professional office but I used to work from home. Many hypnotherapists work in temporary set ups.

I wonder what difference the venue makes to the overall success rate? Do clients respond better if they are hypnotized somewhere that looks like a doctor's office? Or do they do better in a relaxed family surrounding? It's actually quite important. I might be spending all this money on rent for no good reason. People working from home might be scaring off potential referrals.

There would seem to be a lot of scope for research here.

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external distractions

Stay calm and ignore external distractions

I had a client today who must count as one of the strangest inductions I have ever done.

The client came in and stood there looking at me. When I invited her to sit in the chair she immediately said 'No, I can't sit in a chair". I asked her what she meant. She told me that she had a bad back and could not bend to sit down. 'No problem' I said. 'The chair extends almost flat, you can lie down'. No, she said, 'I can only stand or lie flat on my back or on my stomach'.

Now this woman had come to a hypnosis session knowing full well that she would be asked to sit, but made no provision for her own special needs at all. I finally found a cushion she could use for her head and she lay down on the floor.

The interview

I then started interviewing her to find out what she wanted. So there I was asking questions of someone lying flat on her back on the floor. I finally found out what she wanted, she was afraid of retirement (!). She was seventy years old and had been forcibly retired by her employer. She was partly deaf and couldn't really describe what it was that she was afraid of.

Ignore external distractions

Anyway, I formulated a plan to deal with her issues and I began the induction. As luck would have it, a few minutes into the induction a tremendous rainstorm hit. The sound of the rain on the roof and windows made conversation almost impossible. I found myself  with a half deaf client lying on the floor with the biggest rain storm in years raging outside.

I ended up bellowing at her lying there on the floor shouting 'RELAX! LET YOUR MIND FIND SOME QUIET PLACE!' etc., while the pounding of the storm made it hard to hear myself, never mind get through to her.

She did eventually go into trance successfully, but I won't forget this session in a hurry.

I guess the lesson I take from this is to carry on no matter what the external distractions.

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lack of confidence

Lack of confidence treated with hypnosis

The client today was a man in his late twenties with lack of confidence. He lacks the confidence to assert himself. His wife says he always gives in too easily. It is costing him salary and promotion. He just cannot stand up for himself.

In the interview I learned that he will do anything to avoid aggression. He feels he has to keep people happy and never put forward his own views in case he causes aggression. He has to tell people what he thinks they want to hear. It was obvious that he was afraid of confrontation but I couldn't find anything in his life that caused him to want to avoid aggression.

Lack of Confidence behaviour

Like many people he feared rejection and wants to be liked. But I noticed that every time I asked him about how he feels, he tells me what he thinks. This is the typical behaviour of the over-analytical person. One probing further I found that he has many symptoms of hypervigilance.

Hypervigilance starts when a child feels that their environment is unpredictable and they become afraid of what is happening to them. The child then withdraws and puts up barriers to intimacy. The child's reasoning is that they don't feel anything they can't be hurt. This client confirmed that he has no real feelings about anyone.

The client said he felt that he had a shell around him. For most clients this would be the cue to start using a metaphor technique, but when I started with this client he could not get any emotion, he kept talking about what he thought of it.

Hypervigilant clients are hard to hypnotise

Hypervigilant clients are hard to hypnotise because they analyse everything you say to them. Instead of reacting to your suggestions, they analyse the structure of the sentences and wonder about why you used that particular word. They are so busy analysing that you can't get through their defences.

I explained how this usually works and told him that if I couldn't hypnotise him in my office I may have to give him CDs for private study. This technique always works eventually, and often is the only way to get them into trance in any reasonable time.

I thought that he would be hard to hypnotize and he agreed.
So I started the session with a rapid induction, he started smiling, and the impression I got was that he was feeling the induction but refusing to follow what his body was telling him.

Using a kinesthetic induction 

I then did a breathing induction and to my surprise his head started to nod, an indication of trance. I then did a deepener with a staircase induction, and he was in trance. This fast induction surprised me greatly. I tested with an eye catalepsy. Worked.

So I learned that this hypervigilant client, at least, could be hypnotised. I think the key to it was using a kinesthetic induction to get him to focus on a feeling he had never before noticed, the feeling of the air inside his head as he breathed in.

A therapy for lack of confidence

Did the standard RIVERWALK therapy with embelishments.
When he was looking at the town he saw someone like him at a table with friends doing all the things he wanted to do.
Had people following along the other bank.
Had him and his wife walking towards the town. Started with everything around stale and tired.
Then the little bridge where he says aloud what his problem is.
Then DROPPING THE STONES
CLOAK OF POWER
BRIDGE TO FREEDOM
DIRECT SUGGESTION
CONGRATULATE the mind.
FINGER LIFT CONFIRMATION

I felt this turned out to be a good session. What I learned from this is that even a therapy I have used hundreds of times can still surprise me. My own unconscious mind came up with a new twist to suit this particular client.

So what I ended up with is a new way of treating lack of confidence.

It never ceases to amaze me how ingenious the unconscious mind can be.

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Analytic self-hypnosis

Trance for analytic self-hypnosis?

Analytic self-hypnosis

What would you propose as a good way for an analytic to do self-hypnosis? I’ve tried lots of ways and hypnotists but have not had success.

I replied:

Keep in mind everyone can be hypnotized. Start from there. The trick is let your mind analyse the thing until it gets fed up with analysing the same thing and your mind switches off and you drift into trance without realizing you are doing it.

What I recommend is that people get a well made hypno recording and play it over and over until it becomes so familiar your mind gets bored. At some point in the umpteenth listening your mind will forget about analysing what is being said and while the mind is distracted the instructions in the recording will be heard by the unconscious mind without filtering and you will fall into trance. After that, once your mind accepts that you can let go of control and you don't die, then you will be able to go into trance easily anytime.

Or use Benson's Relaxation Response for analytic self-hypnosis

Alternatively, if you want to do self hypnosis, do Benson's Relaxation Response. Sit somewhere without distractions and repeat a word or phrase over and over, either aloud or in your mind. You might have to have several goes at it. But at some point you will lose contact with the meaning of the word and you will realize that you are actually in trance. This is the basis of all mantra based meditation routines - it will work, eventually.

I have spent months on end listening to good hypnosis tapes and I am likely going into hypnosis but I am not getting any of the benefits. It could be that I am just falling asleep but I come back on que so I think not.

I will try repeating a phrase as you suggest. I have not heard of this before. Will see if I will do better with it.

My response was

I wonder if you are expecting too much from hypnosis? It is likely that you are actually going into trance. But because you are expecting something more, you are feeling disappointed. 

You might be better to read up on some metaphor therapy techniques, or visualization techniques and let them guide you. It is quite possible to direct your thoughts while in trance. It takes a bit of practice, but it can be done.

Alternately, get an experienced hypnotist to take you into trance. Then you will know that your entrance. You can arrange for the hypnotist to bring you in and out of trance so that you can feel the difference. A good hypnotist will also be able to teach you, or show you, various things that you can do while in trance. Once you're aware of the feeling you will be able to go into it anytime you want, and be free to explore your own unconscious. It is definitely worth continuing with this. Exploring in trance is almost magical.

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placebo effect

Placebo Effect belief and psychology

The placebo effect

The original meaning of ‘placebo’ comes from the latin word placer – to please (in English "placate"). Placebos were inert substances given to patients to please them so that the patient felt that they were getting some sort of treatment when nothing else was available (Moerman, 2002 p11).
The common meaning of placebo is some inert substance, or some procedure that should not have any medical benefit, but does. 
Moerman (2013) argues that the placebo lies not in the substance, but in the meaning that the receiver takes from it. "I will argue that in most of these, the results usually make more sense if we try to determine how a meaningful interaction occurred, rather than trying to understand the effectiveness of … “nothing.” Whatever form the substance takes, in the mind of the patient it represents the whole of medical knowledge, and is imbued with power."

This has been known for centuries: the King’s touch was believed to cure scrofula, a visit to the doctor makes some people feel better, Chinese Americans born in years associated with ‘earth’, years ending in 8 or 9, disproportionately die of diseases such as lumps and tumours, traditionally associated with earth in Chinese culture.

The placebo effect has been tested extensively

Moerman (2013) cites ten different studies showing the placebo effect. In one, patients got more relief from headaches when they believed the aspirin was a heavily advertised branded version, as opposed to an identical unlabeled aspirin.

In dentistry, the dentists were told that their patients were or were not getting an active drug, but the patients weren’t told. The patients whose dentists were told they were using the active drug actually reported less pain, despite having no knowledge of the experiment at all. Another dentistry study proved that belief in the placebo caused measurable physiological changes in the brain, and produced active opiates to relieve pain.

IBS patients were told that they were getting placebo pills, containing only sugar, but that had proved effective in clinical trials in the past: 97% of the patients who knowingly took the sugar pills proved to be healthier on all measures a week later. In trials of depression drugs, placebos did almost as well and produced much the same results.

The placebo effect also exists with active drugs. After surgery all patients were given Tramadol, but some were injected with it and told what it was, while others had it delivered through their IV line without being aware of it. The injected patients reported much more pain relief from identical doses

The conclusion is that people do not respond to placebos, what they respond to is their own beliefs, to the beliefs for of the carers, to their cultural background and to the words that accompany the intervention. It is the totality of the experience that matters.

Placebo Effect and the cycle of healing

Of course there may be no psychological effect at all. One possible reason is regression to the mean. Many diseases get better on their own. The common cold for example takes about a week and a half to run its course if untreated, but if you get the finest treatment that medical science can provide, it will last only about ten days.

Whatever you do for a cold has no effect, but the cold does come to an end, so you can credit whatever you did as curing it. Many diseases are cyclic: you get unwell, then you get better on your own and then you feel unwell again, but there is no cure. The episodes may well be years apart.

The placebo effect comes in because patients seek help when they are unwell, when the cycle is at or near its peak. Left on its own, the symptoms will subside back to average, and whatever is done has no effect at all because the disease is just running along its cycle. The treatment seems to work, but actually has no effect, so whatever you do the outcome is a placebo effect.

This is most likely the reason for many of the strange folk remedies that people believe in. 

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