Hypnosis has been commonly recognized as an effective intervention in the treatment of obsessions, compulsions, and addictions. It may not be because we normally think. Too often efficacious findings are coupled with head scratching admissions pertaining to the lack of understanding of the causality. Modern findings and recent discoveries by neuroscientists may open the door for understanding the relationship between hypnosis and the treatment of addictions. Suggestions of relaxation and slow, calm breathing as promoted by hypnosis, meditation, and yoga are significant factors in he treatment of addictions.
Compulsions and obsessive behaviour can be linked to self-medication through addictive behaviour and the absence of inhibitory influences from the brain’s executive function. Essentially, compulsions largely start with overactive cingulates, which are the medial substrates in the frontal lobe where the two cerebral hemispheres meet. In particular, the anterior (forward) cingulate gyrus (ACC) is overactive when obsessive and compulsive thoughts are present. (The ACC serves as the switchboard for your thoughts. Over activity means compulsive and obsessive thoughts. Under activity is related to attention deficit.) This ACC over activity can occur simultaneously with a level of under activity in the frontal lobes. This is especially a concern when it is coupled with an Orbital Frontal (over the eyes) Syndrome, which results when semantic markers fail to prevent negative behaviour. In layman’s terms, this means that we try to quell the pain of obsessive thoughts with addictive behaviours which are not stopped by our normal inhibitions.
The self-medication of unhappiness (i.e., obsession and compulsions) affects the entire body. As the ACC is in the medial portion of the brain and sits astride the Limbic System, the emotional centre of the brain and our link to our autonomic functions, it should be obvious that an overactive ACC is related to bodily sensations. Addictive behaviour then affects how our body reacts and craves certain sensations. When the body is “trained” at the cellular level to expect these behaviours, it is even harder to reverse the desire for self-medication.
Add to this the inability of the frontal lobe to combat these self-medicating tendencies. If functioning normally, the somatic markers of the pre-frontal cortex will stop addictive behaviours. (At this point I am not discussing the inability of the front lobe to react due to brain trauma.) While such a low activity in the frontal lobes is normally associated with ADD and ADHD, when coincidental with an overactive ACC, a more complex problem arises. Some psychiatrists call this problem Overactive ADD.
If someone has Overactive ADD, they must seek medical treatment. Such treatment normally includes medications, low protein/high (good) carb diet, and exercise. Psychotherapy should also be part of the equation as a meds-only approach is generally not advised. Furthermore, although being diagnosed as Overactive ADD is a medical issue requiring medical care, it is my contention that many of the clients and patients seen by hypnotherapists, psychologists, and psychotherapists have similar profiles without having reached the level of pathology requiring licensed medical treatment as the primary intervention. This would include people who have smoking, sex addictions, and eating disorders.
Simultaneous overactive ACC’s and under active front lobes make the treatment of addictions is very difficult. The ACC wants peace and quiet and the rest of the front lobe wants stimulation. Too often the serotonin increase brought about by addictive behaviour, such as smoking, is the only solution to calm the ACC. (Note that therefore ex-smokers gain weight as they acquire the increase in serotonin by eating unhealthy carbs.) Meanwhile the bored frontal lobes are craving more stimulation while getting insufficient nutrition and oxygen due to the increased demands of the ACC. Addictive acting out produces such stimulation by promoting the basal ganglia to create sudden rushes of dopamine, which is the excitement neurotransmitter. This often fatigues dopamine production and leaves the addict too burned out to pursue productive behaviours. In summary, addictive acting out results in a simultaneous burning desire for calmness and excitement leading to the lethargy. It is like smoking while drinking your fourth cup of coffee and then feeling so drained (and probably regretting your behaviour).
In looking at the biology of addictions the overactive ACC and under active front lobes must be addressed. In the former case the overactive cingulate can benefit from focused attention and suggestions of relaxation. As the well-balanced ACC is also the center of attention in the brain, being able to calm the mind through hypnosis and meditation is a significant intervention. Additionally, by regulating the breath, which also is happens in hypnosis, meditation, and yoga, this stimulates the brain stem to increase serotonin flow. (The brain stem is the primary regulator of breath and a major producer for serotonin, which is the calming neurotransmitter of the brain.) It is my contention that the most overlooked benefit of hypnosis in combating addictions is the necessity to relax the mind through focused attention thereby tuning down the ACC. This releases necessary blood flow to other parts of the brain to include previously starved frontal lobes, thereby curbing excessive stimulation-seeking and allowing the executive (and thus inhibitory) functions to re-emerge.
When addressing additive behaviour, such as smoking, eating disorders, gambling, and sex addictions, too often the only focus is on the content of guided imagery and hypnosis when in fact the process may be the primary mode of intervention. There have been extensive research and discussions related to the ill effects of stress and the role of the hypothalamus-pituitary adrenal (HPA) axis with too little emphasis on the rest of the neural system. Hypnosis is normally mentioned as a primary stress-fighting tool due to the apparent impact on the HPA. Regardless, scientists normally do not probe further into the impact on other neural substrates. Increased understanding of the biological basis of the process skills of focused attention and rhythmic, relaxing breathing, both of which are components of hypnosis, may indeed provide greater understanding of the positive benefits of the science and art of hypnotherapy.