Tetris Effect on Cravings a Form of Hypnosis

A study published in the Journal of Addictive Behaviors in December 2015 reported that playing Tetris decreases cravings for drugs (alcohol, nicotine, caffeine), food and drink, and activities like sex and gaming. This follows a 2012 study which showed that playing Tetris may be an effective treatment for post traumatic stress syndrome (PTSD) by disrupting the mental imagery involved in flashbacks.

The study set out to determine whether playing Tetris would decrease the frequency and strength of cravings. The study followed 31 undergraduate students. The experimental group was instructed to play Tetris for three minutes when they experienced a craving, and reported a decrease in cravings by about 20% (one-fifth). The study authors suggested that the game has the effect of reducing cravings by engaging and distracting the brain’s visual and spatial systems, the same portions that are involved in the visual fantasy of a craving.

Having a person switch their focus from a craving to another activity is an example of the symptom breaking and symptom substitution that have been used in the practice of hypnotism for many decades. In Medical Hypnosis (1948) the influential psychotherapist Lewis Wolberg described giving a person with alcohol addiction the post-hypnotic suggestion that “Every time you crave a drink you will reach for a malted milk tablet, and this will give you a sense of pleasure and relaxation.” This technique is employed when a hypnotherapist suggests to a smoker that if he thinks of a cigarette he will crave water instead, or when it is suggested to the person with an eye blinking tic that she will instead twitch her index finger for one minute. In the latter example, the shift of motor activity to another part of the body, along with the mental activity of watching the minute pass, distracts the mind and disrupts the old habit pattern. When a new symptom replaces the old one, there is no need to worry, because a more recently acquired symptom usually can be removed easily.

Symptom substitution can be thought of in terms of a conditioned response, which is a new response to a stimulus that is created by training. Ivan Pavlov, the Russian physiologist famous for his work on the “conditioned reflex”, found that if a buzzer was sounded at the same time when food was presented to a dog, the dog would eventually salivate at the sound of the buzzer alone. Hypnotherapy sometimes uses conditioning specifically to create a new response to a stimulus. For the person who thinks constantly about food, cigarettes, or checking their phone, hypnosis can train them to notice the craving more immediately, interrupt the mind from reinforcing the problematic conditioned pattern (the imagery of the craving), and divert attention consistently to the new conditioned response, to the end that the new response is experienced as “automatic.” Through hypnosis the subject experiences a new separation between thoughts and behaviors. He identifies with the more powerful role of an observer watching and examining the craving process, instead of viewing himself as a “victim” of cravings as some autonomous force separate from the power of his own thoughts. All this gives the subject enough detachment from the habit to gain control over it and let it go completely.

Wolberg also noted that alcoholics could be helped by engaging in hobbies that completely absorb them. Likewise, many smokers report that they do not think of cigarettes as frequently while occupied with work, and many people with a tic or a habit report that it disappears completely when they are engrossed deeply in an activity or conversation.

I wonder whether the effect observed in the Tetris study could be attributed to the conditioning of symptom substitution or to deep concentration, rather than the “visual cognitive interference” of the game. I also wonder to what extent the power of suggestion and expectation could have influenced the results. College students asked to report their cravings before and after playing Tetris could surmise that the experimenters are testing for a reduction of cravings and respond accordingly. On the other hand, if the result of the study is in fact due to the influence of Tetris on the visual and spatial portions of the brain, this could further suggest the usefulness of hypnosis. Cravings and addictions involve the visual imagination, and hypnosis is the best way to create vivid mental imagery.

Ultimately, hypnosis helps people to rely on their own internal resources, instead of reinforcing the notion that one must turn to an outside device to distract them from their own feelings. Cravings, like most obsessive compulsive behaviors, are often a defense against the normal human feelings of stress, restlessness, and boredom. To truly overcome cravings, these feelings must be resolved. Otherwise, success may be only temporary, or one might adopt another negative habit (unconscious symptom substitution). Turning to a video game every time one experiences a craving reinforces addictive, escapist behavior, and many people already feel compelled to check their smartphones more than they would like. I would not recommend as a substitute symptom something that already has a tendency to develop into a problematic compulsion.

While the Tetris study may have left some people wondering whether they should pull out their smartphone or iPod every time they have a craving, hypnosis remains an effective and practical way to reduce an eliminate cravings without the need to reply on a device. Hypnosis addresses multiple aspects of the habit:

• Because of the increased suggestibility characteristic of hypnosis, hypnotic suggestion can reduce or remove cravings altogether, which is ultimately what most people seeking hypnosis really want.

• Because stress tends to increase cravings and habits, the deep relaxation of trance can reduce stress to such a degree that the subject simply thinks less obsessively overall.

• Hypnosis can help a person resolve inner conflicts when an addiction or compulsion is not just an “empty habit” (i.e. when the habit is not just a reinforced pattern and has its basis in some unconscious motivation).

• Post-hypnotic suggestions can establish that the craving will trigger an acceptable substitute response. For example, the person who craved sugar craves water instead; or the person who bit their nails rubs their thumb against the side of their finger instead.

• Hypnosis can help the subject train his or her mind to divert the mind consistently from the imagery of a craving to a new, positive image, such that the new image becomes a conditioned response that is experienced as “automatic” by the subject.

Finally, there’s one more benefit to using hypnosis. It won’t leave you with that Tetris music playing in your head!


Hypnosis for Sleep

Insomnia can be a serious issue. While it is not usually a sign of illness, lack of sleep has been linked to chronic issues, including anxiety, depression, heart disease, and obesity. Sleeplessness can also contribute to accidents and injuries.[1] For the person with insomnia, the pressing concern is just feeling tired and impaired throughout the day.

Insomnia takes different forms. The most common pattern is difficulty falling asleep. In more serious cases, the person awakens throughout the night. With these forms of insomnia, the person is often worrying about an ongoing problem or situation (ex: upset over a relationship, distressed about the workplace, or concerned for a loved one). People with depression, or who are anxious, worried, or excited about a particular situation (like a job interview, an upcoming performance, or a trip) often find themselves awakening in the morning earlier than they need to, and unable to go back to sleep.[2]

Insomnia can be caused by anything that increases physical or mental arousal. Physical arousal can come from things like noise, light (including the light from electronic devices), hunger, an uncomfortable bed, temperature, and pain. Mental arousal comes in the form of worry and distress. For children, a frequent worry behind insomnia is fear of injury or death to themselves or their parents.[3] For adults, the most common worries seem to be finances, relationships, and health.

Drugs for insomnia can cause addiction, and can become ineffective over time. Drugs can also cause serious side effects, and interfere with REM sleep and dreaming, which are important for mental health. Fortunately, when illness, substance abuse, or the side effects of medications have been ruled out causes of insomnia, hypnosis can help you sleep. Often a single session is effective in restoring the sleep cycle.[4]

In general, hypnotherapy treatments emphasize relaxation, calmness, and tranquility, but merely giving verbal suggestions to a person that they will be calm and fall asleep is not usually enough. Effective hypnotherapy for insomnia addresses the causes – excess physical or mental arousal – by relaxing the physical body and calming the mind.

To relax the body, a hypnotherapist often helps the patient to experience trance, and trains the patient to reenter that state using self-hypnosis. Techniques that combine physical relaxation with concentration, such as Progressive Muscle Relaxation and Autogenic Training, are known to bring excellent results.[5]

Calming the mind is a different matter. You can sometimes reduce mental arousal by using imagery. The most well known example of using mental imagery to sleep is counting sheep. Many methods of visualizing a number (for example, written on a chalkboard or in the beach sand) and counting downward can help. The focus required to do the task interrupts the problematic thought pattern, and the repetitive nature of the task stimulates a new mental state.[6] In simple terms, doing something boring makes you sleepy.

Hypnotherapy may also be used to dissociate mental activity from physical relaxation and sleep, enabling the patient to sleep without the need for clearing the mind.[7] I have also found success using hypnosis to help patients recognize the signals that sleep is beginning, and to use them to sleep more easily.

In some cases hypnotherapy treats insomnia by helping the patient discover an underlying, unconscious reason they have been keeping themselves awake. For example, one patient in hypnosis remembered being awakened by a house fire.[8] Another remembered students in his dormitory pranking him while he was asleep. Some people using hypnosis remember insomnia beginning after a troubling telephone call in the evening or in the middle of the night. It can help the person with insomnia to think about major life events at the time when sleep became disrupted. When there is a hidden, unconscious cause of insomnia, bringing it to the surface can resolve the issue, sometimes immediately.

Guilt about sleeping can also be an unconscious motive to remain awake. Even though sleep is a natural function and requirement, some people feel guilty for sleeping because they have work to do, or someone needs their care, or they were made to feel guilty for sleeping in at some time in their life. When this is the case, hypnosis can help a person give themselves permission to sleep.

In my experience, most people don’t have an unconscious motive causing insomnia. They just have anxiety or a habit pattern that has disrupted the normal sleep cycle, which needs to be reestablished. It can help to follow these Tips For Better Sleep:

Take care of your body
This may seem obvious, but people who have trouble sleeping sometimes keep their muscles tense, holding the body uncomfortably in a certain position, without realizing it. Pay attention to each muscle group, and consciously let go of any tension you feel, especially in your jaw and facial muscles. It’s amazing how much a little tension in the jaw and facial muscles can transmit tension to the rest of the body and the mind.

Heavy or even moderate exercise can help you sleep. You should avoid heavy exercise a few hours before bedtime.

Watch what you put in your body.
Stop drinking caffeine in the early afternoon. Stop smoking. Like coffee, nicotine is a stimulant and disrupts sleep. Alcohol may help you to fall asleep, but it can cause you to awaken frequently throughout the night. Avoid large meals and foods that cause indigestion for a few hours before going to bed.

Take a hot bath.
An increase and subsequent decrease in body temperature is one way your body prepares you to sleep naturally. When your body temperature increases then decreases after a hot bath it creates the same condition.

Pay attention to the environment:
Comfort is key
It seems obvious that your bed should be comfortable, but many people don’t sleep well because they have the wrong mattress or pillow.

Block out light
Light stimulates wakefulness. Stop looking at electronic devices one hour before bedtime, or dim their lights. Make your bedroom as dark as you can using blackout curtains. Use an eye mask if you can stand having something on your face.

Silence is golden
Not everyone needs complete silence to sleep, but it helps to eliminate annoying sounds. When you can’t get the ticking clock out of the room, fix that dripping faucet, or silence the neighbor’s dog, white noise from an air conditioner or humidifier might help.

Don’t use your laptop or smartphone, or watch television, in bed. You shouldn’t associate your bed with work and mental activity. Whirring sounds, notification alerts, and blinking lights from electronics can also be issues.

Things you can do for your sleep cycle:
Stick to a schedule
If you have trouble sleeping, set an alarm to go to bed and wake up at the same time every day. You might find that this resets your sleep cycle.

Wind down
Create a relaxing environment an hour before bedtime. Dim the lights. Put away electronic devices. Move more slowly. Do something that calms you down, like some light reading, meditation, prayer, or yoga. Have a quiet conversation.

Don’t hit the snooze button
The sleep you get after you hit the snooze button is usually poor anyway, and waiting for the imminent ringing of the alarm while you are half asleep may train you to sleep lightly. You are better off getting out of bed when your alarm rings the first time.

Get some sun
Getting some natural sunlight, especially in the early part of your day, can help you reset your sleep cycle.

How to clear your mind:
Make a list
People with insomnia often have racing thoughts about upcoming tasks. Make a to-do list instead of trying to keep it all in your mind. It’s hard to sleep when you feel like you are trying to remember a list of things to do the next day.

Relaxation, self-hypnosis, and meditation
Breathing exercises, meditation, and yoga can help slow down your heart and brain before bedtime. Self-hypnosis, progressive muscle relaxation, and autogenic training can be especially helpful.

Try not to worry
The more you worry about how the lack of sleep will affect you, the less likely you are to fall asleep. If you cant sleep, and you can’t do anything other than lie in bed worrying about it, get out of bed and do something relaxing to break that thought pattern until you feel tired again.

[1] Insufficient Sleep Among New York Adults. (n.d.). Retrieved April 16, 2015, from Click Here
[2] Spiegel, H., & Spiegel, D. (1978). Trance and treatment: Clinical uses of hypnosis (p. 233). New York: Basic Books.

[3] Watkins, J. (1987). Hypnotherapeutic techniques (p. 292). New York: Irvington.

[4] Kroger, W. (1977). Clinical and experimental hypnosis in medicine, dentistry, and psychology (2d ed., p. 276). Philadelphia: Lippincott.

[5] Spiegel, H., & Spiegel, D. (1978). Trance and treatment: Clinical uses of hypnosis (p. 234). New York: Basic Books.

[6] Watkins, J. (1987). Hypnotherapeutic techniques (p. 291). New York: Irvington.

[7] Spiegel, H., & Spiegel, D. (1978). Trance and treatment: Clinical uses of hypnosis (p. 234). New York: Basic Books.

[8] Watkins, J. (1987). Hypnotherapeutic techniques (p. 292). New York: Irvington.


Hypnosis in America

In an previous post I described how hypnosis began as a form of healing in the sleep temples of the Egyptians around 1550 B.C., and is inseparable from the origins of modern psychology and medicine. Going back to Mesmer in the last quarter of the 1700s, hypnosis was investigated intensely by psychologists. Simultaneously, hypnosis was used as anesthesia, with thousands of surgical operations performed using hypnosis.

Hypnosis was commonplace in the mid-1800s when chemical anesthetics were discovered. Street-corner “tent-shows” were popular entertainments where hypnosis was demonstrated, along with new inhalation drugs and other wonders of chemistry. It was at one of these shows that Horace Wells first got the idea of use nitrous oxide for dental extractions. As chemical anesthetics became popular, the widespread use of hypnosis for anesthesia declined.

In the 1800s there was a deep interest in metaphysical, psychic, and spirit phenomena, and this spawned different types of spiritual healing and mental healing movements. Because hypnosis was already widely known, it was natural for some spiritual healers to induce trance as part of their method. Their movements usually presented their cures as coming from a spiritual source, but the cures probably resulted more often from the combination of trance with the suggestions of the healer and the belief of the subject.

Fortunately, despite the appropriation of hypnosis for tent-shows and spiritual healing, the scientific and academic investigation of hypnosis continued. In the first half of the 20th century Joseph Jastrow taught hypnosis at the University of Wisconsin. His student, Clark Hull, became an experimental psychologist at Yale University who advanced hypnosis research significantly. In 1933 Hull published Hypnosis and Suggestibility, the first major review of hypnosis applying the standards of modern experimental psychology. Ernest Hilgard and Andre Weitzenhoffer conducted significant research at Stanford. Hypnosis gained even more scientific attention when it was used in World Wars I and II and the Korean Conflict to treat war neuroses. Since that time, hypnosis has remained a subject of rigorous scientific study.

Quite apart from the detached academic study of hypnosis, the 20th century had several influential figures using hypnosis in the field. Dave Elman, a hypnosis performer who popularized a rapid induction method of hypnosis, taught his techniques to many doctors and physicians. The American psychiatrist and psychologist Milton Erickson was one of the greatest influences on the hypnosis field. His theories that the unconscious mind is always listening led to indirect techniques of hypnosis, including subliminal suggestion and neurolinguistic programming (NLP).

In the 20th century hypnosis has also been approved by the following major medical and psychological organizations:

• 1955 – The British Medical Association approved hypnosis for treatment of neuroses and for anesthesia during childbirth and surgery, and recommended hypnosis training for medical students and physicians.

• 1958 – The American Medical Association approved hypnosis as a therapeutic procedure and recommended hypnosis training for medical students. In 1987 the AMA rescinded this along with all endorsements made before 1958).

• 1958 – The Canadian Medical Association endorsed hypnosis.

• 1958 – The Canadian Psychological Association endorsed hypnosis.

• 1960 – The American Psychological Association endorsed hypnosis.

• 1961 – The American Psychiatric Association endorsed hypnosis.

From an historical standpoint it is interesting to note that, although hypnosis was at times attached to various passing fads and movements, the clinical practice and scientific study of hypnosis have survived. That alone is a great testament to the enduring power of hypnosis to help people. Thankfully, the medical and academic fields have continued to use and validate hypnosis as a therapeutic procedure, and hypnosis research seems as active as ever. A search of medical periodicals for the terms “hypnosis” or “hypnotherapy” yields over 13,000 results. With new ways of understanding the mind, the brain, consciousness, and memory, I am excited to see what new understandings of hypnosis the 21st century may bring.