When is hypnosis contraindicated?

Contraindications for Hypnosis

Hypnosis is a therapeutic tool used in various clinical settings, but it is not suitable for everyone. Certain conditions and patient characteristics can make hypnosis unsafe or ineffective. Below are expanded details on when hypnosis is contraindicated:

1. Psychotic Disorders

Patients with psychotic disorders such as schizophrenia or bipolar disorder (during manic or depressive episodes) may experience worsening of symptoms when subjected to hypnosis. Hypnosis can sometimes blur the line between reality and fantasy, potentially exacerbating hallucinations, delusions, or disorganized thinking. Hypnosis may also reduce the patient's critical judgment, increasing vulnerability to suggestion in a way that could trigger psychotic symptoms.

• Reference: Spiegel, D., & Cardena, E. (1990). Disintegrated experience: The dissociative disorders revisited. Journal of Abnormal Psychology, 99(3), 308–317.

• Reference: American Psychological Association. (2014). Hypnosis for clinical use [APA Division 30].

2. Severe Personality Disorders

Certain personality disorders, especially borderline and antisocial personality disorders, can complicate hypnotic treatment. Patients with borderline personality disorder may have difficulty maintaining boundaries and emotional regulation during hypnosis, which could lead to distress or unpredictable reactions. Antisocial personality traits might result in resistance or manipulation during the hypnotic process.

• Reference: Lynn, S. J., & Rhue, J. W. (1991). Theories of Hypnosis: Current Models and Perspectives. Guilford Press.

3. Severe Cognitive Impairment

Individuals with dementia, intellectual disabilities, or severe developmental delays often cannot engage effectively in hypnosis because it requires a certain level of comprehension, attention, and cooperation.

• Reference: Nash, M. R., & Barnier, A. J. (2008). The Oxford Handbook of Hypnosis: Theory, Research, and Practice. Oxford University Press.

4. Epilepsy

Although rare, there are reports that hypnosis can provoke seizures in patients with epilepsy. The mechanism is unclear but may involve the alteration of cortical activity during hypnotic states.

• Reference: Duncan, R., & Raz, A. (2017). Hypnosis and seizures: A review of the literature and clinical implications. International Journal of Clinical and Experimental Hypnosis, 65(2), 213–227.

5. Unstable Medical Conditions

Patients with unstable cardiovascular or respiratory conditions, acute infections, or other urgent medical problems should avoid hypnosis until their condition is stabilized because hypnosis may temporarily alter autonomic functions (e.g., heart rate, blood pressure) and mental state.

• Reference: Hammond, D. C. (2010). Hypnosis in the treatment of anxiety- and stress-related disorders. Expert Review of Neurotherapeutics, 10(2), 263–273.

6. Substance Abuse

Patients currently intoxicated or undergoing withdrawal from alcohol or drugs may be poor candidates for hypnosis. Altered mental status due to substances can impair concentration and responsiveness to suggestions during hypnosis.

• Reference: Kirsch, I., Montgomery, G., & Sapirstein, G. (1995). Hypnosis as an adjunct to cognitive-behavioral psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 63(2), 214–220.

7. History of Trauma or Abuse

While hypnosis can be helpful in trauma therapy, it must be undertaken cautiously by experienced clinicians. Hypnosis may inadvertently trigger traumatic memories or dissociative states in vulnerable individuals if not carefully managed.

• Reference: Lynn, S. J., & Rhue, J. W. (1991). Theories of Hypnosis.

8. Lack of Willingness or Cooperation

Hypnosis requires active participation and willingness from the patient for effective outcomes. If a patient is unwilling or skeptical to the point of non-cooperation, hypnosis is unlikely to be successful and may cause frustration or distress.

• Reference: Elkins, G., Barabasz, A., Council, J., & Spiegel, D. (2015). Advancing research and practice: The revised APA Division 30 definition of hypnosis. The International Journal of Clinical and Experimental Hypnosis, 63(1), 1–9.

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