Understanding Hypnosis and How Change Happens in the Brain with Dr. David Spiegel

In today's episode, I'm joined by the global authority on clinical hypnonis, Dr. David Spiegel. Dr. Spiegel is the Director of the Center for Integrative Medicine at Stanford University School of Medicine, and co-founder of Reverie, an app that teaches personalized hypnotherapy and self hypnosis.

Dr. Spiegel discusses the stigma of hypnonsis, the resistance faced from the medical community towards hypnosis, creating a paradigm shift in medicine, how hypnosis works on a neurological level, taking hypnosis direct to consumers and making it widely available for pain mananagement, sleep, stress, anxiety and more.

This conversation offers a unique perspective on the the direction of medicine, and we dive deep into how healing and transformation happen in the brain.

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Transcript

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Flynn Skidmore: Hello and welcome to the Flynn Skidmore podcast. My goal is to help you become exactly who you want to be. We are here to help you take your biggest, boldest, most beautiful vision for life. And turn that vision into reality. Welcome back to the Flynn Skidmore podcast. Today, our guest is Dr. David Spiegel, a leading psychiatrist at Stanford medicine and co founder of Reverie, an app that teaches people self hypnosis for pain, addiction, sleep, smoking, and so much more.

This is a conversation that is jam packed with incredible information about how hypnosis works on a neurological level, how it contributes to change. We also dive into the stigmatization of hypnosis and how Dr. Spiegel's work is contributing to a paradigm shift in medicine by giving people direct affordable access to interventions that create true transformation.

I cannot wait for you to listen. So tell me about when you first learned about hypnosis. 

Dr. Spiegel: Well, uh, Flynn, hypnosis is something of a genetic illness in my family. Both of my parents were psychiatrists and psychoanalysts, and they told me I was free to be any kind of psychiatrist I wanted to be, so here I am.

Um, my, they were both trained, getting their analytic training when World War II broke out, and, um, my father, um, uh, was getting up from the analytic couch one day when his analyst said, Would you like to learn about hypnosis? And my father said, did I say something wrong in my analysis? You know, what's cause you know, they didn't talk much in those days.

And it turned out that a Viennese refugees named Gustav von Schaffenberg had escaped from the Nazis. Could not enlist in the U. S. Army, but had was a forensic psychiatrist who studied hypnosis, and he got into it because he had smallpox as a child, and he had a big smallpox scar in the middle of his forehead, and he noticed when he was questioning prisoners that sometimes they would just stare at the spot in his head and kind of nod off, and he got interested in hypnosis.

So that's He taught young army docs, um, how to use hypnosis. My father learned to use it for things like, um, acute traumatic stress reactions, uh, and pain management. And he was in combat in North Africa doing that. So he came back afterwards, kind of impressed by the things he'd been able to do with hypnosis, but went back to his analytic training.

And, uh, he was, uh, told, um, by one senior analyst who did hypnosis, um, uh, that, uh, Freud had given up hypnosis, so who was he to carry it on? He should go back to his analytic training, it'll ruin his reputation. Uh, but he was fortunate in his institute to have a very famous supervisor named Frieda von Reichman.

Who said, Herbert, what are you so precious about your reputation for at this stage? You're going to teach a course in hypnosis at the Institute because I'm going to take it. She kept him in it and he, for a while, went back to mostly analytic work, but he, he did the unusual thing at the time. He started calling up his patients afterwards to find out how they were doing.

And a lot of the analytic patients were saying, well, thank you, uh, you know, I feel somewhat better, uh, but, uh, if you're looking for patients, I'll talk to some of my friends. Um, but the hypnosis cases were doing very well, you know, they'd gotten over their flying phobia or dog phobia or stop smoking. So he gradually shifted his practice and the dinner table conversations, uh, Flynn, were pretty interesting.

I got to watch him make movies of patients who had. Non epileptic seizures, you know, he'd induce the seizure in them and teach them to control it. It was pretty impressive Wow So when I got to medical school, I thought well you ought to take a hypnosis course. So I took one at Mass General and my first patient That I reused hypnosis with I was on pediatrics clerkship and the nurse says Spiegel your next patient is in room 334 she's in status as Madagascar and I could just hear the wheezing down the hall and I walk in the room pretty 15 year old blonde knuckles white struggling for breath Her mother standing in the room crying, nurse in the room, and she'd twice been unresponsive to subcutaneous epinephrine.

They were thinking about inducing general anesthesia and starting her on steroids. I didn't know what else to do. So I said, you want to learn a breathing exercise? She nods. So I get her hypnotized and then I break into a sweat because I realized that we hadn't gotten asthma in the course yet. So, so I, uh, I said, um, And for something very subtle and very clever, I said, each breath you take will be a little deeper and a little easier.

And within five minutes, she's lying back in bed, she's not wheezing anymore, her knuckles aren't white, her mother stopped crying, the nurse ran out of the room, my intern comes looking for me. And I thought he was going to pat me on the back and say, nice job, Spiegel, you know, what'd you do? He said, the nurse has filed a complaint with the nursing supervisor that you have violated Massachusetts law by hypnotizing a minor without parental consent.

No. You know, Massachusetts has a lot of weird laws, but that's not one of them. And her mother was standing next to me when I did it. Um, so he said, you're going to have to stop doing this. And this, Flynn, is part of the story with hypnosis. I said, why? He said, it's dangerous. And I said, well, you are going to give her general anesthesia and put her on steroids.

And you think my talking to her is dangerous? I don't think so. So I said, Take me off the case if you want, but as long as she's my patient, I'm not going to tell her something I can see is not true. So he stopped off and there was a council of war over the weekend with the chief resident, the attending, and um, they came back with a radical solution on Monday.

They said, let's ask the patient. And she said, I like this, you know, so, uh, she had been hospitalized every month for three months since that asthmatic, because she did have one subsequent hospitalization, but then went on to study to be a respiratory therapist. And I figured that anything that could help a patient that much, that fast, that right under my nose, right in front of me, um, and violate a nonexistent Massachusetts law and frustrate the head nurse had to be worth looking into.

So, I, that was the first of about 7, 000 people I've used hypnosis with in my career, but it was just, you know, it was in my face that, you know, this worked and it worked fast and it taught the patient a sense of mastery over a symptom that she had been just totally overwhelmed by. And of course, as you know, from your studies of You know, unconscious and conscious experience that people kind of get into a mindset, um, about a symptom like asthma, which scares the hell out of them.

And the more anxious they get, the worse it gets, the more it triggers this fight or flight reaction that makes it worse. And if you can just teach them a way to begin to gain control from the body up, um, you can often help them a great deal with problems like asthma, like pain, like. Phobias, like anxiety, and so I've been doing that ever since.

Flynn Skidmore: Do you think that something like asthma can be permanent, like the symptoms of asthma can be permanently stopped? 

Dr. Spiegel: Well I think they can be certainly permanently de escalated. That is there, you know, there are reasons why people get bronchoconstriction and there may be some autoimmune component. Uh, they, they may be reacting excessively to something in the air they're breathing.

Uh, but what happens then is when they start to panic, understandably, as they're having more difficulty breathing, getting air, they sometimes make it worse instead of better. So what you can do is interrupt that cycle of psychological and physical reactivity that just Pushes you down the path to a full blown asthma attack and instead help them better manage it.

And that's true with pain and a lot of other things. It's not all or none, but can it have a sort of deescalating effect on this cycle of anxiety and symptomatology? 

Flynn Skidmore: Yes. When you went in that moment where you went into her room, you applied hypnosis with her. What year was that? 

Dr. Spiegel: And I only think, uh, that was about 1970, 1970.

Flynn Skidmore: And so my takeaway from that, I have a lot of takeaways. One of my takeaways is that conventional medicine at the time was terrified of hypnosis and wanted to reject it. What, what do you think was going on? Why, why is it, was hypnosis something that was so stigmatized? So 

Dr. Spiegel: well, I've been struggling with that all my career.

Um, I think. In part, it's because we have this prejudice in medicine that the only real treatments are the physical ones, incision, ingestion, or injection, that if you're not doing something biomechanical to people, you're not doing anything. And the idea that this three pound organ that sits on the top of our body and is connected to every part of the body doesn't have some Important control features in dealing with illness is sadly, it's ridiculous, but it's widely held.

So I think part of it is that is just prejudice against psychological psychiatric mind, body, mind, brain, body control issues. They aren't real. They can't be real. So the second thing. Is, uh, there's no money in it, you know, um, I, and I, you know, I'm a doctor, I prescribe medications, some meds have made remarkable changes in how people live, so it's not one or the other.

Big pharma is big business, it's big money, and, uh, I don't have a team of ex cheerleaders going around to doctors offices convincing them that hypnosis would be a great thing to do with patients the way pharma does. Um. And, you know, when they say, you know, so these prejudices about hypnosis, either useless or dangerous or both, um, uh, is, you know, you compare how dangerous hypnosis is.

Uh, to the fact that 88, 000 Americans died of opioid overdoses last year alone. The CDC is expecting 111, 000 this year. And most of them are not suicides, they're inadvertent respiratory arrests because opioids inhibit respiration and they do that via different receptors in the brain than the ones that control pain or give you a high.

And so people think, well, my pain's getting worse, I must need more opioids. But the receptor that suppresses respiration doesn't know that. And so they just go to sleep and they don't wake up, you know, that's what happened to Prince, you know, the fabulous musician, guitarist performer, uh, it's happened to hundreds of thousands of people.

And so you want something that's dangerous. You got it. And you have situations like Purdue Pharma, you know, getting rich over getting people hooked on Oxycontin. And I'm here to tell you that I, I sat in, I can remember sitting in my seat at Harvard Medical School, being told as a medical student that people who use opioids for pain control don't get addicted.

They're not just street junkies taking heroin. Well, the opposite is true, that you get reflex hyperalgesia if you're taking them for pain control, you're trapped. Because as you're starting to withdraw, the pain gets even worse than it was when it started. Uh huh. And, and so, but these drug companies went around convincing people that, um, you wouldn't get addicted to opioids if you used them for pain, and that it was cool to take Oxycontin and other drugs like that.

Now, you know, there are lots of things we need to do to help people with pain. I understand that. Opioids can be very effective in reducing pain. That's why we have endogenous opioids in our body. The fact that they are so overutilized and overvalued for pain, particularly chronic pain, where they are not a good idea.

And techniques like hypnosis, which works, and we've shown that in randomized clinical trials, that hypnosis is an effective analgesic and anti anxiety agent during surgical procedures that don't utilize general anesthesia. But it's not used. And I'm just, I'm tired of the prejudice and, and that's why I built our Reverie app, because I want to go direct to consumer.

I want people to get to try it, because I've been, you know, thinking all my career, you know, build it and they will come. Publish enough research, prove that it works clinically, show how it works in the brain. I've done all that, as have many of my other colleagues. And, um, you know what, it hasn't happened.

And I just figured, you know, four years ago, aerial polar serial entrepreneur comes up to me at a brain mind summit and says, David, would you like to try and build an app and see if we can do this? And I said, you're on, you know? You know, we built Reverie, we've had half a million downloads, um, people are using it for stress and pain and anxiety, and I just thought, you know, I can't keep doing this forever.

I love my work, I'm still seeing lots of patients, but I want to reach people who otherwise could never get to me or colleagues like me. And that's why I'm doing 

Flynn Skidmore: it. It sounds like you were interested in creating a paradigm shift and are interested in creating a paradigm shift. You played by the rules of the paradigm.

You produced the research to say this works. One of the things that really stands out to me and. What you've shared thus far. So when you, when you met that 15 year old girl in her hospital room and you helped her body relax, you helped her manage her own symptoms. And then I compare that to what you're saying about people's opioid use and someone who's experiencing pain, who's not being taught how to manage that symptom on their own or how to influence that symptom on their own, what they're taught.

Yeah. Is that the way to manage that symptom is to take more opioids and then people take more opioids and then they end up dying as a result, whereas you're you're here to teach someone about like, I imagine someone almost hyperventilating or in a state of, uh, An asthma attack is similar to the experience of pain.

And if a person can be taught to relate to that experience in a different way, then they can be taught to manage those symptoms differently. You want to create a paradigm shift where that's available for more people. You played the game as it was supposed to be played and it wasn't enough to change anything.

So then you had to go into the commercial world and create a cultural shift by giving the people the tool in their hands in an affordable way. 

Dr. Spiegel: That's very well stated, Flynn, that's exactly right. I thought it would work. And I, you know, for me, it's kind of a legacy project, you know. I know I'm not going to be around doing this forever.

I have colleagues, too. I've trained doctors throughout my career to do it. And there are some of them, but not enough. And, and I realized that, you know, I used to be worried about, you know, what would happen if we were just going around hypnotizing people. And I realized from my own research and others that all hypnosis is really self hypnosis.

It's getting in touch with and controlling aspects of your own mental experience that you may not have thought you could do. And so all I'm doing is showing people how to do it. And, um, what's wrong with that? You know, it's just teaching people to make better use of their own mental resources. And it doesn't mean you can do everything with your brain, but you know, it doesn't come with a user's manual.

You know, there's no reason to think that people, and just like you're doing with your podcast, teaching people how to better use their brains. Um, and, and there's no reason why there isn't a hell of a lot we can learn about how to use them better. And that includes using your hypnotic ability. 

Flynn Skidmore: If I'm so if I'm tracking what you're saying over the last 50 years since.

It's in 1970 when you walked into that 15 year old girl's room, um, there is a rejection of hypnosis because it involves something that's non mechanistic. Like we don't really understand, I mean, in some ways we understand the relationship between the mind and the body, but it's not an injection or it's not doing something to the body.

It fits outside the mechanistic worldview of medicine. And also there's a financial interest in not including something like that. So you've been up against those two things. What are you seeing now in terms of the stigma of hypnosis? How, like what, in this process of getting 500, 000 people to download your app, like what, what's your sense of the perception of hypnosis now?

Dr. Spiegel: Well, uh, you know, I'm hoping and thinking it is getting better. Um, you know, there's been a tremendous movement in the U. S. in the last. 30 years in the direction of integrative medicine. Um, more people go to visits of integrative practitioners in the U S than they do to mainstream medical practitioners.

It's a lot, they spend more money out of pocket for integrative care than mainstream care. And that's another reason why. I decided to go direct to consumers because they're the ones who have led the charge with mindfulness and acupuncture and functional medicine and all these other non pharmacological ways of dealing with medical problems.

So I'm thinking, well, you know, doctors are kind of agreeing with it to some extent. They've grudgingly gone along with it. They just take your other drugs, but do this too. That's fine, which they didn't say, you know, 30 years ago. Yeah, but still, um, so. I think we're making some headway and I, I'm, I'm hopeful that people are getting interested and excited in, uh, in watching what they, what people can do with hypnosis.

That isn't, you know, a stage show trick. And, you know, one of the, one of the other reasons, uh, Flynn that we've had so much. Difficulty is if you ask most, most people, well, what do you know about hypnosis? And they say, well, in high school, we had this hypnotist come and perform it in the auditorium and we made the football coach dance like a ballerina.

You know, that's what they think of. And it either amuses or scares people, but it sure doesn't look like a health class and how to manage your body better. But, you know what, there is an embedded secret in that. And just as you teach people about understanding, you know, their unconscious and the realm of feelings and not just cognitions and all that.

What that shows people is, you know what, you can very rapidly try out being entirely different and see what it feels like. So I'm not recommending that, you know, football coaches become ballerinas, but there is a message there. And the message is, you don't have to decide what's wrong with you. You don't have to step by step go through changing your approach to problems.

You can just see whether you can. Change your body's reaction to the stressor such that you begin to control your asthma attack, or you can make your pain manageable. I had a lovely young woman who was seven months pregnant, had terrible lower back disease. As the baby grew, the back pain got worse, they couldn't give her drugs, and they'd implanted a nerve stimulator, which didn't work.

And so, um, I, she, her pain was seven out of 10. When we started, I had her imagine in hypnosis that she's floating in a warm bath, warm, tingly numbness, filtered the hurt out of the pain. She says, it's down to three. I can live with that. And I said, but you look angry. And she said, I am. Why in the hell are you the last doctor I got sent to instead of the first?

And she was right, you know, and so unfortunately they tend to send people to our integrative medicine center at Stanford, um, uh, when they've run out of other tricks, you know, and nothing else works, then they come to us. Why shouldn't it be the first thing? And that's another reason that we built Reverie.

If people are waiting to get an appointment to deal with pain, to get in a pain clinic, try the app, you know, see if you can teach yourself to, to float in a, in a warm bath or an ice water and filter the hurt out of the pain. And even if it's just a holding operation for a while. You'll be more comfortable till you get some other evaluation and treatment if that's what you want, but it's so simple It's so usable that why in the hell isn't it the first thing people try instead of the last now You know if you're having crushing substernal chest pain, you probably should go to an ER and not control the pain with hypnosis Yes, so sure, you know you need medical evaluation and treatment But you don't need to suffer more than is necessary if you learn ways to manage your pain or manage your stress and anxiety.

So, um, it's, it's simple, it's easy, it's accessible and people ought to try it. 

Flynn Skidmore: In the, in the football coach to ballerina example, one of the things that you said, which, which I find to be one of the most interesting pieces of hypnosis, you said create something, something like creating the conditions in which it's safe For a person to explore change, a change in their identity.

So the football coach might be rigidly attached to a particular identity and might reject anything that doesn't fit within that identity. And that football coach's psychological safety is predicated on remaining as the identity, right? And then all of a sudden he's hypnotized and he's dancing around like a ballerina.

He's exploring a different identity. Now, my, I did a lot of studying of chronic low back pain about a decade ago, so I may be outdated, but what I remember is that chronic low back pain is the second costliest medical problem, uh, or the problem for medicine right behind cancer and that the number one correlate With chronic low back pain was job dissatisfaction, so it's not measuring.

It's not measuring a herniated disc. It's not something that we can measure through imagery. Someone with the worst herniated disc could have zero chronic back pain. Someone with no herniated disc could have a debilitating back pain. And that to me. Speaks to something happening with the connection between mind and body and identity.

And I'm curious about your take on that, like what's happening with the experience of pain and how it relates to identity and 

Dr. Spiegel: well, you know, it's the term of art is secondary gain that there's some advantage from suffering the way you are, even though you're suffering and it may be as you're saying, if you're really fed up with your job, don't like it.

Can't do it well, whatever it is, that the pain becomes a sort of face saving way. to extract yourself from the situation. Um, and you know, back pain is this, you know, it's a complex problem. Um, but it's one that is actually not in general well managed by surgery. It's, it's very expensive and often people, not always, but often people aren't a hell of a lot better after the, the, you've used their discs, you know, you've used two or three discs, but then what you're doing is building in further rigidity.

in the back so that the discs above and below the fusion, uh, then get more stretched than they would have, uh, you know, away and the nerves are more damaged farther away from it. So, you know, there are no perfect fixes surgically. And, and teaching people to manage their pain better and again, you know, some of it is just when you hurt, you're frustrated, you're scared, and that gets you to pay more attention to it.

And one of the cool things about hypnosis is that one of the key things that happens in the brain is that you turn down activity in the salience network, the dorsal anterior cingulate, which is your alarm system, you know, so if you just broke your ankle. that system says, ouch, you better do something about this.

But, you know, we tend to treat all pain as if it were acute pain. You know, when you have a new pain, you better figure out what it is and get protected. But after a while, it's more of a nuisance than a help. And if you're doing what you need to do medically to deal with it. You don't need to pay more attention to it.

So people, but people's frustration with it, their fear about it tends to amplify rather than diminish the pain. And hypnosis can help people to do that and literally reduce how much pain they have. 

Flynn Skidmore: I've, I, uh, the, the amygdala is part of the salience network. Is that correct? So 

Dr. Spiegel: it's in the limbic system.

It triggers activity in the salience network. It's part of what the salience network pays attention to. It says there's a normal pattern in which the amygdala. Uh, which is, you know, fear and anger is not usually involved and it tends to be this mutual stimulation where the salience network fires off in response to activity, but it also triggers fear and anger from the amygdala.

Flynn Skidmore: And is it true that the, the larger the area that the, the larger the amygdala or the area that it takes up, the more sensitive a person is to fear and pain? Is that 

Dr. Spiegel: correct? Well, it tends to be. It's hard But you know, there's a saying that neurons that fire together, wire together, people who utilize, who often experience fear and anger will over time develop larger amygdalas because that part of the brain is being utilized more.

So the brain is constantly, you know, neuroplasticity constantly reshaping itself. And, you know, building new synapses in some areas and getting rid of synapses and others. And so, yes, the amygdala can, can grow over time and become more active. And 

Flynn Skidmore: that's right. I think that that really speaks to the profound benefit of hypnosis, if a person has lived a life where it's made sense to where there, maybe there's been a lot of trauma and it's made sense to be, to have a hyperactive salience network and be alert to fear and to stressors, their amygdala might grow over time. And that person is more sensitive to pain and more sensitive to stressors.

And it's that, that won't. Change unless they learn how to relate to pain or stressors differently, which I think meant, uh, hypnosis can do. 

Dr. Spiegel: Yes, it can. It can help. Um, what happens interestingly, one of the, you know, most children are highly hypnotizable. All 8 year olds are in trances all the time. You know, you call them in for dinner.

They don't hear you, um, work and play are all the same thing to a child. And it's too bad. We make them into little adults too early because they just enjoy learning. But as we develop. Sort of formal operations and learn to value reasoning more and experience and emotion less. Um, many of us lose some of that ability.

Um, but what happens to people who have suffered abuse of one kind or another in childhood is. Um, that they tend to over suppress emotional reaction. And so unlike people with, you know, the hyper arousal kind of PTSD who have constant, uh, explosions from the amygdala, get angry and frustrated and irritable all the time, sometimes they over suppress that they, they have used it as a defense against abuse.

And they, so they, they're less aware sometimes of when they're suffering one way or another and, and more like more 

Flynn Skidmore: number two stimulation. Yeah, right. 

Dr. Spiegel: Yeah. And that's, yeah. And that's got a defensive purpose. You know, I had patients who would just go to a mountain meadow full of wildflowers and just. You know, leave their body somewhere else.

It can be a successful defense. Now, most people who are highly appetizable, it isn't because they're maybe because of positive experiences, imaginative involvements. Parents read them stories every night when they went to sleep. So they look, they enjoyed their imagination. It was not an escape, but a positive experience.

So that can happen too. But what you're pointing out is that there are a number of ways in which the brain can manage. Okay. Uh, aversive experience, pain, distress. And, and the key is to learn to manage them better and use it to your advantage, not to your disadvantage. 

Flynn Skidmore: Let's, let's go into how hypnosis works.

You know, my, my, uh, one of my favorite topics is memory consolidation and memory reconsolidation. And based on what I understand about hypnosis, hypnosis is like an absolute accelerator of memory reconsolidation. Um, I'd love to hear from you about. Well, 

Dr. Spiegel: um, Hypnosis has three main components. It's highly focused attention.

Absorption, it's called you. It's like looking through the telephoto lens of a camera, which you see, you see with great detail, but you're less aware of the surroundings. So that's and when we get into sort of flow states, when we're enjoying things, when we're performing well, athletically, we just immersed in how we're relating to our body and what we're doing it.

Intensified focus. So that's the first part to do that. We dissociate, we put outside of conscious awareness, things that would ordinarily be in consciousness right now. And I think you've used this example in your podcast. Do you feel your feet on the floor, touching the floor? And until. You know, I mentioned it.

Hopefully, you weren't thinking about it. If you were, we could stop the interview right now, but we do it all the time. But in hypnosis, you do it in a more intense and extreme way where you just don't notice things ordinarily you might. So it's like getting so caught up in a good movie that you forget you're watching the movie and you enter the imagined world.

You become part of the movie instead of the audience. Um, and the third part, and that's the, you know, the football coach thing is, um, what people do. Yeah. Fear as suggestibility, but what it really is, is cognitive flexibility. So we find on psychological testing that more highly hypnotizable people, um, are better at set shifting.

That is, if you give them a task called the continuous performance task, part of the way that you do well in the task is to recognize that the rules are changing as you're taking it. So, you know, you'll get, you're right, you're wrong, you're right, you're wrong, and, and, and people who are more hypnotizable are better at letting go of the old formula and finding a new one.

And That's 

Flynn Skidmore: fascinating. 

Dr. Spiegel: And, you know, that is a perfect setting for therapeutic change, for, you know, saying, you know, the way I've been doing this ain't working, maybe there's a better way to do it. So You know, the silly example is a football coach who's saying, Oh, I could dance like a ballerina. The good approach is I can handle conflict in my life differently.

Uh, I, I don't have to be constantly worried about my inadequacies when I'm trying to accomplish something I, I can be better than I sometimes think I am, or I think other people think I am. Um, I don't have to be victimized by this pain. I can manage it. You know, I manage a lot of other sensations. Why not pain?

You know, I can do that. And the brain can do that. So it's, it's this way of getting over yourself and trying out being different, see what it feels like. And if you want to go back to the way you were before, fine. But you might discover that, that you can very rapidly be different the way my asthma patient did where, you know, she's terrified one minute and the next minute she's lying back in bed and breathing better.

So, uh, it's a capacity and we know what happens there that one of the things that we see on functional MRI is that when people go into hypnosis, they have inverse functional connectivity. So functional connectivity is, uh, the, the blood oxygen level dependent signal in the MRI. Uh, if it goes up, one region is more active.

If you have inverse connectivity, when it's up in the prefrontal cortex, it's down in the posterior cingulate, the default mode network. That's a part of the brain where you sit there and reflect, who am I? What do people think of me? What should I be? What am I like? And you can inhibit activity by engaging yourself in the hypnotic experience.

So the football coach is Allowing himself to see what it would feel like to act like a ballerina, but he can also do it to control his pain to get to sleep to stop smoking. There are a lot of other ways you can use it in a way that you can help yourself. So hypnosis turns down activity in the salience network.

So the alarm system is turned off. Um, you also have more functional connectivity between the, the executive control network and the prefrontal cortex and the insula. The insula is this little island of tissue in the middle of the front of the brain that is a mind body conduit. So it's where the brain tells the body to get aroused or to slow down, uh, it's, uh, to breathe differently.

It's also, um, um, A way in which the brain can process through the insula what's happening in the body, we call it interoception. When you feel, you get to some sense of discomfort. It may be your GI tract, it may be something else. It doesn't feel right. Your brain registers that. So, the brain becomes more sensitive to how the body is feeling, but also how to control.

What's happening in the body. And, you know, we can do it, uh, to an extent in hypnosis that none of us would, would have thought we could do. So one, one time with a gastroenterologist buddy of mine, Kent Klein, uh, we got a bunch of highly advertisable people. Into the, uh, uh, into the hospital and early in the morning before they had breakfast and I had them in hypnosis eat a bunch of imaginary meals.

So we did a gastronomic tour of the Bay Area. Um, it was so vivid that one woman said after half an hour, let's stop. I'm full. And, and can put down nasal gastric tube and we got an 89%. Uh, increase in gastric acid secretion, just eating imaginary food. Now, normally your stomach secretes acid when it, when the food's coming down the pipe and you've got to digest it.

No, this is, so then we did something else. We said, um, you're going to be hypnotized and think about anything except food, you know, be on a desert island. Swim, sunbathe, whatever. And we got a 39 percent decrease in gastric acid secretion. So then Kent said, well, let's push it a little farther. We injected them with pentagastrin, which is a hormone that triggers the release of gastric acid in the stomach.

We still got a 19 percent decrease in gastric acid secretion in the people when they were hypnotized to do something other than think about food. So, uh, you know, you, the brain regulates far more than we think how the body reacts to all kinds of stimuli and it can do it in both directions. And so that connection between the prefrontal cortex and the insula is how the brain does it in hypnosis.

It intensifies 

Flynn Skidmore: the, the more cognitively flexible a person is, the more, uh, what, how did you describe it? Hypnotically suggestible. Hypnotizable. Hypnotizable. Okay. So the more cognitive, the person with the higher levels of cognitive flexibility, and the way that I'm understanding that, I really like the example of, uh, the game that they're playing and the rules change of the game and they're able to pick.

up on that and make different choices about how they're strategizing and approaching the game on the fly. They're dynamic and responsive rather than rigidly attached to how this thing is supposed to be done. Um, and when I think about, I'm actually filtering that through the lens of. Playing tennis, which I've, I've taken up in the last year and three months and I love it.

I love playing tennis and I'm starting to get to the point where I'm good enough to think about strategy, but I'm not good enough with strategy to be dynamic with my strategy. So I'll go in with a strategy and I'll be, you know, kind of rigid and nervous about it. Not totally in flow, kind of in my head thinking about it.

And then at the end of the set, I'll be like, Oh my gosh, now I see that in response to my strategy, they changed their play, but I didn't change my strategy in response. You know what I mean? I was rigidly attached to this thing and I imagine that being in a place of higher levels of cognitive flexibility is.

It's paired with the experience of being in flow, like confident, present, immersed in the experience, not so much in your head. And a person who's like that is a person who then is more hypnotizable, which then means they're more self hypnotizable. 

Dr. Spiegel: Yes, that's right. We call it absorption. People who are more hypnotizable are more likely to just get lost in a sunset, you know, or a rainbow.

They'll just totally get engaged with and forget about whatever else they were doing. They give themselves over to that. Another part of it is. Uh, and I heard you talking about this and talking about this sort of, you know, do you privilege the unconscious as more feeling that builds it rather than cognition and planning?

And in a sense, good athletic performance. Is more about how you relate to your body and immerse yourself as you mentioned in the experience and less about worrying about the outcome. There's a book called Zen and the art of archery in which a guy who is studying Zen masters distilled one idea that he starts the book with, which is that Zen master teaching archers would tell them don't focus on the target.

Focus on your relationship with the bow and arrow, because if the relationship is correct, the arrow will go where you want it to go. And if you think about it, that's obviously true. And so if you're, you're, you're learning this skill, you're still thinking about strategy. Um, but, but focused on, you know, the application of this new strategy as a kind of goal, which is a good, it's a usable goal, but eventually you want to get to the point where you can just.

Connect with your body in such a way that it's naturally doing what you want it to do. And part of that will be sensing how your opponent is reacting to you. So it becomes a both a motor but a sensory experience that you can immerse yourself in. I got called by the coach of the Stanford women's swimming team.

We have a fabulous women's swimming team. You know, their swimmers are in the Olympics all the time. But he noticed. That they were swimming faster in practice than they were in meets. Hmm. They thought, well, that's weird. You know, you would think, um, that, uh, you know, you're giving it your all, you've got all this tension and all this, you know, arousal and, you know, people cheering for you.

And it turns out that what they were doing was distracting themselves. By paying attention to how the women in the neighboring lanes were swimming and disconnecting themselves from how they were relating to their bodies and how to make their bodies work as well as they could. And so I had them do self hypnosis and practice swimming their best swim.

Not in a meet, but just focusing on themselves and their body in their own lane and forget about everyone else. Dissociate what else was going on. Cause you know, competitive swimming is not a contact sport. It doesn't matter what she's doing in the next lane. What matters is what you're doing with your body and they did better.

So it's a matter of using this mind body connection to your advantage. And focusing on the process more than on the outcome. 

Flynn Skidmore: That's such a fascinating example because what I'm hearing in there is not simply the awareness of the swimmer in the next lane, but a certain type of awareness where they're then comparing themselves and probably judging themselves relative to the swimmer in the next lane.

And the judgment is probably creating more rigidity in their body, making them less hydrodynamic, right? So, and what you're teaching them to do is to just. Be in love with the process of being in their lane without removing judgment from the system. So there's more fluidity in the system, 

Dr. Spiegel: right? Or, and it allows them more to engage with whatever it takes to help your body do the best it can and to enjoy the feeling of.

Um, using your muscles in ways that, you know, are as, as good as it can be and, and making that an experience that you immerse yourself in and, and you'll do better because you're not worried about doing better, you'll do better because you're engaging the feeling and the process of it more than the outcome.

Flynn Skidmore: You love the process more than you love the outcome of it. Same thing as Zen and the art of archery, right? Which people say all the time, you know, coaches say that all the time. People say that all the time. Be having a practical tool to teach someone how to actually do that, to access more cognitive, that's, that's a whole different thing because I know that so many people are confused.

They know the right words. Fully commit to the process, like fully like be in love with the process, detach from the outcome, but being able to actually access that there's so much confusion around that. 

Dr. Spiegel: Yes, there absolutely is. And people, you can see how you can slip from one to the other, Flynn, how you can start out meeting well, but then you make.

The goal is, well, am I doing it as well as I could be? You know, so you're evaluating rather than just immersing yourself in it. And what you want to do is immerse yourself. So one of the things we've done with reverie is we've, we've built a hypnopharmacy, which is basically go there, tell us what your problems are.

And we'll give you a prescription for. The kinds of exercises that they, we, we think will help you sleep better, um, manage your pain, focus on what you want to accomplish, immerse yourself in an experience in a way that allows you to perform, uh, better, um, stop smoking, eat more sensibly, there are a whole bunch of things so we can help people, um, put together a pattern of exercises Cheers.

That will help them do what they want to do better. 

Flynn Skidmore: Are you, uh, are you tracking results yet? 

Dr. Spiegel: We are, we are, and we haven't, we're analyzing it, we haven't, we're just writing things up for publication now, but we have many thousands of people, and what we're seeing is that within, uh, within 10 minutes, the, the vast majority of people, um, can significantly reduce their pain, significantly reduce their levels of stress.

We're finding that 19 percent of people. Um, stop smoking like period, uh, and the remainder reduce their, the amount they smoke. Substantially, um, one, uh, lovely woman who signed up for one of our studies, we've been evaluating people, we enroll them and measure them at baseline and all that. She said, you know, I smoked for 25 years.

I didn't even want to stop smoking. I like smoking, you know, but I thought you got this study. I'll see what happens. And the first time I didn't, I didn't like it much, but I went home that night and I lit up a cigarette and I looked at it and I said, fair, who needs this? And she said, and I haven't smoked since, and my friends can't believe it.

I'm helping them to stop smoking now. And she said, this is some kind of crazy ass voodoo shit. And I mean that in a good way. I mean it in a good way. And that's one of the things I love people surprise themselves. They surprise their loved ones. They just. They didn't think they could do it and they do it and it's that part of it is the intensity of focus.

Part of it is the approach we take, which is focusing on what you're for and not what you're against. You know, we, the people who use hypnosis are fond of saying the worst thing you can tell someone is don't think about purple elephants, you know, um, so you focus on what you're for respecting and protecting your body.

So the strategy is good. but it's also helping people just turn themselves over to the idea of being different and see what it feels like. And, and also dealing with stressors from the body up rather than the brain down. So, you know, Stress becomes a problem because there's a snowball effect where you see something that scares you or you think about a problem you have, and then you notice your body reacting to it.

Your muscles tense up, you start to sweat, your heart rate goes up, and then you notice that and you say, Oh, my God, this must be really bad. And you get more anxious. So it builds on itself. So we say get your do the one thing about a stressor. You're certainly can do something about which is how your body's reacting to it.

So get your body floating and comfortable. Imagine you're in a bath, a lake, a hut, ever floating in space. Now that you've gotten your body more comfortable, look at the same stressor and see if you can figure one thing to do that might help ameliorate the stressor, but keep your body floating. So you're not having the physical stress compound, the mental stress, and you can usually think through a better way of healing.

With a stressor when you're in that position. So people surprise themselves because they're doing it from the bottom up rather than the top down and they feel better very quickly. 

Flynn Skidmore: So if, if a person is in the habit of being themselves, the habit of a particular identity, that identity is paired with.

Certain physiological and biological processes and certain hormones, like their, their identity might be one that's paired with distress. So if they haven't yet had the experience of, of, of stepping out of that habit of their identity and entering deep relaxation, like floating, like you're talking about, they may have never had.

a physiological experience of considering how to navigate this stressor, how to ameliorate it from a relaxed place. They only know how to address it from the dis as the distressed version of themselves. So in hypnosis, you're asking them to try out a different identity, but that different identity is really not just about the identity.

It's about the physiological experience of that identity and then how that person deals with something. 

Dr. Spiegel: That's right. Well, you know, you know, um, uh, there's, uh, uh, I remember John Kennedy. Somebody said that, you know, he wrote Profiles in Courage and it said somebody that, uh, the definition of courage is grace under pressure.

And somebody quoted that to Kennedy. And he said, that reminds me of a woman I once knew Grace Kelly under pressure. But, um, It is true that many of us associate being under pressure with having stress with a certain kind of physiological fight or flight reaction, and that sometimes that's a good idea, you know, but sometimes it's not.

And the idea of having an array of responses where you can regulate your somatic response. To help you then better address the psychological stressor, uh, is like being different, you know, it's grace under pressure It's knowing when to be afraid and how to manage it. And so you're you're Exploring just like you're changing your tennis game It's a way of exploring your stress response system and saying there's more than one way I could do this and I'll try out this Way and see if it works better Options 

Flynn Skidmore: being able to see the options and a body that's in a more relaxed state is a body that's able to see the landscape of options.

Whereas a more distressed body is limited. So seeing the options and then being willing and responsive dynamic enough to actually choose a different option and practice it. Uh, before we wrap up, and this is, this has been one of my favorite conversations ever. I appreciate your experience, your insight, your knowledge, the, this app that you're, you're offering the world.

I think this is incredible. I love that you're using direct to consumer to shift the paradigm while also being incredibly legitimate in the academic world. Like I, I love that so much. I'm curious to know, what are some of the things that you are great at? Some of the things that you've accomplished that you don't think you would have access that level without self hypnosis.

Dr. Spiegel: Uh, well, I'll tell you a simple example. I, I was, I wanted a water ski. I really did. And I kept face planting in the water, you know, and I realized that I was doing exactly what you should not do. I kept my legs stiff because I wanted to be sure I was upright and, and, and I was bending my arms to try and control the pull of the boat.

And so I had very little body resilience to deal with, with waves and changes and acceleration all that. So I hypnotized myself and I just said, arms straight, knees bent, arms straight, knees bent. I just kept repeating that like a mantra. And all of a sudden, like my arms were just transmitting the pull of the boat.

I wasn't fighting the pull of the boat. I was accepting it. But I was absorbing the shock by having my knees bent so that I could change my relationship to the height of the water and it worked. So you know, and it's funny when I do these things, you know, like I know this is supposed to work, but I always get that same little hit of surprise.

God damn it. Really? I, my wife, Helen is a stem cell biologist at Stanford, Baxter professor. She had, she wanted to be in control of her labor and deliver her deliveries. and labor. And so we did hypnosis throughout her labor. And the first one, Dan, um, was 10 pounds, first baby. It's a big baby. Uh, she wanted to be in control of it, even though it was difficult.

So about halfway, I had her floating in Lake Tahoe pool, tingling and numb. And she said, David, you know, I teach pharmacology. There are drugs for this. That's it. You're floating in Lake Tahoe pool, tingling and numb, filtered air out of the pain. And she gave birth to Dan, uh, she was glad that she was in control of it.

It was a, it was a somewhat difficult birth, but it was fine. And, and I said to her, you know, you, you know, uh, just keep floating, you'll do fine. And, um, I had no pain at all. And she, she did very well. And the second Julia, Julia at breakfast, she said, I think I know what's coming. And by lunch, you know. She had delivered Julia and we were having lunch together.

So, um, it, uh, so I'm able to help other people like my beloved Helen. And I was able to help myself remain upright. And so I, I use it for all kinds of things. 

Flynn Skidmore: Would you, would you say that you love helping people? And is that what 

Dr. Spiegel: motivates you? Yes, absolutely. In eighth grade, the social workers came in and gave us this test called the Cooter Preference Rating Test.

It was supposed to predict, you know, what you were going to be in life and what kind of job you'd have. And the guidance counselor looks at my score and looks at me and says, David, you love people. You know, and she was right. You know, I do love helping people. You know, and what I love about this is, That it's fast and it's often effective and it's a kind of an interaction that, that I really enjoy because I feel like I can reach out and touch people and I can sort of, you know, I, I have, you know, things that I've developed as, as methods, but with each person that I work with, I, I'm sometimes listening to my own brain and words come to me about how to touch that person in a certain way, um, that, that often rings a bell and I love doing that.

Um, it's my own sort of self hypnosis along with theirs, you know, that's, 

Flynn Skidmore: that's the artistry of the work 

Dr. Spiegel: that, well, thanks. That's what I try to do. And I love, I love doing it. I, uh, I've, I've had, uh, you know, sometimes it's, uh, you know, uh, strange experiences, but I had a woman recently, a cancer patient. Um, who was a gourmet chef and had basically lost her taste as a result of some of the treatments.

And it was just so painful for her, you know, and, um, the problem was the more she'd cook these wonderful meals and she was a wine connoisseur and she would, you know, and she couldn't enjoy it. Vanilla, it was the only thing she could still taste, but nothing else. And so eating, which had been a real pleasurable experience, became a terrible one.

And I just, I thought of, um, uh, some lessons I'd had in wine tasting. And I said, well, you know, your taste buds may have a problem, but you've, you get more of your taste from your nose than you do from your mouth. So what I want you to do is. Hold the food in your mouth, inhale through your mouth, exhale through your nose, and see what you can, uh, taste.

And, um, she, you know, did the exercise with me, and then she went home. And I got this email from her the next day saying, I'm cured. I can taste things again, and I am so happy. You know, and so, you know, I had to kind of cook up that approach. Um, I've had people with tinnitus, you know, one was a lawyer who, um, uh, had six years of tinnitus was driving her nuts, you know, this ringing in her ears and, but she was a scuba diver.

And I said, well, I want you to imagine that you're, you're diving and you're in a world that is visually beautiful. And the only noise you hear is the bubbling of your regulator. And she, she comes out of it. And she starts to cry and she said, I can't believe it, but it's the first time, you know, I hear something, but it doesn't bother me.

And, and she said, I'm a lawyer. I'm not supposed to cry. We don't show our vulnerability. So it's wonderful for me when I can touch people that way, when I can help make their lives better. I love it. 

Flynn Skidmore: Are you, are you happy and fulfilled by what you've accomplished and are accomplishing? 

Dr. Spiegel: Sure. I, you know, there's always other, other challenges ahead, but absolutely.

I love what I'm doing and I feel privileged to be able to do it and, and to combine. And that's one thing that Stanford is great for, you know, if you're a professor there and you don't have a startup, you're just not doing anything. So I was able to build a research career. Studying emotional support for cancer patients, studying hypnosis and what goes on in the brain.

And there are many universities where that would be viewed as kind of a strange, you know, career path. But Stanford, if you can get the funding and publish the papers, go for it. You know, and, and I did. And at Stanford, there is an expectation. That you will go from bench to bedside, that you will help people benefit from what it is that you've discovered.

And I've been able to do that too. And I, so I feel very lucky. 

Flynn Skidmore: Before we wrap up, any, anything important that you'd like our audience to know? 

Dr. Spiegel: Well, I just, uh, I, I hope they will benefit from, from the exposure to Reverie, to give it a try, see what it feels like. The first week is free, so if you don't like it.

That's fine. But the great thing about reverie and hypnosis is the worst thing that happens is that it doesn't work. And often it does. And the other thing is you'll know right away, you know, even when your doctor gives you a prescription, you've got to go to the pharmacy, get the drug, try it out, see if it works.

Whereas you can tell within 10 or 15 minutes whether this is going to make you feel better or not. And if it does. You're adding to your own skill and mastery of something that's been troubling for a while. So, I just love the thought that while you and I are talking, I've been helping more people out there than I did in six months, you know, ten years ago.

Yeah. So, um, I feel privileged and lucky to be able to do it and I just hope people will Go to www. reverie. com or download the app from the App Store or Google Play and give it a try. 

Flynn Skidmore: And we'll, we'll put a link to the app in our show notes and I'll also share it on my, on my Instagram. Cause I'm, I'm so, I'm, I, such a huge fan of you, such a huge fan of hypnosis.

I use it all the time. I'm doing it well before I'm sleeping. I do it before tennis matches. I do it before clients. I did it before this podcast. I'm always. trying to self hypnotize my way into the most beautiful experience possible. And I just, I deeply appreciate the contribution you've made to the world, um, through your career.

And thank you so much for being with us here today. 

Dr. Spiegel: Thank you, Flynn. It's been my pleasure. Thank you for having me. What 

Flynn Skidmore: a fantastic conversation. I'm taking away so many things from that. One of the things is, it's just how much I appreciate Dr. Spiegel being a person who's been so ambitious and driven to help others and as a result has accumulated all of these extraordinary experiences and stories that he gets to share with us.

Another piece that stood out for me is the idea of cognitive flexibility and our capacity and willingness to try on different identities and the ways in which the habit of or the addiction to a particular identity is not just a thought experience, it's a physiological and a biological one. Dr. Spiegel, thank you so much for your work, for your contribution to the world.

Thank you for joining us on this podcast. I appreciate you immensely. And to our audience, as always, thank you so much for being here. I hope you got as much out of this as I did.