Hypnotic and therapeutic communication

Emmanuel Boselli: Anestesiólogo.

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Non-pharmacological approaches to increase patient comfort during anesthesia procedures

Abstract

Hypnotic and therapeutic communication are increasingly recognized as effective non-pharmacological tools to improve patient comfort, reduce anxiety, and optimize perioperative experiences. This article explores the mechanisms underpinning suggestive language and the influence of non-verbal cues, as well as practical applications of hypnotic techniques during both regional and general anesthesia. Clinical examples and field studies are presented to illustrate how positively framed communication can modulate a patient’s perception, increase satisfaction, and contribute to improved clinical outcomes without altering pharmacological management. Specific techniques, including the «hypnotic glove» and swaying-body induction, are analyzed.

 

Introduction

Patients facing anesthesia frequently experience anxiety, which can exacerbate physiological stress responses and negatively affect the perception of care. Although pharmacological sedation remains central in anesthetic practice, emerging literature supports the integration of therapeutic communication and hypnotic techniques as effective, safe, and economical adjuncts [1–3]. These non-pharmacological strategies can reduce anxiety, enhance comfort, and improve procedural cooperation. This article presents evidence-based methods of hypnotic communication in anesthesia, drawing on clinical experience, illustrative cases, and the author’s own research.

 

Understanding suggestion and the emotional brain

Under stress, the human brain becomes especially receptive to suggestion. The emotional brain, particularly the limbic system, does not process negation efficiently. As such, common phrases like «Don’t be afraid» or «It won’t hurt» can paradoxically focus the patient’s attention on pain and fear. By contrast, positively phrased statements such as «You are safe here, and I’ll ensure your comfort» provide the brain with a reassuring framework. The avoidance of negative formulations and the use of clear, calming language is foundational in therapeutic communication [1,4].

 

The Power of Words: From nocebo to comfort

Words can either soothe or sensitize. Expressions intended to reassure, such as «just a little prick,» may inadvertently heighten fear. In contrast, framing procedures in a positive and sensory-rich manner support emotional regulation and calm. For instance, suggesting, «You might feel light pressure—I’ll be right here with you,» focuses the patient on safety and presence. A study conducted with 234 patients before and after training operating room staff in therapeutic communication showed a notable improvement in patients’ emotional state, with pre-anesthesia calmness increasing from 17% to 32% [1].

 

Hypnotic communication techniques

Hypnotic communication does not require inducing a formal trance. It involves guiding the patient’s focus through suggestive and structured verbal cues. The speaker maintains a soft, steady voice and uses metaphors that evoke pleasant sensations or memories. Redirecting attention to engaging stimuli (such as music or screen images), and integrating confusion techniques (like surreal or unexpected phrases) can reduce resistance and induce a receptive state [5].

One such technique involves asking a nonsensical question, like «Does your truck still go to the pool?» which momentarily disrupts conscious processing and opens a window for suggestion. These approaches rely on tone, pacing, and the synchronization of breath and language [6].

 

Clinical applications

A series of case studies illustrates how hypnotic communication can be embedded into routine care:

1. Peripheral Venous Access: In a comparative study, three communication styles were used during IV insertion. The first used negative framing (“Watch out, this will sting!”), the second used neutral language (“I’m placing the IV now”), and the third used a confusional phrase (“Is your truck still going to the pool?”). The third group showed greater relaxation and cooperation, suggesting that unexpected language can reduce anticipatory anxiety [6].
2. Pediatric Surgery: A ten-year-old undergoing fracture repair was invited to focus entirely on a balancing bird figurine. This visual redirection allowed him to remain calm and diverted his attention from the procedural environment, showcasing the power of imaginative fixation and non-verbal hypnotic induction.
3. Epidural Analgesia in Labor: Women in labor responded positively to a swaying movement protocol, synchronized with breath and accompanied by metaphors such as «the waves rise and fall.» This method facilitated parasympathetic activation and reduced the discomfort of the epidural, while also enhancing maternal agency and focus [7,8].

 

Advanced technique: The Hypnotic Glove

The «hypnotic glove» is a classic technique for inducing analgesia through suggestion. Patients are guided to imagine wearing a thick, protective glove with specific texture, weight, and temperature. The process involves guided catalepsy and illusory choice, creating a vivid sense of control over sensation. This glove can then be «transferred» to another limb, reinforcing the suggestion of local analgesia. The glove can also be imagined and reapplied later, teaching the patient a tool for autohypnosis and pain management beyond the hospital setting [9].

 

Discussion

These communication techniques are accessible and do not require formal hypnotist certification. They rely on the clinician’s intentional use of language, tone, and attentional focus. Their implementation has been shown to reduce anxiety, enhance cooperation, and increase patient satisfaction. Furthermore, the use of physiological monitoring tools such as the Analgesia Nociception Index (ANI) has revealed objective changes consistent with parasympathetic activation during the application of these methods [5,10].

The impact is particularly significant in vulnerable populations, such as children and parturients, where verbal suggestion and emotional climate can significantly influence the experience of care. Training healthcare providers in this communicative approach can yield improvements in both patient outcomes and staff satisfaction [1].

 

Conclusion

Hypnotic and therapeutic communication techniques offer a practical, low-cost, and scientifically supported complement to pharmacological anesthesia. By attending to the emotional and cognitive dimensions of patient care, these methods reinforce a holistic approach. Their integration into routine anesthetic practice should be encouraged, especially in contexts where patients are awake or lightly sedated. Further clinical research, including randomized controlled trials, would help to formalize protocols and expand their application.

References

1. Boselli E, Demaille N, Fuchs G, Manseur A. Évaluation de la communication thérapeutique pour améliorer l’accueil du patient au bloc opératoire: étude d’impact. Can J Anesth Can Anesth. 2018;65:1138–46.
2. Brugnoli MP. Clinical hypnosis and relaxation in surgery room, critical care and emergency, for pain and anxiety relief. J Anesth Crit Care Open Access [Internet]. 2014 [cited 2025 Jan 13];1. Available from: https://medcraveonline.com/JACCOA/clinical-hypnosis-and-relaxation-in-surgery-room-critical-care-and-emergency-for-pain-and-anxiety-relief.html
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9. Paqueron X, Musellec H, Virot C, Boselli E. Hypnotic glove anesthesia induces skin temperature changes in adult volunteers: A prospective controlled pilot study. Int J Clin Exp Hypn. 2019;67:408–27.
10. Boselli E, Musellec H, Martin L, Bernard F, Fusco N, Guillou N, et al. Effects of hypnosis on the relative parasympathetic tone assessed by ANI (Analgesia/Nociception Index) in healthy volunteers: a prospective observational study. J Clin Monit Comput. 2018;32:487–92.