ADHD Medication May Enhance Hypnotizability
Methylphenidate may improve the response to hypnosis in those with ADHD.
Posted Aug 19, 2015
Approximately 11% of children and 2.5% of US adults have Attention-Deficit/Hyperactivity Disorder (ADHD), although this number varies from state to state. ADHD is characterized by problems with concentration and focus, and significant distractibility. Those with ADHD are at greater risk for depression, anxiety, challenges in relationships, and problems functioning at work or in school. Because of the difficulty in maintaining focused concentration, those with ADHD can develop ineffective coping strategies and have a hard time learning and making use of more adaptive ones.
The research to date suggests that psychotherapy, and cognitive behavioral therapy in particular, combined with medication, tends to produce better results than medication alone. Yet the very nature of ADHD symptoms can make it more challenging to benefit from a structured psychotherapy approach that require focus and completion of homework assignments.
Hypnosis and Focus
Hypnosis is often defined as a state of enhanced focus on one’s inner world versus the outer world. Everyone goes in and out of hypnotic states, referred to as trances, multiple times per day, often without conscious awareness of making this shift. As an example, one might have a vivid daydream of going on vacation while sitting in a work-related meeting. In fact, it’s very common to shift one’s focus from the outside world (i.e., the meeting) to the inner world (i.e., images of a warm, sandy beach, with cool ocean breezes, the sound of waves crashing on the shore, and the tangy-sweet taste of a frosty piña colada). These everyday trances are typically involuntary, and people are more prone to them when bored, tired, or engaged in repetitive activities such as jogging or driving at night.
Formal hypnosis is a therapeutic technique in which a hypnotherapist helps a client to deliberately shift focus, reframe, or even create a desired mental experience. Hypnosis has been linked to a number of benefits, including reduced stress and anxiety, better pain control, decreased nausea and vomiting, and improved athletic performance, to name a few. A recent study found that hypnosis facilitated specific learning modes by reducing competition between different attentional processes.
Hypnosis involves attending to hypnotic suggestions, and it would seem logical that those with ADHD would have greater difficulty paying attention to them. Yet, some research has shown that people with ADHD are in fact more hypnotizable and trance-prone than average despite challenges with focus.
ADHD Medication and Hypnotizability
Based on these findings, researchers from Hadassah – Hebrew University Medical Center in Jerusalem speculated that if those with ADHD could engage successfully in hypnotherapy, it might enhance their ability to learn and employ more adaptive coping strategies.
The team hypothesized that participants with ADHD would demonstrate lower than average hypnotizability at baseline, due to difficulties with concentration, but that the drug methylphenidate (e.g., Concerta and Ritalin), which is commonly prescribed to enhance focus, would also enhance hypnotizability. The team thus recruited 46 adults who presented with ADHD and had not taken ADHD medications previously. Participants’ hypnotizability was assessed using the Stanford Hypnotizability Scale, a standardized measure. Participants fell into low, medium, or high hypnotizability categories based on their scores. They were then prescribed methylphenidate and the dose was increased over time according to each person’s clinical response. Participants were followed for 12 weeks, at which time the same scale was re-administered.
The researchers found that those participants with lower baseline hypnotizability also required higher doses of medication to achieve clinical benefit with regard to attention. They also found that treatment with methylphenidate significantly increased participants’ hypnotizability scores. Notably, all participants who had initially been low scorers scored in the medium or high hypnotizability categories after having been on medication. Those who had lower scores at baseline showed the greatest gains by the end of the study.
Another notable find was that as a whole, the baseline hypnotizability scores among these ADHD patients did not differ significantly from scores in samples of people who do not have ADHD. Participants in this study tended to do worse on later items than on earlier ones, however, suggesting greater difficulty focusing as time went on.
The greatest benefits with regard to hypnotizability were seen in those participants who had the lowest scores at the study’s beginning. These participants also required higher doses of medication to attain clinical benefits with regard to attention and concentration. The team concluded that by enhancing the suggestibility of ADHD patients, they may be more likely to benefit from using hypnosis to address ADHD symptoms that often respond only partially to stimulant therapy alone or other psychotherapy interventions. This study was small, and the first to examine either hypnotizability in those with ADHD or the role of methylphenidate in enhancing hypnotizability in this group. But the findings suggest it is worth further research into the potential benefits of enhancing hypnotizability in this population and the subsequent use of hypnosis to treat ADHD symptoms.
For more information
Lotan, A., Bonne, O., & Abramowitz, E. G. (2015). Methylphenidate Facilitates Hypnotizability in Adults With ADHD: A Naturalistic Cohort Study. International Journal of Clinical and Experimental Hypnosis, 63(3), 294-308.
Nemeth, D., Janacsek, K., Polner, B., & Ambrus, Z. (2013). Boosting Human Learning by Hypnosis. Cerebral Cortex, 23(4), 801-805.
Traci Stein is a certified clinical hypnotherapist and adjunct professor at Teachers College, Columbia University. She is also the author of the forthcoming book, "The Everything Guide to Integrative Pain Management," and the creator of 6 self-hypnosis audio programs designed to foster healthy self-esteem, achieve better sleep, break old habits, quit procrastinating, and achieve a healthy weight.
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