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What Do We Know and When Do We Know It? Hypnosis Research, Cochrane Reviews, and Evidence-Based Medicine

Albert Einstein wrote, “We can understand almost anything, but we can’t understand how we understand.” In pragmatic terms, though, how we understand is exactly what we must specify. In order for knowledge to be communicated among researchers and practitioners, we require agreements specifying how and when we know something. We can think of research methodologies as representing a consensus, which develops over time, of how to know. When results obtained by accepted methods reach specified levels of significance, we agree that an effect has been demonstrated adequately to be added to our fund of knowledge, or at least to merit further study. The wrinkle in this neat description, of course, is that there is not universal agreement as to what the standards should be. Some scholarly journals are more highly regarded than others; universities are not all equally demanding; and not all fields of scientific endeavor are considered to be equally rigorous or “scientific” by those in other disciplines. Clinical research involving treatment of human beings is especially vulnerable to criticism of its rigor. Moreover, research involving hypnotic treatments must address and overcome a particular historical handicap. We must respond to skepticism about what hypnosis is (and our own lack of agreement about this) and whether it is real. This adds special considerations and importance to the design of studies that demonstrate whether it is indeed the hypnosis that is responsible for the benefits when clinical results are shown. The pages of this and other scholarly journals are filled with studies that predict, describe and measure the effects of hypnotic interventions. Yet our methodologies and body of knowledge have not, thus far, led to widespread understanding and acceptance of the power and healing potential of clinical hypnosis. As one important example, the World Health Organization (WHO) does not recognize hypnosis as an effective intervention (for anything) because the studies that could demonstrate effectiveness according to its criteria for Evidence-Based Medicine are only now being carried out. Without this recognition, there are real limitations to the ability of those within the professional hypnosis community to apply techniques that we believe we know are effective, to teach these techniques, and even, in some ways, to carry out further research.