What’s actually happening in hypnosis? The neurophysiology of trance, and how it can support real change

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How Asclepieia Hypnotherapy Skipton harnesses not just the power of your mind, but authentically uses an evidence-based approach - grounded in neuroscience and years of healthcare experience

If you’re considering hypnotherapy, it’s very reasonable to wonder what’s actually going on. “Trance” can sound vague, even a bit mysterious, but in reality, it’s something we can describe in grounded, scientific terms.

It isn’t mind control. It isn’t sleep. And it isn’t about losing awareness.

Instead, hypnosis is best understood as a particular pattern of attention and brain activity - one that can make certain types of psychological work more accessible, and importantly, when it’s used well, those changes can translate into meaningful shifts in behaviour.

Trance as a state of focused attention

At its core, hypnosis involves a shift in how attention is directed. For most people this includes:

• increased focus on internal experience (thoughts, images, sensations)

• reduced attention to external distractions

• greater absorption in what’s being imagined or suggested

This isn’t unique to hypnotherapy. You’ve probably experienced something similar when:

• you’re deeply absorbed in a book

• driving on “autopilot”

• or completely focused on a task

Hypnosis deliberately creates and stabilises that state. From a neuroscience perspective, this involves changes in attentional control networks in the brain - particularly areas of the prefrontal cortex and anterior cingulate cortex (Landry et al., 2017).

What changes in the brain during hypnosis?

Neuroimaging studies (including fMRI and EEG) have identified some consistent patterns. While research is ongoing, hypnosis is associated with:

1. Altered activity in attention and control systems

There is evidence of changes in the dorsal anterior cingulate cortex, an area involved in:

• focusing attention

• monitoring conflict

• regulating responses

This may help explain why people can sustain attention on specific ideas or suggestions more easily during hypnosis (McGeown et al., 2009).

2. Changes in the default mode network (DMN)

The default mode network is active during self-referential thinking - like rumination or “overthinking”. During hypnosis, studies suggest reduced activity or altered connectivity in this network (Landry et al., 2017).

This is relevant because many difficulties (such as anxiety or insomnia) are maintained by repetitive internal narratives. A quieter DMN may make it easier to step outside those patterns.

3. Increased functional connectivity

Some research has shown increased coordination between brain regions involved in:

• executive control

• attention

• and imagery

For example, Kober et al. (2019) found changes in connectivity that may support greater responsiveness to suggestion. In simple terms, different parts of the brain may “work together” more efficiently in this state.

It’s not about losing control

One of the most important points, supported consistently by research, is that hypnosis does not remove your control - either during or after the session. People remain aware and can choose whether or not to engage with suggestions.

The British Psychological Society describes hypnosis as a collaborative process involving focused attention and suggestion - not a state where someone is controlled by another person (BPS, 2001).

That fact is really important, because effective hypnotherapy depends on:

• your engagement

• your goals

• and your readiness for change

How this leads to behavioural change

Understanding the brain state is only part of the picture. The key question is:

• “How does this translate into real-world change?”

There are several mechanisms that are supported, carefully, by current evidence.

1. Making helpful ideas easier to engage with

In everyday thinking, helpful ideas can struggle to compete with:

• habitual thoughts

• anxiety-driven predictions

• or long-standing beliefs

In hypnosis, with attention more focused and distraction reduced, people may find it easier to:

• engage with alternative perspectives

• imagine different outcomes

• and “try on” new ways of thinking

This is not about bypassing logic, it’s about creating conditions where new patterns can be explored more fully.

2. Working with imagery and emotional learning

The brain responds strongly to imagery. Research shows that imagined experiences can activate similar neural pathways to real ones (Kosslyn et al., 2001).

Hypnotherapy often uses this deliberately, for example:

• mentally rehearsing calm responses

• visualising coping successfully

• or revisiting situations in a more manageable way
  

Over time, this can support emotional relearning, a process also central to many other evidence-based therapies.

3. Interrupting automatic patterns

Many behaviours linked to low mood, stress or anxiety are automatic. They happen quickly, often outside conscious awareness. Hypnosis may help by:

• slowing those processes down

• increasing awareness of triggers

• and creating a “pause” where different choices can be made.

This aligns with broader psychological models of behaviour change, including those used in cognitive and behavioural therapies (NICE, 2011).

4. Supporting expectation and belief change

Expectations matter. There is strong evidence that what we expect can influence outcomes, sometimes referred to as expectancy effects (Kirsch, 1997). Hypnosis can work with this by:

• reinforcing realistic, helpful expectations

• reducing fear-based assumptions

• and building confidence in change.

Again, this is not about unrealistic positive thinking. It’s about shifting patterns that may be maintaining difficulty.

Why this needs to be done carefully

Although the mechanisms are grounded in science, applying them isn’t automatic. The same processes that make hypnotherapy helpful also mean it needs to be used appropriately. For example:

• imagery work can be powerful and needs to be paced carefully

• suggestion needs to be relevant and acceptable to the individual

• underlying mental health factors need to be understood

This is where my background and training make a significant difference.

A way of working shaped by NHS mental health practice

Before moving into hypnotherapy, I spent many years working in NHS mental health and patient safety roles as an NMC Registered Mental Health Nurse. That influences how this work is done at every stage. In healthcare, you’re trained to think beyond the technique:

• Is this appropriate for this person?

• What are the potential risks?

• What needs to be in place before we proceed?

Those same questions apply here, because while hypnosis can be helpful, it isn’t something to apply in the same way for everyone.

Staying within evidence - and safely within limits

The current evidence base for hypnosis is promising in many areas (such as pain, anxiety, and some behavioural difficulties), but it is not unlimited. The British Psychological Society and other professional bodies emphasise the importance of:

• avoiding exaggerated claims

• using hypnosis as part of a broader, evidence-informed approach

• and being clear about uncertainty where it exists (BPS, 2001).

That’s an important part of safe, ethical practice. It means:

• not presenting hypnosis as a cure-all

• not working beyond appropriate boundaries

• and being willing to adapt, or not proceed, when needed - and knowing when this is indicated.
  

Why this matters when choosing a hypnotherapist

Because hypnotherapy in the UK is not regulated in the same way as professions like nursing or clinical psychology, practitioners can vary significantly in:

• training

• understanding of mental health

• and approach to risk.

That makes it worth looking beyond techniques alone. A background as an NMC Registered Mental Health Nurse within the NHS brings:

• experience of complex presentations

• training in risk assessment and patient safety

• and a framework for evidence-based decision-making

Not as an add-on, but as a foundation for how the work is carried out.

What this means for you

In practice, this translates into hypnotherapy that is:

• grounded: based on established psychological and neuroscientific principles

• individualised: adapted to your specific situation

• measured: paced appropriately, not rushed

• honest: with realistic expectations

Because meaningful change doesn’t come from the “trance” alone. It comes from how that state is used - carefully, collaboratively, and appropriately.

Final thoughts

The neurophysiology of hypnosis is no longer mysterious. It reflects real, measurable changes in attention, brain networks, and cognitive processing, but those changes are only useful when applied thoughtfully. Hypnotherapy can support behavioural change by:

• creating the right conditions for new patterns to emerge

• helping you engage differently with thoughts and emotions

• and supporting gradual, realistic change over time.

And in a field where knowledge, skill and approaches can (and do) vary significantly, the way that process is managed - safely, ethically, and with professional judgement - is just as important as the techniques themselves.

References

• British Psychological Society (BPS) (2001) The nature of hypnosis. Leicester: BPS.

• Kirsch, I. (1997) Specifying nonspecifics: psychological mechanisms of placebo effects. In: Harrington, A. (ed.) The placebo effect. Harvard University Press.

• Kober, S.E., Schweiger, D., Reichert, J.L. et al. (2019) Hypnotic suggestibility modulates brain activity during suggestion. Neuroscience, 404, pp. 343–356.

• Kosslyn, S.M., Ganis, G. and Thompson, W.L. (2001) Neural foundations of imagery. Nature Reviews Neuroscience, 2(9), pp. 635–642.

• Landry, M., Lifshitz, M. and Raz, A. (2017) Brain correlates of hypnosis: a systematic review and meta-analytic exploration. Neuroscience & Biobehavioral Reviews, 81, pp. 75–98.

• McGeown, W.J., Mazzoni, G., Vannucci, M. and Venneri, A. (2009) Structural and functional correlates of hypnotic depth and suggestibility. Psychiatry Research: Neuroimaging, 174(2), pp. 164–171.

• National Institute for Health and Care Excellence (NICE) (2011) Generalised anxiety disorder and panic disorder in adults: management.