Fiber, although not considered a macronutrient, has a RDA of 25 – 38 gm/ day again according to the National Academy of Sciences Institute of Medicine’s Food and Nutrition Board and is only available from plants. We know that the most healthful diet is one that is high in fiber and low in rapidly digested carbohydrates. This regimen is referred to as a low-glycemic diet because it helps keep our blood glucose at optimum levels. Wild fruits and vegetables are the original low-glycemic foods.
It is estimated that 97% of Americans do not consume the recommended minimum amount of fiber.
Shown above are a few example foods and their fiber density, expressed as grams of fiber per total grams of dry weight of food substance.
Generalizing, fruit and vegetables are significant sources of fiber, but beans and cruciferous vegetables are best and starch and grains much less so.
 Robinson, J. (2013). Eating on the wild side: The missing link to optimum health (pp. 4-5).
 Moshfegh, A., & Goldman, J. (2005). What We Eat in America, NHANES 2001-2002: Usual Nutrient Intakes from Food Compared to Dietary Reference Intakes. U.S. Department of Agriculture, Agricultural Research Service.
Heart disease is well-known as the leading cause of death in the United States as in other developed countries of the western world. The impact of this might be best understood by examining the years of life lost (YLL) to this disease.
Years of Life Lost due to Death: World
YLL due to premature mortality is calculated by multiplying the number of deaths at each age by a reference life expectancy at that age. The table below indicates a total of about two billion years of life lost globally to disease states. The diseases and injuries with the largest number of YLLs in 2015 were cardiovascular disease, lower respiratory infections, stroke, preterm birth complications, and diarrheal disease, shown in the following table.
Cause Global 2015
Lower respiratory infections
Preterm birth complications
Years of Life Lost due to Death: United States
In the United States, by far the leading cause of YLL is cardiovascular disease, followed by lung cancer, stroke, chronic obstructive pulmonary disease (COPD), road injury, and self-harm, as shown in the following table. The reason why road injury and self-harm (suicide) are so high on the list is that the cause of death occurs across the age spectrum – not just in older age.
Cause United States 2010
Despite declines over the past ten years, 15.9% of YLLs were related to cardiovascular disease and 4.3% were related to stroke – cerebrovascular – highlighting the continued dominance of vascular diseases in premature death.
Years of Life Lost to Disability: World
While the goal is to increase years in our lives, an associated need is to have life in our years.
Non-fatal health outcomes from diseases are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. This information has raised awareness about a range of disorders that primarily cause ill health but not death, such as unipolar major depression, bipolar disorder, asthma, and osteoarthritis.
A measure of this is “years lost to disability” (YLD) calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; “disability” refers to any significant short- or long-term loss of health and function.
Note that over three-quarters of a billion years are lost annually due to disabilities. Of these, mental disorders are the major cause of disability in the world, accounting for 22·7% of all YLDs. YLDs for this category as a whole have increased by 37% from 1990 to 2010. If one includes neurological and cerebrovascular diseases, directly related to mental, cognitive, and behavioral disorders – psychoneurological disorders – the importance of this category is further magnified.
Cardiovascular diseases did not contribute more than 5% of global YLDs, mental disorders being 20 times as important and neurological disorders about 5 times as important when considering years lost to disability.
Years of Life Lost to Disability: United States
YLD in the United States is similar to the global trend except COPD and diabetes outranks cancer and cardiovascular disease., as indicated in the following table Again mental or neuropsychiatric disorders, most prominently clinical depression, are the largest cause of years lost to disability.
Cause United States 2010
Major Depressive Disorder
Drug use disorders
Alcohol use disorders
Muscular skeletal disorders
low back pain
Total Musculoskeletal disorders
 Global Health Estimates 2015: Disease burden by Cause, Age, Sex, by Country and by Region, 2000-2015. Geneva, World Health Organization; 2016.
 Murray, C. J. (2013). The State of US Health, 1990-2010. Jama,310(6), 591. doi:10.1001/jama.2013.13805.
 Murray CJ, Ezzati M, Flaxman AD, et al. GBD 2010: design, definitions, and metrics. Lancet. 2012;380(9859):2063-2066.
Audio/ Video and text by Richard Aiken MD PhD @rcaiken
There are many myths about hypnosis. One of the most common myths is that someone takes control of your mind and programs you like a computer. This is not true. No one can be hypnotized if they do not wish to be, and you cannot be made to do anything in hypnosis that would be contrary to your values. No one can violate your free agency. Similarly, no one can make you reveal anything in hypnosis that you don’t wish to reveal.
Another misconception is that when you are hypnotized you lose consciousness or go to sleep. A few individuals go to the very deepest levels of trance and experience spontaneous amnesia for what occurred in hypnosis, thus fitting the common stereotype. However, most people remember everything that happens in hypnosis.
In actuality, hypnosis is not something someone does to you. All hypnosis is really self-hypnosis. You are the one who induces a hypnotic state, and the person working with you is simply a facilitator who guides you in what to do.
There is nothing mystical or magical about hypnosis. Hypnosis is simply a state of concentration and focused attention. It is actually a state of consciousness that we enter naturally, but we usually don’t call it hypnosis or trance. For example, how many times have you driven down the road, deep in thought, preoccupied in thinking about something? You suddenly snap out of it and realize that you haven’t seen anything for several blocks. Almost everyone has had this experience. What happens in this situation is that we are inwardly absorbed. Our conscious mind is concentrating and thinking about something. We are so focused on our thoughts that we do not consciously notice what we are driving past. In this situation, however, another level of our mind that we refer to as the unconscious mind is guiding us along, using the thousands of hours of driving experience that is stored in our memory. It is like being on automatic pilot.
Similarly, sometimes during the interesting scenes of a good movie, we become relatively oblivious to the people around us in the theater. We are so absorbed and concentrated on the movie that we temporarily don’t notice things around us. Many people likewise become absorbed in this way while watching a good television show or reading an interesting novel. These focused, concentrated states of attention are naturally occurring hypnotic or trance-like states.
How does hypnosis work? It is very much like using a magnifying glass in the sunlight. When you use the magnifying glass to focus and concentrate the rays of the sun into a pinpoint of light, the sun’s rays become more powerful. When they are concentrated, they can burn a hole through something or start a fire. Similarly, when we focus and concentrate our mind’s attention, it allows us to use our own mind in a much more powerful way.
One of the most powerful ways of using a hypnotic state is to use your imagination. Imagination can be influential all by itself, but we find that when we use our imagination in this focused state of attention called a hypnotic state, it is even more powerful. For instance, if we picture being in a very peaceful place, it facilitates deep relaxation and comfort. A migraine headache patient may visualize warming his hands in front of a campfire. As he does so, the temperature in his hands often rises several degrees. In a hypnotic state, the unconscious mind seems to know what to do with this image to cause a redistribution of blood in the body, which relieves vascular pressure in the migraine patient’s head.
Without realizing it, many people use spontaneous, informal trance states in a negative manner. For instance, we visualize negative outcomes or memories that stir up anxiety or depression. It is also not uncommon for us to speak to ourselves internally in quite critical ways. As we do these things, we are often in essentially light trance states, preoccupied and internally focused. It is thus important to realize that thoughts, imagination and internal dialogue can be positive and helpful, or counterproductive.
Hypnosis is a method of focusing your mind and then using your imagination and thinking to stir feelings and alter your behavior and attitudes. In a sense, in hypnosis you are altering your internal world. When you change how you think, visualize and imagine things to be, your feelings and behavior will begin to change.
It is commonly believed that people use only five or ten percent of their mental potential. Hypnosis is simply a focused state of attention and concentration that allows you to use more of that potential and power of your own mind. In a very real sense, hypnosis is actually the ultimate in a self-control skill.
However, hypnosis is not unlike many other things in life. We find that people have different native talents. Some individuals have natural artistic talents, and for them drawing or painting seems easy. Other individuals have athletic, mechanical or musical talents. We find that almost everyone can be hypnotized. However, most people have unique and special hypnotic talents. There are a variety of different hypnotic phenomena and most people are very good at some of them and more Medicare at others.
It is important to realize that you are an individual and not everyone experiences the same thing in hypnosis. Therefore, as you begin using hypnosis, simply discover what seems natural and pleasant for you, without worrying if you are experiencing everything that someone else does. Don’t try to force anything to happen; simply allow things to happen in the way that seems natural for you. For instance, in using imagination some people are able to see things, hear things, imagine the physical sensations of things, and even smell or taste things, imagine the physical sensations of things, and even smell or taste things. However, many of us find that we are able to only imagine one or two of these sensory modalities very well.
Preparing for Self-Hypnosis: Creating a Favorable Environment
Especially at first, it is best to do self-hypnosis in a quiet place where you can be comfortable. Later, after your skill has increased from practice, you will be able to go into a trance in other more varied settings. As you prepare to practice, take the phone off the hook or unplug it, post a “do not disturb” sign, and ask people to not interrupt you. You may want to turn the lights down. Sitting in a comfortable, high back chair that will support your neck may be better than lying down. Most of us have a conditioned tendency to more easily drift off to sleep when lying down. It is also recommended that you sit so that your legs are not crossed and your hands not touching.
It is suggested that you set aside twenty to thirty minutes for practice, particularly at first. With practice you can learn to do valuable hypnotic work in shorter periods of time. Many people find it beneficial to do self-hypnosis for 20-30 minutes once a day, and then utilize several brief (3-5 minute) hypnotic experiences spaced throughout the day. However, the amount of time for self-hypnosis will also depend on the complexity of your goals.
Schedule Practice Time
It is further recommended that you set regular times for self-hypnosis. Self-improvement requires disciplined practice, whether you are working to improve your typing, bowling, or ability to control anxiety. It is vital to give self-improvement a high enough priority to schedule regular practice time.
Establish the habit of using self-hypnosis daily. As a way of encouraging the regular use of self-hypnosis, it is often beneficial to make a regular occurrence (such as lunch, the afternoon coffee break, dinner, or beginning to watch television in the evening) contingent on having practiced self-hypnosis. For instance, a businessman may decide to not allow himself to eat dinner until he has done self-hypnosis to decompress and make a transition from the office to his family.
Hypnosis is not a magical substitute for making conscious efforts to change. My philosophy is to use all of your conscious resources and work as changing yourself. Then also discipline yourself to use hypnosis regularly to marshal your unconscious resources to bring about change. Don’t fall into the trap of expecting that your unconscious mind will do all the work of promoting painless change, while you make no effort. Use the resources of both your conscious and unconscious mind.
Write Down Your Goals
Before beginning your twenty to thirty minute session, identify what your goal is for the session. It is better to concentrate on one or two goals for each hypnotic experience. Write down your goal in very specific terms. Rather than just thinking about changing traits (for instance, to be more caring or confident), it is usually more valuable to think specifically about what behaviors need to change and what new feeling you want to have. If you were this new person, how would you act differently, and in what specific situations? How would you feel?
Preparing Hypnotic Suggestions
Verbal (conscious) thinking impedes and lightens a hypnotic state. Therefore, it is helpful to write out suggestions ahead of time so that you don’t have to be mentally creating them in trance. Then, before inducing a hypnotic state, you can briefly review the suggestions that you will give yourself.
It may be even more helpful to tape record your suggestions prior to entering self-hypnosis. You can then play the suggestions back to yourself at the appropriate time in self-hypnosis. In this way, you don’t have to lighten your hypnotic state by trying to remember the suggestions that you prepared.
Read the suggestions onto tape at a casual, slower pace, with occasional brief pauses. Us a relaxed, but confident tone of voice. In preparing taped suggestions, experiment to determine whether you prefer hearing suggestions made in the first person (“I am…”) or in the second person (“You are…”) , as if you were speaking to someone else who was hypnotized.
Use a tape recorder with a microphone that has an on/off switch. Turn the tape recorder on before you enter trance, but turn the switch off on the microphone so that the tape will not start playing. The microphone can rest gently in your hand as you induce a hypnotic state. When you feel ready to listen to the suggestions, simply turn the microphone switch on with your thumb.
Phrase Suggestions Positively
Suggestions seem to be most effective when they are phrased positively rather than negatively. Therefore, as you write your suggestions, avoid words such as “don’t,” “won’t,” “can’t,” “shouldn’t,” “try,” “no,” and “not.” Instead, use phrases such as: “I am,” “I can,” “I will,” “I’m going to,” “I will find,” and “I am free from.”
Be Flexible Regarding Time
In preparing your suggestions, be permissive with regard to the time required for success. Don’t magically expect instant and complete change. It isn’t helpful or realistic to expect ourselves to “leap tall buildings in a single bound.” It is more valuable to think in terms of intermediate goals and taking several steps to reach your final goal. Magical expectations of immediate and complete change can breed discouragement and a sense of failure. Consider, for instance, how the following suggestions contain unrealistic expectations that can set someone up for failure: “I will never eat deserts again.” “From now on I will always be relaxed in all situations.”
In contrast, consider how much more helpful it is to phrase your suggestions in a more permissive and flexible manner. “I am becoming more and more calm, and I have the skills to make myself more relaxed whenever I need to.” “I am increasingly showing more respect for myself by eating with respect for my body.”
What is wrong with the following suggestion? “When my head touches the pillow, I immediately fall deep asleep and sleep completely undisturbed until morning.” The preceding suggestion expects magic–immediately and totally. It will likely be more beneficial for most people to suggest: “As my head touches the pillow, I can find myself feeling sleepy and like yawning, and this is the time for my body to become very peacefully relaxed.”
Notice the demand and time pressure in the following suggestion. “My headache will be gone by the time I awaken from hypnosis.” This suggestion is negative because it focuses attention on the problem. It is also perfectionistic in the expectations conveyed. It seems more helpful to phrase a suggestion in this manner: “My comfort is increasing more and more, and soon [nondemanding and perfectionistic] I will be very comfortable [a positive suggestion].”
Words like “soon” and “before long” don’t set unrealistic time limits which make us feel like failures if instant, 100% complete success doesn’t occur. Be cautious about developing magical expectations about hypnosis. Occasionally we take aspirin, but still have part of a headache that remains with us afterwards. Does this mean that aspirin is completely ineffective? Should we stop using aspirin in the future because it wasn’t totally and immediately successful? Most of us have realistic expectations of aspirin. We realize that it is often quite helpful, but not necessarily immediately and totally so. Nonetheless, aspirin is beneficial in bringing about change.
It is also best to be specific as you phrase your suggestions. Consider exactly how you want to act and feel in specific situations. Here is an example: “When I sit down at my desk to study, I will become so intensely focused on what I’m reading, that other sounds and events will seem distant and unimportant.” The preceeding suggestion is positive, specific, and much more helpful than saying: “I will never again be distracted and totally concentrate.”
Posthypnotic suggestions are suggestions that you make for something to occur in future situations, after you alert yourself from hypnosis. Whenever possible, connect posthypnotic suggestions to an inevitable event, action, or feeling state (e.g., eating, turning on a light, opening the refrigerator door, looking in the mirror, feeling anxious).
In making a posthypnotic suggestion that is connected to a future feeling, you can use the following format: “When I feel (angry, the desire to eat, nervous, a desire for a cigarette), I will (take a deep breath, hold it, and as I exhale, feel a sense of calm comfort wash over me).” If you were struggling with a problem of insomnia, you might give yourself the following posthypnotic suggestion: “As I feel my head touch the pillow [an inevitable action], I will find myself beginning to yawn and get very sleepy.”
Remember, as often as possible, connect posthypnotic suggestions to an inevitable cue. The cues or triggers for posthypnotic suggestions can be:
1) inevitable actions or behaviors;
2) visual cues (e.g., the sight of the refrigerator, a TV commercial, seeing someone light a cigarette);
3) sounds (e.g., your dog barking, your mate saying something common, someone asking you about a certain thing, the sound of the lunch whistle);
4) physical feelings, sensations, or smells (e.g., the smell of food or a cigarette, the feel of bodily tension, hunger pangs);
5) thoughts or emotions (e.g., the thought of eating or having a cigarette, a feeling of anger, feeling anxious, or feeling depressed).
Listed below are some phrases and formats that you may find helpful as models in writing posthypnotic suggestions:
“When you _____, you will _______.”
“After _________, you can ________.”
“While you_____, you can ________.”
“As soon as you ____, then you _____.”
“As you ________, you can ________.”
“And as ________occurs, you will notice __________.”
Include Motivation Statements
It is valuable as you construct suggestions to include phrases or sentences which emphasize your motivations and reasons for wanting to change. For example, “Because I want to live a long, healthy life and raise my children, I will eat in a way that protects my body. I will also eat moderately because I want to look attractive.”
Here is another illustration of a motivation statement that is included in a suggestion: “I will use a calm, quiet and firm voice in disciplining the children, remembering that they are just children. I want their memory of me to be as a kind and loving parent.”
Length & Repetition of Suggestions
In general, self-hypnosis seems most effective when you keep your suggestions relatively brief. You will probably want to construct verbal suggestions that are from one to four sentences long.
However, another important principle in presenting suggestions to yourself is to use repetition. It is recommended that you give the verbal suggestions to yourself three or more times. It is preferable to use language that is somewhat varied each time, rather than simply using the exact same sentence. Although it will be discussed at length shortly, it is vitally important to also remember to use mental imagery and imagination along with all suggestions. In a sense, the use of imagination is another way of repeating the suggestion in a different way.
The Process of Self-Hypnosis
Step 1: Induction
The most effective way to learn to induce self-hypnosis is to have a trained psychologist, physician, dentist or mental health professional train you. This individual can facilitate a hypnotic state, and then teach and condition you through posthypnotic suggestion in a method for inducing hypnosis for yourself. The author believes that inducing a hypnotic state is difficult to learn strictly from reading a book. Therefore, this text is being written for use by individuals who have already learned to induce a self-hypnotic state.
Step 2: Deepening Your Hypnotic State
Once you have used your induction method, it is important to take some time to deepen your hypnotic state. There are several popular methods for deepening your involvement. You may want to imagine walking gradually down a staircase of ten or twenty steps, feeling yourself going deeper into a relaxed, focused state with each step. Some people enjoy imagining that they are gong down a long escalator or series of escalators, or down an elevator.
Progressive relaxation is another method of deepening. In this method, you imagine relaxation flowing gradually from one part of your body to another. Many people find it helpful to imagine what the muscles would look like, softening, loosening, and becoming deeply relaxed.
Another procedure for deepening is to imagine peaceful and interesting places or experiences. This may include imagining yourself on the beach, fishing on a lake, camping or hiking in the mountains, floating in a swimming pool, hang gliding, imagining a visit to a previous vacation spot, skiing, sailing, listening to a symphony, boating, playing golf, ice skating, playing a musical instrument, watching a sunset, or imagining that you are listening to some favorite music. Whatever is interesting, absorbing or peaceful to you can become the focus for using your imagination. You may find, in fact, that simply visualizing yourself lying back, relaxing very deeply, can be a stimulus for deepening.
You can learn to allow various aspects of images to become vehicles for taking you deeper into comfort. For example, you may think to yourself, “with each wave that washes up onto the beach, I drift deeper and deeper relaxed.” As alternatives, you might also imagine that each wave is washing away your tension, or that the warmth of the sun is softening and loosening your muscles more and more.
Make your mental scenes as vivid as possible, imagining any details that make it more real for you. If you are imagining yourself on the beach, for instance, you may imagine that feel of the cool, firm, wet sand. You may notice interesting objects in the sand, the smell of the ocean, the warmth of the sun, and the sound of gulls. The details which you can elaborate may be visual, auditory, tactile or kinesthetic feelings and sensations, smells and even tastes. Most of us find it difficult to imagine details on each one of these sensory dimensions, but you can rely on the modalities that you can most easily create in your mind. However, occasionally you may want to experiment with imagining details on some of the other sensory modalities as well.
Another deepening technique has been called “breathing and counting.” Begin by slowly taking five very deep breaths. As you let each breath out, say to yourself, “deeper and deeper” and imagine yourself sinking deeper into relaxation and comfort. After letting out the fifth breath, take another very deep breath, and hold it for a significant length of time (30-40 seconds. Suggest to yourself that “as I let this breath out, I will sag limply back into the chair, and go much, much deeper into a hypnotic state.” When you are ready to exhale, let the breath out as quickly as possible.
“Fractionation” is another method that may be useful in deepening your hypnotic state. After inducing hypnosis, begin by using another deepening technique for several minutes. Then, give yourself the following suggestion several times: “In a moment I am going to awaken, and then I’ll go back into a much deeper hypnotic state than I was just in.” Then gradually awaken yourself, open your eyes, and then almost immediately induce a hypnotic state again and begin using other deepening techniques. For some people, reentering a hypnotic state (after a brief awakening) is a highly effective method for going deeper. This may be used two, three or even four times. Experiment and determine if this is useful for you.
Instead of fractionation, other individuals enjoy using periods of silence as a deepening tool. They may simply focus on the rhythm of their breathing, imagining themselves sinking deeper or becoming lighter and more buoyant with each breath. Whatever method you use for deepening your involvement and absorption in trance, it is recommended that whenever possible you take 10-20 minutes time for deepening before you begin giving yourself suggestions.
Spectatoring & Dealing with Distractions. Some people find that their conscious mind remains very active in hypnosis. They may, like a spectator, be wondering “is this going to work,” or their mind may wander to extraneous thoughts. One way to deal with negative or distracting thoughts is to simply tell oneself, “I can think about this later.” In other cases, it may prove more helpful to distract your conscious mind while you are drifting deeper into trance, or while you are allowing your unconscious mind to listen to tape recorded suggestions.
One way to occupy your conscious mind is to begin rhythmically counting backwards from 600, imagining yourself drifting deeper relaxed with each number. If this is not sufficiently challenging, you can count backwards in multiples of three. Another method for occupying your conscious mind is to count a number in your mind as you take a breath in, and then to say to yourself, “deeper,” as you breathe out. If you find extraneous or negative thoughts intruding as you listen to recorded suggestions, you may want to visualize peaceful, deepening imagery as you listen. For instance, you may visualize drifting down an escalator or walking in a beautiful garden.
It is not unusual to be distracted occasionally while you are doing self-hypnosis. A loud noise from the other room may startle you, or someone may briefly interrupt you by walking into the room. At another time you may feel an itch or be distracted by feeling a need to shift your body. Feel free to shift your posture or scratch your arm. Once the distraction is over, you can just take another very deep breath, and go right back to drifting deeper.
At other times there will be persistent background noises that may seem disturbing. It may be the sound of cars driving past, the noise of a furnace or air conditioner, footsteps in the hall, the sound of someone typing, or even the pounding of a jackhammer.
There are two ways of utilizing persistent background noises. First, give yourself the suggestion that with each sound (e.g., of the typewriter, of each car passing) that you can go deeper and deeper into trance. In this manner, the sounds become a signal that you use for deepening. A second way to use distracting sounds is to imagine that they are in some way associated with pleasant imagery that you are using. For instance, if you are imagining yourself on the beach, the sound of children outside your window can become the sound of children playing further up the beach. You might modify the sound of an air conditioner into the sound of waves or of the wind in palm trees.
Don’t become overly preoccupied or worried about how you are doing. Just allow things to happen the way they seem to want to happen. Learn to trust the wisdom deep inside of you, and allow the imagery to spontaneously evolve. If you are not entirely sure that you are hypnotized, go ahead and use your imagination anyway and pretend as if you are hypnotized. It may be that you hold some internalized image of hypnosis that is unrealistic. For example, you may be expecting to be “zonked” and suffer amnesia afterwards. It may feel more comfortable to you if you redefine what you are doing in different words. Instead of calling it “hypnosis,” you may want to simply consider this as a state of relaxed attentiveness or meditation. On the other hand, even if you are not hypnotized, if you pretend and act as if you are, you will likely be quite surprised to find that you will enter this state sufficiently for it to be productive.
Step 3: Trance Work
Once you have induced hypnosis, and deepened your state of relaxation and absorption, you are ready to begin using this special state of consciousness. This is what separates hypnosis from most forms of meditation. Meditation produces a state of consciousness like hypnosis, but this is the end goal. Simply entering a meditative or hypnotic state is valuable for promoting stress reduction. However, a hypnotic state of concentration may also be used in very powerful ways for personal growth and change.
After induction and deepening has been done, you can now use the suggestions that you prepared before entering trance. You can either remember them and repeat them to yourself, or if you recorded them, turn on the tape recorder. However, you are encouraged to always combine your verbal suggestions with the use of mental imagery and imagination.
Imagination: The Catalyst for Change. An important hypnotic principle states that when will power (consciously trying to do something) is in conflict with imagination, imagination always wins. Will power has limited effectiveness, especially in influencing your body. As an example, you may recall a time when you went to bed too late and were concerned about having to awaken early the next morning. The harder you tried to help yourself go to sleep, the more wide awake you were. Instead of trying, however, if you had become engaged in a peaceful fantasy, your conscious mind would have been kept occupied with something restful so that it wouldn’t think or worry. Likely sleep would have rapidly followed. This same principle, of course, applies to sexuality. We cannot will erections or orgasms, and in fact, the more we try to do so, the more elusive they become.
Imagination and the use of fantasy is a way to make suggestions more real, and to more effectively stir feelings and the creative processes of the unconscious mind. When you think and imagine “as if” something were real, you are essentially creating a new internal reality that will increasingly influence you. In essence, we are saying that a way to change your behavior and feelings is to change how you interact with yourself. When you focus inwardly on an idea or imagined goal over a period of time, your mind begins to spontaneously move you toward the realization of the goal and image. It is difficult to do what you can’t imagine. But when you alter your internal environment and imagine new ways of being, this expands your possibilities for action.
You can intersperse the use of imagination with your verbal suggestions. As an example, you can follow a sequence of verbal suggestion–imagery–repetition of suggestions–imagery–repetition of suggestions–and then imagery again. At other times it may seem more appropriate to use verbal suggestions simultaneously with the imagery, or to present the suggestions first, and to then afterwards use imagery.
When you write and prepare your suggestions, you may also want to consider ahead of time some possibilities for using your imagination. However, it is often more helpful to allow imagery related to your suggestions and goal to simply spontaneously evolve. For example, a woman who had sinus congestion was in hypnosis in my office. I considered suggesting imagery to her about how her sinus might look. But, instead, I suggested that she simply allow a spontaneous image t form of what her clogged sinus may look like. She imagined it very differently than I had visualized it. She saw a hole or opening with darkness inside. I asked her to change the darkness to a lighter color, as if she were turning a knob on a television, and to notice what happened. As she changed the color from black to gray, and then to white, she could feel her sinus beginning to open and drain. Within a couple of minutes she was breathing more freely than in several days. This illustrates the value of allowing spontaneous images to form in your mind, and then using them therapeutically. Keep in mind that your image does not have to be reality based. Feel free to visualize things symbolically or in whatever way seems best.
The body is influenced by our thoughts, imagination and emotions. We have learned, for example, that if you imagine yourself in a very frightening situation, physiological measurements (such as galvanic skin response) will document that your body is making some of the same responses that it would make to the actual event. Knowledge of this is important because it lets us know that we can influence our body and physiological processes through hypnosis and imagination.
Symbolic Imagery. One way to use your imagination is to create symbolic imagery. An illustration of this was provided above in the case of the woman with sinus congestion. The unconscious mind seems to know what to do with imagery, even in symbolic form, to move us toward our goal. Let me give you an example.
A number of patients with ulcerative colitis or spastic colon have successfully used the following procedure. The patient will imagine what the troubled colon is like. She may see it as being like a tunnel, with very inflamed and red walls. The walls may appear very rough in texture, and she may even imagine feeling with her hand what it feels like. There may also be certain sounds that she is aware of hearing. Each patient imagines the colon is a slightly different way.
The patient is then encouraged to modify certain aspects of the image and to note how her feelings change in the very present moment. For instance, she may gradually begin changing the color of the image. She may imagine turning a knob and watching the color progressively change from a dark, bright red to a light, healthy pink. she may alter the texture of the walls, observing or even feeling them shift from rough and slimy to velvety smooth and clean. She may modify the volume or pitch of the sound. As the patient imagines these changes, he or she can usually feel a discernible difference physically. Her abdomen may begin to relax, for instance, or cramping may decrease. The patient is then instructed to use this imagery daily in self-hypnosis. She will usually be asked to practice once a day for 20-30 minutes, and then three more times a day for five minutes each.
When you are using symbolic imagery to promote change, there are several aspects of the imagery that may be modified. With something you are visualizing, you may modify the color, the brightness, texture, the contrast, the shape, speed, size, or distance from you. For instance, in visualizing yourself coping with an object that frightens you, you might visualize the feared object as becoming smaller or more distant. If sound is part of your image, you could modify the volume, the pitch, the tempo, or perhaps the location of the sound. Finally, if there are tactile or kinesthetic aspects of your image, you can modify the texture, temperature, pressure, hardness or softness.
Principle: What’s the Natural Context for this Response? Before providing further examples, we should emphasize an important concept to consider in planning your use of imagination. Imagine situations or circumstances where the response you are seeking would be a natural accompaniment and response. Whether the desired response is relaxation, numbness, comfort, floating feelings, confidence, peacefulness, tranquillity, or energy, think of a situation where this response would be an inevitable or natural occurrence.
As an illustration, suppose you need t feel more energy? You may recall a vacation where you had a good nights sleep and awakened full of energy and enthusiasm, and looking forward to an activity you would really enjoy. Another image for creating a sense of energy may be to fantasize being at a party that has very lively music that would stimulate energetic kinds of feelings. You would want to consider, in what situation would I naturally feel energized, excited and full of life? Would this be with a certain person, with certain music, after a dive and quick swim in cold water? Where have I had these feelings in the past?
Continuing with our illustration of increasing one’s sense of energy, there are also many possibilities for the use of symbolic imagery. You can imagine an internal reservoir filling, or an internal battery being charged. You may imagine having wires or apparatus attached and receiving an energy transfusion. You could imagine the energy flowing in as you inhale. Simultaneously, while breathing in, you could say to yourself, “filling with energy,” and imagine this process occurring. As this was happening, you could feel yourself increasingly beginning to smile. When you breathed out, you could sometimes do it forcefully, imagining that you were expelling tiredness and fatigue.
Examples of Using Symbolic Imagery. As a way of stimulating your creativity, several more examples will be given of using symbolic imagery. Some of the examples will also illustrate how you can weave together verbal suggestions with imagery.
Suppose we have a person suffering with muscle aches or arthritis pain. Warmth is often helpful for this kind of pain. What would be a natural context for warmth? This individual may imagine being snuggled under a warm electric blanket, or being in a warm tub, shower or sauna. While imagining one of these contexts, the person can symbolically imagine the warmth softening and loosening the sore tissues. While exhaling, this individual could imagine the pain flowing out with the breath, or perhaps imagine it evaporating from the painful area.
In contrast, if the pain were from a burn, coolness could be imagined: an ice pack, or placing the burned area in snow or in a very cold stream. With other kinds of pain, imagine what the pain could look like symbolically, and then modify some aspects of the image. For instance, if pain seems like a know, loosen and open the knot and notice what happens. If the pain feels hard or tight, soften it. If the pain feels like a vise, loosen it. Positive suggestions may be given simultaneously.
Suppose you are lying in bed one night suffering with heartburn. Enter a hypnotic state and visualize symbolically what your heartburn looks like. Perhaps you imagine something like a bubbling hot pot at Yellowstone National Park. Alter and transform the image. You may see the bubbling slowing and observe a gradual transformation as it changes to a cool, crystal clear mountain lake. At the same time you visualize this transformation, you can be using verbal suggestions, telling yourself “cool and calm” with each exhalation.
Helen Watkins suggested a type of symbolic imagery that may be used in getting rid of anger. Suppose that you are furious with your boss or your ex-spouse. You may imagine yourself walking along in a lovely setting that you enjoy. After a time, you come to a large boulder which symbolizes all the anger that you feel toward this person. Nearby is a long-handled hammer, like they use on the railroad. You pick it up and begin hitting the rock, gradually breaking off chips. As you hit the rock, in this imaginary place where you are all alone, you can yell, scream or say anything that you would like. No one will hear or intrude. You keep hitting the rock until it is completely demolished, by which time you will be exhausted and worn out. Afterwards, you can continue walking up a path to a serene and beautiful place where you can rest and imagine filling u the spaces where the anger was with good feelings.
There is also another method that is often helpful for coping with negative feelings like anger, guilt, tension, or fear. Imagine hiking in the mountains, carrying a very heavy backpack. You continue to climb for a long time, noticing details along the way, and feeling the pack becoming heavier and heavier. Finally, you come to a beautiful meadow, where you find a large helium or hot air balloon that is tied down. There is a gondola under the balloon. You go over beside the balloon, and take off the heavy backpack. Inside the pack you find objects (perhaps stones, cans, figurines) filled with the emotion that is such a burden to you. Perhaps the emotion is one of anger toward someone that you have never been able to forgive. One at a time, you take the objects and throw them into the gondola, saying whatever you want as you throw them. With each object that you throw, feel more and more of the feeling leaving you. When the pack is empty, cut the ropes to the balloon, and watch it float away. Rest back on some comfortable grass, and with each movement of the balloon, feel more and more relief. Finally, the balloon can disappear or come to rest on a very distant mountaintop. As an alternative to this method, throw the objects out of the pack into a hole, cover it up, and then get in the balloon and float away.
Another symbolic imagery technique that is often very powerful is the master control room. Imagine yourself entering a master control room in the hypothalamus part of your brain. This is a control room and nerve center for all your feelings and desires. As you enter the room you can notice panels of lights of different colors, and perhaps hear the sound of computers. There are control panels that regulate your level of energy, level of sexual desire, appetite for food, level of pain in different parts of the body, and a panel that regulates the release of natural endorphins that increase your sense of happiness and calm. On each control panel is a dial or lever that can be set from 0-10. You can find the panel that you need, check the current setting, and then gradually change the setting, one number at a time. As you turn the dial, notice the sensations of change that you can be aware of in your body.
Having a Dialogue With Your Symptom. Earlier we discussed the concept of allowing an image of your symptom or problem to form in your mind, and then modifying the image. Another way of working with a symbolic image is to have a dialogue with it. Pretend that the image can talk. Ask it questions, and then imagine the image making a reply. You can ask the image questions like: “What do you want?” “What purpose do you serve?” “What is it that you do?” “Are you trying to help me in some way?” “What do you need from me?” “What will I need to do for you to change or stop?” You may feel silly having this kind of imaginary conversation, but some of the answers may be revealing and may surprise you!
If you have difficulty in establishing an imaginary dialogue with your symptom, there is another method that often works. Visualize an image that symbolizes your symptom or problem. Then identify with this image, pretending that you are this image. Imagine what you are like and how you feel as this object. What is your existence like as this object. Pretend that you are this image, and imagine that you are talking to a doctor. Explain what it is that you need (as this object). What is your purpose? What do you try to do? How do you help this person? Do you protect this person or allow him/her to avoid something?
The Council of Advisers Technique. After more than ten years of doing psychotherapy, I have come to believe that most of us know far more than we give ourselves credit for. Our unconscious mind has a great deal of wisdom and more of the answers than most of us realize. But, we usually seek advice and answers from everyone else. There is a way, however, in which we can often tap that unconscious wisdom that lies deep inside. Once again, it involves entering a trance state and then using the power of imagination.
Many years ago, Napoleon Hill wrote the book, Think and Grow Rich. This highly successful businessman regularly utilized self-hypnotic states. One day he began considering an interesting proposition. If he could somehow have a group of famous men as his personal advisers, who would he choose? After careful thought, he selected six or seven men from throughout history who possessed different qualities of character that he admired. Napoleon Hill was a scholarly man, and having read biographies about each of these men gave him a sense of their personalities and character.
Napoleon Hill began going into self-hypnotic states and imagining himself conversing with these famous individuals. Gradually, he seemed to become acquainted with them and they became almost real to him, although he knew that they were only a figment of his imagination. Each day for more than thirty years, Mr. Hill entered self-hypnosis and imagined himself going into a board room and having a meeting with his personal council of advisers. He consulted them about both personal and professional matters, finding their input invaluable.
There was nothing supernatural about what Napoleon Hill did. There was great wisdom and judgment in his unconscious mind. This method simply gave him a concrete way of accessing that wisdom and in a way that seems perfectly natural to us: feeling deficient, we are accustomed to asking someone else for answers even though deep inside we may already know what needs to be done.
There may be a person of wisdom, or who possesses certain qualities, that you would like to have as an adviser. It may be someone you have known, a religious leader, or someone you have studied and admire. Why not meet with these people in trance, get acquainted and establish a relationship, and then meet regularly with them?
The Inner Adviser Technique. Another popular method to u se for eliciting our own unconscious insights has been called the Inner Adviser technique. After entering a pleasant hypnotic state, imagine yourself in a uniquely serene and beautiful place. As you find yourself in this place, look around to find the first living being that you see. It may be a man or woman, a religious figure, or perhaps a friendly animal. Allow whoever or whatever you see to become your special inner adviser, representing your unconscious mind. Introduce yourself and find out your adviser’s name.
It is entirely possible that you may feel foolish or silly talking to an imaginary adviser. This is a perfectly natural initial response for people raised in our society. In fact, you may want to admit to your adviser that it feels funny or kind of ridiculous. But even if your adviser is a squirrel named “Jupiter,” or an old prospector, just trust this process and see where it goes. Give this method a fair trial.
Assume that your adviser already knows everything about you, and has access to that unconscious reservoir of all your memories and everything you have ever learned. Also assume that he or she cares very deeply about you. You will find that the more frequently you have visits with this wise inner friend, and more powerful and meaningful the visits will become. This will be a process of establishing a very special friendship, and like any trusting relationship, some time will be required. Treat your adviser with the respect you would show a special friend. make appointments for visits, and if you are unable to keep an appointment, be sure to let him or her know what happened and apologize.
Your adviser can be a valuable source of input, but he/she may not always give you quick and easy answers. Your adviser may tell you things to think or meditate about, and give you homework assignments. Advisers will also test your sincerity sometimes to be sure you are committed. One of my patients had an adviser who told her to read a certain book. She thought this was a stupid assignment and rebelliously refused to do it. Afterwards, on several attempts she found that she was unable to find this adviser when she went to her special place. Finally another adviser appeared. This adviser told her, “Look, you asked for his advice, and he told you what to do. If you didn’t want his advice, you shouldn’t have asked, and he’s not going to come back unless you follow through.” She read the book, and was very surprised at what she learned. This illustrates, however, that advisers can sometimes be feisty!
It will be important for you to invest in your relationship with your adviser, just as you would in building any important relationship. With people we are close to, we usually enjoy some physical contact such as a hug, holding each other, or an arm around the shoulder. This will likely seem natural and special with your inner adviser also. You may want to keep a journal of your interactions with your adviser, recording what you were told and assignments or commitments that were made.
Some persons have found the Inner Adviser technique very powerful, even finding their adviser capable of reducing chronic physical pain. For other people, this method doesn’t seem too useful. Give it a fair trial and see what potential it has for you. Also appreciate that because we are all individuals, that the method of communication with advisers will vary from person to person. Some people see their adviser and verbally converse; others can’t clearly perceive their adviser but hear a voice. Still other persons report receiving messages that seem like a transfer of thoughts or feelings instead of a voice.
The possibilities for the use of imagery in self-hypnosis are limited only by your own imagination. In your imagination you can fly like an eagle, float on fluffy clouds, surround yourself with a magical protective barrier that reduces the impact of external stress, or withdraw to a special tranquillity room where no one else can go.
Mental Rehearsal & Age Progression. The use of mental rehearsal is another particularly powerful way of using your imagination. After giving yourself verbal suggestions for a change (e.g., to remain calm with the children), visualize success imagery.
First of all, you may imagine a model acting the way that you wish to act. The model may be someone who possesses the desired attribute and whom you know personally. On the other hand, the model may be someone you know by reputation, or just someone that your mind creates. If you felt that you handled a recent business or interpersonal situation poorly, you can observe a model handling it beautifully. This is much more helpful than our typical pattern of mentally replaying all the negative things that happened, while simultaneously putting ourselves down. Study the model, noting how he/she acts differently.
Next, visualize yourself carrying out the suggestions, acting and feeling differently. Also, and very importantly, imagine the positive outcomes resulting from your change. After observing a model, you may want to observe yourself from outside your body, as if you could float out of your body and watch yourself crying out the suggestions. We call this a dissociated review. After watching as a dissociated observer, you can then visualize the situation again, this time experiencing it as if it is happening to you.
At about the turn of the century, Vaihinger formulated the famous “as if” principle: If you wish to change, act as if you were already the way you wish to be. This is a famous behavioral principle which Alfred Adler and many modern therapists utilize. However, most people haven’t realized that it is equally as powerful to think “as if.”
In a hypnotic state, imagine how your life will be after the changes have already taken place. visualize yourself in the future, after the changes have occurred, and notice what everything is like now, and how you feel in the future. This procedure has been termed age progression. Imagine that you are drifting ahead in time, to a future time when the changes you desire have already taken place. It may be just a few months in the future, or perhaps many years. Notice your new circumstances and how you naturally act and feel differently. You may watch some old home movies that show how you changed, years ago. Perhaps you will find yourself looking at some old photo albums, as you reminisce with a spouse or friend about the progression of changes that occurred.
From the perspective of this future time, notice all the events that were set in motion and snowballed because of the original changes that you made (years ago). In a hypnotic state, you can pretend that you are sitting in a new environment, years in the future, reflecting back on how you used self-hypnosis and changed yourself. And you can appreciate what these changes lead to.
Erickson’s Method of Self-Hypnosis. One of the most creative minds in the field of hypnosis was Dr. Milton Erickson. Dr. Erickson strongly believed in the power of the unconscious mind to assist us. He evolved a unique method of self-hypnosis that presents a strong contrast with the techniques that have just been described.
Erickson suggested that you think for few moments about your goal for the trance prior to entering self-hypnosis. Next, he recommended that you set a watch or clock alarm for twenty or thirty minutes, and then induce hypnosis. Then, rather than giving suggestions to yourself, he recommended that you simply trust the ability and power of your unconscious mind to assist you. He reasoned that your inner mind knows what you need and doesn’t require your conscious assistance (or interference). Therefore, he suggested that you simply allow yourself to drift very deep into trance, and awaken when the alarm sounds. There is no research on the effectiveness of this method, but the author has worked with several persons who found it very useful. Experiment with it and see how effective it is for you.
Methods of Exploration in Hypnosis. In addition to the suggestive methods that have been described, there ware other hypnotic techniques that may be used for self-exploration. Sometimes a symptom serves an unconscious purpose or function. For example, sometimes a symptom will protect us from something we fear, or serve to punish us (or someone else). If you work with a problem through self-hypnosis and it seems resistant to change, the problem may be meeting some underlying needs which need to be explored. The Inner Adviser Technique or having an imagined dialogue with your symptom are two methods that you may use for self-exploration.
However, although exploration can be done in self-hypnosis, it can sometimes be difficult and is certainly much more time consuming to describe. Therefore, if you have a problem for which you believe deeper exploration may be helpful, it is recommended that you consult a professional who is licensed and has an advanced degree. If you do not know who to consult, you can receive qualified referral sources from: The American Society of clinical Hypnosis, 2250 East Devon Ave., Suite 336, Des Plaines, Illinois 60018 (phone 312-297-3317).
Step 4: Return to Pleasant Imagery & Awakening
After you have finished your hypnotic work, using suggestions and imagery, it seems beneficial to return for a minute or two to simply relaxing very deeply with some peaceful imagery. If prior to working on your problem you were imagining yourself walking in the mountains, you may want to return to the same lovely place and enjoy it for another few moments.
then, after enjoying a couple of minutes of deep relaxation, you can gradually alert and awaken yourself. Begin by giving yourself a suggestion for positive feelings after you awaken. For instance, “After I awaken, I will feel refreshed, alert, and clear-headed, and I will carry these wonderful feelings with me into the remainder of my day.” It is then usually most comfortable to awaken yourself gradually, for instance, by counting slowly backwards from ten to twenty to one.
Summary of Steps in Hypnosis
1. Preparation: Schedule regular time for practice, arrange your environment to minimize interruptions, and write down your goals in specific terms.
2. Prepare your suggestions ahead of time. Make your suggestion positive and specific, be flexible concerning time, and don’t hold expectations of instant magic. Connect posthypnotic suggestions to inevitable cues (behaviors, visual cues, sounds, feelings, thoughts, or emotions). Keep suggestions relatively brief, emphasize your motivations for wanting to change, and repeat your suggestions several times. consider tape recording your suggestions.
3. Induce hypnosis and, whenever possible, allow 10-20 minutes for deepening your involvement and relaxation.
4. Use your positive suggestions, and always combine them with the use of imagination. Imagine situations where the response you are wanting would be a natural occurrence. Us symbolic imagery, for instance, imagining your symptom and then modifying it. Whenever possible, use mental rehearsal, visualizing a model and then yourself acting differently. Imagine your life after the changes have taken place (age progression) when you already are the person you wish to be. Erickson’s method of self-hypnosis is another alternative.
5. When exploration of new ideas are needed, consider having a dialogue with your symptom, or consulting inner advisers.
6. Return for a minute or two to the peaceful imagery that you used for deepening, give yourself a suggestion for positive feelings after awakening, and gradually realert yourself.
References for Further Reading
Alman, Brian. Self-Hypnosis: A Complete Manual for Health & Self-Change.
San Diego: International Health Publications, 1983.
Jencks, Beata. Your Body: Biofeedback At It’s Best. Chicago: Nelson
Donald, Kathleen, & Holloway, Elizabeth. Self-Hypnosis to Self-Improvement.
Muncie, Indiana: Accelerated Development Inc., 1984.
The cause of death by “interpersonal violence”, i.e. murder, using the Global Burden of Disease data assembled by the Institute for Health Metrics and Evaluation at the University of Washington is shown on Figure 1 for the time interval 2010 – 2016 (note EN means 0 – 6 days old and PN is 7 days to 1 year old; the line is the mean value).
Figure 1 Murder of males in the US 2010 – 2016 by age
Several aspects of these data are shocking. First, comparison to previous 5 year intervals reveals that the most likely age of those murdered is becoming younger. For example, in the 5 year interval 1980 – 1984, the most likely age to be murdered was about 27 years old; from the data in Figure 1, it is about 15 years old.
Second, the curve is not Gaussian – it is bimodal with two peaks at 15 and at about 2 – 3 years old. This means that young adolescents and young children are being disproportionately murdered. Let’s examine the first most likely peak in murder rate, that of young children.
Although the untimely deaths of children due to illness and accidents are closely monitored, deaths that result from physical abuse or severe neglect is more difficult to track. This is particularly true of the very young, ages 0 – 5 years old prior to their introduction into communities through schools and community activities where there is a degree of monitoring outside the family environment. Child fatalities due to abuse and neglect are very likely underreported.
The highest risk of child homicide victimization is on the first day of life, known as “neonaticide”. Neonaticide is almost always committed by the mother acting alone; the biologic father is frequently no longer a part of the mother’s life. Neonaticidal mothers are often in their teens or 20s; unmarried; and of lower socioeconomic status and the pregnancy is unwanted. Note these deaths are not reported in Figure 1.
An examination of child abuse and neglect resulting in death in the year 2015 from the U.S. Department of Health & Human Services, indicates that about three-quarters (74.8%) of child fatalities involved children younger than 3 years, and children younger than 1 year accounted for about 50% (49.4 %) of all fatalities as shown in Figure 2 .
This is a crisis that must be recognized and then have the highest priority to eliminate.
 Institute for Health Metrics and Evaluation (IHME). Causes of Death (COD) Data Visualization. Seattle, WA: IHME, University of Washington, 2017. Available from http://vizhub.healthdata.org/cod. (Accessed February 18, 2018)
 Friedman, S. H., & Resnick, P. J. (2009). Neonaticide: Phenomenology and considerations for prevention. International Journal of Law and Psychiatry,32(1), 43-47. doi:10.1016/j.ijlp.2008.11.006
Cause of death by firearms is becoming more likely at younger ages in the United States.
The following data on the homicides by firearms  come from the Global Burden of Disease assembled by the Institute for Health Metrics and Evaluation at the University of Washington.
Males in the United States.
In the interval 1980 – 1984, the most likely age for death by firearms was the mid to late twenties. Since that time, the rates have shift toward younger ages. The following graph indicates homicide death by firearms in the more recent interval 2010 – 2016.
More currently, then, the most likely age for death by firearm is about 15 years old, roughly 10 years younger than that 30 years ago.
 Institute for Health Metrics and Evaluation (IHME). Causes of Death (COD) Data Visualization. Seattle, WA: IHME, University of Washington, 2017. Available from http://vizhub.healthdata.org/cod. (Accessed February 18, 2018)