EDMONTON CLINICAL HYPNOTHERAPY, EXECUTIVE COACHING & ACCELERATED SUBCONSCIOUS RESTRUCTURING

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Educational Series

Terri Lee Cooper MSc. RSW NLP_M DCH  

St. Albert Medical Centre

Healthy Mindset and Habit Creation for a Healthier & Slimmer Body

Cooper, Terri (2008).Role of the “Stress Hormone” Cortisol on Weight Gain and Hypnosis as a Tool for Stress Management

Breyer State University Doctoral Project in Clinical Hypnotherapy

Learning to elicit the relaxation response and shifting perceptions regarding stress is a means to manage cortisol.

What does this mean?-Evidence shows that hypnosis is an effective tool for systematic stress inoculation re stress/emotional eating and reduction of fat storing hormones.

Kirsch, Irving (1996).
Hypnotic enhancement of cognitive-behavioral weight loss treatments–Another meta-reanalysis.
Journal of Consulting and Clinical Psychology, 64 (3), 517-519.
Last follow up and post treatment mean weight loss was 6.03 lbs without hypnosis and 14. 88 lbs with hypnosis . Correlation analyses indicated that the benefits of hypnosis increased substantially over time.

What does this mean?-Evidence shows that hypnosis as a systematic adjunct produces longer term results.

Bolocofsky, David N.; Spinler, Dwayne; Coulthard-Morris, Linda (1985).
Effectiveness of hypnosis as an adjunct to behavioral weight management.
Journal of Clinical Psychology, 41 (1), 35-41
Study exploring the use of behavioral treatment with and without the support of hypnosis. Short and longer term follow up evidence that hypnosis subjects showed significant additional weight loss, while those in the behavioral-treatment-only group exhibited little further change.

What does this mean?-Utilizing hypnosis in addition to a healthy weight loss program supports permanent weight loss

Cochrane, Gordon; Friesen, J., (1986) Hypnotherapy in weight loss treatment
Journal of Consulting and Clinical Psychology. Volume: 54 489-492
Study investigated the outcome of subjects who used weight loss and subjects not involved in other treatment, hypnosis was more effective than control group (17 vs. .5 pounds on follow-up).

What does this mean?-Hypnosis for weight loss in the absence of no other program resulted in more weight loss

Greaves, Evelyn, Tidy, G., & Christie, R.A.S. (1995). Hypnotherapy as an adjunct to the dietetic management of obese patients. Nutrition and Food Science, Vol. 95 (6), 15.
Subjects were put on a diet prior to hypnosis treatment. Twenty sessions designed to encourage new eating habits. Results-3-17% decrease in body mass index (BMI), 2yr follow showed 75% of subjects maintained weight loss.

What does this mean?-Hypnosis used to address habits in conjunction with a realistic eating plan increased success

Alfred A. Barrios, Ph.D. reviewed the overall lasting success of various psychological approaches. This study revealed the following success rates:

Hypnotherapy — 93% success rate after 6 sessions
Behavior Therapy — 72% success rate after 22 sessions
Psychotherapy — 38% success rate after 600 sessions”
Psychotherapy: Theory Research and Practice, Volume 7, Number 1, Spring, 1970.)

The British Psychological Society. March 2001. "The Nature of Hypnosis".
"There is evidence from several studies that its [hypnosis'] inclusion in a weight reduction program may significantly enhance outcome"

This study explores the relationship between the “stress hormone” cortisol and weight gain. The premise is that if stress is indeed correlated with weight gain, then, logically, the use of hypnosis would prove to be an efficient modality to address weight gain related to stress.

            After a random scan of weight loss case files, this  researcher found that hypnosis clients do indeed express and initial difficulty with stress management and do sport “the belly roll” that is consistent with cortisol induced weight loss.

            This researcher engages in a qualitative examination of literature currently available and finds that, yes; cortisol is without a doubt linked to abdominal fat. Sources do indicate that hypnosis is a successful modality for weight loss, yet there is little evidence to suggest that hypnosis is a successful modality for weight loss, yet there is little evidence to suggest that hypnosis reduces the cortisol secretion. Nonetheless, the benefits of learning to elicit the relaxation response and shifting perceptions regarding stressors if often suggested in the literature as a means to manage cortisol. Clearly, these are natural outcomes of ethical clinical hypnotherapy. This information is investigated in greater detail below.

            This study addresses the relationship between weight loss and stress. Specifically, this researcher engages in a qualitative examination of literature with respect to the “stress hormone” cortisol. Is there evidence to suggest that cortisol is a factor in weight gain? If cortisol is determined to be related to weight gain, can the use of hypnosis support individuals in the goal of weight loss through improved stress management?

            It seems that, overall, diets and most popular weight management programs do not work. Clients who come to see this clinical hypnotherapist for weight loss, have had little or only short term success with other modalities geared towards weight loss.

            Most clients have used countless diet programs, have counted calories, have attended weight loss groups, have counted food points, have weight food and many have used diet supplements, both doctor approved and popular over the counter herbal remedies. A few have even had surgery in the hopes of losing weight and keeping it off.

            In spite of being knowledgeable about dieting basics and often making genuine efforts the weight does not budge for these clients beyond a small amount. In fact it usually eventually returns.

            Most of these writers’ weigh loss clients present as being extremely frustrated, angry, tired, and “fed up with the vicious cycle of weight loss. In spite of period of being “motivated” these clients are admittedly highly stressed. They present as being stressed by both the frustration incumbent in attempting to lose weight and stressed in general with their lack of ease in day to day living.

            This lack of ease is often a result of other issues such as work demands, parenting responsibilities, martial issues; money concerns and often unresolved past issues etc. In addition to these ongoing challenges there is another over riding discontent that stays with these clients constantly.

            An inner dialogue that does not let up around the exasperating issue of being overweight and a sense of powerless in shedding the excess pounds seems to be a contributing factor to the perception of stress.

            The frustration begins first thing in the morning with clothing feeling tight and it continues throughout the day with recriminations about ones lack of willpower. There is a sense of contempt with the weight scale reading and the negative internal dialogue continues often into the bedtime routine with guilty thoughts about “slips” made during the day. These slips may be overeating in terms of portions, poor food choices, or neglecting to exercise.

            Overall, weight loss clients usually appear to have few emotional reserves left. They are emotionally drained, sometimes receiving inadequate nutrition and disillusioned with popular and expensive weight loss programs. Many clients indicate ongoing stress and an inability to relax of think straight throughout the day.

            The stress appears to be chronic with spikes of acute nervous tension throughout the day as demands made from bosses, children, partners and themselves. Not surprisingly, many of these clients indicate a sense of unrelenting tiredness; they sleep poorly and wake up throughout the night.

            It would appear as though the clients have not developed an adequate ability to regulate their moods throughout the day. They admittedly alter their emotional stare with food, often eating at desks or on the run, in the care and often they “sneak” snacks. These clients describe themselves as “emotional eaters” and admit to using food in an attempt to make themselves feel better.

            It has been noted that the majority of these clients are women and that they are carrying the excess weight around their middles or bellies. Having once read that cortisol had been dubbed the “stress hormone” and that cortisol was suspected to be a factor in the tummy bulge, this researcher became intrigued. On first blush this seemed to make plenty of sense when considering the weight loss client base. As clients learn to relax and alter both thought and behaviour habits, they invariably improve eating habits, regain energy, sleep better, and behind to eventually release excess weight. Thus begun the search for answers as to how weight, cortisol and hypnosis could potentially be linked.

            The main goals of this dissertation are to 1) research the role of the “stress hormone” cortisol and learn how it may contribute to weight gain and 2) explore whether hypnosis has been proven to be effective in terms of managing weight issues affiliated with stress.

            According to Scot (n.d) cortisol is not necessarily a bad hormone, it actually is quite important to our overall survival. It helps us to manage daily stress by providing the burst of energy we need to be alert in emergency situations. Cortisol also enhances our memory functions, boosts immunity and lowers our sensitivity to pain. Cortisol plays a key role in upholding homeostasis in our body.

            Morrison (2001) indicates that when we experience a sudden and acute response to a stressor there are many changes that occur in our body. They changes are related to the hormone cortisol. Physical changes include the heart beating faster, blood pressure rising, the muscles tightening and metabolism altering. The body is getting ready for possible attack. The emotional reaction is a sense of feeling of fear and anxiety.

            This flight or flight response takes place as a reaction to a stress. The stress may actually not be life threatening. We may however perceive the stressor as a threat to our emotional wellbeing and as menacing our physical safety.  According to the Australian Journal of Clinical Hypnotherapy and Hypnosis (2001)

The automatic nervous system responds to information received by the cerebral cortex,setting into operation a series of physiological responses called the fight or flight response.

These reactions and feelings however, sometimes persist long after the usefulness tosurvival and unless they’re released by the persons natural healing mechanism they become repressed at the subconscious level leading to emotional problems and physical illness.

Emotions register in the subconscious mind before they final become strong enough to break through to conscious awareness. Simon (n.d.) addressed the issue of stress as a contributor to weight gain. “Many people develop cravings for a salt, fat, and a sugar to counteract tension. In addition, the weight gained is often abdominal fat, a predictor of diabetes and heart problems.”

            Simon (n.d.) goes on to provide more details around the stress-fat connection:   The release of oncortisol, a major stress hormone, appears to encourage abdominal fat and may be the primary connections between stress and weight gain. Cortisol is a   glucocorticoid. These hormones, along with insulin, appear to be responsible for stress-related food cravings. A 2005 study showed that hormonally induced cravings  for “comfort foods” may have a biological benefit for managing stress. Eating comfort foods appears to reduce the negative hormonal and behavioral changes associated with stress, which might lessen the impact of stress on an individual.

Carbohydrates in particular have been found to significantly increase levels of tryptophan and large neutral amino acids. This produces serotonin, which improves mood and performance under stress.

            Simon goes on to discuss a 2007 study that proposed a reward based stress eating model: In this theory, stress and tasty, high-calorie foods cause the brain to make chemicals called endogenous opioids. These neurotransmitters help protect against the harmful effects of stress by slowing activity of a brain process called the  hypothalamic-pituitary-adrenal (HPA) axis, thus weakening the stress response.

 Repeated stimulation of the reward pathways through stress-induced HPA  stimulation, eating tasty food, or both, may lead to changes in the brain that cause compulsive overeating.

            Scott (n.d.) addressed the subject of cortisol and stress indicating that cortisol “is an important hormone in the body, secreted by the adrenal glands and involved in the following functions and more: Proper glucose metabolism, regulation of blood pressure, insulin, release for blood sugar maintenance, immune function, and inflammatory response.”

            Scott (n.d.) also indicated that cortisol is released in higher level secretions when we move into the flight or fight response. While cortisol has its benefits he does state that “we also need to experience the relaxation response. This response must be activated so that the body’s functions can return to normal following a stressful event.

            Scott (n.d.) mentions that several methods have been found to be helpful for individuals seeking to help the body activate the relaxation response after a fight-flight response. “The following have been found by many to be very helpful in relaxing the body and mind, aiding the body in maintaining healthy cortisol levels; guided imagery, journaling, self-hypnosis.”

            According to Benson (1975), “The physiological changes of the relaxation response are associated with what has been called an altered state of consciousness” (p. 104).  In describing this state; “there appears to be a universal element of rising above the mundane senses, a feeling beyond that of common day existence” (p. 106)

            Benson (1975) outlined “basic elements underlying the elicitation of the relaxation response, regardless of cultural source. The first element is a quiet environment, the second element is an object to dwell upon, the third element is a passive attitude” (p. 110). Benson (1975) indicates that the final component is a relaxed body arrangement.

            Benson’s (1975) chief interest in studying the relaxation response was to determine its effect on hypertension. He states:    By far the most appealing use of relaxation response in relation to hypertension lies in its preventative aspects. The relaxation response serves as a natural way to counteract increase sympathetic nervous system activity associated with the fight-or-flight response.

 This means that the relaxation response should be useful in alleviating other disease states   increased sympathetic nervous system activity is a principal factor in the development of the disease or is an undesirable accompanying factor of that disease. (p.148)

Gilliam (2007) suggests that weight gain cause could be as simple basic as stress. Marjie Gilliam is an International Sports Sciences Association master certified personal trainer and fitness consultant who maintains that:

            Stress increases body fat, particularly around the midsection, due to increased levels of  cortisol. Factors other than the release of cortisol are usually the cause of weight gain during times of stress. When under stress it is not unusual to change normal eating habits  in an attempt to cope, such as consuming more “comfort foods”  in favor of healthier,  lower calorie options. Alcohol consumptions may increase, while activities levels may decrease. Stress often also leads to changes in normal sleeping patterns. Poor sleep quality and/or quantity have been shown to affect certain hormones that regulate appetite.

            Evennett (2000) explores whether weight gain is result or eating too much or hormonal issues. Asking one’s doctor for hormone testing is recommended. Evennett suggests that “women with a “big tummy” are considered to fit into the high cortisol category.” Evennett cites Dr. Malcolm Vandenberg, author of Positive under Pressure as saying: cortisol is one of the hormones we pump out when under stress. It is useful in catapulting your body into action because it sends blood rising to the muscles. But it also encourages  our body to store fat in the tummy, where there is a high concentration of cortisol receptors

than any other part of your body. Cortisol also increases appetite. Anyone who fails to switch of at the end of the day is at risk from the fattening effects of cortisol.           Women’s Health Letter (2001) suggests that prior to thinking about hormone treatment; women should consider how they manage stress: Too much stress can cause the adrenal glands to become exhausted. While we cannot  change stresses in our lives we can change our responses to them. Chronically high cortisol levels are associated with greater deterioration of the hippocampus, a part of  the brain that is associated with memory.

Chronically high cortisol levels can cause weight gain around your stomach, fluctuating blood sugar, a loss of memory, depression,  muscles weakness and wasting, low blood pressure, allergies, glue and bronchitis and thin skin. If you fly off the handle at the slightest provocation you may be suffering from high cortisol of aging; they come from years of chronic stress. The article went on to suggest that people with high cortisol levels have a lower life expectancy than people

 with normal levels. Patients need to deal with stress before they begin any hormone  program. Stress, as well as increasing the levels of hormones we don’t want, also  upresses some important hormones we need to stay healthy. For Instance, DHEA,  which is produced naturally by the body and sometimes touted as an anti-again supplement, seems to be in short supply in people who are chronically stressed.  Since this hormone is an indicator of overall health and vitality, low levels are  definability a warning that you need to chill out.

Research by Boudarene, Legros, & Timsit-Berthier (2002) showed that:    The  role cortisol in the stress response has been shown and now the “possible  action of another adrenal steroid is being increasingly documented. Dehydroiandrosterone (DHEA). The study was aimed at looking at the relationship between these two hormones in relation to stress. The hypothesis of an antagonism between the two hormones is based  on the fact that DHEAs opposes the action of cortisol and exerts a true anticortisol  effect. This antagonism might be related to a competitor in their synthesis and release by the adrenal gland. In this present case, high level of anxiety (state and trait) was associated with an increase in cortical, while low level (of anxiety) was related to an exclusive rise of DHEAs. There are no studies reporting a relation between DHEAs.

There are no studies reporting a relation between DHEAs. There are no studies reporting  a relation between DHEAs and state of trait anxiety. Nevertheless, many authors have  proposed a beneficial action of DHEA on the feeling of well-being. This beneficial role could be related to a double action of DHEA: a direct effect provided by its transformation into sexual hormones, an indirect unmediated by its competition with cortical, of which the synthesis and consequently the activity decrease.

            Research by Sobrinho et al. (2003) found that:   Cortisol, prolactin, growth hormone and neurovegatative responses to emotions elicited  during an hypnoidal state found that evidence that cortisol, prolactin and GH respond to psychological stress in humans, but they are regulated differently from one another.            

            According to hypnosisnetwork.com (n.d.) research demonstrates a significant effect when using hypnosis for weight loss: In a 9 week study of two weight management groups (one using hypnosis and one notusing hypnosis), the hypnosis group continued to get results in the two year follow-up,  while the non-hypnosis group showed no further results (Journal of Clinical Psychology, 1985).

In a study of 60 women separated into hypnosis versus non-hypnosis groups, the groups  using hypnosis lost an average of 17 pounds while the non- hypnosis group lost an average of only .5 pounds (Journal of Consulting and Clinical Psychology, 1986)

In a meta-analysis, comparing the results of adding hypnosis to weight loss treatment across multiple showed that adding hypnosis increased weight loss by an average of 97% during treatment, and even more importantly increased the effectiveness  POST TREATMENT by over 146%. This shows that hypnosis works even better over time (Journal of Consulting  and Clinical Psychology, 1996)

            The Chicago Sun (1986) cited Doris Gruenwalkd, a clinical psychologist and hypnosis specialist at Chicago’s Micheal Reese Hospital as stati     In the case of stress related disorders, patients learn to relax during the critical, often tension  filled period preceding an eating binge. Under hypnosis they may be able to look back to a time before they developed the disorder and come to understand the origins of the problem  Ball (2006) reported on several alternative approaches to weight issues. She references the book Intuitive Eating that states:   We enter the world programmed to feed ourselves without getting fat. “If you give babies  milk they’re done, you can’t get any more milk into them” says the books co-author, Elyse Resch, a registered dietitian and nutrition therapist in Beverly Hills. “Toddlers can leave a cookie on their plate and not even think about it. But adults have all this debris from  media, dietitians, doctors, peer groups."

            Ball (2006) also addresses the use of hypnosis for weight loss in the December edition of Oprah Magazine:In a 1996 analysis of several studies Irving Kirsch PhD, of the University of Connecticut,found that the addition of hypnosis to psychotherapy appeared to have a significant effect on weight loss. Those using it lost an average of nearly 15 pounds, those not using it only 6.

What hypnosis does is get around having to wait for changes says Deirdre Barrett PhD,assistant clinical professor of psychology at Harvard Medical School and president of the American Associations Division 30, a.k.a The Society of Psychological Hypnosis. “Forsome things, the minute you make the change, you get the result. If you quit smoking,you’re a non-smoker the next day. But the day after you decide to lose weight, you don’t necessarily look thinner. Hypnosis can let you experience in vivid fantasy the results you want. “

 Kirsch (2003) wrote that:  Research from Yale University in the US shows that people who react very emotionally to  stressful situations release greater levels of the stress hormone cortisol, which can increase  the appetite. So if you perceive yourself to be permanently under stress, your cortisol levels are constantly high, and so is your appetite. But if you eat because you are stressed, and it  makes you feel better, this can quickly become a habit or a learned response.

Counselor Gillian Riley, who works with people who have eating problems and wrote Eating Less:Take control of Overeating explains, “When you are stressed, your digestive system is lessefficient and so it is wiser to eat more lightly. Unfortunately, our brain sends out the exact opposite signal to reach for the biscuits.

           Regarding why it is difficult for some people to stop eating once they begin “it’s to do with  the connection between cortisol and insulin, the hormone released to help process the sugar in your blood. Nutritionist Patrick Holford explains, “When blood sugar levels shoot up after sugar intake, a stimulant or stressful reaction, the body has to produce more insulin to get

 the sugar out of the blood stream and into the cells, when the blood sugar is too low, this stimulates the adrenal hormone cortisol. The net result of stress and a diet too high in sugar and refine white carbohydrates are an inability to keep blood sugar levels stable.” So snacking on sweet things makes blood levels rise and plummet and when they plummet you want another biscuit. 

            Anderson (2004) reviewed several studies and comments on a study by Vgontzas An et al (1998) on chronic insomnia and stress:    Stress, as evidence by cortisol and catecholamine output, was significantly correlated with aspects of insomnia. Cortisol levels appear to be throttled back at night in healthy individuals.

Perception of stress, elevated night time cortisol output, blunted immune response and poor sleep are associated phenomena which tend to move together. Poor sleep then becomes an additional stress and the cycle is ratchet up one notch. So, better handling of stress and behavioral approaches for enhancement of sleep can both interrupts this vicious cycle.           

            Anderson (2004) also comments on a study by Deaqbler et al. (1973) on the use of relaxation and the use of hypnosis to lower blood pressure and states:  It appears that this almost a conditioning experience, the association between relaxed feeling and lower blood pressure is established by a routine (ex. Progressive relaxation, meditation,self-suggestion) consistent practice reinforces the experience and physiological responses to  stresses and challenges and make their way into lexicon of preferred responses, which then become permanent.

            According to Life Extension (2007) eating high glycemic foods bolsters “feel good” brain neurotransmitters such as serotonin that are worn out by stress. The article goes on to state that people under chronic stress tend to gain weight over time, due both to stress related endocrine changes and stress management behaviours that revolve around food.

                Life Extensions (2007) reviewed a study in Psychosomatic Medicine that established people tend to eat food in order to self-medicate their feelings of stress or anxiety:  In the study 34 volunteers were told that they needed to prepare a four minute speech that would be recorded by video equipment and later assessed by researchers for its quality. This produced so much stress in the participants that their blood pressure increase and their mood worsened, An additional 34 volunteers served as a control group. All participants were then allowed to eat as much as they wanted from selected foods. The outcome?

 The stressed grouped consumed 88% more sweet, fatty food then did the control group. According to Life Extension (2007) scientists believe these choices are not made because of the enjoyable taste of these foods. Carbohydrate-rich, protein poor meals allow greater uptake of the amino acid tryptophan  into the brain, where it serves as a precursor for synthesis of the brain neurotransmitter known as serotonin. Consuming these foods can also relieve stress by stimulating the release of brain opioids known as endorphins, which induce a sense of pleasure and dopamine another brain neurotransmitter that underpins the positive reward system, including anticipation of pleasure.

            Frey (2008) cited Marcy Gregory, a dietitian in Rancho Mirage and author of the book “Loose the Belly Fat” as having stated that stress contributes to abdominal fat via the release of cortisol, a hormone that facilitates fat storage. “Gregory acknowledged that stress is a culprit and associated with the hormone cortisol by continuing to go on to say that “exercise can do double duty by relieving stress and helping to create muscle tissue that can override the fat storing effect.”

            Peeke (2000) pointed out that:  There is a difference between chronic and acute stress and some people are born with an ability to handle stress with greater ease then others. These individuals are actually born with body tissues that are more resistant to stress hormones and therefore hardier. (p.5)

 Peeke (2000) referred to everyday stresses that can become difficult to manage and to childhood stresses that an individual may bring with them into adult hood. She notes that “research has shown that cortisol can be transferred from a mother to her fetus in utero. In essence, jumpy mother have jumpy babies.” (p.7) she Goes on to suggest that “research has shown that many children who had a difficult time in utero may go onto become adults who have a stress response to life that is almost always toxic.” (p.8)

Peeke (2000) notes that:  New evidence suggests that (toxic stress) can give you a raging appetite. It appears that  one of cortisol’s major roles is to help refuel the body after each stress episodes uncontrolled  or toxic stress keeps the refueling appetite on, thus inducing stress eating and weight gain. (p Peeke (2000) explains that adrenaline and cortisol make fuel available for the stress response. When the stress response is activated the adrenalin and cortisol levels arise, together telling the body to release sugar into the blood stream to give it a surge of energy.” (p.24). Peeke (2000) goes on to clarify that:

                        Stress becomes toxic only when it begins to poison the system and threaten the natural  state of homeostasis on a chronic level. Toxic stress is the greatest threat to balance because it never allows the bod to shut down the stress response. (p.11)          

            Once the body returns to normal after a stress response, it begins to prepare for the next stressor. As Peeke (2000) points “not only do the hormones need to be replenished but the fuel levels need to be restored. Because you have burned high octane fat, the body needs to replenish itself. Cortisol sparks your appetite and make you ravenous” (p.24).

            The fight or flight response was designed to keep use safe but as Peeke (2000) points out, “now because our stressors no longer require physical responses, we are left in a state of perpetual imbalance” (pg.29).

            Peeke (2000) in studying the stress-fat connection found that “fat cells have special stress hormone receptors for cortisol. There seems to be more of these of the intra-abdominal fat cells than on the fat cells in other parts of the body” (pg.32). Learning to manage stress allowed individuals “to return to homeostasis as soon as possible. Neither the hunger nor the starvation response remained chronically activated” (pg.30).

            Staying Healthy from Faculty of Harvard Medical School (2007) indicates that sleep is correlated to weight: esearch shows that the less you sleep, the more likely you are to gain weight. Lack of sufficient sleep tends to disrupt hormones that control hunger and appetite. In a 2004 study of more than 1,000 volunteer researchers found that people who slept less than eight hours a night had high levels of body fat than those who slept more, and the people who  slept the fewest hours weighed the most. Stress and lack of sleep are closely connected to psychological well-being, which can also affect diet and appetite as anyone who’s evergorged on cookies or potato chips when feeling anxious or sad can attest.

Studies have demonstrated that some people eat more when affected by depression, anxiety or otheremotional disorders. In turn, overweight and obesity themselves can promote emotional disorders; if you repeatedly try to lose weight and fail, or if you succeed in losing weight only to gain it all back, the struggle can cause tremendous frustration over time, which  can worsen anxiety or depression. A cycle develops that lead to greater and greaterobesity, associated with increasingly severe emotional difficulties. Excess fat aroundthe abdomen helps make the body resistant to insulin, the hormone that enables blood  sugar to enter the cells where it can be used for fuel. If you overeat when you areunder stress, find a stress reduction method that works for you: meditation, relaxation techniques, listening to music, exercising or talking to a friend.

             Fuchs (2001) suggested that to lose weight people must address emotional and physical needs. She states that “We eat because we are lonely, bored or want to avoid doing something. We use food as a substitute for love, to cover up feelings and as a reward.” (p.16).

            Pr Newswire (2002) states that studies published in the American Medical Association and the Lancet suggest that when we lose sleep we may experience increase hunger and changes to our metabolism. Specifically:  Sleep loss has been shown to affect the secretion of cortisol, a hormone that regulates  appetite. As a result, individuals who   lose sleep may continue to feel hungry despite an adequate food intake. Additionally, sleep loss may interfere with the body’s ability to metabolize carbohydrates and cause higher blood levels of glucose, a basic sugar.

Excess glucose promotes overproduction of insulin, which can promote storage of  body fat and can also lead to insulin resistance. The Manila Times (2008) interviewed Nadine Tengco, a US-certified fitness nutritionist and weight management specialist and found that:  As the body experiences stress, the system releases hormones called cortisol that  increases appetite and energy levels. Even after stress passes, these hormonal levels can remain elevated especially if the person is subjected to chronic stress. “Your appetite increases, ultimately driving you to eat more,” Tenneco adds. This is where the problem lies-more stress equals more weight gain.

Bora (2000) writes that: After comprehensively analysing 31 long term studies, UCLA researchers recently concluded that diets don’t work. You can lose 5 to 10% of your weight on any number of diets, but then the weight comes back on. Researchers found that the majority of people regain all the weight, plus more. Sustained weight loss was found only in a small minority. Diets do not lead to sustained weight loss or health benefits for the majority of people.

Oprah.com(n.d.) in speaking with Dr. Peritonea reports that: Our cortisol levels are affected on a daily basis by our attitudes and approach to life. Consequently learning to relieve and deal with stress in a positive manner is an essential part of our anti-aging lifestyle. We need to do everything we can to see that the cortisol levels don’t continue to remain elevated and destroy our very lives. Cortisol is deadly and stress produces cortisol. So, therefore, we must control stress- and getting enough sleep is an  important part of the process.

            An abstract at Sciencedirect.com (2000) discusses a study developed to identify whether physiological variables are related to eating after stress. Specifically: We hypothesized that high cortisol reactivity in response to stress may lead to eating after stress, given the relations between cortisol with both psychological stress and mechanisms affecting hunger. To test this, we exposed fifty-nine healthy pre-menopausald women to both a stress session and a control session on different days.

High cortisol reactors consumed more calories on the stress day compared to low reactors, but ate similar amounts on the control day. In terms of taste and preferences, high reactors ate significantly more sweet food across days. Increases in negative mood in response to the stressors were also significantly related to greater food consumption. These results suggest that psycho physiological response to stress may influence subsequent eating behaviour. Over time, these alterations could impact both weight and health. (p37-49)

Bittman (n.d.) addressed the issue of perceptions and how this impacts weight by suggesting that: Central fat, (you know the stuff) located primarily around our mid-sections, is considered unhealthy as is appears to be commonly associated with heart disease and diabetes.

 Particularly sensitive to cortisol, a circulating hormone typically released as part of the  biological stress response, central fat literally increases with perceived distress.     Yale University of Public Affairs (2000) reports on a study of conducted at Yale that showed the impact of cortisol on abdominal fat:  Weight women who are vulnerable to effects of stress are more likely to have excess abdominal fat, and have higher levels of the stress hormone cortisol. While past studies have examined cortisol response in overweight women, this is the first study to  show that lean women with abdominal fat have exaggerated responses to cortisol.

 Abdominal fat is related to worse health, including greater risk of heart disease and  diabetes. One of the lead researchers, Elissa S. Epel, PhD, indicated that; we also found that women with greater abdominal fat had more negative moods and higher  levels of life stress.

Bolocofsky, Spinler & Coulthard-Morris (1985) examined the effect of adding hypnosis to a behavioural weight-management program on short and long-term weight change:  One  hundred nine subjects, who ranged from 17-67, completed a behavioural treatment either without the addition of hypnosis. At the end of the 9-week program, both interventions resulted in sufficient weight reduction. However at the 8-month and 2-year follow ups, the  hypnosis clients showed significant additional weight loss, while those in the behavioural treatment exhibited little further change. More of the subjects who use hypnosis also achieved and maintained their personal weight goals.

            The Family Networker (2008) recognized that individuals are tired of impersonal Western medicine practices and are “Turning to acupuncture, homeopathy, therapeutic massage, biofeedback, hypnosis, chiropractic and other alternative therapists that treat them as whole people.”

            The Manila Times (2008) goes on to acknowledge the benefit of developing stress management skills as a means to manage weight, in particular a holistic attitude towards weight and “the big three consists of proper nutrition, exercise and relaxation.”

            This researcher questioned whether women who come for hypnotherapy for weight loss are managing stress poorly and wondered whether the stress hormone cortisol could be a culprit in weight gain. Over the course of three years, this researcher has polled weight loss clients regarding perceived stress levels at intake. Time and again stress levels have been reported as high and coping skills as being low. All clients indicated an ability to relax either physically or emotionally.

            Fifteen (15) randomly selected weight loss files from the last three years were pulled for this dissertation and in reviewing case notes, this researcher has determines that 100% were women, age rages have been between 30-50 years, all indicate feeling stressed, overwhelmed, tired, exhausted, and emotionally drained. Each and every one indicated that food was used as a comfort measure and that there was a sense of being out of control with respect to food. Each indicated a lack of physical energy and ongoing difficulties with sleep.

            Clients indicated during session that they used food as a tool and as a stress coping method. Each client indicated that often they do not even taste their food and often do not realize when they are full.

            This researcher will review several sources in order to gather scientific data with respect to the stress hormone cortisol and its role in weight gain. In addition, any sources can be found to address the efficiency, or lack thereof, in the use of hypnosis to address the stress fat connection will be presented.

            The sources cited indicate that, yes, cortisol plays a role in weight gain. Understanding the stress response requires an understanding of the hormone called cortisol, which has recently been dubbed the “stress hormone.” As has been outlined, in spite of this ominous name, cortisol does have an important and positive role to play in our systems.

            Simply recall basic high school biology and the reader will remember that this hormone is secreted by the adrenal gland. Cortisol is a vital player when it comes to metabolizing glucose, regulation blood pressure, releasing insulin, and the overall functioning of our immune system. This hormone is a good guy in the sense that it takes care of key tasks. The trouble comes in when high levels of cortisol are repeatedly secreted into the blood during times of chronic stress.

            Higher levels of cortisol are secreted into the blood when we experience the flight or fight response. Cortisol is one of the hormones secreted and another is epinephrine (which is adrenaline) we all experience this response on a daily basis. Daily hassles such as rushed morning routines, irritations with traffic, co-workers to name a few.

            Most individuals are managing other stressors as well including relationship, financial and parent challenges. These ongoing daily challenged put some individuals at risk for an abundance of cortisol secretion. Clients who come to see this researcher for weight loss purposed indicate that the stress levels in their lives are often overwhelming.

            While it is natural for us to experience periods of flight and fight, our bodies were not designed to continuingly take on and linger in the stress response for extensive periods of time. The body’s system is designed to gradually return to normal after a sharp emotional or physiological response to an event.

            In today’s world, however, with the many burdens and expectations, most clients perceive their lives to be highly stressed. Therefore, their bodies are not having the opportunity to fulfill the primitive natural function of returning to homeostasis through the elicitation of the relaxation response.

            In addition many of these clients have, over time, been conditioned to label themselves as individuals’ who are chronically “stressed” and lack coping skills. However, clients who are appropriate to his researchers service and who do in fact receive service, DO have adequate coping skills, which have simply been buried and require rekindling.

            Most clients who come to hypnosis have spent many years feeling frustrated and overwhelmed with the demands of popular and expensive weight loss programs. A lack of success with diets had generally over time undermined these women’s relationships with their bodies. Ongoing diet programs coupled with constantly feeling overwhelmed and perceiving life as stressful has meant that these women have been activating their body’s stress response repeatedly. Constant engaging in the stress response leaves these women with “belly rolls”, poor eating habits and poor sleep patterns.

            The body’s natural relaxation response is not set into motion for these women. The outcome of this is a chronic stress state and secretion of the hormone cortisol. While this researcher has not tested client’s cortisol levels, the indicators of excessive secretion found in the studies mentioned above are obvious. That is “the belly roll”, sleep difficulties, and cravings for sweets and carbohydrates.

            Once clients begin to benefit from daily progressive relaxation suggestions around sleep hygiene, body movement (exercise) to help work off the intense energy states of fight or flight, they begin to gather around them a sense of power and an ability to manage stress. While the scale may not shift for a period of time, these clients indicate that they have more physical energy, are sleeping better, choosing healthier foods and many indicate that their “belly rolls” have decreased. Most importantly, clients indicate a better reaction to life stressors that they are previously reported as being overwhelmed. That is to say, perceptions about stressors have shifted; life begins to feel more manageable.

            We know that in order to keep cortisol levels healthy and under control the body’s relaxation response should be activated after the flight or fight response occurs. This means clients who learn to relax their body with the aid of hypnosis, who address issues brought to light, and make a committed use of self-hypnosis, along with progressive relaxation as an induction would likely lower cortisol read outs.

            The research clearly shows a connection between cortisol and other health related concerns beyond weight gain. Tummy fat is show to be a predicator of heart disease and diabetes as well. Our world is complex and certainly provides many opportunities for individuals to feel stressed. However, the evidence is clear that managing stress through eliciting the relaxation response allows an individual gain some level of being in control of the “stress hormone” secretion.

            Without a doubt hypnosis can be beneficial in terms of addressing weight gain as a response to stress. Eliciting the relaxation response, deliberately, after the stress response has been activated allows the body’s system to return to normal. In a world where activation of the flight or fight response is thrust into full gear repeatedly throughout the course of a day, learning to elicit and condition the relaxation response makes perfect sense.

            While this researcher in not equipped to tests cortisol levels, client self-evaluations after a course of hypnosis for weight loss indicate not only an eventual change on the scale but several other positive factors as well. That is, clients indicate an improved ability to elicit the relaxation response quickly, they perceive themselves to be managing daily stressors in new healthy and creative manners, they report an increase in physical energy, indicate feeling more emotionally balanced and enjoy improved sleep patterns

            The research clearly shows that the stress hormone cortisol is linked to weight, specifically to storage of fat around the midsection. This has been scientifically proven through numerous studies.

            There is less scientific data regarding hypnosis and the role of the stress hormone cortisol with respect to managing weight. When hypnosis has been used in a study, it is usually an adjunct not a primary mode of therapy. Although several sources did cite hypnosis as being beneficial to weight loss they did not, specifically address the role of cortisol.

            The generalizations made by this researcher are extracted based on the data found and a measure of common sense. That is, it makes good sense to generalize the findings and make an educated guess that hypnosis, aimed at reducing the stress and altering perceptions of stress, conditioning a relaxation response that can be called on and triggered easily throughout the course of a day, would assist to minimize the body’s response to ongoing activation of flight or fight response, thereby addressing the issue of cortisol secretion.

            We live in a stressful world. Oftentimes clients are struggling with many issues beyond the initial presenting concern. Often a healthy adaption to stress has been replaced with aberrant behaviors, one being overeating. Stress includes feelings about weight, unhappy relationships, unfulfilled work life, fatigue, health complaints, difficulties with children, financial concerns, aging parents, unresolved childhood issues, poor boundaries, lack of social outlets or leisure activates and often a sense of being frenetic with not enough time in the day. This means many rushes of cortisol; stress is chronic.

            The relaxation response is outlined by Dr. Benson and has been extracted through the study of several mindful practices. The practices, while not necessarily labeled as hypnotic in nature, obviously are. It would appear that when this book was written there may have been a fear regarding using the term “hypnosis.” This misgiving remains today. While studies may allude to the state of hypnosis, the label is used rarely and rarely do medical doctors refer clients to hypnotherapy for either weight loss or stress management.

            Since how stress is managed appears to be an important factor in terms of weight and certainly overall health it makes sense that hypnosis, from a body, mind and spirit perspective be recognized is a powerful tool. The sources cited make repeated suggestions to manage stress through relaxation and altering perceptions. This can be best carried out while in the receptive state of trance. Yet, there appears to be no little evidence of this when gathering data about cortisol, weight and hypnosis.

            There is mention of hypnosis as being a tool in terms of managing there origin of weight problems. This is significant in the sense that often by discovering and addressing post memories a client can prepare to take charge of conditioning new responses. However, again the link between cortisol, weight and hypnosis was not addressed. In addition, how hypnosis helped in terms of specific suggestions and addressing underlying causes of overeating were not addressed.

            Besides hypnosis being a useful modality for accessing information from the subconscious, often for the purpose of self-discover and healing, hypnosis it is also useful in terms of direct and indirect suggestions for the purpose of conditioning new beliefs and behaviours. That is, conditioning new behaviors and attitudes can be fairly straight forward with a client who is even moderately "hypnotizable". Studies addressing the straight forward use of hypnosis for weight management do indicate success but again, the stress hormone cortisol is not specifically identified as a factor in the research.

            On an almost daily basis this researcher is witness to the body’s ability to re-experience stress while in a perfectly benign and safe environment. Most clients and skilled at using internal processes that recreate physiological and psychological stress response in the body. Simply by using the imagination, choosing images, words and sensations, clients often easily move into a state of fight flight when describing their lives. The body reacts and the mind begins to race, reacting to receive stressors that in fact only imaginary in the moment. This demonstrates an obvious mind body connection.

            How we each interpret situations certainly has plenty to do with how we respond to stress. This was concept was well expressed in the literature. However, responses may be of an outward or inward focus. Outward focused stress responses certainly can be overeating and finding a study on the internal process of the stress response would have been fascinating. An example of how human beings create stress with undisciplined internal dialogue or personal hypnotic patter was not found in the research. When in fact, there is an ongoing internal hypnotic patter that goes on from sun up to sun down for every one of the clients this researcher has worked with.

            The ongoing patter, increases internal perceived stress and therefore, no doubt, cortisol production, which in turn increases appetites, sets up cravings, interferes with sleep and thus, contributes to a vicious cycle.

            As a referenced in one source, it seems clear that diets do in fact, not work. This appears to be the case as well with clients who come to hypnosis for weight loss. They have generally tried numerous popular weight loss programs over time with little long term success. When weight is lost, it is without exception gained back. While the programs may offer nutritional advice, little in terms of managing stresses in relation to food cravings and eating behavior in provided. And yet, it appears that diets programs are a big industry and profiting well.

            It is also clear that the medical profession continues to, for the most part, encourage traditional routes towards healthy weight. This is unfortunate when one begins to link weight issues to diabetes and heart disease, which research is showing is showing are connected to weight. The emotional and physical cost of excess weight is enormous to each individual and there is also a clear financial cost to our health care system,

            The finding that cortisol sets up a craving for sweets and carbohydrates was interesting and no doubt would be validating for many clients who indicate that they feel “addicted to chocolate” and breads. Clients often state that they “lack willpower” or are “weak.” Understanding that there is a biochemical trigger for sweets and that is related to stress allows clients to look at how they may choose to perceive stress differently. This can potentially be useful in soliciting a shift from “victim mode” to one of empowerment whereby one takes a responsibility to manage perceptions and learns to elicit the relaxation response as a counteraction to fight-flight response.

            It is fascinating to learn that hormones such as cortisol and adrenaline were meant to furnish us with “muscle” to deal with threats and therefore hormones must to be burnt off physically. Clients often view exercise as a means to manage weight with a certain amount of dread. Almost all clients state they do not like exercise and are not motivated. Exercise is often seen as a way to counteract extra calories consumed or a way to manage guilt for perceived poor food choices throughout the day.

            Exercise as a way to manage stress and burn off the fight flight hormonal response may be an interesting way to shift perceptions about moving the body. Moving the body as means to regulate excessive cortisol secreted during the flight or fight response may be a new and interesting idea for some clients.

            Learning that cortisol plays a role in metabolism, blood pressure, insulin release and immune function explains why people under stress struggle so much with maintain a basic healthy lifestyle. People who are stressed often or chronically stressed do seem to gain weight, have difficulties with sleeping, change their eating habits and decrease activities that would allow their body to move naturally or exercise.

            The studies did not touch on the spiritual aspect of managing stress or weight loss. It would appear that the subconscious mind appears to be a “non-scientific” entity. However, the efforts of hypnotherapy are to work with and impact the subconscious mind. It is that part of us that stores our memories and is in charge of our feelings. The autonomic nervous system is truly the caretaker standing at the door to the subconscious.

            Change is dependent on emotionalizing new outcomes therefore ignoring the presence and power of the subconscious mind in the change process makes little sense. This researcher questions why scientists seem unwilling to acknowledge the subconscious mind as more than mere chemical processes.

            We know that when we experience a strong emotion, whether in real time or by revisiting a memory, the autonomic nervous system sets in a motion many processes, one being the fight or flight response. In spite of this real response it is not unusual that we may later “forget” something that occurred. That is, we are not accessing the information consciously. This seems to be a survival response beyond mere chemical processes, whether it is our on higher power or soul like function or that of another power of creative intelligence.

            Whatever this may be, it is distinct from mere chemical processes. Most clients have within them is a storehouse of amazing and miraculous resources, ones that either lay dormant or have yet to be activated. Some level of belief in a power greater then themselves is often required, a turning point, a shift that allows for the possibility of something new, whether that be a willingness to consider new information or take on a new behaviour.

            Much of the scientific literature placed most importance on cortisol as a stress hormone and indicated that we must adapt our response to stress though relaxation, exercise and altering perceptions. The other sources cited clearly were not based on the “medical model” and more readily put forth the view of weight being a multidimensional issue that must be addressed through a mind body connection, even if hypnosis per se was rarely suggested.

            The review makes it clear that we are not hard wired for long term stress. In order to have a healthy body we must have a healthy mind and learn to adapt to stress. While a little is said in the way of hypnosis being a valuable tool to manage stress as it relates to weight, this researcher believes that there is clear connection and that further research is warranted.

            There is plenty of evidence to suggest that the stress hormone cortisol is indeed correlated to weight gain. Cortisol is secreted in connection to one’s perception of stress. Our systems must have the opportunity to experience the relaxation response in order to return to homeostasis.

            While the research certainly provide scientific evidence for the role of cortisol and “stress-fat” there is less hard evidence that hypnosis does in fact address the issue of weight gain by addressing the issue of stress. Researchers are more apt to suggestion relaxation exercise and perception management then hypnosis per se.

            Nonetheless, hypnosis has been proven to be an important tool in altering habits and uncovering past hurts for the purpose of healing. Within these researchers private practice the finding has been that hypnosis valuable in terms of addressing emotional causes of overeating, of altering one’s perception of body image and altering eating habits.

            More often than not hypnosis subjects benefit from inductions that are highly relaxing and do elicit the relaxation response. In fact, within his researchers practice many clients learn to elicit a deep relaxation response on cue as a part of the self-hypnosis training provided.

            The link between cortisol and sleep was an unexpected find and helps to explain why new weight loss clients often complain of not feeling rested and sleeping poorly.

            Hypnosis is in fact a useful method of stress management and therefore common sense suggests that its use would impact the secretions of cortisol, which would then influence the biochemical response of the body to store fat.

            Further research is necessary to factually prove hypnosis is beneficial in terms of weight gain related to stress hormone cortisol. That is, a double blind study in a clinical setting should be considered. Partnership between a medical doctor and a clinical hypnotherapist would likely prove this researchers expectation that hypnosis does in fact positively interfere with the stress-fat connection.

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