Erectile dysfunction (ED), sometimes called impotence, is an embarrassing and devastating challenge that most men are afraid to talk about. It can impact romantic relationships, emotions, and self-esteem. ED occurs when not enough blood flows to the penis to maintain an erection during sexual activity. In younger men, it is rare but the chances of ED increase substantially as you age. At age 40, approximately 40 percent of men have experienced some form of ED and by age 70, almost 70 percent of men are affected.
Causes of Erectile Dysfunction
You might be thinking, well that sounds like a physiological problem. How can hypnosis help with that? Although ED can have a physical source, it can also be affected directly by psychological reasons. Sometimes those psychological issues also indirectly impact physical processes, like blood pressure, which in turn appear to cause ED. Hypnosis, in short, can help treat the psychological reasons for ED. It is estimated that 90 percent of teenagers and young men that suffer from erectile dysfunction do so for psychological reasons, mainly related to anxiety. In middle-aged men, the main causes of psychological impotence appear to be stress and relationship problems. As men age, the reasons for erectile dysfunction become more physiological. The following are psychological reasons for ED and the role hypnosis can play in their treatment.
It has long been thought that anxiety plays a major role in erectile dysfunction. In 1986, anxiety researcher David Barlow postulated that anxiety affects impotent and non-impotent men in very different ways. In sexually dysfunctional men, anxiety increases impotence. In more functional men, it may not have a significant effect or it may increase excitation. He hypothesized that men who suffer from erectile dysfunction interpret sexual cues in a way that causes them anxiety instead of excitation. For example, a dysfunctional man may take an erotic cue and begin to think about his potential failure to perform whereas a non-dysfunctional man uses the cue to enhance his sexual experience. Further, worrying takes up space in your mind that could be used to focus on more sexually exciting information.
Performance Anxiety and Erectile Dysfunction
It is a popular conception that all anxiety related to ED is performance anxiety. After all, it makes sense that someone with ED would worry about whether or not they could become erect and satisfy their partner. While performance anxiety does appear to inhibit sexual arousal, it would be incorrect to say that it is the only type of anxiety that contributes to erectile dysfunction. In a study of functional adult males, Hale and Strassberg found that anxiety decreased sexual arousal when the participants were faced with both an anxiety-inducing performance or non-performance cue. Therefore, interventions for all types of anxiety should aid in the treatment of erectile dysfunction.
Hypnotherapy and Anxiety Reduction
Hypnosis research has often focused on the treatment of anxiety. There is a lot of face validity to the utilization of hypnotherapy for the reduction of anxiety symptoms. Hypnosis is thought to elicit a calm and relaxed mind, which is the antithesis of worry. Additionally, hypnosis apps and audio recordings are often marketed to help reduce stress and anxiety. In large scale reviews of relevant research, Fredette, El-Baalbaki, Neron, & Palardy found evidence for using hypnosis in the treatment of anxiety disorders, including social phobia, panic disorder, and generalized anxiety (GAD). Further, non-clinical anxiety, such as can be seen in test-taking and public speaking, can also be reduced through hypnosis.
Hypnosis in Anxiety-Related Medical Treatment
Certain medical procedures and ailments appear to be related to anxious feelings. For example, the occurrence of irritable bowel syndrome, ulcers, and hypertension appear to have an association with anxiety. Additionally, the thought of dental procedures and surgery often causes extensive anxiety. Haven’t we all worried about going to the dentist or going under the knife? For those ailments that seem related to—and exacerbated by–anxiety the use of hypnosis would seem to able to enhance treatment. Hammond identified research where hypnosis reduced tension headaches, ulcers, irritable bowel syndrome, and pain associated with childbirth. There is even research to suggest that hypnosis can lead to an improvement in overall immune function (Hammond, 2010).-6 Hypnosis has also shown promise in reducing anxiety related to medical procedures and illness, such as experienced by cancer and burn patients. Finally, hypnosis has been used successfully post-surgery to promote healing.
Hypnotherapy as an Adjunct to Cognitive-Behavioral Therapy (CBT)
A major area where hypnosis has found success in treating anxiety is in combination with CBT. This makes sense, as behavioral methods similar to hypnosis (e.g, relaxation, meditation), have already been incorporated into many CBT protocols for anxiety treatment. In some studies, the implementation of hypnosis and CBT are mixed, making it difficult to ascertain the effectiveness of hypnosis separate from what is found from CBT alone. For example, Daitch used a combination of CBT, mindfulness, and hypnosis to successfully treat generalized anxiety disorder. As it was a case study, she did not attempt to tease out the effects of CBT from hypnosis. This is the case in much of the hypnosis research. However, there appears sufficient evidence that hypnosis reduces anxiety above what can be obtained only by CBT when the two interventions are used together.
Barlow’s work has indicated that a lack of attention could contribute to erectile dysfunction and his supposition has been validated by the ED literature. When distracted from sexual cues, there is evidence that sexual arousal is decreased. As an example, think about a man who wants to focus on sexual cues to maintain his erection but his mind consistently goes elsewhere. Maybe he can’t ignore nagging work challenges or he is constantly distracted by environmental cues. He is not able to maintain sexual excitement because he cannot concentrate on sexual stimuli. This research has implications for those people who have attentional difficulties, such as people who suffer from ADHD, inattentive presentation. It follows that those people that can concentrate on sexual cues are less likely to have sexual dysfunction.
Hypnosis and Attention
Based on the attention literature, it makes sense that hypnosis would help increase sexual arousal if it can aid in increasing attention. Macleod suggests that hypnosis can be used to control attention and where it is focused. Since Kane et al.found evidence that increasing attention toward sexual cues increases arousal, we can conclude that helping a person with ED focus on positive sexual cues—as opposed to negative performance issues—could increase a person’s level of sexual arousal and decrease the incidence of ED. Therefore, hypnosis can help someone focus on the appropriate sexual cues to maintain an erection.
As mentioned earlier, stress in middle age is one of the primary variables of ED. Kalaitzidou, Venetikou, Konstadinidis, Artemiadis, Chrousos & Darviri found that higher perceived stress levels were related to poorer erectile functioning. In addition, there is a strong relationship between stress and hypertension, which is correlated with the occurrence of ED.
Hypnosis As a Stress Reducer
There is tremendous anecdotal evidence for the use of hypnosis as a stress reliever. Similar to relaxation and meditation, people often turn to hypnosis to cope with stressful situations. Several research studies seek to find support for hypnosis as a stress reducer. A majority of studies reviewed reported a significant reduction in perceived stress when using hypnosis compared to control groups. Unfortunately, due to the less than optimal research design of those experiments, the results supporting the effectiveness of hypnosis can only be called inconclusive at this time.
Hypnosis for Hypertension
Stewart recognized some earlier research studies where hypnosis reduced blood pressure compared to control groups. In a more recent study, Gay found a significant reduction in blood pressure and anxiety for a group of adults with hypertension who underwent hypnosis. This was also true after a year followup.
Post Traumatic Stress Disorder (PTSD)
Although PTSD used to be categorized as an anxiety disorder, I have included it under the heading for stress because it is the stress of undergoing trauma that leads to its symptomatology. Research has consistently shown that a diagnosis of PTSD is positively associated with an increase in erectile dysfunction. In addition, people with PTSD are constantly re-experiencing their trauma and that may distract them from focusing on sexual cues.
Hypnosis for PTSD
PTSD is one of the most studied areas in hypnotism research. Part of the reason for this is that it has been found that people with PTSD are more hypnotizable than other populations. Bryant, Moulds, Nixon, Mastrodomenico, Felmingham & Hopwood, in a study of acute stress disorder, found that hypnosis combined with CBT resulted in less PTSD symptoms when compared to supportive psychotherapy alone. Additionally, the hypnosis/CBT group had a greater reduction in re-experiencing symptoms of PTSD than those people who received CBT alone. Numerous other studies have also indicated the efficacy of hypnosis with PTSD populations, although the authors note that the psychometric properties of the research need improvement to make more definite conclusions. Green, Laurence, & Lynn make an apt summary of the research: “the evidence for hypnosis effectively treating PTSD is positive, yet weaker than that for exposure-based therapies”.
Hypnotherapeutic Olfactory Conditioning
A new area of promise in the use of hypnosis for PTSD treatment is called hypnotherapeutic olfactory conditioning (HOC). HOC uses hypnosis to create positive olfactory associations that replace previous olfactory associations that triggered PTSD symptoms. For example, a person who served in the Iraq war might experience negative symptoms when they smell something (e.g., middle eastern food) that reminds them of the trauma they observed during the war. By making those associations more positive, hypnosis would help reduce the triggers connected to the smells of war. As a promising new treatment, more research on HOC is needed.
Depressive feelings appear to have an association with erectile dysfunction. Barlow found that sexually dysfunctional men displayed negative affective responses when viewing erotic films, while sexually functional men exhibited more positive affective responses. He surmised that negative affect might contribute to the avoidance of erotic cues and thereby facilitate cognitive interference that leads to ED. His observation appears to be borne out by later research. In a review of multiple research studies, depression was found to increase the risk of ED.
Hypnosis for Depression
Alladin & Alibhai are some of the first researchers to conduct controlled trials for the treatment of depression using hypnosis. They note that using hypnosis for the treatment of depression does not have a lengthy history due to the false belief that hypnosis increased suicidal behavior in depressed individuals. To test their hypothesis, the authors created cognitive hypnotherapy (CH), a mixture of CBT and hypnotherapy. Although they found CBT alone to be effective in reducing the symptoms of chronic depression, the use of hypnosis had an additive effect. CH reduced depression more than CBT alone at the time of intervention and six and twelve-month follow-up. In a meta-analysis, Shih, Yang, & Koo looked at six studies that utilized randomized controlled trials in the use of hypnotism for depression. They found that the results supported the contention that using hypnosis for the treatment of depression was more effective than placebo but could not determine if it is any better than other therapeutic interventions. In another examination of hypnosis for depression, McCann & Landes note that some research indicates the effectiveness of hypnotherapy for depression but states there needs to be more robust scientific research to support the contention.
If you look at general sources of information on the internet (e.g., Healthline and Mayo Clinic), it is often said that relationship problems are a source of erectile dysfunction. In support of that assertion, Boddi, Fanni, Castellini, Fisher, Corona & Maggisurveyed almost 4,000 men with sexual dysfunction. They found that over 20 percent reported conflict in their relationship with a significant other. Further, in an exploration of research on relationship conflict and ED, Metz & Epstein reported that multiple studies indicate a role for relationship conflict in the development of ED. They also note that it is difficult to determine the direction of causality with this issue. In other words, does ED lead to relationship challenges or is it the other way around? Nevertheless, there does appear to be evidence for an association between relationship conflict and erectile dysfunction.
Hypnotherapy for Relationship Challenges
The research in this area is sparse and anecdotal, usually provided by hypnotherapists that have used hypnosis in couples therapy. For example, Fergusondescribes how her use of hypnotherapy with couples has helped them to improve engagement and focus on future goals. Additionally, using Ericksonian hypnotic techniques in couples hypnotherapy, Araoz, Burte & Goldin reported that they successfully addressed sexual dysfunction by working on five stages of sexual response (i.e., desire, arousal, foreplay, orgasm, and processing). Couples hypnotherapy is not an area that has received much attention but there are indications it could be beneficial in the treatment of sexual dysfunction. Since erectile dysfunction may be the result of anxiety, stress, and depression, it reasons that an understanding and supportive partner could help alleviate some of the related issues.
Although smoking is not a psychological cause of erectile dysfunction, it has been identified as a behavior related to the disorder and is a condition frequently targeted by hypnotherapy. Kovac, Labbate, Ramasamy, Tang & Lipshultz state that “there is overwhelming evidence in the literature to support the claim that smoking worsens erectile function through vascular mechanisms”. It has also been found that when smokers quit, it decreases the frequency of ED. Further, Biebel, Burnett & Sadeghi-Nejad state that smoking is a risk factor for ED and the risk increases proportionally to the amount people smoke.
Hypnotherapy for Smoking
While numerous studies measure the effectiveness of hypnosis on smoking cessation, the results of those studies are mixed, at best. In one of the most positive conclusions, Williams and Hall found that a single two and a half-hour session of hypnosis was enough to significantly decrease the number of cigarettes smoked when compared to a placebo and no-treatment control group at the time of the intervention and almost a year later. Carmody, Duncan, Simon, Solkowitz, Huggins, Lee & Delucchi reported that hypnosis increased quitting at a greater rate than a behavioral counseling intervention. However, these results were not statistically significant.
Green & Lynn reviewed 59 related studies and found that while hypnosis appeared to yield better results than no intervention, they could not find conclusive evidence that hypnotherapy was more effective for smoking cessation than other therapies or even placebo. They also noted that it was difficult to separate the effects of hypnosis from those of other treatments with which it was often combined. Barnes, McRobbie, Dong, Walker & Hartmann‐Boyce conducted a review of controlled trials measuring the impact of hypnosis on smoking cessation. They found “insufficient evidence” to determine whether hypnotherapy is more effective than other interventions or even when compared to no interventions. If there is a benefit, they concluded, it is “small at most”. They reported that most studies of hypnosis related to smoking cessation are plagued by bias and poor psychometric properties.
Direct Studies of Hypnosis and Erectile Dysfunction
Most of the literature on hypnosis is indirectly related to erectile dysfunction. However, there are a couple of studies that make positive claims about the direct effectiveness of hypnotherapy for ED. Harold Crasilneck, a hypnotherapist, claims to have successfully treated ED in approximately 88 percent of 3000 clients he has seen using hypnosis. This was based on his private practice, however, rather than an experimental analysis. In another study, hypnosis was found to be superior to acupuncture and placebo as a treatment for ED, although the improvement noted between hypnosis, acupuncture, and placebo was not statistically significant.
Weaknesses of the Hypnosis ED Literature
While this paper makes links to the effectiveness of hypnosis in the treatment of ED, the nature of the research makes more definitive conclusions difficult. One impediment to justifying the use of hypnosis for ED comes from the combination of using other treatments with hypnosis. Whether it is CBT, relaxation, or a nicotine patch, the use of other interventions with hypnosis confounds the ability to make accurate deductions about hypnosis alone.
Additionally, it is difficult to make an association between hypnosis and erectile dysfunction when almost all of the research deals with topics that are only indirectly related to ED. For instance, saying that hypnosis is effective in treating anxiety is not the same as saying it works with impotence. Although it makes rational sense to provide that link, it is an indirect association. Scientists are likely to point out that the transitive property does not necessarily work in the case of intervention effectiveness.
It should be noted that the lack of robust scientific research in the field of hypnosis does not mean it is not effective in treating erectile dysfunction. First-person accounts are still relevant. You can’t simply ignore people who claim they benefit from hypnosis. Unfortunately, the scientific community does not give much credence to studies that have poor psychometric properties. Although it is improving, hypnosis relies too heavily on anecdotal evidence and case studies. Without a more robust research design, hypnosis will not receive respect as a viable ED treatment.
A Realistic Role for Hypnosis
It is fair to say that the scientific community questions the use of hypnosis as a primary treatment option. Where hypnosis achieves the most acceptance and appears to have the most practical utility is as an adjunct to other forms of treatment. Michale Yapko, Ph.D., a psychologist and fellow of the American Society of Clinical Hypnosis states the following: “Hypnosis works and the empirical support is unequivocal in that regard. It really does help people. But hypnosis isn’t a therapy in and of itself. Most people wouldn’t regard it that way.” Using hypnosis as an addition to other therapies is certainly valuable, but it also presents a challenge for research: how do you prove hypnosis is a viable treatment if it is almost always included as part of a protocol where another intervention is the primary focus? It becomes a circular challenge.
The Value of Hypnosis for Erectile Dysfunction
Despite the flaws of the hypnosis research, there are direct and indirect indications that hypnotherapy has value as a treatment for erectile dysfunction. Its promise in treating anxiety, depression, stress, attention and relationship difficulties gives credence to its potential. In order to increase the validity of the hypnosis research, studies that utilize randomized controlled trials in making direct associations between hypnotherapy and reduction of ED are needed.
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