Mind over Matter: How Hypnosis and Virtual Reality Can Help Patients with Cancer

The concept of mind over matter has been close to my heart since the earliest days of my training in hematology and oncology in the 1980s. My patients were suffering pain, cancer or treatment-induced nausea and vomiting, and dyspnea. Many felt they could no longer endure the symptoms, and I needed something besides the short-acting and less than effective drugs then available. At that time, hypnosis was the newest emerging technique. I sought training and have used hypnosis ever since; I’ve found it an important adjunct to the drugs I use, and more, it enhances my relationship with my patients. Since then, Virtual Reality (VR) has emerged and been developed as a next-level means of applying mind over matter in difficult cases. I find both methods fascinating and not usually included in discussions of supportive oncology techniques, so I’ve chosen to talk about them with you in this month’s newsletter.

Hypnosis

Hypnosis is one of the most useful non-pharmacologic techniques for managing the symptoms of patients with cancer. Aesculapius and his followers used hypnosis-like techniques, as did Franz Anton Mesmer, and John Elliotson and James Esdaile (1850), British surgeons familiar with Mesmer’s work. Hypnosis has been accredited since the 1950s as a safe, effective procedure in both the United States and England.

Hypnosis is a set of techniques through which patients can be taught to regain control over situations over which they have lost much control. They can minimize their suffering while waiting for pain or antiemetic medications to take effect and may even require lower medication doses. Appetite may be enhanced, and insomnia reduced. Patients often experience newly gained independence and power, which can help even bedridden patients achieve appreciation of their own capabilities and gain a heightened sense of self-control and self-respect.

If you are interested in being trained in hypnotic techniques, I recommend that you attend one of the monthly four-day training sessions held by the American Society of Clinical Hypnosis (ASCH) . You will be able to use hypnosis as soon as you finish the initial training.

Misconceptions
A common misconception is that hypnosis is used less for psychotherapeutic, medical or dental purposes and more for entertainment. Hypnosis is not an entertainment but a therapeutic technique. Patients in trance are not asleep. Their eyes may be open, and they may be sitting comfortably or walking while in trance. No one can be made to enter a trance unwillingly. What occurs during the trance is entirely up to the subject, and nothing can be done that violates the individual’s moral or ethical beliefs. People leave the trance state whenever they want to. The hypnotist cannot keep them there against their will.

Utility in cancer patients
Hypnosis itself is not therapy, but therapy can take place while the patient is in trance. The hypnotist teaches the patient how to experience a state of trance and the hypnotic state itself facilitates the giving and receiving of suggestions relative to specific goals, such as pain relief. Hypnosis can help treat nausea, vomiting, anorexia, sleeplessness, anxiety, and feelings of helplessness and loss of control. The “rehearsal technique” can decrease the anxiety of patients about to undergo various tests, and in helping patients deal with anticipated pain or discomfort prior to surgery, radiation, or chemotherapy.

As I discuss in my book, referenced below, while in a hypnotic trance, patients with cancer can use images or metaphors to change the intensity of their pain or other symptoms. For example, you can ask the patient to visualize a car speedometer with a 0-to-100 scale. Ask her to move the indicator to the number that reflects the intensity of her distress. Next, suggest that she imagine the indicator moving to a higher number and ask if the symptom has also increased in intensity. It usually has. Then suggest that she move the indicator to a position lower than it was initially, and as she does, she will usually experience a lower intensity of the symptom. With appropriate suggestions, the diminished symptom intensity will persist when she comes out of trance.

Distraction and Dissociation
Montaigne once wrote, “We feel one cut from the surgeon’s scalpel more than ten blows of the sword in the heat of battle.” Our peacetime warriors, the weekend football and basketball players, experience the same phenomenon—it is not until after the distraction of the game is gone that the bruises or even broken bones become apparent. The reason they can keep playing is that their minds are distracted by their involvement in the game, and the pain signals are naturally dampened.

Bedridden patients can often use distraction or dissociation during trance to escape from their pain, even without the use of the VR goggles (described below). In hypnosis, patients can be “taken” by the clinician’s suggestions to, for example, the patients’ favorite vacation spots or on a walk in the woods. To enhance the patient’s ability to revisit these experiences on their own, the hypnosis practitioner can make patients a recording of sessions filled with tailored suggestions on the patient’s phone or tablet.

Making a referral for hypnosis
Hypnosis practitioners can be found on the ASCH website membership directory page. Search by Zipcode and “Within 5 miles” to find ASCH members practicing in an area convenient to the patient. You may find, however, that patients resist a referral for hypnosis. They may misinterpret your suggestion as implying that you don’t really believe they are in distress, e.g., from pain. Or they may just be afraid of the techniques themselves. But implicit in your referral is your belief that the patient is really in pain, your faith in the clinician you’ve recommended, and the techniques that person will suggest. I think you’ll find that patients report excellent responses and are grateful for the referral.

Virtual Reality

Virtual reality (VR) headsets provide diversion of attention “on steroids.” VR acts as a distraction, immersing patients in virtual environments to “escape” their home,¹ nursing home, inpatient hospice,² or hospital settings. Some patients report VR helps them recall positive memories. With newer equipment, cybersickness (i.e., a form of motion sickness induced by the VR headsets) is reported in fewer than 5% of users. There can also be psychological adverse effects, in which people feel detached from themselves, or reality, the so-called “depersonalization/derealization” (DP/DR) syndrome (Spiegel). That is why if you’re planning VR for a patient, try to collaborate with a “virtualist”, an expert in the use of therapeutic VR, who will test them for DP/DR. A listing of mental health practitioners who are also virtualists can be found at www.vrtherapistsinternational.com. Centers of research in VR forpatients with cancer include Cedars-Sinai Medical Center, and Stanford Medicine.

Four meta-analyses found that VR was efficacious in improving overall psychological well-being (especially anxiety and depression) as well as physical symptoms (especially pain, but also possibly fatigue, nausea, and sleep quality) ^3-6. A systematic review of immersive (360^°) VR in burn patients found that it decreased the pain, anxiety and stress of dressing changes, physical rehabilitation, and physiotherapy⁷, and it was also effective as a method of distraction in procedural pain⁸. It is likely, therefore, also to be of help for patients with cancer who have painful dressing changes and who undergo numerous painful procedures, especially patients with hematologic malignancies. VR also can be used to simulate procedures like radiation or MRI scans, allowing patients to become familiar with the environment and practice what they’ll be asked to do, such as hold their breath. And a randomized study in patients with cancer receiving chemotherapy showed statistically significant decreases in stress and pain, elevation of positive affect, and decrease of negative affect⁹.

Examples of VR applications

• Distraction therapy: Patients can go on virtual “trips” to places like the canals of Venice or the Taj Mahal during chemotherapy infusions to provide a distraction.
• Relaxation and mindfulness: Programs can use immersive nature scenes to promote relaxation and a sense of calm.
• Medical education: Patients can see a 3D model of their own body, helping them understand their specific diagnosis and treatment path 
• Procedure simulation: Patients can use VR to practice navigating the experience of an MRI machine before the actual scan.

I am very excited about the potential of VR to help patients escape otherwise confining environments, and, as they would in hypnosis, distract themselves from symptoms causing distress. In upcoming months, I hope to be interviewing. Dr. Brennan Spiegel, a leading expert in the application of virtual reality for patients with cancer and will let you know when this interview is available. For those interested, here are links to two videos that can introduce him and his work to you.

References

Hypnosis:
Abrahm, J. Comprehensive Guide to Supportive and Palliative Care for Patients with Cancer. 4^th ed. Johns Hopkins University Press, 2022

Virtual Reality:

1. Brennan Spiegel. How virtual therapeutics will revolutionize medicine. VR_X. Basic Books, New York, 2020
2. Stansel CC, et al. Clin J of Onc Nursing 2025;29:65-71
3. Austin PD et al. Support Care Cancer 2022;30:3995-4005
4. Johnson T, et al. J Palliat Med 2020;23:1233-1238
5. Wu Y et al. J Pain Sympt Manage 2023;65:e467-e482
6. Fereidooni M et al. Support Care Cancer 2024;32:570
7. Hao J et al. Support Care Cancer 2024;32;603
8. Tuğçun T and Çitak EA. Support Care Cancer 2025;33:672  
9. Scapin S. et al. Burns 2018; 44:1403-1416
10. Indovina P et al. Clin J Pain 2018;34:858-877

Additional Resources

Hypnosis:
Integration of self-hypnosis in an enhanced recovery after surgery program in gynecologic oncology: a prospective randomized trial.

Virtual Reality:
Application of virtual reality for supportive care in cancer patients: a systematic review.

Virtual reality-based supportive care interventions for patients with cancer: an umbrella review of systematic reviews and meta-analyses.

Virtual reality in palliative care: a systematic review