This issue of BJPsych Advances includes an article on the use of hypnotherapy in psychiatric practice. The article contains a number of errors and misconceptions regarding the characteristics and practice of hypnosis that we address in this commentary.

The use of hypnotherapy in psychiatry has been controversial. However, evidence presented by Chan and colleagues shows that it is beneficial to the promotion of good mental health and well-being, specifically being applicable in the management of mental disorders. But what does this mean for practice? This commentary looks at what we agree and disagree with, what we opine is missing from the article and what now needs to happen. Patients should be able to access hypnotherapy or hypnosis routinely on the National Health Service. Since it works, who may it work for and how may we make this available to those who could benefit from it?

There seems to be wide acceptance by both professionals and lay people that hypnotic and especially hypnotherapeutic responding is based on the long-standing but still hypothetical dichotomy between the conscious and unconscious minds. In this simplistic view, hypnotic suggestions are considered to bypass consciousness to reach the unconscious mind, there to have the intended effect. This article reports on a single-case experiment investigating the involvement of the unconscious in hypnotherapeutic responding. In this case the subject responded positively to suggestions that could not have reached the unconscious, indicating that the unconscious was not involved in such responding. An alternative view is proposed, namely that hypnotherapeutic responding involves a cognitive process in which a socially constructed new understanding of the problem behaviour and of hypnosis, based on the client's existing attribution of meaning, is followed by action considered appropriate to the new understanding and which then confirms this understanding, leading to behaviour change.

Purpose: The service was piloted in response to requests for assistance with patients experiencing severe anxiety undergoing head and neck radiotherapy. This paper describes the aims of the service, interventions provided and the recorded responses of patients to the support given.

Data: Information about who referred, patient demographics, the interventions provided and patient feedback (n = 112) was extracted from treatment records over a 15-month period.

Findings: All referred patients successfully completed procedures and treatment. About 43 patients voluntarily disclosed past trauma, for example, sexual abuse, assault, childhood trauma, which they judged to have been linked to their claustrophobic responses. Advice and support was given to 40 patients also referred for smoking cessation; an additional three patients requested support when cravings returned.

Conclusion: There is a paucity of information about the extent of the distress triggered by radiotherapy procedures and what interventions could be offered in practice. Further work is required to include an economic assessment and longer term effects on patient compliance with treatment and smoking cessation. Training needs for complementary therapists and radiotherapy staff at this centre were also identified; these are being addressed.

Conventional medical treatment is often ineffective in the management of Irritable Bowel Syndrome (IBS). Although controlled trials of psychotherapy and hypnotherapy have been shown to be effective, psychological interventions are not widely available. The aim of this study was to assess the feasibility of the clinical provision of combined group cognitive-behaviour therapy (CBT) and hypnotherapy delivered by 13 therapists using a standardized protocol. Attempts were also made to disseminate the programme by patient graduates. A session-by-session instruction manual was compiled and the protocol was tested in a pilot group. Thereafter a total of 158 patients in 23 different groups took part in the 16-session intervention. Attrition rate was very low. Significant improvements in both gastrointestinal and psychosocial symptoms were observed following the intervention. The results suggest that professionally led group psychotherapy and hypnotherapy is a feasible option for the treatment of sufferers of IBS and increased efforts should be made in the training and supervision of user facilitators.