Hypnosis and virtual reality: A new synergy (2025)
Audrey Vanhaudenhuyse
Conscious Care Lab, GIGA Consciousness, GIGA Institute, University of Liège, Liège, Belgium
Algology Interdisciplinary Center, University Hospital of Liège, Liège, Belgium
Yanis Mouheb
Conscious Care Lab, GIGA Consciousness, GIGA Institute, University of Liège, Liège, Belgium
Aminata Bicego
Conscious Care Lab, GIGA Consciousness, GIGA Institute, University of Liège, Liège, Belgium
Cognitive Psychology Unit, Social Sciences Faculty, Leiden University, Leiden, The Netherlands
Correspondence: avanhaudenhuyse@chuliege.be
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Keywords: Hypnosis; virtual reality; pain; anxiety
While pharmacological treatments are proposed as the solution for pain management, their efficacy, risks of adverse events, misuse, and dependency remain subjects of concern. Complementary approaches are considered effective techniques for pain relief. Virtual reality (VR) and hypnosis, when used individually, have shown promise in reducing pain. Virtual reality hypnosis (VRH) is described as a hypnotic induction and suggestion provided through tailored VR hardware and software. Although VRH is gaining traction among healthcare providers, understanding of this approach is still in its early stages. We recently highlighted how of the 43 studies that have evaluated the efficacy of VR combined with mind-body therapies in managing pain perception, only 18 focused on the VRH (Louras et al., 2024).
These studies have demonstrated the relevance of VRH in reducing acute pain in healthy volunteers, while results obtained in clinical settings yielded mixed results, with some studies demonstrating a significant reduction in pain (e.g., chronic pain) while others showed no significant difference in pain following VRH use (e.g., trauma) (Louras et al., 2024). It should be noted that, beyond its effect on pain perception, VRH appears to be a promising technique for reducing anxiety related to pain during acute invasive interventions (e.g., endovascular procedure, Louras et al., 2024).
Two recent studies have nuanced these previously reported results by showing no difference in pain and anxiety when VRH was administered to patients hospitalized in an intensive care unit or before an invasive medical procedure, compared to a control group (presence of the researcher, without any specific intervention) or other approaches (hypnosis, VR) (for all references, see Louras et al., 2024; Safy et al., 2024). All groups included in these studies showed similar positive changes in relaxation and/or anxiety. The only novel element integrated into the healthcare of these patients was the presence of a human being next to the patient during periods that are usually spent with patients waiting alone for their clinical examination. During surgeries, some studies have reported that VRH is feasible (Carannante et al., 2024) and reduces the need for medication compared to the usual local anesthesia procedure (e.g., Steinkraus et al., 2024).
Studies have also focused on the neurophysiological mechanisms underlying acute pain perception when VRH is used. When compared to a control condition (without VRH), a decrease in evoked potentials (electrical brain responses to stimulation) was observed in almost all regions of the brain (Rousseaux et al., 2022), while respiratory rate was also reduced (Rousseaux et al., 2022; Terzulli et al., 2023), which was associated with a decrease in subjective pain perception. Finally, the question of the influence of hypnotizability on the VRH experience (e.g., in terms of sense of presence or pain reduction) remains unresolved, as the results in the current literature are not homogeneous (e.g., Enea et al., 2014; Patterson et al., 2006). These findings highlight the urgent need to conduct rigorous studies to better understand the mechanisms underlying VRH’s process, and its clinical relevance in various medical conditions.
References
Carannante, F., Capolupo, G. T., Miacci, V., Ferri, C., Agrò, F. E., Caricato, M., & D’Agostino, F. (2024). The effect of virtual reality hypnosis (HypnoVR) in patients undergoing inguinal hernia repair under local anesthesia. A preliminary report. Langenbeck’s Archives of Surgery, 409(1), 329. https://doi.org/10.1007/s00423-024-03524-4
Enea, V, Dafinoiu, I, Opriş, D, David, D. (2014). Effects of hypnotic analgesia and virtual reality on the reduction of experimental pain among high and low hypnotizables. International Journal of Clinical and Experimental Hypnosis, 62(3), 360–377. doi:10.1080/00207144.2014.901087
Louras, M., Vanhaudenhuyse, A., Panda, R., Rousseaux, F., Carella, M., Gosseries, O., Bonhomme, V., Faymonville, M.-E., & Bicego, A. (2024). Virtual Reality Combined with Mind-Body Therapies for the Management of Pain: A Scoping Review. International Journal of Clinical and Experimental Hypnosis, 72(4), 435-471. https://doi.org/10.1080/00207144.2024.2391365
Patterson, D.R., Hoffman, H.G., Palacios, A.G., & Jensen, M.J. (2006). Analgesic effects of posthypnotic suggestions and virtual reality distraction on thermal pain. Journal of Abnormal Psychology, 115(4):834–841. doi:10.1037/0021-843X.115.4.834
Rousseaux, F., Panda, R., Toussaint, C., Bicego, A., Niimi, M., Faymonville, M.-E., Nyssen, A.-S., Laureys, S., Gosseries, O., & Vanhaudenhuyse, A. (2022). Virtual reality hypnosis in the management of pain : Self-reported and neurophysiological measures in healthy subjects. European Journal of Pain, https://doi.org/10.1002/ejp.2045
Safy, O., Rousseaux, F., Faymonville, M.-E., Libbrecht, D., Fontaine, R., Raaf, M., Staquet, C., Tasset, H., Bonhomme, V., Vanhaudenhuyse, A., & Bicego, A. (2024). Virtual reality hypnosis prior to radiofrequency thermocoagulation for patients with chronic pain : An exploratory clinical trial. Frontiers in Psychology, 15, 1331826. https://doi.org/10.3389/fpsyg.2024.1331826
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