Hypnosis and bleeding disorders: a narrative review—with a focus on hemophilia

Introduction

Hypnosis has been defined as “a state of consciousness involving focused attention and reduced peripheral awareness, characterized by an enhanced capacity for response to suggestion” (1). In vivo brain imaging studies have confirmed the existence of distinct neural correlates associated with the hypnotic state (2-5).

Modern hypnosis was deeply inspired by the American psychiatrist Milton H. Erickson (1901–1980). Erikson’s contributions to modern hypnosis and psychology are immense: his work has been instrumental in the development of cognitive-behavioral, family, and solution-focused therapies. His techniques, including storytelling and indirect suggestion, have been widely adopted and integrated into numerous therapeutic approaches.

The clinical application of hypnosis spans various domains of medical practice and is increasingly supported by general practitioners (6). A growing body of evidence supports the therapeutic potential of hypnosis in both acute settings, such as peri-procedural and procedural pain management, and chronic conditions, including chronic pain syndromes (7).

The potential influence of hypnosis on hemostasis has long been suggested; however, systematic investigations remain limited. A notable historical example involves Grigori Rasputin, a mystic and presumed practitioner of animal magnetism (an early precursor of modern hypnotherapy). His influence in the Russian imperial court has been partially attributed to his alleged ability to mitigate bleeding episodes and pain in Tsarevich Alexei, who suffered from hemophilia B (8,9). More rigorously documented are the pioneering contributions of Wallace and Jeanine LaBaw, who established therapeutic camps in Colorado (“Hemophiliac summer camps”) to teach self-hypnosis to children with hemophilia (10-13). Despite these historical accounts and early clinical observations, the relationship between hypnosis and bleeding control remains inadequately characterized in contemporary medical literature.

The goal of this review is to provide a broad overview of the link between hypnosis and bleeding disorders through a narrative synthesis of the literature across a range of bleeding contexts, with the aim of exploring existing evidence and gaps in the literature. We present this article in accordance with the Narrative Review reporting checklist (available at https://apm.amegroups.com/article/view/10.21037/apm-2026-1-0021/rc).

Methods

A literature review was conducted using the PubMed database, covering the period from its inception in 1946 through October 2025. The search strategy employed the keywords “Hypno*” AND “Bleed*”. No restrictions were applied regarding article origin, language, PICO criteria, or study design. Two authors (J.P. and M.C.) independently screened titles and abstracts for relevance, and full-text articles were reviewed when eligibility was unclear. Any discrepancies were resolved through discussion and consensus. Given the narrative nature of this review, no formal assessment of methodological quality or risk of bias was performed. Nevertheless, preference was given to high-quality, peer-reviewed studies. Search strategy summary is presented in Table 1.

This approach enabled a comprehensive synthesis of the available literature on hypnosis in bleeding disorders, integrating diverse study designs and outcomes to provide a broad and informative overview.

Results

Of the 527 articles identified through systematic database searches, 37 were retained for this narrative review (see Table 2). However, these studies were mostly case reports, corresponding to a low level of evidence. The literature reviewed primarily examined the use of hypnosis in hemophilia (25 articles, 68%), focusing on both reducing bleeding and modulating pain associated with hemophilic arthropathy. Furthermore, additional evidence was identified for other bleeding conditions, including menstrual bleeding, bleeding during oral surgery, and functional hematuria, suggesting a wider potential for hypnotic interventions in the management of hemostasis.

Analysis of the temporal distribution of published studies indicates a progressive evolution in scientific interest regarding the application of hypnosis in bleeding disorders. Most publications are concentrated in the decades from 1960 to 1980, with 15 studies (40.5%) published during the 1960s and 1970s, 10 studies (27%) in the 1980s, and 4 studies (10.8%) in the 1990s. This period of considerable activity contrasts with subsequent decades: 3 studies (8.1%) between 2000 and 2010, and 5 studies (13.5%) from 2010 onward.

The findings derived from this body of literature are presented below.

It is crucial to recognize that, although hypnosis and self-hypnosis are distinct therapeutic modalities, they share underlying mechanisms (1). In this article, hypnosis is defined as a specific altered state of consciousness rather than merely a set of techniques. Consequently, the term “hypnosis” is employed as a conceptual framework to denote this state of consciousness, even though self-hypnosis remains the most frequently utilized modality, as will be specified where relevant. This perspective aligns, among others, with the view of LaBaw (13).

Discussion

Hypnosis & hemophilia

Hemophilia is recognized as the most prevalent inherited bleeding disorder. It results from decreased levels of factor VIII (Hemophilia A) or factor IX (Hemophilia B, also known as Christmas disease). Variations in circulating factor concentrations lead to a spectrum of bleeding severities, ranging from minor hemorrhages to severe events such as intracranial hemorrhages, and influence bleeding frequency, necessitating hospitalization and administration of factor replacement therapies (14,15). Its chronic nature may lead to long-term complications that impact daily activities and require comprehensive medical management, particularly for managing chronic pain caused by hemophilic arthropathy from recurrent joint bleeds (16).

The available literature comprises four randomized controlled trials (RCTs) on hypnosis in patients with hemophilia. These include LaBaw’s study (1975) with 20 participants (12), Swirsky-Sacchetti’s study involving 30 participants (17), and the two pilot trials by Paredes et al., which included 20 adults each (18,19). The 2019 study was conducted as part of the larger PSY-HaEMOPEQ study, a single-center three-arm randomized controlled trial designed to enroll 66 adult participants with moderate or severe hemophilia, allocated to cognitive-behavioral therapy, hypnosis, or to standard care (20). No larger randomized clinical trials or meta-analyses specifically on the use of hypnosis in hemophilia have been identified, likely due to the rarity of the disease and the limited sample sizes. However, hypnosis appears as one of the “cognitive therapies” included in the Cochrane review by Palareti et al. (21), which analyzed seven trials, two focusing specifically on hypnosis (12,17).

The feasibility, safety, and patient acceptability of hypnosis interventions in patients with hemophilia (PWH) have been infrequently examined across existing studies. Paredes et al. documented a retention rate of 90% in their 2019 publication, with participants in the hypnosis cohort attending all scheduled sessions (18). Moreover, qualitative assessments indicated that 100% of participants expressed willingness to incorporate hypnosis into standard comprehensive care. The subsequent three-month follow-up study by the same authors reported a 100% attendance rate among participants who completed the sessions, with no adverse events reported (19). These findings align with the study by Palareti et al. (21), which concluded that such approaches are generally safe and well-accepted, with no unforeseen adverse effects. Furthermore, evidence from various case reports [e.g., (11,13)] indicates that hypnosis constitutes a highly feasible and well-accepted intervention within this population, current evidence supports good feasibility and acceptability, without adverse patient experiences. Additionally, as proposed by LaBaw, a pioneer in this domain, hypnosis is associated with empowering patients to use it for other indications. An illustrative example involves a patient of his who not only improved his ability to cope with the illness—resulting in fewer hospital admissions—but also utilized hypnosis during the later stages of life to manage end-of-life symptoms and prevent hospitalization (13).

Data on bleeding are mixed. Two historical studies (12,17), summarized by Palareti et al. (21) suggest that self-hypnosis may reduce bleeding frequency and the use of clotting factor concentrates over follow-up periods up to 30 months. In contrast, the pilot study by Paredes et al. (19) observed only a downward trend that did not reach statistical significance.

Beyond its effects on coagulation, hypnosis has been used as an integrative approach for managing chronic pain, a frequent complication (35–66%) associated with hemophilic arthropathy (22-24). This major complication, prevalence ranging from 17% to 84% across the literature (19), results from recurrent hemarthroses that induce inflammation and subsequent joint remodeling and substantially reduce the quality of life of PWH (23).

The effect of hypnosis on chronic pain in PWH remains somewhat ambiguous, with a notable distinction between its influence on pain intensity itself and its functional consequences. Although there was no statistically significant reduction in absolute pain intensity, Paredes et al. (18,19) reported a significant decrease in pain interference with daily activities (health-related quality of life, HRQoL), particularly in work-related aspects such as reduced absenteeism. Improvements were also observed in the overall quality of life, including better coping with treatment-related difficulties. A positive impact on social relationships was also noted (18), with effects lasting three months post-intervention (19).

Given the central role of inflammatory mediators in the pathogenesis of pain associated with hemophilic arthropathy (25), Paredes et al. (19) examined whether hypnosis could modulate inflammatory parameters. However, their study did not demonstrate any significant modulatory effect in inflammatory markers, including white blood cell counts, C-reactive protein, IL-1β, IL-6, and TNF-α.

Hypnosis and other bleeding disorders

In addition to hemophilia, hypnosis has been investigated for the management of bleeding across diverse clinical contexts, including surgery (notably oral surgery), menstrual bleeding, gastrointestinal hemorrhage, epistaxis, and hematuria.

Clinical applications have been documented primarily in surgical settings, where hypnosis has been investigated for reducing intraoperative hemorrhage during rhinoplasty and oral surgery procedures (26-28). In a case-control study by Abdeshahi et al. patients in the hypnosis group experienced less persistent hemorrhage after 30 minutes of compression compared to control conditions (26). The study also reported lower pain intensity and reduced analgesic use among those receiving hypnosis, though anxiety levels remained analogous across groups. A case report by Montenegro et al. (27) similarly described reduced bleeding, anxiety, and pain in a patient undergoing tooth implant placement without anesthesia. However, the effect on bleeding appears to be less consistent across surgical contexts; Efsun Ozgunay et al. (28) did not observe significant reduction in intraoperative bleeding during rhinoplasty, though hypnosis demonstrated more pronounced benefits for acute and short-term pain management.

In women’s health, hypnotic interventions have shown promise for menstrual bleeding management. Valiani et al. (29) observed significant reductions in menstrual blood loss following hypnosis. Sporadic case reports have documented the successful application of hypnosis for gastrointestinal bleeding, both upper (30) and lower (31), as well as for epistaxis (32) and stress-related hemoptysis (33). For loin pain hematuria syndrome, Elkins et al. (34) reported favorable outcomes with hypnotherapy, though improvements were documented for the condition rather than hematuria specifically, including marked reductions in pain, anxiety, depression, and functional interference, with near-complete symptom remission in some cases.

A synthesis of the available literature revealed substantial evolution in research objectives regarding hypnosis and bleeding disorders over the past five decades. Notably, most publications were concentrated in the 1960–1980 period, during which hypnosis appeared to be a promising approach for achieving major clinical outcomes, such as reducing bleeding frequency (35). A progressive decline in research on hypnosis for bleeding control subsequently ensued and coincided with significant advances in bleeding management strategies, particularly the broader availability of safer, more effective therapies for hemophilia, which provided more standardized and predictable treatments. These treatments have improved considerably since the 1990s, fundamentally transforming hemophilia care (36). This shift in therapeutic paradigm gradually redirected research priorities toward improving quality of life for people with hemophilia rather than focusing solely on acute bleeding control. In light of this evolution and to address the question of hypnosis in real-world clinical environments, a structured clinical program established at a hemophilia center in Portugal offers a pertinent example. This program comprises four weekly individual hypnosis sessions conducted by trained psychologists within a clinical setting. It has garnered positive patient acceptance and is associated with reduced pain interference and improvement in health-related quality of life among adults with hemophilia.

While sporadic, the application of hypnosis across various hemorrhagic contexts—including surgical bleeding control, menstrual disorders, gastrointestinal hemorrhage, epistaxis, and hematuria—demonstrated its versatility as an adjunctive intervention, although the evidence base remains predominantly composed of case reports and small-scale trials.

Regarding the therapeutic role of hypnosis, it was noteworthy that contemporary hypnosis protocols for bleeding disorders generally did not employ direct suggestions for bleeding control but instead adopted a more permissive approach focusing on overall relaxation, anxiety reduction, and self-regulation, with bleeding outcomes regarded as secondary rather than primary targets of suggestion. This methodological approach was grounded in the understanding that stress and anxiety play significant roles in bleeding across various conditions, including hemophilia (37), gastritis (38), and menstruation (39).

Although the pathogenic mechanisms remain incompletely understood, stress induces the release of tissue plasminogen activator (tPA) from endothelial and chromaffin cells, thereby promoting plasmin generation and fibrin degradation and exerting an acute anticoagulant effect by enhancing fibrinolysis (40). Stress-mediated endothelial dysfunction may also contribute to this process (41). Conversely, hypnosis induces a physiological relaxation response (42) that can counteract the effects of stress on hemostatic balance. Furthermore, parasympathetic activation induced by hypnosis may counterbalance stress-associated sympathetic overactivity, which can elevate blood pressure (43), a factor associated with bleeding complications (44). This bidirectional relationship between psychological state and hemostatic function underscored the potential mechanistic rationale for hypnosis as an adjunctive therapeutic modality in bleeding disorders.

The shift in the therapeutic paradigm of hypnosis for bleeding disorders has gradually redirected research focus, particularly toward enhancing the quality of life for individuals with hemophilia, rather than focusing solely on the acute control of bleeding episodes. Recent publications (18,20,21) reflected this fundamental transition toward comprehensive, patient-centered outcomes, emphasizing the management of chronic pain and improvements in HRQoL, which are increasingly recognized as central to the holistic care of PWH (45,46). This evolution mirrored broader trends in chronic disease management, where psychosocial interventions are valued not merely as adjuncts to pharmacological treatment but as integral components of comprehensive care that address the multidimensional impact of living with a chronic bleeding disorder (47-49).

Hypnosis may therefore be conceptualized as an integrative therapeutic approach that addresses not only medical needs but also the psychosocial dimensions of care. This perspective was consistent with multimodal care models, which combine medical treatment with psychological support, psychoeducation, family-centered interventions, and cognitive-behavioral strategies to optimize patient outcomes (21).

Although the effects of hypnosis on chronic pain in people with hemophilia remained somewhat “paradoxical”, as in Paredes et al. in which hypnosis did not achieve statistically significant reductions in absolute pain intensity, but showed significant decrease in pain interference with daily activities, particularly work-related aspects such as reduced absenteeism, with improvements in overall quality of life, coping with treatment-related difficulties, and social relationships persisting three months post-intervention. These findings were consistent with previous research on the effects of hypnosis in chronic pain conditions, demonstrating that it is a particularly effective tool for helping patients maintain greater control over their lives despite ongoing discomfort (50,51). Moreover, persistent pain severity may be attributable to the chronic nature of hemophilic arthropathy, wherein mechanisms such as central sensitization may contribute to ongoing pain.

Methodologically, the current evidence base remained limited, reflecting the inherent challenges of conducting robust studies in rare bleeding disorders. Sample sizes were necessarily small, and no large-scale randomized controlled trials or meta-analyses specifically examining hypnosis in hemorrhagic conditions have been published. Future research should prioritize adequately powered trials that elucidate the mechanisms underlying hypnosis effects on bleeding outcomes, distinguish between direct hemostatic effects and anxiety-mediated pathways, and identify which patient populations and clinical contexts derive greatest benefit from hypnotic interventions. Given the consistent evidence for improved HRQoL and functional outcomes, hypnosis warrants consideration as an adjunctive component of comprehensive care for bleeding disorders, particularly for patients experiencing chronic pain and psychosocial burden.

Conclusions

The demonstrated applications of hypnosis across diverse hemorrhagic contexts—from hemophilia and surgical bleeding to menstrual disorders, gastrointestinal hemorrhage, epistaxis, and hematuria—underscore its potential as a versatile, patient-centered intervention deserving more rigorous investigation.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://apm.amegroups.com/article/view/10.21037/apm-2026-1-0021/rc

Peer Review File: Available at https://apm.amegroups.com/article/view/10.21037/apm-2026-1-0021/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-2026-1-0021/coif). M.C. serves as an unpaid editorial board member of Annals of Palliative Medicine from April 2025 to March 2027. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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