Active-Alert Hypnosis to Achieve Personal, Professional, and Therapeutic Goals

Hypnosis does not always require suggestions of relaxation in order enter into this state. It can also be induced through suggestions of activation and cognitive alertness. This procedure and the hypnotic state caused by it has been called active-alert hypnosis (AAH). In this chapter, we describe a strategy to increase the probability to achieve goals using an AAH technique in which we ask the patient to move his arms in an alternate way, while imagining that he has a pair of dumbbells of several kilograms in each hand, in order to produce a hypnotic age progression phenomenon, in which the patient is oriented to a positive future and mobilizing hope, and could see himself achieving his goals, creating “memories of the future.” We report several clinical cases in which this hypnotic strategy was used.


Just a little background on hypnosis and hypnotherapy
Over time, hypnosis has been defined in various ways. In its early stages, it was associated with supernatural states. The current official definition, according to the American Psychological Association, is "a state of consciousness, involving a focused attention and reduced peripheral awareness, characterized by an enhanced capacity for response to suggestions" [1]. Unestahl [2] defines hypnosis as "an alternative state of consciousness, where information can bypass the logical mind and bring about changes in suggestibility and perception and in which there are alternative control systems available." Taking both definitions into account, we propose the following definition that describes this state of consciousness more broadly: Hypnosis is a state of intense and focused attention that leads us to a special state of consciousness, in which previously learned experiences can be evoked in an involuntary way. This state is characterized by an increase in suggestibility and the ability to modify the perception, memory, and functioning of the autonomic nervous system [3].
In the past, it was also common knowledge that hypnosis implies a relaxation, or a sleep-like state, in which the hypnotized person loses his/her consciousness temporarily, being completely under the hypnotist's control. Now, however, it is known that hypnosis is a natural state that tends to occur periodically several times a day, approximately every 90 min in human beings, as one of many psychobiological ultradian rhythms [4] during which the person is in total control of his/her will [5].
According to our definition of hypnosis, we can say that this state is not limited to a relaxed state but any state of focused attention that switches our mind to a more creative mode, helping us to find solutions for specific problems or seeing things from a different perspective, enhancing the capacity to access unconscious memories and perceptions and to reframe them, and facilitating processes of dissociation.

Active-alert hypnosis: a path to our goals
In her 1973 doctoral dissertation, Eva Banyai explained her study about the effects of hypnosis in verbal learning that involved 24 patients. She stated that the majority of subjects achieved a classic hypnotic state (a relaxed, passive state), but four of them exhibited a different state: … four subjects exhibited a different behavior: They were in an even "more active" state than the waking ones. They followed the instructions of the experimenter immediately, while their fast movements, lively facial expressions, loud voices, and their fast speech were in sharp contrast with the passive behavior of the average subjects. It was as if they had been released from some kind of pressure, their behavior reflected childlike playfulness [6].
That unexpected finding suggested that hypnosis is not only a relaxed state, but is also a wide spectrum of "altered" conscious states that can be subjectiveley experienced in many different forms by each individual with different behavioral and physiological outcomes.
Banyai called this kind of hypnotic state "active-alert hypnosis." She also stated that the sleep-like outcomes in traditional hypnosis occur due to suggestions from the facilitator rather than from the hypnosis itself. This modality of hypnosis has been applied to high-performing athletes with significantly positive results [1], but also with people who prefer an eyes-open trance, or a more active one. In our experience, this type of induction can also be used for visualization and reaching one's own personal and professional goals.
The original active alert-hypnosis approaches were performed while pedaling a stationary bicycle, receiving hypnotic suggestions of activation and alertness, paying attention to the feelings in their legs, to automatic movement, to their energy, and to their inner peace [7,8].
According to Banyai [6], active-alert hypnosis has been a useful tool in the following cases: Since these original approaches were performed, several methods of achieving an active-alert hypnotic state have been developed. For example, Etzel Cardeña [9] elaborated a gentle active-alert hypnotic technique consisting of simply waving one hand up and down, producing results similar to those of Banyai's study. Even though active-alert hypnotic approaches are used primarily in therapeutic contexts, you can also notice "altered" consciousness states and active-alert hypnotic states in other contexts, such as religious ceremonies, highly competitive sports (while practicing or watching), dancing, teaching, writing, playing a musical instrument, and many other activities that require highly focused attention. This kind of hypnosis has been called in different ways: hyper-alert hypnosis, active hypnosis, waking hypnosis, awake-alert hypnosis, and alert hypnosis.

Goals and motivation
I (AV) would like to share an experience I had some time ago. A friend of mine asked me to slightly change my way of dressing to become a more presentable professional, to give a different image to others and to myself. I have to admit that a part of me was reluctant to make that change, while the other one was just a little curious about what could change for the better if I follow his advice. That curiosity led me to a little inspection of my closet, with some dirty and old clothes hanging there along with some clothes that I did not really use, but there they were, and I came to realize that I needed to go get new clothes, and a new pair of shoes, because my old ones, although comfy, were starting to rip apart, and we all need a good pair of formal and comfortable shoes for formal occasions. After making the decision to go and buy some new clothes and a new pair of shoes, the instruction "buy a pair of shoes" was imprinted in my mind, nothing else.
Get inside the shop, with all those different kinds of shoes, selecting just one pair of them was a difficult task. But my mind was clear: "buy a pair of shoes." I bought a brown pair of shoes, and they were going to be worn next Monday. That day, I put them on and walked a little, and after a few blocks my ankle started to hurt. It was a weak but annoying pain. After a few more blocks, the skin of my Achilles tendon started to peel and I felt an even more annoying pain, and I remembered thinking, "But these shoes are new. Why is this happening?" Now when we make plans, we not only use our conscious mind, but we also use our unconscious one [10]. The question here is: how?
According to some research [11,12], our brain makes decisions even before we think we made them. Let us explain this statement. Imagine that we suggest that you move your lips to the right when you see something beautiful and to your left when you see something that you think is not. Then I show you some images on a screen. When you see an image, the information travels all the way through your visual processing structures in your brain (occipital lobe structures), then after being analyzed it is sent to an interpretation area (temporo-parieto-occipital region), and then to our decision-making structures (prefrontal region) to decide whether it is beautiful. That takes no more than a few microseconds, but it is a complex process, all happening without you realizing it. Now that you have decided to make the movement to the left or right, your frontal lobe sends a signal to your lips to "move" left or right. That is when it gets tricky: it appears that your brain sends that last signal before your prefrontal region does its job.
Can we say that our decision-making process and motivation are, therefore, unconscious? If so, how can we develop a stronger will and motivation to make different or even better decisions? Some evidence suggests that the decision-making process comes from a mixture of conscious and unconscious mind [13].
As hypnotherapists, we are accustomed to "talking to the unconscious mind" [14] and that includes avoiding some of the intellectual and logical barriers that one builds for oneself. In hypnosis, that is achieved through hypnotic suggestions. Weitzenhoffer [15,16] claims that the difference between a hypnotic suggestion and an order is the nonvolitional outcome after the hypnotic suggestion, that is, the hypnotized person does not act according to conscious will but rather in a "dissociative" mode: "it's as if the levitating arm were not mine." As Farvolden and Woody [17] find on their study, diminished activity on frontal lobe structures could be an explanation to this "unconscious" behavior. And that is the key aspect of a hypnotic and posthypnotic suggestions, the nonconscious willingness.
Now, how can we use this process to achieve goals? That is what we will be exploring in this chapter.

Prospective memory
"It's a poor sort of memory that only works backwards." Lewis Carroll (Alice in Wonderland). Prospective memory is the ability that allows us to make plans in the present and then remember and carry them out in the future [18]. It is known that the hippocampus consolidates memory from short term to long term [19] and such a complex process occurs better while sleeping [20]. Also, the amygdala's involvement in the memory consolidation process is well demonstrated since a memory associated with high-intensity emotional content tends to last longer than a boring one [21,22].
In the prefrontal cortex, the Brodmann area 10 seems to be responsible for making plans and translating them into action, with support from the structures mentioned above. Also, the same area is responsible for retrieving information about those plans and maintaining the attention required to execute them [23].

As Milton Erickson said
There has to be an integration of unconscious learnings with conscious learnings. This should be foremost in your mind whenever you use hypnosis on psychiatric patients. You can recognize that you can resolve a conflict, a phobia, or an anxiety in the trance state. But unless you do something about it in the waking state, the patient is still likely to have that anxiety or phobia. ( [14], p. 6) There are some classic hypnotic phenomena reported in literature, such as: We will focus on hypnotic age progression in this section. Age progression is a procedure that projects the person into the future to experience achieving her/his goals as if they were happening right now [24]. This involves not only seeing them as a dissociated image, but also as an associated one, where you can see exactly what you will be seeing, and feeling what you will be feeling once you have accomplished an objective, and then be aware of the steps you take to reach that goal, as if they were made in the past. This approach was used by Erickson in many forms, including the "crystal ball" hypnotic strategy. Now, when you work with this pseudo-orientation in time, you need to make contact with the conscious mind, and that is where goal construction takes place.
According to Robert Dilts [25], people construct their goals using six principal methods: • negation of the problematic state • defining the goal as the polarity or the opposite of the problematic state • using an external role model or reference to define the desired state • taking some key characteristics of the desired state • making a generative outcome (using their own references instead of external ones) • acting "as if " When you are working to generate changes with people, all psychotherapy approaches usually take time to define goals. Some methods establish them in a positive and a future-oriented way, for example "What you are going to be doing once you feel…" [26], or focused on what is going to be happening once you get rid of your problem [27]. In our experience, people often struggle with the construction of their objective because they are ambiguous and lacking both clarity and a deadline. Also people focus on what they do not want rather than on what they really want to reach or accomplish.

Active-alert hypnosis for goal achievement
Now, we are presenting an active-alert hypnotic strategy to increase motivation and visualize goals, a methodology that has shown excellent results in our practice, and that currently is being tested for efficacy not only in therapeutic contexts but also through the use of scientific methodology.

First step: writing your goals
In our experience, the approach that has been most useful in helping people to formulate their goals consists of four simple rules: • Write your goal in the first person: Always start with "I…," even if it is obvious that the goal refers to you, it is important to express it with certainty.
• Write your goal in the present or in the present progressive tense: Use "I'm" and "I'm being" instead of using the future tense.
• Describe your goal with as many details as possible: Remember that if you give details to them, some goals could seem smaller and therefore more attainable.
• Write your goals in a positive way: For example, instead of thinking, "I do not want to get sick," you should write, "I am a healthy person." Here is an example. A common goal is "I want to lose weight." Now, following those four rules, we can formulate that goal in this way: We ask the person to write two or three goals for every important aspect of his/ her life. Then we ask them to read these goals out loud while imagining him/herself in that moment, reaching that goal.

Second step: overcoming fears and limitations
In this second part of the exercise, we ask the patient to write a different list following these instructions: All those things that you thought have stopped you from reaching your goals, all those silly things that you said to yourself that made you feel like you might not be able to reach them… maybe all those fears that you had before and that stopped you from success until now.
In my experience (AT), fear is the principal enemy of setting and achieving your goals, but optimism and good self-esteem will also act as your allies all the way to success.
All those fears and limitations are just like a malicious software, like a computer virus… more like trash… like garbage… like waste… mental trash or mental waste or mental garbage that maybe were put there by somebody that wasn't you, maybe with or without intention… but you can get rid of this trash… of this malicious mental software… you can throw away that waste… you can throw away that garbage.
Once all of these fears and limitations are written on a sheet of paper, we tell the person to say goodbye to them, and tear up the paper with all her/his strength. We tell them: DOI: http://dx.doi.org /10.5772/intechopen.92197 Now that those fears are in that paper… that garbage is in that list… I want you to rip apart that mental waste… with all your strength… to tear that sheet of paper into small… unrecognizable pieces… that cannot be put together again… very small… unrecognizable… insignificant pieces… torn apart… Now… with all your strength… throw that garbage away… mental garbage… mental trash… mental waste… should be in the place where it belongs from now on… (we bring a trash can to them) … in this trash can… where those very small… unrecognizable… insignificant pieces of paper will be placed from now on… (Now with louder voice) While you throw them away… those very small… unrec-ognizable… insignificant pieces of paper… give them a last goodbye… yell to them … while throwing them away… ¡THAT'S RIGHT!

Third step: active-alert hypnosis facilitation: the dumbbells technique (Arnoldo Téllez, n.d.)
This is an active-alert hypnotic technique developed a few years ago, in which we ask the person to sit comfortably and look at any point (you can use a point on the wall or an image). Next, we start to suggest: When you are ready to begin, please just sit and make yourself comfortable. Shall we start? Ok, look at that picture 1

… I would like you to focus your attention on any point of the picture, whichever you want… Now… please put your hands with your palms facing up resting on your legs… that's right… keep looking at the same point… while you concentrate on your breath… Now… I wonder what sensations are going to emerge within your body… when you start to practice this exercise… we are going to practice an exercise … Now… have you ever felt the sensation of a weight in your hands?… that's right… as if you have some weights in your hands right now… I want you to imagine as if you have some weights in each one of your hands, a pair of dumbbells… one in each hand… about 2 or 3 kilos… is that okay?… Right… Now… You can grab them hard… and feel the weight… 2 or 3 kilos in each hand… Right now… you do not know yet… exactly how you feel… but as you move your dumbbells up and down … they will feel heavier… While you watch that point… start raising one dumbbell … up to your shoulder … Now slowly lower it… While lowing it, raise the other dumbbell… Okay… now move up and down the other one… the left arm and then the other… Right… arm… while still looking at that point… that's right … I want you to continue looking at the same point… Maybe now you can feel how the muscles contract and then relax… I want you to feel the weight of those dumbbells… feel how the biceps, the muscles of the arms get tensed… little by little feeling warm… the energy and calories in your arms are burning… the muscles get tensed and then relaxed … and please keep your eyes open looking at the picture… looking at the same point … and with each movement… each time closer to
know how you will be feeling… once you start moving… active… and relaxed… you become more actively relaxed… still focusing on your breathing… now take two or three deep breaths… That's right… now… every time you inhale… You can feel more and more awake … more alert… feeling more active and full of energy… your mind is awakened… your mind is clear and lucid… can you feel it… now… your energy spreading throughout your body and your mind?… not too much or too little energy… just the right amount of energy that you need… you can feel a sensation in your body… that indicates that this energy is spreading throughout your body… toward your feet… through your legs… through your entire body… while you continue… your mind becomes more active… more lucid… clearer …. You feel more energized and in self-control… empowered… in harmony with yourself and your surroundings… looking at the same point… can you recognize the sensation emerging? … now?… your arm movements make your mind become more lucid and clearer … actively more awakened and relaxed … that is it … feel the movements of your body… how it gets stronger every time… with each movement of your arms … your body and your mind get stronger and stronger… that's right… now… with every single movement… that energy of motivation is injected into your interior, a positive energy … what do you know that will happen when… with each movement you repeat to yourself… "I can do it … I can get it"… Right… now… visualize a goal… yes… that goal… that you wrote before… to accomplish… it could be a personal goal…. a professional goal… a goal related to your family, I do not know… but you do (k)now… this goal is your target now… and with each movement imagine… feel this sensation… that you move forward… towards your goal… you are approach-ing… centimeter by centimeter… meter by meter… towards your goal… just feel that sensation… as if you had some pulleys that move you towards… getting you closer to your target … that's right… now … with each movement you can tell yourself… you (k)now? … "I can do it… I can get there," and you are slowly approaching your goal with each movement… closer and closer to your goal… Now… maybe you (k) now… or maybe you do not (k)now now… that sensation emerging through your entire body… do you remember now this sensation… you can keep it… within you… every time you need it… this sensation… you know… within you… every time you move… every time you smile… every time you see that goal… every time you breathe… moving forward with enthusiasm towards your goal… now… I wonder how do you want to be able to go a little faster… now… accelerating your arms movements… keep going towards that goal… more and more… towards that goal… and the more you are moving forward … the more active and clearer your mind becomes… the clearer it becomes… the more you (k) now that sensation emerging… through all your body… with a lot of enthusiasm … you can feel an optimistic… motivation… you become more self-confident… with your arms now moving by themselves … by themselves… automatically… leaving behind any doubts that you thought you had… leaving behind everything… anything what you no longer need to carry on your shoulders… anything that was bothering you… that's right… now… knocking down the obstacles… clearing the way… looking more clearly forward.. with more light as you approach to your goal … that's it… right…. safely…. with certainty … yes… you can… you can go forward, approaching your target… your own goal… with that sensation in your body… within your… body… you keep it… you can remember this sensation… every time you need it… this sensation… every time you move… every time you smile… every time you see your goal… every time you breathe… every time you are using the best of your own inner resources… that's it… forward… right… now… there are people waiting for you there cheering… where your goal is… people who love you… to celebrate your success… more and more… recognizing your own personal strengths… maybe you did not know yourself… that people love whoever love yourself… but (k)now you (k)now yourself… leaving behind any burden that you do not need to carry out with you… breaking boundaries … going beyond… reaching your goal… achieving the target… that's it … right… excellent… wonderful… you almost done it… sure… yes… you can… do it… and… NOW!! you finally have reached your goal… you are already in it… right… great… amazing… enjoying … And you can observe… and feel all those sensations… emotions… and thoughts… linked to the achievement of your goal… look right now… at this moment… inside you … how do you feel?… do you (k)now (k)now how you feel?… that feeling emerging… through your entire body… within your… body… you keep it… you can remember this sensation… every time you need it… this Active-Alert Hypnosis to Achieve Personal, Professional, and Therapeutic Goals DOI: http://dx.doi.org/10.5772/intechopen.92197 As you may notice, some of the words are italicized and we know that you are aware of how to use them, or maybe you can change them a little for your convenience.

6.4
Step four: the dirty rubber band (Arnoldo Téllez, n.d.) Next, you can start another exercise. You may stay in the same place. "This is a feeling that I haven't experienced before, but now I only feel the energy from the front side of my brain to my mouth, and even more than the energy, I feel relaxation and inner peace." "I don't feel exhausted, but relaxed."

Some general guidelines to apply active-alert hypnotic procedure
There is no big difference between how the linguistic structure is applied in common, relaxed trances, as you may have seen in the approach we share with you, there are some "hypnotic language forms" [24] or "Milton Model" patterns [28,29], such as analogical marks, interspersal, ambiguities (phonological and punctuation), or lack of a referential index, among others.
In addition, the use of posthypnotic suggestions is key to the construction of a good and effective hypnotic script, since you are looking for a "posthypnotic behavior" [30] integrated into the "normal" behavior of the person [5], and there are some suggestions for their usage [3]: Active-Alert Hypnosis to Achieve Personal, Professional, and Therapeutic Goals DOI: http://dx.doi.org /10.5772/intechopen.92197 • Say them at different times and with depth in the trance session • Express it in different language levels (such as metaphorical, explicit, or with ambiguity) • Express them as a contingent suggestion (the standard form is "next time that you [unavoidable fact], you will [suggestion]") • Use distinctive nonverbal cues to indicate that suggestion's importance.
Unestahl [2] states that every time that a posthypnotic suggestion is triggered, a "posthypnotic trance" occurs, providing an opportunity for the person to elicit all the sensations and learning acquired in the hypnotic session and to bring them to a context where they will be useful.
There is a process in our brain called hippocampal offline replay that allows our memory to consolidate while in a sleep state. However, there is evidence suggesting that this process can occur in a special consciousness state (relaxed awake state) to bring back learned behaviors or sequences of thoughts in a shorter period of time [31,32]. That process may be the one that will help us to consolidate and accomplish our most important goals through active-alert hypnosis, posthypnotic suggestions, and clearer goal setting.
This did not happen with that half-baked goal of mine about "getting some new shoes" because that instruction was not specific enough to obtain the desired result. My hippocampus just replays "new shoes… new shoes" a lot, without any more details, and that is what I obtained in the end. A better hypnotic suggestion might have been the following "buy a pair of new and comfortable shoes."

Conclusion
Active-alert hypnotic states could be an alternative in some cases where traditional, relaxed-state hypnosis may not be applied. This approach can be used as a tool to guide people to realize how hypnosis could be experienced on a daily basis and as an auto-hypnosis method, making use of posthypnotic trance states.
Reaching a goal requires people to think, to feel, and to act, both consciously and unconsciously. Both active-alert hypnosis and traditional relaxed-state hypnosis help to store goal-seeking information into the unconscious mind in order to encourage the person to reach his/her goals in a nonconscious manner. However, an advantage of active-alert hypnosis is that it seems to increase motivation and energy as well as increasing the probability of producing a state of flow.
According to our experience, this dumbbells technique is an excellent tool helping people to set and achieve their own goals, whatever they are: personal, professional, financial, and health-related ones. Also, in many cases it could produce a flow state characterized by a focused attention and full concentration, merging awareness and action, "freedom" from worries about failure, self-consciousness disappearing, distorted time sense, and auto-rewarding experiences [33]; this flow state leads the person to a higher motivation and energy, augmented self-efficiency perception, mind clarity, and self-control.
AAH could be very useful in high-performance athletes, as has been shown by Unestahl's research [30]. We have used the dumbbells technique, as a kind of AAH, in several cases of high-performance athletes and sport teams, from amateurs to professionals. The following is a report from a female cyclist who won gold medal in 2018 Pan-American games, who experienced this technique after a session of AAH dumbbells technique: