The Runner's Mind: Using Clinical Hypnotherapy to Improve Performance

When I began training for my first marathon, I sought advice from anyone with experience. I received thoughtful guidance on nutrition, hydration, sleep, pacing strategies, and training plans—practical recommendations that help me form the foundation of my preparation. While each was valuable, one piece of advice stood apart.

A fellow therapist and experienced runner encouraged me to train not only my body, but my mind. She suggested incorporating visualization into my preparation by regularly imagining myself running with strength and composure, navigating difficult moments with confidence, and ultimately crossing the finish line. At the time, it seemed almost too simple to make a meaningful difference. Yet that conversation introduced me to an often-overlooked aspect of endurance training: the brain can be trained alongside the body.

Only later did I come to appreciate that this practice was more than positive thinking. Mental imagery and visualization engage many of the same neural circuits involved in physical movement, priming the brain for performance before a single step is taken.

Many elite athletes have long incorporated mental imagery and clinical hypnosis into their training. These techniques are used not only to enhance performance but also to improve concentration, regulate pre-competition anxiety, manage pain associated with injury, and even support the recovery process. Increasingly, research in sport psychology and neuroscience suggests that mental training is not merely complementary to physical training—it is an integral component of optimizing athletic performance.

 What is clinical hypnosis?

 Clinical hypnosis has been used as an adjunctive therapeutic intervention in the treatment of trauma, anxiety, and a variety of psychological and medical conditions for more than two centuries (Spiegel, 2013). Rather than inducing an altered state of consciousness, hypnosis is generally understood as a state of highly focused attention accompanied by increased absorption and responsiveness to therapeutic suggestion (Hammond, 1998). During hypnosis, attention becomes less fragmented by competing internal and external stimuli, allowing individuals to engage more deeply with specific thoughts, sensations, or therapeutic goals.

This heightened state of focused awareness can facilitate cognitive and emotional flexibility, making it easier to modify maladaptive beliefs, regulate emotional responses, and strengthen adaptive patterns of thinking and behavior. As Yapko (2012) suggests, hypnosis is most effective not because it imposes change, but because it amplifies an individual's existing capacities, helping people access internal resources, develop resilience, and discover strengths that may otherwise remain outside conscious awareness.

Although hypnosis has traditionally been studied in the treatment of trauma and anxiety, these same mechanisms of focused attention, enhanced learning, and neuroplasticity have increasingly been applied to athletic performance. For runners, hypnosis offers a way to refine mental skills such as concentration, confidence, pain regulation, and emotional resilience—psychological capacities that often distinguish good performances from exceptional ones.

 The Neurobiology of Hypnosis

 Hypnosis has long been misunderstood as a mysterious or passive state in which individuals lose control of their thoughts or actions. Contemporary neuroscience offers a different perspective. Rather than diminishing consciousness, hypnosis appears to reorganize how the brain allocates attention, processes sensory information, and regulates perception. During hypnosis, the brain becomes exceptionally efficient at filtering competing stimuli and sustaining focused attention, creating an ideal environment for learning, behavior change, and emotional regulation.

 Attention Networks

 One of the defining features of hypnosis is its effect on attention. Neuroimaging studies consistently demonstrate increased engagement of the dorsal attention network, a system responsible for sustaining goal-directed focus while reducing interference from distracting internal and external stimuli.

This narrowing of attention allows individuals to become deeply immersed in therapeutic suggestions, mental imagery, or motor rehearsal.

The dorsolateral prefrontal cortex (DLPFC) is one of the brain's primary executive control centers, supporting planning, decision-making, self-regulation, and cognitive flexibility. Research by David Spiegel and colleagues suggests that hypnosis alters communication between the DLPFC and regions involved in self-monitoring, allowing attention to become more focused and less disrupted by self-doubt or distraction.

For athletes, this may facilitate sustained concentration while reducing cognitive interference from doubt or distraction.

 Pain Modulation

 One of the most extensively researched applications of clinical hypnosis is pain modulation. Brain imaging studies demonstrate that hypnosis can alter activity within networks involved in both the sensory and emotional dimensions of pain. Rather than eliminating discomfort, hypnosis appears to change the brain's interpretation of it, reducing its emotional intensity. For endurance athletes, this distinction is particularly meaningful. The goal is not to ignore pain that signals injury, but to become less reactive to the normal discomfort associated with sustained effort.

 Predictive processing

 One emerging theory proposes that hypnosis works by modifying the brain's predictive models. These expectations influence perception before sensory information is fully processed. The brain is constantly generating expectations about pain, effort, movement, emotions, and bodily sensations. Hypnotic suggestion may temporarily increase the precision of therapeutic expectations, allowing new interpretations of sensory information to emerge.

For example:

Instead of interpreting increased heart rate as anxiety,

the brain may reinterpret it as excitement.

Instead of viewing muscle fatigue as a signal to stop,

it may be experienced as evidence of productive effort.

 Neuroplasticity

Repeated hypnotic practice strengthens neural pathways through experience-dependent neuroplasticity. Each hypnotic session reinforces neural networks involved in emotional regulation, attentional control, confidence, motor learning, and behavioral consistency.

Like physical exercise, hypnosis relies upon repetition.

The more frequently adaptive neural circuits are activated, the more efficient they become.

One of the most powerful aspects of hypnosis is guided imagery.

Functional MRI studies demonstrate that vividly imagining movement activates many of the same brain networks used during actual running, including regions involved in motor planning, coordination, timing, and movement initiation. Specifically, motor imagery engages the supplementary motor area, premotor cortex, cerebellum, basal ganglia, and, to a lesser extent, the primary motor cortex. Repeated mental rehearsal may therefore strengthen the neural pathways that support efficient movement, making visualization a valuable complement to physical training.

 For runners, mentally rehearsing efficient form, maintaining pace, or successfully finishing a race may strengthen the neural representations that support these behaviors during competition.

One of the strongest pieces of evidence supporting the use of hypnosis in sport comes from a 2025 systematic review published in the International Review of Sport and Exercise Psychology. After evaluating 13 studies across a variety of sports, the authors found that therapeutic hypnosis was consistently associated with improvements in athletic performance, enhanced recovery from injury, and reductions in sport-related psychological distress, including competitive anxiety. Although the overall methodological quality of the studies was moderate and many used uncontrolled designs, the findings suggest that hypnosis may be a valuable adjunct to physical training by strengthening the psychological skills that contribute to peak performance. The authors concluded that larger, well-designed randomized controlled trials are needed to better understand the efficacy and mechanisms of hypnosis in athletic populations.

 Why This Matters For Runners

 Running is not simply a physical task—it is a neurobiological one. Every stride is influenced by the brain's regulation of attention, movement, emotion, pain, and effort. Clinical hypnosis offers a method of intentionally training these systems. By improving attentional control, reducing self-critical internal dialogue, enhancing emotional regulation, and reinforcing efficient motor patterns, hypnosis may help runners perform closer to their physiological potential.

That conversation before my first marathon changed far more than my approach to racing—it changed the way I understood performance itself. Since then, hypnosis has become a regular part of both my running and my clinical practice. Over the years, I became formally trained and certified in clinical hypnosis, motivated by a desire to better understand why the techniques that helped me felt so effective.

As both a therapist and a runner, I have come to appreciate that peak performance is rarely limited by the body alone. The brain shapes how we interpret effort, regulate emotion, sustain attention, and respond to discomfort. Training those systems intentionally can be just as valuable as logging another mile.

 While hypnosis is not a substitute for consistent physical training, the emerging evidence suggests it may be a powerful complement. Just as runners strengthen their cardiovascular system through repeated miles, they can strengthen the mental processes that support resilience, confidence, and performance. The mind, like the body, adapts to training.

 You do not need to be an elite athlete to benefit from hypnosis. Many runners begin by practicing brief sessions before workouts or races that combine relaxation with mental rehearsal. Visualizing efficient running form, maintaining composure during fatigue, or crossing the finish line can strengthen the same neural pathways engaged during physical performance. Like any skill, the effects develop through consistent practice.

 References:

Hammond, D. C. (2007). Hypnosis, placebos, and systematic research bias in biological

psychiatry. American Journal of Clinical Hypnosis, 50(1), 37–47.

https://doi.org/10.1080/00029157.2007.10401596Miró, A., Mesperuza, M., Jensen, M. P., Day, M. A., García, F., & Miró, J. (2025). Therapeutic Hypnosis and Sports Performance: A systematic review. International Review of Sport and Exercise Psychology, 1–21. https://doi.org/10.1080/1750984x.2025.2512535 

Spiegel, D. (2013). Tranceformations: Hypnosis in brain and body. Depression and Anxiety, 30,

342–542. https://doi.org/10.1002/da.22046

Yapko, M. (2012). Trancework: An introduction to the practice of clinical hypnosis (4th ed.).

New York, NY: Brunner-Routledge.