Boeke, S.; Bonke, B.; Bouwhuis-Hoogerwerf, M. L.; Bovill, J. G.; Zwaveling, A. (1988). Effects of sounds presented during general anaesthesia on postoperative course. British Journal of Anaesthesia, 60, 697-702.

In a double-blind, randomized study, patients undergoing cholecystectomy were administered one of four different sounds during general anaesthesia: positive suggestions, nonsense suggestions, seaside sounds or sounds form the operating theatre. The effect of these sounds on the postoperative course was examined to assess intraoperative auditory registration. No differences were found between the four groups in postoperative variables
Postoperative course was evaluated by 5 variables: pain, nausea and vomiting, evaluation by nursing staff, subjective well-being, and duration of postoperative hospital stay. From the chart they used amount of postoperative analgesia, volume of nasogastric suction or drainage and fluid lost through vomiting over 6 days post-operatively; duration of postoperative hospital stay was registered after discharge. See p. 699 for details, including wording of questions. They cite their own earlier study that got positive results, and explain the difference as possibly due to use of only male voices on tapes, lack of difference in the sounds on tapes in this study, insensitivity of outcome measures (patients stayed longer in first study than in this one), and sample too small in this study (106).
Boeke et al. (1988) report that this double-blind, randomized study of positive suggestions, noise or sounds from the operating theatre presented to 3 groups of patients undergoing cholecystectomy during general anaesthesia had positive results for older patients. patients > 55 years who received positive suggestions had a significantly shorter postoperative hospital stay than the other patients in this age category.

Goldmann, Les; Ogg, T. W.; Levey, A. B. (1988). Hypnosis and daycase anaesthesia. A study to reduce preoperative anxiety and intraoperative anesthesia requirements. Anesthesia, 43, 466-469.

52 female patients having gynecological surgery as day cases received either a short preoperative hypnotic induction or a brief discussion of equal length. Hypnotized patients who underwent vaginal termination of pregnancy required significantly less methohexitone for induction of anesthesia and were significantly more relaxed as judged by their visual analogue scores for anxiety. Less than half the patients were satisfied with their knowledge about the operative procedure even after discussions with the surgeon and anesthetist. A significant correlation was found between anxiety and perceived knowledge of procedures. Results suggest that preoperative hypnosis can provide a quick and effective way to reduce preoperative patient anxiety and anesthetic requirements for gynecological daycase surgery.

Evans, Frederick J.; McGlashan, Thomas H. (1987). Specific and non-specific factors in hypnotic analgesia: A reply to Wagstaff. British Journal of Experimental and Clinical Hypnosis, 4, 141-147. (Comment in response to Wagstaff, G. (1987). Is hypnotherapy a placebo?

This article is a reply to Wagstaff’s (1984) critique of the McGlashan, Evans & Orne (1969) article which was entitled “The nature of hypnotic analgesia and the placebo response to experimental pain,” published in Psychosomatic Medicine, 31, 227-246. The paper to which the authors are replying is Wagstaff, G. F. (1984). Is hypnotherapy a placebo? Paper given at the First Annual Conference of the British Society of Experimental and Clinical Hypnosis, University College, London. An abridged version appeared in the British Journal of Experimental and Clinical Hypnosis, 1987, 4, 135-140.
The closing comments of this Evans & McGlashan 1987 paper read as follows: “The strategy in this study [i.e. McGlashan, Evans & Orne, 1969] was quite different from the usual experimental design. Our goal was to _maximize_ all of those non-specific factors that we could build into the experimental procedure. Only by attempting to maximize non-specific effects is it possible to see whether hypnosis in appropriately responsive subjects can exceed that degree of pain control which occurs due to the maximal operation of these non-specific effects. These non-specific components of the hypnotic situation may account for a great deal of clinical change. … The critical finding was that hypnosis did add a level of pain control that occurred after maximizing clinically related non-specific factors contributing to change in pain tolerance, and that this increased tolerance occurred only in subjects markedly responsive to hypnosis, in contrast to the significant non-specific effects which were uncorrelated with measured hypnotizability” (pp. 143-144).
The principal findings of the McGlashan, Evans & Orne (1969) study were: “(a) The improved ability to tolerate pain following the ingestion of placebo was roughly the same for high hypnotizable and low hypnotizable subjects. (b) The response to the non-specific aspects of taking a ‘drug’ among low hypnotizable subjects was identical to, and highly correlated (.76) with, their response to the legitimized expectation that change would occur under hypnosis for low hypnotizable subjects. The placebo component of a believe-in ‘drug’ ingestion was the same as the placebo component of a believed-in hypnotic experience for these low hypnotizable subjects. (c) The performance of the highly hypnotizable subjects was significantly greater under hypnotic analgesia conditions than it was under placebo conditions.
“This last finding is important conceptually, though of less clinical relevance. It should be noted that not all high hypnotizable subjects showed this result. Even among highly hypnotizable subjects, not all of them had the experience that profound analgesia had occurred! Thus, based on their subjective experience of the relatively small degree of analgesia, 6 of the 12 highly hypnotizable subjects behaved exactly as the low hypnotizable subjects had — their placebo and hypnotic responses were small, significant, but equal. Only 6 out of 12 carefully screened hypnotizable subjects who subjectively experienced marked analgesia showed dramatic objective changes in pain endurance. Dr. Wagstaff might consider the physiological implications of the observation that we became somewhat frightened about the possibility of tissue damage with two of these six subjects. We had to stop their performance at a point where physiologists had assured us that tissue damage could be expected. They had also assured us, wrongly for these subjects, that we did not have to worry about such a critical point because nobody could endure such a degree of occlusion with this procedure. In fact, for these two subjects, anoxia and muscle cramping were not even apparent!” ( p. 144).

Goldmann, Les (1987, October). Ways of maximizing patient memory for events during anesthesia. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Los Angeles.

Reported a series of experiments: 1. Under atropine, we did not get an orienting response to things having to do with the operation, but did get an orienting response to jokes, dogs barking, and the name of a polite anesthetist. 2. Replicated the research by Bennett and didn’t get ear pulling response. 3. Studied cardiac patients. Gave subjects a pre-anesthesia speech of importance [of hearing under anesthesia? Notes here are not clear.] and a chin touch suggestion that was successful. 7 of 30 subjects gave reports of recall – usually recalled something of particular interest to them. These 7 subjects appeared more anxious postoperatively than previously. 4. Recognition study: Pre-op “IQ” test. Gave subjects answers to the questions while they were under anesthesia, and postoperatively they had better performance than previously. 5. Recall study, double blind. Interviewer learned something about the patient, and told them something about what was learned about the patient during anesthesia e.g., You have a lovely garden. After surgery they were hypnotized by someone who did not know what information was given, and then recall for information “heard” under anesthesia was tested. 6. 10 female patients who were good hypnotic subjects, all received the same statement under anesthesia, that they would believe for a moment that they had green hair. During the interview, one said she was fascinated by green things, one wanted to go home and wash her hair.

Goldmann, Les; Shah, M. V.; Hebden, M. W. (1987). Memory of cardiac anesthesia: Psychological sequelae in cardiac patients of intra-operative suggestion and operating room conversation. Anesthesia, 42 (6), 596-603.

Thirty elective cardiopulmonary by-pass surgery patients were interviewed pre- and postoperatively. A random selection of patients heard a prerecorded audio tape toward the end of surgery after they were rewarmed to 37 degrees C. The tape contained suggestions for patients to touch their chin during the postoperative interview, to remember three sentences, and to recover quickly. The interviewers were blind to the experimental conditions. The experimental group touched their chins significantly more often than the control group (p = .015). Sentence recognition did not reach significance, perhaps due to the small numbers and low salience of the stimuli. Seven patients (23%) recalled intraoperative events, five with the aid of hypnosis. Three reports (10%) were corroborated. Preoperative medication (p < .01) and postoperative anxiety (p < .05) were significant predictors of those patients who reported recall. Hilgard, Ernest R. (1987). Research advances in hypnosis: Issues and methods. International Journal of Clinical and Experimental Hypnosis, 35, 248-264 There are substantial areas of agreement upon the classical phenomena of hypnosis, illustrated by what we now have learned about hypnotic talent, amnesia, hallucinations, analgesia, and dissociative processes. While genuine advances in knowledge about hypnosis have been made in recent decades, differing orienting attitudes have kept some controversy alive, particularly in the interpretation of empirical findings. Differences of interpretation of the phenomenal and behavioral facts are to be expected in the present stage of developmental, cognitive, and social psychology. NOTES 1: The author writes of the "domain of hypnosis" as within the larger domain of social psychology (because it is usually interpersonal); cognitive psychology (because of alterations in perception, imagination, memory, and thought); developmental and personality psychology (because of individual differences); and physiological psychology (because of neurophysiological aspects). In terms of what we know about hypnotic talent, he notes that high hypnotizability is not generally associated with psychopathology; that it may however be associated with a personality measure called absorption; and that there may be some inherited ability (Morgan, 1973). In the author's view, hypnosis is no longer considered simply a response to suggestion, since imagination and/or fantasy are very important. In reviewing evidence of posthypnotic amnesia the author writes, "Subtleties in language require making careful distinctions among concepts such as compliance, suggestion, compulsivity, belief, self-deception, automaticity, the voluntary, the involuntary, and a happening. If these distinctions are glossed over, the choice of words (e.g., substituting compliance for response to suggestion) may give the impression that a finding departs more widely from conventional views than it does. We, too, have found that Ss used varied strategies or skills during amnesia, but this need not deny augmentation by suggestion. "It takes genuinely high Ss to illustrate truly high posthypnotic amnesia... Many of the truly high hypnotizable individuals cannot break amnesia, no matter how hard they try" (p. 253). Regarding the evidence for hypnotic hallucinations and trance logic, the author suggests that trance logic is not a clear concept because the Subject is capable of good logic while tolerating some inconsistencies. "It is ordinary logic to assume that if your hallucination is your own construction, it is you who can influence it by your own wishes. In the rare cases of transparent or diaphanous hallucinations there is still an 'out there' quality. People who report that they see wispy ghosts also see them as 'out there,' so that they qualify as hallucinations. The distinction appears to be one of perception and perception-like experiences within hypnosis rather than of logic" (p. 256). In reviewing the evidence for hypnotic analgesia, the author acknowledges that pain relief is available with other kinds of interventions, or by using other kinds of psychological processes, but that does not diminish the contribution of hypnosis (which has a long and impressive clinical history). Following laboratory studies, it is noted that "the amount of alleviation of pain through hypnosis is positively correlated with the hypnotizability of the candidate for pain reduction. This result is not universally accepted, because some clinicians are convinced that those unsuccessful in hypnotic pain reduction are resisting hypnosis" (p. 256-257). In the present paper he acknowledges but does not review physiological literature on hypnoanalgesia. Regarding the concept of dissociation, the author indicates that he considers it a more useful concept than the concept of trance or hypnotic state "when a person is only slightly or moderately involved in hypnosis ... . The advantage is that dissociations, as compared with altered states, can be described according to limited or more pervasive changes in the cognitive or motor systems that are being activated or distorted through suggestion in the context of hypnosis. Perhaps when all-inclusive enough, such changes can justify the use of the term trance or altered state, but I believe that these terms should be used, if at all, only for those for whom the immersion in the hypnotic experience is demonstrably pervasive" (pp. 258-259). The author goes on to describe his initial discovery of the 'hidden observer' in an experimental context, and to relate the 'hidden observer' to others' earlier observations of a secondary report of an experience previously concealed from S's consciousness (Binet, 1889-1890/1896; Estabrooks, 1957; James, 1899; Kaplan, 1960). "The issues are still being worked on, but as in the case of trance logic the heart of the problem is not whether to speak of a hidden observer, but to recognize that there may be cognitive distortions in hypnosis even while some more realistic information is being processed in parallel, so that everything is not reportable by S" (p. 260). 1986 Farthing, G. William; Venturino, Michael; Brown, Scott W.; Lazar, Joel D. (1986, April). Internal vs. external distraction in the control of pain as a function of hypnotic susceptibility. [Paper] Presented at the annual meeting of the Eastern Psychological Association, New York. NOTES This study tested the prediction, derived from their 1984 study: for highly hypnotizable subjects, pain reduction methods involving either attention to external distracting stimuli or attention to internally generated distracting images will be effective in reducing pain. However, for low hypnotizables only external stimulus distraction will be effective, and internal images will not be effective distractors for reducing pain. Used independent groups of college students, with 1/3 highs, 1/3 mediums, and 1/3 lows. Used five conditions: (n=12 per subgroup 3H x 5T) 1. Suggestion - Subjects told "to image as vividly as you can that your hand is numb and insensitive, as if it were made of rubber." (No hypnotic induction was used.) 2. Guided imagery - Subjects told to listen to a story that would be read to them, and to try to imagine the scenes as vividly as possible. (Story included scenes where the s was the main character.) 3. Word memory - Subjects told to listen to a list of words that would be read to them and try to remember them for later recall test (30 abstract nouns, at rate of 1 every 2 seconds. 4. Pursuit rotor - which subjects did during the ice water immersion. 5. Placebo control - included suggestion, "For this test you will find that you can succeed in not being disturbed by the cold water if you carefully follow the following instructions. While your hand is in the water you should not try to control your thoughts. Just let your mind wander freely to whatever feelings or thoughts or ideas happen to come to you." 1985 Eich, Eric; Reeves, John L.; Katz, Ronald L. (1985). Anesthesia, amnesia, and the memory/awareness distinction. Anesthesia and Analgesia, 64, 1143-1148. Several studies have shown that surgical patients cannot consciously recall or recognize events to which they had been exposed during general anesthesia. Might evidence of memory for intraoperative events be revealed through the performance of a postoperative test that does not require remembering to be deliberate or intentional? Results of the present study, involving the recognition and spelling of semantically biased homophones, suggest a negative answer to this question and imply that intraoperative events cannot be remembered postoperatively, either with or without awareness. NOTES 1: "In this experiment, we attempted to apply the distinction between memory and awareness of memory to the question of whether adequately anesthetized and apparently unconscious patients can register and retain what is said in their presence during surgery. Prior research relating to this question has focused, for the most part, on the ability of postoperative patients to recall or recognize a specific item....The inference need not be drawn, however, that 'patients in so-called surgical planes of anesthesia cannot hear' (15, p. 89) or that anesthetized patients cannot encode and store in memory events that transpire during their surgery. The possibility remains that even though the effects of memory for intraoperative events may not--and probably cannot--be revealed in postoperative tests of retention that require remembering to be deliberate or intentional, such effects might be evident in the performance of tests that do not demand awareness of remembering. "To explore the possible dissociation between memory and awareness of memory for intraoperative events, we modeled our experiment after a recent neuropsychological study by Jacoby and Witherspoon (5)" (p. 1143). "...it appears that the prior presentation of a word has a substantial impact on its subsequent interpretation and spelling, regardless of whether or not the word is correctly classified as 'old' in a later test of recognition memory" (p. 1144). "Approached from the standpoint of anesthesia theory and practice, the idea that recognition and spelling tap different memory processes or systems raises an interesting question for research. Specifically, suppose that during surgery, an anesthetized patient listens to a series of short, descriptive phrases, each consisting of a homophone and one or two words that bias the homophone's less common interpretation (e.g., war and PEACE, deep SEA). Suppose further that several days after surgery, the patient is read a list composed chiefly of old and new homophones (i.e., ones that either had or had not been presented intraoperatively) on two successive occasions. On one occasion, the patient is simply asked to spell each list item aloud; on the other occasion, the patient is asked to state aloud which list items he or she recognizes as having been presented during surgery. Given the situation sketched above, might the patient spell significantly more old than new homophones in line with their less common interpretations, and yet fail to reliably discriminate between the two types of items in the test of recognition memory" (p. 1144). 1984 Gillett, Penny L.; Coe, William C. (1984). The effects of rapid induction analgesia (RIA), hypnotic susceptibility and the severity of discomfort on reducing dental pain. American Journal of Clinical Hypnosis, 27, 81-90. ACT The study was designed to address three issues involved in hypnotic analgesia for dental pain: 1) The effectiveness of J. Barber's (1977) hypnotic procedure for producing analgesia in its usual form and a shortened form, 2) the relationship of hypnotic susceptibility to analgesic responsiveness, and 3) the effect of dental procedure discomfort level on hypnotic analgesia. Sixty unselected dental patients were administered either J. Barber's (1977) RIA or a shortened version of it (SI) before their dental treatment. Measures of hypnotic susceptibility were obtained as were dentists' ratings of the discomfort levels involved in the various dental procedures administered. The 52% success rate of the present study failed to replicate Barber's very high (99%) success rate, although procedural differences might explain the lower rate. RIA and SI were equally effective. Hypnotic susceptibility level did not relate significantly to success with hypnotic analgesia. The level of dental procedure discomfort was the clearest predictor of success with hypnotic analgesia. The greater the discomfort rating of a procedure the less likely that hypnotic analgesia would be successful. 1980 Edwards, William Henry (1980). Direct versus indirect hypnosis for the relief of chronic pain in spinal cord injured patients (Dissertation, United States International University). Dissertation Abstracts International, 40 (10-B), 4996. NOTES 1: This study compared effectiveness of direct hypnosis and indirect hypnosis (Rapid Induction Analgesia, developed by Joseph Barber) in reducing experimental and clinical pain in spinal cord injured patients. The 30 male paraplegic patients who had chronic benign pain volunteered for the study. They were administered three tests: the Pain Estimate Scale (Sternbach, 1974), Ischemic Muscle Pain Test (IMPT), and the Stanford Profile Hypnotic Susceptibility Scale, Form II -- SPHSS -- (Weitzenhoffer and Hilgard, 1967). Each patient experienced three sessions: (1) Baseline Control, (2) Direct Hypnosis, and (3) Indirect Hypnosis. Patients were randomly assigned to Sessions (2) and (3). The results indicated no significant statistical difference in the effectiveness of direct versus indirect hypnotic analgesia in these chronic pain patients. Direct and indirect hypnosis were equally effective; hypnotizability was not associated with outcome. Furthermore, there was no interaction between treatment effects and pretreatment pain level. The results were similar for both clinical and experimental pain. 1979 Barber, Joseph; Donaldson, David; Ramras, Susan; Allen, Gerald D. (1979). The relationship between nitrous oxide conscious sedation and the hypnotic state. Journal of the American Dental Association, 99, 624-626. NOTES 1: Nitrous oxide-oxygen produces a state of consciousness in the patient that is reported to be similar to the hypnotic state. In this investigation, the authors test the hypothesis that nitrous oxide-oxygen heightens a patient's responsiveness. This study apparently did not have a control group receiving nitrous oxide but no suggestions, to evaluate the amnesia and analgesic effects of the drug alone. Bennett, Henry L.; Giannini, Jeffrey A.; Kline, Mark D. (1979, September). Consequences of hearing during general anesthesia. [Paper] Presented at the annual meeting of the American Psychological Association, New York. A double blind 2X2 study exposed 23 herniorraphy and cholecystectomy patients to either a 45 minute suggestion tape or to the actual sounds of the operation. Structured interviews conducted postoperatively assessed hypnotic susceptibility and regressed patients under hypnosis to operative events. Ten patients accurately recalled significant events from surgery but only under hypnosis. Recall was greater and more accurate in patients scoring high on the Stanford Clinical Hypnosis Scale. Fewest number of pain medications were given postoperatively to patients receiving the suggestion tape. Hernia patients showed better recall than gallbladder patients. 1977 Chertok, Leon; Michaux, D.; Droin, M. C. (1977). Dynamics of hypnotic analgesia: Some new data. Journal of Nervous and Mental Disease, 164, 88-96. Following two surgical operations under hypnotic anesthesia, it was possible, during subsequent recall under hypnosis, to elicit a representation of the past operative experience. It would seem that under hypnosis there is a persistence of the perception of nociceptive information and of its recognition as such by the subject. From an analysis of these two experiments in recall, it is possible to formulate several hypotheses concerning the psychological processes involved in hypnotic analgesia. In consequence of an affective relationship, in which the hypnotist's word assumes a special importance for the subject, the latter has recourse to two kinds of mechanism: a) internal (assimilation to an analogous sensation, not, however, registered as dangerous-- rationalization); and b) external (total compliance with the interpretations proposed by the hypnotist), which lead to a qualitative transformation of nociceptive information, as also the inhibition of the behavioral manifestations normally associated with a painful stimulus. 1976 Chaves, John F.; Barber, Theodore Xenophon (1976). Hypnotic procedures and surgery: A critical analysis with applications to 'acupuncture analgesia'. American Journal of Clinical Hypnosis, 18 (4), 217-236. Although hypnotic procedures are useful for reducing the anxiety of surgery and helping patients tolerate surgery, they do not consistently eliminate pain. Six factors that are part of or associated with hypnotic procedures help patients tolerate surgery. These factors pertain to patient selection, the patient-physician relationship, the preoperative 'education' of the patient, the adjunctive use of drugs, and the use of suggestions of analgesia and distraction. It appears that the same factors account for the apparent successes of 'acupuncture analgesia' as well. A frequently-overlooked fact, that most internal tissues and organs of the body do not hurt when they are cut by the surgeon's scalpel, is also important in understanding how surgery can be performed with either 'hypnoanesthesia' or 'acupuncture analgesia.' 1975 Carli, G. (1975). Some evidence of analgesia during animal hypnosis [Abstract]. Experimental Brain Research, 23, 35. The purpose of this study was to investigate the response to painful stimuli during animal hypnosis. The experiments were performed on unanesthetized, free-moving rabbits carrying implanted electrodes for recording the EEG and EMG activity and nerve stimulation. Injection of formaline into the dorsal region of the foot produced long lasting EEG desynchronization and motor pain reactions. In some rabbits a procedure of habituation was used to reduce hypnosis duration below 45 sec. Hypnosis was induced by inversion. The following results were obtained: 1) Polysynaptic reflexes eliced [sic] by electrical stimulation of cutaneous and muscle afferents were depressed during hypnosis. 2) Hypnosis transitorily suppressed all the painful manifestations due to formaline injection and was characterized by hygh [sic] voltage slow wave activity in the EEG, 3) In habituated rabbits, a significant increase in hypnotic duration and EEG synchronization was observed when hypnosis was preceded by formaline injection. Hypnosis duration was not potentiated by painful stimuli when Naloxone (5mg/Kg i.v.) was injected before hypnosis induction. 4) In habituated rabbits a recovery in hypnotic duration coupled to EEG synchronization was obtained, in absence of painful stimuli, following subanalgesic injection of Morphine (1mg/Kg). It has been previously shown that in the rabbit administration of 5-20 mg/Kg of Morphine produces EEG synchronization and strong reduction of pain reactions. It is suggested that, during animal hypnosis in a condition of continuous nociceptive stimulation, the pain response is blocked by a mechanism which exibit [sic] similar effects of Morphine both at spinal cord (polysynaptic reflexes) and at cortical levels (EEG synchronization). 1974 haves, John F.; Barber, Theodore Xenophon (1974). Acupuncture analgesia: A six-factor theory. Psychoenergetic Systems, 1, 11-21. The dramatic successes claimed for acupuncture suggest that Western medicine has failed to identify important factors that pertain to the nature of pain and its control. This may not be the case, as there are at least six factors which are often overlooked by writers describing the absence of pain (i.e., analgesia) during acupuncture: (a) the patients accepted for surgery under acupuncture usually believe that it will work, (b) drugs are frequently used in combination with acupuncture, (c) the pain associated with surgical procedures is less than is generally assumed, (d) the patients are prepared in special ways for surgery under acupuncture, (e) the acupuncture needles distract the patient from the pain of surgery and, (f) suggestions for pain relief are present in acupuncture treatment. It is concluded that more research is needed to determine whether additional factors are needed to help explain the phenomenon of acupuncture analgesia. Chaves, John F.; Barber, Theodore Xenophon (1974). Cognitive strategies, experimenter modeling, and expectation in attenuation of pain. Journal of Abnormal Psychology, 83 (4), 356-363. Verbal reports of pain were obtained from 120 subjects during a base-level pretest and also during a posttest conducted under one of several experimental treatments. The pain stimulus was a heavy weight applied to a finger for two minutes. During the posttest, subjects who had been asked to utilize cognitive strategies for reducing pain (to imagine pleasant events or to imagine the finger as insensitive) showed a reduction in pain as compared to uninstructed control subjects. Subjects led to expect a reduction in pain, but not provided with cognitive strategies, also showed reduced pain during the posttest as compared to control subjects, but the reduction was smaller than for subjects using cognitive strategies. An experimenter modeling procedure, used with one half of the subjects under each experimental treatment, was effective in reducing verbal reports of pain only for subjects with high pretest levels who were asked to imagine pleasant events. 1970 Evans, Michael B.; Paul, Gordon L. (1970). Effects of hypnotically suggested analgesia on physiological and subjective responses to cold stress. Journal of Consulting and Clinical Psychology, 35 (3), 362-371. Relative effects of suggested analgesia and hypnotic induction were evaluated with regard to reduction of stress responses (self-report, heart rate, pulse volume) to the physical application of ice-water stress. Four groups (N = 16 each) of undergraduate female Ss, equated on hypnotic susceptibility, were run individually, receiving (a) hypnotic induction plus analgesic suggestion, (b) hypnotic induction alone, (c) waking self-relaxation plus analgesic suggestion, or (d) waking self-relaxation alone. The major findings were that suggestion, not hypnotic induction procedures, produced reductions in the self-report of distress, and that the degree of reduction was related to hypnotic susceptibility in both "hypnotic and "waking" conditions. Neither suggestion nor hypnotic induction procedures resulted in reduction of the physiological stress responses monitored in this study. Several methodological issues are discussed. Although findings add to the bulk of evidence supporting the "skeptical" view of hypnotic phenomena, results are related to other literature, suggesting that an adequate evaluation of hypnotic analgesia as used clinically has not yet been undertaken. 1969 Barber, Theodore Xenophon (1969). An empirically-based formulation of hypnosis. American Journal of Clinical Hypnosis, 12 (2), 100-130. A formulation is presented which does not invoke a special state of consciousness ("hypnosis" or "trance") to account for the behaviors that have been historically associated with the word hypnotism. Instead, so-called hypnotic behaviors - e.g., "analgesia," "hallucination," "age-regression," and "amnesia" - are conceived to be functionally related to denotable antecedent variables which are similar to those that control performance in a variety of interpersonal test-situations. The antecedent variables which determine behavior in a "hypnotic" situation include Ss' attitudes, expectancies, and motivations with respect to the situation, and the wording and tone of instructions- suggestions and of questions used to elicit subjective reports. The formulation is exemplified by several dozen experimental studies, and prospects for further research are delineated. 1965 Barber, Theodore Xenophon (1965). Physiological effects of 'hypnotic suggestions': A critical review of recent research (1960-64). Psychological Bulletin, 201-222. Recent studies are reviewed which were concerned with the effectiveness of suggestions given under "hypnosis" and "waking" experimental treatments in alleviating allergies, ichthyosis, myopia, and other conditions and in eliciting deafness, blindness, hallucinations, analgesia, cardiac acceleration and deceleration, emotional responses, urine secretion to sham water ingestion, narcotic-like drug effects, and other phenomena. The review indicates that a wide variety of physiological functions can be influenced by suggestions administered under either hypnosis or waking experimental treatments, and direct and indirect suggestions to show the particular physiological manifestations are crucial variables in producing the effects. Bernstein, Norman R. (1965). Observations on the use of hypnosis with burned children on a pediatric ward. International Journal of Clinical and Experimental Hypnosis, 13 (1), 1-10. Several cases are described and observations made about the interplay of forces between staff, patient, and therapist, as well as the expectations of the patients to assess how these factors influenced the use of hypnosis. Hypnosis appears to be a particularly useful means for reaching isolated and depressed children with burns and for improving the morale of the staff team working with these children. The results may be along specific lines in terms of pain tolerance and improved eating, or in general improvement of cooperativeness and mood on the part of the child. (PsycINFO Database Record (c) 2002 APA, all rights reserved) 1964 Attar, A.; Muftic, M. (1964). Narcohypnosis in abdominal surgery. British Journal of Medical Hypnotism, 16 (1), 29-32. Effectiveness of a relaxation technique to increase the comfort level of patients in their first postoperative attempt at getting out of bed was tested on 42 patients, aged 18 to 65, who were hospitalized for elective surgery. Study group patients were taught the relaxing technique; control group patients were not taught the technique. Each group had an equal distribution of cholecystectomy, herniorrhaphy, and hemorrhoidectomy patients. Blood pressure, pulse, and respiratory rates of subjects in both groups were compared prior to surgery and after the postoperative attempt to get out of bed. Subjects' reports of incisional pain and bodily distress were measured via a pain and distress scale after their attempt at getting out of bed. Amount of analgesics used in the first 24 hrs following surgery was examined. Mean differences in report of incisional pain and body distress, analgesic consumption, and respiratory rate changes were statistically significant, supporting the hypothesis that use of a relaxation technique to reduce muscular tension will lead to an increased comfort level of postoperative patients. 1961 Hilgard, Josephine R.; Hilgard, Ernest R.; Newman, Martha (1961). Sequelae to hypnotic induction with special reference to earlier chemical anesthesia. Journal of Nervous and Mental Disease, 133, 461-478. NOTES Although a review of relevant literature turned up little in the way of statistical studies, some case studies were located in which unintended or unexpected results of hypnosis were observed. The authors located 15 cases in which the symptoms that developed subsequent to symptom removal using hypnosis were more disturbing than the original symptom. This type of response occurred in patients with extensive psychiatric history, prior to the hypnosis experience. However, it could not be determined whether the undesired response was due to hypnosis or to the psychotherapy that was provided to these patients. In order to avoid the complications introduced by studying undesired sequelae in psychiatric patients receiving posthypnotic suggestions for therapeutic purposes, this investigation used a sample of non-patient university students (114 male and 106 female) who volunteered for research. Subjects were asked about "aftereffects" in followup interviews. Aftereffects that might be considered sequelae are exemplified by statements such as, "I was 'in a fog' for one hour" and "Things were hazy and vague for four hours." Of the 220 Subjects, 17 (7.7%) reported sequelae, many of them "minor and fleeting." None of the sequelae was of psychotic proportions. Only 2.3% of the sample experienced sequelae that lasted as long as a few hours. Although the relationship of sequelae to hypnotizability was slight, there seemed to be a relationship to having had a difficult experience with chemical anesthesia in early childhood. They present six case studies, three who had difficulty with chemical anesthesia and three for whom the sequelae appeared to relate to a different kind of childhood experience. The investigators concluded that "a routine experience of hypnosis is generally harmless in a student population, but E (or therapist) should be alert for possible aftereffects, and provisions should be at hand for occasional brief psychotherapy, even though the experiments themselves are not oriented toward therapy" (p. 477). The authors present a psychodynamic explanation for the sequelae observed. "It is conjectured that the conflicts within the induction phase of hypnosis that produce either immediate or delayed symptoms are primarily those having to do with the exercise of power and the reaction to authority, hence, conflicts between the conscious willingness to be hypnotized and the unconscious resistance to or fear of the submissive role required. The individual forms that such conflicts take are highly varied. "The conflicts within the established state differ, in that the state is not reached unless the conflicts of the induction are at least temporarily resolved. The new state, which has regressive characteristics, makes S vulnerable to conflicts based on reality distortions (as in suggested hallucinations) or ethical-social issues (as in suggested behavior violating his moral code or superego demands). Sometimes specific suggestions revive early experiences that were traumatic or provocative of fear. "While the language of psychodynamics is appropriate in the discussion of these cases, the many redintegrative factors also suggest that learning theory can have much to say in explanation of them. Because learning theory has ways of dealing with conflict and conflict resolution, it can also encompass some of the problems discussed as conflicts over authority, commonly treated in psychodynamics as transference problems. "The many reflections of earlier childhood experiences in the sequelae, including some of the dreams, suggest the promise of a developmental theory of hypnosis" (p. 477). 1960 Hernandez-Peon, R.; Dittborn, J.; Borlone, M.; Davidovich, A. (1960). Changes of spinal excitability during hypnotically induced anesthesia and hyperesthesia. American Journal of Clinical Hypnosis, 3, 64. (From 21st International Congress of Physiology, Buenos Aires, 1959, pg. 124, Abstracts) Although hypnosis is well established, the physiological mechanisms of the hypnotic state and their related sensory phenomena are far from clear. Hernandez-Peon and Donoso have found that the magnitude of photic evoked potentials in the optic radiations of awake human subjects changed in response to previous verbal suggestions concerning the intensity of the expected photic stimulus. This striking observation led the cited authors to propose that certain hypnotic sensory phenomena might be explained, at least partially, by changes occurring as far down as second-order sensory neurons by centrifugal mechanisms controlling the sensory input to the brain. In the intact subject it is impossible to record uncontaminated electrical indexes of afferent impulses from those lower sensory neurons. However, it is possible to gain indirect evidence of tactile sensory inflow to the spinal cord by recording cutaneous reflexes. In young males, a forearm skin reflex evoked by a single square pulse of 0-.1 msec. duration was recorded with cathode- ray oscilloscope. The amplitude of the evoked potentials was often reduced during the hypnotic state, and it was further reduced by verbally suggesting to the hypnotized subject complete anesthesia of the forearm. Reciprocally, during hypnotically suggested hyperesthesia the cutaneous reflex was enhanced. It is concluded that during hypnotic anesthesia and hyperesthesia excitability changes occur at the spinal level, and it is suggested that these changes probably involve the spinal internuncial system interposed between the dorsal root ganglion cells and the motoneurons. (From Abstracts, 21st Internat. Cong. Physiol., Buenos Aires, 1959, p. 124.) Barber, Theodore Xenophon; Coules, John (1959). Electrical skin conductance and galvanic skin response during 'Hypnosis'. International Journal of Clinical and Experimental Hypnosis, 7 (2), 79-92. ABSTRACT: No Abstract available NOTES 1: "Summary and Conclusions "Six 'good' hypnotic Ss were given a ten-minute 'hypnotic induction' and a series of 'hypnotic tests.' Both basic skin conductance and momentary variations in skin conductance (GSR) were recorded during the experiment. "The results were as follows: 1. There was no significant variation in skin conductance during the 'hypnotic induction procedure.' 2. Skin conductance generally increased throughout the remainder of the experiment, ie., when the Ss wre given suggestions of 'sensory hallucinations,' 'age-regression,' 'analgesia,' 'negative hallucinations,' and 'post'-hypnotic behavior. 3. The Ss usually showed a GSR when they were given 'hallucinatory' suggestions, i.e., when they were told that they were becoming 'itchy,' 'thirsty,' and 'very hot.' 4. The GSR to a pinprick was essentially the same before the experiment and during 'hypnotic analgesia.' Also, the GSR was essentially the same, during 'hypnotic analgesia,' (a) when three Ss were told they would receive a pinprick but did _not_ receive the pinprick, (b) when they were told they would receive a pinprick and _did_ receive the pinprick, and (c) when they received a pinprick without being told they would receive it. 5. Four Ss showed a GSR each time they were asked to look at a 'negatively hallucinated' object and person. Two Ss did _not_ show a GSR when they were asked to look at the 'negatively hallucinated' object (or person). The four Ss who showed a GSR stated, during or after the experiment, that they were by no means convinced that the person or object was no longer in the room. The two Ss who did not show GSR stated, after the experiment, that they had been 'certain' that the object (or person) was not present in the room. 6. Although the Ss stated that they did not 'remember' the 'post'-hypnotic suggestion (or anything else about the experiment), they usually showed a GSR when the E made the _preliminary_ movements to give the signal for the 'post'-hypnotic behavior. (They also showed a GSR when E gave the signal for the 'post'hypnotic behavior.) "Since skin conductance is an index of the S's level of 'activation,' 'arousal,' or 'excitation,' these results indicate the following: 1. Ss do not necessarily become more 'passive' or 'relaxed' during the 'hypnotic induction procedure.' 2. Ss often become more and more 'excited' and 'aroused' when they are given a series of 'active' suggestions such as 'sensory hallucinations,' 'age-regression,' etc. 3. Ss often show momentary 'excitement' when they are 'hallucinating.' 4. A pinprick can 'arouse' a S to the same extent during 'hypnotic analgesia' as it can during 'normal waking.' In addition, 'hypnotic analgesic' Ss are often just as much 'aroused' by the threat of a pinprick as they are by an actual pinprick. 5. Many Ss become momentarily 'excited' when they are asked to look directly at an object (or person) which they have been told they will not be able to see. However, _some_ Ss do _not_ show this momentary 'excitement.' 6. Although Ss may state that they do not 'remember' the 'post'-hypnotic suggestion, they often become momentarily 'excited' when the E makes _preliminary_ motions to give the signal for the 'post'-hypnotic act" (pp. 90-92). 1955 Ament, Phillip (1955). A psychosomatic approach to the use of anesthesia for a hysterical dental patient: A case history. Journal of Clinical and Experimental Hypnosis, 3, 120-123. (Abstracted in Psychological Abstracts 56: 1280) NOTES 1: Author describes a case highly resistant both to anesthesia and dentistry. Although very responsive to hypnosis, she continued moaning and moving from side to side (later determined to be her way of preventing dental work even though anesthetized). Ultimately a combination of hypnosis and multiple anesthetics was needed, including nembutal, sodium pentothal, nitrous oxide and novocain. In the author's experience, most other patients require only hypnosis or hypnosis plus novocaine. ANIMAL MAGNETISM/MESMERISM 2001 Gravitz, M.A. (2001, August). The historical role of hypnosis in the theoretical conceptualization of transference. [Paper] Presented at the Annual Meeting of the American Psychological Association, San Francisco. Long before Freud incorporated rapport and transference into his psychoanalytic theories, Mesmer and a number of his followers had recognized the significance of relationship factors in animal magnetism. While the mesmerists generally held that animal magnetism was transmitted as a physical force (i.e., fluidum) from one person to the other, later dynamic therapists emphasized the importance of psychological factors. This paper documents the contributions over several centuries of these early theoreticians, leading eventually to the work of Freud, Janet, Erickson, and others. 1997 Chaves, John F. (1997). The state of the state debate in hypnosis: A view from the cognitive-behavioral perspective. International Journal of Clinical and Experimental Hypnosis, 45 (3), 251-265. For most of the past 50 years, hypnosis research has been driven by a debate about whether hypnotic phenomena can be best described and understood as the product of an altered state of consciousness. The meanings of some of the pivotal concepts in this debate and the nature of the phenomena that gave rise to them were ambiguous at the outset and led to misconceptions and surplus meanings that have obscured the debate through most of its history. The nature of the posited hypnotic state and its assumed consequences have changed during this period, reflecting the abandonment of untenable versions of hypnotic state theory. Carefully conducted studies in laboratories around the world have refined our understanding of hypnotic phenomena and helped identify the critical variables that interact to elicit them. With the maturation of the cognitive-behavioral perspective and the growing refinement of state conceptions of hypnosis, questions arise whether the state debate is still the axis about which hypnosis research and theory pivots. Although heuristic value of this debate has been enormous, we must guard against the cognitive constraints of our own metaphors and conceptual frameworks. - Journal Abstract 1988 Gibson, H. B. (1988). Discussion commentary: Gauld's (1988) Reflections on Mesmeric analgesia. [Comment/Discussion] . NOTES 1: Author notes that mesmerism is not hypnotism because induction techniques are different and psychological and physiological results are different. Esdaile used mesmerism, not hypnotic suggestion. "If the essential differences between mesmerism and hypnotism were to be generally recognized and acknowledged, a lot of modern writing would be outmoded, hence recognition will be tardy and reluctant, but I think it will come" (p. 25). However, research on mesmerism would be difficult because "it seems likely that successful mesmerism may require not only very lengthy manipulations but subjects in a very real state of heightened emotion or acute fear, such as obtained before surgery in the last century, or was artifically (sic) engendered in the salons of the early mesmerists. It has certainly been demonstrated that the nearest thing to a mesmeric trance that we are likely to witness, the states of tonic immobility that can be produced in animals, are potentiated by stimuli that arouse fear (Gallup et al., 1970)" (p. 27). 1979 Spanos, Nicholas P.; Gottlieb, Jack (1979). Demonic possession, Mesmerism, and hysteria: A social psychological perspective on their historical interrelations. Journal of Abnormal Psychology, 88 (5), 527-546.