Provides a social psychological interpretation of the interrelations among demonic possession, mesmerism, and hysteria. It is argued that the reciprocal role relationship of mesmerist and magnetized S in the 18th and 19th centuries involved the secularization of the role relation that had existed between exorcist and demonically possessed. The commonalities between these 2 sets of social roles are delineated, some of the variables leading an individual to learn and enact the posessed role are outlined, and several lines of historical evidence pertaining to the influence of the exorcist-demoniac relationship on the mesmeric relationship are outlined. The influence of the possessed role in shaping the role of the hysterical patient is also discussed. The use of hysteria as a modern explanatory concept in histories of possession and mesmerism, however, is criticized. (198 ref).

Schneck, Jerome M. (1978). Benjamin Rush and animal magnetism, 1789 and 1812. International Journal of Clinical and Experimental Hypnosis, 26, 9-14.

Little information is available about animal magnetism in the United States during the late eighteenth and early nineteenth centuries. An early assessment of animal magnetism in the United States was provided by Benjamin Rush in 1789 and 1812. Unlike Benjamin Franklin and his colleagues on the 1784 French commission who recognized the role of imagination yet without its potential benefits, Rush discerned the value of both suggestion and imagination in their constructive potential and incorporated them into his medical practice while rejecting Mesmer’s theories and techniques. This is of additional interest because of Rush’s fame as an early American physician and his position as the father of American psychiatry.


Ashton C Jr. Whitworth GC. Seldomridge JA. Shapiro PA. Weinberg AD.Michler RE. Smith CR. Rose EA. Fisher S. Oz MC. Self-hypnosis reduces anxiety following coronary artery bypass surgery. A prospective, randomized trial. Journal of Cardiovascular Surgery 1997;38(1):69-75 OBJECTIVE: The role of complementary medicine techniques has generated increasing interest in today’s society. The purpose of our study was to evaluate the effects of one technique, self-hypnosis, and its role in coronary artery bypass surgery. We hypotesize that self-hypnosis relaxation techniques will have a positive effect on the patient’s mental and physical condition following coronary artery bypass surgery.

EXPERIMENTAL DESIGN: A prospective, randomized trial was conducted. Patients were followed beginning one day prior to surgery until the time of discharge from the hospital. SETTING: The study was conducted at Columbia Presbyterian Medical Center, a large tertiary care teaching institution. PATIENTS: All patients undergoing first-time elective coronary artery bypass surgery were eligible. A total of 32 patients were randomized into two groups. INTERVENTIONS: The study group was taught self-hypnosis relaxation techniques preoperatively, with no therapy in the control group. MEASURES: Outcome variables studied included anesthetic requirements, operative parameters, postoperative pain medication requirements, quality of life, hospital stay, major morbidity and mortality. RESULTS: Patients who were taught self-hypnosis relaxation techniques were significantly more relaxed postoperatively compared to the control group (p=0.032). Pain medication requirements were also significantly less in patients practising the self-hypnosis relaxation techniques that those who were noncompliant (p=0.046). No differences were noted in intraoperative parameters, morbidity or mortality. CONCLUSION: This study demonstrates the beneficial effects self-hypnosis relaxation techniques on patients undergoing coronary artery bypass surgery. It also provides a framework to study complementary techniques and the limitations encountered.

Benson H. Frankel FH. Apfel R. Daniels MD. Schniewind HE. Nemiah JC. Sifneos PE. Crassweller KD. Greenwood MM. Kotch JB. Arns PA. Rosner B. Treatment of anxiety: a comparison of the usefulness of self-hypnosis and a meditational relaxation technique. An overview. Psychotherapy & Psychosomatics. 1978;30(3-4):229-42 We have investigated prospectively the efficacy of two nonpharmacologic relaxation techniques in the therapy of anxiety. A simple, meditational relaxation technique (MT) that elicits the changes of decreased sympathetic nervous system activity was compared to a self- hypnosis technique (HT) in which relaxation, with or without altered perceptions, was suggested. 32 patients with anxiety neurosis were divided into 2 groups on the basis of their responsively to hypnosis: moderate-high and low responsively. The MT or HT was then randomly assigned separately to each member of the two responsively groups. Thus, 4 treatment groups were studied: moderate-high responsively MT; low responsively MT; moderate-high responsively HT; and low responsively HT. The low responsively HT group, by definition largely incapable of achieving the altered perceptions essential to hypnosis, was designed as the control group. Patients were instructed to practice the assigned technique daily for 8 weeks. Change in anxiety was determined by three types of evaluation: psychiatric assessment; physiologic testing; and self-assessment. There was essentially no difference between the two techniques in therapeutic efficacy according to these evaluations. Psychiatric assessment revealed overall improvement in 34% of the patients and the self-rating assessment indicated improvement in 63% of the population. Patients who had moderate-high hypnotic responsivity, independent of the technique used, significantly improved on psychiatric assessment (p = 0.05) and decreased average systolic blood pressure from 126.1 to 122.5 mm Hg over the 8-week period (p = 0.048). The responsivity scores at the higher end of the hypnotic responsivity spectrum were proportionately correlated to greater decreases in systolic blood pressure (p = 0.075) and to improvement by psychiatric assessment (p = 0.003). There was, however, no consistent relation between hypnotic responsivity and the other assessments made, such as diastolic blood pressure, oxygen consumption, heart rate and the self-rating questionnaires. The meditational and self-hypnosis techniques employed in this investigation are simple to use and effective in the therapy of anxiety.

Boutin GE. Tosi DJ. Modification of irrational ideas and test anxiety through rational stage directed hypnotherapy RSDH. Journal of Clinical Psychology 1983;39(3):382-91 Examined the effects of four treatment conditions on the modification of Irrational Ideas and test anxiety in female nursing students. The treatments were Rational Stage Directed Hypnotherapy, a cognitive behavioral approach that utilized hypnosis and vivid-emotive-imagery, a hypnosis-only treatment, a placebo condition, and a no-treatment control. The 48 Ss were assigned randomly to one of these treatment groups, which met for 1 hour per week for 6 consecutive weeks with in-vivo homework assignments also utilized. Statistically significant treatment effects on cognitive, affective, behavioral, and physiological measures were noted for both the RSDH and hypnosis group at the posttest and at a 2-month follow-up. Post-hoc analyses revealed the RSDH treatment group to be significantly more effective than the hypnosis only group on both the post- and follow-up tests. The placebo and control groups showed no significant effects either at post-treatment or at follow-up.

Goldmann L. Ogg TW. Levey AB. Hypnosis and daycase anaesthesia. A study to reduce pre-operative anxiety and intra-operative anaesthetic requirements. Anaesthesia 1988;43(6):466-9 Fifty-two female patients who underwent gynaecological operations as day cases received either a short pre-operative hypnotic induction or a brief discussion of equal duration. Hypnotized patients who underwent vaginal termination of pregnancy required significantly less methohexitone for induction of anaesthesia. They were also significantly more relaxed as judged by their visual analogue scores for anxiety. Less than half of the patients were satisfied with their knowledge about the operative procedure even after discussions with the surgeon and anaesthetist. A significant correlation was found between anxiety and perceived knowledge of procedures. The results suggest that pre-operative hypnosis can provide a quick and effective way to reduce pre-operative patient anxiety and anaesthetic requirements for gynaecological daycase surgery.

Hurley JD. Differential effects of hypnosis, biofeedback training, and trophotropic responses on anxiety, ego strength, and locus of control. Journal of Clinical Psychology 1980;36(2):503-7 Pretested 60 college students on three scales: The IPAT Anxiety Scale, the Barron Ego-strength scale, and the Rotter I-E scale. The Ss then were assigned randomly to one of four treatment groups designated: Hypnotic treatment, biofeedback treatment, trophotropic treatment, and control. Three of these groups met separetely for 60 minutes once a week for 8 weeks. The control group did not meet during this time. During the sessions, each group was trained in a different technique for self-regulation. At the end of the 8-week period the scales were readministered to all groups. A series of covariance analyses indicated that hypnosis was a more effective self-regulatory technique for lowering anxiety levels when compared to biofeedback or trophotropic response procedures. With regard to increasing ego strength, both the hypnotic training group and the biofeedback training group proved to be significant. No significant difference was found between the experimental and control gorups on the I-E scores.


Katcher A. Segal H. Beck A. Comparison of contemplation and hypnosis for the reduction of anxiety and discomfort during dental surgery. American Journal of Clinical Hypnosis 1984;27(1):14-21 Used complex moving visual stimuli to induce states of relaxation, hypnosis, and revery in 42 dental patients (aged 21-60 yrs). To test the efficacy of using aquarium contemplation to induce relaxation, Subjects were randomly assigned to 1 of 5 treatments prior to elective oral surgery: contemplation of an aquarium, contemplation of a poster, poster contemplation with hypnotic induction, aquarium contemplation with hypnosis, and a nonintervention control. Subjects were administered 5 tests of susceptibility adapted from the Stanford Hypnotic Susceptibility Scale; blood pressure, heart rate, and subjective and objective measures of anxiety were also taken. It was found that pretreatment with aquarium contemplation and hypnosis, either alone or in combination, produced significantly greater degrees of relaxation during surgery than poster contemplation or the control procedure. Two-way ANOVA demonstrated that a formal hypnotic induction did not augment the relaxation produced by aquarium contemplation. Findings suggest that aquarium contemplation can alter patients’ subjective experiences and overt behavior during oral surgery. Other clinical applications of the contemplation procedure are discussed.

Melnick J. Russell RW. Hypnosis versus systematic desensitization in the treatment of test anxiety. Journal of Counseling Psychology 1976;23(4):291-295. Assessed the comparative effectiveness of systematic desensitization (SD) and the directed experience hypnotic technique (HT) in reducing self-reported test anxiety and increasing the academic performance of 36 test-anxious undergraduates. Subjects were assigned randomly to either the HT or SD conditions or to 1 of 2 control groups. All Subjects had previously scored above the 50th percentile on Sarason’s Test Anxiety Questionnaire (TAQ) and below the 85th percentile on a midterm exam. Results indicate that only the SD treatment significantly reduced TAQ scores. No significant improvement in academic performance was observed for either treatment. An additional analysis of high- vs moderate-anxious subgroups failed to show differential treatment effects on either dependent measure.
Podolnick EE. Field PB. Emotional involvement, oral anxiety, and hypnosis. International Journal of Clinical & Experimental Hypnosis 1970;18(3):194-210. 48 undergraduates were randomly assigned to either a high or low emotional arousal manipulation and then underwent a tape-recorded hypnotic induction and test of depth. The high-arousal group was exposed to infantile oral objects and were led to believe that they would have to suck on them as part of a physiological psychology experiment in which the cutaneous sensitivity of the human mouth was being mapped. The low-arousal group believed they only had to blow on whistles or pipes. While both groups were anticipating these experiences, hypnosis was induced. Subjects in the high-arousal group were significantly more hypnotizable (p < .001) than their counterparts in the low-arousal group. Subjects in the high-arousal group were significantly less anxious after hypnosis than they were before hypnosis, while the low-arousal Subjects did not show a reduction in anxiety. The groups did not differ on several background personality tests given as checks on the randomization. (Spanish & German summaries) 1993 Rankin EJ. Gilner FH. Gfeller JD. Katz BM. Efficacy of progressive muscle relaxation for reducing state anxiety among elderly adults on memory tasks. Perceptual & Motor Skills 1993;77(3 Pt 2):1395-402 Cognitively intact anxious elderly subjects were randomly assigned to either a progressive muscle relaxation-training condition or control condition (ns = 15) and then completed selected subtests from the Wechsler Memory Scale--Revised. Despite significant reductions in state anxiety in the relaxation group, no significant differences were detected between the two groups on memory measures. These results are discussed within the context of previous research, and suggestions for further research are made 1994 Amigo, Salvador (1994, August). New approach to self-regulation therapy--treatment strategies. [Paper] Presented at the annual meeting of the American Psychological Association, Los Angeles. NOTES Training programs demonstrate that hypnotizability can be improved. Use individualized treatment programs. Cognitive behavioral treatment can be improved by hypnotic suggestions. Emphasis is on alertness and relaxation, not sleepiness; on conversation with the clinician rather than just listening. Emotional self regulation is the procedure studied most. They used three phases: Phase 1: Sensory recall exercises (smell, taste, heaviness provoked by lifting a book). Phase 2: Reproduce sensations (hand stiffness, smell) without therapist stimulus. Phase 3: Generalization. Any demand generates the suggested effects. (Tell Subject his brain is very activated, that he can respond without training. Give therapeutic suggestions.) Case of nicotine addiction presented. Brown, Gail W.; Riddell, Rodney; Summers, David; Coffman, Brent (1994, August). Use of hypnosis by practitioners in the school setting. [Paper] Presented at the annual meeting of the American Psychological Association, Los Angeles. NOTES Hypnosis is a therapeutic procedure that is appropriate for some school-age clients. Through the use of hypnosis that utilizes metaphors and imagery, children can be empowered to find unique solutions to their problems. Children enjoy the feeling of power and mastery that they have when able to perform hypnotic phenomena. They like to play magic and can be told that a finger or other body part will become numb. Because a major goal of hypnotherapy is to teach a child to be an active participant in his or her own behalf, the focus is on creating solutions and mastering the situation rather than enduring the problems. Four case studies demonstrate the utility of hypnosis in the treatment of phantom pain and nausea, sleep terror disorder, school phobia, and spider phobia. In each case, treatment goals were realized. Because the solutions were self- generated, the behavioral changes maintained over time and situation. Case #1: Hypnosis was used to help alleviate phantom limb pain and nausea during chemotherapy following amputation of the right leg at the knee due to cancer in a thirteen- year-old male. The client had indicated that he loved nature and enjoyed the mountains. The metaphor described a young tree that has just begun to grow small silvery leaves. The spring floods tear the limbs and branches from the stump. The deep roots and stump of the tree are all that remain. The tree is not the same as before the flood. Its roots are stronger, its base more sturdy compared to the branches and limbs. The young tree has withstood the catastrophe of the torrent of waters and is even stronger than before. To counter the nausea and vomiting associated with chemotherapy a switch mechanism metaphor was used. The client was adroit with computers and had no difficulty picturing a switch located in his brain which could "turn off" the nausea from chemotherapy. A room contained all the unpleasant feelings that were being experienced. In this room is a light of a particular color that represents all the unpleasant sensations. Press the key on the computer that controls the switch to turn off the colored light in that room. Suggestions for healing were also given. Your body has known for years how to heal. Visualize the battle between good and bad cells and the victory of the good cells. Case #2: Hypnosis was used to alleviate sleep terror disorder in a ten-year-old female. The onset of the subject's parasomnic symptomatology appeared to coincide with her starting kindergarten and her family's relocation shortly before. The initial treatment consisted of progressive relaxation, deep breathing, and the visual image of her "secret safe place." An induction utilizing a variety of images was presented. Hiking barefoot on a cool moss covered mountain trial, sitting in a an alpine meadow on a warm summer afternoon, and flying proved most effective in facilitating trance. The participant was told to "Visualize all your anxiety and tension as hard grey rocks. Pick up these rocks and place them in your pockets. Go to the front porch of your "secret safe place and on the porch is a "magic hefty bag." Place your hard grey rocks that contain all your anxiety and tension in the magic bag. Once in the bag, the rocks will no longer weight you down, you will be free of any feelings of stress or tension. Your bed is magic; it is covered with a special glue which will keep you in a reclining position until you are fully rested and ready to awaken." Case #3: Hypnosis was used in the treatment of school phobia in a nine-year-old male. The student experienced intense anxiety whenever separation from the primary caretaker occurred. The teacher stated that this boy experienced frequent absences and crying spells that were only relieved by phone calls to his mother or the presence of his mother next to him in class. In preparation for the intervention, the student was asked to draw a picture of how he felt inside during a panic attack. He drew a fire. He also said that only his mother could put that fire out. This information was utilized in creating a metaphor that described a house in a small town. "The mother had left, and a young boy was left alone. While at home, the boy looked out the window and saw several boys trying to burn a neighbor's yard! Acting quickly, he called the fire department, grabbed the fire extinguisher and unraveled the garden hose. He was able to extinguish the fire. The neighbors and friends were very happy and praised the boy's performance. When his mother heard the good news, she quickly returned home and held a celebration in his honor." Following the metaphor, hypnotherapy continued with suggestions about fire extinguishers that the subject could use to put out emotional fires. Case #4: Hypnosis was used in the treatment of spider phobia. Diagnosis of phobia was made in this eleven-year-old female when the fear or avoidance behavior was distressing. The child's strained facial expressions occurred even at the thought of seeing what she described as "a creepy, crawly creature with 8 legs." Preparatory to her first induction the participant was read the story of Charlotte's Web (White, 1980) to facilitate the imagery for future hypnotic work. In the following session systematic desensitization was accomplished using characters from the story of Charlotte's Web. During the third session the subject was age regressed to the first time she remembered seeing a spider. She recalled playing in the woods outside her family home on an island and seeing a large web stretched between two trees with a very large spider in the center of its web. She was then asked to remain at that place to look closely at that spider as it was most likely Charlotte or one of Charlotte's family. Upon closer investigation she saw not only Charlotte but "teeny-tiny babies." The event was reconstructed as a happy experience. The imagery provided by Charlotte's Web permitted the subject to fantasize her previous frightful experience and reframe spiders as cute little "teeny-tiny" babies with admirable human qualities. 1993 Morgan, William P. (1993, October). Use of hypnosis in exercise and sport psychology. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL. NOTES: Performance of exercise is rated as equal effort with hypnosis and waking conditions; but with hypnotic suggestion they will perceive it as more or less effortful (uphill exercise vs going down the hill). When they think they are going up hill both cardiac and respiratory response increase physiologically, with catecholamine differences. Mitchell (1981) suggests that respiration changes with exercise do not result from muscle feedback, but that central motor brain signals go to both the cardiovascular centers and to exercising muscle. Actually, it appears that both muscle and cortex give signals, and their synergy governs whether ventilation or heart rate increase. Wang & Morgan, Psychophysiological responses to imagined exercise, Sport Psychology Lab, University of Wisconsin-Madison. Reported that both external (watching someone else) and internal (imagining oneself) visualizing give responses similar to actual exercise. We have done research on the prediction of respiratory distress (dyspnea) - work we have done with fire fighters. The best predictor of this on treadmill with air supply is trait anxiety. Sometimes the firefighters who took off face mask even though they had air did not know why they did. It is an opportunity to use hypnotic age regression. SCUBA divers described in Lynn & Rhue also were age regressed to obtain information that was repressed. They have demonstrated stress responses like panic in a 12 foot tank also. For active people and athletes there is an "iceberg" profile on the POMS, below average on tension, depression, anger, fatigue, and confusion, but higher on vigor. But the divers who panic have a flat profile, around the 50th percentile on all POMS scales. Middleman et al used Navy divers in 25 degree C. water and used hypnosis to increase and decrease their body temperature--one of the best papers on the topic. Ss who were best able to use imagery, to think of a beach, had the poorest responses; the ones who could relax did poorest, because shivering produces heat and keeps you warm. It is opposite of what is needed. In our work, we took 5 highest and 5 lowest anxiety Ss; the latter had higher rates of respiration than the former. All Ss are similar in oxygen use whether volunteers or not. When people volunteer for research before they know hypnosis will be used, the males are lower than females [on hypnotizability?] when they finally volunteer. [He presents a lot of different tests on which volunteers do not differ from nonvolunteers personality wise.] Ikai & Steinhaus is a classic study of Disinhibition of Inhibitory Mechanisms. Taking Ss up to their maximum (in weight training) to a plateau, Ikai & Steinhaus said this is a pseudomaximum. They showed that strength increases if - you fire a starter pistol behind them - you ask them to shout just as they do it - they have alcohol - they have amphetamine sulfate - they have hypnosis It is disinhibition of the inhibitory mechanisms. [He referred to the book Mind of the Marathoner.] In Tibet an anthropologist was amazed to see a man running into their camp, and he ran straight through--a monk carrying messages. He created a non-cultic form of meditation in the laboratory (trained to visually "fix" on mountaintop, to have respiration in synchrony with locomotion, and to use a pseudo mantra "down" each time they put their foot down). Placebo condition was used also. Ss were tested by blinded lab assistants. Endurance time increased from 16 minutes to 20, while controls decreased a minute. Now we can predict who will win a race. Elite runners do not dissociate; they use association strategy. They pay close attention to race strategy, they monitor themselves constantly (they slow down when they feel bad), and attempt informally to stay loose, not get tight, and relax. Dissociation has, however, been used for the last 300 meters of a marathon (New Zealander Dixon). 1992 Bindler, Paul (1992, October). Hypnosis and Psychotherapy: The clinical utility of altered states of consciousness. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA. NOTES Author assesses state, especially attentional changes, with Multidimensional Consciousness Scale (receptivity, arousal, .... etc.) Clinical management of anxiety is goal. Cites Nash as characterizing anxiety disorders with cognitive/affective characteristics similar to hypnotized state. Wickramasekera's model has people high in neuroticism and high in hypnotizable being hypersensitive to stress, with physiological hyperarousal. Lows have alexithymia, may be unresponsive to symbolic events but very responsive to concrete events; poor verbalization of alexithymics leads to somatization. Author focuses on relaxation and anxiety reduction. Suggests that Crawford's attention model (highs better able to shift cognitive and attentional strategies) is useful. Instructions facilitate focusing attention inward so external stimuli become irrelevant. Therapist helps patient focus attention on the link between cognitions and tension. Garssen, Bert; de Ruiter, Corine; Van Dyck, Richard (1992). Breathing retraining: A rational placebo?. Clinical Psychology Review, 12, 141-153 Breathing retraining of patients with Hyperventilation Syndrome (HVS) and/or panic disorder is discussed to evaluate its clinical effectiveness and to examine the mechanism that mediates its effect. In relation to this theoretical question, the validity of HVS as a scientific model is discussed an is deemed insufficient. It is concluded that breathing retraining and related procedures are therapeutically effective, but probably due to principles other than originally proposed, namely decreasing the tendency to hyperventilate. An alternative principle is the induction of a relaxation response, presenting a credible explanation for the threatening symptoms, giving a distracting task to practice when panic may occur, and promoting a feeling of control. NOTES: Goal of treatment is to (1) reduce respiratory rate, and (2) cognitive reattribution of physical symptoms to hyperventilation instead of other more catastrophic causes. Reviews a number of studies, mostly small sample, including panic disorder studies, and concludes that the majority point to a therapeutic effect of breathing retraining and cognitive reattribution of physical symptoms to hyperventilation for patients suffering HVS and the closely related panic disorder with or without agoraphobia. However, the _specificity_ of these techniques for HVS is questionable. Vlaander-van der Giessen (1986) found relaxation training just as effective as breathing retraining; and Hibbert & Chan (1989) found breathing retraining equally effective as a placebo treatment, and not more effective with patients who had recognized symptoms at a hyperventilation provocation test than with those who had not. Levitan, Alexander A. (1992). The use of hypnosis with cancer patients. Psychiatric Medicine, 10, 119-131. Hypnosis has proven to be extremely valuable in the treatment of cancer patients. Specific applications include: establishing rapport between the patient and members of the medical health team; control of pain with self-regulation of pain perception through the use of glove anesthesia, time distortion, amnesia, transference of pain to a different body part, or dissociation of the painful part form the rest of the body; controlling symptoms, such as, nausea, anticipatory emesis, learned food aversions, etc.; psychotherapy for anxiety, depression, guilt, anger, hostility, frustration, isolation, and a diminished sense of self-esteem; visualization for health improvement; and, dealing with death anxiety and other related issues. Hypnosis has unique advantages for patients including improvement of self-esteem, involvement in self-care, return of locus of control, lack of unpleasant side effects, and continued efficacy despite continued use. Morse, Donald R.; Martin, John; Moshonov, Joshua (1992). Stress induced sudden cardiac death: Can it be prevented?. Stress Medicine, 8, 35-46. Previously, psychosomatically induced death relative to stress, hypnosis, mind control, and voodoo was discussed. In this article, emphasis is on one aspect of that - stress induced sudden cardiac death (SCD). A brief review is presented of the sympathetic aspects of the acute stress response and stress induced SCD. Findings from previous studies are presented to highlight sympathetic aspects of the acute stress response. This is followed by a presentation of various strategies to prevent of decrease the possibilities for stress induced SCD. These include long-term measures (e.g. diet control, smoking control, hypertension control, stress management strategies) and immediate measures (e.g. calm, controlled approach, elicitation of the relaxation response, selected use of drugs, and heart rate variability monitoring). Relative to prevention strategies, findings are presented both from previous studies and new investigations. 1991 Bodden, Jack L. (1991). Accessing state-bound memories in the treatment of phobias: Two case studies. American Journal of Clinical Hypnosis, 34, 24-28. Two cases of simple phobia demonstrate the inadequacies of both behavioral and psychodynamic theories. These cases and their treatment outcomes provide support for the state-dependent memory and learning theory. Hypnosis and ideomotor signaling proved to be not only effective treatments but also useful means of illuminating the role and nature of symptom function. Issues of symptom removal and substitution are also discussed in relation to these cases NOTES: The authors state that Rossi and Cheek (1988) summarize a number of experimental studies on animal memory that demonstrate that different information substances are involved in different learning situations. For example, ACTH and cortisol are involved in avoidance learning while angiotensin is involved in operant conditioning. In hypnosis, state dependent memory seems to be implicated. "Hilgard (1977) interpreted the state-dependent memory studies by Overton and others as entirely consistent with and supportive of his theory of hypnosis. Milton Erickson (1948) has also strongly suggested that it is the altered levels of arousal and affect that are responsible for the encoding and recall of stress-related problems with hypnosis" (p. 26). "Affective experiences are apparently stored independently from their intellectual counterparts, or the emotional unit form one set may attach itself to a constellation of cues that make up a totally different cognitive set. Hypnosis may facilitate recall by providing relevant cues during an altered state of consciousness" (p. 27). "In commenting upon [one of Erickson's cases], Rossi (1986) states that Erickson was effective because he helped the patient access state-bound memories by reviewing the context and sensory-perceptual cues that surrounded their original acquisition" (p. 27). "When traditional behavior therapy fails it may be because the original fear stimulus is state bound or unconscious. What is conscious to the patient are those stimuli that are similar in some important respect to the original phobic stimulus and are acquired by stimulus generalization. Desensitization may reduce the patient's reactivity to the associated or acquired stimuli but cannot desensitize the original stimulus until it can be accessed consciously" (p. 27). "The two main psychological explanations of phobic behavior are psychodynamic and behavioral. The psychodynamic approach is built upon the early writings of Freud (1956) on the traumatic basis of neurosis. Freud speculated that the intense anxiety (psychic pain) associated with the emotional trauma lead to dissociation, repression, and amnesia. Symptoms represented a dissociated or symbolic vestige of the repressed ('forgotten') trauma. "Behavioral explanations (e.g., Rimm & Masters, 1974) are built upon classical and operant conditioning models of learning. Classical conditioning explains how a neutral stimulus (e.g., a bridge) can acquire reactivity and elicit a fear response. Avoidant behavior, which preserves the phobia, is acquired and maintained by operant conditioning. Treatment apparently involves gradual extinction of the fear response. "These two divergent explanations have spawned quite different therapeutic approaches, with the behavioral approach (systematic desensitization) demonstrating greater empirical support for its effectiveness (Kaplan & Sadock, 1986). The problem is made complex theoretically by the fact that desensitization doesn't always work, even when applied in a competent fashion" (p. 25). "Freud's early work on the traumatic basis of neurosis pointed to but offered an incorrect explanation of phobias whose origins were unconscious or state bound (i.e., not available to recall during the normal conscious state)" (p. 25). Cochrane, Gordon J. (1991). Client-therapist collaboration in the preparation of hypnosis interventions: Case illustrations. American Journal of Clinical Hypnosis, 33, 254-262. Therapists can use hypnosis in a variety of situations to help clients utilize their own resources effectively. In both heterohypnosis and tape-assisted self-hypnosis, the respectful collaboration of therapist and client in the development of specific intervention strategies can be effective. I have described four cases to illustrate the collaborative aspect of heterohypnosis in a surgical setting and tape-assisted self-hypnosis for anxiety, tinnitus, and situational depression. In each case the clients were willing and able participants. NOTES: "Hypnotic interventions as adjunctive therapeutic modalities for a variety of surgical procedures have been well documented (Frankel, 1987; Gravitz, 1988; Nathan, Morris, Goebel, & Blass, 1987). The availability, relative safety, dependability, and ease of use have made chemical agents the anesthetic of choice in the majority of surgical situations, but hypnosis, either alone or in conjunction with chemical agents, can have a number of advantages for some patients (Udolf, 1987, p. 248). Some patients who have extreme preoperative pain and anxiety can learn to use self-hypnosis (Frankel, 1987); others may use hypnosis when experiencing postoperative nausea and other uncomfortable side effects of chemical anesthetics. Some may fear death under general anesthesia or react to a previous trauma arising from general anesthesia and the operating room procedures in general (Udolf, 1987, p. 250) and therefore choose hypnotic strategies. In the following case illustration the patient feared general anesthesia because of a previous negative postoperative experience" (p. 255). While collaboratively planned hypnosis often empowers the patient, contributing to a sense of personal control and well being, some patients are not able to participate in that manner. Cochrane cites patients who are severely depressed or "who struggle with narcissism and other severe pathologies" (p. 260). He notes that audiotapes are useful for supplementing in-session therapy, contributing to skill development, attitude change, and a sense of self-worth. He cites Eisen and Fromm (1983) as indicating that self hypnosis is also useful for clients "who struggle with issues of control and intimacy" (p. 260). Mauer, D. R. (1991, October). A comparison of cognitive-behavioral and hypnotic techniques in the management of electromyography pain (Dissertation, University of Iowa). Dissertation Abstracts International, 53 (4), 1070-B. (Order No. DA 9217180) "Compared a cognitive behavioral technique that included providing specific sensory and procedural information combined with relaxation with a hypnotic technique (relaxation with guided imagery) and a control group for management of acute EMG pain and anxiety. Pain and anxiety ratings were gathered from 45 EMG patients and observers for both nerve conduction and needle electrode components of the EMG exam. It was found that only the hypnosis group significantly reduced pain and anxiety during the needle electrode portion of the procedure. Patients with unexplained or functional symptoms reported more EMG pain and anxiety than patients who had an organically based disease. Because having had a prior EMG seemed to have an effect on the efficacy of treatment, the data were reexamined. Results determined that inexperienced EMG patients who were treated had less pain and anxiety than patients who experienced EMG before, but inexperienced control patients had an increase in pain and anxiety over experienced patients" (p. 1070). 1990-1991 Avants, S. Kelly; Margolin, Arthur; Salovey, Peter (1990-91). Stress management techniques: Anxiety reduction, appeal, and individual differences. Imagination, Cognition and Personality, 10, 3-23. NOTES Four stress management techniques were evaluated for their general appeal, their immediate benefits, and the subjective experiences they evoke. One hundred undergraduates were randomly assigned to one of five treatment groups: (1) progressive muscle relaxation (PMR); (2) distraction imagery; (3) focused imagery; (4) listening to music; (5) sitting quietly (control). Distraction imagery and listening to music were the only techniques found to reduce anxiety to a greater extent than simply sitting quietly. The techniques differed in the way they made subjects feel, but not in their general appeal. Individuals with a 'blunting' coping style were more likely to find all five techniques appealing. Tests used included the Miller Behavioral Style Scale, Cognitive-Somatic Anxiety Questionnaire of Schwartz, Davidson & Golman, Life Orientation Test of Scheier & Carver, Somatic Perception Questionnaire of Landy and Stern, Body Consciousness Questionnaire of L. C. Miller, Murphy, & Buss, Betts' Questionnaire Upon Mental Imagery, Shortened Form, State-Trait Anxiety Inventory, and Technique Evaluation Questionnaire of the authors. Progressive muscle relaxation was according to Bernstein & Borkovec. Distraction imagery involved successively imagining a walk along a beach, a stroll across a flower filled meadow, sitting by a stream, a walk into the woods, sitting in a cabin in the woods listening to the rain against the windowpane, all including images in a variety of sense modalities. Focused imagery involved creating an image of a stressor, then through symbolic imagery experiences Ss were guided through a typical day's events that might lead up to the stressor, reinterpreting cues associated with the stressor as signals that they are in control, visualizing encountering the stressor feeling strong and determined, and any physical sensations reinterpreted as 'energy' that would help them to cope, visualizing enjoying their success (from Crits-Cristoph & Singer. Music was a 20-min tape (10 min of music used in the distraction imagery tape--Natural Light by Steve Halpern & David Smith) and 10 min of music used in background of the focused imagery tape (Structures of Silence by Michael Lanz). A 5th group, Control, was instructed to sit quietly with eyes closed. This data can be used in support of imagery-suggestion types of hypnosis (as in surgery study) reducing anxiety. It shows particularly strong effects for people high in cognitive anxiety or low in optimism, pre-treatment. Discussion: "... we feel confident that our distraction techniques were more effective for the immediate relief of anxiety than was PMR. This conclusion is consistent with the Suls and Fletcher meta-analysis (29) that suggested that 'avoidance' is an effective short-term coping strategy. That distraction (positive) imagery may be a more useful clinical technique than focused (active involvement) imagery was concluded in a study comparing these two techniques in the treatment of phobias (24)" (p. 19. [Ref #24 is Crits-Cristoph & Singer (1983) in Imagination, Cognition, and Personality.] "Pessimism and cognitive anxiety emerged as the only individual difference variables to influence anxiety reduction. Pessimism as measured by the LOT is cognitive in nature, with most of the items relating to expectations of negative outcomes; similarly, cognitive anxiety is characterized by worry and an inability to control negative thoughts and images. That individuals who perceive their world somewhat negatively should have entered the study more anxious than individuals who do not is hardly surprising. What is surprising is that despite an inverse relation between cognitive anxiety and the ability to relax, these individuals were able to benefit from whatever technique they performed to a greater extent than were individuals with a more positive outlook. In fact, after performing the technique, pessimists had reduced their anxiety to the level of optimists" (p. 19). "The stress management techniques used in the current study did not differ in their appeal" (p. 20). "Our finding that PMR produced more somatic effects than did focused imagery and less cognitive effects than did distraction imagery, listening to music, or sitting quietly is consistent with the model of anxiety proposed by Davidson and Schwartz (17). Our findings are also generally consistent with a conclusion reached by Woolfolk and Lehrer (4): that although various techniques are generally stress reducing, they seem to have highly specific effects. However, we found no support for the hypothesis that individuals who express anxiety cognitively (or somatically) prefer and benefit most from techniques that produce cognitive (or somatic) effects. In fact, the extremely high correlation found between the cognitive and somatic anxiety subscales of the Schwartz et al. measure (5) casts some doubt on the usefulness of a cognitive-somatic distinction, as does the corr between the experience of physical symptoms under stress (the Somatic Perception Questionnaire) with the cognitive, as well as the somatic, anxiety subscale. "The finding that blunters experiences more 'somatic effects' regardless of the technique they were assigned may have been the result of a single response--'how much did mind-wandering interfere with performing the technique'--which was the only Factor 2 item that was highly inversely) related to blunting. Since blunters are more likely to perceive mind wandering as the essence of stress management rather than as 'interference,' we do not view this main effect as particularly illuminating" (p. 20). "However, our finding that blunters experienced all techniques as appealing is consistent with the results of Martelli et al. (1) who found that individuals with low information-preference benefitted from what the authors labeled an 'emotion-focused' intervention, but which, in fact, included many of the quite diverse stress management techniques that we compared in the current study. That 'avoiders' failed to benefit from any intervention in the Scott and Clum study (11) may be due to the nature of the stressor [postsurgical pain]. Our undergraduates may have been more like the Martelli dental patients in terms of their level of distress than were the Scott and Clum subjects who were patients undergoing major surgery (hysterectomy or cholecystectomy). Future research needs to examine possible three-way, technique by patient by stressor-type, interactions (cf. 19)" pp 20-21. Kaye, J. M.; Schindler, B. A. (1990). Hypnosis on a consultation-liaison service. General Hospital Psychiatry, 12, 379-383. Studied the use of hypnosis on a consultation-liaison service with a broad spectrum of medically hospitalized patients. Autohypnosis tapes were used for reinforcement. Twenty-nine women and eight men from 24-75 years of age were hypnotized for relief of depression, pain, anxiety, or side effects of chemotherapy. Results were excellent (total to almost total relief of symptoms) in 68%, fair in 22%, and poor in 11%, with no differences among the results with the various conditions. This demonstrates that hypnotherapy is an extremely useful tool in medical management of patients in consultation-liaison psychiatry. Lazarus, A. A.; Mayne, T. J. (1990). Relaxation: Some limitations, side effects, and proposed solutions. Psychotherapy, 27, 261-266 Deep-muscle relaxation has been widely regarded as anxiety inhibiting, and the relaxation response an antidote to tension and stress. However, some relaxation techniques have been shown to have negative effects. These include relaxation-induced anxiety and panic, paradoxical increases in tension, and parasympathetic rebound. Specific indications and contraindications are discussed. NOTES 1: The following unpleasant side effects have been observed: "unpleasant sensations of heaviness, warmth, perspiration, tingling, numbness, dizziness, floating, coolness; paradoxical increases in tension; rapid heart rate; feelings of physical and psychological vulnerability; depression; fear of losing control; depersonalization; dissociation; myoclonic jerks; spasms; headache; akathesia; negative auditory, gustatory, and olfactory reactions; intrusive images and thoughts; anxiety; irritability; guilt; regressive urges; hallucinations; and panic" (p. 261). People have been observed to have "negative or untoward reactions to meditation ([Lazarus, 1976]; French, Schmid & Ingalls, 1975; Kennedy, 1976), relaxation (Borkovec & Grayson, 1980; Carrington, 1977; Edinger & Jacobsen, 1982), and biofeedback (Miller & Dworkin, 1977). In his doctoral dissertation Heide (1981) found that more than half of his subjects under focused relaxation reported increased tension due to the relaxation session. Recently, the concept of RIA--relaxation-induced anxiety--has appeared in the literature (Heide & Borkovec, 1983; 1984). Clients suffering from generalized anxiety appear to be especially prone to RIA" (pp. 261-262). Others have suggested that relaxation may be counterindicated for asthmatics, because the small airways dilate with sympathetic nervous system arousal. The specific instructions of autogenic training may be counterindicated for patients with gastrointestinal disease because focusing on a sense of warmth in the abdomen tends to produce more peristalsis, increased blood flow in the gastric mucosa, and acidity in the gastric juice (Luthe & Schultz, 1979). Even the standard relaxation therapy for tension headache (as well as other pain problems) is being replaced with cognitive behavioral therapy, which may have relaxation as only one component. "The point again is that relaxation is not a panacea, and that an informed selection and administration of treatments is mandated, even in disorders where relaxation has traditionally been held second only to medication" (p. 264). Interviews suggest people with relaxation induced anxiety (RIA) fear losing control. "Some are afraid of heightened arousal; others refer to helplessness, depression, some unidentified internal or external danger, a fear of going crazy, a negative association with anesthetics, a fear of falling from heights, plus any number of catastrophic expectations (Chambless & Goldstein, 1980)" (p. 264). Lazarus recommends that if someone displays RIA, the therapist may try alternative techniques, which might include for example tensing-relaxing muscles, passive receptivity, positive or pleasant imagery, focus on breathing, subvocal monotonous chant or mantra, or the Vipassana meditation practice of achieving awareness of spontaneous sensations and thoughts. The relationship with the therapist, differences in room illumination, amount of time per session, and sitting or reclining may be important. "If a therapist deduces that a client is likely to derive benefit from relaxation training, three obvious questions arise: (1) Which of the many types of relaxation training programs is this particular client likely to respond to? (2) How frequently, and for what length of time, should the client practice the selected relaxation sequence? (3) Will treatment adherence be augmented or attenuated by the supplementary use of cassettes for home use?" (P. 262). The authors describe their Structural Profile Inventory (SPI; Lazarus, 1989), a 35- item questionnaire, which may be used to predict the preferred sequences and forms of relaxation to employ with individual clients. "A predominantly imagery/sensory reactor, for example, may do well with visualization and autogenic training, whereas a highly active/cognitive client might be better advised first to engage in strenuous exercise followed by calming self-statements (Zilbergeld & Lazarus, 1988)" (p. 265). They suggest that for those patients who are perfectionistic and simply can't "just let go," they might simply fill a bathtub with warm water and sit in it for 10-20 minutes and rest with a magazine (rather than "relax") once or twice a day. McNally, Richard J. (1990). Psychological approaches to panic disorder: A review. Psychological Bulletin, 108 (3), 403-419. Panic disorder has been the subject of considerable research and controversy. Though biological conceptualizations have been predominant, psychological theorists have recently advanced conditioning, personality, and cognitive hypotheses to explain the etiology of panic disorder. The purpose of this article is to provide an empirical and conceptual analysis of these psychological hypotheses. This review covers variants of the "fear-of-fear" construal of panic disorder (i.e., Pavlovian interoceptive conditioning, catastrophic misinterpretation of bodily sensations, anxiety sensitivity), research on predictability (i.e., expectancies) and controllability, and research on information-processing biases believed to underlie the phenomenology of panic. Suggestions for future research are made. 1987 Katz, Ernest R.; Kellerman, Jonathan; Ellenberg, Leah (1987). Hypnosis in the reduction of acute pain and distress in children with cancer. Journal of Pediatric Psychology, 12, 379-394. Hypnosis has been used as a behavioral approach to help children tolerate aversive medical procedures more effectively, but empirical longitudinal research evaluating the outcome of such interventions has been limited. In the present study, 36 children with acute lymphoblastic leukemia between the ages of 6 and 12 years of age undergoing repeated bone marrow aspirations (BMAs) were randomized to hypnosis or play comparison groups. Subjects were selected on their behavioral performance on baseline procedures and received interventions prior to their next three BMA procedures. Major results indicated an improvement in self-reported distress over baseline with both interventions, with no differences between them. Girls exhibited more distress behavior than boys on three of four dependent measures used. Suggestions of an interaction effect between sex and treatment group were noted. The role of rapport between patient and therapist in therapeutic outcome was also evaluated. Results are discussed in terms of potential individual differences in responding to stress and intervention that warrant further research. 1986 Belicki, Kathryn; Belicki, Denis (1986). Predisposition for nightmares: A study of hypnotic ability, vividness of imagery, and absorption. Journal of Clinical Psychology, 42 (5), 714-718. The relationships of nightmare frequency to hypnotic ability, vividness of visual imagery, and the tendency to become absorbed in fantasy-like experiences were examined. Subjects were 841 undergraduate university students who participated in group tests of hypnotic ability, after which they estimated the number of nightmares that they had experienced in the prior year. In addition, 406 of the subjects completed Marks' Vividness of Visual Imagery Questionnaire, and Rotenberg and Bowers' Absorption scale. Of the subjects, 76% reported experiencing at least one nightmare in the prior year; 8.3% indicated one or more per month. Individuals with frequent nightmares scored higher on hypnotizability, vividness of visual imagery, and absorption. NOTES 1: 620, Belicki & Bowers, 1982 ABSTRACT: Investigated the role of demand characteristics in dream change by comparing dream report change following pre- and postsleep administrations of instructions to pay attention to specific dream content. This design was based on the assumption that if presleep instructions merely distort dream reports rather than influence actual dreams, report change should be observable following a postsleep instruction. 42 undergraduates were prescreened with the Harvard Group Scale of Hypnotic Susceptibility (Form A), which allowed experimenters to examine the role of hypnotizability in dream change. Significant differences were observed only following the presleep instructions. It is concluded that report distortion as a result of paying attention to a dimension of dream content was insufficient to account for dream report change following presleep instructions. Hypnotic ability correlated significantly with the amount of dream change. 1984 Billotti, Thomas J. (1984, August). The effects of rational emotive imagery and rational emotive imagery plus hypnosis in reduced public speaking anxiety (Dissertation). Dissertation Abstracts International, 46 (2), 633-634-B. "Previous investigations have demonstrated the effectiveness of rational emotive therapy in reducing public speaking anxiety and the increased benefit derived by combining rational emotive procedures with hypnosis. The present study examined the effectiveness of rational emotive imagery and rational emotive imagery plus hypnosis in reducing public speaking anxiety in subjects with high and low levels of imaginative ability. The dependent measures employed included self report, behavioral and physiological measures of anxiety. "47 undergraduate students who reported anxiety while speaking in public served as subjects in the study. The subjects were divided into high and low levels of imaginative ability and randomly assigned to one of three experimental groups as follows: rational emotive imagery, rational emotive imagery plus hypnosis, and an instructional control group. It was hypothesized that subjects in the rational emotive imagery plus hypnosis group would evidence significantly less anxiety than subjects in the rational emotive imagery and instructional control group, and that subjects with high pre-treatment levels of imaginative ability would evidence significantly less anxiety than subjects with low pre- treatment levels of imaginative ability. "The results of this study provided some support for the efficacy of combining rational emotive imagery with hypnosis. Subjects in the rational emotive imagery plus hypnosis group evidenced significantly less anxiety than subjects in the rational emotive imagery and instructional control group on the two self-report measures. There were no significant differences as between subjects in the rational emotive imagery group and instructional control group or between subjects with high and low imaginative ability on post-treatment assessments. Subjects tended to have their highest pulse rates at the start of the speeches, their lowest pulse rate just after the speeches, and moderate pulse rates just before and during the speeches. "Factors contributing to these results and interpretations of the data were discussed. Suggestions regarding the direction of future research were offered" (p. 633- 634). Katcher, Aaron; Segal, Herman; Beck, Alan (1984). Comparison of contemplation and hypnosis for the reduction of anxiety and discomfort during dental surgery. American Journal of Clinical Hypnosis, 27, 14-21. Complex moving visual stimuli are used to induce states of relaxation, hypnosis and revery. To test the efficacy of using aquarium contemplation to induce relaxation, 42 patients were randomly assigned to one of five treatments prior to elective oral surgery: 1) contemplation of an aquarium, 2) contemplation of a poster, 3) poster contemplation with hypnotic induction, 4) aquarium contemplation with hypnosis, and 5) a non intervention control. Blood pressure, heart rate, and subjective and objective measures of anxiety were used as dependent measures. Pretreatment with aquarium contemplation and hypnosis, either alone or in combination, produced significantly greater degrees of relaxation during surgery than poster contemplation or the control procedure. Two-way ANOVA demonstrated that a formal hypnotic induction did not augment the relaxation produced by aquarium contemplation. NOTES 1: The consent form was designed to reduce anxiety about hypnosis by stating that if hypnosis was used, it would be used only to induce relaxation. Patients were then randomly assigned to one of the 5 pretreatment groups, with 8 in each of the four contemplation groups and 10 in the nonintervention control. 1. Aquarium contemplation. Ss contemplated it for 40 minutes; during the 1st 25 min, 5 tests of suggestibility were administered (from the Stanford) which eliminated all tests the authors considered anxiety-provoking such as suggested hallucination. Also, the terms hypnotically relaxed or hypnotic relaxation replaced the term hypnosis throughout the protocol. 2. Poster contemplation was the same, using a color photo of a mountain waterfall. 3. Poster contemplation with hypnosis used a protocol derived from Stanford, with visual fixation on poster, then the 5 tests, then Ss contemplated the poster for 10 minutes under hypnosis and were given post hypnotic suggestion that they could reenter hypnosis during the dental procedure by closing their eyes and visualizing the poster 4. Aquarium contemplation with hypnosis was like #3 except that Ss were asked to look at "either one fish or a portion of the aquarium" during induction and were told to reenter hypnosis during treatment by closing their eyes and visualizing the aquarium 5. Nonintervention control Ss were given no tests of suggestibility; they were seated in a chair and told to "relax." During surgery, an observer recorded overt signs of anxiety or agitation on a check list, making entries at five-minute intervals. The surgeries took variable lengths of time (5-90 minutes) and variable kinds of procedures (multiple injections, removal of bone, etc.) Surgeons varied in management-- gentleness, etc. Blood pressure fell significantly during all 5 pretreatments without any significant differences between groups. Analysis of interaction effects, significant at the 0.1 level for all 3 dependent variables, indicated that hypnosis had a major effect on relaxation only when the S was contemplating a poster. Hypnosis had no significant influence on the levels of relaxation obtained by contemplation of the aquarium. There were no significant differences between groups in the number of suggestions accepted. 1983 Boutin, Gerald E.; Tosi, Donald J. (1983). Modification of irrational ideas and test anxiety through rational stage directed hypnotherapy (RSDH). Journal of Clinical Psychology, 39 (3), 382-391. Examined the effects of four treatment conditions on the modification of Irrational Ideas and test anxiety in female nursing students. The treatments were Rational Stage Directed Hypnotherapy, a cognitive behavioral approach that utilized hypnosis, and vivid emotive imagery, a hypnosis-only treatment, a placebo condition, and a no-treatment control. The 48 Ss were assigned randomly to one of these treatment groups, which met for 1 hour per week for 6 consecutive weeks with in-vivo homework assignments also utilized. Statistically, significant treatment effects on cognitive, affective, behavioral, and physiological measures were noted for both the RSDH and hypnosis group at the posttest and at a 2-month follow-up. Post-hoc analyses revealed the RSDH treatment group to be significantly more effective than the hypnosis only group on both the post- and follow-up tests. The placebo and control groups showed no significant effects either at posttreatment or at follow-up. Harris, Gina M.; Johnson, Suzanne Bennett (1983). Coping imagery and relaxation instructions in a covert modeling treatment for test anxiety. Behavior Therapy, 14, 144-157. The present study compared the efficacy of instructing test anxious subjects to use personalized coping imagery based on nonacademic experiences of competence with coping imagery based on academic experiences of competence. The effect of relaxation was also examined and the relationship of imagery elaborateness and content to treatment effectiveness was assessed. Sixty-three subjects were randomly assigned to one of four treatments or a waiting list control group. Test anxiety as measured by a self-report instrument significantly decreased in all treatment groups. Improvement in grade point average occurred for all treatment groups except for academic coping imagery without relaxation which was also the least efficient treatment. The waiting list control group significantly deteriorated in academic performance. Relaxation training did not appear to enhance treatment effectiveness or influence the elaborateness or content of the imagery used. Test anxiety scenes elicited highly response- oriented images by all subjects. However, the stimulus/response content of the subjects' images was not influenced by treatment outcome. In contrast, successful treatment was primarily associated with reduction in negative coping imagery descriptions, although an increase in positive coping statements cured as well. Heide, F. J.; Borkovec, T. D. (1983). Relaxation-induced anxiety: Paradoxical anxiety enhancement due to relaxation training. Journal of Consulting and Clinical Psychology, 51, 171-182. The present study was designed to document the occurrence of relaxation- induced anxiety. Fourteen subjects (7 male, 7 female) suffering from general tension and significant levels of anxiety were given one session of training in each of two relaxation methods, progressive relaxation and mantra meditation; order of presentation was counterbalanced. Four of the subjects plus one other who terminated prematurely displayed clinical evidence of an anxiety reaction during a preliminary practice period, while 30.8% of the total group under progressive relaxation and 53.8% under focused relaxation reported increased tension due to the relaxation session. Progressive relaxation produced greater reductions in subjective and physiological outcome measures and less evidence of relaxation-induced anxiety, and the phenomenon was not clearly evident from physiological measures and from subjective ratings even in this clinical population. 1982