Hilgard, Josephine R.; LeBaron, Samuel (1982). Relief of anxiety and pain in children and adolescents with cancer: Quantitative measures and clinical observations. International Journal of Clinical and Experimental Hypnosis, 30, 417-442.

Children and adolescents with cancer, chiefly forms of leukemia, aged 6 to 19 years, underwent medical treatments which required repeated bone marrow aspirations, normally a painful and anxiety-provoking experience. Data were obtained in baseline bone marrow observations on 63 patients, who were then offered the opportunity to volunteer for hypnotic help in pain control. Of the 24 patients who accepted hypnosis, 9 were highly hypnotizable. 10 of the 19 reduced self-reported pain substantially by the first hypnotic treatment (the prompt pain reducers) and 5 more reduced self-reported pain by the second treatment (the delayed pain reducers) while none of the 5 less hypnotizable patients accomplished this. The latter benefitted by reducing anxiety. Short case reports illustrate the variety of experiences.
Analysis of baseline observations before any therapeutic intervention revealed age and sex differences. The difference between self-reported and observed pain was not statistically significant for patients under age 10 but was significant for the patients age 10 and older (p<.001). There were minor but significant sex differences both in observed pain (p<.01) and in self-reported pain (p<.05), with the females reporting more pain. 1981 Fling, Sheila; Thomas, Anne; Gallaher, Michael (1981). Participant characteristics and the effects of two types of meditation vs. quiet sitting. Journal of Clinical Psychology, 37 (4), 784-790. Randomly assigned 61 undergraduate volunteers to Clinically Standardized Meditation (CSM), quiet sitting (SIT), or wait list1 and 19 others to Open Focus (OF) or wait list2. Ss were tested before training and again 8 weeks later. All groups but wait list2 decreased significantly on Spielberger's trait anxiety. All groups became nonsignificantly more internal on Rotter's locus of control. On the Myers-Briggs Type Indicator, meditation volunteers were more introverted than extraverted, intuitive than sensing, feeling than thinking, and perceiving than judging. All groups became more intuitive, approaching significance for CSM only. OF became significantly more extraverted than both CSM and SIT, and CSM significantly more so than wait list1. Practice time correlated with anxiety reduction for the combined treatment groups. More evidence was found for correlations of practice time and outcome with growth motivation than with either new experience motivation or expectancy of benefit. 1980 Heide, Frederick J.; Wadlington, W. L.; Lundy, Richard M. (1980). Hypnotic responsivity as a predictor of outcome in meditation. International Journal of Clinical and Experimental Hypnosis, 28 (4), 358-385. This study tested the hypothesis that measures of hypnotic responsivity would predict outcome from brief meditation training. 58 Ss were matched on hypnotic responsivity and randomly assigned to meditation and control conditions. The Ss in the meditation group displayed significantly greater decreases in trait anxiety than control Ss following a 1-week treatment period. The Ss highest in hypnotic responsivity showed the most substantial decrements in anxiety. It is concluded that hypnotic responsivity is moderately predictive of outcome in meditation. Findings were also consistent with reports that hypnotic responsivity is not increased by practice in meditation. NOTES 1: Subjects in the Meditation condition received 1 hour of group instruction-- a lecture which discussed physiological benefits, guidelines for practice, and possible side-effects. "The technique consisted of the passive, subvocal repetition of a mantra, 'Om,' for a period of 20 minutes. It was emphasized that the mantra should be allowed to 'repeat itself' in a gentle, effortless fashion. The Ss were told that when they found themselves distracted by thoughts, they should not try to block them out but should simply return to repeating the mantra" (p. 360). Ss practiced the technique for 20 minutes and were asked to meditate twice daily for 7 days, keeping a log for that period. Hurley, John D. (1980). Differential effects of hypnosis, biofeedback training, and trophotropic responses on anxiety, ego strength, and locus of control. Journal of Clinical Psychology, 36 (2), 503-507. 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 separately 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 groups on the I-E scores. Lamb, Douglas H.; Strand, Kenneth H. (1980). The effect of a brief relaxation treatment for dental anxiety on measures of state and trait anxiety. Journal of Clinical Psychology, 36 (1), 270-274. Used a brief deep muscle relaxation procedure to reduce patient (N = 39) anxiety during a dental appointment. State anxiety decreased significantly for a relaxed (treated) group from the waiting room period to the actual contact with the dentist. This reduction in state anxiety was maintained for the duration of the dental visit. There were no changes in trait anxiety. Implications for the reduction of state and trait anxiety in an in vivo situation were discussed. Lundy, Richard M.; Heide, Frederick J.; Wadlington, W. L. (1980). Hypnotic responsivity as a predictor of outcome in meditation. International Journal of Clinical and Experimental Hypnosis, 28 (4), 358-366. NOTES 1: TM reportedly diminishes Trait Anxiety (not State Anxiety). Spielberger's Anxiety Scale was administered. Non-analytical attention is increased in TM. Spanos, et al. found a relationship between sustained attention in a meditation task and hypnotizability. Both load on the same factor. Used Control and Experimental groups pretested on a scale of hypnotizability (Harvard Scale?): Lows = 1-4; Mediums = 5-7; Highs = 8-12. Subjects were given instructions for modified TM, including a lecture on physiological benefits. "Let the sound 'OM' repeat itself; let that sound pass through and return to the mantra." Subjects logged practice on their 20 minute meditation twice a day, for 7 days. They were given pre- and posthypnotic tests of State and Trait anxiety. RESULTS. Meditators decreased Trait anxiety but not State anxiety. But anxiety was reduced more for high hypnotizables than for other levels. There was greater change in anxiety for High hypnotizables who practiced meditation . No difference in pre- and posthypnotic test on Harvard, confirming Spanos, et al. CONCLUSIONS. This provides more evidence that the skill of hypnotizability has more utility than we had thought, in therapy. Spanos, et al. also found that improvement in meditation was correlated with hypnotizability (in terms of number of intrusions) and Benson, Frankel, et al., found Lows benefit less in blood pressure change with either meditation or hypnosis. 1978 Benson, Herbert; Frankel, Fred H.; Apfel, Roberta; Daniels, Michael D.; Schniewind, Henry E.; Nemiah, John C.; Sifneos, Peter E.; Crassweller, Karen D.; Greenwood, Martha M.; Kotch, Jamie B.; Arns, Patricia A.; Rosner, Bernard (1978). Treatment of anxiety: A comparison of the usefulness of self-hypnosis and a meditational relaxation technique. Psychotherapy and Psychosomatics, 30, 229-242. 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 responsivity to hypnosis: moderate-high and low responsivity. The NIT or HT was then randomly assigned separately to each member of the two responsivity groups. Thus, 4 treatment groups were studied: moderate-high responsivity MT; low responsivity MT; moderate-high responsivity HT; and low responsivity HT. The low responsivity 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. Counts, D. Kenneth; Hollandsworth, James G., Jr.; Alcorn, John D. (1978). Use of electromyographic biofeedback and cue-controlled relaxation in the treatment of test anxiety. Journal of Consulting and Clinical Psychology, 46 (5), 990-996. The effect of using electromyographic (EMG) biofeedback to increase the efficacy of cue-controlled relaxation training in the treatment of test anxiety was studied. Forty college undergraduates scoring in the upper third on a self-report measure of test anxiety were randomly assigned to one of four treatment conditions - EMG-assisted cue- controlled relaxation, cue-controlled relaxation alone, attention-placebo relaxation, and no-treatment control. Pre-post self-report measures of test anxiety, state anxiety, and trait anxiety were obtained. In addition, a performance measure in the form of a mental abilities test was administered. Subjects from the three relaxation groups received six 45- minute individual sessions over a period of 2 weeks. All treatments were conducted using audiotape recordings. The results indicate that cue-controlled relaxation is effective in increasing test performance for test anxious subjects, that EMG biofeedback does not contribute to the effectiveness of this procedure, and that self-report measures of anxiety are susceptible to a placebo effect. Lehrer, Paul M. (1978). Psychophysiological effects of progressive relaxation in anxiety neurotic patients and of progressive relaxation and alpha feedback in nonpatients. Journal of Consulting and Clinical Psychology, 46 (3), 389-404. Gave 10 anxiety neurotic patients 4 sessions of individual instruction in progressive relaxation; 10 patients served as waiting list controls. 10 nonpatients were assigned to each of the same conditions, and an additional 10 nonpatients were given 4 sessions of alpha feedback. Nonpatients showed more psychophysiological habituation over sessions than patients in response to hearing 5 very loud tones and to a reaction time task. Patients, however, showed greater physiological response to relaxation than did nonpatients. After relaxation, the autonomic responses of the patients resembled those of the nonpatients. The effects of relaxation were more pronounced in measures of physiological reactivity than in measures of physiological activity. Defensive reflexes yielded to orienting reflexes more readily in nonpatients than in patients. There was also a tendency for progressive relaxation to generalize to autonomic functions more than alpha feedback. 1977 Dillbeck, Michael C. (1977). The effect of the transcendental meditation technique on anxiety level. Journal of Clinical Psychology, 33 (4), 1076-1078. Two weeks of twice-daily practice of the Transcendental Meditation (Transcendental meditation) technique was compared with 2 weeks of twice-daily practice of passive relaxation as a means of reduction of anxiety, as measured by the Trait scale of the State-Trait Anxiety Inventory. Thirty-three graduate and undergraduate students were assigned randomly to a relaxation group and a Transcendental meditation group. After a 2-week experimental interval, the relaxation Ss began Transcendental meditation. As hypothesized, in the comparison between the relaxation and meditation Ss, as well as between conditions of the relaxation-meditation group, Transcendental meditation was significantly more effective in reducing anxiety level. Thus, the anxiety-reducing effect of the practice of Transcendental meditation cannot be attributed merely to sitting quietly twice daily, although additional research must determine the extent to which S expectations for change contributed to this effect. Gatchel, Robert J.; Hatch, John P.; Watson, Paur J.; Smith, Dan; Gaas, Elizabeth (1977). Comparative effectiveness of voluntary heart rate control and muscular relaxation as active coping skills for reducing speech anxiety. Journal of Consulting and Clinical Psychology, 1093-1100. The present study investigated whether heart rate biofeedback training is as effective as muscular relaxation training in reducing speech anxiety. Also, a combined muscle relaxation/biofeedback treatment group was included in this study. All treatment groups were compared to a false-biofeedback placebo control group. This investigation also assessed whether the degree of autonomic nervous system awareness significantly influences the treatment process. Ten speech-anxious subjects, half of whom scored high on the Autonomic Perception Questionnaire (APQ) and half of whom scored low on the APQ, were assigned to each group. Results indicated that all four groups demonstrated a decrease in self-reported anxiety. Assessment of physiological measures (heart rate and skin conductance) indicated that the three treatment groups were associated with less physiological responding during the posttreatment assessment of anxiety, relative to the false-biofeedback group. Moreover, among the three treatment groups, the combined relaxation/biofeedback group demonstrated the lowest level of responding. The degree of autonomic awareness was not found to be related to therapeutic improvement Lick, John R.; Heffler, David (1977). Relaxation training and attention placebo in the treatment of severe insomnia. Journal of Consulting and Clinical Psychology, 45 (2), 153-161. This study compared the effectiveness of progressive relaxation training with and without a supplementary relaxation recording, which the subjects played at home, and an attention placebo manipulation in the modification of severe insomnia in adult volunteers. The results indicated that the relaxation training procedures were significantly more effective than placebo and no-treatment controls in modifying several parameters of sleeping behavior, in reducing consumption of sleep-inducing medication, and in influencing a self-report anxiety measure. The supplementary relaxation tape did not increase the effectiveness of relaxation training conducted in the clinic, and there was no difference in the efficacy of the placebo and no-treatment conditions. Physiological data gathered during the last treatment session indicated few significant correlations between reductions in arousal associated with relaxation training and treatment outcome. 1976 Gatchel, Robert J.; Proctor, Janet D. (1976). Effectiveness of voluntary heart rate control in reducing speech anxiety. Journal of Consulting and Clinical Psychology, 381-389. The effects of learned control of heart rate deceleration and therapeutic expectancy set in reducing speech anxiety were investigated in a factorial design employing 36 speech-anxious subjects. Heart rate control training and no heart rate control training were each paired with high-therapeutic-expectancy and neutral- expectancy instructions, in order to assess the individual and combined effects of the two factors. Results demonstrated that learning to control heart rate deceleration led to a significant reduction in self-report, physiological (heart rate and skin conductance level), and overt signs of anxiety, relative to the no-heart-rate control condition. High- therapeutic-expectancy instructions also contributed to a reduction in self-reported anxiety. These results demonstrate that learned heart rate control is an effective therapeutic technique for reducing anxiety. Hemme, Robert; Boor, Myron (1976). Role of expectancy set in the systematic desensitization of speech anxiety: An extension of prior research. Journal of Clinical Psychology, 32 (2), 398-404. SUMMARY The influence of expectancy set with regard to therapy outcome on the effectiveness of systematic desensitization (SD) for reducing public speaking anxiety was investigated. The 7 Ss given a high expectancy set for favorable therapy outcome were informed about psychological research that indicates that SD is effective to reduce public speaking fears. SD was administered with the standard instructions to the 11 Ss given a neutral expectancy set. This expectancy manipulation did not require deception and perhaps could be used with actual SD therapy clients. As in previous research by Woy and Efran, the expectancy set manipulation significantly modified Ss' self-report of subjective perceptions of anxiety from pretratment to posttreatment speeches, but did not affect overt behavioral or physiological indices of anxiety. Since subjective perceptions of anxiety responses are psychologically significant behaviors, these data suggest the importance of conveying a high expectation of improvement to SD and perhaps also to other types of therapy clients. SD sessions administered to small groups of clients on consecutive days, as in this study, appeared to be as effective to reduce speech anxiety as SD sessions administered to each client individually at 1-week intervals, as in the Woy and Efran study" (pp. 403-404). Lawlor, E. D. (1976). Hypnotic intervention with 'school phobic' children. International Journal of Clinical and Experimental Hypnosis, 24, 74-86. Case studies are used to illustrate the use of hypnosis in working with children who exhibit symptoms of "school phobia." Responses obtained during and after hypnosis are utilized to uncover underlying conflicts and fears. The literature (Ansbacher, 1956; Friedman, 1959; Johnson, 1957; Johnson, Falstein, Szurek, & Svendsen, 1941: Kessler, 1966; Waldfogel & Gardner, 1961) confirms the findings that a child through his symptoms has fears which he is unable to bring to consciousness and talk about. Typical are fears of abandonment by parents; fears of disaster befalling parents, especially the mother; fears based on destructive wishes toward siblings due to severe rivalry for the mother's love and attention; fears that exhibiting angry feelings will be punished by the parents; and fears of annihilation and starvation. Hypnosis has aided in restoring these children to a school environment more quickly than more traditional methods. One case is reported with excerpts from a session. The perceptions uncovered through the use of hypnosis can be utilized with children in various school settings 1973 McReynolds, William T.; Barnes, AllanR.; Brooks, Samuel; Rehagen, Nicholas (1973). The role of attention-placebo influences in the efficacy of systematic desensitization. Journal of Consulting and Clinical Psychology, 41 (1), 86-92. Systematic desensitization was compared with two attention- placebo control treatments - one taken from Paul and one currently devised as an elaborate, highly impressive "therapeutic" experience - and no treatment. It was hypothesized that (a) fear reductions following desensitization would be no greater than those associated with an equally compelling placebo treatment and (b) fear and control measure changes following the previously used attention-placebo treatment would be less than those following desensitization and the present placebo control manipulations. Both hypotheses were supported, although support for the first was more consistent than for the second. 1971 McAmmond, D. M.; Davidson, P. O.; Kovitz, D. M. (1971). A comparison of the effects of hypnosis and relaxation training on stress reactions in a dental situation. American Journal of Clinical Hypnosis, 13, 233-242. NOTES 1: Compared the effectiveness of relaxation, hypnosis, and a control condition in reducing in dental phobics the reaction to pressure-algometer stimulation and the injection of anesthesia. For subjects with high baseline skin-conductance levels, relaxation was most effective in reducing stress reactions. Hypnosis did not differ from the control condition. For subjects with a medium or low skin-conductance baseline, relaxation was not effective. The hypnosis group rated their treatment as most effective, and the controls rated their treatment as least effective. Five-month follow-up indicated that all subjects in the hypnosis group returned for dental treatment and that 5 of 10 in the control group and only 1 of the relaxation group returned for care. 1970 Davis, Daniel; McLemore, Clinton W.; London, Perry (1970). The role of visual imagery in desensitization. Behaviour Research and Therapy, 8 (1), 11-13. NOTES Summary: a measure of visual imagery ability was obtained for 33 females who and participated in desensitization therapy for snake phobia. Visual imagery was positively related to pretherapy performance (closeness of approach to a live snake), but not to improvement. On the basis of these results and the results of two other studies, it was hypothesized that the fear of good imagers tends to be based on imagination while that of poor imagers tends to be based on sensory experience. Most psychologists now recognize behavior therapy as effective in alleviating a wide variety of fears, but the nature of the processes underlying the various methods remains an open issue. Imagery has been of particular interest as a possible common denominator among various desensitization techniques. Lazarus (1961), for example, asserts that a "prerequisite for effective application of desensitization is the ability to conjure up reasonably vivid images," and Wolpe (1961) claims, "it is essential for visualizing to be at least moderately clear." London suggests that theoretically opposed treatments such as reciprocal inhibition (Wolpe, 1958) and implosion (Stampfl and Levis, 1967) may both be facilitated by repeated imagery which "produces a discrimination set such that the patient learns to distinguish between the imaginative, cognitive, affective aspects of experience, and the sensory and overt muscular aspects" (1964, p. 130). However, no systematic studies linking visual imagery to desensitization have been reported. This study examined the relationship between visual imagery and success in desensitization therapy. 1968 Nuland, William (1968). The use of hypnotherapy in the treatment of the postmyocardial infarction invalid. International Journal of Clinical and Experimental Hypnosis, 16 (3), 139-150. DEALS WITH THE PSYCHOLOGICAL ASPECTS OF CONVALESCENCE AND REHABILITATION OF PATIENTS FOLLOWING CORONARY INFARCTION. THE FOCUS IS ON THE SITUATIONAL FACTORS WHICH THE PATIENT ENCOUNTERS DURING CONVALESCENCE THAT SERVE TO PROLONG AND REINFORCE THE INVALIDISM. IT IS CONCERNED ESPECIALLY WITH THE VALUE OF HYPNOTHERAPY AS COMPARED WITH OTHER PSYCHOTHERAPEUTIC METHODS IN TREATING THESE CASES. THE ANXIETY AND EMOTIONAL STRESS WHICH CAN BE RELIEVED THROUGH THE USE OF HYPNOSIS IS DIRECTED PRIMARILY TOWARD REDUCING EMOTIONAL TURMOIL WHICH RESULTS FROM THE CORONARY ATTACK WITH THE CONSEQUENT FEAR OF PHYSICAL ACTIVITY AND OF SUDDEN DEATH. SPECIFICALLY, HYPNOSIS IS USED EFFECTIVELY IN REASSURANCE, REEDUCATION, DESENSITIZATION, GUIDANCE, AND OTHER DIRECT SUPPORT TECHNIQUES IN ACCORDANCE WITH THE PATIENT''S SYMPTOMS AND NEEDS. (SPANISH + GERMAN SUMMARIES) (PsycINFO Database Record (c) 2002 APA, all rights reserved) 1965 Davison, Gerald C. (1965, June). Anxiety under total curarization: Implications for the role of muscular relaxation in the desensitization of neurotic fears. [Paper] Presented at the annual meeting of the Western Psychological Association, Honolulu. NOTES 1: I began by describing the Jacobson-Wolpe position on the use of deep muscular relaxation as an anxiety-inhibitor: these writers assume that the considerable reduction in proprioceptive feedback from muscles which are in a relaxed state is incompatible with a state of anxiety. Then I mentioned the evidence that at least modern neuromuscular blocking-agents operate solely at the myoneural junction, with no direct central effects. I went on to discuss the various studies which have used paralytic drugs, primarily d- tubocurarine chloride, to show the learning of fear-responses under complete striate muscle paralysis: the fact that these animals are able to acquire classically-conditioned fear-responses under curare was taken as evidence inconsistent with the views of Jacobson and Wolpe. Several studies were then reviewed which purport to furnish confirmatory evidence for the Jacobson position: these studies showed considerable central depression during curare paralysis. I re-interpreted these studies in the light of the over-riding importance of exteroceptive stimulation, stressing that the animals in the curare learning experiments were likewise deprived of proprioceptive feedback and yet were hardly non- anxious: the important difference was that the animals in the conditioning experiments were stimulated frequently from the environment while curarized, this stimulation maintaining an alert, often anxious state. Finally, two hypotheses were put forward as to why training in muscular relaxation does, in fact, inhibit anxiety: the one suggested that relaxing one's muscles generates strong positive affect states, which in turn inhibit anxiety; the other hypothesis called attention to the fact that the states of muscular relaxation under curare versus under self-induced relaxation differ in the important respect that only with self-induced relaxation is there a reduction in efferent activity--perhaps this elimination of efferents, rather than afferents, inhibits anxiety. 1955 Jacoby, James D. (1955). A statistical report on the practical use of hypnosis in dentistry. Journal of Clinical and Experimental Hypnosis, 3 (2), 117-119. NOTES 1: This is a description of one dentist's office practice employing hypnosis: 197 hypnodontic subjects experienced 776 hypnodontic sessions (about 4 sessions per patient). Appointments included: 107 surgical (exodontics), 527 operative, 15 prosthetic, 46 periodontic surgery, 14 endodontics, and 67 "for suggestive conditioning only." The average depth of trance estimated from the first "conditioning" appointment was: 4 refused all instruction following introduction of the subject; 4 were refractory -- did not enter a trance or relaxed mood; 43 reached hypnoidal stage; 41 reached light trance; 65 reached medium trance; 40 reached somnambule stage. The author concludes, "we might also remind ourselves that all patients do not survive surgical or anesthesia intervention. The hypnodontist or hypnotherapist has a 100% clean record for the survival of his patient or even of any deleterious side effects of his treatment. No other specialty of medical-dental therapy is so fortunate" (p. 119). AROUSAL 1994 Amigo, S. (1994). Self-regulation therapy and the voluntary reproduction of stimulant effects of ephedrine: Possible therapeutic applications. Contemporary Hypnosis, 11 (3), 108-120. NOTES 1: "Emotional self-regulation therapy is comprised of three phases. In the first phase, several sensory recall exercises are used to teach subjects how to voluntarily reproduce various physical sensations (hand numbness and heaviness, smell and taste) that are initially provoked by real stimuli (cold water, a heavy book, cigarette ashes, and lemon juice). Subjects are asked to associate these sensations with images, words, or other cues that will help them to later reproduce the sensations without the physical stimuli. "In the second phase, subjects reproduce these sensations without the physical stimuli and are asked to generate them in response to various cues suggested by the therapist (e.g., touching a pencil, pen, book, etc.) .... "In the last phase ... a demand of any kind generates the suggested effects. In the beginning of this phase, subjects are told that because of previously performed exercises, their minds are highly activated and receptive, so that they can respond to the therapist's verbal suggestions, without needing training for each new sensation. At this point, therapeutic suggestions are given to the patient" (p. 109). 1993 Harris, Ruth M.; Porges, Stephen W.; Carpenter, Myrna E. Clemenson; Vincenz, Lilli M. (1993). Hypnotic susceptibility, mood state, and cardiovascular reactivity. American Journal of Clinical Hypnosis, 36 (1), 15-25. In this study we explored the relationship between hypnotic susceptibility measured with the Harvard Group Scale of Hypnotic Susceptibility (HGSHS) and cardiovascular parameters. After assessing their degree of hypnotic susceptibility, we induced 21 female students into happy mood states and into sad mood states. During the mood state induction we monitored blood pressure, heart rate, and cardiac vagal tone continuously. The study demonstrated a strong relationship between hypnotic susceptibility and both cardiac vagal tone and heart rate reactivity. Subjects with lower heart rate and greater vagal tone during baseline and greater heart rate increases during mood induction were more susceptible to hypnosis. Multiple regression analyses indicated that approximately 40% of the individual difference variance of hypnotic susceptibility was accounted for by baseline cardiac vagal tone and heart rate reactivity during mood state. The data demonstrate that autonomic tone, assessed by cardiac vagal tone and heart rate reactivity, are related to hypnotic susceptibility as measured by the HGSHS. - Journal Abstract 1991 Crowson, J. Jeffrey, Jr.; Conroy Aileen M.; Chester, Traci D. (1991). Hypnotizability as related to visually induced affective reactivity: A brief communication. International Journal of Clinical and Experimental Hypnosis, 39 (3), 140-144. Numerous studies have explored the relationship between hypnotizability and individual differences in imaginative involvement and creativity. Most have assessed imaginative or affective involvement by involving Ss in a variety of imaging tasks. Unlike these earlier studies, however, the present study made no attempt to actively involve Ss in the film viewing task. Rather, individuals assessed as high, medium, or low in hypnotizability were exposed to either a violent film, a neutral film, or no film. Results provided tentative evidence to indicate that the level of negative affect reported was significantly greater for highly hypnotizable Ss. Results were discussed in terms of the limitations of the present study and implications for future studies. 1990 Arendt-Nielsen, Lars; Zachariae, Robert; Bjerring, Peter (1990). Quantitative evaluation of hypnotically suggested hyperaesthesia and analgesia by painful laser stimulation. Pain, 42, 243-251. NOTES: Sensory and pain thresholds to laser stimulation were determined, and the laser-pain evoked brain potentials were measured for 8 highly hypnotizable (Harvard Scores 10-11) student volunteers in 3 conditions: (1) waking, (2) suggestion of hyperaesthesia during hypnosis, (3) suggestion of analgesia during hypnosis. The investigators used a laser beam 3 mm in diameter, with a 200 msec stimulus duration; the same area (but different points within the area) was used for consecutive stimulations. Ss were otherwise maintained in low stimulus conditions so they would not have visual or auditory cues about laser beam onset; they wore goggles, had eyes shut, and had earphones on. Sensory threshold was defined as warmth; pain threshold was defined as a distinct sharp pin prick. The laser intensity used for stimulation corresponded to strong pain. Interstimulus intervals averaged 15 sec (but were randomly varied between 10-20 sec). Sensory and pain thresholds as well as two evoked potential measurements were taken during waking , hypnotized hyperaesthesia, and hypnotized analgesia conditions in a single 1 1/2 hour session. The evoked potential component of interest was the negative complex N1 with latency of 300 msec; amplitude (P1=N1-P2) and latency of this complex (N1) were measured. EEG epochs contaminated by eye movement were omitted from analysis. The standardized induction and deepening of hypnosis required 15-20 minutes; then the suggestion was given that Ss could alter their perception of stimuli such as pain. Hyperaesthesia suggestions were to imagine the right hand was in very hot water, then taken out but still very red, hot, sensitive so that even the vaguest stimulus would be detectable and unpleasant. They were told that they would receive a series of painful but tolerable stimuli, and to raise the left index finger if they could just perceive a laser pulse (sensory threshold), and again if they felt pricking pain (pain threshold). Suggestions for analgesia were to imagine that their right hand was placed on their chest, and that their 'former right hand' was no longer their own but was made of some heavy and completely insensitive material like wood or stone. Sensory and pain threshold measures were then taken. During the evoked potential measurement period they received continuous suggestions of analgesia. They also were told to relax and imagine they were in a pleasant place, ignoring everything except the pleasant, relaxed feelings and imagining pleasant sights, sounds, feelings and the imagined place. They were told that though they would receive stimuli, they probably would be able to ignore the stimuli completely. Results were as follows. 1. In the hypnotic hyperaesthesia condition, sensory and pain thresholds decreased significantly by 47% and 48%, respectively. Three Ss reacted to laser intensities far below what normally can be perceived in the waking state. [The authors ran a separate small control experiment to make sure that the Subjects were not using any other cues, but mention the possibility of light-sensitive skin reacting to the blue laser light, creating evoked potentials.] 2. In the hypnotic analgesia condition, sensory and pain thresholds increased by 316% and 190%, respectively. 7 of 8 Ss did not even respond to pain threshold when the laser intensity was increased to the noxious level of 3W, which is the level at which tissue damage can occur. 3. Pain-related evoked potentials. Amplitude of the first pain-related potential was increased significantly by 14% in the hyperaesthesia condition and reduced significantly by 31% in the analgesia condition. Changes in the evoked potentials were considered minor however compared to those observed for thresholds, which are subjective response measures. Even in Subjects who reported complete analgesia, the experimenters observed the laser pain evoked responses. There were no differences in latencies of the first pain-related potentials for the three conditions (indicating that peripheral and central afferent conduction velocities were the same). Discussion. "There has been some dispute concerning the experimental design and the reliability of the data obtained in studies dealing with hypnotic suggested analgesia [Spanos & Chaves, 1970]. In our design 2 'opposite' conditions were induced, and the 2 inductions gave 'opposite' results. "The experience of pain can be significantly altered by suggestions of analgesia, which is in accordance with a number of other studies (for review see [Barber & Adrian, 1982; Hilgard & Hilgard, 1975]). The finding that suggestions of hyperaesthesia can decrease the sensory and pain thresholds and increase the amplitude of the pain evoked potential is a new observation. Since synchronized auditory and visual stimuli from the laser were blocked, and the stimulus was given at random intervals, the changes might be induced by the hypnotic suggestions" (p. 247). The authors discuss their results in terms of (1) four pain modulation systems (neural/opiate, hormonal/opiate, neural/non-opiate, and hormonal/non-opiate) and (2) focusing and defocusing attention. Because in their pilot study it was necessary to give suggestions continually in order to affect the laser evoked potentials, they conclude that endogenous substances or hormonal/non-opiates would play a minor role, if any, in hypnotic analgesia. (Price and Barber [25] had also found it important to give suggestions continuously.) On the other hand, "event-related potentials [7, 26] and pain-related potentials have, previously, been shown to be sensitive to focused and de-focused attention. Recently, Miltner et al. [23] showed the influence of attention on the late pain-related component of potentials, evoked by painful intracutaneous electrical stimulation. The degree to which the subject paid attention to the painful stimulus had a powerful effect on the pain-related complex. When subjects ignored the pain, it was still possible to record the pain-related complex although all the subjects consistently reported less or no pain. In wakeful subjects where cutaneous pain was abolished by lignocaine infiltration, the pain-related evoked potentials were abolished [4]. In our study, we could also record evoked potentials although the subject subjectively did not feel pain. The reason might be that the S acted as if there was full analgesia to the stimuli, in order to satisfy the hypnotist. During suggested hyperaesthesia the thresholds declined below what normally could be perceived in the wakeful state. The volunteers could, therefore, not act hypersensitive, so something did happen. "The discrepancy in subjective and objective responses might, however, be useful when investigating levels of the neuroaxis at which hypnosis might work" (pp. 248-249). The authors note that this laser induced pain and the tooth pulp stimulation pain of Mayer & Barber both use the A-delta fibers. Barber & Mayer found it impossible to elicit pain within the output range of the stimulator (up to 150 microA) and reached maximal intensity for all volunteers during suggested analgesia. Using cutaneous laser stimulation the authors found that the skin damage level (3W) could be reached in 7 of 8 volunteers without any reaction of pain. During the hyperaesthesia condition the sensory threshold was sometimes lower than can be detected in the waking state. Although some researchers have suggested that red light from a helium-neon laser might activate cutaneous photosensitive receptors and thereby elicit brain potentials, the authors were unable to elicit potentials in waking Subjects using their blue and green argon laser light with below sensory threshold intensity. The authors also note that previous attempts to use physiological correlates of pain such as heart rate, blood pressure, respiration, and galvanic skin response have yielded confusing results. The physiological indicators are present even when Subjects report analgesia, leading some investigators to conclude that the subjective reports are due to illusion [Sutcliffe, 1961], compliance [Wagstaff, 1986], or a placebo induced by the hypnosis context [Wagstaff, 1986]. "These confusing results lead to the conclusion that both the traditional methods used for induction of pain and the monitored physiological responses have been unsatisfactory. The present study has sought to eliminate some of the methodological difficulties by (1) using brief well-defined argon laser stimuli which in awake volunteers induce very stable perceptions between trials [Arendt-Nielsen & Bjerring, 1988], and (2) recording psychophysical thresholds and objective parameters quantitatively related to the intensity of the pain perceived (1, 3)" (p. 249). 1989-1990 Pekala, Ronald J.; Bieber, Stephen L. (1989-90). Operationalizing pattern approaches to consciousness: An analysis of phenomenological patterns of consciousness among individuals of differing susceptibility. Imagination, Cognition and Personality, 9 (4), 303-320. Pattern differences in subjective experience, as assessed by a self-report inventory, the Phenomenology of Consciousness Inventory (PCI), were compared across low, low-medium, high-medium, and high hypnotically susceptible individuals during hypnosis and eyes-closed. A hierarchical factor analytic approach was utilized that allowed for the determination of pattern differences among PCI dimensions as a function of hypnotic susceptibility. The factor analyses found that the four suspectibility (sic) groups were 'pattern equivalent' during eyes-closed, partially pattern dissimilar during hypnosis, and partially pattern dissimilar when comparing hypnosis against eyes-closed. The nature of these results support previous analyses (1) which compared pattern structure differences as a function of correlational matrices. The results suggest the complementarity of Bieber's (2) and Pekala's (3) approaches for assessing pattern differences in consciousness and are congruent with the theorizing of Tart (4), Izard (5), and the PDP researchers on the importance of pattern structure changes in understanding states of consciousness. Pekala, Ronald J.; Kumar, V. K. (1989). Phenomenological patterns of consciousness during hypnosis: Relevance to cognition and individual differences. Australian Journal of Clinical and Experimental Hypnosis, 17 (1), 1-20. Relationships among phenomenological subsystems of consciousness associated with a baseline condition and an hypnotic induction condition were compared across individuals of differing hypnotic susceptibility. Phenomenological experience on 12 subsystems of consciousness was quantified by means of the Phenomenology of Consciousness Inventory (PCI) and the relationships between dimensions were statistically assessed. The results replicated previous findings and suggested that hypnosis has differential effects upon the reported organization of phenomenological structures of consciousness across subjects of differing susceptibility. The data from the previous and present studies were pooled and the combined data were reanalyzed. The results provided further support for the differential pattern structure across low and high susceptibles during hypnosis. Furthermore, differences in pattern structure were augmented when comparing very low versus very high susceptible individuals. NOTES 1: This paper is based on a paper presented to Division 30, Psychological Hypnosis, at annual meeting of the American Psychological Association, Aug 1987. 1988 Kumar, V. K.; Pekala, Ronald J. (1988). Hypnotizability, absorption, and individual differences in phenomenological experience. International Journal of Clinical and Experimental Hypnosis, 36, 80-88. The phenomenological effects associated with a baseline condition of eyes- closed and a hypnotic induction condition were compared across individuals of differing absorption capacity and hypnotizability. The results indicated that individuals of differing absorption capacity and hypnotizability reported different intensities of phenomenological experience during the baseline eyes-closed condition. The induction further augmented intensity differences for low, medium, and high absorption and hypnotizable Ss, but more so for high (and medium) than low hypnotizable Ss. The results support both a trait and state interpretation of hypnotizability, and highlight the importance of the interaction between these factors on the resulting hypnotic experience of S. NOTES 1: Based on a review of relevant literature, the authors predicted that (1) during hypnosis and a baseline condition (eyes-closed), high absorption and high hypnotizable Ss will report the phenomenological effects at greater intensity relative to low absorption and low hypnotizable Ss, respectively; (2) hypnotic induction will be associated with increased absorption; greater alterations in awareness and experience; and decreased volitional control, rationality, and memory; (3) phenomenological intensity differences (hypnosis compared to eyes-closed) will be significantly greater for high than for low hypnotizable Ss. They used the Phenomenology of Consciousness Inventory (PCI) developed by Pekala (1982), which is a 53 item self-report instrument that is completed retrospectively in reference to a preceding stimulus condition. The PCI measures the following dimensions and subdimensions: internal dialogue; self-awareness; state of awareness; imagery (amount, vividness); positive affect (joy, sexual excitement, love); negative affect (anger, fear, sadness); altered experience (time sense, body image, perception, unusual meanings); attention (absorption, direction); memory; rationality; volitional control; and arousal. The 217 Ss were administered the Tellegen Absorption Scale, then sat quietly with eyes closed for four minutes, then completed the PCI, Form 1, relative to that 4-minute period. They were administered a slightly shortened version of the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A); before the posthypnotic suggestion and amnesia suggestion they experienced another 4-minute silent period during which they were told to 'continue to experience the state you are in right now.' After the HGSHS:A they completed PCI, Form 2, in reference to the silent period during the HGSHS:A, before they completed the 11-point questionnaire on the HGSHS: A Subjects who did not have reliable PCI response forms were removed from the sample, leaving 173 Ss who were divided into high, medium, and low Absorption groups, and high, medium, and low hypnotizability groups. The statistical analysis employed MANOVA on intensity scores for first the major PCI dimensions and then the 14 subdimensions using Conditions (eyes closed, hypnosis) and Groups. There were significant main and interaction effects. Subsequent ANOVAs for each (sub)dimension, Conditions by Hypnotizability Groups (2 x 3) were then performed. Hypnosis "was associated with significantly less positive affect (joy, sexual excitement, love); negative affect (anger, sadness); visual imagery (amount, vividness); self-awareness, internal dialogue, rationality, volitional control, and memory; and significantly more altered experience (time sense, perception) and altered state of awareness. "Significant main effects for Hypnotizability Groups were found for positive affect (joy, love); altered experience (body image, time sense, perception, meaning); attention (direction, absorption); self-awareness; altered state of awareness; rationality; volitional control; and memory. "Post-hoc comparisons for the eyes-closed condition revealed that high relative to low, hypnotizables reported significantly greater alterations in body image, time sense, meaning, and altered state of awareness. Medium hypnotizable Ss, compared to low hypnotizables, reported significantly increased alterations in body image and state of awareness. "Post-hoc comparisons for the hypnotic induction condition revealed that high, viz-a-viz low, hypnotizables reported significantly increased absorbed attention; greater altered experience (body image, time sense, perception, meaning); and increased alterations in state of awareness. High hypnotizables also reported significantly less imagery vividness, self-awareness, rationality, volitional control, and memory. Medium hypnotizable Ss, vis-a-vis low hypnotizables, reported significantly more altered experience (body image, time sense, perception, meaning); absorbed attention; and altered state of awareness; and significantly less imagery vividness, self-awareness, rationality, volitional control, and memory. High hypnotizable Ss, relative to medium hypnotizables, reported significantly more altered experience (perception, meaning) and absorption, and significantly less rationality, volitional control, and memory. "Concerning the significant interactions (alpha = .01), graphs of the means indicated significant ordinal interactions between Conditions and Hypnotizability Groups for altered experience (perception), imagery (vividness), self-awareness, altered state of awareness, rationality, volitional control, and memory. For all of the PCI (sub)dimensions, the hypnotic induction condition (compared to eyes-closed) was associated with a significantly greater increase in altered experience (perception), and altered state of awareness; and a significantly greater decrease in imagery (vividness), rationality, volitional control, and memory for the high (and medium) hypnotizable groups relative to the low hypnotizable group. "Significant disordinal interactions were found for absorption and unusual meanings. Whereas high hypnotizable Ss reported a more absorbed attentional focus and more unusual meaning during hypnosis, low hypnotizable Ss reported being less absorbed (or more distracted) during the induction than eyes-closed. Low hypnotizables reported more unusual meanings in reference to eyes closed" (pp. 84-85). Correlations among the major PCI dimensions, absorption, and hypnotizability differ between the two conditions. In hypnosis, the hypnotizability correlations that reached the .001 level were: --Self Awareness -.55 --State of Awareness .60 --Altered Experience .56 --Inward Absorbed Attention .44 --Rationality -.41 --Volitional control -.65 --Memory -.41 --Arousal -.28 In the eyes closed condition, the only PCI variables that Hypnotizability correlated with, at the .001 level, were: --Positive Affect .26 --Altered Experience .32 MANOVAs and ANOVAs were computed for Absorption groups in a similar fashion. Main effects but not interaction effects were significant. Results are not abstracted here. In their Discussion, the authors note that "The three hypotheses were supported by the results. Several of the absorption group comparisons obtained in previous research (Pekala et al., 1985) involving alterations in subjective experience (body image, perception, meaning); state of awareness; and volitional control were replicated in the present research" (p. 85). Neiss, Rob (1988). Reconceptualizing arousal: Psychobiological states in motor performance. Psychological Bulletin, 103 (3), 345-366. This review of research dealing with psychologically induced arousal and motor performance focuses on the hypothesized inverted-U function relating arousal to performance. The inverted-U hypothesis is supported only in a weak and psychologically trivial fashion. More useful research in human motor performance would investigate discrete psychobiological states, which include affect and cognition as well as physiology. Examination of profound individual differences in response to incentive and threat suggests that psychobiological states have their genesis in response expectancies and hypnotic-like self-inductions. The cognitive and affective components of these states are highly interactive and perhaps not profitably separated. Because performance anxiety is a central problem in the motor realm, it is carefully delineated and the test anxiety literature is scrutinized. Psychophysiological test batteries and other investigations in the area are described, and guidelines for future research are provided. Neiss, Rob (1988). Reconceptualizing relaxation treatments: Psychobiological states in sports. Clinical Psychology Review, 8 (2), 139-159 Reviews studies relating relaxation treatments to motor performance and attempts to explain these treatments from a psychological perspective. The inverted-U hypothesis is based on arousal, which has construct validation problems and is a physiological, rather than a psychological, construct. Arousal cannot distinguish among fear, anger, sexuality, and other psychobiological states; predictive validity is low in the area of motor performance. The inverted-U hypothesis is effectively refutable in current usage, and empirically weakly supported. Relaxation treatments are reconceptualized as relatively nonspecific psychological therapies, potentially useful in alleviating dysphoric, debilitating psychobiological states. These treatments are particularly apt for athletics, where performance anxiety is a pervasive problem.. 1984 Pekala, Ronald J.; Kumar, V. K. (1984). Predicting hypnotic susceptibility by a self-report phenomenological state instrument. American Journal of Clinical Hypnosis, 114-121.