In an attempt to predict hypnotic susceptibility (as measured by the Harvard Group Scale of Hypnotic Susceptibility, HGSHS) the phenomenological experiences of an hypnotic induction (HI) procedure and a baseline comparison condition (eyes closed, EC, sitting quietly) were assessed. After each experience the subjects (n=217) completed the Phenomenology of Consciousness Inventory (PCI), a self-report phenomenological state instrument, dealing with that condition. Step-wise multiple regression and discriminant analyses were then performed on data using the subject’s HGSHS score as the dependent variable and the PCI (sub)dimensions as the independent variables. Regression analyses that held up under cross-validation during HI suggest that the PCI may be an appropriate instrument for predicting susceptibility. The possible clinical usefulness of this approach is discussed.
1982
Blum, Gerald S.; Nash, John K. (1982). EEG correlates of posthypnotically controlled degrees of cognitive arousal. Memory and Cognition, 10, 475-478.
Experimental control over five degrees of cognitive (as opposed to organismic) arousal has been developed by hypnotic programming techniques. Previously these posthypnotic manipulations have been applied to the investigation of diverse topics such as visual discrimination, performance on the Stroop test, selective concentration on color versus form of consonants, and cognitive “reverberation.” The present study explored EEG correlates of the five degrees of cognitive arousal in a task requiring participants to visualize objects for one-minute periods while lying on a couch with eyes closed. Analysis of data from the occipital area in left and right hemispheres revealed that the highest degree of arousal was accompanied by larger amplitudes of alpha and beta power and smaller amplitudes of theta. This pattern of results was similar in both hemispheres, although more marked in the left. The findings, which provide an independent source of support for validity of the hypnotic programming, are discussed in relation to EEG literature on cognitive activity.
NOTES 1:
Hypnosis doesn’t enhance imagery. It provides the conditions under which mental alertness may be manipulated, and very clear imagery is associated with the alert condition whereas blurry imagery is associated with the lowest cognitive arousal condition. The other impression comes from clinical work, i.e. that hypnosis enhances imagery. This article is an example of hypnosis used in other research–see last page.
1981
De Piano, F. A.; Salzberg, H. C. (1981). Hypnosis as an aid to recall of meaningful information presented under three types of arousal. International Journal of Clinical and Experimental Hypnosis, 29 (4), 383-400.
This study was designed to examine the effect of hypnotic induction on recall of information which was incidental, meaningful, and contextually presented. A hypnotic induction with task motivating suggestions was found to enhance recall to a greater extent than were task motivating suggestions alone. It was argued that the positive findings of this study might be due to (a) the types of information used for recall in this study, (b) confidence/motivational factors felt to be facilitated by hypnotic induction, and (c) reduction in critical judgment which allows for the reporting of partial memories. Film-induced arousal resulted in physiological measures and self-reports of arousal which varied with the content of the films. The effects of arousal on recall, however, were less clear but with only slight indications that traumatic arousal had a deleterious effect on recall. Support for the contention that a hypnotic induction would aid recall of information learned under traumatic arousal to a greater extent was not found. The range of arousal produced, however, was probably restricted in comparison to “natural” arousal. Greater differences in recall might be found in real world situations.
NOTES 1:
Hypnosis was not mentioned during recruitment of subjects. They were connected to equipment to measure physiological changes, and then shown a film. Each S saw one of 3 films: Low Arousal (depicting scenes of horses running in the distance, landscape, people socializing), Sexual Arousal (two lovers in romantic encounter, culminating in sexual intercourse), or Traumatic Arousal (a transorbital surgical lobotomy of the brain).
1979
Quall, Penelope J.; Sheehan, Peter W. (1979). Capacity for absorption and relaxation during electromyograph biofeedback and no-feedback conditions. Journal of Abnormal Psychology, 88 (6), 652-662.
The present research examined the relation between absorption capacity and relaxation during electromyograph biofeedback and no-feedback (instructions only) conditions. Sixteen high absorption and 16 low absorption female subjects underwent a biofeedback and no-feedback session with the order of conditions counterbalanced. For high absorption subjects in the first session, EMG reductions were greater during no- feedback than during biofeedback, although the performance of biofeedback subjects improved in the second session. For low absorption subjects, no differences in EMG reductions were apparent across experimental conditions. Postexperimental self-report data demonstrated differences between absorption groups in subjects’ state of arousal and quality of consciousness. It was concluded that for subjects with high capacity for absorbed attention, experimental conditions that allow for a withdrawal from the external environment are most conducive to relaxation, whereas for subjects with limited capacity for absorbed attention, conditions such as biofeedback that place an attentional demand on subjects may be preferable.
1978
Parker, Jerry C.; Gilbert, Gary S.; Thoreson, Richard W. (1978). Reduction of autonomic arousal in alcoholics: A comparison of relaxation and meditation techniques. Journal of Consulting and Clinical Psychology, 46 (5), 879-886.
To investigate and compare the effects of progressive relaxation training and meditation training on autonomic arousal in alcoholics, 30 subjects were selected from a population of alcoholics in a Veterans Administration hospital substance-abuse program. The subjects were randomly assigned to one of the following three experimental conditions: (a) progressive relaxation training group, (b) meditation training group, or (c) quiet rest control group. All groups met for 3 weeks during which state anxiety, blood pressure, heart rate, and spontaneous galvanic skin responses were measured. The measures were designed to assess the treatment effects following the first training session and at the end of the total training period. The results indicate that both progressive relaxation training and meditation training are useful for reducing blood pressure in alcoholics. In addition, significant differences between the groups in the effectiveness of the relaxation procedures were found. Meditation training induced blood pressure decreases at an earlier point in the 3-week training period and affected decreases in systolic blood pressure that progressive relaxation training did not. These results support the idea of considerable specificity of response to relaxation techniques.
1977
Fisher, R. (1977). On flashback and hypnotic recall. International Journal of Clinical and Experimental Hypnosis, 217-235.
This essay deals with both the intra-individual and inter-individual varieties of arousal state-bound experiences. The former are labelled as “flashbacks” while the latter embrace the great fantasms and repetitive schemes, the ever re-written plots and images of literature, art, and religion.
Flashbacks are both arousal-state and stage (i.e., set and setting) bound experiences.
Flashback and hypnotic recall differ only in the ways by which they are induced. Induction methods should be distinguished from induced states on the hyperaroused perception-hallucination and hypoaroused eprception-meditation continuum.
Flashbackers may be characterized by their (a) variability on perceptual-behavioral tasks; (b) tendency to minimize (or reduce) sensory input; (c) high resting heart rates; (d) hypnotizability; and, hence (e) preferential right-cerebral-hemispheric cognition; and (f) a display of EEG-alpha dominance in the resting, waking state.
1974
Bloom, Richard F. (1974). Validation of suggestion-induced stress.
NOTES 1:
Technical Memorandum 23-74 (October 1974), US Army Human Engineering Laboratory, Aberdeen Proving Ground, Maryland 21005, AMCMS Code 5910.21.68629, Contract No. DAAD05-73-C-0243, Dunlap and Associates, Inc. (now Stamford, CT), AD002557.
Sixty college men, divided into three equal groups, each attended two induced stress sessions in which their physiological, psychological and performance reactions were measured. Their responses were compared to determine if valid stress reactions could be induced through suggestion in an altered state (in this case, hypnosis), and also to determine the validity of such reactions if the subject had never before experienced that stress situation. It was demonstrated that valid stress reactions can be induced in an individual with the aid of suggestions, especially if the real stress situation has been experienced before. If no previous experience with that real situation exists, the subject still exhibits stressful reactions; however, the closest resemblance to real stress is found in the subjective or psychological measures, less similarity is found in the physiological measures, and the least similarity is found in the performance measures.
1967
Bartlett, Edmund E.; Faw, Terry T.; Liebert, Robert M. (1967). The effects of suggestions of alertness in hypnosis on pupillary response: Report on a single subject. International Journal of Clinical and Experimental Hypnosis, 15 (4), 189-192.
THE PUPIL SIZE OF A SINGLE S WAS RECORDED UNDER 2 TYPES OF HYPNOTIC SUGGESTION: ALERTNESS INSTRUCTIONS AND TRADITIONAL RELAXATION INSTRUCTIONS. IT WAS FOUND THAT THE SIZE OF THE PUPIL INCREASED SIGNIFICANTLY UNDER ALERTNESS INSTRUCTIONS. THIS RESULT WAS TAKEN AS FURTHER CORROBORATION OF THE HYPOTHESIS THAT CHANGES IN VARIOUS PARAMETERS OF AROUSAL APPARENTLY ASSOCIATED WITH HYPNOSIS MAY BE ATTRIBUTED TO SPECIFIABLE CHARACTERISTICS OF THE INSTRUCTIONS USED RATHER THAN TO STABLE CHARACTERISTICS OF THE “STATE” OF HYPNOSIS. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
Blum, Gerald S. (1967). Experimental observations of the contextual nature of hypnosis. International Journal of Clinical and Experimental Hypnosis, 15 (4), 160-171.
EXPLORED THE DISTINCTIVE MENTAL CONTEXT OF HYPNOSIS WITH A WELL TRAINED MALE UNDERGRADUATE. 1ST, A CONTEXT EFFECT WAS DEMONSTRATED BY PRESENTING 2 SETS OF STIMULI ON A TRIAL, 1 UNDER THE HYPNOTIC CONDITION AND 1 UNDER THE WAKING, AND TESTING THEIR SUBSEQUENT SALIENCE IN HYPNOTIC OR WAKING REPORT STATES. ATTEMPTS WERE THEN MADE TO ISOLATE ELEMENTS OF THE HYPNOTIC CONTEXT-CLOSED EYES, LOWERED MENTAL AROUSAL, AND “BLANK MIND”-NONE OF WHICH PROVED TO BE SUFFICIENT IN ITSELF TO ACCOUNT FOR THE OBSERVED PHENOMENON. A GREATER DIFFICULTY OF SPONTANEOUS INFORMATION TRANSMISSION FROM HYPNOTIC TO WAKING CONDITION THAN VICE VERSA LED TO ADDITIONAL EXPERIMENTS IN WHICH PRIOR HYPNOTIC “PRIMING,” IN THE ABSENCE OF SPECIFIC POSTHYPNOTIC SUGGESTION, HAD NO EFFECT ON RELATED WAKING TASKS. FINALLY, A THEORETICAL INTERPRETATION WAS PROPOSED TO EXPLAIN HOW INITIALLY WEAK HYPNOTIC INPUTS, REGISTERED WITHIN A HIGHLY DISTINCTIVE MENTAL CONTEXT, CAN ACQUIRE VIRTUALLY COMPLETE COGNITIVE DOMINANCE. (SPANISH + GERMAN SUMMARIES) (PsycINFO Database Record (c) 2002 APA, all rights reserved)
1960
McCord, Hallack (1960). A note on a change in mental age accompanying hypnosis of a teen-age-girl. International Journal of Clinical and Experimental Hypnosis, 8 (4), 259-262.
NOTES 1:
An adolescent with questionable diagnosis (mental retardation due to organic brain damage or functional psychological disorder) was given the E-G-Y test for an estimate of verbal intelligence. After initial testing, in which attention span was limited and she was very negativistic, she was re-tested in light hypnosis. Her mental age “more than doubled — went up by six years — “in the intervening 24 hours. The author ascribes improvement to relaxation from light hypnosis and opined that the 10 year level achieved under hypnosis was closr to her “true” level of functioning. Subsequent attempts to hypnotize her were not successful, possibly due to short attention span and negativistic tendencies.
1959
arber, Theodore Xenophon; Coules, John (1959). Electrical skin conductance and galvanic skin response during ‘Hypnosis’. International Journal of Clinical and Experimental Hypnosis, 7 (2), 79-92.
NOTES 1:
“Summary and Conclusions
“Six ‘good’ hypnotic Ss were given a ten-minute ‘hypnotic induction’ and a series of ‘hypnotic tests.’ Both basic skin conductance and momentary variations in skin conductance (GSR) were recorded during the experiment.
“The results were as follows:
1. There was no significant variation in skin conductance during the ‘hypnotic induction procedure.’
2. Skin conductance generally increased throughout the remainder of the experiment, ie., when the Ss wre given suggestions of ‘sensory hallucinations,’ ‘age-regression,’ ‘analgesia,’ ‘negative hallucinations,’ and ‘post’-hypnotic behavior.
3. The Ss usually showed a GSR when they were given ‘hallucinatory’ suggestions, i.e., when they were told that they were becoming ‘itchy,’ ‘thirsty,’ and ‘very hot.’
4. The GSR to a pinprick was essentially the same before the experiment and during ‘hypnotic analgesia.’ Also, the GSR was essentially the same, during ‘hypnotic analgesia,’ (a) when three Ss were told they would receive a pinprick but did _not_ receive the pinprick, (b) when they were told they would receive a pinprick and _did_ receive the pinprick, and (c) when they received a pinprick without being told they would receive it.
5. Four Ss showed a GSR each time they were asked to look at a ‘negatively hallucinated’ object and person. Two Ss did _not_ show a GSR when they were asked to look at the ‘negatively hallucinated’ object (or person). The four Ss who showed a GSR stated, during or after the experiment, that they were by no means convinced that the person or object was no longer in the room. The two Ss who did not show GSR stated, after the experiment, that they had been ‘certain’ that the object (or person) was not present in the room.
6. Although the Ss stated that they did not ‘remember’ the ‘post’-hypnotic suggestion (or anything else about the experiment), they usually showed a GSR when the E made the _preliminary_ movements to give the signal for the ‘post’-hypnotic behavior. (They also showed a GSR when E gave the signal for the ‘post’hypnotic behavior.)
“Since skin conductance is an index of the S’s level of ‘activation,’ ‘arousal,’ or ‘excitation,’ these results indicate the following:
1. Ss do not necessarily become more ‘passive’ or ‘relaxed’ during the ‘hypnotic induction procedure.’
2. Ss often become more and more ‘excited’ and ‘aroused’ when they are given a series of ‘active’ suggestions such as ‘sensory hallucinations,’ ‘age-regression,’ etc.
3. Ss often show momentary ‘excitement’ when they are ‘hallucinating.’
4. A pinprick can ‘arouse’ a S to the same extent during ‘hypnotic analgesia’ as it can during ‘normal waking.’ In addition, ‘hypnotic analgesic’ Ss are often just as much ‘aroused’ by the threat of a pinprick as they are by an actual pinprick.
5. Many Ss become momentarily ‘excited’ when they are asked to look directly at an object (or person) which they have been told they will not be able to see. However, _some_ Ss do _not_ show this momentary ‘excitement.’
6. Although Ss may state that they do not ‘remember’ the ‘post’-hypnotic suggestion, they often become momentarily ‘excited’ when the E makes _preliminary_ motions to give the signal for the ‘post’-hypnotic act” (pp. 90-92).
ARTHRITIS/RHEUMATOLOGY
1998
Eimer, Bruce; Freeman, Arthur (1998). Pain management psychotherapy: A practical guide. New York NY: John Wiley & Sons, Inc..
NOTES 1:
“Pain Management Psychotherapy” (PMP) provides a clear and methodical look at pain management psychotherapy beginning with the initial consultation and work-up of the patient and continuing through termination of treatment. It is a thoughtful and thorough presentation that covers methods for psychologically assessing the chronic pain patient (structured interviews, pain assessment tests and rating scales, instruments for evaluating beliefs, attitudes, pain behavior, disability, depression, anxiety, anger and alienation), treatment planning, cognitive-behavioral therapy techniques, and a range of hypnotic approaches to pain management. The book covers both traditional (cognitive and behavior therapy, biofeedback, assessing hypnotizability, choice of inductions, designing an individualized self-hypnosis exercise) as well as newer innovative techniques (e.g., EMDR, pain-relief imagery, hypno-projective methods, hypno-analytic reprocessing of pain-related negative experiences). An extensive appendix reproduces in their entirety numerous forms, rating scale, inventories, assessment instruments, and scripts.
The senior author, Bruce Eimer, states in his online comments on Amazon.com that “most therapists hold the belief that ‘real’ chronic pain patients are quite impossible to help. This book attempts to dispel these misguided beliefs by providing a body of knowledge, theory, and techniques that have proven value in understanding and relieving chronic physical pain.” He also states that “the challenge for the therapist is to persuade the would-ne patient/client that he or she has something to offer that can help take way pain and bring back more pleasure. This challenge is negotiated through the therapeutic relationship. However, the therapist just can’t be ‘warm, accepting, non-judgmental and empathic’. The therapist must also have knowledge and skills relevant to relieving pain. Only then can the therapist impart such knowledge, and in teaching these skills to the pain patient, help the patient become something of a ‘self-therapist’. . . I dedicate this book to everyone who wants to find ways to make living with pain more comfortable, and to the ongoing search for better ways to relieve pain.”
1996
Holroyd, Jean (1996). Hypnosis treatment of clinical pain: Understanding why hypnosis is useful. International Journal of Clinical and Experimental Hypnosis, 44 (1), 33-51.
Clinical and experimental research literature indicates hypnosis is very useful for severe and persistent pain, yet reviews suggest hypnosis is not widely used. To encourage more widespread clinical application, the author reviews recent controlled clinical studies in which hypnosis compares favorably with other interventions; links advances in understanding endogenous pain modulation to a neurophysiologic view of hypnosis and hypnoanalgesia; relates the neurophysiology of hypnoanalgesia to management of chronic pain; challenges the view that hypnotic pain control is only for the highly hypnotizable patient; and raises issues about how people learn to control pain with hypnosis. Training in hypnotic analgesia may usefully enhance nervous system inhibitory processes that attenuate pain.
NOTES 1:
Hypnosis has been more effective for pain management than other cognitive behavioral interventions in studies of fibromyalgia (Haanen, Hoenderdos, Van Romunde, Hop, Malle, Terwiel, & Hekster, 1991); burn treatment (Patterson, Everett, Burns, & Marvin, 1992); and cancer bone marrow transplant procedures (Syrjala, Cummings, & Donaldson, 1992). Central nervous system gating or downward modulation of pain impulses may account for hypnotic pain control. “Hypnosis enables both amplification and attenuation of cortical response subsequent to sensory registration and prior to consciousness, depending on whether suggestions are for increasing or decreasing awareness (Blum & Barbour, 1979)” (p. 36). This type of inhibition may even be observed in the peripheral nervous system (see Hernandez-Peon, Dittborn, Borlone, & Davidovich, 1959/1960; Sharev & Tal, 1989; Kiernan, Dane, Phillips, & Price, 1995). Work by Helen Crawford (1994) suggests that frontal and limbic areas of the brain are involved in inhibitory patterns of brain activity, and that generation of theta EEG rhythms by lower centers is associated with the suppression of awareness of pain.
Some very low hypnotizable people have been able to learn to control pain with hypnosis, suggesting that it is a skill that can be learned. However, few investigations of improvement of hypnoanalgesia were located. Rather, one must generalize from the fact that other kinds of hypnosis skills have been improved using special training programs, such as the Carleton University program developed by Gorassini & Spanos, 1986). Although most research on improving hypnotic response has been based on operant learning principles, a model that incorporates respondent (classical conditioning) principles might be more useful when it comes to understanding the training of a neurophysiological response, such as inhibitory brain patterns associated with hypnoanalgesia. “Historical success with clinical pain, taken together with newer findings in the neurophysiology of hypnosis, indicate that we should be spending more energy investigating how learning may improve hypnotic analgesia” (p. 43). “We should acknowledge that there are advantages to hypnosis beyond those of relaxation, a good placebo, and psychotherapy. … Responsible care demands that we provide training or practice in hypnotic analgesia when treating pain, and especially whenever a chronic pain patient initially appears to be nonresponsive” (p. 43).
1991
Haanen, Huub C.M.; Hoenderdos, Henk T.W.; Van Romunde, Leo K.J.; Hop, Win C.J.; Malle, Constant; Terwiel, Jack P.; Hekster, Gideon B. (1991). Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. Journal of Rheumatology, 18 (1), 72-75.
In a controlled study, 40 patients with refractory fibromyalgia were randomly allocated to treatment with either hypnotherapy or physical therapy for 12 weeks with followup at 24 weeks. Compared with the patients in the physical therapy group, the patients in the hypnotherapy group showed a significantly better outcome with respect to their pain experience, fatigue on awakening, sleep pattern and global assessment at 12 and 24 weeks, but this was not reflected in an improvement of the total myalgic score measured by a dolorimeter. At baseline most patients in both groups had strong feelings of somatic and psychic discomfort as measured by the Hopkins Symptom Checklist. These feelings showed a significant decrease in patients treated by hypnotherapy compared with physical therapy, but they remained abnormally strong in many cases. We conclude hypnotherapy may be useful in relieving symptoms in patients with refractory fibromyalgia.
NOTES 1:
The patients in this study were 38 women and 2 men, ages 30-65, who had had fibromyalgia for an average of 8.5 years (range 1.5 – 40 years). Of these, 25 were on sick leave or incapacitated, and 6 were unemployed. Patients were randomly assigned to hypnotherapy, or to training in muscle relaxation plus massage (designated “physical therapy”). They were withdrawn from analgesics, except for paracetamol (like Tylenol), at the beginning of this program. Hypnotizability was not measured.
Hypnosis treatment consisted of an arm levitation induction, imagery deepening techniques, ego strengthening suggestions, and suggestions for control of muscle pain, relaxation, and improved sleep. Patients received eight one-hour sessions in decreasing frequency over three months; after Session 3 they were given a 30-minute audiotape to assist in daily self hypnosis. Seventeen patients completed hypnotherapy but three were dissatisfied and withdrew after 3 sessions.
Patients did self ratings on (1) duration of morning stiffness, (2) muscle pain, (3) fatigue on awakening, (4) sleep disturbance, and (5) global assessment, the last four using visual analog scales (VAS). Patient assessment at 12 and 24 weeks was the primary outcome measure, since fibromyalgia is diagnosed principally from patient’s self described symptoms.
Independent observers did not know to which group the patient belonged. The physician’s evaluation included (1) dolorimeter measures of point tenderness (for a Total Myalgic Score, TMS), (2) presence of tender points at 30 points, with 5 control points, (3) overall pain rating with visual analogue scale.
The Hopkins Symptom Checklist (HCL-90) also was used to evaluate outcome.
Using analysis of variance techniques and correcting for initial values, the study found significantly more favorable values in the hypnosis group than in the physical therapy group for muscle pain, fatigue on awakening, sleep disturbance, patient’s overall assessment, and HCL total score. However, differences were not significant for morning stiffness, physician’s overall assessment, or T.S. There were no differences between Weeks 12 and 24 for both groups; therefore the mean value for weeks 12 and 24 for each patient were used to calculate percentage change relative to baseline.
The reduction in pain medication used by the hypnosis group was quite remarkable. “Median (range) analgesic drug use at the initiation of the study (mostly paracetamol) was in the hypnotherapy group 3.0 (0-42) tabletsweek and in the physical therapy group 4.5 ( 0-21)/week. At Week 12 this was 1.0 (0-21) tablet/week for the hypnotherapy group and 7.0 (0-34) tablets/week for the physical therapy group. At the end of the study, 10 of 12 patients in hypnotherapy group and 3 of 12 patients in the physical therapy group had reduced their paracetamol use (Fisher exact test: p = 0.006)” (pp. 73-74).
Although it was observed that the total number of tender points decreased (regardless of treatment group), the Total Myalgic Score assigned by the physician had not changed either at week 12 or at week 24. In fact, even the control points were tender in 44% of the patients; most patients showed some pain response to a control point in one or two sessions of the three. “Only 12 of 40 patients had consistently nontender control points, 4 in hypnotherapy group and 8 in the physical therapy group. … No relation was found between the initial HCL total score and the changes in the other variables studied” (p. 74).
Figures taken from Table 2, showing percent change as compared to baseline:
Physical Therapy (%) Hypnotherapy (%) Morning stiffness (minutes) 0.0 -25.0 Muscle pain (VAS) -6.8 -10.2** Fatigue on awakening (VAS) -0.3 -16.7** Sleep disturbance (VAS) -1.0 -23.1** Overall assessment patient -8.4 -33.2** physician +5.7 -3.2 T.S. (kg/3 cm2) -11.1 -2.4 HCL total score -0.9 -13.0**
In their Discussion, the authors write, “In this controlled therapeutic trial in patients with refractory fibromyalgia hypnotherapy was more successful than physical therapy in improving complaints. The assessment of fatigue on awakening, sleep disturbance, muscle pain, the patient’s overall assessment and the total score of the HCL showed a significant decrease in the hypnotherapy group at the end of the hypnotherapy at 12 weeks. This decrease persisted for 3 months after finishing the hypnotherapy. The variables studied in the physical therapy group had not changed significantly at 12 and 24 weeks.
“However, the patients in the hypnotherapy group improved only subjectively. This improvement was not seen via more objective variables (T.S. and number of tender points), in accordance with others [Carette et al., 1986]. This suggests that coping with the disease may be positively influenced by hypnotherapy though the underlying disorder is still present.
“Correction of the sleeping disturbance by hypnotherapy was the most consistent finding and possibly played an important role in the subjective improvement of fibromyalgia” (p. 74).
The authors noted that the HCL yielded scores in the pathological range during the baseline period. “Thus, in our study, patients with long-standing fibromyalgia often showed pathological feelings of discomfort. In the hypnotherapy group the total score of the HCL decreased significantly suggesting that the physical disturbance may be secondary to long-standing fibromyalgia. It is worth noting that only 3 of the 57 questions on the HCL-90 concern fibromyalgia” (p. 74).
The authors express the opinion that their data do not support a distinction between fibromyalgia and psychogenic rheumatism [Simms, Goldenberg, Felson, & Mason, 1988; Campbell, Clark, & Tindall, 1983] based on pain reported at control points. “Most patients in our study had variable tender control points. The finding of tender control points in fibromyalgia is consistent with others [Wolfe, Smythe, Yunus, et al., 1990; Scudds, Rollman, Harth, & McCain, 1987]. Also we found a positive correlation between the number of tender points and the presence of tender control points. Therefore, it seems more likely that there is a fairly large overlap between fibromyalgia and psychogenic rheumatism (tender all over)” (p. 75).
1990
Gil, Karen M.; Williams, David A.; Keefe, Francis J.; Beckham, Jean C. (1990). The relationship of negative thoughts to pain and psychological distress. Behavior Therapy, 21 (3), 349-362.
Examined the degree to which negative thoughts during flare-ups of pain are related to pain and psychological distress in 3 pain populations: sickle cell disease, rheumatoid arthritis, and chronic pain. 185 adults completed the Inventory of Negative Thoughts in Response to Pain (INTRP), a pain rating scale, the SCL-90 (revised), and a coping strategies questionnaire. Factor analysis of the INTRP revealed 3 factors: Negative Self-Statements, Negative Social Cognitions, and Self-Blame. High scorers on Negative Self-Statement and Negative Social Cognitions reported more severe pain and psychological distress. Ss with chronic daily pain had more frequent negative thoughts during flare-ups than those having intermittent pain secondary to sickle cell disease or rheumatoid arthritis. The INTRP appears to have adequate internal consistency and construct validity.
1989
Yousufzai, N. M. (1989). Rheumatoid arthritis and hypnosis: Case report. British Journal of Experimental and Clinical Hypnosis, 6 (3), 178-181.
In this study we aimed to assess the effectiveness of clinical hypnosis on the symptoms and disease activity of rheumatoid arthritis (RA). 66 RA patients participated in a controlled group design. 26 patients learnt the hypnosis intervention, 20 patients were in a relaxation control group, and 20 patients were in a waiting-list control group. During hypnosis , patients developed individual visual imagery aimed at reducing the autoimmune activity underlying the RA and at reducing the symptoms of joint pain, swelling, and stiffness. Subjective assessments of symptom severity and body and joint function, using standardized questionnaires and visual analogue scales, were obtained. Objective measures of disease activity via multiple blood samples during the therapy period and at the two follow-ups were also taken. These measurements were of erythrocyte sedimentation rate, C-reactive protein, hemoglobin, and leukocyte total numbers. Results indicate that the hypnosis therapy produced more significant improvements in both the subjective and objective measurements, above relaxation and medication. Improvements were also found to be of clinical significance and became even more significant when patients practiced the hypnosis regularly during the follow-up periods.
NOTES 1:
“The effect of hypnotic suggestion on pain and mobility of joints was remarkable. On the fifth session there was hardly any pain, and shoulder movements were almost normal” (p. 179).
1985
Domangue, Barbara B.; Margolis, Clorinda; Lieberman, D.; Kaji, H. (1985). Biochemical correlates of hypnoanalgesia in arthritic pain patients. Journal of Clinical Psychiatry, 46, 235-238.
Self-reported levels of pain, anxiety, and depression, and plasma levels of beta-endorphin, epinephrine, nor-epinephrine, dopamine, and serotonin were measured in 19 arthritic pain patients before and after hypnosis designed to produce pain reduction. Correlations were found between levels of pain, anxiety, and depression. Anxiety and depression were negatively related to plasma norepinephrine levels. Dopamine levels were positively correlated with both depression and epinephrine levels and negatively correlated with levels of serotonin. Serotonin levels were positively correlated with levels of beta-endorphin and negatively correlated to epinephrine. Following hypnotherapy, there were clinically and statistically significant decreases in pain, anxiety, and depression and increases in beta-endorphin-like immunoreactive material.
1984
Elkins, Gary R. (1984). Hypnosis in the treatment of myofibrositis and anxiety: A case report. American Journal of Clinical Hypnosis, 27, 26-30.
A 38-year-old woman with chronic myofibrositis pain was treated by the se of hypnosis and psychotherapy. Hypnotherapeutic techniques, including symptom alteration, relaxation, and insight, are described. This regimen resulted in reduction in pain and emotional distress. which was maintained at three months and one year after treatment.
ASORPTION
2003
Holroyd, Jean (2003). The science of meditation and the state of hypnosis. American Journal of Clinical Hypnosis, 46 (2), 109-128.
Two aspects of Buddhist meditation — concentration and mindfulness — are discussed in relationship to hypnosis. Mindfulness training facilitates the investigation of subjective responses to hypnosis. Concentration practice leads to altered states similar to those in hypnosis, both phenomenologically and neurologically. The similarities and differences between hypnosis and meditation are used to shed light on perennial questions: (1) Does hypnosis involve an altered state of consciousness? (2) Does a hypnotic induction increase suggestibility? It is concluded that a model for hypnosis should include altered states as well as capacity for imaginative involvement and expectations.
Sapp, Marty; Hitchcock, Kim (2003). Creative imagination, absorption, and dissociation with African American college students. Sleep and Hypnosis, 5 (2), 95-104.
The purpose of this study was to assess creative imagination, absorption, and dissociation with African American college students. Two hundred thirty-six undergraduate African American students ranging between the ages of 18 to 22 participated in this study. Students were assigned to the following experimental manipulation: (a) Creative Imagination Scale (CIS), a cognitive-behavioral measure of hypnotizability; and (b) Dissociative Experiences Scale (DES), General Dissociation Scale (GDS), and Tellegen Absorption Scale (TAS) embedded within the CIS. Results indicated that dissociation and absorption were affected by the CIS. Finally, this sample was compared with the European American sample obtained by Barber and Wilson (1978) and Wilson and Barber (1978), and clearly the two samples differed on creative imagination, t=(405)=7.00, p<.005. The African American sample had a signficantly lower mean CIS score than the European American sample. NOTES Key words: imagination, hypnosis, absorption, dissociation, adolescents, cultural differences, African American college students, cognition. 2002 Manmiller, Jessica L.; Kumar, V. K.; Pekala, Ronald J. (2002). Hypnotizability, creative capacity, creativity styles, absorption and phenomenological experience. [Paper] Presented at the annual meeting of the American Psychological Association, Chicago. "The study investigated relationships between creative capacity, styles of creativity, hypnotizability, and absorption. Participants were 429 students enrolled in Introduction to Psychology classes. Students first completed questionnaires pertaining to creative capacity, creativity styles, and absorption (Tellegen''''s Absorption Scale). They were subsequently hypnotized using the Harvard Group Scale of Hypnotic Susceptibility and completed the Phenomenology of Consciousness Inventory. The pattern of results suggests that creative capacity is more closely related to absorption than hypnotizability. The support for P. G. Bowers'' assertion that effortless experiencing while engaged in creative tasks and hypnotic tasks is a process that is common to both high creative and high hypnotizable subjects was weak. Hypnotizability was more strongly and negatively correlated with volitional control for suggestions experienced during hypnosis, than both absorption and creative capacity. Creativity styles of belief in unconscious processes, use of techniques, final product orientation (intrinsic/extrinsic) motivation, environmental control and behavioral self-regulation, and supersition were negatively correlated with volitional control (feeling of effortlessness experiencing) during hypnosis, but the correlations were small in magnitude" (Bulletin of Division 30, Psychological Hypnosis, Fall, 2002, Vol. 11, No. 3, P. 14). 2000 Eimer, Bruce. N. (2000). Clinical applications of hypnosis for brief and efficient pain management psychotherapy. American Journal of Clinical Hypnosis, 43 (1), 17-40. (July) This paper describes four specific clinical applications of hypnosis that can make psychotherapy for pain management briefer, more goal-oriented, and more efficient: (1) the assessment of hypnotizability; (2) the induction of hypnotic analgesia and development of individualized pain coping strategies; (3) direct suggestion, cognitive reframing, hypnotic metaphors, and pain relief imagery; and (4) brief psychodynamic reprocessing during the trance state of emtoional factors in the patient''s experience of chonic pain. Important theoretical and clinical issues regarding the relationship between hypnotizability to the induction of hypnotic analgesia are presented, and attempts to individualize pain treatment strategies on the basis of assessed differences in hypnotizability and patients'' preferred coping strategies are described. Some ways are also presented of integrating direct hypnotic suggestion, COGNITIVE-EVALUATIVE reframing, hypnotic metaphors, and imagery for alleviating the SENSORY and AFFECTIVE-MOTIVATIONAL components of pain, with an exploratory, insight-oriented, and brief psychodynamic reprocessing approach during trance for resolving unconscious sources of resistance to treatment, and reducing the emotional overlay associated with chronic pain. Some basic assumptions underlying the use of this approach are discussed, and a brief step-by-step protocol is outlined. Lichtenberg, P.; Bachner-Melman, R.; Gritsenko, I.; Ebstein, R. P. (2000). Exploratory association study between catechol-O-methyltransferase (COMT) high/low enzyme activity polymorphism and hypnotizability. American Journal of Medical Genetics , 96, 771-774. Only recently have studies of electrocortical activity, event-related potentials, and regional cerebral blood flow begun to shed light on the anatomical and neurobiological underpinnings of hypnosis. Since twin studies show a significant heritable component for hypnotizability, we were prompted to examine the role of a common, functional polymorphism in contributing to individual differences in hypnotizability. A group of 109 subjects (51 male, 58 female) were administered three psychological instruments and tested for the high/low enzyme activity COMT val.met polymorphism. We observed a significant correlation between hypnotizability measured by the Stanford Hypnotic Susceptibility Scale (SHSS:C), ability to partition attention (Differential Attentional Processes Inventory or DAPI), and absorptive capacities (Tellegen Absorption Scale or TAS). The effect of COMT on the various dependent variables was initially examined by multivariate analysis that corrects for multiple testing. The dependent variables were SHSS:C hypnotizability scores, four attentional subscales of the DAPI, and TAS total score grouped by the COMT genotype (val/val, val/met, met/met) as the independent variable. Hotelling''s Trace statistic was significant when scores were grouped by the COMT genotype (Hotelling''s T2 = 1.88, P = 0.04). Post-hoc testing using the Bonferroni correction shows that the only significant difference is between the val/met vs. the val/val COMT genotypes on hypnotizability. This association was significant for men but not for women. As for all case-control studies, these results need to be interpreted cautiously and require replication. 1998 Eimer, Bruce; Freeman, Arthur (1998). Pain management psychotherapy: A practical guide. New York NY: John Wiley & Sons, Inc.. NOTES: "Pain Management Psychotherapy" (PMP) provides a clear and methodical look at pain management psychotherapy beginning with the initial consultation and work-up of the patient and continuing through termination of treatment. It is a thoughtful and thorough presentation that covers methods for psychologically assessing the chronic pain patient (structured interviews, pain assessment tests and rating scales, instruments for evaluating beliefs, attitudes, pain behavior, disability, depression, anxiety, anger and alienation), treatment planning, cognitive-behavioral therapy techniques, and a range of hypnotic approaches to pain management. The book covers both traditional (cognitive and behavior therapy, biofeedback, assessing hypnotizability, choice of inductions, designing an individualized self-hypnosis exercise) as well as newer innovative techniques (e.g., EMDR, pain-relief imagery, hypno-projective methods, hypno-analytic reprocessing of pain-related negative experiences). An extensive appendix reproduces in their entirety numerous forms, rating scale, inventories, assessment instruments, and scripts. The senior author, Bruce Eimer, states in his online comments on Amazon.com that "most therapists hold the belief that 'real' chronic pain patients are quite impossible to help. This book attempts to dispel these misguided beliefs by providing a body of knowledge, theory, and techniques that have proven value in understanding and relieving chronic physical pain." He also states that "the challenge for the therapist is to persuade the would-ne patient/client that he or she has something to offer that can help take way pain and bring back more pleasure. This challenge is negotiated through the therapeutic relationship. However, the therapist just can't be 'warm, accepting, non-judgmental and empathic'. The therapist must also have knowledge and skills relevant to relieving pain. Only then can the therapist impart such knowledge, and in teaching these skills to the pain patient, help the patient become something of a 'self-therapist'. . . I dedicate this book to everyone who wants to find ways to make living with pain more comfortable, and to the ongoing search for better ways to relieve pain." 1997-1998 Hillig, Justine A.; Holroyd, Jean (1997-98). Consciousness, attention, and hypnoidal effects during firewalking. Imagination, Cognition and Personality. Subjective experiences of individuals who walked on hot coals during a firewalking ceremony were investigated. This study extended and partially supported an investigation reported by Pekala and Ersek in this Journal [1]. Twenty-three participants completed retrospective questionnaire assessments concerning their subjective experiences while walking on hot coals. Results from twelve participants were compared with the participants' own experiences during a baseline condition. The data suggested that attention during firewalking is significantly more "one-pointed" than during a baseline condition, and that consciousness may be characterized as more "hypnoidal" than during a baseline condition. Walking on hot coals was further characterized by trends toward reporting increased altered awareness, altered experience, and absorbed attention. Participants who developed a grater degree of blistering reported significantly greater hypnoidal effects during the firewalk than those who developed a lesser degree of blistering. 1996 Dixon, Mike; Labelle, Louise; Laurence, Jean-Roch (1996). A multivariate approach to the prediction of hypnotic susceptibility. International Journal of Clinical and Experimental Hypnosis, 44 (3), 250-264. The present study examined the relation between various self-report measures and two measures of hypnotizability within a multivariate framework. A group of 748 participants was tested on the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A), the Tellegen Absorption Scale (TAS), as well as the Preference for an Imagic Cognitive Style (PICS) questionnaire. One hundred ninety of these participants also completed the Paranormal Experiences Questionnaire (PEQ). Data were analyzed using hierarchical multiple regression equations, and the results of the analyses indicated that both the TAS and PICS accounted for significant amounts of unique variance in each of two 373-member samples of HGSHS:A scores. A further sub-sample of participants (n = 161) was tested on the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) to see if these results would generalize to another measure of hypnotizability. Hierarchical multiple regression analyses revealed that although the PEQ predicted significant amounts of unique SHSS:C variance over and above that predicted by the TAS, the PICS failed to do so. This inconsistency in results may be due in part to the generally low intercorrelation between the different hypnotizability scales and points to the need to develop new predictor variables that are orthogonal to each other. - Journal Abstract Kumar, V. K.; Pekala, Ronald J.; Cummings, James (1996). Trait factors, state effects, and hypnotizability. International Journal of Clinical and Experimental Hypnosis, 44 (3), 232-249. This study examined the relationship of 15 trait (e.g., absorption, ego-permissiveness) and 21 phenomenological variables (assessed by the Phenomenology of Consciousness Inventory) with performance on the Harvard Group Scale of Hypnotic Susceptibility, Form A. Factor analyses suggested three trait factors (absorption-permissiveness, general sensation seeking, and social desirability) and five state factors (dissociated control state, positive affect, negative affect, attention to internal processes, and visual imagery). The factors correlated to hypnotizability were absorption-permissiveness, dissociated control, positive affect, and attention to internal processes. In predicting hypnotizability, the amount of variance accounted for by the trait factors was approximately 9%; an additional 22% was accounted for by state factors. The interactions did not account for any additional variance in predicting hypnotizability.