1982
Macleod-Morgan, Crisetta; Court, John; Roberts, Russell (1982). Cognitive restructuring: A technique for the relief of chronic tinnitus. Australian Journal of Clinical and Experimental Hypnosis, 10 (1), 27-33.
A combination of relaxation and imagery was used to teach an altered perception of their chronic tinnitus to a series of clients, for all of whom medical intervention had proved ineffective. Over a number of visits to the Flinders Psychology Clinic, the hum which had been troubling them became a cue for relaxation and peace. Thus,whenever they became aware of their tinnitus it came to be welcomed where prior to intervention it had been a constant irritant
1980
Erickson, Milton H. (1980). Hypnotic alteration of sensory, perceptual and psychophysical processes. (2 ). New York: Irvington Publishers, Inc..
NOTES 1:
This second volume of four has five sections, with chapters as follows. I. Visual Processes
1. The hypnotic induction of hallucinatory color vision followed by pseudonegative afterimages (written with E. M. Erickson)
2. Discussion: Critical comments on Hibler’s presentation of his work on negative afterimages of hypnotically induced hallucinated colors (written by E. M. Erickson)
3. The induction of color blindness by a technique of hypnotic suggestion
4. An experimental investigation of the hypnotic subject’s apparent ability to become unaware of stimuli
5. The development of an acute limited obsessional hysterical state in a normal hypnotic subject
6. Observations concerning alterations in hypnosis of visual perceptions (written by E. M. Erickson)
7. Further observations on hypnotic alteration of visual perception (written by E. M. Erickson)
8. An investigation of optokinetic nystagmus
9. Acquired control of pupillary responses II. Auditory Processes
10. A study of clinical and experimental findings on hypnotic deafness: I. Clinical experimentation and findings
11. A study of clinical and experimental findings on hypnotic deafness: II. Experimental findings with a conditioned response technique
12. Chemo-anaesthesia in relation to hearing and memory
13. A field investigation by hypnosis of sound loci importance in human behavior III. Psychophysiological Processes
14. Hypnotic investigation of psychosomatic phenomena: Psychosomatic interrelationships studied by experimental hypnosis
15. Hypnotic investigation of psychosomatic phenomena: The development of aphasialike reactions from hypnotically induced amnesias (written with R. M. Brickner)
16. Hypnotic investigation of psychosomatic phenomena: A controlled experimental use of hypnotic regression in the therapy of an acquired food intolerance
17. Experimentally elicited salivary and related responses to hypnotic visual hallucinations confirmed by personality reactions
18. Control of physiological functions by hypnosis
19. The hypnotic alteration of blood flow: An experiment comparing waking and hypnotic responsiveness
20. A clinical experimental approach to psychogenic infertility
21. Breast development possibly influenced by hypnosis: Two instances and the psychotherapeutic results
22. Psychogenic alteration of menstrual functioning: Three instances
23. The appearance in three generations of an atypical pattern of the sneezing reflex
24. An addendum to a report of the appearance in three generations of an atypical pattern of the sneezing reflex IV. Time Distortion
25. Time distortion in hypnosis, I (written by L. F. Cooper)
26. Time distortion in hypnosis, II (written with L. F. Cooper)
27. The clinical and therapeutic applications of time distortion
28. Further considerations of time distortion: Subjective time condensation as distinct from time expansion (written with E. M. Erickson) V. Research Problems
29. Clinical and experimental trance: Hypnotic training and time required for their development
30. Laboratory and clinical hypnosis: The same or different phenomena?
31. Explorations in hypnosis research (with a discussion by T. X. Barber, R. Dorcus, H. Guze, T. Sarbin, and A. Weitzenhoffer)
32. Expectancy and minimal sensory cues in hypnosis
33. Basic psychological problems in hypnotic research
34. The experience of interviewing in the presence of observers
1979
Bennett, Henry L.; Giannini, Jeffrey A.; Kline, Mark D. (1979, September). Consequences of hearing during general anesthesia. [Paper] Presented at the annual meeting of the American Psychological Association, New York.
A double blind 2X2 study exposed 23 herniorraphy and cholecystectomy patients to either a 45 minute suggestion tape or to the actual sounds of the operation. Structured interviews conducted postoperatively assessed hypnotic susceptibility and regressed patients under hypnosis to operative events. Ten patients accurately recalled significant events from surgery but only under hypnosis. Recall was greater and more accurate in patients scoring high on the Stanford Clinical Hypnosis Scale. Fewest number of pain medications were given postoperatively to patients receiving the suggestion tape. Hernia patients showed better recall than gallbladder patients.
1977
Ryan, M. L.; Sheehan, Peter W. (1977). Reality testing in hypnosis – subjective versus objective effects. International Journal of Clinical and Experimental Hypnosis, 25, 27-51.
90 unselected Ss wre assigned to a 2 x 3 (Request for Honesty x Suggestibility Instruction) factorial design to test the hypothesis that hypnotic Ss would show pronounced impairment of reality testing by expressing a degree of conviction substantially out of phase with their objective performance. Barber’s operational model of hypnosis was adopted to test the prediction on an unusually distinctive auditory comprehension task. The 2 interdependent measures, confidence and accuracy, were highly positively related indicating that, generally speaking, hypnotic Ss performed adaptively, as did task motivated and control Ss. Results for the difficult aspects of the task were most distinctive. Here, degree of confidence about behavior as expressed by Ss who performed well on the suggestibility tests was relatively greater than the confidence expressed by those who performed poorly; further, hypnotic Ss were distinctively willing to respond on the least intelligible parts of the task. The inconsistent nature of certain features of hypnotic behavior was discussed in some detail.
Trustman, R.; Dubovsky, S.; Titley, R. (1977). Auditory perception during general anesthesia — myth or fact. International Journal of Clinical and Experimental Hypnosis, 25 (2), 88-105.
Reports have appeared periodically in the literature indicating that surgical patients can hear and be influenced by remarks occurring while they are under general anesthesia. Much of the evidence has been obtained by postoperatively studying patients under deep hypnosis. The present article discusses the empirical status of this phenomenon, “auditory perception during anesthesia.” 14 selected studies regarding auditory perception during general anesthesia were critically reviewed. All were found to have serious deficiencies as evidence for or against the occurrence of auditory perception during general anesthesia. Methodological and theoretical difficulties of conducting research into auditory perception during general anesthesia were discussed, and suggestions for future research were offered.
1976
Slade, P. D. (1976). An investigation of psychological factors involved in the predisposition to auditory hallucinations. Psychological Medicine, 6 (1), 123-132.
Previous research by the author (Slade, 1972, 1973) and others has suggested that psychological stress plays an important role in triggering off the experience of auditory hallucinations. Clearly, however, predispositional factors are involved as well. The present study is an attempt to investigate some of the psychological factors which may predispose the individual to such experiences. A battery of tests involving cognitive, personality and mental imagery variables and the verbal transformation effect was administered to two small groups of psychotic patients differing only in respect of a history of auditory hallucinations and a normal control group. The main conclusion was that the results lend direct support to the proposition of Mintz & Alpert (1972) that a combination of vivid mental imagery and poor reality-testing in the auditory modality provides the basic predisposition for the experience of auditory hallucinations.
1968
Scheibe, Karl E.; Gray, Arne L.; Kleim, C. Stephen (1968). Hypnotically induced deafness and delayed auditory feedback: A comparison of real and simulating subjects. International Journal of Clinical and Experimental Hypnosis, 16, 158-164.
PRELIMINARY RESEARCH INDICATES THAT HYPNOTICALLY INDUCED DEAFNESS MAY REDUCE THE SPEECH INHIBITING EFFECTS OF DELAYED AUDITORY FEEDBACK (DAF). REAL AND SIMULATING HYPNOTIC SS WERE COMPARED WITH RESPECT TO THE IMPROVEMENT IN SPEECH CONSEQUENT TO THE SUGGESTION OF DEAFNESS. RESULTS INDICATE VERY SIMILAR IMPROVEMENTS OF DAF SPEECH FOR BOTH GROUPS. AN INCIDENTAL FINDING IS THAT REAL SS HAD LONGER SIMPLE READING TIMES UNDER HYPNOSIS THAN DID SIMULATING SS. (GERMAN + SPANISH SUMMARIES) (PsycINFO Database Record (c) 2002 APA, all rights reserved)
1954
Kline, Milton V.; Guze, Henry; Haggerty, Arthur D. (1954). An experimental study of the nature of hypnotic deafness: Effects of delayed speech feedback. Journal of Clinical and Experimental Hypnosis, 2 (2), 145-156.
NOTES 1:
The research subject was a 29 year old college student who was given delayed speech feedback in both the waking state and deeply hypnotized with suggestions of deafness. (Clinically, during hypnotic deafness he lacked the startle reflex in response to auditory stimuli and lost a conditioned response based on auditory stimulus.) Following the experimental procedures, the authors concluded:
“1. Delayed feed-back in the state of hypnotically induced deafness produces distinct impairment in speech performance. This impairment involves loss of motility, increased errors in enunciation and increasing impairment in proportion to increasing difficulty of vocabulary.
2. The speech impairment found in hypnotically induced deafness is very significantly less than the impairment found in waking feed-back performance.
3. The pattern of speech performance in hypnotic deafness shows a pattern very similar to that of non feed-back with respect to constancy of performance and the linear relationship between performance efficiency and difficulty of verbal stimuli.
4. Waking feed-back performance is significantly more variable and erratic than the non feed-back or hypnotic deafness series.
5. Hypnotic deafness does not appear to follow the same neurophysiological pattern as organic deafness with regard to auditory feed-back.
6. Hypnotic deafness does alter certain behaviorial [sic] responses to audition and appears to alter the character and nature of hearing.
7. Hypnotically induced deafness would appear to represent a valid alteration of hearing function but not a state akin to organic deafness.
8. Hypnosis appears to be capable of altering feed-back mechanism of an auditory nature” (p. 155).
Malmo, Robert B.; Boag, Thomas J.; Raginsky, Bernard B. (1954). Electromyographic study of hypnotic deafness. Journal of Clinical and Experimental Hypnosis, 2 (4), 305-317.
NOTES 1:
The main purpose of the present study was to investigate the question of similarities and differences between hysterical deafness, previously studied, and hypnotically induced deafness. The study was designed to repeat the objective physiological tests previously carried out with a case of ‘total hysterical deafness.’ There was also the more general aim of securing objective data to enrich our general understanding of hypnosis.
“Similarities between hysteria and hypnosis which we observed may be listed as follows: (a) Significantly reduced motor reaction (exclusive of blink) to strong auditory stimulation in the deaf state. (b) Complete hearing loss in the hysteric and in one of the hypnotic subjects, even with strong auditory stimulation (i.e., denial of any auditory sensation). (c) With elicitation of strong startle reaction to the first stimulus in the deaf state, much smaller reaction to the next stimulus than would have been predicted on the basis of habituation. (d) Suggestion of substitution of somesthetic for auditory sensations in all subjects (although this was much less definite in the hypnotic subjects than the hysteric).
“The most outstanding dissimilarity lay in the absence of emotional reaction when ‘hypnotic defense against sound’ was broken through, in contrast to marked affective reaction in the hysterical subject under these conditions.
“The qustion of inhibitory mechanisms in hysteria and hypnosis was discussed” (pp. 316-317).
Schneck, Jerome M. (1954). A hypnoanalytic investigation of psychogenic dyspnea with the use of induced auditory hallucinations and special additional hypnotic techniques. Journal of Clinical and Experimental Hypnosis, 2, 80-90.
This paper describes in detail and with discussion the hypnoanalytic session which was instrumental in relieving a patient of severe dyspnea and fatigue based on intense, long standing psychological conflict. The conflict entailed the intermingling of past concerns and current pressing problems. These had to do with the patient’s long repressed feelings about having been told that her birth had been unplanned. They related to current indecision about becoming pregnant. Attitudes toward her parents were significant and these involved mixed feelings with the significance of her conscious and unconscious images of them. Into this picture there were projected the patient’s attitudes toward herself and her methods of functioning somatically as well as psychologically. The symbolic connotation of her symptoms as deterioration and dying in relation to needs for self-destruction were clarified. The symptoms of one and a half to two years duration were dissipated within a few hours and improvement had been maintained for more than a year at the time of writing.
“The use of induced music associations in order to make inroads into the core of the conflict is described. The dynamic significance of spontaneous choice of such theme [sic] is discussed. Other hypnotic techniques involve visual imagery with dream-like qualities and in the form of scene visualizations (8, 9). Attention is centered on induced auditory hallucinations and interesting facets of such experiences are discussed in relation to subjective and objective qualities of such hallucinations and the issue of dynamic validity” (p. 90).
Schneck, Jerome M. (1954). An experimental study of hypnotically induced auditory hallucinations. Journal of Clinical and Experimental Hypnosis, 2, 163-170.
“Summary. An experimental study of hypnotically induced auditory hallucinations was incorporated into therapeutic contact with a patient at a time when an exploratory phase of treatment process seemed appropriate. The study was divided roughly into ten parts, nine of which involved attempts to induce hallucinations on an auditory level following an initial control procedure involving ‘imagined’ conversation. Choice of perons to be hallucinated was made at times by the therapist and at times this was left for spontaneous development by the patient. Some of the episodes involved marked emotional participation by the patient. Others were less intense. ‘Imagined’ conversations were distinct from hallucinated comments. Her own voice when hallucinated emanated from within herself. Other hallucinated voices had external origins. Some were far away. Her aunt’s voice was in the same room. Spacial and temporal elements were divorced from their conventional relationships and distorted in keeping with psychodynamic needs. The patient was able to discuss her experiences and evaluate certain descriptive and dynamic qualities. Certain parts of the total experience served as controls in the evaluation of other parts. The beginning of hallucinatory behavior did not set a pattern for continuous similar activity. Responsive behavior varied from time to time. A hallucinatory episode might be followed by an ‘imagined’ conversation, although instructions remained the same. Deceased persons were hallucinated on an auditory level. This type of episode with her mother had considerable emotional impact. Her aunt died twenty years ago. Her husband was not hallucinated. Responses involving her daughter showed greater complexity.
“Further studies are in order in connection with the neuropsychological and neurophysiological elements in such hypnotic hallucinatory activity. Such elements as they play a role in visual imagery as described here and in visual hallucinations are also to be examined further. Aside from extensions of the type of investigation presented here, inroads may be made into an understanding of spontaneous hallucinatory activity among psychotic patients through the utilization of hypnotic exploratory methods. This would have to be preceded by more extensive studies of hypnosis in relation to psychotic patients than have been attempted thus far. The procedure discussed here and many potential ramifications makes possible a wide variety of investigations which can be planned for the future” (pp. 169-170).
AUTOGENIC TRAINING
1999
Wickramasekera, Ian (1999). How does biofeedback reduce clinical symptoms and do memories and beliefs have biological consequences? Toward a model of mind-body healing. Applied Psychophysiology and Biofeedback, 24 (2), 91-105.
Changes in the magnitude and direction of physiological measures (EMG, EEG, temperature, etc.) are not strongly related to the reduction of clinical symptoms in biofeedback therapy. Previously, nonspecified perceptual, cognitive, and emotional factors related to threat perception (Wickramasekera, 1979, 1988, 1998) may account for the bulk of the variance in the reduction of clinical symptoms. The mean magnitude of these previously nonspecified or placebo factors is closer to 70% when both the therapist and patient believe in the efficacy of the therapy. This powerful placebo effect is hypothesized to be an elicited conditioned response (Wickramasekera, 1977a, 1977c, 1980, 1985) based on the memory of prior healing. These memories of healing are more resistant to extinction if originally acquired on a partial rather than continuous reinforcement schedule. High and low hypnotic ability in interaction with threat perception (negative affect) is hypothesized to contribute to both the production and reduction of clinical symptoms. High and low hypnotic ability respectively are hypothesized to be related to dysregulation of the sympathetic and parasympathetic arms of the autonomic nervous system. Biofeedback is hypothesized to the most effective for reducing clinical symptoms in people of low to moderate hypnotic ability. For people high in trait hypnotic ability, training in self-hypnosis or other instructional procedures (e.g., autogenic training, progressive muscle relaxation, meditation, CBT, etc.) will produce the most rapid reduction in clinical symptoms.
1994
Ter Kuile, Moniek M.; Spinhoven, Philip; Linssen, A. Corry G.; Zitman, Frans G.; et al. (1994). Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups. Pain, 58 (3), 331-340.
The aims of this study were to (a) investigate the efficacy of autogenic training (AT) and cognitive self-hypnosis training (CSH) for the treatment of chronic headaches in comparison with a waiting-list control (WLC) condition, (b) investigate the influence of subject recruitment on treatment outcome and (c) explore whether the level of hypnotizability is related to therapy outcome. Three different subjects groups (group 1, patients (n = 58) who were referred by a neurological outpatient clinic; group 2, members (n = 48) of the community who responded to an advertisement in a newspaper; and group 3, students (n = 40) who responded to an advertisement in a university newspaper) were allocated at random to a therapy or WLC condition. During treatment, there was a significant reduction in the Headache Index scores of the subjects in contrast with the controls. At post-treatment and follow-up almost no significant differences were observed between the 2 treatment conditions or the 3 referral sources regarding the Headache Index, psychological distress (SCL-90) scores and medication use. Follow-up measurements indicated that therapeutic improvement was maintained. In both treatment conditions, the high-hypnotizable subjects achieved a greater reduction in headache pain at post-treatment and follow-up than did the low-hypnotizable subjects. It is concluded that a relatively simple and highly structured relaxation technique for the treatment of chronic headache subjects may be preferable to more complex cognitive hypnotherapeutic procedures, irrespective of the source of recruitment. The level of hypnotic susceptibility seems to be a subject characteristic which is associated with a more favourable outcome in subjects treated with AT or CSH.
1992
Zitman, Frans G.; Van Dyck, Richard; Spinhoven, Philip; Linssen, A. Corrie G. (1992). Hypnosis and autogenic training in the treatment of tension headaches: A two-phase constructive design study with follow-up. Journal of Psychosomatic Research, 36, 219-228.
Tension headaches can form a chronic (very long duration) condition. EMG biofeedback, relaxation training and analgesia by hypnotic suggestion can reduce the pain. So far, no differences have been demonstrated between the effects of various psychological treatments. In a constructively designed study, we firstly compared an abbreviated form of autogenic training to a form of hypnotherapy (future oriented hypnotic imagery) which was not presented as hypnosis and secondly we compared both treatments to the same future oriented hypnotic imagery, but this time explicitly presented as hypnosis. The three treatments were equally effective at post-treatment, but after a 6- month follow-up period, the future oriented hypnotic imagery which had been explicitly presented as hypnosis was superior to autogenic training. Contrary to common belief, it could be demonstrated that the therapists were as effective with the treatment modality they preferred as with the treatment modality they felt to be less remedial.
NOTES 1:
An earlier review by these authors found that EMG biofeedback and relaxation training were equally effective with headache [Zitman, 1983, Biofeedback and chronic pain, In Advances in Pain Research and Therapy (Edit by Bonica, Lindblom, Iggo) V. 5, pp 794-809. N. Y.: Raven Press]. Other authors also found that hypnotic suggestion, EMG biofeedback and EMG biofeedback plus progressive relaxation training were equally effective [Schlutter, Golden, Blume, 1980, A comparison of treatments for prefrontal muscle contraction headache. Br J. Med Psychol, 53, 47-52.]. The authors raise the question whether any treatment element or perhaps combination of elements can enhance a basic relaxation training procedure, with respect to chronic headache.
The first phase of this research compared autogenic training (AT) and future oriented hypnotic imagery (FI) which was not labeled as hypnosis. Results were the same for both groups, and were reported earlier [van Dyck, Zitman, Linssen et al. International Journal of Clinical and Experimental Hypnosis, 1991, 39, 6-23]. The current study added a third group which received future oriented hypnotic imagery but also was told that they were getting hypnosis (FI-H). Thus the AT and FI groups were ‘historical’ comparison groups for the FI-H group in this study.
Patients were described as having headache complaints of at least 6 months (76% had been suffering for >2 years), were over 18 years old, had no drug dependence and no psychiatric disorder, and no previous therapy with autogenic training or hypnosis; no other treatment during the project; fluent in Dutch.
The autogenic training consisted of six exercises learned in a fixed order. The FI method, in which the hypnotized patient imagines himself in a future, pain-free, situation, had been described by Milton Erickson [1954, Pseudo-orientation in time as a hypnotherapeutic procedure. JCEH, 2, 261-283]. For that future situation the investigators used descriptions that the patients provided. Both kinds of intervention taught patients muscular and mental relaxation. Both methods required home practice of the technique, using audio cassettes.
In order to substantiate the labeling of the hypnotic procedure as hypnotic future oriented imagery (FI-H) “hand levitation induction was employed during session two with the purpose of inducing positive expectancies concerning hypnosis as a procedure capable of changing ordinary experiences in an unexpected way [17]. This hand levitation procedure, however, was not presented on tape. Except for the labeling as hypnosis and the hand levitation induction, the hypnotic future oriented imagery procedure was identical to the future oriented imagery procedure in the first phase” (p. 221).
Treatment lasted for 8 weeks and provided 2 12 hours of therapist and 24 1/2 hours of home training with taped instructions. The outcome measures included: 1. Budzinsky-type headache index (mean daily sum of intensity rating for each hour of headache activity recorded during 3 separate days of the week of an assessment session) 2. State Anxiety 3. Zung-type Self-rating Depression Scale 4. Perceived credibility of treatment (4 Question’s developed by Borkovec & Nau using a visual analogue scale) 5. Neuroticism from the CPI
RESULTS. Of 96 patients who agreed to participate, 17 dropped out before the post-treatment assessment. Of the remaining 79, 28 completed AT treatment, 27 FI, and 24 FI-H. Sixty-six attended the follow-up assessment; there were no dropouts from the FI-H, and the drop-outs were equally divided between the AT and FI condition. The headache index scores were logarithmetically transformed because the distribution was positively skewed.
Using ANOVA, in terms of post-treatment scores, there were no significant main effects for therapist or treatment, nor were there any significant interaction effects when analyzing headache index, state anxiety, and depression. There was a significant main effect for Time for three outcome measures: headache index score, state anxiety, and depression.
Post-treatment, neither amount of medication used nor subjective estimates of headaches differed by treatment or by therapist. However, over time there were beneficial results for both treatment groups. “Patients rated their headaches as significantly reduced compared to pre-treatment (a mean pain reduction of 40%). …they had significantly reduced their use of analgesic medication (a mean decrease of 14%)” (p. 224).
Using ANOVA, in terms of follow-up scores, again there were no significant main effects for Treatment or Therapist on the outcome measures of headache index, state anxiety, or depression. There now were three time periods (pre-, post-, and follow-up), and once again there was significant main effect for Time for headache index (though not for state anxiety). That is, people benefitted over the time of the treatment and follow-up. Moreover, there was a significant interaction effect between Therapy and Time on the headache index measure. “A posteriori contrasts revealed that the patients from the FI-H condition showed a greater reduction in their headaches between pre-treatment and follow-up than patients from the AT condition” (p. 225).
The authors write in their Discussion, “Our data indicate that at least in tension headache patients, defining a procedure explicitly as hypnotherapy may not lead to greater effects at post-treatment, but does lead to longer lasting effects” (p. 226).
“The paucity of differences between the three conditions may be a consequence of the study design: the small number of patients and the large SD may have prevented the detection of more differences in effect between the three conditions” (p. 226).
“Other critical remarks are related to the difference in headache reduction at follow-up between AT and FI-H. Firstly, the differences at follow-up were found only with respect to the headache index and not with respect to the subjective estimate of the pain. Secondly, in defining future oriented hypnotic imagery explicitly as hypnosis, we hoped to enhance the efficacy via increased credibility. We found increased efficacy, but we did not find enhanced credibility. Therefore, the differences in effect at follow-up must have another cause. The different effects at follow-up could be linked to the fact that the FI-H condition was the only one without drop-outs. This absence of drop-outs was due to a new research assistant who tried extraordinarily hard to make the patients return for follow-up. By doing so, she may have prevented the patients who gained much from the treatment from dropping out as well as those who gained little” (p. 226-227).
“In this study, despite the differences in therapists’ preferences, both therapists were equally effective with all three treatments. This is an intriguing finding which goes against the belief commonly held by clinicians that therapists are more effective with the type of therapy they prefer” (p. 227).
“The effects were modest, but it must be kept in mind that most of our patients referred by a neurologist were chronic headache sufferers (76% had been suffering for > 2 yr). In such a group of patients even small effects are important, especially when these effects are long-lasting” (p. 227).
1991
Van Dyck, Richard; Zitman, Frans G.; Linssen, A. Corry G.; Spinhoven, Philip (1991). Autogenic training and future oriented hypnotic imagery in the treatment of tension headache: Outcome and process. International Journal of Clinical and Experimental Hypnosis, 39, 6-23.
The aim of the present study was (a) to investigate the relative efficacy of autogenic training and future oriented hypnotic imagery in the treatment of tension headache and (b) to explore the extent to which therapy factors such as relaxation, imagery skills, and hypnotizability mediate therapy outcome. Patients were randomly assigned to the 2 therapy conditions and therapists. 55 patients (28 in autogenic therapy and 27 in future oriented hypnotic imagery condition) completed the 4 therapy sessions and 2 assessment sessions. Patients were to practice at home. No significant main effect or interaction effects for treatment condition or therapist was revealed. A significant effect for time in analyzing scores for headache pain, pain medication usage, depression, and state anxiety was found. In the self-hypnosis condition, pain reduction proved to be associated with depth of relaxation during home practice (as assessed with diaries) and capacity to involve in imagery (as assessed with the Dutch version of the Creative Imagination Scale). After statistically controlling for relaxation and imagery, hypnotizability scores (assessed by Stanford Hypnotic Clinical Scale) were significantly correlated with ratings of pain reduction. Results are discussed in the context of the neo- dissociation and social-cognitive models of hypnoanalgesia. The clinical relevance and the methodological shortcomings of the present study are also critically assessed.
NOTES 1:
” Unexpectedly, pain reduction occurring in AT [autogenic training] appears to be brought about by different means than in hypnotic treatment. Not only imagery skills and hypnotizability, but also level of relaxation were unrelated to pain reduction achieved during AT. Since the first two therapy sessions of AT and hypnosis were identical and in both treatment conditions patients are explicitly instructed to relax, the absence of a relationship between depth of relaxation and pain reduction in AT cannot be easily explained” (p. 19).
1988
Malone, M.; Strube, M. (1988). Meta-analysis of non-medical treatment for chronic pain. Pain, 34, 231-234.
Conducted a meta-analysis of 109 published studies which assessed the outcome of various nonmedical treatments for chronic pain, 48 of which had sufficient information to calculate effect sizes. The remainder were examined according to proportion of patients rated as improved. Mood and number of subjective symptoms consistently showed greater responses to treatment than did pain intensity, pain duration, or frequency of pain, indicating the importance of using a multidimensional framework for pain assessment. Effect sizes for treatments were 2.74 for autogenic training, 2.67 for hypnosis, 2.23 for pill placebo, 1.33 for package treatments that allowed patients to choose from diverse pain management strategies, .95 for biofeedback, .76 for cognitive therapy, .67 for relaxation, .55 for operant conditioning, and .46 for TENS units. However, the largest numbers of studies were in the area of biofeedback, a treatment package, and relaxation, and we must be cautious in interpreting the effect sizes due to the small number of studies in the sample.
1987
Meyer, von H. K.; Diehl, B. J. M.; Ulrich, P.; Meinig, G. (1987). Kurz- und langfristige Anderungen der kortikalen Durchblutung bei Autogenem Training[Short and long-term changes in cortical circulation caused by autogenic training]. Zeitschrift fur Psychosomatische Medizin und Psychoanalyse, 33 (1), 52-62.
The well-known hyperfrontal pattern of hemispheric blood flow measured with 133-Xenon is not found in 12 healthy resting men who have been practicing Autogenic Training at least six months. This might indicate a long-term decrease in the level of activation. Successfully practiced exercises of Autogenic Training lead to an increased blood flow in the Rolandic area representing the body scem (sic) and to a decreased blood flow in regions related to acoustical attention and to autonomic functions. Left hemispheric cerebral blood flow is lower in rest. The relative activation of the left hemisphere during Autogenic Training is discussed.
Ulrich, P.; Meyer, H. J.; Diehl, B.; Meinig, G. (1987). Cerebral blood flow in autogenic training and hypnosis. Neurosurgery Review, 10, 305-307. (Abstracted in American Journal of Clinical Hypnosis, 1989)
In 12 healthy volunteers with at least an experience of 6 months in autogenic training (AT), the cerebral blood flow (CBF) was measured at rest, in AT, and in hypnosis (H). The results were correlated with individual test profiles. The cortical flow pattern at rest of our AT-trained volunteers did not show the hyperfrontality which is described in the literature. This may be interpreted as an effect of better and habitualized relaxation in long-trained AT practitioners. This flow pattern corresponds to the low grades of neuroticism and aggressivity found in the tests. Furthermore, an activation in central cortical areas and a deactivation in regions which are associated with acoustic and autonomous functions occur. Possible explanations for these phenomena as well as for the relatively low perfusion of the left hemisphere at rest and activation in AT are discussed. The global rise of CBF in Hypnosis may be an activation effect caused by resistance against the hypnotizer: the deeper the trance, the smaller the catalepsy of the right arm and in temporal cortical fields processing acoustic inputs.
1986
Lehrer, Paul M.; Woolfolk, Robert L.; Goldman, Nina (1986). Progressive relaxation then and now. In Davidson, Richard J.; Schwartz, Gary E.; Shapiro, David (Ed.), Consciousness and self regulation: Advances in research and theory (4, ). New York: Plenum Press.
NOTES 1:
Reviews changes that have occurred in progressive relaxation training and their effects. The authors conclude:
“Jacobson’s original progressive relaxation technique differs from the types of progressive relaxation used by many current practitioners in a number of fundamental respects. Jacobson emphasized relaxation as a method of learning to control one’s excess muscle tension 24 hours per day. In his mind, progressive relaxation was not a method by which something is done_ to_ a person. Rather, it is a method by which the individual learns to control his or her own body. Jacobson, therefore, rejected the use of suggestion and of various biofeedback instruments and conditioning techniques that may induce relaxation during a training session. Empirical evaluations of most elements of the two progressive relaxation techniques have not yet been done. Thus, although many studies have compared progressive relaxation with a number of hypnotic, cognitive, and combined somatic-cognitive techniques, no one has dismantled the progressive relaxation technique Jacobson’s or modified versions, in order to study the exact contribution of suggestion or cognitive interventions to the modified progressive relaxation technique, or of teaching one muscle at a time. The evidence reviewed above, however, does lead us to hypothesize that Jacobson’s original technique would be relatively more effective in producing lasting somatic changes, whereas the revised technique might be more effective in producing cognitive changes or even short-term somatic changes. If these hypotheses are borne out, we predict that for many applications in behavioral medicine Jacobson’s original technique will be found to be preferable. This will be especially true for those disorders which cannot be assessed by asking the patient how he or she feels but must be evaluated physiologically (e.g., hypertension and various cardiac arrhythmias, where the patient may sometimes even feel worse when the problem is controlled than when it is not).
“In the ‘big picture’ of therapy, of course, the distinctions between the two techniques may be overshadowed by such overriding issues as whether relaxation therapy is even _relevant_ for the individual. We have extensively discussed this issue elsewhere (Woolfolk & Lehrer, 1984b) but we reemphasize here that we see relaxation training as a specific method for overcoming definable problems and not as a panacea nor as a way of life. Nevertheless, we believe that the various approaches to the progressive relaxation technique are sufficiently different, both in practice and in philosophy, that we would do well to evaluate these differences in a rigorous fashion” (Lehrer, Woolfolk, Goldman 209- 210).
Sargent, Joseph; Solbach, Patricia; Coyne, Lolafaye; Spohn, Herbert; Segerson, John (1986). Results of a controlled, experimental, outcome study of nondrug treatments for the control of migraine headaches. Journal of Behavioral Medicine, 9, 291-323.
Headache variables were examined for 136 subjects who participated for 36 weeks in one of four groups: No Treatment, Autogenic Phrases, EMG Biofeedback, Thermal Biofeedback. All subjects kept daily records of headache activity and medication usage and participated in 22 laboratory sessions during which frontalis EMG and hand temperature measurements were taken; those in the 3 treatment groups practiced at home. There was a substantial reduction in headache variables in all groups. The No- Treatment Group differed significantly from the treatment groups combined, with the least reduction in headache variables. The thermal biofeedback group vs EMG biofeedback and autogenic phrases groups showed a suggestive trend toward improvement in the frequency and intensity of total headache.
1985
Stumpfe, Von Klaus-Dietrich (1985). Psychosomatic reactions of near-death experiences. A state of affective dissociation. Zeitschrift fur Psychosomatische Medizin, 31, 215-225.
The feelings of persons who had encountered life-threatening danger were analyzed and compared with the feelings of persons, who are in hypnoses or trained in autogenic training. The symptoms are widely alike. The result of the comparison is, that there exists a state of affective dissociation, which can be caused by conscious or unconscious actions.
1984
Krenz, Eric W. (1984). Improving competitive performance with hypnotic suggestions and modified autogenic training: Case reports. American Journal of Clinical Hypnosis, 27, 58-63.
Although traditionally trainers of athletes have emphasized physiological refinements for the optimal performance of complex motor skills, research has revealed that heightened levels of stress and anxiety may adversely affect performance. As a result, many athletic training programs, taking into consideration the complex interrelationship of the mind and the body, include “mental training” in an attempt to reduce the negative effects of excess stress. These programs have incorporated various psychological interventions such as post hypnotic suggestions, sensory conditioning, and mental imagery and rehearsal. Modified Autogenic Training, a teaching model based on Standard Autogenic Training, synthesizes the strengths of hypnotic techniques to achieve optimal athletic performance. Athletes trained in these concepts can manage unexpected incidences during competition. The concepts of Modified Autogenic Training are described and four case studies are reported.
1982
Stoyva, J. M.; Anderson, C. (1982). A coping-rest model of relaxation and stress management. In Goldberger, L.; Breznitz, S. (Ed.), Handbook of stress: Theoretical and clinical aspects (pp. 745-763). New York: The Free Press.
NOTES 1:
“Patients with psychosomatic or stress linked disorders are likely to show signs of high physiological arousal, and they are likely, under stress, to react strongly in the symptomatic system and to show evidence of being deficient in the ability to shift from the coping to the rest mode (e.g., slowness of habituation to, and recovery from, stressful stimulation). A corollary inference is that such patients … show activity in the symptomatic system for a higher percentage of the time that [sic] do normal subjects. We suggest that this defect in the capacity to shift to a rest condition is the principal reason that various relaxation procedures have so often proved successful in the alleviation of stress related symptoms” (p. 748).
The authors refer to a number of different stress management procedures. Among those associated with primary focus on the rest phase they include: Relaxation training (progressive relaxation, autogenic training, EMG feedback, meditation [Zen, TM]), Specific biofeedback (hand temperature, electrodermal response [EDR], EMG from particular muscle group), and Systematic desensitization. Among those associated with primary focus on coping phase are: Assertiveness training, Social skills retraining and motor skills retraining, Self-statements, Imagery (Guided waking imagery, autogenic abreaction, covert reinforcement and covert sensitization, behavior rehearsal). These various procedures may reflect three dimensions or aspects of the stress response, with some addressing physiology and others addressing cognition or behavior change.
“Rachman (1978) … found it useful to divide the phenomenon of fear into physiological, cognitive, and behavioral components. Similarly, Davidson and Schwartz (1976) conceptualized relaxation as consisting of somatic, cognitive, and attentional components. Phillips (1977) argued that pain, such as headache pain, can be viewed as consisting of cognitive, behavioral, and physiological aspects (and that, consequently, we should not expect high correlations between headache pain and a particular physiological measure such as forehead EMG level). …
“… In discussing contemporary studies of dreaming, they [Stoyva and Kamiya (1968)] proposed that there is no single, totally valid indicator of dreaming as a mental experience. Instead, there are several imperfect indicators of the dream experience–verbal report, rapid eye movements, and certain electroencephalographic (EEG) stages. … Discrepancies among the indicators can serve to generate hypotheses” (p. 749).
The authors discuss different ways of retraining the capacity to rest: relaxation training (including biofeedback, etc.), systematic desensitization; and of reshaping the coping response: assertiveness training, social skills and motor skills retraining, self- statements, imagery techniques; and discuss controllability. These notes cover only a very small part of their extensive review, the material most relevant to hypnosis and suggestion.
“Although imagery techniques are often employed by stress management therapists, one approaches this area with ambivalence. In part, this uneasiness springs from the unsettling awareness that imagery techniques have been embraced by a freewheeling assortment of lay psychologists such as Emil Coue, Dale Carnegie, and Norman Vincent Peale, not to mention a diverse throng of contemporary ‘mind controllers’ and self-styled healers. A more serious source of uneasiness is ignorance of the specific processes at work. What are the mechanisms by which imagery affects the stress response?” (p. 756).
“There is intriguing recent evidence that simply the illusion of control may exert beneficial effects. Stern, Miller, Ewy, and Grant (1980) noted that subjects who were led to believe by means of bogus information feedback that they were successfully lowering their heart rates showed a reduction in stress type symptoms, especially those of a cardiovascular nature. It seems possible that the feeling of control may be an important part of what we have called ‘placebo responding.’ Stoyva (1979b) suggested that this phenomenon is probably not a unitary entity but, rather, a cluster of processes, of which the feeling of developing control over factors affecting one’s disorder is an important and potentially manipulable component of therapeutic interventions” (p. 758).
1978
Raikov, V. L. (1978). Specific features of suggested anesthesia in some forms of hypnosis in which the subject is active. International Journal of Clinical and Experimental Hypnosis, 26 (3), 158-166.
Experiments are reported in which highly hypnotizable Ss while imagining themselves, during hypnosis, to be cosmonauts with “jammed legs” in a space capsule did not feel an unannounced needle prick that pierced the skin. Control experiments with nonhypnotizable, professional actors showed that imagination alone was unsuccessful in producing this result. Additional experiments using autogenic training showed that the autogenic training alone, without analgesia training, did not alleviate the pain but may have reduced the anxiety connected with the pain; further training involving analgesia reduced the felt-pain as well. Theoretical discussion stresses the importance of attention, imagination, and orientation for experiencing analgesia as well as the added and decisive role played by the modifications of consciousness brought about in deep hypnosis.
1975
Cowings, Patricia S. (1975, September). Observed differences in learning ability of heart rate self-regulation as a function of hypnotic susceptibility. [Paper] Presented at the 3rd Congress of the International College of Psychosomatic Medicine, Rome.
Three groups of eight men and women were given personality tests and were taught to control their own heart rates. Experimental group I and the control group had low hypnotic susceptibility (Stanford Hypnotic Susceptibility Scale), and subjects in experimental group II had high hypnotic susceptibility. The experimental groups received autogenic therapy and biofeedback, while the control group was given biofeedback only. Subjects who received autogenic therapy and biofeedback performed better than the control group. Significant differences, however, were found in all psychological test scores between high and low hypnotic susceptibles.