This study evaluated the effects of a Cognitive Experiential Therapy (CET)–in the past referred to as Rational Stage Directed Hypnotherapy–Cognitive Restructuring (CR), Hypnosis Only (HO), and a no-treatment control condition on the duodenal ulcer syndrome. CET is a systematic, stage-directed therapy that employs hypnosis and the cognitive restructuring of self-defeating cognitive, emotional, physiological, and behavioral tendencies. Seven criterion variables were assessed using two standardized instruments and questionnaire data. The standardized instruments included the Millon Behavioral Health Inventory (MBHI) and the Common Beliefs Survey III (CBS). Twenty-five volunteer duodenal ulcer patients were subjects in a 4 x 3 factorial design with repeated measures consisting of the four treatments and pretest, posttest, and follow-up. There was a significant treatment effect, and effects were observed on personality coping styles, beliefs and locus of control scales, and on gastrointestinal disturbance. CET appeared to have an ameliorative effect on psychological factors associated with duodenal ulcer.

Van den Bergh, Omer; Eelen, Paul; Baeyens, Frank (1989). Brief exposure to fear stimuli: Imagery ability as a condition of fear enhancement and fear decrease. Behavior Therapy, 20, 563-572.

Examined fear enhancement and fear decrease during brief exposure to fear stimuli. 140 good and poor imagery Subjects (aged 14-18 years) with medium fear levels toward spiders were exposed to a live spider, either by looking at it or by thinking of an invisible, but present spider during either 60, 180, or 360 sec. Control Subjects were given a distraction task. Subjective fear and behavioral approach were measured. Brief exposure hindered fear decrease compared to the control condition. Good imagers showed more fear decrease and were less affected by the mode of exposure. Fear enhancement occurred only in poor imagers at the longer exposure duration (360 sec) during thinking. In that condition, good imagers showed their greatest fear decrease.

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.

Tsushima, W. T. (1988). Current psychological treatments for stress-related skin disorders. Cutis, 42, 402-404.

Surveys current methods used by psychologists in the management of stress-related skin disorders, including hypnosis, relaxation training, biofeedback, operant conditioning, and cognitive behavioral therapy. These techniques offer promise in the treatment of certain dermatologic conditions, but the limited amount of well-controlled and replicated studies of their use suggests that caution be taken in their application.

Wakeman, R. J. (1988). Hypnotic desensitization of job-related heat intolerance in recovered burn victims. American Journal of Clinical Hypnosis, 31, 28-32.

The thermally injured patient who suffers extensive third-degree burns usually finds the adaptation to high temperature environments quite difficult. A 7-year study of 50 thermally injured patients with greater than 45% total body surface second- and third-degree burns was conducted to assess the usefulness of hypnosis for improved heat adaptation at the work site. There were 25 subjects in the experimental group who received hypnotic training and 25 in a matched control group. The experimental group achieved a mean of 6.25 hours worked over 16 weeks and 63.5 days worked out of 80. They worked 4.5 to 6.5 hours per day for an average of 221 days per year for up to 3 years from baseline. The control group achieved a mean of 4.5 hours worked over 16 weeks and 54.33 days worked out of 80. The efficacy of hypnosis in heat desensitization is discussed.

Mean age was 38 for the hypnosis group, 33 for the control group; both groups had mean educational level of 8 grades. Mean percentage of total body surface burn was 50% for hypnosis and 54% for control groups.
Each patient was seen for 16 weeks, for 2 hours/week. The hypnosis group received hypnosis, were taught self hypnosis, and were given cassette tapes for use at home. The hypnosis training included a variety of techniques (e.g. progressive deep muscle relaxation, eye-fixation, eye-roll, and visual imagery techniques). They were given suggestions for lower skin temperature, lower ‘inner body’ temperature, less itching, gradual improvement of time spent on the job, as well as ego strengthening suggestions. The control patients received supportive psychotherapy, family consultation, and cognitive behavior therapy for the same amount of contact time with the same therapist.
The hypnosis group was to do self hypnosis every two hours at the worksite, in addition to home practice. Visual imagery suggestions were things like imagery of a cool waterfall flowing over the skin, having a tall cold glass of beer or soft drink, etc. They also had biofeedback of skin temperature during office visits, to reinforce decreases in skin temperature near the burned sites. They had exposure to heat (in a 95 degree sauna) for in gradually increased periods of time (15 to 120 minutes) before returning to the worksite.
Three years after treatment 20 of 25 control patients had quit their jobs or transferred to a cooler worksite, and all 25 had resigned from their original jobs or applied for further disability benefits. In contrast, only 2 of 25 experimental Ss were working in controlled-temperature settings, and none had applied for permanent disability benefits.
The authors note that family support was essential for the hypnosis patients to carry out their treatment program, and family consultations were essential for every patient. They also found the ‘fade-in’ technique using the sauna in the hospital occupational therapy area very useful for bridging the gap between practice in the office and going back to the work setting. “This procedure enabled the subject to practice self- hypnosis under controlled physical conditions while performing a work task that was more realistic than ‘imagined heat’ in the office setting” (p. 31).

Crist, Dwayne Anderson (1987). The effect of suggestibility on the efficacy of relaxation training instruction: A multisession evaluation (Dissertation, University of Alabama). Dissertation Abstracts International, 47 (n9-B), 3950.

“Progressive relaxation is a well established procedure used in the treatment of anxiety related disorders. Research has suggested that the muscle tension-release component of progressive relaxation is the critical variable in producing relaxation effects. However, other techniques which do not employ muscle-tension release have proven effective. It has been suggested that treatment type may interact with personality characteristics to produce greater effects. Suggestibility was selected as a personality characteristic that may facilitate or inhibit relaxation effects. Fifty high and 50 low suggestible individuals were selected to participate based on scores from the Creative Imagination Scale. Half of each group as randomly assigned to either a progressive relaxation or imagery relaxation treatment. Subjects received four weekly sessions of relaxation training. The Relaxation Scale was administered before and after each session to assess effects of training. The results indicated that high suggestible individuals had significantly greater increases in relaxation within session on each of the three scales of the Relaxation Scale, but this appeared to be a result of lower pre-test scores. Only the Physical Assessment scale also demonstrated higher post-test scores for the high suggestible participants. A ceiling effect appeared to be operating for both the Physiological Tension and Cognitive Tension scales. There were no significant differences between the progressive relaxation and imagery relaxation treatments. It appears that muscle tension release may not be a critical variable in relaxation effects” (p. ).

Jay, Susan (1987, October). Hypnotic susceptibility and response to psychological intervention for distress related to painful procedures in leukemic children. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Los Angeles.

Presented children with a cognitive behavioral intervention package that involved five elements 1. Filmed Modeling (child modeling and talking about it with good coping skills) 2. Positive Reinforcement – trophy ‘for doing the best you can,’ to change aversive situation to a positive situation 3. Breathing Exercises – ‘puff yourself up like a tire’ 4. Emotive Imagery/Distraction – super hero image (Superman), or being in a favorite place 5. Behavioral Rehearsal – dollplay, reviewing the procedure with medical equipment.
For Numbers 4 and 5 the therapist would actively guide the procedures; numbers 3, 4 & 5 are hypnotic elements.
Valium had lowered children’s distress prior to procedures but not during the procedures. This study involved Valium plus cognitive behavior therapy.
25 Subjects ages 6-12, were measured for hypnotizability
2 groups: (1) Cognitive Behavior Therapy + Valium given just before intervention started, after film ended; (2) Cognitive Behavior Therapy alone.
Dependent Measures: 1. Observation Scale of Behavioral Distress coded every 15 seconds. 2. Faces Scale for Fear (self report) before procedure
Faces Scale for Pain (self report) after procedure 3. Blood pressure
RESULTS. No Significant Differences were found between the two groups (CBT vs CBT + Valium). Pre-Post Analyses: Post intervention scores were significant lower than Pretest on [missed notes]

Jay, Susan M.; Elliott, Charles H.; Katz, Ernest; Siegel, Stuart E. (1987). Cognitive-behavioral and pharmacologic interventions for children’s’ distress during painful medical procedures. Journal of Consulting and Clinical Psychology, 55, 860-865.

This study evaluated the efficacy of a cognitive-behavioral intervention package and a low-risk pharmacologic intervention (oral Valium), as compared with a minimal treatment-attention control condition, in reducing children’s distress during bone marrow aspirations. The subjects were 56 leukemia patients who ranged in age from 3 years to 13 years. The three intervention conditions were delivered in a randomized sequence within a repeated-measures counterbalanced design. Dependent outcome measures included observed behavioral distress scores, self-reported pain scores, pulse rate, and blood pressure scores. Repeated-measures analyses of variance indicated that children in the cognitive-behavior therapy condition had significantly lower behavioral distress, lower pain ratings, and lower pulse rates than when they were in the attention- control condition. When children were in the Valium condition, they exhibited no significant differences from the attention control condition except that they had lower diastolic blood pressure scores.

Diamond, Michael Jay (1986). Hypnotically augmented psychotherapy: The unique contributions of the hypnotically trained clinician. American Journal of Clinical Hypnosis, 28 (4), 238-247.

In the last century, psychotherapists trained in clinical hypnosis have made a number of unique contributions to the psychotherapeutic endeavor, particularly in the areas of psychotherapeutic theory, technique, and practice. Nine factors indexing the contribution of hypnotherapists are discussed. They are: 1) communication focus; 2) maximizing expectation and belief; 3) mind-body emphasis; 4) handling of resistance; 5) employing trance phenomena; 6) using archaic levels of relationship; 7) stressing healthy, adaptive ego functions; 8) using therapist trance; and 9) permitting responsible creativity. Each factor is considered as it pertains to hypnotic technique and phenomena as well as how it is manifested in clinical treatment.

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.

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).

Miller, Mary E.; Bowers, Kennneth S. (1986). Hypnotic analgesia and stress inoculation in the reduction of pain. Journal of Abnormal Psychology, 95, 6-14.

Investigated the influence of hypnotic ability on 3 methods of reducing cold-pressor pain. Following a baseline immersion, 30 high- and 30 low-hypnotizable undergraduates were randomly assigned to 1 of 3 treatment groups: stress inoculation training, stress inoculation training defined as hypnosis, or hypnotic analgesia. Analysis of pain reports indicated a significant hypnotic ability x treatment interaction. Among Ss receiving hypnotic analgesia, high-hypnotizables reported significantly less intense pain than lows. There was no differential response for high- and low-hypnotizable Ss receiving stress inoculation training, whether or not it was defined as hypnotic. Moreover, Ss in the stress inoculation condition (whether or not defined as hypnosis) reported using cognitive strategies to reduce pain, whereas this was not the case for Ss in the hypnotic analgesia condition. The present findings seem inconsistent with the social psychological account of hypnosis and are discussed from a dissociation perspective, which views hypnosis as involving changes in the way information is processed.

Bolocofsky, David N.; Spinler, Dwayne; Coulthard-Morris, Linda (1985). Effectiveness of hypnosis as an adjunct to behavioral weight management. Journal of Clinical Psychology, 41 (1), 35-41.

109 17-67 year olds completed a behavioral treatment for weight management either with or without the addition of hypnosis. Results show that, at the end of the 9-week program, both interventions resulted in significant weight reduction. However, at 8-month and 2-year follow-ups, the hypnosis Ss showed significant additional weight loss, while those in the behavioral-treatment-only group exhibited little further change. More Ss who used hypnosis also achieved and maintained their personal weight goals. It is suggested that hypnosis may have been an effective motivator for Ss to continue practicing the more adaptive eating behaviors acquired during treatment. Findings support the utility of employing hypnosis as an adjunct to a behavioral weight management program. (25 ref)

Spanos, Nicholas P.; Ollerhead, Virginia Gail; Gwynn, Maxwell I. (1985-86). The effects of three instructional treatments on pain magnitude and pain tolerance: Implications for theories of hypnotic analgesia. Imagination, Cognition and Personality, 5, 321-337.

Between baseline and posttesting on the cold pressor test, subjects were assigned to four treatments: a) hypnotic analgesia, b) brief instructions to “Do whatever you can to reduce pain,” c) stress inoculation, and d) no instruction control. Participants in the three instructional treatments showed significantly greater baseline to posttest decrements in pain magnitude and significantly greater increments in pain tolerance than controls. However, the instructional treatments did not differ significantly from one another in these regards. Pretested hypnotic susceptibility correlated significantly with degree of pain reduction in the hypnotic analgesia treatment but not in the “Do whatever” or stress inoculation treatments. Theoretical implications are discussed.

Billotti, Thomas J. (1984, August). The effects of rational emotive imagery and rational emotive imagery plus hypnosis in reduced public speaking anxiety (Dissertation). Dissertation Abstracts International, 46 (2), 633-634-B.

“Previous investigations have demonstrated the effectiveness of rational emotive therapy in reducing public speaking anxiety and the increased benefit derived by combining rational emotive procedures with hypnosis. The present study examined the effectiveness of rational emotive imagery and rational emotive imagery plus hypnosis in reducing public speaking anxiety in subjects with high and low levels of imaginative ability. The dependent measures employed included self report, behavioral and physiological measures of anxiety. “47 undergraduate students who reported anxiety while speaking in public served as subjects in the study. The subjects were divided into high and low levels of imaginative ability and randomly assigned to one of three experimental groups as follows: rational emotive imagery, rational emotive imagery plus hypnosis, and an instructional control group. It was hypothesized that subjects in the rational emotive imagery plus hypnosis group would evidence significantly less anxiety than subjects in the rational emotive imagery and instructional control group, and that subjects with high pre-treatment levels of imaginative ability would evidence significantly less anxiety than subjects with low pre- treatment levels of imaginative ability. “The results of this study provided some support for the efficacy of combining rational emotive imagery with hypnosis. Subjects in the rational emotive imagery plus hypnosis group evidenced significantly less anxiety than subjects in the rational emotive imagery and instructional control group on the two self-report measures. There were no significant differences as between subjects in the rational emotive imagery group and instructional control group or between subjects with high and low imaginative ability on post-treatment assessments. Subjects tended to have their highest pulse rates at the start of the speeches, their lowest pulse rate just after the speeches, and moderate pulse rates just before and during the speeches. “Factors contributing to these results and interpretations of the data were discussed. Suggestions regarding the direction of future research were offered” (p. 633- 634).

Morrow, Gary R. (1984). Appropriateness of taped versus live relaxation in the systematic desensitization of anticipatory nausea and vomiting in cancer patients. Journal of Consulting and Clinical Psychology, 52 (6), 1098-1099.

Investigated the suggestion that the relaxation part of systematic desensitization–an effective treatment for the nausea and vomiting experienced by approximately 25% of cancer patients in anticipation of chemotherapeutic treatments– could be learned from a prerecorded audiotape prior to meeting a psychologist for treatment. 10 cancer patients who had developed anticipatory nausea or vomiting were assigned to either a live-relaxation or a tape-relaxation group. Results show that 4 of 5 Ss assigned to the tape-relaxation group experienced nausea while listening to the prerecorded audiotape, while none of the patients in the live-relaxation group reported nausea when subsequently listening to an audiotape made during the live presentation of relaxation.

Newton, Bernauer (1984, October). The use of imagery in the treatment of cancer patients. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Antonio, TX.

Several hundred cancer patients were treated with the Simonton visualization method, with the additional factor that they were hypnotized for the visualization. In a long term follow-up study, those patients who were treated for at least 6 months and are still alive had imagery that was vivid, persistent, positive, and passive (“passive” here meaning an underlying sense of calm). Those who died had the opposite kind of images, and retrospective review of clinical notes indicates their aggressive images reflected desperation. Of the patients who were treated less than six months, a few lived. Their images also were vivid, persistent, and positive.

Stam, Henderikus J.; McGrath, Patricia A.; Brooke, Ralph I. (1984). The effects of a cognitive-behavioral treatment program on temporo-mandibular pain and dysfunction syndrome. Psychosomatic Medicine, 46, 534-545.

Sixty-one patients, clearly diagnosed as suffering from temporo-mandibular pain and dysfunction syndrome (TMPDS), were randomly assigned to one of three groups, (1) hypnosis and cognitive coping skills, (2) relaxation and cognitive coping skills, or (3) a no-treatment control group. All patients were evaluated with a standard hypnotic susceptibility scale prior to treatment. The two treatment groups received four weekly sessions of their respective treatments. Patients in the hypnosis and relaxation groups reported equivalent decrements in pain, abnormal sounds in the temporomandibular joint, and limitations of jaw mobility. Hypnotic susceptibility was significantly correlated with reductions in reported pain for the treatment groups. Patients’ age and the duration of pain prior to treatment were not related to treatment outcome. Patients who dropped out of treatment had fewer limitations in jaw movement but did not differ on any other variable from patients who remained in treatment. These findings are discussed in relation to the hypothesis that TMPDS is a stress related muscular pain and dysfunction.

Wideman, Margaret V.; Singer, Jerome E. (1984). The role of psychological mechanisms in preparation for childbirth. American Psychologist, 39, 1357-1371.

Psychoprophylactic (Lamaze) preparation for childbirth consists of six to eight classes held during the last trimester of pregnancy. These classes include instruction in the anatomy and physiology of gestation and parturition, respiration techniques, controlled neuromuscular relaxation, visual focusing, and the training of a labor coach. Although the techniques are based upon psychological principles, they have remained largely unstudied by either psychologists or physicians. This article presents a brief history of the development of the training regimen and critically examines the few empirical studies that have been conducted. Because explanations for the efficacy of the preparation, if it exists, are equivocable, literature on the explicit components of the training–that is, information, respiration techniques, conditioned relaxation, cognitive restructuring, and social support–in situations other than child delivery are reviewed and their implications for the Lamaze method discussed. However, because there exist several, more implicit factors that may affect the type of child delivery a prepared woman experiences, the literature concerning social comparison, the effects of commitment and conformity, perceived control, and endorphin secretion are also discussed as they may apply to psychoprophylactic preparation. Problems associated with the study of childbirth preparation are presented, and suggestions for the direction of future research are made.

Boutin, Gerald E.; Tosi, Donald J. (1983). Modification of irrational ideas and test anxiety through rational stage directed hypnotherapy (RSDH). Journal of Clinical Psychology, 39 (3), 382-391.

Examined the effects of four treatment conditions on the modification of Irrational Ideas and test anxiety in female nursing students. The treatments were Rational Stage Directed Hypnotherapy, a cognitive behavioral approach that utilized hypnosis, and vivid emotive imagery, a hypnosis-only treatment, a placebo condition, and a no-treatment control. The 48 Ss were assigned randomly to one of these treatment groups, which met for 1 hour per week for 6 consecutive weeks with in-vivo homework assignments also utilized. Statistically, significant treatment effects on cognitive, affective, behavioral, and physiological measures were noted for both the RSDH and hypnosis group at the posttest and at a 2-month follow-up. Post-hoc analyses revealed the RSDH treatment group to be significantly more effective than the hypnosis only group on both the post- and follow-up tests. The placebo and control groups showed no significant effects either at posttreatment or at follow-up.

Flatt, Jennifer R. (1983). What makes therapy work? Thoughts provoked by a case study. Australian Journal of Clinical and Experimental Hypnosis, 11 (2), 63-72.

The case described is offered as illustrating the doubt common to introspective therapists: what _did_ cure the patient? “Francesca’s” presenting problem and the object of the short-term psychological intervention described here, was a fairly circumscribed set of fears related to enclosed spaces. The therapeutic approach adopted was primarily hypnobehavioural, with hypnotically-assisted systematic desensitization and “in vivo” exposure being the main components of the planned programme. However, at the client’s suggestion, one hypnotic session with content planned by the therapist as age regression produced rather dramatic and unexpected results claimed by the patient to effect complete cure.

The therapist suggested that “her mind would take her back to a time that was important in understanding her fears and that she would be able to stay calm and relaxed while this past event was revealed to her” (p. 69. She subsequently imagined being in a cave, peaceful and calm. “On being roused from hypnosis, Francesca eagerly described her cave image. She was enthusiastic about the significance of this experience, claiming that it was evidence that in a _previous life_ she had died from being locked into a cave as some sort of punishment and that this pexperience made her fear of enclosed places rational and comprehensible to her” (p. 69).

Myles, (1983, April). Cognition, hypnotic susceptibility, and laboratory induced pain (Dissertation, University of Waterloo). Dissertation Abstracts International, 43 (10), 3360-B.

“Individuals’ experiences of pain, and responses to pain treatments vary greatly. This study attempted to relate two areas of research concerned with this variation: (a) cognitions and pain (thoughts, images, etc.), in particular, catastrophizing versus coping; and (b) hypnotic susceptibility and analgesia. “Subjects were preselected for high or low hypnotic susceptibility. Susceptibility assessment was divorced from the laboratory study to minimize the potential bias of expectancies concerning hypnosis. High hypnotic susceptibility was expected to potentiate therapeutic effects of hypnotic-like treatment that did not involve a hypnotic induction. “Ten high and ten low-susceptible subjects were assigned to each of three groups: (a) a cognitive treatment, encouraging subjects to reduce spontaneous catastrophizing and increase self-generated coping cognitions; (b) a dissociative imagery treatment, encouraging subjects to engage in self-generated engrossing images; (c) an attention- placebo manipulation. “Pre and post-treatment assessments involved tolerance and pain-report measures during the cold-pressor task, and interview and questionnaire information concerning cognitions. “No treatment effects were evident on measures of pain. Cognitive data indicated less catastrophizing and more coping during the post-treatment stressor across all groups. Subjects in the dissociative imagery group did report more imagery during the post- treatment assessment than subjects in the other groups, but this increased use of imagery was not associated with a decrease in pain. “Interview and questionnaire data supported prior reports that catastrophizing is related to increased pain. Low catastrophizing was associated with a high sense of control, high use of a variety of coping strategies, and lower pain reports. These relationships were altered following treatment, however, leading to a caution in generalizing about such variables. “High susceptibility did not potentiate therapeutic effects for either experimental treatment. Nor was susceptibility related in any other consistent way to pain, although high susceptibility was associated with more extensive use of post-treatment imagery. “Methodological inconsistencies and problems in laboratory pain research were discussed, and suggestions made for future work in the area” (p. 3360).

Polk, W. M. (1983). Treatment of exhibitionism in a 38-year-old male by hypnotically assisted covert sensitization. International Journal of Clinical and Experimental Hypnosis, 31 (3), 132-138.

This case study reports the successful treatment of a 38-year-old male with a 14 year history of exhibitionism. A multifaceted treatment program was used, involving hypnotically assisted covert sensitization and brief marital therapy. Hypnosis was used to develop psychic aversive and reinforcing stimuli from the patient’s past experience. The value of hypnosis in enhancing imagery in cognitive treatment approaches and the need for only experienced clinicians to utilize the present intervention strategy is discussed.

Schandler, Steven L.; Dana, Edward R. (1983). Cognitive imagery and physiological feedback relaxation protocols applied to clinically tense young adults: A comparison of state, trait, and physiological effects. Journal of Clinical Psychology, 39, 672-681.

Examined changes in targeted and general tension behaviors as well as reductions in physiological tension associated with cognitive imagery and electromyographic biofeedback relaxation procedures. Three groups of 15 female college students participated. During three weekly sessions each person received either guided cognitive imagery relaxation, frontalis muscle feedback relaxation, or a self-rest control procedure. The Anxiety Differential was administered before and after each session, while frontalis EMG, heart rate, and skin temperature were monitored continuously. A second Temperament Analysis was administered after the final session. The imagery procedure was associated with moderate reductions in physiological tension and significant reductions in state anxiety and three tension-related personality dimensions. Self-rest persons displayed lesser reductions in general tension with little physiological change. While biofeedback persons showed the largest reductions in physiological tension, they displayed only small and variable changes in state anxiety and personality dimensions. The data raise continued questions about the application of physiologically based operant relaxation procedures and support the use of cognitively mediated protocols for the treatment of specific or general anxiety behaviors.


Cognitive therapies have, for the most part, proceeded in ignorance of recent work in hypnosis. The present article attempts to summarize some of the findings in hypnosis that are relevant for clinicians and investigators in the tradition of cognitive behavioral modification. Especially important is the concept of suggestion, and the fact of individual differences in hypnotic ability. It is argued that at least some of the therapeutic effectiveness of non-hypnotic therapies may be due to such individual differences. The importance of suggestion appears to be especially important in the treatment of psychosomatic disorders, and numerous illustrations are given showing that therapeutic outcome with such disorders is correlated with hypnotic ability, even when specific hypnotic procedures are not employed.

Howard, L.; Reardon, J. P.; Tosi, D. (1982). Modifying migraine headache through rational stage directed hypnotherapy: A cognitive-experiential perspective. International Journal of Clinical and Experimental Hypnosis, 30 (3), 257-269.

Recent techniques designed to modify migraine headache have emphasized physiological modification via hypnosis only or biofeedback. Psychological factors, however, have been identified as causal in many psychophysiological disorders such as migraine. The present case study describes the results of utilizing Rational Stage Directed Hypnotherapy (RSDH) of Tosi (1974), Tosi and Marzella (1975), and Tosi (1980a) in the treatment of an individual suffering from severe migraine headaches. RSDH, designed to attend to both physiological and psychological factors, is a cognitive-experientially based, stage directed, systematic psychotherapeutic regimen which utilizes hypnosis and hypnotic imagery to enhance the rational restructuring of negative cognitive/emotional/physiologicla/behavioral states.
In the present case study, RSDH demonstrated superior effects over the hypnosis only treatment and baseline in reducing migraine headaches. The client demonstrated improvement on both self-report measurement (frequency of migraine headaches) and objective test results (MPI, Hathaway & McKinley, 1951; Tennessee Self-Concept Scale, Fitts, 1979). In describing this case, particular attention was given to analyzing cognitive distortions via hypnotic imagery in a temporal framework. Analysis and restructuring of past traumatic events which were symbolically affecting the client’s current behavior were particularly significant aspects of the treatment process.

LeBaron, Samuel; Zeltzer, Lonnie (1982, October). The effectiveness of behavioral intervention for reducing chemotherapy related nausea and vomiting in children with cancer. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Indianapolis, IN.

Eight children (nine to seventeen years, Mean age 12.1) with cancer received behavioral intervention for chemotherapy related nausea and vomiting. Within three to five days after the administration of each course of chemotherapy, patients rated (1-10 scale; 1 = none, 10 = all the time or maximal amount) their nausea and vomiting and the extent to which chemotherapy bothered them and disrupted their daily routine. After a pre-intervention assessment of 2.5 courses of chemotherapy, patients received intervention (Mean = 2.6 courses). Significant reductions following intervention (Wilcoxon matched- pairs signed ranks test) were found in nausea (Z = 2.37, p

Lyles, Jeanne Naramore; Burish, Thomas G.; Krozely, Mary G.; Oldham, Robert K. (1982). Efficacy of relaxation training and guided imagery in reducing the aversiveness of cancer chemotherapy. Journal of Consulting and Clinical Psychology, 50, 509-524.

Fifty cancer patients receiving chemotherapy, 25 by push injection and 25 by drip infusion, were assigned to one of three conditions for their chemotherapy treatments: (a) progressive muscle-relaxation training plus guided-relaxation imagery; (b) therapist control, in which a therapist was present to provide support and encouragement but did not provide systematic relaxation training; and (c) no-treatment control. Patients participated in one pretraining, three training, and one follow-up session. Results indicated that during the training sessions, patients who received relaxation training, relative to patients in either of the other two conditions, (a) reported feeling significantly less anxious and nauseated during chemotherapy, (b) showed significantly less physiological arousal (as measured by pulse rate and systolic blood pressure) and reported less anxiety and depression immediately after chemotherapy, and (c) reported significantly less severe and less protracted nausea at home following chemotherapy. The attending nurses’ observations during chemotherapy confirmed patient reports. In general, patients in the therapist control condition and the no-treatment control condition did not differ significantly from each other. The differences among conditions generally remained significant during the follow-up session. The data suggest that relaxation training may be an effective procedure for helping cancer patients cope with the adverse effects of their chemotherapy.

Oliver, George W. (1982-83). A cancer patient and her family: A case study. American Journal of Clinical Hypnosis, 25 (2-3), 156-160.

In recent years, increasing numbers of mental health workers have been attempting to use techniques of psychotherapy to influence the course of malignant disease. This paper reviews in detail the course of treatment of one female patient with an inoperable malignancy and conveys a sense of the clinical experience of working intensively with a cancer patient and her family. It shows the complex levels of interaction within the patient herself, between the patient and her family, and between the therapist and her family and within the therapist himself during different phases of the therapeutic journey.

Redd, William H.; Andrykowski, Michael A. (1982). Behavioral intervention in cancer treatment: Controlling aversion reactions to chemotherapy. Journal of Consulting and Clinical Psychology, 50 (6), 1018-1029.

During the protracted course of cancer chemotherapy, approximately 25% of patients develop aversion reactions to treatment by becoming nauseated and/or vomiting before their chemotherapy treatments. This phenomenon has been conceptualized as a result of respondent conditioning. Since commonly used antiemetic drugs do not reliably control anticipatory nausea/emesis, behavioral techniques of control have been studied. They include hypnosis used in conjunction with guided-relaxation imagery, progressive muscle relaxation with guided imagery, and systematic desensitization. (67 ref)

Redd, William H.; Andresen, Graciela V.; Minagawa, Rahn Y. (1982). Hypnotic control of anticipatory emesis in patients receiving cancer chemotherapy. Journal of Consulting and Clinical Psychology, 50 (1), 14-19.

NOTES: Deep muscle relaxation hypnosis controlled nausea, gagging, retching in all cases. Anticipatory emesis recurred when hypnosis was not used. During subsequent sessions in which hypnosis was reinstated, anticipatory emesis was again controlled.

Redd, William H.; Rosenberger, Patricia H.; Hendler, Cobie S. (1982-83). Controlling chemotherapy side effects. American Journal of Clinical Hypnosis, 25 (2-3), 161-172.

Severe nausea and vomiting are commonly experienced by cancer patients after receiving chemotherapy treatments. Moreover, approximately 25% of these patients develop conditioned aversions to treatment and become nauseated before they receive their chemotherapy injections. The use of deep muscle relaxation hypnosis in conjunction with guided imagery to control pre- and post-chemotherapy nausea and emesis is discussed. Theoretical and clinical issues raised by this application of hypnosis in cancer treatment arc also addressed.

Shapiro, Arnold (1982-83). Psychotherapy as adjunct treatment for cancer patients. American Journal of Clinical Hypnosis, 25 (2-3), 150-155.

During the past ten years psychotherapy as adjunct treatment for cancer patients has become increasingly common. The use of hypnosis as an integral part of that treatment has also burgeoned. This report will follow the progress of two cancer patients in psychotherapy. While each is highly individual, the commonalities which allow treatment to be systematic will be quite apparent. The ability to minimize pain and discomfort, the ability to keep the white cell count high despite ongoing chemotherapy, and augmenting the ability of the body’s immune system to fight the disease are utilized by both of the patients. All of the above are accomplished through the use of visual imagery in the trance state. Visual imagery is also used to reach feelings which patients are often unable to verbalize, and of which they often claim to be unaware. Other aspects of therapy such as the gradual shift from despair to hope and even confidence, and the development of more assertive behavior are discussed.

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.

“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).

Araoz, Daniel L. (1981). Negative self-hypnosis. Journal of Contemporary Psychotherapy, 12, 45-52.

A review of recent developments in psychotherapeutic methods of cognitive behavior therapy leads to the conclusion that negative self-hypnosis (NSH) is operative in problematic behavior. NSH is elucidated, and a counteractive, five-stage approach of self-hypnosis is proposed to effectively deal with NSH.

Kellerman, J. (1981). Hypnosis as an adjunct to thought stopping and covert reinforcement in the treatment of homicidal obsessions in a twelve-year-old boy. International Journal of Clinical and Experimental Hypnosis, 29 (2), 128-135.

A combined cognitive behavioral approach was used to successfully treat matricidal obsessions in an otherwise psychologically well-adjusted 12-year-old boy. The primary problem was conceptualized as anxiety over loss of control. Therapeutic techniques included re-defining of symptoms, thought-stopping, hypnotic enhancement of imagery in order to facilitate cognitive restructuring, covert reinforcement, home practice, and paradoxical instructions to produce the symptom. A decline in obsessions began after 3 sessions and total remission was observed after 6 sessions (10 weeks). 2-year follow-up revealed no recurrence of symptoms. The value of hypnosis as an adjunct to behavior therapy with children is discussed.

O’Brien, Richard M.; Cooley, Lewis E.; Ciotti, Joseph; Henninger, Kathleen M. (1981). Augmentation of systematic desensitization of snake phobia through posthypnotic dream suggestion. American Journal of Clinical Hypnosis, 23, 231-238.

Nine snake phobics who had scored above eight on the SHSS (Form A) were given four desensitization sessions and five sessions in which a pleasant posthypnotic dream of the phobic object was suggested. These subjects were significantly superior to a desensitization-only control group on a behavioral avoidance test. Seven of the nine hypnosis subjects were able to touch a real snake. The two subjects who did not touch the snake reported dreams in which the snake was either absent or threatening. Although conclusions are limited by differential attention and susceptibility, the technique seems promising.

Scrignar, C. B. (1981). Rapid treatment of contamination phobia with hand-washing compulsion by flooding with hypnosis. American Journal of Clinical Hypnosis, 23, 252-257.

Two obsessive-compulsive patients with contamination phobias and hand-washing compulsions are presented. Psychoanalytic psychotherapy had resulted in little change. Behavior therapy techniques of thought-stopping, systematic desensitization, progressive muscle relaxation, cognitive restructuring and self-imposed response prevention were first used, resulting in some subjective improvement, but no change in the hand-washing rate. Hypnosis, emphasizing relaxation, positive suggestion and corrective information provided further temporary subjective improvement but little change in compulsive rituals. Hypnosis, combined with the behavioral technique of flooding, produced rapid improvement. The patients maintained improvement at seven years and two years. Flooding under hypnosis may afford obsessive-compulsive patients a rapid and economical therapeutic procedure.

Worthington, Everett L.; Shumate, Michael (1981). Imagery and verbal counseling methods in stress inoculation training for pain control. Journal of Counseling Psychology, 28 (1), 1-6.

Investigated 3 elements of stress inoculation training, a therapeutic package for helping clients control anxiety, anger or pain. 96 undergraduate females were tested twice for ice water tolerance. In a 3 design, the independent variables were the presence or absence of (a) pleasant imagery, (b) a conceptualization of pain as a multistage process, and (c) planned, explicit self-instructions. A multivariate analysis of covariance using the (transformed) pretest tolerance rating and 2 self-ratings of pain. Imagery users (Is) controlled their pain better than nonimagery users (NIs). There was a significant interaction of Imagery and Conceptualization. NIs had longer tolerance and less self- reported pain at withdrawal when they heard no conceptualization. The Is did not derive additional benefit from hearing the conceptualization. Self-instruction did not affect pain control. Results suggest that pleasant imagery effectively relieves pain and may account for much of the effectiveness of stress inoculation training. (23 ref)

Bornstein, Philip H.; Devine, David A. (1980). Covert modeling-hypnosis in the treatment of obesity. Psychotherapy: Theory, Research and Practice, 17 (3), 272-276.

Investigated the efficacy of a covert modeling/hypnosis treatment package in the control of obesity. 48 overweight female volunteers (who had been administered the Harvard Group Scale of Hypnotic Susceptibility, Eating Patterns Questionnaire, and Rotter’s Internal-External Locus of Control Scale) were randomly assigned to 1 of the following groups: (a) covert modeling/hypnosis, (b) covert modeling, (c) no-model scene control, and (d) minimal treatment (where Ss received a shortened version of the covert modeling/hypnosis procedure following an 8-wk no-treatment period.) Results indicate a significant effect for weight loss from pretreatment to follow-up across all groups combined. Proportion weight loss measures indicated significantly greater weight loss only for the covert modeling/hypnosis group as compared to the no-model controls. Implications for combining behavior therapy and hypnotic techniques are discussed. (30 ref).

Bornstein, P. H.; Rychtarik, R. G.; McFall, M. E.; Winegardner, J.; Winnett, R. L.; Paris, D. A. (1980). Hypnobehavioral treatment of chronic nailbiting: A multiple baseline analysis. International Journal of Clinical and Experimental Hypnosis, 28 (3), 208-217.

3 highly hypnotizable Ss were administered a hypnobehavioral treatment package in an attempt to alleviate chronic nailbiting behavior. The combined hypnotic and behavioral procedures included standard induction and deepening techniques, motivation enhancement, time-projection, self-reinforcement, aversion-relief, coping self-instructions, and posthypnotic suggestion. A multiple baseline design across Ss was employed as a means of evaluating the treatment intervention. Results for all Ss indicated immediate and dramatic increase in fingernail lengths concomitant with the introduction of treatment. At 3-month follow-up, 1 S demonstrated a moderate reversal effect while the remaining 2 Ss continued to indicate substantial progress. These findings were discussed with regard to the efficacy of hypnobehavioral treatment strategies and utilization of single-case experimental designs in future hypnotherapy research.

Powell, Douglas H. (1980). Helping habitual smokers using flooding and hypnotic desensitization techniques: A brief communication. International Journal of Clinical and Experimental Hypnosis, 28 (3), 192-196.

A subgroup of individuals who were helped to stop smoking by hypnosis or other means returned to consuming a few cigarettes a day. A flooding and hypnotic desensitization technique assisted 4 of 7 individuals who resumed smoking in becoming and remaining abstinent for a 6- to 9-month follow-up period.

Puente, Antonio E.; Beiman, Irving (1980). The effects of behavior therapy, self-relaxation, and transcendental meditation on cardiovascular stress response. Journal of Clinical Psychology, 26 (1), 291-295.