An outstanding collection on hypnosis and related subjects — about 800 items — is housed at Vanderbilt University. It was assembled by Albert Moll, an eminent practitioner, who himself contributed many scholarly works to the field. Information about Moll and his unique collectino is called to the attention of scholars who have a special interest in the history of hypnosis.
Biofeedback
2002
Hammond, D. C. (2002). Treatment of chronic fatigue with neurofeedback and self-hypnosis.. NeuroRehabilitation, 16, 1-6..
A 21 year old patient reported a relatively rapid onset of serious chronic fatigue syndrome (CFS), with her worst symptoms being cognitive impairments. Congruent with research on rapid onset CFS, she had no psychiatric history and specialized testing did not suggest that somatization was likely. Neuroimaging and EEG research has documented brain dysfunction in cases of CFS. Therefore, a quantitative EEG was done, comparing her to a normative data base. This revealed excessive left frontal theta brainwave activity in an area previously implicated in SPECT research. Therefore, a novel treatment approach was utilized consisting of a combination of EEG neurofeedback and self-hypnosis training, both of which seemed very beneficial. She experienced considerable improvement in fatigue, vigor, and confusion as measured pre-post with the Profile of Mood States and through collaborative interviews with both parents. Most of the changes were maintained at 5, 7, and 9 month follow-up testing.
Shenefelt, Philip (2002). Complementary psychotherapy in dermatology: Hypnosis and biofeedback. Clinics in Dermatology, 20 (5), 595-601.
Hypnosis has been used for millenia to treat medical and dermatologic problems. The use of biofeedback is more recent, being dependent on instrumentation to measure such parameters as galvanic skin resistance (GSR) and skin temperature.
Numerous dermatological disorders may be improved or cured using hypnosis as an alternative or complementary therapy. Examples include acne excoriee, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. Dermatologic procedure anxiety can also be reduced using hypnosis.
Skin problems that have an autonomic nervous system component can be assisted by biofeedback with or without hypnosis. Examples include biofeedback of GSR for hyperhidrosis and biofeedback of skin temperature for Raynaud”s syndrome. Hypnosis may enhance the effects obtained by biofeedback.
1999
Kirsch, Irving; Lynn, Steven Jay (1999). Automaticity in clinical psychology. American Psychologist, 54 (7), 504-515.
The authors provide an overview of the literature on the ability of response expectancies to elicit automatic responses in the form of self-fulfilling prophecies and link it to the broader psychological investigation of automatic processes. The authors review 3 areas of research in which response expectancies have been shown to affect experience, behavior, and physiology: placebo effects, the effects of false biofeedback on sexual arousal, and the alteration of perceptual and cognitive functions by hypnotic and nonhypnotic suggestion. Also reviewed are data suggesting that all behavior, including novel and intentional behavior, is initiated automatically. Following this review, the authors summarize some of the ways in which knowledge of response expectancy effects and other automatic processes that influence experience and behavior can enhance clinical practice.
NOTES 1:
Although expectancy accounts for some variance in the development of classical hypnosis effects, it is also true that “experimental data suggest that faking accounts for relatively few of these effects” (p. 507). “The best predictors of hypnotic suggestibility are waking suggestibility and response expectancy, and expectancy remains a significant predictor of hypnotic response even with waking suggestibility controlled (Braffman & Kirsch, in press; Kirsch, 1997)” (p. 508). The authors theorize that automatisms (like Chevreul pendulum) are “responses that are primed for automatic activation by two response sets: an intention and an expectancy for their occurrence” (p. 508). They suggest that most behavior is routine, virtually automatic, because cognitive structures like schemas, scripts, or plans that are outside immediate awareness trigger the behavior. They cite research by Libet (1985) and hypotheses developed by Nisbett & Wilson (1977) and Dennett (1991), concluding that “the feeling of will is a judgment, rather than an introspected content” (p. 509). The authors discuss the Chevreul pendulum phenomenon in terms of expectancy theory and explore how their theory would apply to psychotherapy.
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.
1998
Eimer, Bruce; Freeman, Arthur (1998). Pain management psychotherapy: A practical guide. New York NY: John Wiley & Sons, Inc
NOTES 1:
“Pain Management Psychotherapy” (PMP) provides a clear and methodical look at pain management psychotherapy beginning with the initial consultation and work-up of the patient and continuing through termination of treatment. It is a thoughtful and thorough presentation that covers methods for psychologically assessing the chronic pain patient (structured interviews, pain assessment tests and rating scales, instruments for evaluating beliefs, attitudes, pain behavior, disability, depression, anxiety, anger and alienation), treatment planning, cognitive-behavioral therapy techniques, and a range of hypnotic approaches to pain management. The book covers both traditional (cognitive and behavior therapy, biofeedback, assessing hypnotizability, choice of inductions, designing an individualized self-hypnosis exercise) as well as newer innovative techniques (e.g., EMDR, pain-relief imagery, hypno-projective methods, hypno-analytic reprocessing of pain-related negative experiences). An extensive appendix reproduces in their entirety numerous forms, rating scale, inventories, assessment instruments, and scripts.
The senior author, Bruce Eimer, states in his online comments on Amazon.com that “most therapists hold the belief that ‘real’ chronic pain patients are quite impossible to help. This book attempts to dispel these misguided beliefs by providing a body of knowledge, theory, and techniques that have proven value in understanding and relieving chronic physical pain.” He also states that “the challenge for the therapist is to persuade the would-ne patient/client that he or she has something to offer that can help take way pain and bring back more pleasure. This challenge is negotiated through the therapeutic relationship. However, the therapist just can’t be ‘warm, accepting, non-judgmental and empathic’. The therapist must also have knowledge and skills relevant to relieving pain. Only then can the therapist impart such knowledge, and in teaching these skills to the pain patient, help the patient become something of a ‘self-therapist’. . . I dedicate this book to everyone who wants to find ways to make living with pain more comfortable, and to the ongoing search for better ways to relieve pain.”
1996
DeBenedittis, Giuseppe De (1996). Hypnosis and spasmodic torticollis — report of four cases: A brief communication. International Journal of Clinical and Experimental Hypnosis, 44 (4), 292-306.
Dystonia and particularly spasmodic torticollis are neuromuscular disorders that are extremely resistant to most therapies (physical, medical, or surgical). Torticollis is a unilateral spasm of the neck muscles, particularly of the sternocleidomastoid, that produces violent, tonic turning of the head to one side. The etiology remains uncertain, although the role of psychogenic factors has been emphasized. This article reviews the literature and reports four cases of spasmodic torticollis treated successfully with hypnosis. In all four cases, psychogenic causes were involved. Postural hypnosis (i.e., hypnosis in the standing position) was employed to counteract and minimize muscle spasms due to postural reflexes. A hypnobehavioral approach was adopted along with hypnotic strategies that included hierarchical desensitization, sensory-imaging conditioning, ego-boosting suggestions, and hypnosis-facilitated differential muscle retraining. In two cases, a combined hypnosis and electromyographic-biofeedback approach was used to equilibrate and retrain affected neck muscles. Although the hypnotherapeutic process took several months to induce and stabilize significant changes, outcome results were good to excellent in all cases, with marked reduction of the torticollis and the hypertrophy of the neck muscles as well as a reduced interference of symptoms in daily living. — Journal Abstract
1995
Capafons, A.; Amigs, S. (1995). Emotional self-regulation therapy for smoking reduction: Description and initial empirical data.. International Journal of Clinical and Experimental Hypnosis, 43 (1), 7-19.
Self-regulation therapy (Amigs, 1992)is a set of procedures derived from cognitive skill training programs for increasing hypnotizability. First, experiences are generated by actual stimuli. Clients are then asked to associate those experiences with various cues. They are then requested to generate the experiences in response to the cues, but without the actual stimuli. When they are able to do so quickly and easily, therapeutic suggestions are given. Studies of self-regulation therapy indicate that it can be used sucessfully to treat smoking.
1994
Culbert, Timothy P.; Reany, Judson B.; Kohen, Daniel P. (1994). Cyberphysiologic strategies for children: The clinical hypnosis/biofeedback interface. International Journal of Clinical and Experimental Hypnosis, 42 (2), 97-117.
This article presents an in-depth discussion of the integrated use of self-hypnosis and biofeedback in the treatment of pediatric biobehavioral disorders. The rationale for integrating these techniques and their similarities and differences are discussed. The concepts of children’s imaginative abilities, mastery, and self-regulation are examined as they pertain to these therapeutic strategies. Three case studies are presented that illustrate the integrated use of self-hypnosis and biofeedback in the treatment of children with psychophysiologic disorders. The authors speculate on the specific aspects of these self-regulation or “cyberphysiologic” techniques that appear particularly relevant to positive therapeutic outcomes.
1993
Wickramasekera, Ian (1993). Observations, speculations and an experimentally testable hypothesis on the mechanism of the presumed efficacy of the Peniston and Kulkosky procedure. Biofeedback, 21, 17-20.
Raises the speculation that alpha/theta EEG brainwave training procedures that have shown preliminary effectiveness with alcoholics and PTSD war veterans may be effective, at least in part, because of an enhancement of hypnotizability resulting from such training. Research to evaluate this is suggested.
1992
Bindler, Paul R. (1992, October). Biofeedback-assisted hypnosis: Theoretical and clinical perspectives. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.
NOTES:
Relates personality trait of absorption to biofeedback literature. Surprisingly, low absorption ability Ss do better than high absorption Ss on biofeedback (Qualls & Sheehan). All but one study that compared biofeedback and hypnosis found no difference in effectiveness. However recently Miller & Cross found high hypnotizables reduce EMG better with hypnosis and lows did better with biofeedback.
Our findings also supported notion that highs perform better with sensory imagery instructions and lows do better with biofeedback. Critical in determining the outcome is the way Ss deploy attention. Qualls & Sheehan, and we, find highs don’t like attention drawn away from internal cognitive strategies by the biofeedback signal. However lows find the signal to keep their attention focused. Author developed model combining biofeedback and hypnosis to capitalize on the attentional characteristics of patients, the specific cognitive and affective characteristics of the pt. Highs start with using altered state of consciousness to help them to alter their cognition patterns. Some do not relax during hypnosis and biofeedback can be used. Hypnotic suggestions can be added to biofeedback to emphasize attention to internal discrimination. Attention to stimuli is poor when arousal is too low or too high. Both biofeedback and hypnosis can be used to create a moderate level of attention.
With low hypnotizables, they need to increase awareness of contingencies between cognitions and physiological states; to verbalize and express their feelings. Initially they learn to recognize, label, and express their feelings through biofeedback, which amplifies the physiol. state/body sensations. It provides a means of relaxation. Begin with brief trials of biofeedback to train low arousal states. Duration of training is gradually lengthened to 15 minutes. Patient should be continually questioned about feelings etc. (physical) during exercise, and their response correlated with the feedback signal.
Many lows have difficulty expressing feelings in words. Biofeedback allows the correlation to emerge initially by the instruments. Crystal’s “preparatory” treatment: helping patient with affect tolerance prepares them for next stage of verbalizing emotions. Biofeedback facilitates this by deintensifying the effect of discharged affect.
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
Acosta-Austan, Frank (1991). Tolerance of chronic dyspnea using a hypnoeducational approach: A case report. American Journal of Clinical Hypnosis, 33, 272-277.
A 48-year-old woman with severe, chronic obstructive pulmonary disease was instructed in the use of peak-flow feedback and hypnotically induced relaxation to reduce the intensity of dyspnea during periods of anxiety. Peak-flow information provided physiologic feedback as well as a safety feature in the event that subjective improvement did not correspond with objective physiologic improvement. I used a progressive relaxation method for inducing hypnosis and gave her suggestions of well-being and muscle relaxation. Peak-flow feedback was useful in enhancing the patient’s confidence that hypnotic relaxation was successful in improving respiratory function.
Russell, Christine; Davey, Graham C. (1991). The effects of false response feedback on human ‘fear’ conditioning. Behaviour Research and Therapy, 29 (2), 191-196.
Describes a human electrodermal conditioning experiment in which 28 students (aged 19-30 yrs) were given false skin conductance feedback during conditioned stimulus/stimuli (CS) presentation. In comparison with attentional control groups, Ss who believed they were exhibiting a strong conditioned response (CR) did actually emit a greater magnitude CR, while Ss who believed they were exhibiting a weak CR emitted a lower magnitude CR. When both self-report and behavioral measures of unconditioned stimulus/stimuli (UCS) evaluation were taken after conditioning, response feedback (RFB) had not differentially affected Ss’ evaluation of the aversiveness of the UCS. The response modulating effects of RFB may not be caused by RFB influencing evaluation of the UCS, but they are consistent with the hypothesis that beliefs about the nature of RFB influence the strength of the UCS representation itself.
Schwarz, Shirley P.; Blanchard, Edward B. (1991). Evaluation of a psychological treatment for inflammatory bowel disease. Behaviour Research and Therapy, 29 (2), 167-177.
Compared the effectiveness of a multicomponent behavioral treatment package, which included inflammatory bowel disease (IBD) education, progressive muscle relaxation, thermal biofeedback, and training in use of cognitive coping strategies, with the effectiveness of symptom-monitoring as a control condition. The treatment group consisted of 11 IBD patients (aged 25-62 yrs); 8 of 10 persons (aged 25-71 yrs) in the control group completed treatment. At posttreatment, the treatment group showed fewer reductions in symptoms (5) than the symptom-monitoring controls (8). However, treated Ss perceived themselves as coping better with IBD and as feeling less IBD-related stress. It is hypothesized that the differences in treatment responses may be related to differences between Ss with ulcerative colitis and Ss with Crohn’s disease.
Weisz, G. (1991, December). Meta-analysis of hypnosis and biofeedback pain control with children, adolescents and young adults (Dissertation, Pace University). Dissertation Abstracts International, 52 (6), 3321-B. (Order No. DA 9132945)
NOTES:
This study used meta-analysis to investigate the issues related to treatment efficacy with hypnosis and biofeedback in anxiety management and in child, adolescent, and young adult pain. Analysis revealed that hypnosis and biofeedback were effective in pain and anxiety reduction and appeared equally effective. This contrasts with metaanalysis results by Malone & Strube (1988) showing almost triple superiority of hypnosis and autogenic training over biofeedback. The study notes methodologic variables that may distort or reduce the size of obtained effects.
1990
Schwarz, Shirley P.; Taylor, Ann E.; Scharff, Lisa; Blanchard, Edward B. (1990). Behaviorally treated irritable bowel syndrome patients: A four-year follow-up. Behaviour Research and Therapy, 28 (4), 331-335.
A 4-yr longitudinal study evaluated 19 patients (aged 23-60 yrs) suffering from Irritable Bowel Syndrome (IBS) who had completed a multicomponent treatment involving progressive muscle relaxation, thermal biofeedback, cognitive therapy, and IBS education at baseline. 17 Ss rated themselves as more than 50% improved. Six of the 12 Ss who submitted symptom monitoring diaries met the criteria for clinical improvement, (i.e., achieving at least a 50% reduction in primary IBS symptom scores). The means on all measures at long-term follow-up were lower than those obtained prior to treatment. When follow-up symptom means were compared with pretreatment means, significant reductions were obtained on abdominal pain/tenderness, diarrhea, nausea, and flatulence.
1989
Wickramasekera, Ian (1989). Enabling the somatizing patient to exit the somatic closet: A high-risk model. Psychotherapy: Theory, Research and Practice, 26 (4), 530-544.
Problems in establishing a therapeutic alliance make somatizing patients poor candidates for psychotherapy. A logical analysis is presented of the conspiracy of silence between the somatizing patient, the medical doctor, and the health insurance industry regarding the psychosocial factors contributing to somatization. Alternatives are sought to repeated biomedical tests and therapies that are clinically unproductive and iatrogenic. Two psychophysiological pathways are proposed that are promising to reduce the distance between the medical doctors’ and the psychologists’ procedures. The new profile of illness has produced a paradigm shift with implications for an expansion of the definition of the word “physician”.
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.
Spinhoven, Philip (1988). Similarities and dissimilarities in hypnotic and nonhypnotic procedures for headache control: A review. American Journal of Clinical Hypnosis, 30 (3), 183-194.
Similarities and differences between hypnosis and similar psychological procedures in the treatment of headache are reviewed. A brief outline of various hypnotic and nonhypnotic interventions for headache reduction shows that none of these procedures has consistently proved to produce superior results. Possible common denominators such as control of physiological processes, placebo factors, and the alteration of cognitive factors are discussed. The positive relationship between hypnotic susceptibility and hypnotic pain reduction indicates that the value of hypnosis seems to be less a matter of therapeutic procedure per se than of which context activates a patient’s hypnotic potential for pain reduction.
NOTES:
The author summarizes literature on biofeedback and relaxation: “(a) biofeedback with home practice of relaxation is, at least in some cases, effective in reducing migraine and tension headache; (b) relaxation training alone has also produced some success in reducing migraine and tension headaches; and (c) there is not sufficient evidence that biofeedback in the treatment of these pain problems yields results superior to relaxation training” (p. 184). Hypnotherapy for headache is not reviewed in detail, but he provides a table showing various controlled studies and their results. “With the exception of the methodologically problematic study of Anderson, Basker, and Dalton (1975), no differences in effect are found between hypnosis and biofeedback (Andreychuck & Skriver, 1975; Schlutter, Golden, & Blume, 1980; Friedman & Taub, 1984) and hypnosis and relaxation (Friedman & Taub, 1984; Spinhoven, Van Dyck, Zitman, & Linnsen, 1985)” (p. 184). He notes that there are no studies that directly compare hypnosis and nonhypnotic relaxation interventions for headache.
“In all the studies in which hypnotizability was related to outcome, irrespective of patient selection method of measurement, and hypnotic procedure used, a significant positive relationship between hypnotizability and therapy results was found in more than 350 patients (Andreychuck & Skriver, 1975; Cedercreutz, Lahteenmaki, & Tulikoura, 1976; Cedercreutz, 1978; Friedman & Taub, 1984; Spinhoven et al., 1985). If we consider the level of hypnotizability rather than the details of the hypnotic procedure, it seems that headache patients who are highly hypnotizable benefit more from hypnosis in the reduction of headache.
“However, little reliable information is available concerning the underlying dimensions of hypnotic susceptibility relevant for pain reduction. In the neodissociation theory of Hilgard it is suggested that highly hypnotizable patients register pain covertly outside conscious awareness (Hilgard, 1977, 1979). In the social learning model of Spanos and his coworkers (Spanos, Radtke-Bodorik, Ferguson, & Jones, 1979; Spanos, Kennedy, & Gwynn, 1984), it is assumed that high susceptibles show a relatively greater preference for focusing attention on internal thoughts and images as a way of attenuating pain than low susceptibles.
“A recent experimental study of Miller and Bowers (1986), which directly compared hypnotic analgesia, cognitive-behavior therapy, and cognitive-behavior therapy defined as hypnosis in high and low susceptibles, suggests that pain reduction achieved by highly hypnotizable subjects during hypnosis is not mediated by the deliberate use of cognitive strategies (such as imaginative inattention). Cognitive strategy use resulted in pain reduction only during behavior therapy. Clinical studies about the experiential aspects of high and low susceptible headache patients during hypnosis, biofeedback, relaxation training, and cognitive-behavior therapy are urgently needed. If process research in a clinical setting validates that hypnotic analgesia involves the activation of a subsystem of pain control temporarily dissociated from conscious executive control, a therapy component specific for hypnosis will have been identified” (pp. 189-190).
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.
NOTES:
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).
1986
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
LaRiccia, P. J.; Katz, R. H.; Peters, J. W.; Atkinson, G. W.; Weiss, T. (1985). Biofeedback and hypnosis in weaning from mechanical ventilators. Chest, 87, 267-269.
Weaning patients from mechanical ventilation can be hindered by both physical and psychologic factors. Biofeedback has been used successfully as an adjunct in difficult weaning problems. We have used a combination of hypnosis and biofeedback to wean a patient with neurologic disease who previously failed weaning by standard procedures. A 30-year-old woman with respiratory failure secondary to multiple sclerosis with transverse myelitis was given eight sessions of biofeedback over 12 days in which the movements of her chest wall, as monitored by magnetometers, were displayed on an oscilloscope. The patient was praised for targeted respiratory rate, amplitude, and rhythm. These sessions included hypnosis in which the patient was given suggestions of well-being and that she could breathe as she had five years earlier. In this manner the patient was successfully weaned. Respiratory biofeedback and hypnosis appear to be useful adjuncts in weaning patients form ventilators.
Miller, Lorence S.; Cross, Herbert J. (1985). Hypnotic susceptibility, hypnosis, and EMG biofeedback in the reduction of frontalis muscle tension. International Journal of Clinical and Experimental Hypnosis, 33, 258-272.
Biofeedback and hypnosis have been used in the treatment of similar disorders. While each has been useful, it is unclear whether they involve similar or conflicting processes. Bowers & Kelly (1979) have hypothesized that high hypnotizable Ss are more likely to benefit from hypnosis and similar procedures, than moderate and low hypnotizable individuals. In contrast, Qualls & Sheehan (1979, 1981 a, b, c) have argued that hypnosis and biofeedback involve antithetical abilities. In the present study, high, moderate, and low hypnotizable individuals (N = 60) were randomly assigned to either EMG biofeedback or hypnosis conditions and instructed to relax. It was found that the mean percent reduction in frontalis muscle tension over the last 5 trials was significantly greater for the high hypnotizable Ss during hypnosis than the moderate and low hypnotizable Ss. The moderate and low hypnotizable Ss demonstrated greater reductions in frontalis muscle tension during EMG biofeedback than during hypnosis. These findings are partly supportive of the predictions of Qualls and Sheehan that hypnosis and biofeedback involve antithetical processes.
NOTES:
Qualls and Sheehan (1979, 1981a) “have hypothesized that biofeedback and hypnosis abilities involve antithetical or antagonistic cognitive processes. Specifically, they argued that the biofeedback signal interferes with the natural ability of high absorption Ss to ‘direct their attention in an effortless manner toward subjective, imaginal experience [1981a, p. 33],’ by forcing them to attend to the external environment. In contrast, low absorption Ss, as well as moderate hypnotizable Ss, possess inadequate abilities to direct their attention in such an effortless and absorbing manner towards inner, subjective experiences, and therefore, the biofeedback signal better enables them to focus their attention. While the pattern of EMG results among the high, moderate, and low hypnotizable Ss … was somewhat consistent with these predictions, the self-report data did not reveal differences in Ss’ awareness of the biofeedback signal or hypnotic suggestions. In addition, there was only a trend for the high hypnotizable Subjects to report less effort in attempting to relax. It is, therefore, unclear whether the explanations postulated by Qualls and Sheehan (1979, 1981a) for the differences found in this study are valid” (p. 269).
Subjective relaxation response results were complex. Ss were asked how relaxed they were during the experimental session in comparison to the previous hypnosis sessions (screening tests). Biofeedback Ss rated the experimental session less favorably than hypnosis Ss. Ss were asked to what degree the feedback (or hypnotic suggestions) helped them to relax; there were significant main effects for treatment and trait, as well as a significant trait x sex interaction. Hypnosis Ss reported that this procedure was more helpful than was reported by the biofeedback Ss. Newman-Keuls comparison revealed that the main effect for trait was due to the high hypnotizable Ss reporting more help from the procedures than the low hypnotizable Ss, and moderate hypnotizable Ss. The Trait x Sex interaction was the result of the high hypnotizable female Ss indicating more help from either relaxation procedure, than was reported by the low hypnotizable male Ss and moderate hypnotizable female Ss and the high hypnotizable male Ss indicated that the procedures were significantly more helpful than was reported by the low hypnotizable male Ss.
Schlesinger, Jay Lawrence (1985). Hypnotizability in relation to success in learning biofeedback training: Attentional involvement (Dissertation, Adelphi University). Dissertation Abstracts International, 45 (n8-B), 2701. (Order No. DA 8424937)
NOTES:
“This study investigated the role of attentional focus in the relationship between hypnotizability and success in learning two types of biofeedback training. 40 female college students, aged 18-25, were measured for hypnotic responsiveness, and given one session of EMG biofeedback and one session of temperature biofeedback. For the biofeedback training, 20 Ss received written instructions designed to establish a passive, non-volitional attentional focus on the feedback signal, and 20 received written instructions intended to establish an active, volitional attentional focus on the feedback signal.
“It was hypothesized that level of hypnotizability would be positively related to success in learning EMG and temperature biofeedback training for the Ss given passive, non-volitional attentional instructions, while level of hypnotizability would be negatively related to success in learning biofeedback training for the Ss given active, volitional attentional instructions. It was also hypothesized that higher hypnotizables would perform better with temperature biofeedback than with EMG biofeedback, and that lower hypnotizables would perform better with EMG biofeedback than with temperature biofeedback.
“The hypotheses were not supported, nor was any overall relationship between level of hypnotizability and success in learning biofeedback demonstrated. There was support to suggest that an active, volitional attentional focus on the biofeedback signal was most adequately maintained by the 20 Ss given the active volitional instructions. Clinical implications of these findings and directions for future research were discussed”
1984
Funch, Donna P.; Gale, Elliot N. (1984). Biofeedback and relaxation therapy for chronic temporomandibular joint pain: Predicting successful outcomes. Journal of Consulting and Clinical Psychology, 52 (6), 928-935.
Fifty-seven patients with chronic temporomandibular joint (TMJ) pain were randomly assigned to receive either relaxation or biofeedback therapy. Therapy efficacy was assessed (immediate posttreatment and 2-year follow-up), and pretherapy factors (demographic, clinical, personality) were used to predict successful outcomes for each therapy group. Although there were no significant differences in outcomes, characteristics of patients with successful outcomes were not similar for the two therapies. Successful patients in the relaxation condition tended to be younger, had experienced TMJ pain for a shorter period of time, and had reported problems with other psychophysiologic disorders. Successful patients in the biofeedback group tended to be older, married, had experienced TMJ pain for a longer period of time, and had not received prior equilibration treatment. Only two of these factors, equilibration and presence of other disorders, were related to both short- and long-term outcomes, suggesting that they may be particularly useful as predictors of outcome. These findings do suggest that knowledge of pretherapy factors, particularly clinical, may allow for more optimal assignment to therapy conditions.
Murphy, Joseph K.; Fuller, A. Kenneth (1984). Hypnosis and biofeedback as adjunctive therapy in blepharospasm: A case report. American Journal of Clinical Hypnosis, 27, 31-37.
The efficacy of ophthalmologic, hypnotic, and biofeedback treatment procedures in a case of blepharospasm was evaluated. Manual eye rubbing and eye opening served as dependent measures which were assessed by the patient during treatment and a three month follow-up. Results indicated that ophthalmologic treatment had a limited effect. In contrast, brief hypnosis had a dramatic but short-lived effect and biofeedback had a moderate but sustained effect. Results are discussed in terms of the efficacy of psychological intervention, the limitations of the report, and the need for future research.
1983
Radtke, H. Lorraine.; Spanos, Nicholas P.; Armstrong, L. A.; Dillman, N.; Boisvenue, M. E. (1983). Effects of electromyographic feedback and progressive relaxation training on hypnotic susceptibility: Disconfirming results. International Journal of Clinical and Experimental Hypnosis, 31 (2), 98-106.
The efficacy of relaxation training in modifying hypnotic susceptibility was investigated. Following 2 pretests of hypnotic susceptibility, 24 Ss who scored 7 or below on both tests were randomly assigned to 1 of 2 relaxation training groups (EMG-biofeedback or progerssive relaxaton) or a no-treatment control group. Relaxation training was conducted over 10 20-minute sessions and was monitored by measurement of frontalis EMG. All Ss were then administered a posttest of hypnotic susceptibility. Hypnotic susceptibility did not increase significantly from pretest to posttest. Moreover, change in frontalis EMG was unrelated to change in susceptibility. These results fail to confirm earlier work conducted by Wickramasekera (1972, 1973, 1977).
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.
1982
Credidio, Steven G. (1982). Comparative effectiveness of patterned biofeedback vs meditation training on EMG and skin temperature changes. Behaviour Research and Therapy, 20, 233-241.
Examined whether a low arousal, relaxation pattern of frontalis EMG decreases and peripheral skin temperature increases could be attained more effectively through biofeedback or meditation training. 30 21-59 yr old females were randomly assigned to 1 of 3 groups: patterned biofeedback, clinically standardized meditation, or control. Prior to training, Ss were administered the Eysenck Personality Inventory. Each S was seen weekly for 7 sessions. Subjective experiences and time spent practicing at home were also recorded. Results indicate that the meditation group showed significantly lower EMG levels at the end of treatment than did the control group. The biofeedback group had difficulty in patterning the 2 feedback signals simultaneously. Extraverts in the control group had the highest EMG levels. The most positive subjective reports came from Ss in the meditation group. It is suggested that meditation offers a viable alternative as a relaxation procedure, requiring little time to learn and devoid of any performance criteria levels.
Holroyd, Jean; Nuechterlein, Keith; Shapiro, David; Ward, Frederick (1982). Individual differences in hypnotizability and effectiveness of hypnosis or biofeedback. International Journal of Clinical and Experimental Hypnosis, 30 (4), 45-65.
8 high and 8 low hypnotizable Ss used biofeedback and hypnosis to lower blood pressure in one session and forehead EMG activity in another session. Results were analyzed by repeated measures analyses of covariance using baseline physiological level on the dependent variable as the covariate. Electromyographic level was reduced more immediately by biofeedback than by hypnosis. When the task was to lower blood pressure, blood pressure and skin conductance were more effectively reduced by hypnosis than by biofeedback, considering only the first half of each session to eliminate within- session transfer effects. Hypnotizability did not predict overall outcome. Factors which may have prevented demonstrating a clearer relationship between hypnotizability and success using biofeedback or hypnosis are discussed. State and trait anxiety, cognitive strategies used during the tasks, and self-reported hypnotic depth are examined for correlates of successful performance.
Lehrer, Paul M. (1982). How to relax and how not to relax: A re-evaluation of the work of Edmund Jacobson: I.. Behaviour Research and Therapy, 20 (5), 417-428.
Contrasts E. Jacobson’s (1928-1970) method of progressive relaxation with modified techniques that emphasize suggestion, brevity, and the feeling of large differences between tension and relaxation. The literature suggests that the modifications may have been premature. The psychophysiological effects of suggestion are weaker than those of progressive relaxation. Tape-recorded instruction appears to be completely ineffective as a method for teaching relaxation as a skill that can be used across situations. Live training contributes more than simple feedback; its effectiveness may lie in individualized adaptation of training technique. EMG biofeedback makes taped training more effective but contributes nothing to intensive live training. Despite its greater length, Jacobson’s original technique is preferred to the modified techniques, particularly when psychophysiological effects are important. Length of training does not appear to be a critical factor. (116 ref)