Shapiro, Deane H. (1982). Overview: Clinical and physiological comparison of meditation with other self-control strategies. American Journal of Psychiatry, 139 (3), 267-274.

In 1977, the American Psychiatric Association called for a critical examination of the clinical effectiveness of meditation. The present author reviews the pertinent literature and defines meditation as a family of techniques that attempt to focus attention in a nonanalytical way and attempt not to dwell on discursive, ruminating thought. Meditation is then compared with such self-regulation strategies as biofeedback, hypnosis, and progressive relaxation. Particular attention is given to the “uniqueness” of meditation as a clinical intervention strategy as well as the adverse effects of meditation. Future research should deal with the context of meditation, a component analysis, refinement of the dependent variable, S variables, and the phenomenology of meditation.

Stern, T. E. (1982). The effects of Ericksonian hypnosis and biofeedback on self-reported measures of pain (Dissertation). Dissertation Abstracts International, 43, 3744-B.

Conducted a 6-subject case study comparing the effectiveness of so-called Ericksonian hypnosis and biofeedback on chronic pain. Two subjects improved more on subjective and behavioral pain measures using biofeedback, three improved more using hypnosis, and one did not improve in either condition.

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).

Claghorn, James L.; Mathew, Roy J.; Largen, John W.; Meyer, John S. (1981). Directional effects of skin temperature self-regulation on regional cerebral blood flow in normal subjects and migraine patients. American Journal of Psychiatry, 138, 1182-1187.

Vascular headache of the migraine type is associated with vasomotor changes in cerebral arteries. The authors studied whether skin temperature training (biofeedback) reduced the frequency, severity, and duration of these headaches by measuring the regional cerebral blood flow (CBF) in 11 female migraine patients (27-52 years) and 9 female volunteers (22-37 years), using the noninvasive 133 Xe inhalation technique. Half of each group was randomly assigned to a hand-warming or a hand- cooling group. CBF increased in several regions of the left hemisphere to a significant degree only for the migraineurs who were in the hand-warming group. The pattern of vasomotor regulation apparently differed between migraine and normal Ss. The migraineurs” headache symptoms were affected by both warming and cooling, but warming produced more salutary effects.
Cott, A.; et al. (1981). The long-term therapeutic significance of the addition of electromyographic biofeedback to relaxation training in the treatment of tension headaches. Behavior Therapy, 12, 556-559.
ABSTRACT: Eight tension headache sufferers seeking traditional medical treatment from a neurologist participated in either a therapist-delivered relaxation training (RT) condition or an RT plus EMG feedback condition. Mean hours of pain/day, headache severity, and medication ingestion were significantly lower in both groups following treatment. Results were maintained at a 1-year follow-up for hours of pain/day and medication ingestion. Findings thus indicate no benefit of adding EMG feedback to relaxation training.

Piedmont, Ralph L. (1981). Effects of hypnosis and biofeedback upon the regulation of peripheral skin treatment. Perceptual and Motor Skills, 53, 855-862.

The purpose of this study was to examine the influence of hypnosis on the regulation of peripheral skin temperature. The independent variables were the presence of a hypnotic trance during the session on thermal regulation and the number of trials received. A two-factor mixed-design analysis of variance with repeated measures on one factor showed a significant main effect for trials and a significant interaction between hypnosis and trials. it may be concluded that hypnosis, in conjunction with thermal regulation techniques, exerts a significant influence over performance. The cognitive characteristics influenced by hypnosis may account for this finding.

Adams, Henry E.; Feuerstein, Michael; Fowler, Joanne L. (1980). Migraine headache: Review of parameters, etiology, and intervention. Psychological Bulletin, 87 (2), 217-237.

The migraine headache is a disorder of much interest to clinicians and researchers in the areas of psychology and medicine. Research that has investigated various characteristics of this disorder and the factors contributing to its etiology and a variety of treatment techniques have appeared in both the medical and the psychological literature. The present article provides a comprehensive critical appraisal of this literature, with particular emphasis on psychological intervention. Theoretical issues involving biological and psychological factors in migraine etiology are discussed, and a psychobiological model for the migraine disorder is proposed. Areas requiring further basic and clinical research are identified. Major conclusions include (a) that etiological factors of migraine remain unclear; (b) that pharmacological intervention does not constitute an adequate treatment method in terms of headache elimination; (c) that although a number of psychological treatment approaches have been reported in the literature, there are few well-controlled evaluations, and definitive conclusions regarding differential effectiveness of the various techniques are difficult; and (d) that a biofeedback approach directed at modifying the peripheral pain mechanism in migraine appears to be a promising treatment technique for this disorder.

Crosson, B. (1980). Control of skin temperature through biofeedback and suggestion with hypnotized college women. International Journal of Clinical and Experimental Hypnosis, 28 (1), 75-87.

4 groups of 9 college women attempted to raise finger temperature relative to forehead temperature during hypnosis. After a hypnotic induction, each group of Ss received 1 of the following treatments for temperature control: (a) biofeedback, (b) suggestion and imagery, (c) biofeedback plus suggestion and imagery, and (d) a relaxation, false-feedback control. Groups were initially balanced for hypnotic susceptibility. Between-subject differences in baseline temperatures were statistically controlled. After 4 training sessions, only Ss in the groups receiving biofeedback and biofeedback plus suggestion and imagry demonstrated evidence of learned temperature contol, and only Ss in the biofeedback group demonstrated a significantly greater ability to control skin temperature than Ss in the control group. Changes in temperature during hypnotic induction did not appear to affect changes during the subsequent treatment. There was no significant correlation between hypnotic susceptibility and temperature control for Ss in any group, contrary to popular assumption. Future research should attempt to ascertain if combined use of biofeedback and hypnosis offers any advantages to the use of biofeedback alone.

Dumas, R. A. (1980). Cognitive control in hypnosis and biofeedback. International Journal of Clinical and Experimental Hypnosis, 28 (1), 53-62.

The relation between biofeedback and hypnotic self-control abilities was examined in the EEG alpha biofeedback situation. 17 Ss, selected on the basis of group hypnotic susceptibility tests, completed 4 EEG alpha training sessions, with enhance, suppress, and unreinforced baseline conditions. The 5 Ss who scored high on the hypnotic susceptibility test did not gain significant control over their EEG alpha, whereas those Ss who scored moderate or low on the test did gain control over their alpha. “Control” in this experiment was gained by learning contingent alpha suppression. There were no differences between the hypnotizability groups in baseline EEG alpha production.
“In summary, the results of the present study in combination with the results of the Friedman and Taub (1977) study should lead to the treatment of biofeedback and hypnosis as potentially different processes involving different, possibly antagonistic, cognitive processes. The treatment of hypnosis and hypnotic ability as different phenomena from biofeedback self-control should lead to experimental designs which do not automatically assume additivity of effects. Such enlightened designs will then shed more light on the mechanisms of each and the relation of these two cognitive control techniques” (0. 60).
Hurley, John D. (1980). Differential effects of hypnosis, biofeedback training, and trophotropic responses on anxiety, ego strength, and locus of control. Journal of Clinical Psychology, 36 (2), 503-507.
Pretested 60 college students on three scales: the IPAT Anxiety Scale, the Barron Ego-strength scale, and the Rotter I-E scale. The Ss then were assigned randomly to one of four treatment groups designated: hypnotic treatment, biofeedback treatment, trophotropic treatment, and control. Three of these groups met separately for 60 minutes once a week for 8 weeks. The control group did not meet during this time. During the sessions, each group was trained in a different technique for self-regulation. At the end of the 8-week period the scales were readministered to all groups. A series of covariance analyses indicated that hypnosis was a more effective self-regulatory technique for lowering anxiety levels when compared to biofeedback or trophotropic response procedures. With regard to increasing ego strength, both the hypnotic training group and the biofeedback training group proved to be significant. No significant difference was found between the experimental and control groups on the I-E scores.

Quall, Penelope J.; Sheehan, Peter W. (1979). Capacity for absorption and relaxation during electromyograph biofeedback and no-feedback conditions. Journal of Abnormal Psychology, 88 (6), 652-662.

The present research examined the relation between absorption capacity and relaxation during electromyograph biofeedback and no-feedback (instructions only) conditions. Sixteen high absorption and 16 low absorption female subjects underwent a biofeedback and no-feedback session with the order of conditions counterbalanced. For high absorption subjects in the first session, EMG reductions were greater during no- feedback than during biofeedback, although the performance of biofeedback subjects improved in the second session. For low absorption subjects, no differences in EMG reductions were apparent across experimental conditions. Postexperimental self-report data demonstrated differences between absorption groups in subjects’ state of arousal and quality of consciousness. It was concluded that for subjects with high capacity for absorbed attention, experimental conditions that allow for a withdrawal from the external environment are most conducive to relaxation, whereas for subjects with limited capacity for absorbed attention, conditions such as biofeedback that place an attentional demand on subjects may be preferable.
Turk, Dennis C.; Meichenbaum, Donald H.; Berman, William H. (1979). Application of biofeedback for the regulation of pain: A critical review. Psychological Bulletin, 86 (6), 132
The biofeedback literature for the regulation of pain is reviewed and found wanting on both conceptual and methodological grounds. In particular, studies on the use of biofeedback for the treatment of tension and migraine headaches and chronic pain indicate that biofeedback was not found to be superior to less expensive, less instrument- oriented treatments such as relaxation and coping skills training. The relative absence of needed control comparisons was noted, and the need for caution in promoting biofeedback was stressed. Suggestions for future research are offered.2-1338.

Acosta, Frank X.; Yamamoto, Joe; Wilcox, Stuart A. (1978). Application of electromyographic biofeedback to the relaxation training of schizophrenic, neurotic, and tension headache patients. Journal of Consulting and Clinical Psychology, 46 (2), 383-384.

This study examined the effects of electromyographic (EMG) biofeedback on tension reduction by schizophrenic, neurotic, and tension headache patients. Fourteen patients participated voluntarily in at least 10 weekly EMG biofeedback sessions at a public outpatient clinic. All had complained of chronic tension. Patients showed significant decreases in their muscle tension levels with successive biofeedback training sessions. No significant differences were found between the schizophrenic, neurotic, and tension headache groups. A further contribution was the finding that patients with diverse socioeconomic and educational levels benefitted similarly from EMG biofeedback training.

Counts, D. Kenneth; Hollandsworth, James G., Jr.; Alcorn, John D. (1978). Use of electromyographic biofeedback and cue-controlled relaxation in the treatment of test anxiety. Journal of Consulting and Clinical Psychology, 46 (5), 990-996.

The effect of using electromyographic (EMG) biofeedback to increase the efficacy of cue-controlled relaxation training in the treatment of test anxiety was studied. Forty college undergraduates scoring in the upper third on a self-report measure of test anxiety were randomly assigned to one of four treatment conditions – EMG-assisted cue- controlled relaxation, cue-controlled relaxation alone, attention-placebo relaxation, and no-treatment control. Pre-post self-report measures of test anxiety, state anxiety, and trait anxiety were obtained. In addition, a performance measure in the form of a mental abilities test was administered. Subjects from the three relaxation groups received six 45- minute individual sessions over a period of 2 weeks. All treatments were conducted using audiotape recordings. The results indicate that cue-controlled relaxation is effective in increasing test performance for test anxious subjects, that EMG biofeedback does not contribute to the effectiveness of this procedure, and that self-report measures of anxiety are susceptible to a placebo effect.

Lehrer, Paul M. (1978). Psychophysiological effects of progressive relaxation in anxiety neurotic patients and of progressive relaxation and alpha feedback in nonpatients. Journal of Consulting and Clinical Psychology, 46 (3), 389-404.

Gave 10 anxiety neurotic patients 4 sessions of individual instruction in progressive relaxation; 10 patients served as waiting list controls. 10 nonpatients were assigned to each of the same conditions, and an additional 10 nonpatients were given 4 sessions of alpha feedback. Nonpatients showed more psychophysiological habituation over sessions than patients in response to hearing 5 very loud tones and to a reaction time task. Patients, however, showed greater physiological response to relaxation than did nonpatients. After relaxation, the autonomic responses of the patients resembled those of the nonpatients. The effects of relaxation were more pronounced in measures of physiological reactivity than in measures of physiological activity. Defensive reflexes yielded to orienting reflexes more readily in nonpatients than in patients. There was also a tendency for progressive relaxation to generalize to autonomic functions more than alpha feedback.

Ansel, Edward Leslie (1977). A simple exercise to enhance response to hypnotherapy for migraine headache. International Journal of Clinical and Experimental Hypnosis, 25 (2), 68-71.

A common method of hypnotherapy for migraine headache utilizes suggestions of warmth for the hands and coldness for the head. This procedure reverses the abnormal pattern of vasodilation and excess supply of blood in the head and decreased supply in the extremities associated with this type of headache, threby relieving the pain. A simple exercise, utilizing centrifugal force to dramatically increase blood flow to the hands, is described. It promotes relief in itself and provides a vivid background experience to enhance productino of this effect in hypnosis. It appears to be especially useful in patients exhibiting lesser degrees of trance capacity.

Friedman, Howard; Taub, Harvey A. (1977). The use of hypnosis and biofeedback procedures for essential hypertension. International Journal of Clinical and Experimental Hypnosis, 25, 335-347.
In an attempt to evaluate a procedure combining 2 techniques, hypnosis and biofeedback, which might effect significant changes in diastolic blood pressure in essential hypertensives, Ss were placed in 1 of 4 groups: hypnosis only, biofeedback only, hypnosis and biofeedback combined, or measurement only. The first phase — training sessions and brief follow-ups (1 week and 1 month) — of the long-term study with 6 monthly follow-up periods, was evaluated. Hypnosis only and biofeedback only procedures were both capable of providing significant lowering of diastolic pressure. However, in intergroup comparisons, the hypnosis only procedure showd the most impressive effect. Unexpectedly, the procedure of combining hypnosis and biofeedback into one technique was as ineffective as the measurement only procedure.

In their discussion of the finding that hypnosis + biofeedback did not yield more positive results, the authors state, “it is possible that two opposing sets were established that negated each other: the biofeedback instructions wherein S was enjoined to direct his attention externally and to attempt to change the displayed number which reflected diastolic pressure, versus the more passive, relaxed attitude implied in hypnotic induction. It is interesting to note that Benson et al. (1974b) have similarly suggested that the set involved in biofeedback training may interfere with the elicitation of the ‘relaxation response.’ Also, Orne [personal communication] has indicated that, although anticipating a synergistic effect as a result of combining hypnotic and biofeedback procedures, some difficulty may lie in requiring Ss to be hypnotized during [emphasis on ‘during’ in original] the biofeedback training proceduer”

Pelletier, K. R.; Peper, E. (1977). Developing a biofeedback model: Alpha EEG feedback as a means for pain control. International Journal of Clinical and Experimental Hypnosis, 25, 361-371.

3 adept meditators voluntarily inserted steel needles into their bodies while physiological measures (EEG, EMG, GSR, EKG, and respiration) were recorded. Although each adept used a different passive attention technique, none reported pain. During the insertion, 2 of the 3 Ss increased their alpha EEG activity. The role of alpha EEG and its relationship to pain control is discussed.

The three adepts studied were: (1) RCT, a 34 yr old Ecuadorian who had “demonstrated control over pain by placing bicycle spokes through his body, being suspended from hooks inserted under his shoulder blades, and walking through fire — all without reported pain or observed damage to his skin;” (2) JSL, a 31 yr old Korean karate expert, who “suspended a 25-pound bucket of water from a sharpened spoke placed through a fold of skin on his forearm;” and (3) JS, a 50-yr old Dutch meditator who had “demonstrated pain and bleeding contol” (pp. 363-365). “RCT, JSL, and JS each remarked that pain is principally fear of and attention to pain, and they maintained that anyone can learn to control pain through relaxation and passive attention” (p. 367). Both JS and RCT had increased alpha EEG activity during piercing, whereas JSL showed no increase. The authors suggest that “the karate expert practiced a very focused meditation, during which he mentally saw and felt the ki energy as a point, while RCT and JS employed passive attention and did not attend to the body stimuli. Thus, it is possible for physiological measurements to reflect strategies used in dissociation of pain perception, and that the quality of pain perception is altered if S is at either extreme of focused or unfocused conscious attention” (p. 368). “We hypothesize that, for nonadepts, alpha EEG training without alpha blocking to stimuli could become a distraction technique whereby S again could learn self-control and competence as he becomes more successful in controlling his EEG” (p. 369).

Wickramasekera, Ian (1977). The placebo effect and medical instruments in biofeedback. Journal of Clinical Engineering, 2 (3), 227-230.

This article defines a “placebo effect” and identifies some of its parameters in pain control and in other areas of medicine. It proposes a new model of the placebo effect and advances the hypothesis that biomedical instruments used in biofeedback studies, like drugs, can acquire and generate placebo effects. Such placebo effects can complicate the interpretation of specific experimental treatments in human clinical research in which biomedical instruments are used.

Dugan, Michelle; Sheridan, Charles (1976). Effects of instructed imagery on temperature of hands. Perceptual and Motor Skills, 42, 14.

Sixteen college student volunteers were involved in the research. Subjects were randomly assigned to two groups, either to warm or to cool their hands. All 10 subjects attempting to cool their hands were able to cool at least one hand, and six people cooled both hands. For those trying to warm their hands, five warmed at least one hand and one was able to warm both hands. Four people were able to cool their hands without hypnosis, conditioning, or feedback.
Schaudler, S. L.; Grings, W. W. (1976). An examination of methods for producing relaxation during short-term laboratory sessions. Behaviour Research and Therapy, 14, 419-426.

Subjects were 100 undergraduate students, average age 22.3, distributed into two experiments as follows.
Experiment 1 20 had progressive relaxation (Jacobsonian, abbreviated as done by Paul, 1969) = PR 20 had visual feedback (from forearm extensor) = VFB 20 had tactile feedback (from forearm extensor) = TFB 20 had relaxation control (music) = CT
Experiment 2 10 had auditory feedback (from forearm extensor) = AFB 10 had tactile feedback (from forearm extensor) = TFB
The results obtained for the various measures were as follows. Anxiety was significantly reduced by PR and TFB; perhaps by AFB. Blood pressure was significantly reduced by AFB, TFB, VFB and PR. Heart rate was significantly reduced by VFB, AFB, TFB, but not PR or CT Extensor EMG was significantly reduced by VFB, TFB, PR, and AFB Frontalis EMG was significantly reduced by TFB, PR and AFB Skin conductance was significantly reduced by TFR and PR
In their Discussion the authors noted that tactile biofeedback was especially beneficial and achieved lower levels of response than the other feedback techniques. Visual feedback was somewhat poorer than progressive relaxation and tactile feedback approaches. Also, the progressive relaxation heart rate and respiratory rate changes were not as impressive as the biofeedback group effects.

Alexander, A. Barney (1975). An experimental test of assumptions relating to the use of electromyographic biofeedback as a general relaxation technique. Psychophysiology, 656-662.
Twenty-eight normal adults participated in an experimental test of two assumptions underlying the use of electromyographic (EMG) biofeedback as a general relaxation training technique: 1) that trained EMG reduction in one muscle generalizes to untrained muscles; and 2) that subjective feelings of relaxation are related to EMG reduction. An experimental group received 5 sessions, during the middle 3 of which EMG biofeedback training was offered on the frontalis muscle. Throughout all sessions, EMG recordings were also taken from the forearm and lower leg, and rating of subjective relaxation feelings were obtained at regular intervals. A control group, matched with the experimental group on baseline frontalis EMG, received 5 similar sessions without feedback. Employing a maximum p of .05, the results revealed no evidence of generalization of EMG reduction from the frontalis to the untrained sites, nor any tendency for successful frontalis EMG reduction to result in increased feelings of relaxation beyond what was obtainable from relaxing without the benefit of training. The results were interpreted as suggesting the EMG biofeedback cannot yet be accepted as a viable general relaxation training technique.

Andrews, Reagan H., Jr. (1975). Placebo effects in EMG biofeedback (Dissertation). Dissertation Abstracts International, 36, 1424.

“Differential instructions were employed in a negative placebo model to alter expectancies of success in achieving criterion frontalis EMG voltage levels in 30 female subjects. The negative placebo model dictated that all subjects receive true feedback during both of two 10-minute experimental trials. On one of the two trials they were informed that feedback would be accurate, and on the other trial, that feedback would be accurate only 50% of the trial period. Data was collected for 20 subjects in a 2 X 2 Latin Square design, while 10 subjects were designated control subjects and received high-success expectancy instructions on both experimental trials. Pre-trial measures included administration of a standard hypnotic susceptibility scale and a pre-test subjective questionnaire. Dependent variable was the time from onset of feedback to 70% reduction of resting EMG levels of the frontalis. Significant differences were found between high and low-expectancy trials for experimental subjects. Effects were strongest on the first experimental trial and tended to diminish on the following trial. Correlation of hypnotic susceptibility scores with response latencies was not significant, but subjects’ impression of their degree of relaxation during susceptibility scale administration was significantly correlated with criterion latencies. Importance of subject expectancies, instrumentation standards and implications for future studies in the biofeedback area were discussed” (p. 1424).

Andreychuk, Theodore; Skriver, Christian (1975). Hypnosis and biofeedback in the treatment of migraine headache. International Journal of Clinical and Experimental Hypnosis, 23 (3), 172-183.

A study was made to explore the effects of subject hypnotizability in response to 3 treatment procedures applied to 33 migraine headache sufferers. These treatment procedures included biofeedback training for hand-warming, biofeedback training for alpha enhancement and training for self-hypnosis. The Hypnotic Induction Profile (HIP) of Spiegel & Bridger (1970) was given to each S to determine degree of hypnotizability and the MMPI was administered to all Ss. All 3 treatment groups showed significant reductions in headache rates and there were no significant differences between groups. Cutting across treatment groups, high hypnotizable Ss (N – 15) showed significant reductions in headache rates when compared with low hypnotizable Ss (N – 13). There was no correlation between HIP scores and the hysteria scale of the MMPI.

Cowings, Patricia S. (1975, September). Observed differences in learning ability of heart rate self-regulation as a function of hypnotic susceptibility. [Paper] Presented at the 3rd Congress of the International College of Psychosomatic Medicine, Rome.

Three groups of eight men and women were given personality tests and were taught to control their own heart rates. Experimental group I and the control group had low hypnotic susceptibility (Stanford Hypnotic Susceptibility Scale), and subjects in experimental group II had high hypnotic susceptibility. The experimental groups received autogenic therapy and biofeedback, while the control group was given biofeedback only. Subjects who received autogenic therapy and biofeedback performed better than the control group. Significant differences, however, were found in all psychological test scores between high and low hypnotic susceptibles.

Lick, John R. (1975). Expectancy, false galvanic skin response feedback, and systematic desensitization in the modification of phobic behavior. Journal of Consulting and Clinical Psychology, 43 (4), 557-567.

This study compared systematic desensitization and two pseudotherapy manipulations with and without false galvanic skin response feedback after every session suggesting improvement in the modification of intense snake and spider fear. The results indicated no consistent differences between the three treatment groups, although all treatments were significantly more effective than no treatment in modifying physiological, behavioral, and self-report measures of fear. A 4-month follow-up showed stability in fear reduction on self-report measures for the three treatment groups. Overall, the results of this experiment were interpreted as contradicting a traditional conditioning explanation of systematic desensitization. An alternate explanation for the operation of systematic desensitization emphasizing the motivational as opposed to conditioning aspects of the procedure is discussed.

Melzack, Ronald; Perry, Campbell (1975). Self-regulation of pain: The use of alpha-feedback and hypnotic training for the control of chronic pain. Experimental Neurology, 46, 452-469.

Patients suffering chronic pain of pathological origin received alpha- feedback training methods in association with prior hypnotic training. Changes in the intensity and quality of pain were measured with the McGill Pain Questionnaire. The combined procedures produced a substantial decrease in pain (by 33% or greater) in 58% of the patients during the training sessions. Both the sensory and affective dimensions of the pain were diminished. The EEG records indicated that the majority of patients learned to increase their alpha output during the training sessions. In contrast, patients who received the alpha training alone reported no decreases in pain even though they showed increases in alpha output. Patients who received hypnotic training alone also produced increased EEG alpha during the training sessions and showed substantial (though not statistically significant) decreases in pain. The results demonstrate that chronic, pathological pain can be reduced in a significant number of patients by means of a combination of alpha-feedback training, hypnotic training, and placebo effects. It is concluded, however, that the contribution of the alpha training procedure to pain relief is not due to increased EEG alpha as such but, rather, to the distraction of attention, suggestion, relaxation, and sense of control over pain which are an integral part of the procedure.

London, Perry; Cooper, Leslie M.; Engstrom, D. R. (1974). Increasing hypnotic susceptibility by brain wave feedback. Journal of Abnormal Psychology, 83 (5), 554-560.

Presents a reanalysis of earlier studies by D. R. Engstrom et al (1970) as well as additional findings which show that successful training to increase alpha rhythm duration raises people”s hypnotic susceptibility. Ss in the previous studies were 30 volunteers who had low to moderate hypnotic susceptibility and low alpha production. It was found, subsequent to publication, that some Ss had had previous exposure to alpha training. When they were eliminated in reanalysis, the previous findings were still confirmed; alpha training was more effective for experimental than for control Ss, and hypnotic susceptibility accordingly increased more among experimentals than among controls. In addition, base-rate alpha production in each training session was correlated with feedback alpha output among experimental Ss but not among controls. (24 ref) (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Roberts, Alan H.; Kewman, Donald G.; Macdonald, Hugh (1973). Voluntary control of skin temperature: Unilateral changes using hypnosis and feedback. Journal of Abnormal Psychology, 82 (1), 163-168.

To demonstrate the ability of human Ss to achieve control over specific autonomic functions, hypnosis and auditory feedback were used to train a select group of hypnotically talented subjects to produce a difference in skin temperature in one hand relative to the other in a direction specified by the experimenter. Large and reliable effects were shown demonstrating that some individuals are capable of achieving a high degree of voluntary control over the autonomic processes involved in peripheral skin temperature regulation. Individual differences between subjects were noted, and variables that might account for these are discussed.
Wickramasekera, Ian (1973). Effects of electromyograph feedback on hypnotic susceptibility: More preliminary data. Journal of Abnormal Psychology, 82 (1), 74-77.
The purpose of this double-blind study was to determine if taped verbal relaxation instructions and response-contingent electromyographic feedback training would increase suggestibility or hypnotic susceptibility over that obtained with instructions and false or noncontingent feedback, The present data appear to confirm the hypothesis

Biological Rhythm

Wallace, Benjamin; Kokoska,Andrzej (1995). Fluctuations in hypnotic susceptibility and imaging ability over a 16-hour period. International Journal of Clinical and Experimental Hypnosis, 43 (1), 20-33.

Within-subject variability for hypnotic susceptibility as measured by the Harvard Group Scale of Hypnotic Susceptibility, Form A and for imaging ability as measured by the Vividness of Visual Imagery Questionnaire was determined over a 16-hour period. Half of the subjects were day persons, those most alert during daytime hours (as determined by the Alertness Questionnaire); the remaining subjects were night persons. For day persons, hypnotic susceptibility was greatest at 10:00 a.m. and 2:00 p.m.; for night persons, susceptibility was greatest at 1:00 p.m. and between 6:00 p.m. and 9:00 p.m. Imaging ability also varied as a function of time of administration. However, these peak periods occurred before and after hypnotic susceptibility peaks. Such a pattern was interpreted as indicating the possible existence of an ultradian cycle for imaging ability.

Wallace, Benjamin; Kokoszka, Andrzej (1993, October). Within-subject variability in hypnotic susceptibility and imaging ability: Same or different?. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.

Subjects were given the Harvard scale of hypnotizability and an imagery questionnaire (VVIQ) repeatedly. They had been asked, “when are you the most alert during the day?” and classified as Day People and Night People. People had higher scores on the Harvard for Day People at 10 a.m. and 2 p.m., for Night People at 1 p.m. and at 6, 7, 8, and 9 .m. This replicates my 1993 study. VVIQ scores do not show that pattern; they are zig-zag. What is the relationship between peaks on the two scales? They don’t peak at the same time. This may be why in the literature we don’t find a strong relationship between hypnotizability and imagery ability. VVIQ scores peak before hypnotizability scores on the same people. This might mean an ultradian cycle for imaging ability. So these abilities are not stable throughout 24 hours, despite the fact that hypnotizability scores are stable over 25 years!

Lippincott, Brian (1992). Owls and larks in hypnosis: Individual differences in hypnotic susceptibility relating to biological rhythms. American Journal of Clinical Hypnosis, 34, 185-192.

In 1986 Coleman developed the Owl and Lark Questionnaire to differentiate morning people from evening people, with owl individuals being more alert during the evening phase and lark individuals being more alert during the morning phase. Rossi has hypothesized that the bimodal peaks of hypnotizability found by Aldrich and Bernstein in 1987 were caused by alterations in owl and lark circadian rhythms. In the current study I used the Harvard Group Scale of Hypnotic Susceptibility, Form A to test compliance with hypnotic suggestions among 42 graduate students at three times of the day: in the morning, in the evening, and, as a control, in the middle of the night. Owls were more hypnotizable than larks in the morning, and larks were also significantly more hypnotizable in the evening than owls. There was no difference between the two groups in the middle of the night. A possible implication of this study is that one fundamental mechanism of therapeutic hypnosis is the entrainment of psychobiological rhythms.

The author tested Subjects at 8-10 a.m., 4-6 p.m., and midnight to 2 a.m. because they were the times when owls and larks could be most easily differentiated (morning and late afternoon) or were most equal (night). The goal was “to determine if individuals differentiated by the Owl and Lark Questionnaire have different peaks of hypnotizability associated with the rest phases of their biological rhythms.” (P. 187).
“To control for practice effects (Cooper, Banford, Schubot, & Tart, 1967), one third of the subjects started rotating at each of the three test times and proceeded in clockwise order (morning-evening-night; evening-night-morning; night-morning-evening).
“There were at least 24 hours between tests to assure that boredom from the testing was not a factor” (p. 188).

DISCUSSION. “Rossi has extended Erickson’s naturalistic approach and has hypothesized the entrainment of the ultradian biological rhythms as a possible factor in therapeutic hypnosis. … Rossi states: ‘The ultradian theory of hypnotherapeutic healing proposes that (1) the source of psychosomatic reactions is in stress-induced distortions of the normal periodicity of ultradian cycles and, (2) the naturalistic approach to hypnotherapy facilitates healing by permitting a normalization of these ultradian processes.’ (Rossi, 1982, p. 23)” (pp. 189-190).
“If owls and larks were not separated, the results of this study would show no differences in hypnosis. Perhaps this is why Hollander et al. (1988) found no change in hypnotizability using a direct-suggestion measure after a 2-day training in Ericksonian techniques” (p. 190).

Brown, Peter (1991). The hypnotic brain: Hypnotherapy and social communication. New Haven, CT: Yale University Press.

Notes are taken from a review of this book: Diamond, Michael (1993). Book review. Bulletin of the Menninger Clinic, 57 (Winter), 120-121.
Brown “posits that because the fundamental matrix of the human brain is metaphoric, hypnosis results from skillful matching of metaphorical communication with the brain’s biological, rhythmic alterations. The most significant feature of trance experience is thereby located in the hypnotist-subject interaction” (p. 120).
“The middle section [of the book is comprised largely of] literature reviews in support of Rossi’s (1986) ultradian rhythm theory of hypnosis and Lakoff and Johnson’s (Johnson, 1987; Lakoff & Johnson, 1980) experientialist theory of conceptual thought” (p. 120). The final section includes “research evidence on medical uses of hypnosis, a theory of dissociation and multiple personality disorders, and an uncritical discussion of Milton Erickson’s naturalistic hypnotherapeutic approach … [and also] a brief discussion of the social-cultural functions of possession states among the Mayotte culture” (p. 120).

Brown, Peter (1991). Ultradian rhythms of cerebral function and hypnosis. Contemporary Hypnosis, 8, 17-24.

As a consequence of his observations of the clinical work of Milton Erickson, Ernest Rossi has proposed an ‘ultradian rhythm theory of hypnosis’. Rossi demonstrated that the spontaneous changes in cognition, affect and behaviour which occur as part of the ultradian cycle (which Erickson referred to as ‘the common everyday trance’) are similar to the changes which occur during hypnosis. A review of studies of the phasic changes in hemispheric function suggests that ultradian changes do parallel the changes found in hypnosis.

Falling asleep and waking up are regulated by two separate mechanisms rather than being opposite poles of one mechanism (Winfree, 1980). Kleitman (1961) suggested a 90-min cycle, the basic rest-activity cycle (BRAC). In addition to physiological alterations, there are alterations in cognition, mood and behavior (Rossi & Cheek, 1988); vigilance (Okawa, Matousek & Petersen 1984); peripheral blood flow (Ramano & Gizdulich, 1980); respiratory amplitude (Horne & Whitehead, 1976); visual evoked potentials (Zimmerman, Gortelmeyer & Wiemann, 1983); pupillary diameter, stability and reactivity to light, and saccadic eye movements (Lavie & Kripke, 1981).
These diurnal variations may relate to hypnotic behavior. There is a recurring increase in daydream and fantasy, as well as visual imagery (Kripke & Sonnenschein, 1978). “There is evidence for a parallel recurring cognitive and emotional cycle with increased emotional responsiveness and a more subjective cognitive processing of information (Evans, 1972; Holloway, 1978; Overton, 1978; Thayer, 1987). Subjects appear to repeat the cycle approximately 16 times per day, with a range of 70-120 minutes. Kripke and Sonnenschein (1978) noted that the subjects were personally unaware of any repeating cycle in their mental lives” (p. 19).
The brainstem arousal mechanisms seem to be implicated in periodic changes in the EEG. Ultradian rhythms are “more easily detected under conditions of increased sleep need, reduced external performance demand and lowered motivation to focus externally (Broughton, 1985)” (p. 20). Sterman (1985) observed that the rhythm was most marked in resting state and disappears during complex visuomotor tasks. Relationship of EEG patterns to attentional patterns indicate there may be two different forms of attention, one for focused awareness (often thought to be associated with trance state) and the other a generalized vigilance (which would be reduced in hypnosis). Ultradian changes in consciousness reflected in the EEG may suggest increased internal absorption associated with visual imagery, a feature of the trance state.
“There has recently been a partial direct confirmation of Rossi’s hypothesis. Aldrich and Bernstein (1987 [International Journal of Clinical and Experimental Hypnosis]) reported a bimodal distribution of Harvard Group Scale Hypnotic Susceptibility (HGSHS) scores when they are done at different times throughout the day. They note the parallel of the changes in HGSHS scores and the circadian variations in body temperature which suggest changes in hypnotic responsiveness coinciding with the fluctuations of physiological rhythms.
“Other support comes from some highly original work involving breathing rhythms. There are cyclic alterations in relative air flow between the left and right nostrils with an average period of 2-3 hours (Hasegawa & Kern, 1977). This nasal ultradian rhythm is correlated with an increase in contralateral cerebral hemispheric activity (Werntz, Bickford, Bloom & Shannahoff-Khalsa, 1981, 1983; Klein, Pilon, Prosser & Shannahoff-Khalsa, 1986). The alterations in hemispheric function do appear to be related to changes both in the style of cognition, particularly in an increase in vivid visual imagery, and in performance on specific tasks (Klein et al., 1986). Thus these studies support the notion of an ultradian rhythm of cerebral function which is associated with characteristic physical manifestations mediated by the autonomic nervous system. Whether or not these changes are directly related to the findings reported by Aldrich and Bernstein has yet to be established” (p. 21).
The authors conclude that “the most consistent evidence for ultradian rhythms is demonstrated by the mechanisms of the hypothalamic-limbic system and by brain-stem mechanisms that regulate arousal and attention processes (Parmeggiani, 1987); neuroendocrine regulatory mechanisms (Follenius, Simon, Brandenberger & Lenzi, 1987) and autonomic nervous system function (Bossom, Natelson, Levin & Stokes, 1983; Gordon & Lavie, 1986). These studies also suggest an ongoing dynamic interaction between cortical and subcortical structures throughout the ultradian cycle (Parmeggiani, 1987), and suggest that these interactions may be of great significance in hypnosis” (p. 21).

Aldrich, Kevin J.; Bernstein, Douglas A. (1987). The effect of time of day on hypnotizability: A brief communication. International Journal of Clinical and Experimental Hypnosis, 35, 141-145.

Hypnotizability has been shown to be very stable for long periods of time in a person’s adult life when no attempts at modification are made (Morgan, Johnson, & Hilgard, 1974). Even though it can be improved by several different means, attempts to modify individual hypnotizability may only allow people to reach a ‘plateau’ level of hypnotizability that is predetermined for each person. The present experiment addressed the question of whether hypnotizability like body temperature, reflex response intensity, and performance on various mental and motor tasks, fluctuates in a circadian rhythm. The Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A) of Shor and E. Orne (1962) was used to test compliance with hypnotic suggestions among several large groups of Ss at different hours of the day. A plot of the mean HGSHS:A scores obtained at each time of day showed a bimodal distribution, with the highest mean score significantly different from 2 of the 3 minima. Although the second peak did not differ significantly from the minima, its occurrence was consistent with the bimodal distributions which sometimes occur in other circadian rhythms, such as body temperature and complex mental and motor skill performance. One possible implication for the results of this study is that they suggest that hypnotherapy could be more effective for individuals at different times of the day, as they approach their ‘plateau’ level of suggestibility. Average Harvard score was greatest at noon, least at 8 pm; mid-range at 8 am, 2 pm; and medium high at 10 am, 4 pm, and 6 pm. “The general plot of hypnotizability approximately conforms to plots of average body temperature obtained in other studies (e.g., Horne & Ostberg, 1976; Kleitman, 1963). The dips, however, also appear after times when Ss were likely to have eaten lunch and dinner, suggesting that food consumption may have an effect on hypnotizability. Further research controlling for this possible effect and measuring body temperature, as well as testing Ss in the absence of ‘zeitgeber’ (‘time-givers’ such as clocks, natural light, and other devices to give Ss information about the time of day) will be necessary to determine the diurnal function of hypnotizability and whether it follows a true circadian rhythm” (p. 144).


Enqvist, Bjorn; von Konow, L.; Bystedt, H. (1995). Pre- and perioperative suggestion in maxillofacial surgery: Effects on blood loss and recovery. International Journal of Clinical and Experimental Hypnosis, 43 (3), 284-294.

The basic assumption underlying the present study was that emotional factors may influence not only recovery but also blood loss and blood pressure in maxillofacial surgery patients, where the surgery was performed under general anesthesia. Eighteen patients were administered a hypnosis tape containing preoperative therapeutic suggestions, 18 patients were administered hypnosis tapes containing pre- and perioperative suggestions, and 24 patients were administered a hypnosis tape containing perioperative suggestions only. The patients who received taped suggestions were compared to a group of matched control patients. The patients who received preoperative suggestions exhibited a 30% reduction in blood loss. A 26% reduction in blood loss was shown in the group of patients receiving pre- and perioperative suggestions, and the group of patients receiving perioperative suggestions only showed a 9% reduction in blood loss. Lower blood pressure was found in the groups that received pre- and perioperative and perioperative suggestions only. Rehabilitation was facilitated in the group of patients receiving perioperative suggestions only.

Hopkins, Mildred B.; Jordan, Jeanette M.; Lundy, Richard M. (1991). The effects of hypnosis and of imagery on bleeding time: A brief communication. International Journal of Clinical and Experimental Hypnosis, 39, 134-139.